Publisher Health

A new study is drawing the most detailed picture yet of SARS-CoV-2 infection in the lung, revealing mechanisms that result in lethal COVID-19, and may explain long-term complications and show how COVID-19 differs from other infectious diseases.
Led by researchers at Columbia University Vagelos College of Physicians and Surgeons and Herbert Irving Comprehensive Cancer Center, the study found that in patients who died of the infection, COVID-19 unleashed a detrimental trifecta of runaway inflammation, direct destruction and impaired regeneration of lung cells involved in gas exchange, and accelerated lung scarring.
Though the study looked at lungs from patients who had died of the disease, it provides solid leads as to why survivors of severe COVID may experience long-term respiratory complications due to lung scarring.
“It’s a devastating disease, but the picture we’re getting of the COVID-19 lung is the first step towards identifying potential targets and therapies that disrupt some of the disease’s vicious circuits. In particular, targeting cells responsible for pulmonary fibrosis early on could possibly prevent or ameliorate long-term complications in survivors of severe COVID-19,” says Benjamin Izar, MD, PhD, assistant professor of medicine, who led a group of more than 40 investigators to complete in several months a series of analyses that usually takes years.
This study and a companion paper led by researchers at Harvard/MIT, to which the Columbia investigators also contributed, were published the journal Nature on April 29.
Study Creates Atlas of Cells in COVID Lung
The new study is unique from other investigations in that it directly examines lung tissue (rather than sputum or bronchial washes) using single-cell molecular profiling that can identify each cell in a tissue sample and record each cell’s activity, resulting in an atlas of cells in COVID lung.

Most people will roll up their sleeves for the injection, but some may want to consider an alternate body part.By now most people are familiar with how the Covid-19 vaccine is typically administered: a quick jab to the upper arm. But there is a lesser known place on the body where the vaccine has also been approved for injection: the thigh.While getting the vaccine in the thigh is rare, there are some groups of people who may want to consider it. If you fall into one of the categories below and think you would be better off getting the Covid-19 vaccine in your thigh instead of your arm, it’s best to discuss it first with your doctor.Which adults might want to get a shot in the thigh?People with a history or risk of lymphedema in both arms.Lymphedema is a chronic and painful condition that causes swelling in parts of the body. It can develop in breast cancer patients, for example, who require surgery to remove lymph nodes from under the arm. Removal of the lymph nodes disrupts the flow of lymph, the extra fluid from tissues that would normally drain through the lymphatic system into the bloodstream, causing the fluid to back up and the breast, torso or arm to swell on the affected side.In both the Moderna and Pfizer-BioNTech clinical vaccine trials, some participants experienced swollen lymph nodes at the armpit or the neck region two to four days following vaccination, on the same side where the shot was administered in the arm. This is a normal short-term side effect that means the body is responding to the vaccine. In the case of Moderna, the median duration of swelling was one to two days, and it lasted an average of 10 days in those receiving Pfizer-BioNTech.For patients with lymphedema or at risk for lymphedema, however, this side effect could be concerning. If someone has lymphedema in both arms or if a patient is at risk of lymphedema in both arms, then some medical institutions are recommending that their patients get the Covid-19 vaccine in the thigh as a precautionary measure. The concern is that the vaccine could either make the arms swell even more or, for those who are at risk of lymphedema, create worrisome symptoms where there were none.The immune response might also be less efficient if the shot is administered in an arm without lymph nodes or one that has impaired lymphatic drainage.“The lymph vessels are responsible for draining fluid out of all of our tissues, so if your lymphatic drainage isn’t good, your tissues swell from fluid — and that would also mean you wouldn’t carry a vaccine very efficiently from tissue to lymph node,” said Marc Jenkins, director of the Center for Immunology at the University of Minnesota Medical School.Patients who had lymph nodes removed from one arm may get the vaccine in the unaffected arm rather than the thigh, said Cheryl Brunelle, the associate director of the Lymphedema Research Program at Massachusetts General Hospital in Boston.People who have (or had) breast cancer.Swollen lymph nodes in the armpit can be a sign of breast cancer. If someone with a history of breast cancer didn’t know that the Pfizer-BioNTech or Moderna vaccines can produce swollen lymph nodes, it could be “very scary for her, thinking it may be a recurrence,” Ms. Brunelle said.To alleviate potential concerns, people with a history of breast cancer can opt to get the vaccine in the thigh if they wish.People who need a mammogram within six weeks of their Covid-19 vaccine.Coronavirus vaccinations can cause enlarged lymph nodes in the armpit or near the collarbone that will show up as white blobs on mammograms and potentially be mistaken as a sign of cancer. The Society of Breast Imaging recommends trying to schedule your routine screening mammogram before your first Covid-19 vaccine dose or at least one month after your second vaccine dose. But an alternative plan would be to get the vaccine in your thigh instead.“Injection in thigh would be extremely unlikely to lead to armpit nodes swelling,” Dr. Constance D. Lehman, the chief of breast imaging at Massachusetts General Hospital, told The New York Times earlier this month.If you prefer to get the vaccine in your arm and have already scheduled your mammogram, you can keep that appointment — as well as your vaccine appointment — and call your breast imaging center ahead of time to let them know about the timing of your vaccine.If you received the Covid vaccine in the arm in the last six weeks, your radiologist will expect to see lymph node swelling on the same side that you received the vaccine. This would be a normal finding unless the swelling continued for more than six weeks or there were other clinical concerns; in that case they would take more images as needed, Ms. Brunelle said.Which vaccination sites offer thigh injections?This could take a little persistence. Covid-19 vaccine sites primarily give people arm vaccinations: It’s quick, efficient and there’s no need to find a private room to disrobe. Because the vast majority of people will receive arm injections, some vaccination sites may not have staff who are trained to inject in the thigh.“I just advise patients to call ahead, let the vaccine clinic know or the pharmacy know that they’re asking for the vaccine in the thigh,” Ms. Brunelle said. “I also counsel patients that if a local facility or practitioner giving the vaccine is not familiar with the thigh as an approved alternate site, the patient can share the C.D.C. Standing Orders document that lists the thigh as an alternative site for both the Pfizer and Moderna vaccines.”In New York City, people visiting health department vaccination sites can speak with staff if they have concerns about getting the vaccine in the arm, said Michael Lanza, a health department spokesman. These sites also have “quiet rooms” where thigh injections can be performed discreetly, he added, but “it should only be done when medically necessary.”What if I am a candidate for a thigh vaccine but I already had the vaccine injected in my arm?Experts say not to worry if you already got vaccinated on the side where you had breast cancer or if you were vaccinated in the arm that had fewer lymph nodes; what is important is that you received the vaccine.“We don’t want to scare women who already got vaccinated,” said Dr. Alphonse Taghian, director of the Lymphedema Research Program at Massachusetts General Hospital. “It is possible there will be no problem at all.”To learn more, Dr. Taghian and Ms. Brunelle will be surveying current and former breast cancer patients about the side effects of the vaccine to better understand how many patients report swollen lymph nodes, as well as when and how long the symptom occurs. They hope to have results before the end of the year.Dr. Taghian encourages patients with a history of cancer to contact their oncology team with questions or concerns, and to tell their doctor if they develop new signs of swelling.Why are the vaccines typically injected in the arm?The Covid-19 vaccines are designed to be injected into muscle, and the muscles of the upper arm are convenient for shots and thought to be less painful than some other areas of the body. But a vaccine can be injected into other muscles, provided they are near some of the hundreds of lymph nodes that exist in the body. The upper thigh, for example, is located near multiple lymph nodes and has already been shown to generate an effective immune response after vaccination.Lymph nodes are “absolutely critical for generating immune responses,” said Dr. Akiko Iwasaki, a professor of immunobiology at Yale University.When a vaccine enters the arm or thigh muscle, it gets carried into a nearby lymph node, she added. There, the vaccine is taken up by special cells that teach the white blood cells, known as T cells and B cells, to either become killer cells, which seek out and destroy coronavirus-infected cells, or antibody-secreting cells.Decades ago, other vaccines were often injected into the buttocks. But scientists now understand that the layers of fat cells in our bottoms are too numerous to allow easy access to the muscles and lymph, making the immune response inefficient. In addition, vaccination in the buttocks is generally not done to avoid injury to the sciatic nerve.

Hispanic Americans have died of COVID-19 at a disproportionately high rate compared to whites because of workplace exposure to the virus, a new study suggests.
It’s widely documented that Hispanics are overrepresented among workers in essential industries and occupations ranging from warehousing and grocery stores to health care and construction, much of which kept operating when most of the country shut down last spring.
The analysis of federal data showed that, considering their representation in the U.S. population, far higher percentages of Hispanics of working age — 30 to 69 years old — have died of COVID-19 than whites in the same age groups. A separate look at case estimates showed a similar pattern of unequally high COVID-19 infection rates for Hispanics — meaning that the elevated deaths in the working-age Hispanic population is consistent with elevated exposure to the virus.
“There was no evidence before this paper that really demonstrated that the excess cases were precisely in these working age groups,” said Reanne Frank, professor of sociology at The Ohio State University and co-author of the study.
“Particularly for front-line and essential workers, among whom Hispanics are overrepresented, COVID-19 is an occupational disease that spreads at work. Hispanics were on the front lines and they bore a disproportionate cost.”
Identifying a link between essential work and a higher rate of COVID-19 deaths should lead to better workplace protections, said study co-author D. Phuong (Phoenix) Do, associate professor of public health policy and administration at the University of Wisconsin-Milwaukee.

A compound in avocados may ultimately offer a route to better leukemia treatment, says a new University of Guelph study.
The compound targets an enzyme that scientists have identified for the first time as being critical to cancer cell growth, said Dr. Paul Spagnuolo, Department of Food Science.
Published recently in the journal Blood, the study focused on acute myeloid leukemia (AML), which is the most devastating form of leukemia. Most cases occur in people over age 65, and fewer than 10 per cent of patients survive five years after diagnosis.
Leukemia cells have higher amounts of an enzyme called VLCAD involved in their metabolism, said Spagnuolo.
“The cell relies on that pathway to survive,” he said, explaining that the compound is a likely candidate for drug therapy. “This is the first time VLCAD has been identified as a target in any cancer.”
His team screened nutraceutical compounds among numerous compounds, looking for any substance that might inhibit the enzyme. “Lo and behold, the best one was derived from avocado,” said Spagnuolo.
Earlier, his lab looked at avocatin B, a fat molecule found only in avocados, for potential use in preventing diabetes and managing obesity. Now he’s eager to see it used in leukemia patients.
“VLCAD can be a good marker to identify patients suitable for this type of therapy. It can also be a marker to measure the activity of the drug,” said Spagnuolo. “That sets the stage for eventual use of this molecule in human clinical trials.”
Currently, about half of patients over 65 diagnosed with AML enter palliative care. Others undergo chemotherapy, but drug treatments are toxic and can end up killing patients.
“There’s been a drive to find less toxic drugs that can be used.”
Referring to earlier work using avocatin B for diabetes, Spagnuolo said, “We completed a human study with this as an oral supplement and have been able to show that appreciable amounts are fairly well tolerated.”
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More than a quarter of American infants in 2018 had not received common childhood vaccines that protect them from illnesses such as polio, tetanus, measles, mumps and chicken pox, new research from the University of Virginia School of Medicine reveals.
Only 72.8% of infants aged 19-35 months had received the full series of the seven recommended vaccines, falling far short of the federal government’s goal of 90%. Those less likely to complete the vaccine series include African-American infants, infants born to mothers with less than a high-school education and infants in families with incomes below the federal poverty line.
The researchers warn that failure to complete the vaccine series leaves children at increased risk of infection, illness and death. It also reduces the herd immunity of the entire population, allowing diseases to spread more easily.
“These findings highlight that significant disparities still exist in protecting infants from preventable diseases in the United States,” said researcher Rajesh Balkrishnan, PhD, of UVA’s Department of Public Health Sciences. “The low seven-vaccine series rates in low-income families are disheartening, especially with federal programs such as Vaccine for Children, which provides coverage for their service.”
Trends in Childhood Vaccination
Some good news: There was a 30% increase in the overall number of infants getting the full vaccine series during 2009-2018, the 10-year period the researchers examined.
However, disparities in vaccine uptake grew between low-income families and higher-income families in that time. In 2009, families below the federal poverty line were 9% less likely to get the full vaccine series than families with annual income above $75,000. In 2018, low-income families were 37% less likely to complete the vaccine series.
The researchers say the lower rate among low-income families is especially disheartening considering the availability of federal programs such as Vaccine for Children, which provides free vaccines for uninsured, underinsured and Medicaid-eligible children.
“Free vaccination coupled with no physician administration fees, linked with potential programs that are frequently accessed by low-income families, could be a potential solution to increase immunization rates,” Balkrishnan said “The role of healthcare professionals such as pharmacists could also be expanded to provide these services cost effectively.”
The study found that mothers who had not completed high school were almost 27% less likely to have their infants fully vaccinated than moms with college education. That disparity had increased sharply from a previous study evaluating 1995-2003. The previous study found that mothers with less than high-school education were 7.8% less likely to complete the vaccine series.
Among African-Americans, completion of the vaccine series was significantly lower than in both whites and Hispanics. The researchers call this disparity “unacceptable” and say cost-effective interventions are needed to increase immunization rates and address vaccine hesitancy.
“These findings are particularly important in the context of the current COVID pandemic,” Balkrishnan said. “Particular attention needs to be paid to vulnerable populations in ensuring the availability and access to important life-saving vaccines.”
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Lacticaseibacillus rhamnosus GG, or LGG, is the most studied probiotic bacterium in the world. However, its features are not perfect, as it is unable to utilise the milk carbohydrate lactose or break down the milk protein casein. This is why the bacterium grows poorly in milk and why it has to be separately added to probiotic dairy products.
In fact, attempts have been made to make L. rhamnosus GG better adjust to milk through genetic engineering. However, strict restrictions have prevented the use of such modified bacteria in human food.
Thanks to a recent breakthrough made at the University of Helsinki, Finland, with researchers from the National Institute for Biotechnology and Genetic Engineering, Pakistan, features have now been successfully added to the LGG probiotic without gene editing, making it thrive and grow in milk.
The method used is known as conjugation, which is a technique utilised by certain bacterial groups to transfer their traits to other bacteria. In the process, a bacterium produces a copy of its plasmid, a ring-shaped piece of DNA in the bacterium. Next, the bacterium transfers the plasmid to an adjacent bacterium. The spread of plasmids, which carry traits useful for bacteria, can be rapid among bacterial communities.
In the case of Lacticaseibacillus rhamnosus GG, the plasmid that provided the ability to make use of lactose and casein originated in a specific Lactococcus lactis bacterial strain grown in the same place.
“The new LGG strain is not genetically modified, which makes it possible to consume it and any products containing it without any permit procedures,” says the project leader, Professor of Microbiology Per Saris from the Faculty of Agriculture and Forestry, University of Helsinki.
The new strain can be used as a starting point in the development of new dairy products where the probiotic concentration increases already in the production stage. In other words, the probiotic need not be separately added to the final product.
Furthermore, the new LGG strain can potentially be better equipped to grow, for example, in the infant gut where it would be able to utilise the lactose and casein found in breastmilk, producing more lactic acid than the original strain.
“Lactic acid lowers the pH of the surface of the intestine, reducing the viability of many gram-negative pathogenic bacteria, such as E. coli, Salmonella and Shigella, which threaten the health of infants. Moreover, in larger numbers the new LGG strain can potentially be more effective at protecting infants than the old strain. After all, LGG has previously been shown to alleviate infantile atopic dermatitis and boost the recovery of the gut microbiota after antibiotic therapies.”
The researchers are in negotiations on the further application of their discovery.
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People with diabetes are at increased risk of developing a severe course of COVID-19 compared to people without diabetes. The question to be answered is whether all people with diabetes have an increased risk of severe COVID-19, or whether specific risk factors can also be identified within this group. A new study by DZD researchers has now focused precisely on this question and gained relevant insights.
The COVID-19 pandemic poses unprecedented challenges to science and the health sector. While in some people with a SARS-CoV-2 infection the disease is hardly noticeable, in others it is much more severe and sometimes fatal. So far, knowledge about the course of a COVID-19 disease is still quite meager. However, diabetes has increasingly emerged as one of the risk factors determining the severity of the disease. Several studies on diabetes and SARS-CoV-2 have already observed an approximately two- to threefold increase in mortality due to COVID-19 in people with diabetes compared to people without diabetes. This makes it all the more important to conduct studies that examine the risk factors of people with diabetes for severe COVID-19 disease in more detail.
A new study of the German Diabetes Center, partner of the DZD, led by Dr. Sabrina Schlesinger, head of the junior research group Systematic Reviews at the Institute for Biometrics and Epidemiology, therefore examined the risk phenotypes of diabetes and their possible association with the severity of COVID-19. In their meta-analysis, the researchers combined the results from 22 published studies, so that a total of more than 17,500 people with diabetes and confirmed SARS-CoV-2 infection were included in this study. For individuals with diabetes and SARS-CoV-2 infection, male sex, older age ( >65 years), high blood glucose levels (at the time of hospital admission), chronic treatment with insulin, and existing concomitant diseases (such as cardiovascular disease or kidney disease) were identified as risk factors for a severe COVID-19 course. On the other hand, the results showed that chronic metformin treatment was associated with a reduced risk of a severe course of COVID-19.
“This current systematic review and meta-analysis describes within the high-risk group, namely diabetes mellitus, those individuals with the highest risk of a severe COVID-19 course,” said Professor Michael Roden, scientific director and board member of the German Diabetes Center. “These results will help to classify individuals with diabetes even better in order to improve their therapy and mitigate the course.”
The risk factors identified in the study — i.e. older persons, usually male, with comorbidities of diabetes and chronic insulin treatment — can thus be seen as indicators of diabetes severity or overall poor health. “However, some results, especially on diabetes-specific factors such as type or duration of diabetes and further treatments, are still imprecisely assessed and the significance is low. In order to strengthen the significance, further primary studies are needed that examine these specific risk factors and consider other relevant influencing factors in their analysis,” said Dr. Schlesinger. Her research team is therefore already working on a next version of this review: “This review presents the current study situation and will be updated regularly as long as new findings on this topic are available,” said Dr. Schlesinger.
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How Long Will This Child Live? No one can say what the future holds for Crispin Brake, born last month […]

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

The Senate is considering Eric S. Lander’s nomination after months of delay. Some experts ask what impact an adviser can actually have.On the campaign trail, Joseph R. Biden Jr. vowed to unseat Donald J. Trump and bring science back to the White House, the federal government and the nation after years of presidential attacks and disavowals, neglect and disarray.As president-elect, he got off to a fast start in January by nominating Eric S. Lander, a top biologist, to be his science adviser. He also made the job a cabinet-level position, calling its elevation part of his effort to “reinvigorate our national science and technology strategy.”In theory, the enhanced post could make Dr. Lander one of the most influential scientists in American history.But his Senate confirmation hearing was delayed three months, finally being set for Thursday.The delay, according to Politico, arose in part from questions about his meetings with Jeffrey Epstein, the financier who had insinuated himself among the scientific elite despite a 2008 conviction that had labeled him as a sex offender. Dr. Lander met with Mr. Epstein at fund-raising events twice in 2012 but has denied receiving any funding or having any kind of relationship with Mr. Epstein, who was later indicted on federal sex trafficking charges and killed himself in jail in 2019.The long delay in his Senate confirmation has led to concerns that the Biden administration’s elevation of Dr. Lander’s role is more symbolic than substantive — that it’s more about creating the appearance of strong federal support for the scientific enterprise rather than working to achieve a productive reality.Roger Pielke Jr., a professor at the University of Colorado, Boulder, who has interviewed and profiled presidential scientific aides, recently noted that one of President Biden’s top scientific agendas, climate policy, has moved ahead briskly without any help from a White House science adviser.“Is Biden giving him busy work?” he asked of Dr. Lander’s role. “Or is there actually a policy portfolio?”Likewise, Mr. Biden’s first proposed federal budget, unveiled April 9, received no public endorsement from the presidential science adviser but nonetheless seeks major increases in funding at nearly every science agency.Mr. Biden’s championing of the science post and its unpunctual start have raised a number of questions: What do White House science advisers actually do? What should they do? Are some more successful than others and, if so, why? Do they ever play significant roles in Washington’s budget wars? Does Mr. Biden’s approach have echoes in history?The American public got few answers to such questions during Mr. Trump’s tenure. He left the position empty for the first two years of his administration — by far the longest such vacancy since Congress in 1976 established the modern version of the advisory post and its White House office. Under public pressure, Mr. Trump filled the opening in early 2019 with Kelvin Droegemeier, an Oklahoma meteorologist who kept a low profile. Critics derided Mr. Trump’s neglect of this position and the vacancies of other scientific expert positions across the executive branch.President Richard Nixon with his science adviser, Edward E. David Jr., center, in 1971. Mr. Nixon eliminated the position after Dr. David quit in 1973.Associated PressBut while scientists in the federal work force typically have their responsibilities defined in considerable detail, each presidential science adviser comes into the job with what amounts to a blank slate, according to Shobita Parthasarathy, director of the Science, Technology and Public Policy program at the University of Michigan.“They don’t have a clear portfolio,” she said. “They have lots of flexibility.”The lack of set responsibilities means the aides as far back as 1951 and President Harry S. Truman — the first to bring a formal science adviser into the White House — have had the latitude to take on a diversity of roles, including ones far removed from science.“We have this image of a wise person standing behind the president, whispering in an ear, imparting knowledge,” said Dr. Pielke. “In reality, the science adviser is a resource for the White House and the president to do with as they see fit.”Dr. Pielke argued that Mr. Biden is sincere in wanting to quickly rebuild the post’s credibility and raise public trust in federal know-how. “There’s lots for us to like,” he said.But history shows that even good starts in the world of presidential science advising are no guarantee that the appointment will end on a high note.“Anyone coming to the science advisory post without considerable experience in politics is in for some rude shocks,” Edward E. David Jr., President Richard M. Nixon’s science adviser, said in a talk long after his bruising tenure. He died in 2017.One day in 1970, Mr. Nixon ordered Dr. David to cut off all federal research funding to the Massachusetts Institute of Technology, Dr. David’s alma mater. At the time, it was receiving more than $100 million a year.The reason? The president of the United States had found the political views of the school’s president to be intolerable.“I just sort of sat there dumbfounded,” Dr. David recalled. Back in his office, the phone rang. It was John Ehrlichman, one of Mr. Nixon’s trusted aides.“Ed, my advice is don’t do anything,” he recalled Mr. Ehrlichman saying. The nettlesome issue soon faded away.In 1973, soon after Dr. David quit, Mr. Nixon eliminated the fief. The president had reportedly come to see the adviser as a science lobbyist. After Mr. Nixon left office, Congress stepped in to reinstate both the advisory post and its administrative body, renaming it the White House Office of Science and Technology Policy.The position, some analysts argue, has grown more influential in step with scientific feats and advances. But others say the job’s stature has declined as science has become more specialized and the advisory work has focused increasingly on narrow topics unlikely to draw presidential interest. Still others hold that so many specialists now inform the federal government that a chief White House scientist has become superfluous.Daniel Sarewitz, a professor of science and society at Arizona State University, argued in a 2007 study that the post’s influence “has waxed and waned (mostly waned) with time.”President Bill Clinton with the crew of the space shuttle Discovery, as well as Daniel S. Goldin, second right, the NASA administrator and Neal F. Lane, right, the presidential science adviser, in 1999.The White House/CNP/MediaPunch, via AlamyBut Mr. Biden’s moves, he added in an interview, were now poised to raise the post’s importance and potential sway. “For Democrats,” he said, “science and politics are converging right now, so elevating the status of science is smart. It’s good politics.”The scientific community tends to see presidential advisers as effective campaigners for science budgets. Not so, Dr. Sarewitz has argued. He sees federal budgets for science as having done well over the decades irrespective of what presidential science advisers have endorsed or promoted.Neal F. Lane, a physicist who served as President Bill Clinton’s science adviser, argued that the post was today more important than ever because its occupant provides a wide perspective on what can best aid the nation and the world.“Only the science adviser can be the integrator of all these complex issues and the broker who helps the president understand the play between the agencies,” he said in an interview. The moment is auspicious, Dr. Lane added. Catastrophes like war, the Kennedy assassination and the terrorist attacks of 2001, he said, can become turning points of reinvigoration. So too, he added, is the coronavirus pandemic a time in American history when “big changes can take place.”His hope, he said, is that Mr. Biden will succeed in elevating such issues as energy, climate change and pandemic preparedness.As for the federal budget, Dr. Lane, who headed the National Science Foundation before becoming Mr. Clinton’s science adviser from 1998 to 2001, said his own experience suggested the post could make modest impacts that nonetheless reset the nation’s scientific trajectory. His own tenure, he said, saw a funding rise for the physical sciences, including physics, math and engineering.Some part of his own influence, Dr. Lane said, derived from personal relationships at the White House. For instance, he got to know the powerful director of the Office of Management and Budget, which set the administration’s finances, while dining at the White House Mess.The advisory post becomes most influential, analysts say, when the science aides are aligned closely with presidential agendas. But a commander in chief’s objectives may not match those of the scientific establishment, and any influence bestowed by proximity to the president may prove quite narrow.George A. Keyworth II, President Ronald Reagan’s science adviser from 1981 to 1986.George Tames/The New York TimesGeorge A. Keyworth II was a physicist from Los Alamos — the birthplace of the atomic bomb in New Mexico. In Washington, as science adviser to Ronald Reagan, he strongly backed the president’s vision of the antimissile plan known as Star Wars.Dr. Pielke of the University of Colorado said the contentious issue became Dr. Keyworth’s calling card in official Washington. “It was Star Wars,” he said. “That was it.” Despite intense lobbying, the presidential call for weapons in space drew stiff opposition from specialists and Congress, and the costly effort never got beyond the research stage.Policy analysts say Mr. Biden has gone out of his way to communicate his core interests to Dr. Lander — a geneticist and president of the Broad Institute, a hub of advanced biology run by Harvard University and M.I.T.On Jan. 15, Mr. Biden made public a letter with marching orders for Dr. Lander to consider whether science could help “communities that have been left behind” and “ensure that Americans of all backgrounds” get drawn into the making of science as well as securing its rewards.Dr. Parthasarathy said Mr. Biden’s approach was unusual both in being a public letter and in asking for science to have a social conscience. In time, she added, the agenda may transform both the adviser’s office and the nation.“We’re at a moment” where science has the potential to make a difference on issues of social justice and inequality, she said. “I know my students are increasingly concerned about these questions, and think rank-and-file scientists are too,” Dr. Parthasarathy added. “If ever there was a time to really focus on them, it’s now.”