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They survived serious cases of Covid-19, sometimes spending weeks on a ventilator, but not without complications. Now, a special clinic at an L.A. hospital is helping them get back to their lives.LOS ANGELES — Three days after being released from Martin Luther King Jr. Community Hospital, Gilbert Torres returned on a stretcher, a clear tube snaking from his nose to an oxygen tank. It was the last place he wanted to be.But Mr. Torres, 30, who had just spent two weeks on a ventilator in the intensive care unit, wasn’t there because his condition had worsened. He was there to visit a new outpatient clinic for Covid-19 survivors, intended to address their lingering physical and psychic wounds — and to help keep them from needing to be readmitted.Several medical centers around the country, including Massachusetts General Hospital, have created similar clinics, a sign of an increasing appreciation of the need to address the long-term effects of Covid. Other hospitals that already had I.C.U. aftercare programs have added large numbers of Covid patients to their rolls: Indiana University Health Methodist Hospital, for example, has treated more than 100. And some institutions, like Providence St. Jude in Fullerton, Calif., have recovery programs that also serve coronavirus patients who were never hospitalized.“We put a thousand percent of our energy into these patients,” said Dr. Jason Prasso, one of the intensive care doctors at M.L.K. Hospital who created the clinic there. “We feel accountable for them getting better even after they leave the hospital.”Dr. Jason Prasso, who treated Mr. Torres in the I.C.U., started the clinic with his colleagues when they realized many of their patients were getting little follow-up care.Isadora Kosofsky for The New York TimesWell before the pandemic, doctors knew that some patients recovering from critical illness developed a constellation of symptoms known as post-intensive care syndrome that can include muscle weakness and fatigue. Depression, anxiety and cognitive impairments arise in about half of people who have spent time on ventilators in an I.C.U., studies suggest. About a quarter of these patients develop post-traumatic stress disorder. The risk is higher among those who have had respiratory failure, long hospital stays and treatment with drugs to sedate or paralyze them — all common in the sickest coronavirus patients.Dr. Prasso and his colleagues created the clinic at M.L.K. after realizing that many patients whose lives they had fought to save were getting little follow-up care. The hospital is in a low-income neighborhood where health services, inadequate even before the pandemic, have grown more scarce.Since opening in August, the clinic has seen more than 30 patients. Visits, which happen on Tuesday mornings and include a physical exam and a mental health screening, often entail discussions of housing, food security and employment problems that can arise because of long-term symptoms. Patients are also offered spiritual care.The first to walk into Mr. Torres’s examination room in February was Rudy Rubio, a hospital chaplain who had visited him often in the I.C.U. The pastor asked if they could pray together and offered to get him a Bible.Mr. Torres, whose parents fled war in El Salvador, grew up in the neighborhood and worked cleaning big rigs at a Blue Beacon Truck Wash. Although he was morbidly obese — a risk factor for severe Covid — he enjoyed running and biking and rarely needed to see a doctor. He had no idea how he contracted the coronavirus or became so sick that doctors needed to insert a breathing tube within hours of his arrival at M.L.K. For days before he began showing signs of improvement, they feared he would not survive.“You were spared,” the chaplain told him at the clinic. “What are you going to do with this opportunity?”When Dr. Prasso entered the room, Mr. Torres did not recognize him at first without his protective gown and helmet. “It was you,” he said when the realization dawned.As the doctor examined him, Mr. Torres said he was able to walk short distances but was worried that if he did his oxygen levels would drop. “It is a little bit of a mind game,” Dr. Prasso said. “You may feel short of breath, but your oxygen can still be totally normal.”The clinic would arrange to get Mr. Torres a portable oxygen machine because small tanks were in short supply nationally, the doctor said. He explained that it could take anywhere from a few weeks to several months for patients to wean off; some might require it indefinitely.Mr. Torres brought up another problem. A physical therapist assigned to visit him had canceled. “A lot of the agencies are a little bit resistant to going into people’s homes right now because of Covid,” Dr. Prasso told him. He said the clinic could enroll Mr. Torres in a pulmonary rehabilitation program instead, so that he could work with therapists focused on the recovery of his lungs.Mr. Torres in the intensive care unit in January.Isadora Kosofsky for The New York TimesMr. Torres shared that he was anxious and haunted by memories of beeping I.C.U. monitors and a sensation of choking. He had barely slept since returning home and had not yet seen his 5-year-old son, who was staying temporarily with grandparents. Mr. Torres was afraid of breaking down in front of him.“Everything that you’re feeling is normal,” Dr. Prasso reassured him. “Just know that what you went through was a trauma. It takes time for that to heal.”The two exchanged memories of the moment Mr. Torres’s breathing tube was removed. “You begged me to get the tube out, and as soon as we took the tube out, you asked to have it put back in,” Dr. Prasso said.“It was hard to breathe,” Mr. Torres said. “I didn’t want to be awake.”“This guy had a vise grip on my hand,” Dr. Prasso told Mr. Torres’s partner, Lisseth Salguero, who had joined him in the exam room. Family members, themselves at risk for mental health problems, are encouraged to accompany patients to clinic. Ms. Salguero had developed Covid symptoms the same day as Mr. Torres had, but recovered quickly. Since he had returned home, she had been waking up to check Mr. Torres’s oxygen level at night. “I’m happy as long as he’s OK,” she said.Mr. Torres hours after his breathing tube was removed. He would later recall that “it was hard to breathe” and “I didn’t want to be awake.”Isadora Kosofsky for The New York TimesThe extraordinary stress of an I.C.U. stay in the era of Covid-19 is often compounded by near-unbearable loneliness. Visitor restrictions meant to reduce transmission of the virus can mean weeks separated from loved ones. “I kept asking for someone to hold my hand,” Mr. Torres recalled. “I wanted contact.”The staff members became de facto family. “You have nobody except for your nurses,” Mr. Torres said.For those I.C.U. nurses, caring for Covid patients while being among the few conduits to their family leads to deep emotional attachments. Nina Tacsuan, one of Mr. Torres’s nurses, could not hold back her tears when she saw him in the clinic.“Thank you for keeping me alive, giving me a second chance,” Mr. Torres told her. “I’m grateful.”“You’re my age,” Ms. Tacsuan said. “It was just really hard the whole time.”Nina Tacsuan, wiping tears, and Anahiz Correa, who both work in the I.C.U., joked in the clinic that Mr. Torres was not welcome to return to the unit.Isadora Kosofsky for The New York TimesOften, the experience ends in heartbreak: At the time Mr. Torres was hospitalized, only about 15 percent of Covid patients at M.L.K. being treated with ventilators had survived to go home.Those who do survive, like him, inspire the staff to keep going. But usually I.C.U. workers lack opportunities to see their former patients once they get better. The clinic has changed that.Ms. Tacsuan and a nurse manager, Anahiz Correa, joked that Mr. Torres was no longer welcome in their I.C.U.By the time the transport ambulance picked him up to go home, Mr. Torres said he was feeling much better than when he had arrived. He reunited with his young son, Austin, a couple of days later, and he has continued to improve in the weeks since.Mr. Torres with his partner, Lisseth Salguero, and their 5-year-old son outside their home.Isadora Kosofsky for The New York TimesMr. Torres visited the clinic twice more, in February and in March. Although he ended up declining outpatient rehabilitation — opting instead to climb stairs and do other exercises on his own at home — he said he felt cared for and was glad to have gone.A social worker there connected him with a primary care doctor in M.L.K.’s system for more follow-ups. An osteopath manipulated his back and taught him stretches to help relieve lingering discomfort from his time in the hospital bed. And last week, at his most recent appointment, the clinic staff strung up a congratulatory banner and shouted “Surprise!” as he entered, to mark his “graduation” from having to use an oxygen tank.He still needs more strength and stamina to be able to return to his physically demanding job at the truck wash, he said, but “I’m doing a lot more stuff.” And he is no longer haunted by anxiety, he added. “I feel great.”

From topless politicians to designers, it’s a thing. And it’s part of a longer tradition than you might expect.Someday, when the history of the pandemic is written, it may be a narrative told partly in images: the despair of crowded hospitals and body bags, the fear and isolation of the masks. And then the balm of a smiling individual, one sleeve rolled up practically to the collarbone, with a medical worker poised to jab a needle into their upper arm. Log in to any social platform, and the picture — not to mention The Pose — is almost impossible to miss.The vaccine selfie has gone viral.“I started seeing vaccine selfies almost as soon as the vaccines were available,” said David Broniatowski, an associate professor of engineering and applied science at George Washington University. “It was an almost immediate meme.” And rather than petering out, it seems only to be picking up steam.Indeed, said Jeanine D. Guidry, an assistant professor at Virginia Commonwealth University focusing on public health and health communications, “It may end up being one of the iconic images of this time.”Perhaps unsurprisingly, it has sparked its own bizarre sub-trend: the topless (or partially topless) vaccine selfie, as most often modeled by European politicians, but also the occasional celebrity.The French health minister Olivier Véran receives a dose of vaccine in February.Pool photo by Thomas SamsonPrime Minister Kyriakos Mitsotakis of Greece gets a shot in January.Pool photo by Yannis KolesidisThere have been partially disrobed selfies shared by the French health minister Olivier Véran (white dress shirt unbuttoned and left side exposed) and the Greek prime minister, Kyriakos Mitsotakis (blue button-up pulled rakishly to one elbow, hairy chest on display). See the partially disrobed selfies from a variety of British members of Parliament, including Brendan Clarke-Smith (checked shirt pulled askew practically to the belly button, with one button above the belt done up for modesty) and Johnny Mercer (entirely shirtless).Also, the designer Marc Jacobs, who posed in pink sparkling shorts with his pink shirt entirely off half of his torso, leopard coat, and some pearls.“It’s a look, and a moment, worth celebrating,” Vogue chortled.Perhaps that does explain the dressing choice: Many of us have been hiding inside for so long, feeling scared and powerless, that there’s something liberating about taking clothes off. Though the answer may also be simply that we’ve forgotten how to dress for public-ish injections. Or the need to do something to get attention in an age of social media chaos. If everyone’s taking selfies, how do you signal that your selfie is an important selfie?After all, as Ms. Guidry pointed out, it is both a new phenomenon — and a very, very old one.Before there was either the vaccine selfie or the topless vaccine selfie, there was the vaccine photo op. And before that, the vaccine engraving.Yup, it goes that far back, in part because, for as long as there have been inoculations, there has been unease around the whole idea. (Taking a healthy person and injecting them with a bit of illness to make them better is a hard sell.) And that means there have been conscious efforts by public health authorities to promote them. Which have, most often, involved The Pose.Marc Jacobs takes a selfie as he gets his Covid-19 shot, later posted to his Instagram account.via Marc Jacobs“Images are just very powerful,” said Mark Dredze, an associate professor of computer science at Johns Hopkins University who has studied the way vaccine pictures are shared on Twitter. “People relate to them much more than text.”There are, for example, multiple late-18th-century engravings of Edward Jenner, a vaccine pioneer and creator of the smallpox vaccine, inoculating his own children and patients. One of the most famous of the vaccine photo ops is a 1956 shot of Elvis Presley, then only 21 and a full-fledged teen idol, looking dreamy with his sweater pulled up to get his polio jab. The year before that, a lineup of French models was caught poised to receive their smallpox vaccine, grinning and flashing a bit of shoulder.By 1976, President Gerald Ford, fearful of warnings about a giant wave of swine flu, happily posed in a vest and tie with shirt sleeves rolled up while receiving his flu shot. And, in 2009, President Barack Obama was snapped in the White House with a nurse preparing to administer the H1N1 vaccine. In all cases the theory behind the images was the same.An engraving depicting young James Phipps receiving the first cowpox vaccination from the British physician Edward Jenner in 1796.Adoc-photos/Corbis, via Getty ImagesMembers of the Association of French Models line up for their smallpox vaccinations in 1955.FPG/Hulton Archive, via Getty Images“In public health communications, it’s generally considered good practice to have pictures of trusted leaders” getting their shots,” Mr. Broniatowski said. The thinking goes: You see an elected official being a wiling guinea pig, the picture works its way into your subconscious, and suddenly you start to think: “Oh, I should do that, too.” Follow-the-leader in visual code.And so it went — until the current pandemic.That’s because between President Obama and today, two things happened. First, social media really took off. (It’s hard to remember, but the iPhone was introduced in 2007, which was the same year Facebook and Twitter went global. Instagram didn’t appear until 2010.) Second, as Ms. Guidry said, in something of an understatement, “We’ve seen a breakdown in trust in some areas of science and a breakdown in trust in our political leaders.”That meant that though it was important to see snaps of President-elect Biden and Vice President-elect Harris getting their Covid shots on camera, not to mention Dr. Fauci and Vice President Pence (and though it was significant that President Trump was not captured for posterity receiving his shot), “it’s almost more important to see friends and family getting vaccinated,” Ms. Guidry said.It’s advertising 101, Mr. Dredze said, to make sure “people seeing an ad can relate to what they are seeing in the ad.” In public health terms, that translates to people like us — people of all different ages and colors and genders — getting vaccinated. And because we are all now media producers as well as media consumers, it is possible.President Ford gets a swine flu shot in 1976.Bettman, via Getty ImagesA White House nurse administers H1N1 vaccine to President Obama in 2009.Pete Souza/White House, via Getty ImagesAt a time when social networks have become one of our primary means of communication, the images are important, not just to get the news out, but to normalize the experience and expand it — to effectively pay it forward.In the drive toward herd immunity, the vaccine selfie plays a key role. No longer simply an expression of vanity or lifestyle humble brag, it has effectively turned the crowd, witting or not, into health-care proselytizers.While it is possible that all of these pictures of The Pose may cause some resentment (not everyone who wants to get vaccinated can yet get vaccinated), and the topless politicians may have gotten the most attention for their shots (in both meanings of that word), the selfie stream itself represents a tipping point. One that everyone can see.

Widespread disease outbreaks have the potential to shock societies into new ways of living.This article is part of a series on resilience in troubled times — what we can learn about it from history and personal experiences.Five years ago, I decided to write a novel set in the aftermath of a terrible pandemic.The novel was an alternate history, a revisionist Western set in the 19th century, and I ended up doing copious research on everything from cattle brands to midwifery. But I’m somewhat embarrassed to say now that my research on public health disasters was relatively slight. Essentially, I pulled up a list of flu outbreaks, picked one that best suited my plot (an 1830 pandemic that may have begun in China), and started writing.But as I finished the book, its events collided with the present. I was working through copy-edits in March 2020 when New York City, where I live, began to shut down. Suddenly I had a lot of time, and a lot of motivation, to consider what I had gotten right and wrong about the devastation wrought by disease on a society.In many ways, my imagination had strayed far from reality. For one thing, no known pandemic has ever been as deadly as the one I wrote about, which kills 90 percent of the United States population. But I had one instinct that turned out to be right: that pandemics have the potential to shock societies into new ways of living. The Black Death, for example, led to the end of serfdom and the rise of the middle class in England.But a disease outbreak can also cause governments to double down on repression and bigotry, as when the United States scapegoated Asian-Americans during 19th-century plague epidemics.An artist’s rendering of St. Pancras Smallpox Hospital, circa 1880s, in a tented camp in London.Frank Collins/Buyenlarge, via Getty ImagesHistory can’t tell American policymakers and activists exactly how to respond to Covid-19 — more often, it offers an example of what not to do. Still, outbreaks in 20th-century South Africa, medieval England, ancient Rome and more can offer some lessons for those working to heal the damage of Covid and forge a more just society in its wake.Five years ago, the history of pandemics was a jumping-off point for me — an inspiration, little more. Now it’s something more urgent: an example of what we can dare to hope for in these dark times, as well as what awaits us if we fail to act. Here are some lessons learned.AdaptThe Black Death, a pandemic caused by the bacterium Yersinia pestis that spread across Asia, Africa and Europe beginning in 1346, was “without question the most catastrophic health crisis in recorded history,” Mark Bailey, a historian and the author of “After the Black Death: Economy, Society, and the Law in Fourteenth-Century England,” said in an interview. In England, it killed around 50 percent of the population in 1348 and 1349; in Europe as a whole, estimates range from 30 to 60 percent. The sheer scale of mortality was an enormous shock, though its effects went far beyond that. As Monica Green, a historian of medicine who specializes in medieval Europe, put it, “Who will bring in the harvest if half the people are gone?”Different societies responded in different ways. In many parts of northwestern Europe, such as Britain and what is now the Netherlands, the sudden death of a huge share of working people meant it was easier for the survivors to get work and acquire land. “You get an increase in wealth per head and a reduction in wealth inequality,” Mr. Bailey explained. Economically, at least, “ordinary people are better off.”“Flight of the Townspeople Into the Country to Escape From the Plague,” from 1630. The plague is depicted at far right as a skeleton holding a dagger and an hourglass./Universal Images Group, via Getty ImagesThe reverse was true in much of eastern Europe, where lords consolidated their power over the now-scarce peasantry to reimpose serfdom, forcing them to work the land on terms favorable to landowners. There, inequality flatlined or actually increased in the wake of the plague.There are many competing explanations for the split, but one possibility is that “the Black Death tends to accelerate existing trends,” like a movement toward a less feudal, more consumer-based economy in northern Europe, Mr. Bailey said. But that region didn’t magically become a bastion of equality post-plague — the English government imposed wage caps in the mid-14th century to keep pay from going too high. The result was widespread unrest, culminating in the Peasants’ Revolt of 1381, which brought together people of a wide variety of social backgrounds in an expression of “pent-up frustration” at government mismanagement of the economy, Mr. Bailey said.Over all, if “resilience in a pandemic is coping,” he continued, “economic and social resilience subsequently is adapting.” The modern lesson: “Adapting to the new reality, the new paradigm, the new opportunities, is key.”Fight inequalityThe move toward greater economic equality in England post-plague may have been a bit of an outlier — throughout history, epidemics have tended to intensify existing social inequities.In 1901, for example, when an epidemic of the plague hit South Africa, “thousands of Black South Africans were forcibly removed from Cape Town under the assumption that their free movement was having an effect on the spread of plague within the city,” said Alexandre White, a professor of sociology and the history of medicine whose work focuses on pandemic response. That expulsion laid the groundwork for the racial segregation of the apartheid era.The United States, too, has a history of discriminatory policy during epidemics, including the targeting of Asian-American communities during early 19th- and early 20th-century plague outbreaks in Hawaii and San Francisco, and the sluggish federal response to the H.I.V. epidemic when it appeared to affect primarily L.G.B.T.Q. Americans, Mr. White said. Such decisions have ended up not only widening inequality but also hampering efforts to fight disease — ignoring H.I.V., for example, allowed it to spread throughout the population.A scientist studying the plague at a San Francisco lab in 1961. Smith Collection/Gado/Getty ImagesAnd now, the United States faces a pandemic that has disproportionately sickened and killed Americans of color, who are overrepresented in the essential work force yet less likely to have access to medical care. As federal and state governments manage the vaccine rollout, access to testing and treatment, and economic relief packages, it’s crucial to learn from the past and target policies specifically at reducing the racial and economic inequalities that made the pandemic so devastating in the first place.“If the effects of racism and effects of xenophobia were less systemic within our society, we would likely see fewer deaths as a result of Covid-19,” Mr. White said. “Bigotry is fundamentally bad for public health.”Embrace unexpected innovationEven as pandemics have often re-entrenched old prejudices and forms of marginalization, they’ve also often given rise to something new, especially when it comes to art, culture and entertainment.Ancient Rome, for example, was tormented by epidemics, with one occurring every 15 to 20 years for portions of the fourth, third and second centuries B.C., said Caroline Wazer, a writer and editor who completed a dissertation on Roman public health. At the time, the primary public-health response was a religious one, with Romans experimenting with new rites and even new gods in an attempt to stop the spread of illness. In one case, Ms. Wazer said, with an epidemic dragging on for three years and the public increasingly agitated, the Senate adopted a strange, new ritual from northern Italy: “they bring in actors to perform onstage.” According to the Roman historian Livy, “this is how the Romans get theater,” Ms. Wazer said, though that fact has been debated.A spiritual response to disease brought cultural change to 14th-century England, too. Recalling the mass graves of the Black Death, Britons feared dying without a Christian burial and spending eternity in purgatory, Mr. Bailey said. So they began to form guilds, small religious groups that essentially functioned as “burial insurance clubs,” raising money to give members the proper treatment after death.These guilds hosted parties and other events, and over time there was concern “about boozing of ale going on in and around the church,” Mr. Bailey said. So the guilds began to build their own halls for socializing. Then, during the Reformation in the 16th century, the guilds were dissolved, and the halls became something new: pubs.Indeed, historians have argued that the rise in consumerism and the wealth of ordinary people following the Black Death paved the way for the pub culture for which England remains known today.It would be flippant to call such cultural innovations a “silver lining” of pandemics — after all, plenty of new art forms and social venues have emerged without the catalyst of mass death. It is worth remembering, though, that in the wake of even the most devastating public health disasters, human social life and creativity have re-emerged in new and unexpected ways.“Pandemics are both catastrophes and opportunities,” Mr. Bailey told me. And in the coming years, the world will face the tragic opportunity of rebuilding after Covid-19 — and if we learn the lessons of history, we may be able to do so in a way that’s more fair, more inclusive, and even more joyful than the past we’ve been forced to leave behind.Anna North is a senior reporter at Vox and the author of three novels, including, most recently, “Outlawed.”

I’ve reported on behavior and mental health for 20 years. As I exit, I can’t help but wonder why researchers have placed so little emphasis on helping people in distress today.When I joined the Science staff in 2004, reporters in the department had a saying, a reassuring mantra of sorts: “People will always come to the science section, if only to read about progress.”I think about that a lot as I say goodbye to my job, covering psychiatry, psychology, brain biology and big-data social science, as if they were all somehow related. The behavior beat, as it’s known, allowed tremendous freedom: I wrote about the mental upsides of binge drinking, playing the lotto and sports fandom. I covered basic lab research, the science of learning and memory, the experience of recurrent anguish, through the people who had to live with it. And much, much more.Like most science reporters, I had wanted to report on something big, to have a present-at-the-creation run that would shake up our understanding of mental health problems. At minimum, I expected research that would help people in distress improve their lives.But during my tenure, the science informing mental health care did not proceed smoothly along any trajectory. On the one hand, the field attracted enormous scientific talent, and there were significant discoveries, particularly in elucidating levels of consciousness in brain injury patients who appear unresponsive; and in formulating the first persuasive hypothesis of a cause for schizophrenia, based in brain biology.On the other hand, the science did little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health — rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use — went the wrong direction, even as access to services expanded greatly.What happened? After 20 years covering the field, here and at The Los Angeles Times, I have a few theories, and some ideas on what might be required to turn things around.Early on in my job, I started to field a steady stream of calls and emails, usually from parents asking for advice.“My son is suicidal. We’ve tried everything. What do we do?”“Our daughter is cutting herself, she’s out of control. Can you recommend a therapist, or someone to talk to?”More than a few of these queries came from colleagues at The Times. Others came from friends and family.I always provided suggestions and referrals (with a disclaimer), and helped decode the psychiatric jargon, if needed. I also followed up later, to see how things were going. This second conversation was a reminder, every time, that the mental health system, for all its caring professionals, is chaotic and extremely difficult to navigate. There are few systemwide standards, and vast and hidden differences in quality of care. Good luck finding an authoritative guide to navigating the full range of appropriate options.In time, those seeking help became the lens through which I saw my job, and their questions became my own. What does a diagnosis of bipolar really mean, in a young child? Is this drug necessary? How trustworthy is the evidence?One answer to that last question came in the mid-2000s, when the Food and Drug Administration held a series of hearings on whether antidepressant drugs, like Paxil, Prozac and Zoloft, backfired in a small number of users, causing suicidal thinking and behavior.The hearings were hair-raising. Hundreds of family members who had lost a loved one crowded the rooms, their anger and expectation sucking up most of the oxygen; and some of the parents, it was clear, knew at least as much about the drugs as the doctors.By 2006, the F.D.A. had concluded that a so-called black-box warning on antidepressant drug labels was warranted, citing the suicide risk for children, adolescents and young adults. Many psychiatrists were dismayed by the decision, insisting it would discourage the use of valuable medications.The antidepressant wars, as this debate came to be known (it rages on today), also helped uncover the influence of industry money on academic psychiatry. The pharmaceutical industry paid researchers at brand-name institutions to talk up drugs at seminars and conferences; it paid for “expert panels” to promote their use; and it often had outside firms write up the studies themselves, massaging the data.This state of affairs made it virtually impossible to interpret psychiatric drug studies. Some experiments were undoubtedly honest, rigorous efforts to document the diffuse effects of a medication. Others were no more than “infomercials,” in the phrase of the late Dr. Bernard Carroll, one of the most stubborn critics of his own profession — drug ads, in effect, dressed up as research. The infomercials were usually easy to spot, but not always; and without knowing the back story, the money trail, you couldn’t be sure what to believe.When it came to judging government-funded research projects — a cleaner enterprise, presumably — I again asked the questions that people in crisis continually asked me. Is this study finding useful for my son, or my sister, in any way? Or, more generously, given the pace of research: Could this work potentially be useful to someone, at some point in their lifetime?The answer, almost always, was no. Again, this is not to say that the tools and technical understanding of brain biology didn’t advance. It’s just that those advances didn’t have an impact on mental health care, one way or the other.Don’t take my word for it. In his forthcoming book, “Recovery: Healing the Crisis of Care in American Mental Health,” Dr. Thomas Insel, former director of the National Institute of Mental Health, writes: “The scientific progress in our field was stunning, but while we studied the risk factors for suicide, the death rate had climbed 33 percent. While we identified the neuroanatomy of addiction, overdose deaths had increased by threefold. While we mapped the genes for schizophrenia, people with this disease were still chronically unemployed and dying 20 years early.”And on it goes, to this day. Government agencies, like the National Institute on Drug Abuse and the National Institute of Mental Health, continue to double down, sinking enormous sums of taxpayer money into biological research aimed at someday finding a neural signature or “blood test” for psychiatric diagnoses that could be, maybe, one day in the future, useful — all while people are in crisis now.I have written about some of these studies. For example, the National Institutes of Health is running a $300 million brain-imaging study of more than 10,000 young children with so many interacting variables of experience and development that it’s hard to discern what the study’s primary goals are. The agency also has a $50 million project underway to try to understand the myriad, cascading and partly random processes that occur during neural development, which could underlie some mental problems.These kinds of big-science efforts are well-intended, but the payoffs are uncertain indeed. The late Scott Lilienfeld, a psychologist and skeptic of big-money brain research, had his own terminology for these kinds of projects. “They’re either fishing expeditions or Hail Marys,” he’d say. “Take your pick.” When people are drowning, they’re less interested in the genetics of respiration than in a life preserver.In 1973, the prominent microbiologist Norton Zinder took over a committee reviewing grants by the National Cancer Institute to investigate viruses. He concluded the program had become a “gravy train” for a small group of favored scientists, and advised slashing their support in half. A hard, Zinder-like review of current behavioral science spending would, I suspect, result in equally heavy cuts.How can the fields of behavior and brain science begin to turn the corner, and become relevant in people’s lives? For one, prominent scientists who recognize the urgency will have to speak more candidly about how money, both public and private, can warp research priorities. And funders, for their part, will have to listen, perhaps supporting more small teams working to build the psychological equivalent of a life preserver: treatments and supports and innovations that could be implementedin the near future.There’s a reason that so many people use binge drinking, playing the lotto and runaway eating to support their mental health: because the effects are reliable. Because they don’t require a prescription. And because they’re available, right now.

Nearly everyone with a marketplace health plan can seek more financial help. Many uninsured Americans and people who buy their insurance elsewhere can also benefit.Joe Biden at an event on Nov. 10 to discuss his plans to expand the Affordable Care Act.Jonathan Ernst/ReutersFederal officials have reprogrammed Healthcare.gov, making new benefits available to tens of millions of Americans, weeks after Congress authorized spending billions on additional health law subsidies.The Biden administration has doubled Obamacare’s advertising budget to get the word out, and will now spend $100 million telling Americans about newly affordable options.Nearly everyone with an Affordable Care Act health plan can now qualify for increased financial help with premiums by going back to the website. Many Americans who buy their own insurance outside the A.C.A. marketplaces may also qualify for substantial help, and may benefit from reviewing options and switching to an eligible plan. Uninsured Americans also qualify.For some, the savings could be significant: A 64-year-old who earns $30,000, for example, would see monthly premiums drop to $85 from $195 for a midlevel plan. A family of four that earns $40,000 would go from paying a $136 premium to nothing at all.About a third of uninsured Americans will qualify for financial assistance if they sign up. Nearly six million will be able to find free health plans (the government will fully pay the monthly premium).“These changes are really important because there is a fair number of people who didn’t qualify before,” said Laura Packard, executive director of Get Covered America. “Maybe they gave up trying, maybe they got a substandard policy somewhere else. This is a great opportunity for them to get coverage.”Maximizing subsidies will require enrolling in the right kind of plan, and getting financial help right away will mean logging onto Healthcare.gov. The federal government will not automatically apply the new subsidies to the existing 8.2 million enrollees’ premiums. Instead, those who buy their own insurance will need to log into their accounts and re-enroll in coverage. People who fail to do so will still get the money, but they will have to wait.About 3.3 million people who buy their coverage outside the government marketplace could now qualify for subsidies on the marketplace. These are typically higher-income Americans who previously earned too much to qualify for help. These people will need to switch to a marketplace plan to take advantage of the premium tax credits.The Biden administration has added another $50 million in advertising to an earlier $50 million marketing commitment; the campaign will run on television, radio and online, and will emphasize the reduced cost. In early March, the administration announced $2.3 million in grants to nonprofits that help enroll consumers in coverage. By contrast, the Trump administration slashed the health law’s outreach and advertising budget shortly after taking office.“People deserve the peace of mind that comes with knowing you can take care of your health without going into debt,” said Xavier Becerra, the secretary of Health and Human Services, in a statement. Typically, the opportunity to enroll is only during a brief period in the fall. This year, people will have more time. Customers can buy insurance or switch plans until Aug. 15.The Congressional Budget Office has estimated that the new subsidies will help 1.3 million uninsured Americans get coverage over the next two years. Some analysts say the policies could lower the number of uninsured Americans even more. The additional subsidies are set to expire at the end of 2022, though the Biden administration and Democrats in Congress are working to extend them through future legislation.Linda Blumberg, a health policy expert at the Urban Institute, said the challenges of notifying people about their new options and the temporary nature of the program could limit its effect. But, she said, the Biden administration has the opportunity for a more substantial impact.“If there is a large, aggressive, multifaceted effort at informing people of these much larger premium subsidies that are available to them, I think that can overcome those kinds of concerns and barriers,” she said.Brokers and navigators, who help people enroll in benefits, expect the new subsidies will drive a high number of enrollments — and are already fielding some inquiries about the changes.“It will probably be pretty busy, and the increased marketing and advertising will be really helpful for that,” said Shelli Quenga, director of programs at the Palmetto Project, a nonprofit that runs an insurance brokerage in South Carolina.Ms. Quenga has begun to work with some enrollees to sort out their new subsidies. She has one family, deterred from buying coverage by a $1,200 monthly premium, that expects to enroll now that the amount has dropped to $700. Another client now paying $30 a month will see his premium disappear.Some people will have to wait longer for the stimulus law’s health subsidies. There are 15 states that run their own marketplaces, and some will take slightly longer to update their websites with the new premium amounts.The stimulus law includes additional subsidies for Americans who have used unemployment insurance this year. Those people qualify for a no-cost health plan on the marketplace, but that benefit is more complex to administer and will not be available on Healthcare.gov until July.Shoppers who do not re-enroll in coverage will still eventually get their insurance subsidies. Instead of showing up as a monthly discount on insurance premiums, they will be rolled into that person’s 2021 tax return next spring.If you are uninsured, or are trying to decide whether to switch plans, this guide may be helpful.

For now, the best way to show that you’ve been inoculated against the coronavirus is a simple white card. Here, your key questions answered.As vaccinations become more widely available for people in the United States and travel starts picking up, many people have started sharing their simple white vaccination cards on social media as prized new possessions.With some destinations, cruise lines and venues already requiring travelers to provide proof of vaccination against Covid-19, keeping that record is key. In New York, for example, proof of vaccination or a recent negative test will be required for entry into large venues or catered events when they are allowed to reopen at reduced capacity on April 2. Proof will be required at events with more than 100 people, so anyone having a wedding or Sweet 16 with more attendees will have to ask guests for evidence that they are complying with the rules.There are already a number of vaccination “passport” initiatives underway that would make vaccination status easy to share digitally. Clear, a biometric screening program used in airports across the country, and the technology company IBM have created their own passes, for instance. And last week, New York became the first state to introduce a digital tool to allow people to easily show that they have either tested negative or been inoculated against the virus in order to gain entry into some events and venues.But until such measures are taken more widely across the country, you’ll want to hang onto that little white card.Here’s everything you need to know about your vaccine record, why it’s important and how to keep it safe.A newly inoculated patient reviewed a Covid-19 vaccination record card at Dodger Stadium in Los Angeles in January.Ryan Young for The New York TimesWhat’s on your vaccine card?The vaccine card, given after your first shot and then updated if your vaccine requires a second one, includes the vaccine manufacturer, the dose numbers and the date and location each was administered, according to Alex Brown, a spokeswoman for Walgreens, which is administering vaccinations at more than 5,000 stores nationwide.Walgreens, like other providers, is looking to make its records digital, Ms. Brown said, but for now it is still handing out cards.Walmart and Sam’s Club are already offering their patrons digital access to their vaccine records through both the Health Pass by Clear and the CommonHealth and CommonPass apps from the Geneva-based nonprofit, the Commons Project Foundation.“Our goal is to give customers vaccinated at Walmart free and secure digital access to their vaccine record and enable them to share that information with third parties seeking to confirm their vaccination status,” John Furner, the chief executive officer and president of Walmart U.S., said in a statement.What happens if I lose my card?Getting a new card is easy enough if you got vaccinated at a pharmacy like Walgreens. Ms. Brown said that anyone who loses their card should return to where they were vaccinated and a pharmacy employee can print out a new card from the patient’s electronic records.A member of the Walgreens vaccination team prepared vaccination cards for the staff and residents of Clove Lakes Nursing Home in Staten Island in January.Christopher Occhicone for The New York TimesVaccinations are also tracked by state health departments, so you can reach out to your state’s agency to get a replacement card, according to the Centers for Disease Control and Prevention. The agency lists contact information for the Immunization Information System in each state, which tracks vaccinations, on its website.How should I safeguard my card?Start by taking a picture of it with your phone, so you’ll have the information in your photo library, and emailing it to yourself as backup, said Dr. Uchenna Ikediobi, an assistant professor of general internal medicine and infectious diseases at Yale University.Laminating your card will make it more durable if you’re planning to carry it around in your wallet, though there has been some concern about lamination because it would prevent information from future booster shots from being added. But Dr. Ikediobi said that this “may be a moot point if new cards are issued after a booster shot, as would seem likely.”A number of companies have jumped in to offer free lamination. Staples is offering free lamination of vaccine cards for those who have gotten their doses, according to Jocelyn Moruzzi, a spokeswoman for the office goods retailer. The offer is valid at all of the company’s United States locations with the offer code 81450 and does not yet have an end date.“Customers began seeking out ways to protect their Covid-19 vaccine record cards, knowing they will likely be important to have on hand in the future,” Craig Grayson, vice president of print and marketing services for Staples, said in an email on Wednesday. “Leveraging our existing capabilities in store felt like a natural way to provide a free solution.”People can also get their completed vaccine cards laminated for free at Office Depot and OfficeMax stores nationwide using the code 52516714 through July 25.Dr. Ikediobi also recommends keeping the card in a safe place, as you would your passport, rather than carrying it around. “It does not necessarily need to be on your person at all times,” she said.Do I need my card to travel?In some cases, yes. Some destinations and cruise lines have started requiring that travelers be fully vaccinated before they travel. As of March 26, fully vaccinated Americans who can present proof of vaccination can visit Iceland, for example, and avoid border measures such as testing and quarantining, the country’s government said.The cruise line Royal Caribbean is requiring passengers and crew members 18 or older to be vaccinated in order to board its ships, as are Virgin Voyages, Crystal Cruises and others. These companies will restart cruise operations this spring and summer. None of the companies are yet operating cruises out of United States ports, because the C.D.C. has yet to give them the guidelines they’ll need to follow.For the moment, airlines are not requiring vaccinations for travel. But the idea has been much talked about in the industry. In an interview with NBC Nightly News recently, Ed Bastian, the chief executive officer of Delta Air Lines, said that proof of vaccination will likely eventually be required on international flights, but whether that is paper proof or a digital vaccine passport, is unclear.Will New York require a vaccine passport?Gov. Andrew Cuomo last week announced the launch of Excelsior Pass, a free app that will allow businesses to scan a code to confirm whether someone has been vaccinated or tested negative for the coronavirus. To sign up, New York residents should visit the Excelsior Pass website, where they will be asked to enter their name, date of birth and ZIP code. A pass — a QR code that can be scanned by businesses — will automatically be generated using data from state vaccination records or testing lab data.No one is required to download Excelsior Pass, according to a spokesman for the governor’s office. The pass generated on the website can be printed out, or you can show your vaccine card or evidence of a negative test result instead.Will the Biden administration require a vaccine passport?Among the Biden administration’s executive orders aimed at curbing the pandemic is one that asked government agencies to “assess the feasibility” of producing digital versions of vaccination documents. But while the government is involved in these efforts, the administration has said that it would not be passing a federal mandate or distributing its own vaccine passport.In a White House Covid-19 news conference on Monday, Andy Slavitt, the acting director for the Centers for Medicare and Medicaid Services, said that “unlike other parts of the world, the government here is not viewing its role as the place to create a passport, nor a place to hold the data of citizens.”“We view this as something that the private sector is doing and will do,” he said. “What’s important to us — and we’re leading an interagency process right now to go through these details — are that some important criteria be met with these credentials,” including equitable access and privacy and security concerns.The Krispy Kreme chain is offering one free glazed doughnut a day to anyone who presents proof of Covid-19 vaccination. Timothy A. Clary/Agence France-Presse — Getty ImagesAre there other benefits?Yes. Aside from the health benefits of getting the vaccine, there are also other perks that come with your vaccine card. Businesses across the country, from bars to marijuana dispensaries, have been offering perks to those with a Covid-19 vaccination card. Krispy Kreme, for instance, said last week that for the rest of the year, it would give one free glazed doughnut per day to anyone who presents proof of a Covid-19 vaccination.Michael Tattersfield, the company’s chief executive, told Fox News that as vaccinations have accelerated across the country, “We made the decision that, ‘Hey, we can support the next act of joy,’ which is, if you come by, show us a vaccine card, get a doughnut any time, any day, every day if you choose to.”Follow New York Times Travel on Instagram, Twitter and Facebook. And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation. Dreaming up a future getaway or just armchair traveling? Check out our 52 Places list for 2021.

People discharged from hospital after covid-19 appear to have increased rates of organ damage (“multiorgan dysfunction”) compared with similar individuals in the general population, finds a study published by The BMJ today.
The increase in risk was not confined to the elderly and was not uniform across ethnic groups, prompting the researchers to suggest that the long-term burden of covid-19-related illness on hospitals and broader healthcare systems is likely to be substantial.
Although covid-19 is most well known for causing serious respiratory problems, it can affect other organs and systems within the body, including the heart, kidneys, and liver.
Several unexplained symptoms that continue for more than 12 weeks after covid-19 are said to be part of post-covid syndrome (also known as “long covid”), but the long term pattern of organ damage after infection is still unclear.
To investigate this, a team of UK researchers from the Office for National Statistics, University College London and University of Leicester set out to compare rates of organ dysfunction in individuals with covid-19 several months after discharge from hospital with a matched control group from the general population.
Their findings are based on 47,780 individuals (average age 65, 55% men) in hospital in England with covid-19 who were discharged alive by 31 August 2020.

A manufacturing subcontractor in Baltimore mixed ingredients from the coronavirus vaccines of Johnson & Johnson and AstraZeneca, setting back U.S. production of the “one-and-done” shot.WASHINGTON — Workers at a plant in Baltimore manufacturing two coronavirus vaccines accidentally conflated the ingredients several weeks ago, contaminating as many as 15 million doses of Johnson & Johnson’s vaccine and forcing regulators to delay authorization of the plant’s production lines.The plant is run by Emergent BioSolutions, a manufacturing partner to both Johnson & Johnson and AstraZeneca, the British-Swedish company whose vaccine has yet to be authorized for use in the United States. Federal officials attributed the mistake to human error.The mix-up has delayed future shipments of Johnson & Johnson doses in the United States while the Food and Drug Administration investigates what occurred. Johnson & Johnson has moved to strengthen its control over Emergent BioSolutions’ work to avoid additional quality lapses.The mistake is a major embarrassment both for Johnson & Johnson, whose one-dose vaccine has been credited with speeding up the national immunization program, and for Emergent, its subcontractor, which has faced fierce criticism for its heavy lobbying for federal contracts, especially for the government’s emergency health stockpile.The error does not affect any Johnson & Johnson doses that are currently being delivered and used nationwide, including the shipments that states are counting on next week. All those doses were produced in the Netherlands, where operations have been fully approved by federal regulators.Further shipments of the Johnson & Johnson vaccine — projected to total tens of millions of doses in the next month — were supposed to come from the giant plant in Baltimore. Those deliveries are now in question while the quality control issues are sorted out, according to people familiar with the matter.Federal officials still expect to have enough doses from the three approved coronavirus vaccine makers to meet President Biden’s commitment to provide enough vaccine to immunize every adult by the end of May. The two other federally authorized manufacturers, Pfizer-BioNTech and Moderna, are continuing to deliver as expected.Pfizer is shipping its doses ahead of schedule, and Moderna is on the verge of winning approval to deliver vials of vaccine packed with up to 15 doses instead of 10, further bolstering the nation’s stock.The problems arose in a new plant that the federal government enlisted last year to produce both Johnson & Johnson’s and AstraZeneca’s vaccines. Both use similar technology in which genes unique to the coronavirus are shuttled into human cells, where they cause the immune system to produce antibodies.In less than a year, Emergent hired and trained hundreds of new workers to produce millions of doses of both vaccines that were supposed to be ready by the time that clinical trials showed whether they actually worked. In late February, one or more workers somehow confused a key ingredient for AstraZeneca’s vaccine with Johnson & Johnson’s, raising questions about training and supervision.Vaccine production is a notoriously fickle science, and errors are often expected to occur and ruin batches. But Emergent’s mistake went undiscovered for days until Johnson & Johnson’s quality control checks uncovered it, according to people familiar with the situation. By then, up to 15 million doses had been contaminated, the people said.None of the doses ever left the plant, and the lot has been quarantined. There is no indication that production of AstraZeneca’s vaccine, which has yet to be authorized for emergency use by the Food and Drug Administration, was affected.Johnson & Johnson reported the mishap to federal regulators, who then started an investigation that has delayed the authorization of that plant’s production lines. The company has beefed up the number of its own staff members who monitor Emergent’s work and instituted a variety of new checks intended to protect against future lapses.Johnson & Johnson already faced a lag in its manufacturing that has caused the company to fall behind on its commitments to the federal government, but it seemed on track to catch up. It delivered 20 million doses by the end of March, and has pledged to deliver about another roughly 75 million by the million doses by the end of May.White House officials hedged their projections in a phone call with governors on Tuesday, forecasting certain deliveries from Pfizer and Moderna but warning that Johnson & Johnson’s shipments would fluctuate.In a statement late Wednesday, the company said it expected the steps it was now taking with Emergent would enable it to deliver 24 million doses by the end of April, or about what the federal government expected. But that depends on whether Johnson & Johnson satisfies Food and Drug Administration regulators.The agency last week cleared a bottling facility that Johnson & Johnson uses in Indiana, allowing the release of more doses made in the Netherlands. But that facility cannot send out doses produced in the Emergent plant until the Food and Drug Administration authorizes it.Nearly seven million doses of the vaccine have been delivered so far, and about half of those have been administered, according to the Centers for Disease Control and Prevention.

A drug that unleashes the immune system offers a rare glimmer of hope for those with a cancer that resists most treatments.For decades, esophageal cancer has defied scientific attempts to discover a therapy that extends patients’ survival, year after year claiming the lives of such illustrious people as Humphrey Bogart, Christopher Hitchens and Ann Richards, the former governor of Texas.Now a large clinical trial offers hope, finding that a drug that unleashes the immune system to attack cancer cells can double the disease-free survival times in patients from 11 months to 22 months. The study was published on Wednesday in the New England Journal of Medicine.“It is a game changer,” said Dr. David Ilson, an esophageal cancer expert at Memorial Sloan Kettering Cancer Center in New York, who wrote an editorial accompanying the research. “We’ve waited a long time for this.”In the trial, sponsored by Bristol-Myers Squibb, 794 patients in 29 countries were randomly assigned to receive infusions of the drug, nivolumab, or a placebo.The patients had all had chemotherapy and radiation followed by surgery to remove their cancers. As usually happens, pathology reports showed that the surgery did not remove all of the cancer cells, which still lurked in lymph nodes and elsewhere, setting the stage in these patients for their cancers to return as incurable metastases.Nivolumab is approved for some patients with other cancers, like Hodgkin’s lymphoma, melanoma and colorectal cancer. With the new study, experts expect the drug will readily win approval for treatment of early-stage esophageal cancer.Dr. Ronan Kelly, director of the Charles A. Sammons Cancer Center at Baylor University Medical Center and lead author of the new study, said he and the other researchers urgently wanted to help the 75 percent of patients who go through extraordinarily difficult sequences of radiation, chemotherapy and surgery that disfigures the digestive system, only to learn that cancer is still present or has a high likelihood of recurring.Without some other form of treatment, “we knew many would recur quickly,” Dr. Kelly said. Additional chemotherapy not only was difficult for patients to tolerate, but it also did not seem to help. Nivolumab has few side effects and seemed worth a try.Esophageal cancer is rare in the United States, accounting for 1 percent of all cancers; about 15,000 patients die each year. But it is the seventh most common cancer globally, and frequently seen in East Asia, although it is not clear why, Dr. Ilson said.Smoking is a risk factor, but researchers do not think the high smoking rates in China, for example, explain the high incidence. “We don’t think it’s environmental,” Dr. Ilson said.Other risk factors include alcohol consumption and acid reflux disease.Because the cancer is so rare in the United States, it has not gotten much research attention. While new treatments have revolutionized prospects for other cancer patients, those with esophageal cancer could only look on longingly.That has weighed heavily on people with the disease, said Mindy Mordecai. Her husband, John, died of esophageal cancer in March 2008. She started an advocacy group called Esophageal Cancer Action Network.“You can’t even imagine how demoralizing it is to see all the progress around you. ‘Please sir, may I have some more gruel?’” she said, quoting Oliver Twist, the Charles Dickens character in the eponymous novel, asking for a pittance.The new findings must be seen in the context of what patients go through when they develop esophageal cancer, experts said. Most learn they have the cancer after it has progressed to a point where they are unlikely to survive.But every patient hopes to be one of the lucky ones. “Our patients are always waiting for the other shoe to drop,” Ms. Mordecai said. “You have to understand what it’s like to live with that every day.”The first step for most is chemotherapy and radiation. The treatment is so harsh that an oncology nurse told Mr. Mordecai it “brings Navy Seals to their knees,” Ms. Mordecai recalled.The chemotherapy has difficult side effects, and the radiation causes a burning sensation that makes it difficult to swallow. “Food won’t go down,” Ms. Mordecai said. “You just feel rotten.”The next step is major surgery. A doctor takes out most of the patient’s esophagus, the tract leading from the mouth to the stomach, and then grabs the stomach and pulls it up, attaching it to a stump of esophagus left behind.The result is a stomach that is vertical, not horizontal, and lacks the sphincter muscle that normally keeps stomach acid from spilling out. For the rest of their lives, patients can never lie flat — if they do, the contents of their stomach, including acid, pours into their throats. They can choke, cough and aspirate.Recovery is difficult, and morbidity and mortality are high. But most patients go through with the operation once they weigh their options. To refuse the treatment means giving up and letting the cancer close off the esophagus to the point where some cannot even swallow their own saliva, said Dr. Paul Helft, a professor of surgery and an ethicist at Indiana University School of Medicine.The treatment is so long and harrowing that Dr. Helft often uses it to teach medical students and other trainees about informed consent — about how patients must be fully informed before they start any given treatment. Esophageal cancer patients in particular must be told that they are likely to have a recurrence within the first year.Ms. Mordecai said her husband had his surgery at the end of September 2008. By Dec. 6, he had untreatable metastases in his liver. Now, she said, patients may have a glimmer of hope.Dr. Ilson, who has spent his career trying to develop therapies to help patients with esophageal cancer, said that he did not expect this treatment to succeed: “We all get nihilistic when faced with years of negative studies.”“This is really a landmark paper,” he added, and the drug “will become a new standard of care.”