Publisher Health

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesA single dose of the Pfizer or AstraZeneca vaccine was effective at stopping 62% of coronavirus infections in care homes, a study has found.A team at University College London (UCL) looked at data from 10,000 adults in England with an average age of 86.The research also suggested those who did catch the virus after vaccination may be less infectious.”Our data suggests that both vaccines are effective in frail, older adults,” said UCL’s Dr Maddie Shrotri.The study analysed coronavirus test-result data for 10,412 long-term residents, all aged over 65, at 310 care homes.Highly transmissible variantThe group had routine monthly PCR tests for the virus as well as further targeted tests if an outbreak was suspected. Of the 36,352 tests carried out between December 2020 and mid-March, 1,335 came back positive for the disease.By comparing those with the number of cases before vaccination, the researchers estimated both jabs were effective at preventing 56% of infections after four weeks, rising to 62% after five weeks.Past infection boosts Covid jab response six-foldSlight Covid uptick in secondary school childrenMore than 6,000 ‘lives saved by Covid jabs’The timing and scale of the protective effect was similar for both the Pfizer and AstraZeneca vaccines. “Our findings show that a single dose has an effect that persists from four weeks to at least seven weeks after vaccination,” said Dr Laura Shallcross, a public health medicine consultant at the Institute of Health Informatics at UCL. “We can also infer that the vaccines protect against the highly transmissible UK variant, as this was prevalent during the study period.”Around a quarter of coronavirus deaths in England and Wales have occurred in care homes, according to the latest data from the Office of National Statistics. Other elderly residents are likely to have caught the virus in a home before being transferred to hospital and dying there. Potentially less infectiousAround 11% of care home residents in the study had already been infected with coronavirus in the past.A single dose of either vaccine appeared to have little impact on that group, indicating those with a previous infection were already well-protected. A small proportion did catch the disease in the weeks after being given a single jab. But researchers said laboratory tests on samples from that group suggested they might be less infectious than those who had not yet received a vaccine. “It’s early data but we think that is potentially very significant, especially in a care home setting,” said Dr Shallcross.Although protection from a first dose in the study was described as “substantial”, the research team said a second follow-up shot would still be important to increase the duration of immunity, and to maximise protection that is provided by vaccination.The UCL research, which was funded by the Department of Health and Social Care, is part of the continuing Vivaldi study, investigating Covid-19 infections in care homes.Prof Chris Whitty, Chief Medical Officer for England, said: “These data add to the growing evidence that vaccines are reducing Covid-19 infections and doing so in vulnerable and older populations, where it is most important that we provide as much protection from Covid as possible.”

Chris Adams, 36, has spent the past year of the pandemic living with his grandparents in Wichita, Kan., and being “extremely strict” about social distancing. “I never went out,” he said.But starting Monday, when all adults in Kansas become eligible for the coronavirus vaccine, Mr. Adams plans to find a vaccination site where there is an available appointment. “What I’m looking forward to is seeing my friends again,” he said.Kansas is one of six states — Louisiana, North Dakota, Ohio, Oklahoma and Texas are the others — that are expanding eligibility for the vaccine to all adults on Monday. Minnesota will follow on Tuesday, and Indiana on Wednesday.Gov. Laura Kelly of Kansas urged residents last week to seek out appointments, saying, “With the anticipated increase in supply from the federal government, we must get every dose of vaccine into arms quickly.”Even as vaccine eligibility continues to expand across America — nearly all states have pledged to make every adult eligible by May 1 — the United States has also reported an increase in new cases over the past week. About 75,000 new cases were reported on Friday, a significant increase from the 60,000 added the Friday before.States in the Northeast have accounted for about 30 percent of the nation’s new cases over the past two weeks, up from 20 percent in the first couple of weeks in February.In New York, there has been an average of 8,426 new cases a day, an 18 percent increase from the average two weeks earlier, according to a New York Times database. In New Jersey over the past week, there have been an average of 4,249 new cases reported daily, a 21 percent increase from the average two weeks earlier. And on Friday, Vermont set a single-day case record with 283 new infections; it is the first state to set a case record since Jan. 18.For many, the vaccine cannot come soon enough.Nicole Drum, 42, a writer in the Kansas City, Kan., metro area, cried on Friday when she found out that she would be eligible to get the vaccine as early as Monday. She started calling pharmacies and looking online for available appointments “within minutes of the news breaking,” she said.Ms. Drum called about 10 places without success. She had more luck on a county website, and booked an appointment for Wednesday.She said she planned to wear a special T-shirt saying “I believe in science” to her appointment. “I got myself a fun I’m-getting-the-vaccine outfit,” she said, laughing.She also plans to take her 4-year-old son with her, because she wants him to see “how research and science and people coming together can really help stem these kinds of things,” she said.“I want him to know that there’s no need to be afraid all the time of big scary things, because there are always helpers trying to figure this out,” Ms. Drum said. “While the solution might be something that’s a jab in the arm that hurts a little bit, it’s worth it.”See How the Vaccine Rollout Is Going in Your County and StateSee where doses have gone, and who is eligible for a shot in each state.

She was passionate — and relentless — about making the city she loved navigable for everyone.Edith Prentiss, a fierce and fiery advocate for the disabled who fought to make the city she loved more navigable for everyone, died on March 16 at her home in the Washington Heights neighborhood of Manhattan. She was 69.The cause was cardiopulmonary arrest, her brother Andrew Prentiss said.In 2004, the city’s taxi fleet had only three wheelchair-accessible cabs — minivans with ramps — and people like Ms. Prentiss had a less than one in 4,000 chance of hailing one. “They’re like unicorns,” she told The New York Times that year. “You have to be pure to catch one.”The number of accessible vehicles would eventually inch up to 231, but it took nearly a decade and a class-action lawsuit — of which Ms. Prentiss was a plaintiff — before the city’s Taxi and Limousine Commission agreed to make the fleet 50 percent accessible by 2020. (That deadline was pushed back amid the pandemic and other issues; the fleet is now at 30 percent.)Ms. Prentiss also fought for accessibility on subways and in police stations, restaurants and public parks. And she fought for issues that didn’t affect her directly, like those that might impede people with mental, visual, auditory or other disabilities.When the city held a hearing in 2018 on banning plastic straws, a cause that is a darling of environmentalists but not those in the disability community, she made sure to gather a group and present an opinion. There are those who cannot hold a cup, the group wanted to point out, and straws are essential tools to their visiting a restaurant.At the meeting, group after group testified in favor of the ban. But Ms. Prentiss and her colleagues were not called on.“It’s hard to miss us — most of the people are in wheelchairs,” said Joseph G. Rappaport, executive director of the Brooklyn Center for Independence of the Disabled and the communications and strategy director of the Taxis for All Campaign, of which Ms. Prentiss was the chair, “but it went on and on and finally Edith had had it. She said, ‘Hey, we’re here to speak. We have an opinion about this bill.’” The group was allowed to speak.“She worked the inside, she worked the angles, and if she had to yell, that’s what she did,” Mr. Rappaport added. “And she did it well.”Ms. Prentiss in 2004. She pushed for accessibility on public transportation, and in police stations, restaurants and public parks.Frances Roberts for The New York TimesShe was bristly and relentless and always prepared. Woe to the city officials who had not kept their promise, or done their homework. She knew to an inch the proper length of a ramp, and how high a curb should be cut. She drove her motorized wheelchair as she spoke, with enormous confidence, and sometimes a bit of intentional recklessness; she was not above riding over the toes of those in her way.Among the many New York City officials to issue statements upon Ms. Prentiss’s death were Gale Brewer, the Manhattan borough president, and, in a joint statement, Mayor Bill de Blasio and Victor Calise, commissioner of the Mayor’s Office for People with Disabilities.In May, Ms. Prentiss will be inducted into the New York State Disability Rights Hall of Fame, and Mr. Calise will appear at the virtual ceremony in her place.“She was brilliant,” Ms. Brewer said in a phone interview. “She took no prisoners. She dispensed with the niceties, but her heart was so generous.”Edith Mary Prentiss was born on Feb. 1, 1952, in Central Islip, N.Y., on Long Island. She was one of six children (and the only daughter) of Robert Prentiss, an electrician, and Patricia (Greenwood) Prentiss, a social worker. Edith was asthmatic, and later diabetic. She began using a wheelchair once her asthma became severe when she was in her late 40s.After earning a degree in sociology from Stony Brook University on Long Island, she attended the College of Arts and Science at Miami University in Oxford, Ohio.Early in her career, Ms. Prentiss was an outreach caseworker for ARC XVI Fort Washington, a senior services center. Working from the Port Authority Bus Terminal, she conducted blood pressure screenings and helped older people apply for city services and other benefits. She later worked with Holocaust survivors. Fern Hertzberg, the executive director of ARC, said Ms. Prentiss’s last job, before she retired in about 2006, was with a physical therapy center in her neighborhood.Ms. Prentiss was president of the 504 Democratic Club, which focuses on disability rights, and held positions with many other advocacy groups.She wasn’t known just for her bullying ways. Years ago, Susan Scheer, now chief executive of the Institute for Career Development, an employment and training group for the disabled, was a New York City government official, and she met Ms. Prentiss in the usual way: being yelled at in various hearings. Yet when Ms. Scheer, who has spina bifida, began using a wheelchair about a decade ago, she called Ms. Prentiss for help. She realized she had no idea how to navigate from her East Village apartment to her job at City Hall by bus.Ms. Prentiss in 2019 in a scene from the forthcoming documentary “Edith Prentiss: Hell on Wheels.” Arlene Schulman“Don’t worry,” she recalled Ms. Prentiss saying. “I’m on my way.” (It did take a while, with the usual impediments, like broken subway elevators.)Once there, Ms. Prentiss led Ms. Scheer out of her building and through the snarls of traffic on 14th Street, blocking the vehicles that menaced them, as she coached Ms. Scheer through her first bus launch, which was rocky. As she ping-ponged down the aisle, she ran over the driver’s toes. “Not your problem,” Ms. Prentiss called out behind her.Ms. Prentiss then directed the less-than-enthusiastic driver to secure Ms. Scheer’s chair (drivers are not always diligent about this step). And as the passengers groaned and rolled their eyes, Ms. Scheer said, Ms. Prentiss stared them down and announced: “We are learning here, folks. Let’s be patient.”In her extensive travels, her brother Andrew said, Ms. Prentiss had many traffic accidents and was hit by numerous vehicles, including taxis, a city bus and a FedEx truck. She was often in the emergency room, but if there was a community board meeting or a city hearing, she made sure to phone in from the hospital.In addition to her brother Andrew, Ms. Prentiss is survived by her other brothers, Michael, Robert Anthony, William John and David Neil.In early January, Ms. Prentiss received her first dose of the Covid-19 vaccine at the Fort Washington Armory. Needless to say, she had some complaints, as she told Ms. Hertzberg: The pencils to fill out the health questionnaire were the kind known as golf pencils, and too small for people with certain manual disabilities. The typeface on the questionnaire wasn’t big enough. And the chairs set out in the post-vaccination waiting area had no arms, which many people need as an aid to stand up with. She called the hospital that was administering the program there — and, Ms. Hertzberg said, you can be sure that it didn’t take long for the problems to be fixed.For the last three years, Arlene Schulman, a photographer, writer and filmmaker, has been working on a documentary called “Edith Prentiss: Hell on Wheels,” a title its subject initially quibbled with. She didn’t think it was strong enough.

In the face of limited transportation, patchy internet service and threadbare medical care, community leaders in Alabama and Mississippi are trying to shrink the racial disparities in vaccine access.PANOLA, Ala. — The dog-eared trailer that serves as the only convenience store within 20 miles of this blink-and-you-miss-it rural hamlet, population 144, is more than a place to stock up on life’s essentials. These days the store — or more precisely its proprietor, Dorothy Oliver — has become an unofficial logistics hub for African-American residents seeking the coronavirus vaccine.Even as vaccine supplies in Alabama have become more plentiful, Ms. Oliver’s neighbors, many of them older and poor, lack the smartphones and internet service needed to book appointments. And if they manage to secure a slot, they may not have a way to get to distant vaccination sites.Ms. Oliver helps her neighbors snag appointments online and matches them with those willing to make the 45-minute drive to Livingston, the seat of Sumter County and the nearest town offering inoculations. Nearly three-quarters of the residents of the county, which includes Panola, are African-American.“We’ve got to fend for ourselves because no one else is going to help us,” said Ms. Oliver, 68, a loquacious retired office administrator who spends many of her waking hours on the phone. “That’s the way it’s always been for poor Black people living in the country.”Across the Southern states, Black doctors, Baptist preachers and respected community figures like Ms. Oliver are trying to combat lingering vaccine skepticism while also helping people overcome logistical hurdles that have led to a troubling disparity in vaccination rates between African-Americans and whites.Though local leaders have made headway combating the hesitancy, they say the bigger obstacles are structural: the large stretches of Alabama and Mississippi without an internet connection or reliable cellphone service, the paucity of medical providers, and a medical establishment that has long overlooked the health care needs of African-Americans.As it is, this region has some of the worst health outcomes in the country, and the coronavirus pandemic has disproportionately hit African-Americans, who have been dying at twice the rate of whites.The General Store, run by Ms. Oliver, a retired bookkeeper. The store serves as a logistics hub for people seeking to get vaccinated but unsure of how to do so.Abdul Aziz for The New York TimesDrucilla Russ-Jackson, left, a Sumter County commissioner, encouraged customers at the M&M Market in Geiger, Ala., to get vaccinated.Abdul Aziz for The New York TimesAlabama is one of the few states that does not require vaccine providers to report data on race, but health officials estimate that just 15 percent of the shots have gone to African-Americans, who make up 27 percent of Alabama’s population and 31 percent of all deaths from Covid-19. Whites, who make up 69 percent of residents, have received 54 percent of the vaccine supply, according to the state data, which is missing details on race for a quarter of vaccine recipients.In Mississippi, 40 percent of Covid-19 deaths have occurred among African-Americans — a figure comparable to their portion of the population — but just 29 percent of the vaccines have gone to Black residents compared with 62 percent for whites, who make up nearly 60 percent of the state’s population.The disparities have prompted a flurry of ad hoc organizing across the South that mirrors the increasingly robust get-out-the-vote efforts, which are aimed at surmounting state voting restrictions that critics say dampen minority turnout.In Cleveland, Miss., Pam Chatman, a retired television journalist has been dispatching rented minibuses to ferry older residents to vaccination sites far from their rural homes. In nearby Greenville, the Rev. Thomas Morris uses his weekly Zoom sermons to assuage the concerns of vaccine skeptics — and then offers up church volunteers who book appointments for the flip phone set. And in central Alabama, Dr. John B. Waits, who oversees a constellation of nonprofit health clinics serving the poor, has been sending out mobile vaccinators to reach the homebound and the homeless.Pam Chatman, a retired television journalist and organizer who started the Vaccine Transportation Initiative, which arranges rides to ferry older people to vaccination sites.Rory Doyle for The New York TimesMedical staff waited for patients to arrive at a drive-through site in Cleveland, Miss.Rory Doyle for The New York Times“It’s all hands on deck because this is a life-and-death situation,” said Dr. Vernon A. Rayford, a pediatrician and internal medicine doctor in Tupelo, Miss. Dr. Rayford said he had been disappointed by the state’s reliance on a web-based appointment system and drive-through vaccination sites that are clustered in urban areas and white neighborhoods. Although those without internet access can call a state-run number for help booking appointments, many of his patients, he said, give up after spending long stretches on hold. Instead, he encourages them to call his wife, Themesha, who in recent weeks has made more than 100 online appointments on her laptop.Since returning home to Tupelo eight years ago after a medical residency in Boston, Dr. Rayford said he had been frustrated by the dearth of health care options and entrenched poverty that saddles African-American residents with some of the highest rates of infant mortality, heart disease and diabetes in the country. Mississippi and Alabama are among the dozen states whose Republican-led governments have rejected Medicaid expansion under the Affordable Care Act.“Until we get a better system, we have to come up with these workarounds, but it gets really tiring,” Dr. Rayford said.Public health experts say the $6 billion for community vaccination sites included in President Biden’s recently passed relief package will go a long way to addressing the problem, and officials in Mississippi and Alabama say they have made considerable progress over the past month in narrowing the racial gap in vaccinations. They say they are expanding vaccine distribution to community clinics and expect access to accelerate alongside increasing supplies of the vaccine made by Johnson & Johnson, which needs only one dose and can be kept at normal refrigeration temperatures, making it easier to distribute in rural areas.Dr. Thomas Dobbs, Mississippi’s top health official, said 38 percent of all vaccines administered in the second week of March had gone to African-Americans, a milestone he said was accomplished with the help of local organizations. “The options are increasing very quickly and pretty soon people are not going to have to go to a drive-through site,” he said during a news conference last week.Dr. Karen Landers, Alabama’s assistant state health officer, noted that last week, the Centers for Disease Control and Prevention ranked Alabama among the top 10 states that have vaccinated vulnerable residents — a category that includes racial and ethnic minorities and the economically disadvantaged. But she added that the overwhelmingly rural composition of the state had made the task daunting given Alabama’s limited resources.“We listen to the criticism, and we are certainly trying to take any elements of truth that are in that criticism so we can better serve our citizens,” Dr. Landers said in an interview.Still, the logistical challenges remain stark in rural areas of the Deep South, where years of spending cutbacks and a lack of jobs have made life more difficult for the shrinking number of people left behind.Frances Ford, a registered nurse, has been organizing vaccine appointments in Perry County, Ala., a largely African-American county of 10,000, just north of Selma, where more than a third of all households live in poverty. Ms. Ford, who runs the nonprofit organization Sowing Seeds of Hope, said many older residents were terrified of medical emergencies, even more so at night, given that there are just two ambulances to serve the county’s 720-square miles. The closest critical care hospital, in Tuscaloosa, is nearly 60 miles away.Those who don’t drive and need routine medical care have to rely on a single van operated by the state to take them to dialysis appointments or to see a cardiologist.“We’ve had car accidents where people waited two hours,” Ms. Ford said. She recalled watching in horror three years ago as a woman who had suffered a heart attack at a funeral died before she could get medical care.Cora Toliver climbed onto a bus to be transported to a coronavirus vaccination site in Shaw, Miss.Rory Doyle for The New York TimesWillie Lewis received a vaccine on a minibus at the Cleveland drive-through site.Rory Doyle for The New York TimesThe paucity of health care resources affects much of Alabama. Over the past decade, state budget cuts have led to a 35 percent reduction in staffing at county health departments: Nearly half of them have either one nurse on staff or none at all, according to Jim Carnes, policy director of the advocacy group Alabama Arise, citing internal state data.“Our approach to rural health care has been shameful,” said Mr. Carnes, policy who has been pushing the state to make low-income homebound residents a top priority for vaccination.Dr. Waits, the chief executive of Cahaba Medical Care, which runs 17 clinics in underserved communities across central Alabama, said the state’s ailing public health infrastructure and a severe shortage of health care professionals had made it harder to distribute vaccines to the rural poor. He added that state officials, chastened by news media accounts that have highlighted the racial disparities in vaccine distribution, had begun funneling more doses his way.Dr. Waits is hiring 34 people to help with the logistics and paperwork needed to expand vaccinations — money Cahaba hopes to partially recoup through federal aid — but he says his clinics are still woefully understaffed. “We’ve got more vaccines then we can push out in a day,” he said. “I need more people, or I need money to hire more people.”The lack of qualified vaccinators is also a problem in Sumter County, where Ms. Oliver, the convenience store owner, lives. The pharmacy nearest to Panola that offers vaccines, Livingston Drug, has a waiting list with 400 names. Unlike the nearby county health department, which dispenses vaccines one day a week, the pharmacy has a prodigious supply of vaccines but its owner, Zach Riley, is the only person on staff who can administer inoculations, which he does two dozen times a day between answering the phone, filling prescriptions, restocking the shelves.“We’ve been flooded with calls but there’s only so much I can do I on my own,” he said before excusing himself to tend to Hasty Robinson, 73, who was coming in for her first dose after a monthlong wait. “At the rate we’re going, it might take until the end of August to get everyone vaccinated.”Zach Riley, owner, operator and pharmacist at Livingston Drug in Sumter County, Ala. “We’ve been flooded with calls but there’s only so much I can do I my own,” he said.Abdul Aziz for The New York TimesAfter he heard about a chance to get a vaccine, James Cunningham said, “to be honest, I didn’t even know where to begin.” Abdul Aziz for The New York TimesAfter months of agitation by local elected officials, the state health authorities recently announced that they would use the National Guard to stage a mass vaccination event at a park in Livingston. For Drucilla Russ-Jackson, 72, an African-American district leader in Sumter County, it was a vindication of her efforts to prod the state into action. Armed with a stack of fliers, she spent much of last week navigating the county’s rutted back roads to reach constituents spread across the cotton fields and the pine forests.At the M&M Market, one of the few gas stations in the area, she strong-armed customers like James Cunningham, 71, a retired truck driver who doesn’t own a cellphone or a computer, and who lives with his 87-year-old mother.“To be honest, I didn’t even know where to begin,” he said of his reaction after Ms. Russ-Jackson told him about the one-day vaccination juggernaut, which was scheduled for the following Tuesday, on March 23.The event, it turns out, illustrates the difficulty of the mission. At the end of the day, more than half of the 1,100 doses were left unused. Ms. Russ-Jackson said turnout might have been dampened by the rain. Or perhaps it was the resistance of older residents, scarred by the government-run Tuskegee syphilis experiments in eastern Alabama.Or maybe it was the drive-through vaccination site, given that the state had not arranged transportation for those without cars.“To be honest, we need to bring these vaccines out to the people and I’m going to be asking the state to do that,” Ms. Russ-Jackson said with a sigh. “We’re making progress, but we still have a long way to go.”

In the face of limited transportation, patchy internet service and threadbare medical care, community leaders in Alabama and Mississippi are trying to shrink the racial disparities in vaccine access.PANOLA, Ala. — The dog-eared trailer that serves as the only convenience store within 20 miles of this blink-and-you-miss-it rural hamlet, population 144, is more than a place to stock up on life’s essentials. These days the store — or more precisely its proprietor, Dorothy Oliver — has become an unofficial logistics hub for African-American residents seeking the coronavirus vaccine.Even as vaccine supplies in Alabama have become more plentiful, Ms. Oliver’s neighbors, many of them older and poor, lack the smartphones and internet service needed to book appointments. And if they manage to secure a slot, they may not have a way to get to distant vaccination sites.Ms. Oliver helps her neighbors snag appointments online and matches them with those willing to make the 45-minute drive to Livingston, the seat of Sumter County and the nearest town offering inoculations. Nearly three-quarters of the residents of the county, which includes Panola, are African-American.“We’ve got to fend for ourselves because no one else is going to help us,” said Ms. Oliver, 68, a loquacious retired office administrator who spends many of her waking hours on the phone. “That’s the way it’s always been for poor Black people living in the country.”Across the Southern states, Black doctors, Baptist preachers and respected community figures like Ms. Oliver are trying to combat lingering vaccine skepticism while also helping people overcome logistical hurdles that have led to a troubling disparity in vaccination rates between African-Americans and whites.Though local leaders have made headway combating the hesitancy, they say the bigger obstacles are structural: the large stretches of Alabama and Mississippi without an internet connection or reliable cellphone service, the paucity of medical providers, and a medical establishment that has long overlooked the health care needs of African-Americans.As it is, this region has some of the worst health outcomes in the country, and the coronavirus pandemic has disproportionately hit African-Americans, who have been dying at twice the rate of whites.The General Store, run by Ms. Oliver, a retired bookkeeper. The store serves as a logistics hub for people seeking to get vaccinated but unsure of how to do so.Abdul Aziz for The New York TimesDrucilla Russ-Jackson, left, a Sumter County commissioner, encouraged customers at the M&M Market in Geiger, Ala., to get vaccinated.Abdul Aziz for The New York TimesAlabama is one of the few states that does not require vaccine providers to report data on race, but health officials estimate that just 15 percent of the shots have gone to African-Americans, who make up 27 percent of Alabama’s population and 31 percent of all deaths from Covid-19. Whites, who make up 69 percent of residents, have received 54 percent of the vaccine supply, according to the state data, which is missing details on race for a quarter of vaccine recipients.In Mississippi, 40 percent of Covid-19 deaths have occurred among African-Americans — a figure comparable to their portion of the population — but just 29 percent of the vaccines have gone to Black residents compared with 62 percent for whites, who make up nearly 60 percent of the state’s population.The disparities have prompted a flurry of ad hoc organizing across the South that mirrors the increasingly robust get-out-the-vote efforts, which are aimed at surmounting state voting restrictions that critics say dampen minority turnout.In Cleveland, Miss., Pam Chatman, a retired television journalist has been dispatching rented minibuses to ferry older residents to vaccination sites far from their rural homes. In nearby Greenville, the Rev. Thomas Morris uses his weekly Zoom sermons to assuage the concerns of vaccine skeptics — and then offers up church volunteers who book appointments for the flip phone set. And in central Alabama, Dr. John B. Waits, who oversees a constellation of nonprofit health clinics serving the poor, has been sending out mobile vaccinators to reach the homebound and the homeless.Pam Chatman, a retired television journalist and organizer who started the Vaccine Transportation Initiative, which arranges rides to ferry older people to vaccination sites.Rory Doyle for The New York TimesMedical staff waited for patients to arrive at a drive-through site in Cleveland, Miss.Rory Doyle for The New York Times“It’s all hands on deck because this is a life-and-death situation,” said Dr. Vernon A. Rayford, a pediatrician and internal medicine doctor in Tupelo, Miss. Dr. Rayford said he had been disappointed by the state’s reliance on a web-based appointment system and drive-through vaccination sites that are clustered in urban areas and white neighborhoods. Although those without internet access can call a state-run number for help booking appointments, many of his patients, he said, give up after spending long stretches on hold. Instead, he encourages them to call his wife, Themesha, who in recent weeks has made more than 100 online appointments on her laptop.Since returning home to Tupelo eight years ago after a medical residency in Boston, Dr. Rayford said he had been frustrated by the dearth of health care options and entrenched poverty that saddles African-American residents with some of the highest rates of infant mortality, heart disease and diabetes in the country. Mississippi and Alabama are among the dozen states whose Republican-led governments have rejected Medicaid expansion under the Affordable Care Act.“Until we get a better system, we have to come up with these workarounds, but it gets really tiring,” Dr. Rayford said.Public health experts say the $6 billion for community vaccination sites included in President Biden’s recently passed relief package will go a long way to addressing the problem, and officials in Mississippi and Alabama say they have made considerable progress over the past month in narrowing the racial gap in vaccinations. They say they are expanding vaccine distribution to community clinics and expect access to accelerate alongside increasing supplies of the vaccine made by Johnson & Johnson, which needs only one dose and can be kept at normal refrigeration temperatures, making it easier to distribute in rural areas.Dr. Thomas Dobbs, Mississippi’s top health official, said 38 percent of all vaccines administered in the second week of March had gone to African-Americans, a milestone he said was accomplished with the help of local organizations. “The options are increasing very quickly and pretty soon people are not going to have to go to a drive-through site,” he said during a news conference last week.Dr. Karen Landers, Alabama’s assistant state health officer, noted that last week, the Centers for Disease Control and Prevention ranked Alabama among the top 10 states that have vaccinated vulnerable residents — a category that includes racial and ethnic minorities and the economically disadvantaged. But she added that the overwhelmingly rural composition of the state had made the task daunting given Alabama’s limited resources.“We listen to the criticism, and we are certainly trying to take any elements of truth that are in that criticism so we can better serve our citizens,” Dr. Landers said in an interview.Still, the logistical challenges remain stark in rural areas of the Deep South, where years of spending cutbacks and a lack of jobs have made life more difficult for the shrinking number of people left behind.Frances Ford, a registered nurse, has been organizing vaccine appointments in Perry County, Ala., a largely African-American county of 10,000, just north of Selma, where more than a third of all households live in poverty. Ms. Ford, who runs the nonprofit organization Sowing Seeds of Hope, said many older residents were terrified of medical emergencies, even more so at night, given that there are just two ambulances to serve the county’s 720-square miles. The closest critical care hospital, in Tuscaloosa, is nearly 60 miles away.Those who don’t drive and need routine medical care have to rely on a single van operated by the state to take them to dialysis appointments or to see a cardiologist.“We’ve had car accidents where people waited two hours,” Ms. Ford said. She recalled watching in horror three years ago as a woman who had suffered a heart attack at a funeral died before she could get medical care.Cora Toliver climbed onto a bus to be transported to a coronavirus vaccination site in Shaw, Miss.Rory Doyle for The New York TimesWillie Lewis received a vaccine on a minibus at the Cleveland drive-through site.Rory Doyle for The New York TimesThe paucity of health care resources affects much of Alabama. Over the past decade, state budget cuts have led to a 35 percent reduction in staffing at county health departments: Nearly half of them have either one nurse on staff or none at all, according to Jim Carnes, policy director of the advocacy group Alabama Arise, citing internal state data.“Our approach to rural health care has been shameful,” said Mr. Carnes, policy who has been pushing the state to make low-income homebound residents a top priority for vaccination.Dr. Waits, the chief executive of Cahaba Medical Care, which runs 17 clinics in underserved communities across central Alabama, said the state’s ailing public health infrastructure and a severe shortage of health care professionals had made it harder to distribute vaccines to the rural poor. He added that state officials, chastened by news media accounts that have highlighted the racial disparities in vaccine distribution, had begun funneling more doses his way.Dr. Waits is hiring 34 people to help with the logistics and paperwork needed to expand vaccinations — money Cahaba hopes to partially recoup through federal aid — but he says his clinics are still woefully understaffed. “We’ve got more vaccines then we can push out in a day,” he said. “I need more people, or I need money to hire more people.”The lack of qualified vaccinators is also a problem in Sumter County, where Ms. Oliver, the convenience store owner, lives. The pharmacy nearest to Panola that offers vaccines, Livingston Drug, has a waiting list with 400 names. Unlike the nearby county health department, which dispenses vaccines one day a week, the pharmacy has a prodigious supply of vaccines but its owner, Zach Riley, is the only person on staff who can administer inoculations, which he does two dozen times a day between answering the phone, filling prescriptions, restocking the shelves.“We’ve been flooded with calls but there’s only so much I can do I on my own,” he said before excusing himself to tend to Hasty Robinson, 73, who was coming in for her first dose after a monthlong wait. “At the rate we’re going, it might take until the end of August to get everyone vaccinated.”Zach Riley, owner, operator and pharmacist at Livingston Drug in Sumter County, Ala. “We’ve been flooded with calls but there’s only so much I can do I my own,” he said.Abdul Aziz for The New York TimesAfter he heard about a chance to get a vaccine, James Cunningham said, “to be honest, I didn’t even know where to begin.” Abdul Aziz for The New York TimesAfter months of agitation by local elected officials, the state health authorities recently announced that they would use the National Guard to stage a mass vaccination event at a park in Livingston. For Drucilla Russ-Jackson, 72, an African-American district leader in Sumter County, it was a vindication of her efforts to prod the state into action. Armed with a stack of fliers, she spent much of last week navigating the county’s rutted back roads to reach constituents spread across the cotton fields and the pine forests.At the M&M Market, one of the few gas stations in the area, she strong-armed customers like James Cunningham, 71, a retired truck driver who doesn’t own a cellphone or a computer, and who lives with his 87-year-old mother.“To be honest, I didn’t even know where to begin,” he said of his reaction after Ms. Russ-Jackson told him about the one-day vaccination juggernaut, which was scheduled for the following Tuesday, on March 23.The event, it turns out, illustrates the difficulty of the mission. At the end of the day, more than half of the 1,100 doses were left unused. Ms. Russ-Jackson said turnout might have been dampened by the rain. Or perhaps it was the resistance of older residents, scarred by the government-run Tuskegee syphilis experiments in eastern Alabama.Or maybe it was the drive-through vaccination site, given that the state had not arranged transportation for those without cars.“To be honest, we need to bring these vaccines out to the people and I’m going to be asking the state to do that,” Ms. Russ-Jackson said with a sigh. “We’re making progress, but we still have a long way to go.”

Have you been “zombie eating” during the pandemic? If you put down your phone or turn off the TV, you might enjoy your food a bit more.If you have found yourself over the past year increasingly eating dinner in front of the TV, or scrolling endlessly through your phone over breakfast, you certainly are not alone.“Quarantine permissiveness” is what Susan Albers, a psychologist at the Cleveland Clinic and a best-selling author who focuses on mindful eating, calls the nearly universal phenomenon of allowing yourself bad habits during the pandemic.But it may be time to consider a return to the table.It doesn’t have to be fancy or elaborate, but setting a nice table can encourage you to sit down and eat with your family, roommates or even solo with a good book.“Eating should be an experience and something you enjoy,” Dr. Albers said. “You don’t have to take a lot of time to eat, but when you do it, give it your full attention.” That means putting your phone away and sitting at the table.“Your phone should not be your dining companion,” said Dr. Albers, who calls that familiar habit of eating with one hand and scrolling with the other “zombie eating.” But she acknowledges that sitting at the table instead of in front of the TV, or eating without scrolling on your phone can feel like daunting tasks, because “it’s hard to unlink those two behaviors when you’ve done them day after day.” This can be especially difficult if you’re working from home during the pandemic, or if you feel that eating on the sofa while binge-watching a show is a sort of reward for making it through another hard day.The good news is that sitting down and eating meals at the table doesn’t have to be a chore. When you reframe mealtimes as special parts of the day, a time to connect with loved ones or to unwind alone, they become something to look forward to.Fallon Carter, an event planner based in New York City, recently bought a new dining table. She has found that sitting down to proper meals during the pandemic has been a great way to connect with herself. “When you set the space and set the zone,” she said, “you can turn any place into something special,” she said.Nothing about dining at a table has to be fussy, but a little effort can go a long way toward making the experience enjoyable. Ms. Carter added a floral arrangement to her dining table, with flowers she bought at Trader Joe’s. “It wasn’t a big lift,” she said, laughing, but it made the space feel more inviting. She also suggests using cloth napkins and proper glassware and acquiring a set of dishes that you really love.Many people have leaned into cooking during the pandemic, and setting the table is a great way to honor the work that goes into preparing a meal. Even if you prefer takeout or microwave dinners, the advantages of setting a table still apply. No matter how you get your meal, you can always transfer it to proper dishes.There are lots of good reasons to sit at the table for meals, but don’t stress yourself out. Meals are meant to be enjoyed. Ms. Fallon suggests even getting a little fancy with your table if you want.“Don’t save the good stuff! You deserve the good stuff. We’ve been in a pandemic!”5 easy steps to make mealtimes special:Set the table with cloth napkins, flatware, glassware and dishes that you love.Add candles, flowers or something decorativeKeep the TV off and your phone and laptop in another room.Sit with your feet on the floor and your back against the chair (as you would in a restaurant).Relax and enjoy your food!

After a year spent social distancing, mask wearing and sheltering in place, the prospect of readjusting to in-person social engagements can be a daunting one.As the days grow warmer and vaccination shots reach more arms, you may be looking ahead to getting out and about. An Axios-Ipsos poll released this month found that “the number of Americans engaging in social interactions outside the home is increasing.” And the Centers for Disease Control and Prevention recently issued new recommendations that individuals who have been vaccinated against the coronavirus can start to gather in small groups, without masks, offering a measure of hope in particular to those who have missed the intimacy of double dates and dinner parties.But after a year spent internalizing public health precautions for social distancing and mask-wearing, the prospect of readjusting to in-person social engagements may be a daunting one. For many, it provokes a sense of profound discomfort, apprehension or ambivalence.“It’s a new version of anxiety,” said Dr. Lucy McBride, an internist in Washington who writes a newsletter about managing the coronavirus crisis. You may discover that your continuing concerns about the virus are colliding with a new set of worries about seeing others more regularly: What am I comfortable with? How do I act? What do I say?“There’s two feelings that are continuing to exist for me,” said Allison Harris-Turk, 46, an events and communications consultant and mother of three in San Diego. Mrs. Harris-Turk created the Facebook group Learning in the Time of Corona, where many among the roughly 16,700 members are discussing the pros and cons of re-entry. “There’s the excitement and the optimism and the hope, and then there’s also the grief and the trauma and ‘oh, my goodness, how are we going to recover from this?’”Here’s how some individuals and experts are starting to think about closing the social distance.Start small.Though you may be chafing at the confines of the lockdown, remember that it’s still not entirely safe to resume social activities as before. Across most of the country, the risk of coronavirus transmission remains high.If you’re wary of re-entry, begin with a lower-stakes outing. “It’s like little baby steps getting back into it,” said Dr. David Hilden, a Minneapolis-based internist who hosts a weekly radio show during which he answers listeners’ pandemic questions. He’s observed this firsthand: Earlier this month, he met up with a friend to share a beer for the first time since the onset of the pandemic. “Now that we’ve dipped our toe in the water, a lot of Zoom meetings end with, ‘Hey, I think we can get together now,’” he said.Understand that hanging out might take more effort.After receiving her first shot of a coronavirus vaccine, Aditi Juneja, a New York-based lawyer, expected to feel the same flood of relief that some of her peers had described after getting theirs. While on the phone with a friend, she started to consider future late nights and travel to far-off destinations. “I was like, ‘Man, I want to dance on bars,’” Ms. Juneja, 30, said. “There was a euphoria about imagining the possibilities.”But after 10 minutes, she found even the fantasy versions of these scenarios exhausting. The reality can be, too; she described the sensory overload and disorientation she felt while dining outdoors with a friend for the first time in months. “I think our ability to take inputs has really lowered,” Ms. Juneja said.This is especially true for individuals suffering from social anxiety, for whom the lockdowns have offered some relief, and for whom reopening presents new stressors. But even extroverts may experience an adjustment period as our brains adapt to planning and monitoring responses to unfamiliar situations. At the beginning of the pandemic, people had to change their behaviors to comply with social distancing, mask-wearing and sheltering in place. But learning those new behaviors — and now, relearning old ones — can take a cognitive toll.“Social settings are particularly demanding,” said David Badre, the author of the book “On Task: How Our Brain Gets Things Done” and a professor of cognitive, linguistic and psychological sciences at Brown University. “When we have to really focus and plan what we’re doing, that comes with an experience of mental effort,” he continued. “It feels like a mental fatigue.”There is good news, however: You’ll most likely find it easier to relearn old behaviors than learn entirely new ones. “The key is to not avoid that effort,” Dr. Badre said. “By re-engaging, you will get used to it again.”Set boundaries for yourself.Though the past month has seen a spate of reopenings across the country, some scenarios might still set off a siren in your head. And because these facilities are open, doesn’t mean you need to go.But what if a friend or family member does want to see a movie, or dine out? If you express disagreement over what is safe, you might feel as though you are implying your companions are less responsible or unethical.Sunita Sah, a professor at University of Cambridge and Cornell University has researched this phenomenon, which she calls “insinuation anxiety.” In studies, Dr. Sah has found that patients frequently follow medical advice from their doctor even if they believe their doctor to have a conflict of interest, and that job candidates often answer interview questions they know are illegal to ask. These reactions come partly out of concern that to disagree would suggest the other person — the doctor or the job interviewer — is not trustworthy.A similar situation can play out if you’re confronted with someone whose attitude toward public-health protocols differs from your own. Dr. Sah’s research has shown that when individuals have the opportunity to weigh their decisions in private, they are less likely to experience this anxiety and do something that makes them uncomfortable. She recommended writing down the boundaries that you would like to adhere to and taking time before agreeing to someone else’s plan.“Assess your own risk level and comfort,” Dr. Sah said, “so you’re very clear about what you would and would not like to do.” This will also provide you with a clear document of how your comfort levels are changing over time as you readjust.Brace for tough conversations.Over the past year, public-health guidance often wildly varied on federal, state and even city levels, with some areas flinging open their doors while experts still advised caution. This has also been reflected in interpersonal relationships. It’s created friction between couples, families and friends, and prompted individuals to ask challenging, sometimes seemingly intrusive questions. Now, you may be adding “Are you vaccinated?” to that list. (On Twitter, one woman recently proposed “re-entry doulas” to help families navigate conversations about setting boundaries.)Still, it will continue to be important to have these conversations in the coming months. “This isn’t abstract,” said Marci Gleason, an associate professor in the Department of Human Development and Family Sciences at the University of Texas at Austin whose lab has been surveying relationships in quarantine. “It comes directly to the question of whether we can socialize with others or not, in the way that they want to.” Sometimes, it can feel like a proxy battle over how much you value each other’s friendship. Be open about your own fears and vulnerabilities, and make it clear that when you disagree, you’re expressing your own preference and not rejecting the other person. Keep it simple, too, especially with friends or relatives with whom you don’t frequently have emotional, candid talks.This empathy and candor will also be an asset if you find that your friends and peers have developed the tendency to over share, either out of anxiety or being starved for conversation. (You may be doing it yourself, too.) If a conversation subject makes you uncomfortable or anxious, say so.“Being really open and direct is the best way,” said Dr. Danesh Alam, a psychiatrist and the medical director of behavior health services at Northwestern Medicine Central Dupage Hospital. Dr. Alam suggested studying up for conversations, preparing some questions and topics in order to chat with more intention and keep things on topic.Take your time.It’s OK if you don’t feel ready to see people socially again. Through the challenges of the lockdown period, you may have found that “your mental health is served best when you have time for calm and rest and introspection,” Dr. McBride said. So pace yourself while considering the benefits of getting back out there: Even casual interactions have shown to foster a sense of belonging and community. “Social interaction is critical to our existence,” Dr. Alam said. Remember, too, that there are bound to be some weird moments as you start seeing others more regularly and your pandemic instincts (no hugging) and before-times instincts (“Do you want a bite of this?”) collide. “If you’re comfortable going to a dinner at a small family restaurant, you can do that,” Dr. Hilden said. “If you want to wait a month or two, that’s OK, too.”

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesScientists believe they have worked out why biting down on ice or drinking something really cold causes excruciating pain for some people. They have located the cells and signals in sensitive teeth that detect big temperature drops and trigger toothache and brain freeze. People with dental decay are prone to it because the pathway is exposed.It provides a target for new treatments, such as toothpastes, dental patches or chewing gum, they say.Prof Katharina Zimmermann is lead investigator of the work, published in the journal Science Advances. “Once you have a molecule to target, there is a possibility of treatment,” she explained.The target is called TRPC5, and Prof Zimmermann’s team at the Friedrich-Alexander University Erlangen-Nürnberg in Germany traced its location to a specific cell type – the odontoblast – that resides between the soft inner pulp and the hard outer layer of teeth composed of dentine, then enamel. image copyrightL. Bernal et al./Science Advances 2021Enamel has no feeling, unlike the next layer dentine. The dentine connects to the innermost pulp, where nerve cells live. If the dentine becomes exposed, following tooth decay or gum disease for example, painful stimuli such as temperature or certain liquids will cause pain.The researchers studied mice and humans to understand how the pain arises, recording what was happening in cells and nerves. Dr Zimmermann said: “In human teeth with pits and dental caries we found a much upregulated number of TRPC5 channels, and therefore we believe that engineering a TRPC5 blocker that can be locally applied to teeth via strips or chewing gum would probably be a great help in treating tooth pain or dentine hypersensitivity.”One common home remedy – clove oil – contains a chemical that blocks this TRPC5 pathway. The scientists are not recommending DIY treatments though. People who are experiencing any worrying toothache should still see a dentist, they stress. Prof Damien Walmsley from the British Dental Association (BDA) said blocking the pain might provide temporary relief, but it was vital to treat and prevent the cause. Brushing regularly could stop tooth and gum disease, he advised.”The research is interesting but we can’t ignore the underlying causes of tooth sensitivity, nor people’s perception of pain. Dentists can treat the cause by removing the tooth decay, and advise on toothpaste for sensitive teeth.”He said that in the future, TRPC5 blocking agents might be included in toothpastes or similar to prevent the pain of sensitivity. Prof Zimmermann’s team did not receive any commercial financing for the work. It was funded by government. Tooth decay happens when the enamel and dentine of a tooth become softened by acid attacks after eating or drinking anything containing sugars, says the BDA. Over time, the acid makes a cavity (hole) in the tooth. Your risk of tooth decay is increased by how often you have sugary or acidic foods or drinks, so it is best to limit them to mealtimes.

His death leaves only one family physician in Greenfield, Mo. He died of complications of Covid-19.This obituary is part of a series about people who have died in the coronavirus pandemic. Read about others here.For the past 15 years, there were only two family physicians in Greenfield, Mo., a town with 1,371 residents about 40 miles northwest of Springfield. One of them was Dr. Michael Bennett, who opened his practice, the Greenfield Medical Center, in 2005.He was a vigorous proponent of wearing masks and of social distancing during the coronavirus pandemic, though he faced resistance to his calls from some townspeople, and he offered free Covid-19 testing to his patients with funding help from the federal C.A.R.E.S. Act.Dr. Bennet took precautions in treating infected patients but nevertheless tested positive for the coronavirus in late December. He was soon hospitalized in St. Louis and spent 50 days connected to a ventilator and an ECMO (extracorporeal membrane oxygenation), a machine that acts as an artificial lung. He died of Covid-19 on March 6, his former wife, Teresa Bennett, said. He was 52.Since the start of the pandemic, Dade County, Mo., where Greenfield is situated, has recorded 715 positive tests and 31 deaths, most of the fatalities nursing home residents, according to Pamela Cramer, the administrator of the county health department. “It’s really hit us, but not as hard as other areas,” she said on Wednesday.Nationwide, 452,706 health care workers have tested positive for the coronavirus, and 1,505 have died as of March 26, according to the Centers for Disease Control and Prevention.Michael Keith Bennett was born on Feb. 15, 1969, in New London, Mo., in the northeast part of the state. His father, Bob, was a farmer; his mother, Meredith (Arnold) Bennett, most recently helped manage her son’s clinic.A head injury from a car accident when he was in high school changed Dr. Bennett’s career path.“He was hurt pretty badly, and during that stay in the hospital he decided he wanted to be a doctor,” Ms. Bennett said by phone. “He was into auto mechanics before that.”After earning a bachelor’s degree in biology from the University of Missouri in Columbia, he received his medical degree from its medical school. And after finishing his residency at Cox Medical Center South in Springfield, he worked at St John’s Hospital in nearby Willard, Mo.In addition to his medical practice, which has been shuttered, Dr. Bennett had a 500-acre farm with beef cattle, and he enjoyed fishing and hunting.“I think one of the reasons his patients loved him is he was a good old boy,” said Ms. Bennett, who managed her former husband’s practice until 2012, when they divorced.In addition to his parents, he is survived by his son, Austin; his daughter, Shelby Bennett; his sister, Veronica Bennett; his brother, Damon; and his girlfriend, Haley Hendrixson.Dr. Bennett worked closely with Ms. Cramer, the county official, and suggested to her last year that the town adopt a mask-wearing mandate after several Covid-related nursing home deaths. But the idea did not advance.After learning that Dr. Bennett had tested positive for Covid-19, Ms. Cramer tried to stay in contact. In his final text to her from the hospital, on Jan. 8, he wrote: “I’m hanging in there. Will stay in touch.”

With case numbers still high, coronavirus testing remains essential, experts say, but the goals and approach will change as vaccines roll out.Last May, the city of Los Angeles turned a fabled baseball park into a mass testing site for the coronavirus. At its peak, Dodger Stadium was testing 16,000 people a day for the virus, making it the biggest testing site in the world, said Dr. Clemens Hong, who oversees coronavirus testing in Los Angeles County.But in January, the city pivoted, converting the stadium into an enormous, drive-through vaccination site. Local demand for coronavirus testing has plummeted, Dr. Hong said. He said that he saw the evidence firsthand recently when he visited a community hospital: “The testing site had three people and the vaccine site had a line around the block.”Los Angeles is not an anomaly. Across the nation, attention has largely shifted from testing to vaccination. The United States is now conducting an average of 1.3 million coronavirus tests a day, down from a peak of 2 million a day in mid-January, according to data provided by the Johns Hopkins Coronavirus Resource Center.In some ways, the decline is good news, and can be attributed, in part, to falling case numbers and the increasing pace of vaccination. But the drop-off also worries many public health experts, who note that the prevalence of Covid-19 remains stubbornly high. More than 50,000 new cases and 1,000 deaths are being tallied every day and just 14 percent of Americans are fully vaccinated.“We are very much worried about resurgence,” said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University. “Everybody mentally moved on to vaccines. Obviously, vaccines are quite important. But as long as the majority of us are not protected, then testing remains essential.”The $1.9 trillion stimulus package signed into law this month includes $47.8 billion earmarked for testing, tracing and monitoring the virus.But as society begins to reopen and vaccines roll out more widely, testing strategies are evolving. Here are four reasons that testing still matters, and how officials see the next months, and years, playing out.Diagnosing people who are sickCase numbers remain high, and clinicians still need to identify individuals who have contracted the virus so that these people can receive proper treatment and care. The gold standard for diagnosing Covid-19 is the polymerase chain reaction, or P.C.R., test, which can identify even small traces of genetic material from the coronavirus.This kind of testing will be needed as long as there are Covid-19 cases, but as the disease becomes less common, diagnostic testing is likely to become less centralized.Testing at a site by the 24th Mission Bart Station in San Francisco in early March.Mike Kai Chen for The New York Times“The game has changed a little bit,” Dr. Hong said. “Before, we just had infection popping up everywhere, and we just needed broad, blanket testing access. Now we need to be much more targeted.”Diagnostic testing is shifting from large, government-run sites to smaller, more distributed sites that are spread across local communities, Dr. Hong said. Ultimately, when vaccination rates are high enough and cases are low enough, dedicated testing sites will not be needed at all. “Then we just return testing to the health care system,” he said, and coronavirus tests will simply be one of many options on the menu at the doctor’s office.Slowing the spreadTesting is important not just for identifying individual patients who need treatment but also for public health. When the system is working, a timely Covid-19 diagnosis is what triggers contact tracing and quarantining and can stop virus transmission in its tracks.“The vaccine — marvelous, miraculous as it is — is not in and of itself going to contain this pandemic,” said A. David Paltiel, a professor of health policy and management at Yale School of Public Health.Slowing transmission means fewer people will get sick but it also gives the virus fewer opportunities to mutate. And that reduces the odds that dangerous new variants — some of which may be able to evade vaccine-induced immunity — will emerge.Keeping community spread low will help give vaccines “a fighting chance,” Dr. Paltiel said. “The less work we give the vaccine to do, the better.”As schools and offices reopen, routine screening of asymptomatic people will help minimize viral spread. These screening programs are now beginning to ramp up. Many will rely on rapid antigen tests, which are less sensitive than P.C.R. tests but are cheaper and can return results in 15 minutes. (Antigens are molecules, like the well-known spike protein, that are present on the surface of the coronavirus and trigger the immune system to produce antibodies.) When antigen tests are used routinely and frequently, they can be effective in identifying infectious individuals and reducing viral transmission, several analyses suggest.As vaccination rates increase, these screening programs may become more targeted. If 70 percent to 80 percent of Americans are vaccinated, the prevalence of Covid-19 plummets, and outbreaks are not emerging in group settings, then it may be possible to ease up on widespread screening, said Dr. Mary K. Hayden, an infectious disease specialist at Rush University Medical Center in Chicago. “Then, yes, I think we could relax surveillance testing,” she said before adding, “But it’s a lot of ‘ifs.’”.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-k59gj9{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;width:100%;}.css-1e2usoh{font-family:inherit;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;border-top:1px solid #ccc;padding:10px 0px 10px 0px;background-color:#fff;}.css-1jz6h6z{font-family:inherit;font-weight:bold;font-size:1rem;line-height:1.5rem;text-align:left;}.css-1t412wb{box-sizing:border-box;margin:8px 15px 0px 15px;cursor:pointer;}.css-hhzar2{-webkit-transition:-webkit-transform ease 0.5s;-webkit-transition:transform ease 0.5s;transition:transform ease 0.5s;}.css-t54hv4{-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-1r2j9qz{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-e1ipqs{font-size:1rem;line-height:1.5rem;padding:0px 30px 0px 0px;}.css-e1ipqs a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;}.css-e1ipqs a:hover{-webkit-text-decoration:none;text-decoration:none;}.css-1o76pdf{visibility:show;height:100%;padding-bottom:20px;}.css-1sw9s96{visibility:hidden;height:0px;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-1cz6wm{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;font-family:’nyt-franklin’,arial,helvetica,sans-serif;text-align:left;}@media (min-width:740px){.css-1cz6wm{padding:20px;width:100%;}}.css-1cz6wm:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-1cz6wm{border:none;padding:20px 0 0;border-top:1px solid #121212;}Frequently Asked Questions About the New Stimulus PackageThe stimulus payments would be $1,400 for most recipients. Those who are eligible would also receive an identical payment for each of their children. To qualify for the full $1,400, a single person would need an adjusted gross income of $75,000 or below. For heads of household, adjusted gross income would need to be $112,500 or below, and for married couples filing jointly that number would need to be $150,000 or below. To be eligible for a payment, a person must have a Social Security number. Read more. Buying insurance through the government program known as COBRA would temporarily become a lot cheaper. COBRA, for the Consolidated Omnibus Budget Reconciliation Act, generally lets someone who loses a job buy coverage via the former employer. But it’s expensive: Under normal circumstances, a person may have to pay at least 102 percent of the cost of the premium. Under the relief bill, the government would pay the entire COBRA premium from April 1 through Sept. 30. A person who qualified for new, employer-based health insurance someplace else before Sept. 30 would lose eligibility for the no-cost coverage. And someone who left a job voluntarily would not be eligible, either. Read moreThis credit, which helps working families offset the cost of care for children under 13 and other dependents, would be significantly expanded for a single year. More people would be eligible, and many recipients would get a bigger break. The bill would also make the credit fully refundable, which means you could collect the money as a refund even if your tax bill was zero. “That will be helpful to people at the lower end” of the income scale, said Mark Luscombe, principal federal tax analyst at Wolters Kluwer Tax & Accounting. Read more.There would be a big one for people who already have debt. You wouldn’t have to pay income taxes on forgiven debt if you qualify for loan forgiveness or cancellation — for example, if you’ve been in an income-driven repayment plan for the requisite number of years, if your school defrauded you or if Congress or the president wipes away $10,000 of debt for large numbers of people. This would be the case for debt forgiven between Jan. 1, 2021, and the end of 2025. Read more.The bill would provide billions of dollars in rental and utility assistance to people who are struggling and in danger of being evicted from their homes. About $27 billion would go toward emergency rental assistance. The vast majority of it would replenish the so-called Coronavirus Relief Fund, created by the CARES Act and distributed through state, local and tribal governments, according to the National Low Income Housing Coalition. That’s on top of the $25 billion in assistance provided by the relief package passed in December. To receive financial assistance — which could be used for rent, utilities and other housing expenses — households would have to meet several conditions. Household income could not exceed 80 percent of the area median income, at least one household member must be at risk of homelessness or housing instability, and individuals would have to qualify for unemployment benefits or have experienced financial hardship (directly or indirectly) because of the pandemic. Assistance could be provided for up to 18 months, according to the National Low Income Housing Coalition. Lower-income families that have been unemployed for three months or more would be given priority for assistance. Read more.Even then, however, officials may want to maintain some level of surveillance testing in high-risk settings, like nursing homes, or of high-risk individuals, like travelers, she said.Assessing our progressTesting can help public health officials gauge whether efforts to end the pandemic are paying dividends.A line of cars waiting for a turn at testing at Dodger Stadium in Los Angeles in December.David Walter Banks for The New York Times“Do we want to know how well vaccines are working? We’re going to have to test,” said David O’Connor, a virologist at the University of Wisconsin, Madison. “How are we going to know whether the variants are more contagious? We’re going to have to test. How are we going to know if the vaccines are effectively controlling the variants? We’re going to have to test.”Large screening programs may also help institutions assess the effectiveness of their risk-reduction strategies. If cases begin to rise, schools and offices may find they need to change their mask policies, enforce greater social distancing or boost their ventilation rates.Testing might also help uncover worrisome case clusters, which can signal that a community has not yet reached herd immunity and might benefit from targeted a vaccination campaign.Preventing the next pandemicMany experts now believe that the coronavirus is unlikely to ever disappear completely. But even if the virus continues to circulate only at very low levels, it will be important to keep tabs on it.“It becomes less about trying to interrupt the transmission of the disease and more to understand, Where is the virus?” Dr. Nuzzo said. “What are we missing? And, you know, what could be coming down the road?”The virus will continue to mutate, and new genetic variants will emerge. Some level of continued testing, even years down the line, could help scientists catch worrisome variants early.Tests aren’t perfect, of course, and can produce false negatives and positives. But they provide a critical window into the activity of a pathogen too small to see.“We’re going to want to make sure that after people are vaccinated, it’s not going to bubble up in some other unpredictable way that’s going to put us back where we started,” Dr. O’Connor said.