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COVID Again


Gregory Matthews
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Coronavirus Briefing

March 21, 2022

 

An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment.

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Daily reported coronavirus cases in the United States, seven-day average.The New York Times
 
 

Lessons from Hong Kong

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A supermarket in Hong Kong this month.Billy H.C. Kwok for The New York Times

Experts and government officials say that the worst of the Omicron wave in Hong Kong may have passed. The city announced today that it would lift its ban on international flights and cut quarantine times for vaccinated residents who arrive from overseas in half, to 7 days.

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Daily new coronavirus cases in Hong Kong, seven-day average.The New York Times

But as my colleague Benjamin Mueller reports, getting past the crest of the wave has come at a significant cost.

Hong Kong’s death toll per capita, once far lower than those of Western nations, is no longer exceptional. A month ago, the Covid-19 death rate in the U.S. was 90 times as high as that of Hong Kong. By Monday, the cumulative U.S. toll was three and a half times as high as Hong Kong’s.

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Daily coronavirus deaths in Hong Kong, seven-day average.The New York Times

As the U.S. braces for a potential new wave and China battles its biggest outbreak in two years, scientists are looking to Hong Kong for clues about the future of the pandemic.

One big takeaway: In the era of Omicron and BA.2 — an even more infectious subvariant — vaccinating as many older people as possible should be the top priority, experts said.

In Hong Kong, a fixation on “zero Covid” — shared with mainland China —  meant that vaccination wasn’t a priority, and many older people fell prey to misinformation about the safety of the vaccines. Before Omicron surged, less than a quarter of people age 80 and over had been given two doses.

That lesson is most pressing for China, where vaccination in older age groups appears to be lagging and there is little immunity from earlier infections. But it’s also important for the U.S., where subpar vaccination and booster rates in older people have left scientists concerned about a potential surge of BA.2 cases. More than a third of Americans 65 and over have not gotten a booster shot.

However, scientists do not expect the U.S. to face nearly as serious a situation in the coming months as Hong Kong did, partly because so many more Americans were infected by the coronavirus during earlier waves.

“In the U.S., case declines are losing momentum and starting to plateau,” writes the epidemiologist Katelyn Jetelina. “There may even be signs of increasing trends in the Northeast. But, for now, many pockets still have low transmission. Enjoy it! And prepare for the possibility of putting your mask on if needed. This is also the perfect time to get boosted, get vaccinated and order your second set of free antigen tests.”

 
 

New York’s pandemic timeline

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Pedestrians passing through the nearly empty Oculus in New York City in March 2020.Victor J. Blue for The New York Times

On March 1, 2020, New Yorkers had no idea what was in store.

The governor of New York said on that day that there would be “community spread” of the coronavirus but that there was “no reason for concern.” The mayor of New York City said that the virus “could be anywhere” but told residents to go about their normal lives. It sounded reasonable.

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Hospital workers transferred bodies to refrigerated trucks serving as temporary morgues in Brooklyn in April 2020.Victor J. Blue for The New York Times

Everyone knows what quickly unfolded: A mighty was city silenced. There were thousands of deaths, bodies stacked in freezer trucks and half a million people out of work.

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Ballroom dancers on the Christopher Street Pier in Manhattan in May 2021.Anna Watts for The New York Times

Two years and 40,000 deaths later, rips and rifts remain in the social fabric. Something has been lost, and yet the dire predictions of a city damaged beyond repair have been proved wrong.

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Covid-19 patients at the Brooklyn Hospital Center in January.Victor J. Blue for The New York Times

As Plague Year 3 dawns, The New York Times looked back on the pandemic in the city. Infection rates have plummeted, but the arrival of a new subvariant is also a reminder that the pandemic is not over. We know that there is no going back to “before.”

 
 

What else we’re following

 
 

What you’re doing

The mask mandate at my 12-year-old daughter’s school was lifted yesterday. She was a little worried she’d be the only one still wearing a mask, not because wearing a mask has been a burden to her but because no seventh grader likes to stand out. She cheered up at drop-off when she realized a vast majority of kids were still wearing masks. At the end of the day she reported nothing much had changed; the kids who had been wearing their masks correctly all year are still wearing them, and the kids who had been wearing them as chin straps are now letting their chins fly free.

— Liz, Waco, Texas

Let us know how you’re dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter.

 
 
Angela Jimenez compiled photos for this briefing.
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Coronavirus Briefing

March 23, 2022

 

An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment.

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Daily reported coronavirus cases in the United States, seven-day average.The New York Times
 
 
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The morning commute on London Bridge in England, where the Omicron subvariant BA.2. is driving an increase in Covid cases.Andy Rain/EPA, via Shutterstock

Bracing for the BA.2 wave

Barely two months after the Omicron wave, U.S. epidemiologists are already warning of another swell in the pandemic.

Though Covid case numbers are falling in most of the country, scientists warn that the quiet may soon give way to another surge, driven by an Omicron subvariant, BA.2. It is already fueling an increase in cases in 18 countries, including Britain, France, Germany and Italy.

There are still many question marks about a potential BA.2 wave. To understand what might lie ahead, I spoke with my colleague Benjamin Mueller, a health and science reporter.

What do we know about BA.2?

We know that BA.2 is more contagious than the version of Omicron that spread through the U.S. this winter. We know that some places like New York City are seeing early signs of cases ticking up, though at very low levels overall. And BA.2 is quickly becoming more prevalent in some places. But whether that turns into a wave — as some countries in Europe are seeing — is hard to know for sure.

What are the different scenarios?

There are a few possibilities. Some experts predict that a BA.2 wave could come as soon as April, or perhaps later in the spring or in the early summer.

Another possibility is that BA.2 slows down a decline in cases or produces only a slight uptick — but not a big wave. That could be because so many Americans got infected with the first version of Omicron over the winter, so there’s more immunity in the population. Spring is also here, when people do more socializing outside, which could slow down transmission somewhat.

There’s also some optimism that even if there is a more sizable bump in cases, because of all the immunity in the population, hospitalization rates may not go up so much. That’s been true for some European countries where cases have been rising for a few weeks, but we’ve not yet seen a surge of hospitalizations.

What’s the worst case scenario?

A worse-case scenario is that the U.S. follows the path of the U.K., where not only have cases surged, but so have hospitalizations.

The U.S. has vaccinated and boosted people at lower rates than Western Europe. Even now, Americans are dying from Covid at far higher rates than people in Western Europe. And experts worry that those low booster and vaccination rates, especially in older people, could put the U.S. in a vulnerable position once BA.2 takes hold.

Plus, there’s the fear that even though some parts of the U.S. have effectively been without restrictions for months, reduced masking in other places could help speed a rise in cases.

What do studies say about how much an Omicron infection protects against a BA.2 infection?

There have been some lab studies that suggested that vaccinated people infected with Omicron produce reasonably high levels of antibodies that probably protect against BA.2. And we know from estimates out of the U.K. that vaccines seem to protect about as well against BA.1 as they do against BA.2. The big variable is how long that protection, especially from a previous infection, is going to last.

How should I approach the next few months?

When I asked scientists that question, they said they were encouraging people to do something like what they thought the government should be doing, which is using this moment to get prepared.

That means having good masks, and people availing themselves of the free tests on offer. Scientists also think it’s very important that people get booster shots if they’re eligible. And they hope that the government prepares, too, by securing the money it needs for additional treatments and vaccines and making booster shots more accessible, especially to vulnerable people.

 
 
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A child in Bordeaux, France, receiving a Covid-19 vaccination in February.Caroline Blumberg/EPA, via Shutterstock

Moderna’s shot for children

Moderna said today that it would seek emergency authorization in the U.S. for its coronavirus vaccine for children younger than 6. Interim results from its clinical trial showed that volunteers in that age group had a similar immune response to what was reported in young adults, when given a dose one-fourth as strong.

But Moderna said the vaccine was only about 44 percent effective in preventing symptomatic illness among children 6 months to 2 years old and 37 percent effective in children 2 to 5 years old.

The company’s announcement comes shortly before Pfizer and BioNTech are expected to release results from a three-shot study for children under 5, using doses one-tenth as strong as those for people 12 and older. Those results are expected in April.

Last month, Pfizer delayed seeking emergency authorization of its vaccine for young children after data showed two doses were less than 50 percent effective against symptomatic disease, according to people familiar with the situation.

So far, no standard has been set. But it’s unclear whether the F.D.A., the C.D.C. and parents across the country will be willing to accept Moderna’s average efficacy rate of about 40 percent for children under 6.

While Americans have been hearing for months that the vaccines are less potent against Omicron in all age groups, 40 percent is below what many vaccine experts consider the minimum standard for effectiveness against Covid. The standard initially set for adult coronavirus vaccines was that they be at least 50 percent effective against symptomatic infection.

But there is clearly a demand to protect young children, especially as more of the country unmasks, more parents return to workplaces and patterns of normal life resume. Children under 5, a group of about 18 million, are the only people in the U.S. still not eligible for shots.

 
 
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Francesco Drommi, who lost his sense of smell as a symptom of long Covid, smells a lemon during a sensory workshop in Piacenza, Italy.Fabio Bucciarelli for The New York Times

Have you suffered from long Covid?

Millions of people continue to suffer from long Covid — the constellation of symptoms that can linger months after an infection. The chronic illness can include feelings of exhaustion, cognitive problems, shortness of breath, headaches, joint pain and more. Studies estimate that perhaps 10 to 30 percent of people infected with the coronavirus may develop long-term symptoms.

This week, we’re asking you for resources that may help.

If you’ve had long Covid and managed to treat or deal with some of your symptoms — even a little — we’d like to hear about it. We’re not looking for medical advice, but the approaches or things you have tried that made your situation better. Perhaps it’s a certain type of physical therapy that you hadn’t tried before, a support group you found or your go-to brand of candles for scent training.

You can share your story here. We may use your response in an upcoming newsletter.

 
 

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What you’re doing

I just keep going back to what I learned about the 1918 pandemic and how there were surges that lasted into the mid 1920s. Armed with that information, and having a very rudimentary knowledge about infectious diseases, I am surprised at the leniency around Covid restrictions the minute it seems like things are getting better. You just have to be wary and stop trying to rush something that cannot be rushed. Mother Nature has her own time schedule. Learning that makes life much easier.

— Agnes Simpson, Los Gatos, Calif.

Let us know how you’re dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter.

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Coronavirus Briefing

March 25, 2022

 

An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment.

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Daily reported coronavirus cases in the United States, seven-day average.The New York Times
 
 
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Medication being used to treat long Covid.Alex Wroblewski for The New York Times

Understanding long Covid

Millions of people continue to suffer from long-term Covid symptoms. Studies estimate that 10 to 30 percent of people infected with the coronavirus may develop such symptoms, including cognitive issues, exhaustion, shortness of breath and many others.

“It involves a very varied constellation of symptoms, and it’s still quite mysterious,” said my colleague Pam Belluck, a health and science reporter. “But a growing number of studies are shedding light on the range of symptoms and what they look like. And we’re getting some scientific clues about what seems to be happening in the body.”

I spoke with Pam about our evolving understanding of the disease.

What causes long Covid?

There are different theories, but one of the leading theories has to do with the body’s inflammatory reaction.

When a virus enters the body, the immune system kicks into gear, it tries to fight the invader, and there’s a surge of inflammation. And according to this theory, too much inflammation can cause a range of damage, including to blood vessels and parts of cells that can then limit the body’s ability to use oxygen efficiently.

Another theory is that the body’s immune response didn’t shut down after the acute threat from the virus was defeated. It’s possible, scientists say, that there may be viral fragments that are hanging around at a very low level. They’re giving the immune system the instructions to stay on guard when there’s no reason it should be, and that over-activated immune response is causing symptoms.

Do we know who is more likely to get long Covid?

Recent research that followed a group of patients over time found that the people who were most likely to have long Covid two or three months after their infection had one or more of four biological factors.

One factor was that they had a high viral load in their blood from early in the infection. Another has to do with something called autoantibodies, which are usually associated with diseases like lupus or rheumatoid arthritis. Basically, they are antibodies that mistakenly attack body tissues, and if certain autoantibodies were present at the time of a Covid infection, those patients were more likely to develop long Covid.

The third one has to do with a virus called Epstein-Barr virus. It’s very common and it’s the virus that’s often associated with mono. Many people get infected with Epstein-Barr virus early in life and it might cause no symptoms, and it then becomes dormant. But patients in this study who ended up having reactivated Epstein-Barr virus at the time of their Covid infection were more likely to develop long Covid. Other clues suggest that some pre-existing conditions, like diabetes, may also predispose people.

If you’re vaccinated and you get Covid, are you less likely to have long-term symptoms?

Basically, we don’t know. A couple of studies have suggested that if you’ve been vaccinated and are then infected with Covid, it might make you less likely to have lingering symptoms, but at least one study suggested that vaccination didn’t make any difference.

One thing scientists are saying is that, so far, many long Covid studies have suggested that people who became really sick and were hospitalized from their initial Covid infection are more likely to have serious long-term symptoms. So if you consider that vaccines generally put you at lower risk for acute outcomes like hospitalization, then it makes sense that there might be some positive effect on reducing long-term symptoms. But having a mild Covid infection definitely doesn’t prevent long Covid — many people with long Covid did not get very sick initially or might even have had an asymptomatic Covid infection.

What’s your advice for people with long Covid?

Don’t be afraid to ask for help. There has been some skepticism about long Covid, including from primary physicians, and a lot of throwing up of hands. People may find that they go to their primary physician, and they get a scan, and nothing shows up. A lot of times there isn’t anything physically that an X-ray or blood test can show. But try not to be daunted. It may be better to try to seek help from a long Covid clinic at that point where at least you will get recognition that what you’re going through is a real thing and needs attention.

There are also a bunch of support groups and patient-led research groups that can be very helpful for tips of where to go, or at least just for sharing experiences. And know you’re not alone. There are a lot of people going through this.

Related: Reuters profiled the drugmakers and scientists who are working on treatments for long Covid.

 
 
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A woman with long Covid practicing her physical therapy in Burr Ridge, Ill.Alex Wroblewski for The New York Times

What helped you

We asked readers for approaches to long Covid that worked for them. We’ll leave the medical advice to the doctors, but you had lots of advice and recommendations for ways to cope with and think about the illness. Here’s a selection:

“I got asymptomatic Covid in August 2020 from my parents, both of whom died of Covid three days apart. I still have cognitive issues — the inability to focus, particularly when listening; mental fatigue where my brain just shuts down; and poor long-term and short-term memory. I have developed coping mechanisms such as explaining to people with whom I have to carry on conversations to please understand I may ask many questions and I have difficulty remembering things. I also take notes of every phone call and conversation and anything I may need to remember. At first I was panicked by my loss of memory, however now I feel like I have surrendered to it and I just live in the present. In a weird way that has been a gift.” — Giselle Kovac, Miami Shores, Fla.

“It’s been three months since Covid symptoms first appeared. Old injuries and conditions were exacerbated by Covid and all came to a head like a perfect storm. My doctors are at a loss to help me, so I am learning to listen to my body and resting as much as I can. Approaches that I practice are meditation, journaling, yoga, along with walking daily on our local rail trail. My best advice is to befriend your body and pay attention to its messages and heed them. Only you know best what is going on and what will help you.” — Michele Gara, Connecticut

“Symptom: headaches, fatigue and post-exertional malaise. What helped: strict pacing (carefully keeping activity levels within a threshold at which I do not experience symptoms). Symptom: Loss of former identity (no longer to dance salsa, go to the gym, hike, bike, do Pilates). What helped: finding a new outlet via ceramics classes at Gasworks NYC.” — Elizabeth, Brooklyn

“I have been experiencing smell and taste issues known as parosmia, where everything I smell and taste is distorted in the form of sewage. I found a company that helps people navigate their smell and taste issues both emotionally and physically. It’s pretty cool because I was able to do an at-home diagnostic smell test with instant results, which validated that I am not crazy.” — Paulina Giangregorio, Los Angeles

“It is hard to explain long Covid to those who have not experienced it. It is even harder to explain invisible issues when things appear fine on the outside. The biggest help has been my ability to communicate the issues I’m experiencing with my colleagues. I recognize this is a luxury not everyone has, and for that I am extremely grateful. However, knowing I can step away from my computer or the stress of the daily grind has been amazing. Now if only I could convince myself, a self-diagnosed workaholic, that it is OK to take that time.” — Tiffany Gaidos, Yorktown, Va.

“I found an online long Covid survivors support group that was immeasurable in giving me lots of tips. If you can get into a long Covid clinic or a research trial, go for it. Otherwise, don’t dismiss your own body’s reactions, and methodically address each symptom with the appropriate specialist. Utilize any employee assistance programs and leave-of-absence options if you need more time to heal. Your health is more important than anything else. And finally, it can be a very difficult and long road, but as I know from my first go-around, recovery is possible. Don’t give up.” — Allison Durkin, Philadelphia

 
 

What else we’re following

Let us know how you’re dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter.

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Experts worry about how US will see next COVID surge coming

NEW YORK (AP) — As coronavirus infections rise in some parts of the world, experts are watching for a potential new COVID-19 surge in the U.S. — and wondering how long it will take to detect.

https://apnews.com/article/covid-science-health-pandemics-wastewater-9b6589e908c8532db0922cc4ed3f3910?

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Shanghai starts China’s biggest COVID-19 lockdown in 2 years

BEIJING (AP) — China began its most extensive coronavirus lockdown in two years Monday to conduct mass testing and control a growing outbreak in Shanghai as questions are raised about the economic toll of the nation’s “zero-COVID” strategy.

https://apnews.com/article/covid-china-locking-down-shanghai-b406df3a0113b9be99273324fec2c12e?

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March 28, 2022

 

Good morning. Many experts expect Covid caseloads to rise soon. Here are four steps to protect people.

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Preparing boosters in Washington last month.Kenny Holston for The New York Times

Minimizing the toll

The BA.2 subvariant — an even more contagious version of Omicron — has already caused Covid-19 cases to rise across much of Europe. In the U.S., caseloads have held steady over the past week, ending two months of sharp declines, and many experts expect increases soon.

Today’s newsletter looks at four promising strategies for minimizing Covid’s toll in the coming months.

1. More boosters

Dr. Aaron Richterman, an infectious-disease specialist in Philadelphia, regularly sees patients who have been vaccinated against Covid but have not received a booster shot. Some are not aware they are eligible for a booster. Others have heard about boosters but are not interested. “I just feel like I don’t need it,” one patient — an older man — recently told Richterman.

That attitude is common. Almost one-quarter of U.S. adults have been vaccinated but have not received a booster shot, according to Kaiser Family Foundation surveys. (Any American who was vaccinated more than six months ago is eligible.)

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Source: Kaiser Family Foundation

These vaccinated-but-unboosted Americans are clearly open to receiving a Covid shot. And many would benefit significantly from getting boosted. Without a booster, immunity tends to wane. With a booster, people are even more protected than they were shortly after receiving a second shot, data shows.

Consider the numbers from California, which publishes detailed data by vaccination status. For every million boosted Californians, fewer than two have been hospitalized with Covid at any given time recently:

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Source: California Department of Public Health

“I remain most worried about lack of booster uptake among the elderly and the immunocompromised,” Jennifer Nuzzo, a Johns Hopkins University epidemiologist, told me.

Many Americans still have not gotten this message, though. What might help? A prominent public-service campaign, focused specifically on booster shots rather than vaccination, could. So could encouragement from politically conservative voices. Fewer than 30 percent of Republican adults have received a booster; many Republicans have not received even a first shot.

“The most powerful weapon we have, by far, is vaccination,” Richterman told me, “and that includes first doses, second doses and third doses.”

What about fourth doses (that is, second booster shots)? The Biden administration will soon begin offering them to anybody 50 or older. The evidence suggests that these shots may offer additional protection but that they are less important than first booster shots, as Katelyn Jetelina, an epidemiologist, has explained in her newsletter.

2. The immunocompromised

For a small percentage of Americans, vaccination is impossible or ineffective. This group includes people who are receiving cancer treatments and those who have received certain organ transplants.

Fortunately, a drug now exists that may help many of them. It is an injection called Evusheld, developed by AstraZeneca with help from government funding. It appears to provide months of protection, and the Biden administration has ordered enough doses to treat 850,000 people.

But about 80 percent of the available doses are sitting unused, in warehouses, pharmacies and hospitals, my colleagues Amanda Morris and Sheryl Gay Stolberg have reported. Among the reasons: Many patients are unaware of Evusheld’s existence. Some doctors are uncertain about who qualifies. Some hospitals are refusing to dispense it to eligible patients, saving it for people who they think might benefit more from it.

“The biggest problem is that there is absolutely no guidance or prioritization or any rollout in place at all,” Dr. Dorry Segev of N.Y.U. Langone Health told The Times. “It’s been a mess.”

Biden administration officials have been working with state officials, hospitals, doctors and patient advocates to clear up the uncertainty. They have a long way to go.

3. Post-infection treatments

A knowledge gap is also hampering the distribution of Paxlovid — a post-infection treatment from Pfizer that seems to sharply reduce the chances a Covid illness will become severe. It is most effective when prescribed shortly after symptoms begin, but many Americans do not know it exists.

The good news is that Paxlovid has become more widely available in recent weeks. If you are in a high-risk group and get infected with Covid, you should immediately talk with a doctor. (Here’s an explainer.)

One thing to keep in mind: The government has so far authorized Paxlovid only for high-risk people, like those 65 and older or those with serious underlying medical conditions. I know that many Americans, especially liberal Democrats, are nervous about their own Covid risk and may be tempted to seek out Paxlovid.

But the risk of developing severe Covid for most people who are boosted remains very low, as the chart above shows. And the current supply of Paxlovid is not large enough to treat anywhere near everybody who gets infected, especially if cases rise. “Our supply is fragile,” Dr. Scott Dryden-Peterson of Brigham and Women’s Hospital in Boston told Bloomberg News.

If many younger, otherwise healthy people rush to get a Paxlovid prescription, they may effectively be taking doses from vulnerable people.

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A rock climbing gym in Los Angeles this month.Mark Abramson for The New York Times

4. Masks

Broad mask mandates have not done much to prevent Omicron’s spread. Too many people wear low-quality masks or take them off at times, and Omicron is so contagious that it takes advantage of these gaps.

But masks can still help reduce Covid’s spread:

  • They are especially helpful in hospitals and nursing homes, where high-quality masks can be required and where many people are vulnerable.
  • Masks also make sense for people who have returned to work or school five to 10 days after a Covid infection, Dr. Shira Doron of Tufts Medical Center says.
  • Anybody who is personally anxious about Covid, for any reason, can wear a mask, too, Dr. Tom Frieden, a former C.D.C. director, notes. A high-quality mask will protect the wearer even if others nearby are maskless.

The bottom line

All four of these steps have small costs and large benefits.

They avoid contributing to the pandemic’s continuing crisis of isolation and disruption, like closing classrooms and keeping children home from school for weeks on end. And they can save lives. Covid’s official death toll in the U.S. has already exceeded 975,000. But given the availability of vaccine shots and other treatments, the vast majority of deaths are now avoidable.

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Coronavirus Briefing

March 28, 2022

 

An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment.

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Daily reported coronavirus cases in the United States, seven-day average.The New York Times
 
 
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A transit officer controlled access to a district in lockdown in Shanghai today.Hector Retamal/Agence France-Presse — Getty Images

Shanghai’s lockdown

China’s largest outbreak since the beginning of the pandemic is now gripping Shanghai, its largest city and a global financial center.

The city of 26 million reported more than 2,600 Covid infections yesterday, from just a handful in early March, with hospitals and medical staff already stretched thin. A member of Shanghai’s expert Covid-19 team told Reuters that testing had found “large scale” infections throughout the city.

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Daily new coronavirus cases in China, seven-day average.The New York Times

The government is introducing a two-stage lockdown and plans to test all 26 million residents in the coming weeks. Restrictions and mass testing were set to start this morning in areas east of the Huangpu River, lasting until April 1. Restrictions and testing in districts west of the river will begin on April 1 and continue until April 5.

  • Citizens in locked-down areas, except for those providing essential services, will not be allowed to leave their neighborhoods.
  • Offices and all businesses not considered essential will be closed and public transport suspended.
  • Deliveries will be left at special checkpoints, The Associated Press reported.

Some of the city’s neighborhoods have already been under lockdown for over a week, and an increasing number of people are reporting problems securing daily necessities, including medical supplies. The A.P. and CNN reported incidents of panic buying at supermarkets and other businesses.

The decision to lock down Shanghai “marks a U-turn for authorities,” the South China Morning Post reported, after officials “repeatedly said there would be no citywide stay-at-home orders, and that economic activity and daily operations must remain open.”

Earlier this month, the country’s leader Xi Jinping urged officials to reduce the impact of China’s Covid response on people’s livelihoods.

 
 
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A patient in Israel received a fourth vaccine dose during a trial last year.Nir Elias/Reuters

New data on second boosters

As the U.S. and other countries mull whether to provide some of their citizens with a second booster shot, new data out of Israel suggests that the extra dose significantly lowers the Covid death rate.

The country’s largest health care provider conducted a 40-day study with more than 500,000 people from 60 to 100 years old, and found that older adults who received a second booster of Pfizer’s vaccine had a 78 percent lower mortality rate than those who had only one booster, Reuters reports.

Studies in the U.S. have shown that the mRNA vaccines are holding steady against hospitalization and deaths, but their protection from infection is waning. That is leading a lot of people to wonder: Do I need a fourth shot?

Scientists and physicians are divided. Currently, fourth doses are authorized only for those with weakened immune systems.

My colleague Sharon LaFraniere reported last week that the Biden administration was planning to give Americans ages 50 and older the option of a second booster of the Pfizer or Moderna vaccine without recommending outright that they receive one, according to several people familiar with the plan.

Older adults may benefit from an additional booster shot because the immune system tends to weaken with age, and experts point out that older adults often have other medical conditions, putting them at higher risk of severe disease.

But the timing is also important. If another surge is just around the corner, for instance, seniors may benefit from receiving an extra shot as soon as it’s authorized. But if the next wave doesn’t occur until the summer or fall, receiving a booster now could backfire because the recipients’ immunity may start to wane by the time protection is needed most.

For people younger than 65, who are otherwise healthy, most experts agree that three doses are most likely enough for now. Those in their 20s and 30s who have already received three shots of the vaccine, for instance, will see only marginal benefits in protection from an additional shot, experts said.

The F.D.A. is expected to convene an advisory committee next month to discuss the second booster issue.

 
 

How do you feel about another wave?

It seems like the Omicron wave just let up and already epidemiologists are telling Americans to brace for another surge — this time from the fast-moving BA.2 subvariant. The possibility of a new surge comes with fresh uncertainty — and the virus continues to surprise us at every turn.

As we prepare for BA.2, we’d like to know: How are you feeling about another possible wave? Are you approaching it differently than you did others? Tell us about it. We may use your response in an upcoming newsletter.

 
 

What else we’re following

 
 

What you’re doing

My brother died of Covid last summer. I have had many moments of grief — like thinking about how he might like a certain truck — then remember that he’s gone. I came to a conclusion that it is disrespectful to his memory to accept others’ irrational political and religious denials about the dangers of the pandemic. Then, at the grocery store, a man was spouting off while I waited in line behind him. His transaction was complete but he wouldn’t stop and move on. I told him that he was being disrespectful to those of us who lost loved ones when he talked like that. Of course, he verbally attacked me over and over again. The young clerk moved between us because she thought he was going to get physical. He left without us getting into a physical fight. The clerk told me that he would never understand my feelings but that she did. In retrospect, I probably will hold my peace if it happens again.

— Michael Bailey, Bellingham, Wash.

Let us know how you’re dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter.

 
 
Marcus Payadue compiled photos for this briefing.
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Coronavirus Briefing

March 30, 2022

 

An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment.

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The New York Times
 
 
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A Maryland resident receives a booster shot last month.Kenny Holston for The New York Times

Should you get another booster?

The F.D.A. authorized second boosters for Americans aged 50 and older and those with certain immune deficiencies on Tuesday.

But the scientific evidence for the additional dose is incomplete, at best, and researchers do not agree on whether the shots are needed. So should you get one? My colleague Apoorva Mandavilli answered some common questions.

What do scientists think about second boosters?

Many are dubious. Experts point out that the limited research so far supports a fourth shot only for those older than 65 or who have underlying conditions that put them at high risk.

The most compelling data comes from an Israeli study that found that adults older than 60 who got a fourth dose were 78 percent less likely to die of Covid than those who got only three shots — but that study is deeply flawed. The participants volunteered to get a fourth shot and therefore are likely naturally to be more careful about their health, experts said.

Other factors may make the booster shot look more effective than it actually is. In fact, other data from Israel suggest that a second booster has only marginal benefits in healthy young people.

Who benefits most from a second booster?

Probably people who are immunocompromised or older than 65, according to the limited evidence available.

“If you’re more than five or six months out from your last booster, and you’re at high to very high risk,” the obvious choice is to get the shot, said Dr. Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco. “As a healthy 64-year-old man whose third shot was seven months ago, I will get one this week if I can.”

Should I get the booster now? Or time it to my summer vacation or the next surge?

It takes the immune system about a week to rev up after the shot. From that peak, antibodies taper down over the next two to three months — so a booster shot now will not offer much defense in August or even July. If you qualify for a booster, you may want to have the maximum protection at the right time, like during a trip or a surge.

“The one thing that matters is where we are in this whole pandemic,” said Marion Pepper, an immunologist at the University of Washington. “I would be watching what the variants are doing.”

Are there drawbacks to getting a second booster?

Maybe. Repeated boosting offers diminishing results. Pepper’s team has evidence suggesting that a fourth exposure to the virus — whether through infection or the vaccine — will not make immunity any stronger than it is after the third.

There is also some worry that repeatedly boosting with the original version of the vaccine will make the body less responsive to future versions. There is some evidence that more spacing between shots may produce a stronger, more lasting immune response.

I just had Covid. Do I still need another booster shot?

Probably not for a while, all the experts said in interviews. Pepper’s team found that in people who had been infected and then vaccinated, even the first booster shot did not offer much of an advantage.

 
 
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President Biden received a second booster shot today at the White House.Doug Mills/The New York Times

Biden presses for aid as the country moves on

President Biden stepped up pressure on Congress to approve billions of dollars in emergency coronavirus relief aid. He warned that progress against the virus would be at severe risk without funds to purchase vaccines and reimburse doctors.

“This isn’t partisan. It’s medicine,” Biden declared. At the end of his remarks, he rolled up his sleeve to get his second booster shot.

Despite Biden’s urgency, much of the country appears ready to move on.

According to a new poll by The Associated Press and NORC, fewer Americans are taking precautions against the virus. The poll showed lower levels of mask-wearing and social distancing and higher rates of nonessential travel.

At the same time, local and state officials are scaling back the most visible public health efforts to address the pandemic:

  • Illinois and other states are shuttering free Covid-19 testing sites.
  • Arizona, Nevada, Hawaii and Ohio have stopped releasing daily data on virus hospitalizations, infections and deaths.
  • Some places are also diminishing their campaigns to vaccinate residents, even as federal authorities approve more booster shots.

The cutbacks arrive as new infections of BA.2, an Omicron subvariant, now make up more than half of all cases in the U.S. and as cases are edging upward in several states. The U.S. also continues to lag behind many other countries in vaccination rates.

If another surge is ahead, public health officials said, it could be a daunting challenge to revive the vaccination and testing sites and other measures that are now being shut down.

  • A Covid resource for Americans. The White House launched a new coronavirus website this morning: covid.gov. It is aimed at helping find access to testing, treatment, vaccines and masks. It will also aid U.S. residents in assessing the risk of Covid-19 in their neighborhoods.
 
 

What else we’re following

 
 

What you’re doing

We are one of the many with kids under 5. And, in a word, we’re exhausted. Our oldest still wears a mask every day, and we are counting down the days until she and her baby sister can be vaccinated — because any protection, to me, is better than nothing. We somehow made it through Delta and Omicron without getting Covid so, while I feel lucky, I worry our lack of exposure or infection makes us even more vulnerable with the next surge. We’ve been trying to take advantage of the lull in cases but are bracing ourselves with each new day.

— Maggie Van Arsdell, Ashburn, Va.

Let us know how you’re dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter.

 
 
Sarah Hughes compiled photos for this briefing
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COVID pandemic’s end may bring turbulence for US health care

WASHINGTON (AP) — When the end of the COVID-19 pandemic comes, it could create major disruptions for a cumbersome U.S. health care system made more generous, flexible and up-to-date technologically through a raft of temporary emergency measures.

https://apnews.com/article/covid-health-business-coronavirus-vaccine-medicaid-fbb66b72937f3517a5d3d1ba8840f339?

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March 31, 2022

 

Good morning. The U.S. may soon run out of Covid money. But that’s not the only problem.

 
 
 
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A vaccination clinic in Hagerstown, Md.Kenny Holston for The New York Times

Dollars and knowledge

The short-term and long-term flaws with the country’s current Covid-19 policy are quite different.

In the short term, the main problem is a lack of demand for Covid vaccines and treatments: Not enough people are trying to get them. In the longer term — by the second half of this year — the bigger problem may end up being a lack of supply, especially if cases surge again.

I think this distinction has gotten lost in some of the public discussion. Yesterday, President Biden called for additional Covid funding, after Congress had left out such money from its most recent spending bill because of a disagreement over how to pay for it.

“We need to secure additional supply now,” Biden said in a brief speech, shortly before receiving his second booster shot onstage. “We can’t wait until we find ourselves in the midst of another surge to act. It’ll be too late.”

Biden is right that the lack of funding creates problems. To ensure an adequate supply of vaccines and treatments later this year, the government probably needs to take action soon. Democrats and Republicans have been negotiating over a possible deal this week.

But the potential funding shortfall is nowhere near the entire problem. A lack of money is not preventing many Americans from getting vaccinated or getting valuable treatments right now. Even if Congress does pass more Covid funding, the country will still face a problem that is more about information and persuasion than dollars.

Shots in arms

For months, the United States has been awash in Covid vaccine shots, and many Americans would benefit from getting one. About one-quarter of adults remain unvaccinated, while roughly another quarter are vaccinated but not boosted, according to the Kaiser Family Foundation. A booster shot sharply reduces the chances of severe Covid illness, especially for vulnerable people like the elderly and immunocompromised.

I know that last point may sound counterintuitive. The elderly and immunocompromised, even if boosted, face a higher risk of severe illness than a healthy, younger person. But a booster shot still reduces the risk more for a vulnerable person than for an average person. It’s a common dynamic in medicine: Treatments tend to be most valuable for the most vulnerable even if they do not eliminate risk.

Despite the huge value of additional vaccine shots, many Americans simply aren’t getting one. The number of shots given per day, including both initial doses and boosters, has fallen to the lowest level since the beginning of the mass vaccination campaign, in early 2021.

mail?url=https%3A%2F%2Fstatic01.nyt.com%
Source: Centers for Disease Control and Prevention

What might help?

Employer and customer mandates would probably nudge more people to get initial shots. Previous employer mandates have generally caused more people to get vaccinated and only a tiny share to quit or be fired. But mandates have fallen out of fashion. Even some politically liberal places, like New York City and Washington, D.C., have been dropping theirs recently.

Boosting more people seems as if it should be more feasible, because it involves people who have already received a shot. Still, boosters are lagging. Many Americans seem confused about how much a booster shot matters.

The scientific evidence suggests that everybody who is eligible should get a first booster shot. A second booster shot — now available to people 50 and older, among others — may also make sense, although the benefits appear smaller. And if you are boosted and have already had Omicron, you probably don’t need another booster yet, Dr. Eric Topol of Scripps Research notes (as part of his helpful overview of the evidence).

Treatments

The story is similar with both Evusheld (a drug that appears to boost immunity among the immunocompromised) and post-infection treatments that reduce the chance of severe illness. They are widely available, yet many people remain unaware of them.

Many doctors also seem uncertain how and when to prescribe them. “Doctors are beginning to use this,” a Biden administration official told me, “but it takes a while for things to get absorbed in medical practice.”

Biden yesterday announced a new federal website — Covid.gov — where people can search for pharmacies near them that have both Evusheld and the treatments. I found most parts of it simple to use. But I also thought that Rob Relyea, a Microsoft engineer who has become an advocate for the immunocompromised, made a good critique on Twitter: The Evusheld information is too hard to find.

The bottom line is that Americans would benefit from hearing a series of clear, repeated messages:

  • Getting a booster shot may save your life.
  • Many immunocompromised people would probably be helped by Evusheld, and it’s available.
  • Vulnerable people — like the elderly — should talk with a doctor as soon as they test positive for Covid and seek treatments that can reduce its severity, like Paxlovid or molnupiravir.

As Biden said yesterday, “America has the tools to protect people.”

What’s next

If more people become aware of the treatments, however, some of them are likely to run low later this year. And if the federal government waits until then to act, it may discover that other countries have bought the available supply. “You can’t snap your fingers and buy the stuff,” the Biden administration official told me.

Already, the administration has reduced shipments of one kind of treatment — monoclonal antibodies — that it is sending to states. It has also said it would cut back on new orders of Evusheld in the next several days.

A Covid bill would likely cost $10 billion to $15 billion, or less than 0.25 percent of the annual federal budget. Congressional Republicans have said that the money should be diverted from another area, rather than add to the deficit. My colleague Sheryl Gay Stolberg, who covers the pandemic from Washington, said Congress was likely to agree on a funding source soon, perhaps before lawmakers leave for their April recess. But nobody knows for sure.

Related:

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Shanghai moves to 2nd part of lockdown as testing lines grow

BEIJING (AP) — About 16 million residents in Shanghai are being tested for the coronavirus during the second stage of the lockdown that shifted Friday to the western half of China’s biggest city and financial capital.

https://apnews.com/article/covid-business-health-china-shanghai-cf6622d99c68a285a979aa2c0c0f9a96?

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Coronavirus Briefing

April 1, 2022

 

An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment.

mail?url=https%3A%2F%2Fstatic01.nyt.com%
The New York Times
 
 
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The U.S. is seeing early signs.Scott McIntyre for The New York Times

Preparing for the next wave

Just when the Omicron wave seems to have died down in the U.S., experts are already warning about the next surge of cases — this time driven by the highly infectious subvariant BA.2.

It’s still early days, but there are signs that the next wave may already be upon us. Researchers have seen an uptick in cases in the U.S., and they’ve detected a rise in the viral particles recovered from nearly 150 wastewater-surveillance sites.

To help us prepare for the next wave, my colleagues Tara Parker-Pope and Knvul Sheikh shared the best ways to prepare for a surge:

Pay attention to Covid indicators in your community.

An easy way to do this is to check the color-coded map from the C.D.C. that shows community levels of Covid. As the map shifts to yellow or orange in your area, it’s time to take extra precautions, including donning masks in public spaces and rethinking large indoor gatherings where you don’t know the vaccination status of others.

Another useful indicator is your community’s positive test rate. Experts advise taking more precautions as you see positivity rates start to rise above 5 percent.

Have high-quality masks on hand.

A limited number of free N95 respirator masks are available at pharmacies and community centers. Enter your ZIP code on the C.D.C.’s mask locator site to find a participating distributor. If you want to buy additional masks, use our guide to avoid counterfeits.

Get home Covid tests sooner rather than later.

Order them now — for free from the government — before the weather turns warm. The tests can be damaged by heat, and you don’t want yours sitting for hours in a mail truck on a hot day. People with health insurance can also be reimbursed for eight free tests a month.

Get a booster (when you’re eligible).

Federal regulators authorized a second booster for everyone 50 and older and people 12 and older with certain immune deficiencies. The protective antibodies from a vaccine or an infection tend to wane in four or five months, and a well-timed booster shot can help the body bump up its antibody defenses.

Get a pulse oximeter.

It’s a small device that clips on your finger and measures your blood oxygen levels. When levels drop to 92 or lower, patients should see a doctor. Low oxygen can be a sign of Covid pneumonia and may raise your risk for serious complications. One warning: The devices can be less reliable for people with darker skin.

Make a plan for antiviral drug treatment.

Two oral antiviral therapies are available for high-risk patients with a prescription: Paxlovid, developed by Pfizer, is available for people 12 and older and Molnupiravir, developed by Merck, is available for adults 18 and older.

Check with your doctor to make sure you can receive the medication should you fall ill. Or, look up qualified health centers near you that have authorized medical providers so you can get tested and, if positive, receive antiviral medication on the spot.

People who are immunocompromised should also talk to their doctors about Evusheld, an antiviral drug from AstraZeneca that can be given by injection to provide an additional layer of protection on top of vaccines.

Have backup plans for social events and travel.

If you’re hosting a large event, have an outdoor backup plan if case numbers spike. Before traveling, do a little research on clinics and pharmacies at your destination so you know whether you can receive antiviral drugs. Make sure you have extra funds or plenty of room on your credit card in case you need to extend your trip to recover from Covid.

Before we move on, a farewell. Tara is leaving The Times. She’s a generous colleague who would always jump on the phone and offer thoughtful advice for readers of this newsletter — even when she was also on deadline. We want to thank her for her many contributions and wish her the best of luck.

 
 
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Steps you’re taking, or not, for the next wave.Gabby Jones for The New York Times

How you’re feeling

We asked readers how they were feeling about the prospect of another wave, and how they were preparing for it. Thank you to everyone who wrote in.

“At 78, I’ve stayed very close to home and garden with little interaction with others. I’ve loved it! I’m taking this respite in the pandemic to get some dental work done, some medical appointments including a booster shot and my hair cut, and then I’ll happily go back to commune with nature and reading.” — Beverly Duffield, Bountiful, Utah

“UGH. And not just any UGH … a Charlie Brown, palm-to-face UGH. An UGH without exclamation because I’m just too tired.” — Carol, Kokomo, Ind.

“As far as I’m concerned, Covid is over. Do we talk about every wave of the flu? No, it’s a normal occurrence each year. I do everything I can, like I did before Covid.” — Donna Witte, Merritt Island, Fla.

“As caregiver for my 66-year-old disabled sister who has serious health issues, another wave not only means more isolation with fear and anxiety, but now I no longer feel any community support, with no one wearing masks anymore and just acting like everything is back to normal.” — Beth Steelman, Island Lake, Ill.

“I work in the World Trade Center and have been overjoyed with being able to go back into the office. If another wave hit, I’d be devastated. Trains have been fuller, lunch spots have lines around the corner and there is a sense of optimism that I don’t think anyone is willing to give up so easily. I’m not willing to stay home all week again.” — Sally, New York, N.Y.

“Covid fatigue. I have followed the science and taken all mandated precautions. I do not wear a mask when it is not mandated. When mandated I comply out of respect for others’ immunity challenges, but that is wearing thin. I am tired and losing interest.” — Jeff W., Santa Cruz, Calif.

“Preparing to explain to my friends and family, yet again, why I don’t want to go to a movie, the mall or out to eat — and seeing the distant looks on their faces — is the hard part. As a young person with chronic illness, I can’t think of many activities from the ‘before times’ that are worth the risk of long Covid. Navigating health issues at a young age is lonely — and navigating them during the pandemic has been even lonelier.” — Jenny, Minnesota

 
 

What else we’re following

 
 

Let us know how you’re dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter.

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Coronavirus Briefing

April 4, 2022

 

An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment.

mail?url=https%3A%2F%2Fstatic01.nyt.com%
The New York Times
 
 
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Diabetes and Covid are colliding in a public health disaster.Charity Rachelle for The New York Times

Covid’s terrible toll on people with diabetes

After older people and nursing home residents, no other group seems to have been hit harder by Covid than people with diabetes. They account for a staggering 30 to 40 percent of all U.S. Covid deaths, several studies suggest.

Diabetes patients who are hospitalized with Covid spend more time in intensive care, are likelier to be intubated and are less likely to survive, our colleague Andrew Jacobs reports. One study found that 20 percent of such patients died within a month of admission.

Diabetes is a chronic disease that hobbles the ability to regulate blood sugar and inexorably wreaks havoc on circulation, kidney function and vital organs.

Though researchers are still trying to understand the dynamics between diabetes and Covid, most agree on one thing: Uncontrolled diabetes impairs the immune system and decreases a patient’s ability to withstand a coronavirus infection.

Diabetics often struggle with hypertension, obesity and other medical issues, which can fuel chronic inflammation inside the body. That triggers the release of cytokines, tiny proteins that regulate the body’s immune response to infection or injury.

Covid, it turns out, can also provoke an uncontrolled release of cytokines, and the resulting “cytokine storm” can wreak havoc on vital organs.

Like the pandemic, which has had an outsize toll on communities of color, the burden of diabetes falls more heavily on Latino and Black Americans, highlighting systemic failures in health care that have also made the coronavirus far deadlier for the poor.

“It’s not that diabetes itself makes Covid inherently worse but rather uncontrolled diabetes, which is really a proxy for other markers of disadvantage,” said Nadia Islam, a medical sociologist at NYU Langone Health.

About 1.5 million Americans are diagnosed with diabetes each year, according to the C.D.C., and roughly 96 million, about one in three adults, are at high risk for developing the disease. The disease claims 100,000 lives annually but draws less funding or notice than illnesses such as cancer and heart disease.

Experts say addressing the nation’s diabetes crisis will require well-funded public education campaigns that drive home the importance of exercise and healthy eating. That would require seismic changes to a food system geared to cheap, processed food.

“The only way to move the needle is to reform a system that prioritizes cures and new drugs over prevention,” said Dr. Sudip Bajpeyi, a researcher at the University of Texas at El Paso.

 
 
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Residents lining up last weekend for coronavirus tests outside a Shanghai hospital.Aly Song/Reuters

Shanghai’s child separations

As Shanghai struggles to contain an Omicron outbreak, China’s strict virus prevention measures are provoking outrage — particularly the government’s policy of separating small children from their parents.

Recent photos and video shared online show a series of hospital cribs, each holding several young children, with some of them crying. The cribs appear to be in the hallway of the Shanghai Public Health Clinical Center.

The images and video could not be independently verified, but the health center acknowledged that they were real and did not deny that parents with Covid were being separated from their children.

In Shanghai, anyone who tests positive for the coronavirus must isolate in a hospital or designated facility. One woman, Lucy Zhu, 39, was separated from her 2-year-old daughter last week. In a phone interview with The Times, she called the situation “totally inhumane.”

On Tuesday, she said, her daughter was transferred to a clinical center in Jinshan, and Zhu was told she could not accompany her. From then until Saturday morning, she could not to establish direct contact with her daughter. Although officials said her daughter was fine, they offered no proof.

“The doctor sent me a video at noon today,” Zhu said on Saturday. “In the whole room, there was only one nurse, but I saw around 10 minors.”

The fury and concern of parents is the latest in a series of crises faced by Shanghai officials, who have instituted an enormous rolling lockdown.

Residents have complained that they have little warning about neighborhood lockdowns. Panic shopping has emptied grocery store shelves, and people with life-threatening conditions have posted calls for help online when they have not been able to reach hospitals.

 
 

How has your mental health changed?

After more than two years of illness, upheaval and loss, many of us are being asked to return to something resembling our prepandemic lives. Offices are filling up, masks are coming off and more governments and organizations are making plans to “live with” the virus.

And yet many of us are trying to adapt to the new normal with emotional and mental scars that didn’t exist before the pandemic — or were exacerbated by the events of the last few years. The push toward restoring the status quo may make these wounds more painful and a return to “normal” more challenging.

So as we move into the next phase of the pandemic, we’re asking readers: How has the pandemic changed your mental health? If you’d like to share your story, you can fill out this form here. We may use your response in an upcoming newsletter.

 
 

What else we’re following

 
 

What you’re doing

We all got vaccinated except for my mom. During the Omicron surge, we all got sick but were able to fight the infection. Unfortunately, my mom, who just turned 64 in January, got infected and did not survive. The virus destroyed her lungs. She spent one month in the hospital and it was a nightmare. We couldn’t see her, doctors didn’t give us a straight answer, it was horrible. During that month she spent three weeks intubated and we never saw her alive again, just unconscious from the medications and breathing through a machine. May her light continue to shine bright in her journey to Mictlan.

— Denise Ramirez, Union City, N.J.

Let us know how you’re dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter.

 
 
Phaedra Brown compiled photos for this briefing
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mail?url=https%3A%2F%2Fstatic.nytimes.co

April 6, 2022

 

Good morning. Why haven’t Covid cases started rising again in the U.S.?

 
 
 
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Grand Central Terminal in Manhattan last week.Hiroko Masuike/The New York Times

A new mystery

To many people’s surprise — including mine — new Covid-19 cases in the U.S. have not begun to rise. Over the past two weeks, they have held roughly steady, falling about 1 percent, even as the highly contagious BA.2 subvariant of Omicron has become the dominant form of Covid in the U.S.

Across much of Europe, by contrast, cases surged last month after BA.2 began spreading there, and many experts expected a similar pattern here. That hasn’t happened. “It has not taken off,” Michael Osterholm, a University of Minnesota epidemiologist, told me.

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Chart shows 7-day averages as of April 4. | Sources: New York Times database; Johns Hopkins University

What’s going on? Today’s newsletter looks at four possible explanations.

1. More immunity

Even though the U.S. has a lower vaccination rate than Western Europe, this country may still have built up more immunity — thanks to our politically polarized response to the virus.

In liberal parts of the U.S., vaccination rates can be even higher than in Europe. In conservative communities, many Americans have been so dismissive of Covid that they have long been living almost normally. As a result, the virus has already swept through these communities, conferring at least some immunity on many people.

This laissez-faire approach has had horrible downsides. Covid death rates have been much higher in counties that voted for Donald Trump than those that voted for Joe Biden. But for people who survived a prior Covid infection, it does confer some immune protection, especially if it was recent.

“Most of Europe has been pretty Covid averse,” William Hanage, a Harvard epidemiologist, said on a recent episode of the “In the Bubble” podcast, “whereas parts of the United States have been quite Covid curious.” Hanage said that he still expected U.S. caseloads to rise soon. But, he added, “I don’t think it’s going to be as dramatic as Europe.”

If that’s correct, a preview is already visible in the Northeast, where cases have been rising lately, but not as steeply as in Europe.

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Chart shows 7-day averages. | Source: New York Times database

One possible reason: There are not as many Americans vulnerable to infection. The earlier version of the Omicron variant seems to have infected about 45 percent of Americans, according to Andy Slavitt, a former Covid adviser in the Biden White House. That share appears to be higher than Europe’s.

2. Fewer tests

The shift toward at-home testing in recent months means that a smaller share of actual Covid cases may be showing up in the data that government agencies report and news organizations like The Times publish. The government data relies on laboratory tests.

Another potential factor depressing the volume of tests is reduced access for lower-income Americans. Some uninsured people now must pay for their own tests, and many testing clinics have closed.

All of which raises the possibility that Covid cases really are surging now, even if the data doesn’t show it.

Jessica Malaty Rivera of Boston Children’s Hospital told The Atlantic that the quality of current Covid data was “abysmal.” Dr. Scott Gottlieb, a former F.D.A. commissioner, told CNBC that he thought some parts of the country were “dramatically” underreporting cases.

This chart suggests that underreporting is a real issue. As you can see, official testing in several European countries increased as BA.2 spread, while testing in the U.S. has declined modestly.

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Comparisons across countries are affected by different testing policies and reporting methods. | Source: Our World in Data

Still, the shortage of testing does not seem to be the only reason that cases have not surged in the U.S. Trends in Covid hospitalizations typically lag case trends by only about a week. And hospitalizations have continued to fall in the U.S., to their lowest level in more than two years.

3. Just wait

Even if high levels of immunity have kept cases from rising so far, the effect may not be permanent. Remember: About 45 percent of Americans were infected with Omicron, which leaves about 55 percent who were not. While many of those 55 percent may have had an earlier version of Covid, immunity can wane over time.

The current moment might be one of those times when we’re asking why cases have not begun to rise right as they begin to rise. “It may be too early to see a signal,” Jennifer Nuzzo, a Brown University epidemiologist, told me.

4. Another mystery

Throughout the pandemic, Osterholm — the Minnesota epidemiologist — has lamented that many scientists, journalists and laypeople exaggerate how much we actually know about Covid. His favorite example: The Alpha variant swept through Michigan and Minnesota last year and then largely died out, without causing case increases in other parts of the U.S. Another example: BA.2 has recently become the dominant variant in India, South Africa and some other countries without causing a spike in cases.

When I called Osterholm yesterday to ask why cases had not surged over the past few weeks, he simply said: “I don’t know, and I don’t think anybody really knows.”

Of all the variants, only the original Omicron was so contagious that it spread around the world in predictable ways, he said. Other versions of the virus have surged and receded in mysterious ways, much as a forest fire can die out without burning down an entire forest.

The bottom line: Cases still seem likely to rise, perhaps significantly, in the U.S. soon. But a new wave looks less certain than it did a few weeks ago. Regardless, the steps that can save lives in coming months remain the same: more vaccine shots, including boosters; and greater awareness of available treatments that offer extra protection for the vulnerable.

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Coronavirus Briefing

April 6, 2022

 

An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment.

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The New York Times
 
 
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Workers and volunteers in a compound where residents were tested in Shanghai on Monday.Hector Retamal/Agence France-Presse — Getty Images

Shanghai’s unsparing lockdown

As the highly contagious Omicron variant rips through Shanghai, Chinese authorities have deployed a familiar draconian playbook to try to snuff out the outbreak — no matter the cost.

But this time, the approach has been met with an unusual outpouring of public dissatisfaction — from parents separated from children, from those suffering harsh conditions in quarantine centers and from residents who have been put under a lockdown that keeps being extended.

For a look at the situation in the city, and what it means for China going forward, I spoke to my colleague Keith Bradsher, our new Beijing bureau chief.

What’s the latest on the situation in Shanghai?

Shanghai locked down a third of the city for four days, followed by locking down the other two-thirds of the city for four days. But that has not been enough. They found tens of thousands of cases during those eight days. So they have extended the lockdown for the whole city. They retested all 25 million people in Shanghai on Monday and are doing so again on Wednesday.

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Daily new cases in China, seven-day average.The New York Times

What’s life like in the city’s quarantine centers?

Conditions vary. These convention centers are supposed to be where you are sent if you have only mild symptoms but are still potentially infectious. They have rows of beds for literally thousands of people, but there are not a lot of doctors and nurses.

There are a lot of complaints. There is a high risk of cross-infection. There are essentially no showers. These are convention centers that were originally designed with toilets and sinks for thousands of conventiongoers but not for people to live there. People try to wash their faces and so forth in basins.

There was also a fire on Monday morning next to one of the exhibition centers, with thousands of people sealed inside because they were most likely infected. The fire broke out at a temporary outdoor waste storage area because the trash was piling up from having all these people staying there. Fortunately, the fire was brought quickly under control, but that further alarmed everyone.

Have there been other concerns?

What is really tragic is when you see children separated from their parents as part of this quarantine effort. The day after videos went viral of infants and toddlers sharing a crib and wailing because they had been taken from their parents, a national outcry ensued.

Shanghai authorities have responded by saying that infected children will be allowed to quarantine with their parents if the parents are also infected. Infected children 7 and up whose parents are not infected must be quarantined separately from their parents. The authorities are trying to set up quarantine facilities for very young children or children with special needs who are infected while their parents are not. But for now, young children can still be taken away from their parents and isolated separately. There have also been harsh measures with regard to pets.

How so?

Well, one town in another province announced several days ago that they would kill all the pets of people who tested positive. They later rescinded that. We’ve seen scenes of medical workers taking oral swabs of pets. That’s better than automatically killing all the pets that belong to infected people, but there’s been no word on what happened to the pets that test positive.

What are China’s lessons from Shanghai?

One unfortunate aspect of all of this is that Shanghai had been a leader in China in adopting a slightly less draconian approach to lockdowns. Shanghai had taken pride in locking down a single store — instead of many square miles — in response to a handful of cases.

But even before the current full lockdown in Shanghai, the municipal authorities responded to the detection of even a single case in an office or a store by sometimes locking everyone down at that location for 48 hours or more even if the office or the store had no beds — people just had to sleep on the floors. Despite many restrictions on personal mobility and individual rights, Shanghai is having a lot of trouble containing the highly transmissible Omicron variants.

Has the situation in Shanghai changed how the central government is reacting to the virus?

They are doubling down on a more stringent “zero Covid” approach of lockdowns because that has been proved to work, while neighborhood-specific or even shop-specific lockdowns have sometimes been less effective.

At the same time, we have not seen the current troubles lead yet to changes to what experts have said are the real mistakes in China’s approach. Those mistakes include a refusal to import mRNA vaccines and the lack of a truly sustained national effort by the country to persuade every last person age 80 or more to get three vaccine doses.

Inside Shanghai. A writer and an editor based in the city describes her experience in lockdown in The Times’s Opinion section.

 
 
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A booster shot being given in Los Angeles in March.Alisha Jucevic for The New York Times

The future of U.S. vaccines

A committee of expert advisers to the F.D.A. met today to help fashion the U.S. coronavirus vaccine strategy for the rest of the year, amid growing evidence that new variants have eroded the power of the existing vaccines.

The meeting represents a transition point for the federal government. Many scientists have concluded that the existing vaccines need to be retooled to bolster protection against a fast-evolving virus, and federal officials want to figure out how to do that as soon as possible.

Robert Johnson, the director of an infectious disease division within the Health and Human Services Department, outlined a tight time frame. He said clinical trials would have to be underway by next month in order to produce the shots by the fall.

“If you’re not on your way to that clinical trial by the beginning of May, it is very difficult to have collectively across manufacturers enough product to meet that demand,” he said.

At the same time, multiple experts told the panel that no one knows whether yet another significant variant will emerge before the fall — and if it does, whether it will be more like Omicron and its subvariants or like earlier and more severe variants, such as Delta.

For more: Stat News broke down the event here.

 
 

What are your questions about the future of the virus?

In the beginning, there was Alpha. Then Beta, Delta, Omicron and a bunch of lesser-known coronavirus variants in between. We’re used to the cycle now: Right when we think we can breathe a sigh of relief, a new variant appears with fresh mysteries and confusion.

It’s frustrating to keep having our hopes dashed. And there’s no end in sight because new variants will almost certainly keep appearing.

Given our future with these new versions of the coronavirus, we’re hoping you can help us better understand what’s in store. We’re asking readers: What are your questions about the future of the virus and its variants? We’ll bring your queries to experts and get some answers. If you’d like to participate, you can fill out this form here. We may use your question in an upcoming newsletter.

 
 

What else we’re following

 
 

What you’re doing

My mother passed away in June 2021. My family endured furloughs, contracting Covid and a toilet paper shortage whose memes will last forever. I didn’t think I would enter my senior year of high school motherless. I’ll miss not being able to tell her about my first date, her helping me pick out a dress for prom or waving goodbye as I leave for college. How will I know how to get stubborn stains out of my clothes? Or have someone to vent to about my roommate? I’m scared. How will I get through the rest of my life without her?

— Katherine Beebe, Texas

Let us know how you’re dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter.

 
 
Erin Kelly compiled photos for this briefing. Nancy Wartik contributed to today’s newsletter.
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Coronavirus Briefing

April 8, 2022

 

An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment.

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The New York Times
 
 
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Returning to the office will be stressful for many.Jeenah Moon for The New York Times

R.T.O. and mental health

As more workers return to their offices, many are bringing deep emotional and mental scars from the pandemic to their cubicles — and at a time when the world feels particularly unstable.

“It’s a challenging moment,” said my colleague Emma Goldberg, who covers the future of work for The New York Times. Global upheaval and war are creating shocking events and images, Covid cases are ticking up in certain areas of the country, and some people are worried again about protecting themselves and their families.

“At the same time, some employers are saying, ‘We need to get back to normal,’” Emma said. “And I think some people are saying, ‘What does that even mean?’”

I spoke to Emma for more on this particular moment in the workplace.

How are people feeling about work and mental health?

The past two years have been challenging for so many different reasons — people have lost loved ones, fallen sick, had economic hardships. Many people are struggling with mental health challenges, and mental health care is difficult to obtain and afford in the U.S. So in a lot of cases, workers and workplaces are having to fill in the gaps. Workers are figuring out how they can share personal challenges with colleagues and managers, and some managers say they feel like they’re acting as therapists even if they don’t have training to do so.

What should companies understand about this moment?

What’s at stake here is people’s health and well-being. People across all different industries, geographies and demographics are struggling. And they need support, which starts with mental health care. But it also extends to having teammates and supervisors supporting people showing up as their full selves and not hiding what they’re going through.

How are companies addressing this?

Some of them have expanded the mental health care services on offer. Others are making long-term commitments to flexibility and ensuring people have the support they need to balance their personal and their professional obligations.

I spoke to one company that’s piloting a four-day workweek because they want people to get the rest that they need and have time to spend with their families and take care of themselves. And I spoke to other companies that are training managers to understand how to check in and support workers in dealing with personal challenges.

What should companies take away from this moment?

Over the last couple of years, in a lot of different workplaces, people started to talk more about physical health and safety. But that needs to extend to mental health and emotional health as well. It’s important to understand that the pandemic and its attendant crises have also brought on a mental health crisis. That’s especially true for people who weren’t able to work from home. But it extends to people now preparing for the transition of returning to the office and seeing their routines scrambled.

Before I let you go, is the BA.2 wave throwing off return to work plans?

I haven’t gotten a sense yet that many companies are shifting their approach in light of BA.2. Those that are reopening their offices in the coming weeks and months for the most part seem to feel confident that they know how to keep workplaces safe and open through a combination of vaccine requirements, testing requirements, sometimes masking requirements and encouraging workers to stay home when they don’t feel well and report positive tests.

 
 
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Crisis calls to helplines rose in the pandemic.Brandon Thibodeaux for The New York Times

Your mental health changes

We asked readers how their mental health had changed over the course of the pandemic. Many of you shared your stories — both positive and negative. Thank you to those of you who wrote in.

“I have gotten all too comfortable giving in to my agoraphobia. I no longer have any desire to work through it again and plan to continue to live distanced from social interaction to a very large degree. It has shown me a world I don’t want to be part of and I give up. I will remain the odd old lady down the street who rarely leaves her house.” — Carolyn Rowan, Allentown, Pa.

“I feel wonderful. I was able to work from home, taking early rising, rushed mornings and commuting out of the picture. I was happier, more rested and healthier. Now, back to ‘normal,’ I’ve returned to harried and exhausted — mentally and physically. I don’t need to be elbow-to-eyeball with people to be happy. And I’m not alone with that view.” — D. Moreau, Houston

“Before March 19, 2020, I was fine. My dad, a hospital pathologist, was diagnosed with Covid that day. He was ventilated and died on April 6. I did not get to see him — he died alone — and I have felt intense, indescribable pain ever since. Traumatized and devastated are two words to describe my state. I am a completely different person now. I have been in grief counseling for two years and I have found solace in supporting my students (I teach high school) as we navigate this pandemic.” — Beatriz Bishop, Cleveland

“It’s the best thing that’s ever happened to me, which I realize sounds crazy. The pandemic made me hit a rock bottom I never knew I was so close to. It forced me to see how much I was neglecting my mental health and ignoring warning signs of serious issues and face them full on and work through them. I’m now thriving and couldn’t be more grateful.” — Madeline, West Caldwell, N.J.

“I’ve gone from fearless to fearful. I used to travel internationally regularly. Now I’m terrified and overwhelmed at the thought of any travel. I recently forced myself to take a domestic flight to visit my elderly mother who I hadn’t seen in three years and was overwhelmed at dealing with the airports, security, and navigating through the airport — something I had done with no problem on a regular basis before. I’m terrified at any venture outside my condo.” — Elaine Turner, Denver

“I went from being a child to a teenager during the pandemic, so maybe that’s part of it. During the first lockdown, I stayed optimistic and happy, but when the first Covid winter came, my parents would go in person every day to their jobs, while I was home alone every day for three months until my school reopened hybrid. This was a major time of struggles and depression for me, but the return of fully in-person learning in fall 2021 really brought me joy and true excitement to be back at school. While my mental health isn’t perfect, I’m doing much better than I was pre-pandemic.” — Atticus Howard-Recht, Brooklyn

 
 

What else we’re following

Let us know how you’re dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter.

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As the BA.2 Omicron Variant Dominates in U.S. COVID-19 Cases, How Concerned Should We Be, and What’s Next?

Highly contagious BA.2 now makes up more than half of infections nationwide, but illness for most who test positive has not been severe.

https://www.everydayhealth.com/coronavirus/ba2-omicron-variant-spreading-rapidly-even-as-global-cases-and-deaths-fall/?

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Dolphins' playful social habits form bonds, but spread virus

REEDVILLE, Va. (AP) — Three young male dolphins simultaneously break the water’s surface to breathe — first exhaling, then inhaling — before slipping back under the waves of the Chesapeake Bay.

https://apnews.com/article/dolphins-social-habits-form-bonds-spread-virus-2602b5333d880c57060fdbe917989516?

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Guangzhou closes to most arrivals as China’s outbreak grows

BEIJING (AP) — The manufacturing hub of Guangzhou closed itself to most arrivals Monday as China battles a major COVID-19 surge in its big eastern cities.

https://apnews.com/article/covid-health-business-guangzhou-beijing-e4c1df45c9906cd6818ddeee4d855b3e?

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Coronavirus Briefing

April 11, 2022

 

An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment.

mail?url=https%3A%2F%2Fstatic01.nyt.com%
The New York Times
  • Saudi Arabia will allow a million hajj pilgrims to visit Mecca in July, requiring vaccinations and negative tests.
 
 

VIP cases

Eric Adams, the mayor of New York City, is the latest major political figure to test positive for the coronavirus. Adams is fully vaccinated, has received one booster shot and says he is experiencing very mild symptoms.

It’s usually hard to track how someone was exposed to the virus, but Adams attended the Gridiron Club dinner in Washington last weekend. The formal event appears to have seeded dozens of infections among political officials and journalists, including Attorney General Merrick Garland and Speaker Nancy Pelosi.

That outbreak has not slowed the whirlwind spring season of parties in the U.S. capital.

“After two years at home, the power brokers of the nation’s capital are determined to get back to the serious business of having fun,” The Washington Post reported. “The calculation: The rewards, at least for the vaccinated and boosted, outweigh the possible risk of catching the milder variants of the disease.”

That’s a calculation many Americans have also made, but those decisions may soon become more fraught: Nationally, cases have begun to rise again.

Restrictions may soon follow: On Monday, Philadelphia became the first major U.S. city this spring to announce that it would reinstate an indoor mask mandate, effective next week. And a few colleges and universities are reinstating mask requirements, citing outbreaks on campus.

Across the country, there are, on average, more than 31,000 new virus cases being reported each day, as of Sunday, a 3 percent increase from two weeks ago, according to a Times database.

On Sunday, Dr. Anthony Fauci acknowledged the increase, calling it concerning but not alarming.

Recent vaccination numbers offer some hope. After low numbers for first-time vaccinations in February, the average number of vaccines administered more than doubled to 485,505 a day on Friday from 214,405 a day on March 30, according to data from the C.D.C.

“This is not going to be eradicated, and it’s not going to be eliminated,” Dr. Fauci said on Sunday. “And what’s going to happen is that we’re going to see that each individual is going to have to make their calculation of the amount of risk that they want to take in going to indoor dinners and in going to functions.”

 
 

Considering antivirals

When Eric Adams announced his positive Covid test Sunday, he quickly took the opportunity to spread the word about antiviral medications.

Adams, who has a history of diabetes, is one of millions of Americans who qualify for the drugs Paxlovid and molnupiravir. When taken within days of a positive test, they can drastically reduce an at-risk patient’s chances of being hospitalized.

But often, patients don’t hear of antiviral options, writes our colleague Anne Barnard, an environment and climate reporter for the Metro desk who had Covid last week. Anne’s doctor’s office didn’t mention them. Only after hearing that the mayor was on antivirals did she realize she might be eligible. When Anne checked out a New York City-administered antiviral program, she received a prescription easily.

We also talked to our colleague Knvul Sheikh, who has written extensively about Covid and antivirals. She said antivirals caught on slowly, both because initial supply was low and because even doctors were confused about access. But under President Biden’s “test to treat” program, the drugs are increasingly obtainable free after a diagnosis. Those over 65, pregnant women and those with diabetes, cancer, kidney disease and other conditions are eligible.

To start the process, call your primary-care doctor after testing positive or use a website like this one, this one or this one. At designated “test to treat” locations, you can be prescribed immediately. Antivirals can interact with other medications, so discuss that with your prescriber.

Knvul told us that one of the most important things she learned was that those in antiviral eligible groups should move quickly: “After you’ve crossed the five day mark, you can no longer get these medicines,” Knvul said. “You might pass sniffles off as allergies when it could be Covid. If you test sooner rather than later it will give you more time to act.”

She added, “If you’re living in an area starting to see a rise in cases, maybe be proactive and find the closest dispensing location near you, in case you get sick.”

As antiviral treatments become more widely available, we’d like to know: Have you or a loved one used them? What was your experience? We want to know if they were easy to find or noticeably eased symptoms. Please use this form to respond; your responses may be used in a future newsletter.

 
 

Tensions rise in Shanghai

The lockdown in Shanghai, China’s most populous city, has entered a second week, and residents are reaching the limits of their patience. The shutdown has caused food shortages and reduced access to medical care, according to local reports.

But the government appears to be holding fast to the strict measures. “We cannot let our guard down,” a top health official told residents in an interview with state media on Sunday, arguing that the closures were the best way to ensure “people first, lives first.”

In other news: China’s lockdowns and restrictions are creating further disruptions to global supply chains. Guangzhou, a manufacturing hub, has begun limiting entries and exits amid a major uptick, The Associated Press reports. The city said last week that it would test all 18 million of its residents after fewer than 30 locally transmitted cases were reported over the previous seven days.

 
 

World news

U.S. news

  • A trucker demonstration that protested in the Washington D.C. area in February has returned to California, protesting at City Hall in Los Angeles.
  • An experimental drug halved the death rate among critically ill Covid patients, its maker said on Monday.
 
 

What you’re doing

I moved to Shanghai in September of 2019 for an exciting new position. In December, I decided to accept the two-week quarantine and risk of no return and go home for an extended visit. I was able to properly grieve the loss of my grandfather — who passed in fall 2020 from Covid, at 94 — as well as spend much needed time with family. I spent so much energy and effort to get back to China, my new “home,” only to return to a three-week strict hotel quarantine, followed almost immediately by the lockdown of Shanghai. I now sit here, bartering for food and water, watching parents and children be separated, and pets killed, thinking “What was it that I rushed back for?” It feels like we are going into a terrible nightmare.

— Andi Archer, Shanghai

Let us know how you’re dealing with the pandemic. Send us a response here, and we may feature it in an upcoming newsletter.

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April 12, 2022

 

Good morning. Coronavirus cases are up in the northeastern U.S. It’s uncertain if it’s the beginning of a larger surge.

 
 
 
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Grand Central Terminal in Manhattan last month.Hiroko Masuike/The New York Times

A Covid uptick

Covid outbreaks in elite circles in Washington, D.C., and on Broadway have received a lot of media attention in recent days, but they appear to be only one part of a broader regional rise in infections: States in the Northeast are now reporting an uptick in cases.

Last week, this newsletter covered what seemed like a mystery at the time: Covid cases were not broadly rising across the U.S. despite the emergence of the BA.2 subvariant of Omicron. But the Northeast’s continued increase has driven a new round of concerns, with nationwide cases up 10 percent over the past two weeks.

What is less clear is whether the regional rise will amount to a much larger Covid surge. “There’s definitely something coming,” William Hanage, an epidemiologist at Harvard, told me. “But depending on all the moving parts it might be a ripple relative to previous waves.”

So far, recorded cases are up slightly, standing at about 6 percent of where they were during the peak of the Omicron wave in the Northeast. (More cases are probably going undetected, as more people use at-home tests without reporting them to public health officials.)

Hospitalizations are also relatively low in most Northeastern states, and deaths are actually down. Both lag behind cases, typically by weeks. “So it could be too early to see a rise,” Jennifer Nuzzo, an epidemiologist at Brown University, told me.

But some experts believe an increase in hospitalizations should have started showing up in at least some places, based on how previous waves played out. “This is something of a head scratcher,” said Robert Wachter, chair of the medicine department at the University of California, San Francisco. “It makes me think that the prior relationship between cases and hospitalizations may not be holding, which would be very good news.”

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Chart shows 7-day averages. | Source: New York Times database

Covid uncertainty

Any wave would have to contend with recently built-up immunity, both from the vaccines and the Omicron surge that infected potentially 45 percent of Americans this winter.

Not all regional outbreaks grow into national ones. Around this time last year, the Alpha variant struck hard in Michigan and Minnesota but ultimately fizzled out. Experts still do not really know why — another example of how much we still do not understand about Covid (an issue we have covered in this newsletter).

Still, we do know that BA.2 is spreading rapidly, now making up the vast majority of U.S. Covid cases. Experts worry that could lead to a spike, as it has in other parts of the world.

Britain and other European countries, which have often been ahead of the U.S. in Covid waves, saw a recent surge in Covid cases, fueled by BA.2. But that increase is receding and did not lead to a sharp rise in deaths in Europe.

We do not know what that means for the U.S., which has sometimes seen bigger waves than parts of Europe — but not always. As has been true since the start of the pandemic, a lot of uncertainty surrounds Covid.

What we do know

For all of Covid’s unpredictability, we do know some things can help prevent or mitigate another big surge.

The first is vaccination. To the extent that built-up immunity is keeping another wave at bay, more vaccine-induced immunity can help. “The most serious consequences will, as ever, be mostly determined by how many people are vaccinated/boosted,” Hanage said in an email.

New treatments can help, too. Some are already available: The drug Evusheld can help prevent a Covid infection, particularly for immunocompromised people. And the antiviral medication Paxlovid helps treat infections. (Here’s a guide for where to get it.) More treatments are in the works, such as a drug called sabizabulin aimed at treating critically ill people.

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Philadelphia’s indoor mask mandate will return next week.Michelle Gustafson for The New York Times

Public policy and individual measures, like masking and social distancing, can help, too. Yesterday, Philadelphia announced it was reinstating its indoor mask mandate. Some universities have done so, as well, including American and Georgetown in Washington, D.C., and Columbia in New York City.

But in much of the U.S., policymakers and the general public seem less willing than before to take such steps. As Katherine Wu wrote in The Atlantic, America may be looking at its first “so what?” wave — “a surge it cares to neither measure nor respond to.”

“I’m guessing we’ll be performing a natural experiment — seeing what happens when a significant uptick in cases doesn’t lead to a significant change in behavior or policies,” Wachter told me.

The bottom line

We do not know whether the Northeast’s uptick in cases will translate to a major Covid wave. But there are steps we can all take to help prevent an increase from becoming something bigger.

Related: The Times wants to hear about your experience with antiviral Covid pills.

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Shanghai eases 2-week shutdown, letting some residents out

BEIJING (AP) — Some residents of Shanghai were allowed out of their homes as the city of 25 million eased a two-week-old shutdown Tuesday after a video posted online showed what was said to be people who ran out of food breaking into a supermarket.

https://apnews.com/article/covid-technology-business-health-beijing-27cd81c6eccf6ceb5c5d26e0e00dadc3?

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