Tagged medicine and health

Weekly Health Quiz: Diet, Weight and Covid

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

Diet

Exercise

Hormones

Socioeconomic status

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

Restaurants

Concert halls

Gyms

Churches

3 of 7

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

N95 masks

KN95 masks

KF94 masks

Surgical masks

4 of 7

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

Los Angeles

New York

Seattle

Miami

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

Asbestos

Grit and glass fibers

Chalk

Salt crystals

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

Birth to 3 years

3 to 6 years

6 to 12 years

Over 12 years

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

Heart

Lungs

Liver

Kidney

Learning to Listen to Patients’ Stories

Waclawa “Joanne” Zak, who now lives in Oxford, Wis., fought in the Polish resistance during World War II. As a teenager, she served as a scout, assessing German troop strength and positions. Later in the war she trained as a nurse and was liberated from a German P.O.W. camp. She told her story as part of the “My Life, My Story” program at the William S. Middleton Memorial Veterans Hospital in Madison, Wis.
Waclawa “Joanne” Zak, who now lives in Oxford, Wis., fought in the Polish resistance during World War II. As a teenager, she served as a scout, assessing German troop strength and positions. Later in the war she trained as a nurse and was liberated from a German P.O.W. camp. She told her story as part of the “My Life, My Story” program at the William S. Middleton Memorial Veterans Hospital in Madison, Wis.Credit…Andy Manis for The New York Times

Learning to Listen to Patients’ Stories

Narrative medicine programs teach doctors and other caregivers “sensitive interviewing skills” and the art of “radical listening” to improve patient care.

Waclawa “Joanne” Zak, who now lives in Oxford, Wis., fought in the Polish resistance during World War II. As a teenager, she served as a scout, assessing German troop strength and positions. Later in the war she trained as a nurse and was liberated from a German P.O.W. camp. She told her story as part of the “My Life, My Story” program at the William S. Middleton Memorial Veterans Hospital in Madison, Wis.Credit…Andy Manis for The New York Times

  • Feb. 25, 2021, 5:00 a.m. ET

The pandemic has been a time of painful social isolation for many. Few places can be as isolating as hospitals, where patients are surrounded by strangers, subject to invasive tests and attached to an assortment of beeping and gurgling machines.

How can the experience of receiving medical care be made more welcoming? Some say that a sympathetic ear can go a long way in helping patients undergoing the stress of a hospital stay to heal.

“It is even more important now, when we can’t always see patients’ faces or touch them, to really hear their stories,” said Dr. Antoinette Rose, an urgent care physician in Mountain View, Calif., who is now working with many patients ill with Covid.

“This pandemic has forced many caregivers to embrace the human stories that are playing out. They have no choice. They become the ‘family’ at the bedside,” said Dr. Andre Lijoi, a medical director at York Hospital in Pennsylvania. Doctors, nurses and others assisting in the care of patients “need time to slow down, to take a breath, to listen.”

Both doctors find their inspiration in narrative medicine, a discipline that guides medical practitioners in the art of deeply listening to those who come to them for help. Narrative medicine is now taught in some form at roughly 80 percent of medical schools in the United States. Students are trained in “sensitive interviewing skills” and the art of “radical listening” as ways to enhance the interactions between doctors and their patients.

“As doctors, we need to ask those who come to us: ‘Tell me about yourself,’” explained Dr. Rita Charon, who founded Columbia University’s pioneering narrative medicine program in 2000. “We have fallen out of that habit because we think we know the questions to ask. We have a checklist of symptom questions. But there is an actual person in front of us who is not just a collection of symptoms.”

Columbia is currently offering training online for medical students like Fletcher Bell, who says the course is helping to transform the way he sees his future role as healer. As part of his narrative medicine training, Mr. Bell has kept in touch virtually with a woman who was being treated for ovarian cancer, an experience of sharing that he described as being both heartbreaking and also beautiful.

“Simply listening to people’s stories can be therapeutic,” Mr. Bell observed. “If there is fluid in the lungs, you drain it. If there is a story in the heart, it’s important to get that out too. It is also a medical intervention, just not one that can be easily quantified.”

This more personalized approach to medical care is not a new art. In the not-so-distant past, general practitioners often treated several generations of the same family, and they knew a lot about their lives. But as medicine became increasingly institutionalized, it became more rushed and impersonal, said Dr. Charon.

The typical doctor visit now lasts from 13 to 16 minutes, which is generally all that insurance companies will pay for. A 2018 study published in the Journal of General Internal Medicine found that the majority of doctors at the prestigious Mayo Clinic didn’t even ask people the purpose of their visit, and they frequently interrupted patients as they spoke about themselves.

But this fast-food approach to medicine sacrifices something essential, says Dr. Deepu Gowda, assistant dean of medical education at the Kaiser-Permanente School of Medicine in Pasadena, Calif., who was trained by Dr. Charon at Columbia.

Dr. Gowda recalls one elderly patient he saw during his residency who suffered from severe arthritis and whom he experienced as being angry and frustrated. He came to dread her office visits. Then he started asking the woman questions and listened with interest as her personal history unfolded. He became so intrigued by her life story that he asked her permission to take photographs of her outside the hospital, which she granted.

Dr. Gowda was particularly struck by one picture of his patient, cane in hand, clutching onto the banister of her walk-up apartment. “That image represented for me her daily struggles,” he said. “I gave her a copy. It was a physical representation of the fact that I cared for who she was as a person. Her pain didn’t go away, but there was a lightness and laughter in those later visits that wasn’t there before. There was a kind of healing that took place in that simple human recognition.”

While few working doctors have the leisure time to photograph their patients outside the clinic, or to probe deeply into their life history, “people pick up on it” when the doctor expresses genuine interest in them, Dr. Gowda said. They trust such a doctor more, becoming motivated to follow their instructions and to return for follow-up visits, he said.

Some hospitals have started conducting preliminary interviews with patients before the clinical work begins as a way to get to know them better.

Darrell Krenz of Madison, Wis., recounted his Army days as part of the V.A.’s “My Life, My Story” program.Credit…Andy Manis for The New York Times
Orlando Dowell, a 16-year Marine Corps veteran and “My Life, My Story” participant, at his home in Dakota, Ill.Credit…Andy Manis for The New York Times

Thor Ringler, a family therapist, started the “My Life, My Story” program at the William S. Middleton Memorial Veterans Hospital in Madison, Wis., in 2013. Professional writers are hired to interview veterans — by phone and video conference since the onset of the pandemic — and to draft a short biography that is added to their medical record and read by their attending physician.

“My goal was to provide vets with a way of being heard in a large bureaucratic system where they don’t always feel listened to,” Mr. Ringler said.

The program has spread to 60 V.A. hospitals, including in Boston, where more than 800 veteran stories have been compiled over the past three years. Jay Barrett, nurse manager at the VA Boston Healthcare System, said these biographies often provide critical information that can help guide the treatment.

“Unless they have access to the patient’s story,” Ms. Barrett said, “health care providers don’t understand that this is a mother who is taking care of six children, or who doesn’t have the resources to pay for medication, or this is a veteran that has severe trauma that needs to be addressed before even talking about how to manage the pain.”

Dr. Lewis Mehl-Madrona, a family doctor who teaches at the University of New England in Biddeford, Maine, has been studying veterans who were undergoing treatment for pain. Those who were asked to tell about their lives experienced less chronic pain and rated the relationship with their physician higher than those who had not. The doctors who solicited the stories also reported more job satisfaction and were subject to less emotional burnout, which has become an especially worrisome problem during the Covid pandemic.

Demands have never been greater on health care workers’ time. But narrative medicine advocates say that it only takes a few moments to forge an authentic human connection, even when the communication takes place online, as it often does now. Dr. Mehl-Madrona argues that remote videoconferencing platforms like Zoom can actually make it even easier to keep track of vulnerable people and to solicit their stories.

Derek McCracken, a lecturer at Columbia University who helped develop training protocols for using narrative techniques in telehealth, agrees. “Telehealth technology can be a bridge,” he said, “because it’s an equalizer, forcing both parties to slow the conversation down, be vulnerable and listen attentively.”

The critical point for Dr. Mehl-Madrona is that when people are asked to talk about themselves — whether that happens in person or onscreen — they are “not just delivering themselves to the doctor to be fixed. They become actively engaged in their own healing.”

“Doctors can be replaced by computers or by nurses if they think their only role is just to prescribe drugs,” he added. “If we want to avoid the fate of the Dodo bird, then we have to engage in dynamic relationships with patients, we have to put the symptoms in the context of people’s lives.”

Weekly Health Quiz: Addictive Foods, Exercise and Heart Health

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Certain foods may elicit “addictive-like” cravings, some research suggests, prompting us to overeat. All of the following foods were near the top of the list of “addictive” foods except:

French fries

Pizza

Ice cream

Bacon

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A large analysis of more than 90,000 people found that to bolster heart health you need to complete at least how many minutes of moderate to vigorous exercise a week?

30 minutes

60 minutes

120 minutes

Almost any amount of exercise showed benefits for cardiovascular health

3 of 7

Which statement about asthma is not true?

Cold weather can trigger asthma attacks in some people

More adults suffer from asthma than children

People with asthma are suffering much higher rates of Covid than the general population

Both genetics and environment play a role in who gets asthma

4 of 7

The Covid vaccines currently available in the United States have not been approved for children younger than:

18 years

16 years

12 years

5 years

5 of 7

Which statement about multisystem inflammatory syndrome in children is true?

Symptoms include fever, rash, red eyes or gastrointestinal problems, which typically arise several weeks after infection with coronavirus

It is still rare, but cases are rising, and it has caused about 30 deaths in children in the United States

The median age of infected children is 9 years, but infants and older teenagers can also get it

All of the above

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In otherwise healthy people, the main reason someone would experience neutropenia, or a dangerous drop in white blood cell levels, would be a:

Vitamin B12 deficiency

Viral illness

Medication side effect

Covid side effect

7 of 7

The most effective mask against coronavirus is the:

N95 mask

KN95 mask

KF94 mask

Cloth mask

As Millions Get Shots, F.D.A. Struggles to Get Safety Monitoring System Running

As Millions Get Shots, F.D.A. Struggles to Get Safety Monitoring System Running

For now, the government has been relying on a patchwork of programs that officials say are hampered by limited size and gaps in data collection.

A drive-through mass vaccination site at Coors Field baseball stadium in Denver last month.
A drive-through mass vaccination site at Coors Field baseball stadium in Denver last month.Credit…Chet Strange/Agence France-Presse — Getty Images

  • Feb. 12, 2021, 5:00 a.m. ET

More than 34 million Americans have received Covid vaccines, but the much-touted system the government designed to monitor any dangerous reactions won’t be capable of analyzing safety data for weeks or months, according to numerous federal health officials.

For now, federal regulators are counting on a patchwork of existing programs that they acknowledge are inadequate because of their small sample size, missing critical data or other problems.

Clinical trials have shown both of the vaccines authorized in the United States — one from Pfizer-BioNTech and the other from Moderna — to be highly protective and safe against the coronavirus.

But even the best trials have limited ability to detect adverse reactions that are rare, those that only occur in certain population groups, or which happen beyond the three-month period studied in the trials. Tracking adverse events once the vaccines are administered to the public at large is essential not just to detect problems but to build confidence in the safety of vaccines.

In interviews, F.D.A. officials acknowledged that a promised monitoring system, known as BEST, is still in its developmental stages. They expect it to start analyzing vaccine safety data sometime soon — but likely not until after the Biden administration reaches its goal of vaccinating 100 million people.

“I’m concerned about this disjointed tracking system,” said Dr. Ashish K. Jha, dean of the Brown University School of Public Health. “We knew these vaccines were coming for at least several months before they got authorized, so we really should have had a well-developed system.”

Dr. Jha and others believe that with all the public attention on the vaccines, any serious adverse reactions will likely be reported somewhere. But, they say, a more systematic approach is crucial.

“It’s critical to track, because it will help build confidence,” Dr. Jha said.

Monitoring is all the more important because the vaccines were developed and approved in record time, with the goal of inoculating most of the U.S. population as quickly as possible.

“It’s the right thing to do, but the fact of the matter is we don’t have enough information and we’re desperately in need of post-market information and monitoring,” said a high-ranking F.D.A. official, who asked not to be named because he was not authorized to discuss the matter publicly.

The government is now relying most on a 30-year-old safety monitoring system that the F.D.A. shares with the Centers for Disease Control and Prevention, and a new smartphone app that people who get vaccinated can download and use to report problems if they wish. The C.D.C. also runs the Vaccine Safety Datalink, a collaboration between the agency and nine health systems that collects vaccine data and electronic medical records of roughly 12 million patients. Although it is well-regarded, it is of limited use because of its small size.

Boxes of the Pfizer-BioNTech vaccine were prepared for shipment at a facility in Portage, Miich., in December.
Boxes of the Pfizer-BioNTech vaccine were prepared for shipment at a facility in Portage, Miich., in December.Credit…Pool photo by Morry Gash

“It’s great for routine stuff, but when it comes to safety surveillance, it’s all about size,” said Dr. Daniel Salmon, director of the Institute for Vaccine Safety at Johns Hopkins University, and a former federal vaccine official. “The bigger it is, the faster you get an answer. Eventually the VSD will get a really good answer — probably one of the best answers of anybody out there because they are so good at doing it. But in a pandemic, time isn’t on our side.”

So far, few serious problems have been reported through these channels and no deaths have conclusively been linked to the vaccines. The 30-year-old initiative, known as the Vaccine Adverse Event Reporting System, or VAERS, relies on self-reported cases from patients and health care providers.

Health officials say that so far, the two vaccines already authorized for use appear to be quite safe. There have been a few severe allergic reactions, including anaphylaxis, but they are treatable and considered rare. The rate at which anaphylaxis has occurred so far — 4.7 cases in every million doses of the vaccine by Pfizer and BioNTech, and 2.5 cases per million for the vaccine by Moderna — are in line with what happens with other widely used vaccines.

Bruising and bleeding caused by lowered platelet counts have also been reported, though it is not known if they are linked to the vaccines, or coincidental. In total, 9,000 adverse events were reported, with 979 serious and the rest classified as nonserious, according to the most recent C.D.C. report available.

In interviews, public health experts, including current and former officials at the F.D.A. and the C.D.C., expressed a need to improve upon old “passive” surveillance, which depends on self-reporting. They said that funding shortages, turf wars and bureaucratic hurdles had slowed preparing BEST, formally called the Biologics Evaluation Safety Initiative, to monitor the Covid vaccines.

An earlier version of BEST was started in 2017, to improve the F.D.A.’s tracking of new blood products and vaccines, but the agency has only used it on a limited basis. It is considered an “active” surveillance system because scientists can use data collected from clinical care to hunt for safety problems, rather than rely on individuals to report health problems that they believe — but often without proof — were caused by the vaccine. BEST is part of the agency’s move toward using more real-world evidence to vet new products or monitor them after approval. The F.D.A. has done some preliminary studies using BEST to evaluate the safety of shingles and flu vaccines.

When the monitoring system is fully up and running, the F.D.A. expects to have access to more than 100 million individual medical records, and will be able to look for signs of safety problems, and then determine whether they are real. But critics say it is folly for the F.D.A. to be launching a new system in the midst of a pandemic. And several C.D.C. officials said the F.D.A. was not giving them a real sense of when the complex system would begin to work.

“It’s been a puzzle to me,” said one C.D.C. official who was not authorized to discuss the issue and asked not to be identified. “F.D.A. talks about this in a way that is really unclear as to what is up and ready to go and what isn’t.”

The headquarters of the F.D.A. in Silver Spring, Md.Credit…Jim Lo Scalzo/EPA, via Shutterstock

But even BEST will suffer from a data problem that is already hindering existing systems: the dearth of health insurance claims to show who got which vaccine, and when. Typically health care providers and patients submit such claims to insurers, but with the vaccines being given at no charge, often at government-sponsored events, few are bothering to file claims. Critics say that federal health officials should have predicted this glitch and prepared for it.

“The current safety surveillance system in the U.S. is dependent on health insurance claims data and electronic health records,” said Dr. Salmon. “If the vaccine data information doesn’t get into the safety system, then that safety system is unable to function.”

In December, the C.D.C. launched V-safe, a smartphone-based system that checks in with individuals who get the Covid vaccine to monitor for side effects. Roughly two million people who have been vaccinated have enrolled, a small fraction of the total number, and of those, one million have responded to text queries and surveys about their post-vaccine health.

At a recent C.D.C. advisory meeting, Dr. Tom Shimabukuro, who oversees Covid-19 vaccine safety for the agency, said he was pleased that the new app had enrolled so many users, but he also acknowledged problems like errors that indicated men and older women to be listed as pregnant.

It’s also unclear how heartily vaccine providers are promoting V-safe. Some health care providers send post-vaccine emails to patients noting its availability, and others merely put a stack of C.D.C. fact-sheets about V-safe in the vaccination room and hope patients pick it up. Even Dr. Jha said he didn’t sign up for it.

Still, Dr. Shimabukuro said he was confident in the current surveillance system. “For the national Covid-19 vaccination program, we have implemented the most intense safety monitoring in the history of the United States,” he said. “We have multiple systems that are complementary to each other, that are able to rapidly collect information, that are able to rapidly assess the safety of immunizations.”

Medical workers filled doses of Moderna’s vaccine at a a drive-through site in Robstown, Texas.Credit…Go Nakamura/Reuters

One factor slowing down BEST is that the F.D.A. has not yet calculated what are called background rates, the levels of certain health problems that normally occur in the non-vaccinated population. These are critical for determining whether the vaccine is actually causing a spike in certain problems, such as heart attacks, strokes, and other issues that the F.D.A. and C.D.C. consider adverse events of special interest, which require close monitoring.

Rather than calculate them on its own, as the C.D.C. does, the F.D.A. sent a proposal out for public comment, in which it detailed how it planned to compute the background rates. They plan to start working on it in the next few weeks. This delay strikes some public health experts as unnecessary.

“It’s a little bit surprising,” said Dr. Peter Lurie, president of the Center for Science in the Public Interest, and a former associate commissioner at the F.D.A. “That doesn’t feel like a mechanism appropriate to the urgency of a pandemic. It seems to me that a few well-placed phone calls to key people in the field would provide as much information as a request for comment.”

Dr. Peter Marks, the director of the F.D.A.’s Center for Biologics Evaluation and Research, which oversees vaccine approval and safety, said the agency needed outside input.

“The background rates are a critical input for our rapid cycle analysis, so we followed a deliberative and transparent process,” he said in an interview. “We needed to develop an approach that could be used in several health care claims data systems and we needed to account for the possibility that health care utilization may have changed during the pandemic.”

Jeffrey Brown, an associate professor at Harvard Medical School and a leader of the F.D.A. program that monitors adverse reactions to drugs, said he is concerned about the lack of insurance claims data and other holes in the vaccine safety surveillance systems.

“It is imperative to have policies that ensure vaccination data are submitted to insurers to enable effective use of the nation’s investment in active safety monitoring,” said Dr. Brown. “It is not only critical to get needles into arms, but also to get data into databases. We still have a chance to get it done well.”

Denise Grady contributed reporting.

Credit…Jessica Hill/Associated Press

Weekly Health Quiz: Weight Loss, Masks and Covid Vaccines

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For the first time, a clinical trial suggested that a drug may be highly effective in promoting weight loss, with obese participants losing, on average, 15 percent of their body weight. The drug tested is called:

Orlistat

Semaglutide

Lorcaserin

Phentermine-topiramate

2 of 7

The percentage of Americans who have received at least one Covid vaccine shot is now around:

5 percent

10 percent

20 percent

30 percent

3 of 7

Dr. Anthony Fauci predicted that most Americans would be eligible to get a Covid vaccine as early as:

March

April

May

June

4 of 7

This state surpassed New York with the highest number of Covid deaths since the start of the pandemic:

Florida

New Jersey

California

Texas

5 of 7

This state has had the lowest total number of Covid deaths overall:

Alaska

Hawaii

Maine

Vermont

6 of 7

The Centers for Disease Control and Prevention urged Americans to wear this type of mask to protect against the spread of coronavirus:

A well fitting surgical mask, or a cloth mask over a surgical mask

An N95 mask

A KN94 mask

The C.D.C. does not endorse the use of masks

7 of 7

A large study found that people with this condition were twice as likely to get Covid:

Asthma

Autoimmune conditions

Hypertension

Dementia

Pandemic Lessons in Improving the Medical System

Personal Health

Pandemic Lessons in Improving the Medical System

The pandemic may prompt American medicine to become less expensive, more efficient and more effective at protecting people’s health.

Credit…Gracia Lam
Jane E. Brody

  • Feb. 8, 2021, 5:00 a.m. ET

If there is a silver lining to the devastation wrought by the coronavirus pandemic, it likely lies in the glaring inadequacies and inefficiencies it exposed that are inherent in traditional American medicine. At the same time, it suggests ways to improve medical practice that can ultimately give us more bang for our health care buck.

The Biden administration currently faces overwhelming challenges to stifle Covid-related disease and deaths, responsibly regrow the economy and curb the environmental and dollar costs of climate change. But as the new president and his team strive to get a handle on these critical issues, they might also confront the myriad failings and needed improvements to health care exposed by the pandemic. We’ve paid too high a price for wasteful procedures and inconsistent medical care delivery in this country. And too many people paid with their lives as a result.

Dr. Robert Steinbrook, an editor at JAMA Internal Medicine, said in an interview, “The pandemic exposed serious vulnerabilities in our health care and created opportunities to solve problems for the long term.”

Although the pandemic prompted many people to miss or delay medical care that sometimes resulted in more serious disease and more costly treatment, it also suggested steps American medicine can take to become less expensive, more efficient and more effective at protecting people’s health.

Exhibit No. 1: Half a century of evidence has documented the health-saving, lifesaving and cost-saving benefits of preventive medicine, yet this country has retained a chaotic, penny-wise-and-pound-foolish medical system that too often puts the treatment cart before the health-promoting horse.

As many experts have told me during decades of medical reporting, we really don’t have health care in this country; we have sickness care. We’re not getting more, we’re simply paying more. The United States spends 25 percent more per person on medical care than any other highly developed country and gets less benefit from it. And the care we get leaves us shamefully behind other developed countries in important health metrics, like maternal and infant mortality and healthy longevity.

“Our system is set up to produce a lot of health care but not necessarily a lot of health,” said Dr. Amol S. Navathe, a health economist at the University of Pennsylvania.

Even the routine annual “wellness visits” covered by Medicare are of minimal value for healthy adults and often result in a cascade of follow-up tests that yield little but cost plenty.

Dr. William H. Shrank of Humana, a national health insurance company, and lead author of a report on waste in the current health care system, said, “We’ve just been through a natural experiment that we can learn from.” Our yearlong battle with a deadly virus suggests ways to improve how medicine is practiced and utilized in the United States to foster better health for its inhabitants.

One of the most dramatic examples was the abrupt substitution of telemedicine for in-person visits to the doctor’s office. Although telemedicine technology is decades old, the pandemic demonstrated how convenient and effective it can be for many routine medical problems, Dr. Navathe said.

Telemedicine is more efficient and often just as effective as an office visit. It saves time and effort for patients, especially those with limited mobility or who live in remote places. It lowers administrative costs for doctors and leaves more room in office schedules for patients whose care requires in-person visits.

Even more important, the pandemic could force a reckoning with the environmental and behavioral issues that result increasingly in prominent health risks in this country. We need to stop blaming genetics for every ailment and focus more on preventable causes of poor health like a bad diet and inactivity.

Consider, for example, the health status of those who have been most vulnerable to sickness and death from Covid-19. Aside from advanced age, about which we can do nothing, it’s been people with conditions that are often largely preventable: obesity, Type 2 diabetes, high blood pressure, coronary artery disease and smoking. Yet most physicians are unable to influence the behaviors that foster these health-robbing conditions.

“Many people need help to make better choices for themselves,” Dr. Navathe said. But the professionals who could be most helpful, like dietitians, physical trainers and behavioral counselors, are rarely covered by health insurance. The time is long overdue for Medicare and Medicaid, along with private insurers, to broaden their coverage, which can save both health and money in the long run.

Policy wonks should also pay more attention to widespread environmental risks to health. Too many Americans live in areas where healthful food is limited and prohibitively expensive and where the built environment offers little or no opportunity to exercise safely.

Individuals, too, have a role to play. The pandemic has fostered “an opportunity for patients to take on a more active role in their care,” Dr. Shrank said in an interview.

Covid-based limitations gave prospective patients a chance to consider what procedures they really needed. Most elective surgeries were put on hold when hospitals and medical personnel were overwhelmed with the challenges of caring for a tsunami of patients infected with a deadly virus.

Dr. Shrank suggested that people ask themselves, “How did you do without the procedure?” Maybe you didn’t really need it, at least not now. Maybe instead of costly surgery for a bad back or bum knee, physical therapy, home exercises or self-administered topical remedies could provide enough relief to permit desired activities.

Does every ache and pain require a doctor visit? Short of a catastrophic sign like crushing chest pain or unexplained bleeding, my approach is to wait a week or two to see if a new symptom resolves without medical intervention. I awoke one January morning with pain in my right wrist and forearm so intense I couldn’t brush my teeth. Perhaps I did too much crocheting or slept on it wrong. Ice didn’t help, but I applied an anti-inflammatory ointment, took two naproxen, wrapped my wrist in a brace from the local pharmacy and refrained from crocheting for two days, by which time the pain had resolved.

When professional health care is needed, new approaches have become more acceptable during the pandemic, Dr. Shrank said. Emergency room visits and hospital admissions declined precipitously (though not always wisely by people with symptoms of a heart attack). Noting that many patients can be treated effectively at home by a visiting nurse, Dr. Shrank said, “No one wants to go to the hospital or a rehab facility if there’s a good alternative.”

Weekly Health Quiz: Covid, Climate and Creativity

1 of 7

Austrian researchers reported that people who tended to be physically active performed higher on tests of:

Dependency

Collaboration

Creativity

Trust

2 of 7

IBM researchers reported that artificial intelligence analysis of writing samples could predict the onset of this neurologic illness years later:

Alzheimer’s disease

Parkinson’s disease

Multiple sclerosis

Amyotrophic lateral sclerosis

3 of 7

Myxomas are rare and slow-growing tumors usually found in this organ:

Lung

Heart

Brain

Pancreas

4 of 7

A warming climate has been linked to an increased risk of this ailment:

Asthma

Dementia

Lyme disease

All of the above

5 of 7

Four of the five metropolitan areas with the highest rates of recent coronavirus cases are in this state:

California

Texas

Florida

New York

6 of 7

Which statement about people who have already had Covid is true?

They do not need to be vaccinated

They are more likely experience intense side effects after vaccination

They tend to generate low levels of antibodies after vaccination

All of the above

7 of 7

Some brands of baby foods sold in the United States were found to contain this toxic metal:

Arsenic

Lead

Cadmium

All of the above

Even in Poorer Neighborhoods, the Wealthy Are Lining Up for Vaccines

Even in Poorer Neighborhoods, the Wealthy Are Lining Up for Vaccines

Officials acknowledge that the coveted shots are disproportionately going to white people and that planners’ efforts to course-correct are having limited effect.

Rose Woodside, 93, left, and her daughter, Adora Lee, 70 talking a nurse at a pre-vaccine screening in Washington, D.C. They obtained appointments after the city began giving priority to people in neighborhoods hit hardest by the virus.
Rose Woodside, 93, left, and her daughter, Adora Lee, 70 talking a nurse at a pre-vaccine screening in Washington, D.C. They obtained appointments after the city began giving priority to people in neighborhoods hit hardest by the virus.Credit…Kenny Holston for The New York Times
  • Feb. 2, 2021, 5:00 a.m. ET

WASHINGTON — As soon as this city began offering Covid vaccines to residents 65 and older, George Jones, whose nonprofit agency runs a medical clinic, noticed something striking.

“Suddenly our clinic was full of white people,” said Mr. Jones, the head of Bread for the City, which provides services to the poor. “We’d never had that before. We serve people who are disproportionately African-American.”

Similar scenarios are unfolding around the country as states expand eligibility for the shots. Although low-income communities of color have been hit hardest by Covid-19, health officials in many cities say that people from wealthier, largely white neighborhoods have been flooding vaccination appointment systems and taking an outsized share of the limited supply.

People in underserved neighborhoods have been tripped up by a confluence of obstacles, including registration phone lines and websites that can take hours to navigate, and lack of transportation or time off from jobs to get to appointments. But also, skepticism about the shots continues to be pronounced in Black and Latino communities, depressing sign-up rates.

Early vaccination data is incomplete, but it points to the divide. In the first weeks of the rollout, 12 percent of people inoculated in Philadelphia have been Black, in a city whose population is 44 percent Black. In Miami-Dade County, just about seven percent of the vaccine recipients have been Black, even though Black residents comprise nearly 17 percent of the population and are dying from Covid-19 at a rate that is more than 60 percent higher than that of white people. In data released last weekend for New York City, white people had received nearly half of the doses, while Black and Latino residents were starkly underrepresented based on their share of the population.

And in Washington, 40 percent of the nearly 7,000 appointments initially made available to people 65 and older were taken by residents of its wealthiest and whitest ward, which is in the city’s upper northwest section and has had only five percent of its Covid deaths.

We want people regardless of their race and geography to be vaccinated, but I think the priority should be getting it to the people who are contracting Covid at the highest rates and dying from it,” said Kenyan McDuffie, a member of the City Council whose district is two-thirds Black and Latino.

Alarmed, many cities are trying to rectify inequities. Baltimore will offer the shot in housing complexes for the elderly, going door-to-door.

“The key with the mobile approach is you can get a lot of hard-hit folks at the same time — if we just get enough supply to do that,” said the city’s health commissioner, Dr. Letitia Dzirasa.

Officials in Wake County, N.C., which includes Raleigh, are first attempting to reach people 75 and over who live in nine ZIP codes that have had the highest rates of Covid. “We weren’t going to prioritize those who simply had the fastest internet service or best cell provider and got through fastest and first,” said Stacy Beard, a county spokeswoman.

Fixing the problem is tricky, however. Officials fear that singling out neighborhoods for priority access could invite lawsuits alleging race preference. To a large extent, the ability of localities to address inequities depends on how much control they have over their own vaccine allocations and whether their political leadership aligns with that of supervising county or state authorities.

The experiences of Dallas and the District of Columbia, for example, have resulted in very different outcomes. Dallas County, predominantly Democratic, has been thwarted by the state health department, under the aegis of a Republican governor, which quashed the county’s plan to give vaccines to certain minority neighborhoods first. But Washington was able to quickly course-correct.

D.C. pivots to reach the more vulnerable

Adora Lee, a resident of Washington’s Ward 8, receiving the vaccine. “People who live in Ward 3 and people who live in Ward 8, they’ve got different social realities,” she said. “This is no joke for us.”
Adora Lee, a resident of Washington’s Ward 8, receiving the vaccine. “People who live in Ward 3 and people who live in Ward 8, they’ve got different social realities,” she said. “This is no joke for us.”Credit…Kenny Holston for The New York Times

A few days after its 65-and-older population became eligible for the vaccine on Jan. 11, Mr. McDuffie, the city councilman in the District of Columbia, flagged the issue of wealthier residents getting disproportionate access to the vaccine in a call with city officials. Overall, 74 percent of deaths and 48 percent of cases in Washington have been among Black residents, who make up 46 percent of the population; 11 percent of deaths and 25 percent of cases have been among white residents, who make up nearly the other half of the district.

By the end of that week, the city announced a new policy — offering the first day of new appointments to people in ZIP codes with the highest rates of infection and death from the virus. Under the new system, more appointments would be added a day later and people from other neighborhoods could sign up then. The city also quadrupled the number of workers helping people make appointments through its call center, to 200.

But email lists in wealthier neighborhoods lit up in protest.

“It looked like maybe Ward 3 was being punished for being more computer savvy,” said Mary Cheh, a city council member representing the ward, where houses in neighborhoods near American University or the Potomac River routinely sell for more than $2 million. “I was inundated with emails from people who were just really angry about it.”

The day after the policy change, Ms. Cheh wrote to her constituents, citing the data about the shots and saying that “our anxiety to get one right away should not cloud the pursuit of equitable vaccine distribution.”

“When I sent out that note, people said, ‘Oh thank you, I understand now,’” Ms. Cheh said. Still, she called the city’s new system “a very blunt instrument,” and said it would be fairer to base need on an individual’s risk, not an entire neighborhood’s.

Adora Iris Lee, 70, lives in one of Washington’s priority neighborhoods — Congress Heights, part of Ward 8 in the district’s southern area, which is heavily Black and has had the highest number of Covid deaths. She said she still had spent more than three hours on hold, but obtained appointments for herself and her mother, who is 93.

“Being able to call at a time that was designated for us — I felt good about that,” Ms. Lee said. “People who live in Ward 3 and people who live in Ward 8, they’ve got different social realities. This is no joke for us.”

Still, Mr. Jones, of Bread for the City, said that even with the new system, hardly any of the people coming for shots at his clinic were its regular patients. The clinic started reaching out to its regulars and, with the city’s permission, reserved all its first doses for them and for clients of other social service organizations last week.

“It’s not just a case of preserving the spots for people,” Mr. Jones said. “Somehow we’ve got to persuade them to use those spots.”

Showdown in Dallas

A vaccine line at Fair Park in Dallas last month.Credit…Pool photo by Smiley N.

Dallas County’s rollout plans for the vaccine included an inoculation hub in a neighborhood that is largely African-American and Latino. But when the sign-up website went live, the link speedily circulated throughout white, wealthier districts in North Dallas.

“Instead of getting a diverse sampling, we had a stampede of people who were younger and healthier than those who had initially gotten the links,” said Judge Clayton Jenkins, head of the Dallas County Commissioners Court. Observers told commissioners that those in line were overwhelmingly white.

The county commissioners quietly contacted Black and Latino faith leaders in South Dallas, who encouraged constituents to show up for shots without appointments, as long as they offered proof that they were 75 and older.

That plan worked for a day or so.

“Then city council people in North Dallas got calls and the mayor said it would be open to everyone over 75,” Judge Jenkins said. “That led again to a huge stampede of people from the suburbs who had reliable cars.”

John Wiley Price, a Dallas commissioner who represents voters in South Dallas, argued that the 27,000 people who had signed up from 11 vulnerable ZIP codes should be given the vaccine ahead of other neighborhoods. Already, more than 300,000 Dallas County residents had registered; The county was only receiving a weekly allocation of about 9,000 doses.


Covid-19 Vaccines ›


Answers to Your Vaccine Questions

Currently more than 150 million people — almost half the population — are eligible to be vaccinated. But each state makes the final decision about who goes first. The nation’s 21 million health care workers and three million residents of long-term care facilities were the first to qualify. In mid-January, federal officials urged all states to open up eligibility to everyone 65 and older and to adults of any age with medical conditions that put them at high risk of becoming seriously ill or dying from Covid-19. Adults in the general population are at the back of the line. If federal and state health officials can clear up bottlenecks in vaccine distribution, everyone 16 and older will become eligible as early as this spring or early summer. The vaccine hasn’t been approved in children, although studies are underway. It may be months before a vaccine is available for anyone under the age of 16. Go to your state health website for up-to-date information on vaccination policies in your area

You should not have to pay anything out of pocket to get the vaccine, although you will be asked for insurance information. If you don’t have insurance, you should still be given the vaccine at no charge. Congress passed legislation this spring that bars insurers from applying any cost sharing, such as a co-payment or deductible. It layered on additional protections barring pharmacies, doctors and hospitals from billing patients, including those who are uninsured. Even so, health experts do worry that patients might stumble into loopholes that leave them vulnerable to surprise bills. This could happen to those who are charged a doctor visit fee along with their vaccine, or Americans who have certain types of health coverage that do not fall under the new rules. If you get your vaccine from a doctor’s office or urgent care clinic, talk to them about potential hidden charges. To be sure you won’t get a surprise bill, the best bet is to get your vaccine at a health department vaccination site or a local pharmacy once the shots become more widely available.

Probably not. The answer depends on a number of factors, including the supply in your area at the time you’re vaccinated. Check your state health department website for more information about the vaccines available in your state. The Pfizer and Moderna vaccines are the only two vaccines currently approved, although a third vaccine from Johnson & Johnson is on the way.

That is to be determined. It’s possible that Covid-19 vaccinations will become an annual event, just like the flu shot. Or it may be that the benefits of the vaccine last longer than a year. We have to wait to see how durable the protection from the vaccines is. To determine this, researchers are going to be tracking vaccinated people to look for “breakthrough cases” — those people who get sick with Covid-19 despite vaccination. That is a sign of weakening protection and will give researchers clues about how long the vaccine lasts. They will also be monitoring levels of antibodies and T cells in the blood of vaccinated people to determine whether and when a booster shot might be needed. It’s conceivable that people may need boosters every few months, once a year or only every few years. It’s just a matter of waiting for the data.

Employers do have the right to compel their workers to be vaccinated once a vaccine is formally approved. Many hospital systems, for example, require annual flu shots. But employees can seek exemptions based on medical reasons or religious beliefs. In such cases, employers are supposed to provide a “reasonable accommodation” — with a coronavirus vaccine, for example, a worker might be allowed to work if they wear a mask, or to work from home.

If you have other questions about the coronavirus vaccine, please read our full F.A.Q.

But when Judge Jenkins inquired whether geographical priority would pass muster, state officials said that if Dallas proceeded with the plan, the state would withhold the county’s supply.

According to a state health department spokesman, inoculation hubs had to agree to vaccinate any Texan, because not every county has a site. If Dallas excluded residents by geography, providers would be in breach of contract.

Dallas backed down.

Persuading people to get the shot

A mass Covid vaccination event in Denver on Saturday.Credit…Michael Ciaglo/Getty Images

Even successful efforts to target impoverished neighborhoods are running into another problem. Many Black and Latino people are hesitant to get the vaccine.

In Colorado, 1 of 16 white residents have received the vaccine so far, compared to 1 of 50 Latinos, who comprise 20 percent of the state’s population, according to a Colorado Springs newspaper, The Gazette.

“There are a lot of Chicanos who are like, ‘I want to wait, I have questions, I need some answers,’ ” said Julie Gonzales, a state senator from Denver, who starts her workday sending condolences to constituents, many of them Latino, who have lost family members to the virus.

Public health experts and outreach campaigns need to be attuned to cultural nuances that differ among Latino generations, Ms. Gonzales said. “It’s one thing to speak to an old-school Chicano who has been here for generations versus someone who is concerned about whether I.C.E. can find out their personal information if they try to get the vaccine,” she said, referring to the federal Immigration and Customs Enforcement agency.

A tracking poll by the Kaiser Family Foundation, conducted just before President Biden took office, found that while the share of people overall who wanted to get the vaccine as soon as possible has increased since December, 43 percent of Black adults and 37 percent of Hispanic adults said they wanted to “wait and see how it’s working,” compared with 26 percent of white adults.

When initial statistics in Philadelphia showed that only 12 percent of vaccine recipients were Black, city health officials recoiled. Blindsided by an inexperienced start-up company whose vaccination strategies faltered, health officials also attributed the low numbers to hesitation among city nursing home workers and hospital aides, many of whom are Black.

Now that the city has expanded eligibility, it is hopeful that the distribution will become more equitable. The vaccine is going to residents with high-risk medical conditions, as well as first responders, people who work in public transit and those in retail and food service jobs who come into contact with the public.

“Many of these are people who are paid less, tend to be from communities of color and are at high risk because they are exposed to lots of people,” said James Garrow, a spokesman for the Philadelphia Department of Public Health.

Mixed success as outreach expands

Some cities now provide vaccination pop-up clinics in Black churches. Denver is directing doses to community clinics that serve the underinsured.

Dallas has a new bilingual call center. Still, according to the latest county data, white people, who make up 28.5 percent of Dallas’s population, have gotten 62.6 percent of its vaccine doses.

Even in Washington, D.C., frustrations linger despite clear progress. Last week, city officials announced results of their tweaked distribution plan: Just over half of shots have now gone to residents of neighborhoods given priority, up from 29.6 percent during the first week that older people were vaccinated.

Yet, during a daylong session last week, council members heard pained accounts from people like Janett Gasaway, 77, who still has not been able to get vaccine appointments for herself or her 89-year-old husband. Despite multiple calls — she on their landline, he on his cellphone — on the days that appointments are offered to the most vulnerable ZIP codes, they haven’t succeeded. On Thursday, 1,745 appointments were gone in 18 minutes.

“It is not working,” she said.

Weekly Health Quiz: Exercise, French Fries and Covid

1 of 7

A new study of men at risk for diabetes found that compared to those who worked out in the morning, those who worked out at this time of day showed greater metabolic benefits and loss of belly fat:

Midday

Afternoon

Evening

Time of day had no impact on exercise results

2 of 7

A diet high in fried foods is tied to an increased risk of this cardiovascular ailment:

Heart disease

Heart failure

Stroke

All of the above

3 of 7

Masks can protect against the spread of the coronavirus. The gold-standard in masks, which should be reserved for medical personnel, is the:

KN95 mask

KF94 mask

N95 mask

Surgical mask

4 of 7

The number of coronavirus cases in the United States now exceeds:

1 million

5 million

25 million

100 million

5 of 7

About how many Americans have died from Covid?

100,000

200,000

425,000

1 million

6 of 7

This state has vaccinated more than 9 percent of its residents against Covid, among the highest percentage of any state:

Washington

Delaware

West Virginia

New York

7 of 7

Women who had already had a pregnancy loss were more likely to have a successful pregnancy if they took a low dose of this common drug daily:

Aspirin

Acetaminophen

Ibuprofen

Diphenhydramine

Pregnant Women Get Conflicting Advice on Covid-19 Vaccines

The W.H.O. and the C.D.C. provide differing views, and experts partly blame a lack of data because expectant mothers have been excluded from clinical trials.

To Promote Vaccines, New Orleans Dances With Its Sleeves Rolled Up

To Promote Vaccines, New Orleans Dances With Its Heart on Its Sleeve

The new, upbeat ‘Sleeves Up, NOLA’ campaign deftly uses local personalities and the Carnival dance culture to encourage citizens to get a Covid shot.

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Video by City of New Orleans, courtesy of Crista RockCreditCredit…Crista Rock

  • Jan. 24, 2021, 11:18 a.m. ET

The snap of the snare drums is insistent. New Orleanians take joyous turns high-stepping and chicken strutting, dressed in the hand-sewn feathered finery of their social clubs and krewes. The celebration, shown on a new 30-second public service announcement airing in the city, is both resplendent and aching, an evocation of Carnival masking season that should have begun this month, culminating on Feb. 16 with Mardi Gras. All of it canceled, of course, by the coronavirus pandemic.

Yet the spot is hopeful: to regain this and more, it exhorts, get vaccinated.

The advertisement is one of numerous efforts around the country to persuade people of the importance of getting a Covid shot. But its homegrown approach, using neighborhood personas and invoking local culture with “laissez les bons temps rouler” dance moves and costumes, may make it particularly effective, say experts in vaccine hesitance and behavioral change.

“I’m getting the vaccine so we can have Mardi Gras, y’all!” shouts Jeremy Stevenson, a Monogram Hunter Mardi Gras Indian, also known as Second Chief Lil Pie, as he sways wildly in a 150-pound, 12-foot-tall tower of turquoise feathers and beading, beneath the Claiborne Avenue overpass, a well-known festival meet-up.

Other locals prance forth to offer their own reasons, concluding with the tagline: “Sleeves Up, NOLA!”

“I teared up several times and also just laughed out loud with delight. The sense of community is contagious,” said Alison M. Buttenheim, a vaccine behavioral expert at the University of Pennsylvania School of Nursing who is most decidedly not a New Orleanian.

“Vaccination is framed as a collective action that everyone can contribute to in order to bring back things the community values and cherishes,” added Dr. Buttenheim, the scientific director of the university’s Center for Health Incentives and Behavioral Economics.

Jonathan Fisher of the Young Men Olympians Benevolent Association, a social aid and pleasure club, dancing and promoting vaccination.
Jonathan Fisher of the Young Men Olympians Benevolent Association, a social aid and pleasure club, dancing and promoting vaccination.Credit…City of New Orleans, courtesy of Crista Rock
Lil Pie, second chief of the Mardi Gras Indian tribe the Monogram Hunters, in hand-sewn finery, embellished with a new-norm mask.Credit…City of New Orleans, courtesy of Crista Rock

Although national vaccine hesitation rates are falling, surveys show that antipathy to the new shots is still widespread among some demographic groups, jeopardizing the goal of broad immunity. There has been little consensus, much less activity, around ways to build confidence in the shot.

Since the summer, public health officials and politicians repeatedly called for national pro-vaccination campaigns. But no meaningful federal campaign has materialized, so concerned local officials have begun to develop their own publicity.

New Orleans may be best positioned to be at the forefront. Regularly battered by hurricanes, the city has an emergency management office practiced in public messaging.


Covid-19 Vaccines ›


Answers to Your Vaccine Questions

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

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

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

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

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

Earlier in the pandemic, it devised a “Masks Up, NOLA!” slogan. As the virus raced through neighborhoods, Laura A. Mellem, the city’s public engagement manager for its NOLA Ready program, was acutely aware that it was hitting Black New Orleanians in starkly disproportionate numbers. Black people comprise some 60 percent of the city’s population but nearly 74 percent of its Covid-19 deaths.

“But the communities that are the most impacted by the virus are likely the most hesitant about the vaccine, because of the longstanding history of abuse against them in the name of science,” Ms. Mellem said.

How to persuade them to get the shot?

In November, the city put together the Vaccine Equity and Communications Working Group, a coalition of high-profile public health doctors, faith leaders, leaders from Black, Latino and Vietnamese communities, and heads of the city’s large social clubs. The group filled out surveys, identifying cultural icons that would appeal widely to residents.

Rather than focusing messaging on the miseries wrought by the pandemic, Ms. Mellem said, they decided to emphasize an aspirational and inviting tone, a core insight derived behavioral change research and urban thought leaders in cities like San Francisco. As Edward Maibach, a professor at George Mason University who studies public health messaging, writes, the most effective communications “make the behaviors we are promoting easy, fun and popular.”

“I’m getting my shot so I can visit my 92-year-old mom and we can eat in our favorite restaurants,” says Julie Nalibov of the Krewe of Red Beans, which helps the city’s stricken cultural performing artists, many of whom are over 70.

The “social aid and pleasure clubs, ” which parade with brass-bands on Sundays and offer fellowship and volunteer service usually to Black communities, are represented by the all-female N’awlins Dawlins Baby Dolls, in satiny yellow dresses and parasols: “I’m getting the shot to protect my family!” says Trinette Pichon of the Dawlins , sashaying with a toddler on her hip.

Norman Dixon of the Young Men Olympians Benevolent Association, second-line stepping as he exhorts: “Sleeves Up, NOLA.”Credit…City of New Orleans, courtesy of Crista Rock
The N’awlins Dawlins Baby Dolls, an all-female club that holds volunteer and social events, and dances mightily on Mardi Gras.Credit…City of New Orleans, courtesy of Crista Rock

In beribboned suits, three members of the Young Men Olympians Benevolent Association, one of the oldest and most prominent clubs, display second-line stepping — a New Orleans tradition, in which brass bands are followed by dancing club members and fans, exuberant even during funerals:

I’m getting the vaccine, “to continue my culture,” says one. “So that I can dance another day,” says the second. “So I don’t have to lose another brother,” says the third.

The spot took scarcely an hour to shoot and about eight hours to edit. Because the videographer, Crista Rock, gave the city considerably reduced rates, the ad cost about $1,000 and will be shown on local TV stations and saturate social media. Still photos will adorn citywide billboards.

“I hope state and local health departments around the country can get resources to develop more hyper-local campaigns. Imagine similar spots from Philly, or Boise, or Hawaii, or the Cherokee Nation,” said Dr. Buttenheim.

For Mr. Stevenson, Chief Lil Pie, the promo represents traditions he has known intimately since he was 11, when he began working with his father, Big Chief Pie, on their annual hand-sewn costumes.

Because of the pandemic this year, the Monogram Hunters’ Sunday night Mardi Gras rehearsals, which typically start the weekend after Thanksgiving and draw swelling, call-and-response crowds to the neighborhood tavern, the First and Last Stop Bar, were canceled. On Mardi Gras itself, the tribe, whose members paint their cheeks black and red to honor the local Indians who sheltered runaway New Orleans slaves, will not be stepping out from the First and Last Stop to show off their regalia.

But Mr. Stevenson, determined to sustain the old ways, has been hand-sewing yet another spectacular costume this year: this one features a black Pegasus. He will mount it in a glass case, probably right outside the bar, for people to take selfies with. For homebound fans, he will wheel it through the streets to their doorsteps, so they can have a look.

He misses the heady, throbbing chanting, the drums thudding, tambourines crashing, when the tribes come together on Claiborne Avenue for the traditional Mardi Gras call-and-response throwdown.

“If we don’t get a vaccine,” he said, “how can me and my tribe and the 150 people who follow us meet and gather?”

Weekly Health Quiz: Covid Variants, Moderate Exercise and Coffee

1 of 7

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

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

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

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

Scientists believe current vaccines will be effective against the new variant

2 of 7

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

They shed more body fat

They showed greater improvements in blood pressure

They were better able to metabolize fats in the diet

All of the above

3 of 7

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

Hip

Shoulder

Knee

Elbow

4 of 7

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

100,000

200,000

400,000

1 million

5 of 7

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

Flat-soled and flexible

Stable, supportive and well-cushioned

Tightly laced with a low, broad heel

The type of footwear had little impact on symptoms of arthritis

6 of 7

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

Atrial fibrillation

Heart failure

Heart attack

High blood pressure

7 of 7

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

Erectile dysfunction

Prostate cancer

Amyotrophic lateral sclerosis

Dementia

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

Ask Well

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

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

Credit…Getty Images
Tara Parker-Pope

  • Jan. 19, 2021Updated 3:44 p.m. ET

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

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

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

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

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

How can I protect myself from the new coronavirus variant?

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

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

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

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

Should I upgrade my mask?

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

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


Covid-19 Vaccines ›


Answers to Your Vaccine Questions

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

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

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

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

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

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

Do I need an N95 medical mask?

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

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

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

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

Are there additional ways to reduce my risk?

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

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

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

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

Will the current Covid vaccines work against the new variants?

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

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

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

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

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

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

Are children more at risk from the new variant?

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

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

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

Weekly Health Quiz: Exercise, Body Temperature and a Covid Vaccine Mystery

1 of 7

An 11-minute program of calisthenics and rest, done three times a week for six weeeks, had this effect on out-of-shape young men and women:

It increased their fitness levels

It improved their endurance by 7 percent

It increased their leg power slightly

All of the above

2 of 7

Which statement about body temperatures is not true?

Worldwide, average body temperatures seem to be decreasing

Body temperatures tend to rise during and after exercise

Older people tend to have lower body temperatures than younger people

Body temperature tends to be higher in the morning than in the evening

3 of 7

Health authorities are investigating the death of a 56-year-old doctor in Florida who developed this blood clotting disorder days after receiving the Covid vaccine:

Hemophilia

Pernicious anemia

Acute immune thrombocytopenia

Myelodysplastic syndrome

4 of 7

Creutzfeldt-Jakob disease, sometimes called mad cow disease, is thought to be caused by this type of infectious organism:

Bacteria

Virus

Fungus

Prion

5 of 7

Which statement about throat cancers is not true?

Most throat cancers are caused by human papillomavirus, or HPV

Having oral sex at a young age increases the risk of developing throat cancer

HPV-associated throat cancers are more common in women than men

HPV-associated throat cancers are more common in whites than in African-Americans

6 of 7

Being overweight during pregnancy was tied to this fertility issue, Danish researchers report:

Mothers who are overweight during their first pregnancy are at increased risk of fertility problems during subsequent pregnancies

Daughters born to overweight mothers were at increased risk of having fertility problems

Sons born to overweight mothers were at increased risk of being infertile

All of the above

7 of 7

Diets rich in this vitamin were tied to a lower risk of developing Parkinson’s disease:

Vitamin A

B vitamins

Vitamins C and E

Vitamin D

An 11-Minute Body-Weight Workout With Proven Fitness Benefits

Phys Ed

An 11-Minute Body-Weight Workout With Proven Fitness Benefits

Five minutes of burpees, jump squats and other calisthenics, alternating with rest, improved aerobic endurance in out-of-shape men and women.

Credit…Getty Images
Gretchen Reynolds

  • Jan. 13, 2021, 5:00 a.m. ET

Five minutes of burpees, jump squats and other calisthenics significantly improve aerobic endurance, according to one of the first randomized, controlled trials to test the effects of brief body-weight workouts. The study’s findings are predictable but reassuring, at a time when many of us are relying on short exercise sessions in our homes to gain or retain our fitness. They provide scientific assurance that these simple workouts will work, physiologically, and our burpees will not be in vain.

Last year, when the pandemic curtailed traditional gym hours and left many people hesitant to exercise outside on crowded sidewalks or paths, quite a few of us moved our workouts indoors, into our living rooms or basements, altering how we exercise. Some of us purchased stationary bicycles and started intense spin classes or turned to online personal trainers and yoga classes. But many of us started practicing some version of a body-weight routine, using calisthenics and other simple strength-training exercises that rely on our body weight to provide resistance.

Body-weight training has been a staple of exercise since almost time immemorial, of course. Usually organized as multiple, familiar calisthenics performed one after another, this type of exercise has gone by various names, from Swedish Exercises a century ago to the Royal Canadian Air Force’s Five Basic Exercises (5BX) program in the 1960s, to today’s Scientific 7-Minute Workout and its variations.

In general, one of the hallmarks of these programs is that you perform the exercises consecutively but not continuously; that is, you complete multiple repetitions of one exercise, pause and recover, then move on to the next. This approach makes the workouts a form of interval training, with bursts of intense exertion followed by brief periods of rest.

Traditional interval training has plenty of scientific backing, with piles of research showing that a few minutes — or even seconds — of strenuous intervals, repeated several times, can raise aerobic fitness substantially. But the exercise in these studies usually has involved stationary cycling or running.

Few experiments have examined the effects of brief body-weight workouts on endurance and strength, and those few had drawbacks. Most focused on people who already were fit, and almost none met the scientific gold standard of being randomized and including an inactive control group. Consequently, our faith in the benefits of short body-weight training may have been understandable, but evidence was lacking.

So, for the new study, which was published this month in the International Journal of Exercise Science, researchers at McMaster University in Hamilton, Ontario, and the Mayo Clinic in Rochester, Minn., decided to develop and test a basic body-weight routine. They modeled their version on the well-known 5BX program, which once had been used to train members of the Canadian military in remote posts. But the researchers swapped out elements from the original, which had included exercises like old-fashioned situps that are not considered particularly good for the back or effective in building endurance.

They wound up with a program that alternated one minute of calisthenics, including modified burpees (omitting the push-ups that some enthusiasts tack onto the move) and running in place, with a minute of walking, also in place. The routine required no equipment, little space and a grand total of 11 minutes, including a minute for warming up and cooling down.

They then recruited 20 healthy but out-of-shape young men and women, measured their current fitness, leg power and handgrip strength and randomly assigned half to start practicing the new program three times a week, while the others continued with their normal lives, as a control.

The exercisers were asked to “challenge” themselves during the calisthenics, completing as many of each exercise as they could in a minute, before walking in place, and then moving to the next exercise.

After six weeks, all of the volunteers returned to the lab for follow-up testing. And, to no one’s surprise, the exercisers were more fit, having upped their endurance by about 7 percent, on average. Their leg power also had grown slightly. The control group’s fitness and strength remained unchanged.

“It was good to see our expectations confirmed,” says Martin Gibala, a professor of kinesiology at McMaster University, who oversaw the new study and, with various collaborators, has published influential studies of intense interval training in the past.

“It seemed obvious” that this kind of training should be effective, he says. But “we now have evidence” that brief, basic body-weight training “can make a meaningful difference” in fitness, he says.

The study was small and quite short-term, though, and looked at the effects only among healthy young people who are capable of performing burpees and jump squats. “Some people may need to substitute” some of the exercises, Dr. Gibala says, especially anyone who has problems with joint pain or balance. (See the Standing 7-Minute Workout for examples of appropriate replacements, in that case.)

But whatever mix of calisthenics you settle on, “the key is to push yourself a bit” during each one-minute interval, he says.

Here is the full 11-minute workout used in the study, with video links of each exercise by Linda Archila, a researcher who led the experiment while a student at McMaster University.

  • 1 minute of easy jumping jacks, to warm up

  • 1 minute of modified burpees (without push-ups)

  • 1 minute of walking in place

  • 1 minute of high-knee running in place

  • 1 minute of walking in place

  • 1 minute of split squat jumps (starting and ending in the lunge position, while alternating which leg lands forward)

  • 1 minute of walking in place

  • 1 minute of high-knee running in place

  • 1 minute of walking in place

  • 1 minute of squat jumps

  • 1 minute of walking in place, to cool down

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

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

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

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

  • Jan. 9, 2021, 12:00 p.m. ET

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Covid-19 Vaccines ›


Answers to Your Vaccine Questions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Weekly Health Quiz: Coconut Oil, Coronavirus and Exercise Goals

1 of 7

Which statement about coconut oil is not true?

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

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

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

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

2 of 7

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

5,500 steps

7,500 steps

10,000 steps

15,000 steps

3 of 7

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

Illinois

Pennsylvania

Ohio

Georgia

4 of 7

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

California

New York

Texas

Florida

5 of 7

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

Heart attack

Stroke

Early death

All of the above

6 of 7

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

Thyroid cancer

Breast cancer

Ovarian or endometrial cancer

Cervical cancer

7 of 7

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

Keratitis

Blepharitis

Trachoma

Stye

Weekly Health Quiz: A New Coronavirus Variant, Diet Guidelines and Really Short Workouts

1 of 7

The first case of a highly contagious coronavirus variant originally discovered in Britain was found in the United States, detected in a young man living in this state:

Alabama

California

Colorado

Florida

2 of 7

This state became the first to surpass two million coronavirus cases:

Texas

California

New York

Florida

3 of 7

Middle-aged and older adults saw marked improvements in fitness and strength after performing intense exercise intervals on a stationary bike for periods as short as:

4 seconds

40 seconds

4 minutes

40 minutes

4 of 7

Experts warn that doctors too often prescribe these risky medications to treat sinus and respiratory infections, even though evidence that they provide any benefit is lacking:

Opiates

Blood thinners

Steroid shots or pills

Antibitoics

5 of 7

The newly released Dietary Guidelines for Americans include which of the following changes?

Cutting added sugars in the diet from 10 percent of daily calories to 6 percent of daily calories

Limiting the amount of alcohol men should consume to one drink a day, a decrease from two drinks a day

Avoiding added sugars altogether for children under 2

All of the above

6 of 7

Suicide rates are highest in this group:

White Americans

Black Americans

Hispanics

Asian-Americans

7 of 7

Which statement about hereditary angioedema, or HAE, is true?

It is a rare, inherited disorder that often causes swelling of the face, hands or feet

Painul swelling can also affect the gastrointestinal or respiratory tracts, with sometimes deadly consequences

A pregnancy or starting birth control pills can set off attacks of HAE

All of the above

Weekly Health Quiz: Body Fat, Pulse Oximeters and a New Strain of Coronavirus

1 of 7

Cold weather is hitting many parts of the country, posing challenges for social distancing during the pandemic. Which statement about acclimating to cold weather is not true?

People over 60 tend to be less tolerant of cold than younger people

Carrying extra body fat helps protect against cold

Heat loss tends to be greater in men than women

Being physically active helps protect against cold

2 of 7

A new variant of the novel coronavirus that is sweeping through the United Kingdom appears to be:

Far deadlier than existing strains

Resistant to current vaccines

More contagious than existing strains

All of the above

3 of 7

Pulse oximeters, which measure blood oxygen levels and can be a lifesaving tool for monitoring Covid-19 symptoms, may be less accurate in this group:

People who are sedentary

Athletes

Adults over 70

People with darker skin

4 of 7

A Norweigan study found that older men and women were less likely to die prematurely when they incorporated which of the following into their weekly workouts?

A moderate 50-minute walk

Strength training

Short bursts of intense exercise

All types of exercise showed a similar impact on longevity

5 of 7

Some localities are banning elective surgery because of rising coronavirus case counts. Elective surgery refers to surgery that is:

Optional

Not urgent

Performed in a non-hospital setting

All of the above

6 of 7

Prospective fathers with this medical condition were more likely to sire a pregnancy that did not reach full term:

Diabetes

Hypertension

Obesity

All of the above

7 of 7

Consumption of this beverage was tied to an increased risk of frailty in older women:

Coffee

Tea

Wine

Sugary or artificially sweetened drinks

Covid Guide: How to Get Through the Pandemic

Dec. 18, 2020

Hang in there, help is on the way

Times are tough now, but the end is in sight. If we hunker down, keep our families safe during the holidays and monitor our health at home, life will get better in the spring. Here’s how to get through it.

Tara Parker-Pope

Illustrations by Vinnie Neuberg

Everyone is tired of living like this. We miss our families and our friends. We miss having fun. We miss kissing our partners goodbye in the morning and packing school lunches. We miss travel and bars and office gossip and movie theaters and sporting events.

We miss normal life.

It has been a long, difficult year, and there are many tough weeks still ahead. The coronavirus is raging, and the United States is facing a grim winter, on track for 450,000 deaths from Covid-19 by February, maybe more.

But if we can safely soldier through these next few months, then normal life — or at least a new version of normal — will be within reach. New vaccines that are highly protective against coronavirus are being rolled out right now, first to health care workers and the most vulnerable groups, and then to the general population this spring.

“Help is on the way,” says Dr. Anthony S. Fauci, the nation’s top infectious disease expert. “A vaccine is literally on the threshold of being implemented. To me that is more of an incentive to not give up, but to double down and say, ‘We’re going to get through this.’”

The vaccine won’t change life overnight. It will take months to get enough people vaccinated so that the virus has nowhere to go. But the more everyone does their part to slow down the virus now — by wearing a mask and restricting social contacts — the better and faster the vaccine will work to slow the pandemic once we can all start getting vaccinated this spring.

“Why would you want to be one of the people who is the last person to get infected?” says Dr. Fauci. “It’s almost like being the last person to get killed in a war. You want to hang in there and protect yourself, because the end is in sight.”

(1)

Hunker Down for a Little Bit Longer

The pandemic is surging, but as bad as things are, the end is in sight. By doubling down on precautions, we can slow the virus and save lives.

A crucial number to watch this winter is the test positivity rate for your state and community. The number represents the percentage of coronavirus tests that are positive compared to the overall number of tests being given, and it’s an important indicator of your risk of coming down with Covid-19. When positive test rates in a community stay at 5 percent or lower for two weeks, you’re less likely to cross paths with an infected person. Since the fall, the national test positivity rate has crept above 10 percent, and it’s been 30 percent or higher in several states.

Rising case counts and rising test positivity rates mean there is more virus out there — and you need to double down on precautions, especially if you have a high-risk person in your orbit. Cut back on trips to the store or start having groceries delivered. Scale back your holiday plans. Don’t invite friends indoors, even for a few minutes. Always keep six feet of distance from people who don’t live in your home. Skip haircuts and manicures until the numbers come down again. Wear a mask.

Close your leaky bubble.

Here’s the harsh reality of virus transmission: If someone in your family gets sick, the infection probably came from you, another family member or someone you know. The main way coronavirus is transmitted is through close contact with an infected person in an enclosed space.

“One of the challenges we have is that familiarity is seen as being a virus protector,” said Michael Osterholm, a member of President-elect Joseph R. Biden Jr.’s coronavirus advisory group and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “More likely than not, knowing someone is the risk factor for getting infected.”

This summer, 47 percent of Americans said they had formed a “pod” or social “bubble” that includes two or more households committed to strict precautions so the group can safely socialize indoors.But sometimes your bubble is leakier than you realize. Farhad Manjoo, an opinion columnist for The Times, had initially assumed his bubble was pretty small, but it turned out that he was having direct or indirect contact with more than 100 people.

Whether your bubble is just your immediate household — or you’ve formed a bubble with others — take some time to check in with everyone and seal the leaks. This requires everyone to be honest about the precautions they’re taking (or not taking). Dr. Osterholm said that convincing people that their friends might infect them has been one of the biggest challenges of the pandemic. He told the story of a man and a woman who both contracted Covid-19 after attending a wedding.

“He told me, ‘We didn’t fly. I knew everybody there,’” said Dr. Osterholm. “He somehow had the mistaken belief that by knowing the person, you won’t get infected from them. We’ve got to break through that concept.”

Mask up. You’re going to need it for a while.

A study by the Institute for Health Metrics and Evaluation at the University of Washington estimated that 130,000 lives could be saved by February if mask use became universal in the United States immediately.

Various studies have used machines puffing fine mists to show that high-quality masks can significantly reduce the spread of pathogens between people in conversation. And the common-sense evidence that masks work has become overwhelming. One well-known C.D.C. study showed that, even in a Springfield, Mo., hair salon where two stylists were infected, not one of the 139 customers whose hair they cut over the course of 10 days caught the disease. A city health order had required that both the stylists and the customers be masked.

Choose a mask with two or three layers that fits well and covers your face from the bridge of your nose to under your chin. “Something is better than nothing,” said Linsey Marr, professor of civil and environmental engineering at Virginia Tech and one of the world’s leading aerosol scientists. “Even the simplest cloth mask of one layer of material blocks half or more of aerosols we think are important to transmission.”

Watch the clock, and take the fun outside.

When making decisions about how you’re spending your time this winter, watch the clock. If you’re spending time indoors with people who don’t live with you, wear a mask and keep the visit as short as possible. (Better yet, don’t do it at all.) Layer up, get hand warmers, some blankets, an outdoor heater — and move social events outdoors.

In an enclosed space, like an office, at a birthday party, in a restaurant or in a church, you can still become infected from a person across the room if you share the same air for an extended period of time. There’s no proven time limit that is safest, but based on contact tracing guidelines and the average rate at which we expel viral particles — through breathing, speaking, singing and coughing — it’s best to wear a mask and keep indoor activities, like shopping or haircuts, to about 30 minutes.

Take care of yourself, save a medical worker.

The country’s doctors, nurses and other health care workers are at a breaking point. Long gone are the raucous nightly cheers, loud applause and clanging that bounced off buildings and hospital windows in the United States and abroad — the sounds of public appreciation each night at 7 for those on the pandemic’s front line.

“Nobody’s clapping anymore,” said Dr. Jessica Gold, a psychiatrist at Washington University in St. Louis. “They’re over it.”

In interviews, more than two dozen frontline medical workers described the unrelenting stress that has become an endemic part of the health care crisis nationwide. Jina Saltzman, a physician assistant in Chicago, said she was growing increasingly disillusioned with the nation’s lax approach to penning in the virus. In mid-November, she was astounded to see crowds of unmasked people in a restaurant as she picked up a pizza. “It’s so disheartening. We’re coming here to work every day to keep the public safe,” she said. “But the public isn’t trying to keep the public safe.”

(2)

Scale Back Your Holiday Plans

How and when the pandemic ends will depend on the choices we make this winter, particularly around Christmas and New Year’s Eve.

Nobody wants to open presents by Zoom, light holiday candles at home alone or clink virtual champagne glasses to ring in the New Year.

But here we are, in the midst of a surging pandemic, on course to losing nearly a half million souls in less than a year. Despite the promise of a vaccine on the horizon, only a tiny fraction of Americans will be vaccinated by the end of December. Vaccines won’t enter large-scale distribution until spring 2021.

The only way to drive down infection rates for now will be to avoid large indoor gatherings, wear masks, cancel travel and limit your holiday celebrations to just those who live in your home.

Dr. Fauci said he, his wife and three daughters, who live in different parts of the country, all made a family decision not to travel for the holidays. It will be the first Christmas in 30 years that the entire family won’t be together.

“I’m a person in an age group that’s at high risk of serious consequences,” said Dr. Fauci. “That’s the first Thanksgiving since any of my three daughters were born that we have not spent it as a family. That was painful, but it was something that needed to be done. We are going to do the same thing over Christmas for the simple reason that I don’t see anything changing between Thanksgiving and Christmas and Hanukkah. In fact, I see it getting worse.”

If you do travel, get tested.

People who choose to travel over the holiday season despite the warnings should consider taking precautions. First, try to quarantine for at least a week (two weeks if possible) before your trip or visit with another household. The C.D.C. now recommends that domestic air travelers get tested before and after their trip.

Remember, a lot can go wrong between the time you take a test and the moment you hug Grandma. Not only are false negatives possible, you need to consider the risk of catching the virus after taking the test — in an airport, in a plane or from a taxi driver or rental car agent.

For a laboratory test, check the turnaround time in your area and try to schedule it as close as possible to your visit. If you’re using rapid testing, try to take more than one test over the days leading up to your visit, and if possible, get a rapid test on the same day you plan to visit family, friends or a vulnerable person. Test again after you arrive if you can.

Plan a safer holiday gathering.

If you’re determined to have people to your home for the holidays, keep the guest list small and consider these precautions.

Get tested: If testing is available in your area, consider asking all guests to be tested a few days before the holiday, timing it so they get the results before coming to your home. If rapid testing is available, get tested a few times during the week and on the day of the social event.

Move the event outside: Even if it’s cold outside, try hosting all or part of your holiday celebration outdoors. Look into space heaters and fire pits to warm a porch or patio. Even a partially open space, like a screened-in porch or a garage with the door open, is better than socializing indoors. If you decide to stay indoors, open the windows and turn on exhaust fans to help ventilate your home.

Wear masks: All guests should wear a mask when not eating. If you’re the host, set the example and put your mask on after the meal is over and everyone is enjoying the conversation. Limit the amount of time you spend together indoors.

Socialize outdoors the Scandinavian way.

In the pandemic, rather than feeling depressed that the arrival of cold weather will mean that you’ll be isolated indoors, apart from friends and family, we can take lessons from Scandinavians about how to continue getting together outdoors.

(3)

Take Care of Yourself at Home

Covid-19 can be scary, but we’ve learned a lot about how to monitor the illness and home — and when to seek hospital care.

Since the start of the pandemic, we’ve learned a lot about how to care for people infected with Covid-19. Death rates from the disease are dropping as doctors have gotten better at treating it and advising patients when to seek medical care.

Steroids like dexamethasone have lowered the number of deaths among hospitalized patients by about one-third. And although limited in supply, monoclonal antibodies, a treatment given to President Trump when he was ill with coronavirus, can possibly shorten hospital stays when given early in the course of infection.

But the vast majority of patients with Covid-19 will manage the illness at home. Check in with your doctor early in the course of your illness, and make a plan for monitoring your health and checking in again if you start to feel worse.

Get tested if you have symptoms.

Ideally, you should be able to get a coronavirus test whenever you want it. But in the United States, test availability varies around the country, depending on whether supplies are low or labs are overwhelmed. Check with your doctor, an urgent care clinic or your local health department about where to get tested in your area.

If you feel sick, you should be tested for Covid-19. A dry cough, fatigue, headache, fever or loss of sense of smell are some of the common symptoms of Covid-19. After you take your test, stay isolated from others and alert the people you’ve spent time with over the last few days, so they can take precautions while you’re waiting for your result. Many tests will work best if you are in the first week of your symptoms.

Track your symptoms.

Marking your calendar at the first sign of illness, and tracking your symptoms and oxygen levels, are important steps in monitoring a coronavirus infection. Covid-19 has been unpredictable in the range of symptoms it can cause. But when it turns serious, it often follows a consistent pattern.

While every patient is different, doctors say that days five through 10 of the illness are often the most worrisome time for respiratory complications of Covid-19. Covid-19 is a miserable illness, and it’s not always easy to know when to go to the emergency room. It’s important during this time to stay in touch with your doctor. Telemedicine makes it possible to consult with your doctor without exposing others to your illness.

Get a fingertip pulse oximeter.

The best way to monitor your health during Covid-19 is to use a pulse oximeter, a small device that clips onto your finger and measures your blood oxygen levels. If it drops to 93 or lower, it could be a sign that your oxygen levels are dropping. Call your doctor or go to the emergency room.

Pro tip: One of the things to remember about reading a pulse oximeter is that many of them are designed to be read by someone facing you, not the person wearing it. If you’re looking at it upside down, a healthy reading of 98 could look like an alarming 86.

Caring for someone with Covid-19

Caring for someone with mild to moderate symptoms of the coronavirus is similar to caring for someone with the flu. Give them supportive care, fluids, soups and Tylenol, and have them take their temperature and monitor oxygen levels with a pulse oximeter regularly. Always wear a mask in the sick person’s room even if they are not there or have recovered. Coronavirus particles can last as long as three days on various surfaces, and can be shaken loose when you pick up clothes, change bedding or pick up soiled tissues.

The plight of “Covid long-haulers”

It’s unclear how many people develop lingering and sometimes debilitating symptoms after a bout of Covid-19. Such symptoms — ranging from breathing trouble to heart issues to cognitive and psychological problems — are already plaguing an untold number of people worldwide. Even for people who were never sick enough to be hospitalized, the aftermath can be long and grueling, with a complex and lasting mix of symptoms.

There is an urgent need to address long-term symptoms of the coronavirus, leading public health officials say, warning that hundreds of thousands of Americans and millions of people worldwide might experience lingering problems that could impede their ability to work and function normally.

(4)

Look for Better Days This Spring

With the rollout of the vaccine, an end to the pandemic is in sight. Life will start to feel more normal in mid- to late 2021, depending on how many people get vaccinated.

Earlier this month, The Times spoke with Dr. Fauci about his predictions for the spring. Here’s what he had to say.

The end game for viral disease outbreaks, particularly respiratory diseases, is a vaccine. We can do public health measures that are tempering things, waiting for the ultimate showstopper, which is a vaccine. That’s why I’m saying we need to double down even more on public health measures to get us through to the period when enough people in this country will be vaccinated that the virus will have no place to go. It will be a blanket or an umbrella of herd immunity.

We have crushed similar outbreaks historically. We did it with smallpox. We did it with polio. We did it with measles. We can do it with this coronavirus. It requires a highly efficacious vaccine. Thank goodness we have that. We have multiple vaccines, two of which clearly are very efficacious, and I feel confident that the others that are coming along will be comparably efficacious.

Then the second part of that is getting the overwhelming majority of the population vaccinated. I think that likely will have to be about 70 to 75 percent of people in this country. If we do that, that will be the indicator of when things will get back to normal, when you won’t have to worry about going in a restaurant, when you won’t have to worry about having a dinner party, when the children won’t have to worry about going to school, when factories can open and not worry about their employees getting sick and going to the hospital. That will happen, I guarantee you. If people appreciate the importance of getting vaccinated, and we have a high uptake of vaccines, that will happen. That’s what the future will look like.

The future doesn’t need to be bleak. It’s within our hands to really shape the future, both by public health measures and by taking up the vaccine. — Dr. Fauci

What you need to know about the new vaccines

There aren’t enough doses right now for everyone, so initially the vaccine will be rationed for those who need it most. It will take time to produce and distribute the vaccine, and then schedule two vaccinations per person, three to four weeks apart. As more vaccines get approved, things will speed up. At least 40 million doses (enough for 20 million people) should be available from Pfizer and Moderna by the end of the year, and much more will come in 2021.

The challenges ahead for widespread vaccination

The success of the new vaccines will depend on more than how well they performed in a clinical trial. While there’s much reason for optimism, a lot can still go wrong.

First there’s the challenge of manufacturing and distributing the doses. Pharmaceutical manufacturers have struggled to ramp up vaccine production. They have run short on materials like the bags that line the containers in which the vaccines are made. Both of the leading vaccines must be stored in freezing conditions. And state and local governments have to figure out how to get the vaccines from production facilities into people’s arms.

The dark cloud hanging over vaccine distribution

The vaccines will be much less effective at preventing death and illness in 2021 if they are introduced into a population where the coronavirus is raging — as is now the case in the United States.

An analogy may be helpful here, says David Leonhardt, who writes The Morning newsletter for The Times. He explains that a vaccine that’s 95 percent effective, as Moderna’s and Pfizer’s versions appear to be, is a powerful fire hose. But the size of a fire is still a bigger determinant of how much destruction occurs.

Even if the vaccine is distributed at the expected pace, at the current infection level, experts predict that the country would still face a terrible toll during the six months after the vaccine was introduced. Almost 10 million or so Americans would contract the virus, and more than 160,000 would die.

There is one positive way to look at this: Measures that reduce the virus’s spread — like mask-wearing, social distancing and rapid-result testing — can still have profound consequences. They can save more than 100,000 lives in coming months.

Hoping vaccine skepticism will fade

Despite images of relieved health care workers getting a shot in the arm flashing across TV screens and news sites, a new survey finds that more than one-quarter of Americans say they probably or definitely will not get a coronavirus vaccination. The survey, by the Kaiser Family Foundation, found that Republican, rural and Black Americans were among the most hesitant to be vaccinated.

Nevertheless, confidence in the vaccine appears to be rising. Over all, 71 percent of respondents said they definitely would get a vaccination, an 8 percent increase from what Kaiser found in a September survey. Roughly a third (34 percent) now want the vaccine as soon as possible. A recent study from Pew Research showed that about 60 percent of Americans would definitely or probably get a vaccine, up from 51 percent of people asked in September.

Looking ahead to spring

While the majority of Americans won’t get their shots until spring, the vaccine rollout is a hopeful sign of better days ahead. We asked Dr. Anthony S. Fauci, as well as several epidemiologists and health and science writers for The Times, for their predictions about the months ahead. Here’s some of what they had to say.

When can we go to the movies or the theater?

“It depends on the uptake of the vaccine and the level of infection in the community. If you go to April, May, June and you really put on a full-court press and try to vaccinate everybody within a period of a few months, as you go from second to third quarter of the year, then you could likely go to movies, go to theaters, do what you want. However, it’s unlikely, given what we’re hearing about people’s desire to get vaccinated, that we’re going to have that degree of uptake. If it turns out that only 50 percent get vaccinated, then it’s going to take much, much longer to get back to the kind of normality that we’d like to see.” — Dr. Fauci

What did you learn from pandemic life?

“Staying home with my children has taught me that life with fewer errands to run and activities to partake in is kind of nice. I think in the future we will cut down on our family obligations.” — Jennifer Nuzzo, associate professor, Johns Hopkins

What’s one thing you’ll never take for granted again?

“I won’t take traveling to my extended family for granted.” — Alicia Allen, assistant professor, University of Arizona

Will we ever go to a big, crowded, indoor party without a mask again?

“If the level of infection in the community seems substantial, you’re not going to have the parties with friends in congregant settings. If the level of infection is so low that risk is minuscule, you’re going to see back to the normal congregating together, having parties, doing that. If we want to get back to normal it gets back to my message: When the vaccine becomes available, get vaccinated.” — Dr. Fauci


Contributors: Sara Aridi, Quoctrung Bui, Abby Goodnough, David Leonhardt, Apoorva Mandavilli, Donald G. McNeil Jr., Claire Cain Miller, Yuliya Parshina-KottasRoni Caryn Rabin, Margot Sanger-Katz, Amy Schoenfeld Walker, Noah Weiland, Jeremy White Katherine J. Wu and Carl Zimmer

Weekly Health Quiz: Covid Vaccines, Winter Sports and a Cancer Breakthrough

1 of 7

Which statement about the new coronavirus vaccines is not true?

About 20 million Americans, including health care workers and residents of nursing homes, will be the first to get vaccinated

Vaccination requires two shots, three to four weeks apart

The vaccine can help protect you from getting infected with coronavirus, though it’s uncertain whether it will prevent you from spreading it to others

If you’ve already had natural Covid, it’s not safe to get vaccinated

2 of 7

In rare cases, the coronavirus vaccine has caused a severe allergic reaction, with symptoms such as a rash and shortness of breath developing about how long after getting the shot?

10 minutes

1 day

3 days

10 days

3 of 7

Mycobacterium marinum, a tuberculosis-like infection that can cause painful joint swelling, is spread through cuts in the skin from handling raw:

Pork

Fish

Poultry

Beef

4 of 7

Which of the following Winter Olympic Sports has the lowest rate of injuries?

Snowboard cross

Freestyle skiing aerials

Bobsled

Ski jumping

5 of 7

Paul Farmer, a medical anthropologist, received the $1 million Berggruen Prize for his work on:

Raising awareness of environmental cancers

Providing health care to underserved communities

Discovering the hepatitis C virus

Developing new methods of birth control

6 of 7

In recent decades, the mortality rate from falls in this age group more than doubled:

People aged 25 to 44

People aged 45 to 64

People aged 65 to 75

People over 75

7 of 7

A new scan that detects malignant cells anywhere in the body may lead to improved treatments for this cancer that kills 33,000 American men each year:

Testicular cancer

Penile cancer

Prostate cancer

Male breast cancer

Fears of a ‘Twindemic’ Recede as Flu Lies Low

Fears of a ‘Twindemic’ Recede as Flu Lies Low

Despite early worries, flu patients are not competing with Covid-19 patients for ventilators, and the threat of dueling outbreaks may be waning.

A free flu shot administered at Comerica Park in Detroit, Mich., last month.
A free flu shot administered at Comerica Park in Detroit, Mich., last month.Credit…Seth Herald/Agence France-Presse — Getty Images
Donald G. McNeil Jr.

  • Dec. 13, 2020, 5:00 a.m. ET

Despite the horrifying surge of Covid-19 cases and deaths in the United States right now, one bit of good news is emerging this winter: It looks unlikely that the country will endure a “twindemic” of both flu and the coronavirus at the same time.

That comes as a profound relief to public health officials who predicted as far back as April that thousands of flu victims with pneumonia could pour into hospitals this winter, competing with equally desperate Covid-19 pneumonia victims for scarce ventilators.

“Overall flu activity is low, and lower than we usually see at this time of year,” said Dr. Daniel B. Jernigan, director of the influenza division of the Centers for Disease Control and Prevention. “I don’t think we can definitively say there will be no twindemic; I’ve been working with flu for a long time, and I’ve been burned. But flu is atypically low.”

Since September, the C.D.C. “FluView” — its weekly report on influenza surveillance — has shown all 50 states in shades of green and chartreuse, indicating “minimal” or “low” flu activity. Normally by December, at least some states are painted in oranges and reds for “moderate” and “high.”

(For one puzzling week in November, Iowa stood out in dark burgundy, indicating “very high” flu levels. But that turned out to be a reporting error, Dr. Jernigan said.)

Of 232,452 swabs from across the country that have been tested for flu, only 496, or 0.2 percent, have come up positive.

That has buoyed the spirits of flu experts.

Dr. William Schaffner, medical director for the National Foundation for Infectious Diseases, which promotes flu shots, said he was recently on a telephone discussion with other preventive medicine specialists. “Everybody was in quiet awe about how low flu is,” he said. “Somebody said: ‘Shh, don’t talk about it. The virus will hear us.’”

Flu numbers are likely to remain low for many more weeks, predicted Kinsa Health, a company that uses cellphone-connected thermometers and historical databases to forecast flu trends.

“Going forward, we don’t expect influenza-like illness to go high,” said Inder Singh, Kinsa’s founder and chief executive. “It looks like the twindemic isn’t going to happen.”

7% of population sick with flu

2019–20

6

5

2017–18

4

2018–19

3

2

2020–21

flu season

1

Forecast

Sept.

Oct.

Nov.

Dec.

Jan.

Feb.

7% of population sick with flu

2019–20

6

5

2017–18

4

2018–19

3

2

2020–21

flu season

1

Forecast

Oct.

Nov.

Dec.

Jan.

Feb.

7% of population sick with flu

2019–20

6

5

2017–18

4

2018–19

3

2

2020–21

flu season

1

Forecast

Nov.

Dec.

Jan.

Feb.

By The New York Times | Source: Kinsa

A combination of factors is responsible for the remarkably quiet flu season, experts said.

In the Southern Hemisphere, where winter stretches from June through August, widespread mask-wearing, rigorous lockdowns and other precautions against Covid-19 transmission drove flu down to record-low levels. Southern Hemisphere countries help “reseed” influenza viruses in the Northern Hemisphere each year, Dr. Jernigan said.

Also, to keep Covid-19 out, New Zealand and Australia have closed their borders either to all noncitizens or to Americans, so there has been very little air traffic from those Southern Hemisphere countries.

In the United States, the cancellation of large indoor gatherings, closings of schools and use of masks to prevent coronavirus transmission have also driven down levels of all respiratory diseases, including influenza.

In addition, Dr. Jernigan said, a “phenomenal number” of flu shots were manufactured and shipped to pharmacies, hospitals and doctors’ office in August, a month earlier than usual.

As of late November, 188 million doses had been shipped; the old record was 175 million doses shipped last year. Spot shortages were quickly reported in some cities, so experts assumed that large numbers of Americans took them.

However, there is not yet enough data to confirm that assumption. According to a preliminary tally released Dec. 9, about 70 million adults had received the shots through pharmacies or doctors’ offices as of mid-November, compared with 58 million last year.

Although that appears to be a substantial increase, the C.D.C. does not know how many Americans who normally get their flu shots at work were unable to do so this year because of stay-at-home orders, said Dr. Ram Koppaka, the agency’s associate director for adult immunization. There was a big increase in flu shots delivered by pharmacies, and that may represent people who normally would have received the shots at work.

“The best we can say is that it appears that we are now about where we were last year,” Dr. Koppaka said.

Given that vaccines were available early, he added: “I’m disappointed that it’s not better than it is. We need to keep telling people that it’s not too late to get a flu shot.”

Normally, about 80 percent of all adults who get flu shots have had them by the end of November. But about nine million doses of vaccines that were meant for uninsured adults, and which the federal government purchased this year out of fear of a “twindemic,” are still being delivered, Dr. Koppaka said.

The finally tally of how many shots were taken will not be available until summer, after the flu season is over, he said.

Nonetheless, even the preliminary data showed disturbing trends in two important target groups: pregnant women and children. Only 54 percent of pregnant women have received flu vaccine this year, compared with 58 percent by this time last year. And, although about 48 percent of all children got flu shots both last year and this year, the percentage of Black children who got them dropped substantially this year, by 11 percentage points.

Dr. Koppaka said he could not yet account for those drops in coverage. Pregnant women might have been afraid to go to doctors or pharmacies for fear of getting Covid-19, and many Black children might have been missed because public schools that offer vaccines were closed — but that was just speculation, he emphasized.

Although Dr. Koppaka strongly encouraged unvaccinated Americans to get flu shots, the threat of a two-headed pandemic monster appears to be fading.

Because of the coronavirus pandemic, the C.D.C. is not currently posting forecasts on its FluSight page, where it predicts the future course of the flu season.

Kinsa Health, by contrast, is predicting that flu will stay at historic lows through February, when the season typically peaks. The company has a record of accurately predicting flu seasons several weeks ahead of the C.D.C.

C.D.C. surveillance data is based on weekly reports from doctors’ offices and hospitals noting the percentage of patient visits that are for flu symptoms. Because there are delays in reporting, sometimes for weeks, there is a lag between the time a flu arrives in a county and the agency’s confirmation that it is there.

Also, people who catch flu but never see a doctor are not captured in the C.D.C.’s surveillance net. People avoid doctors for many reasons, including a lack of insurance or because, this year, they are afraid of catching the coronavirus.

Kinsa receives about 100,000 readings each day from about two million thermometers connected to smartphones; the company claims it can detect local fever spikes down to the ZIP code level.

Both Covid-19 and flu can drive up the number of reported fevers, but flu outbreaks can be distinguished from Covid ones, Mr. Singh said.

The company has access to decades of historical flu data from 600 cities across the country, and there are patterns to how flu typically spreads in each city based on climate and population density, said Samuel D. Chamberlain, the company’s chief data scientist.

Also, because everyone is susceptible to the new coronavirus, Covid fevers surge and spread much faster across ZIP codes than do those caused by colds and flu, Mr. Singh said.

Moreover, users are asked to enter all their symptoms in the Kinsa app. Loss of smell and taste is a common Covid-19 symptom. Making things even simpler, the app asks users if they have had a positive coronavirus or flu test.

Currently, flu is at less than half its typical level for early December, Mr. Singh said. By February, when cases typically shoot to a sharp peak, its numbers should be down to about one-quarter of a typical seasonal apex, he predicted.

“In theory, the flu virus could be taking a year off,” said Dr. Arthur Reingold, head of epidemiology at the School of Public Health of the University of California, Berkeley.

He recently asked a friend who was treating Covid-19 cases at the University of California, San Francisco, hospital how many flu cases she had seen this year.

“The answer was zero,” he said. “That’s a relief, and certainly a relief to my friends who do clinical work.”

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Weekly Health Quiz: Exercise, Weight and Covid Deaths

1 of 7

Overweight men and women had to work out about this many minutes a week to lose weight, researchers at the University of Kentucky report:

100 minutes

200 minutes

300 minutes

600 minutes

2 of 7

Karl A. Pillemer, a family sociologist and professor at Cornell, found that about this percentage of the population was living with an active family rift:

5 percent

10 percent

25 percent

50 percent

3 of 7

A global survey found that in the early months of the pandemic, many of us were stress eating, gaining weight and sleeping poorly, with this group particularly affected:

Children

People over 65

Obese people

Unmarried people

4 of 7

The United States saw a shocking new milestone, exceeding this many deaths per day from Covid:

1,000

2,000

3,000

6,000

5 of 7

Total reported deaths from Covid are approaching 300,000 in the United States. This country has the second highest number of reported Covid deaths, with nearly 200,000:

Brazil

India

Russia

China

6 of 7

A single dose of Pfizer’s coronavirus vaccine appeared to offer good protection regardless of age, race or weight after about how many days?

One day

Five days

10 days

30 days

7 of 7

Young women who used tanning beds were at increased risk of this disorder, which can sometimes lead to infertility:

Amenorrhea

Ovarian cysts

Endometriosis

Type 1 diabetes