Tagged Coronavirus (2019-nCoV)

Need to Dust Off Your Social Skills?

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

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

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

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

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

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

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

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

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

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

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

So how do we relearn how to be together?

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

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

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

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

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

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

8 Exercises to Strengthen Your Social Muscles

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

Share food with someone.

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

Tell someone a joke in person.

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

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

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

Reach out to someone you’ve lost touch with.

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

Strike up a conversation with a stranger.

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

Move with someone.

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

Sit quietly with someone …

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

Make a date for the future.

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


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

Has the Era of Overzealous Cleaning Finally Come to an End?

This week, the C.D.C. acknowledged what scientists have been saying for months: The risk of catching the coronavirus from surfaces is low.

When the coronavirus began to spread in the United States last spring, many experts warned of the danger posed by surfaces. Researchers reported that the virus could survive for days on plastic or stainless steel, and the Centers for Disease Control and Prevention advised that if someone touched one of these contaminated surfaces — and then touched their eyes, nose or mouth — they could become infected.

Americans responded in kind, wiping down groceries, quarantining mail and clearing drugstore shelves of Clorox wipes. Facebook closed two of its offices for a “deep cleaning.” New York’s Metropolitan Transportation Authority began disinfecting subway cars every night.

But the era of “hygiene theater” may have come to an unofficial end this week, when the C.D.C. updated its surface cleaning guidelines and noted that the risk of contracting the virus from touching a contaminated surface was less than 1 in 10,000.

“People can be affected with the virus that causes Covid-19 through contact with contaminated surfaces and objects,” Dr. Rochelle Walensky, the director of the C.D.C., said at a White House briefing on Monday. “However, evidence has demonstrated that the risk by this route of infection of transmission is actually low.”

The admission is long overdue, scientists say.

“Finally,” said Linsey Marr, an expert on airborne viruses at Virginia Tech. “We’ve known this for a long time and yet people are still focusing so much on surface cleaning.” She added, “There’s really no evidence that anyone has ever gotten Covid-19 by touching a contaminated surface.”

During the early days of the pandemic, many experts believed that the virus spread primarily through large respiratory droplets. These droplets are too heavy to travel long distances through the air but can fall onto objects and surfaces.

In this context, a focus on scrubbing down every surface seemed to make sense. “Surface cleaning is more familiar,” Dr. Marr said. “We know how to do it. You can see people doing it, you see the clean surface. And so I think it makes people feel safer.”

A “sanitization specialist” at an Applebee’s Grill and Bar in Westbury, N.Y., wiping down a used pen last year. Restaurants and other businesses have highlighted extra cleaning in their marketing since the pandemic began.
A “sanitization specialist” at an Applebee’s Grill and Bar in Westbury, N.Y., wiping down a used pen last year. Restaurants and other businesses have highlighted extra cleaning in their marketing since the pandemic began.Hiroko Masuike/The New York Times

But over the last year, it has become increasingly clear that the virus spreads primarily through the air — in both large and small droplets, which can remain aloft longer — and that scouring door handles and subway seats does little to keep people safe.

“The scientific basis for all this concern about surfaces is very slim — slim to none,” said Emanuel Goldman, a microbiologist at Rutgers University, who wrote last summer that the risk of surface transmission had been overblown. “This is a virus you get by breathing. It’s not a virus you get by touching.”

The C.D.C. has previously acknowledged that surfaces are not the primary way that the virus spreads. But the agency’s statements this week went farther.

“The most important part of this update is that they’re clearly communicating to the public the correct, low risk from surfaces, which is not a message that has been clearly communicated for the past year,” said Joseph Allen, a building safety expert at the Harvard T.H. Chan School of Public Health.

Catching the virus from surfaces remains theoretically possible, he noted. But it requires many things to go wrong: a lot of fresh, infectious viral particles to be deposited on a surface, and then for a relatively large quantity of them to be quickly transferred to someone’s hand and then to their face. “Presence on a surface does not equal risk,” Dr. Allen said.

In most cases, cleaning with simple soap and water — in addition to hand-washing and mask-wearing — is enough to keep the odds of surface transmission low, the C.D.C.’s updated cleaning guidelines say. In most everyday scenarios and environments, people do not need to use chemical disinfectants, the agency notes.

“What this does very usefully, I think, is tell us what we don’t need to do,” said Donald Milton, an aerosol scientist at the University of Maryland. “Doing a lot of spraying and misting of chemicals isn’t helpful.”

Still, the guidelines do suggest that if someone who has Covid-19 has been in a particular space within the last day, the area should be both cleaned and disinfected.

“Disinfection is only recommended in indoor settings — schools and homes — where there has been a suspected or confirmed case of Covid-19 within the last 24 hours,” Dr. Walensky said during the White House briefing. “Also, in most cases, fogging, fumigation and wide-area or electrostatic spraying is not recommended as a primary method of disinfection and has several safety risks to consider.”

And the new cleaning guidelines do not apply to health care facilities, which may require more intensive cleaning and disinfection.

Saskia Popescu, an infectious disease epidemiologist at George Mason University, said that she was happy to see the new guidance, which “reflects our evolving data on transmission throughout the pandemic.”

But she noted that it remained important to continue doing some regular cleaning — and maintaining good hand-washing practices — to reduce the risk of contracting not just the coronavirus but any other pathogens that might be lingering on a particular surface.

Dr. Allen said that the school and business officials he has spoken with this week expressed relief over the updated guidelines, which will allow them to pull back on some of their intensive cleaning regimens. “This frees up a lot of organizations to spend that money better,” he said.

Schools, businesses and other institutions that want to keep people safe should shift their attention from surfaces to air quality, he said, and invest in improved ventilation and filtration.

“This should be the end of deep cleaning,” Dr. Allen said, noting that the misplaced focus on surfaces has had real costs. “It has led to closed playgrounds, it has led to taking nets off basketball courts, it has led to quarantining books in the library. It has led to entire missed school days for deep cleaning. It has led to not being able to share a pencil. So that’s all that hygiene theater, and it’s a direct result of not properly classifying surface transmission as low risk.”

Roni Caryn Rabin contributed reporting

We Weren’t Meant to Grieve Alone

We’ve been deprived of the last moments with loved ones and in-person gatherings to mourn together. What can we do to heal?

Swans do it, chimps do it; even elephants and whales do it. They fall in love and then after their beloved dies, they grieve. Human beings differ only to the extent that we have inherited rituals that help us deal with a shattering emotion. But what happens when those rites must be relinquished or reinvented during a plague year?

This question started to haunt me when a member of my cancer support group, Barbara, dropped out of our Zoom meetings. Hospice nurses had been helping her at home and now she was actively dying from ovarian cancer. How could our group continue to connect with her? I left messages with my name and phone number on her answering machine. I sent an email with that information — perhaps her two adult sons would access her account — but received no response.

In the past, I had sat by the bedside of dying group members and later attended religious services or life celebrations. Now, I found myself grieving the sorry fact that I had not been able to say goodbye to Barbara. After news of her death reached us, I grieved that I did not even know how to reach her family to tell them what a compassionate companion she had been.

The experience made me appreciate if not the curative then at least the consoling value of vigils, wakes, burials, funerals and memorials, each in its own way an event staged to help us stay attached and then begin loosening our ties to the ever-receding dead person. While sitting by a deathbed holding a hand, while standing in a cemetery as a coffin or urn is lowered into the earth with a prayer or a poem, while hearing a memory recalled at a funeral, we treasure the person who had been and gain comfort from others who share our sorrow. Most of these ceremonies have been canceled during the past year.

A new book on grief by the psychologist Dorothy P. Holinger is useful in thinking about the impact of the termination of mourning rituals, although it was written before the pandemic. The book, “The Anatomy of Grief,looks at how grief can wreck the brain, the heart and the emotions of the bereaved, a word that signifies those who feel robbed.

“Grief,” Dr. Holinger explains, “is the price we pay for love.” To be bereaved is to be robbed of the loved one and of the world and the self that had existed when they were alive.

Dr. Holinger’s book made me consider how normal or resilient grief differs from pandemic grief. The distinction reminded me of the bifurcation Sigmund Freud made between mourning — a healthy coming to terms with loss — and melancholia — a dysfunctional passage mired in misery. For in pestilent times, as Shakespeare put it, “grief lies all within.”

At any stage of history, to be sure, grief can destroy the world of survivors who cannot eat, sleep, think clearly, or go about their daily business. Grief can also obliterate identity. Who are we when we are no longer our parent’s child, our child’s parent, our sibling’s brother or sister, our partner’s partner, our friend’s friend? During a lockdown that isolates us by forbidding physical proximity, grief finds no outlet. We are deprived of the last moments in which we can see, touch, hear or speak to the beloved as well as subsequent days and months when we can cry, laugh, hug and reminisce with friends and family.

Dr. Holinger provides a taxonomy of different types of grief — some 17 varieties in all — many of which plunge the mourner into lingering preoccupation with the lost loved one. To use some of her terms about troubled forms of grieving, in a pandemic grief that cannot be made manifest may be “anticipatory” (death is expected), “disenfranchised” (mourners may not be acknowledged), “postponed” (sorrow remains unexpressed) and “forgotten” (loss goes unacknowledged).

When Judy Woodruff, the anchor of the PBS “NewsHour,” pauses each Friday night to memorialize five people killed by Covid-19, she acknowledges that she uses these individuals as representatives of a much larger population. In doing so, she encourages us to entertain the unimaginable fact that more than 500,000 Americans have died from the coronavirus, leaving innumerable widowed, orphaned and heartbroken survivors.

Those who mourn people who died during the pandemic but not from it are also affected. Like many survivors, the members of my cancer support group devised a way to communicate our grief over Barbara’s death. Each of us wrote a letter to her family that we collected and gave to Barbara’s oncologist, who forwarded the packet to her sons.

A few weeks later, I confronted a more fraught death. My former husband, a very dear friend, died unexpectedly, probably from a heart attack. It was a shock to his intimates but especially to our two daughters, neither of whom lives where he did. With travel an impossibility, how could we honor his memory? How could we find solace in each other? How could we bury his remains or sort through his things or close down his apartment?

These challenges have taught me how feeble and how effective electronic solutions can be. In an attempt to join together, the girls organized a series of Zoom shivas, the weeklong condolence calls in which many Jewish mourners engage. But our online meetings felt desiccated without an influx of visitors bringing food, drinks, flowers and a steady supply of embraces, kisses, jokes and tears. Yet a month or so later, the photographs, music and storytelling at a Zoom memorial arranged by the girls did console us as well as many of their father’s far-flung relatives and friends.

Still, there is nothing virtual about death. Perhaps families like ours can gather together on future anniversaries of the death, what in Yiddish is called the yahrzeit.

If, as after other national catastrophes, public memorials are erected to commemorate the suffering inflicted by the pandemic, they will need to honor the dead as well as all the mourners bereft of their bereavement.

Lecciones históricas sobre la resiliencia

Los brotes generalizados de enfermedades tienen el potencial de sacudir a las sociedades para que adopten nuevas formas de vida.

Hace cinco años, decidí escribir una novela ambientada en las secuelas de una terrible pandemia.

La novela era una historia alternativa, un western revisionista ambientado en el siglo XIX, y acabé investigando en abundancia sobre todo tipo de temas, desde las marcas de ganado hasta la obstetricia. Pero me avergüenza admitir que mi investigación sobre las catástrofes sanitarias fue un tanto escasa. Básicamente, analicé una lista de brotes de gripe, elegí el que se adaptaba mejor a mi argumento (una pandemia de 1830 que podría haber empezado en China) y empecé a escribir.

Pero cuando terminé el libro, sus acontecimientos chocaron con el presente. En marzo de 2020 estaba trabajando en las correcciones cuando la ciudad de Nueva York, donde vivo, empezó a cerrar. De repente, tuve mucho tiempo, y mucha motivación, para considerar lo que había acertado y lo que no sobre la devastación que la enfermedad genera en una sociedad.

En muchos aspectos, mi imaginación se había alejado de la realidad. Por un lado, ninguna pandemia conocida ha sido tan mortal como la que escribí, que mata al 90 por ciento de la población estadounidense. Sin embargo, tuve un instinto que resultó ser correcto: las pandemias tienen el potencial de conmocionar a las sociedades para que adopten nuevos estilos de vida. La peste negra, por ejemplo, provocó el fin de la servidumbre feudal y el ascenso de la clase media en Inglaterra.

No obstante, un brote de enfermedad también puede hacer que los gobiernos redoblen la represión y el fanatismo, como cuando Estados Unidos utilizó como chivo expiatorio a los estadounidenses de origen asiático durante las epidemias de peste del siglo XIX.

Una pintura del Hospital de Viruela de San Pancracio, alrededor de la década de 1880, en un campamento provisional en Londres.
Una pintura del Hospital de Viruela de San Pancracio, alrededor de la década de 1880, en un campamento provisional en Londres.Frank Collins/Buyenlarge, vía Getty Images

La historia no puede decirles a los políticos y activistas estadounidenses con exactitud cómo responder a la COVID-19; más bien ofrece ejemplos de lo que no se debe hacer. Sin embargo, los brotes en la Sudáfrica del siglo XX, la Inglaterra medieval, la antigua Roma y otros lugares pueden ofrecer algunas lecciones para quienes trabajan con el fin de curar los daños de la COVID y forjar una sociedad más justa tras su paso.

Hace cinco años, la historia de las pandemias fue un punto de partida para mí, una inspiración, y poco más. Ahora es algo más urgente: representa lo que podemos esperar en estos tiempos oscuros, así como lo que nos espera si no actuamos. A continuación enumero algunas lecciones aprendidas.

Adaptarse

La peste negra, una pandemia causada por la bacteria Yersinia pestis que se extendió por Asia, África y Europa a partir de 1346, fue “sin duda la crisis sanitaria más catastrófica de la historia”, dijo en una entrevista Mark Bailey, historiador y autor de After the Black Death: Economy, Society, and the Law in Fourteenth-Century England. En Inglaterra, la peste mató a cerca del 50 por ciento de la población en 1348 y 1349; en el conjunto de Europa, las estimaciones oscilan entre el 30 y el 60 por ciento. La magnitud de la mortandad fue un impacto enorme, aunque sus efectos fueron mucho más allá. Como dijo Monica Green, historiadora de la medicina que se ha especializado en la Europa medieval: “¿Quién va a recoger la cosecha si la mitad de la gente desapareció?”.

Diversas sociedades han respondido de manera diferente. En muchas partes del noroeste de Europa, como Gran Bretaña y lo que hoy son los Países Bajos, la muerte repentina de una gran parte de los trabajadores significaba que era más fácil para los sobrevivientes conseguir trabajo y adquirir tierras. “Se produce un aumento de la riqueza per cápita y una reducción de la desigualdad de la riqueza”, explicó Bailey. Desde un punto de vista económico, al menos, “la gente corriente está mejor”.

 “Huida de los habitantes del pueblo al campo para escapar de la plaga”, de 1630. La plaga se representa en el extremo derecho como un esqueleto que sostiene una daga y un reloj de arena./Universal Images Group, vía Getty Images

Lo contrario ocurrió en gran parte de Europa del Este, donde los terratenientes consolidaron su poder sobre el campesinado, ahora escaso, para volver a imponer la servidumbre y obligarlos a trabajar la tierra en condiciones favorables para los poderosos. Allí, la desigualdad se estabilizó o incluso aumentó a raíz de la peste.

Hay muchas explicaciones distintas pero una posibilidad es que “la peste negra tiende a acelerar las tendencias existentes”, por ejemplo, el movimiento hacia una economía menos feudal y más basada en el consumo en el norte de Europa, explicó Bailey. Pero esa región no se convirtió por arte de magia en un bastión de la igualdad después de la peste: el gobierno inglés impuso topes salariales a mediados del siglo XIV para evitar que los sueldos subieran demasiado. El resultado fue un malestar generalizado, que culminó en la Revuelta de los Campesinos de 1381, que reunió a personas de muy diversos orígenes sociales en una expresión de “frustración contenida” por la mala gestión de la economía por parte del gobierno, dijo Bailey.

En general, si “la resiliencia en una pandemia es hacer frente”, continuó, “posteriormente, la resiliencia económica y social consiste en adaptarse”. La lección moderna sería: “Adaptarse a la nueva realidad, al nuevo paradigma, a las nuevas oportunidades, es la clave”.

Combatir la desigualdad

El avance hacia una mayor igualdad económica en Inglaterra tras la peste puede haber sido un poco atípico: a lo largo de la historia, las epidemias tienden a intensificar las desigualdades sociales existentes.

En 1901, por ejemplo, cuando una epidemia de peste azotó Sudáfrica, “miles de sudafricanos negros fueron expulsados a la fuerza de Ciudad del Cabo bajo la suposición de que su libre circulación estaba influyendo en la propagación de la peste dentro de la ciudad”, dijo Alexandre White, profesor de sociología e historia de la medicina cuyo trabajo se enfoca en la respuesta a las pandemias. Esa expulsión sentó las bases de la segregación racial de la época del apartheid.

Estados Unidos también tiene un historial de políticas discriminatorias durante las epidemias, como la focalización en las comunidades asiático-estadounidenses durante los brotes de peste de principios del siglo XIX y principios del XX en Hawái y San Francisco, y la lenta respuesta federal a la epidemia de VIH cuando parecía afectar sobre todo a los estadounidenses de la comunidad LGBTQ, dijo White. Ese tipo de decisiones han ampliado no solo la desigualdad, sino que también han obstaculizado los esfuerzos para combatir la enfermedad: ignorar el VIH, por ejemplo, permitió que se extendiera por toda la población.

 Un científico que estudiaba la plaga en un laboratorio de San Francisco en 1961.Smith Collection/Gado/Getty Images

Y ahora, Estados Unidos se enfrenta a una pandemia que ha enfermado y matado de manera desproporcionada a los estadounidenses de color, quienes conforman buena parte de la mano de obra esencial pero tienen menos probabilidades de acceder a la atención médica. Mientras los gobiernos federales y estatales gestionan el despliegue de las vacunas, el acceso a las pruebas y al tratamiento, y los paquetes de ayuda económica, es crucial aprender del pasado y dirigir las políticas que reduzcan las desigualdades raciales y económicas que hicieron que la pandemia fuera tan devastadora.

“Si los efectos del racismo y la xenofobia fueran menos sistémicos en nuestra sociedad, probablemente veríamos menos muertes como resultado de la COVID-19”, comentó White. “La intolerancia es, de manera sustancial, mala para la salud pública”.

Adoptar la innovación inesperada

Aunque las pandemias han reafirmado viejos prejuicios y modos de marginación, también han generado cosas nuevas, especialmente en cuanto al arte, la cultura y el entretenimiento.

La antigua Roma, por ejemplo, estaba atormentada por las epidemias, que se producían cada quince o veinte años durante los siglos IV, III y II a. C., explica Caroline Wazer, escritora y editora que realizó una tesis sobre la salud pública romana. En aquella época, la principal respuesta en materia de salud pública era la religiosa, y los romanos experimentaban con nuevos ritos e incluso con nuevos dioses en un intento por detener la propagación de la enfermedad. En un caso, según Wazer, puesto que una epidemia que se prolongaba durante tres años y el público estaba cada vez más agitado, el Senado adoptó un extraño y nuevo ritual del norte de Italia que consistía en traer “actores para que se presentaran en el escenario”. Según el historiador romano Livio, “así es como los romanos tuvieron su teatro”, dijo Wazer, aunque esa idea ha sido debatida.

Una respuesta espiritual a la enfermedad también provocó un cambio cultural en la Inglaterra del siglo XIV. Recordando las fosas comunes de la peste negra, los británicos temían morir sin un entierro cristiano y pasar la eternidad en el purgatorio, dijo Bailey. Así que empezaron a formar gremios, pequeños grupos religiosos que funcionaban básicamente como “clubes de seguros de entierro”, en los que recaudaban dinero para dar a sus miembros el tratamiento adecuado tras la muerte.

Esas cofradías organizaban fiestas y otros eventos, y con el tiempo surgió la preocupación “por el consumo de cerveza en la iglesia y sus alrededores”, dijo Bailey. Así que los gremios comenzaron a construir sus propios salones para socializar. Luego, durante la Reforma en el siglo XVI, los gremios se disolvieron y los salones se convirtieron en algo nuevo: los pubs.

De hecho, los historiadores han argumentado que el aumento del consumismo y la riqueza de la gente común después de la peste negra allanó el camino para la cultura de los pubs por la que Inglaterra sigue siendo conocida hoy en día.

Sería frívolo calificar a esas innovaciones culturales como un “rayo de luz” originado por las pandemias; después de todo, han surgido muchas formas de arte y nuevos lugares sociales sin el catalizador de las muertes masivas. Sin embargo, vale la pena recordar que, incluso a raíz de los desastres de salud pública más devastadores, la vida social y la creatividad humana han resurgido de formas nuevas e inesperadas.

“Las pandemias son tanto catástrofes como oportunidades”, me dijo Bailey. En los próximos años, el mundo se enfrentará a la trágica oportunidad de reconstruirse tras la COVID-19. Si aprendemos las lecciones de la historia, quizá podamos hacerlo de una manera más justa, más inclusiva e incluso más alegre que el pasado que nos hemos visto obligados a superar.

Anna North es reportera sénior en Vox y autora de tres novelas, entre ellas Outlawed, la más reciente.


Opportunities Out of the Tragedies of the Pandemic

When life is disrupted by crisis, some people see opportunities — for change, action, introspection — they might not otherwise.

This article is part of a series on resilience in troubled times — what we can learn about it from history and personal experiences.

About a year ago, just as the pandemic was hitting New York City, St. John Frizell and his two partners were readying for the grand reopening of Gage & Tollner, a newly renovated, 140-year-old restaurant in Downtown Brooklyn. One day before the March 15 opening — for which the three partners had spent almost a year and a half preparing — they made the difficult decision not to open.

Mr. Frizell retreated to his home in Brooklyn. “The only sounds in the street were ice cream trucks and ambulances,” he recalled. Anxious about going to the supermarket but needing groceries for himself and his son, he reached out to one of his vendors, Lancaster Farm Fresh Co-op, to see about having some food delivered. Lancaster was delivering boxes of seasonal produce, but needed an order large enough to be worth the trip. So Mr. Frizell, who suddenly had downtime, did something he hadn’t done in a while: He reached out to his neighbors.

“I posted something about it in a local Red Hook group on Facebook and got a big response,” he said. “I thought, OK, I can set this up for all of us.”

Mr. Frizell also owns Fort Defiance, a beloved Red Hook bar that he opened in 2009 and that also closed in March; it became the order pickup spot. Neighbors began asking about other grocery items, so Mr. Frizell added things like milk, eggs, cheese and meats. “A lot of people in the neighborhood began looking to us for their staples,” he said.

By midsummer, Fort Defiance had permanently become a general store, with new signage painted over the old “Cafe & Bar.” This March, Mr. Frizell started a crowdfunding campaign to help the store move to a bigger space one block away. (Gage & Tollner, which has been open for takeout since mid-February, plans to open for indoor dining on April 15.) The whole experience made Mr. Frizell aware of how much richer his life is when he is connected to the community. “Reaching out and asking what people needed felt really good, like I was doing what I could to help,” he said. “It felt very purposeful.”

Fort Defiance in 2018. Now, the business operates as a general store serving the Red Hook neighborhood of Brooklyn.
Fort Defiance in 2018. Now, the business operates as a general store serving the Red Hook neighborhood of Brooklyn.Marian Carrasquero/The New York Times

When life is disrupted by crisis, as it has been this past year, some people see opportunities — for change, action, introspection — they might not otherwise. The pandemic has caused many to question the way they live and what is important to them. That’s because a crisis often helps us develop a wider perspective on our lives, said Amit Sood, a physician and executive director of the Global Center for Resiliency and Wellbeing in Rochester, Minn. And that allows us to reframe what we see.

Of course, for many people struggling to make ends meet or lacking savings, a big life change — or even just a shift in perspective — may not be possible. But for those fortunate enough to have the psychological space and economic security, this kind of reframing can present real possibilities for change.

“When people focus on what is right within what seems wrong in their life (for example, the car has a flat tire but isn’t totaled), that can lead to seeing things that present themselves as opportunities,” he said.

This is not the same thing as positive thinking. Instead, said Rick Hanson, a clinical psychologist and author of “Resilient: How to Grow an Unshakable Core of Calm, Strength, and Happiness,” it’s about seeing openings in life for change and transformation, even in difficult circumstances. Mr. Hanson said that although we often think of opportunities as things that exist outside ourselves, like a new job or moving to a different city, opportunities for growth and change exist inside us, too.

Justin E.H. Smith, for example, a philosopher, historian and professor at the University of Paris, made subtle but important changes this past year. Mr. Smith describes himself as an introvert with a tendency to lead a rigid life, doing the same things in the same way every day. The pandemic forced him to restructure his daily life and soften his rigidity.

“I’m aware of the contingency of these new routines now,” he said, “and my power to restructure them if they don’t suit.” Mr. Smith, 48, also admitted that he used to feel too old to try anything new. But the pandemic gave the professor permission to be a novice again. “It didn’t feel shameful any longer for me to be a beginner.”

So after some research, he opened an online brokerage account. He also took up guitar (and now plays every day) and in August, decided to start a paid subscription newsletter on the digital publishing platform Substack, where he writes about the philosophical dimensions of culture, science and politics, and the ways they are changed (and distorted) by technology.

Absent the pandemic, Mr. Smith probably never would have considered it, but for the first time in his professional life, he thought about diversifying his income. “I’m thinking ahead in a precarious moment,” he said.

Those sorts of moments often shake up all that we believe to be true about the world, and that is what leads to personal growth. “These are core beliefs we have about the world that we generally don’t question, such as how vulnerable or safe we are, how much control we have over things or what our identity is,” said Richard Tedeschi, who, along with fellow psychologist Lawrence Calhoun, coined the term “post-traumatic growth” in the 1990s, naming this phenomenon.

Red Hook in November. After the pandemic hit last spring, neighborhood residents began looking to Fort Defiance for basic grocery items.Karsten Moran for The New York Times

We use these assumptions about the world to make decisions every day and to plan for the future. When a crisis hits, we often have trouble believing and accepting what is happening because it disrupts those core beliefs. “That is what qualifies as trauma,” Dr. Tedeschi said. “And it can set in motion major changes in people’s lives.” In fact, one of the five areas where growth and change occur after a crisis is in recognizing new possibilities.

That is what happened to Elaine Mazanec. In mid-2019, she was a co-owner of a public relations agency in Washington and the mother of a 2-year-old when her husband died suddenly. As someone not used to asking for help, she was forced into a position of vulnerability.

“I allowed myself to be cared for in a way I hadn’t before,” Ms. Mazanec said. “I had so much support. It wasn’t comfortable for me, but it was what enabled me to find my footing after the loss.”

Just as she was getting back into a normal routine, the pandemic descended. “For the first few weeks, I felt similar to when I lost my husband, like the rug got pulled out from under me,” she said. In the weeks that followed she became more reflective, appreciating the positives in her life, especially the security and support she has (and that so many others do not).

“I think sometimes when we’re super busy, we don’t get a chance to zoom out and see the bigger picture,” Ms. Mazanec said. “I realized that what had felt the most meaningful for me in the last two years was having the support of others to help me through a terrible loss, to help me process it.”

Ms. Mazanec decided she wanted to be a person who supports others going through difficult times, so she started looking into graduate programs in social work. Most deadlines for applying had already passed, so when she learned that the University of Maryland School of Social Work — her first choice — had extended its deadline because of the pandemic, she took it as a sign she was on the right path.

Now in her second semester of the program and doing her fieldwork in an elementary school, Ms. Mazanec says she feels that the work has real purpose and is closely aligned with her values.

“The loss I experienced, that tragedy, really changed me,” she said. “And then the pandemic gave me an opening. It all came together in a way I couldn’t have predicted, but I know I’m where I’m supposed to be.”

Eilene Zimmerman is author of the memoir “Smacked: A Story of White-Collar Ambition, Addiction and Tragedy.”

Covid Victims Remembered Through Their Objects

The special project “What Loss Looks Like” presents personal artifacts belonging to those who have left us and explores what they mean to those left behind.

Times Insider explains who we are and what we do, and delivers behind-the-scenes insights into how our journalism comes together.

As the art director of the Well desk, I’ve spent the last year looking for images to reflect the devastation of the pandemic and the grief it has wrought. As the crisis has stretched on, I’ve thought of all the people who have lost loved ones to Covid-19 — not to mention those who have lost loved ones, period — and how they were cut off from the usual ways of gathering and grieving. Watching the numbers rise every day, it was easy to lose sight of the people behind the statistics. I wanted to find a way to humanize the death toll and re-establish the visibility of those who had died.

To help our readers honor the lives of those lost during the pandemic, we decided to ask them to submit photographs of objects that remind them of their loved ones. The responses were overwhelming, capturing love, heartache and remembrance. We heard from children, spouses, siblings, grandchildren and friends — people who had lost loved ones not only to Covid-19 but from all manner of causes. What united them was their inability to mourn together, in person.

Dani Blum, Well’s senior news assistant, spent hours speaking with each individual by phone. “It’s the hardest reporting I’ve ever done, but I feel really honored to be able to tell these stories,” she said. “What struck me the most about listening to all of these stories was how much joy there was in remembering the people who died, even amid so much tragedy. Many of these conversations would start in tears and end with people laughing as they told me a joke the person they lost would tell, or their favorite happy memory with them.”

The photographs and personal stories, published digitally as an interactive feature, was designed by Umi Syam and titled “What Loss Looks Like.” Among the stories we uncovered: A ceremonial wedding lasso acts as a symbol of the unbreakable bond between a mother and father, both lost to Covid-19 and mourned by their children. A ceramic zebra figurine reminds one woman of her best friend, who died after they said a final goodbye. A gold bracelet that belonged to a father never leaves his daughter’s wrist because she is desperate for any connection to his memory.

For those who are left behind, these items are tangible daily reminders of those who have departed. These possessions hold a space and tell a story. Spend time with them and you begin to feel the weight of their importance, the impact and memory of what they represent.

Museums have long showcased artifacts as a connection to the past. So has The New York Times, which published a photo essay in 2015 of objects collected from the World Trade Center and surrounding area on 9/11. As we launched this project, we heard from several artists who, in their own work, explored the connection between objects and loss.

Shortly after Hurricane Sandy, Elisabeth Smolarz, an artist in Queens, began working on “The Encyclopedia of Things,” which examines loss and trauma through personal objects. Kija Lucas, a San Francisco-based artist, has been photographing artifacts for the past seven years, displaying her work in her project “The Museum of Sentimental Taxonomy.”

Saved: Objects of the Dead” is a 12-year project by the artist Jody Servon and the poet Lorene Delany-Ullman, in which photographs of personal objects from deceased loved ones are paired with prose to explore the human experience of life, death and memory. And the authors Bill Shapiro and Naomi Wax spent years interviewing hundreds of people and asking them about the most meaningful single object in their lives, gathering their stories in the book “What We Keep.”

As the pandemic continues to grip the nation, the Well desk will continue to wrestle with the large-scale grief that it leaves in its wake. Other features on this topic include resources for those who are grieving, the grief that’s associated with smaller losses, and how grief affects physical and psychological health. As for “What Loss Looks Like,” we are keeping the callout open, inviting more readers to submit objects of importance, to expand and grow this virtual memorial and provide a communal grieving space.

What Loss Looks Like: Times Readers Share Artifacts of Remembrance

One in three Americans has lost someone to the coronavirus. “Those We’ve Lost” is a special series by The Times designed to put names and faces to the numbers. We also spoke to people the pandemic left behind.

During this season of grief, you may be looking for ways to begin healing. We gathered advice from bereavement experts and asked people who have recently experienced loss to share how they are finding peace.

There is also a kind of grief that isn’t routinely acknowledged; it’s called disenfranchised grief. From lost time with grandchildren to missing the milestones of youth, you can give yourself permission to mourn.

If you are having thoughts of suicide, the following organizations can help.

In the United States, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

In Britain, call Papyrus at +44 800 068 4141 (9am to midnight), or message Young Minds: text YM to 85258. You can also find a list of additional resources on Mind.org.

Many Children With MIS-C Had No Covid-19 Symptoms

Pediatricians should be vigilant, experts said, after the release of the largest U.S. study of the syndrome, MIS-C, that can strike young people weeks after their coronavirus infection.

Many children and teenagers who developed the mysterious inflammatory syndrome that can emerge several weeks after contracting the coronavirus never had classic Covid-19 symptoms at the time of their infection, according to the largest study so far of cases in the United States.

The study, led by researchers from the Centers for Disease Control and Prevention, found that in over 1,000 cases in which information about whether they got sick from their initial Covid-19 illness was available, 75 percent of the patients did not experience such symptoms. But two to five weeks later, they became sick enough to be hospitalized for the condition, called Multisystem Inflammatory Syndrome in Children (MIS-C), which can affect multiple organs, especially the heart.

Published Tuesday in JAMA Pediatrics, the study said that “most MIS-C illnesses are believed to result from asymptomatic or mild Covid-19” followed by a hyper-inflammatory response that appears to occur when the patients’ bodies have produced their maximum level of antibodies to the virus. Experts do not yet know why some young people, and a smaller number of adults, respond this way.

“It means primary-care pediatricians need to have a high index of suspicion for this because Covid is so prevalent in the society and children often have asymptomatic disease as their initial Covid infection,” said Dr. Jennifer Blumenthal, a pediatric intensivist and pediatric infectious disease specialist at Boston Children’s Hospital, who was not involved in the study.

The researchers evaluated 1,733 of the 2,090 cases of the syndrome in people age 20 and younger that had been reported to the C.D.C. as of January.

The findings show that although the syndrome is rare, it can be serious. The C.D.C’s data only included patients who were hospitalized. Over 90 percent of those young people experienced symptoms involving at least four organ systems and 58 percent needed treatment in intensive care units.

Many experienced significant heart issues: over half developed low blood pressure, 37 percent developed cardiogenic shock and 31 percent experienced cardiac dysfunction involving their heart’s inability to pump adequately. The study said that a significantly higher percentage of patients who had not had Covid-19 symptoms experienced those heart problems, compared with those who had initial coronavirus symptoms. A greater percentage of initially asymptomatic patients also ended up in intensive care.

“Even the kids with severe MIS-C, who were in the I.C.U. — the vast majority of them did not have a preceding illness that they recognized,” said Dr. Roberta DeBiasi, chief of infectious diseases at Children’s National Hospital in Washington, D.C., who was not involved in the research.

The study provided the most detailed demographic and geographic picture of the syndrome to date. About 34 percent of the patients were Black and 37 percent were Hispanic, reflecting the way that the coronavirus has disproportionately affected members of those communities. As the pandemic went on, the authors wrote, the proportion of patients who were white increased, comprising 20 percent of all cases. People of Asian heritage comprised just over 1 percent of patients.

Overall, nearly 58 percent of the patients were male, but the proportion was not the same across all ages. The youngest group — newborn to age 4 — had roughly equal numbers of boys and girls, and the male-to-female ratio increased in the older groups until it was more than two-to-one male to female in the 18-to-20 group.

The vast majority of patients (nearly 86 percent) were younger than 15. The study found that those under 5 had the lowest risk of serious heart complications and were less likely to need intensive care. Patients 10 and older were significantly more likely to develop issues like shock, low blood pressure and myocarditis (inflammation of the heart muscle).

“I think that’s similar to what we saw with Covid, that the older kids seemed to have more severe disease,” Dr. DeBiasi said. “And that’s because what makes people really sick from the Covid is the inflammatory aspect of it, so maybe these older kids, for whatever reasons, make more inflammation, whether that’s in primary Covid or MIS-C.”

Still, significant numbers of the youngest patients developed heart problems. In the newborn-to-4 age group, 36 percent had low blood pressure, 25 percent had shock and 44 percent were treated in the I.C.U.

Patients of all ages in the study had about the same occurrence of some of the less-common heart issues linked to the syndrome, including coronary aneurysms and fluid buildup. Children 14 and under were more likely to have rash and red eyes, while those older than 14 were more likely to have chest pain, shortness of breath and cough. Abdominal pain and vomiting afflicted about two-thirds of all patients.

There were 24 deaths recorded, spread across all age groups. There was no information in the study about whether patients had underlying medical conditions, but doctors and researchers have reported that young people with MIS-C were often previously healthy and significantly more likely to be healthy than the relatively small number of young people who become seriously ill from initial Covid infections.

Of the 1,075 patients for whom information about initial Covid illness was available, only 265 had symptoms at that time. They were more likely to be older — their median age was 11, while the median age of those with asymptomatic Covid infections was 8. But that could be because “younger children can’t express their concerns as well,” said Dr. Blumenthal, who co-wrote an editorial about the study.

“We don’t necessarily know if there’s actually less symptomatology in the very young population, ” she said.

Similarly unclear are the reasons behind the study’s finding that in the first wave of MIS-C, from March 1 to July 1, 2020, young people were more prone to a few of the most serious heart complications. Dr. DeBiasi said that did not match the experience of her hospital, where “the kids were sicker in the second wave.”

The study documented two waves of MIS-C cases that followed surges in overall coronavirus cases by about a month or more. “The most recent third peak of the Covid-19 pandemic appears to be leading to another MIS-C peak perhaps involving urban and rural communities,” the authors wrote.

The study found that most of the states where the rate of MIS-C cases per population was highest were in the Northeast, which had the first surge of cases, and the South. By contrast, most states with high per-population rates of children with Covid-19 but low rates of MIS-C were in the Midwest and West. While the concentration of cases spread from large cities to smaller towns over time, it wasn’t as pronounced as the overall pandemic trends, the authors said.

Dr. Blumenthal said that geographic pattern could reflect that the “understanding of the complications of the disease” hadn’t caught up to its prevalence in different regions or that many states with lower rates of MIS-C have less ethnically diverse populations. “It could also be something about Covid itself, although we don’t know that,” she said. “Right now, we don’t know anything about how the variants necessarily affect children.”

The study represented only the strictest criteria for MIS-C, excluding about 350 reported cases that met the C.D.C. definition of the syndrome but had a negative antibody test or primarily involved respiratory symptoms. Dr. DeBiasi said there are also many probable MIS-C cases that are not reported to the C.D.C. because they don’t meet all the official criteria.

“These probable MIS-C kids, in real life that’s a big chunk of kids,” she said. In addition, while the focus so far has been on serious cases, “there’s another whole group of kids that may actually have mild MIS-C.”

If a community has experienced a recent coronavirus surge, then “just because the kid says, ‘I never had Covid or my parents never had it,’ that doesn’t mean the kid in front of you doesn’t have MIS-C,” Dr. DeBiasi said. “If your city has Covid, then get ready.”

Many Children With Serious Inflammatory Syndrome Had No Covid Symptoms

Pediatricians should be vigilant, experts said, after the release of the largest U.S. study of the syndrome, MIS-C, that can strike young people weeks after their coronavirus infection.

Many children and teenagers who developed the mysterious inflammatory syndrome that can emerge several weeks after contracting the coronavirus never had classic Covid-19 symptoms at the time of their infection, according to the largest study so far of cases in the United States.

The study, led by researchers from the Centers for Disease Control and Prevention, found that in over 1,000 cases in which information about whether they got sick from their initial Covid-19 illness was available, 75 percent of the patients did not experience such symptoms. But two to five weeks later, they became sick enough to be hospitalized for the condition, called Multisystem Inflammatory Syndrome in Children (MIS-C), which can affect multiple organs, especially the heart.

Published Tuesday in JAMA Pediatrics, the study said that “most MIS-C illnesses are believed to result from asymptomatic or mild Covid-19” followed by a hyper-inflammatory response that appears to occur when the patients’ bodies have produced their maximum level of antibodies to the virus. Experts do not yet know why some young people, and a smaller number of adults, respond this way.

“It means primary-care pediatricians need to have a high index of suspicion for this because Covid is so prevalent in the society and children often have asymptomatic disease as their initial Covid infection,” said Dr. Jennifer Blumenthal, a pediatric intensivist and pediatric infectious disease specialist at Boston Children’s Hospital, who was not involved in the study.

The researchers evaluated 1,733 of the 2,090 cases of the syndrome in people age 20 and younger that had been reported to the C.D.C. as of January.

The findings show that although the syndrome is rare, it can be serious. The C.D.C’s data only included patients who were hospitalized. Over 90 percent of those young people experienced symptoms involving at least four organ systems and 58 percent needed treatment in intensive care units.

Many experienced significant heart issues: over half developed low blood pressure, 37 percent developed cardiogenic shock and 31 percent experienced cardiac dysfunction involving their heart’s inability to pump adequately. The study said that a significantly higher percentage of patients who had not had Covid-19 symptoms experienced those heart problems, compared with those who had initial coronavirus symptoms. A greater percentage of initially asymptomatic patients also ended up in intensive care.

“Even the kids with severe MIS-C, who were in the I.C.U. — the vast majority of them did not have a preceding illness that they recognized,” said Dr. Roberta DeBiasi, chief of infectious diseases at Children’s National Hospital in Washington, D.C., who was not involved in the research.

The study provided the most detailed demographic and geographic picture of the syndrome to date. About 34 percent of the patients were Black and 37 percent were Hispanic, reflecting the way that the coronavirus has disproportionately affected members of those communities. As the pandemic went on, the authors wrote, the proportion of patients who were white increased, comprising 20 percent of all cases. People of Asian heritage comprised just over 1 percent of patients.

Overall, nearly 58 percent of the patients were male, but the proportion was not the same across all ages. The youngest group — newborn to age 4 — had roughly equal numbers of boys and girls, and the male-to-female ratio increased in the older groups until it was more than two-to-one male to female in the 18-to-20 group.

The vast majority of patients (nearly 86 percent) were younger than 15. The study found that those under 5 had the lowest risk of serious heart complications and were less likely to need intensive care. Patients 10 and older were significantly more likely to develop issues like shock, low blood pressure and myocarditis (inflammation of the heart muscle).

“I think that’s similar to what we saw with Covid, that the older kids seemed to have more severe disease,” Dr. DeBiasi said. “And that’s because what makes people really sick from the Covid is the inflammatory aspect of it, so maybe these older kids, for whatever reasons, make more inflammation, whether that’s in primary Covid or MIS-C.”

Still, significant numbers of the youngest patients developed heart problems. In the newborn-to-4 age group, 36 percent had low blood pressure, 25 percent had shock and 44 percent were treated in the I.C.U.

Patients of all ages in the study had about the same occurrence of some of the less-common heart issues linked to the syndrome, including coronary aneurysms and fluid buildup. Children 14 and under were more likely to have rash and red eyes, while those older than 14 were more likely to have chest pain, shortness of breath and cough. Abdominal pain and vomiting afflicted about two-thirds of all patients.

There were 24 deaths recorded, spread across all age groups. There was no information in the study about whether patients had underlying medical conditions, but doctors and researchers have reported that young people with MIS-C were often previously healthy and significantly more likely to be healthy than the relatively small number of young people who become seriously ill from initial Covid infections.

Of the 1,075 patients for whom information about initial Covid illness was available, only 265 had symptoms at that time. They were more likely to be older — their median age was 11, while the median age of those with asymptomatic Covid infections was 8. But that could be because “younger children can’t express their concerns as well,” said Dr. Blumenthal, who co-wrote an editorial about the study.

“We don’t necessarily know if there’s actually less symptomatology in the very young population, ” she said.

Similarly unclear are the reasons behind the study’s finding that in the first wave of MIS-C, from March 1 to July 1, 2020, young people were more prone to a few of the most serious heart complications. Dr. DeBiasi said that did not match the experience of her hospital, where “the kids were sicker in the second wave.”

The study documented two waves of MIS-C cases that followed surges in overall coronavirus cases by about a month or more. “The most recent third peak of the Covid-19 pandemic appears to be leading to another MIS-C peak perhaps involving urban and rural communities,” the authors wrote.

The study found that most of the states where the rate of MIS-C cases per population was highest were in the Northeast, which had the first surge of cases, and the South. By contrast, most states with high per-population rates of children with Covid-19 but low rates of MIS-C were in the Midwest and West. While the concentration of cases spread from large cities to smaller towns over time, it wasn’t as pronounced as the overall pandemic trends, the authors said.

Dr. Blumenthal said that geographic pattern could reflect that the “understanding of the complications of the disease” hadn’t caught up to its prevalence in different regions or that many states with lower rates of MIS-C have less ethnically diverse populations. “It could also be something about Covid itself, although we don’t know that,” she said. “Right now, we don’t know anything about how the variants necessarily affect children.”

The study represented only the strictest criteria for MIS-C, excluding about 350 reported cases that met the C.D.C. definition of the syndrome but had a negative antibody test or primarily involved respiratory symptoms. Dr. DeBiasi said there are also many probable MIS-C cases that are not reported to the C.D.C. because they don’t meet all the official criteria.

“These probable MIS-C kids, in real life that’s a big chunk of kids,” she said. In addition, while the focus so far has been on serious cases, “there’s another whole group of kids that may actually have mild MIS-C.”

If a community has experienced a recent coronavirus surge, then “just because the kid says, ‘I never had Covid or my parents never had it,’ that doesn’t mean the kid in front of you doesn’t have MIS-C,” Dr. DeBiasi said. “If your city has Covid, then get ready.”

Researchers Are Hatching a Low-Cost Coronavirus Vaccine

A new formulation entering clinical trials in Brazil, Mexico, Thailand and Vietnam could change how the world fights the pandemic.

A new vaccine for Covid-19 that is entering clinical trials in Brazil, Mexico, Thailand and Vietnam could change how the world fights the pandemic. The vaccine, called NVD-HXP-S, is the first in clinical trials to use a new molecular design that is widely expected to create more potent antibodies than the current generation of vaccines. And the new vaccine could be far easier to make.

Existing vaccines from companies like Pfizer and Johnson & Johnson must be produced in specialized factories using hard-to-acquire ingredients. In contrast, the new vaccine can be mass-produced in chicken eggs — the same eggs that produce billions of influenza vaccines every year in factories around the world.

If NVD-HXP-S proves safe and effective, flu vaccine manufacturers could potentially produce well over a billion doses of it a year. Low- and middle-income countries currently struggling to obtain vaccines from wealthier countries may be able to make NVD-HXP-S for themselves or acquire it at low cost from neighbors.

“That’s staggering — it would be a game-changer,” said Andrea Taylor, assistant director of the Duke Global Health Innovation Center.

First, however, clinical trials must establish that NVD-HXP-S actually works in people. The first phase of clinical trials will conclude in July, and the final phase will take several months more. But experiments with vaccinated animals have raised hopes for the vaccine’s prospects.

“It’s a home run for protection,” said Dr. Bruce Innes of the PATH Center for Vaccine Innovation and Access, which has coordinated the development of NVD-HXP-S. “I think it’s a world-class vaccine.”

2P to the rescue

The molecular structure of HexaPro, a modified version of the SARS-CoV-2 spike protein, with its six key alterations shown as red and blue spheres.
The molecular structure of HexaPro, a modified version of the SARS-CoV-2 spike protein, with its six key alterations shown as red and blue spheres.University of Texas at Austin

Vaccines work by acquainting the immune system with a virus well enough to prompt a defense against it. Some vaccines contain entire viruses that have been killed; others contain just a single protein from the virus. Still others contain genetic instructions that our cells can use to make the viral protein.

Once exposed to a virus, or part of it, the immune system can learn to make antibodies that attack it. Immune cells can also learn to recognize infected cells and destroy them.

In the case of the coronavirus, the best target for the immune system is the protein that covers its surface like a crown. The protein, known as spike, latches onto cells and then allows the virus to fuse to them.

But simply injecting coronavirus spike proteins into people is not the best way to vaccinate them. That’s because spike proteins sometimes assume the wrong shape, and prompt the immune system to make the wrong antibodies.

Jason McLellan, a structural biologist at the University of Texas at Austin. His research on coronavirus spike proteins aided the development of the Pfizer, Moderna, Johnson & Johnson and Novavax vaccines.Ilana Panich-Linsman for The New York Times

This insight emerged long before the Covid-19 pandemic. In 2015, another coronavirus appeared, causing a deadly form of pneumonia called MERS. Jason McLellan, a structural biologist then at the Geisel School of Medicine at Dartmouth, and his colleagues set out to make a vaccine against it.

They wanted to use the spike protein as a target. But they had to reckon with the fact that the spike protein is a shape-shifter. As the protein prepares to fuse to a cell, it contorts from a tulip-like shape into something more akin to a javelin.

Scientists call these two shapes the prefusion and postfusion forms of the spike. Antibodies against the prefusion shape work powerfully against the coronavirus, but postfusion antibodies don’t stop it.

Dr. McLellan and his colleagues used standard techniques to make a MERS vaccine but ended up with a lot of postfusion spikes, useless for their purposes. Then they discovered a way to keep the protein locked in a tulip-like prefusion shape. All they had to do was change two of more than 1,000 building blocks in the protein into a compound called proline.

The resulting spike — called 2P, for the two new proline molecules it contained — was far more likely to assume the desired tulip shape. The researchers injected the 2P spikes into mice and found that the animals could easily fight off infections of the MERS coronavirus.

The team filed a patent for its modified spike, but the world took little notice of the invention. MERS, although deadly, is not very contagious and proved to be a relatively minor threat; fewer than 1,000 people have died of MERS since it first emerged in humans.

But in late 2019 a new coronavirus, SARS-CoV-2, emerged and began ravaging the world. Dr. McLellan and his colleagues swung into action, designing a 2P spike unique to SARS-CoV-2. In a matter of days, Moderna used that information to design a vaccine for Covid-19; it contained a genetic molecule called RNA with the instructions for making the 2P spike.

Other companies soon followed suit, adopting 2P spikes for their own vaccine designs and starting clinical trials. All three of the vaccines that have been authorized so far in the United States — from Johnson & Johnson, Moderna and Pfizer-BioNTech — use the 2P spike.

Other vaccine makers are using it as well. Novavax has had strong results with the 2P spike in clinical trials and is expected to apply to the Food and Drug Administration for emergency use authorization in the next few weeks. Sanofi is also testing a 2P spike vaccine and expects to finish clinical trials later this year.

Two prolines are good; six are better

Dr. McLellan’s ability to find lifesaving clues in the structure of proteins has earned him deep admiration in the vaccine world. “This guy is a genius,” said Harry Kleanthous, a senior program officer at the Bill & Melinda Gates Foundation. “He should be proud of this huge thing he’s done for humanity.”

But once Dr. McLellan and his colleagues handed off the 2P spike to vaccine makers, he turned back to the protein for a closer look. If swapping just two prolines improved a vaccine, surely additional tweaks could improve it even more.

“It made sense to try to have a better vaccine,” said Dr. McLellan, who is now an associate professor at the University of Texas at Austin.

In March, he joined forces with two fellow University of Texas biologists, Ilya Finkelstein and Jennifer Maynard. Their three labs created 100 new spikes, each with an altered building block. With funding from the Gates Foundation, they tested each one and then combined the promising changes in new spikes. Eventually, they created a single protein that met their aspirations.

The winner contained the two prolines in the 2P spike, plus four additional prolines found elsewhere in the protein. Dr. McLellan called the new spike HexaPro, in honor of its total of six prolines.

The structure of HexaPro was even more stable than 2P, the team found. It was also resilient, better able to withstand heat and damaging chemicals. Dr. McLellan hoped that its rugged design would make it potent in a vaccine.

Dr. McLellan also hoped that HexaPro-based vaccines would reach more of the world — especially low- and middle-income countries, which so far have received only a fraction of the total distribution of first-wave vaccines.

“The share of the vaccines they’ve received so far is terrible,” Dr. McLellan said.

To that end, the University of Texas set up a licensing arrangement for HexaPro that allows companies and labs in 80 low- and middle-income countries to use the protein in their vaccines without paying royalties.

Meanwhile, Dr. Innes and his colleagues at PATH were looking for a way to increase the production of Covid-19 vaccines. They wanted a vaccine that less wealthy nations could make on their own.

With a little help from eggs

The first wave of authorized Covid-19 vaccines require specialized, costly ingredients to make. Moderna’s RNA-based vaccine, for instance, needs genetic building blocks called nucleotides, as well as a custom-made fatty acid to build a bubble around them. Those ingredients must be assembled into vaccines in purpose-built factories.

The way influenza vaccines are made is a study in contrast. Many countries have huge factories for making cheap flu shots, with influenza viruses injected into chicken eggs. The eggs produce an abundance of new copies of the viruses. Factory workers then extract the viruses, weaken or kill them and then put them into vaccines.

The PATH team wondered if scientists could make a Covid-19 vaccine that could be grown cheaply in chicken eggs. That way, the same factories that make flu shots could make Covid-19 shots as well.

In New York, a team of scientists at the Icahn School of Medicine at Mount Sinai knew how to make just such a vaccine, using a bird virus called Newcastle disease virus that is harmless in humans.

For years, scientists had been experimenting with Newcastle disease virus to create vaccines for a range of diseases. To develop an Ebola vaccine, for example, researchers added an Ebola gene to the Newcastle disease virus’s own set of genes.

The scientists then inserted the engineered virus into chicken eggs. Because it is a bird virus, it multiplied quickly in the eggs. The researchers ended up with Newcastle disease viruses coated with Ebola proteins.

At Mount Sinai, the researchers set out to do the same thing, using coronavirus spike proteins instead of Ebola proteins. When they learned about Dr. McLellan’s new HexaPro version, they added that to the Newcastle disease viruses. The viruses bristled with spike proteins, many of which had the desired prefusion shape. In a nod to both the Newcastle disease virus and the HexaPro spike, they called it NDV-HXP-S.

PATH arranged for thousands of doses of NDV-HXP-S to be produced in a Vietnamese factory that normally makes influenza vaccines in chicken eggs. In October, the factory sent the vaccines to New York to be tested. The Mount Sinai researchers found that NDV-HXP-S conferred powerful protection in mice and hamsters.

“I can honestly say I can protect every hamster, every mouse in the world against SARS-CoV-2,” Dr. Peter Palese, the leader of the research, said. “But the jury’s still out about what it does in humans.”

The potency of the vaccine brought an extra benefit: The researchers needed fewer viruses for an effective dose. A single egg may yield five to 10 doses of NDV-HXP-S, compared to one or two doses of influenza vaccines.

“We are very excited about this, because we think it’s a way of making a cheap vaccine,” Dr. Palese said.

A nurse administering the NDV-HXP-S  vaccine to a volunteer at Mahidol University in Bangkok during the country’s first human trial.Government Pharmaceutical Organization of Thailand, via Agence France-Presse — Getty Images

PATH then connected the Mount Sinai team with influenza vaccine makers. On March 15, Vietnam’s Institute of Vaccines and Medical Biologicals announced the start of a clinical trial of NDV-HXP-S. A week later, Thailand’s Government Pharmaceutical Organization followed suit. On March 26, Brazil’s Butantan Institute said it would ask for authorization to begin its own clinical trials of NDV-HXP-S.

Meanwhile, the Mount Sinai team has also licensed the vaccine to the Mexican vaccine maker Avi-Mex as an intranasal spray. The company will start clinical trials to see if the vaccine is even more potent in that form.

To the nations involved, the prospect of making the vaccines entirely on their own was appealing. “This vaccine production is produced by Thai people for Thai people,” Thailand’s health minister, Anutin Charnvirakul, said at the announcement in Bangkok.

From left, Dimas Covas, director of the Butantan Institute in Brazil; João Doria, governor of the state of São Paulo; and Jean Gorinchteyn, the state health secretary, announcing the ButanVac Covid-19 vaccine candidate against in São Paulo on March 26. Miguel Schincariol/Agence France-Presse — Getty Images

In Brazil, the Butantan Institute trumpeted its version of NDV-HXP-S as “the Brazilian vaccine,” one that would be “produced entirely in Brazil, without depending on imports.”

Ms. Taylor, of the Duke Global Health Innovation Center, was sympathetic. “I could understand why that would really be such an attractive prospect,” she said. “They’ve been at the mercy of global supply chains.”

Madhavi Sunder, an expert on intellectual property at Georgetown Law School, cautioned that NDV-HXP-S would not immediately help countries like Brazil as they grappled with the current wave of Covid-19 infections. “We’re not talking 16 billion doses in 2020,” she said.

Instead, the strategy will be important for long-term vaccine production — not just for Covid-19 but for other pandemics that may come in the future. “It sounds super promising,” she said.

In the meantime, Dr. McLellan has returned to the molecular drawing board to try to make a third version of their spike that is even better than HexaPro.

“There’s really no end to this process,” he said. “The number of permutations is almost infinite. At some point, you’d have to say, ‘This is the next generation.’”

Researchers Are Hatching a Low-Cost Covid-19 Vaccine

A new formulation entering clinical trials in Brazil, Mexico, Thailand and Vietnam could change how the world fights the pandemic.

A new vaccine for Covid-19 that is entering clinical trials in Brazil, Mexico, Thailand and Vietnam could change how the world fights the pandemic. The vaccine, called NVD-HXP-S, is the first in clinical trials to use a new molecular design that is widely expected to create more potent antibodies than the current generation of vaccines. And the new vaccine could be far easier to make.

Existing vaccines from companies like Pfizer and Johnson & Johnson must be produced in specialized factories using hard-to-acquire ingredients. In contrast, the new vaccine can be mass-produced in chicken eggs — the same eggs that produce billions of influenza vaccines every year in factories around the world.

If NVD-HXP-S proves safe and effective, flu vaccine manufacturers could potentially produce well over a billion doses of it a year. Low- and middle-income countries currently struggling to obtain vaccines from wealthier countries may be able to make NVD-HXP-S for themselves or acquire it at low cost from neighbors.

“That’s staggering — it would be a game-changer,” said Andrea Taylor, assistant director of the Duke Global Health Innovation Center.

First, however, clinical trials must establish that NVD-HXP-S actually works in people. The first phase of clinical trials will conclude in July, and the final phase will take several months more. But experiments with vaccinated animals have raised hopes for the vaccine’s prospects.

“It’s a home run for protection,” said Dr. Bruce Innes of the PATH Center for Vaccine Innovation and Access, which has coordinated the development of NVD-HXP-S. “I think it’s a world-class vaccine.”

2P to the rescue

The molecular structure of HexaPro, a modified version of the SARS-CoV-2 spike protein, with its six key alterations shown as red and blue spheres.
The molecular structure of HexaPro, a modified version of the SARS-CoV-2 spike protein, with its six key alterations shown as red and blue spheres.University of Texas at Austin

Vaccines work by acquainting the immune system with a virus well enough to prompt a defense against it. Some vaccines contain entire viruses that have been killed; others contain just a single protein from the virus. Still others contain genetic instructions that our cells can use to make the viral protein.

Once exposed to a virus, or part of it, the immune system can learn to make antibodies that attack it. Immune cells can also learn to recognize infected cells and destroy them.

In the case of the coronavirus, the best target for the immune system is the protein that covers its surface like a crown. The protein, known as spike, latches onto cells and then allows the virus to fuse to them.

But simply injecting coronavirus spike proteins into people is not the best way to vaccinate them. That’s because spike proteins sometimes assume the wrong shape, and prompt the immune system to make the wrong antibodies.

Jason McLellan, a structural biologist at the University of Texas at Austin. His research on coronavirus spike proteins aided the development of the Pfizer, Moderna, Johnson & Johnson and Novavax vaccines.Ilana Panich-Linsman for The New York Times

This insight emerged long before the Covid-19 pandemic. In 2015, another coronavirus appeared, causing a deadly form of pneumonia called MERS. Jason McLellan, a structural biologist then at the Geisel School of Medicine at Dartmouth, and his colleagues set out to make a vaccine against it.

They wanted to use the spike protein as a target. But they had to reckon with the fact that the spike protein is a shape-shifter. As the protein prepares to fuse to a cell, it contorts from a tulip-like shape into something more akin to a javelin.

Scientists call these two shapes the prefusion and postfusion forms of the spike. Antibodies against the prefusion shape work powerfully against the coronavirus, but postfusion antibodies don’t stop it.

Dr. McLellan and his colleagues used standard techniques to make a MERS vaccine but ended up with a lot of postfusion spikes, useless for their purposes. Then they discovered a way to keep the protein locked in a tulip-like prefusion shape. All they had to do was change two of more than 1,000 building blocks in the protein into a compound called proline.

The resulting spike — called 2P, for the two new proline molecules it contained — was far more likely to assume the desired tulip shape. The researchers injected the 2P spikes into mice and found that the animals could easily fight off infections of the MERS coronavirus.

The team filed a patent for its modified spike, but the world took little notice of the invention. MERS, although deadly, is not very contagious and proved to be a relatively minor threat; fewer than 1,000 people have died of MERS since it first emerged in humans.

But in late 2019 a new coronavirus, SARS-CoV-2, emerged and began ravaging the world. Dr. McLellan and his colleagues swung into action, designing a 2P spike unique to SARS-CoV-2. In a matter of days, Moderna used that information to design a vaccine for Covid-19; it contained a genetic molecule called RNA with the instructions for making the 2P spike.

Other companies soon followed suit, adopting 2P spikes for their own vaccine designs and starting clinical trials. All three of the vaccines that have been authorized so far in the United States — from Johnson & Johnson, Moderna and Pfizer-BioNTech — use the 2P spike.

Other vaccine makers are using it as well. Novavax has had strong results with the 2P spike in clinical trials and is expected to apply to the Food and Drug Administration for emergency use authorization in the next few weeks. Sanofi is also testing a 2P spike vaccine and expects to finish clinical trials later this year.

Two prolines are good; six are better

Dr. McLellan’s ability to find lifesaving clues in the structure of proteins has earned him deep admiration in the vaccine world. “This guy is a genius,” said Harry Kleanthous, a senior program officer at the Bill & Melinda Gates Foundation. “He should be proud of this huge thing he’s done for humanity.”

But once Dr. McLellan and his colleagues handed off the 2P spike to vaccine makers, he turned back to the protein for a closer look. If swapping just two prolines improved a vaccine, surely additional tweaks could improve it even more.

“It made sense to try to have a better vaccine,” said Dr. McLellan, who is now an associate professor at the University of Texas at Austin.

In March, he joined forces with two fellow University of Texas biologists, Ilya Finkelstein and Jennifer Maynard. Their three labs created 100 new spikes, each with an altered building block. With funding from the Gates Foundation, they tested each one and then combined the promising changes in new spikes. Eventually, they created a single protein that met their aspirations.

The winner contained the two prolines in the 2P spike, plus four additional prolines found elsewhere in the protein. Dr. McLellan called the new spike HexaPro, in honor of its total of six prolines.

The structure of HexaPro was even more stable than 2P, the team found. It was also resilient, better able to withstand heat and damaging chemicals. Dr. McLellan hoped that its rugged design would make it potent in a vaccine.

Dr. McLellan also hoped that HexaPro-based vaccines would reach more of the world — especially low- and middle-income countries, which so far have received only a fraction of the total distribution of first-wave vaccines.

“The share of the vaccines they’ve received so far is terrible,” Dr. McLellan said.

To that end, the University of Texas set up a licensing arrangement for HexaPro that allows companies and labs in 80 low- and middle-income countries to use the protein in their vaccines without paying royalties.

Meanwhile, Dr. Innes and his colleagues at PATH were looking for a way to increase the production of Covid-19 vaccines. They wanted a vaccine that less wealthy nations could make on their own.

With a little help from eggs

The first wave of authorized Covid-19 vaccines require specialized, costly ingredients to make. Moderna’s RNA-based vaccine, for instance, needs genetic building blocks called nucleotides, as well as a custom-made fatty acid to build a bubble around them. Those ingredients must be assembled into vaccines in purpose-built factories.

The way influenza vaccines are made is a study in contrast. Many countries have huge factories for making cheap flu shots, with influenza viruses injected into chicken eggs. The eggs produce an abundance of new copies of the viruses. Factory workers then extract the viruses, weaken or kill them and then put them into vaccines.

The PATH team wondered if scientists could make a Covid-19 vaccine that could be grown cheaply in chicken eggs. That way, the same factories that make flu shots could make Covid-19 shots as well.

In New York, a team of scientists at the Icahn School of Medicine at Mount Sinai knew how to make just such a vaccine, using a bird virus called Newcastle disease virus that is harmless in humans.

For years, scientists had been experimenting with Newcastle disease virus to create vaccines for a range of diseases. To develop an Ebola vaccine, for example, researchers added an Ebola gene to the Newcastle disease virus’s own set of genes.

The scientists then inserted the engineered virus into chicken eggs. Because it is a bird virus, it multiplied quickly in the eggs. The researchers ended up with Newcastle disease viruses coated with Ebola proteins.

At Mount Sinai, the researchers set out to do the same thing, using coronavirus spike proteins instead of Ebola proteins. When they learned about Dr. McLellan’s new HexaPro version, they added that to the Newcastle disease viruses. The viruses bristled with spike proteins, many of which had the desired prefusion shape. In a nod to both the Newcastle disease virus and the HexaPro spike, they called it NDV-HXP-S.

PATH arranged for thousands of doses of NDV-HXP-S to be produced in a Vietnamese factory that normally makes influenza vaccines in chicken eggs. In October, the factory sent the vaccines to New York to be tested. The Mount Sinai researchers found that NDV-HXP-S conferred powerful protection in mice and hamsters.

“I can honestly say I can protect every hamster, every mouse in the world against SARS-CoV-2,” Dr. Peter Palese, the leader of the research, said. “But the jury’s still out about what it does in humans.”

The potency of the vaccine brought an extra benefit: The researchers needed fewer viruses for an effective dose. A single egg may yield five to 10 doses of NDV-HXP-S, compared to one or two doses of influenza vaccines.

“We are very excited about this, because we think it’s a way of making a cheap vaccine,” Dr. Palese said.

A nurse administering the NDV-HXP-S  vaccine to a volunteer at Mahidol University in Bangkok during the country’s first human trial.Government Pharmaceutical Organization of Thailand, via Agence France-Presse — Getty Images

PATH then connected the Mount Sinai team with influenza vaccine makers. On March 15, Vietnam’s Institute of Vaccines and Medical Biologicals announced the start of a clinical trial of NDV-HXP-S. A week later, Thailand’s Government Pharmaceutical Organization followed suit. On March 26, Brazil’s Butantan Institute said it would ask for authorization to begin its own clinical trials of NDV-HXP-S.

Meanwhile, the Mount Sinai team has also licensed the vaccine to the Mexican vaccine maker Avi-Mex as an intranasal spray. The company will start clinical trials to see if the vaccine is even more potent in that form.

To the nations involved, the prospect of making the vaccines entirely on their own was appealing. “This vaccine production is produced by Thai people for Thai people,” Thailand’s health minister, Anutin Charnvirakul, said at the announcement in Bangkok.

From left, Dimas Covas, director of the Butantan Institute in Brazil; João Doria, governor of the state of São Paulo; and Jean Gorinchteyn, the state health secretary, announcing the ButanVac Covid-19 vaccine candidate against in São Paulo on March 26. Miguel Schincariol/Agence France-Presse — Getty Images

In Brazil, the Butantan Institute trumpeted its version of NDV-HXP-S as “the Brazilian vaccine,” one that would be “produced entirely in Brazil, without depending on imports.”

Ms. Taylor, of the Duke Global Health Innovation Center, was sympathetic. “I could understand why that would really be such an attractive prospect,” she said. “They’ve been at the mercy of global supply chains.”

Madhavi Sunder, an expert on intellectual property at Georgetown Law School, cautioned that NDV-HXP-S would not immediately help countries like Brazil as they grappled with the current wave of Covid-19 infections. “We’re not talking 16 billion doses in 2020,” she said.

Instead, the strategy will be important for long-term vaccine production — not just for Covid-19 but for other pandemics that may come in the future. “It sounds super promising,” she said.

In the meantime, Dr. McLellan has returned to the molecular drawing board to try to make a third version of their spike that is even better than HexaPro.

“There’s really no end to this process,” he said. “The number of permutations is almost infinite. At some point, you’d have to say, ‘This is the next generation.’”

Covid-19 Vaccine Side Effects: Your Questions Answered

The most common questions about vaccination side effects, answered.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What to Expect When You Get Your Covid Vaccine

What to Expect When You Get Your Covid Vaccine

Kevin Mohatt for The New York Times

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

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

Mar. 10, 2021
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Are Spring Sports Safe for Kids?

Youth sports are ramping up in many parts of the country. But without a vaccine for children, we still need to avoid spreading the coronavirus.

Leila Manuel is rarely without her soccer cleats. The 10 year old does drills at a field near her home on days with no practice and wears her club soccer jacket everywhere.

“She identifies as being an athlete,” said her mother, Solmaz Manuel. “Soccer is her favorite thing.”

For many athletic kids like Leila, the last year of social distancing has meant sidelining not only school and friendships, but also sports. For five months, Leila’s San Francisco team canceled practice altogether. Then it was another six months of no-contact drills.

Last week, though, Leila finally got to scrimmage again — the beginning of what she hopes will be a normal spring season.

Following a year of stops and starts and changing levels of Covid-19 precautions, many youth players are back on the field and court this spring. And the safety measures that teams are taking vary widely.

Earlier this month, the American Academy of Pediatrics updated its Covid-19 guidance on returning to sports and physical activity. In this latest version, the guidelines place more emphasis than previous versions on avoiding shared travel and meals, after a joint study by the N.F.L. and the Centers for Disease Control and Prevention showed transmission during both.

But most of the advice hasn’t changed: maintain distancing and wear masks when six feet isn’t possible. Disinfect equipment and “prioritize non-contact activity such as conditioning and drills.” And to transition gradually into high-intensity exercise to avoid injury.

So what are coaches and parents doing to keep sports safe this spring? And how are they prioritizing safety without compromising the things that make sports so important: social connection and fitness, but also fun?

The Spectrum of Safety Measures

In San Francisco, Leila’s soccer club, Girls Unite, is taking careful precautions. Coaches, spectators and kids all wear masks, even while playing. Parents are distanced on the sidelines, and players must fill out digital health forms before each practice and game.

“Parents are entrusting me with their children,” said Lindsay Kauffman, Girls Unite’s founding director. “It’s absolutely my responsibility above and beyond any game to make sure their kids are happy and healthy.”

In Frisco, Texas, on the other hand, a Little League game looks no different than it did five years ago, said Andrew Rah, a recreational youth soccer and baseball coach. On his 7-year-old son’s baseball team, all masking and social distancing requirements have been dropped. Parents sit in the bleachers unmasked.

“The feeling around here is that outside is safer than inside and baseball is a totally outside sport,” Rah said. “We’ve been happy with the way sports have been run here, and happy with the normalcy we’ve been able to have compared to a lot of other places.”

There are many factors to consider when making decisions on sports and safety, said Sankar Swaminathan, the chief of the division of infectious diseases at University of Utah Health and a member of the medical advisory committee for the Pac-12 Conference, one of the five major Division I conferences in collegiate sports.

“Where’s the worst place you can be?” Dr. Swaminathan said. “In a small bar with a lot of people without a mask who are talking and singing. And the best place you can be is by yourself on a mountaintop. Every other activity lies somewhere between those two.”

When making decisions about sports and safety, parents and coaches should consider transmission rates in their community, the safety protocols the sports league is taking and whether the activity is outdoors. Consider also the risk to society, including other kids with compromised immunity, he said.

Playing volleyball and soccer outdoors and masked is relatively low risk, Dr. Swaminathan said. Same goes for sports with minimal contact, like cross country, swimming and tennis. Indoor basketball is higher risk, he said, but if people are masked, and there’s no crowding in the showers or locker rooms, that risk goes down.

Creative Approaches to Playing

Eric Worley, co-founder and program director of Philadelphia Youth Basketball and Philly Triple Threat, a sports-based youth development program serving young people from underserved communities, also requires his players to mask up at all times, even on the courts, which are indoors. Early on, players were uncomfortable wearing masks while playing, he said. “But as time has elapsed, it’s become quite normal.”

Last May, all of the gyms in the city that his teams used for practice — in recreation centers, district schools and local college campuses — had been shut down. Leagues in nearby suburbs simply switched to private facilities, but Worley’s organization rented the floor of a armory, converted it into two basketball courts and set up a basketball-themed learning pod, where children complete virtual schooling during the day and play pickup games during breaks.

The armory, located in Philadelphia’s city center, has an open floor for drills and a cargo bay door big enough to allow plenty of ventilation. This season, the space also doubles as a practice space for his six competitive teams.

“I really am a firm believer that sports unite people and bring people together in a way that other things just aren’t able to do,” Worley said. “There are so many things in the sport of basketball that translate to life. Learning how to win and lose and do it in stride. Being part of a team.”

Teams are taking other creative approaches to safety in order to stay active this spring. Kauffman prepares “P.P.E. kits” for all of her soccer coaches to use in practices and games. Kits include extra disposable masks, gloves, disinfectant spray and hand sanitizer.

At GMS Gymnastics in Manassas, Va., the gymnasts, who are separated into pods, carry their personal items around the gym in a milk crate. Using hand-held machines they call “foggers,” coaches sprays a disinfectant mist onto the balance beams, uneven bars and floor mats between pod rotations. Parents aren’t allowed inside at meets, so they watch their kids’ events on Zoom from the parking lot.

‘Let’s Help Them Have Joy’

Al Bazley, president of the West Tampa Little League, in Florida, which reopened this spring for the first time in nearly a year, said he’s seen more financial hardship among families this year than ever before, meaning sponsorships and donations are down. To save money, he personally pressed 250 jerseys rather than rely on third-party vendors.

“The job loss is really gut wrenching,” he said. “It’s hit a lot of people hard.” And while baseball can’t fix their problems, he said, it does provide a sense of normalcy.

It’s the inclusiveness that helps children, Bazley said. “It’s the cheering and the sounds when you go up to bat and you make a good play and all the parents go nuts and you feel this sense of accomplishment.”

Making the game fun is especially important right now, said Kauffman, who occasionally shows up to soccer practice in a tutu and suspenders, just to get the kids laughing.

“We’ve made birthdays a big freaking thing this year,” she said. The kids remain socially distanced while they celebrate, and everyone gets a squirt of hand sanitizer before getting a cupcake. “But also, we’re singing and dancing around the birthday kid. We’re making each kid feel like, ‘We see you.’”

Kauffman encourages parents to have perspective this season and to forget about the wins and losses.

“Let’s just help them have some joy and be active,” she said. “These kids just need fun in their lives right now.”


Jenny Marder is a senior science writer for NASA and a freelance journalist. She was formerly digital managing editor for the PBS NewsHour.

Your ‘Maskne’ Might Not Be Acne at All

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

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

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

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

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

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

What causes it

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

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

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

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

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

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

How to prevent and treat it

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Can Vaccinated People Spread the Virus? We Don’t Know, Scientists Say.

Researchers pushed back after the C.D.C. director asserted that vaccinated people “do not carry the virus.”

The Centers for Disease Control and Prevention on Thursday walked back controversial comments made by its director, Dr. Rochelle P. Walensky, suggesting that people who are vaccinated against the coronavirus never become infected or transmit the virus to others.

The assertion called into question the precautions that the agency had urged vaccinated people to take just last month, like wearing masks and gathering only under limited circumstances with unvaccinated people.

“Dr. Walensky spoke broadly during this interview,” an agency spokesman told The Times. “It’s possible that some people who are fully vaccinated could get Covid-19. The evidence isn’t clear whether they can spread the virus to others. We are continuing to evaluate the evidence.”

The agency was responding in part to criticism from scientists who noted that current research was far from sufficient to claim that vaccinated people cannot spread the virus.

The data suggest that “it’s much harder for vaccinated people to get infected, but don’t think for one second that they cannot get infected,” said Paul Duprex, director of the Center for Vaccine Research at the University of Pittsburgh.

In a television interview with MSNBC’s Rachel Maddow, Dr. Walensky referred to data published by the C.D.C. showing that one dose of the Moderna or Pfizer-BioNTech vaccine was 80 percent effective at preventing infection, and two doses were 90 percent effective.

That certainly suggested that transmission from vaccinated people might be unlikely, but Dr. Walensky’s comments hinted that protection was complete. “Our data from the C.D.C. today suggests that vaccinated people do not carry the virus, don’t get sick,” she said. “And that it’s not just in the clinical trials, it’s also in real-world data.”

Dr. Walensky went on to emphasize the importance of continuing to wear masks and maintain precautions, even for vaccinated people. Still, the brief comment was widely interpreted as saying that the vaccines offered complete protection against infection or transmission.

In a pandemic that regularly spawns scientific misunderstanding, experts said they were sympathetic to Dr. Walensky and her obvious desire for Americans to continue to take precautions. It was only Monday that she said rising caseloads had left her with a sense of “impending doom.”

“If Dr. Walensky had said most vaccinated people do not carry virus, we would not be having this discussion,” said John Moore, a virologist at Weill Cornell Medicine in New York.

“What we know is the vaccines are very substantially effective against infection — there’s more and more data on that — but nothing is 100 percent,” he added. “It is an important public health message that needs to be gotten right.”

Misinterpretation could disrupt the agency’s urgent pleas for immunization, some experts said. As of Wednesday, 30 percent of Americans had received at least one dose of a vaccine and 17 percent were fully immunized.

“There cannot be any daylight between what the research shows — really impressive but incomplete protection — and how it is described,” said Dr. Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center in New York.

“This opens the door to the skeptics who think the government is sugarcoating the science,” Dr. Bach said, “and completely undermines any remaining argument why people should keep wearing masks after being vaccinated.”

All of the coronavirus vaccines are spectacularly successful at preventing serious disease and death from Covid-19, but how well they prevent infection has been less clear.

Clinical trials of the vaccines were designed only to assess whether the vaccines prevent serious illness and death. The research from the C.D.C. on Monday brought the welcome conclusion that the vaccines are also extremely effective at preventing infection.

The study enrolled 3,950 health care workers, emergency responders and others at high risk of infection. The participants swabbed their noses each week and sent the samples in for testing, which allowed federal researchers to track all infections, symptomatic or not. Two weeks after vaccination, the vast majority of vaccinated people remained virus-free, the study found.

Follow-up data from clinical trials support that finding. In results released by Pfizer and BioNTech on Wednesday, for example, 77 people who received the vaccine had a coronavirus infection, compared with 850 people who got a placebo.

“Clearly, some vaccinated people do get infected,” Dr. Duprex said. “We’re stopping symptoms, we’re keeping people out of hospitals. But we’re not making them completely resistant to an infection.”

The number of vaccinated people who become infected is likely to be higher among those receiving vaccines made by Johnson & Johnson and AstraZeneca, which have a lower efficacy, experts said. (Still, those vaccines are worth taking, because they uniformly prevent serious illness and death.)

Infection rates may also be higher among people exposed to a virus variant that can sidestep the immune system.

Cases across the country are once again on the upswing, threatening a new surge. Dr. Walensky’s comment came just a day after she made an emotional appeal to the American public to continue taking precautions.

“I am asking you to just hold on a little longer, to get vaccinated when you can, so that all of those people that we all love will still be here when this pandemic ends,” she said.

Given the rising numbers, it’s especially important that immunized people continue to protect those who have not yet been immunized against the virus, experts said.

“Vaccinated people should not be throwing away their masks at this point,” Dr. Moore said. “This pandemic is not over.”

How to Start Healing During a Season of Grief

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

We are all grieving right now.

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

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

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

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

Lean on your virtual community

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

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

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

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

Online religious services can also provide a sense of community.

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

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

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

Learn something new

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

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

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

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

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

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

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

Explore podcasts and books

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

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

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

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

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

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

Speak with a grief counselor, religious leader or other professional

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

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

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

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

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

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

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

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

Get active

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

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

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

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

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

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

Spend time in nature

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

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

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

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

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

What the History of Pandemics Can Teach Us About Resilience

Widespread disease outbreaks have the potential to shock societies into new ways of living.

This article is part of a series on resilience in troubled times — what we can learn about it from history and personal experiences.

Five years ago, I decided to write a novel set in the aftermath of a terrible pandemic.

The novel was an alternate history, a revisionist Western set in the 19th century, and I ended up doing copious research on everything from cattle brands to midwifery. But I’m somewhat embarrassed to say now that my research on public health disasters was relatively slight. Essentially, I pulled up a list of flu outbreaks, picked one that best suited my plot (an 1830 pandemic that may have begun in China), and started writing.

But as I finished the book, its events collided with the present. I was working through copy-edits in March 2020 when New York City, where I live, began to shut down. Suddenly I had a lot of time, and a lot of motivation, to consider what I had gotten right and wrong about the devastation wrought by disease on a society.

In many ways, my imagination had strayed far from reality. For one thing, no known pandemic has ever been as deadly as the one I wrote about, which kills 90 percent of the United States population. But I had one instinct that turned out to be right: that pandemics have the potential to shock societies into new ways of living. The Black Death, for example, led to the end of serfdom and the rise of the middle class in England.

But a disease outbreak can also cause governments to double down on repression and bigotry, as when the United States scapegoated Asian-Americans during 19th-century plague epidemics.

An artist’s rendering of St. Pancras Smallpox Hospital, circa 1880s, in a tented camp in London.
An artist’s rendering of St. Pancras Smallpox Hospital, circa 1880s, in a tented camp in London.Frank Collins/Buyenlarge, via Getty Images

History can’t tell American policymakers and activists exactly how to respond to Covid-19 — more often, it offers an example of what not to do. Still, outbreaks in 20th-century South Africa, medieval England, ancient Rome and more can offer some lessons for those working to heal the damage of Covid and forge a more just society in its wake.

Five years ago, the history of pandemics was a jumping-off point for me — an inspiration, little more. Now it’s something more urgent: an example of what we can dare to hope for in these dark times, as well as what awaits us if we fail to act. Here are some lessons learned.

Adapt

The Black Death, a pandemic caused by the bacterium Yersinia pestis that spread across Asia, Africa and Europe beginning in 1346, was “without question the most catastrophic health crisis in recorded history,” Mark Bailey, a historian and the author of “After the Black Death: Economy, Society, and the Law in Fourteenth-Century England,” said in an interview. In England, it killed around 50 percent of the population in 1348 and 1349; in Europe as a whole, estimates range from 30 to 60 percent. The sheer scale of mortality was an enormous shock, though its effects went far beyond that. As Monica Green, a historian of medicine who specializes in medieval Europe, put it, “Who will bring in the harvest if half the people are gone?”

Different societies responded in different ways. In many parts of northwestern Europe, such as Britain and what is now the Netherlands, the sudden death of a huge share of working people meant it was easier for the survivors to get work and acquire land. “You get an increase in wealth per head and a reduction in wealth inequality,” Mr. Bailey explained. Economically, at least, “ordinary people are better off.”

“Flight of the Townspeople Into the Country to Escape From the Plague,” from 1630. The plague is depicted at far right as a skeleton holding a dagger and an hourglass./Universal Images Group, via Getty Images

The reverse was true in much of eastern Europe, where lords consolidated their power over the now-scarce peasantry to reimpose serfdom, forcing them to work the land on terms favorable to landowners. There, inequality flatlined or actually increased in the wake of the plague.

There are many competing explanations for the split, but one possibility is that “the Black Death tends to accelerate existing trends,” like a movement toward a less feudal, more consumer-based economy in northern Europe, Mr. Bailey said. But that region didn’t magically become a bastion of equality post-plague — the English government imposed wage caps in the mid-14th century to keep pay from going too high. The result was widespread unrest, culminating in the Peasants’ Revolt of 1381, which brought together people of a wide variety of social backgrounds in an expression of “pent-up frustration” at government mismanagement of the economy, Mr. Bailey said.

Over all, if “resilience in a pandemic is coping,” he continued, “economic and social resilience subsequently is adapting.” The modern lesson: “Adapting to the new reality, the new paradigm, the new opportunities, is key.”

Fight inequality

The move toward greater economic equality in England post-plague may have been a bit of an outlier — throughout history, epidemics have tended to intensify existing social inequities.

In 1901, for example, when an epidemic of the plague hit South Africa, “thousands of Black South Africans were forcibly removed from Cape Town under the assumption that their free movement was having an effect on the spread of plague within the city,” said Alexandre White, a professor of sociology and the history of medicine whose work focuses on pandemic response. That expulsion laid the groundwork for the racial segregation of the apartheid era.

The United States, too, has a history of discriminatory policy during epidemics, including the targeting of Asian-American communities during early 19th- and early 20th-century plague outbreaks in Hawaii and San Francisco, and the sluggish federal response to the H.I.V. epidemic when it appeared to affect primarily L.G.B.T.Q. Americans, Mr. White said. Such decisions have ended up not only widening inequality but also hampering efforts to fight disease — ignoring H.I.V., for example, allowed it to spread throughout the population.

A scientist studying the plague at a San Francisco lab in 1961. Smith Collection/Gado/Getty Images

And now, the United States faces a pandemic that has disproportionately sickened and killed Americans of color, who are overrepresented in the essential work force yet less likely to have access to medical care. As federal and state governments manage the vaccine rollout, access to testing and treatment, and economic relief packages, it’s crucial to learn from the past and target policies specifically at reducing the racial and economic inequalities that made the pandemic so devastating in the first place.

“If the effects of racism and effects of xenophobia were less systemic within our society, we would likely see fewer deaths as a result of Covid-19,” Mr. White said. “Bigotry is fundamentally bad for public health.”

Embrace unexpected innovation

Even as pandemics have often re-entrenched old prejudices and forms of marginalization, they’ve also often given rise to something new, especially when it comes to art, culture and entertainment.

Ancient Rome, for example, was tormented by epidemics, with one occurring every 15 to 20 years for portions of the fourth, third and second centuries B.C., said Caroline Wazer, a writer and editor who completed a dissertation on Roman public health. At the time, the primary public-health response was a religious one, with Romans experimenting with new rites and even new gods in an attempt to stop the spread of illness. In one case, Ms. Wazer said, with an epidemic dragging on for three years and the public increasingly agitated, the Senate adopted a strange, new ritual from northern Italy: “they bring in actors to perform onstage.” According to the Roman historian Livy, “this is how the Romans get theater,” Ms. Wazer said, though that fact has been debated.

A spiritual response to disease brought cultural change to 14th-century England, too. Recalling the mass graves of the Black Death, Britons feared dying without a Christian burial and spending eternity in purgatory, Mr. Bailey said. So they began to form guilds, small religious groups that essentially functioned as “burial insurance clubs,” raising money to give members the proper treatment after death.

These guilds hosted parties and other events, and over time there was concern “about boozing of ale going on in and around the church,” Mr. Bailey said. So the guilds began to build their own halls for socializing. Then, during the Reformation in the 16th century, the guilds were dissolved, and the halls became something new: pubs.

Indeed, historians have argued that the rise in consumerism and the wealth of ordinary people following the Black Death paved the way for the pub culture for which England remains known today.

It would be flippant to call such cultural innovations a “silver lining” of pandemics — after all, plenty of new art forms and social venues have emerged without the catalyst of mass death. It is worth remembering, though, that in the wake of even the most devastating public health disasters, human social life and creativity have re-emerged in new and unexpected ways.

“Pandemics are both catastrophes and opportunities,” Mr. Bailey told me. And in the coming years, the world will face the tragic opportunity of rebuilding after Covid-19 — and if we learn the lessons of history, we may be able to do so in a way that’s more fair, more inclusive, and even more joyful than the past we’ve been forced to leave behind.

Anna North is a senior reporter at Vox and the author of three novels, including, most recently, “Outlawed.”

Virus Variants Can Infect Mice, Scientists Report

Infected rodents pose no immediate danger to humans, but the research suggests that mutations are helping the coronavirus expand its range of potential hosts.

Bats, humans, monkeys, minks, big cats and big apes — the coronavirus can make a home in many different animals. But now the list of potential hosts has expanded to include mice, according to an unnerving new study.

Infected rodents pose no immediate risk to people, even in cities like London and New York, where they are ubiquitous and unwelcome occupants of subway stations, basements and backyards.

Still, the finding is worrying. Along with previous work, it suggests that new mutations are giving the virus the ability to replicate in a wider array of animal species, experts said.

“The virus is changing, and unfortunately it’s changing pretty fast,” said Timothy Sheahan, a virologist at the University of North Carolina at Chapel Hill, who was not involved in the new study.

In the study, the researchers introduced the virus into the nasal passages of laboratory mice. The form of the virus first identified in Wuhan, China, cannot infect laboratory mice, nor can B.1.1.7, a variant that has been spreading across much of Europe, the researchers found.

But B.1.351 and P1, the variants discovered in South Africa and Brazil, can replicate in rodents, said Dr. Xavier Montagutelli, a veterinarian and mouse geneticist at the Pasteur Institute in Paris, who led the study. The research, posted online earlier this month, has not yet been reviewed for publication in a scientific journal.

The results indicate only that infection in mice is possible, Dr. Montagutelli said. Mice caught in the wild have not been found to be infected with the coronavirus, and so far, the virus does not seem to be able to jump from humans to mice, from mice to humans, or from mice to mice.

“What our results emphasize is that it is necessary to regularly assess the range of species that the virus can infect, especially with the emergence of new variants,” Dr. Montagutelli said.

The coronavirus is thought to have emerged from bats, with perhaps another animal acting as an intermediate host, and scientists worry that the virus may return to what they describe as an animal “reservoir.”

Apart from potentially devastating those animal populations, a coronavirus spreading in another species may then acquire dangerous mutations, returning to humans in a form the current vaccines weren’t designed to fend off.

A mink looks out from its cage at a farm in Denmark, where mink populations were hit hard by the coronavirus.
A mink looks out from its cage at a farm in Denmark, where mink populations were hit hard by the coronavirus.Mads Claus Rasmussen/Agence France-Presse — Getty Images

Minks are the only animals known to be able to catch the coronavirus from humans and pass it back. In early November, Denmark culled 17 million farmed mink to prevent the virus from evolving into dangerous new variants in the animals.

More recently, researchers found that B.1.1.7 infections in domesticated cats and dogs can cause the pets to develop heart problems similar to those seen in people with Covid-19.

To establish a successful infection, the coronavirus must bind to a protein on the surface of animal cells, gain entry into the cells, and exploit their machinery to make copies of itself. The virus must also evade the immune system’s early attempts at thwarting the infection.

Given all those requirements, it is “quite extraordinary” that the coronavirus can infect so many species, said Vincent Munster, a virologist at the National Institute of Allergy and Infectious Diseases. “Typically, viruses have a more curtailed host range.”

Mice are a known reservoir for hantavirus, which causes a rare and deadly disease in people. Even though the coronavirus variants don’t seem to be able to jump from mice to people, there is potential for them to spread among rodents, evolve into new variants, and then infect people again, Dr. Munster said.

The variants may also threaten endangered species like black-footed ferrets. “This virus seems to be able to surprise us more than anything else, or any other previous virus,” Dr. Munster said. “We have to err on the side of caution.”

Dr. Sheahan said he was more concerned about transmission to people from farm animals and pets than from mice.

“You’re not catching wild mice in your house and snuggling — getting all up in their face and sharing the same airspace, like maybe with your cat or your dog,” he said. “I’d be more worried about wild or domestic animals with which we have a more intimate relationship.”

But he and other experts said the results emphasized the need to closely monitor the rapid changes in the virus.

“It’s like a moving target — it’s crazy,” he added. “There’s nothing we can do about it, other than try and get people vaccinated really fast.”

Eating Disorder Symptoms Have Spiked During Covid

Anxiety, disrupted routines and loneliness are fueling people’s food issues as they hunker down during the Covid-19 crisis.

Malinda Ann Hill decided to resume treatment for her eating disorder almost as soon as she shifted to working remotely in March 2020. She knew even before the pandemic that isolation at home would be detrimental to her ongoing recovery from anorexia nervosa. “I had made a really distinct decision not to work from home, so that sent me into a tailspin,” said Ms. Hill, 49, who lives with her daughter in Wynnewood, Pa., and works as an art therapist and bereavement coordinator for a local hospital.

The community and structure of her workplace were helpful for someone who had struggled with disordered eating since her early teens. Sudden loneliness, mounting fears about the unfolding pandemic and a new lack of boundaries between work and home all helped tip off a relapse that Ms. Hill said had already been brewing.

“I thought maybe I should get back into treatment now,” she said. “Because this is going to be bad. And this is going to set off a lot of other people, too.”

Indeed, some doctors, therapists and dietitians who treat eating disorders, such as anorexia, bulimia and binge eating disorder, are reporting an overwhelming spike in the need for their services, with waiting lists growing at many practices and treatment centers across the country.

The National Eating Disorders Association reported a 41 percent increase in messages to its telephone and online help lines in January 2021 compared with January 2020. And in a study of about 1,000 American and Dutch people with eating disorders published last July, more than one-third of subjects reported that they were restricting their diet and increasing “compensatory behaviors,” like purging and exercise. Among the Americans, 23 percent also said they would regularly binge-eat stockpiled food.

“I’m seeing more clients, and I’m getting clients who are sicker when they come to me, because we cannot get them access to a higher level of treatment,” said Whitney Trotter, a registered dietitian and nurse in Memphis who provides one-on-one nutritional counseling for adolescents and adults of color with eating disorders. She noted that many in-patient treatment centers are fully booked due to the heightened demand.

The uptick in her practice stems from a mix of relapse cases, like Ms. Hill’s, and disorders that have newly taken hold in the past year. “I’m treating more teenagers, and also more teachers, doctors, nurses and other first responders and essential personnel,” Ms. Trotter said. “An eating disorder can manifest as a trauma response. Our nervous systems were not meant to deal with a long-term pandemic.”

How food scarcity can stoke eating disorders

Early on in the pandemic, fears around grocery store shortages and food access re-triggered some people’s disordered eating. “I found myself lying awake at 3 a.m., thinking, ‘What if there is no more baby food at the store?’” said Aneidys Reyes, 33, a stay-at-home father in Madison, Wis., who had been in eating disorder recovery for more than six years before the pandemic.

Mx. Reyes, who was raised as a girl, said that their eating disorder originally began as a coping strategy for the gender dysphoria they experienced as a teenager. Now that they identify as transgender, the urge to restrict food is less connected to body image anxieties. “It’s weird for me, because it’s not the same old eating disorder,” they said. “But once I’m at a certain level of anxiety, then my brain is like, ‘Do you remember these neuropathways? What if it’s what you’re eating? What if your clothes don’t fit tomorrow?’ All these old, familiar thoughts come back.”

Even after grocery store shortages eased, patients who were being treated for eating disorders struggled with how pandemic rules required them to navigate eating with less professional support. “For a patient who would previously have spent the day at a treatment center having all their meals provided for them, a virtual program requires so much more autonomy than they would have previously had,” said Lauren Muhlheim, a psychologist in private practice in Los Angeles.

Ms. Hill deliberately chose an in-person treatment program, even during the early days of social distancing, because she knew she needed hands-on help making decisions around what and how much to eat. When her program switched to virtual support, she had to think about meal planning again. “Suddenly I had to be in charge of the food,” she said. “They wanted me to have more variety, but I didn’t want to go back to the grocery store. I started having panic attacks.”

Our societal tendency, on social media especially, to demonize quarantine comfort eating and pandemic-related weight gain hasn’t helped. “The pressure to have used the pandemic time to have gotten or kept in shape is a big theme,” said Dr. Muhlheim. Ms. Hill said that “diet culture noise” had felt louder to her in the past year.

Why treating eating disorders over Zoom is harder

The majority of residential eating disorder treatment programs have stayed in-person, but they are typically reserved for patients who need the highest level of care due to the severity of their eating disorder behaviors or related medical complications. The next step down is known as a “partial hospitalization program,” where patients live at home and manage some meals themselves, but attend a mix of individual and group therapy meetings, plus meal support sessions (where eating is monitored so patients cannot restrict food or purge afterward), for anywhere from six to 11 hours a day.

Many such programs, as well as individual outpatient services (where patients have daily or weekly check-ins with a therapist or dietitian), have shifted to a virtual treatment model. In addition to leaving patients to navigate food shopping and meal preparation alone, the virtual model makes meal support sessions trickier. “You can’t tell as well from a camera how much someone is eating,” Dr. Muhlheim said.

Dr. Muhlheim said that she is also concerned about the loss of casual interactions that normally take place between participants in group treatment. “You can only have one conversation at a time on Zoom,” she said. “You can’t just pull someone over to chat, so you lose a lot of that connection.” In fact, in a recent survey of 63 eating disorder patients, 68 percent said they would not choose to continue with online therapy once in-person services resumed.

But some therapists said they are thrilled that virtual services have increased access for patients who would otherwise not be able to travel for treatment. “For my teacher clients, especially, virtual therapy is much more accessible because they can do a session on a planning period or right at the end of the school day,” noted Ms. Trotter, the dietitian. Virtual care can also be more affordable than residential treatment programs.

Sometimes it’s even free. In March of 2020, Diane Summers, a nutrition therapist in Seattle, asked her colleagues if anyone had time to offer no-cost meal support via Instagram Live. “I was kind of hoping for maybe two or three people a day to go live,” she said. “But we were just flooded with willingness to be a part of the project.” Therapists and dietitians signed up in every time zone, enabling the account (@covid19eatingsupport) to offer live meal support 24 hours a day for several months of the pandemic.

When teens fixate on restrictive eating

Teenagers have been particularly vulnerable to developing eating disorders during the pandemic, both because adolescence is already the most common time for such struggles to emerge and because of the added pressures they face now. “It’s a combination of the loss of structure, the loss of peer connections and the loss of their usual activities,” Dr. Muhlheim said. “They have all this time and they decide to focus on an exercise program, or maybe it feels like running is the only thing they can really still do. But we know exercise is a huge trigger.”

That’s how it started for Lily, a 16-year-old high school sophomore in Los Angeles who said that body image anxieties weren’t a big part of her life until the pandemic. “I don’t think weight loss was ever on my mind at all,” she said. “It was more of, ‘I love running, I have all this time, so why not push myself and see how far I can run?’” She began working out every day to fill the time previously occupied by school and team sports. “Lily is super book smart and school comes easily to her, so she’s had a lot of extra time,” with the switch to remote learning, her mom, Nikki, explained. (The family asked to use only their first names to protect Lily’s privacy.)

After a few weeks of intensive exercise, Nikki noticed that Lily was eating less at family meals, too. “I wasn’t necessarily skipping meals, but I was trying to eat less meat and dessert and more vegetables,” Lily said. “I thought I was being healthy.” But she also became more fixated on her weight and further curbed her eating.

In those who are vulnerable to eating disorders, even unintentionally dipping into a negative energy balance, which happens when you expend more energy than you consume in calories, can trigger the rigid, restrictive mindset that is the hallmark of most eating disorders, said Dr. Kenisha Campbell, director of adolescent medicine outpatient clinical services at the Children’s Hospital of Philadelphia.

“Eating disorders are brain disorders because the brain cannot function without appropriate nutrition. So once the ‘eating disorder brain’ is in control, they can’t make any decisions around eating,” explained Dr. Campbell, who specializes in eating disorder treatment. “We have to feed the brain, so the brain can fight the eating disorder.”

By December, Lily often felt dizzy and had developed a resting heart rate of 40 beats per minute, which was dangerously low for her. She was put on bed rest by her family doctor, and a psychologist prescribed an intensive family-based treatment in which her parents planned meals and monitored everything she ate. On tough days, it felt like the whole family was trapped in the house with her eating disorder, Nikki said.

Lily knows that once going out for dinner or getting ice cream with friends is again an option, she’ll be presented with more challenges than she currently has when eating in the safety of her own home. “It doesn’t feel like I have to miss out on things because of my eating disorder,” she said. “I’m missing out on everything because of the pandemic.”


Virginia Sole-Smith is the author of “The Eating Instinct: Food Culture, Body Image and Guilt in America,” and writes the newsletter Burnt Toast.

The Pfizer-BioNTech Vaccine Is Said to Be Powerfully Protective in Adolescents

A clinical trial found no infections among vaccinated children ages 12 to 15, the companies said, and there were no serious side effects. The data have not yet been reviewed by independent experts.

The Pfizer-BioNTech coronavirus vaccine is extremely effective in adolescents 12 to 15 years old, perhaps even more so than in adults, the companies reported on Wednesday. No infections were found among children who received the vaccine in a recent clinical trial, the drug makers said; the children produced strong antibody responses and experienced no serious side effects.

The findings, if they hold up, may speed a return to normalcy for millions of American families. Depending on regulatory approval, vaccinations could begin before the start of the next academic year for middle school and high school students, and for elementary school children not long after.

The companies announced the results in a news release that did not include detailed data from the trial, which has not yet been peer-reviewed nor published in a scientific journal. Still, the news drew praise and excitement from experts.

“Oh my god, I’m so happy to see this — this is amazing,” said Akiko Iwasaki, an immunologist at Yale University. If the vaccines’s performance in adults was A-plus, the results in children were “A-plus-plus.”

The good news arrives even as the country records another rise in infections and health officials renew calls for Americans to heed precautions and get vaccinated. On Monday, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said that rising cases had left her with sense of “impending doom,” while President Biden called on state and local officials to reinstate mask mandates.

Vaccination efforts are accelerating throughout the nation. As of Tuesday, 29 percent of adults had received at least one dose of a coronavirus vaccine, and 16 percent had been fully inoculated, according to the C.D.C.

But the country cannot hope to reach herd immunity — the point at which immunity becomes so widespread that the coronavirus slows its crawl through the population — without also inoculating the youngest Americans, some experts say. Children under 18 account for about 23 percent of the population in the United States.

“The sooner that we can get vaccines into as many people as possible, regardless of their age, the sooner we will be able to really feel like we’re ending this pandemic for good,” said Angela Rasmussen, a virologist affiliated with Georgetown University in Washington.

Data from Israel suggest that vaccinating adults alone can significantly decrease the number of cases, but “long term, to hit the herd immunity threshold, we will have to vaccinate children,” she said.

The trial included 2,260 adolescents ages 12 to 15. The children received two doses of the vaccine three weeks apart — the same amounts and schedule used for adults — or a placebo of saltwater.

The researchers recorded 18 cases of coronavirus infection in the placebo group, and none among the children who received the vaccine. Still, the low number of infections makes it difficult to be too specific about the vaccine’s efficacy in the population at large, Dr. Rasmussen said.

“But obviously, it looks good for the vaccine if there were zero Covid cases among the vaccinated people,” she added.

The adolescents who got the vaccine produced much higher levels of antibodies on average, compared with participants 16 to 25 years of age in an earlier trial. The children experienced the same minor side effects as older participants, although the companies declined to be more specific.

Dr. Iwasaki said she had expected antibody levels in adolescents to be comparable to those in young adults. “But they’re getting even better levels from the vaccines,” she said. “That’s really incredible.”

She and other experts cautioned that the vaccine might be less effective in children, and adults, against some of the variants that have begun circulating in the United States.

Pfizer and BioNTech have begun a clinical trial of the vaccine in children under 12 and started inoculations of children ages 5 to 11 just last week. Company scientists plan to start testing the vaccine next week in even younger children, ages 2 to 5, followed by trials in children ages 6 months to 2 years.

Results from that three-phase trial are expected in the second half of the year, and the companies hope to make the vaccine available for children under 12 early next year.

“We share the urgency to expand the use of our vaccine to additional populations and are encouraged by the clinical trial data from adolescents between the ages of 12 and 15,” Albert Bourla, Pfizer’s chairman and chief executive officer, said in a statement.

Moderna has also been testing its vaccine in children. Results from a trial in adolescents ages 12 to 17 are expected in the next few weeks and in children 6 months to 12 years old in the second half of this year.

AstraZeneca started testing its vaccine in children 6 months and older last month, and Johnson & Johnson has said it will wait for results from trials in older children before testing its vaccine in children under 12.

Some parents have said they are reluctant to immunize their children because the risk posed by the virus is low. Children make up fewer than 1 percent of deaths from Covid-19, but about 2 percent of children who get the illness require hospital care.

The new results may not sway all of those parents, but they may reassure parents who have been wary of the vaccines, said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security.

“While I don’t think we have to wait until children are vaccinated to fully reopen schools, being able to vaccinate children may help some families feel safer about returning to school,” she said.

Pfizer and BioNTech plan to request from the Food and Drug Administration an amendment to the emergency use authorization for their vaccine, in hopes of beginning immunizations of older children before the start of the next school year. The companies also are planning to submit their data for peer review and publication in a scientific journal.

They will monitor the participants for two years after the second dose to assess the vaccine’s long-term safety and efficacy. Side effects of vaccines are usually apparent within the first six weeks, said Dr. Kristin Oliver, a pediatrician and vaccine expert at Mount Sinai Hospital in New York. “Still, it’s good to know that safety monitoring is going to continue,” she said.

The C.D.C. recommends that people avoid getting other vaccines for two weeks before and after receiving the two doses of the coronavirus vaccine.

But children receive more vaccines in the few weeks before the school year than at any other time, Dr. Oliver noted, so pediatricians and parents should aim to get those other immunizations done earlier than usual.

The coronavirus vaccines should ideally be given by pediatricians who have deep experience in immunizing children, Dr. Oliver added. “Now is the time to start planning how that rollout is going to take place in this age group,” she said.

Getting One Vaccine Is Good. How About Mix-and-Match?

Researchers are exploring the possible benefits of pairing doses from two different Covid-19 vaccines.

In January, Britain made a change to its vaccine guidelines that shocked many health experts: If the second dose of one vaccine wasn’t available, patients could be given a different one.

The new rule was based on sheer guesswork; there was no scientific data at the time demonstrating that mixing two coronavirus vaccines was safe and effective. But that may change soon.

In February, researchers at the University of Oxford began a trial in which volunteers received a dose of the Pfizer-BioNTech vaccine followed by a dose of AstraZeneca’s formulation, or vice versa. This month, the researchers will start analyzing the blood of the subjects to see how well the mix-and-match approach works.

As growing numbers of vaccines are being authorized, researchers are testing other combinations. A few are in clinical trials, while others are being tested in animals for now.

Mixing vaccines might do more than just help overcome supply bottlenecks. Some researchers suspect that a pair of different vaccines might work better than two doses of the same one.

“I think we’re on the cusp of some interesting data,” said Adam Wheatley, an immunologist at the University of Melbourne in Australia.

The concept of mixing vaccines — sometimes called a heterologous prime-boost — is not new to our pandemic era. For decades, researchers have investigated the approach, hoping to find potent combinations against a range of viruses, such as influenza, H.I.V. and Ebola.

But scientists had little to show for all that research. It was easy enough to demonstrate that two vaccines may work well together in a mouse. But running full-blown clinical trials on a combination of vaccines is a tall order.

“For a single company to develop two parallel arms of a vaccine is twice the work and twice the cost,” Dr. Wheatley said.

Some of the early successes for heterologous prime-boosts came in the search for vaccines for Ebola. Many researchers focused their efforts on presenting the immune system with a protein found on the surface of the Ebola virus.

The gene for that protein was inserted into a different, harmless virus. When people received an injection of the vaccine, the harmless virus entered their cells; the cells then read the instructions in the Ebola gene and mass-produced Ebola’s surface protein. The immune system encountered the Ebola protein and made antibodies against it. And those antibodies protected the vaccinated people if they became infected with a full-blown Ebola virus.

This type of vaccine, called a viral vector vaccine, came with a big risk: The recipients might develop immunity to the viral vector after just the first dose. When the second dose arrived, their immune systems could swiftly wipe out the viral vector before it delivered its payload.

A number of vaccine makers decided to sidestep this potential threat by using different viruses for each dose. That way, the viral vectors in the second dose would be as new to the immune system as the first was. In 2017, for example, researchers at the Gamaleya Research Institute in Russia created an Ebola vaccine whose first dose contained a virus called an adenovirus. The second shot used another virus, called vesicular stomatitis virus.

When the Covid-19 pandemic began last year, the Gamaleya researchers used a similar strategy to create vaccines against the new coronavirus. The first dose used the same adenovirus as in their Ebola vaccine, called Ad5. The second dose contained a different human adenovirus, Ad26. The researches inserted a gene into both viruses for the protein on the surface of the coronavirus, called spike.

Studies revealed that the vaccine, now known as Sputnik V, provided a strong defense against Covid-19. In clinical trials, the researchers found that it had an efficacy of 91.6 percent. Sputnik V is now in use in Russia and 56 other countries.

Recently, the Gamaleya institute joined forces with AstraZeneca, which makes its own Covid-19 vaccine. AstraZeneca’s consists of two doses of a chimpanzee adenovirus called ChAdOx1. Last week, the company reported that its vaccine had an efficacy of 76 percent.

The Gamaleya and AstraZeneca teams want to see how well their vaccines work together. They have registered a pair of clinical trials in which volunteers will receive a dose of AstraZeneca’s ChAdOx1 and another of Sputnik V’s Ad26.

A spokesman for AstraZeneca said that one trial in Azerbaijan is underway, and a second, in Russia, is still under review by the country’s ministry of health.

Dr. Jakob Cramer, the head of clinical development at CEPI, a vaccine development organization, said that vaccines using viral vectors were not the only kind that might benefit from mixing. In fact, certain combinations might provoke a different, more effective immune response than a single type of vaccine. “Immunologically, there are several arguments in favor of exploring heterologous priming,” Dr. Kramer said.

Another kind of Covid-19 vaccine being tested contains the actual spike protein, rather than genetic instructions for it. Some of the vaccines contain the entire protein; others contain just a fragment of it. Currently, there are 29 protein-based vaccines for Covid-19 in clinical trials, although none have been authorized yet.

Dr. Wheatley and his colleagues have been testing protein-based vaccines in mice. They injected the full spike protein into the animals as a first dose. For the second dose, they injected only the tip of the spike, a region known as the receptor-binding domain, or R.B.D.

Dr. Wheatley and his colleagues found that the mixture worked better than two doses of the spike or of the R.B.D.

The researchers suspect that the first dose produces a broad range of antibodies that can stick to spots along the length of the spike protein, and that the second dose delivers a big supply of particularly potent antibodies to the tip of the spike. Together, the assortment of antibodies does a better job of stopping the coronavirus.

“You’re able to basically take that initial immunity that was elicited to that spike vaccine, and then really focus it down onto that R.B.D.,” Dr. Wheatley said.

Other combinations of vaccines may bring benefits of their own. Some vaccines, especially protein-based ones, do a good job of generating antibodies. Others, such as viral vectors, are better at training immune cells. A viral vector followed by a protein boost might offer the best of both worlds.

John Moore, a virologist at Weill Cornell Medicine, cautioned that there was no guarantee that clinical trials would reveal a benefit to mixing vaccines. In the search for an H.I.V. vaccine, researchers tried combining viral vectors and protein boost without success, he noted. Still, Dr. Moore said, the story might turn out differently for coronavirus vaccines.

“I’d like to see these studies done,” he said. “Doing it in the Covid space is completely rational, but may not be necessary.”

Some researchers are investigating heterologous vaccines not to find a superior mixture, but simply to open up more options for countries desperate to vaccinate their populations. Last week, India held back exports of vaccines to other countries as it grappled with a surge of Covid-19. For countries that were counting on those vaccines, a safe alternative for second doses could save lives.

After Britain was criticized in January for suggesting that vaccines could be mixed, researchers at the University of Oxford set out to put the idea to a formal test. In a trial called Com-Cov, they recruited 830 volunteers to test the two vaccines authorized by the British government: AstraZeneca’s adenovirus-based vaccine and the vaccine by Pfizer-BioNTech.

Pfizer-BioNTech’s vaccine uses a fundamentally different technology to produce spike proteins in the body. It contains tiny bubbles with genetic molecules called RNA. Once the bubbles fuse to cells, the cells use the RNA to make spike proteins.

One group of volunteers is receiving a Pfizer-BioNTech shot followed by AstraZeneca, while another will receive them in the reverse order. The other volunteers are receiving the standard two-dose version of the vaccines.

Later this month, the Oxford team will draw blood from the volunteers, examining their antibodies and immune cells to see whether the heterologous prime-boost creates an immune response roughly as strong as two doses of each of the authorized vaccines.

If more vaccines are authorized in Britain, the Com-Cov team may add them to the trial. Dr. Matthew Snape, who is leading the Com-COV trial, hopes it will be useful not just to his own country but to others that will be trying to vaccinate their citizens over the next few years.

“It might be that actually this flexibility becomes essential in the future,” he said.

Dr. Cramer said CEPI is planning to support additional heterologous prime-boost studies. There are plenty of possible studies to run. Worldwide, 13 vaccines are now in use against Covid-19, with 67 more in clinical trials.

“In the current situation, we have a quite a luxurious position of having so many advanced, effective vaccines,” Dr. Wheatley said.

As the number of authorized vaccines grows, the possible combinations in which they can be used will explode. Recently, researchers at China’s National Institutes for Food and Drug Control scaled up their research on heterologous prime-boosts by trying out four different vaccines that have either been authorized in China or are in late-stage clinical trials there — vaccines based on adenoviruses, proteins, RNA and coronaviruses that have been inactivated with chemicals.

The researchers injected mice with a first dose of one vaccine, then a second dose of another. Some of the combinations caused the mice to produce stronger immune responses than mice that received the same vaccine for both doses.

Whether scientists carry out more experiments on other vaccines will depend on the willingness of the vaccine manufacturers. “You’re requiring quite large pharmaceutical companies to play nice together,” Dr. Wheatley said.

Dr. Bernard Moss, a virologist at the National Institute of Allergy and Infectious Diseases, suspects that a number of companies will be willing to let their vaccines be tested in combinations. “It’s always better to be a part of something that is going to be used,” he said, “than to wholly own something that isn’t.”

One Vaccine Is Good. How About Mixing Two?

Researchers are exploring the possible benefits of combining doses from two different Covid-19 vaccines.

In January, Britain made a change to its vaccine guidelines that shocked many health experts: If the second dose of one vaccine wasn’t available, patients could be given a different one.

The new rule was based on sheer guesswork; there was no scientific data at the time demonstrating that mixing two coronavirus vaccines was safe and effective. But that may change soon.

In February, researchers at the University of Oxford began a trial in which volunteers received a dose of the Pfizer-BioNTech vaccine followed by a dose of AstraZeneca’s formulation, or vice versa. This month, the researchers will start analyzing the blood of the subjects to see how well the mix-and-match approach works.

As a growing number of vaccines are being authorized, researchers are testing other combinations. A few are in clinical trials, while others are being tested in animals for now.

Mixing vaccines might do more than just help overcome supply bottlenecks. Some researchers suspect that a pair of different vaccines might work better than two doses of the same one.

“I think we’re on the cusp of some interesting data,” said Adam Wheatley, an immunologist at the University of Melbourne in Australia.

The concept of mixing vaccines — sometimes called a heterologous prime-boost — is not new to our pandemic era. For decades, researchers have investigated the approach, hoping to find potent combinations against a range of viruses, such as influenza, H.I.V. and Ebola.

But scientists had little to show for all that research. It was easy enough to demonstrate that two vaccines may work well together in a mouse. But running full-blown clinical trials on a combination of vaccines is a tall order.

“For a single company to develop two parallel arms of a vaccine is twice the work and twice the cost,” Dr. Wheatley said.

Some of the early successes for heterologous prime-boosts came in the search for vaccines for Ebola. Many researchers focused their efforts on presenting the immune system with a protein found on the surface of the Ebola virus.

The gene for that protein was inserted into a different, harmless virus. When people received an injection of the vaccine, the harmless virus entered their cells; the cells then read the instructions in the Ebola gene and mass-produced Ebola’s surface protein. The immune system encountered the Ebola protein and made antibodies against it. And those antibodies protected the vaccinated people if they became infected with a full-blown Ebola virus.

This type of vaccine, called a viral vector vaccine, came with a big risk: The recipients might develop immunity to the viral vector after just the first dose. When the second dose arrived, their immune systems could swiftly wipe out the viral vector before it delivered its payload.

A number of vaccine makers decided to sidestep this potential threat by using different viruses for each dose. That way, the viral vectors in the second dose would be as new to the immune system as the first was. In 2017, for example, researchers at the Gamaleya Research Institute in Russia created an Ebola vaccine whose first dose contained a virus called an adenovirus. The second shot used another virus, called vesicular stomatitis virus.

When the Covid-19 pandemic began last year, the Gamaleya researchers used a similar strategy to create vaccines against the new coronavirus. The first dose used the same adenovirus as in their Ebola vaccine, called Ad5. The second dose contained a different human adenovirus, Ad26. The researches inserted a gene into both viruses for the protein on the surface of the coronavirus, called spike.

Studies revealed that the vaccine, now known as Sputnik V, provided a strong defense against Covid-19. In clinical trials, the researchers found that it had an efficacy of 91.6 percent. Sputnik V is now in use in Russia and 56 other countries.

Recently, the Gamaleya institute joined forces with AstraZeneca, which makes its own Covid-19 vaccine. AstraZeneca’s consists of two doses of a chimpanzee adenovirus called ChAdOx1. Last week, the company reported that its vaccine had an efficacy of 76 percent.

The Gamaleya and AstraZeneca teams want to see how well their vaccines work together. They have registered a pair of clinical trials in which volunteers will receive a dose of AstraZeneca’s ChAdOx1 and another of Sputnik V’s Ad26.

A spokesman for AstraZeneca said that one trial in Azerbaijan is underway, and a second, in Russia, is still under review by the country’s ministry of health.

Dr. Jakob Cramer, the head of clinical development at CEPI, a vaccine development organization, said that vaccines using viral vectors were not the only kind that might benefit from mixing. In fact, certain combinations might provoke a different, more effective immune response than a single type of vaccine. “Immunologically, there are several arguments in favor of exploring heterologous priming,” Dr. Kramer said.

Another kind of Covid-19 vaccine being tested contains the actual spike protein, rather than genetic instructions for it. Some of the vaccines contain the entire protein; others contain just a fragment of it. Currently, there are 29 protein-based vaccines for Covid-19 in clinical trials, although none have been authorized yet.

Dr. Wheatley and his colleagues have been testing protein-based vaccines in mice. They injected the full spike protein into the animals as a first dose. For the second dose, they injected only the tip of the spike, a region known as the receptor-binding domain, or R.B.D.

Dr. Wheatley and his colleagues found that the mixture worked better than two doses of the spike or of the R.B.D.

The researchers suspect that the first dose produces a broad range of antibodies that can stick to spots along the length of the spike protein, and that the second dose delivers a big supply of particularly potent antibodies to the tip of the spike. Together, the assortment of antibodies does a better job of stopping the coronavirus.

“You’re able to basically take that initial immunity that was elicited to that spike vaccine, and then really focus it down onto that R.B.D.,” Dr. Wheatley said.

Other combinations of vaccines may bring benefits of their own. Some vaccines, especially protein-based ones, do a good job of generating antibodies. Others, such as viral vectors, are better at training immune cells. A viral vector followed by a protein boost might offer the best of both worlds.

John Moore, a virologist at Weill Cornell Medicine, cautioned that there was no guarantee that clinical trials would reveal a benefit to mixing vaccines. In the search for an H.I.V. vaccine, researchers tried combining viral vectors and protein boost without success, he noted. Still, Dr. Moore said, the story might turn out differently for coronavirus vaccines.

“I’d like to see these studies done,” he said. “Doing it in the Covid space is completely rational, but may not be necessary.”

Some researchers are investigating heterologous vaccines not to find a superior mixture, but simply to open up more options for countries desperate to vaccinate their populations. Last week, India held back exports of vaccines to other countries as it grappled with a surge of Covid-19. For countries that were counting on those vaccines, a safe alternative for second doses could save lives.

After Britain was criticized in January for suggesting that vaccines could be mixed, researchers at the University of Oxford set out to put the idea to a formal test. In a trial called Com-Cov, they recruited 830 volunteers to test the two vaccines authorized by the British government: AstraZeneca’s adenovirus-based vaccine and the vaccine by Pfizer-BioNTech.

Pfizer-BioNTech’s vaccine uses a fundamentally different technology to produce spike proteins in the body. It contains tiny bubbles with genetic molecules called RNA. Once the bubbles fuse to cells, the cells use the RNA to make spike proteins.

One group of volunteers is receiving a Pfizer-BioNTech shot followed by AstraZeneca, while another will receive them in the reverse order. The other volunteers are receiving the standard two-dose version of the vaccines.

Later this month, the Oxford team will draw blood from the volunteers, examining their antibodies and immune cells to see whether the heterologous prime-boost creates an immune response roughly as strong as two doses of each of the authorized vaccines.

If more vaccines are authorized in Britain, the Com-Cov team may add them to the trial. Dr. Matthew Snape, who is leading the Com-COV trial, hopes it will be useful not just to his own country but to others that will be trying to vaccinate their citizens over the next few years.

“It might be that actually this flexibility becomes essential in the future,” he said.

Dr. Cramer said CEPI is planning to support additional heterologous prime-boost studies. There are plenty of possible studies to run. Worldwide, 13 vaccines are now in use against Covid-19, with 67 more in clinical trials.

“In the current situation, we have a quite a luxurious position of having so many advanced, effective vaccines,” Dr. Wheatley said.

As the number of authorized vaccines grows, the possible combinations in which they can be used will explode. Recently, researchers at China’s National Institutes for Food and Drug Control scaled up their research on heterologous prime-boosts by trying out four different vaccines that have either been authorized in China or are in late-stage clinical trials there — vaccines based on adenoviruses, proteins, RNA and coronaviruses that have been inactivated with chemicals.

The researchers injected mice with a first dose of one vaccine, then a second dose of another. Some of the combinations caused the mice to produce stronger immune responses than mice that received the same vaccine for both doses.

Whether scientists carry out more experiments on other vaccines will depend on the willingness of the vaccine manufacturers. “You’re requiring quite large pharmaceutical companies to play nice together,” Dr. Wheatley said.

Dr. Bernard Moss, a virologist at the National Institute of Allergy and Infectious Diseases, suspects that a number of companies will be willing to let their vaccines be tested in combinations. “It’s always better to be a part of something that is going to be used,” he said, “than to wholly own something that isn’t.”

Family Travel Gets Complicated Without a Covid Vaccine for Kids

Amid the chatter of travel’s long-awaited rebound one year into the pandemic, many families with children feel largely left out of the conversation.

Nearly every summer, Ada Ayala, a teacher, and her husband, Oscar Cesar Pleguezeulos, travel with their children to visit Mr. Cesar Pleguezeulos’s parents in Spain. But this year, even though they will both soon be fully vaccinated in their home state of Florida, they are changing their plans. The reason? There is still no pediatric Covid-19 vaccine available for their kids.

The travel industry, buoyed by news of vaccine rollouts, is anticipating a summer rush after a year of devastation. But amid the chatter of travel’s long-awaited rebound, many families with children — who comprise roughly 30 percent of the global travel market — say they are largely being left out of the conversation.

In a March survey on Bébé Voyage, an online community for traveling families, 90 percent of respondents said that amid unclear guidelines on Covid-19 testing, they were searching for flexible bookings. The topic also comes up often on Bébé Voyage’s Facebook page, particularly among parents in the United States. “It’s the Americans in the group that are the most nervous traveling with kids,” said the Bébé Voyage chief executive, Marianne Perez de Fransius.

Ms. Ayala, 44, is among those nervous parents. “If it wasn’t for the kids, we would definitely be flying this summer,” she said. Ms. Ayala already received her shot as a teacher. Her husband, also 44, will soon receive his shots, too, because Florida recently opened vaccinations to those age 40 and up. But their children, Charlise, 6, and Oscar, 2, will have to wait many more months to be inoculated.

“My 2-year-old isn’t going to wear a mask for 10 hours on a flight, and I don’t know if I want to expose him for a 16-hour trip with layovers,” Ms. Ayala said. “I’ll feel more confident when vaccination reaches more people worldwide, or at least in the destinations we want to go.”

Nearly one in three adults in the United States have now received at least one dose of the Covid-19 vaccine. But a full pediatric Covid-19 vaccine currently isn’t expected until the end of 2021 at the earliest, and while they wait, parents are struggling to figure out how they, too, can travel safely this summer, and even where their children are welcome as rules on quarantine and testing continue to shift.

“This is the elephant in the room right now,” said Cate Caruso, an adviser for Virtuoso, a network of luxury travel agencies, who also owns her own travel planning company, True Places Travel. The potential that a child could become infected with Covid-19 while abroad and not be allowed on a return flight, she said, is a major deterrent for parents. “Anywhere you go outside of the U.S. right now, you’ve got to think about how you’re going to get back in,” she said. “It’s leaving behind a whole bunch of people who are ready to go.”

In Ms. Ayala’s case, a compromise has been struck: If and when Spain — which is currently closed to American travelers — opens its borders, Mr. Cesar will travel to Spain with their daughter, Charlise, while Ms. Ayala will remain in Florida with Oscar. “She goes to school and is very good with wearing her mask, cleaning her hands and keeping distance,” Ms. Ayala said of her daughter. “So I think she can be safe. But it’s just not possible with a baby.”

But she doesn’t plan to stay home all summer. Whether or not her husband and daughter make it to Spain, Ms. Ayala is planning a family road trip at some point this summer, likely within Florida.

After a year of road trips, R.V.s and rental cottages, many Americans are now ready to fly again: Online searches for late-summer flights are up as much as 75 percent, and hotels on both coasts are reporting that they are sold out through October. But families, more than any other travel sector, continue to play it safe.

Family travel plans for this summer are more low-key than two years ago, with bookings to Mount Rushmore National Memorial, in the Black Hills of South Dakota, reported to be significantly up.
Family travel plans for this summer are more low-key than two years ago, with bookings to Mount Rushmore National Memorial, in the Black Hills of South Dakota, reported to be significantly up.Tannen Maury/EPA, via Shutterstock

Rovia, a membership-based global travel agency that works with both travelers and travel agents, reports that beach and camping destinations within driving distance are the most popular choices for families this summer. An exception? Disney World, which is seeing an uptick in reservations for summer from families looking to visit while capacity remains limited (and lines, as a result, remain shorter).

“The rate of couples traveling by air has increased faster, whereas families are still leaning toward travel by car and R.V. rentals,” said Jeff Gwynn, Rovia’s director of communications.

Montoya and Phil Hudson, who showcase their travels as a Black family on their popular blog, The Spring Break Family, are among them. “Most years we go pretty far — Spain, Italy, France, as far as we can go. This year it was about what’s reachable by car,” Ms. Hudson said. She and Mr. Hudson, who both work in the health care industry, are vaccinated, but admit they probably won’t be willing to fly with their two daughters, Leilah, 11, and Layla, 8, for several more months.

That’s because they want to wait for herd immunity to help keep their daughters safe. “The goal is to wait until the majority of the population is vaccinated, or has at least had the opportunity to become vaccinated,” Ms. Hudson said.

In addition to preferring driving over flying this summer, travel analysts say families with children will also continue to opt for rental homes over hotel rooms.

In fact, when it comes to the vacation cottage market, parents are booking faster than anyone else. “Families are the number one group expected to travel in 2021,” said Vered Schwarz, the president and chief operating officer of Guesty, a short-term property management platform which reports that its summer reservations are already 110 percent higher than 2020, with families comprising more than 30 percent of those booking. “For families with unvaccinated children, private rentals are appealing — they are comfortable and they avoid hotels chock-full of crowded common areas,” she said.

The question of how to treat unvaccinated children who may be traveling with their parents is also presenting a legal and ethical minefield for American travel operators.

The European Union is considering a vaccine passport that will allow free travel within the bloc for those who can show proof of inoculation. In Israel, a green pass has been established for those who have been vaccinated, granting holders not just the ability to cross a border but also check into a hotel or eat inside a restaurant, but children are not exempt — so parents with unvaccinated children must dine outside at restaurants and find babysitters before heading to the gym or a show.

But in the United States, such policies are unlikely to take hold, said Chuck Abbott, the general manager of the InterContinental San Diego. “Most hotels would not ask for that information, because it violates the privacy of the guest,” he said. “Even putting vaccinated guests on a different floor than other guests would likely present a legal issue.”

Compared with summer 2019, families’ plans for summer 2021 are more low-key: Travelocity reports that bookings to Mount Rushmore and Nashville are significantly up over two years ago; internationally, family bookings to London, Paris and Rome, destinations that were top family sites in 2019, but have still not reopened to U.S. travel, are way down, while Cancún, which is currently open to American travelers without quarantine requirements, is up nearly 50 percent.

Some European countries, like Iceland, have begun inching open their borders, but only to passengers who are vaccinated. That means individuals who can present proof of the Covid-19 jab can bypass quarantine when they arrive — unless they are parents traveling with children.

“Unvaccinated children would still need to quarantine for five days, and the parents, of course, must stay with the child,” said Eric Newman, who owns the travel blog Iceland With Kids. “Iceland’s brand-new travel regulations are not friendly to families hoping to visit with children.”

After a year of virtual schooling and working from home, parents have no desire to quarantine with their kids, said Anthony Berklich, the founder of the travel platform Inspired Citizen. “What these destinations are basically saying is you can come but your children can’t,” he said.

Instead, families are opting for warm-weather destinations closer to home.

When the Centers for Disease Control and Prevention announced in January that proof of a negative PCR test would be required of all air passengers arriving in the United States, many tropical resorts — including more than a dozen Hyatt properties — began offering not just free on-site testing, but a deeply discounted room in which to quarantine in case that test comes back positive. That move, said Rebecca Alesia, a travel consultant with SmartFlyer, has been a boon for family travel business.

“What happens if the morning you’re supposed to come home, you get up and Junior has a surprise positive test?” she said. “A lot of my clients have booked this summer because of this policy.”

For parents struggling to decide how and when to return to travel, there is good news on the horizon, said Dr. Shruti Gohil, the medical director of infection prevention at the University of California, Irvine.

“The chances of a good pediatric vaccine coming soon are high,” she said, noting that both Pfizer and Moderna are already running pediatric trials on their vaccines. “There is no reason to think that the vaccine will have any untoward effects on children that we haven’t already noted in adults.”

In the meantime, she said, parents with children need to continue to be cautious. That doesn’t mean families shouldn’t travel at all, but she recommends choosing to drive rather than fly; to not allow unvaccinated children to play unmasked with children from other households; and to remain vigilant about wearing masks and regularly washing hands while on the road.

“We can’t keep saying that you can’t go anywhere,” she said. “At some point we have to have some kind of nuance around this. But this is a game we are all still playing until the virus is gone.”

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