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Social medicine programs, which often encourage patients to engage with other people, can help address dementia, isolation and more.This article is part of our new series on the Future of Health Care, which examines changes in the medical field.Less than five years ago, Mary Albrecht was a professor of marketing at Maryville University in St. Louis. She gave lectures and led classroom discussions; she advised students; she interacted with her faculty colleagues. In 2017, Ms. Albrecht learned she had Alzheimer’s disease, and she retired that same year — losing a network of students, colleagues and friends that had nourished her for 31 years.As her Alzheimer’s advanced, Ms. Albrecht found herself — despite the best efforts of her husband, Jack, and their children — increasingly isolated. Then in 2019 a social worker told Mr. Albrecht about a cognitive stimulation therapy group at Saint Louis University’s Aging and Memory Clinic. The group follows a treatment protocol designed to help engage patients with moderate-to-severe levels of Alzheimer’s and Lewy Body dementia. Ms. Albrecht, 70, who lives with her husband in the St. Louis suburb of Chesterfield, Mo., has now been taking part in the weekly sessions with around eight other dementia patients for about a year and a half.Ms. Albrecht is one of 144 participants in the clinic’s 12 groups, which are funded by a research grant so there is no cost to the patients. During the hourlong group sessions, at first in person but now remote during the pandemic, Ms. Albrecht and the other patients listen to music and participate in group discussions led by a moderator. These discussions vary depending on the level of impairment and include topics such as what animals patients like at the zoo and what movies they’ve seen. The goal is to improve various aspects of cognition and memory in a stimulating, positive social environment where patients engage with one another.“The interaction,” said Mr. Albrecht, an engineer who retired last year from a career in the energy conservation field to help take care of his wife, “that’s the main benefit we see for Mary.”“She’s always been a people person,” he added. “So, this is really great for her.”She’s not alone. “Like all human beings, people with dementia continue to need social interaction,” said Aimee Spector, a professor of old age clinical psychology at University College London, who created the cognitive-stimulation program that the Saint Louis University group is based on. Although the program was originally designed to allow patients to interact in groups or one-on-one, “we’ve found that cognition and quality of life seems to improve significantly when they’re in a group.”As such, the program is an example of what may become part of the treatment for a wide range of issues: socialization, or, as it’s often being described, “a social prescription.”This is not just a case of physicians encouraging their patients to get out and see friends a little bit more. Social medicine is more systematic and often involves the use of structured group interactions.“I think it’s the way of the future,” said the U.C.L.A. neurologist Indu Subramanian, director of the Department of Veterans Affairs Southwest Parkinson’s Disease Research, Education and Clinical Center. “Social prescribing meets people in the community where they are, and links them to social support structures.”Dr. Subramanian said she had seen the value of social group interactions for her Parkinson’s patients: “Loneliness is a big issue for them. Any way we can develop connections can help.”Social prescriptions are already being written in Britain, where physicians can now direct patients to a “link worker,” a trained specialist who focuses on connecting patients to community groups and services for practical and emotional support. Link workers not only connect patients with existing groups but also help create new groups, working as needed with local partners.Britain’s National Health Service calls social prescribing a “key component” of the country’s health care system, and it has set a goal to have nearly one million patients referred for social-prescription interventions by 2024.“It’s now part of normal practice,” said Dr. Krishna Kasaraneni, a general practitioner in the Yorkshire city of Sheffield, and a member of the British Medical Association executive committee that helped lead the effort to implement social prescribing in 2019. “We use it for vulnerable older patients who live by themselves, for people with diabetes who are overweight, and we put them in touch with community groups that can help get them outside and exercising.”And, he added, it’s not just older adults who benefit. “I have young patients with other chronic conditions, people with mental health issues,” he said. “There are no age barriers, no limits on what social prescribing can support people with.”A social prescription may involve helping patients to get outside and exercise.Sean Gallup/Getty ImagesThat view appears to be shared by a growing number of individuals and organizations in the United States, including Surgeon General Vivek H. Murthy, who in his 2020 book “Together: The Healing Power of Human Connection in a Sometimes Lonely World,” wrote that social prescribing “reflects a recognition that loneliness affects our health, and we have a universal need to connect with one another.”Last year, the V.A. started “a new social prescription program,” called Compassionate Contact Corps. Originally a home visitation program, it was restarted as a teleservice for veterans experiencing loneliness and social isolation when the pandemic hit. About 1,000 veterans are participating in the program, which involves phone or video calls with trained volunteers and requires a referral from the veteran’s medical care team.“Veterans we weren’t able to reach with the in-home program, we are able to reach with the ‘phone buddy’ program,” said Prince Taylor, deputy director for the V.A.’s Center for Development and Civic Engagement. “Overwhelmingly, the veterans who have participated in this program tell us it is helping them.”But how, exactly? And can the outcomes of social prescribing be accurately measured? “I would not have any hesitation saying that socialization is an important aspect of health,” said the Cleveland Clinic neurologist Marwan Sabbagh, director of translational research at the clinic’s Lou Ruvo Center for Brain Health in Las Vegas. “But the quantification is something that needs to be done in a way that would be universally accepted. We can measure things like memory and cognition, but I’m not familiar with ways we can clinically capture or quantify social isolation.”He added that researchers in other disciplines — the social sciences, for example — might have tools to help with this and could play a role in the future of developing social prescription protocols in the United States.The authors of a recent New England Journal of Medicine article on the British social prescription model agree that better assessment methods are needed. While calling the implications of social prescribing “profound,” they noted that “physicians need reliable information on what interventions work best and for whom and how social prescription can best be integrated into conventional medical practice.”Some see this as linked to a larger shift in medicine toward a more holistic approach. “We have to remember,” said Dr. Kasaraneni, “people don’t come to us with a list of medical problems; they come with a life, and a life that may have medical issues but also social and emotional issues.”Other doctors say that social prescribing may become the norm in the United States sooner than later. “I think the pandemic has really opened up the door for this kind of thing,” said Dr. Malissa J. Wood, co-director of the Corrigan Women’s Heart Health Program at the Massachusetts General Hospital Heart Center. Dr. Wood has used structured support groups as part of community programs she designed to improve the cardiovascular health of low-income, high-risk women.“I think this will definitely become more of a structured part of the practice of medicine,” she said. “People recognize that it’s not that hard to log on to a virtual group meeting, and it can bring people together who wouldn’t have otherwise been able to.”That’s how Mr. Albrecht said he felt about his wife’s weekly group sessions at the Saint Louis University program. And his criterion for assessing its value is simple. “Any time she gets that social interaction, the smile is there,” he said. “I wish she could do it every day.”

Physical activity during pregnancy might have long-lasting benefits for a child’s health, new research suggests.The lifestyles of soon-to-be mothers and fathers could shape the health of their unborn offspring in lasting ways, according to a surprising new animal study of exercise, diet, genetics and parenthood.The study found that rodent parents-to-be that fatten on a greasy diet before mating produce offspring with sky-high later risks for metabolic problems. But if the mothers stay active during their pregnancies, those risks disappear.The study involved mice, not people, but does suggest that when a mother exercises during pregnancy, she may help protect her unborn children against the unhealthy effects of their father’s poor eating habits, as well as her own. The findings add to our growing understanding of the ways in which parents influence children’s long-term health, even before birth, and suggest how physical activity during pregnancy might help to ensure that those impacts are beneficial.Researchers have known for some time that parents, and especially mothers, begin influencing the health and behavior of their offspring well before conception. Studies involving both animals and people show that mothers with diabetes, obesity, insulin resistance or other metabolic problems before pregnancy tend to have babies with a predisposition to those same conditions as adults, even if the offspring follow healthy lifestyles. Mothers who are lean and physically active during pregnancy, meanwhile, tend to have children who, as adults, are active and metabolically healthy.A hefty percentage of these differences are a result, no doubt, of nurture, since children readily adopt the diet and exercise habits of their parents. But some proportion of babies’ metabolic futures seem hard-wired, built into them as they develop in the womb, through a process that scientists call metabolic programming.Metabolic programming is complex and still only partially understood, but involves the inner workings both of the womb and of parental DNA. Some aspects of the environment inside the womb can change, depending on a mother’s health and lifestyle, affecting the development of organs and biological systems in the fetus.Ditto for parental genetics. The operations of certain of our genes shift in response to our diets, exercise habits, metabolic health and other lifestyle factors. These shifts, which are known as epigenetic changes, become embedded in our DNA and can be passed along to the next generation by mothers or fathers.In this way, metabolic problems can be inherited, propagating across generations.But there are hints that physical activity snips this cycle. In past rodent studies, if the soon-to-be parents ran before mating, they typically produced offspring without heightened risks for diabetes or obesity, even if the parents themselves experienced those conditions.Most of these studies focused their attention on the impacts of the mothers’ health and habits, though. Less has been known about how a father’s metabolic health changes his children’s long-term metabolic prospects and whether a mother’s activities during pregnancy might counter any negative outcomes from a father’s way of life.So, for the new study, which was published in March in the Journal of Applied Physiology, scientists at the University of Virginia School of Medicine and other institutions first gathered a large group of mice. Some of the animals, male and female, were allowed to gorge on a high-fat, high-calorie diet, inducing obesity and metabolic problems, while others remained on normal chow, at their usual weight.Next, the mice hooked up, with obese animals of both genders mating with normal-weight mice, so that, in theory, one parent in each pairing could bequeath unhealthy habits and metabolism to the young. A few normal-weight animals without metabolic problems also mated, to produce control offspring.Finally, some mothers, including the obese, jogged on little running wheels throughout the resulting pregnancies, voluntarily covering up to seven miles a week in the early stages of their three-week gestations.Afterward, the researchers tracked the metabolic health and underlying genetic activity of the offspring, until they reached adulthood. This second generation ate normal chow and led normal, lab-mouse lives.Many, though, developed multiple metabolic problems as adults, including obesity, insulin resistance and other disruptions of their blood-sugar control. These conditions were most pronounced in the male children of obese mothers and in both the male and female children born to obese fathers.Interestingly, the underlying genetics of their conditions differed by parental gender. Mice born to obese mothers displayed unusual activity in a set of genes known to be involved in inflammation. Those born to obese fathers did not.In other words, the genetic legacies from mothers and fathers “operate through different biological pathways,” says Zhen Yan, a professor of medicine and director of the Center for Skeletal Muscle Research at the University of Virginia School of Medicine, who oversaw the new study.Perhaps most important, though, when the mothers ran during pregnancy, their children showed almost no undesirable metabolic outcomes as adults, whether the mother or father was obese. These offspring, metabolically and genetically, remained indistinguishable from animals born to healthy parents.Of course, this was a rodent study and we are not mice, so it is impossible to know if we — as mothers, fathers or offspring — respond similarly to diets and exercise, or if the effects are amplified when both parents are affected. The study also does not show if it is obesity or a high-fat diet that most drives intergenerational harms or what the ideal timing, types and amounts of exercise might be by either mom or dad, to combat those effects.Dr. Yan says he and his colleagues plan to investigate those questions in future experiments. But already, the current study and other research suggest, he says, that physical activity, before and during pregnancy, and by both the expectant mother and father, “should absolutely be encouraged.”

Here’s what parents need to know.As a psychologist who cares for adolescents I am well aware of the prevalence of eating disorders among teenagers. Even still, I am stunned by how much worse the situation has become in the pandemic.According to the psychologist Erin Accurso, the clinical director of the eating disorders program at University of California, San Francisco, “our inpatient unit has exploded in the past year,” taking in more than twice as many adolescent patients as it did before the pandemic. Dr. Accurso explained that outpatient services are similarly overwhelmed: “Providers aren’t taking new clients, or have wait-lists up to six months.”The demand for eating disorder treatment “is way outstretching the capacity to address it,” said the epidemiologist S. Bryn Austin, a professor at the T.H. Chan School of Public Health and research scientist in the Division of Adolescent and Young Adult Medicine at Boston Children’s Hospital. “I’m hearing this from colleagues all across the country.” Even hotlines are swamped. The National Eating Disorders Association helpline has had a 40 percent jump in overall call volume since March 2020. Among callers who shared their age over the last year, 35 percent were 13 to 17 years old, up from 30 percent in the year before the pandemic.What has changed in the pandemic?There are several possible explanations for this tsunami of eating concerns in teenagers. When adolescents lost the familiar rhythm of the school day and were distanced from the support of their friends, “many of the things that structured a teenager’s life evaporated in one fell swoop,” said Dr. Walter Kaye, a psychiatrist and the founder and executive director of the eating disorders program at University of California, San Diego. “People who end up with eating disorders tend to be anxious and stress sensitive — they don’t do well with uncertainty.”Further, eating disorders have long been linked with high achievement. Driven adolescents who might have normally poured their energy into their academic, athletic or extracurricular pursuits suddenly had too much time on their hands. “Some kids turned their attention toward physical health or appearance as a way to cope with anxiety or feel productive,” Dr. Accurso said. “Their goals around ‘healthy’ eating or getting ‘in shape’ got out of hand” and quickly caused significant weight loss.For some, an increase in emotional eating in the pandemic has been part of the problem. Attending school from a home where food is constantly available may lead some young people to eat more than usual as a way to manage pandemic-related boredom or stress. “Being at school presents a barrier to using food as a coping mechanism; at home, we don’t have that barrier,” noted Kelly Bhatnagar, psychologist and co-founder of the Center for Emotional Wellness in Beachwood, Ohio, a practice specializing in the treatment of eating disorders.In many households the pandemic has heightened food insecurity and its attendant anxieties, which can increase the risk of eating disorders. Research shows that, compared to teenagers whose families have enough food, those in homes where food is scarce are more likely to fast, to skip meals, and to abuse laxatives and diuretics with the aim of controlling their weight.The Instagram influenceWhat teens see on their screens is also a factor. During the pandemic, teenagers have spent more time than usual on social media. While that can be a source of much needed connection and comfort, scrutinizing images of peers and influencers on highly visual social media has been implicated in body dissatisfaction and disordered eating. Dr. Austin noted that teenagers can be prone to comparing their own bodies to the images they see online. “That comparison creates a downward spiral in terms of body image and self-esteem. It makes them more likely to adopt unhealthy weight control behaviors.”When adolescents take an interest in managing their weight, they often go looking for guidance online. Indeed, a new Common Sense Media survey found that among teenagers who sought health information online between September and November of 2020, searches on fitness and exercise information came second only to searches for content related to Covid-19 — and ahead of searches on anxiety, stress and depression.What young people find when they go looking for fitness information can be highly problematic. They are likely to come across harmful “thinspiration” and “fitspiration” posts celebrating slim or sculpted bodies, or even sites that encourage eating disordered behavior. Worse, algorithms record online search information and are “deliberately designed to feed harmful weight loss content to users who are already struggling with body image,” such as advertisements for dangerous diet supplements, Dr. Austin said.When to worryWith so many forces contributing to teenagers’ body dissatisfaction and eating disordered behavior, how do parents know when to worry?Parents should be alarmed, Dr. Kaye said, “if your child suddenly loses 10 to 20 pounds, becomes secretive about eating, or if you are seeing food disappear,” as becoming furtive about what, how and when one eats is a common occurrence in anorexia, bulimia and other eating disorders.Experts agree that adults should be on the lookout for behaviors that veer from previous norms, such as suddenly skipping family meals or refusing to eat food from entire categories, such as carbohydrates or processed foods. Worth concern, too, is the teenager who develops fixations such as carefully counting calories, exercising obsessively or hoarding food, which may be a sign of a binge eating disorder. Parents should also pay close attention, said Dr. Accurso, if adolescents express a lot of guilt or anxiety around food or eating, or feel unhappy or uncomfortable with their bodies.According to Dr. Bhatnagar, the view of eating disorders as a “white girls’ illness” can keep teens who are not white girls from seeking help or being properly screened for eating disorders by health professionals, even though eating disorders regularly occur across both sexes and all ethnic groups.“Boys are having the same troubles,” said Dr. Bhatnagar, “but heterosexual boys may talk about body image a little differently. They tend to talk in terms of getting fit, getting lean or being muscular.”Dr. Austin also noted that it is common to see elevated rates of eating disorders in lesbian, gay and bisexual youth of all genders as well as transgender and gender diverse young people.“Eating disorders,” Dr. Accurso said, “don’t discriminate.”How to helpResearch shows that early identification and intervention play a key role in the successful treatment of eating disorders. Accordingly, parents who have questions about their teen’s relationship with eating, weight or exercise should not hesitate to seek an evaluation from their pediatrician or family health provider. Trustworthy eating disorder information, screening tools and support can also be found online. And when necessary, online resources can provide guidance and support to those on treatment waiting lists. “It may not be ideal for many,” Dr. Kaye said, “but it’s the reality of the situation we’re in.”Parents can also take steps to reduce the likelihood that an eating disorder will take hold in the first place. Experts encourage adults to model a balanced approach to eating and to create enjoyable opportunities for being physically active while steering clear of negative comments about their teenager’s body or their own. Parents should also openly address the dangers of a ubiquitous diet culture that emphasizes appearance over well-being, creates stigma and shame around weight and links body size to character and worth. As Dr. Accurso noted, “We are not defined by a number on a scale.”Where to find helpThe National Eating Disorders Association, or NEDA, is a good starting place. It supports individuals and families affected by eating disorders.F.E.A.S.T. is an international nonprofit organization run by caregivers of those suffering from eating disorders, meant to help others.Maudsley Parents was created by parents who helped their children recover with family-based treatment, to offer hope and help to other families confronting eating disorders.The Academy for Eating Disorders offers many resources, as do the Eating Disorders Center for Treatment and Research at University of California, San Diego, and the Eating Disorders Program at Boston Children’s Hospital.

Inside this facility in Chesterfield, Missouri, trillions of bacteria are producing tiny loops of DNA containing coronavirus genes — the […]

SharecloseShare pageCopy linkAbout sharingimage copyrightReutersA single dose of a coronavirus vaccine can reduce household transmission of the virus by up to half, a study shows.Those given a first dose of either the Pfizer or AstraZeneca vaccines – and who became infected three weeks later – were between 38% and 49% less likely to pass the virus on than unvaccinated people, PHE found.Health Secretary Matt Hancock described the study’s results as “terrific news”.He has urged “everybody to get their vaccines as soon as they are eligible”.In the study, protection against Covid was seen from about 14 days after vaccination, with similar levels of protection regardless of age of cases or contacts, PHE said in a statement.It added that this protection was on top of the reduced risk of a vaccinated person developing symptomatic infection in the first place, which is around 60 to 65% – four weeks after one dose of either vaccine.When will I get the vaccine?How many people have been vaccinated so far?Covid vaccine offered to 42-year-olds in EnglandDr Mary Ramsay, head of immunisation at PHE, said: “Vaccines are vital in helping us return to a normal way of life. Not only do vaccines reduce the severity of illness and prevent hundreds of deaths every day, we now see they also have an additional impact on reducing the chance of passing Covid-19 on to others.”But, while she said the findings were “encouraging”, she said it was important people continue to act like they have the virus, “practise good hand hygiene and follow social distancing guidance”.Households are high-risk settings for transmission, meaning the study provides early evidence on the impact of vaccines in preventing onward transmission, PHE said. Similar results could be expected in other settings with similar transmission risks, such as shared accommodation and prisons, it added.This is the latest piece of evidence to indicate that vaccines are slowing the transmission of the virus as well as saving lives.Households are among the most likely places for infection to spread, so these set of results are particularly encouraging. Public Health England has said it would expect similar results in other high-risk settings, such as shared accommodation and prisons. All this bodes well for the continued easing of restrictions, especially as the vaccination campaign is making good progress into younger age groups – who are more likely to spread the virus. And it also gives further reassurance to those concerned about the fact that children will not be vaccinated – and so might bring infection into households.A cause for concern, though, is whether newer variants of the virus, which might be more resistant to vaccines, might cause a new surge in infections. But the expert opinion is that the current vaccines will provide a significant degree of protection, especially against severe illness.NEW VARIANTS: How worried should we be?GLOBAL SPREAD: How many worldwide cases are there?COVID IMMUNITY: Can you catch it twice?VACCINE: When will I get the jab?The study, which has yet to be fully peer-reviewed, included more than 57,000 contacts from 24,000 households in which there was a lab-confirmed coronavirus case that had received a vaccination, compared with nearly one million contacts of unvaccinated cases.Contacts were defined as secondary cases of coronavirus if they tested positive two to 14 days after the initial household case. Most of the people in the study were under the age of 60.Previous PHE studies have shown that both the Pfizer-BioNTech and Oxford-AstraZeneca vaccines are highly effective in reducing Covid-19 infections among older people, with 10,400 deaths prevented in over-60s by the end of March.PHE is also undertaking separate studies on the effect of vaccination on transmission in the wider population.

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesThe most common side effects of the Covid-19 vaccines are pain or tenderness at the injection site – in other words, a sore arm – a UK study has suggested. Roughly one in four people had wider effects like fever, headache, nausea and fatigue.But these only lasted on average for one day.Researchers involved in the ZOE Covid Symptom Study app saw fewer reactions than were seen in clinical trials. Confidence in the vaccines has continued to grow since the end of last year, with more than 80% saying they believe the vaccines are safe and effective, compared with about 70% who said the same towards the end of 2020, according to a survey of 5,000 people.The survey, run in association with the National Institute for Health Research, found twice as many people say they want to have the vaccine as soon as possible – although the number of people saying they would actively prefer the Oxford-AstraZeneca vaccine has fallen.The ZOE study researchers looked at self-reported symptoms in 627,383 people using their app in the eight days after being vaccinated. My vaccine side effects and what they meanAbout 70% of people having the Pfizer jab had some reaction around where the needle went in, including pain, tenderness, redness or swelling, compared with just under 60% for the AstraZeneca jab. The trend was reversed for those reactions that affect the whole body rather than just the site of the injection.For the AstraZeneca jab, 34% had some “systemic” (whole body) reaction like headache, tiredness or chills. For the Pfizer vaccine this was only 14% after the first dose and 22% after the second. The most common of these side effects was a headache. ‘Mild and short-lived’The study’s lead scientist, Prof Tim Spector of King’s College London, said these findings should reassure people the after effects of the vaccine are “usually mild and short-lived”.But he pointed out there was a wide range of responses to the vaccine, just as there was to the virus, depending on age and sex among other things. The study did not look at what happened after a second dose of the Oxford-AstraZeneca jab since hardly anyone had received it at the time of the study, which went up to 10 March. Among all vaccinated users of the ZOE symptom app, one in four (25%) had one of these whole body reactions and two-thirds (66%) had a local reaction.Women, people under 55 and those who had a Covid infection in the past were all more likely to experience side effects.In the final stage of the Pfizer vaccine’s clinical trials, roughly 77% of people had pain at the injection site compared with just under 30% in this study, while the proportion of people experiencing fatigue and headache was three to five times smaller. For AstraZeneca, roughly half as many people had a whole body reaction like fever or fatigue as was recorded in clinical trials.This may be because people in the clinical trials were younger and healthier, or because people enrolled in the trial of an experimental vaccine might be more nervous and so more likely to identify symptoms, Prof Spector suggested. Dr Cristina Menni from King’s College London, lead author of the paper, said the results supported the safety of both vaccines and should “help allay safety concerns of people willing to get vaccinated”.

One in four people experience mild, short lived systemic side effects after receiving either the Pfizer or AstraZeneca vaccine, with headache, fatigue and tenderness the most common symptoms. Most side effects peaked within the first 24 hours following vaccination and usually lasted 1-2 days.
The study published today in the Lancet Infectious Diseases is the first large scale study to compare the two vaccines and investigate the prevalence of mild side effects of the UK’s vaccination programme.
The analysis by researchers from King’s College London of data from the ZOE COVID Symptom Study app reassuringly found much fewer side effects in the general population with both the Pfizer and AstraZeneca vaccines than reported in trials.
The study also reports a significant decrease of infection rates from 12 to 21 days after the first dose of the Pfizer (58% reduction) and AstraZeneca (39% reduction) vaccines compared to a control group. The drop in infection at least 21 days after the first dose for Pfizer is 69% and for AstraZeneca 60%.
This large-scale analysis examined the differences of reported side effects from the two vaccines currently distributed in the UK. Systemic effects — meaning side effects excluding where the injection took place — included headache, fatigue, chills and shiver, diarrhoea, fever, arthralgia, myalgia, and nausea; whilst local side effects — meaning side effects where the injection took place in the arm — included pain at the site of injection, swelling, tenderness, redness, itch, warmth and swollen armpit glands.
The data comes from 627,383 users of the ZOE COVID Symptom Study app who self-reported systemic and local effects within eight days of receiving one or two doses of the Pfizer vaccine or one dose of the AstraZeneca vaccine between December 8 and March 10.

“Go get the shot,” President Biden declared Tuesday, hailing an easing of federal guidance on outdoor mask wearing as a step toward post-pandemic normalcy.WASHINGTON — The Centers for Disease Control and Prevention took a major step on Tuesday toward coaxing Americans into a post-pandemic world, relaxing the rules on mask wearing outdoors as coronavirus cases recede and people increasingly chafe against restrictions.The mask guidance is modest and carefully written: Americans who are fully vaccinated against the coronavirus no longer need to wear a mask outdoors while walking, running, hiking or biking alone, or when in small gatherings, including with members of their own households. Masks are still necessary in crowded outdoor venues like sports stadiums, the C.D.C. said.But President Biden hailed it as a landmark moment in the pandemic, wearing a mask as he approached the lectern on a warm spring day on the White House grounds — and pointedly keeping it off as he walked back into the White House when he was done.“Go get the shot. It’s never been easier,” Mr. Biden said. “And once you’re fully vaccinated, you can go without a mask when you’re outside and away from big crowds.”The C.D.C. stopped short of telling even fully vaccinated people that they could shed their masks outdoors altogether — citing the worrying risk that remains for transmitting the coronavirus, unknown vaccination levels among people in crowds and the still-high caseloads in some regions of the country. The guidance also cautioned even vaccinated people against going without masks in medium-size outdoor gatherings.But even the C.D.C.’s director, Dr. Rochelle Walensky, emphasized a more expansive interpretation, telling reporters at a White House briefing, “We no longer feel that the vaccinated people require masks outdoors,” outside “large public venues, such as concerts, stadiums and things like that.”The order had immediate ripple effects in the states. Governors in California, New York, Louisiana, Maine and Massachusetts all relaxed outdoor mask mandates after the C.D.C.’s announcement. In Tennessee, Gov. Bill Lee, a Republican, went much further, ignoring the federal government’s advice as he declared it was “time for celebrations and weddings and conventions and concerts and parades and proms” to take place “without limits on gathering sizes.”On Capitol Hill, a group of Republican lawmakers who are also medical professionals released an advertisement on Tuesday encouraging vaccination, in which they appeared wearing white coats with stethoscopes draped around their necks. Senator Roger Marshall, a freshman Republican from Kansas and a medical doctor, told viewers that the reason to get vaccinated was simple: “So we can throw away our masks, and live life as free as before.”Mr. Marshall, who organized the effort, said it was based on research conducted by Frank Luntz, a Republican pollster working to reduce vaccine hesitancy among conservatives. In an interview, Mr. Luntz said Mr. Biden’s announcement was a positive step, and could give people who are reluctant to get vaccinated a reason to get their shots.“It gives them a light at the end of the tunnel,” he said. “‘Tell me when I can get rid of my mask’ is actually the language that they use, so the fact that this is a meaningful, measurable step toward returning to normal is a big deal.”President Biden said Americans had made “stunning progress” and promised to outline a plan next week to restore a greater sense of normalcy by July 4.Erin Scott for The New York TimesFor Mr. Biden, who will address Congress on Wednesday and mark his 100th day in office on Thursday, the C.D.C.’s announcement was a moment to bask in what he called the “stunning progress” Americans had made since he took office. Next week, he said, he will outline a plan “to get us to July 4 as our target date to get life in America closer to normal and begin to celebrate our independence from the virus.”Americans have been whipsawed on the issue of mask wearing since the beginning of the pandemic, when top health officials said people did not need them — in part because of severe shortages of protective gear for health care workers on the front lines. Masks became the centerpiece of the culture wars that surrounded the pandemic, especially after President Donald J. Trump insisted that they were optional and that he would not wear one.That led states to adopt patchwork mask restrictions, often along partisan lines, despite the evidence of a mask’s protection for individuals and those around them. Many states have already lifted restrictions they had put in place for indoor and outdoor activities. Others maintained mask-wearing requirements even for outdoor spaces, citing the threat of potentially more contagious variants.The guidelines issued Tuesday reflect some basic coronavirus math: As the number of vaccinated people goes up, cases are going down.So far, about 43 percent of Americans have received at least one dose of a Covid-19 vaccine, and 29 percent have received both doses of the two vaccines requiring double shots. The United States is averaging around 55,000 new cases a day, a roughly 20 percent drop from two weeks ago, according to a New York Times database.“I know the quarantine and shutdowns throughout the pandemic have been exhausting,” Dr. Walensky said. “I know we all miss the things we used to do before the pandemic, and I know we all want to do the things we love and soon. Today is another day we can take a step back to normalcy of before.”Her remarks, and those of the president, got a welcome reception even from some of the Biden administration’s fiercest Republican critics in Congress, many of whom have complained that coronavirus restrictions were an intrusion on their personal freedoms.“It’s about time,” said Representative Jim Jordan, Republican of Ohio, who recently excoriated Dr. Anthony S. Fauci, the federal government’s top infectious disease specialist, at a hearing on Capitol Hill. “Now when do we get the rest of our liberties back?”Senator Ron Johnson, Republican of Wisconsin, who has spread fringe theories and given a platform to vaccine skeptics, called the guidance “long overdue.”Senator Ted Cruz, Republican of Texas, who quit wearing masks indoors after he was vaccinated, said he was “glad the C.D.C. finally acknowledged what has been obvious for a long time, which is that wearing a mask outside is silly and not remotely justified by the science.”In fact, the science behind the C.D.C.’s new guidance is not comprehensive. A growing body of research indicates that the odds of the virus spreading outdoors is far lower than it is indoors, but the risk is not zero and is hard to quantify.Most if not all of the research about viral transmission outside was done before the vaccine was available, so it does not distinguish between the risk to those who are inoculated and those who are not.But experts say that viral particles disperse quickly outdoors, meaning brief encounters with a passing walker or jogger pose very little risk of transmission.“The two main things you have going for you outdoors is that the virus rapidly becomes diluted” and decays quickly in the sunlight, said Linsey Marr, an aerosol expert at Virginia Tech, adding, “I think something like sitting at a baseball game where people are really cheek by jowl, side by side, and in front and behind each other, and there’s yelling, cheering — I would wear a mask in that situation.”Still, the evidence is somewhat thin. A recent systematic review of studies that examined the transmission of the novel coronavirus and other respiratory viruses among unvaccinated individuals identified only five studies about the coronavirus that met the authors’ criteria.The study concluded that fewer than 10 percent of infections occurred outdoors, and that the odds for indoor transmission was 18.7 times as high as outdoors (the odds of super-spreading events was 33 times as high as indoors).One of the paper’s authors, Dr. Nooshin Razani, an associate adjunct professor in epidemiology, biostatistics and pediatrics at University of California, San Francisco, cautioned that the low odds of transmission outdoors may simply reflect the fact that people spend little time outdoors.In one documented case in Italy, the virus spread between joggers who were running outdoors together, side by side.The C.D.C.’s new guidance was issued amid growing debate over why the federal government was still recommending that people wear masks outdoors. Writing in The New England Journal of Medicine last week, Dr. Paul Sax, an infectious disease expert at Brigham and Women’s Hospital in Massachusetts, said it was time to end outdoor mask mandates.Along with the guidelines, the C.D.C. published a color-coded chart outlining masking recommendations for a variety of scenarios such as, “dine at an outdoor restaurant with friends from multiple households,” “visit a barber or hair salon” and “go to an uncrowded, indoor shopping center or museum.”But Dr. Marr said that seemed overly complex: “I would have to carry around a sheet of paper — a cheat sheet with all these different stipulations.” She added: “I worry that this is not as helpful as it could be.”And there are other scenarios, not addressed in the guidelines, in which wearing a mask outdoors can still be an important social signal. For instance, Dr. Mercedes Carnethon, an epidemiologist at Northwestern University, noted, no vaccine has yet been authorized for children under 16.“When we’re going to require children to wear masks, at school and on the playground when they’re at school,” she said, “I think that it is responsible for the adults in the situation to model that behavior and normalize mask wearing even when outside.”Emily Anthes

SharecloseShare pageCopy linkAbout sharingimage copyrightReutersThe harrowing scenes from India have shocked the world, as the country struggles with soaring cases of Covid. But the outbreak isn’t just a crisis for India – it’s a crisis for everyone.”The virus doesn’t respect borders, or nationalities, or age, or sex or religion,” says Dr Soumya Swaminathan, the World Health Organization’s chief scientist.”And what’s playing out in India now unfortunately has been played out in other countries.”A visual guide to the Covid crisis in IndiaWhy India’s vaccine manufacturers need US help The pandemic has revealed just how interconnected the world is. And if a country has very high levels of infection, then it’s likely to spread to other countries. Even with travel restrictions, multiple tests and quarantine, infections can still leak out; and if a traveller has come from somewhere where the virus is very prevalent, they have a higher chance of taking the virus with them. On a recent flight from New Delhi to Hong Kong about 50 passengers tested positive for Covid-19.But there’s another concern with India’s high infection rates: variants.A new variant has emerged in India called B.1.617. It’s been dubbed by some as the “double mutant” because of two key mutations on the spike of the virus. There’s some lab evidence that suggests it’s slightly more transmissible and that antibodies may find it harder to block the virus, but scientists are still assessing how much immunity is lost. “I don’t think there’s any evidence that it’s an escape mutation [which would mean] it fundamentally can’t be stopped by the vaccines,” Dr Jeff Barrett, director of the Covid-19 Genomics Initiative at the Wellcome Sanger Institute, told BBC News. “I think we have to obviously watch carefully, but there’s at present no reason to panic about it.”‘We called 200 people to find a hospital bed’What is the India Covid variant?But the higher the number of Covid cases a country has, the more likely it is that new variants will emerge. That’s because every single infection gives the virus a chance to evolve and a major concern is that mutations could arise that render vaccines ineffective.”The way to limit viral variants emerging in the first place is to prevent the virus replicating in us… so the best way to control variants is actually to control the global amount of disease that we have at the moment,” explains Prof Sharon Peacock, Director of the Covid-19 Genomics UK consortium (Cog-UK).Lockdowns and social distancing measures will do this – but vaccination is also vital.This is happening slowly in India: so far less than 10% of its population have had the first dose of the vaccine and less than 2% are fully vaccinated. This is despite the fact that it’s home to the world’s biggest vaccine manufacturer – the Serum Institute of India. And this is another reason why India’s surge in cases has a knock-on effect for the rest of the world.

Getty ImagesTop Indian Covid vaccine makersSIICovishield, NovavaxBharat BiotechCovaxin, CoraVaxBiological EJohnson & JohnsonZydus CadilaZyCoV-DHetero BiopharmaSputnik VDr Reddy’s LabSputnik VSource: Media reportsIn March, as infections in India started to surge, authorities there halted large exports of the Oxford-AstraZeneca vaccine.That included vaccines for the UN-backed Covax scheme to provide doses to low and middle-income countries. On Monday, the Global Vaccine Alliance (Gavi), which is a partner in the scheme, said it was waiting to hear when supplies from India would resume. This will certainly impact on vaccination roll-outs in many countries. But it means more of India’s vaccines are diverted for domestic use, while it tries to ramp up production.And with India’s dire situation, scientists say this is a priority.”We really need to double down on vaccination as quickly as possible or the virus is going to try and do everything it can to keep on spreading from person to person,” says Swaminathan.Globally, the pandemic shows no sign of easing, with the virus devastating country after country.The situation in India is a bleak reminder that none of us will be safe until everyone is safe.Follow Rebecca on Twitter

In India’s capital city, hospitals are full, oxygen supplies are low and crematoriums are running out of space for the dead as the city’s second wave of Covid continues.The BBC witnessed nurse Manjusha Mathew’s attempts to revive a coronavirus patient in a hospital in Delhi.She describes what it’s like working in an emergency room on the brink.