She was rushed to the hospital with a high fever and, she says, spent a week there unconscious. By May, some 18 of her co-workers had died. Before she was allowed to go home, K.G.B. agents took her a document to sign, prohibiting her from talking about the events for 25 years.

At Sverdlovsk’s epidemiological service, the epidemiologist Viktor Romanenko was a foot soldier in the cover-up. He says he knew immediately that the disease outbreak striking the city could not be intestinal, food-borne anthrax as the senior health authorities claimed. The pattern and timing of the cases’ distribution showed that the source was airborne and a one-time event.

“We all understood that this was utter nonsense,” said Dr. Romanenko, who went on to become a senior regional health official in post-Soviet times.

But in a Communist state, he had no choice but to go along with the charade, and he and his colleagues spent months seizing and testing meat. K.G.B. agents descended on his office and took away medical records. The Soviet Union had signed a treaty banning biological weapons, and national interests were at stake.

“There was an understanding that we had to get as far away as possible from the biological-weapons theory,” Dr. Romanenko recalled. “The task was to defend the honor of the country.”

There were even jitters at the Evening Sverdlovsk, a local newspaper. A correspondent from The New York Times called the newsroom as the outbreak unfolded, recalls a journalist there at the time, Aleksandr Pashkov. The editor in chief told the staff to stop answering long-distance calls, lest anyone go off-message if the correspondent called again.

“He who can keep a secret comes out on top,” Mr. Pashkov said.

As the Soviet Union crumbled, so did its ability to keep secrets. For a 1992 documentary, Mr. Pashkov tracked down a retired counterintelligence officer in Ukraine — now a different country — who had worked in Sverdlovsk at the time. Telephone intercepts at the military lab, the officer said, revealed that a technician had forgotten to replace a safety filter.

Soon, Mr. Yeltsin — who himself was part of the cover-up as the top Communist official in the region in 1979 — admitted that the military was to blame.

“You need to understand one simple thing,” Mr. Pashkov said. “Why did all this become known? The collapse of the Union.”

The husband-and-wife team of Dr. Meselson and Dr. Guillemin visited Yekaterinburg several times in the 1990s to document the leak. Interviewing survivors, they plotted the victims’ whereabouts and investigated weather records, finding that Dr. Meselson and others had been wrong to give credence to the Soviet narrative.

Dr. Meselson said that when he contacted a Russian official in the early 1990s about reinvestigating the outbreak, the response was, “Why take skeletons out of the closet?”

But he said that determining the origins of epidemics becomes more critical when geopolitics are involved. Had he and his colleagues not proved the cause of the outbreak back then, he said, the matter might still be an irritant in the relationship between Russia and the West.

The same goes for the investigation into the source of Covid-19, Dr. Meselson said. As long as the pandemic’s source remains a matter of suspicion, he said, the question will continue to raise tensions with China, more so than if the truth were known.

“There’s a huge difference between people who are still trying to prove a point against emotional opposition and people who can look back and say, ‘Yeah, yeah, I was right,’” Dr. Meselson said. “One of them fuels wars. The other is history. We need to get all these things solved. We need history, we don’t need all this emotion.”

Unlike Covid-19, anthrax does not easily pass from human to human, which is why the Sverdlovsk lab leak did not cause a broader epidemic. Even the Sverdlovsk case, however, has not been fully solved. It remains unclear whether the secret activity at the factory was illegal biological weapons development — which the Soviet Union is known to have performed — or vaccine research.

Under President Vladimir V. Putin, revealing Russian historical shortcomings has increasingly been deemed unpatriotic. With the government mum on what exactly happened, a different theory has gained currency: Perhaps it was Western agents who deliberately released anthrax spores to undermine the Communist regime.

“The concept of truth, in fact, is very complicated,” said Lev Grinberg, a Yekaterinburg pathologist who secretly preserved evidence of the true nature of the outbreak in 1979. “Those who don’t want to accept the truth will always find ways not to accept it.”

Oleg Matsnev contributed research.

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Is It Covid or the Flu? New Combo Tests Can Find Out.

“We in the laboratory are preparing for another big boom in testing,” said Dr. Baird, whose team has run more than two million coronavirus tests since the beginning of the pandemic. “Even if people are vaccinated, they’re going to wonder, ‘Am I the breakthrough case?’”

In addition to Cepheid, other companies have developed tests that look for influenza and the coronavirus at the same time, including Roche, which has received emergency use authorization for a test that looks for the coronavirus, influenza A and influenza B at once.

In recent years various hospitals have developed in-house versions of these combination tests as well, some of which look for more than a dozen different respiratory pathogens simultaneously using P.C.R. technology. Those “multiplex” tests are especially helpful in diagnosing illnesses in people with weak immune systems because they allow doctors to swiftly discern what pathogen is making a person sick before it is too late to start the right treatments.

A French company, bioMérieux, sells a P.C.R. test that looks for the coronavirus as well as 21 other viruses and bacteria simultaneously. And Roche recently bought a company that sells a machine that can screen for more than 20 pathogens in one go.

Testing for multiple pathogens does not always lead to a simple treatment, however. Co-infections, in which a person is infected with multiple viruses simultaneously, are more common than doctors expected, and sometimes the multiplex tests might detect a viral infection but miss a bacterial one, said Dr. Daniel Griffin, chief of infectious diseases at ProHealth New York. A patient could carry the influenza virus but also test positive for a bacterium such as pneumococcus, for example.

“We initially thought that every time we identified a virus, we would just be able stop all antibiotics and just treat the virus if effective antiviral therapy was available,” Dr. Griffin said. “We now know that we often need to continue antibiotics,” he explained, because sometimes the multiplex tests are not sensitive enough to rule out a bacterial culprit.

Doctors and test developers are still grappling with how many pathogens to test patients for in different settings. “A burning question at every company is what panel is best — is it one, two, four, 20?” said Dr. Mark Miller, chief medical officer at bioMérieux. Relatively young and healthy adults might just need a quad test to know if they should start on Tamiflu for influenza, for example, but patients with underlying chronic diseases who are very sick might benefit from receiving the test for 22 different pathogens so that doctors can decide whether they need to be admitted to a hospital.

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Operating Rooms Go Under the Knife

Ceilings are not overlooked. Freeing up valuable floor space, monitors are often affixed to ceiling-mounted booms, which can have several arms and may also serve as a conduit for gases needed for anesthesia. Ultraviolet cleaning systems, which eliminate bacteria and viruses, can be anchored in the ceilings, to assist with disinfection. And the space above the ceiling is often larger to house a range of cables and other electronic equipment, in addition to ductwork with sophisticated air filtration systems.

Access to the space above the ceiling, as well as behind the walls, has become important, so that any technical problems can be investigated and remedied within hours, rather than shutting a room down for lengthy repairs. Some hospitals, for example, are now considering stainless steel prefabricated wall systems for their surgical suites because they are both easier to clean and easier to take out if the electronics hidden behind break, Ms. Saba said.

Other important factors are lighting and noise. When it comes to increasingly common laparoscopic surgery, monitors that guide surgeons are lit but overhead lights may be turned off to reduce glare, Dr. Hawn said.

That “can be somewhat dangerous because it can be quite dark and people run into things or trip over things,” she added. “We now have green lighting, which allows us to be able to see a sharp image on the monitors without the glare that you get from the white light.”

Noise is distracting at best, but with physical repercussions, like hypertension, especially for staff exposed for long periods. High decibel levels are “associated with increased difficulty in communication, which is the largest source of preventable errors in the hospital environment,” John Medina, an affiliate associate professor at the University of Washington department of bioengineering, said in an email.

At the Loma Linda University Medical Center in California, which is expected to open a new hospital on its campus this year, the operating room walls are built to mitigate outside noise as well as vibrations, and air duct silencers are being used as well, said Allison Ong, the head of campus transformation.

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Chipotle Sued by N.Y.C. Over Workers’ Scheduling

New York City on Wednesday sued the fast-food giant Chipotle Mexican Grill over what it says are hundreds of thousands of violations of a fair scheduling law at several dozen stores.

Workers are owed over $150 million in relief for the violations, according to the complaint, and financial penalties could far exceed that amount, making it the largest action the city has brought under the law.

The suit cites violations of the so-called Fair Workweek Law that include changing employees’ schedules without sufficient notice or extra pay; requiring employees to work consecutive shifts without sufficient time off or extra pay; and failure to offer workers additional shifts before hiring new employees to fill them.

The allegations cover the period from November 2017, when the law took effect, to September 2019, when the city filed an initial suit involving a handful of Chipotle stores. The new complaint, filed by the Department of Consumer and Worker Protection at the Office of Administrative Trials and Hearings, said that Chipotle had made some attempt to comply with the law since 2019, but that violations were continuing.

can exact a large physical and emotional toll on workers and their children.

Under the law, fast-food employers must provide workers with their schedules at least 14 days in advance — or, if not, obtain written consent for them and pay them a premium for the shifts.

Employers must also provide workers with at least 11 hours between shifts on consecutive days or obtain written consent and pay them $100. The hope is to discourage the practice of forcing workers to work late into the evening and then help open a store in the morning, known as “clopening.”

The provision requiring employers to offer workers additional shifts before hiring new workers was intended to make it easier for workers to earn enough income to sustain themselves.

Employers in fast-food and retail operations often hire more workers at fewer hours to add scheduling flexibility, said Saravanan Kesavan, an expert in retail operations at the University of North Carolina. Dr. Kesavan has conducted research showing that financial performance can actually improve when employers provide more stable and predictable schedules.

The complaint also accuses the company of violating the city’s paid sick leave law, which was enacted in 2014 and mandated up to 40 hours of paid leave per year. (The ceiling grew to 56 hours beginning this January for larger employers.) The city contends that Chipotle illegally denied requests for time off, required workers to find their own replacements or did not pay workers for time they took.

According to the complaint, all of the estimated 6,500 Chipotle employees in New York City from November 2017 to September 2019 were affected by violations involving scheduling and sick leave, and on average they experienced more than three scheduling violations a week.

became sick after eating at Chipotle restaurants in 2015 and 2016, some from E. coli bacteria, leading to a sharp decline in the company’s stock price and threatening the image it had cultivated as a purveyor of “food with integrity.”

Last year, Chipotle was fined nearly $1.4 million over accusations that it regularly violated Massachusetts child labor laws from 2015 to 2019. The company settled the case without admitting violations.

But the company has posted solid sales growth during the pandemic, with revenue of $6 billion last year, and its stock price has soared.

According to the New York City complaint, Chipotle frequently violated the law by either destroying or failing to maintain or produce records attesting to its scheduling policies.

“Chipotle failed to produce certain categories of scheduling information the department requested, in part because it had destroyed paper schedule records,” the complaint states. “However, the evidence Chipotle did produce, as well as evidence that employees provided, shows that Chipotle did not begin to implement key elements of the Fair Workweek Law in any of its New York City locations until approximately September 2019.”

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U.S. Bet on Covid Vaccine Manufacturer Even as Problems Mounted

Because of the pandemic, most of the auditors drew their conclusions from documents and video tours, during which Emergent workers controlled the camera angles, one former company official said.

Johnson & Johnson’s auditors said monitoring reports for bacteria or other contaminants were filed four to six months late. AstraZeneca’s said that Emergent repeatedly loosened monitoring criteria so it appeared to meet them, resorting to measures like “historical averages.” But even then it failed the tests, the report said.

In another audit, BARDA officials documented similar concerns, classifying some of them, including the risks of microbiological contamination, as “critical.” That designation is reserved for the most serious problems that pose an immediate and significant risk.

Emergent’s own internal audit in July also said the flow of workers and materials through the plant was not adequately controlled “to prevent mix-ups or contamination.”

The reports echoed quality-control shortcomings documented in an April inspection by the F.D.A., reported earlier by The Associated Press, that concluded the facility was “not ready for commercial operations.”

Multiple audits underscore how poorly the company was prepared for the huge workload it accepted.

The Covid-19 projects required significantly more testing to ensure materials remained stable, but Emergent had just one employee coordinating it all, the BARDA audit found. Emergent acknowledged at the time that its testing system was “not ideal” and pledged to train at least one more Emergent worker and hire a third. BARDA did not respond to requests for comment on its audit or any of the others, beyond saying that it had “worked with Emergent to resolve the issues” raised during the F.D.A. inspection.

Another internal investigation in August found that Emergent approved four raw materials used to produce AstraZeneca’s vaccine without first fully testing them. That type of shortcut, called a conditional release of material, occurred on average twice a week in October, internal logs show. The measure was deemed necessary because the company was working with shortened production times, testing backlogs and the needs of Operation Warp Speed, the Trump administration’s crash vaccine development program. And while a manager “knowingly deviated” from standards, the report said, the batches of vaccine would be not released without quality and safety tests.

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A Terrifying Disease Stalks Seaside Australia: Flesh-Eating Ulcers

He has treated more than a thousand patients, both in Australia and overseas, for the disease. Many of those in Australia are older, but others are young teachers, laborers and even children.

He measures their lesions gently with a ruler, marking them to track their progression. Though they look like the stuff of nightmares — some have ulcers that eat all the way to the bone — most patients describe them as painless. The flesh-eating toxin produced by the bacteria presents a peculiar horror: It both weakens the immune response and numbs the flesh it is consuming. It’s “quite an extraordinary organism, really,” Dr. O’Brien said of the bacterium, “and a formidable foe.”

In Mr. Courtney’s case, the ulcer had ravaged the top half of his foot before doctors could give a diagnosis. They have since performed surgeries to remove the necrotic, concrete-like tissue. “Unless you get rid of that dead flesh, the skin will never heal,” said Dr. Adrian Murrie, a physician at the clinic who has been treating Mr. Courtney.

Other patients with less severe cases sometimes decline treatment, instead opting for natural remedies like applying heat and clay. Though the body can occasionally fight off smaller ulcers, such treatments can pose a real danger in serious cases, Dr. O’Brien said.

In most cases, the course of treatment is antibiotics. Previously, the disease was largely treated with surgery, but with better medications, the prognosis has vastly improved in recent years. “It was thought the antibiotics didn’t work,” Dr. O’Brien said. “Because it actually gets worse before it gets better.”

Still, for now, prevention is close to impossible.

“We don’t know how to stop it,” he said. But if the answer is to be found anywhere, he said, it’s in Australia.

For Mr. Courtney, his battle with the disease is far from over. Doctors expect his treatment to last at least another six months.

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