The agency endorsed additional doses for people at high risk.The Centers for Disease Control and Prevention on Wednesday expanded its Covid vaccine recommendations, urging some people to get additional doses of the updated shots.The agency said that people 65 and older and those who are moderately or severely immunocompromised should receive a second dose of the vaccines that rolled out this fall six months after their first shot. Under the new guidelines, people with compromised immune systems also have the flexibility to get three or more doses of the updated vaccine, in consultation with their health care providers. This group includes people with advanced H.I.V. infection and those undergoing chemotherapy or receiving some therapies for autoimmune conditions, said Dr. Donald Dumford, an infectious disease doctor at the Cleveland Clinic.The move makes it easier for those most at risk for dying or becoming very sick from Covid to get additional protection.“If the person is willing to get it, great — we now have the green light to give it to them, in no uncertain terms,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center.Not everyone, of course, will be willing: Covid vaccine uptake has remained stubbornly low over the last few years. As of Oct. 12, only around 12 percent of adults reported receiving an updated vaccine, according to data from the C.D.C.The vaccines are well matched against the variants that are currently circulating, offering some defense against infection and curbing a person’s risk of hospitalization or death from the virus. Vaccines also reduce a person’s chances of developing long Covid. But immunity wanes over time.“There’s just a greater need than ever to have a more durable strategy, vaccination-wise,” said Dr. Marc Sala, co-director of the Northwestern Medicine Comprehensive Covid-19 Center in Chicago.Covid poses a particular challenge because the virus spreads year-round, spiking in unpredictable waves; it’s difficult to sustain protection, especially among people with compromised immune systems. The C.D.C.’s new recommendations signal a shift in how the medical community thinks about vaccinations, Dr. Schaffner said.“This is not a way we usually give vaccines,” he said. But, he added, “we have to move into this new way of providing vaccine protection.”

Pemgarda, available in the coming weeks, is intended for immunocompromised people who are unlikely to mount an adequate response after vaccination.The Food and Drug Administration has greenlit a new medicine to protect some of the people most at risk from Covid.The agency granted emergency use authorization for Pemgarda, a monoclonal antibody infusion, in immunocompromised people ages 12 and older. The drug is intended to protect against Covid for people who are not likely to mount an adequate immune response after vaccination. This includes those who have received stem cell or organ transplants and cancer patients taking medications that suppress the immune system.“It’s going to be for a very small section of Americans,” said Dr. Michael Mina, a former Harvard epidemiologist who is now the chief science officer for eMed, a telehealth company. But, he said, it’s a vital group to protect: the people who most feel left behind at this stage in the pandemic.“For people who are immunocompromised and literally defenseless because their immune system doesn’t really work, this is really an important development,” said Dr. Ziyad Al-Aly, the chief of research and development at the Veterans Affairs St. Louis Healthcare System.Pemgarda will become available within the next week or two, said David Hering, the chief executive of Invivyd, the company that makes it. The company is still evaluating what the drug will cost, Mr. Hering said; he expects that Medicare and private insurance plans will cover it.The drug is given as an infusion in doctors’ offices and other health care settings; it takes about an hour to complete the infusion. The most common side effects in a clinical trial included reactions at the infusion site, cold and flulike illness, fatigue, headaches and nausea. Four out of 623 participants in the trial experienced anaphylaxis, a severe allergic reaction.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The obesity medication contains tirzepatide, the same active ingredient in the diabetes drug Mounjaro.The decision by the Food and Drug Administration on Wednesday to approve the weight loss drug tirzepatide adds a potent new tool to the fast-growing arsenal of obesity drugs.The drug, which will go by the brand name Zepbound, contains the same compound in the sought-after diabetes drug Mounjaro. Many people have used Mounjaro off-label to lose weight since it was initially approved in May 2022, but the move could pave the way for insurance coverage and open the floodgates for more prescriptions.Zepbound is the second drug in a new class of obesity medications to be approved for weight loss, following Wegovy. And it is now likely the most effective treatment to combat obesity besides bariatric surgery, said Dr. Scott Hagan, an assistant professor of medicine at the University of Washington. But for many, Mounjaro has been hard to find in the year since it hit the market.“It’s very similar to what we went through with Ozempic,” said Dr. Andrew Kraftson, a clinical associate professor in the division of metabolism, endocrinology and diabetes at Michigan Medicine, noting that demand for weight loss medications has hit a “fever pitch.” Now, he said, patients will likely be clamoring for this new drug. Here’s what to know.Who qualifies for Zepbound?The F.D.A. approved Zepbound for people who have a body mass index — a much-criticized metric — of 30 or greater, which technically qualifies them as having obesity, or those with a B.M.I. of 27 who also have certain weight-related conditions, such as high blood pressure. Regulators said the drug should be used in combination with a reduced calorie diet and increased physical activity.How does tirzepatide work for weight loss?Zepbound, made by Eli Lilly, is the brand name for tirzepatide when used for weight loss. When the drug is prescribed for diabetes, it is sold under the brand name Mounjaro.Eli LillyLike semaglutide, the compound in Ozempic and Wegovy, tirzepatide slows down the emptying of the stomach. People feel fuller, quicker and for longer. All three drugs also target the area of the brain that regulates appetite, blunting cravings for many people.Semaglutide simulates a single hormone in the body, while tirzepatide mimics two, which experts say may be why it’s often more effective at triggering weight loss. In a 72-week clinical trial, funded by Eli Lilly, participants with obesity taking the highest dose of tirzepatide lost around 18 percent of their body weight on average. If I’m already taking Ozempic or Wegovy, should I switch?Not everyone reacts to these medications in the same way — someone might lose little to no weight on semaglutide, but shed pounds on tirzepatide, and vice versa, said Dr. Janice Jin Hwang, the division chief of endocrinology and metabolism at the University of North Carolina School of Medicine. People whose weight loss may be most closely tied to other health outcomes — such as those at risk for heart failure or liver disease — may benefit more from losing a significant amount of weight on a drug like Zepbound.But some people can lose too much weight taking these drugs, Dr. Hwang cautioned. Older people, in particular, should be mindful about their weight loss, since it can lead to shrinking muscle mass. Physicians need to weigh the risks and benefits for each patient, she said.“There’s no guidelines around any of this,” she said. “We’re just trying to think holistically about the patient.”Will insurance cover it and what is it likely to cost out of pocket?Coverage can differ from plan to plan, but some insurance companies will likely cover it for those who meet the F.D.A.’s criteria. Eli Lilly said in a press release that it expects Zepbound will be available in the U.S. by the end of the year at a list price of $1,059.87. What are the side effects?In an Eli Lilly-funded study of tirzepatide for obesity, gastrointestinal issues were the most common side effects. Roughly one-third of participants taking the highest dose of tirzepatide experienced nauseaand around one-fifth experienced diarrhea. Some participants also reported abdominal pain, vomiting, constipation, headache and dizziness. The F.D.A. approval states that people taking Zepbound may also experience burping, hair loss and gastroesophageal reflux disease.Because tirzepatide is so new, we do not know much yet about its long-term effects, Dr. Hwang said. And people taking these kinds of drugs for weight loss typically are advised to stay on them for the rest of their lives, she said.

Researchers are struggling to understand what is driving the gender disparity in lung cancer cases among people 35 to 54.Over the last several decades, the rates of new cases of lung cancer have fallen in the United States. There were roughly 65 new cases of lung cancer for every 100,000 people in 1992. By 2019, that number had dropped to about 42.But for all that progress, a disparity is emerging: Women between the ages of 35 and 54 are being diagnosed with lung cancer at higher rates than men in that same age group, according to a report published Thursday by researchers at the American Cancer Society. The disparity is small — one or two more cases among every 100,000 women in that age range than among men — but it is significant enough that researchers want to know more.The report adds to a mounting body of evidence that emphasizes the lung cancer risks for women in particular. Overall, lung cancer remains the leading cause of cancer death in the United States. The Centers for Disease Control and Prevention estimates that, nationwide, around 197,000 people are diagnosed with the disease each year.There’s a common perception that lung cancer occurs only in older men who have smoked for decades, said Dr. Narjust Florez, a thoracic medical oncologist at the Dana-Farber Cancer Institute. But, every day, she said, hundreds of women are “dying of lung cancer in this country.”What do we know about lung cancer disparities?Researchers are trying to make sense of why lung cancer rates are higher among younger women, as well as the best way to help patients. But there aren’t definitive answers. While lung cancer is still far more common in older patients, some doctors say they’re seeing more and more younger patients with the disease, even if they are not smokers — another puzzle they’re working to understand.Cigarette smoking remains the leading cause of lung cancer, and while there have been widespread efforts to reduce smoking, women have generally been slower to successfully quit, said Ahmedin Jemal, senior vice president of surveillance and health equity science at the American Cancer Society and an author on the new study.But about 15 to 20 percent of lung cancer cases in women are among those who have never smoked, he said. It’s tricky to tease out why these women develop the disease. They may be exposed to secondhand smoke. Or women might metabolize carcinogens differently from the way men do, said Dr. Jyoti Patel, medical director of thoracic oncology at the Lurie Cancer Center at Northwestern Medicine.Environmental exposures could also play a role. Air pollution has been linked to lung cancer, and it’s possible that women could be particularly susceptible to it, for reasons researchers are still working to understand, said Dr. Patrick Forde, an associate professor of oncology at Johns Hopkins Kimmel Cancer Center.Additionally, the C.D.C. cites radon — an invisible, naturally occurring gas that can build up in some homes — as the second leading cause of lung cancer. But data on residential radon exposure is mixed, Dr. Florez said.Ultimately, there is no clear-cut explanation for the disparities. “The differences are really not obvious,” said Dr. Humberto Choi, a pulmonary medicine doctor at the Cleveland Clinic. “This is definitely an area for future studies.”What are the early signs of lung cancer? And who should get screened?In 2021, the U.S. Preventive Services Task Force broadened its lung cancer screening recommendation: Anyone ages 50 to 80 who smoked at least a pack of cigarettes a day for 20 years or more, and who currently smokes or who has quit within the last 15 years, should get a CT scan annually. Medicare and most insurance plans fully cover this screening.Still, less than half of those eligible actually get screened, said Dr. Charu Aggarwal, a lung cancer specialist at Penn Medicine’s Abramson Cancer Center. That may be because of barriers to access, stigma associated with lung cancer or fear of what a screening may find.Gender bias can also affect testing, Dr. Florez said. Women, and particularly women of color, are less likely to be offered tests for lung cancer, she said.“I have women that have come with chest pressure and leave the office with Xanax,” she said. “And then when they start coughing up blood, that’s when somebody listens to them.”In light of the disparities, experts urged women to get screened if they qualify. If you have a close family history of lung cancer not associated with smoking, you should also talk to your doctor about evaluating your cancer risk, Dr. Forde said.And everyone should be aware of symptoms of lung cancer. Lung cancer is typically not detected until it is late stage, Dr. Forde said: partly because the symptoms go underrecognized, and partly because screening is underused. Early signs can include a cough that lasts for longer than six weeks, upper back pain, shortness of breath and unexplained weight loss, Dr. Florez said. Some people may also develop a hoarse voice; in severe cases, they may cough up blood, Dr. Patel said.“We’re seeing the demographics change,” Dr. Patel said. “People shouldn’t ignore symptoms that could lead to lung cancer diagnosis.”

The situation has left many patients frustrated and unable to start taking the weight loss drug.When Mark Basa needed his next dose of Wegovy, he worked his way down a list of 10 CVS stores within a 25-mile radius of his Peekskill, N.Y., home — and struck out at every one. In the 10 weeks he couldn’t find the drug, he regained the eight pounds he had lost on the medication, and his blood sugar rose. He felt himself get out of breath more often. His shirts fit tighter.“It was anxiety-inducing,” Mr. Basa, 37, said. “It was like, ‘Well, I’m never going to lose this weight.’”Wegovy has appeared on the Food and Drug Administration’s drug shortage list since March 2022. But doctors and patients say that the situation has worsened in the months since Novo Nordisk, the Danish company that manufactures the drug, limited the availability of the three lowest doses of Wegovy. With demand climbing faster than supply can keep up, the move effectively slows the pace of people starting the drug, because patients must begin with a low dose that is gradually increased. The shortage has fueled widespread frustration among potential patients, as well as those like Mr. Basa who need to refill their prescriptions or risk regaining weight.“It’s created this living hell,” said Dr. Andrew Kraftson, a clinical associate professor in the division of metabolism, endocrinology and diabetes at Michigan Medicine.A Novo Nordisk representative wrote in an email that the drugmaker anticipates “ongoing supply disruption” for those three doses as demand continues to outpace production. The company did not have an estimate for how long they will continue to limit those doses.“The pipe is closed,” said Dr. Scott Hagan, an assistant professor of medicine at the University of Washington who studies obesity. Dr. Hagan sees patients with severe arthritis in need of hip and knee replacements who are above the body mass index threshold for surgery; Wegovy could help them lose enough weight to have surgery, he said, but not if they’re unable to start the drug.What happens when people can’t find Wegovy?Wegovy is an injectable version of a compound called semaglutide, which slows the emptying of the stomach and, in turn, makes people feel full faster and for longer. It also targets the areas of the brain that regulate appetite, reducing cravings and silencing what some people call “food noise.”New patients start by injecting themselves weekly with the lowest dose of Wegovy for a month; after that, they can increase the dose monthly until they reach a “maintenance dose.”When people stop taking Wegovy, they often regain weight. And when patients can only access the medication in fits and starts, they may end up “weight cycling,” a term researchers use to describe fluctuations in weight — which may increase the risk of cardiovascular disease.Some patients end up temporarily taking older weight loss medications like Saxenda as a stopgap, but those alternatives are far less effective and can come with new side effects, Dr. Kraftson said. Others may end up trying to source semaglutide from compounding pharmacies, which can introduce a host of dangers and complications. Patients may want to switch to Ozempic, but that, too, can be hard to find.Dr. Padmaja Akkireddy, an endocrinologist at Nebraska Medicine, said that when patients stop taking Wegovy for more than a month, she starts them back on a lower dose — which can be disappointing for people looking to lose more weight, and faster.Others, like Ali Husain, have tried to find workarounds. Mr. Husain, 51, started the medication in March to cut down on weight he had gained earlier in the Covid-19 pandemic. By June, he was only able to find higher doses in stock. When his pharmacy accidentally sent him the highest dose after he spent weeks without the drug, he decided to measure his own lower doses. But after he resumed taking the medication and reached a higher dose, the side effects rattled Mr. Husain, who vomited so intensely that his stomach ached for days.One reason that patients are advised to follow the strict dosing schedule is to stave off side effects.“With a higher dose, there’s more weight loss, but also more side effects,” Dr. Hagan said. People can also experience more side effects if they go on and off the medication, Dr. Akkireddy said, because their bodies struggle to recalibrate.Mr. Husain’s doctor decided to put him back on a lower dose to mitigate his side effects. Hours before he spoke with The New York Times, Mr. Husain received a text from Walgreens. It was out of stock.

The updated shot is here. But pharmacies are rescheduling appointments, and some people are being told their insurance will not cover it.Vero Lopez was excited about getting the new Covid vaccine. She’s cautious about the virus, still carrying a mask around and avoiding indoor dining. So Ms. Lopez, 52, contacted her health care provider, Kaiser Permanente, as soon as she found out the shots were approved last week. She couldn’t get the vaccine through them yet, but a CVS drugstore near her home in Los Angeles did have an appointment. After another call to confirm her insurer would reimburse her, she booked it.Days later, she got a text from CVS: Her appointment had been canceled. More than a week after new Covid vaccines were approved and recommended for all Americans aged 6 months and older, some are having trouble getting the shots. Insurance companies are denying coverage, with some blaming the difficulties on billing codes. Pharmacies are canceling some appointments because the drugs haven’t arrived. And because the government is no longer paying for everyone’s vaccine, headaches around in- and out-of-network coverage are adding to the confusion.This is the first commercial Covid vaccine rollout since the start of the pandemic, marking the beginning of a newly privatized era for the drugs. Millions of doses have been shipped as hospitalizations rise. But, as with the earlier Covid vaccines, actually getting shots in arms has proved tricky.“We’ve heard these stories, and we’ve contacted the insurers,” said Xavier Becerra, the U.S. health and human services secretary, at a press event on Wednesday, where he received his own updated vaccine. He stressed that anyone with Medicaid, Medicare or private insurance should have the shot covered without a co-payment, and that anyone without insurance could request a free shot at pharmacies participating in the Bridge Access Program. “We’ve contacted the pharmacists, and we’re working with them to make sure everyone understands how this works,” Mr. Becerra said.Coverage is delayed for some people because the billing codes for the updated vaccines were not uploaded “in a timely manner,” said Danielle De Souza, a representative for the New York State Department of Health.Insurance companies are working to fix the billing issues, said James Swann, a representative for A.H.I.P., a national association of health insurance companies. Anthem Blue Cross Blue Shield said Thursday that its payment systems were now updated. A representative for Cigna Healthcare said that “most” claims were correctly processing.Several of the nation’s largest pharmacy chains acknowledged a challenging rollout. CVS, Walgreens and Safeway pharmacies have had to cancel and reschedule some appointments because of delayed shipments of the vaccines, the companies said. Other providers delayed making the shots available. Rite Aid said new vaccines would be in stores by this weekend; Kaiser Permanente said it would largely not administer Covid shots until next week.Kit Longley, a representative for Pfizer, said in an email that the company was not experiencing any shortages of its vaccine and had delivered several million doses. Moderna released a statement on Thursday saying it had also shipped millions of updated vaccines and was working to support distributors to ensure the doses got delivered. “We’ve gone from the federal government steering and driving vaccine supply and coverage to it being pushed out through regular market channels like it’s just another health care product,” said Lindsay Allen, a health economist at Northwestern Medicine.Cynthia Cox, a vice president at KFF, the health policy nonprofit formerly known as the Kaiser Family Foundation, expressed frustration that some insurers had failed to update their systems in time, even though the billing codes were released over a month ago. “This is a somewhat unprecedented situation,” she said. “I think there’s some understanding that there could be hiccups. But at the same time, we’re three years into this, and insurers and pharmacies have had months to prepare.”KFF did not know how many people were affected, she said. “At this point, we only have anecdotes, but we’re hearing so many of them that it feels like there is a widespread issue.” She added that health plans were supposed to cover vaccines at out-of-network pharmacies if there were no providers available in network. But Ms. Cox said that she herself could not get the vaccine at her local Walgreens in Silver Spring, Md., because the pharmacy was out of her network and wouldn’t accept a cash payment.“Even thought this is the exact area that I work in, there’s nothing I could do about it,” she said. What to do if your coverage gets denied“Our message is simple,” a representative for the Department of Health and Human Services said. “If you are being turned away for no coverage, please call your insurance for details about in-network coverage to receive the updated COVID-19 vaccine.” A representative from CVS advised people to schedule a later vaccine appointment if they ran into issues with their insurance. Ms. De Souza, the representative for the New York State Department of Health, said that people who paid out of pocket should contact their insurers as soon as possible.

For some, it’s a startling side effect.Until she started taking the weight loss drug Wegovy, Staci Klemmer’s days revolved around food. When she woke up, she plotted out what she would eat; as soon as she had lunch, she thought about dinner. After leaving work as a high school teacher in Bucks County, Pa., she would often drive to Taco Bell or McDonald’s to quell what she called a “24/7 chatter” in the back of her mind. Even when she was full, she wanted to eat.Almost immediately after Ms. Klemmer’s first dose of medication in February, she was hit with side effects: acid reflux, constipation, queasiness, fatigue. But, she said, it was like a switch flipped in her brain — the “food noise” went silent.“I don’t think about tacos all the time anymore,” Ms. Klemmer, 57, said. “I don’t have cravings anymore. At all. It’s the weirdest thing.”Dr. Andrew Kraftson, a clinical associate professor at Michigan Medicine, said that over his 13 years as an obesity medicine specialist, people he treated would often say they couldn’t stop thinking about food. So when he started prescribing Wegovy and Ozempic, a diabetes medication that contains the same compound, and patients began to use the term food noise, saying it had disappeared, he knew exactly what they meant.As interest has intensified around Ozempic and other injectable diabetes medications like Mounjaro, which works in similar ways, that term has gained traction. Videos related to the subject “food noise explained” have been viewed 1.8 billion times on TikTok. And some of the people who have managed to get their hands on these medications — despite persistent shortages and list prices that can near or surpass a thousand dollars — have shared stories on social media about their experiences.When food noise fadesWendy Gantt, 56, said she first heard the term food noise on TikTok, where she had also learned about Mounjaro. She found a telehealth platform and received a prescription within a few hours. She can remember the first day she started taking it last summer. “It was like a sense of freedom from that loop of, ‘What am I going to eat? I’m never full; there’s not enough. What can I snack on?’” she said. “It’s like someone took an eraser to it.”For some, the shortages of these medications have provided a test case, a way to see their lives with and without food noise. Kelsey Ryan, 35, an insurance broker in Canandaigua, N.Y., hasn’t been able to fill her Ozempic prescription for the last few weeks, and the noise has crept back in. It’s not just the pull of soft-serve each day, she said. Food noise, to Ms. Ryan, also means a range of other food-related thoughts: internal negotiations about whether to eat in front of other people, wondering if they’ll judge her for eating fried chicken or if ordering a salad makes it look like she’s trying too hard. Ozempic is more of a way to silence the food noise than anything else, she said.“It’s a tool,” she said. “It’s not like a magic drug that’s giving people an easy way out.”What causes food noise?There is no clinical definition for food noise, but the experts and patients interviewed for this article generally agreed it was shorthand for constant rumination about food. Some researchers associate the concept with “hedonic hunger,” an intense preoccupation with eating food for the purpose of pleasure, and noted that it could also be a component of binge eating disorder, which is common but often misunderstood.Obesity medicine specialists have tried to better understand why a person may ruminate about food for some time, said Dr. Robert Gabbay, chief scientific and medical officer of the American Diabetes Association. “It just seems to be that some people are a little more wired this way,” he said. Obsessive rumination about food is most likely a result of genetic factors as well as environmental exposure and learned habits, said Dr. Janice Jin Hwang, chief of the division of endocrinology and metabolism at the University of North Carolina School of Medicine.Why some people can shake off the impulse to eat, and other people stay mired in thoughts about food, is “the million-dollar question,” Dr. Hwang said.How does medication suppress food noise?The active ingredient in Ozempic and Wegovy is semaglutide, a compound that affects the areas in the brain that regulate appetite, Dr. Gabbay said; it also prompts the stomach to empty more slowly, making people taking the medication feel fuller faster and for longer. That satiation itself could blunt food noise, he said.There’s another theoretical framework for why Ozempic might quash food noise: Semaglutide activates receptors for a hormone called GLP-1. Studies in animals have shown those receptors are found in cells in regions of the brain that are particularly important for motivation and reward, pointing to one potential way semaglutide could influence cravings and desires. It’s possible, although not proven, that the same happens in humans, Dr. Hwang said, which could explain why people taking the medication sometimes report that the food (and, in some cases, alcohol) they used to crave no longer gives them joy.Researchers are continuing to investigate how semaglutide works, how it may influence aspects of the brain like food noise and the potential it has for other uses, like treating addiction.Ms. Klemmer said she worried about the potential long-term side effects of a medication she might be on for the rest of her life. But she thinks the trade-off — the end of food noise — is worth it. “It’s worth every bad side effect that I’d have to go through to have what I feel now,” she said: “not caring about food.”

As wildfire smoke blankets large swaths of the eastern United States, many people are experiencing physical symptoms, like prickling, stinging eyes; a scratchy throat; a runny nose; and some coughing. For those without underlying conditions, this will largely be a passing source of irritation. “You’ll be miserable a little bit, but you’ll be able to brush it off,” said Dr. Panagis Galiatsatos, a pulmonary and critical care medicine physician at Johns Hopkins Medicine.But for those who are most vulnerable, even brief exposures can have immediate ramifications, as exposure to toxins in the smoke can trigger inflammation and exacerbate existing health issues. This group includes children and adults with respiratory or cardiovascular conditions. “For vulnerable populations, the brevity of exposure may be enough to flare up underlying lung issues, or conditions overall,” Dr. Galiatsatos said. Babies, young children, older adults and pregnant women are also at higher risk of serious health effects.Governor Kathy Hochul of New York said that people with asthma are particularly at risk. “The bottom line is this: If you can stay indoors, stay indoors,” she said.Everyone may want to take precautions, but doing so is particularly critical if you are vulnerable. Here’s what health experts advise to minimize your risk:Monitor air quality.“Don’t let your eyes be the sole deciding factor” to determine the air quality, Dr. Galiatsatos said. Monitor the local Air Quality Index, which can be found at AirNow.gov.If the air quality is poor, stay inside as much as you can, said Dr. Samantha Green, a family physician at Unity Health Toronto. If the air quality is moderate and you have underlying conditions, you may want to continue to take precautions and minimize your time outside. Air Quality Index values above 100 mean that the air is unhealthy, and values between 51 and 100 are considered moderate.“These toxins — if you can avoid them, avoid them,” Dr. Galiatsatos said. “Staying at home, windows closed, that would be the most ideal situation.”Take precautions if you need to go outside.Don’t exercise or perform strenuous activity outdoors, said Laura Corlin, an assistant professor at Tufts University School of Medicine. If you need to go outside, wear a tightfitting mask, like an N95. When you return home, change your clothes, Dr. Galiatsatos said.The Centers for Disease Control and Prevention notes that dust masks, surgical masks and bandannas are not sufficient to protect children from smoke, and that N95 masks are typically not fitted for kids and may not provide adequate coverage. (Another well-fitting mask, like a KF94, can help.) The agency also said that breathing through a wet cloth would most likely not protect children from smoke.Make your indoor space as safe as possible.Experts advised keeping your windows closed. An air purifier like a HEPA filter can help, especially if it is in the room you spend the most time in. Dr. Corlin recommended minimizing activities that could interfere with indoor air quality: Don’t burn candles or use a fireplace, and don’t fry or boil meat.Limit time with large groups.Our immune systems work less effectively after we’ve been exposed to high levels of fine particulate matter in the air, said Dr. Francesca Dominici, a professor of biostatistics, population and data science at the Harvard T.H. Chan School of Public Health. If you are immunocompromised, you may want to limit unmasked indoor time with large groups of people, since you may be less able to fight off a virus someone passes to you.Monitor your health.Exposure to toxic air pollutants can raise the risk of heart attacks. If you are experiencing chest pain or shortness of breath, seek emergency attention.For people with underlying respiratory conditions, like asthma or chronic bronchitis, watch out for exacerbated symptoms, like difficulty breathing or more intense coughing, Dr. Dominici said. If you are experiencing heightened symptoms, contact your doctor, who might suggest increasing medication.Watch babies and young children to make sure that they are not struggling to breathe or excessively coughing, Dr. Dominici said. Parents may want to contact their children’s doctor if a child has asthma to see if they should alter their medication.

Billions of people live with the infection, but there has been scant progress for treatments and tests.When Lauren went to her doctors with stinging clusters of sores on her genitals, she assumed the pain was from a urinary tract infection. But at the OB-GYN, her doctor swabbed the bumps and told her that the rash was herpes. “No,” she remembered responding. “It’s not.”At the time, Lauren, who asked that her last name be withheld in order to talk about personal health issues, was a 19-year-old college student. She was in a two-year monogamous relationship with her second-ever sexual partner — a guy who occasionally dealt with an errant blister on his lip.They hadn’t known that oral herpes could induce cold sores, and that HSV-1, the virus that causes oral herpes, could be transferred to the genitals. Lauren’s boyfriend was convinced that she had cheated on him, and he broke up with her, she said.Lauren became withdrawn and almost failed out of college. “You think, Why does anything even matter anymore?” she said. “I’m never going to date. I’m never going to have a boyfriend.”That was in 2013. Over the last decade, Lauren has had only a few additional outbreaks, none as painful as her first. The mental strain — the depression she fell into after the diagnosis, the fear that future partners wouldn’t accept her — has been, by far, the hardest part of managing the disease. “It attacks your self-worth,” she said.Herpes is extremely common: The World Health Organization estimates that 3.7 billion people live with HSV-1, some oral and some genital. And cases like Lauren’s, where HSV-1 spreads to the genitals during oral sex, have sharply increased over the past two decades, said Dr. Jonathan Zenilman, a professor of medicine at Johns Hopkins University School of Medicine who specializes in sexually transmitted infections.But herpes isn’t a top priority for researchers, said Dr. Larry Corey, a professor and virologist at Fred Hutch Cancer Center in Seattle who has studied the virus. It isn’t even the top priority among those who study sexually transmitted infections, he added. “The disease has been sort of ignored by both the pharmaceutical industry as well as the medical research establishment,” he said.There are several potential reasons for this, experts theorize, including the relatively mild physical symptoms for most patients, clinicians’ reluctance to discuss sexual health and how hard it is to develop a vaccine for herpes.“The fact that a lot of the toll is psychological makes physicians not that interested in it,” said Dr. Anna Wald, a clinical virologist and a professor of medicine at the University of Washington School of Medicine.There has been little progress on more accurate tests, vaccines or additional treatments over the last few decades, Dr. Wald said. Part of the challenge is that the herpes virus can hide inside neurons that are shielded from the immune system, making the body’s immune response insufficient at eradicating the virus, she said — that’s why herpes remains in a person’s body for life. Vaccine attempts, so far, have not stimulated an immune response that can control the virus or prevent infection, she said.If a patient does not have symptoms, doctors typically diagnose herpes with an antibody test that is frequently inaccurate. Up to half of positive commercial test results could be false, according to past research. There is another antibody test, called the herpes Western blot, that scientists consider the gold standard in diagnosing herpes — but the test is only available through the University of Washington, which can be cumbersome and expensive for patients to obtain. Testing is typically reliable when a patient has symptoms; doctors can swab a lesion and run a highly sensitive molecular test.The U.S. Preventive Services Task Force doesn’t recommend routine genital herpes screenings for people without symptoms, in part because false positive rates are so high. On Tuesday, the task force reaffirmed its recommendation. In a related paper, a group of doctors wrote that the recommendation was, in part, based on “psychosocial harms” associated with false positives on herpes tests.And so the virus continues to spread essentially unchecked — exacerbated by just how ineffective the most widely available tests for herpes are, said Terri Warren, a nurse practitioner who has researched herpes. As cases circulate, patients are left grappling with a diagnosis that can be psychologically devastating, Dr. Zenilman said.“You can control the symptoms,” he added. “But lots of people feel stigmatized, dirty.”How herpes got sidelinedHerpes can be severe in certain cases: Babies can contract neonatal herpes from their mothers, putting them at risk for severe complications and even death. For people who are immunocompromised, outbreaks can be more prolonged and painful. In the vast majority of cases, though, people will have very mild symptoms, and many will have none. That’s part of the reason the infection is so pervasive: People pass it onto partners without knowing they have herpes. Those who contract HSV-1 may develop blisters on or around their mouths or, in some cases, on their genitals. HSV-2, the other predominant strain, is usually characterized by one or more lesions around the genitals or the rectum. In the United States, around one in six people between the ages of 14 and 49 has genital herpes, and over half of adults have oral herpes.Antiviral medications help reduce the amount of the virus a person sheds, lowering the chance that someone with herpes will pass it on to a sexual partner. Some patients take antivirals daily; others only take medication when they have an outbreak. But the risk of spreading herpes is never zero. The disease lingers in the body, putting the onus on patients to disclose their diagnosis to anyone with whom they have intimate contact.When Lauren started dating after her diagnosis, she found herself staying in relationships for longer than she might otherwise, scared nobody else would want to be with her. “I thought I was going to die alone,” she said.Brittany, 29, who asked that her last name be withheld in order to discuss her personal health, only thinks about her HSV-2 when she scrolls through a dating app. In the two years since she was diagnosed, she’s only had one outbreak. Still, when she looks at each profile, she wonders how the man would respond to learning about her diagnosis. “I just worry so much that people are going to judge me,” she said. “That no matter how I present it to them, I’ll still face rejection. That weighs heavily on me.”Some men have told her, flat-out, that they would never date someone with herpes, but what bothers her, too, are the ones who say, “I’m so sorry this happened to you.”“I don’t want people to feel sorry for me,” she said. “I wake up every day and I’m fine.”Scientists have worked on herpes vaccines in fits and starts since the 1970s, said Dr. Harvey Friedman, a professor of medicine at the University of Pennsylvania Perelman School of Medicine who has studied the disease for over 40 years. But past attempts have failed, for reasons researchers are still trying to uncover.Because herpes has been around for so long, the viruses have evolved alongside us, making them more difficult to eradicate, said Christine Johnston, an associate professor at the University of Washington School of Medicine who has studied herpes. There are new vaccines under development. Dr. Friedman is working with BioNTech on an HSV-2 vaccine candidate that was given to the first human subject in December. But none are in late-stage clinical trials, said Dr. Ina Park, a professor of family and community medicine at the University of California, San Francisco, and author of “Strange Bedfellows: Adventures in the Science, History, and Surprising Secrets of S.T.D.s.” “There’s nothing anywhere close to prime time,” she said.‘One of the biggest secret societies’When Ella Dawson, 30, contracted genital HSV-1 in college, she started to post openly about her diagnosis on social media. To her surprise, people came out of the woodwork to share their stories — friends, relatives, even a cashier who worked at the grocery store on campus. Many told her that they had never disclosed their diagnosis to anyone other than a sexual partner.“It’s one of the biggest secret societies in the world,” said Ms. Dawson, a novelist and writer who often speaks publicly about her experience with herpes.Courtney Brame, 34, started the herpes education advocacy organization and podcast Something Positive for Positive People after his own HSV-2 diagnosis. He’s seen how the disease “completely shatters a person’s identity,” he said, partly because of how central sexuality can be to someone’s self-worth. “They don’t feel like they have anything to contribute to a relationship now, just because they have herpes,” he said. “It’s like, ‘Who’s going to want me now that I have this?’”Mr. Brame has seen this in his own life. He was once messaging a woman on Tinder who brought up her struggle with chronic asthma; when he disclosed his own chronic condition, she stopped responding. But more often than facing rejection, when he shares his diagnosis, he said, he gets a different response: Women share that they, too, have herpes.Herpes stigma stems in part from the idea that people with the infection have done something “wrong,” Dr. Park said. But you can exercise every precaution and still get it, she added — condoms do not entirely prevent transmission, and you don’t even need to have penetrative sex to contract the virus.Though condoms can reduce the risk of transmission, not everyone with herpes will use a barrier method in long-term, monogamous relationships. In 2021, Something Positive for Positive People conducted a survey of over 1,000 people diagnosed with herpes; around 66 percent said a partner had consented to sex without a condom or other barrier method. And there is little research on how the virus spreads between women who have sex with women, Dr. Park said.Medical providers, in general, often don’t receive extensive education on talking to patients about sexual health, Dr. Johnston said. When it comes to herpes in particular, “health care providers can be really insensitive about it and minimize it,” she said. “This is thought of more as a nuisance than a serious infection.”“Clinicians don’t want to deal with this,” Ms. Warren said. “It involves people talking about sex. They’re crying, they’re going to have to talk about various specifics like is oral sex OK, is anal sex OK — I don’t think they want to go there,” she said.Without support from doctors, or medical innovations to cure the infection, people with herpes are left “dealing with two viruses at the same time,” as Ms. Dawson put it. “You’re dealing with the physical symptoms of the virus,” she said, “and you’re dealing with the mental strain.”

New research affirms what doctors have long advised: Go to bed and wake up at the same time every day for big health benefits.There are a few tried and true pieces of advice that sleep doctors always give for battling insomnia: Watch those alcoholic drinks at dinner, cut the afternoon coffee, stop scrolling before bed. And please, they beg: Keep your sleep schedule consistent.Flip-flopping between wake-up times — jolting awake at 7:30 on a Friday morning and then dozing until the afternoon on Saturday — wreaks havoc on our internal body clocks. Sleep experts refer to this as “social jet lag,” said Dr. Sabra Abbott, a sleep medicine specialist at the Northwestern Feinberg School of Medicine. Similar to changing time zones, heading to bed at vastly different times from night to night may throw off your circadian rhythm.And still, as anyone who’s worked a night shift, taken care of a toddler or fumbled back home after a party might tell you: Going to bed and waking up at the same times is easier said than done. “It’s a luxury, right?” said Kelsie Full, a behavioral epidemiologist and an assistant professor at Vanderbilt University Medical Center.Dr. Full is the lead author of a new study that tied irregular sleep to an early marker of cardiovascular disease. Researchers examined a week’s worth of sleep data from 2,000 adults over 45 and found that those who slept varying amounts each night and went to bed at different times were more likely to have hardened arteries than those with more regular sleep patterns.People whose overall sleep amounts varied by two or more hours from night to night throughout the week — getting five hours of sleep on Tuesday, say, and then eight hours on Wednesday — were particularly likely to have high levels of calcified fatty plaque built up in their arteries, compared with those who slept the same number of hours each night.The study could not confirm that inconsistent sleep patterns definitively caused the heart issues, Dr. Full said. And the findings don’t necessarily mean that the occasional late night or very early morning should be off the table.“An off day or two is OK,” said Dr. Tianyi Huang, an assistant professor of medicine at Harvard Medical School and a co-author of the study. “It’s more about the long-term pattern.”For most people, if you have a night or two of inconsistent sleep timing, you’re likely not going to throw off your entire circadian rhythm, said Aric Prather, a psychologist and sleep specialist at the University of California, San Francisco. And if you go to bed at 4 a.m. on a Saturday, you’re probably better off sleeping until noon and avoiding some of the acute effects of sleep loss than forcing yourself awake at the time you get up for work, he said.But the new study supports what previous research has theorized: Consistent sleep is crucial for health. A 2020 study found that people ages 45 to 84 with erratic sleep schedules were nearly twice as likely to develop cardiovascular disease as those with more regular sleep patterns. An analysis of over 90,000 people linked circadian rhythm disruptions with a greater risk of mood disorders. Researchers have even tied irregular sleeping patterns to high cholesterol and hypertension.Over the last decade, researchers have strengthened the link between sleep and heart health, specifically. Last summer, the American Heart Association added sleep duration to its checklist for measuring cardiovascular health. One theory for why consistent sleep helps your heart is that maintaining your circadian rhythm — the 24-hour cycle of your body’s internal clock — helps regulate cardiovascular function, Dr. Huang said. And a mounting body of research shows that catching up on your sleep during the weekends can’t compensate for staying up during the week, he added.People often think that sleeping in after several nights of limited sleep or insomnia will make them feel better, said Dr. Marri Horvat, a sleep specialist at the Cleveland Clinic, “but it usually doesn’t help,” she said. “Keeping a regular, set schedule is more likely to put your body in a place where it needs to be to get a full night’s sleep going forward.”So how do you actually get yourself to bed and wake up on a schedule? We asked sleep doctors to share tips.How to build a consistent sleep scheduleTreat yourself.Set a wake-up goal that feels attainable (even if it’s challenging), Dr. Prather said — and then reward yourself for getting out of bed. That could mean heading to your favorite coffee shop or saving the show you’ve been looking forward to for Saturday morning instead of Friday night.Pay attention to your pre-bedtime ritual.A regular bedtime routine — reading a few pages of a novel after you brush your teeth, for example — can help lock in a set sleep schedule. But the hours before you wind down for bed matter too, Dr. Horvat said. In the four hours or so before you head to bed, avoid alcohol, she suggested, and don’t work out (you may want to switch your dedicated exercise time to the morning.) These shifts will help you fall asleep faster and stay asleep longer.Find an accountability partner.Recruit a friend or a family member to get up around the same time you do, Dr. Prather recommended, and hold yourselves accountable by texting each other when you wake up. Even better: Make an early(ish) plan for brunch or a morning walk to give yourself added motivation for getting up.Get some sun.Light helps regulate our circadian rhythm, Dr. Abbott said, signaling to our bodies that it’s time to wake up. Take (even a brief) morning walk, if the weather allows, to expose yourself to sunlight around the same time each day, she recommended.Make your alarm as annoying as possible.If you can’t pry yourself out of bed on the weekends, Dr. Prather said, go for the nuclear option: Opt for an alarm you can’t ignore. Set a grating song as your alarm tone, or try a puzzle alarm — an app that makes you solve a puzzle to shut it off. For extra incentive to wake up, keep your phone across the room at night, instead of by your bed, so you have to force yourself out of your covers to turn off the alarm.Give yourself grace.“How aligned you are with your biological clock and how consistent you keep things does matter,” Dr. Prather said. “But that doesn’t mean every little moment, every week, matters.” Long-term sleep patterns are more important for overall health, he added, rather than worrying about one or two nights’ bad sleep. “It takes the pressure off,” he said.