Paul Alexander, who died at 78, was paralyzed with polio at age 6 and relied on the machine to breathe. Still, he was able to earn a law degree, write a book and, late in life, build a following on TikTok.After he was paralyzed by polio at age 6, Paul Alexander was confined for much of his life to a yellow iron lung that kept him alive. He was not expected to survive after that diagnosis, and even when he beat those odds, his life was mostly constrained by a machine in which he could not move.But the toll of living in an iron lung with polio did not stop Mr. Alexander from going to college, getting a law degree and practicing law for more than 30 years. As a boy, he taught himself to breathe for minutes and later hours at a time, but he had to use the machine every day of his life.He died on Monday at 78, according to a statement by his brother, Philip Alexander, on social media.He was one of the last few people in the United States living inside an iron lung, which works by rhythmically changing air pressure in the chamber to force air in and out of the lungs. And in the final weeks of his life, he drew a following on TikTok by sharing what it had been like to live so long with the help of an antiquated machine.It was unclear what caused Mr. Alexander’s death. He had been briefly hospitalized with the coronavirus in February, according to his TikTok account. After he returned home, Mr. Alexander struggled with eating and hydrating as he recovered from the virus, which attacks the lungs and can be especially dangerous to people who are older and have breathing problems.Mr. Alexander contracted polio in 1952, according to his book, “Three Minutes for a Dog: My Life in an Iron Lung.” He was quickly paralyzed, and doctors at Parkland Hospital in Dallas put him in an iron lung so that he could breathe.“One day I opened my eyes from a deep sleep and looked around for something, anything, familiar,” Mr. Alexander said in his book, which he wrote by putting a pen or pencil in his mouth. “Everywhere I looked was all very strange. Little did I know that each new day my life was unavoidably set on a path that would become unimaginably strange and more challenging.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Alaska state health officials said that a man died last month of the virus, which occurs mostly in small mammals and causes lesions. There have been seven reported human cases since 2015.An Alaska man died last month of Alaskapox, a rare virus that occurs mostly in small mammals and can cause skin lesions, according to state health officials.Alaskapox was first identified in 2015 in a woman who lived near Fairbanks, Alaska, and there have been a total of seven cases of the virus reported to the Alaska Section of Epidemiology. Until last month, no one had been hospitalized or died of Alaskapox, which can also cause swollen lymph nodes and muscle or joint pain, Alaska epidemiology officials said on Friday.Of the seven people who have had Alaskapox, six lived in the Fairbanks North Star Borough, where red-backed voles and shrews have been found to have the virus, according to the Alaska Department of Health. Alaskapox has not been found to spread between humans.Dr. Julia Rogers, an epidemiologist with the Centers for Disease Control and Prevention, said in an interview on Tuesday that the symptoms from Alaskapox infection were generally mild.“There could have been cases in the past that we just did not pick up because of that,” Dr. Rogers said, adding that it is possible that recorded cases could increase as more doctors learn how to identify it.The Alaska Section of Epidemiology, which did not release the name of the man who died of the virus, said in a statement that he was “an elderly man from the Kenai Peninsula with a history of drug-induced immunosuppression.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The ship, by some measures the world’s largest, will depart from Miami in January on its maiden voyage. Some can’t wait to board. Others call it a “monstrosity” that is bad for the environment.When the Icon of the Seas sets sail early next year, it will take some time to disappear from the horizon. At 1,198 feet long and a gross tonnage of 250,800, it is hard to miss.The Royal Caribbean cruise ship will have 20 decks packed with more than 20 bars and restaurants, seven pools, nine whirlpools, and six water slides, as well as mini golf, rock climbing and an arcade. It will carry up to 7,960 people — up to 5,610 guests and a crew of 2,350 to pour drinks, turn back covers, swab the decks and keep the vessel on course.Since Royal Caribbean announced this newest ship last year, it has helped to boost the company’s sales with high demand for advanced bookings.It has also become an object of fascination (and scorn) on social media.Some can’t wait to climb aboard, with rooms already selling out for the ship’s first voyage. But others have criticized its size and bright colors, calling it a “monstrosity.” One critic called an artist’s rendering a “Candy Crush version of the dystopian underground world” from science-fiction series “Silo” on Apple TV+.Some critics even drew comparisons to an ill-fated ocean liner of yesteryear, noting it is five times “larger and heavier than the Titanic,” and about 300 feet longer.Royal Caribbean bills the older Wonder of the Seas as the “biggest ship in the world.” When the new one is ready, it will be 10 feet longer, heavier and will carry more people, perhaps giving it bragging rights as the world’s largest.Royal Caribbean said in a statement last month that the Icon of Seas had passed its first round of sea trials, traveling in the open ocean for the first time near Turku, Finland. The ship will have another round of trials later this year ahead of its debut in January, the company said.Interest in the ship comes as the cruise industry tries to bounce back from the coronavirus pandemic, when multiple outbreaks onboard ships led the Centers for Disease Control and Prevention to chastise the industry and ban cruises.But now the voyages have resumed and vacationers have returned to the sea, even as the industry still faces health and environmental concerns.This year, for example, the C.D.C. has recorded 13 norovirus outbreaks on cruise ships, four of them on Royal Caribbean International cruises.And environmentalists like Marcie Keever, program director of oceans and vessels at Friends of the Earth in Washington, contend that cruise lines “continue to build bigger ships that rely on fossil fuels, dump toxic wastewater into our oceans and burden coastal communities with air, water and garbage pollution.”Royal Caribbean referred a request for comment on Tuesday seeking more details about the ship to its website. The company said it could not comment about environmental concerns, citing a quiet period required ahead of its next earnings report.However, the company has touted the effect that the Icon of the Seas is already showing on its bottom line, saying in a statement that advance bookings during the first quarter were ”significantly higher” than the first quarter of 2019.Jason Liberty, president and chief executive of Royal Caribbean Group, said during an earnings call in May that the Icon of the Seas has been “significantly more booked” for its inaugural season “than any other Royal Caribbean ship launch.”Michael Bayley, president and chief executive of Royal Caribbean International, said during the call that the ship was “the best performing new product launch we’ve ever had in the history of our business.”“It’s really driving a huge amount of demand,” Mr. Bayley said.

The proposed settlement, which requires a judge’s approval, would resolve a legal battle that began after the company, in 2016, raised the price for two EpiPens to $608 from $100.Viatris, the drugmaker previously known as Mylan, announced on Monday that it had agreed to pay $264 million to settle a class-action lawsuit that alleged the company was involved in an illegal scheme to monopolize the market for epinephrine auto-injector devices known as EpiPens, which are used to treat severe allergic reactions.The proposed settlement, which needs to be approved by a judge, would resolve a legal battle that began after Mylan, in 2016, raised the price for a pack of two EpiPens to $608 from $100, the price since 2007, according to court documents.In the lawsuit, a group of plaintiffs made up of consumers, health insurance companies and other third-party payers, alleged that by drastically raising the price of EpiPens, the drugmaker was “unlawfully exercising its monopoly power,” according to a complaint.“Were the price increases attributable to market conditions, increases in manufacturing costs or shortages in the supply of epinephrine?” the complaint said. “Absolutely not. They were driven solely by unaccountable executives and companies who sought to profit off of human misery and fear.”Many people involved in the lawsuit had paid thousands of dollars for EpiPens over the years, including a mother from Arizona who had paid $2,475 out of pocket for her son who is allergic to tree nuts and peanuts, and a father from Delaware who spent more than $1,100 on EpiPens for his son who is allergic to milk, eggs and peanuts, according to the lawsuit.EpiPens are made by two subsidiaries of Pfizer — King Pharmaceuticals and Meridian Medical Technologies — and are sold by Viatris.In July, Pfizer and its subsidiaries settled its part of the lawsuit for $345 million, and denied any wrongdoing.In its quarterly earnings report on Monday, Viatris said that the company “maintains that it acted lawfully and pro-competitively and the settlement contains no admission of liability.”“The board of directors believes that this settlement is in the best interests of the company and its stakeholders,” the report said. “The resolution of these indirect purchaser cases will allow the company to move forward and continue focusing on its strategic priorities and its mission of empowering people worldwide to live healthier at every stage of life.”Neither Viatris officials nor lawyers representing the company immediately responded to a request for comment on Monday night.Lynn Sarko, a lawyer representing the plaintiffs, said in a statement that he urged consumers and third-party payers who paid for EpiPens to learn more about the settlement at a website where claims can be filed.“We are pleased that the EpiPen antitrust litigation is now concluded,” Paul Geller, another lawyer representing the plaintiffs, said in a statement, adding that the settlement is subject to court approval.The lawsuit also alleged that the drugmaker misclassified EpiPens under the Medicaid Drug Rebate Program to save hundreds of millions of dollars in rebates, and that it intervened in regulatory proceedings to delay competitors from entering the market.The price jump in 2016 drew widespread outrage, especially among parents of children with allergies. Thousands of people signed a petition urging Congress to intervene.After protests over the company’s raising the price of EpiPens in 2016, Mylan, as Viatris was then known, introduced a generic version of its own product. But it was announced with a wholesale list price of $300 for a pack of two, half the price of the brand-name EpiPen.In 2016, Mylan reached a $465 million settlement with the Justice Department and other government agencies over allegations that the drugmaker had overcharged Medicaid for the treatment by improperly classifying it as a generic drug.

When astronauts return to Earth from space, they can experience a number of health and physical issues after they land — a result of living without gravity.For flights that go as long as six months, astronauts can experience difficulties with balance, muscle weakness and cardiovascular deconditioning, according to NASA. Although the Inspiration4 flight was only three days long, the four astronauts returning will also receive a health screening.It’s unclear exactly what that health screening might consist of. Health researchers working with Inspiration4 said the astronauts were to undertake some experiments that gauge their sense of balance — standing without swaying and moving between sitting and standing positions.They will also perform a series of tests measuring their cognitive performance — the same ones they performed before liftoff and each during orbit.A NASA medical requirements overview from the era when astronauts flew on the space shuttles provides an idea of what doctors look for in astronauts returning from shorter flights in space.For flights that last less than 30 days, doctors screen the astronauts’ vital signs and look for neurological issues as well as problems with chest and lungs.Headaches, dizziness, vertigo and feeling faint are among the neurological symptoms that doctors screen for in astronauts.The functions of the eyes of returning astronauts are also checked, and they are asked to perform a series of tasks, including: touching their finger to their nose, rising from a chair, lifting a leg and hopping, walking in a straight line and then turning, and a heel-toe-walk.If the doctors observe enough issues, they may decide that an astronaut needs to undergo additional testing.Even before splashdown, the four astronauts have already gone through a series of health screenings while they were in space in hopes of furthering human exploration of space. They have been screened for heart activity, sleep, blood oxygen saturation, and blood.

The American Red Cross said rising trauma cases, transplants and surgeries had led hospitals to ask for more blood than expected.As many Americans return to prepandemic lifestyles, hospitals are facing a new issue: a desperate need for blood.Over the past few months, hospitals have seen a rise in trauma cases, organ transplants and elective surgeries, prompting a national blood shortage, the American Red Cross said last week.The lack of blood is so great that some hospitals are pumping the brakes on the pace of elective surgeries and “delaying crucial patient care,” until blood supply levels rebound, Chris Hrouda, president of Red Cross Biomedical Services, said in a statement.“The Red Cross is currently experiencing a severe blood shortage,” Mr. Hrouda said, adding that the organization was working to distribute more blood than expected over the past three months. “But we can’t do it without donors. Every two seconds, someone in the U.S. needs blood.”The demand for blood is not new. There was also a shortage last year when blood donation centers were forced to close because of the coronavirus pandemic.But in some ways, it seems more dire than before. During last year’s shortage, for example, Brian Gannon, chief executive of the Gulf Coast Regional Blood Center in Texas, said his organization had one or two days’ worth of Type O red blood cells, down from a normal supply of three to four days’ worth.In recent weeks, Type O blood supply has been down to half a day’s worth, according to the Red Cross, which said there was also an “emergency need” for the donation of platelets, half of which go to patients undergoing cancer treatments.Dr. Merlyn Sayers, president and chief executive of Carter BloodCare, based in Texas, called the need for blood a “national crisis.”“Carter BloodCare dreads reaching the point, with blood inventories so jeopardized, that patients needing transfusion cannot be confident that the blood is there for them,” Dr. Sayers said.The blood shortage is a result of two challenges caused by the pandemic — closing and reopening, Dr. Sayers said.“In the first place, the pandemic, for more than a year, imposed conditions, such as social distancing, that were inimical to blood donation,” Dr. Sayers said, adding that many businesses that typically supported blood donation campaigns at workplaces had closed. “And now, with the gradual emergence from restrictions, hospital demands for blood have increased dramatically as patients who understandably avoided hospitalization for fear of Covid are presenting for treatment.”The Red Cross said patients who did not seek care during the height of the pandemic in the United States were showing up in hospitals with “more advanced disease progression,” which in some cases requires more blood transfusions.In addition to patients who delayed seeking treatment for fear of the virus, another possible reason for the increased demand for blood is that as cities reopen, more people are exposed to potential dangers leaving their homes.The Red Cross said hospitals across the country had been responding to an “atypically high” rise in trauma cases and emergency room visits. The organization said it had seen demand from hospitals with trauma centers increase by 10 percent this year, compared with 2019.“Where there’s more people on the road, there’s probably more accidents. We did quarantine for a long time,” said Cameron Palmer, a community development coordinator with the Gulf Coast Regional Blood Center in Houston. “Having more people on the road can cause more accidents, which can cause people to need more transfusions.”The Gulf Coast Regional Blood Center is still making its collection calls, but hospitals have had a greater need for blood, Mr. Palmer said.“It’s not really a shortage. It’s more of a usage,” he said. “It’s just that our hospitals are now asking for more than expected.”

The caterpillars, known as browntail moths, have tiny hairs that can cause skin rashes and even breathing issues for some people.While parts of the country deal with swarms of cicadas this summer, Maine is struggling with an infestation of an invasive species of caterpillar with poisonous hairs that can cause people to develop painful rashes and even breathing problems.The caterpillars, known as browntail moths, are about 1.5 inches long and have white dashes down their sides and two red dots on their backs.Browntail moths are most common along Maine’s coast and on Cape Cod, but they’ve been spotted this year in all of Maine’s 16 counties, said Jim Britt, a spokesman for the Maine Department of Agriculture, Conservation and Forestry.“People are finding them everyplace: on the ground, on the picnic table, on the electrical box, on the corner — you name it,” Mr. Britt said. “They are heavily present. Folks will see them all over.”“We are in the midst of an outbreak,” he said.The caterpillars have tiny poisonous hairs that can remain toxic for as long as three years, the Maine Department of Health and Human Services warned.After people come in contact with the caterpillar’s hairs, they can develop a red and bumpy rash similar to a reaction to poison ivy that can linger for a few hours to several weeks, the department said. If the hairs are inhaled, some people can develop breathing issues.Other people, like Mr. Britt who said he recently came across the caterpillars in a park, develop no symptoms.“They were everywhere, and I had absolutely no reaction to them,” he said.There’s no specific treatment for the rash, other than remedies like calamine lotion, the department said.In Waterville, Maine, a city about 20 miles north of Augusta, the caterpillar infestation has gotten so out of control that the mayor called an emergency meeting of the City Council to declare a public health emergency and order insecticide.“After a pandemic year, while we are finally able to start getting out and socializing, this is the last thing we want to be dealing with,” the mayor, Jay Coelho, said at the meeting, adding that he had received several emails from Waterville residents with pictures of painful rashes.The caterpillars spend the winter in oak trees and other hardwood trees, and emerge in the spring, Mr. Britt said.Browntail moths are not new to Maine, which has had them for a century. The caterpillars originally came from Massachusetts, but ended up in Maine “because they’re expert hitchhikers,” Mr. Britt said.While it’s unclear what exactly caused this recent infestation, Mr. Britt said dry conditions are “absolutely ideal” for browntail moths to expand their reach.During the Waterville emergency meeting, a City Council member, Thomas Klepach, expressed concern that climate change could worsen infestations in years to come.“It is wise for the city to get the outbreak under control as much as we can now,” Mr. Klepach said, “and to recognize that this may be on ongoing problem.”Maine’s Department of Health and Human Services recommends showering and changing clothes after being in areas with browntail moths, wearing a mask and goggles when doing outdoor activities, such as raking leaves, and doing yardwork on wet days.

Norwegian Cruise Line plans to require Covid-19 vaccine documentation from its crew members and customers, but Florida recently enacted a law that bars businesses from doing so.Norwegian Cruise Line is threatening to keep its ships out of Florida ports after the state enacted legislation that prohibits businesses from requiring proof of vaccination against Covid-19 in exchange for services.The company, which plans to have its first cruises available to the Caribbean and Europe this summer and fall, will offer trips with limited capacity and require all guests and crew members to be vaccinated on bookings through at least the end of October.During a quarterly earnings call on Thursday, Frank Del Rio, chief executive of Norwegian Cruise Line, said the issue had been discussed with Florida’s governor, Ron DeSantis, a Republican. Mr. Del Rio said if the cruise line had to skip Florida ports, it could operate out of other states or the Caribbean.“We certainly hope it doesn’t come to that,” Mr. Del Rio said. “Everyone wants to operate out of Florida. It’s a very lucrative market.”The clash between Norwegian Cruise Line and Florida is one of the many that are likely to surface about how states and businesses address whether proof of vaccination will be required. While some states have yet to take a position on businesses requiring vaccines, others are already operating with such protocols in place.At many events in New York, such as Major League Baseball and National Basketball Association games, state health and safety guidelines require that fans provide proof of vaccination or of a negative coronavirus test within 72 hours of attendance.“We hope that this hasn’t become a legal football or a political football,” Mr. Del Rio said on the call.Norwegian Cruise Line is headquartered in Florida along with Royal Caribbean Cruises and Carnival Corporation. In 2019, about 60 percent of all U.S. cruise embarkations were from Florida ports, according to an economic analysis prepared last year for the Cruise Lines International Association.In a business update on Thursday, Norwegian Cruise Line said it was experiencing “robust future demand” with bookings for the first half of 2022 that were “meaningfully ahead” of 2019 bookings. Through the end of the first quarter of 2021, the company said it had $1.3 billion of advance ticket sales.In addition to prohibiting businesses to require proof of vaccination, the Florida law also prevents state and local governments from closing businesses or schools for in-person learning unless there is a hurricane emergency.“I have refused to take the same approach as other lockdown governors,” Mr. DeSantis said in a statement on Monday when he signed the bill. “In Florida, your personal choice regarding vaccinations will be protected and no business or government entity will be able to deny you services based on your decision.”His office did not immediately respond to a request for comment on Saturday, and Norwegian Cruise Line could not be reached for comment.“We hope that everyone is pushing in the same direction, which is we want to resume cruising in a safe manner, especially at the beginning,” Mr. Del Rio said on the earnings call. “Things might be different six months from now or a year from now.”The latest guidance from the Centers for Disease Control and Prevention allows for cruise ships to conduct “simulated voyages” with volunteer passengers to see how cruise lines can safely resume operations with measures such as testing and potential quarantines.The C.D.C. requires cruise lines to complete the test runs before they can be cleared to sail with passengers this summer.“It is not possible for cruising to be a zero-risk activity for spread of Covid-19,” the C.D.C. said this week. “While cruising will always pose some risk of Covid-19 transmission, C.D.C. is committed to ensuring that cruise ship passenger operations are conducted in a way that protects crew members, passengers and port personnel.”The latest guidance recommends, but does not require, that travelers and crew members on cruise lines receive a vaccine when it is available to them.On the earnings call this week, Mr. Del Rio said Norwegian Cruise Line had submitted a proposal to the C.D.C. that includes requiring proof of vaccines from all of its crew members and passengers.It is unclear how much business Norwegian Cruise Line could stand to lose by avoiding Florida ports. Of the dozens of ports listed on its website, Norwegian Cruise Line has Florida ports listed in Tampa, Miami and Key West.Mr. Del Rio said “pent-up demand” had helped fill bookings quickly.“I believe it’s the No. 1 destination for Americans to the Caribbean,” Mr. Del Rio said. “Who knows? That vessel might prove to be so profitable there that it never returns back to U.S. waters.”

Alaska Airlines said it would not allow State Senator Lora Reinbold to fly because she refused to comply with its mask rules.Alaska Airlines has banned an Alaska state lawmaker from its flights for violating its mask policies, the company said.The lawmaker, Lora Reinbold, a Republican state senator, was captured on video arguing with employees at Juneau International Airport about the airline’s mask rules, according to footage posted on Twitter.“We need you to pull the mask up, or I’m not going to let you on the flight,” an airport employee is heard saying to Ms. Reinbold on the videos, which were posted on Thursday.“It is up,” Ms. Reinbold responds.“It is not,” an employee says. “It’s down below your nose. We can’t have it down.”It was not clear if she was permitted on the flight and one of the videos showed her leaving the boarding area. In the videos, Ms. Reinbold can be seen wearing a mask. It was not clear what prompted the confrontation at the airport or what happened immediately before the footage was taken.Ms. Reinbold said on Facebook she learned on Saturday that she was banned from flying with the airline.“We have notified Senator Lora Reinbold that she is not permitted to fly with us for her continued refusal to comply with employee instruction regarding the current mask policy,” the airline said, adding that the suspension is being reviewed.Ms. Reinbold said that she was suspended before getting a chance to speak to someone from the airline and that she did not get “a warning via a yellow card per their policy either,” according to a post on Facebook.“There was no due process before a temporary decision that is ‘under review’ was made public,” she wrote. “Alaska Airlines sent information, including my name, to the media without my knowledge nor permission. I do believe constitutional rights are at risk under corporate covid policies.”The clash over the company’s rule was the latest to surface in the country about masks during the pandemic. Mask mandates have become a rallying cry for some activists and a divisive political talking point. Disputes about the rules have sometimes led to angry confrontations.In an interview with Fox News last week, Senator Rand Paul, a Republican of Kentucky, suggested President Biden should “go on national TV, take his mask off and burn it” to motivate Americans to get vaccinated.A federal mandate issued in January requires travelers to wear masks on planes and at airports, as well as on other modes of public transportation, including trains.Under the federal mandate, the only travelers exempt from wearing a mask include children ages under 2, a person with a disability who cannot wear one or someone “for whom wearing a mask would create a risk to workplace health, safety,or job duty.”“I test negative weekly,” Ms. Reinbold wrote. “I hope people can hear the truth of my actual actions thru the media mischaracterization.”Ms. Reinbold’s office did not immediately respond to a request for comment on Monday.On Sunday, Ms. Reinbold posted on Facebook that she had traveled to Juneau, Alaska, by road and ferry. Without a flight, the trip from the Anchorage area to Juneau takes more than 19 hours.Last week’s episode is not the first confrontation that Ms. Reinbold has had with Alaska Airlines. She has previously complained about the company on Facebook.“Mask bullies in full force,” Ms. Reinbold said of a flight with Alaska Airlines. “Sadly Alaska airlines is part of mask tyranny and not providing proof required in law they help stop the spread (I can show they cause health problems).”In February, Gov. Mike Dunleavy of Alaska, a Republican, sent a letter to Ms. Reinbold asking her to stop sharing misinformation about the pandemic.“It is clear you have abdicated the tenets of your oath as a public servant,” Mr. Dunleavy wrote. “You impugned the motivations of unelected and nonpolitical employees working for the State of Alaska with baseless allegations that, on multiple occasions, were demonstrated to you to be false.”In March, Ms. Reinbold said on Facebook that she was asked to leave a committee hearing because she was not wearing an approved face shield. After that, Ms. Reinbold was banned from the State Capitol until she complied with health and safety protocols.“My actions are to protect my constitutional rights, including civil liberties and those who I represent, even under immense pressure and public scrutiny,” Ms. Reinbold said.Ms. Reinbold has since returned to the State Capitol in a clear face mask.

The Centers for Disease Control and Prevention said 19 people had been sickened in eight states.A salmonella outbreak linked to contact with wild songbirds and bird feeders has sickened 19 people across eight states, eight of whom have been hospitalized, federal health authorities said.The Centers for Disease Control and Prevention said it was investigating salmonella infections in California, Kentucky, Mississippi, New Hampshire, Oklahoma, Oregon, Tennessee and Washington State in people ranging in age from 2 months to 89 years old.Six cases were reported in Washington and five in Oregon. No deaths have been reported.Public health officials across the country interviewed 13 of the people who were infected and asked them about animals they had come in contact with a week before they became ill, the C.D.C. said. Nine said they owned a bird feeder, and two reported they had come into contact with a sick or dead bird. Ten people said they had pets that had access to or contact with wild birds, the agency said.To prevent further cases, the C.D.C. recommends cleaning bird feeders and bird baths once a week or when they are dirty. People should avoid feeding wild birds with their bare hands, and should wash their hands with soap and water after touching a bird feeder or bath, or after handling a bird.In California, where three human cases have been reported, the state’s Department of Fish and Wildlife warned of an outbreak in February, and reported that it had been “inundated with calls” from Californians who had discovered sick or dead finches at bird feeders.Andrea Jones, director of bird conservation for Audubon California, said the state had found that most of the birds affected by the outbreak were pine siskins, a finch species that spends the winter in California. Pine siskins congregated in California in large numbers this year, which allowed the outbreak to spread among the birds.“It can happen any year, but this has been a particularly bad year,” Ms. Jones said. “Pine siskins are not very good at social distancing.”Sick birds can often look weak or lethargic, or may appear to be struggling to breathe, Ms. Jones said. She added that most birds die within 24 hours of being infected by salmonella.Many pine siskins are now leaving California for Canada, Ms. Jones said, adding that she hoped the outbreak might be nearing an end.Salmonella bacteria can spread from birds to pets and to humans. People may experience diarrhea, fever and stomach cramps for anywhere from six hours to six days after infection, according to the C.D.C. Children, adults 65 and older, and people with weakened immune systems sometimes suffer worse cases of salmonella, though most people recover in a week or less without treatment.Because many people recover quickly and are not tested for salmonella, the C.D.C. said it was likely that the true number of cases resulting from the outbreak was much higher than the number of reported cases.About 1.35 million cases of salmonella are reported every year in the United States. Of those, about 26,500 require hospitalization and 420 result in death, according to the C.D.C.