Tagged Protective Clothing and Gear

How to Buy a Real N95 Mask Online

Tech Fix

How to Buy a Real N95 Mask Online

Fakes and little-known brands still abound, even as health officials have advised us to up our mask game. Here’s what to do.

Credit…Glenn Harvey
Brian X. Chen

  • Feb. 17, 2021, 5:00 a.m. ET

A year into the coronavirus pandemic, buying a heavy-duty medical mask online remains downright maddening.

The most coveted mask to keep safe against Covid-19 has been the N95, the gold standard for pandemic protection because of its tight fit and 95 percent efficiency in filtering airborne particles. Then there’s the KN95 from China, a mask for medical workers, which also offers high filtration and is somewhat looser fitting.

But these masks have been far from easy to buy on the internet. When the pandemic hit last year, they immediately became scarce as health care workers and governments rushed to obtain them. The demand was so intense that a gray market sprang up for them.

Yet even after supplies have improved, it is often not easy to find authentic N95s and KN95s online. That’s because there are few brand-name makers, so it can be hard to know which of the dozens of manufacturers are reliable. And counterfeiters continue to flood the market, even on trusted sites like Amazon.

The result is frequently frustration, when wearing a heavy-duty mask is more important than ever. Last week, federal health officials emphasized the need for all of us to have tightfitting masks because of new fast-spreading coronavirus variants.

“People don’t know what’s legit, and they don’t know which suppliers are legit,” said Anne Miller, an executive director of Project N95, a nonprofit that helps people buy protective coronavirus equipment. “We’ve had that issue since the very beginning of the pandemic.”

I recently spent hours comparing masks online and almost bought a pack of counterfeits on Amazon. Thankfully, I avoided falling into the trap and eventually found legitimate, high-quality masks from a trustworthy online retailer.

Along the way, I learned plenty about how to spot fraudulent mask listings and how to sidestep fake reviews. So here’s how to home in on real medical-grade masks that will keep you and your loved ones safe.

Pick a mask

My journey began on the website for the Centers for Disease Control and Prevention. There I found charts of N95 and KN95 masks that the agency has tested, including the make, model number and filtration efficiency.

After some reading, I learned about the trade-offs between the two types of masks. The N95s typically have bands that strap over the back of your head, which is what makes them snug. They can be uncomfortable to wear for long periods.

The KN95s, which the Food and Drug Administration has approved for emergency use by health care workers, have ear loops for a tight fit that is slightly more comfortable than an N95. The downside is that the KN95 leaks a bit more air than an N95.

If you are often in high-risk areas like hospitals, N95s may be more suitable. But if you just need a protective mask for more casual use, like the occasional trip to the grocery store, KN95s are probably sufficient.

After doing the research, I decided a KN95 mask from Powecom, a Chinese brand, was best for my purposes. The mask scored 99 percent filtration efficiency in the C.D.C.’s tests.

From there, I visited Amazon, where I buy everything from dog food to batteries in the pandemic. That’s when things went awry.

Beware of Amazon

When I typed “Powecom KN95” into Amazon’s search box, the masks instantly popped up with a rating of 4.5 stars. I quickly clicked “Add to Cart.”

But before checking out, I scrolled down to read the reviews. There were about 130 — including a handful of one-star reviews from aggrieved buyers who said the masks were most likely fake. I emptied my shopping cart.

How had I almost bought a counterfeit? Saoud Khalifah, the founder of Fakespot, a company that offers tools to detect fake listings and reviews online, said a third-party seller had probably taken control of the product listing and sold fakes to make a quick buck.

“It’s a bit of a Wild West,” he said. “The normal consumers that shop on Amazon do not know that they just bought a fake mask. This is the biggest critical problem: You think it’s real, and suddenly you get sick.”

Mr. Khalifah presented other examples of questionable masks that were being sold on Amazon:

  • A pack of 50 masks was highlighted on Amazon this week as the No. 1 new release in women’s fashion scarves. Obviously, masks are not scarves, which was a giveaway that something was off. The listing description also replaced all of the letter A’s with accented characters. This was a technique used to bypass Amazon’s fraud detection systems, Mr. Khalifah said. Amazon removed the listing after I called about it.

  • Another pack of 20 masks looked attractive and was described as approved by the C.D.C. It even had positive reviews with an average of 4.4 stars. But the reviews revealed that most customers had received the masks for free, probably an incentive to leave positive feedback. One lukewarm review from someone who had paid for the product noted that the masks were “thin and very, very big.”

  • Mr. Khalifah’s software also detected that the reviewers of another pack of 100 masks, which had unanimous five-star ratings, had a history of writing promotional reviews for other brands.

Amazon said in a statement that it prohibits the sale of counterfeit products and invests to ensure its policy is followed. It said it had specific policies for N95 and KN95 masks, including a process for vetting inventory and taking action on those who sold fakes.

Amazon also said it had addressed the questionable Powecom mask that I nearly purchased, as well as the mask advertised as a scarf. It added that there was no evidence that the pack of 20 masks was counterfeited and did not comment on the pack of 100 masks.

Mr. Khalifah cautioned that the fakes he spotted on Amazon could just as easily be on websites for other big retailers, such as Walmart and eBay, that allow third-party sellers to ship products. To buy authentic masks, he said, I should take a less traditional approach to shopping online.

Order from an authorized source

Armed with this advice, I continued my search for the Powecom mask.

I visited the manufacturer’s website, which listed steps for verifying that a mask is real. That involved scanning a bar code on the package with a phone camera. Then I did a web search for the mask, which brought me to bonafidemasks.com, an online retailer that shows documentation stating that it is an authorized distributor of Powecom masks in the United States.

That was more reassuring. So I ordered a pack of 100 for $99. When the package arrived in the mail, I scanned the bar codes to confirm their authenticity. They were the real deal.

Another path I could have taken was to order masks directly from the manufacturer. Verified mask producers like DemeTech, in Miami, and Prestige Ameritech, in Texas, sell N95s through their websites.

But ordering directly from a manufacturer presents other challenges. Often you have to buy a large quantity to reduce the cost.

So what if you just want to buy a few to try on? Ms. Miller’s nonprofit Project N95 buys bulk orders of masks and breaks them up so people can buy smaller batches. “It’s a very painstaking process to go through,” she said.

No kidding.

Dental Practices Change in the Covid Era

Less Drilling, Less Germ Spray: Dentistry Adapts to the Covid Era

The pandemic has forced dentists and hygienists to change some of the methods for maintaining good oral hygiene, to protect patients as well as themselves.

Dr. Todd Kandl performs a root canal at his dentistry practice in East Stroudsburg, Pa., with extra Covid precautions, including an external oral air scrubber, an oral dental dam on the patient and extra layers of protective clothing.
Dr. Todd Kandl performs a root canal at his dentistry practice in East Stroudsburg, Pa., with extra Covid precautions, including an external oral air scrubber, an oral dental dam on the patient and extra layers of protective clothing.Credit…Jonno Rattman for The New York Times

  • Feb. 9, 2021, 2:30 a.m. ET

Ann Enkoji normally enjoys seeing her dental hygienist, but when her dentist’s office in Santa Monica, Calif., canceled her cleaning visit last spring, she felt relieved.

She had been wary of keeping the appointment anyway, worried about someone else’s fingers and instruments exploring her mouth at a time when more than 25,000 Americans were contracting the coronavirus daily.

“It’s just too up close in that mouth-nasal region,” said Ms. Enkoji, 70, a marketing design consultant based in Santa Monica.

When she returned to her dentist’s office in September for a cleaning, she was asked to wash her hands and use an antimicrobial mouth rinse, steps that federal health guidance said might help curb the spread of germs in aerosol and splatter during treatment.

Without a doubt, dentistry is among the more intimate health professions. Patients must keep their mouths wide open as dentists and hygienists poke around inside with mirrors, scalers, probes and, until recently, those cringe-inducing drills.

Such drills and other power equipment, including ultrasonic scalers and air polishers, can produce suspended droplets or aerosol spray that may hang in the air, potentially carrying the virus that could endanger patients and staff.

Today, dental offices operate in a markedly different way than they did pre-pandemic. Since reopening in May and June, they have been following federal guidelines and industry group recommendations aimed at curtailing the spread of Covid.

Los Angeles County, where Ms. Enkoji lives, passed 1.4 million in cases, and New York City has reported more than half a million cases.

And while vaccination offers fresh promise, there are new worries about more contagious variants of the virus as well as a months-long timetable for rolling out the vaccines to the general public.

Many dental offices have stayed open in recent months, with dentists and hygienists geared up in face shields, masks, gowns, gloves and hair covers resembling shower caps. They have set aside aerosol-spewing power equipment, and hygienists instead rely on traditional hand tools to remove patients’ built-up plaque and tartar.

Under the new practices, patients typically get called a few days before visits and are asked if they have any Covid symptoms. They may be told to wait in their cars until they can be seen. Their temperatures may be taken before entering a dental office, and they have to wear masks, except during treatment, all measures recommended by the U.S. Centers for Disease Control and Prevention.

Dental offices also look different now. Many dentists are allowing only one patient in the office at a time. At Exceptional Dentistry on Staten Island, the waiting area is bereft of magazines, and plexiglass shields have been installed at the front desk, said Dr. Craig Ratner, owner of the office in the Tottenville neighborhood.

Donning a face shield over his cap, Dr. Kandl wears two masks, a surgical gown and dental loupes.Credit…Jonno Rattman for The New York Times
A dental dam is used to isolate a work area and to cover a patient’s mouth.Credit…Jonno Rattman for The New York Times

And visits may last longer, because scaling by hand is more laborious than applying ultrasonic scalers, and because some patients have built-up tartar, stains and plaque on their teeth stemming from pandemic-related gaps in visits, said Dr. Ratner, who is president of the New York State Dental Association.

“It’s unfortunate, but understandable,” he said.

This revolution in dental protective gear has been compared to the one that accompanied the HIV/AIDS pandemic, when many dental workers began wearing gloves and masks for the first time, according to an article in the journal JDR Clinical & Translational Research.

“Dentistry has changed — it’s incredible how it has changed over the last few months,” said Dr. Donald L. Chi, a pediatric dentist and professor of oral health sciences and health services at the University of Washington.

Covid-19 had barely touched the United States early last February when Dr. William V. Giannobile, dean and professor at the Harvard School of Dental Medicine in Boston, heard from a counterpart in Wuhan, China.

The dean of the dental school in Wuhan, where the coronavirus was first been reported on New Year’s Eve in 2019, asked Dr. Giannobile if he would help get his team’s findings republished in the United States.

The authors of the article, which would appear in The Journal of Dental Research, laid out basic safety measures that would later be adopted by thousands of U.S. dentists.

“They showed that the provision of dental care is safe and that guidelines could be put in place to triage patients and provide dental care,” Dr. Giannobile said.

Those guidelines include not only the now-ubiquitous use of staff protective gear, but also pre-visit questions and temperature checks and patients’ use of masks. And the Wuhan researchers stated that “in areas where Covid-19 spreads, nonemergency dental practices should be postponed” — advice endorsed early last year by the C.D.C. and the American Dental Association.

The springtime shuttering of dental businesses caused a lot of hardship for many dental practices. Only 3 percent of those offices in the United States stayed open in March and April, and layoffs and furloughs led to the disappearance of more than half of dental-office jobs, said Marko Vujicic, the chief economist for the A.D.A.

“This was an unprecedented event in dentistry,” Mr. Vujicic said. But when doors swung open later in the spring, the number of patients soared.

His association has been seeking permission to provide tests for the virus nationwide, as well as to administer Covid vaccines. Dentists were allowed to administer the vaccine in 20 states, including California, Connecticut, New Jersey and New York, A.D.A. research showed.

Dr. Donald L. Chi, who practices at the Odessa Children’s Clinic in Seattle, says that one way that he avoids drilling — and unnecessarily spreading the virus — is to place silver diamine fluoride on a child’s baby tooth to prevent a cavity from growing.
Dr. Donald L. Chi, who practices at the Odessa Children’s Clinic in Seattle, says that one way that he avoids drilling — and unnecessarily spreading the virus — is to place silver diamine fluoride on a child’s baby tooth to prevent a cavity from growing.Credit…Jovelle Tamayo for The New York Times

Dentists rank high on the priority lists for those eligible to get the vaccine, with Phase 1a status in 40 states. The C.D.C. recommends that dental hygienists and assistants also be included on the vaccine priority list.

In New York City, the College of Dentistry at New York University suspended in-person visits last winter, but resumed urgent cases in late June. Since then, it has treated more than 700 patients a day, said Elyse J. Bloom, associate dean of the college. And its mandatory virus testing for students and members of the faculty and the staff has helped keep the college’s count of positive cases significantly lower than that of New York City over all, she said.

Fear of job losses has rippled through the industry.

“This was a very frightening time for many individuals,” said JoAnn Gurenlian, a professor of dental hygiene at Idaho State University who heads a return-to-work task force for the American Dental Hygienists Association.

More than half of dental hygienists, dental therapists and oral health specialists reported that they were not working in a June 2020 survey conducted by the International Federation of Dental Hygienists. Half said they were deeply concerned that they would not have enough personal protective gear to treat patients.

Patients, too, have been anxious. Some dentists have found themselves treating stressed clients who were grinding their teeth in their sleep and needed devices to prevent chips or fractures.

“Honestly, I’ve made a lot of night guards,” said Dr. Todd C. Kandl, who has spent 13 years building up his family practice with a staff of eight in East Stroudsburg, Pa., tucked away in the Poconos.

Forced to close the practice in mid-March, Dr. Kandl received a federal loan that allowed him to reopen on June 1. In between, he tried to diagnose patients’ conditions over the phone, he said. Now, most of his patients have come back.

He and his staff follow C.D.C. guidelines by putting on a clean gown for each patient and changing it afterward. They launder all gowns at the office.

He has installed a number of the upgrades recommended by the C.D.C., including high-efficiency particulate air, or HEPA, filter units to trap fine particles. And he purchased several suction systems that remove droplets and aerosols, as well as ultraviolet light to help sanitize.

Dr. Kandl also chose to discontinue use of nitrous oxide, a gas used to mildly sedate and relax anxious dental patients. In the past, he rarely used the gas, but amid the Covid-19 outbreak, he grew concerned about his system, an older type that wasn’t worth the risk of exposing patients.

Lynn Uehara, 55, the business manager for a Hawaii family dental practice, said that island living had resulted in shipping problems to obtain the protective gear that her employees need.

“Our masks and gloves are being rationed by our main dental suppliers,” Mrs. Uehara said. Gowns ordered four months ago finally arrived. And prices are soaring. “We used to pay about $15 for a box of gloves. Now they are charging us $40 to $50 a box.”

But like other dental workers, she is now a veteran of uncertainty. If the lack of protective gear means reducing the number of patients, “then that’s what we will do,” she said.

Dental tools await sterilization at Dr. Kandl’s office.Credit…Jonno Rattman for The New York Times
A U.V. sterilizer in Dr. Kandl’s office.Credit…Jonno Rattman for The New York Times

The Uehara family has offices in Honolulu on Oahu and in Hilo, on the Big Island of Hawaii. The pandemic lockdowns hurt its practices. Family members commute between the two islands by commercial jet, posing another risk.

The reopening went slowly, but patients have returned. “I’ve heard the sound of laughter back in the office,” Mrs. Uehara said.

A surge in coronavirus cases among children has also posed challenges for pediatric dentists.

In early December, the C.D.C. strongly endorsed school-based programs in which dentists apply thin coatings called sealants on the back teeth of children in third through fifth grades. Such sealants are especially helpful for children at risk of cavities and for children whose families can’t afford private dentists, the agency said.

Dr. Chi, the pediatric dentist and University of Washington professor, said that dentistry was turning to more conservative methods of dealing with tooth decay now that some drills and tools might heighten the risk of contagion.

Dr. Chi, who practices at the Odessa Children’s Clinic in Seattle, said that one way that he avoided drilling was to place silver diamine fluoride on a child’s baby tooth to prevent a cavity from growing.

He can also select stainless steel crowns to block the growth of a cavity. Applying such crowns normally requires numbing the tooth, using a drill to remove decay and reshape the tooth, and then installing the crown.

A more conservative approach: placing a crown directly on the baby tooth without removing decay or reshaping. Evidence suggests that it is as effective as the traditional approach, takes less time and is more cost-effective, Dr. Chi said.

“Covid has really encouraged dentists to look at all the options you have to treat dental disease,” he said.

Some dentists, however, may choose to leave the profession. The A.D.A. conducted a survey asking dentists how they would react if their patient visits remained the same for several months.

“Our data show that 40 percent of dentists 65 and older would seriously consider retiring in the coming months if patient volume remains at what it is today,” Dr. Vujicic said.

Over time, though, some patients have learned to adjust.

Enid Stein of Staten Island has visited Dr. Ratner’s practice five times since it reopened, for implant surgery and new crowns. A self-described germaphobe who carries alcohol spray in her pocketbook, she brought her own pen to pay by check.

“I’m done, thank God,” she said. “Not that I don’t mind seeing him and all the girls in the office, but I’m in good shape.”

Yes, You Still Need to Wear a Mask

Personal Health

Yes, You Still Need to Wear a Mask

Short of a total lockdown, universal mask-wearing is the most effective way to slow the relentless rise in hospitalizations and deaths from Covid-19.

Credit…Gracia Lam
Jane E. Brody

  • Jan. 25, 2021, 5:00 a.m. ET

As a professional health writer and concerned citizen, the ache in my heart deepens with each new report of the devastation wrought by the novel coronavirus, the cause of immeasurable — and still increasing — personal and economic pain for people caught in its deadly spikes.

In a recent five-week period, 100,000 Americans died from complications of Covid-19, a toll that took the country four months to reach last spring.

My distress is magnified by the knowledge that it didn’t have to be this bad. One simple measure — consistent wearing of face coverings in public — could have helped to stem the agony. In December, the Centers for Disease Control and Prevention reiterated advice first given in July: “Wear a mask over your nose and mouth. Everyone should wear a mask in public settings and when around people who don’t live in your household, especially when other social distancing measures are difficult to maintain.”

Masks, the agency emphasized, protect both the wearer and those the wearer encounters in the course of daily life.

Now, with the emergence of a highly contagious variant of the virus and the chaotic attempts to distribute and administer vaccines to hundreds of millions of vulnerable Americans, short of a total lockdown, universal mask-wearing is the most effective way to slow the relentless rise in hospitalizations and deaths from Covid-19.

It will take many months to immunize everyone willing and able to get a Covid vaccine. Meanwhile, we’re facing another tsunami of deadly coronavirus infections as the new variant sweeps through swaths of still-unprotected millions.

As with many other measures not taken by the last administration to minimize the spread of Covid-19, mask-wearing was left up to the states to mandate and enforce. Masks became a political football, and the former president publicly ridiculed opponents who wore them. Some elected officials even made the ridiculous, baseless claim that masks not only don’t thwart the spread of the virus, they actually enhance it. I wonder if they also ignored parents and teachers who told them to cover their mouths when they coughed or sneezed.

I also wonder about the economic savvy of our former president and the governors who have resisted issuing mask mandates, some of whom got Covid-19 themselves yet clamored to open the economy. Goldman Sachs estimated last June that implementing a nationwide mask mandate could have a potential impact on the U.S. GDP of one trillion dollars.

Lately, as I await my second vaccine shot, I’ve become increasingly aware of how many people walk, run or cycle without a mask or, if they have a mask, wear it ineffectively. I’ve taken to speaking up more often: “Please wear your mask” or “The mask should cover your nose and mouth.” Among the ignorant responses: “I don’t need a mask when I’m outside,” “I already had Covid so I can’t get it again or give it to you,” and my favorite while walking on a four-foot-wide path, “I stay six feet away from people.”

Although six-foot social distancing is not totally arbitrary, it’s based on limited evidence among airline passengers and may not apply at all, for example, to the unmasked cyclists shouting to one another as they ride past me or to the heavy-breathing runners I pass.


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.

I’ve also heard a few people say, “I already got the vaccine, so I don’t need a mask.” This may be the most dangerous excuse of all. First, although the vaccines are very good, they’re not perfect, and chances are these vaccine recipients haven’t been checked for strong antibodies to the virus. Second, we don’t yet know if the vaccines, while highly effective in preventing sickness and death, will also prevent asymptomatic infection that can spread the virus to others.

As Jeremy Howard, a data scientist at the University of San Francisco, said of mask refusers: “How would you feel if you made your best friend sick, or killed your friend’s mother?”

Last February, after the World Health Organization, with no supporting data, advised against wearing a mask unless you were already sick, Mr. Howard amassed an international team of 19 scientists to review the evidence for mask-wearing, expecting to find “that masks were a waste of time,” he said in an interview. Instead, he said, the team found that “the data on the benefit of masks is really compelling.” The results of their exhaustive study were published recently in PNAS, the peer-reviewed Proceedings of the National Academy of Sciences.

Mr. Howard said that preliminary reports of their findings resulted “in all sorts of abuse, including death threats” from mask resisters. But that has not kept him from repeating that “wearing any kind of mask will greatly help to keep you from accidentally infecting others, which is important for the community and the economy. About half of coronavirus infections are spread by people who don’t know they’re sick, and the new variant is much more transmissible.”

A Chinese study found that the viral load in the upper respiratory tracts of infected people without symptoms can be just as high as those with symptoms, and simply talking and breathing can spread virus-laden droplets and aerosols. And because the virus resides in high amounts in the nose and throat, sneezing can spew an infectious cloud 10 or more times further than coughing.

Which brings me to the question of whether the face coverings most people use are sufficiently protective. I now know that the bandannas, exam masks and the slim neoprene masks I’ve been using for the last 11 months are better than nothing but not very good. They provide too many routes for virus-carrying particles to reach an unsuspecting nose or mouth.

I should have followed the advice my colleague Tara Parker-Pope offered months ago on upgrading your mask.

“Masks,” Mr. Howard said, “need a nose wire to provide a close fit and proper filtration material, like a nanofiber, that filters very small particles.”

He and his co-authors concluded that for most of us, KN95 masks, especially those with bands that fit around the head, are currently the best to prevent contracting and spreading the virus.

Another option is the KF94 mask or, if it’s not too uncomfortable, doubling up on masks for added protection.

KN95 masks meet foreign certification standards and are designed to filter out 95 percent of particles down to 0.3 microns in size. (The gold standard N95 masks, which meet U.S. certification standards, should be reserved for health care and emergency personnel who are most likely to interact with Covid-infected individuals.)

Powecom KN95 masks have an emergency use authorization from the Food and Drug Administration. I just ordered a packet of 11 on Amazon for $23.80 and I expect to be using them for many months after I’m vaccine-protected. I might still be able to transmit the virus and I want to set a good example for my fellow citizens.

Double-Masking: Why Two Masks Are the New Masks

Two Masks Are the New Masks

Double-masking is a sensible and easy way to lower your risk when you have to spend more time around others — in a taxi, on a train or plane, or at an inauguration.

Pete Buttigieg, right, the former mayor of South Bend, Ind., and his husband, Chasten Buttigieg, wearing double masks at the Capitol on Wednesday for the inauguration of President Biden.
Pete Buttigieg, right, the former mayor of South Bend, Ind., and his husband, Chasten Buttigieg, wearing double masks at the Capitol on Wednesday for the inauguration of President Biden.Credit…Kevin Dietsch – Pool/Getty Images
Tara Parker-Pope

  • Jan. 21, 2021Updated 8:18 p.m. ET

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Many of us who watched the inauguration this week were delighted by the fashion on display — the colorful matching coat and mask ensembles worn by the first lady, Jill Biden, and the Biden granddaughters, the power purple worn by Vice President Kamala Harris, Michelle Obama and Hillary Clinton, and of course, Senator Bernie Sanders’s delightful mittens made of recycled wool sweaters.

But the fashion trend that most excited me was the double mask! Double-masking is a sensible and easy way to lower your risk, especially if circumstances require you to spend more time around others — like in a taxi, on a train or plane, or at an inauguration. Pete Buttigieg, the former presidential candidate and now the nominee for secretary of transportation, was spotted double-masking. It appears he was wearing a high-quality medical mask underneath a black cloth mask. His husband, Chasten, was sporting a similar double-masked look, but with a fashionable plaid cloth mask that coordinated with his winter scarf.

We should all be thinking about the quality of our masks right now. New variants of the coronavirus continue to emerge, and one in particular is cause for pressing concern in the United States because it’s so contagious and spreading fast. I wrote about the steps you can take to better protect yourself.

The bottom line is that you should keep taking the same pandemic precautions you always have, but do a little better. 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 mutation in the virus may mean 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.

That’s why the quality of your mask is more important than ever. You can read about the latest research urging a well-fitted two- or three-layer mask. Or you can keep the masks you’ve been using and just double-mask when you go to the store or find yourself spending time with people from outside your household. You can read more about double-masking here.

One big advantage of double-masking that I’ve found is that it creates a better fit and closes the gaps around the edge of your mask. I like layering my masks. When I walk the dog or exercise outdoors, I wear a regular mask to comply with area mask rules. When I want more protection for short errands, I wear a better mask. When I’m in a taxi or on a train, I double-mask.

I’ve just bought a new set of masks called KF94s that I really like. They fit well, have added flaps to close gaps around the face and include a moldable band to tighten the fit around the bridge of the nose. Now I wear a KF94, a type of mask made in South Korea that can be purchased easily online, covered by a cloth mask. I recently learned about the KF94 from Dr. Ashish K. Jha, dean of the Brown University School of Public Health. Dr. Jha notes that the gold-standard N95 masks are still hard to find, and we should save them for health workers. The KF94 mask 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 — although double-masking can help close any gaps.

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 several 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.

And speaking of masks: If you, like me, shouted at your television when you saw Chief Justice John Roberts’s mask slipping below his nose at the inauguration, then you’ll enjoy this story from my colleague James Gorman on the Science desk: Is Mask-Slipping the New Manspreading?

Distractions: The nation was captivated this week by Amanda Gorman, the youngest inaugural poet in U.S. history, who read “The Hill We Climb.” You can watch the video of her appearance and learn more about the back story in “Amanda Gorman Captures the Moment, in Verse.” The Times wrote about Ms. Gorman in 2017 when she was named “America’s First Youth Poet Laureate.” But the best interview with Ms. Gorman was with CNN’s Anderson Cooper in the hours after the inauguration. It’s an eight-minute chat about the research she did before writing the poem, the mantra she says to herself before every reading and how Twitter, the musical “Hamilton” and the Jan. 6 insurrection at the Capitol all influenced the final work. Watch the full interview here, which left Mr. Cooper at a loss for words, other than to tell the young poet, “Wow! You’re awesome.”

As usual, the Well team has been hard at work sharing the latest advice for living well everyday. Jane Brody has exciting developments in hip replacement surgery. Gretchen Reynolds weighs in on the benefits of moderate exercise. And here’s some big news! We now have a shareable link for those of you who want to do the Standing 7-Minute Workout more often!

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All you need is a wall, a chair for balance and sturdy shoes for this workout from Chris Jordan, director of exercise physiology at the Johnson & Johnson Human Performance Institute.

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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.

One Mask Is Good. Would Two Would Be Better?

One Mask Is Good. Would Two Would Be Better?

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

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

  • Jan. 12, 2021, 12:51 p.m. ET

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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One 18-Hour Flight, Four Coronavirus Infections

One 18-Hour Flight, Four Coronavirus Infections

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

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

  • Jan. 7, 2021, 5:50 p.m. ET

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The Covid Balancing Act for Doctors

Doctors

The Covid Balancing Act

At the start of the pandemic, I was “Dr. No” to my in-laws and cancer patients, but my conversations have become more nuanced.

Credit…Getty Images

  • Jan. 7, 2021, 5:00 a.m. ET

My wife’s parents have led a relatively monastic existence since about mid-March.

Both are in their 80s and live independently in rural Pennsylvania, maintaining a three-acre property by themselves. My father-in-law, the older of the two, has skirted major medical problems despite a decades-long indiscriminate diet, a testimony to the triumph of genetics over lifestyle choices. My mother-in-law, on the other hand, has been ravaged by lupus, which flares regularly and requires medications that suppress her immune system.

So when Covid-19 hit, we feared for their health, given their ages and her compromised immunity, and begged that they place themselves on lockdown, so we wouldn’t lose them to the pandemic.

And they did.

Where they used to buy groceries at their local Giant Eagle supermarket (which they call the “Big Bird,”) they turned instead to Instacart for home delivery, shrugging off the random items their shopper would get wrong with good humor.

Where they used to attend church in person every Sunday, they caught the video highlights online when they became available on Monday morning.

We arranged weekly Zoom calls with them, to replace our frequent visits.

We used to say that their social life rivaled ours, as they got together with friends they have known since kindergarten (kindergarten!) several times each week for dinner, drinks or shows. Instead, during the pandemic, they’ve replaced those social events with going cruising together in their blue ’55 Chevy Bel Air, satisfying themselves with the feel of a car they first drove in their teens, the beautiful countryside and a wave at their friends, who sat at a safe distance on their front porches.

Our whole family has been proud of them to the point of bursting. But in September, after six months of this, my father-in-law got antsy and did the unthinkable: He went to the hardware store, ostensibly for a tool, but really to see his friends who tend to congregate there.

He caught hell for his modest indiscretion, first from his wife, and then from mine. They explained to him that he could have ordered the piece online. They reminded him that his actions can affect my mother-in-law, and her frail health, too. Finally, he had enough.

“I’m 85 years old,” he said. “Eighty-five! I’m careful, I wore a mask. What do you expect me to do, spend the rest of my days here in prison?”

That gave me pause — my wife, too. At 85, he had done the math. Despite his lucky genetics, he probably didn’t have many years left on this earth, and he didn’t want to spend one or two of them in isolation.

Understanding the risks and consequences of his actions, shouldn’t he be allowed to see his buddies at the hardware store, and maybe buy a tool while he’s there?

I thought about it from the perspective of my patients, many of whom also don’t have much time left on this earth, and the conversations we had been having in clinic.

At the beginning of the pandemic, I was “Dr. No,” prohibiting my patients, most of whom have devastated immune systems, from engaging in their usual social activities. Where much of what we had all been hearing from government authorities about Covid-19 transmission had often been contradictory, I wanted to give concrete advice.

Attending a family gathering to celebrate a birthday? No.

How about a high school graduation party for a granddaughter? No.

Visiting elderly parents in another state? Not safe for you or them.

A road trip to Montana with a friend (this from a man in his 80s with leukemia): Are you kidding me?

At the risk of sounding paternalistic, I feared for my patients’ health, as I did for my in-laws’ health, and wanted to protect them.

But perhaps because our understanding of Covid-19’s epidemiology has gotten better over time; or with our recognition that we may have to live with the pandemic for many months more; or given my father-in-law’s perspective that people at the end of life should make their own risk-benefit calculations, my conversations have now become more nuanced.

I’m more open to my patients not missing important life events, when there may not be much life for them left, provided they take precautions to avoid endangering themselves or those around them, particularly amid the most recent surge in Covid-19 cases.

One woman with leukemia was receiving chemotherapy early in 2020 when her daughter had a miscarriage. Now that her daughter is eight months pregnant again, can she hold the baby when it is born? Absolutely, let’s talk about how to do it safely.

Another patient’s mother died. Can she attend the funeral? Yes, with appropriate distancing, limited numbers, and personal protective equipment. But skip the reception.

The road trip to Montana? I still wasn’t comfortable with that, but my patient and his friend went anyway, took their own food, slept in their truck, and he returned without Covid-19.

And my father-in-law? He gets out of the house a little bit more than he used to, but not as much as he’d like. The rare times that he does nowadays, he is always masked and stays outdoors, and both he and my mother-in-law remain Covid-19-free.

Which strikes me as about the right balance.

Mikkael Sekeres (@mikkaelsekeres) is the chief of the Division of Hematology, Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and author of When Blood Breaks Down: Life Lessons from Leukemia.”

Covid Vaccine During Pregnancy? Even Doctors Struggle With This Question

Doctors

I’m a Pregnant Doctor. Should I Get the Covid Vaccine?

A doctor struggles with the lack of data surrounding the Covid-19 vaccine and pregnancy.

Credit…Nam Y. Huh/Associated Press

  • Dec. 22, 2020, 5:00 a.m. ET

The morning after the Food and Drug Administration approved the emergency use authorization of the first coronavirus vaccine, I awoke to a message from my hospital asking me to sign up for an appointment to get vaccinated.

It brought tears to my eyes. As a primary care doctor, I haven’t exactly been on the front lines of the Covid-19 fight, but it’s upended my life and the lives of my patients. With the vaccine’s approval — and now a second one — we finally have an end in sight. Within hours, my colleagues were all texting each other, abuzz with the excitement of scheduling their vaccine appointments.

But I quickly learned I have an impossible choice ahead of me.

I am pregnant, and all of the clinical trials on Covid-19 vaccines excluded pregnant people. This is no surprise: pregnant people are frequently left out of clinical research because of the complexity of pregnancy, including concerns about potential harm to the fetus. That leaves us with little data to help us make decisions about medications and vaccines.

Instead we’re on our own, winging it during an already vulnerable time. And as I care for a ballooning number of coronavirus-positive patients each day, my decision about the vaccine seems more urgent than ever.

The news of my pregnancy was a joyful moment for my family in a difficult year, but Covid-19 has been a terrifying backdrop. I practice in Camden, N.J., and our community has been hard-hit. Infections are soaring above the springtime peak. My inbox contains positive case after positive case.

My patients are the most essential of essential workers — home health aides, warehouse workers, janitors — still, even after all we’ve learned this year, with little job security, minimal paid sick leave and inadequate personal protective equipment. And as my patients get exposed to the virus, so do I.

The data on coronavirus infection during pregnancy are not reassuring. Pregnant people who get the virus seem to have a higher risk for severe symptoms and complications, and there also may be a small increased risk of preterm birth. Each day I walk into my clinic, I ask myself, “Will this be the day I get it?”

The early news about the efficacy of the vaccines was thrilling. But there has been little data on how the vaccine affects pregnant people. No pregnant patients were enrolled in the early trials, although some people got pregnant during the course of the study. Researchers are monitoring them to see how they do.

According to Ruth Faden, a Johns Hopkins bioethicist who studies vaccine policy, the reluctance to include pregnant research subjects in clinical trials has a long history.

“There’s an inertia that’s set in,” she told me. Studying pregnant people requires extra effort in safe study design and recruitment efforts, so rather than do the hard work, she says, pregnant women are often just excluded altogether.

“It’s an ethically complex situation,” she added. “Pregnancy is like nothing else. Anything you do to a pregnant woman also has a chance of affecting the developing offspring.”

Researchers estimate we have adequate data on the risk of birth defects in less than 10 percent of medications approved by the Food and Drug Administration since 1980. That means any time a pregnant person thinks about using a medication or vaccine, she might feel like she’s making a decision at random, without any rigorous information to guide her.

That’s certainly how I feel right now. My medical training taught me to respect my patients’ autonomy; I see my job as guiding them through confusing medical information and helping them make decisions, not making decisions for them. Patient autonomy is a primary value in medicine.

I was glad to see that the F.D.A. left the choice of whether or not to get the Covid-19 vaccine up to pregnant women, rather than excluding us from eligibility altogether. For a pregnant nursing home aide, or a pregnant intensive care unit nurse, the risk of getting Covid-19 might be greater than the risk of any potential vaccine side effects.

This isn’t a theoretical exercise for hundreds of thousands of health care workers. Women make up an estimated 76 percent of the health care work force, many of us of childbearing age. I have text message chains with several pregnant and breastfeeding physician friends, all of us trying to sort through the limited information we have.

But without any data to guide me, my autonomy to make the decision doesn’t feel as meaningful. The American College of Obstetricians and Gynecologists offered this wildly unsatisfying recommendation: “Covid-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination.” The Centers for Disease Control and Prevention issued similarly noncommittal guidance: “Health care personnel who are pregnant may choose to be vaccinated.” Both are a far cry from the two organizations’ enthusiastic support for the flu vaccine in pregnancy, for example.

So it’s up to me and my nurse midwife, both of us smart clinicians, but not vaccine experts. I asked her what she thought, and she told me, “Honestly, I have no idea.”

I try to weigh the costs and benefits: I care for positive patients, but it’s not as if I’m an I.C.U. doctor. Many vaccines are safe in pregnancy — I gladly got my flu shot early on — but other vaccines aren’t. How can I weigh the costs and benefits if I don’t know what the costs are?

The two vaccines that have now been approved use a novel messenger RNA technology that has not been studied in pregnancy. It’s possible the mRNA and the bubble it travels in, made of lipid nanoparticles, could cross the placenta, according to Dr. Michal Elovitz, a preterm labor researcher and obstetrician at the University of Pennsylvania. This might, in theory, cause inflammation in utero that could be harmful to the developing fetal brain.

Or, the lipid nanoparticles might not cross the placenta, Dr. Elovitz says. It’s also possible the new vaccines could be totally safe in pregnancy, like the flu shot. We just don’t have the data yet.

“To avoid having pregnant people guess, we should be advocating for more preclinical and clinical research focused on pregnant patients,” she told me.

My bottom line: If I have the chance, I’ll gladly enroll in a clinical trial of a Covid-19 vaccine for pregnant people. It’s a choice that feels much more grounded in science than trying to figure this out on my own, because I’d be making it alongside the expertise of the scientists designing the trial.

I’d feel reassured that experts in immunology and pregnancy physiology had determined the safest trimester to get the vaccine. I’d feel reassured that they had done that using evidence from animal studies, and I’d feel reassured by the ethics board that approved the trial. It wouldn’t be a risk-free decision, but it would make me feel like it wasn’t a totally reckless one.

Until then, I’ll take care of my patients with my mask, my face shield, and my gloves, hoping I don’t get infected, thinking every day about my health and the health of my baby.

Dr. Mara Gordon is a family physician in Camden, N.J.

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

How Effective Is the Mask You’re Wearing? You May Know Soon

A C.D.C. division is working with an industry standards group to develop filtration standards — and products that meet them will be able to carry labels saying so.

Covid Testing: What You Need to Know

photophoto

What You Need to Know About Getting Tested for Coronavirus

Long lines, slow results and inconsistent advice have left many of us confused about when and how to get tested. We talked to the experts to answer your questions.

Dec. 9, 2020

Testing is essential to controlling the coronavirus. Once people know they are infected, they can isolate, alert others of the risk and stop the spread.

But months into the pandemic, many people still are frustrated and confused about virus testing. Long lines at testing sites, delays in getting results and even surprise testing bills have discouraged some people from getting tested. Many people don’t understand what a test can and can’t tell you about your risk — and wrongly think a test result that comes back negative guarantees they can’t spread the virus to others.

We asked some of the nation’s leading experts on testing to help answer common questions about how to get tested, what to expect and what the different tests and results really mean. Here’s their advice.

When should I be tested for coronavirus?

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. In some places, you still need a doctor’s prescription to get tested. In other communities, you can get tested easily by walking in to a clinic or even using a home test kit. There are four main reasons to get a test.

Symptoms: Feeling sick is the most urgent reason to get tested. A dry cough, fatigue, headache, fever or loss of sense of smell are some of the common symptoms of Covid-19. (Use this symptom guide to learn more.) While you’re waiting for your results, stay isolated from others and alert the people you’ve spent time with over the last few days, so they can take precautions. Many tests are most reliable during the first week you have symptoms.

Exposure: Did you find out that you recently spent time with an infected person? Were you in a risky situation, like an indoor gathering, or a large event or in an airport and airplane? You should quarantine and get tested. If testing isn’t widely available and you have only one chance to take a test, it’s best to get tested five to six days after a potential exposure to give the virus the opportunity to build up to detectable levels in the body. Test too early, and you might get a false negative result. If you’re in a city where it’s easy to get a test, get tested a few days after the exposure and, if it’s negative, get tested again in three or four days. If you think you’ve been exposed to the virus, the Centers for Disease Control and Prevention advises you quarantine for at least seven days and receive a negative test result before returning to normal activity.

Precautions: Some people get tested as a safeguard. Hospitals may require you to be tested before certain invasive medical procedures or surgery. Visitors to nursing homes may be given a rapid test before they are allowed to enter. Many colleges and boarding schools test students frequently and suggest they be tested before leaving campus and when they return. If you must travel, it’s a good idea to be tested before you leave, and a few days after you arrive. A negative test result is never a free pass to mingle with others, but knowing your infection status will lower the chance that you are unknowingly spreading the virus. Check on the turnaround time at the testing site in your area, and try to time it so you get a result as close as possible to the event or visit. Even if your test result is negative, you still need to wear a mask, maintain distance from others and take other precautions.

Community testing: In some cases, local health officials will encourage widespread testing for everyone, offering tests at health clinics, pharmacies and drive-through testing sites. Testing lots of people helps measure the level of spread in an area and can help slow or stop the spread in areas where known infections have occurred. In New York City, for instance, a health department advertising campaign is encouraging people to be tested often, even if they feel fine. “We learned that one of the ways we can control this virus effectively is by making sure as many people as possible are tested at a given time, so we can pick up people who are infected but don’t yet know they have the infection,” said Dr. Jay K. Varma, deputy commissioner for disease control at the New York City Health Department.

What type of test should I get?

Virus tests are categorized based on what they look for: molecular tests, which look for the virus’s genetic material, and antigen tests that look for viral proteins. The various tests all use a sample collected from the nose, throat or mouth that may be sent away to a lab or processed within minutes. Testing should be free or paid for by your insurance, although some testing centers are adding extra charges. Here are the common tests and some of the pros and cons of each.

Laboratory molecular test: The most widely available test, and the one most people get, is the P.C.R., or polymerase chain reaction, test, a technique that looks for bits of the virus’s genetic material — similar to a detective looking for DNA at a crime scene.

Pros: This test is considered the gold standard of coronavirus testing because of its ability to detect even very small amounts of viral material. A positive result from a P.C.R. test almost certainly means you’re infected with the virus.

Cons: Because these tests have to go through a laboratory, the typical turnaround time is one to three days, though it can take 10 days or longer to get results, which can limit this test’s usefulness, since you may be spreading virus during the waiting period. Like all coronavirus tests, a P.C.R. test can return a false negative result during the first few days of infection because the virus hasn’t reached detectable levels. (One study showed that among people who underwent P.C.R. testing three days after symptoms began, 20 percent still showed a false negative.) Another frustration of P.C.R. testing is that it sometimes detects the virus’s leftover genetic material weeks after a person has recovered and is no longer contagious. The tests are also expensive, costing hospitals and insurers $50 to $150 per test.

Rapid antigen test: An antigen test hunts for pieces of coronavirus proteins. Some antigen tests work sort of like a pregnancy test — if virus antigens are detected in the sample, a line on a paper test strip turns dark.

Pros: Antigen tests are among the cheapest (as little as $5) and speediest tests out there, and can deliver results in about 15 to 30 minutes. Some college campuses and nursing homes are using rapid tests to check people almost daily, catching many infectious people before they spread the virus. Antigen tests work best when given a few times over a week rather than just once. “It tells you, am I a risk to my family right now? Am I spreading the virus right now?” said Dr. Michael Mina, an epidemiologist at Harvard University’s School of Public Health and a proponent of widespread rapid testing. Though, he cautioned, “if the test is negative, it doesn’t tell you if you’re infectious tomorrow or if you were infectious last week.”

Cons: An antigen test is less likely than P.C.R. to find the virus early in the course of the infection. One worry is that a negative rapid test result will be seen as a free pass for reckless behavior — like not wearing a mask or attending an indoor gathering. (The White House Rose Garden event is a good example of how rapid testing can create a false sense of security.) A negative antigen test won’t tell you for sure that you don’t have the coronavirus — it only tells you that no antigens were detected, so you’re probably not highly infectious today. (In one study, a rapid antigen test missed 20 percent of coronavirus infections found by a slower, lab-based P.C.R. test.) Antigen tests also have a higher rate of false positive results, so a positive rapid test should be confirmed.

Rapid molecular test. Some tests combine the reliability of molecular testing with the speedy results of a rapid test. Abbott’s ID Now and the Cepheid Xpert Xpress rely on a portable device that can process a molecular test right in front of you in a matter of minutes.

Pros: These tests are speedy and highly sensitive, and they can identify those exposed to coronavirus about a day sooner in the course of an infection than a rapid antigen test. A rapid molecular test isn’t quite as accurate as the laboratory version, but you’ll get the result much fast

Cons: Depending on where you live, rapid molecular tests might not be widely available. They are also less convenient and often slower than many antigen tests. And like all coronavirus tests, a negative result isn’t a guarantee you don’t have the virus, so you’ll still need to take precautions. Like its laboratory cousin, a rapid molecular test can detect leftover genetic material from the virus even after you’ve recovered.

What happens during a coronavirus test?

Some tests require a health care worker to collect a sample through the patient’s nose or mouth. Other tests allow patients to use a swab or spit to collect their own samples.

  • Nose swab: Many tests collect a sample via the nose. The most reliable sampling method uses a nasopharyngeal swab — a long, flexible stick with absorbent material on the end — that is inserted deep into your nasal cavity until it reaches the upper part of your throat. A trained health worker must perform nasopharyngeal swab tests. A more comfortable method inserts a swab about a half-inch into one nostril and twists and rubs the swab on the inside of your nose for about 15 seconds. Less invasive nose swabs like these can often be self-administered.

  • Mouth swab: In some cases, you may be asked to say “ahh” as the swab is used to collect a sample from the back of your throat, similar to a common test for strep throat. Another method gathers fluids from your mouth by swabbing the cheeks, gums or tongue.

  • Saliva sample: One collection method requires the patient to drool into a test tube. There are no swabs involved, and people taking the test can collect their own saliva, making the procedure safer for health workers who don’t have to get near someone who might be infected.

What happens next? For laboratory tests, the sample is packaged, usually in a chemical soup that keeps it from degrading, and shipped to a facility that can process it. For a rapid test, the sample can be processed immediately, and the results given in a matter of minutes.

How do I get a test? How long will it take?

Roughly 2 million coronavirus tests are run in the United States every day. But testing availability varies considerably from state to state, even city to city. Tests are generally less available in rural areas or in communities where cases have surged and medical and laboratory resources are stretched.

The best way to find out about testing in your community is to check your local public health department website or call your doctor or a local urgent care clinic. Some cities and towns have also set up drive-in community testing sites. If your doctor or local public health clinic offers rapid testing, you usually can get the result in 15 to 30 minutes. But a positive rapid result might need to be confirmed by an additional test, especially if you don’t have symptoms.

In some communities, it can still be difficult to get the results of a laboratory P.C.R. test quickly. A survey from Northeastern University and Harvard Medical School found that this fall, patients had to wait days just to schedule a test and even more time to get results. On average it’s been taking six or seven days after symptoms start to find out if you have the virus, and by then most people are on their way to recovery, making the test pretty useless. (In some parts of the country, people have had to wait as long as two weeks to get test results.) The research also found that Black patients, on average, had to wait almost two days longer to get results than white patients.

Testing turnaround times are improving in some cities. In New York City, for instance, you can get a P.C.R. laboratory test result in about a day. If rapid testing is available in your area, you can get the result in minutes, but rapid tests work best when taken a few times over the course of a week.

What do the results mean for me?

A virus test can produce one of three results: positive (or virus detected), negative (or virus not detected) or inconclusive. Here’s what the results really mean.

Positive: A positive test result means you should continue to stay home and isolate, and alert people you spent time with over the past few days. If you feel sick, contact your primary care doctor for guidance, and monitor your symptoms at home, seeking medical attention when needed. The Centers for Disease Control and Prevention says that you still should wait at least 10 days after symptoms started, and go 24 hours without a fever, before ending isolation. For some people who are severely ill, this timeline might be longer.

Negative: If your test result is negative, it’s reassuring, but it’s not a free pass. You still need to wear a mask and restrict social contacts. False negatives happen and could mean that the virus just hasn’t reached detectable levels. (It’s similar to taking a pregnancy test too early: You’re still pregnant, but your body hasn’t created enough pregnancy hormones to be detected by the test.)

“A negative result is a snapshot in time,” said Paige Larkin, a clinical microbiologist at NorthShore University HealthSystem in Chicago, where she specializes in infectious disease diagnostics. “It’s telling you that, at that exact second you are tested, the virus was not detected. It does not mean you’re not infected.”

Inconclusive: Sometimes a test comes back inconclusive because the sample was inadequate or damaged, or a sample can get lost. You can get retested but, depending on how much time has passed, it might be easier to just finish 10 days of quarantine. If you are sick but receive a negative or inconclusive test, you should consult your health care provider.

If I get tested, can I see my family for the holidays?

Sorry, but a negative test does not mean you can safely visit another household or travel for the holiday to see friends and family. A lot can go wrong between the time you took the test and the moment you hug a family member. False negatives are common with coronavirus testing — whether it’s a laboratory P.C.R. test or a rapid antigen test — because it takes time for the virus to build up to detectable levels in your body. It’s also possible that you weren’t infected with the virus when you took the test, but you got infected while you were waiting for the results. And then consider the risk of catching the virus in an airport, on a plane or from a taxi driver or rental car agent — and you may end up bringing the virus home with you for the holidays.

“I don’t want somebody to have a negative test and think they can go visit grandma,” said Dr. Ashish Jha, dean of Brown University’s School of Public Health.

Despite these limits, if you feel you must travel, it’s a good idea to get tested. If you’re using rapid testing, try to take more than one test over the days leading up to your visit, including a test on the day you plan to see a vulnerable person. If you’re getting a laboratory test, check the turnaround time and try to schedule it as close as possible to your visit. While the test doesn’t guarantee you’re not infected, a negative result will lower the odds that you’ll be spreading the virus. And, of course, a positive test tells you that you should cancel your plans. A test “filters out those who are positive and definitely shouldn’t be there,” said Dr. Esther Choo, an emergency medicine physician and a professor at Oregon Health and Science University. “Testing negative basically changes nothing about behavior. It still means wear a mask, distance, avoid indoors if you can.”

Is home testing an option? Is it reliable?

Communities around the country, including in California, Minnesota and New Jersey, are starting to roll out home testing kits. The cost typically is covered by the government if it’s not covered by your personal insurance. To find out if home testing is available in your area, check your state or local health department website or ask your doctor.

Two types of home tests are currently available. Several companies offer customers the option of spitting in a test tube at home, and then shipping the sample to a laboratory for processing. Results are delivered electronically in a day or two.

In November, the Food and Drug Administration issued an emergency green light for the first completely at-home coronavirus test, made by Lucira. The Lucira test kit allows a person to swirl a swab in both nostrils, stir it into a vial, and use a battery-powered device to process the test and get a result in 30 minutes. The test kit requires a prescription and is not yet widely available. Several companies have rapid home tests in development but still need F.D.A. approval.

Some experts are concerned that widespread home testing is impractical. Even if a new generation of home tests is approved, they question whether people would use the tests correctly or as frequently as recommended, and whether they would isolate if they test positive. But home testing also has several prominent supporters, among them Dr. Anthony S. Fauci, the country’s top infectious disease expert. Dr. Fauci notes that home tests — from home pregnancy tests to home H.I.V. tests — have long prompted skepticism, and that when home H.I.V. test kits were first developed, many experts worried that people would become despondent if they got a positive result while home alone and act brashly. “That’s a standard pushback against home tests,” he said.

But Dr. Fauci and other proponents of home testing say that simple, cheap home kits could allow people to take daily tests before going to work in an office, grocery store or restaurant or before going to school (although it’s still not clear how well the tests work in children). Rapid testing at home a few days a week could potentially identify an infection even before a person develops symptoms.

“I have been pushing for that,” Dr. Fauci said. “I think home testing is the same as a pregnancy test and should be available to people. As long as there is some Covid around, then I think a home test would be useful.”

Should I get an antibody test?

This blood test is designed to detect antibodies that signal you were infected with coronavirus in the past, but shouldn’t be used to diagnose a current infection. It can take one to three weeks after infection for your body to begin producing antibodies. Blood is taken by pricking the finger or drawing blood from your arm through a needle. You can get the test through a doctor’s office, many urgent care clinics or a local public health clinic. You may be offered a free antibody test when you donate blood as well. The waiting time for results varies from a few days to two weeks.

Pros: An antibody test can tell you if you were infected with coronavirus in the past. But experts warn against assuming too much about what a positive result says about immunity to the virus. Scientists generally agree that the presence of antibodies most likely indicates some level of protection, but they don’t know to what extent or for how long. Although reinfections are thought to be rare, they have occurred, and experts stress that a positive result on an antibody test should not give someone a free pass to shirk masks or mingle with others.

Cons: Many antibody tests are inaccurate, some look for the wrong antibodies, and even the right antibodies can fade over time. Some tests are notorious for delivering false positives — indicating that people have antibodies when they do not. These tests may also produce false negative results, missing antibodies that are present at low levels. An antibody test should not be used by itself to determine whether a person is currently infected.

If you do decide to get an antibody test, the result should not change your behavior. You still need to take all public health precautions and assume that you can still contract or spread the virus. If you know you had the coronavirus, and it was confirmed by a diagnostic test at the time you were ill, you may be eligible to donate convalescent plasma, which can potentially help patients still suffering from Covid-19, who can get an infusion of your antibodies to accelerate their recovery time.

How much will virus testing cost me?

In most cases, your test for coronavirus should not cost you a dime. Congress passed laws requiring insurers to pay for tests, and the Trump administration created a program to cover the bills of the uninsured. Cities and states have set up no-cost testing sites.

However, some medical offices and private testing sites are adding extra charges or facility fees, so check in advance about the bill. A New York Times investigation by our colleague Sarah Kliff found that many people have been billed large, unexpected fees or denied insurance claims related to coronavirus tests, and they’ve faced bills ranging from a few dollars to more than $1,000.

To lower your chance of getting a surprise bill, she recommends the following precautions:

  • Get tested at a public testing site set up by your city, county or state health department. If a public test site isn’t an option where you live, you might consider your primary care doctor or a federally qualified health clinic.

  • Avoid getting tested at a hospital or free-standing emergency rooms. Those places often bill patients for something called a facility fee, which is the charge for stepping into the room and seeking service.

  • Ask ahead of time how you will be billed and what fees will be included. It can be as simple as saying: “I understand I’m having a coronavirus test. Are there any other services you’ll bill me for?”

  • If you don’t have insurance, ask ahead of time how providers handle uninsured patients. Ask if they are seeking reimbursement from the federal government’s provider relief fund or if they plan to bill you directly.

You can find more guidance in How to Avoid a Surprise Bill for Your Coronavirus Test. And if you have a coronavirus bill you want to share, submit it here.

What’s next for testing?

More than 200 tests for the coronavirus have been given emergency green lights by the F.D.A., with many more likely to come. Experts think some of the next wave of tests will include more products that can be self-administered from start to finish at home.

As the nation speeds toward the winter months, combination flu/coronavirus tests, which can search for both types of viruses at the same time, are likely to become increasingly common. Many of these tests are already available in doctors’ offices and clinics.

Researchers are also exploring other types of tests that might be able to measure other aspects of the immune response to the virus.

So what’s the bottom line?

More testing is needed to stop the spread of the coronavirus. The more testing we do and the faster we get the results back — whether it’s a P.C.R. test or a rapid test — the more information we have to make good choices and keep those around us safe. Tests are useful when used correctly, and when you know the limits of the information they give you. A positive test of any kind should keep you home and isolating. (If you have good reason to doubt the result, get tested again.)

A negative test is not a free pass to drop your mask and socialize in groups. It’s a snapshot in time. A negative P.C.R. test tells you that you were negative a few days ago when you took the test. A negative rapid antigen test tells you that you’re probably not infectious right now, but it’s better to take a few more tests over the next few days to be sure. In both cases it’s possible you still have the virus (just as it’s possible to get a negative pregnancy test and still be pregnant).

In general, if you have symptoms, your doctor will order a P.C.R. test to confirm if you have Covid-19. If you’re living on a college campus, or going to work in a factory or grocery store every day, frequent rapid testing can be a useful way to monitor your health regularly. Because testing has not been consistently available around the country, you may not have the option for getting either type of test quickly. Wearing a mask, maintaining your distance and restricting contact with people outside your household remain essential to stopping the spread of the coronavirus.

Produced by Jaspal Riyait

What You Need to Know About Getting Tested for Coronavirus

Weekly Health Quiz: Better Masks, a Sleep Benefit and Another Coronavirus Vaccine

1 of 7

For better protection against coronavirus, experts recommend all of the following measures for masks except:

Having multiple layers of material

Using soft materials rather than stiff ones

Having ties rather than ear loops

Wearing a face shield rather than a mask

2 of 7

Over the past week, this state has had the highest number of Covid-19 deaths per 100,000 population:

Wisconsin

Texas

North Dakota

South Dakota

3 of 7

The drug maker AstraZeneca announced promising results from a new coronavirus vaccine that is made from a cold virus that affects these animals:

Dogs

Cats

Chimpanzees

Bats

4 of 7

All of the following sleep habits were tied to a decreased risk of heart failure except:

Getting seven to eight hours of sleep a night

Rarely or never snoring

Being a “night owl”

Feeling refreshed during the day

5 of 7

People who ate this style of diet were at the lowest risk of bone fractures:

Vegetarian

Vegan

Fish but no meat

Meat eaters

6 of 7

True or false? Teenagers can become addicted to the nicotine in e-cigarette products.

True

False

7 of 7

Girls born very prematurely, before 28 weeks of gestation, were at higher risk of this mental health disorder as young adults:

Bipolar disorder

Depression

Anorexia nervosa

Schizophrenia

Masks Offer Covid Protection, Provided You Wear Them Right

Is it time to upgrade your mask?

By now most of us have settled on a preferred cloth mask to protect ourselves and others from coronavirus. But new research shows that a few simple upgrades in fabric, filters and fit are likely to provide even more protection.

Linsey Marr, professor of civil and environmental engineering at Virginia Tech and one of the world’s leading aerosol scientists, led the research, which tested 11 different mask materials. The findings confirmed what other labs have found: You don’t need a gold-standard N95 medical mask to stay safe from coronavirus. The right cloth mask, properly fitted, does a good job of filtering viral particles of the size most likely to cause infection.

But Dr. Marr and her colleagues found that small improvements to your mask can go a long way toward improving how well the mask protects you and others from potential infectious particles. They found that:

Three layers are better than two. The best mask has two tightly woven layers of outer material with a filter material sandwiched in the middle, Dr. Marr said. You can use surgical mask material or even a piece of a vacuum bag as a filter between two pieces of fabric. Coffee filters are an option, but can be less breathable. If you like your two-layer mask, you can just wear it over a surgical mask when you want added protection. A well-fitting fabric mask with a third filter layer can stop 74 to 90 percent of risky particles, the researchers found.

Flexible material is better. Stiff material creates gaps. Look for a mask made of tightly woven flexible material that contours to your face. Masks with wire that can be molded around the nose also fit better by closing gaps where air can escape out and seep in.

Ties are better than ear loops. Masks that tie around your head fit better and can be more comfortable. Ear loop masks can leave bigger gaps around your face and cause ears to become sore with longer use.

Face shields should be used with a mask. Face shields alone offered little to no protection. Although the clear plastic shield is impermeable, air seeps out and comes in around the edges of the shield. “It was the worst of everything,” said Jin Pan, a civil and environmental engineering Ph.D. student who was a co-author of the study. A face shield combined with a mask offers added protection, particularly for the eyes.

A well-fitted mask protects the wearer. Dr. Marr and her colleagues tested cloth masks for how well they protected others (outward protection) as well as the wearer (inward protection). Although masks are most efficient at filtering outgoing germs, they do stop incoming germs at nearly the same rate in most cases, the researchers found. Masks that did a poor job protecting the wearer were those made of stiffer materials and those worn loosely and with gaps around the edges.

A recent study from Denmark suggested that masks don’t protect the wearer, but Dr. Marr noted that in that study, many people weren’t using masks properly. “Fewer than half wore them as instructed,” Dr. Marr said. Although Dr. Marr’s findings come from a lab, rather than the real world, she said her group’s latest research should offer reassurance to people who wear well-fitted masks that they are getting additional protection from other people’s germs.

The research should also reassure people about the benefits of cloth masks, Dr. Marr said. She noted that masks can’t do “100 percent of the work,” and it’s important to combine mask wearing with other measures, like hand-washing and restricting social contacts.

“Something is better than nothing,” Dr. Marr said. “Even the simplest cloth mask of one layer of material blocks half or more of aerosols we think are important to transmission. If you go to a tighter weave and more layers, you’ll get even better performance.”

The Virginia Tech study was published online and has not yet been peer reviewed.

Masks Offer Covid Protection, Provided You Wear Them Right

Is it time to upgrade your mask?

By now most of us have settled on a preferred cloth mask to protect ourselves and others from coronavirus. But new research shows that a few simple upgrades in fabric, filters and fit are likely to provide even more protection.

Linsey Marr, professor of civil and environmental engineering at Virginia Tech and one of the world’s leading aerosol scientists, led the research, which tested 11 different mask materials. The findings confirmed what other labs have found: You don’t need a gold-standard N95 medical mask to stay safe from coronavirus. The right cloth mask, properly fitted, does a good job of filtering viral particles of the size most likely to cause infection.

But Dr. Marr and her colleagues found that small improvements to your mask can go a long way toward improving how well the mask protects you and others from potential infectious particles. They found that:

Three layers are better than two. The best mask has two tightly woven layers of outer material with a filter material sandwiched in the middle, Dr. Marr said. You can use surgical mask material or even a piece of a vacuum bag as a filter between two pieces of fabric. Coffee filters are an option, but can be less breathable. If you like your two-layer mask, you can just wear it over a surgical mask when you want added protection. A well-fitting fabric mask with a third filter layer can stop 74 to 90 percent of risky particles, the researchers found.

Flexible material is better. Stiff material creates gaps. Look for a mask made of tightly woven flexible material that contours to your face. Masks with wire that can be molded around the nose also fit better by closing gaps where air can escape out and seep in.

Ties are better than ear loops. Masks that tie around your head fit better and can be more comfortable. Ear loop masks can leave bigger gaps around your face and cause ears to become sore with longer use.

Face shields should be used with a mask. Face shields alone offered little to no protection. Although the clear plastic shield is impermeable, air seeps out and comes in around the edges of the shield. “It was the worst of everything,” said Jin Pan, a civil and environmental engineering Ph.D. student who was a co-author of the study. A face shield combined with a mask offers added protection, particularly for the eyes.

A well-fitted mask protects the wearer. Dr. Marr and her colleagues tested cloth masks for how well they protected others (outward protection) as well as the wearer (inward protection). Although masks are most efficient at filtering outgoing germs, they do stop incoming germs at nearly the same rate in most cases, the researchers found. Masks that did a poor job protecting the wearer were those made of stiffer materials and those worn loosely and with gaps around the edges.

A recent study from Denmark suggested that masks don’t protect the wearer, but Dr. Marr noted that in that study, many people weren’t using masks properly. “Fewer than half wore them as instructed,” Dr. Marr said. Although Dr. Marr’s findings come from a lab, rather than the real world, she said her group’s latest research should offer reassurance to people who wear well-fitted masks that they are getting additional protection from other people’s germs.

The research should also reassure people about the benefits of cloth masks, Dr. Marr said. She noted that masks can’t do “100 percent of the work,” and it’s important to combine mask wearing with other measures, like hand-washing and restricting social contacts.

“Something is better than nothing,” Dr. Marr said. “Even the simplest cloth mask of one layer of material blocks half or more of aerosols we think are important to transmission. If you go to a tighter weave and more layers, you’ll get even better performance.”

The Virginia Tech study was published online and has not yet been peer reviewed.

Sunscreen and Bug Spray: Children’s Summer Skin Care

Photo

Credit Getty Images

Summer is here, and we know we’re supposed to shield children from the sun. There’s strong evidence that early sun exposure can increase children’s risk of later skin cancer, and that’s true also for darker-skinned children who are less likely to burn. Boston and Miami Beach are providing free sunscreen in public places, and now New York is talking about it, too.

Parents have certainly gotten much more aware about sun protection, though they sometimes feel a little overwhelmed by the variety of products and by the job of keeping up with the imperatives for proper use.

And with old worries about ticks and new worries about mosquito-borne viruses, parents wonder if they should also be coating a child’s exposed skin with bug repellent.

But babies’ delicate skin is more permeable than adults’, so any chemicals we apply may be more likely to be absorbed, and their immature organs may be less able to handle those chemicals. What stays on the skin may be absorbed; but what doesn’t stay on the skin doesn’t shield. Dermatological toxicology involves considering the balance between “wash in,” the risk of absorbing potentially toxic substances through the skin, and “wash out,” the loss of protection as substances are lost by sweating or water exposure or rubbing. Both are highly complex processes, with many variables, and not necessarily well studied in young children.

With little babies, the advice is always to rely on reducing exposure, on shade and clothing for sun, and on adding screens and netting to keep the bugs off. Both the Food and Drug Administration and the American Academy of Pediatrics emphasize that babies under 6 months should be kept out of direct sunlight, protected with shade, shielded with sunhats and protective clothing when they do have to be out, rather than relying on sunscreen.

Babies’ skin surface is large in proportion to their body volume and their internal fluids, putting them at high risk for heat and dehydration. So make sure they are drinking and wetting their diapers regularly.

Adults and children alike are advised to avoid the hours of maximum exposure — to stay out of the sun between 10 and 2, and to avoid going outside at dusk in areas with lots of mosquitoes. But of course, that isn’t necessarily easy.

Sun hats and protective clothing are important for older babies and toddlers, and so is avoiding those peak hours. For children under 2, “the rule of thumb in this age group is clothing first,” said Jacqueline Thomas, an assistant professor of dermatology and surgery at Nova Southeastern University in Fort Lauderdale, who is the senior author on a commentary reviewing pediatric sunscreen and sun safety guidelines published last year in the journal Clinical Pediatrics. Dark colors and more tightly woven fabrics are more effective.

As to sunscreen, experts say not to choose by what is marketed for children or babies, and to read the label carefully. In 2011, the F.D.A. required much more information to be standardized on sunscreen labels; parents should look for products with an SPF of 30 or higher, advises the American Academy of Dermatology, and make sure they are labeled as “water resistant” (lasts 40 minutes in the water) or “very water resistant” (80 minutes), and as “broad spectrum,” meaning that they block both UVA and UVB rays, both of which do damage. There is no such thing as waterproof sunscreen.

The active agents in sunscreen can be either chemical blockers or physical blockers, and the physical blockers are safer for children because they are much less likely to be absorbed. For children ages 2 to 12, look for products with titanium or zinc as their active ingredients, rather than chemical agents, which really haven’t been studied in children.

The recommended amount for an adult-size body is variously described as a shot glass and a golf ball for the trunk and extremities; for under 12, some authorities suggest using the amount that would fill a child’s cupped hand as a rough guide. It needs to be reapplied after two hours, because the efficacy is gone, even if you can still feel the lotion on your skin, and sunscreens with higher SPFs don’t last any longer than those with lower SPFs (in fact, there is no evidence that SPFs over 50 are more protective).

Although spray-on sunscreens are popular, their efficacy has not been studied,, and there’s concern about children inhaling them. The F.D.A. has asked for more data.

What about insects? Mosquito repellents generally contain either DEET, picaridin or one of several essential plant oils, most commonly oil of lemon eucalyptus, as an active ingredient; permethrin, which is meant to be applied to clothing (or sometimes already applied by manufacturers) works to repel ticks.

There has been concern in the past about DEET toxicity, and the recommendation is to avoid DEET and picaridin for babies younger than 2 months, and to avoid oil of lemon eucalyptus for children under 3. But most pediatricians would recommend being very sparing with all of these substances on babies and young children, applying them only to exposed skin, right before going outside, and washing them off when you come back in. Don’t let young children apply the stuff themselves, and keep it away from their eyes and their mouths, and their hands if they tend to put those in their mouths. If possible, put the repellent on the clothing, or on the tent; there are also clip-on devices that can be attached to strollers.

Dr. Adelaide A. Hebert, a professor of dermatology and pediatrics at McGovern Medical School at the University of Texas Health Science Center at Houston, said she tends to recommend picaridin-based insect repellents such as Cutter Advanced and Off Clean Feel for children over those that contain DEET. “I like picaridin. I feel there’s less concern for parents using it with regard to toxicity,” she said. The strength of these insect repellents can vary as well, so again, it’s important to read the label. “We don’t recommend DEET strength above 20 percent because of concern about toxicity,” Dr. Hebert said.

Combination products are another problem, though the idea of a single lotion that protects against both sun and insects is very appealing. “I never recommend combination products,” said Dr. Hebert. “We don’t want to reapply the insect repellent as often as we may need to reapply the sunscreen.” Further, there’s evidence that the mixture may make the sunscreen less effective, and the chemicals more likely to be absorbed.

So keep babies out of the sun, be scrupulous about sun hats and protective clothing, about screens and mosquito netting. As children grow, don’t forget about protecting the eyes; think about broad-brimmed hats and sunglasses. If you need protection against insects, apply insect repellent over sunscreen, and reapply the sunscreen after two hours, on top of the insect repellent, which does not have to be reapplied so frequently.

The skin is the largest organ of the body, proportionally larger in the smallest children, and protecting it properly needs our care and attention.

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