Thousands of people each year partake in the 75-day program meant to build “mental toughness,” according to its creator, but health experts caution the program may be too rigid and intense.Two 45-minute daily workouts. One gallon of water. 10 pages of a nonfiction book. A diet. No “cheat meals” or alcohol. For 75 days.And if you mess up, you have to start from the beginning.Sound like a lot? It’s supposed to be. The program, called 75 Hard, is meant to build mental toughness. Some say that rigidity is what makes it great, and others say that makes it problematic.Since it was created in 2019, 75 Hard has developed somewhat of a cult following, with practitioners posting daily progress pictures and videos that sometimes rack up millions of views on TikTok and Instagram. One of Reddit’s biggest subreddits, with over 44,000 members, is dedicated to the program.But is it beneficial, and are the changes sustainable? Psychologists say that while the program can have mental-health benefits, certain vulnerable groups may be pushing themselves too far without benefit. Exercise experts also say the regimen could be too taxing for those who aren’t young and active already, and could lead to physical injury.“It can sound really cool and exciting and helpful, but is this something that’s actually really ultimately helpful, sustainable, good for the person?” asked Dr. Thea Gallagher, a clinical psychologist and the director of wellness programs at New York University.“It would be great to have more continued rigorous research around these exciting programs-slash-challenges,” she said.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.

Covid-19 treatments are widely available to at-risk New Yorkers, but many who could benefit from them may not even be aware they exist.One such treatment, an antiviral medication called Paxlovid, is very effective, said Dr. Ted Long, the head of New York City’s Test and Trace Corps, a city program that provides free testing and support to New Yorkers with Covid-19.“For every 20 New Yorkers that we treat with Paxlovid, we prevent one New Yorker from getting so sick that they would have to be admitted to the hospital,” Dr. Long said.Coronavirus cases in New York City have increased 6 percent over the past two weeks, according to The New York Times’s tracker, driven largely by the highly contagious Omicron subvariant BA.2. Hospitalizations have crept up 23 percent over the same time period.Across the country, hundreds of thousands of Paxlovid pills have gone unused, and the White House announced plans this week to expand access.The city’s health department did not say how many pills had been distributed in New York, though Dr. Ashwin Vasan, the health commissioner, said that uptake had been “significant.” This city has worked to get the word out through newspaper ads and public service announcements.“We’re in a new phase of the pandemic response, where we’ve got a range of tools at our disposal,” said Dr. Vasan.But some experts believe far too few people know about the treatments.“I’m not really sure that the average person who needs Paxlovid — by that I mean older people, people with comorbidities or otherwise medically vulnerable, unvaccinated people — know this critical information,” said Dr. Denis Nash, a professor of epidemiology at the City University of New York.Paxlovid, a Pfizer drug that was authorized in late December, is one of several available treatments that have been proven effective against Covid-19. It is preferred by the federal government and New York City officials because of how effectively it reduced the risk of death and hospitalization from Covid-19 in high-risk, unvaccinated adults during trials.Here’s an overview of the various Covid-19 treatments and how to get them in New York City.Which Covid-19 treatments are available?Evusheld is for people who are allergic to vaccines or who are immunosuppressed.Ted S. Warren/Associated PressBoth oral antiviral treatments and monoclonal antibodies are available. Antiviral pills work by interrupting the cycle of viruses infecting cells and then taking over those cells to replicate in the body, said Dr. Vasan. Monoclonal antibodies work by sweeping up the proteins that viruses produce, which in turn helps boost a person’s immune system.Two oral antiviral pills are available for Covid-19 in New York City: Paxlovid and molnupiravir.Paxlovid is prescribed as three pills taken twice a day for five days, while molnupiravir — authorized for use in December — is prescribed as four pills taken twice a day for five days.Both pills are available through an online pharmacy, Alto, and at a select number of pharmacies across the city. You can find a list of those nearby on a federal website.Most New Yorkers seeking antiviral treatments should expect to receive Paxlovid, given its efficacy, said Dr. Vasan.There are also two antibody treatments that appeared to be effective against BA.2 in laboratory studies: Bebtelovimab, authorized for use in February and taken intravenously, and Evusheld, authorized for use in December, for people who are allergic to vaccines or are immunosuppressed.Who is eligible for the treatments?For most of the treatments, city officials give priority to people who have not only tested positive for the coronavirus, but who also have mild to moderate symptoms and are at increased risk of developing serious illness. (Evusheld is given to people before they test positive.)You are considered at high risk of developing serious illness from Covid-19 if you are age 65 or older, or if you have health risks such as diabetes, hypertension or heart disease. Immunosuppressed people are also considered to be at high risk. The federal government has urged providers to prioritize the treatments for people who are unvaccinated, or aren’t yet fully vaccinated.You have to be older than 12 and weigh more than 40 kilograms, or around 88 pounds, to receive Paxlovid, bebtelovimab, and Evusheld. But you have to be at least 18 to take molnupiravir.People with severe kidney or liver disease may not be eligible for Paxlovid, and molnupiravir cannot be used during pregnancy. Pregnant or breastfeeding women should talk to their health care providers before taking Paxlovid, according to the F.D.A. fact sheet for the treatment.It is important for patients to talk with their providers about the medications they are taking, as they could negatively interact with the treatments, said Dr. Andrew Wallach, the ambulatory care chief medical officer at New York City Health and Hospitals.How do I get them?After you test positive, you should inform your doctor or call the city’s Covid hotline, 212-COVID19 (212-268-4319) and press 9 to be connected to one of the city’s doctors to determine your eligibility. You can also visit Virtual Express Care to schedule a phone or video visit or fill out the city’s screening tool too.After a doctor decides which treatment is right for you, it will be sent to a nearby pharmacy or to your home. The city’s partnership with Alto Pharmacy makes same-day home delivery possible.The Biden administration also recently unveiled a “test to treat” initiative, which makes it possible to get tested for the coronavirus at certain pharmacies, and if you test positive, receive free antiviral pills on the spot. You can find locations on the federal website.Do I have to pay?They are currently free for all New Yorkers, Dr. Vasan said.Are the treatments effective?The oral treatments have been proven to reduce hospitalization and death from Covid-19 if taken soon after the onset of symptoms.Paxlovid reduced the risk of hospitalization and death in high-risk, unvaccinated people by 88 percent when taken within five days of the onset of symptoms in a Pfizer trial published in December, before the Omicron wave.Molnupiravir reduced the risk of hospitalization and death in high-risk, unvaccinated people by 30 percent when taken within five days of the onset of symptoms, according to an analysis from Merck that was published in November.Bebtelovimab, which must be administered within seven days of symptoms starting, has not been tested in a study that can show whether it can stave off severe disease, and the Food and Drug Administration said it should not be a preferred treatment.Evusheld, which can be administered as often as every six months, was found to be strongly effective at preventing Covid in a clinical trial.Are there any side effects?The treatments have shown to be effective at reducing hospitalization and death from Covid-19.Eli Lilly and Company, via Associated PressPaxlovid is “well-tolerated,” said Dr. Wallach. Side effects that have been seen in small numbers in clinical trials include diarrhea, hypertension and soreness.Because bebtelovimab is given intravenously, some people may experience a rash at the injection site.How many New Yorkers have received these treatments?It’s hard to say. The health department was unable to provide data, in part because it didn’t “have visibility into the entire universe of pharmacies” that distribute many of the treatments, said Patrick Gallahue, a spokesman.There is an immunization registry that tracks vaccinations, but there isn’t a registry for prescription medication, said Dr. Nash.“It’s a problem that they don’t have their finger on the pulse of this, because it is the main thing that is going to help us contain these surges, hospitalizations and deaths,” he said. “That plus vaccines and boosters.”Dr. Nash worried that the inequities seen during each phase of the pandemic, including with the rollout of testing and vaccines, would play out again with these treatments.“If you don’t anticipate that the underlying inequities in access to health care are going to be magnified, if you don’t plan for it, then you’ve done a poor job at your job of taking care of the most vulnerable people in the city,” said Dr. Nash.How has the rollout gone so far?New Yorkers can expect to receive Paxlovid, but there are certain scenarios where a person will receive one of the other treatments, such as molnupiravir, instead.Amr Abdallah Dalsh/ReutersThe treatments are now available via Alto Pharmacy and community health centers. The health department is working on expanding access to brick-and-mortar pharmacies throughout the city, too. Ultimately, state officials decide how to allocate treatments to pharmacies.Colombo’s Pharmacy in Queens is one of the places that now offers Paxlovid and molnupiravir.It received its first batch, 20 doses of each medication, earlier this month. Dr. David Kandov, the pharmacist, said only about five people had asked for the treatments so far.Dr. Kandov expressed frustration about how long it took to receive the first batch, saying the network to which he belongs had been trying unsuccessfully to get access to the medications since December, when they were first authorized.He blamed the health department. “They effectively cut us out of it, and cut out the access in the communities,” Dr. Kandov said. “Because at the end of the day, as much as things are available virtually, mail order and those types of things, that’s not anywhere near the same as patients having it right there in their community.”“The city is offering a delivery model that ensures rapid access to any New York address, which started at a time when supplies were insufficient to stock brick and mortar pharmacies throughout the City,” said Mr. Gallahue. “As supplies have improved, more pharmacies have been onboarded.”

It has long been clear that Black Americans have experienced high rates of coronavirus infection, hospitalization and death throughout the pandemic.But those factors are now leading experts to sound the alarm about what will may come next: a prevalence of long Covid in the Black community and a lack of access to treatment.Long Covid — with chronic symptoms like fatigue, cognitive problems and others that linger for months after an acute Covid-19 infection has cleared up — has perplexed researchers, and many are working hard to find a treatment for people experiencing it. But health experts warn that crucial data is missing: Black Americans have not been sufficiently included in long-Covid trials, treatment programs and registries, according to the authors of a new report released on Tuesday.“We expect there are going to be greater barriers to access the resources and services available for long Covid,” said one of the authors, Dr. Marcella Nunez-Smith, who is the director of Yale University’s health equity office and a former chair of President Biden’s health equity task force.“The pandemic isn’t over, it isn’t over for anyone,” Dr. Nunez-Smith said. “But the reality is, it’s certainly not over in Black America.”The report, called the State of Black America and Covid-19, outlines how disinvestment in health care in Black communities contributed to Black people contracting Covid at higher rates than white people. Black people were then more likely to face serious illness or death as a result.The Black Coalition Against Covid, the Yale School of Medicine and the Morehouse School of Medicine were authors of the report, which also offers recommendations to policy leaders.In the first three months of the pandemic, the average weekly case rate per 100,000 Black Americans was 36.2, compared with 12.5 for white Americans, the authors write. The Black hospitalization rate was 12.6 per 100,000 people, compared with 4 per 100,000 for white people, and the death rate was also higher: 3.6 per 100,000 compared with 1.8 per 100,000.“The severity of Covid-19 among Black Americans was the predictable result of structural and societal realities, not differences in genetic predisposition,” the report says.Black Americans were overrepresented in essential-worker positions, which increased the risk of exposure to the virus, the authors write. And they were also more likely than white Americans to live in multigenerational homes or crowded spaces, be incarcerated, or live in densely populated areas.Many Black Americans who contracted the coronavirus experienced serious illness because of pre-existing conditions like obesity, hypertension and chronic kidney disease, which themselves were often the result of “differential access to high-quality care and health promoting resources,” the report says.The authorization of the first coronavirus vaccines was seen by many experts as a light at the end of the tunnel, but new disparities emerged, driven by both vaccine hesitancy and limited access to the shots.Though the gap in vaccinations has since narrowed — 80 percent of Black Americans were fully vaccinated as of January, compared with 83 percent of white Americans, the report says — disparities persist.“We understand that there remains unfinished work yet to do to save and protect our communities from the Covid-19 pandemic,” wrote Dr. Reed Tuckson, who in April 2020 co-founded the Black Coalition Against Covid.And when it comes to unfinished work, long Covid is top of mind.“So much of even getting a long Covid diagnosis is tied to having had a positive test right at the beginning,” said Dr. Nunez-Smith, adding that early on in the pandemic, many Black Americans “weren’t able to secure a test and in some cases, were denied testing.”She emphasized the importance of investing adequate resources into studying long Covid. “Like everything else, without intentionality, we’re not going to get to equity there,” she said.