After a staff member dismissed racism as a problem in medicine on a podcast, a petition signed by thousands demanded a review of editorial processes at the journal.Following controversial comments on racism in medicine made by a deputy editor at JAMA, the editor in chief of the prominent medical journal was placed on administrative leave on Thursday.A committee of the American Medical Association, which oversees the journal, said Dr. Howard Bauchner would be replaced by an interim editor pending results of an independent investigation. The decision was announced on Thursday in an email to employees.JAMA is one of the world’s leading medical journals, publishing research that shapes the scientific agenda and public policy around the globe. The controversy began when Dr. Ed Livingston, a deputy editor, said on a Feb. 24 podcast that structural racism no longer existed in the United States.“Structural racism is an unfortunate term,” said Dr. Livingston, who is white. “Personally, I think taking racism out of the conversation will help. Many people like myself are offended by the implication that we are somehow racist.”The podcast was promoted with a tweet from the journal that said, “No physician is racist, so how can there be structural racism in health care?” The response to both was swift and angry, prompting the journal to take down the podcast and delete the tweet.A week later, Dr. Bauchner addressed the controversy. “Comments made in the podcast were inaccurate, offensive, hurtful, and inconsistent with the standards of JAMA,” Dr. Bauchner said in a statement. “We are instituting changes that will address and prevent such failures from happening again.”Dr. Livingston later resigned. On Thursday night, officials at JAMA did not immediately respond to a request for comment.Many in the medical community said that the journal had not gone far enough and that the events offered an opportunity to make more systemic changes. In an email sent to leaders of the A.M.A., a group of doctors called for “a careful investigation of the JAMA editorial staff and board, up to and including the removal of Dr. Howard Bauchner.”The authors also initiated a petition, now signed by nearly 7,000 people, asking the journal to hold Dr. Bauchner accountable and to review and restructure the editorial process.“It’s not just that this podcast is problematic — it’s that there is a long and documented history of institutional racism at JAMA,” said Dr. Brittani James, a Black physician who practices on the South Side of Chicago and who helped begin the petition.“That podcast should never have happened,” said Dr. Uché Blackstock, an emergency physician in New York. “That tweet should never have happened. The fact that podcast was conceived of, recorded and posted was unconscionable.”“I think it caused an incalculable amount of pain and trauma to Black physicians and patients,” she said. “And I think it’s going to take a long time for the journal to heal that pain.”Recently, other prominent journals have had to reckon with their roles in perpetuating racism in medicine. In January, Alan Weil, editor in chief of Health Affairs, acknowledged that the journal’s “staff and leadership are overwhelmingly white and economically privileged,” and he committed to reviewing its editorial process.In the email to JAMA employees, Dr. James L. Madara, chief executive of the American Medical Association, promised that its investigation would probe “how the podcast and associated tweet were developed, reviewed, and ultimately published,” and said that the A.M.A. had engaged independent investigators to ensure objectivity.He did not offer a date for conclusion of the investigation.

Other drug makers have begun similar trials of their Covid-19 vaccines. If they work in children younger than 12 as expected, it will be easier for the U.S. to reach herd immunity.Pfizer has begun testing its Covid-19 vaccine in children under 12, a significant step in turning back the pandemic. The trial’s first participants, a pair of 9-year-old twin girls, were immunized at Duke University in North Carolina on Wednesday.Results from the trial are expected in the second half of the year, and the company hopes to vaccinate younger children early next year, said Sharon Castillo, a spokeswoman for the pharmaceutical company.Moderna also is beginning a trial of its vaccine in children six months to 12 years of age. Both companies have been testing their vaccines in children 12 and older, and expect those results in the next few weeks.AstraZeneca last month began testing its vaccine in children six months and older, and Johnson & Johnson has said it plans to extend trials of its vaccine to young children after assessing its performance in older children.Immunizing children will help schools to reopen as well as help to end the pandemic, said Dr. Emily Erbelding, an infectious diseases physician at the National Institutes of Health who oversees testing of Covid-19 vaccines in special populations.An estimated 80 percent of the population may need to be vaccinated for the United States to reach herd immunity, the threshold at which the coronavirus runs out of people to infect. Some adults may refuse to be vaccinated, and others may not produce a robust immune response.Children under 18 account for about 23 percent of the population in the United States, so even if a vast majority of adults opt for vaccines, “herd immunity might be hard to achieve without children being vaccinated,” Dr. Erbelding said.Pfizer had initially said it would wait for data from older children before starting trials of its vaccine in children under 12. But “we were encouraged by the data from the 12 to 15 group,” said Ms. Castillo, who did not elaborate on the results so far.Scientists will test three doses of the Pfizer vaccine — 10, 20 and 30 micrograms — in 144 children. Each dose will be assessed first in children 5 through 11 years of age, then in children ages 2 through 4 years, and finally in the youngest group, six months to 2 years.After determining the most effective dose, the company will test the vaccine in 4,500 children. About two-thirds of the participants will be randomly selected to receive two doses 21 days apart; the remaining will get two placebo shots of saline. The researchers will assess the children’s immune response in blood drawn seven days after the second dose.“It sounds like a good plan, and it’s exciting that another Covid-19 vaccine is moving forward with trials in children,” said Dr. Kristin Oliver, a pediatrician and vaccine expert at Mount Sinai Hospital in New York.Dr. Oliver said about half of the parents she sees in practice are eagerly waiting for vaccines, and even to volunteer their children for clinical trials, while the rest are skeptical because comparatively few children become seriously ill from coronavirus infection.Both groups of parents will benefit from knowing exactly how safe and effective the vaccines are in children, she said.Children represent 13 percent of all reported cases in the United States. More than 3.3 million children have tested positive for the virus, at least 13,000 have been hospitalized and at least 260 have died, noted Dr. Yvonne Maldonado, who represents the American Academy of Pediatrics on the federal Advisory Committee on Immunization Practices.The figures do not fully capture the damage to children’s health. “We don’t know what the long-term effects of Covid infection are going to be,” Dr. Maldonado said.Other vaccines have helped to control many horrific childhood diseases that can cause long-term complications, she added: “For some of us who’ve seen that, we don’t want to go back to those days.”Children often react more strongly to vaccines than adults do, and infants and toddlers in particular can experience high fevers. Any side effects are likely to appear soon after the shot, within the first week and certainly within the first few weeks, experts have said.Some vaccines are tested only in animals before being assessed in children, and have to be monitored carefully for side effects.“But this is a little different, because we’ve already had experience with tens of millions of people with these vaccines,” Dr. Maldonado said. “So there’s a higher degree of confidence now in giving this vaccine to kids.”Some experts suggested that the Food and Drug Administration may require up to six months of safety data from studies of children before authorizing the Covid-19 vaccines. But a spokeswoman said the agency did not expect six months of safety data to support the vaccines’ authorization.The Pfizer-BioNTech vaccine is authorized for children 16 through 18 years old, and the authorization for that age group was based on just two months of safety data, she said.Parents will want to know how the companies and the F.D.A. plan to monitor and disclose side effects from the vaccines, and how long they will continue to follow trial participants after the vaccines’ authorization, Dr. Oliver said.“I think everyone has learned throughout this,” she said. “The more transparent you can be, the better.”

People over 65 are more likely to experience a second bout with the virus, according to a large study of medical records.The vast majority of people who recover from Covid-19 remain shielded from the virus for at least six months, researchers reported on Wednesday in a large study from Denmark.Prior infection with the coronavirus reduced the chances of a second bout by about 80 percent in people under 65, but only by about half in those older than 65. But those results, published in the journal Lancet, were tempered by many caveats.The number of infected older people in the study was small. The researchers did not have any information beyond the test results, so it’s possible that only people who were mildly ill the first time became infected again and that the second infections were largely symptom-free.Scientists have said that reinfections are likely to be asymptomatic or mild because the immune system will suppress the virus before it can do much damage. The researchers also did not assess the possibility of reinfection with newer variants of the virus.Still, the study suggests that immunity to a natural infection is unpredictable and uneven, and it underscores the importance of vaccinating everyone — especially older people, experts said.“You can certainly not rely on a past infection as protecting you from being ill again, and possibly quite ill if you are in the elderly segment,” said Steen Ethelberg, an epidemiologist at Statens Serum Institut, Denmark’s public health agency.Because people over 65 are at highest risk of severe disease and death, he said, “they are the ones we are most eager to protect.”Rigorous estimates of second infections have generally been rare because many people worldwide did not initially have access to testing, and laboratories require genetic sequences from both rounds of testing to confirm a reinfection.But the findings are consistent with those from experiments in a wide variety of settings: sailors on a fishing trawler in Seattle, Marine Corps recruits in South Carolina, health care workers in Britain and patients at clinics in the United States.The new study’s design and size benefited from Denmark’s free and abundant testing for the coronavirus. Nearly 70 percent of the country’s population was tested for the virus in 2020.The researchers looked at the results from 11,068 people who tested positive for the coronavirus during the first wave in Denmark between March and May 2020. During the second wave, from September to December, 72 of those people, or 0.65 percent, again tested positive, compared with 3.27 percent of people who became infected for the first time.That translates to a 80 percent protection from the virus in those who had been infected before. The protection fell to 47 percent for those over 65. The team also analyzed test results from nearly 2.5 million people throughout the epidemic, some longer than seven months after the first infection, and found similar results.“It was really nice to see that there was no difference in protection from reinfection over time,” said Marion Pepper, an immunologist at the University of Washington in Seattle.She and other experts noted that while 80 percent might not seem superb, protection from symptomatic illness was likely to be higher. The analysis included anyone who was tested, regardless of symptoms.“A lot of these will be asymptomatic infections, and a lot of these will likely be people who have a blip of virus,” noted Florian Krammer, an immunologist at the Icahn School of Medicine at Mount Sinai in New York. “Eighty percent risk reduction against asymptomatic infection is great.”The findings indicate that people who have recovered from Covid-19 should get at least one dose of a coronavirus vaccine to boost the level of protection, Dr. Krammer added. Most people produce robust immune response to a natural infection, “but there’s a lot of variability,” he said. Following vaccination, “we don’t see variability — we see very high responses in basically everybody, with very few exceptions.”Experts were less convinced by the results in people over 65, saying the findings would have been more robust if the analysis had included more people from that age group.“I wish it had actually been broken down into specific decades over 65,” Dr. Pepper said. “It would be nice to know whether the majority of people who were getting reinfected were over 80.”The immune system grows progressively weaker with age, and people over 80 typically mount weak responses to infection with a virus. The lower protection in older people seen in the study is consistent with those observations, said Akiko Iwasaki, an immunologist at Yale University.“I think we kind of tend to forget how the vaccines have been pretty amazing in offering protection in this age group, because you can see that natural infection doesn’t confer the same kind of protection,” she said. “This really does emphasize the need to cover older people with the vaccine, even if they have had Covid first.”

#masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutNew Variants TrackerAdvertisementContinue reading the main storySupported byContinue reading the main storyIn Oregon, Scientists Find a Virus Variant With a Worrying MutationIn a single sample, geneticists discovered a version of the coronavirus first identified in Britain with a mutation originally reported in South Africa.Coronavirus testing at the Virginia Garcia clinic in Hillsboro, Ore., last year. A variant found in Oregon may have evolved with a mutation that blunts the body’s immune response.Credit…Ruth Fremson/The New York TimesMarch 5, 2021, 12:38 p.m. ETScientists in Oregon have spotted a homegrown version of a fast-spreading variant of the coronavirus that first surfaced in Britain — but now combined with a mutation that may make the variant less susceptible to vaccines.The researchers have so far found just a single case of this formidable combination, but genetic analysis suggested that the variant had been acquired in the community and did not arise in the patient. “We didn’t import this from elsewhere in the world — it occurred spontaneously,” said Brian O’Roak, a geneticist at Oregon Health and Science University who led the work. He and his colleagues participate in the Centers for Disease Control and Prevention’s effort to track variants, and they have deposited their results in databases shared by scientists.The variant originally identified in Britain, called B.1.1.7, has been spreading rapidly across the United States, and accounts for at least 2,500 cases in 46 states. This form of the virus is both more contagious, and more deadly, than the original version, and is expected to account for most infections in America in a few weeks.The new version that surfaced in Portland has the same backbone, but also a mutation — E484K, or “Eek” — seen in variants of the virus circulating in South Africa, Brazil and New York City.Lab studies and clinical trials in South Africa indicate that the Eek mutation renders the current vaccines less effective by blunting the body’s immune response. (The vaccines still work, but the findings are worrying enough that Pfizer-BioNTech and Moderna have begun testing new versions of their vaccines designed to defeat the variant found in South Africa.)The B.1.1.7 variant with Eek also has emerged in Britain, designated as a “variant of concern” by scientists. But the virus identified in Oregon seems to have evolved independently, Dr. O’Roak said.Dr. O’Roak and his colleagues found the variant among coronavirus samples collected by the Oregon State Public Health Lab from an outbreak in a health care setting. Of the 13 test results they analyzed, 10 turned out to be B.1.1.7 alone, and one the combination.Other experts said the discovery was not surprising, because the Eek mutation has arisen in forms of the virus all over the world. But the mutation’s occurrence in B.1.1.7 is worth watching, they said.In Britain, this version of the variant accounts for a small number of cases. But by the time the combination evolved there, B.1.1.7 had already spread through the country.The Coronavirus Outbreak

#masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutNew Variants TrackerElderly citizens arrived for vaccinations last month at St. Anthony’s Parish Center in Pawtucket, R.I. The state was hit hard by the coronavirus. Credit…David Degner for The New York TimesHow Rhode Island Fell to the CoronavirusA dense population of vulnerable citizens set the stage for a frightening epidemic.Elderly citizens arrived for vaccinations last month at St. Anthony’s Parish Center in Pawtucket, R.I. The state was hit hard by the coronavirus. Credit…David Degner for The New York TimesSupported byContinue reading the main storyMarch 5, 2021, 5:00 a.m. ETPROVIDENCE, R.I. — The numbers began ticking up in September. After a quiet summer, doctors at Rhode Island Hospital began seeing one or two patients with Covid-19 on each shift — and soon three. Then four.Cases climbed steadily until early December, when Rhode Island earned the dubious distinction of having more cases and deaths per 100,000 people than any other state in the country. The case rate still puts it among the top five states.Where did this tightly knit state go wrong? Former Gov. Gina Raimondo’s “pauses” on economic activity were short-lived and partial, leaving open indoor dining, shopping malls and bowling alleys. But the shutdowns were no patchier than those in many other states.Until late summer, she was lauded for reining in the virus. Even now, few residents blame her for the bleak numbers. (Ms. Raimondo was sworn in as the secretary of commerce on Wednesday night.)Experts point instead to myriad other factors, all of which have played out elsewhere in the country but converged into a bigger crisis here.The fall chill sent people indoors, where risk from the virus is highest, and the holidays brought people together. Rhode Island is tiny — you can traverse it in 45 minutes. But crammed into that smallish area are a million people, for a population density second only to that of New Jersey. If everyone in the world is connected by six degrees of separation, Rhode Islanders seem to be connected by maybe two.Central Falls, the epicenter of Rhode Island’s epidemic, has a density of 16,000 people per square mile, almost twice that of Providence. “Just imagine, 16,000 people per square mile — I mean, that’s amazing,” said Dr. Pablo Rodriguez, a member of the government committee that guides Covid vaccine distribution in Rhode Island. “It doesn’t take much for the spark to create an outbreak.”Apart from its density, Rhode Island has a high percentage of elderly residents in nursing homes, accounting for the bulk of deaths. Packed into the state are multiple urban areas — Central Falls, Pawtucket, Providence — where language barriers, mistrust and jobs have left immigrant families in multigenerational homes particularly vulnerable. The state is also home to multiple colleges that set off chains of infection in the early fall.For months, the hospitals in Rhode Island were understaffed and overwhelmed. Doctors and nurses were trying to cope with rising caseloads, often without the protective equipment they needed, with constantly shifting guidelines and with their own resilience stretched to the limit.Dr. Megan Ranney, a researcher and public health advocate, is also an emergency room physician at Rhode Island Hospital who has witnessed the full scope of the state’s crisis firsthand. What she saw unfold over a single shift offers a window into what happened.Dr. Megan Ranney, an E.R. physician at Rhode Island Hospital in Providence. “I’ve just got to plow through it,” she said during a surge in December.Credit…David Degner for The New York TimesAn ambulance outside Rhode Island Hospital last month.Credit…David Degner for The New York TimesA map on the asphalt of a school parking lot in Pawtucket.Credit…David Degner for The New York TimesPlowing Through ItOne day in late December, as the crisis reached new heights, Dr. Ranney girded for a long eight-hour shift. The sores behind her ears, where her glasses and the straps of the N95 and surgical masks dug in, still had not healed. But how could she complain, Dr. Ranney said, when her medical residents “eat, sleep, breathe Covid” five days a week?The patients had it worse, she knew. Anxious and isolated, they became even more discomfited by the masked and unrecognizable doctors and nurses rushing around them. During Dr. Ranney’s shift the prior week, she had seen a broad spectrum: elderly people on a downward spiral, otherwise healthy young Latino men, Cape Verdean immigrants with limited English comprehension.These demographics are partly what made Rhode Island particularly susceptible, said Dr. Ashish Jha, dean of the School of Public Health at Brown University in Providence: “Certainly in New England, it is the poorest state — so a lot of poverty, and a lot of multigenerational poverty.”As in most of the country, the Latino community has borne the brunt of the epidemic. In Rhode Island, Latinos have 6.7 times the risk for hospitalization and 2.5 times the risk of death, compared with white people. In the days before her shift, Dr. Ranney had been working in a part of the hospital intended to deal with non-Covid cases. But even people with other ailments, like ankle fractures, turned out to be positive for the virus, she found.“I never know from day to day how bad the surge will be,” she said. “I’ve just got to plow through it.”It turned out to be an extraordinarily busy day. “The E.R. is full, the hospital is full, the intensive care unit is full,” Dr. Ranney said. “All of our units are moving as quickly as they can, but the patients keep coming in.”Every time she took off masks during a shift, she ran the risk of contaminating herself. She had had four cups of coffee before this shift, and nothing since.The average age of the patients that night was about 70. One elderly woman who had trouble breathing could not isolate because she lived with her children and grandchildren. At any rate, she arrived at the hospital 10 days into her illness, too late for isolation to matter.The Coronavirus Outbreak

#masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutNew Variants TrackerAdvertisementContinue reading the main storySupported byContinue reading the main storyPlan to Ditch the Mask After Vaccination? Not So Fast.It’s not clear whether vaccinated people may still spread the virus, but the answer to that question is coming soon. Until then, scientists urge caution.A health care worker prepared a dose of the Pfizer-BioNTech vaccine at a vaccination site in San Francisco on Monday.Credit…Mike Kai Chen for The New York TimesMarch 3, 2021, 3:23 p.m. ETWith 50 million Americans immunized against the coronavirus, and millions more joining the ranks every day, the urgent question on many minds is: When can I throw away my mask?It’s a deeper question than it seems — about a return to normalcy, about how soon vaccinated Americans can hug loved ones, get together with friends, and go to concerts, shopping malls and restaurants without feeling threatened by the coronavirus.Certainly many state officials are ready. On Tuesday, Texas lifted its mask mandate, along with all restrictions on businesses, and Mississippi quickly followed suit. Governors in both states cited declining infection rates and rising numbers of citizens getting vaccinated.But the pandemic is not yet over, and scientists are counseling patience.It seems clear that small groups of vaccinated people can get together without much worry about infecting one another. The Centers for Disease Control and Prevention is expected shortly to issue new guidelines that will touch on small gatherings of vaccinated Americans.But when vaccinated people can ditch the masks in public spaces will depend on how quickly the rates of disease drop and what percentage of people remain unvaccinated in the surrounding community.Why? Scientists do not know whether vaccinated people spread the virus to those who are unvaccinated. While all of the Covid-19 vaccines are spectacularly good at shielding people from severe illness and death, the research is unclear on exactly how well they stop the virus from taking root in an immunized person’s nose and then spreading to others.It’s not uncommon for a vaccine to forestall severe disease but not infection. Inoculations against the flu, rotavirus, polio and pertussis are all imperfect in this way.The coronavirus vaccines “are under a lot more scrutiny than any of the previous vaccines ever have been,” said Neeltje van Doremalen, an expert in preclinical vaccine development at the National Institutes of Health’s Rocky Mountain Laboratories in Montana.And now coronavirus variants that dodge the immune system are changing the calculus. Some vaccines are less effective at preventing infections with certain variants, and in theory could allow more virus to spread.The research available so far on how well the vaccines prevent transmission is preliminary but promising. “We feel confident that there’s a reduction,” said Natalie Dean, a biostatistician at the University of Florida. “We don’t know the exact magnitude, but it’s not 100 percent.”Still, even an 80 percent drop in transmissibility might be enough for immunized people to toss their masks, experts said — especially once a majority of the population is inoculated, and as rates of cases, hospitalizations and deaths plummet.A line to register for a vaccination appointment in San Francisco. Experts say that people who have been inoculated should continue to wear masks to protect others.Credit…Mike Kai Chen for The New York TimesBut most Americans are still unvaccinated, and more than 1,500 people are dying every day. So given the uncertainty around transmission, even people who are immunized must continue to protect others by wearing masks, experts said.“They should wear masks until we actually prove that vaccines prevent transmission,” said Dr. Anthony S. Fauci, director of the National Institute for Allergy and Infectious Diseases.The Coronavirus Outbreak