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The disorder is rare, but so severe that the vaccine is on hold while experts weigh the risks and alert doctors and patients about symptoms and treatment.An 18-year-old woman was stricken with severe headaches, vomiting, seizures, confusion and weakness in one arm early this month, strokelike symptoms that doctors at a Nevada hospital were shocked to see in someone so young.Scans found several large blood clots blocking veins that drain blood from the brain, a condition that can disable or kill a patient.Doctors performed a procedure to suction huge clots from her brain, only to find that new ones had formed.The patient is one of six women ages 18 to 48 who developed clots in the brain within two weeks of receiving the Johnson & Johnson coronavirus vaccine. One died, and their devastating cases led U.S. health officials to recommend on Tuesday that use of the vaccine be paused.Two more cases have been added since then: one involving a man who was vaccinated during the company’s clinical trials and another involving a woman who received the vaccine after it had been authorized for general use.As in several of the original cases, the young woman in Nevada was initially treated with heparin, a standard blood-thinner that experts have since learned may actually worsen the rare clotting disorder that has affected small numbers of people who received the Johnson & Johnson or AstraZeneca vaccines in several countries. But until the last few weeks, doctors around the world had little information about the condition, and the doctors in Nevada did not recognize it immediately.“We were flying blind, based on reports from Europe and the U.K. hematological society,” said Dr. Brian Lipman, an infectious-disease specialist who helped care for the Nevada patient at Dignity Health St. Rose Dominican Hospital, Siena Campus, in Henderson.The U.S. decision to call for suspension of the use of the vaccine was intended to give officials time to learn more about the rare disorder causing the clots, to assess whether it is linked to the vaccine and to inform doctors and patients about how to recognize symptoms and treat the condition.The pause may last until at least next Friday, when expert advisers to the Centers for Disease Control and Prevention are scheduled to meet to review the data and decide whether to resume using the vaccine. Dr. Rochelle Walensky, the director of the C.D.C., and other top U.S. health officials sought on Friday to reassure the public that the pause, now extended more than a week, was a reasonable safeguard to assess risk. They also emphasized that over all, the Johnson & Johnson vaccine and the other vaccines in use in the United States were safe, given how many millions of Americans had gotten their shots without concern.But with the world staggered by a relentless epidemic, even temporarily stopping the use of a highly effective vaccine, which many countries had planned to deploy, is a fraught decision. Public health experts fear that the move sends a message that will erode trust globally even if the vaccine is reinstated and that huge numbers of people who could have been immunized will die needlessly from Covid-19 because they or their governments rejected the company’s vaccine.The United States, where Johnson & Johnson provided only about 5 percent of the Covid vaccine supply, can afford the suspension: It has plenty of other vaccine doses from Moderna and Pfizer-BioNTech to fill the gap. Other countries do not. And many nations have also stopped or limited the use of another effective vaccine, the one made by AstraZeneca, because it, too, has been linked to a similar rare clotting disorder.Health workers receiving the Johnson & Johnson vaccine in Johannesburg last month. While the U.S. can rely on other vaccines during the suspension, other countries do not have that luxury.João Siva/The New York TimesAbout 7.4 million Americans have received the Johnson & Johnson vaccine, and so far, only eight cases of the clotting problem have been reported, seven of them in women. In Europe, Britain, and three other countries, 222 cases have been reported, mostly in women under 60 — of 34 million people who have received the AstraZeneca vaccine. Several countries have now limited its use to older adults because so many cases have involved younger people.Researchers suspect that in these rare cases, the vaccine causes an intense reaction by the patient’s immune system, which churns out antibodies that activate platelets, a blood component needed for clotting. An unusual syndrome results, with extensive clotting that leaves the patient with low platelet levels and a tendency to bleed at the same time. Why this occurs in some people, many of them younger women, is not known, and experts say that they have so far been unable to identify traits or underlying conditions that may make some people susceptible.In a statement issued on Wednesday, Johnson & Johnson said: “The safety and well-being of the people who use our products is our number one priority, and we strongly support awareness of the signs and symptoms of this extremely rare event to ensure the correct diagnosis, appropriate treatment and expedited reporting by health care professionals. We continue to believe in the positive benefit-risk profile of our vaccine.”The company also said, in a letter published on Friday in The New England Journal of Medicine, that no causal link had been established between its vaccine and the clotting disorder.To some critics, it makes no sense to hobble a global vaccination campaign during a pandemic just because of a few cases of a rare disorder.But while rare side effects may be tolerated as the price we must pay for some drugs or vaccines, even the rarest ones are difficult to accept if they are severe and unpredictable — like blood clots in the brain, especially in young, healthy people.“This is a devastating complication,” Dr. Anthony Fauci, the chief medical adviser for the pandemic in the Biden administration, said in an interview.He added: “One woman died, three are in the hospital, one in intensive care. Even though the numbers are small, it is a devastating complication, so I believe — I didn’t make the decision — I believe their rationale, at least from what they communicated to me, is that they wanted to call a quick pause to see, to alert people. Sometimes this starts with minor symptoms, like a little abdominal discomfort, and then all of a sudden they wind up having a stroke.”He also said, “Maybe there are a lot more people out there we’re not noticing, because of the spectrum of the disease.”Informing doctors and the public of the symptoms — severe headaches, shortness of breath, leg or abdominal pain — could help identify more cases.Another reason for the pause, Dr. Fauci said, is to let doctors know that the drug heparin, a standard treatment for blood clots, should not be given to these patients, “because heparin in this circumstance can make things worse.”It is not known whether the heparin initially given to some of the patients exacerbated their condition.Experts are recommending the use of other blood thinners, which patients urgently need, because their blood clots keep growing, and new ones keep forming. Doctors in Europe who treated recipients of the AstraZeneca vaccine who had a similar condition said it could worsen rapidly..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-yoay6m{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-yoay6m{font-size:1.25rem;line-height:1.4375rem;}}.css-1dg6kl4{margin-top:5px;margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-1pd7fgo{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-1pd7fgo{padding:20px;width:100%;}}.css-1pd7fgo:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-1pd7fgo{border:none;padding:20px 0 0;border-top:1px solid #121212;}.css-1pd7fgo[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-1pd7fgo[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-1pd7fgo[data-truncated] .css-5gimkt:after{content:’See more’;}.css-1pd7fgo[data-truncated] .css-6mllg9{opacity:1;}.css-1rh1sk1{margin:0 auto;overflow:hidden;}.css-1rh1sk1 strong{font-weight:700;}.css-1rh1sk1 em{font-style:italic;}.css-1rh1sk1 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#ccd9e3;text-decoration-color:#ccd9e3;}.css-1rh1sk1 a:visited{color:#333;-webkit-text-decoration-color:#ccc;text-decoration-color:#ccc;}.css-1rh1sk1 a:hover{-webkit-text-decoration:none;text-decoration:none;}“The real issue is how long they take to make up their mind about what they’re going to do,” Dr. Fauci said of the C.D.C.’s advisory panel. “The rest of the world is watching this, and J.&J. is hopefully going to be an important part of the worldwide response, as is AstraZeneca.” He added, “You don’t want to rush them, but I hope they make up their minds in a reasonable amount of time.”Another of the first six patients with the clotting condition was a healthy 48-year-old woman who went to an emergency room in Nebraska because she had felt ill with abdominal pain for three days. Her case was described in a letter to the editor of The New England Journal of Medicine published on Wednesday. Her platelet count was low, and other blood tests were also abnormal. A C.T. scan found extensive blood clots in veins in her abdomen. She began having headaches, and another scan found clots in her brain.She was given heparin. More clots developed, and she had a hemorrhagic stroke.Doctors then learned that she had received the Johnson & Johnson vaccine two weeks before. They stopped the heparin and gave her a different blood thinner, along with intravenous immune globulin, a treatment also recommended for the clotting disorder. Her platelet count increased, but, the doctors wrote, “The patient remained critically ill at the time of this report.”The young woman in Nevada was fighting for her life and had to be placed on a ventilator, according to Dr. Lipman. He said he was speaking independently and not as a representative of the hospital.The patient’s family declined a request for an interview.Dr. Anthony S. Fauci discussed the pause of Johnson & Johnson Covid inoculations during a news briefing on Tuesday.Pete Marovich for The New York TimesDr. Lipman said that as the team had studied her blood samples, the pieces began to fall into place, and they realized that she appeared to have the same problem that they knew had been occurring in Britain and Europe after patients received the AstraZeneca vaccine, mostly in young women. They switched from heparin to another blood-thinner and began following guidance provided by doctors in Britain who had treated AstraZeneca recipients with a similar disorder.Hoping for more information about the condition and any possible connection to the Johnson & Johnson vaccine, Dr. Lipman called an emergency number at the Food and Drug Administration. It was a weekend, and he said the person who answered told him that no one was available to help and that the line had to be kept open for emergencies.“I thought this was an emergency,” Dr. Lipman said. “She hung up on me.”He called back, to ask how to reach Janssen, which makes the Johnson & Johnson vaccine. That information was not available, and he said the person who answered had also told him that the F.D.A. could not provide advice on patient care.An F.D.A. spokeswoman, Stephanie Caccomo, said in an email, “We’ll look into this further to ensure physicians calling F.D.A. for assistance receive the help they are seeking.”Dr. Lipman said that the pharmacist at his hospital had submitted a report online to the Centers for Disease Control and Prevention in early April but that the agency had not contacted him to ask about the case until this week. The agency declined to comment on whether it had communicated with Dr. Lipman, a spokeswoman, Kristen Nordlund, said by email.At a meeting on Wednesday of a C.D.C. advisory panel, Johnson & Johnson and Dr. Tom Shimabukuro, a safety expert at the agency, both presented data about the young woman in Nevada. After the meeting, Nevada officials issued a statement saying the meeting was the first time they had learned of a case in their state — they had previously told the public that no cases had been reported — and they were asking “federal partners” why the state had not been informed.At the Nevada hospital, an interventional radiologist passed a tube through blood vessels and on into the young woman’s brain and used a device to suction out the blood clots. More clots formed later, and he performed the procedure again.But the condition causes more than clots: The patient, like others, also had a brain hemorrhage.She was transferred to a larger hospital, where she is still on a ventilator, Dr. Lipman said. Her prognosis is uncertain, he said, adding, “Her life, not just her life, her entire family’s life, has been transformed.”Benjamin Mueller

SharecloseShare pageCopy linkAbout sharingimage copyrightReutersThe rate of coronavirus infections in Canada’s biggest province has reached an all-time high as hospitals warn they are close to being overwhelmed. A panel of experts say infections in Ontario could increase by 600% by June if public health measures are weak and vaccination rates do not pick up. Last week, for the first time since the pandemic began, Canada registered more cases per million than the US.About 22% of Canadians have now received a first vaccine dose. That compares to 37% in the US. Ontario is now introducing strict new public measures, including:a six-week stay-at-home orderrestrictions on non-essential travel, including checkpoints at the borders with the neighbouring provinces of Quebec and Manitobanew powers for police to stop and question people who leave home a halt to non-essential constructionCanadian Prime Minister Justin Trudeau said the federal government would help Toronto, the largest city in the country, which has been hard-hit by the latest surge. “We’re going to do whatever it takes to help. Discussions are ongoing about extra healthcare providers, and we are ready to step up,” he said on Friday. Covid infections in Canada edge closer to US rateWhy Canada is falling behind in Covid vaccinations Why has it suddenly got worse? New variants – especially the UK variant, B1.1.7 – account for more than two-thirds of infections in Ontario. Even with vaccinations progressing, the expert panel warned that the number of new cases in Ontario could go as high as 30,000 a day – in a province with 14 million people, 38% of the total population of Canada. On Friday, Ontario reported 4,812 new cases, its third straight day of setting new records since the pandemic began. Hospital admissions and the number of patients in intensive care also set records for Ontario: 1,955 and 701, respectively. image copyrightReutersThe expert panel said the best-case scenario would bring new cases down to about 5,000 a day, but only with considerably more stringent public health measures than the ones now in place. It would also require a vaccination rate of 300,000 a day – three times the current pace. Last week the College of Physicians and Surgeons of Ontario warned doctors that they might have to start making decisions about who to admit to intensive care, because units were stretched almost to capacity. The co-chairman of Ontario’s expert panel, Adalsteinn Brown, said Ontario’s hospitals could no longer function normally. “Our children’s hospitals are admitting adults. This has never happened in Ontario before. It’s never happened in Canada before.”A field hospital is now being set up in the car park of one of Toronto’s main hospitals. How is the vaccination campaign going? After a slow start, the pace of vaccination is now picking up. Canada was quick to buy up stocks of vaccine doses, but until recently the rollout was lagging behind other industrialised countries. Nine million Canadians have now received at least one vaccine dose. There was mixed news on Friday. Moderna said it would cut its next shipment to Canada by almost half, to 650,000 doses, but Pfizer is to supply an additional eight million doses after it reached a new deal with the Canadian government. Unlike some European countries, Canada has not withdrawn the Oxford-AstraZeneca vaccine, but is advising its use only in patients over 55 while the risk from blood clots is assessed. Canadian health officials say the risk from catching Covid-19 far outweighs the risk of rare blood clots. The Canadian Medical Association (CMA) has called for a national response, sharing resources across provincial and territorial boundaries to deliver to the areas most in need.

Making memories involves more than seeing friends or taking photos. The brain constantly adapts to new information and stores memories by building connections among neurons, called synapses. How neurons do this — reaching out arm-like dendrites to communicate with other neurons — requires a ballet of genes, signaling molecules, cellular scaffolding and protein-building machinery.
A new study from scientists at Scripps Research and the Max Planck Florida Institute for Neuroscience finds a central role for one signaling molecule, a long, noncoding RNA that the scientists named ADEPTR.
Using a variety of technologies, including confocal and two-photon microscopy, they track ADEPTR’s moves, watching as it forms, travels, amasses at the synapse and activates other proteins upon a neuron’s stimulation.
Its journey to the far reaches of a brain cell is made possible by a cellular carrier that that tiptoes along a dendrite’s microtubule scaffolding. Called a kinesin motor, it deposits ADEPTR near the synapse junction, where it activates other proteins.
The team also found that if ADEPTR is silenced, new synapses don’t form during stimulation.
The study, “Activity regulated synaptic targeting of lncRNA ADEPTR mediates structural plasticity by localizing Sptn1 and AnkB in dendrites,” is published online April 16 in the journal Science Advances.
Long noncoding RNAs have often been described as “genomic dark matter,” because their role in cells has yet to be fully characterized, especially in neurons, says the study’s lead author, Scripps Research neuroscientist Sathyanarayanan Puthanveettil, PhD. Puthanveettil’s team is finding that they play a signaling role in neural plasticity — how neurons adapt and change with experience.

Scientists at Sanford Burnham Prebys have identified a set of human genes that fight SARS-CoV-2 infection, the virus that causes COVID-19. Knowing which genes help control viral infection can greatly assist researchers’ understanding of factors that affect disease severity and also suggest possible therapeutic options. The genes in question are related to interferons, the body’s frontline virus fighters.
The study was published in the journal Molecular Cell.
“We wanted to gain a better understanding of the cellular response to SARS-CoV-2, including what drives a strong or weak response to infection,” says Sumit K. Chanda, Ph.D., professor and director of the Immunity and Pathogenesis Program at Sanford Burnham Prebys and lead author of the study. “We’ve gained new insights into how the virus exploits the human cells it invades, but we are still searching for its Achille’s heel so that we can develop optimal antivirals.”
Soon after the start of the pandemic, clinicians found that a weak interferon response to SARS-CoV-2 infection resulted in some of the more severe cases of COVID-19. This knowledge led Chanda and his collaborators to search for the human genes that are triggered by interferons, known as interferon-stimulated genes (ISGs), which act to limit SARS-CoV-2 infection.
Based on knowledge gleaned from SARS-CoV-1, the virus that caused a deadly, but relatively brief, outbreak of disease from 2002 to 2004, and knowing that it was similar to SARS-CoV-2, the investigators were able to develop laboratory experiments to identify the ISGs that control viral replication in COVID-19.
“We found that 65 ISGs controlled SARS-CoV-2 infection, including some that inhibited the virus’ ability to enter cells, some that suppressed manufacture of the RNA that is the virus’s lifeblood, and a cluster of genes that inhibited assembly of the virus,” says Chanda. “What was also of great interest was the fact that some of the ISGs exhibited control across unrelated viruses, such as seasonal flu, West Nile and HIV, which leads to AIDS.”
“We identified eight ISGs that inhibited both SARS-CoV-1 and CoV-2 replication in the subcellular compartment responsible for protein packaging, suggesting this vulnerable site could be exploited to clear viral infection,” says Laura Martin-Sancho, Ph.D., a senior postdoctoral associate in the Chanda lab and first author of this study. “This is important information, but we still need to learn more about the biology of the virus and investigate if genetic variability within these ISGs correlates with COVID-19 severity.”
As a next step, the researchers will look at the biology of SARS-CoV-2 variants that continue to evolve and threaten vaccine efficacy. Martin-Sancho notes that they have already started gathering variants for laboratory investigation,
“It’s vitally important that we don’t take our foot off the pedal of basic research efforts now that vaccines are helping control the pandemic,” concludes Chanda. “We’ve come so far so fast because of investment in fundamental research at Sanford Burnham Prebys and elsewhere, and our continued efforts will be especially important when, not if, another viral outbreak occurs.”
Additional study authors include Lars Pache, Anshu P. Gounder, Courtney Nguyen, Yuan Pu, Heather M. Curry, Paul D. De Jesus, Ariel Rodriguez-Frandsen and Xin Yin at Sanford Burnham Prebys. Other authors include Mary K. Lewinski, Charlotte A. Stoneham, Aaron L. Oom, and John Guatelli at the University of California at San Diego and the VA San Diego Healthcare System; Mark Becker, Thomas J. Hope and Judd F. Hultquist at the Northwestern University Feinberg School of Medicine; Dexter Pratt, Christopher Churas, Sara B. Rosenthal, Sophie Liu, Fan Zheng, Max W. Chang, Christopher Benner, Trey Ideker and Alan M. O’Neill at the University of California San Diego; Lisa Miorin, Matthew Urbanowski, Megan L. Shaw and Adolfo García-Sastre at the Icahn School of Medicine at Mount Sinai; Stuart Weston and Matthew B. Frieman at the University of Maryland School of Medicine; and Chunxiang Wu and Yong Xiong at Yale University.

It is well established that autism occurs much more frequently in boys than in girls, and that girls seem to have a greater resilience to developing the condition. It has been unclear, however, why that is.
In a new Yale-led study, researchers find that autism may develop in different regions of the brain in girls than boys and that girls with autism have a larger number of genetic mutations than boys, suggesting that they require a larger “genetic hit” to develop the disorder.
The findings appear in the April 16 edition of the journal Brain.
“We know so little about how autism unfolds in the brain,” said Dr. Abha Gupta, assistant professor of pediatrics at the Yale School of Medicine and lead author of the study. “It’s important to be able to land on spots where the dysfunction might arise because that gives us more traction into where in the brain to look. We need to be accurate about this.”
Other members of the research team included Dr. Allison Jack, from George Mason University, and Dr. Kevin Pelphrey, from the University of Virginia’s Brain Institute (and formerly of Yale School of Medicine).
Autism Spectrum Disorder (ASD) is a developmental disorder that can interfere with the ability to interact, communicate, and learn. Rates have been steadily climbing — ASD now impacts one in 54 children in the U.S. and boys are four times more likely than girls to receive a diagnosis. Even when controlling for important factors — such as boys’ tendency to “externalize” symptoms — the discrepancy remains, said Gupta.

In “The New Normal,” Dr. Jennifer Ashton explores the mental health repercussions of the pandemic and ways to rebuild our overall health.As the chief medical correspondent for ABC News, Dr. Jennifer Ashton has spent the past year helping to make sense of the pandemic for the network’s millions of viewers.But another aspect of the pandemic that she deals with is the toll it has taken on our nation’s mental health, which she sees on a daily basis at her medical practice in New Jersey, where Dr. Ashton is an obstetrician-gynecologist. In the past year, she says, patient after patient has opened up to her about the crippling stress and uncertainty caused by Covid-19 and their struggles with fear, anxiety, loneliness, frustration and depression.“I have patients ranging in age from teenagers to women in their 70s and 80s, and they all say this to me,” Dr. Ashton said. “They express it to me almost with this tone that they think there’s something wrong with it. The first thing that I do is I help them recognize that it’s appropriate and it’s OK. Everyone is having these feelings.”HarperCollins publishersDr. Ashton explores the psychological toll of the pandemic in her new book, “The New Normal,” which shows us how thinking like a doctor may help us to build resilience and strengthen our overall health. We recently caught up with Dr. Ashton to discuss her thoughts on how the pandemic is affecting our mental health, why it’s essential that we practice self-care during these stressful times, and one of the best hacks she found to improve her diet. Here are edited excerpts from our conversation.Q. How do you define the “new normal”?This past year has been filled with so much uncertainty and unfamiliarity. Nothing that we are doing today or have lived through in the last year is normal. The approach that I’ve taken to covering this pandemic has been that of viewing the country as one big patient, and the first step in healing or recovery from any illness is accepting the current situation.It’s like taking care of a patient who has recently undergone an amputation. The goal of rehabilitation is to get that person walking again or using a prosthetic device. That is their new normal. If they keep thinking of what they did before the amputation, it just hinders their progress. But when you stop looking back and start focusing on the present and the future, you can have an incredible healing and recovery.Q. You write that a lot of people have developed signs of post-traumatic stress this past year, even if they didn’t develop Covid-19. Can you explain?I divide it up into different subsets of the population. First, you have to address the frontline health care workers, and not just doctors and nurses. The transporters, technicians, clinical clerks — there are so many people who work in hospitals that never get recognized. And yet every death due to Covid affects them in the same way. To be in a hospital setting where you are losing a patient every hour for months on end takes a massive psychological toll.And for everyone else, I’ve spoken to many mental health professionals over the last year, and every single one has said that the social isolation and persistence of this pandemic has affected all of us. Human beings are social creatures. If you think about how many of us have been isolated for so long, it’s easy to see how entire elements of our society will have post-traumatic stress disorder because of that.Q. You say that it’s essential for people to practice self-care right now. What are some of the best ways to do that?How you eat, sleep and move is what I call the trifecta of good health and wellness. But I realized after the first stay-at-home period in New York, when I was working 15-hour days from my small New York apartment, that I had let all of those things fall by the wayside, and it had a massive impact on how my brain and my body felt. I had to turn the doctor lens on myself and say, ‘How would you talk to you, if you were your own patient?’I said it’s time to go back to the basics: Stop eating this comfort food that you never ate before the pandemic. Make sure that you get outside and exercise every day. I recommitted to getting eight hours of sleep and doing my meditation practice every day, and it was incredibly transformative. It made a huge difference in how I felt.Q. In the book you talk about how the pandemic has changed the way we eat, and mostly for the worse. What is one of your top rules for eating right?For those of us who are lucky, one of the blessings of this pandemic was that by necessity we started cooking from home. I could not cook a single meal before this pandemic. But I learned to cook and no one was more shocked than my children, who couldn’t believe what they were seeing. So, I would say my first rule is don’t be afraid to fail safely and quickly when it comes to trying new things with food, whether that’s with cooking or a new diet. Now is the time to be curious and experiment. I had to quarantine three different times in the last year because of exposure to positive cases. The last time I quarantined, I experimented with being completely vegan. In only 10 days, my LDL cholesterol dropped from 111 to 85. I had never considered going vegan before, but there are certain parts of it that I’m going to continue forever.Q. You’re a busy doctor and journalist. What do you do for exercise, and what advice do you have for our readers?Exercise is my stress release. I like a combination of resistance training and all kinds of cardio. Sometimes I do what I call low and slow, which is when I’m barely sweating but it’s something I can do while I’m on my device or watching TV. I do a lot of work with resistance bands because it never gets easy. You can work your entire body. You can do it anywhere, and they’re cheap. I keep them in my office and in my apartment. That’s my default.Q. What is one thing you do every day for your mental health?I’m a big believer in meditation. I do 20 minutes of it every day, and it’s life changing. I try to start my day with it because then I know that I’ll get it in. As the saying goes, I don’t find the time, I make the time. It’s helped me immensely during this pandemic.

Although antibodies induced by SARS-CoV-2 infection are largely protective, they do not completely protect against reinfection in young people, as evidenced through a longitudinal, prospective study of more than 3,000 young, healthy members of the US Marines Corps conducted by researchers at the Icahn School of Medicine at Mount Sinai and the Naval Medical Research Center, published April 15 in The Lancet Respiratory Medicine.
“Our findings indicate that reinfection by SARS-CoV-2 in health young adults is common” says Stuart Sealfon, MD, the Sara B. and Seth M. Glickenhaus Professor of Neurology at the Icahn School of Medicine at Mount Sinai and senior author of the paper. “Despite a prior COVID-19 infection, young people can catch the virus again and may still transmit it to others. This is an important point to know and remember as vaccine rollouts continue. Young people should get the vaccine whenever possible, since vaccination is necessary to boost immune responses, prevent reinfection, and reduce transmission.”
The study, conducted between May and November 2020, revealed that around 10 percent (19 out of 189) of participants who were previously infected with SARS-CoV-s (seropositive) became reinfected, compared with new infections in 50 percent (1.079 out of 2,247) of participants who had not been previously infected (seronegative). While seronegative study participants had a five times greater risk of infection than seropositive participants, the study showed that seropositive people are still at risk of reinfection.
The study population consisted of 3,249 predominantly male, 18-20-year-old Marine recruits who, upon arrival at a Marine-supervised two-week quarantine prior to entering basic training, were assessed for baseline SARS-CoV-2 IgG seropositivity (defined as a 1:150 dilution or greater on receptor binding domain and full-length spike protein enzyme-linked immunosorbent [ELISA] assays.) The presence of SARS-CoV-2 was assessed by PCR at initiation, middle and end of quarantine. After appropriate exclusions, including participants with a positive PCR during quarantine, the study team performed three bi-weekly PCR tests in both seronegative and seropositive groups once recruits left quarantine and entered basic training.
Recruits who tested positive for a new second COVID-19 infection during the study were isolated and the study team followed up with additional testing. Levels of neutralising antibodies were also taken from subsequently infected seropositive and selected seropositive participants who were not reinfected during the study period.
Of the 2,346 Marines followed long enough for this analysis of reinfection rate, 189 were seropositive and 2,247 were seronegative at the start of the study. Across both groups of recruits, there were 1,098 (45%) new infections during the study. Among the seropositive participants, 19 (10%) tested positive for a second infection during the study. Of the recruits who were seronegative, 1,079 (48%) became infected during the study.
To understand why these reinfections occurred, the authors studied the reinfected and not infected participants’ antibody responses. They found that, among the seropositive group, participants who became reinfected had lower antibody levels against the SARS-CoV-2 virus than those who did not become reinfected. In addition, in the seropositive group, neutralising antibodies were less common (neutralising antibodies were detected in 45 (83%) of 54 uninfected, and in six (32%) of 19 reinfected participants during the six weeks of observation).
Comparing new infections between seropositive and seronegative participants, the authors found that viral load (the amount of measurable SARS-CoV-2 virus) in reinfected seropositive recruits was on average only 10 times lower than in infected seronegative participants, which could mean that some reinfected individuals could still have a capacity to transmit infection. The authors note that this will need further investigation.
In the study, most new COVID-19 cases were asymptomatic — 84% (16 out of 19 participants) in the seropositive group vs 68% (732 out of 1,079 participants) in the seronegative group — or had mild symptoms and none were hospitalised.
The authors note some limitations to their study, including that it likely underestimates the risk of reinfection in previously infected individuals because it does not account for people with very love antibody levels following their past infection. They strongly suggest that even young people with previous SARS-CoV-2 infection be a target of vaccination since efforts must be made to prevent transmission and prevent infection amongst this group.
This work was supported by the Defense Health Agency through the Naval Medical Research Center and the Defense Advanced Research Projects Agency.

Scientists have figured out how to modify CRISPR’s basic architecture to extend its reach beyond the genome and into what’s known as the epigenome — proteins and small molecules that latch onto DNA and control when and where genes are switched on or off.
In a paper published April 9, 2021, in the journal Cell, researchers at UC San Francisco and the Whitehead Institute describe a novel CRISPR-based tool called “CRISPRoff,” which allows scientists to switch off almost any gene in human cells without making a single edit to the genetic code. The researchers also show that once a gene is switched off, it remains inert in the cell’s descendants for hundreds of generations, unless it is switched back on with a complementary tool called CRISPRon, also described in the paper.
Because the epigenome plays a central role in many diseases, from viral infection to cancer, CRISPRoff technology may one day lead to powerful epigenetic therapies. And since this approach doesn’t involve any DNA edits, it’s likely to be safer than conventional CRISPR therapeutics, which have been known to cause unwanted and potentially harmful changes to the genome.
“Though genetic and cellular therapies are the future of medicine, there are potential safety concerns around permanently changing the genome, which is why we’re trying to come up with other ways to use CRISPR to treat disease,” said Luke Gilbert, PhD, a professor at UCSF’s Helen Diller Family Comprehensive Cancer Center and co-senior author of the new paper.
Transforming CRISPR From Genome to Epigenome Editor
Conventional CRISPR is equipped with two pieces of molecular hardware that make it an effective gene-editing tool. One component is a DNA-snipping enzyme, which gives CRISPR the ability to alter DNA sequences. The other is a homing device that can be programmed to zero in on any DNA sequence of interest, imparting precise control over where edits are made.

Putting a risk in context: The rate of blood clots is extremely low, but the pause in the Johnson & Johnson vaccine could reveal more cases.A mass vaccination site in Elgin, Ill., closed for a day because of the pause put on the Johnson & Johnson vaccine.Rick West/Daily Herald, via Associated PressWhen federal officials paused administration of the Johnson & Johnson vaccine after six cases of a rare clotting disorder, one fatal, among the 6.9 million people who had received the vaccine, many critics noted that the chance of a serious ailment was so rare as to be negligible — less frequent than being struck by lightning.But that roughly one-in-a-million rate is far from certain. Doctors may ultimately find the vaccine is not responsible for the ailment. However, if the two are linked, it’s also possible that the chance of an adverse effect will be higher, even if it remains low.“Numbers seem quite solid, like, ‘Oh, it’s 10,’” said Caitlin Rivers, an assistant professor at Johns Hopkins University, who studies infectious disease. She said epidemiologists deal with similar matters of uncertainty at the beginning of disease outbreaks. “But they’re estimates, and they will need to be refined, and they may need to be refined a lot, especially since they are small numbers.”How do we know how common this event is?If there is a connection between the vaccine and this rare syndrome, new cases are likely to emerge now that the word is out. Regulators announced the pause in part to alert doctors to the existence of this syndrome; as people begin looking, they may be more likely to find and report it. With numbers so low, the addition of even a few more cases could increase the rate. (In the last few days, Johnson & Johnson has reported two more possible cases, one in a woman, and one in a man.)Cases of rare blood clotsReported cases of cerebral venous sinus thrombosis in those receiving the Johnson & Johnson vaccine, compared with the number of cases that would normally be expected in that many people over 20.5 days.

Gary Stewart’s wife Jude died from the coronavirus at the start of the year. She had been living in a care home and he hadn’t been able to see her for months.Because of restrictions caused by the pandemic, no more than 30 people could attend and they had to socially distance.Gary, who lives near Peterborough, describes his wife’s funeral as “a ridiculous non-event” and not “what she deserved”.He spoke to the BBC ahead of Prince Philip’s funeral this Saturday, which will only have 30 mourners in line with Covid rules.