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The Centers for Disease Control and Prevention said 19 people had been sickened in eight states.A salmonella outbreak linked to contact with wild songbirds and bird feeders has sickened 19 people across eight states, eight of whom have been hospitalized, federal health authorities said.The Centers for Disease Control and Prevention said it was investigating salmonella infections in California, Kentucky, Mississippi, New Hampshire, Oklahoma, Oregon, Tennessee and Washington State in people ranging in age from 2 months to 89 years old.Six cases were reported in Washington and five in Oregon. No deaths have been reported.Public health officials across the country interviewed 13 of the people who were infected and asked them about animals they had come in contact with a week before they became ill, the C.D.C. said. Nine said they owned a bird feeder, and two reported they had come into contact with a sick or dead bird. Ten people said they had pets that had access to or contact with wild birds, the agency said.To prevent further cases, the C.D.C. recommends cleaning bird feeders and bird baths once a week or when they are dirty. People should avoid feeding wild birds with their bare hands, and should wash their hands with soap and water after touching a bird feeder or bath, or after handling a bird.In California, where three human cases have been reported, the state’s Department of Fish and Wildlife warned of an outbreak in February, and reported that it had been “inundated with calls” from Californians who had discovered sick or dead finches at bird feeders.Andrea Jones, director of bird conservation for Audubon California, said the state had found that most of the birds affected by the outbreak were pine siskins, a finch species that spends the winter in California. Pine siskins congregated in California in large numbers this year, which allowed the outbreak to spread among the birds.“It can happen any year, but this has been a particularly bad year,” Ms. Jones said. “Pine siskins are not very good at social distancing.”Sick birds can often look weak or lethargic, or may appear to be struggling to breathe, Ms. Jones said. She added that most birds die within 24 hours of being infected by salmonella.Many pine siskins are now leaving California for Canada, Ms. Jones said, adding that she hoped the outbreak might be nearing an end.Salmonella bacteria can spread from birds to pets and to humans. People may experience diarrhea, fever and stomach cramps for anywhere from six hours to six days after infection, according to the C.D.C. Children, adults 65 and older, and people with weakened immune systems sometimes suffer worse cases of salmonella, though most people recover in a week or less without treatment.Because many people recover quickly and are not tested for salmonella, the C.D.C. said it was likely that the true number of cases resulting from the outbreak was much higher than the number of reported cases.About 1.35 million cases of salmonella are reported every year in the United States. Of those, about 26,500 require hospitalization and 420 result in death, according to the C.D.C.

SharecloseShare pageCopy linkAbout sharingimage copyrightEPAThe Indian state of Maharashtra will see tighter restrictions from Monday following a sharp spike in Covid-19 infections.A night time curfew will be enforced and the state will be under a full lockdown on weekends.India saw its highest day of infections since mid-September on Sunday, with 93,249 new cases.More than half of those were in Maharashtra, which has India’s largest city Mumbai as its capital.Prime Minister Narendra Modi has asked a specialist teams to visit the state and investigate why there has been such a severe spike there.Some 165,000 people have died of Covid-19 in India, and there have been 12.5 million confirmed infections. This is Maharashtra’s second full lockdown and government officials had been warning the move was imminent for some time.What did Maharashtra’s leader say?In a televised address on Friday, Maharashtra’s Chief Minister Uddhav Thackeray said people were not following safety rules and some had caught Covid-19 after being vaccinated because they had stopped wearing masks.”People have become complacent. We are in a catch-22 situation – should we look at the economy or health?” Mr Thackeray said.”If this condition continues, I have told you already that in 15 days we will exhaust our [health] infrastructure,” he added.Pune city, which is about 160km (100 miles) east of Mumbai, had already imposed a curfew and closed religious places, hotels, bars, shopping malls and cinemas for a week.image copyrightEPAWhat are the new rules?Maharashtra is already under Covid restrictions that include a ban on public gatherings. But now, from Monday, there will be a night time curfew from 20:00 to 07:00 local time.On weekends, there will be a full lockdown starting at 20:00 on Fridays and going through till 07:00 on Mondays. Only essential businesses can operate during this time.Public transport will still run, but cinemas and playgrounds will be shut. Shops, bars and restaurants will be open only for take-away and parcel services only. Government office buildings have been told to operate at 50% capacity, with people to work from home if possible. These restrictions will last until 30 April, the government said.What about the rest of India?India has had the third highest number of cases after the US and Brazil. The situation seemed to be stabilising in January, with fewer than 15,000 daily infections. But cases began to spike again in March largely because of poor test-and-trace and lax safety protocols.Experts say India’s second wave is being fuelled by people being less cautious – and mixed messaging by the government.As the infections fell, a sense of complacency set in and after being cooped up in their homes for nearly a year, many Indians began attending big weddings and family functions and started visiting crowded marketplaces.Thousands have also participated in large election rallies in several states where regional elections are being held.What about vaccines?The country has launched the third phase of its coronavirus vaccination drive with those older than 45 eligible for the jab. In the first two phases, frontline workers and people above the age of 60 were vaccinated.India has the world’s biggest inoculation drive, and has so far administered more than 68 million doses. It wants to cover 250 million people by July, but experts say the vaccinations need to move faster to stop the spread.

Colorful paper blooms are easy to make and perfect for a spring table top. “There are always flowers for those who want to see them,” Henri Matisse said. Even in this newspaper — just glue a skewer between two pieces of colored or painted newspaper and snip it into simple flower shapes.Group the flowers together for an everlasting and inexpensive centerpiece for your spring table, or place one at each place setting. Mini versions can be used as place cards; they’d make even a tiny gathering feel special. If you leave the bottom of the skewers undecorated, you can poke the flowers into a cake or cupcakes for an instant decoration. Or cheer up someone’s work-from-home situation with a potted paper bouquet; they’ll thank you a bunch.Jodi Levine for The New York TimesSuppliesNewspaper (find colorful spots or paint it)Acrylic craft paint and paintbrush (if you want to paint the newspaper)PencilScissorsWooden skewersWhite glueSmall bowl and a paintbrush (optional, for the glue)Glue stick (optional)Small flowerpots, vases, recycled bottles or jars.Fine gravel or sand (available in craft stores, optional)Make the flowers1. If you’d like to, paint a few sheets of newspaper.2. Cut two pieces of paper to the height and width of your planned flower, leaf and stem or just the flower head.Jodi Levine for The New York Times3. Brush or squeeze a thin strip of glue down the center of the paper, place your dowel on top and apply some more glue over it. Apply a think layer of glue over the rest of the newspaper and place the other piece on top. Gently press it down. (If you want to use as cake toppers, leave the end of your dowel bare.)Jodi Levine for The New York TimesJodi Levine for The New York Times4. Lightly pencil a design (you can use the ones here as a guide or make up your own) and cut out. Let Matisse’s flowers inspire you.Jodi Levine for The New York Times5. “Plant” the flowers in small flowerpots, vases or repurposed bottles or jars. Pour an inch or two of sand or fine gravel into the container to anchor the stems.

Many people may have deferred maintenance because their cars mostly sat around in the pandemic. But that creates its own ills.You may have put off going to the doctor, the dentist, getting hair cuts, abandoned your commute and reduced your driving to essential errands during the pandemic. Staying put has most likely made you safer, but you weren’t doing any favors for your car, especially if you were also putting off maintenance.Cars need regular use and upkeep to stay in shape, even if you are barely driving them.Make that: Especially if you’re barely driving them.That said, there is some car maintenance you can delay and some you cannot. The “can” list is shorter, so let’s start with that.Consider miles driven, not time. Maintenance obligations can be loosely divided into two categories: those based on miles driven and those based on time since the last service. One of the chores based on miles is tire rotation, and a car that has barely been used can relax the routine that’s intended to even out the wear on all four tires. Usually, after about 5,000 miles you would move the positions of the tires, like putting the right front tire on the right rear, though the pattern to follow can differ from car to car.Also, while tires deteriorate over time, the past year of diminished use won’t have much affect on that deterioration.You can also relax about the engine coolant and the air and cabin filters, which are all tied to usage. John Ibbotson, the shop supervisor for the auto fleet of Consumer Reports, said that some automakers don’t call for the system to be flushed and new coolant installed until 100,000 miles, or 10 years. He also said the filters should typically be “looked at every 15,000 miles and changed at 30,000.”The general maintenance guidance he relies on is the owner’s manual, but he cautions that the patterns of life in the pandemic have complicated matters. With people driving only short local trips, the typical family car has shifted from normal service to what automakers regard as severe duty. In other words, making those quick hops to the Starbucks may be functionally the equivalent of towing a trailer or pounding down dusty farm roads, as far as your engine’s oil is concerned.Short trips do not bring the engine up to operating temperature, which is necessary to rid the oil of moisture that accumulates in normal use. Nor does the engine coolant circulate and deliver anti-corrosion additives to vital spots. Longer drives also help make sure that vital components like gears and bearings maintain a coating of lubricant.The most important task: changing the oil. If you are not taking longer drives, then you really don’t want to delay changing your oil. It’s the most familiar maintenance task and perhaps the one that is most important to your car’s good health. On an older car, following the owner’s manual mileage recommendation for severe conditions will help to keep the lubricant and its blend of protective additives fresh (if you no longer have the manual, they are often available online and from the automaker). The systems built into many new cars that remind you of required service, like oil changes, take into account the length of trips and will recommend changes based on actual driving.Changing the oil is also the ideal time to look in on other maintenance tasks, including checks of all belts and hoses; while both suffer the effects of engine heat under the hood, they can also develop cracks while the car just sits.Add car batteries to the time list. They have a limited life that’s not based on miles driven. They often start to decline after three years and give up altogether after five to seven.Jill Trotta, a certified technician and vice president for marketing at RepairPal, a website that provides cost estimates and connects car owners with qualified mechanic shops, knows how to properly care for a car. Yet even she let a battery run down past the point where it could be revived with a charge, which is exactly what happened to her 2014 Hyundai Sonata Hybrid when it sat in the driveway for months without being driven during the pandemic.The solution: a low-power battery maintainer, which keeps the charge topped up between drives. Basic ones start at about $25. Keep in mind, too, that while battery replacement is an entirely straightforward swap on most cars, some electronics-intensive models make it more painful. BMWs going back nearly two decades require a registration and programming process, which means added expense and a possible visit to a dealer. It’s worth preventing a dead battery in the first place.Another maintenance task that should not be deferred is replacing the timing belt in engines that use them. The belt turns the camshafts that open the engine’s valves and can cause major engine damage if it fails. Typically good for 80,000 to 100,000 miles of service, the belt can degrade even while sitting, so stick to the automaker’s recommendation on years between renewal.Don’t forget the brakes. A telling sign of a car not being driven is a layer of rust on the brake discs. A light coating is no problem, though it may be noisy for a few blocks; it will be polished off by the first few presses of the brake pedal on a careful drive around the neighborhood.More critical are brake parts you can’t see. The hydraulic fluid that makes the system work absorbs water from the air, potentially reducing stopping power. The fluid can be tested for water, but if it’s visibly dirty have the system flushed and refilled with fluid that meets the specifications in the owner’s manual.Also look for corrosion that can keep the brake calipers, which squeeze the discs to stop the car, from working correctly. If your car doesn’t roll freely at low speeds when driven for the first time in awhile, have the brakes checked immediately — and ideally nearby.One downside to dormancy that doesn’t fall under normal maintenance routines: rodent occupation. Lift the hood to see whether mice or squirrels have taken up residence, a problem that may be more common than you’d think. Clear out any nesting materials or droppings before starting the engine, especially from areas near an exhaust system that will get hot.At the same time, knock off accumulations of dirt, leaves and bird droppings, which can damage the paint. Ms. Trotta suggested a gentle pass with a yard blower; in any case, don’t rub accumulated dirt with a cloth or a brush because the abrasion will leave scratches. You can also rinse the surface with plain water to remove as much as possible. Pay attention to the tracks where a sunroof or the power windows slide, clearing debris that could jam the glass.The yearlong hiatus in regular car use calls for a bit of special attention to the car’s mechanical and cosmetic needs, but for the most part it is not disastrous for every aspect of a car’s well-being. As Covid restrictions loosen around the country and with warmer weather, drivers will be putting their vehicles back into regular service, and there may be a crush at the local shop or dealership. Taking care of deferred maintenance soon may be a smart plan to avoid a wait for service.

The extraordinary move came just days after officials learned the plant had ruined 15 million doses of Johnson & Johnson’s coronavirus vaccine.WASHINGTON — The Biden administration on Saturday put Johnson & Johnson in charge of a troubled Baltimore manufacturing plant that ruined 15 million doses of the Johnson & Johnson coronavirus vaccine and moved to stop the plant from making another vaccine by AstraZeneca, senior federal health officials said.The extraordinary move by the Department of Health and Human Services came just days after officials had learned that Emergent BioSolutions, a contract manufacturer that has been making both the Johnson & Johnson and the AstraZeneca vaccines, mixed up ingredients from the two, which led regulators to delay authorization of the plant’s production lines.By moving the AstraZeneca vaccine out, two senior federal health officials said, the plant can be solely devoted to the Johnson & Johnson single-dose vaccine and avoid future mishaps.The Department of Health and Human Services directed Johnson & Johnson to install a new leadership team to oversee all aspects of production and manufacturing at the Emergent Baltimore plant, the officials said. The company said in a statement that it was “assuming full responsibility” for the vaccine made at the Emergent plant.With President Biden making an aggressive push to have enough doses to cover every adult by the end of May, federal officials are worried that the mix-up will erode public confidence in Covid-19 vaccines. The AstraZeneca vaccine in particular has generated safety concerns; Germany, France and other European nations briefly suspended its use after reports of rare brain blood clots in some vaccine recipients.The ingredient mix-up, and Saturday’s move by the administration, is a significant setback and a public relations debacle for Emergent, a Maryland-based biotech company that has built a profitable business by teaming up with the federal government, primarily by selling its anthrax vaccines to the Strategic National Stockpile.A spokesman for Emergent declined to comment, except to say that the company would continue making AstraZeneca doses until it received a contract modification from the federal government.Unlike Johnson & Johnson, AstraZeneca does not yet have emergency authorization from the Food and Drug Administration for its vaccine. With three federally authorized vaccines (the other two are by Pfizer-BioNTech and Moderna), it is not clear whether the AstraZeneca vaccine, which has had a troubled history with regulators, could even be cleared in time to meet U.S. needs.However, one of the federal officials said the Department of Health and Human Services was discussing working with AstraZeneca to adapt its vaccine to combat new coronavirus variants. AstraZeneca said in a statement that it would work with the Biden administration to find a new site to manufacture its vaccine.So far, none of the Johnson & Johnson doses made by Emergent have been released by the F.D.A. for distribution. Officials have said it may take weeks to sort out whether other batches of vaccine were contaminated and for F.D.A. inspectors to determine whether the Emergent plant can be cleared to release any doses that it has made.The acting F.D.A. commissioner, Dr. Janet Woodcock, said in a statement on Saturday that the agency “takes its responsibility for helping to ensure the quality of manufacturing of vaccines and other medical products for use during this pandemic very seriously.”But she made it clear that the ultimate responsibility would rest with Johnson & Johnson, saying: “It is important to note that even when companies use contract manufacturing organizations, it is ultimately the responsibility of the company that holds the emergency use authorization to ensure that the quality standards of the FDA are met.”In another arrangement brokered by the Biden administration last month, Johnson & Johnson is now working with Merck, one of the world’s biggest vaccine manufacturers. Officials said Merck would help with management of the Baltimore plant.Emergent’s Baltimore plant is one of two that are federally designated as “Centers for Innovation in Advanced Development and Manufacturing” and were built with taxpayer support. Last June, the government paid Emergent $628 million to reserve space there as part of Operation Warp Speed, the Trump administration’s fast-track initiative to develop coronavirus vaccines.Johnson & Johnson and AstraZeneca both contracted with Emergent to use the space. Both vaccines are so-called live viral-vector vaccines, meaning they use a modified, harmless version of a different virus as a vector, or carrier, to deliver instructions to the body’s immune system. The Johnson & Johnson vaccine is administered in one dose, AstraZeneca’s in two doses.Experts in vaccine manufacturing said that in the past, the F.D.A. had a rule to prevent such mishaps by not allowing a plant to make two live viral vector vaccines, because of the potential for mix-ups and contamination.Last month, Mr. Biden canceled a visit to Emergent’s Baltimore plant, and his spokeswoman announced that the administration would conduct an audit of the Strategic National Stockpile, the nation’s emergency medical reserve. Both actions came after a New York Times investigation into how the company had gained outsize influence over the repository.

New research led by investigators at Massachusetts General Hospital (MGH) provides insights on why people with red hair exhibit altered sensitivity to certain kinds of pain. The findings are published in Science Advances.
In people with red hair (as in numerous other species of animals with red fur), the pigment-producing cells of the skin — called melanocytes — contain a variant form of the melanocortin 1 receptor. This receptor sits on the cell surface, and if it becomes activated by circulating hormones called melanocortins, it causes the melanocyte to switch from generating yellow/red melanin pigment to producing brown/black melanin pigment. Earlier work by David E. Fisher, MD, PhD, director of the Mass General Cancer Center’s Melanoma Program and director of MGH’s Cutaneous Biology Research Center, demonstrated that the inability of red-haired individuals to tan or darken their skin pigment is traced to inactive variants of this receptor.
To investigate the mechanisms behind different pain thresholds in red-haired individuals, Fisher and his colleagues studied a strain of red-haired mice that (as in humans) contains a variant that lacks melanocortin 1 receptor function and also exhibits higher pain thresholds.
The team found that loss of melanocortin 1 receptor function in the red-haired mice caused the animals’ melanocytes to secrete lower levels of a molecule called POMC (proopiomelanocortin) that is subsequently cut into different hormones including one that sensitizes to pain and one that blocks pain. The presence of these hormones maintains a balance between opioid receptors that inhibit pain and melanocortin 4 receptors that enhance perception of pain.
In red-haired mice (and therefore, possibly humans), having both hormones at low levels would seemingly cancel each other out. However, the body also produces additional, non-melanocyte-related factors that activate opioid receptors involved in blocking pain. Therefore, the net effect of lower levels of the melanocyte-related hormones is more opioid signals, which elevates the threshold for pain.
“These findings describe the mechanistic basis behind earlier evidence suggesting varied pain thresholds in different pigmentation backgrounds,” says Fisher. “Understanding this mechanism provides validation of this earlier evidence and a valuable recognition for medical personnel when caring for patients whose pain sensitivities may vary.”
Fisher adds that the results suggest new ways to manipulate the body’s natural processes that control pain perception — for example, by designing new medications that inhibit melanocortin 4 receptors involved in sensing pain.
“Our ongoing work is focused on elucidating how additional skin-derived signals regulate pain and opioid signaling,” adds co-lead author Lajos V. Kemény, MD, PhD, a research fellow in Dermatology at MGH. “Understanding these pathways in depth may lead to the identification of novel pain-modulating strategies.”
This work was supported by the National Institutes of Health, the Melanoma Research Alliance, the U.S.-Israel Binational Science Foundation, and the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation.
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Materials provided by Massachusetts General Hospital. Note: Content may be edited for style and length.

Waiting for your turn can be frustrating, especially when it comes to COVID-19 vaccinations. But prioritizing who receives the limited supply of vaccines available saves lives and reduces spread of infection, according to a study published today in the journal PNAS from the University of California, Davis.
While there is mostly universal agreement that older people should be prioritized, debates are currently underway about prioritizing a variety of other groups. Still others argue against targeting at all.
“Prioritization has benefits because people differ in at least two key ways — their risk of infection and the likelihood of serious consequences from infection,” said senior author Michael Springborn, a UC Davis professor in the Department Environmental Studies and an economist focused on environmental risk, including infectious disease. “We know that front-line essential workers have less capacity to socially distance and thus an elevated risk, while seniors are more seriously impacted by infection. Accounting for this substantially increases the benefits of vaccination.”
For the study, the researchers modeled COVID-19 transmission rates and the optimal allocation of an initially limited vaccine supply in the U.S. under a variety of scenarios. They found that deaths, years of life lost and infections were between 17 to 44 percent lower when vaccinations targeted vulnerable populations — particularly seniors and essential workers — rather than an alternative approach where everyone is equally likely to be vaccinated.
“We also found that in regions where there was a faster increase in infections, and where there is less masking and social distancing occurring, targeting was even more important in avoiding those outcomes,” said lead author Jack Buckner, a Ph.D. candidate in the UC Davis Graduate Group in Ecology.
Essential Considerations
Building on the standard approach in modeling analyses to account for age groups, the study is the first to include front-line essential workers as their own category. In doing so, the researchers identified that such workers should be a vaccination priority along with or shortly after seniors. Policies that target based on both age and essential worker status substantially outperformed those that consider age only.

Declining infection rates over all masked a rise in more contagious forms of the coronavirus. Vaccines will stop the spread, if Americans postpone celebration just a bit longer.For weeks, the mood in much of the United States has been buoyant. Cases, hospitalizations and deaths from the coronavirus have fallen steeply from their highs, and millions of people are being newly vaccinated every day. Restaurants, shops and schools have reopened. Some states, like Texas and Florida, have abandoned precautions altogether.In measurable ways, Americans are winning the war against the coronavirus. Powerful vaccines and an accelerating rollout all but guarantee an eventual return to normalcy — to backyard barbecues, summer camps and sleepovers.But it is increasingly clear that the next few months will be painful. So-called variants are spreading, carrying mutations that make the coronavirus both more contagious and in some cases more deadly.Even as vaccines were authorized late last year, illuminating a path to the pandemic’s end, variants were trouncing Britain, South Africa and Brazil. New variants have continued to pop up — in California one week, in New York and Oregon the next. As they take root, these new versions of the coronavirus threaten to postpone an end to the pandemic. At the moment, most vaccines appear to be effective against the variants. But public health officials are deeply worried that future iterations of the virus may be more resistant to the immune response, requiring Americans to queue up for regular rounds of booster shots or even new vaccines.“We don’t have evolution on our side,” said Devi Sridhar, a professor of public health at the University of Edinburgh in Scotland. “This pathogen seems to always be changing in a way that makes it harder for us to suppress.”Seniors wait in line to receive vaccinations in Belford Roxo, Brazil. A variant first found in the country has appeared in North America.Dado Galdieri for The New York TimesHealth officials acknowledge an urgent need to track these new viruses as they crawl across the United States. Already, B.1.1.7, the highly contagious variant that walloped Britain and is wreaking havoc in continental Europe, is rising exponentially in the United States.Limited genetic testing has turned up more than 12,500 cases, many in Florida and Michigan. As of March 13, the variant accounted for about 27 percent of new cases nationwide, up from just 1 percent in early February.The Biden administration has pledged a “down payment” of $200 million to ramp up surveillance, an infusion intended to make it possible to analyze 25,000 patient samples each week for virus variants. It’s an ambitious goal: The country was sequencing just a few hundred samples each week in December, then scaling up to about 9,000 per week as of March 27.Until recently, B.1.1.7’s rise was camouflaged by falling rates of infection over all, lulling Americans into a false sense of security and leading to prematurely relaxed restrictions, researchers say.“The best way to think about B.1.1.7 and other variants is to treat them as separate epidemics,” said Sebastian Funk, a professor of infectious disease dynamics at the London School of Hygiene and Tropical Medicine. “We’re really kind of obscuring the view by adding them all up to give an overall number of cases.”Other variants identified in South Africa and Brazil, as well as some virus versions first seen in the United States, have been slower to spread. But they, too, are worrisome, because they contain a mutation that diminishes the vaccines’ effectiveness. Just this week, an outbreak of P.1, the variant that crushed Brazil, forced a shutdown of the Whistler Blackcomb ski resort in British Columbia.A patient brought into the Royal London Hospital in Britain in January. A surge of infections mostly caused by a more contagious variant was difficult to bring under control. Andy Rain/EPA, via ShutterstockThe world is caught in a sprint between vaccines and variants, and the shots eventually will win, scientists say. But because each infection gives the coronavirus a chance to evolve still further, vaccinations in the United States and elsewhere must proceed as fast as possible.Infections are rising again, driven to an uncertain degree by B.1.1.7 and other variants. Earlier this week, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, pleaded with Americans to continue to practice masking and social distancing, saying she felt a sense of “impending doom.”“We have so much to look forward to — so much promise and potential of where we are and so much reason for hope,” she said. “But right now I’m scared.”‘More infectious for more days’The coronavirus was supposed to be slow to change shape. Like all viruses, it would pick up mutations and evolve into thousands of variants, scientists said at the beginning of the pandemic. But it would not change significantly for years — a stupid virus, some called it.The pathogen defied those predictions. “We expected the virus to change,” said Dr. Michael Diamond, a viral immunologist at Washington University in St. Louis. “We didn’t quite anticipate how quickly it was going to occur.”A variant is of concern only if it is more contagious, causes more severe disease, or blunts the immune response. The variants identified in Britain, South Africa, Brazil and California all fit the criteria.B.1.1.7, the first to come to widespread attention, is about 60 percent more contagious and 67 percent more deadly than the original form of the virus, according to the most recent estimates.The variant is no different from the original in how it spreads, but infected people seem to carry more of the virus and for longer, said Katrina Lythgoe, an evolutionary biologist at the University of Oxford. “You’re more infectious for more days,” she said.So contagious is B.1.1.7 that Britain succeeded in driving down infections only after nearly three months of strict stay-at-home orders, plus an aggressive vaccination program. Even so, cases fell much more slowly than they did during a similar lockdown in March and April.In continental Europe, a wave of B.1.1.7 cases was building for months, mostly unnoticed beneath a steady churn of infections. The variant wave is now cresting.A shopping area in Berlin. Germany’s daily case rate has doubled, triggering a ban on nighttime gatherings in Berlin.Lena Mucha for The New York TimesA doctor vaccinated a staff worker at a hospital in Munich. Much of Europe has been overwhelmed by a more contagious version of the coronavirus called B.1.1.7.Laetitia Vancon for The New York TimesPoland’s rate of daily new cases has quintupled since mid-February, forcing the closure of most public venues. Germany’s has doubled, triggering a ban on nighttime gatherings in Berlin.In France, where B.1.1.7 is causing three-quarters of new infections, some hospitals have had to move coronavirus patients to Belgium to free up beds. Roughly as many people are dying each day from Covid-19 in Europe as were this time a year ago.For too long, government officials disregarded the threat. “Case plateaus can hide the emergence of new variants,” said Carl Pearson, a research fellow at the London School of Hygiene and Tropical Medicine. “And the higher those plateaus are, the worse the problem is.”In the United States, coronavirus infections began a rapid decline in January, soon prompting many state leaders to reopen businesses and ease restrictions. But scientists repeatedly warned that the drop would not last. After the rate bottomed out at about 55,000 cases and 1,500 deaths per day in mid-March, some states — notably Michigan — began seeing an uptick.Since then, the national numbers have steadily risen. As of Saturday, the daily count was up to nearly 69,000, and the weekly average was 19 percent higher than the figure two weeks earlier.Even when cases were falling, researchers questioned the notion that vaccinations were the reason. Millions of Americans are immunized every day, but even now only 31 percent have received a single dose of a vaccine, and just 17 percent of the population have full protection, leaving a vast majority susceptible.“The fact is that we’re still in a position now where we don’t have enough vaccinated people,” said Kristian Andersen, a virologist at the Scripps Research in San Diego. “And if we, like Texas, say we’re done with Covid-19, B.1.1.7 will come in and remind us that we are not right. I have no doubt about it.”A nurse swabbed a patient for coronavirus infection at the Desmond Tutu HIV Foundation Youth Center in Masiphumelele, near Cape Town, South Africa.Joao Silva/The New York TimesVolunteers fumigated a senior citizen center in Soweto, South Africa, in February.Joao Silva/The New York TimesThe variant is particularly pervasive in Florida, where the state lifted restrictions and initially did not see a surge. Officials in other states cited this as a rationale for reopening. But now Florida’s infection rate is curving upward.The variant may only have been obscured by what scientists like to call seasonality. Respiratory infections are usually rare in Florida in the spring, noted Sarah Cobey, an evolutionary biologist at the University of Chicago. Coronavirus infections peaked in Florida last year in the summer, as heat drove people indoors, and may do so again.“I still don’t think we’re out of the woods,” Dr. Cobey said, referring to the country at large. “If we don’t have another wave this spring, then I’m going to be really, really worried about the fall.”While most vaccines are effective against B.1.1.7, researchers are increasingly concerned about other variants that contain a mutation called E484K. (Scientists often refer to it, appropriately, as “Eek.”)This mutation has evolved independently in many variants worldwide, suggesting that it offers the virus a powerful survival advantage.In laboratory studies, the Pfizer-BioNTech and Moderna vaccines seem to be slightly less effective against B.1.351, the variant identified in South Africa. That variant contains the Eek mutation, which seems to enable the virus to partly sidestep the body’s immune response. The vaccines made by Johnson & Johnson, AstraZeneca and Novavax were even less potent against B.1.351.“I think for the next year or two, E484K will be the most concerning” mutation, said Jesse Bloom, an evolutionary biologist at the Fred Hutchinson Cancer Research Center in Seattle.The mutation slightly alters the so-called spike protein sitting on the surface of the coronavirus, making it just a bit harder for antibodies to latch on and destroy the invader.The good news is that the virus seems to have just a few survival tricks in its bag, and that makes it easier for scientists to find and block those defenses. “I’m feeling pretty good about the fact that there aren’t that many choices,” said Michel Nussenzweig, an immunologist at Rockefeller University in New York.The Eek mutation seems to be the virus’s primary defense against the immune system. Researchers in South Africa recently reported that a new vaccine directed against B.1.351 ought to fend off all other variants, as well.Pfizer, BioNTech and Moderna already are testing newly designed booster shots against B.1.351 that should work against any variants known to blunt the immune response.Instead of a new vaccine against variants, however, it may be just as effective for Americans to receive a third dose of the Pfizer-BioNtech or Moderna vaccines in six months to a year, said Dr. Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases.That would keep antibody levels high in each recipient, overwhelming any variant — a more practical strategy than making a specialized vaccine for each new variant that emerges, he said.“My only concern about chasing all the variants is that you’d almost be playing Whac-A-Mole, you know, because they’ll keep coming up and keep coming up,” Dr. Fauci said. In one form or another, the new coronavirus is here to stay, many scientists believe. Multiple variants may be circulating in the country at the same time, as is the case for common cold coronaviruses and influenza. Keeping them at bay may require an annual shot, like the flu vaccine.The best way to deter the emergence of dangerous variants is to keep cases down now and to immunize the vast majority of the world — not just the United States — as quickly as possible. If significant pockets of the globe remain unprotected, the virus will continue to evolve in dangerous new ways.“This might be something that we have to deal with for a long time,” said Rosalind Eggo, an epidemiologist at London School of Hygiene and Tropical Medicine.Still, she added, “Even if it changes again, which it is very likely to do, we are in a better, much stronger position than a year ago to deal with it.”

When Peter Goldin, a 44-year-old communications director, and his husband decided to start a family through in vitro fertilization, they faced mounds of paperwork at the fertility clinic.What should happen to any remaining embryos if one partner dies or becomes mentally incapacitated? Who would decide whether remaining embryos should be donated or destroyed? Who would determine the disposition of remaining embryos in the case of divorce or separation?The couple, who used one embryo to have a daughter, decided that if they broke up, Mr. Goldin would be the one who decided what to do with their one remaining embryo, since it was created with his sperm and a donor egg.But Mr. Goldin said that when he and his husband separated last year, his husband no longer wanted him to have sole authority to determine what would happen to the embryo.“He had forgotten what he had signed at the clinic,” said Mr. Goldin, who, with the help of a lawyer, ultimately gained custody after a month of back and forth.Mr. Goldin, who lives in Richmond, Va., said he would advise couples trying to have a family through I.V.F. to draw up a legal contract detailing each partner’s rights rather than to rely solely on the fertility clinic forms.“Nobody gets married with the intention of getting divorced,” he said. “But it happens, and it happens all the time.”Anyone who has been divorced knows the painful process well: disentangling finances, dividing possessions and mapping out custody arrangements for any children. And in recent years, with the use of artificial reproductive technologies on the rise, more couples have been confronting the even stickier question of what to do with frozen embryos.The issue played out publicly last month when a Los Angeles Superior Court judge ruled against Nick Loeb, the ex-fiancé of the “Modern Family” actress Sofía Vergara, after he sued her for custody of embryos they created while they were together.“It’s so common that now it’s a routine question that I have to ask: Is there any genetic material that we need to talk about?” said Monica Mazzei, a family lawyer at Sideman & Bancroft who represents high net worth clients in Silicon Valley.In the event of divorce, she said, “you’re not together anymore, you probably don’t like each other and if one person is going to use the embryo and have the child, that leaves the other person in an awkward spot.”Several major clinics said that the use of I.V.F. and other fertility treatments had risen during the coronavirus pandemic, with more people reassessing what matters to them.The New York University Langone Fertility Center, one of the busiest in the United States, saw a 30 percent increase in the number of new patients from June to December last year, compared with the same period in 2019. Another clinic, Seattle Reproductive Medicine, saw a 15 percent increase in the number of new patients last year compared with 2019. The National Embryo Donation Center in Knoxville, Tenn., the largest embryo donation clinic in the country, estimates that there are 1 million to 1.3 million frozen embryos in storage, up from about 500,000 to 600,000 a decade ago.“For New Yorkers, they’re actually sitting still,” said Dr. Brooke Hodes-Wertz, a specialist at N.Y.U. Langone Fertility Center.I.V.F. requires self-administering daily injections of fertility drugs, called gonadotropins, for eight to 12 days in order to stimulate the ovaries so that they mature numerous eggs. Next, a doctor guides a needle through the vagina to retrieve the eggs while the patient is under anesthesia. The eggs are then fertilized with sperm in the clinic’s laboratory, and one or more embryos are placed back into the womb, or they can be tested for genetic abnormalities and frozen for a future embryo transfer.I.V.F. can take a physical and emotional toll on patients, but working from home makes it easier. And at the moment, patients can undergo treatment without having to tell colleagues about appointments for blood tests or having to commute to an office, Dr. Hodes-Wertz said.A woman who is not ready for children may decide to freeze just her eggs. But a woman may also decide to fertilize her eggs with a partner’s sperm or a donor’s sperm, since embryos have better survival rates than eggs and will provide more information, such as whether they are healthy enough to be fertilized and begin development, Dr. Hodes-Wertz said. But if you create an embryo together, your genetic material is stuck together.“I see a fair amount of patients that make embryos with their current partners because it’s a benefit from their office,” Dr. Hodes-Wertz said, referring to the increasing number of companies that include fertility treatments in their health insurance plans. “Sometimes if I get a sense that they’re not certain about their relationship, I’ll try to gear them toward eggs, but ultimately, obviously, it’s their decision.” One of her patients froze both embryos with her partner in addition to unfertilized eggs, just in case.For those who fail to plan for the worst, the results can be devastating.Dr. Mimi Lee, a physician-scientist and pianist, said she and her husband froze their embryos before she underwent cancer treatment.Dr. Mimi Lee said that it did not register for her that the form she signed at a fertility clinic was binding.Béatrice de Géa for The New York TimesThey produced five healthy embryos and froze them for when they would be ready to have children. Three years later, when they divorced, Dr. Lee wanted to use the embryos, but her husband sued to prevent her from doing so. The judge upheld the agreement that they had signed at the fertility clinic, saying that the embryos could be brought to term only with the consent of both partners.Dr. Lee, 52, said she did not even remember signing the form at the clinic. “My state of mind at the time was complicated by cancer, being a newlywed and just this hope and opportunity to have children,” she said. “It was unfathomable that that’s what would eventually determine that my last chance of having biological children would be taken away from me.”Richard Vaughn, a partner at the International Fertility Law Group in Los Angeles, said he had seen an increase in the number of people coming into his office for legal advice on frozen embryos. Giving a partner the sole rights to embryos could have emotional and financial consequences, should that partner or ex-partner bring the embryos to full term.He said one recent client called him in a panic after signing documents at a fertility clinic that gave his girlfriend full control of the embryos. “We’ve got this issue of lots and lots of frozen material out there,” Mr. Vaughn said. “People have to figure what to do with them.”Laws governing the disposition of frozen embryos vary from state to state. Judges have generally ruled in favor of the person who does not want to develop the embryo, but in Arizona, for example, the custody of disputed embryos goes to the party who wants to bring them to term.Kathleen Pratt, 36, said that the process of poring over sheafs of legal documents to finalize the use of a surrogate led to several discussions with her husband, William, about what they would do with any remaining embryos if they divorced.Ms. Pratt said her husband initially told her it made more sense to give her custody of remaining embryos — made with a donor egg and her husband’s sperm — because she was unable to have biological children. Then, Ms. Pratt said, she felt he should get to keep the embryos because they contained his genetic material, not hers.Eventually they came to a decision: Neither should keep the embryos. Ms. Pratt, who lives in Charleston, S.C., remembers she and her husband saying to each other, “Why would we raise these babies outside of our family? If things go sour, let’s just call it a day.”They ended up using both embryos to have a daughter in 2019 and a son last year. “I wouldn’t recommend anyone go through this with someone unless your relationship is solid,” she said.

Actor Ruthie Henshall has spoken about her happiness at being able to see her mother, Gloria, again in her care home after restrictions were eased two weeks ago. She can now go into the care home and feed her mother lunch, read to her, or sing her favourite songs. Speaking to BBC Breakfast, she said the improvement in her mum’s condition had been “incredible”.