Tagged Coronavirus (2019-nCoV)

Making New Friends During a Pandemic

Find and Keep New Friends

The coronavirus pandemic has profoundly disrupted some social circles. Here’s what experts and new pals have to say about making, and maintaining, pandemic friends.

Credit…Abbey Lossing

  • Jan. 23, 2021, 11:23 p.m. ET

It took a pandemic, a layoff and last year’s racial-justice protests to impel Margo Gabriel, a travel and food writer, to finally fulfill a long-held aspiration: to move to Lisbon from Boston. “I was like, ‘OK, I really need to think about next steps,’” Ms. Gabriel, 34, said recently. “I’m getting older.” She applied for, and was accepted to, a two-year master’s program at the Universidade Católica Portuguesa. She arrived in October.

Forming new relationships in Lisbon was a priority, but she worried about making the connections she needed to thrive in her new home, especially during the pandemic. “I’m an introvert by nature,” Ms. Gabriel said, “so I’m easily overwhelmed.” An editor she frequently works with recommended she reach out to another expat. They hit it off over coffee, finding solidarity in their shared identity as Black American women in Portugal. “We’ve been hanging out ever since,” she said.

The pandemic has profoundly disrupted some social circles: Perhaps you’ve moved yourself, or maybe you’re looking up after a year of social distancing to find your close friends are the ones who have relocated. And the guidance of public health officials to keep your distance, to mask up, to limit gatherings and to remain six feet apart? None of these are helpful for meeting new people and nurturing new friendships.

Nevertheless, Niobe Way, a professor of developmental psychology at New York University who has studied friendship for more than three decades, has anecdotally observed what she described as an “explosion of friendships” last summer, particularly in her own Manhattan neighborhood — a display of optimism in the face of our oxymoronic collective isolation. It just takes a little more intention and a little more openness.

Here’s what experts and new pals have to say about making, and keeping, pandemic friends.

Get creative about meeting prospective friends.

“It’s a difficult time to connect with new people,” said Marisa G. Franco, a psychologist and friendship expert. “The first question you can ask yourself is, ‘Is there someone you want to reconnect with?’” According to one study, rekindling “dormant ties,” or those you’ve lost touch with, is often easier than making new friends, because the individuals already trust one another. Look through your phone to see who you were texting this time last year, or reach out to a high school or college club you were affiliated with.

Lean on existing networks of friends and acquaintances, too. Though chance meetings in corridors or cafeterias may be infrequent these days, you can still turn casual connections, whether neighbors or work colleagues, into friends, or reach out to new people through shared acquaintances.

Or if that fails, join a virtual book club or a volunteer effort to connect with a stranger over a shared pastime. (It’s still possible!) Last year, Emily Beyda, a novelist, joined a roller-skating club with two other women in Los Angeles. It has since blossomed to around nine members who share techniques for new jumps, spins and tricks and linger after their practice has ended, just to talk.

And, with no clubs for dancing or reasons to go out, the group’s members have taken to dressing up: “Everyone’s showing up at 1 p.m. on a Sunday just looking gorgeous,” Ms. Beyda, 31, said. “Leopard-print bell bottoms, a gold lamé jumpsuit — dressed to the nines in the public park.”

Even if you feel as if your social muscles have atrophied, don’t brace yourself for rejection. Approaching strangers in public places might not feel so welcome these days, but “in general, people underestimate how much strangers like them,” Dr. Franco said.

Stay connected.

Writing letters, sending voice memos, scheduling phone or video dates — keeping in touch during the pandemic doesn’t have to be impersonal, even if it’s not in person. Not long after Catherine Smith, 34, moved to rural Abingdon, Va., from Philadelphia, she started trading favorite hiking routes and local tips with a new friend over Instagram. A quintessential social media meet-cute, with one pandemic-specific hitch: “We still haven’t gotten to meet in person,” Ms. Smith said.

Aminatou Sow, who hosts the podcast “Call Your Girlfriend” and wrote the book “Big Friendship” with Ann Friedman, suggested that friends try to avoid communicating over the same airwaves used for work. So if you video chat all the time for your job, don’t video chat your friends.

“We are two friends who love the Postal Service,” Ms. Sow said of herself and Ms. Friedman. Letter-writing can even be a way to meet new people across distances: In the spring, the writer Rachel Syme started a pen pal exchange called Penpalooza that has since connected more than 7,000 participants.

However you choose to stay in touch, keep it consistent: Send monthly postcards, tiny gifts or whatever baked good you’ve been perfecting recently, or get a weekly phone call on the books.

Talk frankly about your friendship.

A year ago, frequent, granular discussions about how you handle exposure to disease weren’t especially common among even close pals. Now, they’ve probably become hallmarks of your relationships. Having open, candid conversations can help buoy friendships along by establishing shared expectations and trust.

“Part of making friends in adulthood — in general, but particularly in this moment — is trying to figure out how you fit into someone’s life,” Ms. Friedman said.

Ms. Sow added: “The stating of intentions is the first place to start. In this pandemic moment, I think that is also really important to remember because so many people feel lonely and so many people feel overwhelmed and so many people feel scared.”

This means setting aside time to have conversations about how much friendship you’re looking for — whether a mere running buddy or a BFF — while still allowing for the relationship to evolve. Talking about the Covid-19-related precautions you’re each taking can also make any in-person meet-ups more comfortable.

“I tend to overcommunicate, especially now,” said Amanda Zeilinger. In July, Ms. Zeilinger, 23, moved in Minnesota to St. Paul from Northfield to start a new job at a mosaic workshop in the Twin Cities. She had anticipated it might be harder to make friends in a new city amid shutdowns, but that hasn’t been the case: Recently, she formed a pod with two colleagues so they could foster their friendship outside of work. “I think people are so starved for human connection that we’re that much more open,” she said.

Go on a date — or two or three.

“One of the defining features of our friends is that they’re exclusive,” Dr. Franco said. That means you have shared memories and experiences. So if you met through work or school or a club, plan a one-on-one virtual teatime or socially distanced walk. “Repotting” friendships, or moving them from one setting to another — a term the digital strategist Ryan Hubbard uses — can also help them gain momentum.

Developing a new friendship is not dissimilar to entering a romantic relationship, and initial meet-ups with a new friend can feel “sort of like a first date,” said Jordan Bennett, 31, a communications professional who lives in New York City. “You have the same nerves.”

Several of Mr. Bennett’s close friends left New York last summer; this, combined with a natural tendency to be “very, very social,” led him to start exchanging messages with a new friend through Bumble BFF. They met for the first time in September, and though it was platonic, Mr. Bennett said, he was also unsure how this prospective friend might react upon learning he is gay. “You don’t know if someone is an ally, or how comfortable they are,” he said. The subject emerged organically, producing a comfortable conversation about relationships; they’ve since ventured out to bars, the gym and watched the vice-presidential debate together.

After a successful initial get-together, make plans to continue meeting up regularly. Several experts agreed that consistency strengthens bonds. “Ritual is really important when it comes to connection, especially friendship,” said Adam Smiley Poswolsky, the author of the forthcoming book “Friendship in the Age of Loneliness.” Attaching friendship to a shared goal — a regular yoga practice; keeping up with a TV show — can help reinforce the relationship and your new habit.

“Being intentional, being available, being reliable and being excited are all things that work in your favor,” Ms. Sow said.

Eating Outside During the Pandemic

When Dinner is Outdoors, New Rules Apply

During the pandemic, wind chill and loaner blankets are the new considerations (don’t forget your handwarmers).

Credit…Zack DeZon for The New York Times
Steven Kurutz

  • Jan. 23, 2021, 10:02 p.m. ET

When the weather turned cold, Rachel Sugar, a contributing writer for the New York City food blog Grubstreet, thought people would give up dining al fresco. But, she said, that hasn’t been the case: “Restaurants, more than ever, are a place where people feel relatively comfortable.”

Indeed, in cities around the country, restaurants have adapted for colder conditions and diners are proving game, even in northern latitudes. On a recent weekday in Portland, Maine, where the high was 28 degrees, the eatery Little Giant turned its back patio into an outdoor dining deck, with 35,000 watts of electric heat. In Seattle, the seafood spot Westward has installed two fire pits to keep patrons cozy. Scarpetta, in New York, built private dining “chalets.” It’s a testament to local food cultures and the universal human need for social connection that people are willing to eat outside in the depths of winter.

But between the not freezing part and the not getting Covid-19 part, if you decide to visit a restaurant, eating out has become something you need to plan for: Whose outdoor setup promises warmth, what to wear to battle the elements, what to order that won’t get cold as soon as it hits the table (or maybe will still taste good even if it is cold). Getting a table used to be the main concern. Now you have to think about wind chill and the chance of snow.

How are diners and restaurateurs making it work? Here, the new rules for eating outside.

Know what you’re facing.

The pandemic diner will quickly discover that every restaurant offers its own version of the outdoor experience. Heated, custom-designed tents called Yurt Villages, a collaboration between American Express and the dining app Resy, have been set up at 13 in-demand restaurants across the country, including Zahav in Philadelphia and Arlo Grey in Austin, Texas. Many more eateries have erected cheap, rustic structures made of wood or plastic, which Ms. Sugar of Grubstreet has codified by architectural style, from Upmarket Shanty to Cold-Weather Cabana. You’ll want to do some research to know exactly what the set up will be — are there heaters at every table? Blankets on loan? How windy and exposed is the location?

“I generally won’t go to a restaurant without having seen their outdoor situation beforehand,” said William Li, a founder of The Hao Life, a wellness brand, who on a recent week ate out in New York nearly every night. “A lot of them are just tables outside without any heating whatsoever. Even if you’re dressed appropriately, it’s not comfortable.”

Jessica Siskin, a food artist behind the popular Instagram account Misterkrisp, follows the same rule but for different reasons. Ms. Siskin won’t eat inside plastic enclosures or structures that approximate indoor settings. “I don’t think of plastic as a ventilated material,” she said.

Ms. Siskin does a scouting mission, she said, for her sake and the restaurant’s: “The last thing I want is to get to a restaurant, feel uncomfortable and leave. That’s a reservation that could have gone to someone else.”

Which brings up another point about planning: Make a reservation where you can. Many restaurants are operating with far fewer tables than normal, and on weekends (at brunch especially, when it’s relatively warmer) those tables fill up fast.

Bundle up!

Jeremy Levitt, a founder of Parts and Labor Design, a hospitality design firm, has a piece of advice about dress. “Go as if you’re having a hot toddy outside in front of a bonfire that doesn’t exist,” he said.

Mr. Levitt, who lives in Manhattan, has learned the hard way that his feet become blocks of ice when he sits outside for an hour or more. He’s taken to wearing warm shoes with a few layers of socks, and he and his wife and children also make sure to bring blankets.

With their beanies, winter jackets and gloves, outdoor diners have the look of winter athletes. Erika Chou, a Manhattan restaurateur who operates the spots Kimika and Wayla, has seen people come in “with a full snowboarding outfit, like Burton head to toe,” she said.

Mr. Li swears by fleece-lined Heattech pants from Uniqlo and thick wool socks from L.L. Bean. Ms. Siskin has “a couple of tricks I picked up,” she said, including layering long underwear beneath her jeans and a thin Patagonia liner under her coat.

On a recent night, “I went out to dinner and wore those air-activated foot warmers that you buy for skiing,” she said. “I also got this hand warmer that’s been a game changer,” a rechargeable model by Ocoopa.

Restaurant owners are helping their customers stay warm, too. At the Odeon in New York’s TriBeCa neighborhood, there are the ubiquitous infrared heat lamps, along with microfiber blankets to rent for $7 or purchase for $20. The restaurant also has mylar blankets like the ones given to marathon runners for customers to use for free. Many other restaurants are providing blankets, too, which they wash or dry-clean after each use.

Order the soup.

Even the best dishes don’t taste as good cold, so it’s worth considering how a restaurant has adapted.

Back in the fall, Cédric Vongerichten, the chef and owner of Wayan, which serves Indonesian food with a French flair, found that dishes like lobster noodles were getting cold in minutes. Inspired by his childhood in France, Mr. Vongerichten introduced a burner device like the ones for cheese fondue, which plugs into an electrical outlet at select tables, a concept he calls Indo-Chalet.

In addition, Wayan’s kitchen staff now plates hot dishes in cast-iron pans, which Mr. Vongerichten said would retain heat throughout a meal. Off the menu? Es Teler, a shaved ice dessert. And while the restaurant still offers ice cream, servers are suggesting hot desserts like a cookie baked in a cast iron pan.

When ordering, it helps to think about your courses, to minimize having dishes sit on the table for too long or to focus on warming items.

At Heights Café in Brooklyn Heights, a popular brunch spot even on frigid days, soups and hot toddies have become popular orders. The Odeon has been selling a lot of French onion soup and cassoulet, said the owner Lynn Wagenknecht.

It makes sense to adapt your appetite to the weather, as well. Shanise Djuhari, a dental resident who lives in Brooklyn, recently ate outside on a very cold, windy and rainy day. “I typically don’t go for stews,” she said. “But that day, we had a couple of stews on the table. It seemed weather appropriate.”

Even if a restaurant’s menu pays no deference to the cold, there are simple ways to warm up. “I always order hot water,” said Ms. Chou, the restaurateur. “I think that helps. It’s good for your digestive system as well.”

Do a time and temperature check.

With daylight hours limited, lunch is the new dinner, and dinner begins at an hour more common to retirement communities.

At Kimika, Ms. Chou now starts dinner service at 4 p.m. “It’s lighter out so maybe slightly warmer,” she said. “I’m sure people are trying to eat at earlier times when there’s less crowding.”

Ms. Wagenknecht said 4 to 8 is her busiest time on weekends. And anyway, a lingering, late-night meal is virtually impossible: In New York State, restaurants must close by 10. Massachusetts also enacted a 10 p.m. curfew, while other states and cities (like Chicago, which requires restaurants to close one hour later) have similar rules. The compressed dinner service may mean that your restaurant will no longer hold a table if one or more guests arrive late, so maybe ditch you friends who are always texting that they’re five minutes away.

“We have such a small window of service, if everyone’s late, we lose half a turn,” Ms. Wagenknecht said.

In addition to being conscious of time, check the weather during your planned dining hour.

Even worse than the cold, rain or snow is the wind. It rattles under canopy roofs, renders the portable heaters useless and frays the servers’ nerves. On blustery days, it’s better to stay home.

Embrace it.

For Mr. Levitt, who dines outside frequently, the cold is “part of the fun,” he said. “I’m going out to dinner and I’m going to be sitting outside for an hour. People need to embrace that.”

Mr. Li expressed a similar sentiment. He said he has adopted a Scandinavian approach to dining out: There’s no such thing as bad weather, only bad clothing.

Ms Wagenknecht perhaps sums it up best, with advice for eating outside if not for life itself: “If you don’t approach it with a spirit of fun and adventure, you’re probably going to be miserable.”

Weekly Health Quiz: Covid Variants, Moderate Exercise and Coffee

1 of 7

A new variant of coronavirus, first identified in Britain, is spreading through the United States. Which statement about the new variant is not true?

The new variant is much more contagious than earlier forms of the coronavirus

The new variant is much more deadly than earlier forms of the virus

The new variant is expected to be the dominant form of the virus in the United States by March

Scientists believe current vaccines will be effective against the new variant

2 of 7

A new study compared high-intensity interval training with moderate workouts in sedentary, overweight men. Men who did moderate workouts showed this benefit:

They shed more body fat

They showed greater improvements in blood pressure

They were better able to metabolize fats in the diet

All of the above

3 of 7

Robotic-assisted surgery has shown the most gains in replacement of this joint:

Hip

Shoulder

Knee

Elbow

4 of 7

The United States reached a grim milestone in Covid-related deaths, which now exceed:

100,000

200,000

400,000

1 million

5 of 7

Men and women with pain and stiffness from knee arthritis showed the most improvements when they wore shoes that were:

Flat-soled and flexible

Stable, supportive and well-cushioned

Tightly laced with a low, broad heel

The type of footwear had little impact on symptoms of arthritis

6 of 7

Just one alcoholic drink a day was tied to an increased risk of this heart disorder:

Atrial fibrillation

Heart failure

Heart attack

High blood pressure

7 of 7

Men who drank coffee were at lower risk of this condition:

Erectile dysfunction

Prostate cancer

Amyotrophic lateral sclerosis

Dementia

U.S. Vaccine Supply: What to Know

U.S. Covid Vaccine Supply: How to Make Sense of Those Confusing Numbers

Can President Biden really boost production? Why are governors trying to buy directly from Pfizer? And when will supply exceed demand?

New Yorkers lined up at a  vaccine hub set up by the city’s Health Department in Jamaica, Queens, this month.
New Yorkers lined up at a  vaccine hub set up by the city’s Health Department in Jamaica, Queens, this month.Credit…Hiroko Masuike/The New York Times

  • Jan. 21, 2021, 12:23 p.m. ET

Demand for vaccines is skyrocketing as the United States grapples with a record death toll from Covid-19 and the threat of new, more contagious variants. After a slow start in December, many states and cities have quickly ramped up vaccine delivery, widening access to larger groups of people and setting up mass testing sites.

But now there’s a new wrinkle: Some mayors and governors say they have run out of available vaccines, and have had to cancel appointments.

The Biden administration has promised to overhaul the country’s faltering vaccine effort, but there’s only so much it can do to increase the available supply.

Here’s what you need to know.

How many doses are available?

There are simply not enough doses of authorized vaccines to meet the enormous demand. And that is not likely to change for the next few months.

The two companies with authorized vaccines, Moderna and Pfizer, have each promised to provide the United States with 100 million vaccine doses by the end of March, or enough for 100 million people to get the necessary two shots.

But that doesn’t mean those 200 million doses are sitting in a factory warehouse somewhere, waiting to be shipped. Both companies are manufacturing the doses at full capacity, and are collectively releasing about 12 million doses each week, a number expected to gradually increase.

As of Wednesday, nearly 36 million doses of the Pfizer and Moderna vaccines had been distributed to state and local governments. However, only about 16.5 million shots had been administered to patients.

But as local health authorities become more adept at vaccine distribution, they will eventually catch up to the limited supply. Some local officials, including those in New York City, have said they are already reaching that point, and have had to cancel appointments because they said they do not have enough.

President Biden said he would use the Defense Production Act to increase supply. Will that help?

Vaccine experts and the companies themselves have said that at least in the short term, using the Defense Production Act will not significantly increase supply, although every little bit could help. That’s because manufacturing facilities are already at or near capacity, and there is a worldwide race to develop vaccines that use a finite amount of resources.

Although the Trump administration was criticized for not using the Defense Production Act more aggressively to ramp up production of testing supplies and protective gear, it did use the act many times to give vaccine manufacturers priority access to suppliers of raw ingredients and equipment.

In a plan released on Thursday, the Biden administration indicated it would continue to use the act to boost supplies needed for vaccine manufacturing, as well as other materials that are required to immunize tens of millions of people. Although the plan provided few details, one example cited is increasing production of a special syringe that can squeeze six doses out of Pfizer vials that were originally intended to contain five.

A drive-through vaccination center in Napa, Calif., earlier this month.
A drive-through vaccination center in Napa, Calif., earlier this month.Credit…Max Whittaker for The New York Times

What about the federal stockpile of vaccines?

There is no significant reserve of vaccines to speak of. For the most part, vaccines are being shipped out each week as they are manufactured. (The exception is a small emergency stockpile that the Biden administration has said will continue.)

Last week, Alex M. Azar II, the outgoing secretary of health and human services, stirred confusion when he announced that the federal government would be releasing a reserve of vaccine doses. Many states said they were told that this meant an influx of vaccines was on the way, which could be used to inoculate more people.

In his news conference, Mr. Azar urged states to open up their immunization policies, and said they had been moving too slowly to use the doses they had already been sent. As a result, several governors, including Andrew Cuomo in New York, changed eligibility rules to allow people 65 and older to get the vaccine.


Covid-19 Vaccines ›


Answers to Your Vaccine Questions

While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.

Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.

Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.

The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.

No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

However, senior administration officials clarified last Friday that all of those reserve doses were already earmarked as booster shots for people who had gotten the vaccine, and that Mr. Azar was just spelling out the logical extension of a distribution policy that had been established by top federal officials in December, when shipments began. The release of the reserve doses would go to people who needed their second dose, not new pools of people who were getting their first shot.

Going forward, Mr. Azar said, the government would shift to a new model: rather than holding onto a reserve of booster shots, each weekly shipment from the manufacturers would include doses for new people as well as second doses for those due for their booster shots. President Biden echoed that policy in announcing his vaccine plan last week.

Will there be enough vaccine supply to give everyone a second dose?

Federal officials have previously said they were working with states to track who has gotten a vaccine, and when they are due for their booster shots, which is three weeks later for the Pfizer vaccine and four weeks later for the Moderna one.

They have said that each weekly shipment will give priority to people who need their second dose that week, and whatever is left will go to vaccinating new people.

But the plan relies on state and federal governments working together and accurately reporting who has received a vaccine, and what is needed from week to week. Many state governments have complained they do not have the resources to carry out the vaccine distribution plan, and the next few weeks will demonstrate how well the system works.

The incoming Biden administration has vowed to overhaul distribution to the states, providing more transparency to local officials about how much vaccine they can expect, in the hopes of allowing states to better plan.

Doses of Moderna’s vaccine were prepared at the Sonoma County Fairgrounds in Santa Rosa, Calif.Credit…Jim Wilson/The New York Times

Some Democratic governors have asked to buy vaccines directly from Pfizer. Is that possible?

No, it’s not likely to happen.

Last week, Gov. Gretchen Whitmer of Michigan asked the federal government for permission to buy 100,000 doses of vaccine directly from Pfizer. And on Monday, Gov. Cuomo wrote a letter to Pfizer asking for the state to buy vaccines directly.

Pfizer and Moderna’s supply has been fully claimed for at least the first quarter of this year, meaning it’s unlikely there will be any spare vaccine to sell to individual states.

In addition, the emergency use authorizations for the Pfizer and Moderna vaccines stipulate that the federal government oversees distribution.

In a statement, a Pfizer spokeswoman said the company “is open to collaborating with the U.S. Department of Health and Human Services on a distribution model that gives as many Americans as possible access to our vaccine as quickly as possible.” But she noted that “before we can even consider direct sales to state governments, H.H.S. would need to approve that proposal.”

A state official said on Tuesday that the governor felt it was important to exhaust all his options, no matter how unlikely they would be succeed, and pointed to his efforts in March to directly buy ventilators from manufacturers — setting up a bidding war among states that he later criticized the federal government for fueling.

But advisers to the Biden administration have indicated that they are not in favor of such a move. On Monday, Dr. Celine Gounder, a pandemic adviser to Mr. Biden during his presidential transition, said allowing states to reach separate deals would cause more problems than it would solve.

In an interview on CNBC, Dr. Gounder noted Mr. Cuomo’s previous criticism of bidding over ventilators. “I think this kind of an approach to vaccine allocation is going to result, frankly, in the same kind of situation that he, himself, was criticizing last spring,” she said.

Vaccinations underway in Minneapolis on Tuesday.Credit…Octavio Jones for The New York Times

Are we going to get more vaccines anytime soon?

Yes, most likely.

At least three other vaccines are in late-stage clinical trials, and the success of any one of them could mean millions of more doses for U.S. residents by this spring.

Johnson & Johnson is expected to announce the results of its vaccine trial any day now, and if it is successful, the first doses could become available in the United States by February. Although early production of the vaccine has lagged, the company has signed a deal to provide 100 million doses of its one-dose vaccine by the end of June.

By March and April, results from trials testing two-dose vaccines by AstraZeneca and Novavax could also be made public. AstraZeneca has an arrangement with the U.S. government to provide 300 million doses, and Novavax to provide 110 million.

What’s more, both Pfizer and Moderna say their factories are ramping up and expanding capacity each week. They have signed deals to supply an additional 100 million doses each of their vaccines in the second quarter of this year.

When will we have enough vaccines for everybody in the country?

It’s still not clear, although conservatively, there could be enough vaccines by the summer.

If no other vaccines are authorized, the United States has signed deals with Pfizer and Moderna for a total of 400 million doses to be delivered by summer, or enough for 200 million people.

That’s pretty close to the American population of 260 million adults (the vaccines are not approved yet for children although studies are underway).

But if other vaccines do prove safe and effective — which experts say is likely — millions more people could be vaccinated more quickly, possibly by late spring.

Amid One Pandemic, Students Train for the Next

Amid One Pandemic, Students Train for the Next

Researchers have banded together to find safe, virtual ways to teach the principles of microbiology and epidemiology.

Teresa Bautista, a student at the High School for Environmental Studies in Manhattan, collecting goose dropping samples at Van Cortlandt Park in the Bronx.
Teresa Bautista, a student at the High School for Environmental Studies in Manhattan, collecting goose dropping samples at Van Cortlandt Park in the Bronx.Credit…Christine Marizzi/BioBus
Katherine J. Wu

  • Jan. 21, 2021, 5:00 a.m. ET

On a crisp afternoon in November, Teresa Bautista ventured into Van Cortlandt Park in the Bronx, N.Y., on the lookout for feces. It didn’t take long for Ms. Bautista, 17 — and, to her chagrin, her white Puma shoes — to hit some serious pay dirt.

Speckled all across the park’s grass was the greenish glint of goose droppings, which Ms. Bautista eagerly swabbed and swirled into a tubeful of chemicals. “This was my first time digging into poop,” she said. “It was really fun.”

Ms. Bautista was after more than just bird excrement. Teeming within it, she hoped, were swarms of infectious viruses ready to spill their genetic secrets and, perhaps, help young scientists like her stop future pandemics.

Over the next few months, Ms. Bautista and four other New York area high school students will continue to gather samples from the city’s birds as a part of the Virus Hunters program, hosted by the nonprofit science outreach organization BioBus. Their goal is to catalog the flu viruses that often lurk in urban fowl, some of which might have the potential to someday hop into humans.

The surveillance program, which was developed in partnership with virologists at the Icahn School of Medicine at Mount Sinai, is one of several outreach efforts that have emerged in recent years to equip young scientists with hands-on experience in outbreak preparedness — a quest that has only gained urgency since the new coronavirus started its tear across the globe.

For many months to come, Covid-19 will continue to shutter schools and thwart attempts to gather. The changes have forced educators and researchers to change their teaching tactics. But several groups have met the challenge head on, not merely weathering the pandemic’s inconveniences but transforming them into opportunities for scientific growth.

In Cambridge, Mass., a team of computational biologists designed an outbreak simulation that eerily portended the stealthy spread of the coronavirus and is now fighting the spread of Covid-19 in real-time. In Tucson, Ariz., an immunologist has led an effort to include young, underrepresented scientists in microbiology research, even while the pandemic rages on.

And in New York, where Ms. Bautista is nurturing her love for virology, the effects of these efforts are already starting to take shape. That foraging trip to Van Cortlandt Park, she said, wasn’t just her first experience sampling feces: “It was the first time I actually felt like a scientist.”

Viruses of a feather

The Virus Hunters program was borne of a collaboration among BioBus, a wildlife rehabilitation center called the Wild Bird Fund and a group of researchers led by the Mount Sinai virologist Florian Krammer. Flu viruses are fairly cosmopolitan pathogens that are capable of jumping into a wide range of animals, including birds, and changing their genetic material along the way. Only some of these viruses pose a possible threat to people, Dr. Krammer said. But which ones? Researchers won’t know unless they check.

“There is very little information on influenza circulating in birds in New York City,” Dr. Krammer said. “I wanted to know what’s in my backyard.”

Florian Krammer of the Icahn School of Medicine at Mount Sinai.
Florian Krammer of the Icahn School of Medicine at Mount Sinai.Credit…Brittainy Newman/The New York Times

The project was awarded funding in early 2020, said Christine Marizzi, the chief scientist at BioBus. Weeks later, the coronavirus began to pummel the nation, and the team was forced to shift their plans. But Dr. Marizzi, who has long specialized in community-based research, was undeterred. For the remainder of the school year, the team will train its virus hunters through a mix of virtual lessons, distanced and masked lab work, and sample collection in the field.

It is a welcome distraction for Ms. Bautista, who, like many other students, had to switch to remote learning at her high school in the spring. “When the pandemic hit, I felt really helpless,” she said. “I felt like I couldn’t do anything. So this program is really special to me.”

School of outbreak

A thousand miles south, the students of Sarasota Military Academy Prep, a charter school in Sarasota, Fla., have also had to make some drastic changes since the coronavirus made landfall in the United States. But a select few of them may have entered 2020 a bit more prepared than the rest, because they had experienced a nearly identical epidemic just weeks before.

These were the graduates of Operation Outbreak, a researcher-designed outreach program that has, for the past several years, simulated an annual viral epidemic on the school’s campus. Led by Todd Brown, Sarasota Military Academy Prep’s community outreach director, the program began as a low-tech endeavor that used stickers to mimic the spread of a viral disease. With guidance from a team of researchers led by Pardis Sabeti, a computational biologist at Harvard University, the program quickly morphed into a smartphone app that could ping a virtual virus from student to student with a Bluetooth signal.

Sarasota’s most recent iteration of Operation Outbreak was uncanny in its prescience. Held in December 2019, just weeks before the new coronavirus began its rampage across the globe, the simulation centered on a viral pathogen that moved both swiftly and silently among people, causing spates of flulike symptoms.

The students in each simulation, partitioned into roles in government, public health, medicine, the military and the media, had to scramble to adapt and work together.

Bradford Walker, a junior at the academy, said he felt “really confident” going into the simulation as an eighth grader in 2017. “I was like, ‘We’ll get this together, no problem.’”

But the moment the campus’s outbreak began, “everything became a mess,” Mr. Walker said. Panic ensued; protests flared up; Nerf-gun shots were fired. Media personnel stalked and pestered Mr. Walker, who was acting as a government official. “It was very reminiscent of real life,” he said.

Students with the Sarasota Military Academy Prep “rescued” an ill student to triage as part of the school’s Operation Outbreak program.Credit…Becky Morris

Surrounded by a real pandemic, Mr. Walker often thinks back to his Operation Outbreak days. The program gave him an inkling of what a true viral outbreak might bring, he said. But he’s been unnerved by how wholly unprepared the world was for the coronavirus.

“The coronavirus is a wake-up call,” he said. “We have to be ready for this kind of stuff.”

Operation Outbreak was slated to run several in-person courses in 2020, until an actual pandemic intervened. But Dr. Sabeti and her colleagues have been building online tools, curriculums and games that can bring the lessons of their program to anyone who wants them.

After some careful finagling, the team was also able to engineer a handful of in-person outbreak simulations at college and high school campuses, using an updated version of their smartphone app. One simulation, run over Halloween weekend at Colorado Mesa University, followed a group of more than 350 students as they mingled during their normal routines. Unsurprisingly, an increase in interactions fueled the spread of the fictional virus — the same dynamic that was causing outbreaks of Covid-19 on campus that same semester.

The Operation Outbreak app has since grown more sophisticated. As part of the simulations, users can now toggle their epidemics to include diagnostic tests, masks, vaccines and other public health tools that curb and monitor the spread of infection. Eventually, schools and other organizations might be able to use the simulations as guides as they prepare to reopen for business.

“Beyond being an education tool, it’s a tool to get real-world data,” Dr. Sabeti said. “It’s an exercise in preparing public health teams.”

Expanding science’s reach

Isabel Francisco, left, a doctor of veterinary medcine at the Icahn School of Medicine at Mount Sinai, with Shatoni Bailey, a student at Central Park East High School, participating in BioBus’s virus hunters program.Credit…Christine Marizzi/BioBus

In Arizona, the microbiologist Michael D.L. Johnson has also taken advantage of the pivot to virtual learning prompted by the pandemic. Last summer, he led an effort to enroll 250 students from underrepresented backgrounds in the National Summer Undergraduate Research Program, or NSURP, matching them to more than 150 mentors with expertise in microbiology.

All the projects were remote. But, Dr. Johnson said, that obstacle likely also created opportunities for students who might otherwise have been excluded from science because of geographical or socioeconomic restrictions. And mentors who had old data sets lying around, or heavily computational projects that needed an extra pair of hands, found themselves partnered with eager new collaborators.

“The pandemic has made us adapt,” Dr. Johnson said. “We’re learning that there are some better ways of doing this.”

Some NSURP students even had the opportunity to better understand the coronavirus that had upended their summers. Emy Armanus, now a freshman at the University of California, Irvine, was paired with Suhana Chattopadhyay, an environmental health researcher at the University of Maryland School of Public Health, and spent the summer investigating how the use of nicotine products can worsen cases of Covid-19.

“It definitely made me more knowledgeable about the pandemic,” said Ms. Armanus, who is interested in pursuing a career in medicine. “This program was a great way to discover myself.”

The pandemic has altered just about every aspect of daily life. But Dr. Marizzi of BioBus said students should still feel empowered to engage in scientific discourse — something that sorely needs a new generation of diverse and enthusiastic voices.

For Ms. Bautista, the budding virologist in New York, the Virus Hunters program is bound to leave a lasting impression. Already, she has learned the basics of how viruses infiltrate hosts and how to coax intact genetic material out of cells — and, of course, to never again wear white shoes on a field survey.

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Emerging Coronavirus Variants May Pose Challenges to Vaccines

Emerging Coronavirus Variants May Pose Challenges to Vaccines

Laboratory studies of mutations circulating in South Africa suggest they may dodge some of the body’s immune responses.

Health workers tended to a Covid-19 patient at Greenacres Hospital in Port Elizabeth, South Africa, in November.
Health workers tended to a Covid-19 patient at Greenacres Hospital in Port Elizabeth, South Africa, in November.Credit…Samantha Reinders for The New York Times
Apoorva Mandavilli

  • Jan. 20, 2021, 6:37 p.m. ET

The steady drumbeat of reports about new variants of the coronavirus — first in Britain, then in South Africa, Brazil and the United States — have brought a new worry: Will vaccines protect against these altered versions of the virus?

The answer so far is yes, several experts said in interviews. But two small new studies, posted online Tuesday night, suggest that some variants may pose unexpected challenges to the immune system, even in those who have been vaccinated — a development that most scientists had not anticipated seeing for months, even years.

The findings result from laboratory experiments with blood samples from groups of patients, not observations of the virus spreading in the real world. The studies have not yet been peer-reviewed.

But experts who reviewed the papers agreed that the findings raised two disturbing possibilities. People who had survived mild infections with the coronavirus may still be vulnerable to infection with a new variant; and more worryingly, the vaccines may be less effective against the variants.

Existing vaccines will still prevent serious illness, and people should continue getting them, said Dr. Michel Nussenzweig, an immunologist at Rockefeller University in New York, who led one of the studies: “If your goal is to keep people out of the hospital, then this is going to work just fine.”

But the vaccines may not prevent people from becoming mildly or asymptomatically infected with the variants, he said. “They may not even know that they were infected,” Dr. Nussenzweig added. If the infected can still transmit the virus to others who are not immunized, it will continue to claim lives.

The vaccines work by stimulating the body to produce antibodies against the coronavirus. Scientists had expected that over time, the virus may gain mutations that allow it to evade these antibodies — so-called escape mutations. Some studies had even predicted which mutations would be most advantageous to the virus.

But scientists had hoped that the new vaccines would remain effective for years, on the theory that the coronavirus would be slow to develop new defenses against them. Now some researchers fear the unchecked spread has given the virus nearly unfettered opportunities to reinvent itself, and may have hastened the appearance of escape mutations.

The studies published on Tuesday night show that the variant identified in South Africa is less susceptible to the antibodies created by natural infection and by vaccines made by Pfizer-BioNTech and Moderna.

Vaccinations of nurses, doctors and health professionals in São Paulo, Brazil, this week.
Vaccinations of nurses, doctors and health professionals in São Paulo, Brazil, this week.Credit…Victor Moriyama for The New York Times

Neither the South African variant nor a similar mutant virus in Brazil has yet been detected in the United States. (The more contagious variant that has blazed through Britain does not contain these mutations and seems to be susceptible to vaccines.)

Fears that the vaccines would be powerless against new variants intensified at a scientific conference held online on Saturday, when South African scientists reported that in laboratory tests, serum samples from 21 of a group of 44 Covid-19 survivors did not destroy the variant circulating in that country.

The samples that were successful against the variant were taken from patients who had been hospitalized. These patients had higher blood levels of so-called neutralizing antibodies — the subset of antibodies needed to disarm the virus and prevent infection — than those who were only mildly ill.

The results “strongly, strongly suggest that several mutations that we see in the South Africa variant are going to have a significant effect on the sensitivity of that virus to neutralization,” said Penny Moore, a virologist at the National Institute for Communicable Diseases in South Africa who led the study.

The second study brought better tidings, at least about vaccines.

In that study, Dr. Nussenzweig and his colleagues tested samples from 14 people who had received the Moderna vaccine and six people who had received the Pfizer-BioNTech vaccine.


Covid-19 Vaccines ›


Answers to Your Vaccine Questions

While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.

Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.

Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.

The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.

No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

The researchers saw a slight decrease in antibody activity directed against engineered viruses with three of the key mutations in the variant identified in South Africa. That result was significant “because it’s seen in just about every individual tested,” Dr. Nussenzweig said. Still, it “is not something that we should be horribly freaked out about.”

In most people, infection with the coronavirus leads to a strong immune response; the vaccines seem to induce an even more powerful response. Two doses of the vaccines from Pfizer and Moderna, at least, produce neutralizing antibodies at levels that are higher than those acquired through natural infection.

Even if antibody effectiveness were reduced tenfold, the vaccines would still be quite effective against the virus, said Jesse Bloom, an evolutionary biologist at the Fred Hutchinson Cancer Research Center in Seattle.

In Liverpool, England, people lined up to receive a coronavirus test at a recreational tennis center last year.Credit…Mary Turner for The New York Times

And while neutralizing antibodies are essential for preventing infection, the vaccines — and natural infection — also lead to production of thousands of other types of antibodies, not to mention various immune cells that retain a memory of the virus and can be roused to action when the body encounters it again.

Even when confronted with variants, those other components of the immune system may be enough to prevent serious illness, said Florian Krammer, an immunologist at the Icahn School of Medicine at Mount Sinai in New York. In clinical trials, the vaccines protected people from illness after just one dose, when the levels of neutralizing antibodies were low or undetectable, he noted.

Vaccine trials being conducted in South Africa by Novavax and Johnson & Johnson will provide more real-world data on how the vaccines perform against the new variant there. Those results are expected within the next few weeks.

All viruses mutate, and it’s no surprise that some of those mutations sidestep the body’s immune defenses, experts said. Each new host affords a virus fresh opportunities to amass and test mutations by slightly scrambling the sequence of RNA letters in its genetic code.

“The beauty, the elegance, the evolution and the magnificence of a virus is that every single time it infects a person, it’s exploring that sequence space,” said Paul Duprex, director of the Center for Vaccine Research at the University of Pittsburgh.

Some mutations don’t improve on the original, and fade away. Others add to the pathogen’s power, by making it more contagious — like the variant first identified in Britain — more fit, or less susceptible to immunity.

The mutations in the variant circulating in South Africa, called B.1.351, have independently emerged more than once, and all together, suggesting that they work in concert to benefit the virus.

A field hospital for treating Covid-19 patients outside Port Elizabeth, South Africa, in November. Credit…Samantha Reinders for The New York Times

The key mutation, called E484K, and two of its companions alter the shape of a part of the virus that is crucial for immune recognition, making it difficult for antibodies to attach themselves to the virus. The trio popped up in several lab studies that tried to predict which mutations would be advantageous to the virus.

“I think we need to monitor mutations closely and look out for things like that that could be becoming dominant in certain parts of the world,” said Akiko Iwasaki, an immunologist at Yale University.

Britain detected the more contagious variant circulating there because it sequences more virus samples than any other nation. The United States lags far behind: It has sequenced about 71,000 samples so far, a tiny proportion of the millions infected in the country. But the Centers for Disease Control and Prevention plans to work with state and local public health labs to sequence as many as 6,000 samples per week, agency scientists said Friday.

It will be important to limit travel — and the import of variants — from other countries until a majority of the population is immunized, said John Moore, a virologist at Weill Cornell Medicine in New York.

“Even if they are already here, the more often they are reintroduced, the more likely there could be a super-spreader event,” Dr. Moore said. (President Joseph R. Biden Jr. plans to sustain existing travel restrictions on anyone who has recently traveled to Europe and Brazil.)

The mRNA technology on which the Pfizer and Moderna vaccines rely can be altered in a matter of weeks, and far more easily than the process used to produce flu vaccines. But it would be wise to prepare for this eventuality now and think through not just the technical aspects of updating the vaccines, but the testing, approval and rollout of those vaccines, experts said.

Still, the best path forward is to prevent the emergence of new mutations and variants altogether, they said.

“Imagine having to do catch-up like this all the time — it’s not something desirable,” Dr. Iwasaki said. “If we can just stop the spread as soon as possible, while the vaccine is very effective, that’s the best way.”

Could a Small Test Screen People for Covid-19?

Could a Smell Test Screen People for Covid?

A new modeling study hints that odor-based screens could quash outbreaks. But some experts are skeptical it would work in the real world.

A health worker in Altos de San Lorenzo, a neighborhood outside Buenos Aires, Argentina, administered a smell test last year.
A health worker in Altos de San Lorenzo, a neighborhood outside Buenos Aires, Argentina, administered a smell test last year.Credit…Alejandro Pagni/Agence France-Presse — Getty Images
Katherine J. Wu

  • Jan. 19, 2021, 5:49 p.m. ET

In a perfect world, the entrance to every office, restaurant and school would offer a coronavirus test — one with absolute accuracy, and able to instantly determine who was virus-free and safe to admit and who, positively infected, should be turned away.

That reality does not exist. But as the nation struggles to regain a semblance of normal life amid the uncontrolled spread of the virus, some scientists think that a quick test consisting of little more than a stinky strip of paper might at least get us close.

The test does not look for the virus itself, nor can it diagnose disease. Rather, it screens for one of Covid-19’s trademark signs: the loss of the sense of smell. Since last spring, many researchers have come to recognize the symptom, which is also known as anosmia, as one of the best indicators of an ongoing coronavirus infection, capable of identifying even people who don’t otherwise feel sick.

A smell test cannot flag people who contract the coronavirus and never develop any symptoms at all. But in a study that has not yet been published in a scientific journal, a mathematical model showed that sniff-based tests, if administered sufficiently widely and frequently, might detect enough cases to substantially drive transmission down.

Daniel Larremore, an epidemiologist at the University of Colorado, Boulder, and the study’s lead author, stressed that his team’s work was still purely theoretical. Although some smell tests are already in use in clinical and research settings, the products tend to be expensive and laborious to use and are not widely available. And in the context of the pandemic, there is not yet real-world data to support the effectiveness of smell tests as a frequent screen for the coronavirus. Given the many testing woes that have stymied pandemic control efforts so far, some experts have been doubtful that smell tests could be distributed widely enough, or made sufficiently cheat-proof, to reduce the spread of infection.

“I have been intimately involved in pushing to get loss of smell recognized as a symptom of Covid from the beginning,” said Dr. Claire Hopkins, an ear, nose and throat surgeon at Guy’s and St. Thomas’ Hospitals in the United Kingdom and an author of a recent commentary on the subject in The Lancet. “But I just don’t see any value as a screening test.”

A reliable smell test offers many potential benefits. It could catch far more cases than fever checks, which have largely flopped as screening tools for Covid-19. Studies have found that about 50 to 90 percent of people who test positive for the coronavirus experience some degree of measurable smell loss, a result of the virus wreaking havoc when it invades cells in the airway.

“It’s really like a function of the virus being in the nose at this exact moment,” said Danielle Reed, the associate director of the Monell Chemical Senses Center in Philadelphia. “It complements so much of the information you get from other tests.” Last month, Dr. Reed and her colleagues at Monell posted a study, which has not yet been published in a scientific journal, describing a rapid smell test that might be able to screen for Covid-19.

In contrast, only a minority of people with Covid-19 end up spiking a temperature. Fevers also tend to be fleeting, while anosmia can linger for many days.

A coronavirus testing site in Los Angeles. Smell tests, unlike P.C.R. and antigen tests, would not diagnose the disease nor look for the virus directly.
A coronavirus testing site in Los Angeles. Smell tests, unlike P.C.R. and antigen tests, would not diagnose the disease nor look for the virus directly.Credit…Kendrick Brinson for The New York Times

A smell test could also come with an appealingly low price tag, perhaps as low as 50 cents per card, said Derek Toomre, a cell biologist at Yale University and an author on Dr. Larremore’s paper. Dr. Toomre hopes that his version will fit the bill. The test, the U-Smell-It test, is a small smorgasbord of scratch-and-sniff scents arrayed on paper cards. People taking the test pick away at wells of smells, inhale and punch their guess into a smartphone app, shooting to correctly guess at least three of the five odors. Different cards contain different combinations of scents, so there is no answer key to memorize.

He estimated that the test could be taken in less than a minute. It is also a manufacturer’s dream, he said: A single printer “could produce 50 million of these tests per day.” Numbers like that, he argued, could make an enormous dent in a country hampered by widespread lack of access to tests that look directly for pieces of the coronavirus.

In their study, Dr. Larremore, Dr. Toomre and their collaborator Roy Parker, a biochemist at the University of Colorado, Boulder, modeled such a scenario using computational tools. Administered daily or almost daily, a smell screen that caught at least 50 percent of new infections was able to quash outbreaks nearly as well as a more accurate, slower laboratory test given just once a week.

Such tests, Dr. Larremore said, could work as a point-of-entry screen on college campuses or in offices, perhaps in combination with a rapid virus test. There might even be a place for them in the home, if researchers can find a way to minimize misuse.

“I think this is spot on,” said Dr. Carol Yan, an ear, nose and throat specialist at the University of California, San Diego. “Testing people repeatedly is going to be a valuable portion of this.”

Dr. Toomre is now seeking an emergency use authorization for the U-Smell-It from the Food and Drug Administration, and has partnered with a number of groups in Europe and elsewhere to trial the test under real-world conditions.

Translating theory into practice, however, will come with many challenges. Smell tests that can reliably identify people who have the coronavirus, while excluding people who are sick with something else, are not yet widely available. (Dr. Hopkins pointed to a couple of smell tests, developed before the pandemic, that cost about $30 each and remain in limited supply.) Should they ever be rolled out in bulk, they would inevitably miss some infected people and, unlike tests that look for the actual virus, could never diagnose disease on their own.

And smell loss, like fever, is not exclusive to Covid-19. Other infections can blunt a person’s sense of smell. So can allergies, nasal congestion from the common cold, or simply the process of aging. About 80 percent of people over the age of 75 have some degree of smell loss. Some people are born anosmic.

Moreover, in many cases of Covid-19, smell loss can linger long after the virus is gone and people are no longer contagious — a complication that could land some people in a post-Covid purgatory if they are forced to rely on smell screens to resume activity, Dr. Yan said.

There are also many ways to design a smell-based screen. Odors linked to foods that are popular in some countries but not others, such as bubble gum or licorice, might skew test results for some individuals. People who have grown up in highly urban areas might not readily recognize scents from nature, like pine or fresh-cut grass.

Smell also is not a binary sense, strictly on or off. Dr. Reed advocated a step in which test takers rate the intensity of a test’s odors — an acknowledgment that the coronavirus can drastically reduce the sense of smell but not eliminate it.

But the more complicated the test, the more difficult it would be to manufacture and deploy speedily. And no test, even a perfectly designed one, would function with 100 percent accuracy.

Dr. Ameet Kini, a pathologist at Loyola University Medical Center, pointed out that smell tests would also not be free of the problems associated with other types of tests, such as poor compliance or a refusal to isolate.

Smell screens are “probably better than nothing,” Dr. Kini said. “But no test is going to stop the pandemic in its tracks unless it’s combined with other measures.”

Could a Smell Test Screen People for Covid?

Could a Smell Test Screen People for Covid?

A new modeling study hints that odor-based screens could quash outbreaks. But some experts are skeptical it would work in the real world.

A health worker in Altos de San Lorenzo, a neighborhood outside Buenos Aires, Argentina, administered a smell test last year.
A health worker in Altos de San Lorenzo, a neighborhood outside Buenos Aires, Argentina, administered a smell test last year.Credit…Alejandro Pagni/Agence France-Presse — Getty Images
Katherine J. Wu

  • Jan. 19, 2021, 5:49 p.m. ET

In a perfect world, the entrance to every office, restaurant and school would offer a coronavirus test — one with absolute accuracy, and able to instantly determine who was virus-free and safe to admit and who, positively infected, should be turned away.

That reality does not exist. But as the nation struggles to regain a semblance of normal life amid the uncontrolled spread of the virus, some scientists think that a quick test consisting of little more than a stinky strip of paper might at least get us close.

The test does not look for the virus itself, nor can it diagnose disease. Rather, it screens for one of Covid-19’s trademark signs: the loss of the sense of smell. Since last spring, many researchers have come to recognize the symptom, which is also known as anosmia, as one of the best indicators of an ongoing coronavirus infection, capable of identifying even people who don’t otherwise feel sick.

A smell test cannot flag people who contract the coronavirus and never develop any symptoms at all. But in a study that has not yet been published in a scientific journal, a mathematical model showed that sniff-based tests, if administered sufficiently widely and frequently, might detect enough cases to substantially drive transmission down.

Daniel Larremore, an epidemiologist at the University of Colorado, Boulder, and the study’s lead author, stressed that his team’s work was still purely theoretical. Although some smell tests are already in use in clinical and research settings, the products tend to be expensive and laborious to use and are not widely available. And in the context of the pandemic, there is not yet real-world data to support the effectiveness of smell tests as a frequent screen for the coronavirus. Given the many testing woes that have stymied pandemic control efforts so far, some experts have been doubtful that smell tests could be distributed widely enough, or made sufficiently cheat-proof, to reduce the spread of infection.

“I have been intimately involved in pushing to get loss of smell recognized as a symptom of Covid from the beginning,” said Dr. Claire Hopkins, an ear, nose and throat surgeon at Guy’s and St. Thomas’ Hospitals in the United Kingdom and an author of a recent commentary on the subject in The Lancet. “But I just don’t see any value as a screening test.”

A reliable smell test offers many potential benefits. It could catch far more cases than fever checks, which have largely flopped as screening tools for Covid-19. Studies have found that about 50 to 90 percent of people who test positive for the coronavirus experience some degree of measurable smell loss, a result of the virus wreaking havoc when it invades cells in the airway.

“It’s really like a function of the virus being in the nose at this exact moment,” said Danielle Reed, the associate director of the Monell Chemical Senses Center in Philadelphia. “It complements so much of the information you get from other tests.” Last month, Dr. Reed and her colleagues at Monell posted a study, which has not yet been published in a scientific journal, describing a rapid smell test that might be able to screen for Covid-19.

In contrast, only a minority of people with Covid-19 end up spiking a temperature. Fevers also tend to be fleeting, while anosmia can linger for many days.

A coronavirus testing site in Los Angeles. Smell tests, unlike P.C.R. and antigen tests, would not diagnose the disease nor look for the virus directly.
A coronavirus testing site in Los Angeles. Smell tests, unlike P.C.R. and antigen tests, would not diagnose the disease nor look for the virus directly.Credit…Kendrick Brinson for The New York Times

A smell test could also come with an appealingly low price tag, perhaps as low as 50 cents per card, said Derek Toomre, a cell biologist at Yale University and an author on Dr. Larremore’s paper. Dr. Toomre hopes that his version will fit the bill. The test, the U-Smell-It test, is a small smorgasbord of scratch-and-sniff scents arrayed on paper cards. People taking the test pick away at wells of smells, inhale and punch their guess into a smartphone app, shooting to correctly guess at least three of the five odors. Different cards contain different combinations of scents, so there is no answer key to memorize.

He estimated that the test could be taken in less than a minute. It is also a manufacturer’s dream, he said: A single printer “could produce 50 million of these tests per day.” Numbers like that, he argued, could make an enormous dent in a country hampered by widespread lack of access to tests that look directly for pieces of the coronavirus.

In their study, Dr. Larremore, Dr. Toomre and their collaborator Roy Parker, a biochemist at the University of Colorado, Boulder, modeled such a scenario using computational tools. Administered daily or almost daily, a smell screen that caught at least 50 percent of new infections was able to quash outbreaks nearly as well as a more accurate, slower laboratory test given just once a week.

Such tests, Dr. Larremore said, could work as a point-of-entry screen on college campuses or in offices, perhaps in combination with a rapid virus test. There might even be a place for them in the home, if researchers can find a way to minimize misuse.

“I think this is spot on,” said Dr. Carol Yan, an ear, nose and throat specialist at the University of California, San Diego. “Testing people repeatedly is going to be a valuable portion of this.”

Dr. Toomre is now seeking an emergency use authorization for the U-Smell-It from the Food and Drug Administration, and has partnered with a number of groups in Europe and elsewhere to trial the test under real-world conditions.

Translating theory into practice, however, will come with many challenges. Smell tests that can reliably identify people who have the coronavirus, while excluding people who are sick with something else, are not yet widely available. (Dr. Hopkins pointed to a couple of smell tests, developed before the pandemic, that cost about $30 each and remain in limited supply.) Should they ever be rolled out in bulk, they would inevitably miss some infected people and, unlike tests that look for the actual virus, could never diagnose disease on their own.

And smell loss, like fever, is not exclusive to Covid-19. Other infections can blunt a person’s sense of smell. So can allergies, nasal congestion from the common cold, or simply the process of aging. About 80 percent of people over the age of 75 have some degree of smell loss. Some people are born anosmic.

Moreover, in many cases of Covid-19, smell loss can linger long after the virus is gone and people are no longer contagious — a complication that could land some people in a post-Covid purgatory if they are forced to rely on smell screens to resume activity, Dr. Yan said.

There are also many ways to design a smell-based screen. Odors linked to foods that are popular in some countries but not others, such as bubble gum or licorice, might skew test results for some individuals. People who have grown up in highly urban areas might not readily recognize scents from nature, like pine or fresh-cut grass.

Smell also is not a binary sense, strictly on or off. Dr. Reed advocated a step in which test takers rate the intensity of a test’s odors — an acknowledgment that the coronavirus can drastically reduce the sense of smell but not eliminate it.

But the more complicated the test, the more difficult it would be to manufacture and deploy speedily. And no test, even a perfectly designed one, would function with 100 percent accuracy.

Dr. Ameet Kini, a pathologist at Loyola University Medical Center, pointed out that smell tests would also not be free of the problems associated with other types of tests, such as poor compliance or a refusal to isolate.

Smell screens are “probably better than nothing,” Dr. Kini said. “But no test is going to stop the pandemic in its tracks unless it’s combined with other measures.”

What You Can Do to Avoid the New Coronavirus Variant Right Now

Ask Well

What You Can Do to Avoid the New Coronavirus Variant Right Now

It’s more contagious than the original and spreading quickly. Upgrade your mask and double down on precautions to protect yourself.

Credit…Getty Images
Tara Parker-Pope

  • Jan. 19, 2021Updated 3:44 p.m. ET

New variants of the coronavirus continue to emerge. But one in particular has caused concern in the United States because it’s so contagious and spreading fast. To avoid it, you’ll need to double down on the same pandemic precautions that have kept you safe so far.

The variant known as B.1.1.7., which was first identified in Britain, doesn’t appear to cause more severe disease, but it has the potential to infect an estimated 50 percent more people. The Centers for Disease Control and Prevention has predicted that this variant could become the dominant source of infection in the United States by March. Variants with the same mutation have been reported in Brazil and South Africa, and now scientists are studying whether a variant with a different mutation, and first found in Denmark, has caused a surge in cases in California.

The new variant spreading in the United States appears to latch onto our cells more efficiently. (You can find a detailed look inside the variant here.) The change suggests it could take less virus and less time in the same room with an infected person for someone to become ill. People infected with the variant may also shed larger quantities of virus, which increases the risk to people around them.

“The exact mechanism in which it’s more transmissible isn’t entirely known,” said Nathan D. Grubaugh, assistant professor and epidemiologist at the Yale School of Public Health. “It might just be that when you’re infected, you’re exhaling more infectious virus.”

So how do you avoid a more-contagious version of the coronavirus? I spoke with some of the leading virus and infectious disease experts about what makes the new variant so worrisome and what we can do about it. Here’s what they had to say.

How can I protect myself from the new coronavirus variant?

The variant spreads the same way the coronavirus has always spread. You’re most likely to contract the virus if you spend time in an enclosed space breathing the air of an infected person. The same things that have protected you from the original strain should help protect you from the variant, although you may need to be more rigorous. Wear a two- or three-layer mask. Don’t spend time indoors with people not from your household. Avoid crowds, and keep your distance. Wash your hands often, and avoid touching your face.

“The first thing I say to people is that it’s not a different virus. All the things we have learned about this virus still apply,” said Dr. Ashish K. Jha, dean of the Brown University School of Public Health. “It’s not like this variant is somehow magically spreading through other means. Anything risky under the normal strain just becomes riskier with the variant.”

And let’s face it, after months of pandemic living, many of us have become lax about our Covid safety precautions. Maybe you’ve let down your guard, and you’re spending time indoors and unmasked with trusted friends. Or perhaps you’ve been dining in restaurants or making more trips to the grocery store each week than you did at the start of lockdowns. The arrival of the variant means you should try to cut back on potential exposures where you can and double down on basic precautions for the next few months until you and the people around you get vaccinated.

“The more I hear about the new variants, the more concerned I am,” said Linsey Marr, professor of civil and environmental engineering at Virginia Tech and one of the world’s leading aerosol scientists. “I think there is no room for error or sloppiness in following precautions, whereas before, we might have been able to get away with letting one slide.”

Should I upgrade my mask?

You should be wearing a high-quality mask when you run errands, go shopping or find yourself in a situation where you’re spending time indoors with people who don’t live with you, Dr. Marr said. “I am now wearing my best mask when I go to the grocery store,” she said. “The last thing I want to do is get Covid-19 in the month before I get vaccinated.”

Dr. Marr’s lab recently tested 11 mask materials and found that the right cloth mask, properly fitted, does a good job of filtering viral particles of the size most likely to cause infection. The best mask has three layers — two cloth layers with a filter sandwiched in between. Masks should be fitted around the bridge of the nose and made of flexible material to reduce gaps. Head ties create a better fit than ear loops.


Covid-19 Vaccines ›


Answers to Your Vaccine Questions

While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.

Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.

Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.

The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.

No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

If you don’t want to buy a new mask, a simple solution is to wear an additional mask when you find yourself in closer proximity to strangers. I wear a single mask when I walk my dog or exercise outdoors. But if I’m going to a store, taking a taxi or getting in the subway, I double mask by using a disposable surgical mask and covering it with my cloth mask.

Do I need an N95 medical mask?

While medical workers who come into close contact with sick patients rely on the gold-standard N95 masks, you don’t need that level of protection if you’re avoiding group gatherings, limiting shopping trips and keeping your distance from others.

“N95s are hard to get,” said Dr. Jha. “I don’t think people should think that’s what they need. Certainly there are a lot of masks out in the marketplace that are pretty good.”

If you’re working in an office or grocery store, or find yourself in a situation where you want added mask protection, you can get an alternative to the N95. Dr. Jha suggested using a KF94 mask, a type of mask made in South Korea that can be purchased easily online. It resembles an N95, with some differences. It’s made of a similar nonwoven material that blocks 94 percent of the hardest-to-trap viral particles. But the KF94 has ear loops, instead of elastic head bands, so it won’t fit as snugly as an N95.

The KF94 is also disposable — you can buy a pack of 20 for about $40 on Amazon. While you can let a KF94 mask air dry and reuse it a few times, it can’t be laundered and won’t last as long as a cloth mask. One solution is to save your KF94 mask for higher risk situations — like riding a subway, spending time in a store or going to a doctor’s appointment. Use your cloth mask for outdoor errands, exercise or walking the dog.

Are there additional ways to reduce my risk?

Getting the vaccine is the ultimate way to reduce risk. But until then, take a look at your activities and try reducing the time and number of exposures to other people.

For instance, if you now go to the store two or three times a week, cut back to just once a week. If you’ve been spending 30 to 45 minutes in the grocery store, cut your time down to 15 or 20 minutes. If the store is crowded, come back later. If you’re waiting in line, be mindful of staying at least six feet apart from the people ahead of you and behind you. Try delivery or curbside pickup, if that’s an option for you.

If you’ve been spending time indoors with other people who aren’t from your household, consider skipping those events until you and your friends get vaccinated. If you must spend time with others, wear your best mask, make sure the space is well ventilated (open windows and doors) and keep the visit as short as possible. It’s still safest to take your social plans outdoors. And if you are thinking about air travel, it’s a good idea to reschedule given the high number of cases around the country and the emergence of the more contagious variant.

“The new variants are making me think twice about my plan to teach in-person, which would have been with masks and with good ventilation anyway,” Dr. Marr said. “They’re making me think twice about getting on an airplane.”

Will the current Covid vaccines work against the new variants?

Experts are cautiously optimistic that the current generation of vaccines will be mostly effective against the emerging coronavirus variants. Earlier this month, Pfizer and BioNTech announced that their Covid vaccine works against one of the key mutations present in some of the variants. That’s good news, but the variants have other potentially risky mutations that haven’t been studied yet.

Some data also suggest that variants with certain mutations may be more resistant to the vaccines, but far more study is needed and those variants haven’t yet been detected in the United States. While the data are concerning, experts said the current vaccines generate extremely high levels of antibodies, and they are likely to at least prevent serious illness in people who are immunized and get infected.

“The reason why I’m cautiously optimistic is that from what we know about how vaccines work, it’s not just one antibody that provides all the protection,” said Dr. Adam Lauring, associate professor of infectious disease at the University of Michigan. “When you get vaccinated you generate antibodies all over the spike protein. That makes it less likely that one mutation here or there is going to leave you completely unprotected. That’s what gives me reason for optimism that this is going to be OK in terms of the vaccine, but there’s more work to be done.”

If I catch Covid-19, will I know if I have the new variant?

Probably not. If you test positive for Covid-19, the standard PCR test can’t definitively determine if you have the variant or the original strain. While some PCR test results can signal if a person is likely to be infected with a variant, that information probably won’t be shared with patients. The only way to know for sure which variant is circulating is to use gene sequencing technology, but that technology is not used to alert individuals of their status. While some public health and university laboratories are using genomic surveillance to track the prevalence of variants in a community, the United States doesn’t yet have a large-scale, nationwide system for checking coronavirus genomes for new mutations.

Treatment for Covid-19 is the same whether you have the original strain or the variant. You can read more about what to do if you get infected here.

Are children more at risk from the new variant?

Children appear to get infected with the variant at about the same rate as the original strain. A large study by health officials in Britain found that young children are only about half as likely as adults to transmit the variant to others. While that’s good news, the highly contagious nature of the variant means more children will get the virus, even if they are still proportionately less contagious and less prone to getting infected than adults. You can learn more here.

If I’ve already had Covid-19, am I likely to have the same level of immunity to the new strain?

Most experts agree that once you’ve had Covid-19, your body has some level of natural immunity to help fight off a second infection — although it’s not known how long the protection lasts. The variants circulating in Brazil and South Africa appear to have mutations that allow the virus to evade natural antibodies and reinfect someone who has already had the virus. The concern is based on lab tests using antibodies of people with a previous infection, so whether that translates to more reinfections in the real world isn’t known. The effect of the vaccine against these variants isn’t known yet either. While all of this sounds frightening, scientists are hopeful that even if the vaccines don’t fully protect against new variations of the virus, the antibodies generated by the vaccine still will protect people from more serious illness.

Modern Love: Lockdown Was Our Breaking Point

Modern Love

Lockdown Was Our Breaking Point

We needed to marry for our relationship to survive. But “le confinement” was too much.

Credit…Brian Rea

  • Jan. 15, 2021, 12:00 a.m. ET

Our two-year-old marriage was already struggling before the pandemic sent France into lockdown. Now here we were, stuck in our Paris apartment with my two teenage sons. “Le confinement,” as the French lyrically call it.

My husband, two decades younger than me, sought refuge from all the forced togetherness by barricading himself in the guest room, shoving the heavy sofa bed — normally used by my ex-husband when he comes to visit his sons — against the door.

I hated sleeping apart but rationalized our growing distance by telling myself that his snoring and my tossing made it difficult for us to get a good night’s rest. (Never mind that those things hadn’t been issues before.)

Besides, what couple doesn’t need space from time to time? Especially when the French government permitted only one hour of outside exercise per day, within one kilometer of home. To leave the house, we had to fill out a form and carry ID. Police were checking paperwork and issuing fines.

This was the flip side of having fallen madly in love with a man born the year I finished college. In the early days of our courtship, in Cairo, I was so caught up in the post-divorce, risk-laden thrill of stealing illicit kisses on poorly lit street corners — public displays of affection can land you in jail in Egypt — that I scarcely noticed the age difference.

Love may be blind, but lust is both blind and idiotic.

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As a mother, I had often felt the need to choose between the demands of parenthood and my sexual desires. That duality became even more stark when I met my second husband, who helped me rediscover the sensuality lying dormant during the 20 years I was married to the father of my children.

When I started letting him spend the night in the Cairo villa I shared with my sons, I was choosing the erotic version of myself over the maternal version. The boys must have thought I had been body snatched.

They would have been right. Sexual empowerment reanimated me. When my new lover and I met, he was exactly the same age I had been when I first got married. Choosing him felt like both a do-over and an escape from the invisibility of midlife. Not only did he see me as desirable, but our being together suddenly made me a source of envy. Women his age who admired his good looks would try to figure out our relationship. It was exactly the kind of validation I craved after a marriage in which the erotic flame had been doused long before we ended it.

I liked that our May-September romance was unconventional. Bucking the norms I had hewed to out of a sense of duty felt as validating as it did challenging.

My husband had to confront the alienation of his Tunisian family, who refused to acknowledge my existence, even after our wedding. Yes, we had fallen deeply in love, but choosing to marry was also an act of rebellion for each of us, a rejection of what society and friends and family expected. It felt like setting out into uncharted territory. It was exhilarating.

But marriage was also a necessity for our relationship’s survival. When I moved to Paris with my sons, my lover’s Tunisian passport made it nearly impossible for him to spend time with me here. We fixed our problem by flying to California and tying the knot.

Alas, thrill-seeking and passion can only take a marriage so far and, now that we were living as a family, reality had set in. Gone was the Middle Eastern backdrop, the inexpensive four-bedroom house with the verdant garden. The City of Lights is as romantic as ever, but Paris, for me, represented a return to the responsibilities of adult life with its endless loads of laundry and the drudgery of putting dinner on the table every night.

Since my husband’s arrival, I had been bumping up against the uncomfortable understanding that the way I wanted to live as a woman in my 50s was starkly different from how he thought life in his late 20s should look. My middle-aged friends bored him. My insistence on living in a clean and orderly house was, to him, senseless. And the hours he lost to Facebook, to watching European football, seemed pointless to me.

We sought out couples’ therapy, twice, but were no more able to communicate past our language and cultural barriers than we had been before. We still didn’t have the tools to address the imbalance of power that resulted from his being dependent on me for financial and visa support. He resented being reliant on me and, truthfully, I resented it too. I wanted an equal partner, someone I could depend on, someone who would share the load.

As wonderful a diversion as our love had been, I simply could not turn back the clock and be a suitable spouse to someone as young as my husband. I couldn’t pretend I hadn’t matured over the previous 22 years. I couldn’t unlearn what experience had taught me, nor did I want to. I love being 54. Falling in love with a younger man had rejuvenated me. I looked and felt better than ever. But surface is no substitute for depth.

As the days wore on, my husband’s self-isolation grew to feel less benign. Before long, we were not engaging in even monosyllabic exchanges. His main form of communication became the missives he left on strategically placed Post-it notes. I might wake up in the morning to find “I scrubbed this” on a pot that wasn’t getting clean or return from my run and discover “please refill after use” on the Brita pitcher.

I could hear the thump, thump of the weights he lifted for hours, but I hardly ever saw him. I never knew when he might burst out of the guest room to cook himself a meal or zip out to the grocery store.

Mostly, I wanted to protect my boys from seeing my pain. I felt guilty enough for letting them watch me fall to pieces when my marriage to their father collapsed, and here I was, forcing them into front-row seats to witness the failure of yet another relationship.

One day, when sifting through the cupboard and trying to find something he could eat that hadn’t been claimed by a Post-it with my husband’s initials, my 19-year-old turned to me in exasperation. “I can’t take it anymore,” he said.

I broke through the couch barricade to the guest room and told my husband we needed to talk. We were over, I said. We couldn’t go on like this. We were all suffering too much. And then, with nothing to lose, we allowed ourselves to say all the things we hadn’t been able to.

He told me how overwhelming the previous few years had been. Between estrangement from his family, fruitless job hunting, living in the land of his country’s former colonizer, the pressures of sharing a house with me and my teenagers, and never speaking his native Tunisian, he hadn’t been able to let his guard down for a minute. He loved me, but he had never wanted to be a stepfather.

For him, “le confinement” had allowed him to catch his breath. He hadn’t been stewing in anger in the spare room, as I had thought. Solitude had been a respite.

I heard his anguish. I felt his suffering. I managed to move past my anger and disappointment at my feelings of failure and having been failed. For a beautiful moment, we each saw the other. The love that we shared in that room briefly eclipsed the pain we had inflicted on one another. We vowed to do better.

I think, even then, we knew the futility of our promises. Confinement had both locked us down and birthed an unavoidable truth: We loved each other, but love wasn’t enough.

By choosing a man nearly half my age, I had not chosen the sexually empowered iteration of myself, but rather the mother. As I watched him unburden himself, I saw a beautiful man who was too young, too inexperienced to be my partner. If I wanted to fully embody the woman I had become, I had to release both him and the 25-year-old self I was trying to reinhabit.

When confinement finally lifted, and we were once again allowed to move freely through the city, my husband signed the lease on a sun-filled studio astride the Canal Saint Martin, where young hipsters hang out drinking craft beers.

Grabbing a black suitcase crammed full of clothes, he walked out of his self-imposed exile and into his new life. As I watched him leave, I cried. Of course I cried. But with confinement over, I could already feel the first flutters of my own rebirth.

Monique El-Faizy, who lives in Paris, is the co-author of “All the President’s Women.”

Modern Love can be reached at modernlove@nytimes.com.

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What Does a More Contagious Virus Mean for Schools?

What Does a More Contagious Virus Mean for Schools?

The coronavirus variant discovered in Britain is more easily spread among children, as it is among adults. Current safeguards should protect schools, experts said, but only if strictly enforced.

Children in Knutsford, England, returning to school this month following a Christmas break.
Children in Knutsford, England, returning to school this month following a Christmas break.Credit…Martin Rickett/PAMPC, via Associated Press
Apoorva Mandavilli

  • Jan. 14, 2021, 3:46 p.m. ET

It wasn’t until last fall that many parents started to breathe easier, as it became clear that elementary schools, at least, were not cesspools of infection with the coronavirus. But the alarming news of a more contagious version of the virus, first identified in Britain, revived those concerns.

Initial reports were tinged with worry that children might be just as susceptible as adults, fueling speculation that schools might need to pre-emptively close to limit the variant’s spread. But recent research from Public Health England may put those fears to rest.

Based on detailed contact-tracing of about 20,000 people infected with the new variant — including nearly 3,000 children under 10 — the report showed that young children were about half as likely as adults to transmit the variant to others. That was true of the previous iteration of the virus, as well.

“There was a lot of speculation at the beginning suggesting that children spread this variant more,” said Muge Cevik, an infectious disease expert at the University of St. Andrews in Scotland and a scientific adviser to the British government. “That’s really not the case.”

But the variant does spread more easily among children, just as it does among adults. The report estimated that the new variant is about 30 percent to 50 percent more contagious than its predecessors — less than the 70 percent researchers had initially estimated, but high enough that the variant is expected to pummel the United States and other countries, as it did Britain.

Prime Minister Boris Johnson of Britain had promised last year to do all he could to keep schools open. But he changed course in the face of soaring infections and buckling hospital systems, and ordered schools and colleges to move to remote learning. Other European countries put a premium on opening schools in September and have worked to keep them open, though the variant already has forced some to close.

In the United States, the mutant virus has been spotted only in a handful of states but is expected to spread swiftly, becoming the predominant source of infections by March. If community prevalence rises to unmanageable levels — a likely proposition, given the surge in most states — even elementary schools may be forced to close.

But that should be a last resort, after closures of indoor restaurants, bars, bowling alleys and malls, several experts said.

“I still say exactly what many people have said for the past few months — that schools should be the last thing to close,” said Helen Jenkins, an infectious disease expert at Boston University. Keeping schools open carries some risk, but “I think it can be reduced substantially with all the mitigations in place,” she said.

Reports of the new variant first surfaced in early December, and some researchers initially suggested that unlike with previous versions of the virus, children might be just as susceptible to the new variant as adults.

Researchers at P.H.E. looked at how efficiently people of various ages transmitted the variant to others. They found that children under 10 were roughly half as likely as adults to spread the variant.

Adolescents and teenagers between ages 10 and 19 were more likely than younger children to spread the variant, but not as likely as adults. (The range for the older group in the study is too broad to be useful for drawing conclusions, Dr. Cevik said. Biologically, a 10-year-old is very different from a 19-year-old.)

Over all, though, the variant was more contagious in each age group than previous versions of the virus. The mutant virus will result in more infections in children unless schools shore up their precautions, experts said.

“The variant is not necessarily affecting children particularly, but we know that it’s adding on more transmissibility to all age groups,” Dr. Cevik said. “We need to find ways to return these kids back to school as soon as possible; we need to use this time period to prepare.”

A schoolyard in Dortmund, Germany, this month. Fears of the new variant prompted Chancellor Angel Merkel to order schools closed.
A schoolyard in Dortmund, Germany, this month. Fears of the new variant prompted Chancellor Angel Merkel to order schools closed.Credit…Ina Fassbender/Agence France-Presse — Getty Images

In Germany, Chancellor Angela Merkel had vowed that schools would be the last thing to close during the second lockdown that began in November. Schools went to great lengths to keep in-person classes in session, requiring children to wear masks and opening windows to ensure better ventilation even as temperatures plummeted.

But fear of the variant’s spread prompted Ms. Merkel to keep schools closed following the holiday break at least through the end of January.

In France, where the new variant has not resulted in a surge of infections so far, schools reopened earlier this month after the winter break. France was not dealing with a particularly difficult epidemic, and health protocols put in place last September limited transmission in schools, Jean-Michel Blanquer, France’s education minister, has said.

The Italian government, too, has allowed not just elementary schools to open but also high schools, albeit at half capacity. Still, local leaders have implemented tighter restrictions, with some high schools slated to stay closed until the end of the month.

In the United States, the variant has only been spotted in a handful of states, and still accounts for less than 0.5 percent of infections. Schools remain open in New York City and many other parts of the country, but some have had to shut down because of rising virus infections in the community.

“Obviously, we don’t want to get to a point where it seems like we closed schools too late,” said Dr. Uché Blackstock, an urgent care physician in Brooklyn and founder of Advancing Health Equity, a health care advocacy group. “But at the same time, I think that we should try to keep our young children in school for as long as possible for in-person learning.”

It’s been clear for months what measures are necessary, Dr. Blackstock and other experts said: requiring masks for all children and staff; ensuring adequate ventilation in schools, even if just by opening windows or teaching outdoors; maintaining distance between students, perhaps by adopting hybrid schedules; and hand hygiene.

The new variant, while more contagious, is still thwarted by these measures. But only a few schools in Britain implemented them.

“When we look at what’s happened in the U.K. and think about this new variant, and we see all the case numbers going up, we have to remember it in the context of schools being open with virtually no modification at all,” Dr. Jenkins said. “I would like to see a real-life example of that kind of country or state or location, which has managed to control things in schools.”

There are some examples within the United States.

Erin Bromage, an immunologist at the University of Massachusetts Dartmouth, advised the governor of Rhode Island, as well as schools in southern Massachusetts, on preventive measures needed to turn back the coronavirus. The schools that closely adhered to the guidelines have not seen many infections, even when the virus was circulating at high levels in the community, Dr. Bromage said.

“When the system is designed correctly and we’re bringing children into school, they are as safe, if not safer, than they would be in a hybrid or remote system,” he said.

The school Dr. Bromage’s children attend took additional precautions. For example, administrators closed the school a few days before Thanksgiving to lower the risk at family gatherings, and operated remotely the week following the holiday.

Officials tested the nearly 300 students and staff at the end of that week, found only two cases, and decided to reopen.

“That gave us the confidence that our population was not representative of what we were seeing in the wider community,” he said. “We were using data to determine coming back together.”

The tests cost $61 per child, but schools that cannot afford it could consider testing only teachers, he added, because the data suggest the virus is “more likely to move from teacher to teacher than it is from student to teacher.”

In New York City, students and teachers are randomly tested, and have so far shown remarkably low rates of transmission within schools.

Dr. Blackstock has two children at an elementary school in Brooklyn, and said her son has not been tested all year. Even if the new variant brings a spike in cases, the city’s policy of closing a school if it has two unrelated infections is “too conservative,” she said.

If the number of cases skyrockets and the schools shut down more often, “then I would probably say, ‘This doesn’t feel right, let’s keep them home,’” she said. “But they’re going to be in school as long as I can possibly keep them.”

Emma Bubola contributed reporting from Milan, Melissa Eddy from Berlin, Constant Méheut from Paris and Benjamin Mueller from London.

Zoom Funeral Tips

How to Hold a Virtual Memorial Service

A virtual memorial offers several advantages: It’s easy for distant guests to attend, and you can record it.

Credit…Derek Abella

  • Jan. 14, 2021, 5:00 a.m. ET

When my 80-year-old father recently died, coronavirus restrictions meant that our family, like many others, could not safely gather for a funeral. My mother, brother and sister-in-law in New York, along with me in Berkeley, Calif., hastily organized a memorial service on Zoom.

What could have been a disaster or fodder for an episode of “Curb Your Enthusiasm” ended up being incredibly moving. Rather than diminishing the experience or getting in the way, videoconferencing facilitated an event filled with emotion, humor and love. During a difficult time for our family — in a devastating year for the entire world — that was an unexpected blessing.

Despite our fatigue with remote work meetings, we all were struck by how well-suited it turned out to be for a memorial.

Families who are opting for video memorials are probably doing so because of pandemic restrictions limiting the number of people who can attend an indoor gathering. Since you can join a virtual event from anywhere — and with minimal planning — more people are likely to attend than if they needed to travel to an in-person event.

In our case, the immediate family was on both coasts, one grandchild was in Scottsdale, Ariz., and the rabbi, Jeff Salkin of Temple Israel West Palm Beach, a longtime friend and former student of my dad, was in Florida.

With a videoconferencing service, you can style your memorial as you like. While we did not include photos, videos or music, nothing prevents you from doing so. In addition, a virtual memorial costs much less than an in-person event, where you’d have to pay for the brick-and-mortar venue and perhaps catered food. And you can easily record the event to share and save for posterity.

A virtual memorial also might accommodate more speakers than an in-person event. Ours began with moving eulogies by Rabbi Salkin, followed by my brother and me, then morphed into an impromptu shiva, as numerous guests offered wonderful remembrances and reflections about my dad. The event lasted two and a half hours; many people remained the entire time.

My father’s was not Rabbi Salkin’s first Zoom memorial service. He was skeptical before he led a Zoom gathering after his stepmother died of Covid-19 in April.

“I feared that such funerals would be alienating,” he said. “I was wrong. Wi-Fi carries the love quite effectively. In person, you can hold people’s hands and embrace them. On Zoom, it’s more about holding people’s eyes and simply being with them, in every way that matters.”

At the beginning of lockdown, Zoom ran into security issues. As the technology writer Brian X. Chen detailed in a column in April, weak privacy protections resulted in uninvited “Zoombombers” crashing meetings in embarrassing fashion.

That happened when my kids’ school district started distance learning: A nude man entered a virtual class and used racial slurs. It was a lesson for our family to be sure our event was password protected.

Even Jonathan Leitschuh, a software engineer and security researcher who identified flaws in Zoom’s security protocols that allowed hackers to take over Mac users’ webcams in 2019, turned to Zoom to plan a funeral for his mother who died in April.

“I went in terrified about a Zoombombing,” Mr. Leitschuh said. “I’d seen the same media coverage everyone else did.” But he said: “For this use case, I wasn’t aware of a better platform.”

There are several alternatives to Zoom, including Google Meet, Skype and GoTo Meeting, which may offer enhanced security protections and come with their own inherent trade-offs.

Funeral homes are also offering livestreamed services, in conjunction with limited in-person memorials. Chris Robinson, a fourth-generation funeral director in Easley, S.C., and spokesman for the National Funeral Directors Association, said his funeral home has been livestreaming services via its website, allowing anyone to attend without the need to download software or register for a videoconferencing platform.

“It’s important to go ahead and put together a virtual service,” he said, “rather than wait until the pandemic is over, because it could be a long time, and delaying indefinitely can be an ongoing trauma.”

In my family’s case, we were truly impressed by how videoconferencing, which can be so enervating in our daily work lives, enabled us to celebrate my dad’s full life in a beautiful and moving way.

If you have to arrange a memorial service on a video platform, here are some tips.

Go Pro

We purchased a one-month subscription to Zoom Pro (right now it’s $14.99 a month and you can cancel at any time). It allows for up to 100 participants (other plans allow for more, at additional cost), with unlimited meeting time, and stores a recording in the cloud. We’re glad we did. If we had had to limit the time of the event, we would have missed many moving contributions from participants.

Identify Someone to Handle Logistics

Because I created the account, I was the de facto meeting host. In hindsight I wish I had handed the role to my 17-year-old daughter, a digital native. Responsibilities include admitting people from the waiting room; muting all mics as appropriate; unmuting the officiant or other speakers; troubleshooting technical issues; providing assistance to guests; and passing messages along to family members in the chat box. Introduce the tech host at the beginning of the service, so people know whom to contact for help.

Familiarize Yourself With Platform Settings

The back end of video platforms have settings that can be tricky if you are new to them, especially if it is an emotional event. The host can go through the “toggle” switches in advance to figure out how to mute people upon entry or enable the waiting room, a security feature that keeps guests in a queue until the host admits them.

Who Will Lead?

Our virtual memorial succeeded, in part, because the rabbi wasn’t thrown off by the difficulties inexperienced Zoomers had muting themselves at the start. When the service segued into the shiva, my mother moderated — greeting people and making sure everyone who wanted to offer a remembrance had the chance to do so.

Plan a Dry Run to Anticipate Issues

Schedule one or more short practice sessions to work out kinks and make sure you’re on the same page about various roles. Some participants at our event were complete Zoom novices, fearful of missing the eulogy, and self-conscious about holding up the program as they attempted to mute as requested. We recommend offering tips to guests about logging on and off; muting and unmuting; switching screen views; and using the chat function — either along with the invitation, or on request ahead of the event. Don’t assume that everyone will be joining with up-to-date devices.

Invitations

We sent an email to notify friends and relatives of my dad’s death and of the Zoom event, including a link and password. Each of our family members compiled and distributed our own lists. You can also use Zoom to send email invitations.

You’re on TV (Sort of)

Without being obsessive, think about your on-screen appearance, makeup, lighting, camera height and angle and backdrop.

Beware of Tech Gremlins

While we were spared technical disruptions, the specter lurked in our minds. Many parts of the country experienced power outages this summer, and we’ve all had our internet connections go down or struggled with microphones and screens that freeze at just the wrong time. Although impossible to predict, be mindful of what could go wrong and how you’d handle it.

Ultimately, you want to make sure the virtual event accomplishes the same things an in-person funeral or memorial service would, honoring the life of the deceased and comforting the survivors. As it turned out, many more of my parents’ circle — friends and family in their 70s and 80s — were able to attend the funeral than would have been able to, even without Covid restrictions. Likewise, more people spoke than would have stepped to the lectern at an in-person funeral service. And the video we have is a blessing, which will enable my family to keep my father’s memory alive and hold on to vivid memories of those who so loved him.

Steven Birenbaum is senior communications officer at the California Health Care Foundation in Oakland, Calif.


Kids and Covid Tests: What You Need to Know

So You Think Your Kid Needs a Covid Test

Here’s everything you need to know about when to get it and what to expect.

Credit…Sonia Pulido
Christina Caron

  • Jan. 13, 2021, 6:00 a.m. ET

My 4-year-old daughter is pretty tough when it comes to medical procedures. The flu shot? Not even a flinch. Stitches in her forehead? No big deal. Years earlier, she calmly watched as a nurse pricked her finger and squeezed the blood, drop by drop, into a tiny vial to test it for lead.

But the Covid test was different.

In early September, just before her preschool reopened, she began sneezing and had a sore throat. When her congestion worsened, we knew that she needed to get a coronavirus test. But as the nurse approached her, holding a long stick with a brush on the end resembling a pipe cleaner, she covered her face and backed away. In the end, two people had to hold her down. She screamed as the swab activated her lacrimal reflex, bringing tears to her eyes. It was over quickly, but she cried for half an hour afterward and insisted that she would never visit another doctor again. She now refers to that probe as “the needle.”

In late December she needed another test for her preschool, but this time she wasn’t sick. With the memory of her last experience still fresh in my mind, I immediately started researching. Were there less invasive tests to consider? If so, how would we find one? Would it be accurate enough? And was there an ideal way to prepare a squeamish young child who was averse to getting tested?

As it turned out, none of these questions had simple answers. So I consulted with five doctors and two of the largest urgent care providers in the United States to learn more.

How do I know if my child needs a test?

There are four main reasons a child might need to be tested:

  • They have symptoms

  • They have been exposed to someone infected with the virus

  • Their school, day care or a hospital requires it

  • They need it as a precaution before and after traveling

If your child has any symptoms of Covid — even mild ones like a runny nose or a sore throat — it’s a good idea for them to get tested and stay home, said Dr. Stanley Spinner, chief medical officer and vice president of Texas Children’s Pediatrics, the largest pediatric primary care group in the country, and Texas Children’s Urgent Care.

“We have seen, time and time again, kids with very mild symptoms with no known exposures who get tested with our very accurate PCR and sure enough, they come back positive,” Dr. Spinner said.

If your child has been in close contact with someone who tested positive for Covid-19 — even if your child does not have any symptoms — they should get tested, the experts said. The Centers for Disease Control and Prevention define close contact as spending at least 15 minutes within six feet of someone who has the coronavirus, or having any type of direct physical contact with an infected person, including kissing or hugging.

If your child is in school or day care, those institutions may have rules on when they must be tested, and how.

It’s safest to stay home, but if you and your children must travel, the C.D.C. recommends getting tested one to three days before your trip and then again three to five days after your trip.

If you’re still unsure if your child needs a test, call their pediatrician, said Dr. Kristin Moffitt, an infectious disease specialist at Boston Children’s Hospital. You can also take the C.D.C.’s clinical assessment tool, which can be used for any family member, including children.

Which types of tests are available for kids?

Virus testing for children is, for the most part, the same as it is for adults. The Food and Drug Administration has authorized the emergency use of two basic categories of diagnostic test. The most sensitive ones are the molecular PCR tests, which detect the genetic material of the virus and can take days to deliver results (some locations offer results in as little as a day). The second type of test, the antigen test, hunts for fragments of proteins that are found on or within the coronavirus. Antigen tests typically yield results quickly, within 15 minutes, but can be less sensitive than the molecular tests.

The way your provider collects your sample can vary. For instance, regardless of whether you get a PCR test or an antigen test, the collection method could be any of the following: nasopharyngeal swab (the long swab with a brush at the end that reaches all the way up the nose toward the throat); a shorter swab that is inserted about an inch into the nostrils; a long swab of the tonsils at the back of the throat; or a short swab swizzled on the gums and cheeks. The new saliva tests, which are still being vetted, require you to drool into a sterilized container, which could be difficult for young children.

FastMed Urgent Care, which has a network of more than 100 clinics in Arizona, North Carolina and Texas, currently uses a long swab to perform the rapid antigen test and a short swab for the PCR test, said Dr. Lane Tassin, one of the company’s chief medical officers. But MedExpress, a different urgent care group with clinics in 16 states, tests all patients with the shorter nasal swab when doing either PCR or antigen tests at its nearly 200 urgent care centers, said Jane Trombetta, the company’s chief clinical officer.

Which diagnostic test should my child get?

The type of test that your child gets will largely depend on what is available in your area, how long it takes to get the results back and why the child needs it, the experts said.

Some day care centers and schools will only accept PCR results for clearance to return to school, so it is best to double check their rules beforehand.

The long-swab molecular test is considered the “gold standard,” but other less-invasive testing methods are also reliable. For routine testing, Dr. Jay K. Varma, senior advisor for public health at the Office of the Mayor of New York City, said the shorter swab “performs basically as well as the longer, deeper swab does. That’s true in both adults and children.” In fact, he added, New York City’s public hospital testing sites began switching from the long swab to the short swab during the summer.

Dr. Jennifer Lighter, a pediatric infectious disease specialist at NYU Langone Health, said she likes the antigen tests because they can quickly identify Covid-positive kids when they are contagious. Antigen tests are most accurate when the amount of virus in the sample is highest — typically around the day that symptoms start.

If you have a preference on which test you’d like your child to get, call your pediatrician’s office first and ask what kinds of tests they perform and how they collect the samples. Clarify whether they use the shallow (anterior) swab or the long (nasopharyngeal) swab. If you want the more comfortable, shallow PCR test but your pediatrician’s office does not offer it, try other testing centers in your area, including pediatric urgent care centers.

Some tests are now available for home use. But if you’re using a home test, check the label. Some aren’t indicated for children.

Are there any downsides to getting my kid tested? Is it safe?

Many testing sites offer drive-through services where you don’t need to leave your car. But if you must walk into a clinic, the experts I spoke with said that the risk of getting Covid while you’re there is low.

“In my experience, everyone that is delivering health care now is being incredibly careful with infection control,” said Dr. Sean O’Leary, the vice chairman of the American Academy of Pediatrics’ committee on infectious diseases. “The risk of going into a health care facility is probably pretty low relative to a lot of the other things people are currently engaging in in the U.S.”

Testing facilities require people to wear masks and to maintain physical distancing, he added.

The experts also said that the tests themselves are not harmful for young children, including infants, even if done repeatedly. The long swab may produce discomfort for a brief period — Dr. O’Leary jokingly calls it the “brain biopsy” — but he is not aware of any long-term risk to the nose or throat.

How can I prepare my child for the test?

To avoid any surprises, ask your provider about which types of tests they offer and how they collect the samples ahead of time.

It’s usually best to be straightforward with your kid about what to expect. For short nasal swabs, explain that a doctor will tickle the inside of their nose with a cotton swab to collect their boogers, and that it won’t hurt.

For the long swab, you may want to prepare your child by explaining that the swab might feel a little uncomfortable, but that it will be over quickly. You can also share that kids of all ages are getting the test, even babies.

Over all, convey that it’s no big deal and it’s something that simply needs to get done, Dr. Lighter said.

“Kids are only as anxious as the information that’s coming to them,” she added.

If your child might be intimidated by the protective gowns, masks and face shields that health providers wear, explain that they wear that clothing to stay safe — kind of like how people wear cloth masks when they go outside.

Some hospitals have created videos like this one from the Children’s Hospital Colorado that show how the Covid test works and what families can expect. If your child is old enough to understand, it might be helpful to watch a video like this together and then talk about it afterward.

Try to find out how long you might need to wait. Many areas have long lines at testing sites, so consider bringing water, snacks and entertainment (crayons, storybooks) for your kids.

If your child’s pediatrician is administering Covid tests, it might be reassuring for your child to have the test performed by someone they are already familiar with. But if not, “try and go somewhere that has experience working with children,” Dr. O’Leary said. Doctors and nurses who test children regularly will most likely know what to do if your child is nervous or scared.

One Mask Is Good. Would Two Would Be Better?

One Mask Is Good. Would Two Would Be Better?

Health experts double down on their advice for slowing the spread of the coronavirus.

A double-mask wearer in New York City in April.
A double-mask wearer in New York City in April.Credit…Kena Betancur/Getty Images
Katherine J. Wu

  • Jan. 12, 2021, 12:51 p.m. ET

Football coaches do it. President-elects do it. Even science-savvy senators do it. As cases of the coronavirus continue to surge on a global scale, some of the nation’s most prominent people have begun to double up on masks — a move that researchers say is increasingly being backed up by data.

Double-masking isn’t necessary for everyone. But for people with thin or flimsy face coverings, “if you combine multiple layers, you start achieving pretty high efficiencies” of blocking viruses from exiting and entering the airway, said Linsey Marr, an expert in virus transmission at Virginia Tech and an author on a recent commentary laying out the science behind mask-wearing.

Of course, there’s a trade-off: At some point, “we run the risk of making it too hard to breathe,” she said. But there is plenty of breathing room before mask-wearing approaches that extreme.

A year into the Covid-19 pandemic, the world looks very different. More than 90 million confirmed coronavirus infections have been documented worldwide, leaving millions dead and countless others with lingering symptoms, amid ongoing economic hardships and shuttered schools and businesses. New variants of the virus have emerged, carrying genetic changes that appear to enhance their ability to spread from person to person.

And while several vaccines have now cleared regulatory hurdles, the rollout of injections has been sputtering and slow — and there is not yet definitive evidence to show that shots will have a substantial impact on how fast, and from whom, the virus will spread.

Through all that change, researchers have held the line on masks. “Americans will not need to be wearing masks forever,” said Dr. Monica Gandhi, an infectious disease physician at the University of California, San Francisco, and an author on the new commentary. But for now, they will need to stay on, delivering protection both to mask-wearers and to the people around them.

The arguments for masking span several fields of science, including epidemiology and physics. A bevy of observational studies have suggested that widespread mask-wearing can curb infections and deaths on an impressive scale, in settings as small as hair salons and at the level of entire countries. One study, which tracked state policies mandating face coverings in public, found that known Covid cases waxed and waned in near-lockstep with mask-wearing rules. Another, which followed coronavirus infections among health care workers in Boston, noted a drastic drop in the number of positive test results after masks became a universal fixture among staff. And a study in Beijing found that face masks were 79 percent effective at blocking transmission from infected people to their close contacts.

Recent work by researchers like Dr. Marr is now pinning down the basis of these links on a microscopic scale. The science, she said, is fairly intuitive: Respiratory viruses like the coronavirus, which move between people in blobs of spittle and spray, need a clear conduit to enter the airway, which is crowded with the types of cells the viruses infect. Masks that cloak the nose and mouth inhibit that invasion.

The point is not to make a mask airtight, Dr. Marr said. Instead, the fibers that comprise masks create a haphazard obstacle course through which air — and any infectious cargo — must navigate.

“The air has to follow this tortuous path,” Dr. Marr said. “The big things it’s carrying are not going to be able to follow those twists and turns.”

Experiments testing the extent to which masks can waylay inbound and outbound spray have shown that even fairly basic materials, like cloth coverings and surgical masks, can be at least 50 percent effective in either direction.

Several studies have reaffirmed the notion that masks seem to be better at guarding people around the mask-wearer than mask-wearers themselves. “That’s because you’re stopping it right at the source,” Dr. Marr said. But, motivated by recent research, the Centers for Disease Control and Prevention has noted that there are big benefits for those who don masks as well.

Masks awaiting disinfecting at the Battelle N95 decontamination site in Somerville, Mass.
Masks awaiting disinfecting at the Battelle N95 decontamination site in Somerville, Mass.Credit…Michael Dwyer/Associated Press

The best masks remain N95s, which are designed with ultrahigh filtration efficiency. But they remain in short supply for health workers, who need them to safely treat patients.

Layering two less specialized masks on top of each other can provide comparable protection. Dr. Marr recommended wearing face-hugging cloth masks over surgical masks, which tend to be made with more filter-friendly materials but fit more loosely. An alternative is to wear a cloth mask with a pocket that can be stuffed with filter material, like the kind found in vacuum bags.

But wearing more than two masks, or layering up on masks that are already very good at filtering, will quickly bring diminishing returns and make it much harder to breathe normally.

Other tweaks can enhance a mask’s fit, such as ties that secure the fabric around the back of the head, instead of relying on ear loops that allow masks to hang and gape. Nose bridges, which can help the top of a mask to fit more snugly, offer a protective boost as well.

Achieving superb fit and filtration “is really simple,” Dr. Gandhi said. “It doesn’t need to involve anything fancy.”

No mask is perfect, and wearing one does not obviate other public health measures like physical distancing and good hygiene. “We have to be honest that the best response is one that requires multiple interventions,” said Jennifer Nuzzo, a public health expert at Johns Hopkins University.

Mask-wearing remains uncommon in some parts of the country, in part because of politicization of the practice. But experts noted that model behavior by the nation’s leaders might help to turn the tide. In December, President-elect Joseph R. Biden Jr. implored Americans to wear masks for his first 100 days in office, and said he would make doing so a requirement in federal buildings and on planes, trains and buses that cross state lines.

A large review on the evidence behind masking, published this month in the journal PNAS, concluded that masks are a key tool for reducing community transmission, and is “most effective at reducing spread of the virus when compliance is high.”

Part of the messaging might also require more empathy, open communication and vocal acknowledgment that “people don’t enjoy wearing masks,” Dr. Nuzzo said. Without more patience and compassion, simply doubling down on restrictions to “fix” poor compliance will backfire: “No policy is going to work if no one is going to adhere.”

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An Appreciation for Vaccines, and How Far They Have Come

The Checkup

An Appreciation for Vaccines, and How Far They Have Come

The DTP vaccine teaches us about how brilliant vaccine technology can be, but also how it can be studied and improved over time.

Credit…Getty Images

  • Jan. 11, 2021, 5:00 a.m. ET

This time of year, my thoughts turn to the DTP vaccine. Last year I wrote about the apocryphal “Christmas miracle” of 1891, in which the newly discovered diphtheria antitoxin may (or more likely, may not) have been used before it had been approved to save a child’s life.

Still, the moral was that bacteriology, that new 19th-century science, had figured out how one of the deadly microscopic bacteria did its damage, with a poison that could choke off children’s airways, and had invented an antidote, and that was miracle enough.

Soon after that column was published, we began to hear about a new microbial threat making it hard for people to breathe in Wuhan, China, and, well, you know the rest of the story. But now, a year later, I am — no surprise — thinking about vaccines, and how far this technology has come.

When I write about diphtheria, I usually mention that I have never seen it; by the time that I went to medical school and trained in pediatrics, it was already a historical disease in this country. My teachers could remember measles, and some of the older ones had seen polio, but no one in the 1980s in Boston was telling war stories about diphtheria.

Pertussis was different — the “P” in the DTP. Pertussis, better known as whooping cough, was still around, still something to worry about when a baby came in with a particularly bad cough, still something we worried we might miss. Once we heard the whoop, our teachers told us, we would never forget it.

And since the immunity did not last forever, either from childhood vaccines or from actual disease, and there was, at that time, no safe adult booster shot for pertussis, there was no way to protect us; whenever a child did turn out to have the disease, all the doctors and nurses and family members who had been exposed to that child would have to take a course of antibiotics, in case they had also been infected, and many pediatric residents ended up taking those antibiotics two or three times.

But you didn’t always know that you’d been exposed. In fact, I managed to catch pertussis in the line of duty and, without knowing it, to expose lots of babies and children, since I went on working when I was sick (in my own not-very-valid defense, I was just behaving in accordance with the fairly idiotic and highly macho rules of medicine, rules we can hope that the experience of Covid-19 will change forever).

The first thing you should know about the DTP vaccine is that all three of the diseases against which it protected a child — diphtheria, tetanus and pertussis — are bacterial diseases, unlike, for example, polio or smallpox, which are viral diseases. And one reason you may have been reading recently about the triumphs of polio vaccine in the 1950s, or the successful campaign to eradicate smallpox worldwide, is that the biological entities that cause those illnesses are more similar to the coronavirus that causes Covid-19 than any bacterial illness.

Still, the story of the DTP vaccine, and in particular the story of vaccinating against pertussis, has some interesting things to tell us, about how brilliant vaccine technology can be, but also how it can be studied and improved over time, and about trade-offs and controversies.

The first pertussis vaccines were developed and tested in the 1920s and 1930s and were in universal use by the end of the 1940s. And they worked. Dr. James Cherry, a distinguished research professor of pediatrics at David Geffen School of Medicine at the University of California, Los Angeles, and an expert on pertussis who has done extensive research both on the disease and on the vaccines, cites more than 36,000 pertussis deaths from 1926 to 1930 in the United States, most in young infants; from 1970 to 1974, there were 52.


Covid-19 Vaccines ›


Answers to Your Vaccine Questions

While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.

Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.

Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.

The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.

No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

Even so, when I started out in pediatrics, in the 1980s, the DTP was, no question, the shot we least liked giving. Of the shots that we routinely gave, this was the one that kids tended to react to — with fevers, with sore arms, and sometimes, though very rarely, with more serious reactions. “Reactogenic,” we sometimes called it.

The reactions had a lot to do with what went into the vaccine: whole inactivated Bordetella pertussis bacteria. And though bacteria are microscopically small, they are enormous and complex cells compared to viruses, which are just made up of protein and nucleic acid (DNA or RNA). In other words, a whole-cell vaccine contained many different compounds in it that the body might react to — there are more than 3,000 different proteins in the bacterial cell. For diphtheria and tetanus, single “toxoids” were used, inactivated versions of the poisons manufactured by those bacteria, so those components were much less reactogenic.

There were parents who believed that their children had been harmed by the vaccine, and strong sentiment against it in what we would now call the anti-vaccine movement, along with ongoing medical controversy over which problems had been caused by the vaccine and which were coincidences of timing in a vaccine given at 2, 4 and 6 months of age, and then again at around a year and a half.

Since 1999, children in the United States have been vaccinated with DTaP, rather than DTP, with the “a” standing for “acellular.” No more whole cells; these vaccine developers used specific proteins to which the body would manufacture immunity. DTaP shots are significantly less “reactogenic.”

They also tend to be less effective in provoking a long-lasting effective immune response; in a 2019 review, Dr. Cherry wrote that in almost every clinical trial, the whole-cell vaccines were more efficacious than the acellular vaccines. That meant a certain balancing of risks and benefits, and ongoing discussion, as the changeover to DTaP has been linked to recent resurgences in the number of cases, though not necessarily in deaths, and Dr. Cherry argues that the increased number of reported cases may actually be a result of raised awareness and better testing. But even if there is more pertussis around in adults, thanks to the vaccines, this is no longer a deadly disease of young children.

Although a safe adult booster called the Tdap has now been developed, there is still a great deal of pertussis infection in adolescents and adults, and it often goes undiagnosed, even among doctors, because in adults it may not look that different from other coughs and colds.

But it can; for me, it was a miserable disease, though not particularly dangerous — I wasn’t at risk of dying from it, even if it was the worst cough I ever had. Adults don’t even tend to produce the characteristic “whoop,” which comes from sucking in air back across the closed glottis, after a paroxysm of coughing — if I’d been whooping, surely I would have diagnosed myself, or my colleagues at the health center would have diagnosed me.

I see this as a story that should help us appreciate the unending ingenuity of the science that finds ways to turn on our complicated immune responses without making us suffer through a disease that once choked the life out of countless babies.

At the same time we can understand that getting the most out of the body’s immune defenses can take some learning and some study, and that there can be trade-offs that you consider for the good of the individual patient or the good of the community. We vaccinate adults against pertussis now not only to protect them, but also to make sure that the vulnerable — in this case, infants — are less likely to be exposed, and in fact, vaccinating pregnant women with the adult booster turns out to be a good way to protect their newborns.

Dr. Cherry said that vaccinating all pregnant women with Tdap “will prevent virtually all deaths from pertussis in the first two months of life.”

Surely, as we live though this pandemic, we can take a moment to be grateful for the remarkable progress in vaccine technology that has given us vaccines that target Covid-19 so elegantly and specifically, and offers us ways to protect not only ourselves, but also those around us.

Pressure Grows for States to Open Vaccines to More Groups of People

Pressure Grows for States to Open Vaccines to More Groups of People

Some states are already expanding eligibility to people 65 and over, even though millions of people the C.D.C. recommends go first — health care workers and nursing home residents — have yet to get shots.

Gov. Ron DeSantis of Florida, right, during vaccinations at the John Knox Village nursing home in Pompano Beach, Fla., last month.
Gov. Ron DeSantis of Florida, right, during vaccinations at the John Knox Village nursing home in Pompano Beach, Fla., last month.Credit…Marta Lavandier/Associated Press
Abby Goodnough

  • Jan. 9, 2021, 12:00 p.m. ET

Just weeks into the country’s coronavirus vaccination effort, states have begun broadening access to the shots faster than planned, amid tremendous public demand and intense criticism about the pace of the rollout.

Some public health officials worry that doing so could bring even more chaos to the complex operation and increase the likelihood that some of the highest-risk Americans will be skipped over. But the debate over how soon to expand eligibility is intensifying as deaths from the virus continue to surge, hospitals are overwhelmed with critically ill patients and millions of vaccine doses delivered last month remain in freezers.

Governors are under enormous pressure from their constituents — especially older people, who vote in great numbers and face the highest risk of dying from the virus — to get the doses they receive into arms swiftly. President-elect Joseph R. Biden Jr.’s decision, announced Friday, to release nearly all available doses to the states when he takes office on Jan. 20, rather than holding half to guarantee each recipient gets a booster shot a few weeks after the first, is likely to add to that pressure.

Some states, including Florida, Louisiana and Texas, have already expanded who is eligible to get a vaccine now, even though many people in the first priority group recommended by the Centers for Disease Control and Prevention — the nation’s 21 million health care workers and three million residents of nursing homes and other long-term care facilities — have not yet received a shot.

On Friday afternoon, New York became the latest state to do so, announcing that it would allow people 75 and over and certain essential workers to start receiving a vaccine on Monday.

But reaching a wider swath of the population requires much more money than states have received for the task, many health officials say, and more time to fine-tune systems for moving surplus vaccine around quickly, to increase the number of vaccination sites and people who give the shots, and to establish reliable appointment systems to prevent endless lines and waits.

Some states’ expansions have led to frantic and often futile efforts by older people to get vaccinated. After Florida opened up vaccinations to anyone 65 and older late last month, the demand was so great that new online registration portals quickly overloaded and crashed, people spent hours on the phone trying to secure appointments and others waited overnight at scattered pop-up sites offering shots on a first-come first-served basis.

Similar scenes have played out in parts of Texas, Tennessee and a handful of other states.

Still, with C.D.C. data suggesting that only about a third of the doses distributed so far have been used, Alex M. Azar II, the health and human services secretary, told reporters this past week: “It would be much better to move quickly and end up vaccinating some lower-priority people than to let vaccines sit around while states try to micromanage this process. Faster administration would save lives right now, which means we cannot let the perfect be the enemy of the good.”

Boxes of Moderna’s vaccine were prepared for shipment at a distribution center in Olive Branch, Miss., last month.
Boxes of Moderna’s vaccine were prepared for shipment at a distribution center in Olive Branch, Miss., last month.Credit…Pool photo by Paul Sancya

The C.D.C. guidelines were drawn up by an independent committee of medical and public health experts that advises the agency on immunization practices; it deliberated for months about who should get vaccinated initially, while supplies were still very limited. The committee weighed scientific evidence about who is most at risk of getting very sick or dying from Covid-19, as well as ethical questions, such as how best to ensure equal access among different races and socioeconomic groups.

Although the committee’s recommendations are nonbinding, states usually follow them; in this case, the committee suggests that states might consider expanding to additional priority groups “when demand in the current phase appears to have been met,” “when supply of authorized vaccine increases substantially” or “when vaccine supply within a certain location is in danger of going unused.”

Dr. Kevin Ault, an obstetrician at the University of Kansas Medical Center who serves on the advisory committee that came up with the C.D.C. guidelines, said that it was reasonable for states to start vaccinating new groups before finishing others, but that they should be careful about exacerbating inequities and biting off more than they can chew.

“Obviously if you’re going to vaccinate that group you need to have a well-thought-out plan in hand,” he said, referring to the over-65 population. “Having people camping out for vaccine is less than ideal, I would say.”

He added, “We put a lot of thought and effort into our guidelines, and I think they are good.”

After the first vaccines were given in mid-December, a dichotomy emerged between governors who were adhering precisely to the guidelines and others who moved quickly to populations beyond health care workers and nursing home residents.

Until Friday, Gov. Andrew M. Cuomo of New York, a Democrat, had threatened to penalize hospitals that provided shots to people who are not health care workers. By contrast, Gov. Ron DeSantis of Florida, a Republican, traveled to retirement communities around his state to emphasize the importance of getting people 65 and older, who number more than five million there, immunized fast.

“In Florida we’ve got to put our parents and grandparents first,” Mr. DeSantis said at The Villages, the nation’s largest retirement community, just before Christmas.

Gov. Andrew Cuomo of New YorkCredit…Andrew Kelly/Reuters
Gov. Mike DeWine of OhioCredit…Tony Dejak/Associated Press
Gov. Greg Abbott of TexasCredit…Eric Gay/Associated Press
Gov. Larry Hogan of MarylandCredit…Jonathan Ernst/Reuters

Decisions on how soon to expand eligibility for the shots have not fallen neatly along partisan lines.


Covid-19 Vaccines ›


Answers to Your Vaccine Questions

While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.

Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.

Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.

The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.

No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

Gov. Larry Hogan of Maryland, a Republican, announced Tuesday that he would immediately switch to what he called the “Southwest Airlines model” for vaccine allocation, referring to the airline’s open seating policy. “We’re no longer going to be waiting for all the members of a particular priority group to be completed,” he said, “before we move on to begin the next group in line.”

Gov. Mike DeWine of Ohio, a Republican, urged patience in a news briefing Tuesday as he declined to estimate when the state would start vaccinating people beyond the first priority group, known as “1a.”

“We’re asking every health department, ‘Don’t go outside 1a, stay within your lane,’” he said, adding about the vaccines, “This is a scarce commodity.”

By Thursday Mr. DeWine had set a date for people 80 and older to start getting the vaccine — Jan. 19 — and said he would phase in everyone 65 and older, as well as teachers, by Feb. 8.

The reasons so many doses received by states have not yet been administered to the first priority group are manifold. The fact that vaccination began around Christmas, when many hospital employees were taking vacation, slowed things. More health care workers are refusing to get the vaccine than many of their employers expected, and some hospitals and clinics received more doses than they needed but felt constrained by state rules from giving them to people outside the first priority groups. Some initially worried they could not even offer leftover doses in open vials to people in lower priority groups and let them go to waste.

Frontline health care workers and people age 65 and older waited to be vaccinated at a sports complex in Fort Myers, Fla., last month.Credit…Octavio Jones for The New York Times

And federal funding for vaccination efforts has been slow to reach states and localities: They got only $350 million through the end of last year, a little more than $1 per resident of the country. The economic rescue package that Congress passed in December included $8 billion for vaccine distribution that state health officials had long sought, but the first tranche of it, about $3 billion, is only now starting to be sent out.

“There was great funding in the development of these products, great funding in the infrastructure to ship them and get them out,” said Dr. Steven Stack, commissioner of the Kentucky Department for Public Health. “But then there was no funding provided of meaning for administering the vaccine, which is the last mile of this journey.”

The C.D.C. has recommended that a “1b” group consisting of people 75 and older and certain essential workers, including teachers, corrections officers and grocery store employees, be vaccinated next. The second group is much larger, about 50 million people. And the third recommended priority group — people 65 to 74, anyone 16 and older with high-risk medical conditions, and essential workers not already reached — numbers almost 130 million.

Pfizer and Moderna have pledged to deliver enough vaccine doses for 100 million people to each get the two necessary shots by the end of March, and many more in the second quarter. Several other vaccine candidates are far along in the pipeline, and if approved for emergency use here could help ramp up distribution more quickly.

The C.D.C. committee initially considered recommending that a wide range of essential workers get vaccinated before older Americans. Its rationale was that many essential workers are low-wage people of color, who have been hit disproportionately hard by the virus and had limited access to good health care. That sparked a backlash, and several governors, including Mr. DeSantis, quickly made clear they would cater to older people first.

Alex M. Azar, the health and human services secretary, left, and Surgeon General Jerome Adams, right, during a vaccination at George Washington University Hospital on Dec. 14.Credit…Pool photo by Jacquelyn Martin-Pool

Dr. Mark McClellan, who formerly headed the F.D.A. and now runs Duke University’s health policy center, said that while pushing ahead to vaccinate older people and other particularly vulnerable groups would accelerate the overall effort, “we’re going to be missing a lot of higher-risk individuals along the way.”

“I do worry about that becoming uneven in terms of access,” he said during a press briefing, “with lower-income groups, minority groups maybe in a tougher position if we don’t make it very easy for people in these high-risk groups to get vaccinated.”

Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, said he was surprised to hear federal officials like Mr. Azar and Dr. Jerome Adams, the surgeon general, advocate expanding vaccine access so broadly so soon.

“We didn’t come up with priority populations to slow things down, but because we knew there would be limited numbers of doses,” Dr. Plescia said. “If we try to do this in an equitable, fair way, it’s not going to be as fast as if our only goal is to get vaccine into as many arms as possible.”

Whether or not they are widening access now, governors are ramping up pressure on hospitals to use their allocated doses more quickly. Mr. Cuomo threatened to fine those that did not use their initial allocations by the end of this past week and not send them any more.

Mr. Hogan warned hospitals this past week, “Either use the doses that have been allocated to you or they will be directed to another facility or provider.”

Weekly Health Quiz: Coconut Oil, Coronavirus and Exercise Goals

1 of 7

Which statement about coconut oil is not true?

A tablespoon of coconut oil contains more calories than a tablespoon of butter

Coconut oil is primarily an unsaturated fat, similar to the fats in avocado

Coconut oil raises blood levels of LDL (“bad”) cholesterol

Coconut oil raises levels of HDL (“good”) cholesterol

2 of 7

People who walked about 5,000 steps a day were most likely to stick with a ramped-up exercise routine when they set an exercise target of about:

5,500 steps

7,500 steps

10,000 steps

15,000 steps

3 of 7

This state became the fifth to surpass a million coronavirus cases, after California, Texas, Florida and New York:

Illinois

Pennsylvania

Ohio

Georgia

4 of 7

Total Covid-related deaths have been highest in this state, with more than 38,000:

California

New York

Texas

Florida

5 of 7

A difference in blood pressure readings taken from the right and left arms may signal an increased risk of:

Heart attack

Stroke

Early death

All of the above

6 of 7

Women who have used oral contraceptives may be at lower risk of this form of cancer:

Thyroid cancer

Breast cancer

Ovarian or endometrial cancer

Cervical cancer

7 of 7

Julius Schachter, a microbiologist, died in December from Covid-19. He is perhaps best known for his reserach into this eye disease caused by the Chlamydia bacterium:

Keratitis

Blepharitis

Trachoma

Stye

Modern Love: We Needed More Significant Others

Modern Love

We Needed More Significant Others

A cancer diagnosis in the midst of the pandemic led to our improvising a wedding and joining a commune, where our family of two became 14.

Credit…Brian Rea

  • Jan. 8, 2021, 12:00 a.m. ET

Last June, instead of a rehearsal dinner the night before our wedding, Scott and I hosted a rooftop comedy roast for his soon-to-be-amputated right foot. One by one, our friends took turns walking up to the mic, wiping it down and removing their masks before making jokes about my fiancé’s doomed appendage.

“At least for the rest of your life,” said our friend Tank, “everything you do will be considered ‘brave.’”

A few months earlier, as coronavirus cases started to rise and people began hoarding toilet paper, Scott had ankle pain that wouldn’t go away. When physical therapy didn’t help, he got an M.R.I. Inconclusive results led to a PET scan.

After his first visit with the orthopedic oncologist, Scott stood in our newly outfitted home office in our small San Francisco apartment and said, “She told me if it’s a bone tumor, I’ll need surgery.”

“We can handle that,” I said. “Plenty of people have ankle surgery, right?”

“Surgery,” he said, “means amputation.”

After multiple biopsies over many weeks (Scott said he felt as if he were an Ikea desk being drilled into), his doctor called to deliver the diagnosis. We pulled off the highway and put her on speakerphone. It was osteosarcoma, a rare form of bone cancer that afflicts some 800 Americans a year. It appeared to have spread. The five-year survival rate for multifocal osteosarcoma is 30 percent.

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After we hung up, Scott — vegan, athlete, artificial intelligence engineer, the kind of person who adds turmeric to all his food — took my hand. Together for five years, we were only 32.

“Don’t worry,” he said. “I’ve never been below the top 30 percent for anything. But if something happens to me, I want to make sure you’re taken care of. Let’s get married now.”

We scheduled Scott’s below-the-knee amputation for 10 days later, a Monday. Our friends announced they were throwing us a wedding in Golden Gate Park the day before the surgery.

I wanted a wedding celebration, even if it was last-minute, so we could mark the occasion with more than just the administrative staff of the county clerk. Scott, however, wanted something more in line with his arid sense of humor: a foot roast. That’s how we ended up gathered on a roof telling amputation jokes and making bad puns about Scott getting “cold feet” before the wedding.

The next day we stood, masked and socially distanced, in Golden Gate Park with our closest friends, gathered at a week’s notice. I looked at Scott, handsome in his navy suit, noting that this was the last day he would fill it out with two legs and two feet.

Twenty-four hours later, I met him in the postoperative recovery room. He grinned a goofy, Fentanyl-fueled smile, but it faded as the drugs wore off and what he called the “Civil War pain” of his surgery kicked in. Soon the hospital’s Covid-19 visitor restrictions forced me to leave, and I stole one last glance at the space in the bed where the bottom of his leg had been.

When I unpacked Scott’s suitcase at home, I discovered his right shoe rolled up in a trash bag. Upset about that and all of the right shoes he would no longer need, I collected every one and shoved them into the back of the closet.

After our honeymoon (spent on the seventh floor of the hospital, followed by my mother-in-law moving into the apartment next door for two weeks), we received more bad news: The other suspicious spots meant he would have to undergo six cycles of intensive chemotherapy, during which he would need to live in the hospital. Two major surgeries would also be required to remove the lesions.

We faced the hardest year of our lives. Covid precautions would make it hard for friends or family to help or even visit, and the hospital would only allow Scott a single visitor per day. I looked into the future and saw night after night of coming home to an empty apartment, numbing myself with pizza and Netflix, and thought: We can’t do this by ourselves.

We tried to soldier on but struggled. One afternoon, our good friends Kristen and Phil visited us in our backyard; for the first time, they understood the gravity of what we were dealing with.

Not long after, they invited us to their place in Oakland for an outdoor dinner, but “their place” requires some explanation. A couple of years earlier, they founded a co-owned community called Radish, where a dozen or so people in their 20s and 30s live together. Most have their own one-bedroom apartment, but they share food expenses, cooking responsibilities and an outdoor space with a hot tub, fire pit and hammock. These days, they were working from home and following extremely strict Covid protocols.

As a researcher who studies romantic relationships, I have always been intrigued by this kind of arrangement. Modern couples expect to get all of their needs met by one romantic partner, but that can put a lot of pressure on the relationship. In 2015, a team of psychologists, led by Elaine Cheung, found that relying on different people for discrete needs leads to happier relationships. Eli Finkel, another psychologist, coined a name for them: OSOs (Other Significant Others).

An OSO can be a friend or family member who fulfills a need that your significant other cannot: a triathlete who exercises with you because your partner doesn’t, or a sibling you call to vent about work because your significant other hates corporate politics. This web of support is not new, but for many of us it has been lost.

For couples to survive and thrive, they need OSOs. That’s especially true during nightmarish years like the one Scott and I faced, which was exacerbated by the pandemic separating us from our normal network of support.

That evening, as we sat at a picnic table at Radish, one of the residents brought out roasted asparagus, a salad topped with seeds and berries, and a platter of sweet potatoes — a stark contrast to all that cold pizza and hospital food. As I ate and laughed, I felt happy and relaxed for the first time in months.

When we got into the car to drive home, I said to Scott, “We should move here.”

Scott and I are career-driven professionals. Living in a commune had not exactly been our life plan. Then again, none of this had been. So we adjusted. And after months of losses, we finally got a win: Radish had a one-bedroom, first-floor apartment opening up. Three weeks later we moved in.

Life at Radish has felt like turning on the lights after months of living in the dark. My new, bigger family and I have cooked elaborate dinners, commiserated about challenging co-workers and spent hours wilting in the hot tub.

Scott was still mostly confined to the hospital, but for me, instead of returning home from visits to a pizza-stained rug, I was welcomed with hugs and tea. And Scott got regular visits from many more significant others than me.

One rare Sunday morning when Scott was back home, I jumped into the shower before he woke up. There, against the stark white of the porcelain, were clumps of short red hair. I cleaned them up and crawled back into bed, where he turned to me, half-asleep, and said, “My hair is falling out.”

“I know.”

“I don’t want the nurses to shave it off with a dull razor,” he said. In the morning, he would be returning to the hospital for another week of chemo.

I’d had the strength to push through the foot roast and last-minute wedding, but something about his hair falling out really broke me, perhaps because I love his red hair so much. So I texted the group, and within minutes we decided to create a hair-shaving ceremony.

That evening, Misha D.J.ed songs from the musical “Hair” while Lauren ran a slide show of sexy bald men behind him. We all took turns shaving Scott’s head, moving through a series of faux hawks and mohawks before it all disappeared.

Hearing Scott laugh, I knew we would make it. I had known, in theory, about the importance of having OSOs in your life, but now I was surviving thanks to them.

One morning not long ago, when I was poaching eggs in the communal kitchen, Scott texted: “Where are my right shoes?”

I hadn’t imagined he would ever need them again, but of course he would, for his prosthetic. His first fitting was in the morning. Our housemate, Alex — who, unlike me, is a sports hardware engineer — had signed up to take him.

Logan Ury is the director of relationship science at Hinge. Her first book, “How to Not Die Alone,” will be published in February.

Modern Love can be reached at modernlove@nytimes.com.

To find previous Modern Love essays, Tiny Love Stories and podcast episodes, visit our archive.

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One 18-Hour Flight, Four Coronavirus Infections

One 18-Hour Flight, Four Coronavirus Infections

An outbreak aboard a September flight from Qatar to New Zealand offers researchers, and airlines, an opportunity to study in-transit contagion.

A masked passenger on a flight out of Kansas City, Mo., last year. The study of a largely empty flight last fall suggests that airlines will need to further tighten precautions on flights.
A masked passenger on a flight out of Kansas City, Mo., last year. The study of a largely empty flight last fall suggests that airlines will need to further tighten precautions on flights.Credit…Charlie Riedel/Associated Press
Benedict Carey

  • Jan. 7, 2021, 5:50 p.m. ET

The millions of airline passengers who traveled over the holidays experienced firsthand the unsettling uncertainties that come with flying during a pandemic. The anxious glances. The awkward semi-distancing. The haphazard mask etiquette, and the absence of regular service.

In an effort to reassure, the airlines have updated and adjusted their requirements for travelers, with patchwork results. Some airlines work to maintain social distance, both at the gate and at boarding; others are less vigilant. Mask-wearing is dependent on passenger compliance, and not predictable; nor, increasingly, is flight capacity, which can range from 20 percent to nearly full.

Given the variables, infectious disease specialists have had a hard time determining the risks of flying. But a study published on Wednesday provides some clarity.

After an 18-hour flight from Dubai landed in Auckland, New Zealand, in September, local health authorities discovered evidence of an outbreak that most likely occurred during the trip. Using seat maps and genetic analysis, the new study determined that one passenger initiated a chain of infection that spread to four others en route.

Previous research on apparent in-flight outbreaks focused on flights that occurred last spring, when few travelers wore masks, planes were running near capacity and the value of preventive measures was not broadly understood. The new report, of a largely empty flight in the fall, details what can happen even when airlines and passengers are aware and more cautious about the risks.

The findings deliver a clear warning to both airlines and passengers, experts said.

“The key message here is that you have to have multiple layers of prevention — requiring testing before boarding, social distancing on the flight, and masks,” said Dr. Abraar Karan, an internal medicine physician at Brigham and Women’s Hospital and Harvard Medical School who was not part of the study team. “Those things all went wrong in different ways on this flight, and if they’d just tested properly, this wouldn’t have happened.”

The new infections were detected after the plane landed in New Zealand; the country requires incoming travelers to quarantine for 14 days before entering the community. The analysis, led by researchers at the New Zealand Ministry of Health, found that seven of the 86 passengers on board tested positive during their quarantine and that at least four were newly infected on the flight. The aircraft, a Boeing 777-300ER, with a capacity of nearly 400 passengers, was only one-quarter full.

A diagram from the study shows the seating arrangement of the seven passengers who tested positive. The open circles represent passengers who tested negative for the coronavirus after the flight. All other seats shown remained empty.
A diagram from the study shows the seating arrangement of the seven passengers who tested positive. The open circles represent passengers who tested negative for the coronavirus after the flight. All other seats shown remained empty.Credit…Centers for Disease Control and Prevention

These seven passengers came from five countries, and they were seated within four rows of one another for the 18-hour duration of the flight. Two acknowledged that they did not wear masks, and the airline did not require mask-wearing in the lobby before boarding. Nor did it require preflight testing, although five of the seven passengers who later tested positive had taken a test, and received a negative result, in the days before boarding.

The versions of the coronavirus that all seven carried were virtually identical genetically — strongly suggesting that one person among them initiated the outbreak. That person, whom the report calls Passenger A, had in fact tested negative four or five days before boarding, the researchers found.

“Four or five days is a long time,” Dr. Kamar said. “You should be asking for results of rapid tests done hours before the flight, ideally.”

Even restrictive “Covid-free” flights, international bookings that require a negative result to board, give people a day or two before departure to get a test.

The findings are not definitive, cautioned the authors, led by Dr. Tara Swadi, an adviser with New Zealand’s Health Ministry. But results “underscore the value of considering all international passengers arriving in New Zealand as being potentially infected, even if pre-departure testing was undertaken, social distancing and spacing were followed, and personal protective equipment was used in-flight,” the researchers concluded.

Previous studies of infection risk during air travel did not clearly quantify the risk, and onboard air filtration systems are thought to reduce the infection risk among passengers even when a flight includes one or more infected people. But at least two recent reports strongly suggest that in-flight outbreaks are a risk: one of a flight from Boston to Hong Kong in March; the other of a flight from London to Hanoi, Vietnam, also in March.

On the Hong Kong flight, the analysis suggested that two passengers who boarded in Boston infected two flight attendants. On the Hanoi flight, researchers found that 12 of 16 people who later tested positive were sitting in business class, and that proximity to the infectious person strongly predicted infection risk.

Airline policies vary widely, depending on the flight and the carrier. During the first months of the pandemic, most U.S. airlines had a policy of blocking off seats, or allowing passengers to reschedule if a flight was near 70 percent full. But by the holidays those policies were largely phased out, said Scott Mayerowitz, executive editor at The Points Guy, a website that covers the industry.

All carriers have a mask policy, for passengers and crew — although passengers are not always compliant.

“Even before the pandemic, passengers weren’t always the best at following rules on airplanes,” Mr. Mayerowitz said. “Something about air travel brings out the worse in people, whether it’s fighting over reclined seats, or overhead bin space, or wearing a mask properly.”

Temperature checks are uncommon and are less than reliable as an indicator of infectiousness. And coronavirus tests are not needed for boarding, at least on domestic flights. Some international flights are “Covid tested”: to fly from New York to Rome on Alitalia, for example, passengers must have received a negative test result within 48 hours of boarding. They are tested again on arrival in Rome.

Dr. Kamar said that, unless all preventive measures are in place, there will be some risk of infection on almost any flight.

“It is surprising and not surprising, on an 18-hour flight, that an outbreak would occur,” Dr. Kamar said. “It’s more than likely that more than just those two people took off their mask at some point,” and every such lapse increases the likelihood of spread.

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A Riot Amid a Pandemic: Did the Virus, Too, Storm the Capitol?

A Riot Amid a Pandemic: Did the Virus, Too, Storm the Capitol?

Some scientists fear that the mayhem on Capitol Hill may have led to a so-called super-spreading event.

The rally on the National Mall before a mob entered the Capitol on Wednesday.
The rally on the National Mall before a mob entered the Capitol on Wednesday.Credit…Pete Marovich for The New York Times
Apoorva Mandavilli

  • Jan. 7, 2021, 3:29 p.m. ET

The mob that stormed the Capitol yesterday did not just threaten the heart of American democracy. To scientists who watched dismayed as the scenes unfolded on television, the throngs of unmasked intruders who wandered through hallways and into private offices may also have transformed the riot into a super-spreader event.

The coronavirus thrives indoors, particularly in crowded spaces, lingering in the air in tiny particles called aerosols. If even a few extremists were infected — likely, given the current rates of spread and the crowd size — then the virus would have had the ideal opportunity to find new victims, experts said.

“It has all the elements of what we warn people about,” said Anne Rimoin, an epidemiologist at the University of California, Los Angeles. “People yelling and screaming, chanting, exerting themselves — all of those things provide opportunity for the virus to spread, and this virus takes those opportunities.”

President Trump has downplayed the pandemic almost since its beginning, and many of his supporters who entered the Capitol yesterday did not appear to be wearing masks or making any effort at social distancing. Under similar conditions, gatherings held in such close quarters have led to fast-spreading clusters of infection.

But transmission of the virus has always been difficult to track. There is little effective contact tracing in the United States, and many in the crowd at the Capitol arrived from communities far from Washington.

The Black Lives Matter protests in the summer raised similar concerns. But most were held outdoors, and greater numbers of participants seemed to be masked. Research afterward suggested these were not super-spreading events.

Attendees of the rally preceding the rush to the Capitol on Wednesday also stood outdoors close together for hours, but “I’m less worried about what was happening outdoors,” Dr. Rimoin said. “The risk increases exponentially indoors.”

Rioters in the National Statuary Hall in the Capitol on Wednesday.
Rioters in the National Statuary Hall in the Capitol on Wednesday.Credit…Anna Moneymaker for The New York Times

Hundreds of rioters shouting in crowded rooms and hallways for extended periods of time can infect dozens of people at once, she and other experts said.

Three distinct groups — Capitol Police, rioters and members of Congress — “were spending time indoors, without social distancing, for long periods of time,” said Dr. Joshua Barocas, an infectious diseases physician at Boston University. The melee likely was a super-spreader event, he added, “especially given the backdrop of the highly transmissible variants that are circulating.”

Dr. Barocas was referring to a highly contagious new variant of the coronavirus, first identified in Britain. It has been spotted in several U.S. states but may well have spread everywhere in the country, making events like the Capitol riot even more risky, he said.

The idea that members of Congress may have been exposed, amid an already difficult transfer of power, particularly disturbed some scientists. “I am worried not only that it could it could lead to super spreading, but also super spreading to people who are elected officials,” said Dr. Tom Ingelsby, director of the Center for Health Security at Johns Hopkins University.

And infected members of Congress and law enforcement could have spread the virus to one another as they sheltered from the violence, he noted.

Rep. Jake LaTurner, Republican of Kansas, announced on Twitter early Thursday morning that he had tested positive for the virus. Mr. LaTurner was cloistered in the chamber with other members of Congress for much of the day.

At least a dozen of the 400 or so lawmakers and staff who were huddling in one committee room refused to wear masks even after being offered one, or wore them improperly below their chins, said Representative Susan Wild, Democrat of Pennsylvania.

They gathered in a committee room that quickly became crowded, making social distancing impossible, she said. Some of the lawmakers were unmasked, and several were shouting: “Tensions were high, and people were yelling at each other.”

“I just started getting really kind of angry, thinking about the holidays just passed, and how so many people did not spend time with their immediate families for fear of spreading,” she added, referring to her unmasked colleagues.

Representative Debbie Dingell, Democrat of Michigan, said the environment made her so nervous she sat on the floor at one point, hoping to duck whatever virus might be floating about. She has asked experts whether the lawmakers present should now quarantine, she said. She was wearing two masks, as she often does.

“I get that they think they have their individual freedoms,” she said of Republican lawmakers who eschewed masks. “It’s a rule for a reason. It’s to protect the common good.”

Electoral College votes were returned to a joint session of Congress late Wednesday.Credit…Erin Schaff/The New York Times

The risk for members of Congress will depend greatly on ventilation in the room where they sheltered, said Joseph Allen, an expert on buildings quality at the Harvard T.H. Chan School of Public Health in Boston.

“If there is a well-designed secure facility, then it would have great ventilation and filtration,” Dr. Allen said. “If it’s a place where they were just hunkered down wherever they could go that was safe, and it was not a place that was designed like that, then we don’t really know.”

It’s natural in a heart-pounding crisis to disregard risks that seem intangible or theoretical, he and other scientists noted.

“You cannot keep distance if you’re trying to leave a very intense and dangerous situation,” said Seema Lakdawala, an expert in respiratory virus transmission at the University of Pittsburgh. “You’re weighing the risk of your life over the risk of getting a virus at that moment.”

Members of Congress returned to continue the electoral count after the rioters were cleared from the Capitol. Some legislators took off their masks before giving a speech, Dr. Barocas noted, at precisely the time they needed to wear them. Talking at a high volume can expel vast quantities of aerosols, propelling them through an enclosed space.

Scientists have documented infectious aerosols suspended in air nearly 20 feet from an infected person. And a recent study from South Korea found that two people had become infected after spending just five minutes in a restaurant, 15 feet away from an infected patron.

Many Americans breathed sighs of relief as rioters departed the Capitol. Some experts feared that rioters heading back home could set off new chains of infection, perhaps impossible to track.

“We might get an inkling into how bad it might be because of the federal employees,” Dr. Barocas said. But “I don’t think that we’re going to know the extent of this super-spreader event.”

Even as the mob stormed the Capitol on Wednesday, the pandemic marked a grim milestone: The virus claimed nearly 4,000 lives, the highest daily toll thus far. The numbers are expected to keep rising.

The president has “created a culture in which people think it’s a hoax, and these basic control measures are being flouted repeatedly everywhere,” Dr. Allen said.