In two decades covering medicine for The New York Times, the people I met, and the truths they revealed, have always stayed with me.“I would like to have lived longer, worked longer,” Sister Mary Andrew Matesich, a Catholic nun, told me in 2004. But, she said, “It’s not the hand I’ve been dealt.”She had breast cancer that had spread, and she had volunteered for experimental treatments, knowing they would probably not save her but hoping the research would help other patients.“I wouldn’t be alive today if other women hadn’t been in clinical trials,” she said.She died about a year after we spoke. She was 66.In 22 years of writing about medicine for The New York Times, I’ve covered births, deaths, diseases, new treatments that worked and some that failed, bold innovations in surgery and countless studies written up in medical journals. The goal has always been to provide clear information that readers would find useful and interesting, and to show the human side, what the news might mean for patients. Reporting on Covid in the past year, my work focused on vaccines and treatments, and also people with other serious illnesses who missed out on care because of the pandemic.Today is my last day as a staff writer at The Times. As I head into retirement, what stays with me most vividly are the people: their faces, their voices, their stories, the unexpected truths they revealed — sometimes after I put my notebook away — that shook or taught or humbled me, and reminded me that this beat is about much more than all the data I had tried to parse over the decades. It is a window into the ways that illness and injury can shape people’s lives, and the tremendous differences that advances in medicine can make, for those who have access to them.Many who spoke with me had suddenly become what we all fear turning into — patients — and faced tough situations. None were looking for attention, but they consented to interviews in the hopes that their stories might help or encourage other people.Tom and Kari Whitehead invited me into their home in 2012 to meet their daughter, Emily, then 7, who had been near death from leukemia when they gambled on an experimental treatment that genetically altered some of her cells. She was the first child to receive it. During our visit seven months after she was treated, she was doing somersaults and had decorated the family’s Christmas tree with a naked Barbie doll. Emily is 16 now, and the treatment she received was approved by the Food and Drug Administration in 2017.Other stories were achingly instructive. A woman described her painful, aggressive cancer, caused by a sexually transmitted virus, but needed her name left out because she believed her mother-in-law would call her a “slut” if she learned the diagnosis.A young former Marine, with a brain injury and severe damage to his face from a bomb in Iraq, said he had had a girlfriend before his deployment, and they had talked about getting married when he came back. “But I didn’t come back,” he said.Moments of kindness and wisdom stand out, too. A physician, pointing out that a little extra time for a cancer patient could mean being there for a wedding or graduation, forever softened my science writer’s cynicism about treatments that might add just months to a person’s life.In the middle of the night, I accompanied a transplant team assigned to recover organs, with parental consent, from a young woman who was brain-dead from a drug overdose. The team members slipped into a waiting room, taking special care to make sure that the relatives would not have to see the ice chests that would carry the young woman’s organs, including her heart.Looking for help with an article in January, I told Dr. James Bussel, an expert on blood disorders at Weill Cornell Medicine, about a woman who had developed a severe bleeding problem after a Covid vaccination. He surprised me by asking for the family’s phone number, so he could offer to help. Guided by Dr. Bussel, the woman’s doctors altered her treatment, a course change that the patient believes saved her life. Since then, Dr. Bussel has provided similar help in about 30 to 40 other cases of this rare disorder around the country.When I asked why he was willing to get involved, he said he had become a doctor to help people, and added, “I feel like I have this specialized knowledge and it would be silly to waste it, if I could make a contribution and help somebody.”In a smaller way, I’ve had similar aspirations. I’ve had the chance to do work that I believe is valuable, and that I hoped might do some good. Reporting for The Times has been a license to meet fascinating people and ask them endless questions. I am in debt to everyone who took the time to talk to me, and I hope I’ve done their stories justice.

Infected early in the pandemic, Dr. Tomoaki Kato, a renowned transplant surgeon, was soon on life support, and one of the sickest patients in his own hospital.Early in the pandemic, as hospitals in New York began postponing operations to make way for the flood of Covid-19 cases, Dr. Tomoaki Kato continued to perform surgery. Patients still needed liver transplants, and some were too sick to wait.At 56, Dr. Kato was healthy and exceptionally fit. He had run the New York City Marathon seven times, and he specialized in operations that were also marathons, lasting 12 or 16 or 20 hours. He was renowned for surgical innovations, deft hands and sheer stamina. At NewYork-Presbyterian/Columbia University Irving Medical Center, where he was the surgical director of adult and pediatric liver and intestinal transplantation, his boss has called him “our Michael Jordan.”Dr. Kato became ill with Covid-19 in March 2020.“I was in a denial situation,” he said. “I thought I was going to be fine.”But he soon became one of the sickest patients in his own hospital, dependent on a ventilator and other machines to pump oxygen into his bloodstream and do the work of his failing kidneys. He came close to death “many, many times,” according to Dr. Marcus R. Pereira, who oversaw Dr. Kato’s care and is the medical director of the center’s infectious disease program for transplant recipients.Colleagues feared at first that he would not survive and then, when the worst had passed, that he might never be able to perform surgery again. But after two months in the hospital, Dr. Kato emerged with a determination to get back to work and a new sense of urgency about the need to teach other surgeons the innovative operations he had developed. His own illness also enabled him to connect with patients in ways that had not been possible before.“I really never understood well enough how patients feel,” he said. “Even though I’m convincing patients to take a feeding tube, and encouraging them, saying, ‘Even though it looks like hell now, it will get better and you’ll get through it,’ I really never understood what that hell means.”He approaches those moments differently now: “‘I was there’ are very powerful words for patients.”Dr. Kato was infected before most doctors in New York understood the siege that lay ahead.“When we really realized something serious was coming, I think it was already there,” Dr. Kato said. “No one realized how much the virus had spread through the city. The virus was everywhere.”Dr. Marcus Pereira, who oversaw Dr. Kato’s care. “He looked very sick from the moment he got here, and you realize, this potentially might not end up well,” he said. “It was a very shocking moment.”Joshua Bright for The New York TimesHis illness began with a bad backache, and then fevers that went up and down for a few days. He stayed home, periodically checking his oxygen level, and getting readings of 93 and 94 percent — results now recognized as a possible sign of Covid pneumonia.But at that early point in the pandemic, he said, “Nobody knows what Covid pneumonia is.” And he did not feel very sick, he told colleagues who kept in touch by phone.Dr. Pereira said: “I think that fooled us for a few days while he was at home. His oxygen levels were a little low, but he said, ‘I feel fine,’ and his heart rate was not that fast. He was one of the first-wave patients, and we were still learning about Covid.”‘An eye-opening moment’One morning in the shower Dr. Kato suddenly could not breathe, and he began coughing violently. He tested his oxygen again: It was dangerously low, below 90 percent. He had resisted being hospitalized, as doctors often do, but now he had no choice.“That’s when I decided to check into the hospital,” he said.Dr. Pereira, a friend as well as a colleague, was stunned by Dr. Kato’s condition.“When we actually saw him in the hospital, it was an eye-opening moment,” Dr. Pereira said. “He looked very sick from the moment he got here, and you realize, this potentially might not end up well. It was a very shocking moment. His oxygen levels were very low, he was breathing very rapidly, his heart rate was going very fast, his chest X-ray looked like he had severe Covid.”By the next day, Dr. Kato was on a ventilator.“From there,” he said, “I have no consciousness for about four weeks.”His condition worsened. Bacterial infections set in, followed by sepsis. His kidneys began to fail, and he needed dialysis. His lungs could not work well enough to use the oxygen from the ventilator, and in the middle of one desperate night a surgeon was called in to connect him to a machine that would take over for his lungs by pumping oxygen directly into his blood and taking carbon dioxide out.The machine — called ECMO, for extracorporeal membrane oxygenation — is a last resort.“When someone is on ECMO, you’re suddenly into the absolute highest-mortality group,” Dr. Pereira said. “Your chances of coming back from that are in the single digits. When he went on that, it was sort of a moment. We all felt we were about to lose him.”Dr. Kato was a star, a towering figure in his field, and to see him struck down shook the hospital staff.“It was horrific,” said Dr. Jean C. Emond, the chief of transplant services, and Dr. Kato’s boss. “It was a terrible thing touching a friend and colleague. There was this fear like, Was the world going to end — this global sense of doom. A fear of surfaces. Would you bring it home on your shoes? That deep emotional context of both the global and the personal was happening at once.”People in the highest levels of leadership at the hospital kept asking how Dr. Kato was doing.“His survival represented the fate of all, in a funny way,” Dr. Emond said.A Covid patient in Billings, Mont., hooked up to extracorporeal membrane oxygenation. “When someone is on ECMO, you’re suddenly into the absolute highest-mortality group,” Dr. Pereira said.Larry Mayer/The Billings Gazette, via Associated PressPushing the limits in surgeryDr. Emond in 2008 had lured Dr. Kato away from the University of Miami, for his rare expertise in intestinal transplants and so-called ex vivo operations for cancer, in which the surgeon cuts out abdominal organs to get at hard-to-reach tumors, and then sews the organs back in. Most important, Dr. Emond saw in Dr. Kato a willingness to push the limits of what could be done surgically to help patients.“He brought his culture of innovation,” Dr. Emond said. “And his personal capability, his ability to work for long hours, never quitting, never giving up, no matter how difficult the situation, carrying out operations that many would deem impossible.”In his first year at Columbia, Dr. Kato and his team operated successfully on a 7-year-old girl, Heather McNamara, whose family had been told by several other hospitals that her abdominal cancer was inoperable. The surgery, which involved removing six organs and then putting them back in, took 23 hours.More and more patients from around the country, and around the world, began seeking out Dr. Kato for operations that other hospitals could not or would not perform. He had also begun making trips to Venezuela to perform liver transplants for children and teach the procedure to local surgeons, and he created a foundation to help support the work there as well as in other Latin American countries.As Dr. Kato’s colleagues struggled to save him, a waiting list of surgical patients clung to hopes that he would soon be able to save them.Gradually, Dr. Pereira said, there were signs of recovery.“You come in early in the morning to see him,” he said. “The hospital hallways are empty and everybody’s looking at each other, scared and anxious. You go into the intensive care unit dreading bad news, and the team is giving you a sort of hopeful thumbs-up that maybe he’s looking better.”Dr. Kato spent about a month on a ventilator, and a week on ECMO. Like many people with severe Covid, he was tormented by frightening and vivid hallucinations and delusions. In one, he was arrested at the Battle of Waterloo. In another, he had been deliberately infected with anthrax; only a hospital in Antwerp could save him, but he could not get there. He saw the white light that some people describe after near-death experiences. “I felt like I died,” he said.He had spent much of his adult life in hospitals, but never as a patient.“I never got sick,” he said. “I had never faced the reality of death.”When he was finally freed of the machines and breathing on his own, his doctors were elated.But the joy faded when he regained full consciousness and it was clear he was not himself. He was still caught up in the delusions. More worrisome, he seemed confused, his razor-sharp mind not fully back.“I wasn’t making sense,” Dr. Kato said.Scans found a blood clot and a hemorrhage in Dr. Kato’s brain. Although not severe, they were still troubling.“I remember seeing him, and not seeing him the way I wanted him to be,” Dr. Pereira said, adding that at the end of one day, “I went to my car and broke down. I said, ‘I hate Covid. Why won’t you even let me have a small victory?’”Dr. Emond said, “Once we got over, ‘Would he survive?’ in our minds was, ‘Will he be able to be a doctor again?’ He suffered. He paid a huge price.”But the brain hemorrhage and clot turned out to be minor. Mentally, Dr. Kato quickly recovered.About a week after coming off the ventilator, he said, “I woke up in my mind.”Physically, he struggled. He had lost 25 pounds, nearly all of it muscle. He needed a feeding tube. He was so weak that one day it took him an hour to reach the device to adjust the incline of his bed, and when he finally got it, he was too weak to push the button. His hair fell out. A shoulder injury from the way he had been positioned kept him from fully raising one arm, and some of his neck and back muscles had wasted away. He needed extensive physical therapy.His family could not visit. Painful as that was for them, he said, it may have been just as well that they never saw him at his worst, in a web of tubes and machines in the intensive care unit.In late May 2020, after two months in the hospital, he went home, his departure cheered by about 200 staff members, chanting “Kato! Kato!”‘He was back.’In August, he began performing surgery again. For the first operation, a hernia repair, he used a robotic device that allowed him to work sitting down.“It was a really big day for everybody,” Dr. Emond said. “A lot of us went in to see how it was going.”By September, Dr. Kato was performing liver transplants, with his sore shoulder wrapped in athletic tape.“He was back,” Dr. Emond said. “I think he was working exceptionally hard to prove to himself and everybody else that he was back.”After two months in the hospital, Dr. Kato was discharged in May 2020. By August, he was performing surgery again.Joshua Bright for The New York TimesHis first transplant patient wound up staying in the same hospital room where Dr. Kato had been, and they snapped a picture together.“From there, I’m kind of full speed,” Dr. Kato said. By March of this year, he had completed 40 transplants and 30 other operations.Memories of his own recovery have tempered his dealings with patients.“I can be much more on their side, in their shoes, in their thinking,” he said.He so disliked the thickened liquids used to help restore swallowing ability that now, he is less inclined to push them on reluctant patients.“It just tastes so horrible,” he said. “I really cannot blame anybody who cannot take it. A few weeks ago, a patient complained about the thickened milk. In the past I would have just said, ‘You have to do this to get better.’ Now I can say, ‘Maybe you don’t have to do it.’ Each patient may have a different way.”He even offers tips on the hospital menu.“The patient hates the food, I hate the food, but I know the Cajun shrimp is a little better,” he said. Protein drinks? “I recommend the strawberry flavor.”When he was taken off the ventilator, at first he could not speak.“I learned that when you cannot talk, it does not mean you are not thinking,” he said. “The mind is so clear.”Facing death has also brought his career and his goals into a sharper focus, he said.“You don’t really want to waste your time, because you never know — one day all of a sudden you are in this situation,” he said.He realized, he said, that he must recruit more surgeons to continue the work that he and his foundation had started, to bring liver transplants to children in Latin America.“If I died and nobody else picks it up, that’s a problem,” he said.He also feels driven to promote and teach others to perform the complex cancer operations that involve removing multiple organs to reach a tumor, and then putting the organs back in.“This cannot be just my thing forever,” he said “It has to be everybody’s.”

The disorder is rare, but so severe that the vaccine is on hold while experts weigh the risks and alert doctors and patients about symptoms and treatment.An 18-year-old woman was stricken with severe headaches, vomiting, seizures, confusion and weakness in one arm early this month, strokelike symptoms that doctors at a Nevada hospital were shocked to see in someone so young.Scans found several large blood clots blocking veins that drain blood from the brain, a condition that can disable or kill a patient.Doctors performed a procedure to suction huge clots from her brain, only to find that new ones had formed.The patient is one of six women ages 18 to 48 who developed clots in the brain within two weeks of receiving the Johnson & Johnson coronavirus vaccine. One died, and their devastating cases led U.S. health officials to recommend on Tuesday that use of the vaccine be paused.Two more cases have been added since then: one involving a man who was vaccinated during the company’s clinical trials and another involving a woman who received the vaccine after it had been authorized for general use.As in several of the original cases, the young woman in Nevada was initially treated with heparin, a standard blood-thinner that experts have since learned may actually worsen the rare clotting disorder that has affected small numbers of people who received the Johnson & Johnson or AstraZeneca vaccines in several countries. But until the last few weeks, doctors around the world had little information about the condition, and the doctors in Nevada did not recognize it immediately.“We were flying blind, based on reports from Europe and the U.K. hematological society,” said Dr. Brian Lipman, an infectious-disease specialist who helped care for the Nevada patient at Dignity Health St. Rose Dominican Hospital, Siena Campus, in Henderson.The U.S. decision to call for suspension of the use of the vaccine was intended to give officials time to learn more about the rare disorder causing the clots, to assess whether it is linked to the vaccine and to inform doctors and patients about how to recognize symptoms and treat the condition.The pause may last until at least next Friday, when expert advisers to the Centers for Disease Control and Prevention are scheduled to meet to review the data and decide whether to resume using the vaccine. Dr. Rochelle Walensky, the director of the C.D.C., and other top U.S. health officials sought on Friday to reassure the public that the pause, now extended more than a week, was a reasonable safeguard to assess risk. They also emphasized that over all, the Johnson & Johnson vaccine and the other vaccines in use in the United States were safe, given how many millions of Americans had gotten their shots without concern.But with the world staggered by a relentless epidemic, even temporarily stopping the use of a highly effective vaccine, which many countries had planned to deploy, is a fraught decision. Public health experts fear that the move sends a message that will erode trust globally even if the vaccine is reinstated and that huge numbers of people who could have been immunized will die needlessly from Covid-19 because they or their governments rejected the company’s vaccine.The United States, where Johnson & Johnson provided only about 5 percent of the Covid vaccine supply, can afford the suspension: It has plenty of other vaccine doses from Moderna and Pfizer-BioNTech to fill the gap. Other countries do not. And many nations have also stopped or limited the use of another effective vaccine, the one made by AstraZeneca, because it, too, has been linked to a similar rare clotting disorder.Health workers receiving the Johnson & Johnson vaccine in Johannesburg last month. While the U.S. can rely on other vaccines during the suspension, other countries do not have that luxury.João Siva/The New York TimesAbout 7.4 million Americans have received the Johnson & Johnson vaccine, and so far, only eight cases of the clotting problem have been reported, seven of them in women. In Europe, Britain, and three other countries, 222 cases have been reported, mostly in women under 60 — of 34 million people who have received the AstraZeneca vaccine. Several countries have now limited its use to older adults because so many cases have involved younger people.Researchers suspect that in these rare cases, the vaccine causes an intense reaction by the patient’s immune system, which churns out antibodies that activate platelets, a blood component needed for clotting. An unusual syndrome results, with extensive clotting that leaves the patient with low platelet levels and a tendency to bleed at the same time. Why this occurs in some people, many of them younger women, is not known, and experts say that they have so far been unable to identify traits or underlying conditions that may make some people susceptible.In a statement issued on Wednesday, Johnson & Johnson said: “The safety and well-being of the people who use our products is our number one priority, and we strongly support awareness of the signs and symptoms of this extremely rare event to ensure the correct diagnosis, appropriate treatment and expedited reporting by health care professionals. We continue to believe in the positive benefit-risk profile of our vaccine.”The company also said, in a letter published on Friday in The New England Journal of Medicine, that no causal link had been established between its vaccine and the clotting disorder.To some critics, it makes no sense to hobble a global vaccination campaign during a pandemic just because of a few cases of a rare disorder.But while rare side effects may be tolerated as the price we must pay for some drugs or vaccines, even the rarest ones are difficult to accept if they are severe and unpredictable — like blood clots in the brain, especially in young, healthy people.“This is a devastating complication,” Dr. Anthony Fauci, the chief medical adviser for the pandemic in the Biden administration, said in an interview.He added: “One woman died, three are in the hospital, one in intensive care. Even though the numbers are small, it is a devastating complication, so I believe — I didn’t make the decision — I believe their rationale, at least from what they communicated to me, is that they wanted to call a quick pause to see, to alert people. Sometimes this starts with minor symptoms, like a little abdominal discomfort, and then all of a sudden they wind up having a stroke.”He also said, “Maybe there are a lot more people out there we’re not noticing, because of the spectrum of the disease.”Informing doctors and the public of the symptoms — severe headaches, shortness of breath, leg or abdominal pain — could help identify more cases.Another reason for the pause, Dr. Fauci said, is to let doctors know that the drug heparin, a standard treatment for blood clots, should not be given to these patients, “because heparin in this circumstance can make things worse.”It is not known whether the heparin initially given to some of the patients exacerbated their condition.Experts are recommending the use of other blood thinners, which patients urgently need, because their blood clots keep growing, and new ones keep forming. Doctors in Europe who treated recipients of the AstraZeneca vaccine who had a similar condition said it could worsen rapidly..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-yoay6m{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-yoay6m{font-size:1.25rem;line-height:1.4375rem;}}.css-1dg6kl4{margin-top:5px;margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-1pd7fgo{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-1pd7fgo{padding:20px;width:100%;}}.css-1pd7fgo:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-1pd7fgo{border:none;padding:20px 0 0;border-top:1px solid #121212;}.css-1pd7fgo[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-1pd7fgo[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-1pd7fgo[data-truncated] .css-5gimkt:after{content:’See more’;}.css-1pd7fgo[data-truncated] .css-6mllg9{opacity:1;}.css-1rh1sk1{margin:0 auto;overflow:hidden;}.css-1rh1sk1 strong{font-weight:700;}.css-1rh1sk1 em{font-style:italic;}.css-1rh1sk1 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#ccd9e3;text-decoration-color:#ccd9e3;}.css-1rh1sk1 a:visited{color:#333;-webkit-text-decoration-color:#ccc;text-decoration-color:#ccc;}.css-1rh1sk1 a:hover{-webkit-text-decoration:none;text-decoration:none;}“The real issue is how long they take to make up their mind about what they’re going to do,” Dr. Fauci said of the C.D.C.’s advisory panel. “The rest of the world is watching this, and J.&J. is hopefully going to be an important part of the worldwide response, as is AstraZeneca.” He added, “You don’t want to rush them, but I hope they make up their minds in a reasonable amount of time.”Another of the first six patients with the clotting condition was a healthy 48-year-old woman who went to an emergency room in Nebraska because she had felt ill with abdominal pain for three days. Her case was described in a letter to the editor of The New England Journal of Medicine published on Wednesday. Her platelet count was low, and other blood tests were also abnormal. A C.T. scan found extensive blood clots in veins in her abdomen. She began having headaches, and another scan found clots in her brain.She was given heparin. More clots developed, and she had a hemorrhagic stroke.Doctors then learned that she had received the Johnson & Johnson vaccine two weeks before. They stopped the heparin and gave her a different blood thinner, along with intravenous immune globulin, a treatment also recommended for the clotting disorder. Her platelet count increased, but, the doctors wrote, “The patient remained critically ill at the time of this report.”The young woman in Nevada was fighting for her life and had to be placed on a ventilator, according to Dr. Lipman. He said he was speaking independently and not as a representative of the hospital.The patient’s family declined a request for an interview.Dr. Anthony S. Fauci discussed the pause of Johnson & Johnson Covid inoculations during a news briefing on Tuesday.Pete Marovich for The New York TimesDr. Lipman said that as the team had studied her blood samples, the pieces began to fall into place, and they realized that she appeared to have the same problem that they knew had been occurring in Britain and Europe after patients received the AstraZeneca vaccine, mostly in young women. They switched from heparin to another blood-thinner and began following guidance provided by doctors in Britain who had treated AstraZeneca recipients with a similar disorder.Hoping for more information about the condition and any possible connection to the Johnson & Johnson vaccine, Dr. Lipman called an emergency number at the Food and Drug Administration. It was a weekend, and he said the person who answered told him that no one was available to help and that the line had to be kept open for emergencies.“I thought this was an emergency,” Dr. Lipman said. “She hung up on me.”He called back, to ask how to reach Janssen, which makes the Johnson & Johnson vaccine. That information was not available, and he said the person who answered had also told him that the F.D.A. could not provide advice on patient care.An F.D.A. spokeswoman, Stephanie Caccomo, said in an email, “We’ll look into this further to ensure physicians calling F.D.A. for assistance receive the help they are seeking.”Dr. Lipman said that the pharmacist at his hospital had submitted a report online to the Centers for Disease Control and Prevention in early April but that the agency had not contacted him to ask about the case until this week. The agency declined to comment on whether it had communicated with Dr. Lipman, a spokeswoman, Kristen Nordlund, said by email.At a meeting on Wednesday of a C.D.C. advisory panel, Johnson & Johnson and Dr. Tom Shimabukuro, a safety expert at the agency, both presented data about the young woman in Nevada. After the meeting, Nevada officials issued a statement saying the meeting was the first time they had learned of a case in their state — they had previously told the public that no cases had been reported — and they were asking “federal partners” why the state had not been informed.At the Nevada hospital, an interventional radiologist passed a tube through blood vessels and on into the young woman’s brain and used a device to suction out the blood clots. More clots formed later, and he performed the procedure again.But the condition causes more than clots: The patient, like others, also had a brain hemorrhage.She was transferred to a larger hospital, where she is still on a ventilator, Dr. Lipman said. Her prognosis is uncertain, he said, adding, “Her life, not just her life, her entire family’s life, has been transformed.”Benjamin Mueller

New studies from Germany and Norway examined cases involving mostly younger people who developed serious and sometimes fatal blood disorders.Two reports published on Friday in a leading medical journal help to explain how AstraZeneca’s Covid vaccine can, in rare cases, cause serious and sometimes fatal blood clots.Scientific teams from Germany and Norway found that people who developed the clots after vaccination had produced antibodies that activated their platelets, a blood component involved in clotting. The new reports add extensive details to what the researchers have already stated publicly about the blood disorder.Why the rare reaction occurred is not known. Younger people appear more susceptible than older ones, but researchers say no pre-existing health conditions are known to predispose people to the problem, so there is no way to tell if an individual is at high risk.Reports of the clots have already led a number of countries to limit AstraZeneca’s vaccine to older people, or to stop using it entirely. The cases have dealt a crushing blow to global efforts to halt the pandemic, because the AstraZeneca shot — easy to store and relatively cheap — has been a mainstay of vaccination programs in more than 100 countries.Regulators in Europe have emphasized that the clotting disorder is rare, and that the vaccine’s benefits far outweigh its risks. But when a side effect has the potential to be devastating or fatal — like the blood clots in the brain linked to this vaccine — some regulators and segments of the public find the risk unacceptable, even if it is extremely rare.As of Sunday, European regulators had received reports of 222 cases of the rare blood-clotting problem in Britain and the 30-nation European Economic Area (the European Union plus Iceland, Norway and Liechtenstein). They said that about 34 million people had received the AstraZeneca vaccine in those countries, and that the clotting problems were appearing at a rate of about one in 100,000 recipients.European regulators said that as of March 22, they had carried out detailed reviews of 86 cases, 18 of which had been fatal.The safety bar for vaccines is set high, because they are given to healthy people. The seemingly greater vulnerability of younger people to the clotting disorder is of particular concern, because their risk of severe illness from Covid itself is lower than that in older people. Those differences suggest that overall, compared to older people, younger people may have less to gain and more to lose from the AstraZeneca vaccine.Doses of the Astra Zeneca vaccine, which is easy to store and relatively inexpensive, in a refrigerator in St. Mary’s Hospital in Dublin.Clodagh Kilcoyne/ReutersGermany, the Netherlands, the Philippines, Portugal and Spain have recommended that the AstraZeneca vaccine be given only to people over 60. Canada and France have limited it to those over 55; Australia, over 50; Belgium, over 56. Britain, where the vaccine was developed, has been its staunchest defender, but announced on Wednesday that it would begin offering alternative shots to people under 30.Cameroon, the Democratic Republic of Congo, Denmark and Norway have stopped using the vaccine.Full vaccination with the AstraZeneca vaccine requires two doses, but regulators in France have recommended that people under 55 who have had one dose get a different vaccine for their second shot.The AstraZeneca vaccine is not authorized for use in the United States, but the Food and Drug Administration is reviewing data on it to determine whether it should be.On Wednesday, the European Medicines Agency said that the vaccine’s labeling should be revised to include listing the clotting disorder as a “very rare” side effect of the vaccine.In a statement on its website, AstraZeneca said it was “actively collaborating with the regulators to implement these changes to the product information and is already working to understand the individual cases, epidemiology and possible mechanisms that could explain these extremely rare events.”The two new reports were published by The New England Journal of Medicine. One from Germany describes 11 patients, including nine women ages 22 to 49. Five to 16 days after vaccination, they were found to have one or more clots. Nine had cerebral venous thrombosis, a clot blocking a vein that drains blood from the brain. Some had clots in their lungs, abdomen or other areas. Six of the 11 died, one from a brain hemorrhage.One patient had pre-existing conditions that affected clotting, but during a news briefing on Friday, Dr. Andreas Greinacher, an author of the report, said those conditions most likely played only a minor role in the disorder that occurred after vaccination.All the patients, as well as 17 others with clots after vaccination whose blood was tested, had antibodies known to activate platelets.The antibodies led to a condition called thrombotic thrombocytopenia, which causes both clotting and abnormal bleeding. The researchers suggested naming the newly identified version in these patients “vaccine-induced immune thrombotic thrombocytopenia.”The article described specialized blood tests that can be used to diagnose the disorder, and suggested treatment with a blood product called intravenous immune globulin, which is used to treat various immune disorders. Drugs called anti-coagulants, or blood thinners, can also be administered in some cases, but not a commonly used one, heparin — because the vaccine-related condition is very similar to one that occurs, rarely, in people given heparin.The second report, from Norway, described five patients, one male and four female health care workers ages 32 to 54, who had clots and bleeding from seven to 10 days after receiving the AstraZeneca vaccine. Four had severe clots in the brain, and three died. Severe headaches were among their early symptoms. Like the German patients, all had high levels of antibodies that could activate platelets.The team from Norway also recommended treatment with intravenous immune globulin. The researchers said the disorder was rare, but “a new phenomenon with devastating effects for otherwise healthy young adults,” and they suggested that it may be more common than previous studies of the AstraZeneca vaccine had indicated.On Friday, European regulators also said they were reviewing reports of a few blood clot cases that occurred in people who had received the Johnson and Johnson vaccine. In the United States, federal agencies are investigating reports of a different type of unusual blood disorder involving a precipitous drop in platelets that emerged in a few people who had received either the Pfizer-BioNTech or Moderna vaccines.Benjamin Mueller and Melissa Eddy contributed.

“Breakthrough” cases, though quite uncommon, are a sharp reminder that vaccinated people should wear masks while the virus is circulating widely.More than two months after he was fully vaccinated against Covid, a doctor in New York woke up with a headache and a dull, heavy feeling of fatigue. A fever and chills soon followed, and his senses of taste and smell began to fade.This, he thought, could not be happening. But it was: He tested positive for the coronavirus.“It was a huge shock,” he said. He knew that no vaccine was perfect and that the Pfizer-BioNTech shots he received had been found 95 percent effective in a large clinical trial. “But somehow in my mind, it was 100 percent,” he said.The doctor, who requested anonymity to protect his privacy, is among the few reported cases of people who have been infected after being partly or even fully vaccinated. Nearly 83 million Americans have received at least one dose of a Covid vaccine, and it’s unclear just how many of them will have a “breakthrough” infection, though two new reports suggest the number is very small.One study found that just four out of 8,121 fully vaccinated employees at the Southwestern Medical Center in Dallas became infected. The other found that only seven out of 14,990 workers at UC San Diego Health and the David Geffen School of Medicine at the University of California, Los Angeles tested positive two or more weeks after receiving a second dose of either the Pfizer-BioNTech or Moderna vaccines. Both reports, published on Tuesday in the New England Journal of Medicine, show how well the vaccines work in the real world, and during a period of intense transmission.But these breakthrough cases, though quite rare, are a sharp reminder that vaccinated people are not invincible, especially when the virus continues to circulate widely.“We felt really strongly that this data should not lead people to say, ‘Let’s all get vaccinated and then we can all stop wearing masks,’” said Dr. Francesca J. Torriani, an infectious disease specialist at UC San Diego Health who led the California study. “These measures have to continue until a larger segment of the population is vaccinated.”Only some of the Covid-positive health workers in the California study showed symptoms, she said, and they tended to be mild, suggesting that the vaccines were protective. That echoes data from the vaccine trials indicating that breakthrough infections were mild and did not require hospitalizations. Some people had no symptoms at all, and were discovered only through testing in studies or as part of their medical care.For example, doctors at the University of North Carolina found a few asymptomatic cases in vaccinated patients who were tested for the coronavirus ahead of surgery or other medical procedures, according to Dr. David Wohl, the medical director of that center’s vaccine clinic.He said the absence of symptoms may have meant that the vaccine was doing exactly what it is supposed to do: prevent people from getting sick, even if it does not fully block the virus from infecting them.The Centers for Disease Control and Prevention has a small team studying breakthrough cases, said an agency spokeswoman, Kristen Nordlund. One question the researchers are considering is whether particular variants of the coronavirus might play a role in breakthrough cases.“Currently, there is no evidence that Covid-19 after vaccination is occurring because of changes in the virus,” Ms. Nordlund said.In the next few months, Pfizer and Moderna are expected to release data that should indicate how often vaccinated people become infected by the virus, even if they have no symptoms. The companies have been testing participants in their vaccine trials for antibodies to a protein called N that is part of the coronavirus but not part of the vaccine. Finding those antibodies means that a vaccinated person has been infected by the virus. Some volunteers from the studies are also having their noses swabbed regularly to test for an active viral infection.Another question is how effective the vaccines are in people whose immune systems have been weakened by illness or medications, said Dr. William Schaffner, an infectious disease expert at Vanderbilt University. Breakthrough cases might occur in those people because their bodies cannot produce a robust reaction to a vaccine.“And it is amazing how pervasive immunocompromise is,” Dr. Schaffner said. He called the condition “a testament to modern medicine,” because many patients with it are being treated successfully for conditions that not so long ago would have killed them.The doctor who became ill in New York despite full vaccination stayed in isolation at home for nearly two weeks. He described his illness as relatively mild, and said he was treated with monoclonal antibodies to fight the virus. “If the worst flu is a 10, this was a four,” he said.Without the vaccine, he said, he believes he would have been sicker.“I would have been in fear for my mortality,” he said. “But I didn’t have a moment’s anxiety. I did not think I was going to die. Thinking you’re not going to die — that’s a pretty big thing.”Apoorva Mandavilli contributed reporting.

#masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutGuidelines After VaccinationAdvertisementContinue reading the main storyCovid-19 Live Updates: Worries Over AstraZeneca Doses Upend Europe’s Vaccine DriveModerna begins testing Covid vaccine in babies and young children.March 16, 2021, 7:02 a.m. ETMarch 16, 2021, 7:02 a.m. ETBrittany Siguenza, 5, watching her mother receive a Moderna vaccine dose in Massachusetts on Friday.Credit…Cj Gunther/EPA, via ShutterstockThe drug company Moderna has begun a study that will test its Covid vaccine in children under 12, including babies as young as six months, the company said on Tuesday.The study is expected to enroll 6,750 healthy children in the United States and Canada. “There’s a huge demand to find out about vaccinating kids and what it does,” said Dr. David Wohl, the medical director of the vaccine clinic at the University of North Carolina, who is not involved the study.In a separate study, Moderna is testing its vaccine in 3,000 children ages 12 to 17.Many parents want protection for their children, and vaccinating children should help to produce the herd immunity considered crucial to stopping the pandemic. The American Academy of Pediatrics has called for expansion of vaccine trials to include children.Each child in Moderna’s study will receive two shots, 28 days apart. The study will have two parts. In the first, children aged 2 years to less than 12 may receive two doses of 50 or 100 micrograms each. Those under 2 years may receive two shots of 25, 50 or 100 micrograms.In each group, the first children inoculated will receive the lowest doses and will be monitored for reactions before later participants are given higher doses.Then, researchers will perform an interim analysis to determine which dose is safest and most effective for each age group.Children in part two of the study will receive the doses selected by the analysis — or placebo shots consisting of salt water.The children will be followed for a year, to look for side effects and measure antibody levels that will help researchers determine whether the vaccine is effective. The antibody levels will be the main indicator, but the researchers will also look for coronavirus infections, with or without symptoms.Dr. Wohl said the study appeared well designed and likely to be efficient, but he questioned why the children were to be followed for only one year, when adults in Moderna’s study are followed for two years. He also said he was somewhat surprised to see the vaccine being tested in children so young this soon.“Should we learn first what happens in the older kids before we go to the really young kids?” Dr. Wohl asked. Most young children do not become very ill from Covid, he said, though some develop a severe inflammatory syndrome that can be life threatening.Johnson & Johnson has also said it would test its coronavirus vaccine in babies and young children after testing it first in older children.Pfizer-BioNTech is testing its vaccine in children ages 12 to 15, and has said it plans to move to younger groups; the product is already authorized for use in those 16 and up in the United States.Last month, AstraZeneca began testing its vaccine in Britain in children 6 years and older.AdvertisementContinue reading the main story

AdvertisementContinue reading the main storySupported byContinue reading the main storyEbola Survivor Infected Years Ago May Have Started New OutbreakGenetic sequencing of virus samples from patients in Guinea suggest that the new outbreak is a continuation of the 2014-16 epidemic.Researchers were shocked to discover that an Ebola outbreak in Guinea was most likely started by a man infected at least five years ago. Here a hospital worker in Guinea is given an Ebola vaccine.Credit…Carol Valade/Agence France-Presse — Getty ImagesMarch 12, 2021, 10:31 p.m. ETAn Ebola outbreak now occurring in Guinea was almost certainly started by someone who survived West Africa’s historic 2014-16 epidemic, harbored the virus for at least five years and then transmitted it via semen to a sex partner, researchers reported on Friday.The finding, based on genetic sequencing of virus samples taken from patients in the current outbreak, shocked researchers. Until now, the longest the virus had been known to persist in a survivor was 500 days.“It’s a stunner,” Dr. William Schaffner, an infectious-disease expert at Vanderbilt University who was not involved in the research, said in an interview. “This is an extraordinary phenomenon.”The current outbreak in Guinea was first recognized in January and has infected at least 18 people and killed nine.The discovery that a survivor most likely started the outbreak has profound implications. West Africa’s previous epidemic infected more than 28,000 people, killed more than 11,000 and left thousands of survivors, some of whom were already being shunned because of fears about the disease. The prospect that those who survived might be infectious for years is likely to worsen their plight.The new finding also raises the possibility that other outbreaks in the region, assumed to have begun with transmission from animals, may actually have been started by survivors with unrecognized, lingering infections.One possible solution, Dr. Schaffner said, would be “to vaccinate much of equatorial Africa” against Ebola even where there is no current outbreak. Effective vaccines are available, one made by Merck and another by Johnson & Johnson, but so far they have generally been used only in response to outbreaks.People recover from Ebola when their immune systems wipe out the virus. But certain parts of the body, including the eye, the central nervous system and the testes are so-called privileged sites, beyond the reach of the immune system. The virus can sometimes hide in those spots. But no one knew it could hide out for so long.“We have no idea how often this may be happening,” Dr. Schaffner said. “Some studies are underway. As you can imagine, it’s not easy to study hiding viruses in immunologically privileged sites, like the testicles, the eye and, rarely, the central nervous system. Those are not accessible places for easy study.”Genetic sequences of virus samples from the current patients were compared to those from the 2014-16 outbreak and were found to be so similar that they had to be closely related, researchers said. The report, posted online on Friday, involved researchers from the Guinea Ministry of Health, other labs in that country, Senegal’s Pasteur Institute, the University of Edinburgh, the University of Nebraska Medical Center and the company PraesensBio.The findings were reported earlier on Friday by Science and Stat.“There are very few genomic changes, and for those to occur, the virus has to multiply,” Dr. Schaffner said. “I think the virus is in hibernation for the most part.”“Among other things, it shows you what brilliant insights molecular whole-genome sequencing can provide,” he said. “Till this moment, all of us thought the current outbreak was a consequence of transmission from nature, from bats. But it likely came from a human reservoir.”Michael Wiley, a virologist at the University of Nebraska Medical Center and the chief executive of PraesensBio, which provided materials used to study the samples, described the current outbreak as a “continuation” of the previous one.He said persistent infections and sexual transmission had already been recognized during the West African outbreak and during one in the Democratic Republic of Congo. Each new milestone for viral persistence has come as a shock, he said: first 180 days, then 500 days, and now more than five years after the initial infection.The U.S. Centers for Disease Control and Prevention said in a statement provided by its spokesman, Thomas Skinner: “CDC has reviewed the sequencing data from samples taken during the current outbreak in Guinea. While we can’t be 100 percent certain, CDC agrees that data supports the conclusion that cases in the current outbreak are likely linked to cases in the area during the 2014-2016 West Africa Ebola outbreak.”He added: “This suggests the outbreak was likely started from a persistent infection, a survivor, and not a new introduction of the virus from the animal reservoir. While we have seen outbreaks in the Democratic Republic of Congo linked to survivors, the length of time between the end of the 2014-2016 outbreak and the emergence of this outbreak is surprising and highlights the need for further research to better understand the complex epidemiology and ecology of Ebola.”Dr. Ian Lipkin, a virologist at Columbia University, said that after male patients had several semen samples that tested negative for Ebola, they were generally assumed to have cleared the virus, but that that was not always a correct assumption.“Somebody who had Ebola should probably be monitored on a regular basis to make sure they’re negative and remain negative,” he said.AdvertisementContinue reading the main story

AdvertisementContinue reading the main storySupported byContinue reading the main storyYearly Lung Cancer Scans Are Advised for People 50 and Over With Shorter Smoking HistoriesNew advice from an influential panel will make more women and African-Americans eligible for CT scans, but some who need them most may not be able to afford them.A computed tomography scan of the lungs of a healthy adult man. The panel recommended low-dose CT scans, so-called because they involve a relatively small amount of radiation, and cost about $300.Credit…Alamy Stock PhotoMarch 9, 2021Updated 11:21 a.m. ETNew guidelines from medical experts will nearly double the number of people in the United States who are advised to have yearly CT scans to screen for lung cancer, and will include many more African-Americans and women than in the past.The disease is the leading cause of U.S. cancer deaths, and the goal of the expanded screening is to find it early enough to cure it in more people at high risk because of smoking. In those individuals, annual CT scans can reduce the risk of death from the cancer by 20 to 25 percent, large studies have found.The new recommendations, by the U.S. Preventive Services Task Force, include people ages 50 to 80 who have smoked at least a pack a day for 20 years or more, and who still smoke or have quit within the past 15 years.The advice, published on Tuesday in the medical journal JAMA, differs in two major ways from the task force’s previous guidelines, issued in 2013: It lowers the age when screening should start, to 50 from 55, and it reduces the smoking history to 20 years, from 30.Those changes will add more women and African-Americans to the pool eligible for screening, because they tend to smoke less heavily than the white male study participants on whom earlier guidelines were based. Women and Black Americans also tend to develop lung cancer earlier and from less tobacco exposure than do white men, experts said.Why the risk appears to differ by race and gender is not known.“Some studies have alluded to some hormonal influences in women,” Dr. Mara Antonoff, a lung surgeon at the M.D. Anderson Cancer Center in Houston, said in an interview. “In terms of racial differences, we don’t have an answer. We have population-based data to show they have a tendency to develop lung cancer younger and with less exposure to tobacco, but we don’t have a mechanism.”Under the new criteria, 14.5 million people in the United States will qualify for the screening, an increase of 6.4 million.The task force includes 16 physicians, scientists and public health experts who periodically evaluate screening tests and preventive treatments. Members are appointed by the director of the federal Agency for Healthcare Research and Quality, but the group is independent and its recommendations often help shape U.S. medical practice.The use of chest X-rays to detect lung cancer was largely abandoned decades ago because they could not find the disease early enough to be useful.The CT scans, called low-dose CT — because they involve a relatively small amount of radiation — cost about $300. Patients are advised to stop the screening once they have not smoked for 15 years, or if they develop health problems that would substantially shorten their life expectancy or make them unable to have lung surgery if needed.Patients have not flocked to clinics for this screening. Researchers estimate that only 6 to 18 percent of those who qualify and could be helped by the screening have taken advantage of it. Some cannot afford it.“Part of the low uptake is simply lack of access to care,” said Dr. Robert Smith, a screening expert at the American Cancer Society. “Smoking in general is increasingly concentrated in lower-income populations.”The Affordable Care Act does require that insurers cover any screening broadly recommended by the task force, with no out-of-pocket costs.Bettye Givens, right, of south Kansas City, reviewing lung scans with her doctor in 2017. She received a low-dose CT scan that detected her lung cancer at its earliest stage and was successfully treated.Credit…Andy Marso/Kansas City Star/TNS/Alamy Live NewsBut researchers have found that half the population eligible for lung-cancer screening had either no insurance, or Medicaid, Dr. Smith said. Not all Medicaid plans have covered the screening, according to an editorial in JAMA.“There could be a 15-year period when you might quality for screening and not have any insurance,” Dr. Smith said.He and other researchers also said that patients may be missing out on lung-cancer screening because they just don’t know about it. It has not received as much attention as other cancer screenings, like mammograms, colonoscopies and Pap tests. Some doctors may not encourage it as strongly, and especially with former smokers, may not take the time to calculate a patient’s smoking history to see if it matches the guidelines.The changes in the criteria for smoking history and screening age were based on new data from multiple studies, Dr. Alex H. Krist, the task force chairman and a professor of family medicine and population health at Virginia Commonwealth University, said in an interview.“Lung cancer is the No. 1 cancer killer in America,” Dr. Krist said, adding that with the new data, “we have even more confidence that screening does save lives.”Like other kinds of screenings affected by the pandemic, those for lung cancer remain below 2019 levels, according to an analysis of Medicare data by Avalere Health, a consulting firm, conducted for Community Oncology Alliance, which represents independent cancer specialists.While the number of screenings had started to rebound in the summer, the fresh spike in Covid cases later in the year caused them to fall again. In November, screenings were down by 30 percent, compared to 2019, and the number of lung biopsies had also dropped, indicating cases were not being diagnosed.Using its own grading system, the task force gave its recommendation a B, saying there was “moderate certainty” that annual screening was of “moderate net benefit.”That may not sound like a ringing endorsement, given that a grade of A means “high certainty that the net benefit is substantial.” But anything with an A or B grade should be offered to patients, according to task force rules.“There is building evidence that a pretty simple, five-minute, low-dose, low radiation scan can really save a lot of people’s lives,” said Dr. Bernard J. Park, a lung surgeon and the clinical director of the lung-screening service at Memorial Sloan Kettering Cancer Center in New York. About 75 to 85 percent of the cancers found with this screening are Stage 1, and curable with just surgery or radiation, he estimated.Dr. Park said that many people who signed up for the screening had quit smoking or were trying to stop, but that a few regarded clear scans as a sign that they could keep smoking.Dr. Smith said that the American Cancer Society was due to revise its own guidelines for lung-cancer screening, and that its advice would probably be similar to that of the task force.In 2013, the American Academy of Family Physicians declined to recommend for or against CT screening for lung cancer, saying there was insufficient evidence. But the president, Dr. Ada Stewart, said in an emailed statement on Monday that the academy would review the new task force evidence and decide whether to update its own recommendation to its members.Globally, there were 2.09 million new cases of lung cancer in 2018, and the disease is also the leading cause of cancer deaths, killing 1.76 million people that year, according to the World Health Organization.There were 228,820 new cases of lung cancer in the United States in 2020, and 135,720 people died from it, according to the National Cancer Institute. About 90 percent of cases occur in people who smoke, and current smokers’ risk of developing the disease is about 20 times that of nonsmokers.Only about 20.5 percent of patients survive five years after the diagnosis. Most cases are diagnosed late, after the cancer has begun to spread. But if it can be found and treated early, cure is possible, doctors say.CT screening has risks, and doctors say those must be explained to patients, who may decide to decline the testing. The scans detect tiny nodules in the lungs that may be early cancers — or maybe not. A suspicious-looking spot could be just a minor infection, inflammation or a benign growth, Dr. Park said.Often, the nodules can just be monitored with repeat scans, but it can be nerve-racking for patients to spend months waiting for the next test, knowing there is something in their lung that might be malignant.False positive rates, when something harmless is mistaken for cancer, have ranged from 3.9 to 25 percent and higher in studies, but tend to decrease over time, as the patient has more annual scans.A major concern about false positives is that they can lead to invasive procedures like lung biopsies. One large study found that invasive procedures were performed needlessly in 1.7 percent of the patients who were screened. The task force report said that standards created by radiology societies for evaluating the scans could help to prevent some unnecessary procedures spurred by false positives.Another possible risk from screening is the chance that the cumulative radiation exposure could cause cancer. But the dose is low, and the risk is thought to be small, especially when compared with the risk of lung cancer caused by smoking.In theory, screening could also lead to unneeded invasive tests and treatment for a cancer that would not have progressed or harmed the patient. How often that might occur is not known, but it is considered rare.Reed Abelson contributed to this article.AdvertisementContinue reading the main story

#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 storyA Few People Report Delayed Skin Reactions to the Covid VaccineDoctors are reporting additional, minor symptoms that appear several days after people have received their shots.By sharing the information about reactions, doctors said they wanted to help prevent the needless use of antibiotics and to ease patients’ worries about getting their second vaccine shot.Credit…Mike Kai Chen for The New York TimesMarch 3, 2021, 6:27 p.m. ETSome people are having delayed reactions to their first dose of a Covid vaccine, with their arms turning red, sore, itchy and swollen a week or so after the shot.The reactions, though unpleasant, appear to be harmless. But the angry-looking skin condition can be mistaken for an infection, according to a letter published on Wednesday in The New England Journal of Medicine. The doctors said they wanted to share information about the cases to help prevent the needless use of antibiotics and to ease patients’ worries and reassure them that they can safely get their second vaccine shot.“We modified our patient handout once we started seeing this,” Dr. Kimberly G. Blumenthal, an author of the letter and an allergist at Massachusetts General Hospital, said in an interview. “We had said it was normal to get redness, itching and swelling when you get the vaccine. We changed the wording to say it can also start seven to 10 days after you get the vaccine.”The letter describes the experiences of 12 people who had “delayed large local reactions” that began four to 11 days after the first shot of the Moderna vaccine, within a median of eight days. The report is not a controlled study, but rather a series of cases that came to the doctors’ attention because the vaccine recipients were concerned and wanted to know whether they should get the second shot.Most were vaccinated at Massachusetts General Hospital, where both the Moderna and Pfizer-BioNTech vaccines were administered. But the delayed reactions occurred only in people who had received the Moderna shot, Dr. Blumenthal said, adding, “I don’t understand why.”Delayed skin reactions in various patients after receiving the mRNA Covid vaccines.Credit…New England Journal of MedicineModerna reported delayed skin reactions in its large clinical trial in 0.8 percent of recipients after the first dose, and 0.2 percent after the second dose.The Coronavirus Outbreak