Rising Covid cases have spurred a return to mask-wearing in the U.S. and overseas, at a time when flawed KN95s from China continue to dominate e-commerce sites.The N95 mask, arguably the most essential and coveted piece of pandemic protective gear, is no longer a rare commodity, thanks to the return of Chinese imports and a resurgence in U.S. domestic production.But good luck buying them online or at big box retailers.Consumers who try to purchase N95 masks, mainly on Amazon, are often led to vendors selling fake or poorly made KN95s, a Chinese-made mask that is often marketed as an N95 equivalent despite the lack of testing by U.S. regulators to confirm virus-filtering claims.In fact, KN95 masks offered on Amazon and through other retailers are being sold without authorization for use in health care settings from the Food and Drug Administration, which last July revoked its emergency use authorization for imported masks that lack approval from the Centers for Disease Control and Prevention — a category that includes all KN95s from China.They include brands like Boncare, which is produced by a company that has repeatedly failed federal testing standards; Yotu, whose manufacturer has also failed European Union testing; and ChiSip, an Amazon top seller whose manufacturer, Chengde Technology, was cited by the C.D.C. for falsely claiming approval by federal regulators.All but a handful of the 50 best-selling KN95 masks on Amazon are plagued by similar problems, according to an analysis of sales data published by the marketing analytics firm Jungle Scout. Last month, companies that make or sell masks of dubious quality racked up almost $34 million in sales.“It’s really the Wild West out there with so many bad actors ripping people off,” said Anne Miller, executive director of Project N95, a nonprofit that connects people to bona fide personal protective equipment.In a statement on Monday, Amazon said it required all high-filtration masks sold on its site to pass a rigorous review process. “Before listing N95 and KN95 masks in our store, we verify that they are sourced from a trusted manufacturer by reviewing product packing, product description and invoices to trace the inventory, and we verify that the mask is not listed on the C.D.C.’s counterfeit mask list,” said Peter Kadushin, an Amazon spokesman.Experts say masks still matter, even amid rising vaccination rates. Case numbers in the United States have been increasing just as the nation is heading into winter and the holiday travel season. The discovery of a new variant, Omicron, is a bracing reminder about the perils of complacency. Communities in Colorado, New York and California have reimposed mask mandates, and polls suggest that a third of elementary-school-age children will likely remain unvaccinated in the near future. Millions of people whose weakened immune systems can render vaccines ineffective continue to rely on masks for protection.“There are a lot of things about Covid-19 we can’t control, like poor ventilation in buildings or whether other people are vaccinated, but aside from ensuring you and your family get vaccinated, wearing a high-quality mask is the single most important thing people can do to protect themselves and their kids,” said Aaron Collins, a mechanical engineer with a background in aerosol science who has conducted performance tests on hundreds of masks he purchased online.Counterfeit and defective face masks have been a problem since the earliest days of the pandemic, when states and medical institutions, desperate to find protective gear amid a calamitous shortage, were sometimes hoodwinked into spending tens of millions of dollars on fake N95s.Mask production at Protective Health Gear, an N95 startup in Paterson, N.J. The company scrambled this summer to rehire workers who had been fired in the months before the Delta variant prompted an uptick in sales.Bryan Anselm for The New York TimesBut more than a year and a half into the pandemic, the United States is still awash in knockoff masks, a problem that experts say underscores the need for a more muscular federal role in regulating consumer products crucial for protecting people from the coronavirus and other airborne pathogens.Although the vast majority of questionable masks are made in China, American companies have also been accused of making exaggerated claims about the level of protection in face coverings that they sell.Lutema, a San Diego manufacturer, sells a children’s mask that it describes as a M95c — a nonexistent category — and CovCare, a Staten Island-based start-up, promotes an “F.D.A.-approved” N95 mask, a claim made by many companies despite the agency’s efforts to curtail use of the phrase. Some products are registered, but not approved, the agency said, calling such claims “misleading.”But Chinese-made mask producers have been especially egregious, according to U.S. regulators, watchdog groups and industry executives.The flood of fake and poorly made masks, they say, are a threat to public health because they give people a false sense of security, increasing the likelihood that someone might be exposed to the virus while attending class, a music concert or when traveling by plane.Amazon, which is responsible for more than half of all e-commerce retail sales, is the single-biggest source for masks bought by consumers, though brick-and-mortar retailers have also been selling masks of poor quality, consumer advocates say.Saoud Khalifah, founder of Fakespot, a web browser extension that helps consumers detect fraudulent vendors, said that many KN95s sold on Amazon are promoted by fake reviews, a problem not just confined to masks. The F.D.A. says it is trying to crack down on the surge of counterfeits. In addition to revoking its authorization for Chinese-made KN95s, the agency said it issues import alerts for fraudulent products. It also has been working with customs officials to stop banned imports: Since the beginning of the pandemic, border agents have seized some 34 million counterfeit masks, half of them from China.“Consumers should be aware of the proliferation of fraudulent and counterfeit masks and respirators sold online,” said Judith McMeekin, the F.D.A.’s associate commissioner for regulatory affairs, who encouraged the public to report websites and individuals they suspect of selling fraudulent or unapproved products.But these efforts have had little effect on the e-commerce platforms where many American consumers do their shopping. Senator Elizabeth Warren, Democrat of Massachusetts, said Amazon has for months ignored her entreaties to ban vendors selling counterfeit masks and to modify the algorithms that lure consumers away from the best respirators. “Amazon needs to do more to prevent consumers from receiving counterfeits and fakes, and the Department of Justice and Federal Trade Commission must act if these failures continue,” she said in a statement.Various masks the apartment lab of Mr. Collins, who shares his findings on YouTube.Jenn Ackerman for The New York TimesThe problem is amplified by online sites that participate in Amazon’s affiliate marketing program, which gives publications a share of online sales for products they recommend to their readers.For American producers, the resurgence of Chinese imports — and a return to their domination of the U.S. market — threatens the survival of an industry born in the early months of the pandemic, when Beijing cut off supplies and left health care workers scrambling to find face masks, disposable gloves and isolation gowns.The domestic industry’s woes extend beyond the consumer mask market. In recent months, the medical supply giants that serve the country’s large hospital systems have eagerly resumed buying lower cost protective equipment from overseas.The companies, among them McKesson, Henry Schein and Cardinal Health, have been lobbying the Biden administration to retain a tariff exemption on imported protective gear that was put in place earlier in the pandemic. Those pressing for the continued tax exemption on Chinese masks, including the American Hospital Association, say domestic producers cannot meet the still-surging demand for single-use respirators and other protective gear.Opponents sharply disagree, noting that many American companies have been struggling to find institutional buyers as hospital systems increasingly turn to Chinese imports. The price difference often amounts to a few cents per mask — enough to sway cost-conscience bulk purchasers.In a letter they sent in October to U.S. Trade Representative Katherine Tai, a dozen Senate Democrats framed the issue as a matter of national security. “Rather than providing relief to Chinese-made products, we should invest in and support our domestic manufacturers so they are capable of providing U.S. health systems and other essential workers with the high-quality P.P.E. and vital supplies they need to manage the Covid-19 pandemic and prepare for future public health threats,” they wrote.A spokesman for Ms. Tai’s office said the tariffs would be reimposed beginning Nov. 30.Company executives said they had been heartened by language in the new infrastructure bill that strengthens existing rules requiring federal agencies to purchase domestically made medical equipment.But government spending alone is unlikely to save many of the companies, whose sales have been plummeting amid the resurgence of Chinese imports, according to the American Mask Manufacturers Association, which says that nearly half the group’s 25 members have stopped making masks in recent months.“We’re holding on to dear life at the moment but the deck is really stacked against us,” said Brian Wolin, the chief executive of Protective Health Gear, a N95 start up in Paterson, N.J., that last summer scrambled to rehire dozens of workers who had been fired in the months before the arrival of the Delta variant, which led to an uptick in sales.To win approval from the National Institute for Occupational Safety and Health — and the right to print the words NIOSH and N95 on its masks — Mr. Wolin and other U.S. mask-makers must navigate a rigorous, costly testing regimen.Chinese KN95s are not subjected to similar regulatory vetting, although KN95 standards are overseen by the Chinese government. Both KN95s and N95s are meant to filter out 95 percent of tiny airborne particles, but the standards for N95 are considered more stringent. The most visible difference is in their design: KN95s use ear loops while N95s use a headband, which creates a more snug fit.Kelly Carothers, director of government affairs and sustainability at Project N95. “It doesn’t seem unreasonable for the F.D.A. to say that if you failed testing, you can’t sell your masks in this market,” she said.Eve Edelheit for The New York TimesNot all foreign-made masks are problematic. South Korea produces a N95 equivalent known as a KF94, which experts commend for its consistent quality, and the European Union’s respirator standards earn high marks from industry experts.The regulatory vacuum in the United States for imports has inspired a slew of amateur mask-testing sleuths, among them Mr. Collins, the mechanical engineer from Minneapolis, who broadcasts his findings on YouTube, and Lloyd Armbrust, president of the American Mask Manufacturer’s Association, who buys Chinese masks on Amazon and tests them at a lab he built at Armbrust American, the Texas company he started last year to make N95s.Others, like Kelly Carothers, the director of government affairs and sustainability at Project N95, has spent the past few months compiling a database of problematic masks sold online. She said that among her findings is that one Chinese company, Chengde Technology, is responsible for nearly a third of all mask purchases on Amazon, with $15 million in monthly sales. The company sells masks under a number of brand names, among them Missaa, ChiSip, WWDoll, Miuphro and Hotodeal. Chengde has had its emergency authorization status revoked and then reinstated by the F.D.A., and earlier this year the company was cited by the C.D.C. for claiming its WWDoll masks were approved by NIOSH.“American mask makers wouldn’t need to be propped up by the government if we just did better vetting of Chinese KN95s, and it doesn’t seem unreasonable for the F.D.A. to say that if you failed testing, you can’t sell your masks in this market,” she said. “That’s not only fair, but it would also save lives.”In an email exchange, a Chengde employee in China sought to dispute the failing test results but declined to provide further details.Mr. Armbrust said he had given up trying to prod Amazon or government regulators, and instead his company began producing its own KN95s in October.The masks are nearly the same as his N95s, but consumers, he said, have been misleadingly programmed to favor the KN95. “You can’t unring a bell,” he said.Last month, he began selling the masks, and within a week, he said, they were already outselling the more protective N95s. “If you can’t beat ’em,” he said, “join ’em.”

Listen to This ArticleTo hear more audio stories from publications like The New York Times, download Audm for iPhone or Android.APPLE VALLEY, Calif. — Jose Martinez, a former Army gunner whose right arm and both legs were blown off by a roadside bomb in Afghanistan, has a new calling: He’s become one of the most effective lobbyists in a campaign to legalize the therapeutic use of psychedelic drugs across the country.On a Zoom call this spring with Connie Leyva, a Democratic legislator in California who has long opposed relaxing drug laws, Mr. Martinez told her how psilocybin, the psychoactive ingredient in “magic” mushrooms, had helped to finally quell the physical pain and suicidal thoughts that had tormented him.Ms. Leyva says she changed her mind even before the call ended, and she later voted yes on the bill, which is expected to become law early next year.“We ask these men and women to go fight for our freedoms,” she said in an interview. “So if this is something that is helping them live a more normal life, I feel like I shouldn’t stand in the way.”In the two years since Oregon, Washington, D.C., and a half-dozen municipalities decriminalized psilocybin, vets have become leading advocates in the drive to legalize psychedelic medicine, which they credit with helping ease the post-traumatic stress, anxiety and depression that are often tied to their experiences in the military.The campaign has been propelled by the epidemic of suicides among veterans of Iraq and Afghanistan, but also by the national reckoning over the mass incarceration of people on drug charges that has softened public attitudes on prohibition.More than 30,000 service members have taken their own lives in the years since Sept. 11 — four times the number of those who died on the battlefield — and the Department of Veterans Affairs has struggled to address the crisis with the traditional repertoire of pharmacological interventions.The recent U.S. withdrawal from Afghanistan may have marked the end of America’s “forever war,” but the psychological fallout from two decades of military conflict continues to reverberate among many of the 1.9 million personnel who served overseas.“I will not be told no on something that prevents human beings from killing themselves,” Mr. Martinez said.Jesse Gould, a former Army Ranger who started Heroic Hearts Project, an organization that connects veterans to psychedelic therapies available in Latin America, also measures the desperation in the daily barrage of emails he gets from vets seeking help.The waiting list for a treatment slot, he said, has stretched to 850 people.“The federal health care system has failed us, which is why veterans have to seek care outside the country,” he said. “They are already turning to psychedelic options in droves so we can either decide to call these veterans criminals, which is what we do now, or we can make sure they can get effective care here at home.”Recent studies have buttressed anecdotal accounts of benefit and helped to quantify the therapeutic value of substances like LSD, psilocybin and MDMA, the drug better known as Ecstasy. A study in Nature Medicine found that MDMA paired with counseling brought marked relief to patients with severe PTSD. Another in the New England Journal of Medicine highlighted the potential of psilocybin therapy for treating severe depression.Although current federal law largely prohibits the medical use of these compounds, researchers expect MDMA-assisted talk therapy to win approval from the Food and Drug Administration in the next year or two, followed soon after by psilocybin, which has already received agency approval as a “breakthrough therapy” for severe depression. In 2019, the F.D.A. gave approval to esketamine, a nasal spray derived from the anesthetic ketamine, for treatment-resistant depression. Off-label use of ketamine for depression has also become increasingly popular.Juliana Mercer, a Marine Corps veteran who helps connect former service members to psychedelic therapies. “I think our voices are impactful because we’ve put our lives on the line for our country,” she said.Damon Casarez for The New York TimesKevin Matthews, a military veteran who led a 2019 ballot measure in Denver that decriminalized psilocybin mushrooms — the first U.S. city to do so — said personal testimonies about psychedelic therapy have been pivotal in winning over skeptics who worry that decriminalization will fuel increased recreational use.“The key to doing that is getting the right people in front of the right constituencies,” he said.Decriminalization advocates have made remarkable progress over the past two years. Last month Seattle embraced the decriminalization of psilocybin and other plant-based psychoactive drugs, and Michigan and several other cities across the country are poised to do the same.But as psychedelics have gained acceptance among mental health professionals, even enthusiastic supporters of decriminalization acknowledge the potential perils of doing so without adequate regulation or professional guidance. Overdoses are rare, and the compounds are not considered addictive, but experts stress the importance of chaperoned drug trips given anecdotal reports about adverse reactions among people with serious disorders like schizophrenia.At first glance, former military personnel might seem unlikely champions for illegal, mind-altering drugs that many Americans associate with the countercultural peaceniks of the 1960s and 1970s. But veterans have become powerful emissaries for psychedelics across the political spectrum.Juliana Mercer, a Marine Corps veteran from San Diego who helps connect former service members to psychedelic therapies, says her lobbying efforts are especially useful with Republican legislators who often harbor antidrug attitudes but hold veterans in high esteem.“It helps that I’m not some stereotypical hippie doing LSD for fun,” she said. “But I think our voices are impactful because we’ve put our lives on the line for our country, and after 20 years of war, we need help healing because nothing has worked so far.”Recent converts include Rick Perry, the former Republican governor of Texas, who earlier this year returned to the State Capitol to join Democratic lawmakers promoting a bill to authorize the clinical study of psilocybin. The bill passed both legislative chambers in June, and became law.Understand the Taliban Takeover in AfghanistanCard 1 of 6Who are the Taliban?

The analysis by Penn State and Iowa researchers strongly indicates that deer are getting the virus from humans, worrying experts about a deep wild reservoir for the virus.A new study of hundreds of white-tailed deer infected with the coronavirus in Iowa has found that the animals probably are contracting the virus from humans, and then rapidly spreading it among one another, according to researchers.Up to 80 percent of deer sampled from April 2020 through January 2021 in the state were infected, the study indicated.Scientists said the findings pose worrisome implications for the spread of the coronavirus, although they were not able to identify how the deer might have contracted the virus from humans. There is no evidence that deer have passed the virus back to humans.Researchers and outside experts characterized the study’s findings as a troubling development in the course of the pandemic. Widespread infection among North America’s most ubiquitous game species could make eradicating the pathogen even more difficult, especially if they became a reservoir for mutations that eventually spilled back over to humans.The study has not been published in a peer-reviewed science journal yet, but its authors at Penn State University and wildlife officials in Iowa found the results so disturbing that they are alerting deer hunters and others who handle deer to take precautions to avoid transmission.Earlier this year, a multistate survey of white-tailed deer by the U.S. Department of Agriculture’s Animal and Plant Health Inspection Service turned up antibodies for the virus among less than half the deer in four states, but that study confirmed exposure, not infection. (Antibodies could mean the deer fought off infection.)This new analysis — conducted by examining the lymph nodes of samples from roadkill and from those felled by hunters — showed active infections, the researchers said. The veterinary microbiologists who led the Penn State study, Suresh Kuchipudi and Vivek Kapur, said they were not prepared to find such widespread infection.“It was effectively showing up in all parts of the state,” said Dr. Kuchipudi. “We were dumbfounded.”Evidence of transmission from people, the scientists said, was found in the genomic sequencing of the samples collected over months that reflected the virus lineages circulating among humans.“There is no reason to believe that the same thing isn’t happening in other states where deer are present,” Dr. Kapur said.Previous studies have hinted at such a possibility because a number of other animals are susceptible to infection with SARS-CoV-2, the virus that causes Covid-19 in humans. They include ferrets and primates that have been intentionally infected in lab experiments, zoo animals that caught the virus from their handlers and captive mink that were sickened after being exposed to the pathogen by farm workers.In the case of mink, the coronavirus has already demonstrated an ability to sicken animals infected by humans, and last year, Denmark slaughtered its entire population of 17 million farmed mink after scientists discovered they could pass the virus back to people. The virus, they found, had also picked up mutations along the way, but officials said none were especially worrisome.If the virus were to become endemic in wild animals like deer, it could evolve over time to become more virulent and then infect people with a new strain capable of evading the current crop of vaccines.The findings were verified on Tuesday by federal scientists at the National Veterinary Services Laboratories, according to a spokesperson.Scientists unaffiliated with the study who reviewed the findings said they were stunned, but not entirely surprised.“If deer can transmit the virus to humans, it’s a game changer,” said Tony Goldberg, a veterinarian at the University of Wisconsin-Madison who studies the evolution of infectious diseases as they jump between animals and people. “To have a wildlife species become a reservoir after transmission from humans is very rare and unlucky, as if we needed more bad luck.”The Penn State researchers have been working with the Iowa Department of Natural Resources, which already conducts surveillance on chronic wasting disease, a fatal neurological illness among white-tailed deer. The first positive test results showed up in September 2020 — in two deer at different ends of the state. Between late November and early January, as the pandemic was surging in humans across Iowa, 80 percent of the deer specimens tested positive for the virus.By then, the researchers had tested only 300 of the 5,000 lymph nodes available to them; but the evidence was overwhelming.Such a high rate of infection, Dr. Kuchipudi said, was effectively 50 times greater than its prevalence among Iowa’s human residents during the peak of the pandemic.What they found as they probed deeper was even more astounding. Using tests to decode the genomic makeup of each viral sample, they found similar patterns between the emergence of mutations and variants in the state’s deer population and those infecting people. Researchers said that offered stronger proof of human-to-deer transmission as well as evidence that deer were then spreading the virus to one another at a rapid clip. Mapping the location of each sample also suggested that the infections were occurring simultaneously across the state as hunting season ramped up. The study’s authors say it is unclear whether the deer were sickened by the infection.How the virus passes from people to deer, however, is not entirely clear. Rachel Ruden, Iowa’s state wildlife veterinarian and an author of the study, said there were plenty of opportunities for transmission given that 445,000 deer roam the state.The virus can spread when people feed deer in their backyard, through sewage discharges or maybe when an animal licks a splotch of chewing tobacco left behind by an infected hunter. “Perhaps it doesn’t take much of a loading dose to get deer infected,” she said. “But either way, all of this is a striking example that we’re all in this pandemic together.”The study raises a multitude of questions that scientists will be keen to examine, including whether other wild animals can also carry the virus, particularly rodents like mice that live in even closer proximity to people. The more species capable of carrying the virus, the greater the chances it can evolve in ways that threaten human health.Such a scenario is not at all far-fetched. Even if the exact origins of SARS-CoV-2 remain a subject of debate, many scientists are inclined to believe the virus was a product of natural transmission from animals, most likely bats. There is no shortage of unpleasant pathogens that toggle between humans and animals, among them yellow fever, West Nile virus and strains of seasonal influenza that can infect birds and pigs.Despite their concerns that the country’s 38 million white-tailed deer could become a lasting reservoir for the coronavirus, experts say such a scenario does not mean all hope is lost in the battle to conquer the pandemic.A dangerous mutation that one day finds its way from deer to people could be tackled with a booster shot — not unlike how vaccines for the seasonal flu are developed each year. A coronavirus vaccine for deer is also a possibility — scientists have already created them for zoo animals — but the practicality of inoculating millions of free-roaming ungulates would be daunting, to say the least.In the meantime, several states have advised deer hunters to take precautions when dealing with white-tailed deer: wear rubber gloves and perhaps a mask when field dressing and processing; sanitize hands and instruments after dressing; and bag carcass remains before disposing in trash. Health officials say eating cooked venison carries little risk as long as it reaches an internal temperature of 165°F.Barbara Han, a disease ecologist at the Cary Institute of Ecosystem Studies who has been studying the spillover capacity of SARS-CoV-2 in various mammals, said the findings reinforced the need for a more robust system of surveillance that can quickly detect the transmission of pathogens from animals to people.The pandemic has already prompted better coordination among laboratories across the United States, but she said she hoped the latest findings might turbocharge efforts to create a national, federally funded surveillance network for so-called zoonotic diseases. Despite a global death toll that has surpassed five million, Dr. Han and other experts say Covid-19 could have been far deadlier, a possibility underscored by viruses like Ebola.“We can’t keep playing whack-a-mole with these zoonotic diseases because it’s just too costly, both financially and from a human losses standpoint,” she said. “We have got to do better.”

A flurry of litigation by advocacy groups seeks to combat what they say is a rise in deceptive marketing by food giants.Shoppers drawn to sustainable, humanely raised meat and dairy products could be forgiven for thinking the nation’s big food companies have turned away from the industrial farming practices that have long dominated American agriculture.Consider the package labels and marketing claims for some of the country’s best known brands: Cargill turkeys are sourced from “independent family farmers,” Sargento cheeses contain “no antibiotics” and Tyson uses “humane and environmentally responsible production” to raise its chickens while providing workers “a safe work environment.”But some claims may not be what they seem, according to a flurry of litigation by advocacy groups seeking to combat what they describe as a surge in deceptive marketing by food giants. The misleading labels, the plaintiffs say, seek to profit off consumers’ growing interest in clean eating, animal welfare and environmentally friendly agriculture — but without making meaningful changes to their farming and production practices.Class-action litigation against food and beverage companies hit a record high last year, with 220 lawsuits filed in 2020, up from 45 a decade ago, according to a tally by the law firm Perkins Coie.The mounting wave of legal activism in part reflects the frustration of advocates who have made little headway in recent years convincing federal regulators to increase their oversight of the nation’s food supply — or even to provide definitions for words like “healthy” or “all natural.” Big Food, advocates say, has eagerly exploited the regulatory vacuum.A recent lawsuit and complaint filed with the Federal Trade Commission questions Tyson’s “all natural” claims on its chickens, as well as its “safe work environment” claims.Kaiti Sullivan for The New York TimesAccording to the lawsuits and complaints, Cargill turkeys are actually produced by contract farmers who have no say in the way the birds are raised — and who often become mired in debt complying with Cargill’s strict husbandry requirements. Tyson’s “all natural” chickens, claims a lawsuit and a complaint filed with the Federal Trade Commission, are mass-produced in crowded sheds contaminated with antibiotic-resistant pathogens, and after slaughter, they are bathed in chemical disinfectants. The federal complaint also questioned Tyson’s “safe work environment” claims, noting that 39 Tyson processing plant employees have died of Covid-19 and 12,500 others had become infected, four times more cases than its biggest competitors.In a statement, Tyson said it complied with all labeling regulations, and was transparent about environmental, animal welfare and workplace safety efforts.Farmed versus wild salmon is another category with nebulous definitions that consumers find hard to parse.And that antibiotic-free Sargento cheese? One of the two recently filed lawsuits against the company included lab tests that found trace amounts of antibiotics. Sargento declined to comment, but in court filings, it said the amount of antibiotics the plaintiffs claimed to have detected are so minute that it “represents the equivalent of less than half a teaspoon of water in an Olympic-sized swimming pool.”The Organic Consumers Association, the Family Farm Action Alliance and the Animal Welfare Institute, among the nonprofit organizations behind some of the litigation, say that misleading and exaggerated marketing dupes consumers into believing they are supporting companies whose practices align with their values. But deceptive marketing, they contend, has a more pernicious effect: It ensures the continued mistreatment of millions of cows, pigs and chickens raised by Big Agriculture while harming the livelihoods of small farmers committed to more humane animal husbandry.“We don’t believe that companies should be able to profit from deceiving consumers about their practices,” said Jay Shooster, a lawyer whose firm, Richman Law & Policy, has filed several cases on behalf of advocacy groups. “Even if we can’t sue Tyson for abusing their chickens, at least we can sue them for misleading about how their chickens are treated.”The companies say the complaints are meritless, noting that a number of cases have been dismissed. Pooja S. Nair, a corporate food lawyer with the firm Ervin Cohen & Jessup, said many are patently frivolous, among them some four dozen cut-and-paste lawsuits filed last year against vanilla flavored products.The lawsuits, most of which were dismissed, claimed consumers were misled into thinking the flavoring comes from vanilla beans or vanilla extract “The landscape for businesses has become increasingly hostile,” she said. “It’s forcing companies to be more creative, and careful, in how they advertise their products.”The legal fight over package labels represents a new front in the effort by environmental and animal welfare groups to increase corporate transparency and to prod large food companies to embrace less harmful practices. The litigation also seeks to harness consumers’ growing interest in sustainability by naming and shaming companies they accuse of “greenwashing” their brands.“My family tries to eat as sustainably as possible, and we don’t mind paying a premium for products that are advertised as such, but it really raises my hackles when companies are dishonest about what they are selling,” said Dezzi Rae Marshall, a career counselor from Los Angeles who is the lead plaintiff in a lawsuit filed in June in California against Red Lobster. The lawsuit contends that much of the company’s shrimp and lobster are sourced from suppliers employing fishing practices that are not environmentally sustainable.Red Lobster declined to comment on the litigation, but said it is committed to sustainability “to ensure there’s seafood to enjoy, now and for generations.”Although many of the recently filed lawsuits are still winding their way through federal and state courts, the plaintiffs have been encouraged by a handful of favorable rulings. Other deceptive advertising cases have been settled before trial or through adjudication by the National Advertising Division of the Better Business Bureau.Last year, Ben & Jerry’s stopped describing the cows that provide the milk for their ice cream as “happy” after the company was sued by an advocacy group. In 2018, General Mills agreed to no longer promote its Nature Valley granola bars as “made with 100 percent natural whole grain oats,” bowing to plaintiffs who claimed the snack bars contained trace amounts of the herbicide glyphosate. And last month, the N.A.D. recommended that Butterball modify or drop the phrase “farmers humanely raise our turkeys every day” from its labels — although it said it was acceptable for the company to continue saying it has a “zero-tolerance policy against any form of animal mistreatment.”Advocates say much of the litigation could be avoided through more stringent federal oversight. While they have been heartened by the Biden administration’s efforts to address exaggerated food marketing claims through the F.T.C. and the F.D.A., they say more systemic change is needed.A bill introduced in Congress last month would overhaul front-of-package food labeling through a standardized system of symbols to convey whether a product is truly healthy. The measure also directs federal regulators to specifically define terms like “healthy,” and it would require companies to clearly explain how much “whole grain” is in a loaf of highly processed bread. The measure has the backing of nutritionists and healthy food advocates, but opposition from industry lobbyists is likely to complicate its passage in a narrowly divided Congress.For now, advocates are trying to prod federal regulators through legal activism and public pressure. The Animal Welfare Institute, for instance, has been trying to draw attention to the U.S.D.A.’s role in approving the label descriptions for meat and egg products, which it does by reviewing documents submitted by companies seeking its approval. Inspectors with the Food Safety and Inspection Service, the U.S.D.A. agency charged with verifying labeling claims, only have jurisdiction over slaughterhouses and meat processing plants, not the farms where the animals are raised.Kaiti Sullivan for The New York TimesSince 2013, the institute has requested documentation from the F.S.I.S. for nearly 100 package label claims. In more than half of these cases, the agency has been unable to find any documentation to back up its decisions, according to a report. In its review of the files provided, the institute found that 28 percent of label claims lacked adequate substantiation.The F.S.I.S. disputed the group’s findings, citing flaws in the institute’s requests submitted under the Freedom of Information Act.Food marketing can be notoriously fuzzy. Without clear-cut definitions for words like “sustainable,” “humane” or “natural,” food companies have been using claims they know will resonate with Americans concerned with the environment, animal welfare and worker safety.But companies that have been targeted by litigants say advocates and plaintiffs are sometimes seeking to forge definitions for words that no reasonable consumer would recognize.Ivan Wasserman, a food lawyer in Washington D.C., said some of the demands can border on extortion. For every case that makes its way to court, he said dozens of others are quietly settled with monetary compensation — often without making changes to the contested label. Even cases that end up in court can strain credulity, he said, citing lawsuits claiming Kellogg’s Froot Loops and Quaker Oats’ Cap’n Crunch’s Crunchberries cereals deceived consumers into believing they contained actual fruit.The lawsuits were dismissed.“These cases can really have a chilling effect on speech,” Mr. Wasserman said. “And I think that’s damaging not only to the company, but also potentially for consumers, if companies are afraid of giving truthful and accurate information for a fear of being roped into a meritless lawsuit.”Still, he acknowledged that some of the recent litigation was not entirely outlandish, and said he had become increasingly emphatic in advising clients to avoid words like “natural” or “sustainable” on their labels. The flood of litigation has become so intense that Mr. Wasserman’s firm, Amin Talati Wasserman, recently opened an office in California, which has some of the country’s most stringent consumer protection regulations.Jennifer Jacquet, an associate professor of environmental studies at New York University, said legal activism has become the single-most effective tool for holding companies accountable for questionable marketing claims. Professor Jacquet, an expert on seafood production, said the labeling rules for farmed salmon, for example, are so weak that companies do not have to disclose whether their fish are wild caught or raised with antibiotics in vast, tightly packed coastal enclosures that can have devastating effects on the surrounding ecosystems.“Many of these sustainability claims are dubious and wildly overblown,” she said. “And given that labeling requirements are so pathetic, there really is little way for consumers to determine their truthfulness.”The deceptive advertising claims against Cargill are typical of many recent cases. In a petition filed with the F.T.C., six advocacy groups took issue with the company’s prominent use of “independent family farmers” to describe the sourcing of the company’s turkey products. The phrase appears on the shrink-wrapped poultry marketed through its Shady Brook Farms and Honest Turkey brands, and cheery claims about the environment are a regular feature of the company’s advertising campaigns.Critics say production practices, however, can be less than idyllic. “Far from the bucolic family farms portrayed by Cargill’s marketing, Cargill’s actual production methods exploit contract farmers and slaughterhouse workers, systematically abuse animals and cause grave harms to the environment,” the complaint said.In a statement, Cargill said the allegations were without merit, noting that the company’s marketing claims are vetted by the U.S.D.A. “Cargill conducts business in a legal, ethical and responsible manner,” it said.The F.T.C. said it does not comment on pending complaints.From a regulatory standpoint, the meaning of “family farmer” is far from clear. The U.S.D.A. says the words can describe any farm in which the operator, or their relatives, own at least half of the business — a category that includes more than 97 percent of the nation’s farms. But in 2018, the Small Business Administration said the contract farming arrangements that Cargill and other big poultry companies employ should be considered subsidiaries, not independent farming operations, when it comes to federal lending decisions.Angela Huffman, a co-founder of the Family Farm Action Alliance, one of the complainants against Cargill, said contract farmers are often bound by mandates that dictate every step of production, from the breed of birds and feed they receive from Cargill to the type of equipment they must buy — requirements that she contended could saddle farm operators with crushing debts. Because Cargill and a handful of other companies dominate the turkey market, many contract farmers have few alternatives. “They are under the thumb of Cargill, and then customers who see the red barn and green grass on the label are duped into thinking they are supporting family farms,” she said.Greg Gunthorp at his farm in Indiana.Kaiti Sullivan for The New York TimesFor the nation’s dwindling band of independent poultry growers, the marketing strategies of corporate behemoths can have real-life implications. Greg Gunthorp, a fourth-generation farmer in northeast Indiana, prides himself on raising his turkeys in ways that resonate with consumers focused on sustainability. The birds spend much of their lives on pasture, where they can peck at grass and insects, and the Gunthorp family processes the turkeys themselves, without the use of disinfectants like chlorine.But last Thanksgiving, one of Mr. Gunthorp’s longtime retail clients said they would no longer buy his turkeys. Shoppers, the retailer told him, were increasingly drawn to cheaper, brand-name turkeys making similar sustainability claims.“Big Ag has co-opted and bastardized every one of our messages,” he said. “When they use a fancy label with absolutely meaningless adjectives, there’s just no way we can compete.”

The coronavirus pandemic has been especially tumultuous for children as they hunkered down over the past year and a half, experiencing disrupted schooling, increased social isolation and heightened anxiety at a time when millions of households have been buffeted by upheaval.The crisis, it turns out, has also been linked to substantial excess weight gain among children and adolescents, according to a recent study published in the medical journal JAMA.The researchers found a 9 percent increase in obesity among children ages 5 to 11, with an average weight gain of five pounds during the pandemic. Among adolescents, 16- and 17-year-olds gained an average of two additional pounds, they found.The study, which analyzed electronic health records for nearly 200,000 young people in the Kaiser Permanente health network in Southern California, confirms what many Americans have experienced firsthand: The pandemic expanded waistlines.Experts said the study was among the first to quantify the effects on young people of the disruptions to normal activities and resources. “We know that kids have been gaining weight during the pandemic, but the numbers are shocking and worse than I expected,” said Dr. Sarah Barlow, a childhood obesity specialist at Children’s Health in Dallas who was not involved with the study.Some weight gain can be tied to the school closures that limited access to physical activity and nutritious meal programs. Remote learning, experts say, has often meant more sedentary time — and more access to the refrigerator.Dr. Rachana Shah, a pediatrician at Children’s Hospital of Philadelphia, noted the pandemic’s effects on mental health and how stress can lead to poorer eating habits. Dr. Shah, who specializes in metabolic and obesity-related illnesses, said, “During Covid, a lot of the people have been even more stretched and less able to provide their kids with healthy options.” She added that food can become “a coping mechanism” for those with anxiety or depression.Dr. Deborah Young, the director of Kaiser Permanente’s division of behavioral research and an author of the study, said she expected the obesity spike to decline as children returned to school and their routines, but she and others expressed concern that not everyone would shed the excess pounds.“Excess weight in adolescence and young adulthood translates into excess weight in adulthood and all the comorbidities associated with that, like heart disease, diabetes and high blood pressure,” she said.Jamie Bussel, a senior program officer at the Robert Wood Johnson Foundation who focuses on childhood obesity, said the pandemic had worsened systemic problems like the lack of access to healthy foods in poorer communities and the ubiquity of junk food and sugary drinks.“Covid really highlighted how negligent our food system really is,” she said. “We need long-term policy fixes. Otherwise, we’re just putting a Band-Aid on a gaping wound.”

At least 180 coronavirus infections in three states have been traced to an Illinois youth camp and an affiliated men’s conference that did not require attendees to be vaccinated or tested for the virus, according to an investigation published on Tuesday by the Centers for Disease Control and Prevention.There have been no deaths linked to the outbreak, but five of those infected required hospitalization, according to the C.D.C., which noted that all of those hospitalized were unvaccinated. Roughly 1,000 people in four states were ultimately exposed to the virus by people who attended the two events, which took place in mid-June.The report, which expands on an earlier investigation by the Illinois Department of Public Health, highlights the perils of ignoring established safety guidelines for summer camps, business meetings and religious gatherings during a pandemic that continues to pummel the United States.And with the Delta variant causing significant spikes in infections across many states, some public health officials have expressed concerns about large Labor Day gatherings that do not include masks, or gate-keeping measures for admission, like testing or proof of vaccination.In the report, more than 120 of those infected were camp and conference attendees, and most of the others were members of their immediate households, researchers said. Twenty-nine of the 180 people infected were fully vaccinated against Covid-19, which is also known among epidemiologists as SARS-CoV-2.“This investigation underscores the impact of secondary SARS-CoV-2 transmission during large events such as camps and conferences when Covid-19 prevention strategies, including vaccination, masking, physical distancing, and screening testing, are not implemented,” the C.D.C.’s report said.Although coronavirus infections have affected youth camps across the country, those that have embraced testing and masks for attendees — and contact tracing and isolation for the infected — have fared much better than those that have taken a more laissez-faire approach, according to a number of studies.Sarah Patrick, the acting epidemiologist for the state of Illinois, said the outbreak illustrated the role that children can play in transmission of the virus — and the importance of ensuring they are included in efforts to curb its spread.“We’ve learned that kids, who some had thought might not be able to easily spread disease between each other, can actually be the fire starter that increases transmission beyond their immediate contacts and into the community,” she said.The Crossing, a nondenominational Christian group that organized the five-day youth camp and a two-day men’s conference, did not ask participants to be vaccinated or tested, nor did it not require mask wearing during the gatherings.The “What to Bring” page of camp’s website includes water shoes, sleeping bags and the Bible, but makes no mention of masks. Campers were between 14 and 18 years old, making them eligible for the vaccines.The phone number listed on the website for Crossing Camp was disconnected on Tuesday. Email and voice mail messages left by a reporter seeking comment at the church’s main office in Quincy, Ill., were not immediately returned.

The intruder stalks its prey with stealth and precision, preparing to puncture its quarry’s armor. Once inside, the aggressor forces its host to produce more intruders, and then causes it to explode, spewing out a multitude of invaders who can continue their rampage on a wider scale.The drama, depicted in a microscopic video of SARS-CoV-2 infecting bat brain cells, provides a window into how the pathogen turns cells into virus-making factories before causing the host cell to die.The video was produced by Sophie-Marie Aicher and Delphine Planas, virologists at the Pasteur Institute in Paris who won honorable mention in a microscopic video competition sponsored by Nikon, the photography company.Filmed over 48 hours with an image recorded every 10 minutes, the footage shows the coronavirus as red spots circulating among a mass of gray blobs — the bat’s brain cells. After they are infected, the bat’s cells begin to fuse with neighboring cells. At some point, the entire mass bursts, resulting in the death of the cells.Ms. Aicher, who specializes in zoonotic diseases — those that can be transmitted from animals to humans — said this infectious juggernaut was the same in bats and humans, with one important distinction: Bats ultimately do not get sick.In humans, the coronavirus is able to evade detection and cause more damage in part by preventing infected cells from alerting the immune system to the presence of the invaders. But its special power is the ability to force host cells to fuse with neighboring ones, a process known as syncytia that allows the coronavirus to remain undetected as it replicates.“Every time the virus has to exit the cell, it’s at risk of detection so if it can go straight from one cell to another, it can work much faster,” Ms. Aicher said.She said she hoped the video would help demystify the virus, and make it easier for people to understand and appreciate this deceitful nemesis that has upended billions of lives.“It’s important to help people get past the scientific jargon to understand that this a very sophisticated and clever virus that is well adapted to make humans sick,” she said.

“When hospitals are understaffed, people die,” one expert warned as the U.S. health systems reach a breaking point in the face of the Delta variant.Cyndy O’Brien, an emergency room nurse at Ocean Springs Hospital on the Gulf Coast of Mississippi, could not believe her eyes as she arrived for work. There were people sprawled out in their cars gasping for air as three ambulances with gravely ill patients idled in the parking lot. Just inside the front doors, a crush of anxious people jostled to get the attention of an overwhelmed triage nurse.“It’s like a war zone,” said Ms. O’Brien, who is the patient care coordinator at Singing River, a small health system near the Alabama border that includes Ocean Springs. “We are just barraged with patients and have nowhere to put them.”The bottleneck, however, has little to do with a lack of space. Nearly 30 percent of Singing River’s 500 beds are empty. With 169 unfilled nursing positions, administrators must keep the beds empty.Nursing shortages have long vexed hospitals. But in the year and half since its ferocious debut in the United States, the coronavirus pandemic has stretched the nation’s nurses as never before, testing their skills and stamina as desperately ill patients with a poorly understood malady flooded emergency rooms. They remained steadfast amid a calamitous shortage of personal protective equipment; spurred by a sense of duty, they flocked from across the country to the newest hot zones, sometimes working as volunteers. More than 1,200 of them have died from the virus.Now, as the highly contagious Delta variant pummels the United States, bedside nurses, the workhorse of a well-oiled hospital, are depleted and traumatized, their ranks thinned by early retirements or career shifts that traded the emergency room for less stressful nursing jobs at schools, summer camps and private doctor’s offices.“We’re exhausted, both physically and emotionally,” Ms. O’Brien said, choking back tears.Cyndy O’Brien, an emergency room nurse at Ocean Springs Hospital. “We are just barraged with patients and have nowhere to put them,” she said.Rory Doyle for The New York TimesA Covid patient under treatment at Ocean Springs Hospital, part of the Singing River nonprofit health system, which has 169 unfilled nursing positions.Rory Doyle for The New York TimesLike hospital leaders across much of the South, Lee Bond, the chief executive of Singing River, has been struggling to stanch the loss of nurses over the past year. Burnout and the lure of financially flush health systems have hobbled hospitals during the worst public health crisis in living memory.With just over a third of Mississippi residents fully vaccinated, Mr. Bond is terrified things will worsen in the coming weeks as schools reopen and Gov. Tate Reeves doubles down on his refusal to reinstate mask mandates. “Our nurses are at their wits’ end,” Mr. Bond said. “They are tired, overburdened, and they feel like forgotten soldiers.”Across the country, the shortages are complicating efforts to treat hospitalized coronavirus patients, leading to longer emergency room waiting times and rushed or inadequate care as health workers struggle to treat to patients who often require exacting, round-the-clock attention, according to interviews with hospital executives, state health officials and medical workers who have spent the past 17 months in the trenches.The staffing shortages have a hospital-wide domino effect. When hospitals lack nurses to treat those who need less intensive care, emergency rooms and I.C.U.s are unable to move out patients, creating a traffic jam that limits their ability to admit new ones. One in five I.C.U.s are at least 95 percent capacity, according to an analysis by The New York Times, a level experts say makes it difficult to maintain standards of care for the very sick.“When hospitals are understaffed, people die,” said Patrica Pittman, director of the Health Workforce Research Center at George Washington University.Oregon’s governor has ordered 1,500 National Guard troops to help tapped-out hospital staff. Officials in a Florida county where hospitals are over capacity are urging residents “to consider other options” before calling 911. And a Houston man with six gunshot wounds had to wait a week before Harris Health, one of the country’s largest hospital systems, could fit him in for surgery to repair a shattered shoulder.“If it’s a broken ankle that needs a pin, it’s going to have to wait. Our nurses are working so hard, but they can only do so much,” said Maureen Padilla, who oversees nursing at Harris Health. The system has 400 openings for bedside nurses, including 17 that became vacant in the last three weeks.In Mississippi, where coronavirus cases have doubled over the past two weeks, health officials are warning that the state’s hospital system is on the verge of collapse. The state has 2,000 fewer registered nurses than it did at the beginning of the year, according to the Mississippi Hospital Association. With neighboring states also in crisis and unable to take patient transfers, the University of Mississippi Medical Center in Jackson, the only Level 1 trauma unit in the state, has been setting up beds inside a parking garage.“You want to be there in someone’s moment of need, but when you are in disaster mode and trying to keep your finger on the leak in the dike, you can’t give every patient the care they deserve,” said Dr. LouAnn Woodward, the medical center’s top executive. With staffing shortfalls plaguing hospitals coast to coast, bidding wars have pushed salaries for travel nurses to stratospheric levels, depleting staff at hospitals that can’t afford to compete. Many are in states flooded with coronavirus patients.Workers sanitized a Covid field clinic in the parking garage of the University of Mississippi Medical Center. Rory Doyle for The New York TimesDr. LouAnn Woodward, the top executive at the University of Mississippi Medical Center. “When you are in disaster mode and trying to keep your finger on the leak in the dike, you can’t give every patient the care they deserve,” she said.Rory Doyle for The New York TimesTexas Emergency Hospital, a small health system near Houston that employs 150 nurses and has 50 unfilled shifts each week, has been losing experienced nurses to recruiters who offer $20,000 signing bonuses and $140-an-hour wages. Texas Emergency, by contrast, pays its nurses $43 an hour with a $2 stipend for those on the night shift. “That’s ridiculous money, which gives you a sense of how desperate everyone is,” said Patti Foster, the chief operations officer of the system, which runs two emergency rooms in Cleveland, Texas, that are over capacity.Ms. Foster sighed when asked whether the hospital offered signing bonuses. The best she can do is pass out goody bags filled with gum, bottled water and a letter of appreciation that includes online resources for those overwhelmed by the stress of the past few weeks.Business has never been better for travel nurse recruiters. Aya Healthcare, one of the country’s biggest nurse recruitment agencies, has been booking 3,500 registered nurses a week, double its prepandemic levels, but it still has more than 40,000 unfilled jobs listed on its website, said April Hansen, the company’s president of work force solutions. “We’re barely making a dent in what’s needed out there,” she said.There were more than three million nurses in the United States in 2019, according to the Bureau of Labor Statistics, which estimates 176,000 annual openings for registered nurses across the country in the next few years. But those projections were issued before the pandemic.Peter Buerhaus, an expert on the economics of the nursing work force at Montana State University, is especially rattled by two data points: A third of the nation’s nurses were born during the baby boom years, with 640,000 nearing retirement; and the demographic bulge of aging boomers needing intensive medical care will only increase the demand for hospital nurses. “I’m raising the yellow flag because a sudden withdrawal of so many experienced nurses would be disastrous for hospitals,” he said.Many experts fear the exodus will accelerate as the pandemic drags on and burnout intensifies. Multiple surveys suggest that nurses are feeling increasingly embattled: the unrelenting workloads, the moral injury caused by their inability to provide quality care, and dismay as emergency rooms fill with unvaccinated patients, some of whom brim with hostility stoked by misinformation. Nurses, too, are angry — that so many Americans have refused to get vaccinated. “They feel betrayed and disrespected,” Professor Buerhaus said.Oxygen tanks being delivered to the emergency room at the University of Mississippi Medical Center.Rory Doyle for The New York TimesPatti Foster, left, chief operations officer at Texas Emergency Hospital, and Cassie Kavanaugh, the chief nursing officer for the hospital’s network. “I don’t know how much more we can take,” Ms. Kavanaugh said.Michael Starghill Jr. for The New York TimesIncreasing the nation’s nursing workforce is no easy task. The United States is producing about 170,000 nurses a year, but 80,000 qualified applicants were rejected in 2019 because of a lack of teaching staff, according to the American Association of Colleges of Nursing.“We can’t graduate nurses fast enough, but even when they do graduate, they are often not prepared to provide the level of care that’s most needed right now,” said Dr. Katie Boston-Leary, director of nursing programs at the American Nurses Association. Newly minted nurses, she added, require on-the-job education from more seasoned ones, placing additional strains on hospital resources.Some of the proposed remedies include federal policies that can stabilize the profession, including financial assistance to help nursing schools hire more instructors and staffing-ratio mandates that limit the number of patients under a nurse’s care.“This simplistic notion that the labor market will just produce the number of nurses we need just isn’t true for health care,” said Professor Pittman of George Washington University. “Nursing is in crisis, and maybe the pandemic is the straw that will break the camel’s back.”The crisis is on full display at Texas Emergency Hospital, which has been treating patients in hallways and tapping administrators to run specimens to the lab. In recent days, 90 percent of those admitted to the hospital have tested positive for the coronavirus. Short on ventilators, and with hospitals in Houston no longer able to take their most critically ill patients, officials have been contemplating the unthinkable: how to ration care.On Friday, Cassie Kavanaugh, the chief nursing officer for the hospital’s network, was dealing with additional challenges: Ten nurses were out sick with Covid. She had no luck renting ventilators or other breathing machines for her Covid patients. Many of the new arrivals are in their 30s and 40s and far sicker than those she saw during previous surges. “This is a whole different ballgame,” she said.Ms. Kavanaugh, too, was running on fumes, having worked 60 hours as a staff nurse over the previous week on top of her administrative duties. She was also emotionally wrought after seeing co-workers and relatives admitted to her hospital. And her anguish only mounted after she stopped at the grocery store: Almost no one, she said, was wearing masks.“I don’t know how much more we can take,” she said. “But one thing that hit me hard today is a realization: If things keep going the way they are, we’re going to lose people for sure, and as a nurse, that’s almost too much to bear.”

For the first time, the C.D.C. identified several cases of Candida auris that were resistant to all drugs, in two health facilities in Texas and a long-term care center in Washington, D.C.A deadly, hard-to-treat fungal infection that has been spreading through nursing homes and hospitals across the United States is becoming even more dangerous, according to researchers, who for the first time have identified several cases in which the fungus, Candida auris, was completely impervious to all existing medication.The finding, released Thursday by the Centers for Disease Control and Prevention, is an alarming development in the evolution of C. auris, a tenacious yeast infection discovered in Japan in 2009 that has since spread across much of the world.Federal health officials say the bug has spread even more widely during the coronavirus pandemic, with overwhelmed hospitals and nursing homes struggling to keep up with the surveillance and control measures needed to contain local outbreaks.In the new report, the C.D.C. said, five of more than 120 cases of C. auris were resistant to treatment.The C.D.C. did not identify the facilities where the novel infections took place, but health officials said there was no evident link between the outbreaks, which occurred in Texas at a hospital and a long-term care facility that share patients, and at a single long-term care center in Washington, D.C. The outbreaks took place between January and April.Nearly a third of the infected patients died within 30 days, according to the C.D.C., but because they were already gravely ill, officials said it was unclear whether their deaths were caused by the fungus.Over the past eight years, the C.D.C. has identified more than 2,000 Americans colonized with C. auris — meaning the fungus was detected on their skin — with most cases concentrated in New York, New Jersey, Illinois and California. Between 5 and 10 percent of those colonized with the pathogen go on to develop more serious bloodstream infections.Once it gains a foothold, the fungus is difficult to eliminate from health care facilities, clinging to cleaning carts, intravenous poles and other medical equipment. While relatively harmless to those in good health, the yeast infection can be deadly to seriously ill hospital patients, residents of long-term care facilities and others with weakened immune systems.“If you wanted to conjure up a nightmare scenario for a drug-resistant pathogen, this would be it,” said Dr. Cornelius J. Clancy, an infectious diseases doctor at the VA Pittsburgh Health Care System. “An untreatable fungus infection would pose a grave threat to the immunocompromised, transplant recipients and critically ill patients in the I.C.U.”While C. auris has long been notoriously hard to treat, researchers for the first time identified five patients in Texas and Washington, D.C., whose infections did not respond to any of the three major classes of antifungal medication. So-called panresistance had been previously reported in three patients in New York who were being treated for C. auris, but health officials said the newly reported panresistant infections occurred in patients who had never received antifungal drugs, said Dr. Meghan Lyman, a medical officer at the C.D.C. who specializes in fungal diseases.“The concerning thing is that the patients at risk are no longer the small population of people who have infections and are already being treated with these medications,” she said.Infectious disease specialists say the coronavirus pandemic has probably accelerated the spread of the fungus. The shortages of personal protective equipment that hobbled health care workers during the early months of the pandemic, they say, increased opportunities for the fungus’s transmission, especially among the thousands of Covid-19 patients who ended up on invasive mechanical ventilation.The chaos of recent months also did not help. “Infection control efforts at most heath care systems are stretched thin in the best of times, but with so many Covid patients, resources that might have gone to infection control were diverted elsewhere,” Dr. Clancy said.For many health experts, the emergence of a panresistant C. auris is a sobering reminder about the threats posed by antimicrobial resistance, from superbugs like MRSA to antibiotic-resistant salmonella. Such infections sicken 2.8 million Americans a year and kill 35,000, according to the C.D.C.Dr. Michael S. Phillips, chief epidemiologist at NYU/Langone Health, said health systems across the country were struggling to contain the spread of such pathogens. The problem, he said, was especially acute in big cities like New York, where seriously ill patients shuttle between nursing homes with lax infection control and top-notch medical centers that often draw patients from across a wider region.“We need to do a better job at surveillance and infection control, especially in places where we put patients in group settings,” he said. “Candida auris is something we should be concerned about, but we can’t lose sight of the bigger picture because there are a lot of other drug-resistant bugs out there we should be worried about.”

A largely unmasked nation will celebrate the nation’s return to near-normalcy this weekend with a ticker-tape parade in New York City, a dazzling fireworks display over the Washington Monument and countless Independence Day gatherings in cities and towns across the country.“A summer of freedom. A summer of joy,” is how the White House tried to promote a new national mood in a letter encouraging local officials to hold public events during the July 4th holiday.And in most parts of the country, Americans have reason to cheer, with more than half of those over 12 fully vaccinated, state after state lifting all emergency restrictions and caseloads decreasing by double-digits week over week. Families are traveling again, diners are flocking to restaurants and baseball is back as America’s seasonal pastime.But the summer is turning out to be fairly joyless in places like CoxHealth Medical Center in Springfield, Mo., where nurses, doctors and respiratory therapists have been grappling with a resurgence in coronavirus cases that forced the hospital to reopen the 80-bed Covid unit it had shuttered in May.Dr. Terrence Coulter, a critical care specialist at CoxHealth, said he and his colleagues were stunned to find themselves back in the trenches after the briefest of respites. “With everyone masked, you learn to read the emotions in your co-workers’ eyes,” he said. “They’re weary and they’re also disappointed that the country has started the end zone dance before we cross the goal line. The truth is we’re fumbling the ball before we even get there.”America’s health care workers are in crisis, even in places that have had sharp declines in coronavirus infections and deaths. Battered and burned out, they feel unappreciated by a nation that lionized them as Covid heroes but often scoffed at mask mandates and refused to follow social distancing guidelines. Many of those same Americans are now ignoring their pleas to get vaccinated.Doctors and nurses are also overworked, thanks to chronic staffing shortages made worse by a pandemic that drove thousands from the field. Many are struggling with depression and post-traumatic stress; others are mourning at least 3,600 colleagues who won’t be around for the celebrations.“People don’t realize what it was like to be on the front lines and risking your own safety without adequate protective gear while dealing with so much death,” said Mary Turner, a registered nurse in Minneapolis who was unable to comfort her own father as he lay dying alone of Covid in a nursing home in the early days of the pandemic. A few months later, she found herself sobbing uncontrollably in a hospital room as she held up a phone so a man could say goodbye to his father. “A lot of us are still dealing with PTSD,” she said.In recent weeks, a familiar sense of dread has returned to emergency rooms across the South and Mountain West as the more transmissible Delta variant gained traction among the unvaccinated, fueling a jump in hospitalizations. In Missouri alone, caseloads increased more than 40 percent from two weeks earlier; at CoxHealth where Dr. Coulter works, the Delta variant comprised 93 percent of all cases last week, he said.Mary Turner, a nurse in Minneapolis, lost her own father to Covid early in the pandemic. “A lot of us are still dealing with PTSD,” she said.Caroline Yang for The New York TimesDr. Clay Smith, an emergency room doctor who travels between two distant hospitals in South Dakota and Wyoming, said he worried about his children, who are both too young to get inoculated. “It’s really disconcerting to work in a community where people are doing so little to protect themselves and others from the virus,” Dr. Smith said.With fewer than a third of adults in the counties served by the hospitals fully vaccinated, he has been treating a small but steady stream of Covid patients, some of whom insist the coronavirus is a hoax even as they struggle to breathe. “People think they are exercising their rights by refusing to get vaccinated, but in reality they’re exposing themselves and others to risk,” Dr. Smith said.Some health care workers are also refusing to get jabbed. Earlier this month, 153 employees at the Houston Methodist hospital system resigned or were terminated after they refused to abide by a policy requiring all staff to be vaccinated against Covid. Similar standoffs over vaccine mandates will most likely multiply as hospitals across the country embrace similar policies.In interviews, nearly two dozen health care providers expressed a range of conflicting emotions: Elation over how quickly the vaccines were created and relief that the pandemic’s darkest days are in the past, but fear that the large number of unvaccinated Americans could lead to localized outbreaks that persist for the foreseeable future.Few are in a celebratory mood.Deborah Burger, co-president of National Nurses United, a union that represents 170,000 registered nurses, said the revelries planned for the Fourth of July weekend felt ill-conceived and tone deaf, and not just because the pandemic continues to claim hundreds of lives a day.Nurses, she said, face a welter of indignities at work. Dire staff shortages are preventing many from taking much-needed vacations, and some hospitals are still requiring employees to reuse disposable N95 masks even though supply chain bottlenecks have eased. Then there is the open hostility from patients who have spent months steeped in right-wing commentary and conspiracy theories that have turned health workers into adversaries.“I’ve been in the field for 45 years and I’ve never seen things this bad,” said Ms. Burger, who is a registered nurse. “It’s really frustrating and dispiriting that the pandemic has been turned into a political event, rather than a public health crisis, and it’s health care workers who are left to deal with the aftermath.”The pandemic continues to vex hospitals and their employees, often in unexpected ways. Dr. Mara Windsor, an emergency room doctor in Phoenix, rarely sees Covid patients these days, but she said an alarming shortage of nurses had gummed up the admissions process, forcing patients to wait upward of eight hours before they can be seen by a doctor. The problem is shared by hospitals across the city.Infuriated patients, she said, often scream at her; others will storm out before they can be treated. “It’s very anxiety provoking to have 30 patients in the lobby and not being able to take them because we have no nurses,” said Dr. Windsor, who has been forced to scale back her hours and take a pay cut because of the drop off in admissions. “What if someone has a heart attack? The whole environment has become really challenging.”The conflict over vaccines has complicated, and sometimes curdled, the relationship between patients and health care providers. As a woman of color well aware of the systemic racism in American health care, Dr. Mati Hlatshwayo Davis, an infectious disease doctor in St. Louis, said she was sympathetic to the vaccine-hesitant but that she sometimes struggled to contain her frustration, especially given that her sisters in South Africa had little hope of getting the shots any time soon.Dr. Mati Hlatshwayo Davis, an infectious disease physician in St. Louis, said she sometimes felt frustrated when counseling the vaccine-hesitant. “It’s heartbreaking, but we’re also really, really tired.”Neeta Satam for The New York Times“There are moments of overwhelming joy when seeing patients I know who survived Covid, but then I’ll treat multiple members of a family with Covid or we will have to intubate someone and you can’t help but think this was preventable,” she said. “It’s heartbreaking, but we’re also really, really tired.”Dr. Teena Chopra, the medical director of infection prevention and hospital epidemiology at the Detroit Medical Center, takes a no-nonsense approach with the Covid patients she treats, most of them increasingly young. Although caseloads across the state have dropped significantly since a calamitous third surge ended in April, only 51 percent of adults in Michigan have received one vaccine dose. In Detroit, that figure is 40 percent.The interactions she has with Covid patients, many of them African American, often leave her shaken. She recalled a recent exchange with a woman in her 40s who was struggling to breathe. When Dr. Chopra asked whether she had been vaccinated, the woman shook her head defiantly between gasps, insisting that the vaccines were more harmful than the virus. The patient later died.“It leaves me angry, frustrated and sad,” Dr. Chopra said. “These nonbelievers will never accept our viewpoint, and the result is that they are putting others at risk and overwhelming the health care system.”The emotional fallout of the last 16 months takes many forms, including a spate of early retirements and suicides among health care providers. Dr. Mark Rosenberg, an emergency room doctor at St. Joseph’s University Medical Center in Paterson, N.J., a predominantly working class, immigrant community that was hit hard by the pandemic, sees the toll all around him.He recently found himself comforting a fellow doctor who blamed himself for infecting his in-laws. They died four days apart. “He just can’t get past the guilt,” Dr. Rosenberg said.At a graduation party for the hospital’s residents two weeks ago — the emergency department’s first social gathering in nearly two years — the DJ read the room and decided not to play any music, Dr. Rosenberg said. “People in my department usually love to dance but everyone just wanted to talk, catch up and get a hug.”Dr. Rosenberg, who is also president of the American College of Emergency Physicians, is processing his own losses. They include his friend, Dr. Lorna Breen, who took her own life in the first months of the pandemic and whose death has inspired federal legislation that seeks to address suicide and burnout among health care professionals.Most of the suffering goes unseen or unacknowledged. Dr. Rosenberg compared the hidden trauma to what his father, a World War II veteran, experienced after the hostilities ended.“My dad didn’t like to talk about the war but once in a while he did and what he said was that so many of his fellow soldiers died after they came home,” he said. “We would now describe this as PTSD, and I see the same thing happening among health care workers.”Dr. Rosenberg said he had mixed feelings about the festivities planned for July 4. He is proud of the camaraderie and self-sacrifice he witnessed among colleagues who bravely faced down a deadly virus, but he is uncomfortable with the expression “health care heroes,” especially given the widespread resistance to vaccinations.“We’re ready to stand shoulder to shoulder again and face whatever comes our way,” he said. “But to be honest, we’re wiped out and we just want society to show us that we really are appreciated — by getting vaccinated.”