Tagged Winter (Season)

How to Walk Safely in the Snow, Ice and Slush

Personal Health

How to Walk Safely in the Snow, Ice and Slush

Walk like a penguin: Turn your feet slightly outward and take short, flat-footed steps.

Credit…Gracia Lam
Jane E. Brody

  • Feb. 22, 2021, 5:00 a.m. ET

This has been a most challenging winter, especially for folks like me in their upper decades who’ve had to contend not only with pandemic-induced loneliness and limitations but also with streets piled high with snow and sidewalks coated with ice.

I take my little dog to the park for his off-leash run every morning, and often have had to rely on the kindness of strangers to help me navigate paths glazed with ice so I could get back home in one piece.

I not-so-silently curse the neighbors who high-tailed it to their country retreats for the Covid-restricted winter without arranging to have their sidewalks shoveled whenever it snowed, which it has done with a particular vengeance in New York City this February.

Many in my neighborhood who did shovel created only a narrow path for walkers and failed to clear the snow from the inner part of the sidewalk, where some of it periodically melted during the day and refroze at night, leaving a slick of black ice for pedestrians to slip and fall on in the morning. An elderly friend who lives alone landed on one of those icy patches and broke her wrist, a challenging injury, but at least her hips and head remained intact.

It’s not that I don’t know how to walk on icy surfaces. I review the guidelines every winter and thought I was well equipped, but I may have been lulled into complacency by last year’s relatively mild winter and failed to pay adequate attention to what to put on my feet. The other morning I changed my boots three times without finding a pair able to keep me reliably upright over snowy, slushy and icy terrain, despite them all having supposedly good rubber treads.

Perhaps I should have consulted the Farmer’s Almanac for 2021. Had I anticipated how bad it could get I might have checked the laboratory-tested advice on the best anti-slip footwear from a research team at the Kite Toronto Rehabilitation Institute-UHN. It would have alerted me to the fact that none of the boots in my closet are really much good, especially for someone my age facing the conditions I’ve encountered on Brooklyn streets and Prospect Park this winter.

Aiming to keep Canadian bones intact during long icy winters, in 2016 the team, headed by Geoff Fernie, a professor of biomedical engineering at the University of Toronto, tested 98 different types of winter boots, both work and casual, and found that only 8 percent of them met the lab’s minimum standard of slip resistance.

Using what it calls the Maximum Achievable Angle testing method, the team evaluated slip resistance of footwear in a winter-simulated indoor laboratory with an icy floor that can be tilted at increasing angles. While attached to a harness to prevent a real fall when they slip, participants wearing the shoes being tested walk on the ramp uphill and downhill over bare ice or melting ice. Shoes that prevent slippage with the ramp set at an angle of at least seven degrees get a single snowflake rating. Two snowflakes are awarded for non-slippage at 11 degrees, and three snowflakes for 15 degrees. But 90 types of footwear initially tested by 2016 failed to get any snowflakes, and none got more than one snowflake.

Things have improved in the past few years, with 65 percent of boots tested in 2019 getting at least one snowflake, Dr. Fernie said in an interview. The latest ratings, which are updated continually, can be found online at ratemytreads.com.

He explained that two types of outer soles, Arctic Grip and Green Diamond, provide the best traction on ice. Green Diamond acts like rough sandpaper, with hard grit incorporated into the rubber sole, that works best on cold hard ice. Arctic Grip soles contain microscopic glass fibers that point downward to give firm footing on wet ice. You might be able to find a few brands that use both technologies in the same sole to achieve protection on both hard and wet ice.

Alas, I tried too late in the current snow-and-ice season to locate a pair in my size of any of the top-rated boots Dr. Fernie’s lab tested. So for now I’ll have to rely on the Yaktrax pull-on cleats I bought years ago and struggle to get them onto my existing shoes.

Properly shod or not, it pays to know how to walk safely on snowy and icy surfaces.

My No. 1 rule: Never go out without your cellphone, adequately charged, especially if you’ll be alone. Take it slow, and use handrails on steps when available. On slippery steps, if there’s nothing to hold on to, go down sideways.

Walk like a duck or penguin. The posture is anything but glamorous but could help to keep you out of the emergency room. Extend your arms to the side to improve balance. Keep your hands out of your pockets; you may need them to break a possible fall. And wear gloves!

Bend forward a little from your knees and hips to lower your center of gravity and keep it aligned over your forward leg as you walk. With your legs spread a little further apart than usual, turn your feet slightly outward and take short, flat-footed steps. Or if that’s not possible, shuffle side to side at an angle to move forward without raising your feet.

Pay attention to your surroundings and look ahead of you as you walk to avoid trip hazards. If you use a cane, fit the end with an ice pick made for the purpose; an ordinary rubber-tipped cane is not much better on ice than slippery shoes.

Avoid carrying heavy packages that can throw you off balance. I use a backpack to carry small items, or if I’m shopping for anything bigger, I take a grocery cart.

And know how to fall to minimize the risk of a serious injury. Should you start to fall backward, quickly tuck your chin to your chest to avoid hitting your head and extend your arms away from your body so that your forearms and palms, not your wrists and elbows, hit the ground.

If you fall forward, try to roll to one side as you land so that a forearm, not your hand, is first to hit bottom.

Getting up from an icy surface can also be challenging. If you’re not injured, turn over onto your hands and knees. Keeping your feet shoulder-width apart, place one foot between your hands, then bring the other foot between them and try to push yourself up.


How to Recognize and Address Seasonal Depression

How to Recognize and Address Seasonal Depression

Despair in the winter months can point to a serious condition. Experts recommend light boxes, earlier wake-up times and therapy.

Credit…Pablo Amargo

  • Feb. 5, 2021, 2:38 p.m. ET

Seeing friends was normally the highlight of Kendra Sands’ week. One night in January 2018, she had plans to meet two for dinner, but instead, Ms. Sands, who lives in Charlotte, N.C., crawled into bed. She wanted to go out, but she was stuck in a dark room, sobbing.

“I forced myself to put on different clothes, touch up my makeup and get in the car,” she said. “But driving to the restaurant, I realized hibernating in bed had been a pattern for weeks.”

Sands initially blamed PMS for the crying episodes, but after a month she still had no relief. After asking about her mental health pattern in previous years, Ms. Sands’ therapist eventually diagnosed her with seasonal affective disorder. “I knew I didn’t like the cold or dreariness of winter, but I never thought I had a form of depression,” Ms. Sands said.

According to Vaile Wright, senior director of health care innovation and practice directorate at the American Psychological Association, seasonal affective disorder (S.A.D.) is a type of major depression. What makes S.A.D. unique is its timing: “It has a distinct seasonal onset, typically in winter, and a spontaneous remission of symptoms,” she said.

S.A.D. patients experience classic depression symptoms: sadness, irritability, trouble concentrating, lack of interest in activities and increased sleep and appetite. It doesn’t have to be cold or snowy, people can experience S.A.D. in sunny climates like Florida or Southern California.

“The important consideration for all forms of S.A.D. is the effect of your surroundings,” said Dr. Amit Etkin, a professor of psychiatry and behavioral sciences at Stanford University. “The light you experience, how you interact with the world when you get up, and when you go to bed all have a disproportionate effect on your mood.”

Recognize S.A.D. in yourself.

Michael Terman, professor of clinical psychology at Columbia University and founder of the Center for Environmental Therapeutics, said it’s common to gain weight and feel lethargic in winter, but only around three percent of the population has S.A.D.

To be diagnosed, you need to experience at least five of nine clinical symptoms for at least two weeks, said Paul Desan, assistant professor of psychiatry at Yale School of Medicine. If you don’t, you could have subsyndromal S.A.D., a milder version Dr. Desan said people often call “winter blues.”

A distinct, seasonal pattern is key to recognizing S.A.D., feeling normal during spring and summer, then dwindling in energy and mood as days get shorter — almost like you want to hibernate. If you have a family member with S.A.D., you might be more likely to develop it, and Dr. Desan said the disorder is three times more common in women.

According to Dr. Terman, S.A.D. prevalence increases as you move north, until you hit 38 degrees (around Washington D.C.). Anywhere farther north is essentially equally affected at maximum severity. The likelihood also rises near the western edges of time zones, where dawn occurs later.

Experts agree it’s important to treat S.A.D. if you think you may have it. Here are some of the most common treatment methods they recommend.

Start with simple changes.

Many forms of depression, Dr. Wright said, benefit from changes to sleep schedule, a nutritious diet, exercise and social interaction. If you have S.A.D., put a winter spin on these behaviors.

For example, even if you want to sleep later, set an alarm each day so you can experience early-morning sunshine, which helps with S.A.D. symptoms. “Engaging actively in the world, as if you already had those rhythms, is a good way to help reset your circadian rhythm,” Dr. Etkin said.

What you do at night matters, too. Dr. Etkin suggests basic sleep hygiene like avoiding screens (and any artificial light). Try to keep your bedtime consistent — not too late — and avoid too much caffeine or alcohol, which can interfere with your quality of rest and ability to get up.

Try a light box.

Light activates a bodily signal that informs your cells what time of day it is. Morning light causes cortisol to spike, giving you energy. The time of that initial spike determines when your brain releases melatonin, a hormone that makes you sleepy before bedtime.

During winter, people often get less light in the morning and too much artificial light at night, which throws off these signals, affecting sleep and mood.

Light boxes — devices that produce artificial light similar to sunlight — may be an effective way to correct that. In a meta-analysis of 19 studies, bright light therapy was superior to placebo; another small study found 61 percent of light-therapy patients saw their depression symptoms ebb in four weeks.

There is some evidence that sitting in front of a 10,000-lux (the measure of light intensity) light box for 30-45 minutes every day around sunrise during fall and winter decreases S.A.D. symptoms. If you’re currently experiencing S.A.D. symptoms, it’s not too late to start. You can also begin treating next season’s symptoms in the fall.

As tempting as it is to hit the snooze button on weekends, Dr. Desan said your mood will start to sag again if you don’t do your treatment every day around sunrise, so build light therapy into your life. Most research-grade light boxes allow you to sit at arm’s length and move your head, so you should be able to eat breakfast, drink coffee or read.

An effective light box is usually at least $100, but not every option is equally effective. Of the 24 devices Dr. Desan tested in 2019, only seven met clinical criteria. The rest weren’t as effective as research-grade boxes.

Get outside.

According to Anna Wirz-Justice, professor emeritus in the Centre for Chronobiology at the University of Basel, in Switzerland, natural light isn’t only cheaper than a light box, it’s also brighter. Sunrise light is equivalent to 1,000 lux. A rainy morning provides around 10,000 lux, and snow on the ground is even brighter, at 50,000 lux.

Aim to go outside within 30 minutes after sunrise. “You don’t need to see the sun cross the horizon,” said Dr. Huberman. “What you’re looking for is the quality of light that happens when the sun is low in the sky.”

Duration depends on where you live and the weather. Dr. Huberman suggested around five minutes outside if it’s bright or 10-15 minutes if it’s cloudy. It’s OK to wear glasses or contacts, but skip sunglasses and never look at the sun directly.

See a psychotherapist.

Since 2000, Kelly Rohan, a psychology professor at the University of Vermont, has been conducting clinical trials comparing cognitive behavioral therapy (or C.B.T.) to light therapy. Her work suggests both treatments are effective for people with S.A.D. — especially after a new diagnosis. But when she followed people with S.A.D. for two winters, C.B.T. worked better than bright light therapy to prevent recurrences.

Dr. Rohan said C.B.T. may reduce symptoms more effectively because it provides long-term coping skills for changing negative thought and behavior patterns — whereas light therapy only works when you do it.

For Ms. Sands, the combination of lifestyle changes and psychotherapy made a significant difference in reducing her symptoms. But nothing helped more than naming the debilitating dip in her mood every winter. “Because I have a diagnosis, I can be proactive,” Ms. Sands said. “I don’t have to wait until spring to feel better.”


Ashley Abramson is a freelance writer based in Milwaukee, Wis.

How to Pretend You’re in Quebec City Tonight

A toboggan slide runs along the promenade known as Dufferin Terrace toward the castlelike Fairmont le Château Frontenac in Québec City.
A toboggan slide runs along the promenade known as Dufferin Terrace toward the castlelike Fairmont le Château Frontenac in Québec City.Credit…Renaud Philippe for The New York Times

How to Pretend You’re in Quebec City Tonight

As the song goes, there’s no place like home for the holidays. Wherever you are, you can embrace the coziness of the season like Québécois do.

A toboggan slide runs along the promenade known as Dufferin Terrace toward the castlelike Fairmont le Château Frontenac in Québec City.Credit…Renaud Philippe for The New York Times

  • Dec. 22, 2020, 5:00 a.m. ET

While your travel plans may be on hold, you can pretend you’re somewhere new for the night. Around the World at Home invites you to channel the spirit of a new place each week with recommendations on how to explore the culture, all from the comfort of your home.

When the snow falls and the wind howls, the people of Quebec City don’t hibernate. Rather, they bundle up and celebrate with one of the most picturesque winter carnivals in the world. Overlooking the St. Lawrence River, with cobblestone streets and quaint stone houses, Old Quebec looks like an enchanted snow globe village — especially at Christmastime. In fact, the historic district of this former French colony is a UNESCO World Heritage site, thanks in part to it being the only city in North America to have preserved its ramparts.

From left; In Quebec City, winter pleasures include strolling the 400-year-old city's streets, views of the St.-Jean-Baptiste area and snow bathers with Bonhomme. the official representative of the Quebec Winter Carnival, earlier this year.
From left; In Quebec City, winter pleasures include strolling the 400-year-old city’s streets, views of the St.-Jean-Baptiste area and snow bathers with Bonhomme. the official representative of the Quebec Winter Carnival, earlier this year.Credit…From left, Christinne Muschi for The New York Times; Renaud Philippe for The New York Times; Jacques Boissinot/The Canadian Press, via Associated Press

If I were there I’d be taking in sweeping river views from the promenade known as Dufferin Terrace and the Fairmont le Château Frontenac, the castlelike hotel where Alfred Hitchcock filmed scenes for “I Confess.” In the evening, I’d stroll amid evergreens and twinkling string lights on the Rue Petit-Champlain and stop into Notre-Dame-des-Victoires, one of the oldest stone churches in North America. Hours would be spent ice skating, warming up at an outdoor fire pit and refueling with hearty fare like poutine and tourtière (meat pie) from beloved restaurants.

But as the song goes, there’s no place like home for the holidays. Wherever you happen to be, you can embrace the coziness of the season like Québécois do — with maple syrup-inspired recipes, craft beer, outdoor pursuits and good cheer — even if a single snowflake never falls.

Le Projet Spécialité Microbrasseries, a bar in Quebec City, is known for its craft ciders and beers.Credit…Renaud Philippe for The New York Times

Cook up comfort with meat and maple syrup

“Blast some cheesy Celine Dion song on your iPhone at earsplitting decibels, find a good recipe for poutine — that trouser-busting dish of French fries, Cheddar cheese curds and gravy — and, if you are in chillier climes, go outside and build a snowman,” advises Dan Bilefsky, the Canada correspondent for The Times. Born in Quebec, Mr. Bilefsky has written about the “cultural skirmish over who deserves credit” for poutine: Québécois — or the rest of Canada. Happily, all you have to decide is which poutine recipe to make. Try one from Saveur, CBC/Radio-Canada, or Chuck Hughes, the co-owner and executive chef of Montreal’s Garde Manger and Le Bremner.

From left, a classic poutine, tartine au sucre and tourtière.Credit…From left, Alexi Hobbs for The New York Times; Craig Lee for The New York Times; Gentl and Hyers for The New York Times. Food stylist: Maggie Ruggiero. Prop stylist: Jerrie-Joy.

“Québécois culture is defined by a certain cowboy excess when it comes to food,” as Mr. Bilefsky put it in an email. Cook up comfort with a New York Times Cooking recipe for a savory tourtière, or one for maple-roasted rack of venison from the celebrated Canadian chef Martin Picard of Au Pied de Cochon (often credited with reimagining poutine with foie gras). Be inspired by First Nations cuisine with chef Martin Gagné’s venison carpaccio with cedar jelly and sea buckthorn jam. And turn to chefs David McMillan and Frédéric Morin, owners of the acclaimed Joe Beef in Montreal, for more recipes in “The Art of Living According to Joe Beef” cookbook.

For dessert, fill your kitchen with the scent of maple syrup pie. Though why stop there? Bake maple syrup-soaked doughnut holes or maple tarte tartin with sweet recipes from Mr. Picard, who also created Au Pied de Cochon Sugar Shack where the essential ingredient is — what else?— maple syrup.

Host your own winter carnival

Take part in some typical Quebec Winter Carnival activities from your hometown (though perhaps skip the local tradition of ax-throwing). Make snow sculptures and go sledding or snowshoeing. Not living in a winter wonderland? You can string up white fairy lights, sing “Au Royaume du Bonhomme Hiver” with Renée Martel (to the tune of “Winter Wonderland”), and savor the Carnival grog, a hot, usually alcoholic drink. A recipe to make some at home with maple syrup, cranberry juice, cinnamon, cloves and sweet grass is on the Quebec Winter Carnival website.

A view of the Château Frontenac.Credit…Alice Chiche/Agence France-Presse — Getty Images

Parlez français

On days it’s too cold to linger outdoors, learn or brush up on your French, the official language of government in Quebec (and a delicate subject in a majority French-speaking province surrounded by English speakers). Stick to your budget with “Want to Learn French? Italian? Russian? There’s No Time Like the Present” for language tools that are free or won’t break the bank.

Get cozy with a stack of detective novels

What better way to spend long winter nights than with intrigue and mystery set in a small Quebec hamlet? Light a fire, real or virtual, crack open one of Louise Penny’s best-selling detective novels and spend the evening with Chief Inspector Armand Gamache of the Sûreté du Québec police force. In the most recent book, “All the Devils Are Here,” published this fall, the inspector heads to Paris. But the 15 books in the Gamache series that precede it are steeped in the culture and cuisine of Quebec (with the occasional murder), beginning with “Still Life.”

From left, still images from the films “Matthias and Maxime,” “And the Birds Rained Down” and “Antigone.”Credit…From left, Mubi; Films Outsiders; ACPAV

Spend movie night with directors from Quebec

Keep au courant with Canada’s Top Ten, the Toronto International Film Festival’s annual list of the country’s best films (10 features and 10 shorts). The 2019 selections include several from Quebec directors such as Louise Archambault, whose “And the Birds Rained Down” (“Il Pleuvait des Oiseaux”) is about older hermits living in the wild and a love that blossoms there; and Sophie Deraspe’s “Antigone,” a riff on Sophocles’ tragedy centered on an immigrant family in Montreal (it won best Canadian feature at the Toronto International Film Festival). Also on the list is “Matthias and Maxime” from the writer and director Xavier Dolan, the Cannes Film Festival regular who shared the Jury Prize in 2014 for his film “Mommy” with the French filmmaker Jean-Luc Godard. (The 2020 list was recently posted online.)

Sing along with Celine Dion

For a road trip across Quebec in 2018, Mr. Bilefsky, the Times correspondent, made a playlist of songs that he felt embodied Québécois identity and would also provide an atmospheric soundtrack to the province’s landscapes. There was music from Samian, an Indigenous rapper who sings in French and Algonquin; Leonard Cohen; Éric Lapointe; Les Cowboys Fringants; the Dead Obies; and Arcade Fire. Obviously, Celine Dion, born in Charlemagne, Quebec, was on the list with “Destin.” After all, you haven’t really sung Celine until you’ve done so in French.

Notre-Dame-des-Victoires, center, and Fresque des Québécois, right.Credit…Catherine Côté for The New York Times

Wander galleries from your living room

Step inside Quebec City’s art galleries like Galerie Perreault, where you can browse works by contemporary artists as well as Canadian masters. Or take a virtual tour of the gallery. Discover Canadian Inuit sculptures through the Galerie Art Inuit Brousseau’s Instagram account. And stroll around town with photos of public artworks from Quebec City Tourism. You won’t even need to pull on your snow boots.

How are you going to channel the spirit of Quebec City in your home? Share your ideas in the comments.

To keep up with upcoming articles in this series, sign up for our At Home newsletter or follow New York Times Travel on Instagram, Twitter and Facebook. See more Around the World at Home guides here.


Stephanie Rosenbloom, the author of “Alone Time: Four Seasons, Four Cities, and the Pleasures of Solitude” (Viking), has been writing travel, business and styles features for The Times for nearly two decades. Twitter: @Stephronyt. Instagram: @StephanieRosenbloom

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.

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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

Fears of a ‘Twindemic’ Recede as Flu Lies Low

Fears of a ‘Twindemic’ Recede as Flu Lies Low

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

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

  • Dec. 13, 2020, 5:00 a.m. ET

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

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

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

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

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

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

That has buoyed the spirits of flu experts.

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

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

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

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By The New York Times | Source: Kinsa

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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