A visit to the dentist unexpectedly led to a resolution.The dental hygienist greeted her longtime patient enthusiastically. Unexpectedly, the 68-year-old woman burst into tears. “I feel so bad,” she said, her voice cracking with emotion. “I’m worried I might be dying.” She was always tired, as if all her energy had been sucked out. And she felt a strange dread that something awful was happening to her. And if that weren’t enough, for the past couple of weeks she had lost much of her hearing in her right ear. She was sure she had a brain tumor — though none of her doctors thought so. After offering sympathy, the dental assistant realized she had something more to offer: “We have a dental CT scanner. Should we get a CT of your head?” The patient was amazed. Yes — she would very much like a CT scan of her head. It would cost her $150, the technician told her. At that point, it seemed like a bargain. And, just like that, it was done. And there was a mass. It wasn’t on the right side, where she thought her trouble lay. It was on the left. And it wasn’t in her ear, but in the sinus behind her cheek. That was confusing. She thanked the tech for the scan. She had an ENT and would send the images to him to see what he thought. A History of Ear IssuesThat right ear had been giving the patient trouble for more than 20 years, she reminded her ear, nose and throat doctor in Prescott, Ariz., when she spoke with him. In her 40s she developed terrible vertigo. She was living in Atlanta then and saw an ENT there who told her she probably had Ménière’s disease, a disorder induced by increased pressure in the inner ear. The cause is unknown, though in some cases it appears to run in families. And it’s characterized by intermittent episodes of vertigo usually accompanied by a sensation of fullness in the ear, as well as tinnitus and hearing loss. These symptoms can be present from the start, but often develop over time. There’s no definitive test for the disease, though evidence of the increased pressure is sometimes visible on an M.R.I. Medications like antihistamines and steroids can mitigate the symptoms, but there is no treatment for the disease itself. The patient was encouraged when her vertigo went away after a few months, and she tried to forget about it, but her body wouldn’t let her. Two years later she developed a problem with her balance. It wasn’t the sense of motion she had felt with the vertigo. Instead, there were times when the simple action of walking seemed strangely unnatural; times when she found it difficult to walk in a straight line. It could last for weeks, then disappear for months. And she couldn’t predict its coming or going. It got so bad that she started using a hiking stick whenever she walked farther than her front yard.She went to a neurologist, who ordered an M.R.I. of her brain. The images showed a little patch of something on the right side of her skull, near her inner ear. But both he and the radiologist thought it wasn’t significant. Besides, it was in the wrong place to be causing her symptoms. Instead, her doctor sent her to physical therapy to treat a disorder known as benign paroxysmal positional vertigo (B.P.P.V.), the most common cause of vertigo, usually triggered by head movements. The inner ear has fluid-filled tubes called semicircular canals. The sensation of the fluid moving in these canals tells your brain the position of your body in the world and helps you keep your balance. B.P.P.V. occurs when small pieces of bone (otoliths) are dislodged and roll around on the sensitive surface of the semicircular canals, sending confusing signals to the brain about the body’s position in the world.Physical therapy is normally effective in the treatment of B.P.P.V., though it didn’t do much for this patient. Throughout all this, even though all her doctors agreed that her right ear was the source of her intermittent loss of balance and vertigo, she never had a problem with the ear itself. She never had earaches. Her hearing was perfect. And then one day, it wasn’t. Photo illustration by Ina JangBuzzing That Would Not StopTwo years earlier, when she was 66, she was awakened one morning by a loud buzz. It took her a minute to locate the sound. It was coming from inside her right ear. It sounded like a fluorescent light on its last legs. Tinnitus is what her ENT at the time called it. It was, he told her, just one more thing she would have to put up with. Those were not words the patient wanted to hear. It was so loud that at times it was hard to hear what people were saying. The buzz — or, sometimes, a siren — was so intense it could wake her up from a dead sleep. Sometimes it would quiet down, but it never went away. Never.When her own doctors had nothing to offer, the woman looked elsewhere. She saw chiropractors, naturopaths and doctors specializing in alternative medicine. She was treated with antibiotics, antivirals and lots and lots of supplements. Nothing helped. Then, just weeks before she went to her dentist, she woke up and could hardly hear at all out of that ear. Everything was muffled, as if that ear was underwater. Her current ENT prescribed prednisone to reduce any inflammation.But when he saw the dental CT, he immediately ordered a conventional CT of her head. The dental scan was developed to give a three-dimensional image of the jaw and teeth, so it can’t be expected to show the entire skull. The full CT confirmed that there was a small mass in the left sinus. Based on its appearance, her doctor suspected it was a remnant of an infection from years before. But on the right side there was something else: A mass about the size of a strawberry had destroyed much of the mastoid bone just behind her ear. It was in the same place as the much smaller abnormality seen in the first M.R.I. years earlier. Now it was large enough to compress one of the vessels leading to the jugular vein. The radiologist said it looked like an infection. Or possibly a rare kind of bone cancer. Stray Cells in the BrainWith cancer a possibility, the patient decided she needed a second opinion. She reached out to the Arizona branch of the Mayo Clinic, in Phoenix, and was scheduled to see Dr. Peter Weisskopf two weeks later. Weisskopf listened as the patient described the vertigo, tinnitus and loss of hearing, along with the debilitating fatigue and terrifying sense of impending doom. “I’m not sure this mass could cause all that,” he told her, but he agreed that an M.R.I. would provide important diagnostic information. He suspected that she had something known as a cholesteatoma. These are benign growths of cells that get trapped inside the ear — or, rarely, as in this patient’s case, inside the brain — and start to grow. Sometimes these cells are imported into the ear after a chronic infection, but most of the time they get left there during fetal development. Weisskopf reviewed the M.R.I. The brain tissue showed up, as expected, as stripes of light and dark gray surrounded by fluid, which appears black. But just behind this patient’s ear, nestled into the lower edge of the mastoid bone of the skull, was a big bright cloud of white. Based on that appearance, Weisskopf knew what she had. It was a cholesteatoma. Although this is not a cancer, these sorts of tumors have to be removed. Left in place, they continue to enlarge until they cause real trouble. The patient was eager to have the thing removed. She felt certain that it had to be behind the symptoms she had been living with these past few years. Removing the large mass took two operations, the second one late last spring. But it was worth it, the patient told me. The worst symptoms are completely gone. Her fatigue and sense of oppression and doom disappeared after the first surgery. But even after the second, she still has the tinnitus, which is very loud at times. She still has trouble with her balance. Her hearing is not as good as it used to be. Weisskopf doesn’t believe the mass caused the patient’s symptoms. The patient respectfully disagrees; where it really mattered, with her mood, her sense of well-being, she feels back to something like her old self. And even though her doctor can’t see the link, she’s certain it all came from that growth, which, she thinks, maybe wasn’t quite as benign as her doctors and the textbooks say.Lisa Sanders, M.D., is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries.” If you have a solved case to share with Dr. Sanders, write her at Lisa .Sandersmd@gmail.com.

SharecloseShare pageCopy linkAbout sharingimage copyrightEPAAustralia has fallen 3.4 million doses short of its target of delivering four million Covid vaccinations by 31 March, prompting criticism of the government.The 85% shortfall comes two days after Brisbane entered another snap lockdown to combat a small outbreak.Last week the government said the vaccine rollout did not demand urgency given Australia’s low infection rates.The country has recorded 909 deaths and 29,300 cases since the pandemic began – far fewer than many other nations.But sporadic outbreaks have led to six lockdowns in cities in recent months. Critics say situations like Brisbane’s outbreak show why a quick vaccine programme is still needed.Brisbane’s two clusters have been linked to a nurse and a doctor who contracted the virus from a Covid ward at the same hospital. It’s unclear why those health workers had not yet been vaccinated, officials said.Australian PM is vaccinated as rollout beginsQantas says vaccines will be required to fly Australia to send Papua New Guinea vaccinesCritics have accused the government of mishandling the rollout, which began on 22 February – later than in many countries.Australia is administering the Pfizer and AstraZeneca vaccines and has a rate of 2.3 vaccines per 100 people. That is expected to increase in coming months as vaccine access is opened up to the wider population.On Wednesday, Health Minister Greg Hunt said a record 72,826 vaccinations had been given in the past day – taking the total to 670,000.”That’s showing that the national vaccination programme is accelerating exactly as intended in the manner that was intended,” he told reporters.But in January, Prime Minister Scott Morrison promised to have four million people inoculated with their first shot by March.Earlier this month, the government pushed that target back to April, and said six million people would be vaccinated by mid-May. It has also dialled back a promise to have every Australian fully vaccinated by October – now saying that everyone will have received a first shot by then.Slowed rolloutAustralia is currently up to stage two of its four-phase rollout for its 25 million population.Doses are being offered to people over 70, those in aged care homes, frontline health workers, emergency services workers, Aboriginal and Torres Strait Islander people over 55, and people with underlying health conditions.Authorities have not specified why the pace has been so slow, but issues such as booking technicalities have been reported. There are also reports that some people are choosing to not get the vaccine.Natural disasters – such as the massive floods in eastern Australia last week – have also disrupted the rollout.Earlier this month, the EU blocked a shipment of AstraZeneca doses to Australia, arguing there was a greater need for them in Europe.Australia said the one shipment of 250,000 doses would not greatly affect its own programme, as it built up its own manufacturing capability. However, Australia has asked the EU to review the ban on its order, which Mr Morrison said had been paid for.Labor opposition leader Anthony Albanese said the government, by its own admission, could not blame international supply issues.”They said that target wasn’t dependant on anything else and they would certainly reach the target,” he told the ABC. “Yet again it’s an example of how Scott Morrison is always strong on announcement and weak on delivery.”Concerns in BrisbaneQueensland’s capital reported two more community transmission cases on Wednesday, bringing the outbreak to 15 infections in total.There are fears that the city’s three-day lockdown, due to finish on Thursday, will need to be extended. Contact tracers are scrambling to track down infected people and have so far placed more than 1,000 of their close contacts in quarantine.The lockdown has forced many in Queensland and interstate to cancel their Easter and school holiday plans. Queensland’s state economy is heavily reliant on tourism – and operators have forecast that the three-day lockdown has caused a A$35m (£19m; $26m) loss.

As Buruli ulcer cases have risen, they have taken a physical and psychological toll but also offered hope that scientists can solve the bacteria’s many mysteries.SORRENTO, Australia — To Rob Courtney, it looked like a sunburn. But after a few days, the redness and inflammation got worse. Soon, the skin on his right foot was split open, the wound oozing. His doctor sent him straight to the emergency room.Then came the horrifying diagnosis: Mr. Courtney was infected with a species of flesh-eating bacteria.In recent years, cases of the disease, known as Buruli ulcer, have exploded in the seaside area where Mr. Courtney, 80, lives in southeastern Australia.As he would learn, it is a fearsome intruder.The ulcer left the flesh on his foot corroded and gangrenous. It devoured a skin graft. Eventually, doctors prescribed the same powerful antibiotics used to treat leprosy and tuberculosis. The drugs made him feel nauseated and fatigued, and turned his sweat and tears orange. He spent nearly 50 days in the hospital.“It’s been a bit of a journey,” Mr. Courtney said recently as he lay on an examination table at his local clinic, where he has endured a daily wound dressing for several weeks. “I wouldn’t recommend it.”Buruli ulcer has been reported in 33 countries, primarily in Africa, where a lack of access to health care can mean that cases go on for months, sometimes resulting in disfigurement and disability.In Australia, where cases of the ulcer have been recorded since the 1940s, the recent increase in infections has brought new attention to the neglected disease. That, along with a growing global interest in infectious diseases, has raised hopes that scientists might finally have the resources to crack its code.The area hit hardest in Australia is the Mornington Peninsula, in the state of Victoria. More than 180 cases per year have been reported in the state since 2016, peaking in 2018 at 340. In February, the disease crept further into the suburbs of Melbourne, a city of five million people.No one knows exactly how the infection spreads or why it has flared on the Mornington Peninsula, an affluent region less than 50 miles from Melbourne where cafes line leafy boulevards and thousands of tourists visit each year.The small town of Blairgowrie on the Mornington Peninsula. No one knows exactly how the infection spreads or why it has flared in the region.Christina Simons for The New York TimesScientists think that Buruli ulcer — and up to 75 percent of emerging diseases, including the coronavirus — is zoonotic, meaning it jumps from animals to humans. They say zoonotic disease are becoming more common in part because of human encroachment on wild environments.As for the spike in cases in Victoria, the leading theory is that possums, a marsupial native to Australia, carry the bacteria, which are then transmitted to humans by mosquitoes that have come into contact with the animal’s feces.The bacterium has long been present, but “what we’ve done is stumbled into it and maybe helped it to amplify and become the unwitting victims,” said Dr. Paul Johnson, a physician and professor of infectious diseases at Austin Health in Melbourne. “We’ve provided situations where it can expand rapidly and cause human disease.”In recent years, as attention to the disease has increased funding for research, Dr. Johnson and others have been trying to figure out exactly how Buruli ulcer is transmitted. To test their theory, the scientists are working to reduce the number of mosquitoes on the Mornington Peninsula to see whether cases of Buruli ulcer drop as well.On a Saturday in late February, Dr. Johnson and Tim Stinear, a professor of microbiology at the Doherty Institute at the University of Melbourne, led a troop of more than a dozen researchers — clad in yellow “Beating Buruli in Victoria” vests — as they set mosquito traps in the suburbs of the Mornington Peninsula.The researchers have also been on the hunt for possum feces, which they say has given them a crucial map of hot spots where the bacteria are present. “Once you start looking for this stuff, you see it everywhere,” Professor Stinear said as he knelt in a driveway, using a stick to scoop the scat into a sandwich bag. “Because it is everywhere.”Tim Stinear and Stacey Lynch, who are studying how Buruli ulcer is transmitted, preparing mosquito traps in the Mornington Peninsula last month.Christina Simons for The New York TimesDespite possums’ ubiquitousness, they are protected as native creatures in Australia. That has tended to stall research and has stood in the way of culling programs that could reduce the spread of the disease. (Vaccinating the animals, though, is a possibility.) Efforts to cull mosquitoes with insecticide have also met pushback from environmentalists.The opposition is hardly a surprise, researchers say, given the global wave of distrust in science. But funding work on obscure diseases like Buruli ulcer is crucial to halting future outbreaks. “We never know when they will become important,” Professor Stinear said. “This is a lesson that we learned with coronavirus.”For those who contract Buruli ulcer, the journey can be arduous, leading to severe illness and sometimes even amputation and death in older and vulnerable patients. The wounds can take months to heal, scarring patients both physically and psychologically.“It’s a huge illness to deal with,” said Dr. Daniel O’Brien, an infectious disease specialist based in Geelong, 50 miles southwest of Melbourne. “It becomes quite disconcerting for people in the community.”Michael Steele, a Buruli ulcer patient, was waiting for a skin graft this month. He said he believed he contracted the disease in Sorrento last year.Christina Simons for The New York TimesOn a Friday in March, Dr. O’Brien, masked and bespectacled, treated Mr. Courtney and more than a dozen other patients at a clinic in Sorrento on the Mornington Peninsula. When Dr. O’Brien began traveling there about a decade ago, he would see a handful of patients each week. Now he sees up to 50.He has treated more than a thousand patients, both in Australia and overseas, for the disease. Many of those in Australia are older, but others are young teachers, laborers and even children.He measures their lesions gently with a ruler, marking them to track their progression. Though they look like the stuff of nightmares — some have ulcers that eat all the way to the bone — most patients describe them as painless. The flesh-eating toxin produced by the bacteria presents a peculiar horror: It both weakens the immune response and numbs the flesh it is consuming. It’s “quite an extraordinary organism, really,” Dr. O’Brien said of the bacterium, “and a formidable foe.”In Mr. Courtney’s case, the ulcer had ravaged the top half of his foot before doctors could give a diagnosis. They have since performed surgeries to remove the necrotic, concrete-like tissue. “Unless you get rid of that dead flesh, the skin will never heal,” said Dr. Adrian Murrie, a physician at the clinic who has been treating Mr. Courtney.Other patients with less severe cases sometimes decline treatment, instead opting for natural remedies like applying heat and clay. Though the body can occasionally fight off smaller ulcers, such treatments can pose a real danger in serious cases, Dr. O’Brien said.In most cases, the course of treatment is antibiotics. Previously, the disease was largely treated with surgery, but with better medications, the prognosis has vastly improved in recent years. “It was thought the antibiotics didn’t work,” Dr. O’Brien said. “Because it actually gets worse before it gets better.”Still, for now, prevention is close to impossible.“We don’t know how to stop it,” he said. But if the answer is to be found anywhere, he said, it’s in Australia.For Mr. Courtney, his battle with the disease is far from over. Doctors expect his treatment to last at least another six months.“When you’re 80 years old, and you lose a year,” he said, “you get really savage about it.”A mosquito trap left by the researchers.Christina Simons for The New York Times

A company memo on Tuesday informed the staff that NYU Langone would “provide vaccines for Bloomberg employees who meet the eligibility requirements.”NYU Langone Health, a major New York hospital system, has set aside Covid-19 vaccination shots for employees of Bloomberg L.P., the financial data and media company owned by the billionaire Michael R. Bloomberg.Bloomberg employees were told of the arrangement in an internal memo on Feb. 16. On Tuesday, as New York adults ages 30 and older became eligible for vaccination, Bloomberg’s head of human resources, Ken Cooper, sent a second email to the staff on the matter under the subject line “*URGENT* Covid-19 vaccines in New York.”“NYU Langone has informed us that they are able to provide, in limited quantities each week, vaccines for Bloomberg employees who meet the eligibility requirements,” Mr. Cooper wrote in the email, which was obtained by The New York Times.The email on Tuesday informed staff members that registration instructions would be sent to them after they submitted a ticket on the company’s financial terminal system. The memo added that only Bloomberg employees were eligible under the plan, not their dependents.“Given the complexities around vaccine supply and distribution, we still encourage you to do everything possible to obtain an appointment on your own if you wish to receive the vaccine and are eligible,” the email said. “It’s possible that these appointments could come through for you sooner than those that become available via N.Y.U.”A Bloomberg spokesman declined to comment.Mr. Bloomberg has given billions of dollars to environmental, education, public health and other causes, including gifts amounting to more than $3 billion to his alma mater, Johns Hopkins University.His philanthropic arm has made at least two gifts to New York University. The university’s Robert F. Wagner Graduate School of Public Service announced on March 2 that it would receive a $25 million donation from Bloomberg Philanthropies. The gift was made for a fellowship in the names of Mr. Bloomberg’s daughter Georgina and his mother, Charlotte. In 2017, Mr. Bloomberg’s philanthropic arm gave nearly $6 million to establish an environmental law center at the New York University School of Law.NYU Langone Health has “formal corporate partnerships with organizations, school districts and municipalities for whom we serve as a preferred provider and offer corporate wellness programs in addition to facilitated access to our services,” a spokeswoman for the hospital system said in a statement. “As part of this partnership, we have helped to secure vaccines for Bloomberg employees who are our patients and in accordance with New York State guidelines.”“Philanthropy is not tied to NYU Langone’s vaccine programs,” the spokeswoman added. Of Mr. Bloomberg’s March 2 donation, she said: “It is important to note that the gift made was to N.Y.U.’s Wagner Graduate School. It wasn’t made to NYU Langone Health or N.Y.U. Grossman School of Medicine. It was completely separate from our institution.”New York residents over 30 became eligible for the vaccine on Tuesday, creating a rush to book appointments.Mr. Bloomberg has told his employees that he expects them to return to the office once they are vaccinated. “As vaccines become available, we expect people to take advantage of the safety they provide and return to the office,” he wrote in a memo on Feb. 2, which was reported by Business Insider. “Any questions? I’m at my desk.”

Research published today in the peer-reviewed Journal of Vertebrate Paleontology describes a newly discovered species of dinosaur — named the ‘one who causes fear’, or Llukalkan aliocranianus.
Around 80 million years ago as tyrannosaurs ruled the Northern Hemisphere, this lookalike was one of 10 currently known species of abelisaurids flourishing in the southern continents.
A fearsome killer, Llukalkan was “likely among the top predators” throughout Patagonia, now in Argentina, during the Late Cretaceous due to its formidable size (up to five meters long), extremely powerful bite, very sharp teeth, huge claws in their feet and their keen sense of smell.
It had a strange short skull with rough bones, so in life its head had bulges and prominences like some current reptiles such as the Gila monster or some iguanas. Its hearing was also different to other abelisaurids. The make-up of its skull suggests this was better than most of the other abelisaurids and similar to that of modern-day crocodiles.
Its full name comes from the native Mapuche for ‘one who causes fear’ — Llukalkan, and the Latin for ‘different skull’ — aliocranianus.
It lived in the same small area and period of time as another species of furileusaurian (stiff-backed lizard) abelisaurid — Viavenator exxoni — just a few million years before the end of the age of dinosaurs.

The coronavirus pandemic has had an impact on everyone’s mental wellbeing but those on the front line of dealing with it have suffered more than most. BBC Health reporter Laura Foster talks to three doctors in the NHS for their tips on how you can help support health and care workers with their mental health.Video by Laura Foster and Mel Lou

As eligibility for Covid-19 vaccination rapidly expands to all adults in many states over the next month, a new poll shows a continuing increase in the number of Americans, particularly Black adults, who want to get vaccinated. But it also found that vaccine skepticism remains stubbornly persistent, particularly among Republicans and white evangelical Christians, an issue that the Biden administration has flagged as an impediment to achieving herd immunity and a return to normal life.By now, roughly 61 percent of adults have either received their first dose or are eager for one, up from 47 percent in January, according to the latest monthly survey by the Kaiser Family Foundation.The shift was most striking among Black Americans, some of whom have previously expressed hesitancy but who have also had access issues. Since just February, 14 percent more Black adults said they wanted or had already gotten the vaccine. Over all, Black adults, who have also been on the receiving end of vigorous promotional campaigns by celebrities, local Black physicians, clergy members and public health officials, now want the vaccine in numbers almost comparable to other leading demographic groups: 55 percent, compared with 61 percent for Latinos and 64 percent for white people.The Biden administration has made equity a focus of its pandemic response and has added mass vaccination sites in several underserved communities. In early March, a New York Times analysis of state-reported race and ethnicity information showed that the vaccination rate for Black people in the United States was half that of white people, and the gap for Hispanic people was even larger.Dr. Reed Tuckson, a founder of the Black Coalition Against Covid, hailed the increasing acceptance rates but noted that practical problems still get in the way of uptake.“The data, and our anecdotal feedback, are encouraging and further support the need for equitable distribution and easy-to-access vaccination sites that are led by trustworthy organizations,” he said. “The system needs to support those choices by making the right thing to do the easy thing to do.”Over all, the poll found that the so-called wait and see group — people who have yet to make up their mind — is shrinking commensurately, now at 17 percent, down from 31 percent in January. The seven-day average of vaccines administered hit 2.77 million on Tuesday, an increase over the pace the previous week, according to data reported by the Centers for Disease Control and Prevention.The survey was taken between March 15 through March 22, among a random sample of 1862 adults.Despite the progress, one in five adults (20 percent) say they would either definitely refuse the shot or only be vaccinated if required by their job or school. A number of employers and institutions are considering imposing such a requirement. Last week, Rutgers University became the first large academic institution to require students this fall to get the vaccine (with exemptions for some medical or religious reasons).The people most likely to firmly oppose being vaccinated identify as Republicans (29 percent) or as white evangelical Christians (28 percent). In contrast, only 10 percent of Black adults said they would definitely not get it.According to the Kaiser survey as well as other polls, Republicans have budged little in their views on vaccine acceptance in recent months, although they were more open last fall, before the November presidential election. The partisan divide over the Covid shots is wide, with just 46 percent of Republicans saying they have received at least one shot or want to get it, compared with 79 percent of Democrats.No group is monolithic in its reasons to oppose or accept the vaccines. Those who are skeptical say they mistrust the government generally and are apprehensive about the speed of the vaccine’s development. Awash in online misinformation, many cling to a fast-spreading myth — that tracker microchips are embedded in the shots.For rural residents, access to the vaccine is so problematic that they see the logistics and travel time involved as simply not worth it.With so many reasons cited to avoid the vaccine, crafting messages to coax vaccine confidence can be difficult. But the latest Kaiser report identified some approaches that seem to be successful in moving people to consider the shots.At least two-thirds of the so-called wait and see group said they would be persuaded by the message that the vaccines are “nearly 100 percent effective at preventing hospitalization and death from Covid-19.” Other strong messages included information that the new vaccines are based on 20-year-old technology, that the vaccine trials included a broad diversity of candidates, and that the vaccines are free.The survey also noted that many people who are hesitant would be amenable to certain incentives. As the country begins to open up and on-site work returns, the role of the employer in vaccination is becoming increasingly pertinent. A quarter of those who are hesitant and have a job said that they would get the shot if their employer arranged for workplace vaccination. Nearly as many would agree if their employers gave them financial incentives ranging from $50 to $200.But over all, the strong growth in adults who have either gotten one dose of the vaccine or are inclined to get it is most likely because of their increasing familiarity with the notion. Surveys show that as they begin to know more friends and relatives who have gotten the shot, they can more readily imagine getting it themselves.See How the Vaccine Rollout Is Going in Your County and StateSee where doses have gone, and who is eligible for a shot in each state.

COVID-19 can have damaging effects on multiple organs in the body, including the brain. A new study led by investigators at Massachusetts General Hospital (MGH) and Beth Israel Deaconess Medical Center (BIDMC) indicates that some hospitalized patients with COVID-19 experience non-convulsive seizures, which may put them at a higher risk of dying. The findings are published in the Annals of Neurology.
“Seizures are a very common complication of severe critical illness. Most of these seizures are not obvious: Unlike seizures that make a person fall down and shake, or convulse, seizures in critically ill patients are usually nonconvulsive,” explains co-senior author M. Brandon Westover, MD, PhD, an investigator in the Department of Neurology at MGH and director of Data Science at the MGH McCance Center for Brain Health. “There is increasing evidence that non-convulsive seizures can damage the brain and make outcomes worse, similar to convulsions.”
Westover notes that there have been only a few small reports of seizures in patients with severe COVID-19 illness, and it was previously unclear whether such seizures primarily occur in patients who already have a seizure disorder or whether they can arise for the first time because of COVID-19. The effects of such seizures on patients’ health was also unknown.
To provide insights, Westover and his colleagues analyzed medical information for 197 hospitalized patients with COVID-19 who underwent electroencephalogram (EEG) monitoring — tests that detect electrical activity of the brain using small metal discs attached to the scalp — for various reasons at nine institutions in North America and Europe.
The EEG tests detected nonconvulsive seizures in 9.6% of patients, some of whom had no prior neurological problems. Patients who had seizures needed to be hospitalized for a longer time, and they were four times more likely to die while in the hospital than patients without seizures — suggesting that neurological complications may be an important contributor to the morbidity and mortality associated with COVID-19.
“We found that seizures indeed can happen in patients with COVID-19 critical illness, even those without any prior neurologic history, and that they are associated with worse outcomes: higher rates of death and longer hospital stay, even after adjusting for other factors,” says co-senior author Mouhsin Shafi, MD, PhD, an investigator in the Department of Neurology at BIDMC, medical director of the BIDMC EEG laboratory, and director of the Berenson-Allen Center for Noninvasive Brain Stimulation. “Our results suggest that patients with COVID-19 should be monitored closely for nonconvulsive seizures. Treatments are available and warranted in patients at high risk; however, further research is needed to clarify how aggressively to treat seizures in COVID-19.”
Westover is an associate professor of Neurology at Harvard Medical School (HMS) and Shafi is an assistant professor of Neurology at HMS.
This work was supported by the National Institutes of Health, the Football Players Health Study at Harvard University, the Glenn Foundation for Medical Research and the American Federation for Aging Research, the American Academy of Sleep Medicine, the Department of Defense, and the Eleanor and Miles Shore Fellowship.
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Materials provided by Massachusetts General Hospital. Note: Content may be edited for style and length.

A year ago scientists everywhere were scrambling to get their minds around the SARS-CoV-2, a novel coronavirus that caused the pandemic from which we are only now beginning to emerge. The world clung to every new development, every bit of science that could provide clues to managing life in the presence of this mysterious killer.
Many science-backed COVID-19 management concepts remain unchanged to this day: handwashing with soap and warm water disrupts the virus’ lipid membrane. Social distancing can attenuate the virus’s spread, ideally keeping it out of a host until it degrades. Other notions, such as droplet contact being the primary mode of transmission, were modified when emerging evidence showed that under certain conditions, the virus could remain suspended in air for extended periods of time.
In a letter in the Journal of Infectious Diseases, a team of researchers from UC Santa Barbara, Oregon State University, University of Manchester and ETH Zurich examines another of SARS-CoV-2’s well known characteristics — its vulnerability to sunlight. Their conclusion? It might take more than UV-B rays to explain sunlight inactivation of SARS-CoV-2.
The idea that an additional mechanism might be in play came when the team compared data from a July 2020 study(link is external) that reported rapid sunlight inactivation of SARS-CoV-2 in a lab setting, with a theory(link is external) of coronavirus inactivation by solar radiation that was published just a month earlier.
“The theory assumes that inactivation works by having UV-B hit the RNA of the virus, damaging it,” said UC Santa Barbara mechanical engineering professor and lead author Paolo Luzzatto-Fegiz(link is external). Judging from the discrepancies between the experimental results and the predictions of the theoretical model, however, the research team felt that RNA inactivation by UV-B “might not be the whole story.”
According to the letter, the experiments demonstrated virus inactivation times of about 10-20 minutes — much faster than predicted by the theory.

The magazine’s Ethicist columnist on balancing health care providers’ privacy against patients’ concerns, creating an equitable vaccine system and more.I was planning to make an appointment with a hygienist working under my dentist and was told by a third party that one of the hygienists had contracted Covid, been treated and was back to work. I am 69, and my nephew died of Covid last May. Four other relatives contracted the virus and recovered. I am nervous about the pandemic.I requested not to be treated by that hygienist and received this email in response: “To protect the privacy of our staff, just as we do for our patients, we cannot confirm or deny if someone has recovered from the coronavirus. This would be a violation of HIPAA. Your request to not be seen by someone who tested Covid-19 positive was not appropriate, as C.D.C. guidelines state that after 14 days of quarantine, individuals are safe to go out in public. In addition, our clinicians wear appropriate P.P.E. for treatment (including N95 masks, face shields, gowns, gloves), and our office has implemented additional infection-control measures. We monitor for symptoms, take temperatures and measure oxygen saturation daily for everyone that comes into our suite. If this policy makes you uncomfortable, our office may not be a good fit for you.”I have a problem with putting the privacy of an employee ahead of the concerns of a patient. I also thought that HIPAA applied only to disclosures by a doctor about their patients. Am I out of line to make this request? Should a doctor or dentist tell patients if a staff member has had the virus so that the patient can make an informed decision about treatment? Jack L. Schwartz, Los AngelesAll employers, including medical employers like your dentist, are entitled to have certain kinds of health information about employees. But, like health care providers, they should generally keep that information confidential. It’s granted to them for a limited class of purposes and should be seen only by people who require access to it for those reasons. (The federal rules are complicated, but the basic idea is that information about people’s health shouldn’t be given without their consent unless necessary.) Your dentist is entitled to know that employees are sick in order to confirm that they have medical reasons for taking sick days and to be sure that they pose no risks when they return to patient care. But precisely because the dentist was allowed the information necessary to decide whether the hygienist could safely be at work, patients in the clinic don’t need this information.The really important thing isn’t whether someone once had the virus but whether everyone in the clinic is taking the appropriate precautions with respect to hygiene and P.P.E. As it happens, people who have recovered from Covid-19 are thought to have immunity to it for some time, and people who have immunity to the virus are less likely to transmit it. So it doesn’t make sense to avoid a hygienist who has recovered. Someone who has never had the disease or has not been vaccinated poses the greater risk. (Though, again, a minimal one given proper precautions.)The C.D.C. says that someone who has had Covid-19 can be around others if 10 days have elapsed since symptoms began, a full day has elapsed without fever and other symptoms are improving. Although your dentist’s précis was inexact, it sounds as if the office erred on the side of safety and is rigorous about protocols. Your dentist was making the point that there was no clash here between employee privacy and the legitimate concerns of a patient. Possibly, though, I wouldn’t have added that slightly barbed final comment (“If this policy makes you uncomfortable, our office may not be a good fit for you”). Dentists, of all people, should understand the power and prevalence of irrational anxieties, and one element of good medicine is an understanding heart.I am a college student who spent my break working as an E.M.T. for a private ambulance service. My state’s Covid-19 vaccine protocol prioritizes first responders, and I have the option to receive a shot next week. Given that it can take up to a few weeks for the vaccine to promote antibodies, however, if I get the vaccine now, it won’t protect me until after I’m back at school. My early vaccination provides no benefit to the community, and I could be taking a dose from someone who is at greater risk. Is it wrong for me to get the vaccine knowing that if it weren’t for a few weeks of work, I would be waiting months? Elizabeth Hopkinson, MassachusettsA fair and reasonable system that isn’t unworkably complicated will end up vaccinating some people earlier than others whose need is greater. It’s not your job to add further criteria of your own. What’s more, the available evidence suggests that significant protection starts to kick in about 10 to 14 days after initial vaccination, which could overlap with your period of work as an E.M.T. And being vaccinated does provide a benefit to your community. It lowers the chance of your transmitting the disease by reducing the likelihood that you’ll contract it and, very likely, by reducing the likelihood that you’ll transmit it even if you do. Adding to the overall vaccination rate, which this does, will be necessary in order to reach something like herd immunity.An acquaintance asked me to refer him for an open position at my company. Normally, I would be happy to do so, but he mentioned that for New Year’s he rented a house in another state with a group of friends and later traveled to yet another state to ski. I think it is irresponsible of him to have engaged in recreational travel during the winter peak of the pandemic. The position he’s applying for is at a company where all employees currently work remotely. My concern is not that he’ll get anyone sick but that his recent travel indicates poor judgment, which may be obliquely relevant to his ability to do the job. Should I decline to refer him on these grounds or is that too big of a logical leap? Name WithheldYou’re not obliged to recommend an acquaintance for a job just because he asks. And if you do, you should not hide faults relevant to that job. But your resistance to recommending this person doesn’t seem to be that you think he wouldn’t do a good job; it’s that you disapprove of his behavior during the pandemic.As an empirical matter, though, there’s reason to doubt that people’s character traits are “global” — that the careful accountant is a careful driver, that the faithless spouse is a disloyal friend, that the effective product manager will share your sensible concerns about unnecessary travel and socializing. So yes, that’s a big logical leap.Still, you’re entitled to decline to recommend him because you think that he failed to display a concern for the common good; as an ethical matter, you can deny a favor to someone who, in your view, lacks an important virtue. What you can’t do is say you’ll recommend him and then not do so.I’m in a high-risk group, eligible for a Covid vaccination in both the state I live in and a neighboring state. My state is doing a poor job of distributing vaccines, and I’ve failed to get an appointment. But the neighboring state has a terrific system. A friend who lives there got me an appointment. I know that they don’t ask for your address when you arrive for your appointment, which suggests that they’re not overly concerned about residency, and my friend didn’t misrepresent me when signing me up. Am I right to feel a twinge of guilt all the same? Name WithheldDifferent states have different approaches. Our collective goal, as a nation, is to get as many people vaccinated — especially those at particular risk — as quickly as we can. But because states are allocated vaccines on the basis of their population, some are taking a firm line, restricting vaccinations to those who live or work there; they may require documentation or at least self-attestation to this effect. Other state officials seem OK with letting visitors in the line. So long as you don’t misrepresent yourself at any point, you can proceed with an easy conscience.Kwame Anthony Appiah teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to ethicist@nytimes.com; or send mail to The Ethicist, The New York Times Magazine, 620 Eighth Avenue, New York, N.Y. 10018. (Include a daytime phone number.)