The NIH has reported that many individuals with COVID-19 develop abnormal blood clots from high inflammation, which can lead to serious health complications and mortality. To find ways to decrease clotting related to COVID-19, researchers from the University of Minnesota and Basel University in Switzerland looked at reducing hospitalizations by using prescribed blood thinners.
“We know that COVID-19 causes blood clots that can kill patients,” said lead author Sameh Hozayen, MD, MSC, an assistant professor of medicine at the U of M Medical School. “But, do blood thinners save lives in COVID-19? Blood thinners are medications prescribed to prevent blood clots in patients with a prior blood clot in their lungs or legs. They also prevent blood clots in the brain secondary to abnormal heart rhythms, like atrial fibrillation. Blood thinners are the standard of treatment in these diseases, which is why we looked at data to see if it impacted hospitalizations related to COVID-19.”
“We already know that overwhelmed hospitals have a higher risk for death among their patients, so reducing hospitalization may have a positive impact during a COVID-19 surge,” Hozayen said.
Published in Lancet’s Open Access EClinical Medicine, the study found that: patients on blood thinners before having COVID-19 were admitted less often to the hospital, despite being older and having more chronic medical conditions than their peers; blood thinners — regardless of if they are being used before being infected with COVID-19 or started when admitted to the hospital for treatment of COVID-19 — reduce deaths by almost half; and, hospitalized COVID-19 patients benefit from blood thinners regardless of the type or dose of the medication used.”Unfortunately, about half of patients who are being prescribed blood thinners for blood clots in their legs, lungs, abnormal heart rhythms or other reasons, do not take them. By increasing adherence for people already prescribed blood thinners, we can potentially reduce the bad effects of COVID-19,” Hozayen said. “At M Health Fairview and most centers around the world now, there are protocols for starting blood thinners when patients are first admitted to the hospital for COVID-19 — as it is a proven vital treatment option. Outside of COVID-19, the use of blood thinners is proven to be lifesaving for those with blood coagulations conditions.”
Using de-identified data from M Health Fairview and after obtaining appropriate ethical committee approval, the study was a collaborative effort between U of M Medical School faculty Chris Tignanelli, Michael Usher, Zachary Kaltenborn, Surbhi Shah, and Diana Zychowski; U of M School of Public Health faculty Ryan Demmer, Pamela Lutsey, and Sydney Benson; and Basel University Pathology Institute faculty Alexander Tzankov and Jasmin Haslbauer.
Researchers note that the next steps for this work is to ensure that the results of this study are consistent and not isolated to the health care systems in advanced countries — like the United States and Switzerland — or in certain populations, like Caucasians. They are currently working with research groups in other parts of the world, like Egypt, to look at how blood thinners impact patients in less-invested health care systems and in different patient populations.
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Materials provided by University of Minnesota Medical School. Original written by Kat Dodge. Note: Content may be edited for style and length.

New research provides insights on the immune responses of kidney transplant recipients following infection with the virus that causes COVID-19. The study, which is published in JASN, may help explain why these individuals face a higher risk of dying from COVID-19 than others in the general population.
Recent reports have generated conflicting results concerning whether kidney transplant recipients, who must take immunosuppressive medications to prevent rejection of their transplant, mount strong immune responses against SARS-CoV-2 after becoming infected with the virus or receiving COVID-19 vaccines.
Now a team led by Jonathan Maltzman, MD, PhD (Stanford University School of Medicine) has examined the dynamics of the immune response of these individuals after natural infection with SARS-CoV-2. Such an immune response involves different antibody types, including IgG, IgM, and IgA.
This multicenter study involving investigators from Mount Sinai, Montefiore, Emory, and Cincinnati, in addition to Stanford, included 49 kidney transplant recipients with SARS-CoV-2 infection. Production of IgG antibodies against SARS-CoV-2 was delayed, but IgM and IgA responses were similar to those observed in individuals who had not received a transplant.
The findings indicate that the antibody response to SARS-CoV-2 infection is delayed but preserved in kidney transplant recipients. “Almost all kidney transplant recipients infected with the virus that causes COVID-19 generate immune responses,” said Dr. Maltzman. “But some aspects of the response are patients with kidney transplants have a slower immune response to infection and make slightly different types of antibodies.”
The findings likely extend to other people on chronic immunosuppression and may be useful for devising strategies to boost these individuals’ immune responses following vaccination.
Study co-authors include Paolo Cravedi, MD-PhD, Patrick Ahearn, MD, Lin Wang, PhD, Tanuja Yalamarti, MD, Susan Hartzell, BS, Yorg Azzi, MD, Madhav C. Menon, MD, Aditya Jain, MD, Marzuq Billah, MD, Marcelo Fernandez-Vina, PhD, Howard M Gebel, PhD, E. Steve Woodle, MD, Natalie S. Haddad, Andrea Morrison-Porter, F. Eun-Hyung Lee, MD, Ignacio Sanz, MD, Enver Akalin, MD, and Alin Girnita, MD, PhD.
Disclosures: JSM has received honoraria from One Lambda, Inc., is a member of the Qihan Biotech SAB, and has a family member who is employed by and has an equity interest in Genentech/Roche. FEL is the founder of Micro-plex, Inc and receives grants from BMGF and Genentech.
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Materials provided by American Society of Nephrology. Note: Content may be edited for style and length.

Links between obesity and mortality have become increasingly evident, since the earliest pandemic of the 21st century, leading researchers from The University of Texas at San Antonio and the University of Wisconsin-Milwaukee to investigate if excess body weight may have been associated with high rates of COVID-19 mortalities around the globe.
Lead principal investigator Hamid Beladi, UTSA’s Janey S. Briscoe Endowed Chair in Business, and his colleagues recently published a novel study in Public Health in Practice analyzing plausible associations of COVID-19 mortality and excess weight in nearly 5.5 billion adults from 154 countries around the world.
To identify potential patterns in data, the researchers employed cutting-edge techniques of statistical analyses.
“The main finding from the analysis is a statistically significant positive association between COVID-19 mortality and the proportion of the overweight in adult populations spanning 154 countries,” Beladi said. “This association holds across countries belonging to different income groups and is not sensitive to a population’s median age, proportion of the elderly, and/or proportion of females.”
Beladi added that when the proportion of the overweight people in a country’s adult population is one percentage point higher than the proportion of the overweight in a second country’s adult population, based on this study, it is reasonable to predict that COVID-19 mortality would be 3.5 percentage points higher in the first country than it would be in the second.
“The average individual is less likely to die from COVID-19 in a country with a relatively low proportion of the overweight in the adult population, all other things being equal, than she or he would be in a country with a relatively high proportion of the overweight in the adult population,” Beladi said.
The study’s authors say that, clinically, excess body weight is related to several comorbidities that can lead to an increasingly severe course of and consequent death from COVID-19. Metabolic disorders, for example, can predispose individuals to a poorer COVID-19 outcome. Since excess body weight can result in a greater volume and longer duration of contagion, it can also lead to a higher level of exposure to COVID-19.
They added that on average, the COVID-19 pandemic has been more fatal for adult populations residing in parts of the world characterized by excess body weight.
The researchers believe their findings can be used to uphold public policy regulations on the food industry, to the extent that it profits off the sales of processed foods, foods high in salt, sugar and saturated fats.
With the death toll from the current pandemic exceeding 4.5 million, the group’s main findings call for immediate and effective regulations that are long overdue, Beladi said.
“Some firms in the food industry have taken the liberty of using the pandemic as a platform for marketing in ways that are all but conducive to restraining body weight,” he explained. “Our observed association, between COVID-19 mortality and the share of the overweight in nearly 5.5 billion adults residing across 154 countries that host almost 7.5 billion people around the globe, serves as a caution against putting more lives at stake.”
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Materials provided by University of Texas at San Antonio. Note: Content may be edited for style and length.

Scott Kirby, the chief executive of United Airlines, reached a breaking point while vacationing in Croatia this summer: After receiving word that a 57-year-old United pilot had died after contracting the coronavirus, he felt it was time to require all employees to get vaccinated.He paced for about half an hour and then called two of his top executives. “We concluded enough is enough,” Mr. Kirby said in an interview on Thursday. “People are dying, and we can do something to stop that with United Airlines.”The company announced its vaccine mandate days later, kicking off a two-month process that ended last Monday. Mr. Kirby’s team had guessed that no more than 70 percent of the airline’s workers were already vaccinated, and the requirement helped convince most of the rest: Nearly all of United’s 67,000 U.S. employees have been vaccinated, in one of the largest and most successful corporate efforts of the kind during the pandemic.The key to United’s success, even in states where vaccination rates are at or below the national average, like Texas and Florida, was a gradual effort that started with providing incentives and getting buy-in from employee groups, especially unions, which represent a majority of its workers.About 2,000 employees have applied for medical or religious exemptions, though their fate remains unclear as United fights a lawsuit over its plan to place them on temporary leave. A few hundred more failed to comply with the mandate and could be fired in coming weeks.When United announced its mandate in early August, it was part of a lonely group of large employers willing to broadly require vaccination. Some companies, like Disney and Walmart, had acted earlier but initially required only some employees to be vaccinated, primarily white-collar staff.United’s work force includes professionals with advanced degrees and workers who haven’t finished high school. Its racial breakdown roughly matches that of the U.S. population.The airline earned high praise from President Biden, who weeks later announced that regulators would require all businesses with 100 or more workers to require vaccinations or conduct weekly virus testing. And the company drew scorn from conservatives.Other mandates are producing results, too. Tyson Foods, which announced its vaccine requirement just days before United but has provided workers more time to comply, said on Thursday that 91 percent of its 120,000 U.S. employees had been vaccinated. Similar policies for health care workers by California and hospitals have also been effective.On Friday, American Airlines said it would impose a vaccine mandate, too. But Delta Air Lines and Southwest Airlines have not. In late August, Delta said it would charge its unvaccinated employees an additional $200 per month for health insurance.A Year in the MakingUnited had been laying the groundwork for a vaccine mandate for at least a year. The airline already had experience requiring vaccines. It has mandated a yellow fever vaccination for flight crews based at Dulles International Airport, near Washington, because of a route to Ghana, whose government requires it.In January, at a virtual meeting, Mr. Kirby told employees that he favored a coronavirus vaccine mandate.Writing letters to families of the employees who had died from the virus was “the worst thing that I believe I will ever do in my career,” he said at the time, according to a transcript. But while requiring vaccination was “the right thing to do,” United would not be able to act alone, he said.The union representing flight attendants pushed the company to focus first on access and incentives. It argued that many flight attendants couldn’t get vaccinated because they were not yet eligible in certain states.Mr. Kirby acknowledged that widespread access would be a precondition. The airline and unions worked together to set up clinics for staff in cities where it has hubs like Houston, Chicago and Newark.Widespread access to vaccines was a precondition of a mandate, so United and its unions set up airport clinics for staff.Gabriela Bhaskar/The New York TimesBut the issue came to a head in late April when a United official called Capt. Todd Insler, the head of the United pilots’ union, to tell him the company planned to announce a mandate affecting his members very soon. The company conveyed a similar, though less definitive, message to the flight attendants.Mr. Kirby said that the phone calls had been driven by the need to make sure pilots and flight attendants were vaccinated when they flew to countries where infection rates were rising, and that no final decision had been made.“Cases had waned in the U.S., but now we’re asking them to fly into hot spots around the world,” Mr. Kirby said.Both unions were extremely supportive of vaccinations but adamant that the airline should give workers incentives to get vaccinated before imposing a mandate. “We emphasized voluntary incentives and education,” Captain Insler said.Other airlines had been offering incentives, and Mr. Biden was calling on all employers to do so. A mandate would strike workers as unfair and create unnecessary conflict, the flight attendants’ union argued.“The more people you get to take action on their own, the more you can focus on reaching the remaining people before any knock-down, drag-out scenario,” said Sara Nelson, the president of the Association of Flight Attendants, which represents more than 23,000 active workers at United.In May, the pilots reached an agreement that would give them extra pay for getting vaccinated and the flight attendants worked toward an agreement that would give them extra vacation days. Both incentives declined in value over time and typically expired by early July.Then, shortly after Mr. Kirby’s decision a few weeks later, the airline began informing the two unions that it would impose the mandate in early August. Employees would have to be vaccinated by Oct. 25 or within five weeks of a vaccine’s formal approval by the Food and Drug Administration, whichever came first. The timing was intended to ensure that the airline had adequate staffing for holiday travel, said Kate Gebo, who heads human resources.This time, the unions were more resigned.“For those 92 percent of pilots who wanted to be vaccinated, we captured $45 million in cash incentives,” said Captain Insler, whose union is challenging the decision to fire employees who don’t comply. “For those who did not want to be vaccinated, we were able to hold off a mandate for several months.”Getting Over the Finish LineThe success of the incentives — about 80 percent of United’s flight attendants were also vaccinated by the time the airline announced its mandate in August — inspired the company to expand them to all employees, offering a full day’s pay to anyone who provided proof of vaccination by Sept. 20.The company hadn’t surveyed its workers, but estimated that 60 to 70 percent were already vaccinated. Getting the rest there wouldn’t be easy..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-1kpebx{margin:0 auto;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-1kpebx{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-1kpebx{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-1kpebx{font-size:1.25rem;line-height:1.4375rem;}}.css-1gtxqqv{margin-bottom:0;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}.css-19zsuqr{display:block;margin-bottom:0.9375rem;}.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-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 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:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}Margaret Applegate, 57, a 29-year United employee who works as a services representative in the United Club at San Francisco International Airport, helps illustrate why.Ms. Applegate normally does not hesitate to get vaccines, noting that her late father was a doctor and that her daughter does research in nutritional science.Her daughter urged her to get vaccinated, but she remained deeply ambivalent. Friends and co-workers “were feeding me stories about horrible things happening to people with the vaccine,” she said. She worried about the relatively new technology behind the Pfizer and Moderna vaccines, and whether her heart condition could pose complications, though her cardiologist assured her it wouldn’t.For months, United had encouraged employees to get a shot. The company held question-and-answer sessions for employees. A medical official visited hangars in the middle of the night to answer technicians’ questions about the vaccine. The airline also encouraged employees to publicly share their reasons for getting vaccinated.The mandate proved to be the push that many needed.United’s communications team, led by Josh Earnest, previously a press secretary for President Barack Obama, informed the media of its plans in the hope that approval from health experts on television might help.“That echo chamber, I think, was important in influencing the way that our employees responded to this,” he said.But an initial spike in employees who provided proof of vaccination was followed by a lull. Some employees needed more pushing than others.As Ms. Applegate agonized, she reached out to Lori Augustine, the vice president who oversees United’s San Francisco hub. Ms. Augustine assured Ms. Applegate that she was a valued employee the company wanted to keep, and offered to accompany her to get her shot. As they walked to the clinic early last month, Ms. Applegate said, she felt empowered but anxious.Since she got her shot, her conversations with people firmly opposed to vaccinations have diminished. “The ones talking about pros and cons more seriously, without just saying everything is a con, those I was able to continue having a conversation with,” she said.The airline, too, prepared for blowback in places like its Houston hub and Florida, where it operates many flights.A United employee in San Francisco, where a company vice president accompanied an anxious Margaret Applegate to her vaccination.Gabriela Bhaskar/The New York Times“We thought about the possibility that we could face situations in some states where laws might be passed to counter a decision that we might make and what the implications of that might be,” said Brett J. Hart, the airline’s president. “That legal risk did not trump the possibility of keeping some of our team members, who otherwise wouldn’t be here, alive.” The airline said dozens of its employees had died after coming down with Covid.United executives said they were surprised that positive feedback from politicians, customers and the public far outweighed the criticism it received.Customers thanked the airline, and job applicants said they were excited to join a company that took employee safety seriously. United has received 20,000 applications for about 2,000 flight attendant positions, a much higher ratio than before the pandemic.There has been some resistance. Last month, six employees sued United, arguing that its plans to put exempt employees on temporary leave — unpaid in many circumstances — is discriminatory. United has delayed that plan for at least a few weeks as it fights the suit.Still, United’s vaccination rate has continued to improve. There was another rush before the deadline to receive the pay incentive and one more before the final Sept. 27 deadline. Toward the end of September, the company said 593 people had failed to comply. By Friday, the number had dropped below 240.“I did not appreciate the intensity of support for a vaccine mandate that existed, because you hear that loud anti-vax voice a lot more than you hear the people that want it,” Mr. Kirby said. “But there are more of them. And they’re just as intense.”

Researchers have been studying how much care American adults will require as they age, and for how long.Say you’re a 65-year-old looking ahead, wondering about your health and your finances, pondering what life might be like in 20 years.You might get lucky, like Susan Green, a retired social worker. At 82, she enjoys hiking, golfing and cross-country skiing (although she has given up downhill) with her husband in Ketcham, Idaho. The only assistance they need: a weekly housekeeper.Or you might be as fortunate as Sally Dorst, also 82, a retired magazine editor who lives on the Upper West Side in Manhattan. A committed museum visitor and concertgoer (we couldn’t talk the first time I called because Ms. Dorst was attending the New York City Ballet’s reopening performance), she manages personal care and household tasks on her own, including toting heavy bags of litter home for her two cats.“I’ve always been pretty independent,” she said. “The only thing I need help with is that my ceilings are so tall that I can’t reach them.” (Her building superintendent replaces burned-out bulbs for her.)Most older Americans, however, eventually need assistance. Nancy Canu’s granddaughter, Renee Turner, moved into her home in Rochester Hills, Mich., five years ago to care for her. At 92, Ms. Canu takes multiple medications for heart failure, and joint pain makes it hard for her to walk more than a block, even while using a walker. Ms. Turner, 37, has gradually taken over household tasks, such as shopping, cooking, cleaning, doing the laundry and paying the bills.She administers her grandmother’s medications, drives her to doctors’ appointments, hovers nearby when she showers and helps her up the stairs. If Ms. Turner, a wedding singer and massage therapist, has to be away for more than an hour or two, she recruits another relative to step in.“It wasn’t a question,” Ms. Turner said. “I wanted to be here for her.” Still, she added, “it’s become my full-time job.”For years, researchers have tried to calculate what proportion of the aging population will need such extensive care. “Becoming frail and needing help with basic personal care is probably the greatest financial risk people face at older ages,” said Richard Johnson, the economist who directs the Program on Retirement Policy at the Urban Institute.A 2019 study he undertook for the federal Department of Health and Human Services, for example, found that over their lifetimes, about 70 percent of older adults will need help from family caregivers or paid aides or some combination, in their own homes or in long-term care facilities. Other surveys have reported roughly similar results.But such analyses often don’t distinguish between short rehab stays, perhaps after a knee replacement, and the years of round-the-clock care that is required for someone with deepening dementia.Ms. Turner and Ms. Canu hold hands. Ms. Turner helps her grandmother with her medications, drives her to doctor’s appointments and helps her up the stairs. Cydni Elledge for The New York Times“Even if you need a lot of care, if it’s for a short period, it’s not that big a deal,” said Alicia Munnell, an economist and director of the Center for Retirement Research at Boston College.Recent work by Dr. Munnell and her colleagues explored those nuances. Using data from the federal Health and Retirement Study as well as other federal surveys, they looked at both intensity and duration — how much help older Americans will need and for how long.Policy types perpetually lament Americans’ inadequate retirement savings; only about half of the U.S. population will be able to maintain their standard of living after they stop working, according to a Boston College index.But retirees can also overestimate their need for care, lowering their quality of life with unnecessary scrimping. “I think that’s actually a bigger risk than the more conventional idea of taking an around-the-world cruise and then ending up with nothing,” Dr. Munnell said.Her team assessed seniors’ lifetime care needs as low, medium or high intensity, based on how many so-called activities of daily living they needed assistance with. Then the researchers calculated how many older Americans would need help for short (up to a year) or medium durations (one to three years) or for longer than three years.Their results: Seventeen percent of 65-year-olds will need no long-term care. Almost one-quarter will develop severe needs, requiring many hours of help for more than three years.Most older people will fall between those poles, with 22 percent having only minimal needs. The largest group, 38 percent, can expect moderate needs — like support while they recover from a heart attack, after which they can again function independently.Unsurprisingly, the need for more intense or extended care hits some groups harder than others. People who attended college for some period fare far better than those without high school diplomas, the Boston College team found. Black and Hispanic seniors, reflecting entrenched economic and health inequities, are more apt than older white people to develop moderate or severe needs.And married people are less likely to need extensive care than those who are single. They have higher incomes, Dr. Munnell pointed out, and spouses provide “regular meals and someone nagging you to go see the doctor — all that having another person to care about your welfare entails.”Where an individual falls on this spectrum will determine whether such predictions feel reassuring or terrifying. But data from a second Boston College analysis veer toward the latter.“I wish all elderly people had someone like Renee to care for them,” Ms. Canu said. “We have a happy life, in spite of all the things that happen.”Cydni Elledge for The New York TimesThe researchers calculated how much care retirees would need, how much they could receive from family and how much they could afford to buy (at $22 an hour for a home health aide in 2018). The study determined that 36 percent of people in their late 60s could not cover even a year of minimal care without exhausting their resources; only 22 percent could cover severe needs.“There’s only a small chance that you’ll need care for an extended period,” Dr. Johnson said. “But a lot of people will need care for a shorter time, and that will take money.”Low-income people, who are less able to purchase help but more likely to need it, might qualify for Medicaid, which pays for long-term care. But that could mean a nursing home, because Medicaid waiting lists for home care are years long in some states. A few people, about 10 percent, have bought private long-term care insurance. Others will be left in a bind that financial planning can’t really address.“That’s something insurance is designed to correct,” Dr. Johnson said.When the Affordable Care Act passed in 2010, it contained a measure called the Class Act, a voluntary long-term care insurance program that never materialized. Critics feared an actuarial “death spiral”: If ailing workers only enrolled, costs would soon outstrip premiums paid in.To start a sustainable public insurance program for long-term care, “we’d have to make it mandatory,” Dr. Johnson said. “Everyone would have to contribute.” The payoff: “It would give people peace of mind.”Washington recently became the first state to establish such a program. Beginning next year, employees must contribute 0.58 percent of their earnings (self-employed workers could opt in, too), or about $290 in annual premiums on a $50,000 salary.It’s a modest program — starting in 2025, participants can receive up to $36,500 in benefits — but it’s a start on the kind of safety net that the Netherlands, Germany and South Korea already provide. Illinois, Minnesota and Hawaii are also discussing long-term care insurance, Dr. Johnson said.American families still bear the greatest brunt of responsibility for elder care. Ms. Canu’s family hopes to keep her in the house where she has lived for 44 years. If she had to pay a home health aide or move into assisted living, she or her children would face costs of thousands of dollars a month. That still might happen.But for now, she has her oldest grandchild. “I wish all elderly people had someone like Renee to care for them,” Ms. Canu said. “We have a happy life, in spite of all the things that happen.”

The timing of the meetings later this month suggests that the agency plans to move quickly to decide both issues.The Food and Drug Administration on Friday scheduled three days of public meetings with its panel of independent vaccine experts for later this month, as the agency prepares to make high-profile decisions on whether to authorize emergency use of the Pfizer-BioNTech vaccine for children ages 5 to 11 and booster shots for adult recipients of the Moderna and Johnson & Johnson vaccines.The F.D.A. typically issues its decisions within a few days of advisory committee meetings, during which members discuss safety and efficacy data. The timing of the upcoming meetings indicates that the agency intends to move quickly to decide whether to authorize both the booster and children’s shots.The committee will meet on Oct. 14 and 15 to discuss booster doses, and is tentatively scheduled to discuss Pfizer’s pediatric vaccine on Oct. 26, the agency said.“It’s critical that as many eligible individuals as possible get vaccinated as soon as possible,” Dr. Peter Marks, the agency’s top vaccine regulator, said in a statement.He added that “the available data make clear that protection against symptomatic Covid-19 in certain populations begins to decrease over time, so it’s important to evaluate the information on the use of booster doses in various populations.”The decision to have the committee discuss the evidence for Moderna and Johnson & Johnson booster shots two weeks before it does so for Pfizer’s children’s vaccine appears to reflect the F.D.A.’s priorities and the availability of data. But the agency’s decisions on those emergency use authorizations could come in quick succession.Pfizer and BioNTech have yet to formally ask the F.D.A. to authorize emergency use of their vaccine for pediatric doses; they are expected to do so next week, according to people familiar with the companies’ plans. If regulators grant that request, it could help protect as many as 28 million children and ease the anxiety of parents across the nation. Dr. Scott Gottlieb, a Pfizer board member, has said the F.D.A. could decide as early as Halloween.Children rarely become severely ill from the coronavirus, but the Delta variant drove nearly 30,000 of them into hospitals in August. Over the course of the pandemic, at least 125 children ages 5 to 11 have died from Covid, and nearly 1.7 million others in that age group have been infected with the virus.They account for 5 percent of Covid cases and 9 percent of the nation’s population, according to the Centers for Disease Control and Prevention.Pfizer’s vaccine has already been authorized for children 12 to 15 on an emergency basis, and is fully approved for those 16 and older. Moderna has also sought emergency authorization to offer its vaccine to adolescents, but regulators have yet to rule on that request..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-1kpebx{margin:0 auto;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-1kpebx{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-1kpebx{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-1kpebx{font-size:1.25rem;line-height:1.4375rem;}}.css-1gtxqqv{margin-bottom:0;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}.css-19zsuqr{display:block;margin-bottom:0.9375rem;}.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-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 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:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}Clearance of Pfizer-BioNTech’s pediatric dose depends not just on the strength of the clinical trial data, but on whether the companies can prove to the F.D.A. that they can properly manufacture a new pediatric formulation. Dr. Janet Woodcock, the F.D.A.’s acting commissioner, said again on Friday that regulators would thoroughly review safety and efficacy data before ruling.“We know from our vast experience with other pediatric vaccines that children are not small adults,” she said in a statement.It may turn out that the decision on whether to approve Pfizer’s vaccine for children is more straightforward, however, than the question of booster shots for Moderna and Johnson & Johnson recipients.Last month, the F.D.A. authorized a booster shot for many recipients of the Pfizer-BioNTech vaccine six months after their second shot, and the Centers for Disease Control and Prevention recommended its use. But those actions followed fraught meetings of the advisory committees for both agencies. In the end, the government decided to offer a third shot only for those 65 and older and those who live in long-term care facilities. It is also offering booster injections to adults with underlying medical conditions and those who are at higher risk of exposure to the virus because of their jobs or institutional settings — a broad category that includes health care workers and prisoners.Along with deciding whether to authorize boosters for Moderna and Johnson & Johnson recipients, the F.D.A. is also weighing whether people should be allowed to get a booster shot of a different vaccine than the one they originally received. Researchers with the National Institutes of Health have been conducting a so-called mix-and-match study in an effort to answer that question.Separately on Friday, the Biden administration provided new details on a rule it announced last month requiring federal workers to get vaccinated against the coronavirus. The administration said in a memo that agencies could start enforcing that requirement on Nov. 9. “Employees who refuse to be vaccinated or provide proof of vaccination are subject to disciplinary measures, up to and including removal or termination from federal service,” the memo said.

BBC journalist Gem O’Reilly was 16 when she was diagnosed with a heart condition. Now, 10 years later she’s been signed off to run long distance. Gem’s condition, if unknown, could potentially cause sudden death through cardiac arrest and she is not alone.Every week in the UK, 12 young people die from an undiagnosed heart condition. Reporter and producer: Gem O’ReillyCamera: Jamie Moreland & Vince Rogers

The Alpha variant traveled more efficiently in small droplets, two new studies found. The Delta variant may have continued this evolution.Newer variants of the coronavirus like Alpha and Delta are highly contagious, infecting far more people than the original virus. Two new studies offer a possible explanation: The virus is evolving to spread more efficiently through air.The realization that the coronavirus is airborne indoors transformed efforts to contain the pandemic last year, igniting fiery debates about masks, social distancing and ventilation in public spaces.Most researchers now agree that the coronavirus is mostly transmitted through large droplets that quickly sink to the floor and through much smaller ones, called aerosols, that can float over longer distances indoors and settle directly into the lungs, where the virus is most harmful.The new studies don’t fundamentally change that view. But the findings signal the need for better masks in some situations, and indicate that the virus is changing in ways that make it more formidable.“This is not an Armageddon scenario,” said Vincent Munster, a virologist at the National Institute of Allergy and Infectious Diseases, who led one of the new studies. “It is like a modification of the virus to more efficient transmission, which is something I think we all kind of expected, and we now see it happening in real time.”Dr. Munster’s team showed that small aerosols traveled much longer distances than larger droplets and the Alpha variant was much more likely to cause new infections via aerosol transmission. The second study found that people infected with Alpha exhaled about 43 times more virus into tiny aerosols than those infected with older variants.The studies compared the Alpha variant with the original virus or other older variants. But the results may also explain why the Delta variant is so contagious — and why it displaced all other versions of the virus.“It really indicates that the virus is evolving to become more efficient at transmitting through the air,” said Linsey Marr, an expert in airborne viruses at Virginia Tech who was not involved in either study. “I wouldn’t be surprised if, with Delta, that factor were even higher.”The ultratransmissibility of the variants may come down to a mix of factors. It may be that lower doses of the variants are required for infection, or that the variants replicate faster, or that more of the variant virus is exhaled into aerosols — or all three.The Alpha variant proved to be twice as transmissible as the original virus, and the Delta variant has mutations that turbocharged its contagiousness even more. As the virus continues to change, newer variants may turn out to be even more transmissible, experts said.But the tools at our disposal all still work well to halt the spread. Even loosefitting cloth and surgical masks block about half of the fine aerosols containing virus, according to the study of people infected with variants, published this month in the journal Clinical Infectious Diseases.Still, at least in some crowded spaces, people may want to consider switching to more protective masks, said Don Milton, an aerosol expert at the University of Maryland who led the research.“Given that it seems to be evolving towards generating aerosols better, then we need better containment and better personal protection,” Dr. Milton said of the virus. “We are recommending people move to tighter-fitting masks.”To compare how different variants spread through the air, his team asked participants with mild or asymptomatic infections to recite the alphabet, sing “Happy Birthday” loudly or shout out the University of Maryland slogan, “Go Terps!”People infected with the Alpha variant had copious amounts of virus in their nose and throat, much more than those infected with the original virus. But even after adjusting for that difference, those infected with the variant released about 18 times as much virus into the smallest aerosols.But the researchers examined only four people infected with Alpha, and 45 with older variants. That could skew the observed differences between the variants, said Seema Lakdawala, a respiratory virus expert at the University of Pittsburgh, who was not involved in either new study.Infected people can pass the virus along to many, many others — or to none at all. How much virus they expel may depend on where in the respiratory tract it is replicating, the nature of the mucus in its environment, and what other microbes it may hitch a ride with..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-1kpebx{margin:0 auto;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-1kpebx{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-1kpebx{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-1kpebx{font-size:1.25rem;line-height:1.4375rem;}}.css-1gtxqqv{margin-bottom:0;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}.css-19zsuqr{display:block;margin-bottom:0.9375rem;}.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-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 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:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}“We have really no idea why some individuals are superspreaders and others are not,” Dr. Lakdawala said. “There’s a lot of heterogeneity between individuals.”Data from a greater number of participants would be more convincing, but the two studies together do suggest that enhanced transport through aerosols at least partly contributes to the variant’s contagiousness, she said.Dr. Munster’s study did not involve people at all, but Syrian hamsters. Using the animals allowed the team to control the experimental conditions tightly and focus only on the movement of aerosols, Dr. Munster said.The researchers separated pairs of hamsters with tubes of different lengths that allowed airflow but no physical contact. They looked at how well the different variants traveled from infected “donor” hamsters to uninfected “sentinel” hamsters.When the cages were more than two meters apart, only the smallest aerosols — particles smaller than 5 microns — were shown to infect the sentinel hamsters. And the team found, as expected, that the Alpha variant outcompeted the original virus in infecting the sentinel hamsters.The results were posted on bioRxiv, a website that features papers before they have been published in a scientific journal.The researchers are now testing the Delta variant and expect to find that it is even more efficient, Dr. Munster said.Together, the new findings underscore the importance of masks for vaccinated people, especially in crowded spaces, experts said. Although people with breakthrough infections after vaccination are much less likely to spread the virus than unvaccinated people, the contagiousness of the variants raises the probability.With billions of people worldwide vaccinated, and billions still unvaccinated, the virus may still change in unexpected ways, Dr. Munster said: “There might be additional evolutionary pressures, shaping the evolutionary direction of this virus.”

Whether it’s reporting on conflicts abroad and political divisions at home, or covering the latest style trends and scientific developments, Times Video journalists provide a revealing and unforgettable view of the world.Whether it’s reporting on conflicts abroad and political divisions at home, or covering the latest style trends and scientific developments, Times Video journalists provide a revealing and unforgettable view of the world.

Researchers at Cedars-Sinai have found that aging produces significant changes in the microbiome of the human small intestine distinct from those caused by medications or illness burden. The findings have been published in the journal Cell Reports.
“By teasing out the microbial changes that occur in the small bowel with age, medication use and diseases, we hope to identify unique components of the microbial community to target for therapeutics and interventions that could promote healthy aging,” said Ruchi Mathur, MD, the study’s principal investigator.
Research exploring the gut microbiome, and its impact on health, has relied predominantly on fecal samples, which do not represent the entire gut, according to Mathur. In their study, investigators from Cedars-Sinai’s Medically Associated Science and Technology (MAST) Program analyzed samples from the small intestine-which is over 20 feet in length and has the surface area of a tennis court-for examination of the microbiome and its relationship with aging.
“This study is the first of its kind to examine the microbial composition of the small intestine of subjects 18 years of age to 80. We now know that certain microbial populations are influenced more by medications, while others are more affected by certain diseases. We have identified specific microbes that appear to be only influenced by the chronological age of the person,” said Mathur, an endocrinologist and director of the Diabetes Outpatient Treatment & Education Center.
The 21st century has been referred to as the “era of the gut microbiome” as scientists turn considerable attention to the role trillions of gut bacteria, fungi and viruses may play in human health and disease. The microbiome is the name given to the genes that live in these cells. Studies have suggested that disturbances in the constellations of the microbial universe may lead to critical illnesses, including gastroenterological diseases, diabetes, obesity, and some neurological disorders.
While researchers know that microbial diversity in stool decreases with age, Cedars-Sinai investigators identified bacteria in the small bowel they refer to as “disruptors” that increase and could be troublesome.
“Coliforms are normal residents of the intestine. We found that when these rod-shaped microbes become too abundant in the small bowel-as they do as we get older-they exert a negative influence on the rest of the microbial population. They are like weeds in a garden,” said study co-author Gabriela Leite, PhD.
Investigators also found that as people age, the bacteria in the small intestine change from microbes that prefer oxygen to those that can survive with less oxygen, something they hope to understand as the research continues.
“Our goal is to identify and fingerprint the small intestinal microbial patterns of human health and disease. Given the important role the small bowel plays in absorption of nutrients, changes in the microbiome in this location of the gut may have a greater impact on human health, and warrants further study,” said Mark Pimentel, MD, director of the MAST program and a co-author of the study.
This research is part of Cedars-Sinai’s ongoing REIMAGINE study: Revealing the Entire Intestinal Microbiota and its Associations with the Genetic, Immunologic, and Neuroendocrine Ecosystem.
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