The agreement would end thousands of lawsuits against the three largest distributors and Johnson & Johnson and require them to pay billions for addiction treatment and prevention.The three largest pharmaceutical distributors and Johnson & Johnson are on the verge of a $26 billion deal with states and municipalities that would settle thousands of lawsuits over their role in the opioid epidemic and pay for addiction and prevention services nationwide.An agreement could be announced later this week, although several people with direct knowledge of the talks cautioned that there were still details being negotiated.The settlement would not conclude all of the multifaceted nationwide opioid litigation but would end legal action against some of the companies with the deepest pockets in the pharmaceutical supply chain: the country’s major medical distributors, Cardinal Health, McKesson and AmerisourceBergen, along with the pharmaceutical giant Johnson & Johnson.The distributors, which by law are supposed to monitor quantities of prescription drug shipments, have been accused of turning a blind eye for two decades while pharmacies across the country ordered millions of pills for their communities. Plaintiffs also allege that Johnson & Johnson, which used to contract with poppy growers in Tasmania to supply opioid materials to manufacturers and made its own fentanyl patches for pain patients, downplayed addictive properties to doctors as well as patients.Negotiations, which began more than two years ago, intensified this summer as trials opened in several states and overdose rates reached record levels.Unlike earlier settlement proposals, this one appears to have the critical backing of more than 40 states and a sweetener of $2 billion for plaintiffs’ attorneys. In recent weeks, many terms were nailed down and the fees for private lawyers in the cases — a previous sticking point — bumped up, prompting enthusiasm that an announcement was imminent, lawyers involved in the talks said.In a briefing with several reporters on Tuesday morning, lawyers for thousands of cities and counties were careful to use words like “optimistic” to describe the talks, saying that states had to agree first before local governments could even vote on the settlement. A statement from attorneys general of 10 states, including Pennsylvania, North Carolina and Tennessee, said the negotiations were “progressing well and potentially nearing their completion.”Cardinal Health declined to discuss the negotiations. The other distributors did not reply to requests for comment.Johnson & Johnson said in a statement, “There continues to be progress toward finalizing this agreement and we remain committed to providing certainty for involved parties and critical assistance for families and communities in need.”The company said the agreement would not be an admission of liability or wrongdoing and that it would continue to defend in cases brought by plaintiffs who were not part of the settlement.In court proceedings, the distributors have repeatedly argued that they were participants in the supply chain for drugs that were federally approved.A separate agreement between Native American tribes and the companies is still being negotiated.Even if the negotiators reach a deal, numerous steps are required before formal agreement, including voting by all of the thousands of plaintiffs. It includes carrot-stick incentives to induce more parties to come on board.The deal is contingent on agreement by a large majority of states. People involved in the talks say that eight or so states are still not on board, because they believe the amount of money the companies would pay is insufficient.“Their proposal can be described in three words — not good enough,” said Bob Ferguson, the attorney general of Washington, which has a September trial scheduled against the distributors. “It does not represent real accountability, and will not provide a transformative amount of money to help communities respond to the crisis they helped cause.”Another contentious issue in the proposed deal is what is known as “global peace” — the companies want assurance that a settlement would mean that plaintiffs would put down their litigating swords for good. They are asking that states ensure that local governments that have not brought cases against the companies, as well as those that have cases pending, refrain from future legal action against the companies over opioids.Once a state agrees to the deal, it would ask all of its local governments — even municipalities that have not filed lawsuits — to back it. Reimbursement would work on a tier: full payment is conditional on a state’s local governments signing on.For example, said Mr. Ferguson, most of the money that would be apportioned to his state would be contingent on Washington’s 39 counties and 281 cities signing on — a very high bar.Many major players in the prescription opioid industry have yet to settle cases against them. Some manufacturers, like Purdue Pharma and Mallinckrodt, have sought bankruptcy protection. Teva, Allergan and Endo are on trial. Cases against pharmaceutical chains, such as CVS Health, Walgreens and Walmart, are even further from resolution.According to lawyers familiar with negotiations, Johnson & Johnson, which ended its relationship with poppy growers and stopped making its fentanyl patch and other opioids, would pay $3.7 billion in the first three years and $1.3 billion over the next six years.Collectively the distributors would pay $21 billion over 17 years. The fees of lawyers, who pursued and financed the costly litigation for years, would be deducted from the total figure and are expected to be paid more quickly than some funds for addiction treatment.The distributors would establish a third-party monitor to track their own and their competitors’ drug shipments, intended to quickly alert red-flag pill sales.“It will provide an entirely new method of tracking narcotic drugs at a national level and will make data instantaneously available,” said Joe Rice, a lawyer for many local governments who is on the negotiating team.The negotiations for the states have been led by New York, North Carolina, Pennsylvania, Tennessee, Florida, Texas and California, among others.The negotiations were stalled for months over attorneys’ fees. Innumerable lawyers have contributed different amounts of work and have fought over who should get paid how much. Now, about $1.6 billion in fees and costs would be paid to private lawyers representing thousands of counties and municipalities, $50 million in costs and about $350 million to private lawyers who worked for states. (Many states are represented by their own salaried, government lawyers.)Another critical lever in advancing settlement terms has been the high-stakes gamble of a trial. The distributors have been locked in trial in a West Virginia federal court and in a New York state court. The West Virginia case is ongoing but on Tuesday, Letitia James, the attorney general for New York, announced a $1.179 billion settlement with the distributors that releases them from the case. That money would be deducted from the overall $26 billion settlement. Payments to New York could begin in two months, Ms. James said.A persistent tension in the talks has been over the division of funds among states and small governments, including cities and counties.The new settlement envisions a national formula for disbursing money to states and flexibility within each state to broker a deal with localities, so that the bulk of the funds is aimed at alleviating the opioid epidemic and preventing its recurrence.For months, states and counties elbowed each other, even as they fought with defendants. The distribution to each state now relies on extensive federal data and includes metrics like a state’s population, overdose deaths, opioid pill sales and disorders related to pain pill abuse.Most states will most likely work up their own disbursement plans. Ohio, North Carolina, Arizona, Texas, Florida and others have already brokered internal, state-specific formulas. Last month, the New York legislature passed bills that would ensure that all funds from the opioid litigation settlement would go into a “locked box,” to be used only to address the crisis.Johnson & Johnson is widely known as a company willing to try cases rather than settle, but it has faced rivers of adverse publicity recently: litigation over asbestos deaths related to its talcum powder, a recall of some sunscreens, and reports of rare adverse neurological events associated with its single-dose Covid vaccine. The company remains on trial in California state court but settled with the state of New York and two New York counties last month, on the eve of trial.The money for the New York settlement, $230 million, will be paid over nine years with an additional $33 million for lawyers’ costs and fees, and will be deducted from the national amount.

The states, including Massachusetts and New York, agreed to drop opposition to the bankruptcy organization plan of the company, the maker of OxyContin.Fifteen states have reached an agreement with Purdue Pharma, the maker of the prescription painkiller OxyContin, that would pave the way toward a $4.5 billion settlement of thousands of opioid cases.The states decided late Wednesday to drop their opposition to Purdue’s bankruptcy reorganization plan, in exchange for a release of millions of documents and an additional $50 million from members of the Sackler family, the company’s owners.The agreement was contained in a late-night filing by a mediator in U.S. Bankruptcy Court in White Plains, N.Y.The settlement extracts concessions that will be added to a comprehensive proposal now being voted upon by more than 3,000 plaintiffs, including cities, counties, tribes and states, who sought to hold Purdue and its owners responsible for their role in the opioid epidemic, during which more than 500,000 Americans have died from overdoses of prescription and illegal opioids.Trials against other opioid manufacturers and drug distributors are underway.Nearly two years ago, the Sacklers had proposed paying $3 billion in cash. Both the company and family members had resisted releasing the full trove of documents, including hundreds of thousands of work emails and communications with attorneys, reaching back decades. According to last night’s filing, Purdue and the Sacklers will now release some 33 million documents, and the money has risen to $4.5 billion, plus an additional $225 million in a civil settlement with the Department of Justice.According to spokesmen, two branches of the Sackler family noted that the settlement included no finding of liability or wrongdoing. In a statement, they said: “This resolution to the mediation is an important step toward providing substantial resources for people and communities in need. The Sackler family hopes these funds will help achieve that goal.”The Sacklers will have nine years to make payments, but the new agreement includes an enhanced schedule.If Judge Robert Drain, who is presiding over the bankruptcy proceedings, certifies the plan after an August hearing, as is now widely expected, both the family and the company would be shielded from further opioid-related lawsuits.Maura Healey, the attorney general of Massachusetts, who was the first to sue individual Sacklers, said, “While I know this resolution does not bring back loved ones or undo the evil of what the Sacklers did, forcing them to turn over their secrets by providing all the documents, forcing them to repay billions, forcing the Sacklers out of the opioid business, and shutting down Purdue will help stop anything like this from ever happening again.”Another official in the pursuit of the Sacklers was Letitia James, the attorney general of New York.“For nearly two years, since Purdue Pharma declared bankruptcy, the company and the Sackler family have used every delay tactic possible and misused the courts — all in an effort to shield their misconduct,” she said. “While this deal is not perfect, we are delivering $4.5 billion into communities ravaged by opioids on an accelerated timetable and it gets one of the nation’s most harmful drug dealers out of the opioid business once and for all. ”Nine states and the District of Columbia continue to oppose the agreement. “While some progress has been made — especially around the public document depository — this plan is far from justice,” said William Tong, the attorney general of Connecticut. “Purdue and the Sacklers have misused this bankruptcy to protect their vast wealth and evade consequences for their callous misconduct. This deal alarmingly allows the Sacklers to still walk away with their personal wealth intact, and now allows funds already intended for charity to be included in this deal. We are evaluating all options to continue to fight this bankruptcy plan until all viable options are exhausted.”

Most medical consent laws require parental permission for minors to get a vaccine. Now some places are easing restrictions for Covid shots while others are proposing new ones.Teenagers keep all sorts of secrets from their parents. Drinking. Sex. Lousy grades.But the secret that Elizabeth, 17, a rising high-school senior from New York City, keeps from hers is new to the buffet of adolescent misdeeds. She doesn’t want her parents to know that she is vaccinated against Covid-19.Her divorced parents have equal say over her health care. Although her mother strongly favors the vaccine, her father angrily opposes it and has threatened to sue her mother if Elizabeth gets the shot. Elizabeth is keeping her secret not only from her father, but also her mother, so her mom can have plausible deniability. (Elizabeth asked to be identified only by her middle name.)The vaccination of children is crucial to achieving broad immunity to the coronavirus and returning to normal school and work routines. But though Covid vaccines have been authorized for children as young as 12, many parents, worried about side effects and frightened by the newness of the shots, have held off from permitting their children to get them.A recent poll by the Kaiser Family Foundation found that only three in 10 parents of children between the ages of 12 through 17 intended to allow them to be vaccinated immediately. Many say they will wait for long-term safety data or the prod of a school mandate. But with many teenagers eager to get shots that they see as unlocking freedoms denied during the pandemic, tensions are crackling in homes in which parents are holding to a hard no.Forty states require parental consent for vaccination of minors under 18, and Nebraska sets the age at 19. (Some states carve out exemptions for teenagers who are homeless or emancipated.) Now, because of the Covid crisis, some states and cities are seeking to relax medical consent rules, emulating statutes that permit minors to obtain the HPV vaccine, which prevents some cancers caused by a sexually transmitted virus.Last fall, the District of Columbia City Council voted to allow children as young as 11 to get recommended vaccines without parental consent. New Jersey and New York Legislatures have bills pending that would allow children as young as 14 to consent to vaccines; Minnesota has one that would permit some children as young as 12 to consent to Covid shots.But other states are marching in the opposite direction. Although South Carolina teenagers can consent at 16, and doctors may perform certain medically necessary procedures without parental permission on even younger children, a bill in the Legislature would explicitly bar providers from giving the Covid shot without parental consent to minors. In Oregon, where the age of medical consent is 15, Linn County ordered county-run clinics to obtain parental consent for the Covid shot for anyone under 18. According to the National Conference of State Legislatures, which has been tracking Covid-related bills, some states, including Tennessee and Alabama, are working on legislation to prevent public schools from requiring Covid shots.The issue of who can consent to the Covid shots is providing fresh context for decades-old legal, ethical and medical questions. When parents disagree, who is the arbiter? At what age are children capable of making their own health decisions and how should that be determined?“Isabella wants it because her friends are getting it, and she doesn’t want to wear a mask,” said Charisse, a mother of a 17-year-old in Delray Beach, Fla., who asked that her last name be withheld for family privacy. Charisse fears the shot could have an effect on her daughter’s reproductive system (a misperception that public health officials have repeatedly refuted).“Isabella said, ‘It’s my body.’ And I said, ‘Well, it’s my body until you’re 18.’”Many teenagers see the Covid shot as unlocking freedoms denied to them during the pandemic. In New Orleans, Ava Kreutziger, 14, left, high-fives Croix Hill, 15, after Croix received her first dose.Kathleen Flynn/ReutersAs both the legal debates and family arguments unfold, those administering the vaccine at pharmacies, clinics and medical offices are trying to determine how to proceed when a young teen shows up for the Covid shot without a parent.“We may be in a legal gray zone with this vaccine,” said Dr. Sterling Ransone Jr., a family physician in Deltaville, Va. In his health system, a parent can send a signed consent form for a teenager to be vaccinated. But because the Covid vaccine is authorized only for emergency use, the health system requires a parent to be present for a patient under 18 to get that shot.Marina, 15, who lives in Palm Beach County, Fla., — and who, like others interviewed, asked not to be fully identified — longs for the shot. But her mother says absolutely not. The subject is not open for discussion.And so Marina has been excluded from the social life she covets. “Five of my friends are throwing a party and they invited me, but then they said, ‘Are you vaccinated?’” she said. “So I can’t go. That hurts.”As the pandemic ebbs, some teen social circles are reconstituting based on vaccination status. “I see my friends posting on social media — ‘Woo-Hoo I got it!’ — and now when I see them, they ask me things like, ‘Where have you been? Are you traveling a lot? Are you sure you don’t have Covid?’ It sucks that I can’t get the shot,” Marina continued.Increasingly, frustrated teenagers are searching for ways to be vaccinated without their parents’ consent. Some have found their way to VaxTeen.org, a vaccine information site run by Kelly Danielpour, a Los Angeles teenager.The site offers guides to state consent laws, links to clinics, resources on straightforward information about Covid-19 and advice for how teenagers can engage parents.“Someone will ask me, ‘I need to be able to consent at a vaccine clinic that is open on weekends and that is on my bus route. Can you help?’” said Ms. Danielpour, 18, who will begin her freshman year at Stanford in the fall.She started the site two years ago, well before Covid. The daughter of a pediatric neurosurgeon and an intellectual property lawyer, she realized that most adolescents know neither the recommended vaccine schedule nor their rights.“We automatically talk about parents but not about teens as having opinions on this issue,” she said. “I decided I needed to help.” Ms. Danielpour wrangled experts to help her understand vaccination and consent laws, and she recruited teenagers to be “VaxTeen ambassadors.”“I want teenagers to be able to say to pediatricians, ‘Hey, I have this right,’” added Ms. Danielpour, who gives talks at conferences to physicians and health department officials.In Los Angeles, Kelly Danielpour, 18, started VaxTeen.org, a site that lists state health care consent laws, vaccine clinic locations and advice for how teens can address vaccine hesitancy in their parents.Jessica Pons for The New York TimesElizabeth surreptitiously got her vaccine at a school pop-up clinic.After administrators at her boarding school informed parents they would be offering Covid shots, her mother gave permission. Her father forbade it. Upset, Elizabeth consulted the school nurse, who said she could not be vaccinated without approval from both. Elizabeth researched state laws, learning that she wasn’t old enough to consent on her own.She showed up anyway. At worst, she figured, the school would just turn her away.Apparently, they took note only of her mother’s consent. Saying nothing, Elizabeth stuck out her arm.Now she is in a pickle. The school is requiring students to be vaccinated for the fall semester and she says her father has begun warring with the administration over the issue. Elizabeth is afraid that if he learns how she was vaccinated, he will be furious and tell the school, which will discipline her for having deceived vaccinators, a stain on her record just as she is applying to college.Gregory D. Zimet, a psychologist and professor of pediatrics at Indiana University School of Medicine, pointed out the irony of an adolescent being legally prevented from making a choice that was strenuously urged by public health officials.Developmentally, he said, adolescents at 14 and even younger are at least as good as adults at weighing the risks of a vaccine. “Which isn’t to say that adults are necessarily great at it,” he added.In many states, young teenagers can make decisions around contraception and sexually transmitted infections, which are, he noted, “in many ways more complex and fraught than getting a vaccine.”Pediatricians say that even parents who have themselves been vaccinated are wary for their children. Dr. Jay Lee, a family physician and chief medical officer of Share Our Selves, a community health network in Orange County, Calif., said parents say they would rather risk their child having Covid than get the new vaccine.“I will validate their concerns,” Dr. Lee said, “but I point out that waiting to see if your child gets sick is not a good strategy. And that no, Covid is not just like the flu.”Elise Yarnell, a senior clinic operations manager for the Portland, Ore., area at Providence, a large health care system, recalled a 16-year-old girl who showed up at a Covid vaccine clinic at her school in Yamhill County.Her parents oppose the vaccine so she wanted to get it without them knowing, which she could do legally because Oregon’s age of consent is 15. She teared up when she saw the shots were not ready before she had to be home, but she was able to return that night without alerting her parents and was vaccinated.“She was extremely relieved,” Ms. Yarnell said.Isabella is the 17-year-old daughter of Charisse, the Delray Beach, Fla., mother who refuses to grant permission for the vaccine. Asked why she wanted the shot, Isabella gave a stream of reasons. “A lot of older people in my family are at risk for catching Covid and possibly dying,” she said. “I want to get the vaccine so I can be around them, and they’ll be safe. And then I can go out with my friends again, and they won’t be so much at risk either.”Although doctors have been trying to instill vaccine confidence in parents as well as patients, there’s not much they can do when parents object. Recently, Dr. Mobeen H. Rathore, a pediatrics professor at the University of Florida medical college in Jacksonville, told a patient whose mother refused consent that she couldn’t get the Covid vaccine until she turned 18, three weeks hence.“She got vaccinated on her birthday,” Dr. Rathore said. “She sent me a message saying that was her birthday gift to herself.”

The United States has a dark history of court-sanctioned sterilization, but more recent rulings and legislation suggest it would violate a basic right.Among the stunning assertions that the pop star Britney Spears made to a Los Angeles probate judge this week, as she sought to end her protracted conservatorship, was one that shook experts in guardianship law and reproductive rights deeply. She said a team led by her father, who is her conservator, prevented her from having her IUD removed because the team did not want her to have more children.“Forcing someone to be on birth control against their will is a violation of basic human rights and bodily autonomy, just as forcing someone to become or stay pregnant against their will would be,” said Ruth Dawson, a principal policy associate at the Guttmacher Institute, a research group that supports reproductive rights.Court-condoned compelled contraception is rare in conservatorship. But the specter it raises — forced sterilization — does have a grim, extensive history in the United States, especially against poor women, women of color and inmates. In the early 20th century, the state-sanctioned practice was upheld by the United States Supreme Court.Although the court moved away from that position in the 1940s, and consensus arose through the growing canon on informed consent that forced sterilization was inhumane, the practice continued to be quietly tolerated.Finally, by the end of the 1970s, most states had repealed laws authorizing sterilization, although allegations of forced hysterectomies and tubal ligations on women in immigrant detention centers continue to be raised. It wasn’t until 2014 that California formally banned the sterilization of female inmates without consent.The scant law on the question in conservatorship indicates what an outlier the Spears case may be. In 1985, the California Supreme Court denied the petition of guardian parents of a 29-year-old woman with Down syndrome who wanted her to undergo a tubal libation.Typically, a conservator has temporary control over the finances and even medical care of an incapacitated person. Experts underscored that Ms. Spears’s assertion is unverified. But if it’s accurate, they said, the most likely rationale, however suspect, might be that Jamie Spears, her father, wants to protect her finances from a baby’s father, potentially her boyfriend, who is reportedly at odds with Mr. Spears.If a guardian fears that a ward will make financially unwise choices, “the remedy is not to say they can’t procreate,” said Sylvia Law, a health law scholar at New York University School of Law. “It’s unspeakable.”According to experts in trust and estate law, the handful of cases in which a guardian, usually a parent, has asked a court to order contraception involved severely disabled children.“Such a child would lack the capacity to understand that a penis and vagina could make a baby,” said Bridget J. Crawford, an expert on guardianship law at Pace University law school. “And that certainly is not the Britney Spears case.”Eugenics was a leading rationale for female sterilization. In the 1927 case Buck v. Bell, the Supreme Court upheld the right to sterilize a “feeble-minded” woman who had been committed to a state mental institution, with Justice Oliver Wendell Holmes infamously writing, “Three generations of imbeciles are enough.”Although the opinion was never formally overturned, in a 1942 case, Skinner v. Oklahoma, which challenged forced sterilization of certain convicted criminals, Justice William O. Douglas, writing for a unanimous court, said that the right to procreate was fundamental. “Any experiment the state conducts is to his irreparable injury,” he wrote. “He is forever deprived of a basic liberty.”While Ms. Spears has not been sterilized, Ms. Crawford said, if she is being prevented from getting her IUD removed, that would be a proxy for sterilization, in particular because she testified that she wanted to bear more children.Melissa Murray, who teaches reproductive rights and constitutional law at N.Y.U. law school, pointed to another unnerving element in the allegation by Ms. Spears, who, at 39, has been under her father’s guardianship for 13 years. Ms. Murray said that Ms. Spears, an adult, appeared to be living a legally constructed childhood.“It’s unusual that her father is making the kinds of decisions we’d expect a parent to make for a teenager,” she added.

Jittery pet owners are asking vets, animal poison control centers and Twitter. Read on for answers.Of course you’re anxious.Your sweet, admittedly not overbright, four-legged pandemic pal is enamored with the horror movie of the season: relentless hordes of fat and sassy cicadas.Clattering and slow-moving, the 2021 Brood X swarmageddon taunts cats and dogs, who seem incapable of affecting diffidence. In recent weeks, many pets have obsessively been lunging and swatting. Then, gulping.Fearful owners are rushing to veterinarians and animal poison control centers, to say nothing of Dr. Google. Can cicada exoskeletons pierce intestinal linings? Is cicada fungus toxic to dogs?The answers are no and no.Christine Klippen, an emergency veterinarian at Friendship Hospital for Animals in Washington, a city currently held captive by cicadas, sounded a tad weary.“No, eating a cicada won’t make a dog or cat sick,” Dr. Klippen said.Large areas in 15 states, mostly from the Mid-Atlantic, stretching west to Ohio, are now thrumming with billions of Brood Xers, which have burst forth after a 17-year gestation, full of so much pent-up reproductive energy that last week they invaded a White House press corps charter plane, delaying a flight for hours. And in a pandemic year during which, according to a survey by the American Society for the Prevention of Cruelty to Animals, one in five American households adopted dogs and cats, rookie pet owners are primed to swallow cicada myths whole.After all, they have not had years of exposure to the God-awful things that pets routinely snarf down.More good news: If you haven’t seen or heard Brood X cicadas yet, you’re unlikely to. John Cooley, a cicada researcher and expert in ecology and evolutionary biology at the University of Connecticut, said that by now, they had all emerged and that by the Fourth of July, their newborns would have hatched and burrowed.“If it’s cold and miserable like it’s been in Maryland, that prolongs things,” Dr. Cooley, who maps sightings, said. “Sunny, hot weather burns them out.”An Invitation to the Cicada PartyThis spring, billions of cicadas will emerge from underground tunnels to sing, mate and die across the eastern United States. Here’s what to expect.To dogs and cats, cicadas look like “big flying treats,” as Dr. Klippen says. But, she adds, unless an animal has a rare allergy to chitin, the exoskeleton material, the bugs are not toxic. That includes a fungus that has been seen on these periodical cicadas, which can affect the bugs but not the snackers.“Most pets who ingest a few cicadas will only develop mild stomach upset,” said Tina Wismer, a veterinarian who is a senior director at the ASPCA Animal Poison Control Center in Urbana, Ill. Some cats and dogs have bellies so sensitive, she added, that they can even have a reaction to a new kibble. Most cicada-related calls to the poison center, she said, involve dogs vomiting up the exoskeletons.The wings are crunchy “but no more than dry dog food,” observed Ann Hohenhaus, a veterinary oncologist at the Animal Medical Center in New York.She and others dismissed the chatter about cicada shells slicing through intestinal walls. “Dogs will eat bones and feel sick but even shards don’t poke through the intestines,” she said. “But cicada shells are unknown to us, so we have decided we should worry about them.”Because dogs spend more time outdoors than cats, calls about feline cicada ingestion are rare. But cats do enjoy the occasional cicada amuse-bouche.“Outdoor cats don’t like static food,” Dr. Hohenaus said. “If something is alive and moving, they will go for it. People worry that because cats have small digestive tracts, the cicada will get stuck, but a cat can eat a whole mouse. It will digest the cicada just fine.”.css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{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;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-1jiwgt1{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;margin-bottom:1.25rem;}.css-8o2i8v{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-8o2i8v p{margin-bottom:0;}.css-12vbvwq{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-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[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 operative word here is “few.” Consuming too much of anything, including cicadas, can lead to lethargy, diarrhea and vomiting, say veterinarians as well as basic common sense.“Dogs eat lots of stuff — they will paw open a pantry and eat five pounds of dog food before owners catch them,” Dr. Hohenhaus said. “One dog puked up a shark toy. So if you have a dog who goes to the country for the weekend and eats horse poop, he’ll have diarrhea on Monday morning.”As for those pets who have hoovered up cicadas and landed in the vet E.R., she said, cause and effect are not necessarily obvious. “I don’t know if the cicada shells made the dog sick or it was the Kleenexes and trash the dog ate out of the bathroom basket.”Cicadas can, however, incite some cats and especially dogs to binge. (Think potato chips: Can you eat just one?)“Because cicadas are so easy to catch, some animals are going to town eating them,” said Dr. Klippen, who sees perhaps a handful of dogs a week for this reason. The risks are not from the bugs, she said, but from dehydration related to vomiting and diarrhea, or from having absorbed pesticide sprayed on the cicadas.For dogs who can’t quit cicadas, “consider a basket muzzle,” Dr. Klippen said. “It’s beneficial and doesn’t prevent dogs from panting and drinking.”Also try walking your dog at dawn and dusk, Dr. Wismer advised, when cicadas are least active. Since cicadas are found in and around mature trees, avoid routes that include them.The heebie-jeebies over pets and cicadas springs mostly from the alignment of several factors. There’s the once-in-nearly-two-decades emergence of the bugs. And the heightened attachment and overprotectiveness that owners developed toward their pets in the past year during lockdown. Moreover, veterinarians said, people’s concerns are being revved by the internet and, er, the news media.“But basically, it’s something for us to talk about other than the coronavirus,” Dr. Klippen said.

The survey found big increases over last month in Latinos getting the shot and in unvaccinated people who say they have made an appointment.A new poll suggests the United States could be on track to vaccinate at least 70 percent of the adult population against Covid-19 by this summer. In the latest survey by the Kaiser Family Foundation, 62 percent of respondents said they had received at least one dose of a vaccine, up from 56 percent in April. At the same time, about a third of those categorized as “wait and see” reported that they had already made vaccine appointments or planned to do so imminently.Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases and a vaccine expert, found the results encouraging.“I think there are many people who were on the fence who were worried about things moving too rapidly and about possible side effects, but those concerns are being allayed as they see more of their friends and acquaintances celebrating getting vaccinated,” said Dr. Schaffner, who was not involved in the monthly survey, the Covid-19 Vaccine Monitor.“They’re getting that growing sense of comfort and reassurance that ‘people like me’ are getting vaccinated,” which, he said, was essential to instilling confidence in the vaccines.The two demographic groups reporting the greatest increase in vaccination rates from April to May were Latino adults (from 47 percent to 57 percent) and adults without college degrees (from 48 percent to 55 percent).The telephone survey of 1,526 adults was conducted in English and Spanish from May 18 through May 25.On May 10, the Food and Drug Administration authorized the vaccine made by Pfizer and BioNTech for children ages 12 and older. The survey found that 40 percent of parents said that either their child had already gotten at least one dose or would be getting one soon.But parents of younger children were notably more guarded, with only about a quarter expressing a willingness to get their children vaccinated as soon as the shots become authorized for them.The finding suggests that efforts to protect as many young students as possible from Covid-19 by the start of the school year could face barriers.While public health experts welcomed the continuing improvement in vaccination rates, they noted that it meant the pool of the most willing adults was shrinking.“At this point, there’s almost no low-hanging fruit, but there’s a path toward a slow-but-steady increase in vaccination rates through improved access, information, persuasion and incentives,” said Drew Altman, the president and chief executive of the Kaiser Family Foundation.President Biden set a goal of 70 percent vaccine coverage for adults by July 4. Dr. Schaffner said he thought the goal was possible. “We have to work harder,” he said.The authors of the survey said the goal was realistic, because in addition to 62 percent of adults who had received at least one dose, another 4 percent said they wanted the shot as soon as possible, and still another 4 percent — representing a third of the “wait-and-see” group — said they had scheduled an appointment or intended to do so within three months.But despite the positive news, vaccination rates among adults who have previously reported significant hesitancy (7 percent) or outright refusal (13 percent) have remained static for several months. And a third of the “wait-and-see” group said they would wait at least a year before getting the shots.The survey also looked at attitudes about vaccination incentives as well as the impact of government messaging about the shots. Financial enticements, such as Ohio’s million-dollar lottery for the newly vaccinated, are receiving some derisive pushback.But the survey found that such rewards can be successful motivators for people to get the shots. Fifteen percent of unvaccinated adults in the survey said that being offered $100 by their state might make them reconsider, as would free transportation and free tickets to a sporting event or concert.Earlier this month, people who showed up to be vaccinated at an event at the Talladega Superspeedway in Alabama could take two victory laps around the track. (Cars and trucks, yes; motorcycles, no.) Similar incentives are being offered around the country.About 20 percent of the unvaccinated workers said they would be more likely to get the shots if their employer gave them paid time off for the appointments and for any time needed to recover from side effects.The report also showed that the public has some confidence in government health-related messages, though many were confused by the announcement this month by the Centers for Disease Control and Prevention saying that vaccinated people could largely eschew face masks and social distancing. Over half said that the C.D.C.’s guidance was generally clear and accessible, but about 40 percent found it confusing and murky.Strikingly, 85 percent of unvaccinated people said that the C.D.C.’s new guidance did not make them more willing to get vaccinated.But another cohort looked to government approval as a potential starting gun. The survey found that a third of unvaccinated adults, including 44 percent in the “wait-and-see” group, said they would be more likely to get a vaccine once it received full approval from the Food and Drug Administration. The makers of the Moderna and the Pfizer-BioNTech vaccines have recently said that they are making progress toward that goal.

Issues of access and fears of employment and immigration consequences have kept their Covid vaccination rates low, the findings suggest.Latino adults in the United States have the lowest rates of Covid-19 vaccination but among the unvaccinated, they are the demographic group most willing to receive the Covid shots as soon as possible, a new survey shows.The findings suggest that their depressed vaccination rate does not uniformly reflect skepticism about the shots, but rather is also indicative of misinformation about their cost and access, as well as concerns about employment and immigration issues, according to the latest edition of the Kaiser Family Foundation Covid-19 Vaccine Monitor.“With so many unvaccinated Hispanic adults eager to get a shot, there’s an opportunity to further close the gap in vaccination rates by addressing worries about costs and practical concerns such as time off work,” said Liz Hamel, a vice president of the foundation and director of public opinion and survey research.Indeed 33 percent of unvaccinated Latino adults responding to the survey said they wanted the shots as soon as possible, compared with 16 percent of the unvaccinated white adults and 17 percent of the unvaccinated Black adults.Over all, nearly half of the Latino respondents, 47 percent, said they had gotten at least one dose of a Covid vaccine, compared with 60 percent of white adults and 51 percent of Black adults.“The report shows that many Latinos have a high motivation to get vaccinated,” said Kurt Organista, a professor of social welfare at the University of California, Berkeley. “They live in multigenerational households and cramped quarters. They want to protect their families.”But, he added, “they work a lot — their work participation rates are higher than average Americans — so they don’t want to jeopardize their jobs by taking time off to get vaccinated.”The survey showed that misunderstandings about cost and eligibility had also stymied them.Even though the Covid vaccines are free in the United States, half of the unvaccinated Latino respondents worried that they would have to pay for the shot. Two-thirds said they feared they would have to miss work because of side effects.About 18 percent of the Latino respondents said they did not yet have permanent residential status in the United States. Though the Biden administration and local public health officials have reiterated that the shots are available to anyone regardless of immigration status, more than half of this group reported being unsure about whether they were eligible to get the shots.Nearly 40 percent of all the unvaccinated Latinos responding to the survey said they feared they would need to produce government-issued identification to qualify. And about a third said they were afraid that getting the shot would jeopardize either their immigration status or that of a family member.Many health departments have been undertaking increasingly inventive measures to sign up Spanish speakers and to reassure them that their immigration status will not be endangered, said Erin Mann, the program manager for the National Resource Center for Refugees, Immigrants and Migrants, based at the University of Minnesota, which advises communities about best practices to reach underserved people. These include having language-specific drive-up lanes for testing and vaccination, holding events in the evenings and having health care workers phone individuals to sign them up.The results of the poll were drawn from a nationally representative telephone survey, conducted between April 15 and April 29, of 2,097 adults, including 778 English- and Spanish-speaking Latinos.The report on the findings also explored the disproportionately harsh impact of the pandemic on Latino families, which helped explain their willingness to be vaccinated. About 38 percent of Latino adults said that a relative or close friend had died from Covid-19, compared with 18 percent of white adults who reported having had similar experiences. Two-thirds of Latino adults said they feared that either they or a relative might get sick from the coronavirus. Financial fears related to the pandemic rippled through Latino families, too. Nearly half said they had been adversely affected economically, compared with about one-third of white respondents who said so.While about a third of unvaccinated Latino adults were eager to get a shot as soon as possible, two-thirds were more reluctant, describing themselves as wait-and-see, only if required by work or definitely not (35 percent, 13 percent and 17 percent). But this group did seem amenable to incentive strategies, the report suggested. For them, improved access would be helpful.More than half in this group who are overall reluctant and also employed said they would get the shots if their employers gave them paid time off to recover from side effects, which the Biden administration has urged, a rate nearly three times that of white workers. And 38 percent of this group would be inclined to be vaccinated if their employer arranged for the shots to be distributed at the work site. Nearly four in 10 said they would be more likely to get the shot if their employer provided a $200 incentive to do so.Their responses also pointed to the importance of community-based access. Nearly half said they would be more likely to get vaccinated if the shots were available at sites where they normally go for health care. Dr. Organista said this finding showed the growing use of such clinics, which rely heavily on “promotores de salud”— community-based health workers, often volunteers, who provide assistance especially to Spanish-speaking residents.“These clinics treat people irrespective of their ability to pay and immigration status,” he said. “People in the community know this. That’s a big opportunity and a solution for vaccination.”

The American public’s willingness to get a Covid vaccine is reaching a saturation point among adults, and many parents do not plan to vaccinate their children, a new national survey suggests.Only 9 percent of respondents said that they had not yet gotten a shot but intended to do so, according to the survey, which was published in the April edition of the Kaiser Family Foundation’s Vaccine Monitor.Three in 10 parents said they planned to vaccinate their children as soon as they could. No vaccine is yet available in the U.S. for children; the Pfizer-BioNTech vaccine is expected to be authorized soon for those aged 12 to 15.The survey found that public confidence in the Johnson & Johnson vaccine has plummeted since health authorities suspended using it for 10 days to examine possible links to a rare, dangerous blood clotting problem.But it also found significant progress in persuading Republicans, who have been among the most hesitant, to be vaccinated.The findings highlight the challenges ahead for the Biden administration’s efforts to persuade hesitant people to take the vaccine, even as a growing number of scientists and public health experts have concluded that it is unlikely that the country will reach herd immunity.Overall, slightly more than half of a nationally representative sample of 2,097 adults surveyed said they had gotten at least one dose of the vaccine, a finding that matches data from the Centers for Disease Control and Prevention.The administration announced steps on Tuesday to encourage more pop-up and mobile vaccine clinics and to distribute shots to local pharmacies as well as primary care doctors and pediatricians.

The new survey also found that only 9 percent of adults who hadn’t gotten the shot planned to do so, suggesting the country is nearing the limit of people planning to get immunized.The American public’s willingness to get a Covid vaccine is reaching a saturation point, a new national poll suggests, one more indication that achieving widespread immunity in the United States is becoming increasingly challenging.Only 9 percent of respondents said they hadn’t yet gotten the shot but intended to do so, according to the survey, published in the April edition of the Kaiser Family Foundation’s Vaccine Monitor. And with federal authorization of the Pfizer vaccine for adolescents ages 12 through 15 expected imminently, the eagerness of parents to let their children be vaccinated is also limited, the poll found.Overall, slightly more than half of those surveyed said they had gotten at least one dose of the vaccine, a finding that matches data from the Centers for Disease Control and Prevention.“We’re in a new stage of talking about vaccine demand,” said Mollyann Brodie, executive vice president of Kaiser’s Public Opinion and Survey Research Program. “There’s not going to be a single strategy to increase demand across everyone who is left. There will be have to be a lot of individually targeted efforts. The people still on the fence have logistical barriers, information needs, and lots don’t yet know they are eligible. Each strategy might move a small number of people to get vaccinated, but all together, that could matter a lot.”With a growing number of scientists and public health experts concluding that it is unlikely that the country will reach the threshold of herd immunity, the Biden administration has stepped up efforts to reach those who are still hesitant. On Tuesday, the administration announced steps to encourage more pop-up and mobile vaccine clinics and to distribute shots to primary care doctors and pediatricians as well as local pharmacies.The survey also showed that confidence in the Johnson & Johnson vaccine had suffered a significant blow after the 10-day pause in dispensing it while the authorities examined rare incidents of life-threatening blood clots in people who had taken it. While 69 percent of people said they had confidence in the safety of the vaccines made by Pfizer and Moderna, only 46 percent felt confident about the safety of the Johnson & Johnson vaccine. Among adults who have not been vaccinated, one in five said that the news about the Johnson & Johnson shot had prompted them to change their minds about getting a Covid-19 vaccine.The survey did show that there had been some progress among Republicans, who have been among the firmest holdouts. Among that group, 55 percent said they had gotten a shot or intended to do so, up from 46 percent in March. The percentage who will “definitely not” get the vaccine is shrinking as well, down to 20 percent from 29 percent in March.The results were based on telephone surveys of a nationally representative sample of 2,097 adults from April 15 through April 29.The so-called “wait and see” group — people who are seeking more information before deciding — inched down slightly, to 15 percent from 17 percent in March. The proportion of people who said they would get vaccinated only if required to do so by employers or schools dipped to 6 percent from 7 percent.A vaccination event at AmericanAirlines Arena near Miami.Saul Martinez for The New York TimesThe Pfizer vaccine is expected to be authorized for children ages 12 through 15 within days. Among parents who were surveyed, three in 10 said they would get their children vaccinated right away, and 26 percent said they wanted to wait to see how the vaccine was working. Those figures largely mirrored the eagerness with which those parents themselves sought to get vaccinated.Commensurately, 18 percent said they would do so only if a child’s school required it, and 23 percent said they would definitely not get their children vaccinated.A consortium of universities that includes Harvard, Northeastern and Rutgers has been conducting online polls during the pandemic and recently focused on parents. The group’s latest survey, conducted throughout April and reaching 21,733 adults across 50 states, found that the divide between mothers and fathers in views about the vaccine for children had widened.Fathers are becoming more accepting, with their resistance falling to 11 percent from 14 percent since February. But over a quarter of mothers, researchers said, still say they are “extremely unlikely” to vaccinate their children. Both genders are more resistant to the vaccine for younger children than for teenagers. Other research shows that mothers tend to have more sway over the final decision than fathers.The responses from parents may well change over time, experts say. Just as adults were far more reluctant last summer when the vaccine was still a concept, parents surveyed several weeks ago, when imminent authorization for children under 16 had not been widely discussed, might also have been reacting to a hypothetical situation rather than a reality.But pediatricians and others who are seen as trusted sources of information are already aware that they have considerable work to do to instill vaccine confidence in this latest cohort.Dr. Sean O’Leary, a pediatrician in Denver who is vice chairman of the committee on infectious diseases for the American Academy of Pediatrics, predicted that just as adults had swarmed Covid vaccine providers during the initial weeks of distribution, parents and pent-up young teenagers would rush for it at the start, too.But Dr. O’Leary, who often gives talks to pediatricians about how to motivate patients to accept vaccinations, worries that a slowdown will inevitably follow. To persuade hesitant parents, he said, “we have to make the vaccine available in as many places as possible.”He added, “If parents and patients are in the pediatrician’s office and the doctor can say, ‘Hey, I’ve got it,’ that may be enough of a nudge for them to say, ‘Let’s go ahead and do this.’”

The new survey also found that only 9 percent of adults who hadn’t gotten the shot planned to do so, suggesting the country is nearing the limit of people planning to get immunized.The American public’s willingness to get a Covid vaccine is reaching a saturation point, a new national poll suggests, one more indication that achieving widespread immunity in the United States is becoming increasingly challenging.Only 9 percent of respondents said they hadn’t yet gotten the shot but intended to do so, according to the survey, published in the April edition of the Kaiser Family Foundation’s Vaccine Monitor. And with federal authorization of the Pfizer vaccine for adolescents ages 12 through 15 expected imminently, the eagerness of parents to let their children be vaccinated is also limited, the poll found.Overall, slightly more than half of those surveyed said they had gotten at least one dose of the vaccine, a finding that matches data from the Centers for Disease Control and Prevention.“We’re in a new stage of talking about vaccine demand,” said Mollyann Brodie, executive vice president of Kaiser’s Public Opinion and Survey Research Program. “There’s not going to be a single strategy to increase demand across everyone who is left. There will be have to be a lot of individually targeted efforts. The people still on the fence have logistical barriers, information needs, and lots don’t yet know they are eligible. Each strategy might move a small number of people to get vaccinated, but all together, that could matter a lot.”With a growing number of scientists and public health experts concluding that it is unlikely that the country will reach the threshold of herd immunity, the Biden administration has stepped up efforts to reach those who are still hesitant. On Tuesday, the administration announced steps to encourage more pop-up and mobile vaccine clinics and to distribute shots to primary care doctors and pediatricians as well as local pharmacies.The survey also showed that confidence in the Johnson & Johnson vaccine had suffered a significant blow after the 10-day pause in dispensing it while the authorities examined rare incidents of life-threatening blood clots in people who had taken it. While 69 percent of people said they had confidence in the safety of the vaccines made by Pfizer and Moderna, only 46 percent felt confident about the safety of the Johnson & Johnson vaccine. Among adults who have not been vaccinated, one in five said that the news about the Johnson & Johnson shot had prompted them to change their minds about getting a Covid-19 vaccine.The survey did show that there had been some progress among Republicans, who have been among the firmest holdouts. Among that group, 55 percent said they had gotten a shot or intended to do so, up from 46 percent in March. The percentage who will “definitely not” get the vaccine is shrinking as well, down to 20 percent from 29 percent in March.The results were based on telephone surveys of a nationally representative sample of 2,097 adults from April 15 through April 29.The so-called “wait and see” group — people who are seeking more information before deciding — inched down slightly, to 15 percent from 17 percent in March. The proportion of people who said they would get vaccinated only if required to do so by employers or schools dipped to 6 percent from 7 percent.A vaccination event at AmericanAirlines Arena near Miami.Saul Martinez for The New York TimesThe Pfizer vaccine is expected to be authorized for children ages 12 through 15 within days. Among parents who were surveyed, three in 10 said they would get their children vaccinated right away, and 26 percent said they wanted to wait to see how the vaccine was working. Those figures largely mirrored the eagerness with which those parents themselves sought to get vaccinated.Commensurately, 18 percent said they would do so only if a child’s school required it, and 23 percent said they would definitely not get their children vaccinated.A consortium of universities that includes Harvard, Northeastern and Rutgers has been conducting online polls during the pandemic and recently focused on parents. The group’s latest survey, conducted throughout April and reaching 21,733 adults across 50 states, found that the divide between mothers and fathers in views about the vaccine for children had widened.Fathers are becoming more accepting, with their resistance falling to 11 percent from 14 percent since February. But over a quarter of mothers, researchers said, still say they are “extremely unlikely” to vaccinate their children. Both genders are more resistant to the vaccine for younger children than for teenagers. Other research shows that mothers tend to have more sway over the final decision than fathers.The responses from parents may well change over time, experts say. Just as adults were far more reluctant last summer when the vaccine was still a concept, parents surveyed several weeks ago, when imminent authorization for children under 16 had not been widely discussed, might also have been reacting to a hypothetical situation rather than a reality.But pediatricians and others who are seen as trusted sources of information are already aware that they have considerable work to do to instill vaccine confidence in this latest cohort.Dr. Sean O’Leary, a pediatrician in Denver who is vice chairman of the committee on infectious diseases for the American Academy of Pediatrics, predicted that just as adults had swarmed Covid vaccine providers during the initial weeks of distribution, parents and pent-up young teenagers would rush for it at the start, too.But Dr. O’Leary, who often gives talks to pediatricians about how to motivate patients to accept vaccinations, worries that a slowdown will inevitably follow. To persuade hesitant parents, he said, “we have to make the vaccine available in as many places as possible.”He added, “If parents and patients are in the pediatrician’s office and the doctor can say, ‘Hey, I’ve got it,’ that may be enough of a nudge for them to say, ‘Let’s go ahead and do this.’”