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Need to Dust Off Your Social Skills?

After a year of virtual gathering, getting back to real-life relationships can be intimidating. These eight simple exercises can help.

As we move through the spring of The Great Vaccination, many of us are feeling cautious optimism, and also its flip side: creeping dread.

Maybe you have a sense of ambivalence about how to interact with others again. If you used to work in an office, you might be worried about returning to work — but eager to see people again. Or you find yourself having to confront a neighbor about a longstanding problem — but you’re out of practice with conflict resolution. (I’m not sure I remember how to talk to another human anymore, let alone one I disagree with.)

Whatever the specifics, “there will be new forms of social anxiety, said Dacher Keltner, a professor of psychology and the director of the Social Interaction Lab at the University of California, Berkeley.

“People are really anxious about being out in restaurants with friends, or about dancing with a big sweaty group of people — or even about sharing a yoga mat,” he said. “It’s always good to remember individual differences — there’s a lot of variability. But there will be a lasting societal legacy around intimacy, the noise that comes with returning to school, the complexity of the playground and of work.”

Dr. Keltner has studied human behavior and the biological and evolutionary underpinnings of emotions for decades, with a focus on “pro-social” states — behavior that strengthens connections between individuals — that are especially good for society.

“We’re hyper-social mammals — it’s our most signature strength,” said Dr. Keltner, a co-founder of the Greater Good Science Center who was also a scientific consultant on emotions for the Pixar film “Inside Out.” “It’s what sets us apart from other primates: We help, we laugh, we collaborate, we assist.”

Lately, we’ve been living our lives siloed away online, missing many of the essential face-to-face experiences that are key to human interaction. It’s notable that Dr. Vivek Murthy, the newly reappointed U.S. Surgeon General, has talked not only about the physical and economic toll of the pandemic, but also of “the social recession.”

Before Covid, this kind of post-isolation anxiety was most often suffered by people who re-enter the civilian world after prison, wartime deployment, humanitarian aid work or remote expeditions. The challenge now is that so many more of us will be experiencing some aspect of this all at once, and coming back to social situations with others who likely have their own fears too. It is stalled social development, on a societal level.

Debra Kaysen, a clinical psychologist and a professor of psychiatry and behavioral sciences at Stanford University, said that coming back to so-called “civilian life” can be disorienting, surreal and difficult — and not just for combat veterans. Her clinical and research work focuses on anxiety disorders and trauma, and she has worked on developing coping strategies for health care workers dealing with mental health concerns during the pandemic.

Now, everyone is trying to navigate conflicting threat levels in a way that used to be specific to those populations, she said. Cues that used to be neutral or positive, like being around other people (I love my friends and family!) are now associated with threat (my friends and family might infect me with Covid!). And we are confronting the challenge of how to turn off that alarm. “What’s a true alarm and what’s a false alarm has gotten more confusing for all of us,” Dr. Kaysen said.

So how do we relearn how to be together?

Give yourself permission to set small, achievable goals. And accept that other people are going to have different responses than you — the friend or family member who wants to eat inside the restaurant when you don’t, for example, or who is ready to get on a plane and take a vacation.

Accept that certain activities may feel tough for awhile. Driving an hour to a meeting. Flying a red-eye to a conference. Attending a family reunion, say, or four pandemic-postponed weddings in one month.

All of this can prompt you to ask, of your family or your boss or even yourself: “Is it really worth the time?” and “Now that I know things can be different, do I want to go back to my old life?”

Recovering doesn’t mean you go back to the way you were before, Dr. Kaysen said, using kintsugi, the Japanese technique of repairing broken pottery with gold, as an analogy for coming out of hard times with awareness of the change, and stronger than before. “It’s that you create a new normal, one that’s functional and beautiful — and different.”

Dr. Keltner agreed that we may need to “re-educate ourselves” — “like, how do we hug again?” Your timing might be off for a hug, or a joke or even a compliment. “How do you look someone in the eye so that it’s not intrusive? How do you compliment someone? You might not have done it for a year.”

Rather than be overwhelmed by everything at once — for example, going to a party where you have to adjust to greeting acquaintances, eating with others and attempting to make small talk — all at the same time — why not take things step by step? This moment can be an opportunity.

8 Exercises to Strengthen Your Social Muscles

Here are eight small, science-based exercises Dr. Keltner recommends to help ease back into your community. Go at your own pace.

Share food with someone.

Eating a meal together boosts mood and is a potent antidote for loneliness — aiming for in-person interaction around the ritual of eating is a great goal, even if you don’t meet it every single day. An outdoor picnic or a distanced backyard happy hour is a great and safe option for reconnecting with friends and family.

Tell someone a joke in person.

You may be out of practice and have to work on your timing. But making eye contact and laughing together is essential to feeling connected to someone else — even if the joke falls flat, being silly together will feel really good.

Ask someone what they’re listening to or reading right now.

Music and literature can be a community-building gift. Listen to music together; exchange books and have an in-person discussion afterward. This is a social exercise, but also one that will give you a much-needed hit of novelty along with the insight.

Reach out to someone you’ve lost touch with.

Make a phone call, send a meaningful text, write an email. It’s time to start rebuilding the larger social infrastructure outside our immediate circles.

Strike up a conversation with a stranger.

Pick someone with whom you have passing contact: a fellow dog-walker, the cashier at a grocery store, a delivery person on your doorstep. Make eye contact; talk to each of them as a person rather than as a function. It’s so easy to ignore the human behind a mask. Make the effort to ask something outside the normal transaction — what’s changed since the last time you saw each other, what they’re looking forward to.

Move with someone.

Dance, walk, run, swim, bike — or even do the dishes and fold the laundry together. Physical synchronicity is one of the most important ways we have to connect with someone else.

Sit quietly with someone …

and remember how to comfortably be, without talking, in companionable silence, with someone else. Let the other person know it’s OK to not always fill the air. Nonverbal communication is important to practice — and it’s a way to deepen your relationship.

Make a date for the future.

Think of something fun to do with someone you love — it could be a summer beach weekend, or maybe a ski trip next winter. Having something to look forward to is essential for well-being. Practice optimism, in anticipation of normalcy. Plan with hope.


Bonnie Tsui’s books include “Why We Swim” and “The Uncertain Sea.”

Music Therapy: Why Doctors Use it to Help Patients Cope

Music therapy is increasingly used to help patients cope with stress and promote healing.

“Focus on the sound of the instrument,” Andrew Rossetti, a licensed music therapist and researcher said as he strummed hypnotic chords on a Spanish-style classical guitar. “Close your eyes. Think of a place where you feel safe and comfortable.”

Music therapy was the last thing that Julia Justo, a graphic artist who immigrated to New York from Argentina, expected when she went to Mount Sinai Beth Israel Union Square Clinic for treatment for cancer in 2016. But it quickly calmed her fears about the radiation therapy she needed to go through, which was causing her severe anxiety.

“I felt the difference right away, I was much more relaxed,” she said.

Ms. Justo, who has been free of cancer for over four years, continued to visit the hospital every week before the onset of the pandemic to work with Mr. Rossetti, whose gentle guitar riffs and visualization exercises helped her deal with ongoing challenges, like getting a good night’s sleep. Nowadays they keep in touch mostly by email.

The healing power of music — lauded by philosophers from Aristotle and Pythagoras to Pete Seeger — is now being validated by medical research. It is used in targeted treatments for asthma, autism, depression and more, including brain disorders such as Parkinson’s disease, Alzheimer’s disease, epilepsy and stroke.

Live music has made its way into some surprising venues, including oncology waiting rooms to calm patients as they wait for radiation and chemotherapy. It also greets newborns in some neonatal intensive care units and comforts the dying in hospice.

While musical therapies are rarely stand-alone treatments, they are increasingly used as adjuncts to other forms of medical treatment. They help people cope with their stress and mobilize their body’s own capacity to heal.

“Patients in hospitals are always having things done to them,” Mr. Rossetti explained. “With music therapy, we are giving them resources that they can use to self-regulate, to feel grounded and calmer. We are enabling them to actively participate in their own care.”

The Healing Power of Music

“A Song for Wayne,” performed by Edie Elkan and written as she played at the bedside of a student who was dying.

Even in the coronavirus pandemic, Mr. Rossetti has continued to perform live music for patients. He says that he’s seen increases in acute anxiety since the onset of the pandemic, making musical interventions, if anything, even more impactful than they were before the crisis.

Mount Sinai has also recently expanded its music therapy program to include work with the medical staff, many of whom are suffering from post-traumatic stress from months of dealing with Covid, with live performances offered during their lunch hour.

It’s not just a mood booster. A growing body of research suggests that music played in a therapeutic setting has measurable medical benefits.

“Those who undergo the therapy seem to need less anxiety medicine, and sometimes surprisingly get along without it,” said Dr. Jerry T. Liu, assistant professor of radiation oncology at the Icahn School of Medicine at Mount Sinai.

A review of 400 research papers conducted by Daniel J. Levitin at McGill University in 2013 concluded that “listening to music was more effective than prescription drugs in reducing anxiety prior to surgery.”

“Music takes patients to a familiar home base within themselves. It relaxes them without side effects,” said Dr. Manjeet Chadha, the director of radiation oncology at Mount Sinai Downtown in New York.

It can also help people deal with longstanding phobias. Mr. Rossetti remembers one patient who had been pinned under concrete rubble at Ground Zero on 9/11. The woman, who years later was being treated for breast cancer, was terrified by the thermoplastic restraining device placed over her chest during radiation and which reawakened her feelings of being entrapped.

“Daily music therapy helped her to process the trauma and her huge fear of claustrophobia and successfully complete the treatment,” Mr. Rossetti recalled.

Some hospitals have introduced prerecorded programs that patients can listen to with headphones. At Mount Sinai Beth Israel, the music is generally performed live using a wide array of instruments including drums, pianos and flutes, with the performers being careful to maintain appropriate social distance.

“We modify what we play according to the patient’s breath and heart rate,” said Joanne Loewy, the founding director of the hospital’s Louis Armstrong Center for Music & Medicine. “Our goal is to anchor the person, to keep their mind connected to the body as they go through these challenging treatments.”

Edie Elkan plays the harp as part of the music therapy program at Robert Wood Johnson Hospital in New Jersey.
Edie Elkan plays the harp as part of the music therapy program at Robert Wood Johnson Hospital in New Jersey.Edie Elkan

Dr. Loewy has pioneered techniques that use several unusual instruments like a Gato Box, which simulates the rhythms of the mother’s heartbeat, and an Ocean Disc, which mimics the whooshing sounds in the womb to help premature babies and their parents relax during their stay in noisy neonatal intensive care units.

Dr. Dave Bosanquet, a vascular surgeon at the Royal Gwent Hospital in Newport, Wales, says that music has become much more common in operating rooms in England in recent years with the spread of bluetooth speakers. Prerecorded music not only helps surgical patients relax, he says, it also helps surgeons focus on their task. He recommends classical music, which “evokes mental vigilance” and lacks distracting lyrics, but cautions that it “should only be played during low or average stress procedures” and not during complex operations, which demand a sharper focus.

Music has also been used successfully to support recovery after surgery. A study published in The Lancet in 2015 reported that music reduced postoperative pain and anxiety and lessened the need for anti-anxiety drugs. Curiously, they also found that music was effective even when patients were under general anesthesia.

None of this surprises Edie Elkan, a 75-year-old harpist who argues there are few places in the health care system that would not benefit from the addition of music. The first time she played her instrument in a hospital was for her husband when he was on life support after undergoing emergency surgery.

“The hospital said that I couldn’t go into the room with my harp, but I insisted,” she said. As she played the harp for him, his vital signs, which had been dangerously low, returned to normal. “The hospital staff swung the door open and said, ‘You need to play for everyone.’”

Ms. Elkan took these instructions to heart. After she searched for two years for a hospital that would pay for the program, the Robert Wood Johnson University Hospital in Hamilton, N.J., signed on, allowing her to set up a music school on their premises and play for patients at all stages in their hospitalization.

Ms. Elkan and her students have played for over a hundred thousand patients in 11 hospitals that have hosted them since her organization, Bedside Harp, was started in 2002.

In the months since the pandemic began, the harp players have been serenading patients at the entrance to the hospital, as well as holding special therapeutic sessions for the staff outdoors. They hope to resume playing indoors later this spring.

For some patients being greeted at the hospital door by ethereal harp music can be a shocking experience.

Recently, one woman in her mid-70s turned back questioningly to the driver when she stepped out of the van to a medley of familiar tunes like “Beauty and the Beast” and “Over the Rainbow” being played by a harpist, Susan Rosenstein. “That’s her job,” the driver responded, “to put a smile on your face.”

While Ms. Elkan says that it is hard to scientifically assess the impact — “How do you put a number on the value of someone smiling who has not smiled in six months?”— studies suggest that harp therapy helps calm stress and put both patients and hospital staff members at ease.

Ms. Elkan is quick to point out that she is not doing music therapy, whose practitioners need to complete a five-year course of study during which they are trained in psychology and aspects of medicine.

“Music therapists have specific clinical objectives,” she said. “We work intuitively — there’s no goal but to calm, soothe and give people hope.”

“When we come onto a unit, we remind people to exhale,” Ms. Elkan said. “Everyone is kind of holding their breath, especially in the E.R. and the I.C.U. When we come in, we dial down the stress level several decibels.”

Ms. Elkan’s harp can do more than just soothe emotions, says Ted Taylor, who directs pastoral care at the hospital. It can offer spiritual comfort to people who are at a uniquely vulnerable moment in their lives.

“There is something mysterious that we can’t quantify,” Mr. Taylor, a Quaker, said. “I call it soul medicine. Her harp can touch that deep place that connects all of us as human beings.”

How Barely-There Botox Became the Norm

Will starting injections in your 20s and 30s make you look older? Preventive Botox explained.

Forget what you think you know about Botox. Once considered the not-so-secret tool of celebrities and the wealthy with a bad rap for freezing faces, the wrinkle-melting injections have become a commonplace activity of a normie class with money to spare.

“Many millennials prioritize taking care of themselves early on and really believe in prevention,” said Dr. Panta Rouhani Schaffer, a dermatologist in New York who has seen an uptick in younger patients requesting Botox in the last few years. “That just got amplified during the pandemic, when people have spent so much time staring at themselves on screens.”

But they’re looking for results à la J. Lo, not Jocelyn Wildenstein. It’s a softer approach, called “baby Botox” by some and “preventive Botox” by others, that is changing the common question, “Would you ever get Botox?” to “When will you start?”

The answer from millennials and Gen Zers is, increasingly, in their 20s and 30s, ages when most baby boomers and Gen Xers were not yet fretting over aging with the same all-consuming anxiety. (See: sunscreen, considered a must today but an afterthought for many until the early 1990s.)

Leah Walkiewicz, a 27-year-old product manager in Manhattan, has been getting Botox in her forehead since she was 24, a decision spurred by what she felt was early wrinkle formation and a close look at how her family has aged.

“I always had obvious fine lines on my forehead, and makeup would settle into those lines really obviously,” she said of her decision to start so young.

Despite some nerves, the discreet shots her dermatologist administered led her to return for more, roughly every 10 months. This year she moved beyond getting Botox in the forehead and glabella (the area between the eyebrows) to test out injections in her “crow’s feet.”

“It’s been crazy to see the progress,” Ms. Walkiewicz said. “If more people had told me what you can do with Botox sooner, I think I would have gone a couple of years earlier.”

From Stigma to Sharing

Social media has been both a blessing and a curse in our relationship to Botox. While the selfie-heavy platforms have made it easier than ever for people to compare and despair over their looks, they’ve also helped destigmatize and increase education about the once-taboo subject.

Kathryn Gongaware, a 32-year-old yoga teacher and comedian in Chicago, was always curious about Botox, but it wasn’t until she started mentioning it to friends and realized that people she wouldn’t have expected (including her au-natural-everything acupuncturist) were getting it that she felt comfortable making the jump at age 30.

“The more people were open about it, the more it felt destigmatized,” she said.

This forthrightness has been particularly transformative among women of color, who are often left out of conversations and marketing about cosmetic procedures. There’s also a deeply rooted stigma in many communities of color that by opting for cosmetic procedures that have inclined toward European beauty ideals, you’re rejecting your roots, said Dr. Onyeka Obioha, a dermatologist in Los Angeles who has been getting Botox since she was 25.

“Historically, and even today, the majority of advertisements for cosmetic procedures do not feature or target minorities,” Dr. Obioha said. “But now with social media, there’s more attention given to the fact that women of color also get cosmetic procedures, so the stigma surrounding them seems to be decreasing.”

While online sharing has helped reduce the stigma, it has brought with it some downside, too — namely, young people thinking they need to start Botox because their friends are doing it.

“I’ve had 20-year-olds in college come in without knowing anything about Botox who really don’t need it, but they have this sense of FOMO because their friends are doing it,” said Dr. Sheila Farhang, a dermatologist and cosmetic surgeon in Arizona, who doles out skin-care tips to thousands of followers on Instagram and YouTube. “I will not inject someone that age, and I try to explain to them why they really don’t need it.”

The Difference in ‘Baby Botox’

A shift in how Botox is administered has also helped convince younger people to try it. “When Botox first came out, people were using it to really isolate and freeze the muscles, so that frozen look was what people associated it with,” Dr. Schaffer said. At the time, doctors were using 20 to 30 units in one area or muscle alone, a dosing that has lowered significantly in the last 10 years.

“People are starting to appreciate that by doing less, you still get a very nice softening that gives people enough of what they want to see in terms of tightening and retexturizing,” she said.

“Baby Botox” involves using 20 to 35 units spread out across multiple muscles in the face, most commonly in the forehead (two to 12 units), glabella and brow area (20 to 22 units) and the corners of the eyes (three to four units per eye). The result when done right is a refreshed look that doesn’t render one’s face immobile.

Most patients in their 20s and 30s are looking to smooth out fine lines and prevent the formation of deep, static wrinkles in the future. “With Botox, over time, you’re thinning out that muscle and using it less, so those lines don’t really get etched in,” Dr. Schaffer said.

For some patients, the benefits of Botox extend beyond preventing wrinkles. Dr. Farhang has used small doses of Botox in the muscle above the lip to flip it out so it looks fuller; in the columella area just below the nose to raise the nasal tip a millimeter; and in the muscles at the corners of the jawline for slimming purposes.

While these injections don’t last as long as traditional Botox, because of lower doses and increased muscle movement in these areas, “they offer little tweaks” that can make a difference in one’s appearance,” Dr. Farhang said.

What Could Go Wrong?

While less risky than filler injections, Botox is not always the Benjamin Button miracle cure it’s made out to be. Proceeding with caution, particularly when starting young, is key.

“Botox is very much a medical procedure,” Dr. Farhang said. “It’s not a Groupon situation.”

On the plus side, the impermanence of Botox means that even if an injector overdoes the dosage, it will wear off without long-term facial alteration. With continued high doses, your muscles can technically atrophy, or lose their strength. But with other muscles moving in the face, that’s not something you’ll necessarily notice, Dr. Farhang said, and some research has shown that if you take a break from Botox, those muscles rebuild.

Although it’s rare, some patients who start with high doses in their 20s say their skin has thinned over time, but experts say this has not been shown in research literature. In fact, some studies suggest that Botox can improve the elasticity of skin.

Still, Dr. Schaffer said, “one could postulate that the skin may feel thinner or appear crepey because the muscle mass that was providing volume under the skin has decreased.” To avoid such eventualities, it’s best to find a doctor with a conservative touch and supplement the procedure with skin-supporting routines like daily SPF.

As for the concern that your body will get “used to” Botox and stop working, doctors say there’s little such evidence. “In my experience, many patients just require fewer units over time because their facial muscles are less dynamic and thus require less,” Dr. Schaffer said.

Despite its impermanence, “bad” Botox can last for months, making it risky for your self-esteem. A few weeks ago, Dr. Farhang saw a bride-to-be three weeks out from her wedding with a droopy eyelid from having been injected too low and too deep in the forehead and brow area.

“There’s literally nothing I can do to fix it until it wears off, besides prescribing her an eyedrop that activates that muscle a bit,” she said. “It may be temporary, but four months is a really long time to look wonky.”

Born to Be Lazy? What Bears Can Teach Us About Our Exercise Habits

Scientists have found that grizzlies, like people, seem to choose the path of least resistance.

Grizzly bears move across landscapes in much the same way as most people do, favoring flat paths over slopes and gentle speeds over sprints, according to a remarkable new study of grizzlies and how their outdoor lives compare to ours.

The study, which involved wild and captive bears, a specialized treadmill, apple slices and GPS trackers, expands our understanding of how a natural drive to save energy shapes animals’ behavior, including ours, and could have implications for health and weight management. The findings also help explain why, in the great outdoors, the paths of bears and people so often intersect, providing useful reminders about wilderness planning and everyone’s safety.

Biologists and other scientists have become increasingly interested in recent years in how we and other creatures make our way through our surroundings. And while some preliminary answers have begun to emerge about why we choose to move and navigate as we do, the findings are not, on the whole, especially flattering.

Accumulating research suggests that we humans, as a species, are apt to be physically lazy, with a hard-wired inclination to avoid activity. In a telling 2018 neurological study, for example, brain scans indicated that volunteers were far more attracted by images of people in chairs and hammocks than of people in motion.

This apparently inborn preference for not moving made sense for us once, long ago, when hunting and gathering demanded hard effort and plentiful calories and resting under a tree did not. Being inactive is more problematic now, with food everywhere.

But the extent to which we share this penchant for physical ease with other species and whether these predilections affect how we and they traverse the world has remained unclear.

So, cue grizzlies, particularly those living at the Washington State University Bear Center, the nation’s primary grizzly bear conservation and research center. University biologists affiliated with the center study how the animals live, eat and interact with humans.

Now, for the new study, which was published recently in the Journal of Experimental Biology, they decided to explore precisely how much energy grizzlies expend when they move in different ways and how those and comparable numbers might affect real-life behavior, not only of bears but of us and other animals.

To start, they constructed a sturdy enclosure around a treadmill originally built for horses. With modifications, it could tip up or down by as much as 20 percent, while handling the size and weight of a grizzly. At the front of the enclosure, the scientists added a feeding box with a built-in rubber glove.

Then they taught the center’s nine male and female grizzlies — most of them resident at the center since birth and sporting names like John, Peeka and Frank — to clamber onto the treadmill and walk, while sedately accepting slices of hot dogs and apples as a reward.

“Grizzlies are very food driven,” says Anthony Carnahan, a doctoral candidate at Washington State University who led the new study.

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By measuring changes in the composition of the air in the enclosure, the researchers could track each bear’s energy expenditure at varying speeds as they walked uphill and down. (The bears never ran on the treadmills, because of concerns for their safety.) Using this data, the researchers determined that the most efficient pace for the bears, physiologically — the one at which they used the least oxygen — was about 2.6 miles per hour.

Finally, the scientists gathered available information about the movements of wild bears, using GPS statistics from grizzlies in Yellowstone National Park, along with mapping data and comparable numbers from past studies of people and other animals wandering through natural landscapes.

Comparing the data, the scientists found that wild grizzlies, like us, seem born to laze. The researchers had expected the wild bears to move at their most efficient speed whenever possible, Mr. Carnahan says. But in reality, their average pace traveling through Yellowstone was a pokey and physiologically inefficient 1.4 miles per hour.

They also almost invariably chose the least-steep route to get anywhere, even when it required extra time. “They did a lot of side-hilling,” Mr. Carnahan says.

Interestingly, these speeds and routes resembled those of people when picking routes through wildlands, the researchers noted.

Taken as a whole, the findings suggest that the innate urge to avoid exertion plays a greater role in how all creatures, great and small, typically behave and navigate than we might imagine.

The study does not rule out, however, that grizzlies, like other bears, can move with sudden, staggering speed and ferocity, when they decide to, Mr. Carnahan points out. “I’ve seen a bear run across a mountain meadow in six or seven minutes, when it took me all afternoon,” he says.

The results likewise do not tell us that we humans are fated always to hike slowly, sticking to the flats, but only that it may require mental as well as physical effort and goal setting to avoid defaulting to the easiest routes.

Finally, the study is a bracing reminder that we share the outdoors with large apex predators who may naturally pick the same pathways as us. You can find useful information about remaining safe in grizzly country at the website of the Interagency Grizzly Bear Committee.

¿Ya podemos besarnos con desconocidos?

Una serie de nuevos comerciales muestra besos ensalivados. Los viajes en avión están regresando. Y la inminente vacunación puede parecer un boleto de vuelta a la normalidad para los veinteañeros de Estados Unidos, muchos de los cuales se sienten desesperados por volver a su vida social de 2019 con fiestas abarrotadas y pistas de baile con luz estroboscópica, así como la posibilidad de enviarle un mensaje de texto espontáneo a un amigo: ¿Quieres ir por un trago?

Los adultos más jóvenes han sido de vital importancia en la propagación del coronavirus.

Un informe de los Centros para el Control y la Prevención de Enfermedades (CDC, por su sigla en inglés) mostró que, de junio a agosto de 2020, las infecciones por COVID-19 entre las personas de 20 a 29 años aumentaron y representaron más del 20 por ciento del número total de casos en el país. Poco después, los datos mostraron que esos casos provocaron un aumento en los contagios entre personas de mediana edad y mayores, lo cual pudo haber contribuido al incremento nacional de casos en Estados Unidos.

Ahora, a medida que se ha dado prioridad a la vacunación de personas de la tercera edad y alrededor de dos tercios de los mayores de 65 años ya recibieron al menos una dosis de la vacuna, su riesgo de enfermar de gravedad tras contagiarse por un joven ha disminuido de manera considerable.

Pero eso no significa que sea completamente seguro ir de fiesta como si fuera 2019.

La forma de calcular el riesgo de transmitir el virus a personas más vulnerables dependerá de tus circunstancias individuales: si vives con tus padres u otros veinteañeros, si hay personas con riesgo de padecer síntomas graves de COVID-19 en tu círculo social. “No hay una simple luz roja o luz verde”, afirmó William Schaffner, experto en enfermedades infecciosas de la Universidad de Vanderbilt.

A continuación, algunas respuestas a preguntas habituales sobre qué pueden hacer los jóvenes que presentan un bajo riesgo en general después de vacunarse.

¿Se puede volver a la normalidad así como así?

Nos dirigimos hacia una especie de normalidad, subrayan los expertos, pero todavía hay muchas incógnitas sobre qué pasará en los próximos meses. Aunque el aumento de las tasas de vacunación y el descenso de los casos son alentadores, explicó Schaffner, hay tres situaciones que podrían obstaculizar o anular ese progreso: si la gente se niega a vacunarse, si las tasas de transmisión comunitaria siguen siendo altas y si las variantes del virus disminuyen la eficacia de las vacunas.

“Si los adultos mayores y los más jóvenes se vacunan, y las variantes no son demasiado variantes, entonces podríamos tener muchas fiestas en la piscina”, dijo. “Los bares podrían abrir”.

“La vuelta a la vida normal debería ser un lento proceso gradual”, comentó Tara Kirk Sell, asociada principal del Centro Johns Hopkins para la Seguridad Sanitaria, que investiga eventos sanitarios a gran escala. Recomendó que la gente escoja una actividad de mayor riesgo que haya querido realizar durante la pandemia —como ver a los amigos o salir a comer— y la lleve a cabo para celebrar su vacunación. “Estamos hablando de un avance gradual, en lugar de actuar como si estuviéramos cantando ‘Libre soy’”, dijo.

Lelanie Foster for The New York Times
Lelanie Foster for The New York Times

Sin embargo, gran parte de esto depende de la cantidad de virus que circule en tu comunidad.

“Una vez que se llegue a una combinación de casi ningún caso en la comunidad y un alto porcentaje de gente vacunada; entonces, todo cambia”, afirmó Paul E. Sax, especialista en enfermedades infecciosas en el Brigham and Women’s Hospital de Boston. “De hecho, eso es lo que esperamos. Ahí es cuando dices: ‘Claro, me arriesgaré a ir a un restaurante. Mi probabilidad de ir a un restaurante y enfermar de COVID-19 no es mayor que el riesgo de enfermar de un resfriado normal’. Es un riesgo que la gente debería estar muy dispuesta a correr”.

“La gente tiene que estar atenta al entorno de la COVID-19 del mismo modo que lo está al clima”, comentó Peter Chin-Hong, experto en enfermedades infecciosas de la Universidad de California en San Francisco. Recomendó que la gente vigile las tasas de vacunación en su comunidad y los casos por cada 100.000 habitantes. Carlos del Río, especialista en enfermedades infecciosas de la Universidad Emory, recomienda el sitio Covid ActNow para consultar el número de casos por condado; The New York Times también da seguimiento al nivel de riesgo por condado.

Si te encuentras en una zona que tiene menos de 10 casos por cada 100.000 habitantes, es más seguro ir a una fiesta o socializar al aire libre en un grupo mayor donde todos estén vacunados. Un escenario mucho menos seguro sería participar en el tipo de fiestas relacionadas con las vacaciones de primavera que están atrayendo la atención en Florida, que registró 22 casos por cada 100.000 habitantes en los últimos siete días y se piensa que tiene una concentración importante de B117, la variante más contagiosa y tal vez más letal del virus identificada por primera vez en el Reino Unido.

¿Podemos besarnos con desconocidos?

Los expertos entrevistados para este artículo dijeron que besarse y tener otro tipo de contacto íntimo con desconocidos tras vacunarse puede ser seguro siempre y cuando puedas confirmar que la otra persona también está vacunada.

Incluso sin esa confirmación, puede que besarse con un extraño sea una actividad de menor riesgo que ir a un lugar abarrotado como una discoteca o una fiesta, afirmó David Rubin, profesor de Pediatría de la Facultad de Medicina Perelman de la Universidad de Pensilvania. “Es una de esas cuestiones que se dejan a criterio de cada persona, sin juzgar”, comentó.

“Si estás en un entorno controlado y solo te encuentras con esa persona y quieres asumir el riesgo de besarla y crees que esa persona no parece tener ningún riesgo de padecer COVID-19 grave, conforme a los lineamientos de los CDC, adelante, puedes hacer todo lo que quieras con esa persona”, comentó Chin-Hong.

Si estás vacunado, pero no puedes confirmar la vacunación o la condición médica de la otra persona, aun así, no habrá problema para la mayoría de los jóvenes, agregó.

“La cuestión aquí es el control”, continuó. “Cuantas más narices y bocas se junten, más riesgo potencial de transmisión”.

También está el evidente dilema logístico: puede ser difícil verificar de modo casual y rápido que alguien recibió todas las dosis requeridas de la vacuna y que es de bajo riesgo. Hace poco, una aplicación de citas, Coffee Meets Bagel, añadió una opción para incluir el estado de vacunación en los perfiles de citas, aunque no requiere verificación.

¿Podemos reunirnos en grupos?

A principios de marzo, los CDC dieron a conocer recomendaciones que afirmaban que era seguro para los adultos vacunados reunirse en grupos pequeños sin cubrebocas ni distanciamiento social. Una vocera de los CDC comentó en un correo electrónico que dichos lineamientos aplicaban a toda la gente que reside en Estados Unidos y que no había consideraciones adicionales para los adultos más jóvenes.

En la práctica, eso significa que no hay problema en que un grupo de entre cinco y diez amigos vacunados se reúnan sin tomar precauciones. Pero cuanto mayor sea la reunión, más probable será que alguien del grupo no esté vacunado. Aunque las tres vacunas que se administran en Estados Unidos (Pfizer, Moderna y Johnson & Johnson) parecen ser eficaces para prevenir los síntomas graves de la enfermedad del virus, aún no sabemos si evitarán que las personas contagien a otras.

¿Qué pasa con los bares en espacios cerrados?

Ashish K. Jha, decano de la Escuela de Salud Pública de la Universidad Brown, predijo que la mayoría de los bares abrirán para el verano en todo el país. También predijo que serán una fuente importante de propagación del virus entre las personas no vacunadas, aunque, en general, deberían ser seguros para quienes han recibido la vacuna.

“La conclusión es que, si quieres ir a un bar, si quieres ir a una discoteca, puedes hacerlo y estarás bastante seguro” una vez que te hayas vacunado, explicó Jha. No obstante, otros expertos advirtieron que todavía hay demasiadas incógnitas (relacionadas con las variantes o si se puede seguir transmitiendo el virus después de haberse vacunado) como para animar con toda libertad a la gente a volver a los bares en interiores.

Los bares al aire libre pueden ser más seguros, dependiendo de su configuración y de si la transmisión en la comunidad es baja. Solo asegúrate de que tu grupo de amigos sea pequeño y no una multitud.

¿Qué pasa con los conciertos al aire libre?

Los expertos coinciden en que los conciertos al aire libre pueden ser seguros, sobre todo si los asistentes usan cubrebocas y se mantienen distanciados. Las actividades al aire libre pueden admitir grupos mucho más grandes de personas vacunadas, comentó Sax.

“La gente se pregunta por qué no hubo más casos después de las manifestaciones del verano. Bueno, se debe a que se llevaron a cabo al aire libre. Será el mismo caso para los conciertos al aire libre, además, me sorprendería mucho que hubiera algún evento de propagación importante vinculado con un concierto en un espacio abierto”.

¿Es necesario que los jóvenes se vacunen?

Los expertos expresaron su preocupación por la reticencia a vacunarse entre los jóvenes. En enero, la Oficina del Censo de Estados Unidos dio a conocer datos de una encuesta que mostraban que los estadounidenses menores de 44 años eran los más renuentes a vacunarse.

“Hemos estado promoviendo la vacuna entre las personas mayores a fin de protegerlas de la hospitalización y la muerte”, afirmó del Rio. “La mayoría de los jóvenes, si se contagian, tienen síntomas leves. Necesitamos poder comunicar de manera muy clara que la vacunación es benéfica para los jóvenes, además de decir: ‘No te vas a morir’”.

“Cuanto más rápido vacunemos a la gente, más probable es que tengamos una vida más normal”, recalcó.

Use Your Newspaper to Make Flowers

Colorful paper blooms are easy to make and perfect for a spring table top.

“There are always flowers for those who want to see them,” Henri Matisse said. Even in this newspaper — just glue a skewer between two pieces of colored or painted newspaper and snip it into simple flower shapes.

Group the flowers together for an everlasting and inexpensive centerpiece for your spring table, or place one at each place setting. Mini versions can be used as place cards; they’d make even a tiny gathering feel special. If you leave the bottom of the skewers undecorated, you can poke the flowers into a cake or cupcakes for an instant decoration. Or cheer up someone’s work-from-home situation with a potted paper bouquet; they’ll thank you a bunch.

Jodi Levine for The New York Times

Supplies

  • Newspaper (find colorful spots or paint it)

  • Acrylic craft paint and paintbrush (if you want to paint the newspaper)

  • Pencil

  • Scissors

  • Wooden skewers

  • White glue

  • Small bowl and a paintbrush (optional, for the glue)

  • Glue stick (optional)

  • Small flowerpots, vases, recycled bottles or jars.

  • Fine gravel or sand (available in craft stores, optional)

Make the flowers

1. If you’d like to, paint a few sheets of newspaper.

2. Cut two pieces of paper to the height and width of your planned flower, leaf and stem or just the flower head.

Jodi Levine for The New York Times

3. Brush or squeeze a thin strip of glue down the center of the paper, place your dowel on top and apply some more glue over it. Apply a think layer of glue over the rest of the newspaper and place the other piece on top. Gently press it down. (If you want to use as cake toppers, leave the end of your dowel bare.)

Jodi Levine for The New York Times
Jodi Levine for The New York Times

4. Lightly pencil a design (you can use the ones here as a guide or make up your own) and cut out. Let Matisse’s flowers inspire you.

Jodi Levine for The New York Times

5. “Plant” the flowers in small flowerpots, vases or repurposed bottles or jars. Pour an inch or two of sand or fine gravel into the container to anchor the stems.

Car Maintenance During the Pandemic

Many people may have deferred maintenance because their cars mostly sat around in the pandemic. But that creates its own ills.

You may have put off going to the doctor, the dentist, getting hair cuts, abandoned your commute and reduced your driving to essential errands during the pandemic. Staying put has most likely made you safer, but you weren’t doing any favors for your car, especially if you were also putting off maintenance.

Cars need regular use and upkeep to stay in shape, even if you are barely driving them.

Make that: Especially if you’re barely driving them.

That said, there is some car maintenance you can delay and some you cannot. The “can” list is shorter, so let’s start with that.

Consider miles driven, not time.

Maintenance obligations can be loosely divided into two categories: those based on miles driven and those based on time since the last service. One of the chores based on miles is tire rotation, and a car that has barely been used can relax the routine that’s intended to even out the wear on all four tires. Usually, after about 5,000 miles you would move the positions of the tires, like putting the right front tire on the right rear, though the pattern to follow can differ from car to car.

Also, while tires deteriorate over time, the past year of diminished use won’t have much affect on that deterioration.

You can also relax about the engine coolant and the air and cabin filters, which are all tied to usage. John Ibbotson, the shop supervisor for the auto fleet of Consumer Reports, said that some automakers don’t call for the system to be flushed and new coolant installed until 100,000 miles, or 10 years. He also said the filters should typically be “looked at every 15,000 miles and changed at 30,000.”

The general maintenance guidance he relies on is the owner’s manual, but he cautions that the patterns of life in the pandemic have complicated matters. With people driving only short local trips, the typical family car has shifted from normal service to what automakers regard as severe duty. In other words, making those quick hops to the Starbucks may be functionally the equivalent of towing a trailer or pounding down dusty farm roads, as far as your engine’s oil is concerned.

Short trips do not bring the engine up to operating temperature, which is necessary to rid the oil of moisture that accumulates in normal use. Nor does the engine coolant circulate and deliver anti-corrosion additives to vital spots. Longer drives also help make sure that vital components like gears and bearings maintain a coating of lubricant.

The most important task: changing the oil.

If you are not taking longer drives, then you really don’t want to delay changing your oil. It’s the most familiar maintenance task and perhaps the one that is most important to your car’s good health.

On an older car, following the owner’s manual mileage recommendation for severe conditions will help to keep the lubricant and its blend of protective additives fresh (if you no longer have the manual, they are often available online and from the automaker). The systems built into many new cars that remind you of required service, like oil changes, take into account the length of trips and will recommend changes based on actual driving.

Changing the oil is also the ideal time to look in on other maintenance tasks, including checks of all belts and hoses; while both suffer the effects of engine heat under the hood, they can also develop cracks while the car just sits.

Add car batteries to the time list. They have a limited life that’s not based on miles driven. They often start to decline after three years and give up altogether after five to seven.

Jill Trotta, a certified technician and vice president for marketing at RepairPal, a website that provides cost estimates and connects car owners with qualified mechanic shops, knows how to properly care for a car. Yet even she let a battery run down past the point where it could be revived with a charge, which is exactly what happened to her 2014 Hyundai Sonata Hybrid when it sat in the driveway for months without being driven during the pandemic.

The solution: a low-power battery maintainer, which keeps the charge topped up between drives. Basic ones start at about $25. Keep in mind, too, that while battery replacement is an entirely straightforward swap on most cars, some electronics-intensive models make it more painful. BMWs going back nearly two decades require a registration and programming process, which means added expense and a possible visit to a dealer. It’s worth preventing a dead battery in the first place.

Another maintenance task that should not be deferred is replacing the timing belt in engines that use them. The belt turns the camshafts that open the engine’s valves and can cause major engine damage if it fails. Typically good for 80,000 to 100,000 miles of service, the belt can degrade even while sitting, so stick to the automaker’s recommendation on years between renewal.

Don’t forget the brakes.

A telling sign of a car not being driven is a layer of rust on the brake discs. A light coating is no problem, though it may be noisy for a few blocks; it will be polished off by the first few presses of the brake pedal on a careful drive around the neighborhood.

More critical are brake parts you can’t see. The hydraulic fluid that makes the system work absorbs water from the air, potentially reducing stopping power. The fluid can be tested for water, but if it’s visibly dirty have the system flushed and refilled with fluid that meets the specifications in the owner’s manual.

Also look for corrosion that can keep the brake calipers, which squeeze the discs to stop the car, from working correctly. If your car doesn’t roll freely at low speeds when driven for the first time in awhile, have the brakes checked immediately — and ideally nearby.

One downside to dormancy that doesn’t fall under normal maintenance routines: rodent occupation. Lift the hood to see whether mice or squirrels have taken up residence, a problem that may be more common than you’d think. Clear out any nesting materials or droppings before starting the engine, especially from areas near an exhaust system that will get hot.

At the same time, knock off accumulations of dirt, leaves and bird droppings, which can damage the paint. Ms. Trotta suggested a gentle pass with a yard blower; in any case, don’t rub accumulated dirt with a cloth or a brush because the abrasion will leave scratches. You can also rinse the surface with plain water to remove as much as possible. Pay attention to the tracks where a sunroof or the power windows slide, clearing debris that could jam the glass.

The yearlong hiatus in regular car use calls for a bit of special attention to the car’s mechanical and cosmetic needs, but for the most part it is not disastrous for every aspect of a car’s well-being. As Covid restrictions loosen around the country and with warmer weather, drivers will be putting their vehicles back into regular service, and there may be a crush at the local shop or dealership. Taking care of deferred maintenance soon may be a smart plan to avoid a wait for service.

Si sufres de alergias, las mascarillas podrían ayudarte con los síntomas

Los estudios muestran que usar mascarillas en los espacios exteriores, además de ser efectivo contra la COVID-19, puede proteger a quienes sufren por las alergias estacionales.

Mientras llegamos a nuestra segunda primavera pandémica, muchos estamos desesperados por quitarnos los cubrebocas. Pero para 19,2 millones de estadounidenses adultos que sufren de alergias estacionales hay otra razón para seguir usando mascarillas.

Aunque los cubrebocas de tela y los quirúrgicos funcionan bien para protegernos de las partículas virales, los estudios muestran que las mascarillas también pueden ser efectivas para filtrar los alérgenos comunes, que normalmente flotan en tamaños mucho más grandes, lo que hace que sean más fáciles de bloquear. El polen de pino, por ejemplo, es aproximadamente 800 veces más grande que el coronavirus, dijo David Lang, alergólogo de la Clínica Cleveland. Incluso antes de la pandemia, les aconsejaba a sus pacientes con alergias graves que usaran mascarillas al aire libre, especialmente durante actividades prolongadas como la jardinería o la limpieza de los patios.

El uso de mascarillas para aliviar los síntomas de las alergias puede requerir un poco de “ensayo y error”, dijo Purvi Parikh, alergóloga e inmunóloga en el centro de salud NYU Langone. Pero “si hay menos polen entrando en la nariz y boca, es menos probable que sufras un ataque de alergia”, dijo.

Recientemente, un grupo de investigadores israelíes estudió cuánto cambiaban los síntomas de las personas con alergias leves, moderadas y graves al usar mascarillas. Con base en los datos recopilados por 215 miembros del personal de enfermería que usaron cubrebocas quirúrgicos o mascarillas N95 durante un período de dos semanas, encontraron que en el caso de 44 trabajadores sanitarios con síntomas de alergia severa, casi el 40 por ciento experimentó menos estornudos, secreción y congestión nasal cuando usaban una mascarilla quirúrgica o N95. Entre las 91 personas con síntomas moderados, el 30 por ciento mejoró cuando usaron una mascarilla quirúrgica; y esa cifra se elevó al 40 por ciento cuando usaban una N95. Entre las 80 personas que comenzaron el estudio con síntomas leves, 43 (alrededor del 54 por ciento), sintieron que sus síntomas mejoraron al utilizar una mascarilla quirúrgica o N95, dijo Amiel Dror, médico científico del Centro Médico Galilee y académico en la Facultad de Medicina Azrieli de la Universidad Bar-Ilan que es el autor principal del estudio.

El uso de mascarillas también fue más efectivo para los miembros del personal sanitario con alergias estacionales que para quienes presentan síntomas durante todo el año. Usar cubrebocas no resolvió el problema de la picazón en los ojos, según el reporte de septiembre, publicado en The Journal of Allergy and Clinical Immunology.

Aunque los hallazgos sugieren que usar una mascarilla puede reducir los síntomas de alergia en algunas personas, los investigadores advirtieron que se necesitan más estudios. Es posible que el personal sanitario experimente menos síntomas porque, cuando no estaban trabajando, se quedaban en casa y evitaban las multitudes durante los encierros, por lo tanto, tenían menos exposición a los alérgenos presentes en el medioambiente. Pero el hecho de que el uso de mascarillas, que cubren la nariz y la boca, se asociara con la mejoría de los síntomas nasales, pero no con la irritación de los ojos, sugiere que usar cubrebocas probablemente ayudó a reducir muchos síntomas de las alergias.

Además de filtrar los alérgenos, usar mascarillas también hace que el aire en nuestras cavidades nasales sea más cálido y húmedo, dijo Dror. “Sabemos que el aire seco y el aire frío a veces pueden provocar una reacción en la nariz”, dijo. “Este es un beneficio adicional de usar cubrebocas. Con todo lo malo, eso es algo bueno”.

La protección varía dependiendo de la mascarilla, el ajuste y, en el caso de las mascarillas de tela, según el tejido que se use en la fabricación. Y, a menos que usen cubrebocas en todo momento, las personas pueden verse afectadas por los alérgenos de interiores como los ácaros del polvo o el polen que se transportan a través de las ventanas abiertas con la brisa primaveral.

“Puede ayudar, pero no necesariamente eliminará todos los síntomas”, dijo Sandra Lin, profesora de Otorrinolaringología y cirugía de cabeza y cuello en la Escuela de Medicina Johns Hopkins. “Mucha gente usa mascarillas la mayor parte del tiempo y todavía tiene síntomas de alergia”.

Aquí hay otros consejos para reducir sus síntomas durante la temporada de alergias.

  • Protege tus ojos. Lang recomienda a las personas que sufren de alergias usar anteojos o gafas cuando estén al aire libre, lo que ayuda a evitar que los alérgenos como el polen de los árboles entren en contacto directo con los ojos.

  • Lava y cambia con frecuencia la mascarilla. “Lo último que quieres es que se quede algún alérgeno atrapado ahí”, dijo Parikh. Ella recomienda a los pacientes cambiarse de ropa al volver a casa y ducharse antes de dormir, para asegurarse de que el polen no se pegue a la piel y lavar las mascarillas reutilizables con frecuencia. Los Centros para el Control y la Prevención de Enfermedades recomiendan lavar los cubrebocas de tela después de cada uso.

  • Encuentra una mascarilla que no te irrite el rostro. Elegir la mascarilla correcta para un usuario con alergias puede ser importante. La gente con piel sensible puede reaccionar a algunos tintes textiles y deben usar detergentes sin aroma, o elegir mascarillas quirúrgicas o de grado médico, que es menos probable que irriten la piel. “Mis pacientes con alergias tienen piel muy sensible porque los mismos bichos que los hacen estornudar o toser también pueden irritarles la piel”, dijo Parikh.

  • Consulta con un médico si los síntomas de alergia son severos. “Si las personas continúan presentando síntomas que interfieren con sus actividades normales, si faltan al trabajo o la escuela, si su sueño se interrumpe por las noches, deben consultar a su médico”, dijo Lang. “Podemos ayudar de otras maneras. No deberían sufrir innecesariamente”.

Dani Blum es asistente de noticias en la sección Well de The New York Times.


Covid-19 Vaccine Side Effects: Your Questions Answered

The most common questions about vaccination side effects, answered.

Every day nearly three million people in the United States are getting the Covid-19 vaccine. And every new jab prompts new questions about what to expect after vaccination.

Last week I asked readers to send me their questions about vaccinations. Here are some answers.

Q: I’ve heard the Covid vaccine side effects, especially after the second dose, can be really bad. Should I be worried?

Short-lived side effects like fatigue, headache, muscle aches and fever are more common after the second dose of both the Pfizer-BioNTech and the Moderna vaccines, which each require two shots. (The Johnson & Johnson vaccine requires only a single shot.) Patients who experience unpleasant side effects after the second dose often describe feeling as if they have a bad flu and use phrases like “it flattened me” or “I was useless for two days.” During vaccine studies, patients were advised to schedule a few days off work after the second dose just in case they needed to spend a day or two in bed.

Data collected from v-safe, the app everyone is encouraged to use to track side effects after vaccination, also show an increase in reported side effects after the second dose. For instance, about 29 percent of people reported fatigue after the first Pfizer-BioNTech shot, but that jumped to 50 percent after the second dose. Muscle pain rose from 17 percent after the first shot to 42 percent after the second. While only about 7 percent of people got chills and fever after the first dose, that increased to about 26 percent after the second dose.

The New York Times interviewed several dozen of the newly vaccinated in the days afterward. They recounted a wide spectrum of responses, from no reaction at all to symptoms like uncontrolled shivering and “brain fog.” While these experiences aren’t pleasant, they are a sign that your own immune system is mounting a potent response to the vaccine.

Q: Is it true that women are more likely to get worse side effects from the vaccine than men?

An analysis of safety data from the first 13.7 million Covid-19 vaccine doses given to Americans found that side effects were more common in women. And while severe reactions to the Covid vaccine are rare, nearly all the cases of anaphylaxis, or life-threatening allergic reactions, occurred in women.

The finding that women are more likely to report and experience unpleasant side effects to the Covid vaccine is consistent with other vaccines as well. Women and girls can produce up to twice as many antibodies after receiving flu shots and vaccines for measles, mumps and rubella (M.M.R.) and hepatitis A and B. One study found that over nearly three decades, women accounted for 80 percent of all adult anaphylactic reactions to vaccines.

While it’s true that women may be more likely to report side effects than men, the higher rate of side effects in women also has a biological explanation. Estrogen can stimulate an immune response, whereas testosterone can blunt it. In addition, many immune-related genes are on the X chromosome, of which women have two copies and men have only one. These robust immune responses help to explain why 80 percent of autoimmune diseases afflict women. You can read more about women and vaccine side effects here.

Q: I didn’t have any side effects. Does that mean my immune system didn’t respond and the vaccine isn’t working?

Side effects get all the attention, but if you look at the data from vaccine clinical trials and the real world, you’ll see that many people don’t experience any side effects beyond a sore arm. In the Pfizer vaccine trials, about one out of four patients reported no side effects. In the Moderna trials, 57 percent of patients (64 or younger) reported side effects after the first dose — that jumped to 82 percent after the second dose, which means almost one in five patients reported no reaction after the second shot.

A lack of side effects does not mean the vaccine isn’t working, said Dr. Paul Offit, a professor at the University of Pennsylvania and a member of the Food and Drug Administration’s vaccine advisory panel. Dr. Offit noted that during the vaccine trials, a significant number of people didn’t report side effects, and yet the trials showed that about 95 percent of people were protected. “That proves you don’t have to have side effects in order to be protected,” he said.

Nobody really knows why some people have a lot of side effects and others have none. We do know that younger people mount stronger immune responses to vaccines than older people, whose immune systems get weaker with age. Women typically have stronger immune responses than men. But again, these differences don’t mean that you aren’t protected if you don’t feel much after getting the shot.

Scientists still aren’t sure how effective the vaccines are in people whose immune systems may be weakened from certain medical conditions, such as cancer treatments or H.I.V. infection or because they are taking immune suppressing drugs. But most experts believe the vaccines still offer these patients some protection against Covid-19.

The bottom line is that even though individual immune responses can vary, the data collected so far show that all three vaccines approved in the United States — Pfizer-BioNTech, Moderna and Johnson & Johnson — are effective against severe illness and death from Covid-19.

Q: I took Tylenol before I had my Covid vaccine shots and had very little reaction to the shots. Did I make a big mistake?

You shouldn’t try to stave off discomfort by taking a pain reliever before getting the shot. The concern is that premedicating with a pain reliever like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), which can prevent side effects like arm soreness as well as fever or headache, might also blunt your body’s immune response.

While it’s possible that taking a pain reliever before your shots might have dampened your body’s immune response, vaccine experts say you shouldn’t worry, and you shouldn’t try to get another shot. Studies of other vaccines suggest that while premedicating can dull the body’s immune response to a vaccine, your immune system can still mount a strong enough defense to fight infection. A review of studies of more than 5,000 children compared antibody levels in children who took pain relievers before and after vaccinations and those who did not. They found that pain relievers did not have a meaningful impact on immune response, and that children in both groups generated adequate levels of antibodies after their shots.

The high efficacy of all the Covid vaccines suggests that even if taking Tylenol before the shot did blunt your body’s immune response, there’s some wiggle room, and you are likely still well protected against Covid-19. “You should feel reassured that you’ll have enough of an immune response that you’ll will be protected, especially for vaccines that are this good,” said Dr. Offit.

Q: What about taking a pain reliever after the shot?

“It’s OK to treat” side effects with a pain reliever, said Dr. Offit, but if you don’t really need one, “don’t take it.”

While most experts agree it’s safe to take a pain reliever to relieve discomfort after you get vaccinated, they advise against taking it after the shot as a preventive or if your symptoms are manageable without it. The concern with taking an unnecessary pain reliever is that it could blunt some of the effects of the vaccine. (In terms of the vaccine, there’s no meaningful difference if you choose acetaminophen or ibuprofen.)

During the Moderna trial, about 26 percent of people took acetaminophen to relieve side effects, and the overall efficacy of the vaccine still was 94 percent.

Q: Are the side effects worse if you’ve already had Covid-19?

Research and anecdotal reports suggest that people with a previously diagnosed Covid-19 infection may have a stronger reaction and more side effects after their first dose of vaccine compared to those who were never infected with the virus. A strong reaction to your first dose of vaccine also might be a sign that you were previously infected, even if you weren’t aware of it.

If you previously tested positive for Covid-19 or had a positive antibody blood test, be prepared for a stronger reaction to your first dose, and consider scheduling a few days off work just in case. Not only will it be more comfortable to stay home and recover in bed, the vaccine side effects can resemble the symptoms Covid-19, and your co-workers won’t want to be near you anyway.

Q: I had Covid-19 already. Does that mean I can just get one dose?

Studies suggest that one dose might be adequate for people who have a previously confirmed case of Covid-19, but so far the medical guidelines haven’t changed. If you’ve received the Pfizer-BioNTech or Moderna vaccines, you should plan to get your second dose even if you’ve had Covid-19. Skipping your second dose could create problems if your employer or an airline ask to see proof of vaccination in the future. If you live in an area where the single-dose Johnson & Johnson vaccine is available, then you can be fully vaccinated after just one dose. You can read more here about the vaccine response in people who’ve had Covid-19.

Q: Will the vaccines work against the new variants that have emerged around the world?

The vaccines appear to be effective against a new variant that originated in Britain and is quickly becoming dominant in the United States. But some variants of the coronavirus, particularly one first identified in South Africa and one in Brazil, appear to be more adept at dodging antibodies in vaccinated people.

While that sounds worrisome, there’s reason to be hopeful. Vaccinated people exposed to a more resistant variant still appear to be protected against serious illness. And scientists have a clear enough understanding of the variants that they already are working on developing booster shots that will target the variants. The variants identified in South Africa and Brazil are not yet widespread in the United States.

People who are vaccinated should still wear masks in public and comply with public health guidelines, but you shouldn’t live in fear of variants, said Dr. Peter J. Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. “If you’re vaccinated, you should feel pretty confident about how protected you are,” said Dr. Hotez. “It’s unlikely you’ll ever go to a hospital or an I.C.U. with Covid-19. In time you’re going to see a recommendation for a booster.”

I hope these answers will reassure you about your own vaccine experience. You can find a more complete list of questions and answers in our special vaccine tool “Answers to All Your Questions About Getting Vaccinated Against Covid-19.”

What to Expect When You Get Your Covid Vaccine

What to Expect When You Get Your Covid Vaccine

Kevin Mohatt for The New York Times

With more Americans becoming eligible for vaccination, many have questions about what the experience is like.

Here, Times science and health reporters answer some frequently asked questions about vaccination →

Mar. 10, 2021
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Your ‘Maskne’ Might Not Be Acne at All

Perioral dermatitis, a complex facial rash that is often mistaken for acne, is becoming more common, some experts say. Here’s how to spot, treat and prevent this irritating condition.

It started as a mini constellation of red dots near the right corner of my lips. Probably just “maskne,” I figured. I slathered on some acne cream and tried to forget about it.

But the inflamed, rashy spots didn’t fade away. In fact, they grew larger, spawning dandruff-like scales and flakes. Within days, the red dots had spread to the left side of my mouth, and even — to my horror — sprinkled across my eyelids. When I opened my mouth, I felt the raw, burning skin at the corners crack.

After a telemedicine visit with my dermatologist, I learned that I had perioral dermatitis — a noncontagious facial rash that often shows up as clusters of tiny, scaly, red, uncomfortable bumps above irritated skin. “We see it mainly around the mouth,” said Dr. Anna Chien, a dermatologist at the Johns Hopkins University School of Medicine. “Some people can have similar breakouts around the eyes.”

Cases have become more common since the coronavirus outbreak began, some experts say. In one Canadian survey of 77 dermatologists published in September, more than a third reported either a large or slight increase in perioral dermatitis instances since the beginning of the pandemic.

“In our clinic,” Dr. Chien said, “we are seeing many more perioral dermatitis and other rashes related to masks.” Dr. Jessica Sprague, a dermatologist at the U.C. San Diego School of Medicine, noted a similar phenomenon. “Masks alter the skin environment, and they can also cause a lot of skin irritation,” she said, adding, “I’m definitely seeing it more now in the setting of mask wearing.”

What causes it

Perioral dermatitis might look a lot like acne, but the resemblance is deceptive, said Dr. Carrie Kovarik, a dermatologist at the Hospital of the University of Pennsylvania and a member of the American Academy of Dermatology’s Covid-19 task force. “People confuse it with ‘maskne,’ and they are two different things.”

With mask-induced acne, your pores get clogged with dirt, skin flakes or oil, giving rise to inflamed cysts that may burst. But perioral dermatitis is more of an inflammatory rash. There can be various causes, but it tends to be triggered by a disruption of your skin’s natural equilibrium, Dr. Sprague said, from the use of topical substances like steroid medications or irritating cosmetics.

The humid, enclosed space behind a mask may also encourage perioral dermatitis rashes to form. “Depending on what kind of mask you’re wearing, you could really have a lot of moisture sitting there on your face,” Dr. Kovarik said. “You’re almost creating this skin fold-type area,” a little like the damp crevices that can form between rolls of skin.

That can modify the face’s natural microbial balance, research suggests, contributing to perioral dermatitis and related conditions. “When you wear a mask, you’re basically changing the terrain,” said Dr. Whitney Bowe, a dermatologist based in New York.

This can encourage or discourage the growth of certain microbes, like bacteria and yeast, which may be involved in perioral dermatitis, and can touch off “this cycle of making the disease even worse,” Dr. Kovarik said.

The rash appears most often in adult women, but can also crop up, albeit less frequently, in young children. Unlike cold sores, perioral dermatitis bumps are not thought to be caused by a specific virus and usually do not migrate onto the lips themselves.

How to prevent and treat it

Since perioral dermatitis is so complex, it can be challenging to treat and may take a long time to clear, Dr. Sprague said. But if you monitor your skin closely and follow some simple rules, you might be able to steer clear of the condition completely or nip it in the bud.

Practice good mask hygiene. Masks are currently a public health necessity, but cleaning them regularly may help keep perioral dermatitis at bay.

As soon as you are home and can safely remove your mask, wash your face with a gentle, fragrance-free cleanser, Dr. Sprague said. When it’s time to don your mask again, resist the temptation to use one that is dirty, since it can disrupt your face’s microbial balance. “It’s like underwear,” Dr. Bowe said. “You wouldn’t wear your underwear two days in a row.”

Avoid steroid-based skin creams. Many people use steroidal anti-inflammatory medications, like hydrocortisone cream, to manage symptoms of perioral dermatitis, Dr. Chien said, but while such medications may clear redness temporarily, a rebound rash is likely to appear once you stop using them. “It’s very reasonable to think, put on some steroids, but that tends to make it worse,” she said. “The minute you stop, it comes back with a vengeance.”

Researchers don’t completely understand why this happens, but some think that steroid creams might allow bacteria to overgrow by suppressing the body’s local immune response.

If you have allergies or asthma, think about switching your meds. As with steroid creams, Dr. Sprague said, inhaled or spray steroidal medications commonly used to treat allergies or asthma — like Flonase, Nasacort or Symbicort — are thought to trigger perioral dermatitis, perhaps because they modify the body’s immune response.

If you use any of these medications and are worried about perioral dermatitis, talk with your doctor about your treatment plan. Some allergy or asthma sufferers may need to remain on steroid medications, Dr. Sprague said. However, others may be able to consider other nonsteroidal drugs, like cetirizine (Zyrtec), which are not thought to cause perioral dermatitis.

Streamline your skin-care products. Using too many skin care products can throw off your skin’s natural balance, according to Dr. Bowe, increasing the risk of an outbreak. In one study of 232 people in Australia, those who used foundation, night cream and moisturizer were 13 times more likely to develop perioral dermatitis than those who used moisturizer alone.

Similarly, if you’re managing a flare, minimalism is key. “The best thing you can do is baby your skin,” Dr. Sprague said. “Stop any thick cosmetics, serums, etc.”

Dr. Jennifer Holman, a dermatologist in Tyler, Texas, recommended washing your face twice a day with a gentle cleanser, such as a sulfur face wash, and following up with a fragrance-free moisturizing lotion. It’s OK to use a little mineral makeup, she added, because it doesn’t tend to aggravate the rash.

Don’t dabble in unproven treatments — see your dermatologist. Plenty of alternative treatments for perioral dermatitis are available on the web, from swabbing the skin with apple cider vinegar to taking supplements of certain herbs, like neem. But those haven’t been scientifically proven to work, Dr. Holman said. And since the rash is notorious for sticking around, it’s important to seek professional help.

Dr. Sprague said she’ll often start by prescribing a topical antibiotic, like metronidazole — not to banish an infection per se, but to reduce the inflammation and give the skin a chance to heal. Pimecrolimus, a nonsteroidal anti-inflammatory cream that is commonly used to treat rosacea and eczema, can also help clear up the rash.

When these treatments fall short, Dr. Sprague said she’ll sometimes recommend a several-week course of an oral antibiotic, like doxycycline, which can also help to reduce inflammation.

Perioral dermatitis “seems like something minor, but you can really get into difficult situations” where the rash persists, Dr. Kovarik said. “You want someone who’s familiar with treating this.”

My own perioral dermatitis has improved since I started treating it with a topical antibiotic and a gentle, fragrance-free lotion, but it hasn’t yet vanished. I still have some tiny bumps around my mouth and eyes, so I’m leveling up with a monthlong course of oral doxycycline. I hope it will restore my clear skin — and I look forward to a post-pandemic future when I can let my face breathe freely once again.

Elizabeth Svoboda is a science writer in San Jose, Calif., and the author of “What Makes a Hero?: The Surprising Science of Selflessness.”

Depression in Young Children

We tend to think of childhood as a time of innocence and joy, but as many as 2 to 3 percent of children from ages 6 to 12 can have serious depression.

When parents bring their children in for medical care these days, there is no such thing as a casual, “Hey, how’s it going?” We doctors walk into every exam room prepared to hear a story of sadness and stress, or at the very least, of coping and keeping it together in this very hard year, full of isolation, loss, tragedy and hardship, with routines disrupted and comfort hard to come by.

Parents have carried heavy burdens of stress and responsibility, worrying about themselves but also watching their children struggle, and there is worldwide concern about depression and suicidality among young people. But it isn’t only the adults and the young adults and teenagers who are suffering and sad; young children can also experience depression, but it can look very different, which makes it challenging for parents — or doctors — to recognize it and provide help.

Rachel Busman, a clinical psychologist at the Child Mind Institute in New York City, said that it can be hard to think about depression in younger children because we picture childhood as a time of innocence and joy. But as many as 2 to 3 percent of children ages 6 to 12 can have serious depression, she said. And children with anxiety disorders, which are present in more than 7 percent of children aged 3 to 17, are also at risk for depression.

Dr. Helen Egger, until recently the chair of child and adolescent psychiatry at N.Y.U. Langone Health, said that according to her epidemiologic research, between 1 and 2 percent of young children — as young as 3 — are depressed

Depression was originally conceived of as an adult problem. Maria Kovacs, professor of psychiatry at the University of Pittsburgh School of Medicine, said that in the 1950s and ’60s, there were child psychiatrists who believed that children did not have sufficient ego development to feel depression, but that research that she and other colleagues did in the ’70s showed that “school age children can suffer from diagnosable depression.”

Before adolescence, depression is equally common in girls and boys, though among adolescents, it is twice as common in girls, and that predominance then lasts across most of adult life, until old age, when it again appears to equalize.

What does depression look like in younger children?

When young children are depressed, Dr. Kovacs said, it’s not unusual for “the primary mood to be irritability, not sadness — it comes across as being very cranky.” And children are much less likely to understand that what they’re feeling is depression, or identify it that way. “It almost never happens that they say, ‘something’s wrong because I’m sad,’” Dr. Kovacs said. It’s up to adults to look for signs that something is not right, she said.

The best way for parents to recognize depression in young children is not so much by what a child says as by what the child does — or stops doing. Look for “significant changes in functioning,” Dr. Kovacs said, “if a child stops playing with favorite things, stops responding to what he used to respond to.”

This might mean a child loses interest in the toys or games or jokes or rituals that used to be reliably fun or entertaining, or doesn’t seem interested in the usual back and forth of family life.

“You’ve had a kid who was one way and then you see that they’re more irritable and sad,” said Dr. Egger, who is now the chief medical and scientific officer at Little Otter, a new online mental health care company for children. Children may seem flattened, have less energy or tire easily. And they may start complaining about physical symptoms, especially stomach aches and headaches. They may sleep more — or less — or lose their appetites.

A preschool-aged child might be depressed if she is having daily tantrums, with behaviors that risk hurting herself or other people. Depression “may look like a behavior problem but is really being driven by what the kid is feeling inside,” Dr. Egger said.

“It’s like walking through the world with dark-colored glasses,” Dr. Busman said. “It’s about myself, about the other person, and the world — I suck, this sucks, everything sucks.”

Should I ask about suicidal thoughts?

The irritability and the anger — or the flatness and the shutting down — can be signs of profound sadness. And while suicide attempts by elementary school-aged children are rare, they do happen and have increased in recent years. Suicide was the second leading cause of death in children 10 to 14 in 2018, and a 2019 JAMA study showed increasing emergency room visits by children for suicidal thoughts or actions from 2007 to 2015 — 41 percent in children under 11 years old. The presence of suicidal thoughts should be seen as a call for help.

The most problematic myth about suicide is the fear “that if you ask about suicide you’re putting the idea in their heads,” said Dr. Kovacs, who developed the Children’s Depression Inventory which is used all over the world.

“If you’re dealing with a child for whom this is not an issue, they’re just going to stare at you like you’re out of your head,” Dr. Kovacs said. “You cannot harm somebody by asking them.”

But what if children say they have thought of suicide? As with adults, this suggests the child is living with pain and perhaps thinking about a way out. Dr. Kovacs said, children may imagine death as “a release, a surcease, a relief.”

Dr. Busman said that she works with children who may say, “I don’t want to kill myself but I feel so bad I don’t know what else to do and say.”

If a child talks about wanting to die, ask what that child means, and get help from a therapist if you’re concerned. A statement like this can be a real signal that a child is in distress, so don’t dismiss it or write it off as something the child is just saying for attention, she said.

How can treatment help?

“Parents should take child symptoms very seriously,” said Jonathan Comer, professor of psychology and psychiatry at Florida International University. “In serious forms it snowballs with time, and earlier onset is associated with worse outcomes across the life span.”

In a 2016 longitudinal study, Dr. Kovacs and her colleagues traced the course of depression starting in childhood, and found recurrent episodes in later life.

So if you see changes like withdrawal from activities, irritability or sadness, fatigue, or sleep disturbances that persist for two weeks, consider having the child evaluated by someone who is familiar with mental health issues in children of that age. Start with your pediatrician, who will know about resources available in your area.

Parents should insist on a comprehensive mental health evaluation, Dr. Busman said, including gathering history from the parent, spending time with the child and talking to the school. An evaluation should include questions about symptoms of depression as well as looking for other problems, like attention deficit hyperactivity disorder or anxiety, which may be at the root of the child’s distress.

Early treatment is effective, Dr. Comer said, “There’s terrific evidence for family-focused treatment for child depression — it focuses on family interactions and their impact on mood.” With children from 3 to 7, he said, versions of parent-child interaction therapy, known as PCIT, are often used — essentially coaching parents, and helping them emphasize and praise what is positive about their children’s behavior.

As much as possible, parents should try to keep children going outside, taking walks, even playing outdoor games, even if they are less enthusiastic about their usual activities. As with adults, physical exercise has both mental and biological benefits — as do fresh air and sunshine.

Depression does not necessarily lend itself to simple cause-and-effect explanations, but Dr. Kovacs emphasized that with a first episode in a child, there is almost always a particular stressor that has set off the problem. It could be a change in the family constellation — a parental divorce, a death — or it could be something more subtle, like an anxiety that has spiraled out of control. If a child does begin therapy, part of the treatment will be to identify — and talk about — that stressor.

How can I find help for my child?

If you’re concerned that your child might be depressed, start with your pediatrician or other primary care provider. Some clinics and health centers will have in-house mental health services, and you may be able to have your child seen there. Some doctors will have links to local therapists with experience with young children. Mental health specialists can be in short supply (and there’s a lot of need right now), so be open to the possibility of care being delivered remotely, through telehealth. Dr. Kovacs also suggested that parents who are looking for treatment consider clinical psychology department clinics at a local university, where students in psychology and counseling are supervised by licensed psychologists; she said such clinics often have good availability.

[The Society of Clinical Child and Adolescent Psychology has advice on how to know if treatment is evidence-based.]

“Parents should see children’s struggles as opportunities to intervene,” Dr. Comer said. “The majority of early child mood problems will go away with time, sensitive parenting and supportive environments.”

How to Start Healing During a Season of Grief

There is no singular way to respond to heartache or sorrow. Find the strategy that works best for you.

We are all grieving right now.

Perhaps you’re one of the millions who has lost a loved one to the brutalities of Covid-19, or maybe you’re grieving another kind of loss: missed time with family and friends, a postponed wedding, a former job. Many of us have also grieved circumstances or deaths unrelated to the coronavirus — each made even more difficult in the context of a pandemic.

Every loss deserves to be acknowledged and addressed. So we gathered advice from bereavement experts and asked people who have recently experienced grief to tell us how they are finding peace.

There are a wide variety of strategies. But it’s important to acknowledge that many people “don’t have the luxury of attending fully to grief and mourning,” said Therese A. Rando, the clinical director of the Institute for the Study and Treatment of Loss in Warwick, R.I. “That’s one of the most insidious things about the pandemic.”

If you’re running on adrenaline and still living in survival mode, start small and see if one of the methods below might be helpful to you, too.

Lean on your virtual community

“In initial stages of bereavement, many grievers find the most helpful resource to be other supportive people,” said Sherry Cormier, a psychologist and bereavement trauma specialist in Edgewater, Md. “This is because grief can feel like abandonment, and because it can feel isolating.”

Finding this kind of support in person can be a challenge during the pandemic, but video chats with helpful friends or family are often useful substitutes for get-togethers, she added.

Online resources like Grieving.com and Grief Healing Discussion Groups offer moderated group discussion forums, and the websites National Covid-19 Day and Modern Loss have additional resources for people who need support.

What people tend to find most helpful during the grieving process is “acknowledgment, and an ongoing invitation to share their experiences,” said Rebecca Soffer, the co-founder and chief executive of Modern Loss. “This has become all the more urgent as grieving people have had to endure the process in relative isolation for more than a year.”

Online religious services can also provide a sense of community.

Elizabeth Sanford, 58, who lives in Atlanta, said she started listening to the morning prayers of a monastery in Cumbria, England, a few months after her father died and the country went into lockdown. She watches nearly every morning on Facebook Live at 3 a.m., which is when she now tends to wake up.

“It’s like getting a hug,” she said. “The bells ring. The guided imagery helps me cry. The prayers bring peace.”

Finally, keep an eye out this spring for a new online guide with nearly 80 websites pertaining to grief during the pandemic. The guide, which is being curated by Camille B. Wortman, an expert on grief and a professor emeritus of psychology at Stony Brook University in New York, will cover topics as varied as how to process feelings of guilt or lack of closure; how to explain death to a child; and how to help those who are mourning.

Learn something new

“It’s hard to be grieving actively when you are learning something new,” Dr. Cormier said. “It’s stimulating to our brain, and it takes our mind off of our struggle.”

Whether you start volunteering, foster a pet or take up a hobby, you are giving yourself a mental break from grieving, the experts said.

That was the case for Allyn Young, 43, who lives in Manhattan. After her father died of Covid in December, she said, she became “obsessed with horses.”

She started reading books about horses, following horse rescues on Instagram and watching a documentary series that described how horses are used for therapy.

“I had no idea!” she said. “Right now I’m trying to get in touch with the stables around N.Y.C. to take lessons and volunteer. My newfound and totally random excitement at the idea of petting a horse has been bringing me joy.”

Mark Seaman, 51, a cake decorator who lives in Chicago, said he became sad and fearful when his husband started suffering from serious health problems in December of 2019. A few months later Mr. Seaman began teaching himself to crochet by watching a how-to video on the website Craftsy, and started to feel more at ease.

“The repetitive nature of the activity distracted me so fully from the reality of the pandemic that the world was experiencing that I felt calm,” Mr. Seaman said.

Explore podcasts and books

Many people who are in the depths of grief find inspiration and connection while listening to podcasts, Dr. Cormier said.

In “Everything Happens,” Kate Bowler, a professor at Duke Divinity School, talks with people about what they’ve learned in dark times; “Terrible, Thanks for Asking” is hosted by Nora McInerny, an author who asks people to share their complicated and honest feelings about how they are actually doing; and “Unlocking Us,” with Brené Brown, a research professor at the University of Houston, aims to reveal the “messiness of what it means to be human.”

Then there are books — far too many examples to mention here, including “Finding Meaning: The Sixth Stage of Grief” by David Kessler (2019); and “It’s OK That You’re Not OK: Meeting Grief and Loss in a Culture That Doesn’t Understand” by Megan Devine (2017).

Dr. Cormier has also written a book, “Sweet Sorrow: Finding Enduring Wholeness After Loss and Grief” (2018), based in part on her own experience with cumulative grief. In the span of six years, she lost her father, husband, mother and sister.

“I really get what people are going through. I get the heartbreak. I get the wanting to stay under the covers all day,” she said.

If you have young children or teenagers, there are a variety of books and films that can help them cope with loss, too. And check out these articles about how to talk with children about death and how to help children with pandemic grief.

Speak with a grief counselor, religious leader or other professional

Kristin Taylor, 39, of Oak Park, Ill., who lost her mother to pancreatic cancer in November, had tried it all: meditation, talking with friends who lost their parents, long walks, writing in a journal and yoga. “Nothing helped too much,” she said.

Then she started speaking with a grief counselor once a week.

“I feel I have a place to not only openly weep and mourn without burdening another person, but I also now have someone to help me sort out the trauma I experienced while caregiving and witnessing an aggressive and ruthless cancer take over my mother’s body,” Ms. Taylor said.

A November survey of more than 800 U.S. adults who lost someone to Covid-19 found that two-thirds of the respondents were suffering from debilitating levels of grief, a type of mourning that can disrupt a person’s ability to live life normally.

If you are using drugs or alcohol to cope, or if you are having trouble functioning, it’s important to speak with a professional, said Sherman A. Lee, an associate professor of psychology at Christopher Newport University in Newport News, Va., and one of the authors of the study. Dr. Lee’s website, The Pandemic Grief Project, offers a short test that people can use to assess their level of distress: A score of seven or higher suggests that additional assessment or treatment is needed.

The demands of the pandemic have made it even more difficult for some people to find a mental health provider, however, especially one who takes insurance.

Psychology Today maintains a large list of providers that you can filter by location, insurance, specialty or other criteria. But if you can’t find a provider who is accepting new patients, ask the providers you contacted or your primary care provider for referrals.

Online therapy services may also be worth exploring if you need to speak with someone quickly.

Get active

Sayrah Garrison, 47, a licensed clinical social worker and dance teacher, is grieving the death of her mother-in-law, and missing her family’s California home now that they have moved across the country to New Jersey to be closer to her father-in-law. In March, she found a “grief dancer” workshop, rooted in the meditative 5Rhythms movement practice, to be cathartic and enlightening.

“I realized how much I actually missed our home in Oakland and how much I missed my regular students and the incredibly healing dance spaces we shared together,” she said.

Aerobic exercise may also release mood-elevating endorphins, the chemicals that can help you feel relaxed and happy after a workout.

Yoga is another option that helps strengthen your body and build flexibility, while offering an added spiritual component that can be calming in times of stress.

Tania Bunik of Minneapolis, Minn., 55, said the Down Dog yoga app, which she uses every day, helped preserve her mental health during a time of chaos by giving her the space to do something therapeutic for herself.

“It allows you to tailor your yoga session by the amount of time you have, the pace, the background music, the areas of your body you want to work on,” she said. “It gave me a sense of control because I had choices.”

Spend time in nature

Several people who are grieving told us that they have found it relaxing to take walks in nature; nurture their garden; or simply sit outside and observe.

“I was determined to make our backyard a nature sanctuary with a lot of beautiful flowers in the gardens, a bird bath and feeders,” said Carol Struve, 70, an artist and retired nurse who lives in Kingston, N.Y. Last year, Ms. Struve fractured her sternum, mourned the deaths of three older relatives and then grappled with a uterine cancer diagnosis.

“I restored the vintage, rusty patio furniture and bought a new umbrella for the table,” said Ms. Struve, who spent many afternoons making drawings of the flowers and gardens. “This helped me find my way through the cancer diagnosis and surgery, along with the support of my therapist and friends.”

If you don’t have easy access to a scenic spot, watching tranquil scenes on video can also be soothing. Dr. Wortman said that she and her husband take about 15 minutes a day to watch nature videos featuring scenic landscapes and animals.

It is easy and comforting, she added, and “it shows you that there’s still beauty in the world.”

How Wearing a Mask Can Reduce Allergy Symptoms

Research shows that wearing masks outdoors can protect against more than Covid-19 for people who suffer from seasonal allergies.

As we head into our second pandemic spring, many of us may be itching to give up our masks. But for the 19.2 million American adults suffering from seasonal allergies, there’s another reason to keep wearing your mask.

While cloth and medical masks do a good job of protecting us from viral particles, studies show masks also can be effective at filtering common allergens, which typically float around in much larger sizes, making them easier to block. Pine tree pollen, for example, is about 800 times larger than the coronavirus, said Dr. David Lang, an allergist at Cleveland Clinic. Even before the pandemic, he advised patients with severe allergies to wear a mask outside, especially for prolonged activities like gardening or yardwork.

Using masks to alleviate allergy symptoms can require a bit of “trial and error,” said Dr. Purvi Parikh, an allergist and immunologist at N.Y.U. Langone Health. But over all, “if there’s less pollen going into your nose and mouth, you’re less likely to have an allergy attack,” she said.

Israeli researchers recently studied how much difference wearing a mask could make for allergy sufferers with mild, moderate and severe symptoms. Using data collected from 215 nurses who used surgical masks or N95 masks during a two-week period, they found that among the 44 nurses with severe allergy symptoms, nearly 40 percent experienced less sneezing, runny nose and stuffy nose when they wore either a surgical or N95 mask. Among the 91 nurses with moderate symptoms, 30 percent improved when they wore a surgical mask; that rose to 40 percent when they wore an N95. Among the 80 nurses who started the study with mild symptoms, 43 nurses, or about 54 percent, felt their symptoms improved while wearing a surgical or N95 mask, said Dr. Amiel Dror, a physician-scientist at Galilee Medical Center and Bar-Ilan University Azrieli Faculty of Medicine and the lead author on the study.

Mask use was also more effective for the nurses with seasonal allergies than those with year-round symptoms. Wearing a mask did not solve the problem of itchy eyes, according to the September report, published in The Journal of Allergy and Clinical Immunology.

Although the findings suggest that wearing a mask can reduce allergy symptoms for some people, the researchers noted that more study is needed. It could be that the nurses experienced fewer symptoms because, when they weren’t working, they were staying home and avoiding crowds during lockdowns, and thus had less exposure to allergens in the environment. But the fact that mask wearing, which covers the nose and mouth, was associated with improvements in nasal symptoms, but not eye irritation, suggests that masking probably did help reduce many allergy symptoms.

In addition to filtering out allergens, wearing a mask also makes the air in our nasal cavities warmer and more humid, said Dr. Dror. “We know that dry air and cold air sometimes has the ability to elicit a reaction in the nose,” he said. “This is an extra benefit of wearing a mask. With all the bad, you can find some good.”

Protection varies mask to mask, depending on the fit and, for cloth masks, the weave of the fabric. And unless you wear a mask at all times, you may still be affected by indoor allergens such as dust mites or pollen carried through open windows on spring breezes.

“It can help, but it’s not necessarily going to take away all your symptoms,” said Dr. Sandra Lin, a professor of Otolaryngology — Head and Neck Surgery at Johns Hopkins School of Medicine. “Pretty much everyone’s wearing masks most of the time now, and people are still getting allergy symptoms.”

Here are some more tips to reduce your symptoms during allergy season.

  • Protect your eyes. Dr. Lang recommends people who suffer from allergies wear glasses or sunglasses when they’re outside, which helps block allergens like tree pollen from making direct contact with eyes.

  • Wash and change your mask frequently. “The last thing you want is allergen getting trapped in it,” Dr. Parikh said. She recommends patients change their clothes when they get home and shower before sleep, to ensure that pollen doesn’t stick to their skin, and wash reusable masks frequently. The Centers for Disease Control and Prevention recommends washing a cloth mask after each use.

  • Find a mask that doesn’t irritate your skin. Choosing the right mask for an allergy-prone wearer can also be important. People with sensitive skin may react to dyes in some fabric masks and should use perfume-free detergents. Or choose a surgical or medical grade mask, which are less likely to irritate skin. “My allergy sufferers have very sensitive skin because the same critters that make them sneeze or cough also can irritate their skin,” Dr. Parikh said.

  • Talk to a doctor if your allergy symptoms are severe. “If people are continuing to have symptoms that interfere with normal activity — if they’re missing work, missing school, their sleep is disrupted at night — see a physician,” Dr. Lang said. “There are other ways we can help. You shouldn’t be suffering needlessly.”

How to Lower Your Child’s Risk for Addiction

A strong sense of self-efficacy is one of the most powerful protective factors parents can give their children.

In the decade that I was an active alcoholic, my focus was on protecting my right to drink the way I wanted to drink, and keeping my drinking a secret from my family. From the day I got sober in 2013, however, my focus shifted to protecting my two sons from the genetic and environmental risks of addiction I’d strewn in their path.

For five years, I felt great about my efforts. I was setting a good example by being sober, my husband modeled healthy moderation and we were raising our kids with the support of a proverbial village of families we’d known and trusted for years.

Then, in 2018, my husband had a job opportunity that required us to leave that community and move to another state: Vermont. Our older son was already in college, so the change didn’t affect him too much, but our younger son, Finn, who was about to transition from middle to high school, was devastated.

“You are ruining my life,” he said, when we told him about the move. There was no yelling, no wild gesticulations, just a calm statement of fact, which was much, much worse.

According to all the research on risk for substance use disorder, the move had the potential to be a disaster for Finn. We had voluntarily exposed our 14-year-old boy to a host of risk factors for substance abuse during a vulnerable period of cognitive development on top of the genetic risk he already faced. A stressful physical and emotional transition that was out of his control? Check. Living in a state with permissive marijuana laws? Check. Sever ties with a peer group we trust? Check. Replace those peers and their supportive, loving parents with families we have never met? Check.

Before we moved, Finn had plenty of protections heaped on the prevention side of his metaphorical substance abuse scale: physical, financial and emotional stability; lack of stress; and his friends’ parents looking out for him and providing healthy models for sobriety, support and coping. My job was to figure out what I could do to balance the weight of his risk by loading the other side of the scale with as much protection as possible.

I could not help him make new friends, let alone pick their parents, but I could help restore Finn’s sense of control, agency and hope by building his sense of self-efficacy.

Self-efficacy, as defined by the psychologist Albert Bandura, is one’s belief in one’s ability to succeed; to regulate one’s thoughts, emotions and life; and to cope with challenges in a positive way. Self-efficacy is also the foundation for so many other positive traits, including resilience, grit, fortitude and perseverance. Self-efficacy is what gives kids a sense of control, agency and hope, even when the world around them feels out of control.

People with a weak sense of self-efficacy, on the other hand, tend to be pessimistic, inflexible, quick to give up, have low self-esteem, exhibit learned helplessness, get depressed, and feel fatalistic and hopeless. Not coincidentally, people who exhibit these traits are more likely to turn to drugs and alcohol to alleviate these negative feelings.

I wanted Finn to be able to talk to me about all his fears and anxiety around the move, and I knew that self-efficacy could help with that, too. It promotes open parent-child communication while helping kids resist peer pressure both directly and indirectly. Research shows that when a child believes he has the ability to resist peer pressure, he will be a lot more likely to do so, and further, he will be more likely to talk to his parents about those episodes of peer pressure when they arise. On the other hand, kids who don’t feel as if they can resist peer pressure don’t tend to talk to their parents about the things they do outside the home.

Lack of self-efficacy is a risk factor for substance abuse and other negative health outcomes, but when converted into its opposite and equal force, a strong sense of self-efficacy, it can be one of the most powerful protective factors we can give our children. Here are some practical ways parents can boost kids’ perceptions of their own self-efficacy and help kids with low self-efficacy get back on the right path:

Start with yourself.

Model, model, model self-efficacy for your kids. Start questioning your own assertions of “I can’t” with “I can’t yet,” then turn that perspective outward, toward your children. That helps kids believe competence is not congenital, it is learned, and often hard-won.

Give kids skills.

Praise alone won’t give your child a sense of self-efficacy or competence; these things come from the actual experience of trying, doing, failing, trying again, and succeeding. Give kids age-appropriate tasks that help them stay engaged and challenged while granting opportunities to taste success. Teach them how to make dinner from start to finish and see what they create on their own. Encourage your teen to take the family car to the garage and have that rattle behind the dash fixed.

Project optimism.

Optimism is about more than seeing a glass as half full; it’s a mind-set that has a very real impact on physical and mental health. Optimistic children are better able to resist learned helplessness and depression, whereas pessimists are much more likely to give in to feelings of helplessness and are consequently at much higher risk of suffering from a wide range of negative mental and physical health outcomes. According to the psychologist Martin Seligman, author of “The Optimistic Child,” pessimistic kids see obstacles as permanent, pervasive, and their fault. Optimistic children, on the other hand, view setbacks as temporary, specific and attributable to behaviors that can be changed. As Dr. Seligman explains: “Children learn their pessimism, in part, from their parents and teachers, so it is very important that you model optimism for your children as a first step.”

Make failures specific, but generalize success.

Guide children toward optimism by framing their success as generally as possible. If your daughter has a good day in math class, help her globalize that success. Instead of “I did well in math class because I paid attention,” move toward “School

is going well because I am doing all my assignments on time.” Help her expand her success beyond the boundaries of one class or one day.

Be specific in your praise.

General praise, such as “Good job!” is useless when it comes to bolstering self-efficacy in kids because it has no real meaning. Aim for behavior-specific praise that reinforces practices you want to encourage, such as, “I’m so proud of you for sticking with that project even when you got frustrated.” Behavior-specific praise describes the desired behavior, is specific to the child, and offers a positive, clear, statement.

Don’t go overboard with your praise.

Experts on the use of behavior-specific praise in the classroom recommend a 3:1 or 4:1 ratio of praise to correction, a ratio I have tried to maintain with my own students and children. I teach and parent older teens, but this guideline is effective for kids of any age. Research shows it not only boosts good behavior, but also creates a sense of community and positivity that helps kids hear our constructive criticism when it inevitably comes.

A belief in self-efficacy, Dr. Bandura writes in his book “Self-Efficacy: The Exercise of Control,” is “the foundation of human motivation, well-being, and accomplishments.” That might have been what my son needed most to get started in a new school, and not just as a protection against substance abuse. It could help him set and achieve goals, view obstacles as surmountable, have a lower fear of failure and approach new challenges with the assumption that he could succeed.

While I can’t know which, if any, of the preventions I’ve heaped on Finn during his adolescence will inoculate him against developing a substance use disorder, I do know that boosting his self-efficacy has been essential to building up his sense of competence, well-being and happiness.

One year after the move, Finn and I hiked up to the top of the mountain behind our house to pick wild huckleberries. We’d spent an hour or so crawling around on our hands and knees talking about whatever drifted through our minds, when Finn sat back on his heels, dumped a handful of berries into his mouth and admitted to being happy. What’s more, he was looking forward to his second year of high school. As we sat together, eating huckleberries and looking out over the Vermont landscape, I felt the weight of his risk ease from my shoulders, at least for a while.


Jessica Lahey is a former teacher and the author, most recently, of “The Addiction Inoculation,” from which this article is adapted.

Write a Golden Shovel Poem

A form called the Golden Shovel honors the poet Gwendolyn Brooks, and you just need a newspaper to get started.

Celebration and honor are two touchstones of the poetic tradition. With April’s National Poetry Month approaching, let’s write a poem in honor of another poem, and another poet.

Say hello to the golden shovel.

The golden shovel is a contemporary poetic form that follows a set of rules invented by the acclaimed poet Terrance Hayes in homage to Gwendolyn Brooks, the former poet laureate and the first African-American to win the Pulitzer Prize. When Mr. Hayes created his poem, “The Golden Shovel,” originally published in his 2010 collection “Lighthead,” it was inspired by Brooks’s classic, and the name of his form came from her poem’s epigraph, “The Pool Players./Seven at the Golden Shovel.” Mr. Hayes’s created his poetic form in honor of a poet he deeply respects, and also in honor of something he does in many of his poems, play.

Poetry is very much about play. That is the joy of writing a poem and of being a poet. As Brooks herself once said: “Words can do wonderful things. They pound, purr. They can urge, they can wheedle, whip, whine. They can sing, sass, singe.”

Poets are always celebrating one another, as all poems are really inspired by other poems. You are going to do the same thing: Use what has come before you as inspiration to create your own golden shovel. In doing so, you too, are honoring Gwendolyn Brooks, one line at a time.

So, what exactly is the golden shovel?

It’s a poem that takes a line from another poem or text (often a Gwendolyn Brooks’ poem, but not always) and uses each word in that line as the end of a line in the poem. For this poem, you will be using a headline from the newspaper as your line.

In honor of this poetic form, think about focusing your poem on the notion of “celebration” or “honor.” What do you celebrate in your life? What do you honor?

Here’s how to do it:

Be Picky. Search the paper for a headline of five or more words that speaks to you; you might cut out a few, so that you have options. Each word in the headline will be the final word of a line in your poem, so the length of your composition is dictated by the headline you choose.

Examine. Spread your headlines out before you and examine them. Which ones have the most potential? When you look at them, can you already imagine where those end words might take you? Pick one.

Credit. Be sure to write down the author of the article your headline came from, as well as the date of the issue. You will need to give credit to that writer at the bottom of your poem. (The poem above is drawn from an article by Jason Zinoman in the March 14 print edition of The New York Times.)

Layout. Cut out your words and place them on a piece of paper at the end of each line in the order in which they originally appeared, following the pattern in the poem above.

Write. You are ready to write or type your poem (you might want to do this on scratch paper). Each line must end with your end word, but your actual sentence can flow over into the next line, though the final word of each line should feel like some kind of ending. In the poem above, for example, the first line ends with “aching,” which corresponds to the first word of the selected headline. See if you can include a simile, a metaphor or maybe some imagery to evoke the five senses. Do you want your poem to “pound” or “purr” on the page? Then, focus on sound and musicality. Have fun with this.

Ta-Da! Write in your poem (or print it out and place each of your end words with its line). Congratulations, you’ve written a golden shovel. If the form intrigues you, check out “The Golden Shovel Anthology,” published by the University of Arkansas Press.

Virtual Concerts to Watch

Looking for signs of a return to normal? Sitting back to enjoy a live-music performance might be a good place to start.

The performing arts have endured a year like no other, but the decimation of touring and in-person shows has in no way squelched music fans’ love of a live performance. And in many ways, the pandemic has yielded creative new ways for artists to engage with their listeners.

Since March 2020, for example, the wildly popular Instagram Live series Verzuz, created by Timbaland and Swizz Beatz, has recruited some of the biggest names in rap, hip-hop and R&B for nostalgia-driven battles. Highlighting their musical oeuvres and mimicking D.J. battles, each artist plays a song, then their opponent follows with one of their own works, chosen with the intention of one-upping. Engaged audiences argue passionately about the victor. (In a testament to their popularity and relevance, the voting rights activist Stacey Abrams appeared on a November show featuring the Atlanta artists Gucci Mane and Jeezy to promote voting in the Georgia Senate runoffs.)

At the same time that small concerts with socially distanced audiences are gradually beginning to return, livestream musical events allow the unvaccinated and those across the country to take part in intimate shows from some great artists. Here is a selection of performances in the coming week that are worthy of a festival lineup, but with a comfortable front-row seat guaranteed.

March 30

Pandora LIVE Powered by Women

Pandora is honoring Women’s History Month with a streamed all-female event, hosted by Hoda Kotb, which will include performances by Jazmine Sullivan and Gwen Stefani. They will also sit down with the fellow artists Becky G and Lauren Alaina for a round-table discussion on issues facing women in music. 9 p.m. Eastern, free for Pandora members; pandoralivepoweredbywomen.splashthat.com/PR

April 2

Blind Boys of Alabama Easter Weekend Special

The Grammy-winning gospel group will perform a Good Friday show to celebrate the Easter holiday with a slate of new and old hits. The ensemble began performing in the late ’30s — its first members were children attending the Alabama Institute for the Negro Blind — and since then there has been a rotating roster of band members, many of whom are visually impaired. The socially distanced, in-person show, held at Nashville’s City Winery, will be livestreamed. 9 p.m. Eastern, tickets start at $18; boxoffice.mandolin.com

April 3

Emmylou Harris and Steve Earle, “Woofstock at the Winery”

Steve Earle, who was recently featuted on a cover of “The Times They Are A-Changin’” to benefit Feeding America, will perform live with the country-music icon and avid dog-rescuer Emmylou Harris. Filmed at City Winery Nashville, the performance will benefit the animal charities Crossroads Campus and Bonaparte’s Retreat a canine-rescue initiative founded by Ms. Harris and located on her property. 9 p.m. EST, tickets $15; form.jotform.com/210543759066156

April 4

Dionne Warwick At Home With You

The legendary songstress has had a very busy past year, increasing her fan base by becoming a must-read on Twitter, appearing on the third season of “The Masked Singer” (she was disguised as a mouse) and popping up for a guest appearance on the Gladys Knight vs. Patti LaBelle Verzuz battle. Ms. Warwick, who was nominated for the Rock & Roll Hall of Fame in February, will be performing two virtual shows on Easter Sunday, plus another two on Mother’s Day. She is also expected to resume touring in October. 2 p.m. and 8 p.m. EST, tickets $20, boxoffice.mandolin.com/pages/dionnewarwick

April 4

Verzuz: Isley Brothers vs. Earth, Wind & Fire

The Verzuz battles have become one of the singular joys of quarantine Following the esteemed pairings of Snoop Dogg and DMX, and Alicia Keys and John Legend, the Isley Brothers and Earth, Wind & Fire will appear in the next round of the beloved series, the first time that two bands have duked it out on the series. 8 p.m. EST, free to view on Instagram Live @verzuztv or on Triller.

Return to the Dining Table

Have you been “zombie eating” during the pandemic? If you put down your phone or turn off the TV, you might enjoy your food a bit more.

If you have found yourself over the past year increasingly eating dinner in front of the TV, or scrolling endlessly through your phone over breakfast, you certainly are not alone.

“Quarantine permissiveness” is what Susan Albers, a psychologist at the Cleveland Clinic and a best-selling author who focuses on mindful eating, calls the nearly universal phenomenon of allowing yourself bad habits during the pandemic.

But it may be time to consider a return to the table.

It doesn’t have to be fancy or elaborate, but setting a nice table can encourage you to sit down and eat with your family, roommates or even solo with a good book.

“Eating should be an experience and something you enjoy,” Dr. Albers said. “You don’t have to take a lot of time to eat, but when you do it, give it your full attention.” That means putting your phone away and sitting at the table.

“Your phone should not be your dining companion,” said Dr. Albers, who calls that familiar habit of eating with one hand and scrolling with the other “zombie eating.” But she acknowledges that sitting at the table instead of in front of the TV, or eating without scrolling on your phone can feel like daunting tasks, because “it’s hard to unlink those two behaviors when you’ve done them day after day.” This can be especially difficult if you’re working from home during the pandemic, or if you feel that eating on the sofa while binge-watching a show is a sort of reward for making it through another hard day.

The good news is that sitting down and eating meals at the table doesn’t have to be a chore. When you reframe mealtimes as special parts of the day, a time to connect with loved ones or to unwind alone, they become something to look forward to.

Fallon Carter, an event planner based in New York City, recently bought a new dining table. She has found that sitting down to proper meals during the pandemic has been a great way to connect with herself. “When you set the space and set the zone,” she said, “you can turn any place into something special,” she said.

Nothing about dining at a table has to be fussy, but a little effort can go a long way toward making the experience enjoyable. Ms. Carter added a floral arrangement to her dining table, with flowers she bought at Trader Joe’s. “It wasn’t a big lift,” she said, laughing, but it made the space feel more inviting. She also suggests using cloth napkins and proper glassware and acquiring a set of dishes that you really love.

Many people have leaned into cooking during the pandemic, and setting the table is a great way to honor the work that goes into preparing a meal. Even if you prefer takeout or microwave dinners, the advantages of setting a table still apply. No matter how you get your meal, you can always transfer it to proper dishes.

There are lots of good reasons to sit at the table for meals, but don’t stress yourself out. Meals are meant to be enjoyed. Ms. Fallon suggests even getting a little fancy with your table if you want.

“Don’t save the good stuff! You deserve the good stuff. We’ve been in a pandemic!”

5 easy steps to make mealtimes special:

Set the table with cloth napkins, flatware, glassware and dishes that you love.

Add candles, flowers or something decorative

Keep the TV off and your phone and laptop in another room.

Sit with your feet on the floor and your back against the chair (as you would in a restaurant).

Relax and enjoy your food!

Save Money at the Store

Food is pleasure and connection for most of us. Staying within your budget can bring peace of mind and keep your overall spending on track.

How do you spend the right amount on food?

According to an online survey of more than 1,000 people by LendingTree and Qualtrics published in October, weekly household grocery bills in the United States were up 17 percent on average last year compared with before the pandemic. Thirty-one percent of the respondents said that they “almost always overspend” at the grocery store.

Regardless of how large or small your food budget, staying within it can bring peace of mind and keep your overall spending on track. Whether you want to establish a food budget for the first time, or you want to get back to one, here are strategies to save money in your kitchen and at the grocery store.

Adam Glanzman for The New York Times

Plan simple meals, light on meat and dairy.

Cooking does not have to mean hovering over a stove for hours or complex meal plans. Cooking is sautéing some garlic in oil then adding canned tomatoes instead of opening a jar of pasta sauce. In addition to saving money, you will also have more control over your health. Meat and dairy are costly, so plan more meals that use them for flavor rather than bulk, enjoy more vegetables and fruit in their many affordable forms, and keep meals simple so you don’t burn out on cooking.

Rely on cheap, flexible staples.

Consider inexpensive staples like rice, pasta, oats, bread, canned and dried beans, canned tomatoes and eggs: How do they already play a role in your routine? Then think about what you can easily procure. You should discover a solid Venn diagram revealing the meals you can make more often; start stocking up on the basics that form their foundations. (Store-brand or cheaper versions of these staples can be found by looking to the bottom or top of store shelves. See what savings you find.) As you get more comfortable, take it further. If you normally enjoy a rice dish with lamb and sausage, can you try chickpeas and half the sausage this week? Cheap staples are a starting point, not a cage.

Embrace vegetables: fresh, frozen and canned.

If you begin to use meat and dairy more sparingly, rely on vegetables and fruits to add flavor. It can sound expensive or work intensive to eat more produce, but that’s not a certainty. Canned and frozen fruits and vegetables don’t have to be lower quality. Canned squash is puréed and ready to make a silky soup at half the cost and effort of a fresh squash. Frozen fruits and vegetables are often already chopped without the markup you see on pre-cut fresh versions.

And no matter how careful a meal planner you are, you’ll have times when something you bought with the best of intentions is past its prime. Find a recipe that calls for you to throw just about anything into it, like a soup, stew or stir-fry. Think of leftovers and past-prime produce as an asset rather than a burden.

Tim Gruber for The New York Times

Choose versatility by purchasing the basics.

You can save money by eating a smaller variety of food in a given week, but if you stick to the versatile stuff it won’t get monotonous. Cut out single-use items unless they’re important to you (keep the hot sauce). A cake mix is limited and comes at higher cost, whereas flour, sugar and baking soda hold boundless possibility. Single-serving yogurts cost more and can be eaten only as is, whereas plain yogurt can be eaten for breakfast with a swirl of honey, made into a sauce, baked into a tea cake or added to smoothies.

Let the seasons be an inspiration.

When planning your food shopping, stay open to the changes of the seasons to create natural variety and liveliness without added cost. Fruits and vegetables are usually less costly in season — think of those midsummer four-for-a-dollar deals on corn on the cob. If you have the space and time, freeze or can the bounty. But don’t think you have to plan hundreds of new menus every time the wind changes. Let the seasons be an inspiration, not a burden.

Limit packaged snacks.

If you snack between — or instead of — meals, remember that packaged snacks get expensive. This goes for drinks too. Limiting prepared snacks and drinks can be one of the quickest routes to a grocery bill that lets you breathe easy. If you need guidance to pare it down, think about your pleasure-to-versatility ratio. Kombucha isn’t all that versatile, but it may be your only way to get through the long afternoons. Plan around that if you can.

But keep the treats.

For some, the pleasure of saving money itself is enough; the absence of worry creates motivation to continue. Food is pleasure and connection for most of us. So don’t budget pleasure out of the picture. If you used to have dessert and a glass of wine with a friend on Friday evenings, consider an inexpensive replacement, like a piece of chocolate and a cup of chamomile tea.

Leanne Brown is the author of Good and Cheap and Good Enough (January 2022).

Naturally Dye Your Easter Eggs

Using ingredients straight from your kitchen, these dyed Easter eggs make a fun and festive way to celebrate.

Egg decorating is a festive activity that celebrates the arrival of spring, a season of renewal. The egg, an ancient symbol of rebirth and new life, has a long and storied history tied to holidays and seasonal celebrations around the world, including Easter. In fact, if you’ve hand-dyed eggs, then you have, perhaps unknowingly, participated in one of the oldest known decorative art forms. In 2010, archaeologists in South Africa discovered engraved ostrich eggs dating back around 60,000 years. Since then, eggs have been decorated in every way imaginable, including traditional pysanky (Ukrainian Easter egg decoration) and arts-and-craft inspired decoupage eggs.

This tutorial keeps things simple and relies on natural ingredients, which result in rich, jewel-toned dyes that cover the egg in a wash of color but also let the shell’s speckled beauty show through. Drawing on spring’s color palette for inspiration — from robin’s egg blue to daffodil yellow — the dye recipes shared here require little more than a few kitchen ingredients and a bit of patience.

These dyes are not fast-working like their commercial counterparts; the eggs need to soak for a few hours at a minimum. To achieve the vibrant colors shown here, you must soak your eggs overnight. If you prefer more pastel tones, a shorter soak is effective. Keep in mind that this is not an exact science — colors will vary greatly depending on a number of factors, including the color of your eggs’ shells and the amount of time you soak them for.

Christine Chitnis for The New York Times

Materials

Natural dye ingredients, such as

  • 3 cups of yellow onion skins from roughly 8-10 onions

  • 3 cups of red cabbage, roughly chopped

  • 3 tablespoons ground turmeric

  • 3 cups of beets, chopped

  • 3 cups frozen blueberries

  • 3 tablespoons hibiscus loose-leaf tea

1.5 quarts water per dye ingredient

12 tablespoons white vinegar

2 dozen white or brown eggs, or both, hard-boiled

To create a dye bath, combine a single natural dye ingredient (listed above) with one and a half quarts of water in a saucepan. Bring to a boil over high heat. Once the water is boiling, turn the heat to low and simmer for roughly 30 minutes. Remove the pan from the heat and allow the mixture to cool before straining the liquid into a large glass jar or bowl. Avoid using stoneware as the dye can stain. Compost or dispose of the solids. Stir two teaspoons of white vinegar into the dye.

Repeat these instructions for each of the dye ingredients in separate pots, or use the same pot washed thoroughly after each preparation.

Christine Chitnis for The New York Times
Christine Chitnis for The New York Times

To dye the eggs, add a single layer of hard-boiled eggs to a jar or baking dish, and pour the dye over them until they are completely submerged. For soft, pastel colors, allow the eggs to soak for two to three hours; for vibrant, richer colors, place the dye bath of eggs in the fridge and allow them to soak overnight. You can experiment with the vibrancy of the dye by giving the eggs multiple soaks in the dye, but just be sure to dry them in between soaks. You can also dip the eggs in different baths to achieve different colors; the purple eggs resulted from dyeing the eggs in the beet dye, and later, in the cabbage dye.

To remove the eggs from the dye, it’s best to use a slotted spoon. The key is to remove them gently and allow them to dry completely before you handle them — the dye can rub off or streak if you handle or wash the eggs before they are dry. Use a cooling rack or empty egg carton for drying.

As long as the eggs are properly refrigerated and stored according to food safety guidelines, they are perfectly safe to eat for up to a week, and the dyes leave no discernible flavor.

Christine Chitnis for The New York Times

Closing the Social Distance

After a year spent social distancing, mask wearing and sheltering in place, the prospect of readjusting to in-person social engagements can be a daunting one.

As the days grow warmer and vaccination shots reach more arms, you may be looking ahead to getting out and about. An Axios-Ipsos poll released this month found that “the number of Americans engaging in social interactions outside the home is increasing.” And the Centers for Disease Control and Prevention recently issued new recommendations that individuals who have been vaccinated against the coronavirus can start to gather in small groups, without masks, offering a measure of hope in particular to those who have missed the intimacy of double dates and dinner parties.

But after a year spent internalizing public health precautions for social distancing and mask-wearing, the prospect of readjusting to in-person social engagements may be a daunting one. For many, it provokes a sense of profound discomfort, apprehension or ambivalence.

“It’s a new version of anxiety,” said Dr. Lucy McBride, an internist in Washington who writes a newsletter about managing the coronavirus crisis. You may discover that your continuing concerns about the virus are colliding with a new set of worries about seeing others more regularly: What am I comfortable with? How do I act? What do I say?

“There’s two feelings that are continuing to exist for me,” said Allison Harris-Turk, 46, an events and communications consultant and mother of three in San Diego. Mrs. Harris-Turk created the Facebook group Learning in the Time of Corona, where many among the roughly 16,700 members are discussing the pros and cons of re-entry. “There’s the excitement and the optimism and the hope, and then there’s also the grief and the trauma and ‘oh, my goodness, how are we going to recover from this?’”

Here’s how some individuals and experts are starting to think about closing the social distance.

Start small.

Though you may be chafing at the confines of the lockdown, remember that it’s still not entirely safe to resume social activities as before. Across most of the country, the risk of coronavirus transmission remains high.

If you’re wary of re-entry, begin with a lower-stakes outing. “It’s like little baby steps getting back into it,” said Dr. David Hilden, a Minneapolis-based internist who hosts a weekly radio show during which he answers listeners’ pandemic questions. He’s observed this firsthand: Earlier this month, he met up with a friend to share a beer for the first time since the onset of the pandemic. “Now that we’ve dipped our toe in the water, a lot of Zoom meetings end with, ‘Hey, I think we can get together now,’” he said.

Understand that hanging out might take more effort.

After receiving her first shot of a coronavirus vaccine, Aditi Juneja, a New York-based lawyer, expected to feel the same flood of relief that some of her peers had described after getting theirs. While on the phone with a friend, she started to consider future late nights and travel to far-off destinations. “I was like, ‘Man, I want to dance on bars,’” Ms. Juneja, 30, said. “There was a euphoria about imagining the possibilities.”

But after 10 minutes, she found even the fantasy versions of these scenarios exhausting. The reality can be, too; she described the sensory overload and disorientation she felt while dining outdoors with a friend for the first time in months. “I think our ability to take inputs has really lowered,” Ms. Juneja said.

This is especially true for individuals suffering from social anxiety, for whom the lockdowns have offered some relief, and for whom reopening presents new stressors. But even extroverts may experience an adjustment period as our brains adapt to planning and monitoring responses to unfamiliar situations. At the beginning of the pandemic, people had to change their behaviors to comply with social distancing, mask-wearing and sheltering in place. But learning those new behaviors — and now, relearning old ones — can take a cognitive toll.

“Social settings are particularly demanding,” said David Badre, the author of the book “On Task: How Our Brain Gets Things Done” and a professor of cognitive, linguistic and psychological sciences at Brown University. “When we have to really focus and plan what we’re doing, that comes with an experience of mental effort,” he continued. “It feels like a mental fatigue.”

There is good news, however: You’ll most likely find it easier to relearn old behaviors than learn entirely new ones. “The key is to not avoid that effort,” Dr. Badre said. “By re-engaging, you will get used to it again.”

Set boundaries for yourself.

Though the past month has seen a spate of reopenings across the country, some scenarios might still set off a siren in your head. And because these facilities are open, doesn’t mean you need to go.

But what if a friend or family member does want to see a movie, or dine out? If you express disagreement over what is safe, you might feel as though you are implying your companions are less responsible or unethical.

Sunita Sah, a professor at University of Cambridge and Cornell University has researched this phenomenon, which she calls “insinuation anxiety.” In studies, Dr. Sah has found that patients frequently follow medical advice from their doctor even if they believe their doctor to have a conflict of interest, and that job candidates often answer interview questions they know are illegal to ask. These reactions come partly out of concern that to disagree would suggest the other person — the doctor or the job interviewer — is not trustworthy.

A similar situation can play out if you’re confronted with someone whose attitude toward public-health protocols differs from your own. Dr. Sah’s research has shown that when individuals have the opportunity to weigh their decisions in private, they are less likely to experience this anxiety and do something that makes them uncomfortable. She recommended writing down the boundaries that you would like to adhere to and taking time before agreeing to someone else’s plan.

“Assess your own risk level and comfort,” Dr. Sah said, “so you’re very clear about what you would and would not like to do.” This will also provide you with a clear document of how your comfort levels are changing over time as you readjust.

Brace for tough conversations.

Over the past year, public-health guidance often wildly varied on federal, state and even city levels, with some areas flinging open their doors while experts still advised caution. This has also been reflected in interpersonal relationships. It’s created friction between couples, families and friends, and prompted individuals to ask challenging, sometimes seemingly intrusive questions. Now, you may be adding “Are you vaccinated?” to that list. (On Twitter, one woman recently proposed “re-entry doulas” to help families navigate conversations about setting boundaries.)

Still, it will continue to be important to have these conversations in the coming months. “This isn’t abstract,” said Marci Gleason, an associate professor in the Department of Human Development and Family Sciences at the University of Texas at Austin whose lab has been surveying relationships in quarantine. “It comes directly to the question of whether we can socialize with others or not, in the way that they want to.” Sometimes, it can feel like a proxy battle over how much you value each other’s friendship. Be open about your own fears and vulnerabilities, and make it clear that when you disagree, you’re expressing your own preference and not rejecting the other person. Keep it simple, too, especially with friends or relatives with whom you don’t frequently have emotional, candid talks.

This empathy and candor will also be an asset if you find that your friends and peers have developed the tendency to over share, either out of anxiety or being starved for conversation. (You may be doing it yourself, too.) If a conversation subject makes you uncomfortable or anxious, say so.

“Being really open and direct is the best way,” said Dr. Danesh Alam, a psychiatrist and the medical director of behavior health services at Northwestern Medicine Central Dupage Hospital. Dr. Alam suggested studying up for conversations, preparing some questions and topics in order to chat with more intention and keep things on topic.

Take your time.

It’s OK if you don’t feel ready to see people socially again. Through the challenges of the lockdown period, you may have found that “your mental health is served best when you have time for calm and rest and introspection,” Dr. McBride said.

So pace yourself while considering the benefits of getting back out there: Even casual interactions have shown to foster a sense of belonging and community. “Social interaction is critical to our existence,” Dr. Alam said. Remember, too, that there are bound to be some weird moments as you start seeing others more regularly and your pandemic instincts (no hugging) and before-times instincts (“Do you want a bite of this?”) collide.

“If you’re comfortable going to a dinner at a small family restaurant, you can do that,” Dr. Hilden said. “If you want to wait a month or two, that’s OK, too.”

In a Role Reversal, Asian-Americans Aim to Protect Their Parents From Hate

Earlier in the pandemic, Ellen Lee offered to bring her parents groceries, to protect them from catching the coronavirus while shopping. They refused. Now when she asks, it’s because she’s worried they might get assaulted when they’re out running errands.

“They want to be independent,” said Ms. Lee, 44, a Chinese-American journalist and mother of three. “The way they see it, they are the parent, and their job is to take care of me.”

Her parents, who are in their mid-70s, told her they’re taking precautions, going to satellite Chinatowns in San Francisco rather than the main one and popping in and out to fetch delicacies such as egg tarts and roast duck. “They’ll turn it around on me, and say, ‘You’re the one who should be scared,’” she said, after they pointed out that her neighborhood might be unsafe because an elderly Chinese-American man was robbed and killed a few miles away from her Oakland hills home.

In the wake of recent shootings in Atlanta by a white gunman that left eight dead — six of them of Korean or Chinese descent — and surging attacks against Asian-Americans across the country, families have grappled with how to talk to their elders about protecting themselves.

Of the more than 18 million Asian-Americans in the United States, roughly three-quarters of adults were born abroad, according to William H. Frey, a demographer who is a fellow at the Brookings Institution and professor at the University of Michigan who analyzed data from the Census Bureau’s 2019 American Community Survey. That’s because of both historical immigration policy and recent immigration trends.

Generational and cultural gaps make conversations about race and violence difficult with their American-born and raised children and grandchildren, who may not fluently speak the native language of their elders.

Be candid and direct, said Anni Chung, chief executive of Self-Help for the Elderly, a service provider in San Francisco’s Chinatown. “You can say: ‘I worry about you. If you have to run to the bank, will you let me know? I’ll take time off. If you go to the grocery, let me accompany you,’” she said. “Offer to help. They might not accept it, but the care and attention will please them.”

Ms. Chi, of Fremont, Calif., talked with her relatives about the recent rise in attacks on Asian-Americans.Carolyn Fong for The New York Times
Ms. Yi and the others imagined a victim’s final worry: “‘What about my babies? Who will take care of them?’”Carolyn Fong for The New York Times

Asian-American adults may be looking out for their elders while struggling with the recent attacks themselves. Emily Chi, a 31-year-old Korean-American in Fremont, Calif., noted how quickly Asian-Americans came together after the Atlanta shootings, with online fund-raising, critical historical analysis and other efforts. But she’s also grieving. She planned to attend a vigil in Oakland focused on the victims. “Let’s make sure they aren’t erased,” Ms. Chi said. “Let’s not forget them, before we skip to action.”

In her conversations with her grandmother, aunt and mother, they all imagined a victim’s final worry: “‘What about my babies? Who will take care of them?’” Ms. Chi said. “We see their names, we see their faces, and you feel like it could be you,” she said of the Asian-Americans killed. “It could be your grandmother.”

Small-business owners may have already suffered vandalism and other crimes firsthand. “Honor the first generation’s experience with violence — if you ignore it, the conversation will end,” said June Lee, executive director of the Korean Community Center of the East Bay.

But at the same time, give them context for understanding hate crimes, especially if they’ve come from racially homogeneous countries, she said. Explain the systemic issues behind what might seem like a random killing. “They also need to know their rights,” she said. “Asians are known for their silences, but silence isn’t a virtue in this situation. We have to speak up.”

Such conversations are a fraught yet tender rite of passage that reverses the traditional parent-child dynamic; parents who want to remain independent may brush off their children’s concerns for their safety.

If the elders are hierarchical in their thinking, and prefer advice from someone they consider their equal or in a position of higher standing, adult children could consider enlisting their doctor, pastor, or someone else in the community they trust, said Lia Huynh, a San Jose therapist who specializes in Asian-American issues.

“Asian-Americans have always been told, ‘Don’t make waves; don’t speak up,’” she explained. “Now things are coming to the surface, the feelings we had to stuff down for many years. People can feel alone, wondering, ‘Am I the only one dealing with this?’”

But they are not alone. About 42 percent of Asian-Americans say that Asian people in this country face “a lot” of discrimination, according to a recent Pew survey conducted before the killings in Atlanta.

The organization Stop AAPI Hate — which began tracking violence and harassment against Asian-Americans and Pacific Islanders in the United States in 2020 — received reports of 3,292 cases that year; in 2021, until the Atlanta shootings, 503 cases had been reported.

“We see their names, we see their faces, and you feel like it could be you,” Ms. Chi said of the Asian-Americans killed. “It could be your grandmother.”
“We see their names, we see their faces, and you feel like it could be you,” Ms. Chi said of the Asian-Americans killed. “It could be your grandmother.”Carolyn Fong for The New York Times

In November, while out walking her dog early one morning in Oakland, Calif., Deanne Chen, a 31-year-old Taiwanese-American, was mugged at gunpoint. Her assailant, who was Black, bear-hugged her from behind, shoved her to the ground, and flashed his gun at her. After she handed over her phone, he and his accomplice drove off. In the weeks that followed, the Oakland Police Department noted an uptick in violent robberies, with suspects targeting Asian and Latino communities.

When she told her parents what happened, she emphasized that she did not want Black people to be racially profiled. “I had to explain that one bad individual doesn’t represent an entire community. I asked them, ‘Holistically, what do you think creates crime?’” Ms. Chen said.

With the latest — and continuing — attacks against Asian-Americans, she added, “I don’t want this to be an opportunity for Blacks and Asians to get pitted against each other.”

She’s shared practical safety tips with her parents, telling them to remain vigilant when getting in and out of their car or unloading groceries. They’ll mention how their friends say they should watch out for each other and how their friends say they’re scared to go shopping. Her parents “don’t talk about their feelings, but will talk about everyone else’s. Which is a very Asian thing,” Ms. Chen said. “I know the fear is there.”

And yet, her mother also surprised her, calling the police in Atlanta “incompetent” and stating that their “racial bias” made everything worse for the victims. “I didn’t realize my mom was so woke!” Ms. Chen said with a laugh.

However, her parents would never admit that she might have influenced their opinion. “The trick is making them think it was their idea,” she said. “If you have the conversation in small, different ways, over time they start to read the news through the lens you provide them, and they come to their own conclusion.”

Ask a lot of questions, suggests Ener Chiu, of the East Bay Asian Local Development Corporation. “Ask them how they feel, and what we can do to help them feel safe.”

As more seniors get vaccinated, he encourages them to gather in groups again, whether in parks, recreation centers, or elsewhere, and in time, become “actively engaged” in their community. “People won’t feel so isolated, carrying their pepper spray, ‘you against the world,’” Mr. Chiu said.

Recent events have galvanized some older Asian-Americans such as Ms. Lee’s parents, the ones who insisted on going grocery shopping.

Usually, her father texts her photos of wild turkeys and deer wandering the streets of their retirement community in the suburbs east of San Francisco. The other day, though, he sent a picture from a neighborhood protest, with her mother holding up a cardboard sign, “Stop Asian Hate.”

“Up until now, my parents have not felt heard except in ethnic media,” Ms. Lee said. “They complain, but they wonder who is listening. Now there’s a groundswell of energy, not only from other Asian-Americans, but allies, too.”

Vanessa Hua is the author of “Deceit and Other Possibilities,” “A River of Stars” and the forthcoming novel “Forbidden City.”

When Can Vaccinated People Date Again?

A slew of new ads show sloppy kisses. Air travel is ticking back up. And impending vaccination can seem like a ticket back to normalcy for 20-somethings in the United States, many of whom feel desperate to get back to their 2019 social lives. Cramped parties. Strobe-lit dance floors. The ability to spontaneously text a friend: Want to grab a drink?

Younger adults have played a disproportionate role in spreading the coronavirus. A report from the Centers for Disease Control and Prevention showed that from June to August 2020, Covid infections among 20- to 29-year-olds surged, accounting for more than 20 percent of the country’s total cases. Shortly after, data showed that those cases then led to an increase in infections among middle-aged and older people, potentially contributing to a national surge in cases.

Now, as older adults have been prioritized for vaccination and about two-thirds of those over 65 have received at least one dose, their risk of getting severely ill after catching the virus from an infected young person has decreased significantly.

But that doesn’t mean it’s completely safe to party like it’s 2019.

How you calculate your risk of passing the virus onto more vulnerable people will hinge on your individual circumstances: whether you live with parents or people in their 20s, whether there are people at risk for severe outcomes of Covid in your social circle. “There’s not a simple red light, green light,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University.

Here are some answers to common questions about what, in general, younger adults who are low risk can do when they’re fully vaccinated.

Can we just go back to normal?

A return to a kind of normal is coming, experts stressed, but there are still many unknowns about how the next few months will play out. While rising vaccination rates and falling cases are encouraging, said Dr. Schaffner, there are three situations that could hamper or negate that progress: if people refuse vaccination, if community transmission rates stay high and if virus variants render vaccines less effective.

“If the older and younger adults get vaccines, and the variants are not too variant, then we could have lots of pool parties,” he said. “Bars could open up.”

“The movement back to normal life should be a slow step-by-step,” said Tara Kirk Sell, a senior associate at the Johns Hopkins Center for Health Security, who researches large-scale health events. She recommended that people pick out one riskier activity they’ve been craving during the pandemic — seeing friends, going out to eat — and do that to celebrate their vaccination. “Then it should be a gradual move forward, rather than this huge explosion of, ‘I’m free!’,” she said.

Lelanie Foster for The New York Times
Lelanie Foster for The New York Times

But much of that is dependent on how much virus is circulating in your community.

“Once you get to a combination of hardly any cases in the community and a high proportion of people vaccinated — then, everything changes,” said Dr. Paul E. Sax, an infectious disease specialist at Brigham and Women’s Hospital in Boston. “That’s really what we’re looking forward to. Then you say, ‘Sure, I’ll take the chance of going to a restaurant. My chance of going to a restaurant and getting sick from Covid is no higher than the risk of getting sick from a regular cold.’ That’s a risk people should be very willing to take.”

“People have to keep their eyes on the Covid landscape the way they do the weather,” said Dr. Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco. He recommended that people monitor vaccination rates in their community and cases per 100,000. Dr. Carlos del Rio, an infectious disease specialist at Emory University, recommended the Covid ActNow site to check case numbers per county; The New York Times also tracks risk level by county.

If your area has fewer than 10 cases per 100,000, it’s safer to go to a party or hang out indoors in a larger group of all vaccinated people. A far less safe scenario would be to participate in the kinds of spring break-related parties that are drawing attention in Florida, which reported 22 cases per 100,000 in the past seven days and is thought to have a large concentration of B.1.1.7, the more contagious and possibly more lethal virus variant first identified in Britain.

Can we make out with strangers?

Experts interviewed for this piece said that kissing and other intimate contact with someone you don’t know once you’ve been vaccinated is likely to be safe as long as you can confirm that they are also vaccinated.

Even without that confirmation, making out with a stranger is likely to be a lower risk activity than going into a crowded setting like a club or party, said Dr. David Rubin, a professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania. “It’s one of those events best left to the individual person, to make that choice and not judge it,” he said.

“If you’re in a controlled setting and you’re just with that person, and you want to take a chance on making out with that person and you think that person doesn’t have any risk of getting bad Covid — from the C.D.C. guidance, you can go ahead and make out with that person all you want,” said Dr. Chin-Hong.

If you’re vaccinated but can’t confirm the vaccination or medical status of the person you want to kiss, it will be OK for most young people, he said.

“The name of the game here is control,” he said. “The more noses and mouths that get together, the potentially riskier it is for transmission.”

There’s also the obvious logistical quandary: It can be hard to casually and quickly verify that someone is fully vaccinated and low-risk. One dating app, Coffee Meets Bagel, recently added an option to include vaccine status on dating profiles, although it does not require verification.

Can we gather in groups?

The C.D.C. released recommendations earlier this month that said that it’s safe for vaccinated adults to gather in small groups without masks or social distancing. A C.D.C. spokeswoman said in an email that those guidelines applied to all people living in the United States, and that there were no additional considerations for younger adults.

Practically, that means it’s OK for a group of about five to 10 vaccinated friends to hang out without precautions. But the larger the gathering, the more likely it is that someone in the group will be unvaccinated. While all three vaccines seem to be effective at preventing severe illness from the virus, we don’t yet know if they’ll prevent people from transmitting the virus to others.

What about indoor bars?

Dr. Ashish K. Jha, dean of the Brown University School of Public Health, predicted that most bars will be open across the country this summer. He also predicted that they’ll be a major source of viral spread among unvaccinated people, though they should be mostly safe for those who have received the vaccine.

“The bottom line is, if you want to go to a bar, you want to go to a club — you can, and you’ll be pretty safe” once you’ve been vaccinated, Dr. Jha said. But other experts cautioned that there are still too many unknowns — about variants, about whether you can still transmit the virus after you’ve been vaccinated — to fully encourage people to flock back to indoor bars.

Outdoor bars can be safer, depending on their setup and particularly if community transmission is low. Just be sure to stick to a small group of friends, rather than a large crowd.

What about outdoor concerts?

Experts agreed that outdoor concerts could be safe, particularly if attendees wear masks and keep distanced. Outdoor activities can support much larger groups of vaccinated people, Dr. Sax said.

“People were wondering why there weren’t more cases after the protests this summer,” he said. “Well, it’s because they took place outside. That’s going to be true about outdoor concerts, also — I’d be very surprised if there were any major spreader events linked to an outdoor concert.”

Do young people need to get vaccinated?

Experts expressed concerns about vaccine hesitancy among young people. In January, the U.S. Census Bureau released survey data that showed that Americans under 44 were most reluctant to get vaccinated.

“We’ve been selling the vaccine to older individuals as a way to protect against hospitalization and death,” Dr. del Rio said. “Most young people, if they get infected, they get a mild disease. We need to be able to communicate very clearly that there’s an advantage to getting the vaccine for young people, besides saying, ‘You’re not going to die.’”

“The faster we vaccinate people, the more likely we are to have a more normal life,” he said.

Covid Stole Your Sense of Smell? Try Physical Therapy for Your Nose.

When Laura Drager contracted Covid-19 in July, it was as though someone had suddenly muted her olfactory system.

One morning she was sipping her favorite Gatorade (the yellow one), and two hours later the drink was completely flavorless. She immediately lit a candle and blew it out, but she couldn’t smell the smoke.

Her sense of smell had disappeared. Now, she said, “everything either tastes like bleach or tastes like nothing.”

Over the past few months she has lost 19 pounds. “I don’t have that ‘I’m hungry’ feeling,” said Ms. Drager, 41, who lives in Sevierville, Tenn., about 45 minutes from Knoxville. “I think you forget how much smell and taste is a part of your life until it goes away.”

As the coronavirus continues to spread, there are increasing numbers of people who have either lost their senses of smell after contracting Covid or are struggling with parosmia, a disturbing disorder that causes previously normal odors to develop a new, often unpleasant aroma.

One meta-analysis published in September found that as many as 77 percent of those who had Covid were estimated to have some form of smell loss as a result of their infections.

The recommended treatment for these conditions is smell training. But how exactly do you do it, and why should you bother?

We spoke with several experts to demystify the process.

What is smell training?

First, let’s talk about what smell training is not. If the words conjure up images of a “Rocky” training montage — as they did for Tejal Rao, a New York Times restaurant critic who lost her sense of smell after contracting Covid last year — the reality is very different. Smell training is more akin to physical therapy for your nose: tedious and repetitive. It involves sniffing several potent scents twice a day, sometimes for months, to stimulate and restore the olfactory system — or at the very least to help it function better.

“It’s not a quick fix,” said Chrissi Kelly, a member of the Global Consortium for Chemosensory Research and the founder of AbScent, a nonprofit based in England and Wales that offers support and education to people around the world who have smell disorders. “You have to keep up with it.”

If it has been a couple of weeks since you lost your sense of smell and it hasn’t started to come back, then it makes sense to start smell training. When your smell starts to come back, it might happen gradually rather than all at once. At first, scents might seem distorted or foul.

Scientists are still learning about all of the mechanisms by which the coronavirus affects the olfactory system, but they believe parosmia occurs because the neural pathways from the nose to the brain have been disrupted, “kind of like a telephone operator from the 1950s connecting the wrong party to another line,” said Pamela Dalton, a faculty member at the Monell Chemical Senses Center, a nonprofit research institute in Philadelphia.

For most people, parosmia is a symptom of recovery, and that’s why experts believe smell training can be beneficial as you continue to heal.

Patricia Voulgaris for The New York Times

Why smell training?

Even if you’re devastated over having lost your sense of smell, you might be thinking: Do I really need to add smell training to my to-do list? Won’t my sense of smell return eventually all by itself?

For many people, it appears to come back within weeks of being infected.

A study published in January that recruited patients from 18 European hospitals found that among 1,363 coronavirus patients with olfactory dysfunction, most recovered their senses of smell within two months and 40 percent saw their ability to smell return within two weeks. All patients were encouraged to follow two daily sessions of smell training at home, said Dr. Jerome R. Lechien, a professor of otolaryngology at the University Hospital of Brussels and one of the authors of the study. Though it’s unclear how many patients did the training, nearly one-quarter were still experiencing smell dysfunction 60 days after the onset of their symptoms. By the six-month mark, 95 percent of the patients had recovered their senses of smell.

Robust studies examining the efficacy of olfactory training among Covid survivors have not yet been published. Several studies, however, have demonstrated that smell training can help people who have lost some or all of their senses of smell to other viral illnesses like sinus infections — that’s why it is widely considered the best option for those who can no longer smell properly after contracting Covid.

“It has no risk — except boredom,” Dr. Dalton said wryly.

Before you begin, however, it is wise to rule out other conditions that could be affecting your sense of smell.

“I saw somebody recently who had smell dysfunction following Covid-19, and it turned out they had inflammatory nasal polyps,” said Dr. Sunthosh K. Sivam, an ear, nose and throat specialist and an assistant professor at the Baylor College of Medicine in Houston. Once he removed the polyps, which were unrelated to Covid, his patient’s sense of smell improved greatly.

“Seeing an E.N.T. is a good way to make sure nothing else is missed,” he added.

How do you choose your scents?

To start, decide on four scents that are familiar to you and that evoke strong memories, the experts said. These are the fragrances that you will stick with throughout the initial phase of your training. Maybe one of them is a scented shampoo, a favorite cologne or lemons from the tree in your backyard. An avid home cook, for example, might use certain spices from his pantry.

Alternatively, “some people have had a lot of success with things that smell bad,” Dr. Dalton said.

At one point during her smell training, Ms. Rao, the restaurant critic, used spoiled milk. Ms. Drager, who had Covid-19 over the summer, extinguishes a candle every day and tries to smell the smoke.

If that doesn’t sound appealing, you can choose to buy a smell kit that contains essential oils: the classic scents are rose, eucalyptus, clove and lemon. The kits usually retail for under $50.

Or you can purchase these oils yourself at a place like Whole Foods. Ms. Kelly includes instructions on how to make your own scent kit on the AbScent website.

If you buy your own oils and you want to smell them directly from the open container, first ask someone who isn’t smell impaired to try it. Then ask whether the person can easily smell the fragrance when the scent is a few inches below his or her nose. (Some containers have such small openings that it might be difficult to get a good whiff.) In the process, avoid getting any of the oils on your skin because they are highly concentrated.

How does smell training work?

There is not one uniform, universal way of undergoing smell training, but the experts we spoke with offered similar advice.

They recommend keeping your scents in an easily accessible location — such as by your bedside — and smelling each scent for about 20 seconds so that the entire smell-training session lasts approximately one minute.

While you’re doing this, take short sniffs rather than deep inhales, recommended Ms. Kelly of AbScent as she demonstrated a series of repetitive whiffs that she referred to as “bunny sniffs.”

While you’re smelling the fragrances, it often helps to look at a picture of the thing that you’re smelling, said Dr. Nicholas R. Rowan, an assistant professor of otolaryngology-head and neck surgery at the Johns Hopkins University School of Medicine in Baltimore.

Then, try to imagine what the item used to smell or taste like to you.

“It’s not simply the act of smelling something, but it’s also this sort of mindful imagining of what that smelled like when you were eating it or when you put it on your skin — if it was a lotion, for example,” Dr. Dalton said. “It just makes it more enjoyable to continue with the process.”

Smelling something that is connected to a memory or emotion is ideal, she said, because the brain plays such a big role in how we perceive smell.

How long do you need to do it?

Generally, doctors advise their patients to do smell training twice a day for three months.

“Keep on training for a year if you have to,” said Dr. Thomas Hummel, a researcher at the Smell and Taste Clinic of the otorhinolaryngology department at the Technical University of Dresden in Germany, whose work has informed the odor training methods now used around the world.

The success of your training depends on a variety of factors, including your age. In general, younger people recover their sense of smell after a viral illness at a higher rate than older people, Dr. Hummel added. This is partly because older people tend to have fewer olfactory receptor neurons — the cells that detect and transmit information about smells to the central nervous system — and their receptor neurons do not regenerate as quickly.

“When you’re older, everything is slower,” he said.

How do you stay motivated?

As with any process that doesn’t yield immediate results, you may find it difficult to stick with the plan.

“It’s very frustrating for patients,” Dr. Rowan said. “They seek out this care because they can’t smell and want it fixed and then we say, ‘Hey, use this sensory function that you don’t have.’” But, he added, “this is the best thing out there.”

He suggested using a calendar to record each scent training session in order to build the habit.

Keeping a diary can also be helpful, Ms. Kelly said, so that you can take notes on what you’re experiencing during each session. For further motivation, the AbScent website offers an app called Snif that can help you track your progress.

Finally, if you don’t know many people who have a smell dysfunction, consider joining an online community for support and inspiration. The AbScent Facebook group for people with Covid has grown to more than 25,000 people, Ms. Kelly said.

As for Ms. Drager, although she is still working to heal her olfactory system, she did smell a lemon scent this year for the first time since her sense of smell disappeared.

She cried with relief.

“I’m making slow progress,” she said.

Is Ringing in the Ears a Symptom of Coronavirus?

Researchers are just beginning to untangle how Covid might be linked to a ringing in the ears. Here’s what we know.

Shortly after she fell ill with Covid-19 last April, Andrea Ceresa, an office manager and singer in Branchburg, N.J., noticed an unusual sensation in her ears: a ringing and buzzing that had never been present before. Now, nearly a year later, Ms. Ceresa, 47, said that of all the debilitating post-Covid symptoms that have lingered — the heart palpitations, headaches, stomach troubles, numbness and weakness in her hands and feet — the most frustrating one is the tinnitus, a condition that can cause sufferers to hear phantom ringing, buzzing, whistling, chirping or other sounds.

“There’s never not a time when I don’t have noise running through my head,” Ms. Ceresa said. “It makes it hard to concentrate, it makes it hard to hold conversations with others, it makes it almost impossible to lie down and go to sleep. It’s maddening, and you can’t fully understand it unless you experience it yourself.”

Following the recent death of Kent Taylor, the founder and chief executive of the Texas Roadhouse restaurant chain who took his own life at age 65 after suffering from post-Covid-19 symptoms, including severe tinnitus, many are wondering how Covid and tinnitus may be linked. Also, how might tinnitus — a vexing condition that afflicts as many as 60 million people in the United States — influence mental health?

While some early research and anecdotal evidence suggest an association between tinnitus and Covid-19, experts caution that it’s still too early to make a definitive link. “Am I seeing patients who come in saying they noticed tinnitus after developing Covid-19? Yes,” said Dr. Douglas Hildrew, an ear, nose and throat specialist and surgeon at Yale Medicine. But, he noted, it may also be exacerbated by other factors, like stress.

Here’s what we know.

What causes tinnitus?

According to Dr. Maura Cosetti, an ear, nose and throat specialist at Mount Sinai Hospital in New York City, the most common cause of chronic tinnitus is age. As the hair cells inside your inner ear become damaged over time, she said, they may no longer send sound waves to your brain, so your brain tries to recreate them on their own, which is what might cause the ringing.

But experts have long known that some viruses can temporarily cause hearing loss or ringing in the ears, too. When the body fights an infection, the overall inflammation from the virus can damage the nerves or hair cells in the ear, Dr. Cosetti said.

“Sometimes, a patient has already had mild tinnitus that they never really noticed before,” said Dr. David Friedmann, an ear, nose and throat specialist at NYU Langone Medical Center. “But once it’s temporarily exacerbated by a virus, they continue be bothered by it even after the initial infection has resolved.”

Can Covid-19 cause tinnitus?

There’s not enough research to say for sure. “There haven’t been any studies yet that I’m aware of that compare rates of tinnitus among survivors of Covid-19 with those in the general population,” Dr. Hildrew said.

In one review, published Monday in the International Journal of Audiology, researchers pooled data from nearly 60 case reports and studies and found that nearly 15 percent of adults diagnosed with Covid-19 reported tinnitus. Another study, published in the same journal in July, followed 138 patients for eight weeks after they had been discharged from a hospital in the United Kingdom after suffering severe symptoms of Covid-19. Among them, 16 (13 percent) reported either a change in hearing or tinnitus.

Natalie Lambert, an associate research professor of biostatistics and health data science at the Indiana University School of Medicine, surveyed nearly 5,200 “long-hauler” Covid-19 patients and found that nearly 17 percent reported new tinnitus, with more than three-quarters of those people saying it was ongoing. She cautioned that more research is needed to confirm the results, which have not yet been peer-reviewed or published in a medical journal.

There’s also evidence that Covid-19 symptoms can exacerbate existing tinnitus. In one online survey of about 3,100 people from 48 countries who suffer from tinnitus, researchers found that among the 237 people who experienced Covid-19 symptoms, 40 percent said that their tinnitus symptoms had been significantly worsened. Nearly a third of all the respondents also reported the stress of the pandemic itself exacerbated their tinnitus, even if they hadn’t contracted Covid-19. “We know that anxiety can worsen tinnitus, and it becomes a vicious cycle: The worse your tinnitus, the more anxious you are,” Dr. Hildrew said. “It becomes a very aggressive loop that can be difficult to break.”

How does tinnitus affect mental health?

When Marlene Suarez contracted Covid-19 during the second week of January, her symptoms of fever, cough and difficulty breathing weren’t so severe that she needed to be hospitalized, but they were bad enough to warrant treatment with monoclonal antibodies to reduce her risk of serious complications. About a week after her diagnosis, while watching TV, she noticed a ringing in her left ear, and that she couldn’t hear anything in her right.

“I went to the emergency room, where the E.N.T. on call said it was probably from Covid-19,” said Ms. Suarez, 62, an attorney in Collinsville, Ill. The ringing continued for weeks. “I was so depressed and scared I’d never get better,” Ms. Suarez said. “I speak and talk for a living — how was I going to be able to have a conversation with a client or present in court if it constantly sounded like bells were exploding on my left side?”

Ms. Suarez was given oral corticosteroids for several weeks, and now, more than two months later, her tinnitus and hearing loss have mostly resolved. But for many with more chronic ringing in the ears, the result can be devastating.

Tinnitus has been linked to several mental health conditions, including anxiety and depression, and mostly in women. “It can be particularly challenging for many people initially because it’s something they have absolutely no control over,” said Richard Tyler, an audiologist at the University of Iowa Carver College of Medicine. “No one can tell them if it will get worse, or if it will eventually go away. Suddenly, they have trouble sleeping, they can’t carry on a conversation, and they can’t concentrate. It can seem an overwhelming challenge.”

The condition has also been linked to an increased risk of suicide. In a research letter published in JAMA Otolaryngology–Head & Neck Surgery in 2019, researchers found that among more than 16,000 adults in Sweden who had ever experienced tinnitus, women — and in particular, those with severe tinnitus — had a small increased risk of suicide. However, those who had been diagnosed, and possibly treated for, the condition were not at increased risk.

“For most people with tinnitus, the worst time is the first six to nine months after it begins,” Dr. Tyler said. “After that, most people adjust and learn to live with it, especially if they’re given the right treatments.”

How is tinnitus treated?

If you are diagnosed with Covid-19 and you experience tinnitus that lasts for more than two days, tell your doctor right away. “The same treatment that can help you recover from tinnitus and sudden hearing loss is a steroid, which can also help treat Covid-19,” Dr. Hildrew said. Nonsteroidal anti-inflammatories, like ibuprofen, can also temporarily cause tinnitus, Dr. Cosetti added. This usually resolves within a few days once you stop taking them.

If your tinnitus persists after you’ve recovered from the virus, make an appointment with an ear, nose and throat doctor, who can check for blockages in your ears (like from fluid or ear wax), which can cause symptoms. If no blockage exists, you might be sent to an audiologist to check your hearing.

If your tinnitus does persist and is related to hearing loss, your E.N.T. may refer you back to an audiologist to get fitted for a hearing aid, Dr. Friedmann said. Your audiologist may be able to add a device to it that produces low-level sounds to help mask tinnitus noise.

There’s also good evidence that cognitive behavioral therapy, a type of talk therapy that can help you strategize ways of ignoring your tinnitus or dealing with the stress of it, can help. One study found that incorporating C.B.T. with mindfulness techniques, like meditation, significantly reduced tinnitus-related distress.

After many months of dealing with the tinnitus that began last spring, Ms. Ceresa is now being treated for her constellation of lingering symptoms at the Center for Post-Covid care at Mount Sinai Hospital in New York City. Tinnitus is still near the top of her list of complaints. “It’s always there and with me all the time — I can never escape it,” she said, adding that she has to take sedatives now to fall asleep. “I have days when I don’t know if I can handle this anymore. But I have to go on being hopeful.”

Hallie Levine is a health journalist who lives with her three children and two Labrador retrievers in Fairfield, Conn.

Is It Safe to Go Back to Group Exercise Class at the Gym?

Indoor fitness classes, which often result in heavy breathing in poorly ventilated rooms, can be risky. Here’s a guide to help you decide if your gym is doing enough to prevent the spread of Covid-19.

Last summer, a 37-year-old fitness instructor in Hawaii taught a spin class to 10 people. He was perched on a bike in the front of the room, facing his students as he shouted instructions and encouragement. The doors and windows were closed, but three large floor fans created a breeze to keep everyone cool. As a precaution against Covid-19, all the bikes were spaced at least six feet apart. (At the time, the gym didn’t require people to wear masks.)

But just four hours after class, the instructor began feeling fatigued. By the morning he had chills, body aches, a cough and other respiratory symptoms. Soon, he tested positive for Covid-19, and eventually, everyone who attended his class that day tested positive, too.

The outbreak didn’t stop there, though. A 46-year-old fitness instructor who attended the spin class went on to infect another 11 people during personal training sessions and kickboxing classes over the next few days, before falling ill himself and landing in intensive care.

The case of the Hawaii spin instructor was alarming because of the efficiency with which the virus left his respiratory tract and swirled around the enclosed classroom, reaching every person in the room. Among epidemiologists, that’s known as a 100 percent attack rate, and it’s a lesson in why group fitness classes, which often encourage high-energy huffing and puffing in poorly ventilated classrooms present such a daunting challenge to infection control.

At the same time, most public health experts agree that the drop in physical activity and weight gain that many people experienced during a year of pandemic living presents another set of risks to human health, and that communities need to find a balance between infection control and allowing people to return to their favorite fitness activities.

In the United States, gyms and fitness programs have reopened in some capacity in every state, allowing an estimated 73 million eager members to return to exercise. For the first time in more than a year, indoor group fitness classes were allowed to resume in New York City as of Monday, albeit at 33 percent capacity, and face coverings will be required.

The good news is that it’s possible to lower the risk of group fitness classes by improving ventilation, limiting class size, wearing a mask and increasing physical distance between participants.

Linsey Marr, an engineering professor at Virginia Tech and one of the world’s leading experts on viral transmission, is an avid exerciser herself and longed to return to her CrossFit sessions as the pandemic wore on. She worked with the owner of the gym, examining building plans and calculating potential class size and ventilation patterns in the facility.

Dr. Marr said the challenge with group fitness classes is that the participants often are breathing heavily. During a workout, people exhale and inhale at far higher volumes than when at rest.

“If someone is there who happens to be infected, they are releasing more virus into the air,” Dr. Marr said. “And the people around them are breathing heavily too, so they’re taking more in. You get this multiplicative factor. You’re breathing four times as hard, and the person who is sick is breathing four times as hard, so you’re breathing in 16 times more than you would under nonexercise conditions.”

Because of the potential for heavy breathing, Dr. Marr suggested increasing the physical distance between participants at the workout space to 10 feet rather than the standard recommendation of six feet. To achieve that level of spacing, it required limiting the class size at Dr. Marr’s workouts to just 10 people.

The facility took additional measures to minimize the chances of infection.

The solution was to open multiple garage-style doors, even in the middle of the Virginia winter. To make sure the ventilation was adequate, the gym acquired a carbon dioxide monitor to measure the buildup of carbon dioxide in a room. Because humans exhale carbon dioxide, its level can be an indicator of how well a room is ventilated.

Under everyday conditions, such as while shopping at a supermarket, an indoor carbon dioxide reading of 800 parts per million suggests that ventilation levels are adequate to reduce the risk of breathing in other people’s exhaled germs. But given the heavy breathing that occurs during a workout, Dr. Marr advised trying to keep indoor carbon dioxide levels even lower, to around 500 parts per million, and to increase ventilation if the number begins to creep toward 600.

Wearing a mask during exercise is recommended by the Centers for Disease Control and Prevention, but Dr. Marr noted that with heavy breathing, mask material can quickly get moist and lose its effectiveness. “The level of protection provided by masks is so variable that we cannot rely on them alone,” she said.

So far, the strategy seems to be working. Dr. Marr said her gym hasn’t experienced any coronavirus outbreaks, even though her state doesn’t require gym goers to wear masks while exercising. “We figured out if we kept all the doors open it should be pretty low risk,” she said. “But it was cold!”

There was one instructor who contracted the virus from somewhere outside the facility, but the well-ventilated room and rules about physical distancing appear to have protected 50 people who were exposed to him during several different classes.

While Dr. Marr’s gym is just a single case study, it shows that group fitness classes can continue safely during the pandemic, provided the facility focuses on ventilation and enforces distancing precautions and capacity limits. (Dr. Marr notes that CrossFit Inc. invited her to join its medical advisory board in December, and she helped craft a set of safety recommendations.)

We asked Dr. Marr and other experts to answer questions about how participants can decide whether their fitness class is safe to attend. Here’s what they had to say.

Does the type of exercise in the classroom make a difference?

Yes. While Covid can spread in any type of indoor class, risk is likely to go up as exercise intensity increases because breathing rates increase.

The volume of air someone breathes in and out every minute is called the “minute ventilation rate,” said Dr. Michael Koehle, the director of the Environmental Physiology Laboratory at the University of British Columbia and an expert on respiration during exercise. It naturally rises more during strenuous workouts, such as spin or dance classes, than in lighter workouts, such as yoga or Pilates.

“At low intensities — yoga, Pilates and some strength work — you can breathe more through your nose, which is a natural filter,” said Dr. Koehle. “Another very important factor is that it is more comfortable to wear a mask during strength training and lower-intensity exercise than high-intensity exercise. People should still be wearing masks indoors.”

This past August, an outbreak occurred among high-intensity exercisers at a fitness facility in Chicago. Everyone brought their own weights and mats, but not everyone wore masks. In that case, 55 out of 81 people (68 percent) who attended classes over an eight-day period at one facility came down with Covid-19. Early in the pandemic, 112 people in South Korea who took part in Zumba classes, or spent time with someone who did, were infected.

How will I know if the room has adequate ventilation?

While gyms and fitness classes are advised to meet certain ventilation standards, it’s tough for the average person to know whether a building ventilation system is adequate for infection control. “High ceilings are good,” said Dr. Marr. “If you can smell someone else, that’s a bad sign.”

Ideally, a group class should be held in a room with open windows and doors on opposite sides of the room to allow for cross ventilation. A classroom with only one entrance and no windows — a common situation in many gyms — probably does not have adequate ventilation to keep you safe. Adding several portable air cleaners to a space that lacks more doors or windows could help. “It would be much better if you can get cross ventilation — opening doors or windows on opposite sides,” said Dr. Marr. “That’s what we specified in my gym, at least two open on opposite sides.”

Do fans help?

Overhead exhaust fans or window fans that pull air out of the room are fine. But avoid any class that uses fans to recirculate air and cool down the room. Fans that recirculate air in the room just increase the risk of viral spread.

How far apart should I stand?

While six feet of distancing is recommended by public health officials for most situations, Dr. Marr advises extending it to at least 10 feet — in front of you, to either side, and behind you — during exercise.

The rules vary by state. In Massachusetts, for instance, indoor classes must have enough room for people to stand 14 feet apart. If barriers between participants are installed, then six feet is considered adequate. South Carolina requires a 10-foot by 10-foot area (100 square feet) per person; New Jersey requires twice that. Montana has required fitness classes to take place outdoors, while South Dakota has no guidance. (You can find more details about different state requirements here.)

How many people should be in the class?

States have different rules for class size, with some limiting attendance to 25 percent to 40 percent of capacity, and others allowing no more than nine or 10 people per class. Dr. Marr notes that class size is best determined by how far apart people can stand. When people keep 10 feet of distance from one another on all sides, that often limits the class size to 10 people or fewer. If you can’t achieve that much space between you and other participants, including the instructor, it’s time to find a new class.

Do I need to wear a mask?

It’s a good idea to wear a mask, and many states require them, but you can’t rely on your mask to protect you entirely. Mask quality varies, and during exercise, masks get moist, reducing their filtering efficiency. And while many gyms require masks to enter, mask wearing often is not enforced or even required during exercise classes.

In the Chicago and Hawaii outbreaks, most people were not wearing masks. At the Hawaii gym, two participants wore masks during kickboxing sessions, but their infected instructor did not, and both became ill. The C.D.C. advises that “to reduce SARS-CoV-2 transmission in exercise facilities, employees and patrons should wear a mask, even during high-intensity activities.”

Is there a way to monitor the air in my fitness class?

Not every facility will have a carbon dioxide monitor, but it’s worth asking your facility if they have one in the group fitness room and whether you can check it. If the carbon dioxide levels are below 600 parts per million (the closer to 500 the better), it’s a sign that the room ventilation is adequate for exercise. If the numbers start to increase, ask to open a window or door — or leave the class. When Dr. Marr was attending an indoor swimming pool, she noticed ventilation levels in the room were poor, so she left.

Is there a way to know if my gym has made a commitment to Covid safety precautions?

The International Health, Racquet and Sportsclub Association, an industry group, has an initiative called the IHRSA Active & Safe Commitment to follow industry best practices to provide a safe environment. Facilities that sign the pledge promise to adhere to physical distancing and mitigation measures, safety protocols and contact tracing.

The IHRSA urges the gym to have a list of protocols on its website and at the facility. At the bare minimum, protocols should include ventilation and fresh air exchange, capacity limits, distancing protocols and a clear mask policy. “I would specifically ask about ventilation practices, if mask wearing at all times is mandatory, and if classes and equipment were to be spaced out to allow for appropriate social distancing,” said Cedric Bryant, president and chief science officer for the American Council on Exercise.

What if I’ve been vaccinated?

Your risk for contracting coronavirus or developing serious illness drops dramatically if you’ve been vaccinated, but people who are vaccinated are still advised to take the same precautions as everyone else in public settings. And in most states, the people most likely to go to gyms or instruct a fitness class are younger and healthier, and therefore less likely to be among the first groups to be vaccinated. According to the IHRSA, 73 percent of gym and fitness class participants are 55 and younger.

Does cleaning and disinfection make a difference?

While everyone should wash their hands and wipe down gym equipment, patrons should not judge a gym solely on how often it promises to clean and sanitize an area. “We should still do what we did before, which is wipe down your machine when you’re done,” said Dr. Marr. “Maintaining a normal level of cleaning is appropriate. But any extra time and effort a gym has, put it toward cleaning the air.”

Dr. Marr notes that proper ventilation, physical distancing and class size limits will have the biggest impact on your safety. She recently posted on Twitter that ventilation is so important, she even had a nightmare about it.

“I had my first Covid-19 related nightmare (that I remember),” Dr. Marr’s tweet read. “I finished a hard, group workout in a gym. I looked around and panicked because I saw that all the doors were closed.”

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