A couple’s health is surprisingly intertwined according to a recent cohort study that looked at Dutch and Japanese marriages.
The study discovered that spouses have a high degree of commonality in not only lifestyle habits, but body shape, blood pressure, and even incidence of some diseases.
When it comes to marriage, the adage “birds of a feather flock together” is relatively true. Previous studies have indicated that we gravitate towards people of similar social class, educational background, race, and weight. The scientific name for this is assertive mating, and it means that spouses are often genetically similar. This allows researchers to explore environmental factors in greater detail.
Researchers examined 5,391 pairs from Japan and 28,265 from the Netherlands, drawing on data from the Tohoku Medical Megabank Project, and the Lifelines study in the Netherlands.
Couples from both countries shared similar lifestyle habits and physical traits such as smoking, drinking, weight, abdominal circumference, and body mass index. When the researchers dived further into the data, they determined that couples had corresponding blood pressure, cholesterol, and triglycerides levels. Moreover, related incidents of hypertension, diabetes, and metabolic syndrome were also found.
Many of the correlations were between couples with low genetic similarity and high lifestyle similarity, suggesting the importance of healthy choices. The researchers encourage healthcare guidance for couples and a healthy dose of competition between partners that encourages each other to improve their health, especially against diseases shaped by lifestyle and environment.
So, the next time you go for a checkup, why not bring your partner? Better yet, challenge them to a walk to the clinic.
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Materials provided by Tohoku University. Note: Content may be edited for style and length.

People with treatment-resistant hypertension successfully reduced their blood pressure by adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan, losing weight and improving their aerobic fitness by participating in a structured diet and exercise program at a certified cardiac rehabilitation facility, according to new research published today in the American Heart Association’s flagship journal Circulation.
Uncontrolled high blood pressure (130/80 mm Hg or higher) despite the use of three or more medications of different classes including a diuretic to reduce blood pressure is a condition known as resistant hypertension. Although estimates vary, resistant hypertension likely affects about 5% of the general global population and may affect 20% to 30% of adults with high blood pressure. Resistant hypertension is also associated with end-organ damage and a 50% greater risk of adverse cardiovascular events, including stroke, heart attack and death.
Diet and exercise are well-established treatments for high blood pressure. In June 2021, the American Heart Association advised that physical activity is the optimal first treatment choice for adults with mild to moderately elevated blood pressure and blood cholesterol who otherwise have low heart disease risk.
This new study, Treating Resistant Hypertension Using Lifestyle Modification to Promote Health (TRIUMPH), is the first to evaluate the impact of lifestyle modifications in people with resistant hypertension. Researchers found that behavioral changes, including regular aerobic exercise, adoption of the DASH (Dietary Approaches to Stop Hypertension) diet, reducing salt consumption and losing weight, can lower blood pressure significantly and improve cardiovascular health in people with resistant hypertension. The DASH eating plan is rich in fruits, vegetables, low-fat dairy products and limited salt, and aligns with the American Heart Association’s nutrition recommendations.
The four-month clinical trial involved 140 adults with resistant hypertension (average age 63; 48% women; 59% Black adults; 31% with type 2 diabetes; and 21% with chronic kidney disease). Participants were randomly divided into two groups — 90 participants received weekly dietary counseling and exercise training in an intensive, supervised cardiac rehabilitation setting three times a week. The other 50 participants received a single informational session from a health educator and written guidelines on exercise, weight loss and nutritional goals to follow on their own.
Researchers found: The participants in the supervised program had about a 12-point drop in systolic blood pressure, compared to 7 points in the self-guided group. Systolic blood pressure (the first number in a blood pressure reading) indicates how much pressure blood is exerting against artery walls when the heart beats and is recognized as a major risk factor for cardiovascular disease for adults ages 50 and older. Blood pressure measures captured through 24 hours of ambulatory monitoring during a typical day revealed that the group in the supervised lifestyle program had a 7-point reduction in systolic blood pressure, while the self-guided group had no change in blood pressure. Participants in the supervised program also had greater improvements in other key indicators of heart health, suggesting that they had a lower risk of a heart event in the future.”Our findings showed lifestyle modifications among people with resistant hypertension can help them successfully lose weight and increase their physical activity, and as a result, lower blood pressure and potentially reduce their risk of heart attack or stroke,” said James A. Blumenthal, Ph.D., first and senior author of the study, and J.P. Gibbons Professor of Psychiatry and Behavioral Sciences at Duke University School of Medicine in Durham, North Carolina. “While some people can make lifestyle changes on their own, a structured program of supervised exercise and dietary modifications conducted by a multidisciplinary team of health care professionals in cardiac rehabilitation programs is likely more effective.”

The COVID-19 pandemic triggered life expectancy losses not seen since World War II in Western Europe and exceeded those observed around the dissolution of the Eastern Bloc in central and Eastern European countries, according to research led by scientists at Oxford’s Leverhulme Centre for Demographic Science.
The research team assembled an unprecedented dataset on mortality from 29 countries, spanning most of Europe, the US and Chile — countries for which official death registrations for 2020 had been published. They found that 27 of the 29 countries saw reductions in life expectancy in 2020, and at a scale which wiped out years of progress on mortality, according to the paper published today in the International Journal of Epidemiology.
Women in 15 countries and men in 10 countries were found to have a lower expectancy at birth in 2020 than in 2015, a year in which life expectancy was already negatively affected by a significant flu season.
According to the study’s co-lead author Dr José Manuel Aburto, ‘For Western European countries such as Spain, England and Wales, Italy, Belgium, among others, the last time such large magnitudes of declines in life expectancy at birth were observed in a single year was during WW-II.’
But, he says, the scale of the life expectancy losses was stark across most countries studied, ’22 countries included in our study experienced larger losses than half a year in 2020. Females in eight countries and males in 11 countries experienced losses larger than a year. To contextualize, it took on average 5.6 years for these countries to achieve a one-year increase in life expectancy recently: progress wiped out over the course of 2020 by COVID-19.’
Across most of the 29 countries, males saw larger life expectancy declines than females. The largest declines in life expectancy were observed among males in the US, who saw a decline of 2.2 years relative to 2019 levels, followed by Lithuanian males (1.7 years).
According to co-lead author, Dr Ridhi Kashyap, ‘The large declines in life expectancy observed in the US can partly be explained by the notable increase in mortality at working ages observed in 2020. In the US, increases in mortality in the under 60 age group contributed most significantly to life expectancy declines, whereas across most of Europe increases in mortality above age 60 contributed more significantly.’
In addition to these age patterns, the team’s analysis reveals that most life expectancy reductions across different countries were attributable to official COVID-19 deaths.
Dr Kashyap adds, ‘While we know that there are several issues linked to the counting of COVID-19 deaths, such as inadequate testing or misclassification, the fact that our results highlight such a large impact that is directly attributable to COVID-19 shows how devastating a shock it has been for many countries. We urgently call for the publication and availability of more disaggregated data from a wider-range of countries, including low- and middle-income countries, to better understand the impacts of the pandemic globally.’
Life expectancy, also known as period life expectancy, refers to the average age to which a newborn live if current death rates continued for their whole life. It does not predict an actual lifespan. It provides a snapshot of current mortality conditions and allows for a comparison of the size of the mortality impacts of the pandemic between different countries and populations.
Note: Interactive visualizations of the paper’s main results/findings are available on this website: https://covid19.demographicscience.ox.ac.uk/lifeexpectancy
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Materials provided by University of Oxford. Note: Content may be edited for style and length.

The mother of a 31-year-old woman who died from cancer after her chemotherapy was paused due to pandemic Covid measures has spoken publicly for the first time, saying she’s “broken” by her daughter’s death. Kelly Smith from Macclesfield died from bowel cancer in June 2020.Her mum, Mandy Russell, and dad started a petition calling for an end to cancer treatment delays, which had more than 370,000 signatures when they handed it to the government this summer. Research by the Institute for Public Policy Research has now estimated it could take more than a decade to clear the cancer-treatment backlog in England.NHS England said: “While the pandemic inevitably had a knock on effect on other services, the NHS continued to prioritise cancer care throughout the pandemic and referral and treatment numbers are now back to usual levels.”

It was a hot morning in Baton Rouge, La., the day that Peter Naughton woke up on the floor.Sore, disoriented, he’d already grasped what his mother was now telling him: He’d had another seizure. But he also grasped a larger truth: He needed to pull it together and somehow go to work.A cashier and self-checkout host at the nearby Walmart, Mr. Naughton dreaded depleting his limited paid time off in the midst of a pandemic. His mother, for her part, insisted that her epileptic son, then 44, stay home and rest. The hours after a seizure were difficult enough. Toss in the stress of Covid-19 and a customer base that largely — and often angrily — rejected mask use, and a day at work seemed anything but recuperative.In the end, Mr. Naughton’s growing headache and general fogginess were intense enough that he conceded to his mother’s wishes. He dialed once, twice, three times. No answer. Given the penalty for missing work without giving notice — and the fear of risking his job during uncertain times — he saw what he had to do. Reeling, he made the trip to the store and clocked in.That was the summer of 2020, and in the bewildering year since, the stakes and strain around low-wage frontline jobs like Mr. Naughton’s seem only to have multiplied.As shuttered offices cautiously debate the merits and logistics of reopening, a parallel sphere of workers — retail employees, day laborers, emergency personnel, medical staff, and so on — seemingly inhabit another country entirely. In their case nothing ever shuttered. Often their jobs just got really, really hard.“Every day is frightening,” Mr. Naughton said recently, now nearly two years into his employment at Walmart.Mr. Naughton said this in the dark, his power still out days after Hurricane Ida had barreled through Louisiana. It was 93 degrees. Later he would take another cold shower, also in the dark, in hopes of cooling off before bed.Mr. Naughton lives on a quiet, grassy street of low brick homes with his aging parents, not far from where he attended high school some two decades prior. He had an apartment of his own for a while last year, but his $11.55 hourly wage wasn’t enough to pay the rent, even working full time. So he moved back in with his mother and father, and now lives in fear of bringing the highly contagious Delta variant home to them. (Mr. Naughton is fully vaccinated. But at 78, his father has health issues that prevent him from getting the shots, Mr. Naughton said — health issues that make severe illness likelier should he contract the disease.)Mr. Naughton, 45, lives with his aging parents and worries about bringing the highly contagious Delta variant home to them.Emily Kask for The New York TimesElsewhere in the country, the conversation has begun to move on, away from early Covid alarm and into something more guardedly speculative. What will post-pandemic life look like? How have our priorities shifted? But for vast swaths of the nation, largely untouched by doses from Pfizer and Moderna, it remains late 2020 in many ways.“A lot of people here still don’t believe the virus is real — even when the hospitals are full, even when they have family dying,” Mr. Naughton said. “With the vaccines, one co-worker told me getting it would go against her faith. Another told me it contains baby fetuses and mercury. Someone else said it was created by Bill Gates to insert microchips to track you. I said, ‘Why would he want to track you?’”The conversations Mr. Naughton describes may be epidemiologically out of step, but he and thousands of others seem trapped in an America-right-now vortex, a swirl of politics, belief, resentment and fear. At fast food restaurants, grocery stores, warehouses, nursing homes and anywhere else frontline workers show up each day, a deep schism has taken hold. Workers nervous about the virus find themselves at the mercy of those who aren’t.“If I ask people to wear a mask or socially distance at work, they get mad and tell the manager. Then I have to get coached. If you get coached too many times, you lose your job,” Mr. Naughton said, referring to the company’s system for managing worker infractions. (Charles Crowson, a Walmart spokesman, did not dispute that an accumulation of coachings could lead to termination.)Draped over this dynamic are often the stark realities of poverty, and the stresses of navigating a low-paying job in a high-pressure situation. And so an already strained situation strains further. Bitterness over masking requests, job insecurity, a run on bottled water, vaccine politics — tensions routinely boil over in his store and beyond, Mr. Naughton said.“It wasn’t always like this. It used to be more friendly here. It’s become hostile. People are really on edge. They fight with you in the store, or with each other,” he said. “The other day a woman wanted to fight over the price of potatoes. You can even see it in how people drive, like they have a death wish.”These days Mr. Naughton passes a fair amount of time alone. He burns off stress at the gym, goes on hikes, reads books on politics. (By flashlight, in the days after Hurricane Ida.) The Delta resurgence also dealt a blow to his social life — at one point, concerned about the alarming spread in Louisiana, he canceled plans to see live comedy with a co-worker. She went on without him; “she wasn’t worried about it,” he said.Over the last few months, Mr. Naughton has pinned his hopes on a transfer — there’s another nearby Walmart he believes to be less stressful. After extensive lobbying, he said the move was finally approved. Coincidentally, it’s to the same store where his father routinely shops, Covid risks and all.Mr. Naughton had an apartment of his own last year, but his $11.55 hourly wage wasn’t enough to pay the rent.Emily Kask for The New York Times“He’s stubborn. He goes there for pastries, for Coke. He spends hours there. We tell him not to, it’s not safe,” Mr. Naughton said.With nearly 1.6 million workers, Walmart is the largest private employer in the country. It employs 35,954 people in Louisiana alone, working for one of the 137 Supercenters, discount stores, neighborhood markets or Sam’s Clubs across the state. Covid appears to have been good for the bottom line: During fiscal 2020, the company generated $559 billion in revenue, up $35 billion from the previous year. But labor activists say too little of that money has gone toward work force protections, which in turn has prolonged the pandemic..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-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;}According to United for Respect, a nonprofit labor advocacy group for Walmart and Amazon workers — Mr. Naughton is an outspoken member — safety measures remain deeply insufficient.“Thousands of Walmart associates across the country like Peter have been forced to endure poverty wages and abysmal benefits while working through a deadly pandemic, managing panic-buying sprees and culture wars over mask mandates,” said Bianca Agustin, the accountability director for United for Respect.In a survey the group conducted of Walmart associates — the term the company uses for all non-temporary employees — in May 2020, nearly half said they had come into work sick or would do so, fearing retaliation otherwise. This past April the group released a report with the public health nonprofit Human Impact Partners, finding that Walmart could have prevented at least 7,618 Covid cases and saved 133 lives with a more robust paid sick time policy. (Researchers have estimated that some 125,000 Walmart workers nationwide likely contracted Covid between February 2020 and February 2021.)United for Respect is pushing for five measures in response: hazard pay of $5 per hour; access to adequate paid and unpaid leave; immediate notification of positive cases within a given store; the inclusion of workers in the creation of safety protocols; and protection from retaliation. In the meantime, it has created a Covid reporting tool for workers at Amazon and Walmart. So far almost 1,900 cases have been claimed at 360 stores and facilities.“Walmart lets in people without masks all the time, and social distancing isn’t enforced,” Mr. Naughton said. “Our lives are constantly in danger. They have ‘health ambassadors,’ but all they do is sit at the door offering customers masks. I’ve had to fill in for them. A lot of people just ignore you, or else get angry.”In response, Mr. Crowson, the Walmart spokesman, replied that the company “has worked hard to protect the health and safety of associates and customers. This includes administering no-cost vaccinations, enhanced cleaning practices, daily health screenings and temperature checks for our associates, special bonuses and an emergency leave policy.”For Mr. Naughton, donning his yellow “Proud Walmart Associate” vest each morning and going to work is basic survival in perilous economic times.Emily Kask for The New York TimesFor his part, Mr. Naughton continues fearing work while also fearing the idea of missing any. That’s partly the work ethic he inherited from his father, who never once called in sick to the chemical plant where he spent his career. But it’s also basic survival in perilous economic times. Putting aside any medical implications for him or his loved ones, he worries that contracting Covid could cost him his job. At 45, reliant on Medicaid for health coverage and having no retirement plan to speak of, he continues to don his yellow “Proud Walmart Associate” vest each morning.Over the years Mr. Naughton has worked at fast food restaurants, grocery stores and an amusement park. The idea of finding a more Covid-safe work-from-home gig appeals to him, but his hours at Walmart leave little time for job hunting. Regardless, he says the positions he comes across are “the kind you can’t get without experience, but you can’t get experience without a job.”Asked about the distant universe of office careers and mask-wars-free remote work, Mr. Naughton, he replied that it all feels “unfair.”“They say we’re essential,” he said, “but they treat us like we’re disposable.”

A smartphone sensor, much like what is used in GPS systems, might be a way to determine whether or not someone is intoxicated after consuming marijuana, according to a new study by the Rutgers Institute for Health, Health Care Policy and Aging Research.
According to the study, published in Drug and Alcohol Dependence, which evaluated the feasibility of using smartphone sensor data to identify episodes of cannabis intoxication in the natural environment, a combination of time features (tracking the time of day and day of week) and smartphone sensor data had a 90 percent rate of accuracy.
“Using the sensors in a person’s phone, we might be able to detect when a person might be experiencing cannabis intoxication and deliver a brief intervention when and where it might have the most impact to reduce cannabis-related harm,” said corresponding author, Tammy Chung, professor of psychiatry and director of the Center for Population Behavioral Health at the Rutgers Institute for Health, Health Care Policy and Aging Research.
Cannabis intoxication has been associated with slowed response time, affecting performance at work or school or impairing driving behavior leading to injuries or fatalities. Existing detection measures, such as blood, urine or saliva tests, have limitations as indicators of cannabis intoxication and cannabis-related impairment in daily life.
The researchers analyzed daily data collected from young adults who reported cannabis use at least twice per week. They examined phone surveys, self-initiated reports of cannabis use, and continuous phone sensor data to determine the importance of time of day and day of week in detecting use and identified which phone sensors are most useful in detecting self-reported cannabis intoxication.
They found that time of day and day of week had 60 percent accuracy in detecting self-reporting of cannabis intoxication and the combination of time features and smartphone sensor data had 90 percent accuracy in detecting cannabis intoxication.
Travel patterns from GPS data — at times when they reported feeling high — and movement data from accelerometer that detects different motions, were the most important phone sensor features for detection of self-reported cannabis intoxication.
Researchers used low burden methods (tracking time of day and day of week and analyzing phone sensor data) to detect intoxication in daily life and found that the feasibility of using phone sensors to detect subjective intoxication from cannabis consumption is strong.
Future research should investigate the performance of the algorithm in classifying intoxicated versus not intoxicated reports in those who use cannabis less frequently. Researchers should study reports of intoxication using tools that law enforcement might use showing a stronger correlation with self-reported cannabis use.
Study authors include faculty from Stevens Institute of Technology, Stanford University, Carnegie Mellon University, University of Tokyo, Japan, and University of Washington, Seattle.
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Materials provided by Rutgers University. Original written by Nicole Swenarton. Note: Content may be edited for style and length.

A Coleraine judo club is one of the first in Northern Ireland to offer training for visually impaired participants.Stephanie Stewart was born blind because of an undeveloped optic nerve. She started to attend once lockdown restrictions around sport began to ease.“I’ve learnt a lot about how to break your fall and fall safely, so it’s been really useful in a practical way and it’s fun”, she told BBC News NI.Diabetic retinopathy caused Iain Catlin to go blind in his left eye and he only see shapes through his right eye.He says judo has had a big impact on his life.“I was struggling with the mental health aspects of coming to terms with my sight loss.“But with the padded floors and mats, judo has allowed me to keep fit and exercise in a safe environment.”Judo and martial arts are becoming more popular among people with sight difficulties and there are hundreds of clubs in other parts of the UK.Jonathan Adams from the Royal National Institute of Blind People says he hopes more judo clubs in Northern Ireland will follow suit.He said: “I’d love to see it grow and I hope other clubs across the province embrace the fact that judo can be accessible for people with a visual impairment.”Video journalist: Niall McCracken

A student has said it will be “incredibly emotional” to run the London Marathon with the bone marrow donor who saved her life 13 years ago.Vicky Lawrence, 21, had an autoimmune disorder when she was younger and received a transplant from Elliott Brock, from Mersea Island in Essex.”It’s crazy to think… I am about to embark on 26 miles of running alongside the person who did save my life,” said Ms Lawrence, who is from Birmingham and is a medical student in Newcastle.Mr Brock said: “Hopefully, our amazing back story we’ve got will obviously raise the awareness of what Anthony Nolan does but also inspire other people to join the bone marrow register, that’s just as important really.”Video by Dawn GerberFind BBC News: East of England on Facebook, Instagram and Twitter. If you have a story suggestion email eastofenglandnews@bbc.co.uk

Health officials were preparing on Friday to start giving booster shots to older and at-risk Americans, trying to make sense of new and broad eligibility guidelines.WASHINGTON — State health officials rushed on Friday to roll out campaigns to provide coronavirus booster shots for millions of vulnerable people who got the Pfizer-BioNTech vaccine and to help a confused public understand who qualifies for the extra shots.Among their challenges: making sure that recipients of the Moderna and Johnson & Johnson vaccines know that they are not yet eligible for boosters, reaching isolated elderly people and informing younger adults with medical conditions or jobs that place them at higher risk that they might be eligible under the broad federal rules.“Those of us overseeing vaccine rollouts don’t have a clear idea of what to do,” said Dr. Clay Marsh, West Virginia’s Covid-19 czar.In his state, pharmacies sent staff members into the largest nursing homes on Friday to administer booster doses. In Vermont, health officials opened booster shot appointments to people 80 and older on Friday, and said many other eligible people could get them starting next week. But the state said it was waiting for clarity from the Centers for Disease Control and Prevention on which workers and medical conditions would qualify.In virus-battered North Dakota, officials struggling to make sense of the federal guidance delayed a broad booster rollout until next week, with a focus on reaching elderly residents and those in long-term care settings, said Kylie Hall, an adviser to the state’s Health Department.Across the country, vaccine providers are facing the reality that many more people became eligible for boosters after Dr. Rochelle P. Walensky, the C.D.C. director, overruled her expert committee early Friday. She said people at greater risk of exposure to the virus “because of occupational or institutional setting” would qualify, opening up boosters to millions of people her advisory committee had left out.People 65 and older and residents of long-term care facilities and adults who have certain medical conditions also qualify for the boosters.After Dr. Walensky’s announcement, President Biden said 20 million people could get boosters immediately because they had gotten their second Pfizer-BioNTech shot at least six months ago. In all, he said, 60 million people will be eligible for a Pfizer-BioNTech booster over the coming months.“If you got the Pfizer vaccine in January, February, March of this year and you’re over 65 years of age, go get the booster,” Mr. Biden said. “Or if you have a medical condition like diabetes, or you’re a frontline worker, like a health care worker or a teacher, you can get a free booster now.”Still, people like Don Driscoll remain wary of coronavirus vaccines. Mr. Driscoll, 38, who lives in suburban Pittsburgh, has been derided by friends for not getting vaccinated. But he is not comfortable yet, he said, because of the lack of consensus about the shots.With exasperation, he pointed to the ping-ponging of contradictory booster advice in the last few weeks from federal health authorities and the White House, which has only reinforced his apprehension.“I feel that everything that has been happening is justifying people’s hesitancy,” he said.State and federal officials said the booster program would look much different than earlier coronavirus vaccination drives, which relied heavily on mass inoculation sites at sports stadiums and convention centers. Instead, pharmacies, primary care physicians and smaller vaccination clinics that have become accustomed to offering shots will deliver boosters.“That track has been laid, and we can continue to move the booster train, if you will, right down that same set of tracks,” Karen Timberlake, the secretary designee of Wisconsin’s Department of Health Services, told reporters this week.Pharmacies are providing roughly 70 percent of coronavirus vaccinations as of this week, according to the C.D.C. Mr. Biden said booster shots would be available at 80,000 locations around the country, including more than 40,000 pharmacies.CVS said on Friday that its pharmacies were ready to provide booster shots and would rely on customers to “self-attest” regarding their eligibility.Patrick Allen, the director of the Oregon Health Authority, said that as officials in his state sorted out federal guidance, their message to people with questions about eligibility was: “Call your doctor or check with your local pharmacy.” A large vaccination site at a county fairgrounds was set to offer booster shots starting this weekend, he said. Another site at Oregon State University could open if demand for boosters proves high enough, he added.“This gets to the whole unknowable thing of what the uptake is going to be,” he said.Administration officials were hoping that the C.D.C.’s recommendations would bring some closure to a dissent-filled month of preparing for a booster campaign. The C.D.C. held calls with state health departments and pharmacies on Friday to discuss how to roll out the shots, and the White House briefed governors on the topic.Dr. Mark Levine, Vermont’s top health official, pointed to one potential challenge for his state: Many teachers there received the single-dose Johnson & Johnson vaccine, for which booster shots are not yet authorized, leaving them in limbo. A booster program with only Pfizer-BioNTech’s vaccine, he said, will require “a lot more messaging and communication.”In West Virginia, which has one of the highest daily average case rates in the country, Dr. Marsh said many who most needed extra shots would be left waiting. More isolated nursing homes in the state received the Moderna vaccine, he said. So did rural communities in Alaska, said Dr. Anne Zink, the state’s top health official. But Dr. Marsh praised the C.D.C.’s allowance of booster shots for health workers, saying it could help sustain badly strained hospitals in his state.Dr. Zink said the early morning C.D.C. decision had provided needed clarity about how to advise vaccine providers. “It was the bow at the end,” she said.Most nursing homes, whose residents have been particularly vulnerable during the pandemic, are not concerned about their ability to deliver booster shots. While the Trump administration had relied on the large national pharmacy chains CVS and Walgreens to deliver vaccines when they became available last winter, facilities are now largely using the pharmacies they typically use for vaccinations and prescriptions.These specialized pharmacies are used to working with nursing homes, going room to room to immunize residents. “We can vaccinate for both the Covid booster and the seasonal flu vaccine,” said Chad Worz, the chief executive of the American Society of Consultant Pharmacists, a trade group for pharmacists serving older adults..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-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-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-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;}But vaccinating older Americans who are living in less formal arrangements — in assisted-living facilities, adult day care centers or getting care at home — could be more challenging. For some who had been eagerly waiting for a booster, the C.D.C. recommendation was all they needed to spring into action. Gary Valan, a technology consultant in Oakland, Calif., who said he was older than 65, was so eager for the booster that he scheduled an appointment for Friday afternoon. In an online comment about a New York Times article on booster shots, he wrote: “Folks in my neighborhood, just stay the heck away from my path to the pharmacy. I’ll knock down the old ladies to get my shot 🙂 You have been warned.”Others were still trying to make sense of the recommendations. Mildred Fine, 96, who lives in an assisted-living facility in Baton Rouge, La., said it had been confusing to watch television coverage of the debate about whether booster shots were needed and for whom.“They seem to change their minds every day or two,” she said of federal scientists. She was eager to get her Pfizer-BioNTech booster shot as soon as possible. With so many virus cases in Louisiana, she said, she was still wary of going to Costco to get her hearing aids adjusted, or eating inside a restaurant.State and federal officials said they were unconcerned for now about the vaccine supply, which remains ample enough to cover at least those eligible for booster shots over the next few months.“There are tens of millions of doses already out at sites across the country now, and pharmacies and states can continue to order additional supply,” said Sonya Bernstein, a senior policy adviser for the White House’s Covid-19 Response Team. But officials are most anxious to get shots to unvaccinated Americans, a concurrent campaign that many public health experts say is more important than boosting those already vaccinated. “We can’t take our foot off the gas” with the unvaccinated, said Ms. Hall, the adviser in North Dakota, which ranks near the bottom in the U.S. in vaccination rates.The booster campaign is getting underway amid a fierce debate among vaccine experts about what kinds of benefits the extra shots confer and who needs them. Scientists at the Food and Drug Administration and C.D.C. have said that protection against severe Covid-19 and hospitalization — the metrics they would typically use to assess whether boosters are needed — have remained high across age groups. Top F.D.A. vaccine experts have publicly argued that there is no case for giving them to the general population.At the C.D.C.’s advisory committee meeting this week, experts agreed that a third dose could substantially increase antibody levels. But they said it was unclear how long the resulting protection might last, whether it translated to meaningful extra protection against severe Covid-19 and whether it could significantly decrease transmission of the virus.As a practical matter, the official recommendations were unlikely to deter millions of Americans who might not be eligible yet from pursuing booster doses, by claiming medical conditions or weakened immune systems, by asking doctors to prescribe the vaccine off label or by finding a pharmacist willing to give them one. The C.D.C. said on Thursday that millions of Americans had already received an extra shot.Asked on Friday how officials might prevent ineligible people from getting a shot, Dr. Walensky said providers would have to rely on people giving their word.Winthrop Gardner, of Durham, N.C., said that several weeks ago his 65-year-old wife, a hospital administrator, was growing anxious; her second Pfizer-BioNTech shot had been nine months earlier. So, Mr. Gardner said, she decided to take matters into her own hands.On an online pharmacy portal, she read a list of medical conditions that would render her eligible, some of which she did not even recognize. The last option read: “I don’t know.” Because she is scrupulously honest, he said, she checked that box. And immediately got her booster appointment.

A committee of scientific advisers to the Centers for Disease Control and Prevention voted on Thursday to recommend booster doses of the Pfizer-BioNTech coronavirus vaccine to many Americans who were fully inoculated with the same vaccine. The panel advised that those booster shots go to older Americans and people with certain medical conditions, but excluded those at risk because of their jobs.But the panel was not asked to judge whether people who received the Moderna and Johnson & Johnson vaccines should receive Pfizer boosters. The Food and Drug Administration is reviewing data for a Moderna booster, but has not received an application from Johnson & Johnson for a booster of its vaccine.Several experts nevertheless supported a mix-and-match strategy, and signaled that they would revisit the issue as new data emerge.The advisers wrestled with the practicalities of endorsing a booster shot of Pfizer’s vaccine, but not the other two. Recipients of those vaccines may rightly feel resentful of being asked to wait if the evidence suggests they need boosters, they noted.“I just don’t understand how, later this afternoon, we can say to people 65 and older, ‘You’re at risk for severe disease and death, but only half of you can protect yourselves right now,’” said Dr. Sarah Long, a pediatrician and infectious diseases expert at Drexel University College of Medicine in Pennsylvania.“It might be the right thing to do,” she said. “It just doesn’t sound like a good public health policy.”Some experts seemed to suggest on Wednesday that it might be better to hold off on recommending any booster shots until recipients of all three vaccines could qualify for them.Moderna’s authorization may arrive in a few days, or weeks. The company has applied for authorization of a booster carrying half the dosage given in the first two shots, which has delayed the F.D.A.’s deliberations.Federal regulators have indicated that there was insufficient evidence for mixing first shots of the Moderna vaccine with a Pfizer booster, or vice versa.