Do counselors have to be vaccinated? Will there be singing around campfires? We asked the experts.At 8:30 one morning in March, online registration opened for the summer day camp run by my local community center. By 8:35 a.m., all the spots were taken and a wait list was building.After more than a year of living with pandemic restrictions, it’s not surprising that families are in a frenzy over in-person camp this year. In contrast to last summer, when many camps didn’t open at all or opened with strict limitations, the American Camp Association said that most overnight and day camps plan to open this summer. “There is a huge demand,” said Paul McEntire, chief operating officer of the Y.M.C.A. of the U.S.A. For many of its more than 10,000 camps, registrations are at their highest levels ever. “Camps have never been more needed,” he said.But what will summer camp actually look like this year, and what kinds of Covid-19 protocols will be required? Will kids be able to have fun and stay safe? To find out, we scoured the updated guidance from the Centers for Disease Control and Prevention and spoke with three public health experts who are working with camps to develop rigorous safety protocols, as well as with two camp executives.First off, can camps even be run safely?While just 18 percent of overnight camps, and 60 percent of day camps, ran in-person last year, according to the A.C.A., camp and health officials were still able to learn quite a bit about the kinds of practices that did — and didn’t — keep campers and employees safe.Between June 17 and 27, for instance, nearly half of the 597 campers, staff members and trainees at one overnight camp in Georgia tested positive for Covid-19 after an outbreak there caused the camp to close. According to a later C.D.C. report, health officials learned that the camp had not implemented certain safety protocols, like requiring masks for campers or opening windows and doors for ventilation; the camp also allowed “daily vigorous singing and cheering,” the report said.The experience taught camps “what you don’t want to do,” said Dr. Dipesh Navsaria, a pediatrician at the University of Wisconsin-Madison School of Medicine and Public Health who has been working to develop Covid-19 protocols for camps, including one in Wisconsin.But there were also signs that camps could be run safely. Between June 15 and Aug. 16, four overnight camps in Maine had just three positive cases out of 1,022 campers and staff members, because “they followed a multilayered approach, which is generally recognized as the best way to handle any aspect of this pandemic — distancing, outdoors, masking, hand hygiene,” Dr. Navsaria said. One study published this month also found that among 54 Y.M.C.A. day camps in North Carolina, which followed similar protocols, few experienced Covid-19 infections.“If a parent asked me, ‘Can you guarantee my child won’t get Covid?’ Well, no,” Dr. Navsaria added. But, “we made the decision that opening this year was not only safe, but really important to the mental, social and emotional health of the children that we serve.”What kinds of safety protocols will be in place this year?On April 24, the C.D.C. released updated and detailed guidance for both day and overnight summer camps, which emphasized a few basic principles. It called for outdoor, masked and distanced activities whenever possible; ventilation and reduced capacity in poorly ventilated or indoor areas; and a strong recommendation for vaccination of any employees and campers who are eligible (though camps will probably not require staff members to be vaccinated, Mr. McEntire, of the Y.M.C.A., said). It did not recommend limiting how many people can attend camp overall.For day camps, the C.D.C. said that children 2 and up should wear masks at all times except when eating, drinking, swimming or napping, and should be broken into small groups that interact only with each other. All campers must stay three feet from others in their cohort (six feet when eating or drinking), and six feet from everyone else (including their own counselors). The guidelines also recommend daily symptom checks for campers and staff, and periodic Covid-19 testing for campers, if tests are available. Employees should be tested weekly if they interact with multiple camper groups.If your child is attending an overnight camp, the C.D.C. advised that anyone who is eligible to receive a Covid vaccine should get one before they arrive, ideally receiving their final shot at least two weeks before. Unvaccinated attendees should try to practice Covid-19 safety measures — like avoiding unnecessary travel, physical distancing and wearing masks in public — as much as possible for two weeks before overnight camp begins, and they should take a Covid-19 test one to three days before they arrive.Once at camp, the C.D.C. recommended breaking campers into groups by cabin, as well as daily symptom checks and periodic testing. Campers will only need to wear masks and physical distance around those not in their bunks.Keep in mind that the federal guidance is meant to supplement, not replace, state and local guidelines. So some states may choose not to follow it, said Tom Rosenberg, president and chief executive of the A.C.A. Texas’ overnight camp guidelines, for instance, do not require camps to screen campers or the staff for Covid-19 before or during camp (though they do recommend testing if a camper or staff member becomes ill during their stay). And some overnight camps will allow campers from different groups to intermingle over time, if local guidelines allow it and there have been no cases, Mr. Rosenberg said.State guidelines may also change between now and when camp starts, said Dr. Lucy McBride, a physician in Washington, D.C., who is advising an overnight camp in Maine. “The landscape is changing enormously,” she said. So parents may want to check camp protocols close to when their kids will attend to confirm which procedures will be in place.Campers who are at high risk for coronavirus complications (or whose family members are) may want to be even more stringent with risk mitigation and should be sure to get vaccinated as soon as they’re eligible, Dr. McBride added. Camps may even advise some families that they would be better off not sending their kids to camp at all; high-risk families may want to consult with their doctors. Some camps for kids with medical conditions — such as camps run by the Muscular Dystrophy Association and the American Diabetes Association — will be run virtually again this year for safety reasons.How will beloved camp activities — campfires, field trips, singalongs — differ from those in prepandemic years?Some camp traditions may not make an appearance this year. “We’re not going to have the loud, raucous dining hall filled with incomprehensible yelling,” said Dr. Daniel Griffin, an infectious disease physician at Columbia University who is advising a handful of camps this summer. (Campers may still sing and chant, just outdoors.) Parents probably won’t be able to visit, or even step foot inside cabins at drop-off, and staff members may not be allowed to leave camp premises during breaks.Camp activities that involve cabins competing against each other, like the popular Color War competitions, may not happen this year, Dr. Navsaria added.Other camp activities may be allowed, but modified. For instance, camps probably won’t allow kids from different cohorts to mingle during electives like dance or archery. Evening campfires might still take place, but campers may be required to sit with their cohorts and six feet away from other groups. Camp performances will still happen, but they will most likely be held outside. And campers may still play some outdoor sports, but the C.D.C. advised against indoor sports as well as close-contact sports, like wrestling and basketball, even if done outside.The C.D.C. has also advised camps to avoid day trips to places like amusement parks or movie theaters that would put attendees in close contact with the public.What happens if my kid gets sick?Camp policies may vary, but if your child is in day camp and develops symptoms of (or tests positive for) Covid-19, the camp will probably isolate the child from other campers and call you to come pick her up. If your child is positive, she will most likely be able to return to camp after 10 days, provided she has no fever and her symptoms are improving. If your child is exposed to Covid-19 at camp — or if you or someone else in your household (or another close contact) contracts Covid-19 — your child may be asked to stay home and quarantine for up to 14 days.If your child is at an overnight camp and develops symptoms of Covid-19, the staff should immediately isolate and test her. If she tests positive, they will most likely move her to a dedicated facility with any other infected campers, under the care of medical providers. The staff will probably call you and let you decide if you want to pick her up or let her stay at camp until she has recovered. If your child is exposed to Covid-19 at camp, her group should also be quarantined for up to 14 days, monitored for symptoms, and may be tested regularly, though they should still be able to do some limited sports and activities as a group.If kids go home because of Covid-19, or if camps have to close because of an outbreak, Mr. McEntire said that most Y.M.C.A. day and overnight camps plan to provide prorated refunds. It’s wise to ask camps in advance about their refund policies.If this all seems complicated, it is — but experts say that camps need to be run carefully in order to keep everyone safe. And despite the rules and regulations, campers can still have plenty of fun. “Kids can have a joyous, immersive summer experience,” Mr. Rosenberg said, as long as the camps do it “in a very structured, smart way.”Melinda Wenner Moyer is the author of a forthcoming book on science-based parenting and writes a free parenting newsletter.

#masthead-section-label, #masthead-bar-one { display: none }El brote de coronavirusVacunas: lo que debes saberIdentifica las N95 falsasEficacia vs. EfectividadAsí funciona la Sputnik V¿Una vacuna cubana?AdvertisementContinue reading the main storySupported byContinue reading the main storyLas mujeres informan de peores efectos secundarios tras la vacuna para la covidLos hombres y las mujeres suelen responder de forma diferente a muchos tipos de vacunas. Esto se debe probablemente a una mezcla de factores, como las hormonas, los genes y la dosis de las vacunas.Los investigadores de los CDC analizaron los datos de seguridad de 13,7 millones de vacunas para la COVID-19 y descubrieron que el 79,1 por ciento de los efectos secundarios notificados procedían de mujeres, aunque solo el 61,2 por ciento de las vacunas se habían administrado a mujeres.Credit…Mike Kai Chen para The New York Times10 de marzo de 2021 a las 15:51 ETRead in EnglishLa mañana que Shelly Kendeffy recibió su segunda dosis de la vacuna de Moderna contra la COVID-19, se sintió bien. En la tarde, sintió el brazo adolorido y dolor corporal, y para la noche, tenía síntomas parecidos a los de la influenza.“Los dientes me castañeteaban, pero estaba sudando… como empapada y a la vez congelándome”, contó Kendeffy, una paramédica de 44 años de State College, Pensilvania.Al día siguiente, fue a trabajar y preguntó entre sus colegas —ocho hombres y siete mujeres— acerca de su experiencia con las vacunas. Seis de las mujeres tuvieron dolor de cuerpo, escalofríos y fatiga. La única mujer que no tuvo síntomas de influenza estuvo despierta vomitando gran parte de la noche.Los ocho hombres dieron testimonios muy diferentes. Uno tuvo un ligero dolor en el brazo, dolor de cabeza y dolor corporal. Dos hablaron de una ligera fatiga y un poco de dolor muscular. Uno tuvo dolor de cabeza. Y cuatro no experimentaron ningún síntoma.“Yo trabajo con mujeres muy fuertes”, afirmó Kendeffy. Pero dijo: “es evidente que, para nosotras, los efectos secundarios fueron más intensos”. Después de 24 horas, ya se sintió mejor y está muy contenta de haber recibido la vacuna. “No me arrepiento, porque seguro que esto es mejor que la alternativa”, señaló. “Pero tampoco sabía qué esperar”.Las diferencias que Kendeffy observó entre sus colegas están apareciendo en todo el país. En un estudio publicado el mes pasado, los investigadores de los Centros para el Control y la Prevención de Enfermedades (CDC, por su sigla en inglés) analizaron los datos de inocuidad de los primeros 13,7 millones de dosis de vacunas contra la COVID-19 administradas a los estadounidenses. De los efectos secundarios reportados a este organismo, el 79,1 por ciento vino de mujeres, pese a que solo habían aplicado el 61,2 por ciento de las vacunas a personas del sexo femenino.La mayor parte de las insólitas reacciones anafilácticas a las vacunas contra el coronavirus también se han presentado en mujeres. Los investigadores de los CDC informaron que los 19 sujetos que habían sufrido esa reacción a la vacuna de Moderna eran mujeres y que las mujeres representaban 44 de los 47 sujetos que han tenido reacciones anafilácticas a la vacuna de Pfizer.“No me sorprende en absoluto”, señaló Sabra Klein, microbióloga e inmunóloga de la Escuela de Salud Pública Bloomberg de la Universidad Johns Hopkins. “La diferencia que se da según el sexo coincide por completo con informes anteriores relacionados con otras vacunas”.En un estudio de 2013, los científicos de los CDC y de otras instituciones descubrieron que cuatro veces más mujeres que hombres entre 20 y 59 años reportaron reacciones alérgicas después de recibir la vacuna de 2009 contra la influenza, pese a que fueron vacunados más hombres que mujeres. En otro estudio, se descubrió que entre 1990 y 2016, las mujeres conformaron el 80 por ciento de todos los casos de reacciones anafilácticas a las vacunas en personas adultas.En general, las mujeres “tienen más reacciones a una diversidad de vacunas”, mencionó Julianne Gee, funcionaria médica en la Oficina de Seguridad de la Inmunización de los CDC. Eso incluye las vacunas contra la influenza que se administran a los adultos, así como algunas que se administran en la infancia, como las vacunas contra la hepatitis B y la de sarampión, rubeóla y paperas (SRP).Sin embargo, la noticia no es tan mala para las mujeres. Casi siempre, los efectos secundarios son leves y de poca duración. Además, estas reacciones físicas son una señal de que la vacuna está surtiendo efecto, de que estás “desarrollando una respuesta inmunitaria muy consistente y es probable que, como consecuencia” estés “protegida”, señaló Klein.Así avanza la vacunación en el mundoTracking Coronavirus Vaccinations Around the WorldMore than 316.6 million vaccine doses have been administered worldwide, equal to 4.1 doses for every 100 people.¿Pero por qué se dan estas diferencias según el sexo? Parte de la respuesta podría ser de comportamientos. Rosemary Morgan, investigadora de salud a nivel internacional de la Escuela de Salud Pública Bloomberg de la Universidad Johns Hopkins dijo que es posible que las mujeres hablen de efectos secundarios más que los hombres incluso cuando sus síntomas sean los mismos. No existe ninguna investigación específica sobre las vacunas que respalde esta aseveración, pero es menos probable que los varones consulten a un médico cuando están enfermos, así que quizás sea menos probable que reporten efectos secundarios, comentó.Sin embargo, no hay duda de que la biología tiene una participación importante. “De muchos modos, la respuesta inmunitaria de las mujeres es distinta a la de los hombres”, señaló Eleanor Fish, inmunóloga de la Universidad de Toronto.Las investigaciones han demostrado que, en comparación con sus contrapartes masculinos, las mujeres y las niñas producen más anticuerpos que combaten las infecciones —en ocasiones hasta el doble— como respuesta a las vacunas contra la influenza, SPR, fiebre amarilla, rabia, así como hepatitis A y B. Gee mencionó que también a menudo desarrollan respuestas más consistentes que vienen de las células inmunitarias llamadas células T. La mayor parte de las veces, estas diferencias son más importantes en adultos jóvenes, lo cual “nos habla de un efecto biológico que tal vez esté relacionado con las hormonas de la reproducción”, señaló.Las hormonas sexuales que incluyen los estrógenos, la progesterona y la testosterona pueden adherirse a la superficie de las células inmunitarias e influir en la manera en que funcionan. Por ejemplo, la exposición a los estrógenos hace que las células inmunitarias produzcan más anticuerpos como repuesta a la vacuna contra la influenza.Además, según Klein, la testosterona “parece ser muy inmunosupresora”. La vacuna contra la influenza tiende a ser menos protectora en los varones que tienen mucha testosterona, en comparación con los que tienen una menor cantidad de esa hormona sexual. Entre otras cosas, la testosterona inhibe la producción de sustancias químicas inmunitarias, conocidas como citoquinas, que realiza el cuerpo.También es posible que las diferencias genéticas entre hombres y mujeres tengan alguna influencia sobre la inmunidad. Muchos genes relacionados con la inmunidad se encuentran en el cromosoma X, del cual las mujeres tienen dos copias y los hombres solo una. Los inmunólogos siempre han creído que solo se encendió un cromosoma X en las mujeres y que el otro estaba inactivo. Pero ahora, las investigaciones demuestran que el 15 por ciento de los genes eluden esta inactivación y se expresan más en las mujeres.Estas fuertes respuestas inmunitarias ayudan a explicar por qué el 80 por ciento de las enfermedades autoinmunes afecta a las mujeres. “Las mujeres poseemos una mayor inmunidad, ya sea hacia nosotras mismas, hacia un antígeno vacunal o hacia un virus”, afirmó Klein.También puede ser importante la cantidad que contiene una dosis de la vacuna. En algunos estudios, se ha demostrado que las mujeres absorben y metabolizan los medicamentos de una manera distinta a la de los varones y que casi siempre requieren menos dosis para que estos surtan el mismo efecto. Pero hasta la década de 1990, en gran parte de los ensayos clínicos para fármacos y vacunas se excluía a las mujeres. “Desde siempre, las dosis recomendadas de los medicamentos se basan en ensayos clínicos en los que los participantes son hombres”, señaló Morgan.Los ensayos clínicos actuales ya incluyen a las mujeres. Pero, según Klein, en los ensayos para las nuevas vacunas contra la covid, no se distinguieron ni se analizaron lo suficiente los efectos secundarios por sexo. Tampoco probaron si una dosis más pequeña podría ser igualmente eficaz para las mujeres y producirles menos efectos secundarios.Hasta que no lo hagan, comentó Klein, los profesionales de la salud deben hablar con las mujeres sobre los efectos secundarios de las vacunas para que no se asusten si los presentan. “Creo que es útil alertar a las mujeres de que quizás tengan más reacciones adversas”, afirmó. “Eso es normal y es probable que sea un reflejo de que su sistema inmunitario está funcionando”.Vacunas contra la COVID-19: respondemos todas tus dudasLos periodistas del Times respondieron a las preguntas de los lectores sobre la vacunación, qué podemos esperar y lo que va a pasar ahora.AdvertisementContinue reading the main story

AdvertisementContinue reading the main storySupported byContinue reading the main storyWomen Report Worse Side Effects After a Covid VaccineMen and women tend to respond differently to many kinds of vaccines. That’s probably because of a mix of factors, including hormones, genes and the dosing of the shots.C.D.C. researchers analyzed safety data from 13.7 million Covid-19 vaccinations, finding 79.1 percent of reported side effects came from women, though only 61.2 percent of the vaccines had been administered to women.Credit…Mike Kai Chen for The New York TimesMarch 8, 2021, 11:44 a.m. ETOn the morning that Shelly Kendeffy received her second dose of the Moderna Covid-19 vaccine, she felt fine. By afternoon, she noticed a sore arm and body aches, and by evening, it felt like the flu.“My teeth were chattering, but I was sweating — like soaked, but frozen,” said Ms. Kendeffy, 44, a medical technician in State College, Pa.The next day, she went to work and surveyed her colleagues — eight men and seven women — about their vaccine experiences. Six of the women had body aches, chills and fatigue. The one woman who didn’t have flu symptoms was up much of the night vomiting.The eight men gave drastically different reports. One had mild arm pain, a headache and body aches. Two described mild fatigue and a bit of achiness. One got a headache. And four had no symptoms at all.“I work with some very tough women,” Ms. Kendeffy said. But “clearly, us women suffered a severity of the side effects.” She felt better after 24 hours, and is thrilled she got the vaccine. “I wouldn’t change a thing, because it sure beats the alternative,” she said. “But I also didn’t know what to expect.”The differences Ms. Kendeffy observed among her co-workers are playing out across the country. In a study published last month, researchers from the Centers for Disease Control and Prevention analyzed safety data from the first 13.7 million Covid-19 vaccine doses given to Americans. Among the side effects reported to the agency, 79.1 percent came from women, even though only 61.2 percent of the vaccines had been administered to women.Nearly all of the rare anaphylactic reactions to Covid-19 vaccines have occurred among women, too. C.D.C. researchers reported that all 19 of the individuals who had experienced such a reaction to the Moderna vaccine have been female, and that women made up 44 of the 47 who have had anaphylactic reactions to the Pfizer vaccine.“I am not at all surprised,” said Sabra Klein, a microbiologist and immunologist at the Johns Hopkins Bloomberg School of Public Health. “This sex difference is completely consistent with past reports of other vaccines.”In a 2013 study, scientists with the C.D.C. and other institutions found that four times as many women as men between the ages of 20 and 59 reported allergic reactions after receiving the 2009 pandemic flu vaccine, even though more men than women got those shots. Another study found that between 1990 and 2016, women accounted for 80 percent of all adult anaphylactic reactions to vaccines.In general, women “have more reactions to a variety of vaccines,” said Julianne Gee, a medical officer in the C.D.C.’s Immunization Safety Office. That includes influenza vaccines given to adults, as well as some given in infancy, such as the hepatitis B and measles, mumps and rubella (M.M.R.) vaccines.The news isn’t all bad for women, though. Side effects are usually mild and short-lived. And these physical reactions are a sign that a vaccine is working — that “you are mounting a very robust immune response, and you will likely be protected as a result,” Dr. Klein said.See How the Vaccine Rollout Is Going in Your StateSee where doses have gone, and who is eligible for a shot in each state.But why do these sex differences happen? Part of the answer could be behavioral. It’s possible that women are more likely than men to report side effects even when their symptoms are the same, said Rosemary Morgan, an international health researcher at the Johns Hopkins Bloomberg School of Public Health. There’s no vaccine-specific research to support this claim, but men are less likely than women to see doctors when they are sick, so they may also be less likely to report side effects, she said.Still, there’s no question that biology plays an important role. “The female immune response is distinct, in many ways, from the male immune response,” said Eleanor Fish, an immunologist at the University of Toronto.Research has shown that, compared with their male counterparts, women and girls produce more — sometimes twice as many — infection-fighting antibodies in response to the vaccines for influenza, M.M.R., yellow fever, rabies, and hepatitis A and B. They often mount stronger responses from immune fighters called T cells, too, Ms. Gee noted. These differences are often most robust among younger adults, which “suggests a biological effect, possibly associated with reproductive hormones,” she said.Sex hormones including estrogen, progesterone and testosterone can bind to the surface of immune cells and influence how they work. Exposure to estrogen causes immune cells to produce more antibodies in response to the flu vaccine, for example.And testosterone, Dr. Klein said, “is kind of beautifully immunosuppressive.” The flu vaccine tends to be less protective in men with lots of testosterone compared with men with less of the sex hormone. Among other things, testosterone suppresses the body’s production of immune chemicals known as cytokines.Genetic differences between men and women may also influence immunity. Many immune-related genes are on the X chromosome, of which women have two copies and men have only one. Historically, immunologists believed that only one X chromosome in women was turned on, and that the other was inactivated. But research now shows that 15 percent of genes escape this inactivation and are more highly expressed in women.These robust immune responses help to explain why 80 percent of autoimmune diseases afflict women. “Women have greater immunity, whether it’s to ourselves, whether it’s to a vaccine antigen, whether it’s to a virus,” Dr. Klein said.The size of a vaccine dose may also be important. Studies have shown that women absorb and metabolize drugs differently than men do, often needing lower doses for the same effect. But until the 1990s, drug and vaccine clinical trials largely excluded women. “The drug dosages that are recommended are historically based on clinical trials that involve male participants,” Dr. Morgan said.Clinical trials today do include women. But in the trials for the new Covid vaccines, side effects were not sufficiently separated and analyzed by sex, Dr. Klein said. And they did not test whether lower doses might be just as effective for women but cause fewer side effects.Until they do, Dr. Klein said, health care providers should talk to women about vaccine side effects so they are not scared by them. “I think that there is value to preparing women that they may experience more adverse reactions,” she said. “That is normal, and likely reflective of their immune system working.”Answers to All Your Questions About Getting Vaccinated for Covid-19Times reporters answered questions from readers about getting the vaccine, what to expect and what happens next.AdvertisementContinue reading the main story