surrounded and detained by armed men. It was only when the army arrived that Ms. Izquierdo was released.

Still, despite continually confronting danger on the job, Ms. Izquierdo said her greatest challenge in life came when her partner of 18 years, who had been battling cancer and kidney problems, finally succumbed.

“I wanted to kill myself because I loved him so much that I stopped loving myself,” she said.

Then, in 2015, she was diagnosed with ovarian cancer and given eight months to live. Again, she thought about giving up.

But her friends and family convinced her to keep fighting. She underwent chemotherapy and multiple surgeries, leaving her body scarred.

“I would cry in front of the mirror when I looked at myself because my body looked mutilated,” Ms. Izquierdo said. “I felt like Frankenstein.”

Eventually she defeated the cancer — but in 2017 it returned, this time in her stomach. In February of that year she had a heart attack.

After surviving a second heart attack months later, Ms. Izquierdo said everything changed. While unconscious, Ms. Izquierdo said she had a vision during which she heard her deceased partner’s voice telling her to go on living.

“If I came back to life it was for one purpose,” she said. “To keep living, to be happy, and to help other people with my life experience.”

It was that positive attitude that catapulted her to TikTok fame. But along with all the followers came the trolls, who called her overweight or unattractive. At first, the negative comments started getting to her; then, she decided to stop caring.

“When I was allowing myself to be affected by unfounded negative comments, I said to myself, ‘No — I love myself.’”

Before long, the number of negative comments started dropping, even as her followers increased. Watching haters change their attitude toward her, Ms. Izquierdo said, is what she considers one of the greatest achievements of her TikTok presence. That, and the messages she receives from fans telling her the effect she’s had on their lives.

A few weeks ago, one of those fans, Ms. Méndez, summoned the courage to contact her idol. The resulting phone conversation, she said, has turned her life around: She’s gone to see a specialist about losing weight and plans to start working out.

“I want to wake up dancing every morning like she does,” Ms. Méndez said. “She’s a woman worth her weight in gold.”

For Ms. Izquierdo, this kind of impact is the point of all her efforts.

“It’s all worth it if I can change someone who is facing a problem,” she said. “If I can make them smile.”

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New Zealand Wants a 90% Vaccination Rate. Its Street Gangs May Hold the Key.

AUCKLAND, New Zealand — Rawiri Jansen, a Maori doctor, had an urgent message for the 150 people, mostly patch-wearing members of New Zealand’s plentiful street gangs and their families, who sat before him on a bright Saturday afternoon.

Covid is coming for them, he said. Cases in New Zealand’s hospitals are rising rapidly. Soon, dozens of new infections a day might be hundreds or even a thousand. People will die. And vaccination is the only defense. “When your doctors are scared, you should be scared,” he said.

By the end of the day, after an exhaustive question-and-answer session with other health professionals, roughly a third of those present chose to receive a dose then and there.

Having abandoned its highly successful “Covid-zero” elimination strategy in response to an outbreak of the Delta variant, New Zealand is now undergoing a difficult transition to trying to keep coronavirus cases as low as possible. On Friday, the country set a target of getting at least 90 percent of the eligible population fully vaccinated — a goal, the highest in the developed world, whose success hinges on persuading people like those who gathered to hear Dr. Jansen.

intensely criticized, including by police leaders.

Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines. Pfizer and Moderna recipients who are eligible for a booster include people 65 and older, and younger adults at high risk of severe Covid-19 because of medical conditions or where they work. Eligible Pfizer and Moderna recipients can get a booster at least six months after their second dose. All Johnson & Johnson recipients will be eligible for a second shot at least two months after the first.

Yes. The F.D.A. has updated its authorizations to allow medical providers to boost people with a different vaccine than the one they initially received, a strategy known as “mix and match.” Whether you received Moderna, Johnson & Johnson or Pfizer-BioNTech, you may receive a booster of any other vaccine. Regulators have not recommended any one vaccine over another as a booster. They have also remained silent on whether it is preferable to stick with the same vaccine when possible.

The C.D.C. has said the conditions that qualify a person for a booster shot include: hypertension and heart disease; diabetes or obesity; cancer or blood disorders; weakened immune system; chronic lung, kidney or liver disease; dementia and certain disabilities. Pregnant women and current and former smokers are also eligible.

The F.D.A. authorized boosters for workers whose jobs put them at high risk of exposure to potentially infectious people. The C.D.C. says that group includes: emergency medical workers; education workers; food and agriculture workers; manufacturing workers; corrections workers; U.S. Postal Service workers; public transit workers; grocery store workers.

Yes. The C.D.C. says the Covid vaccine may be administered without regard to the timing of other vaccines, and many pharmacy sites are allowing people to schedule a flu shot at the same time as a booster dose.

Chris Hipkins, the minister responsible for New Zealand’s Covid-19 response, acknowledged earlier this month that the decision to enlist gang leaders was an unusual one.

“Our No. 1 priority here is to stop Covid-19 in its tracks, and that means doing what we need to do to get in front of the virus,” he said. “Where we have been able to enlist gang leaders to help with that, and where they have been willing to do so, we have done that.”

Some gang leaders have acted independently to help the vaccination effort. They have connected members of their community to health officials, organized events with health professionals like Dr. Jansen, and streamed events on Facebook Live to allow an open forum for questions about rare health risks. In some cases, they have taken vaccines to communities themselves.

“Our community is probably less well informed; they’re probably not as health literate,” said Mr. Tam, the Mongrel Mob member, who is a former civil servant and who received the border exemption. Constant media criticism has turned them off from reading traditional news outlets, he added.

“They then resort to social media, because they have much greater control,” he said. “It’s also a space that perpetuates conspiracy theories and false information and all the rest of it.” Health advice has to come from trusted individuals and leaders in the community, he said.

In the past week, Mr. Tam has traveled almost the length of the country organizing pop-up vaccination events for members and their communities, as well as coordinating with other chapter leaders to get their members vaccinated, he said.

It was difficult work that put him at personal risk, he said, and that invited intense skepticism from people who thought of gangs only as violent or connected to organized crime.

“Why do we bother?” Mr. Tam said. “We bother because we care about those people that others don’t care about, as simple as that. They can talk about my gang affiliation, all the rest of it. But it’s that affiliation that allows me to have that penetration, that foot in the door. I can do the stuff that they can’t do.”

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The Vaccine Class Gap

The story here is bigger than Covid-19. Last year, the economists Anne Case and Angus Deaton published a book called “Deaths of Despair and the Future of Capitalism” that documented a growing class divide in one area of American life after another.

Income and wealth have grown much more quickly over recent decades for people with a bachelor’s degree than people without one. Marriage, church attendance and self-reported happiness have declined more for the working class than the professional class; chronic pain, obesity and alcohol consumption have increased more. As the title of the book indicates, life expectancy has also diverged, partly because of deaths from alcoholism, drug overdoses and suicide.

“This B.A./non-B.A. divide,” says Deaton, a Nobel laureate, “just comes up again and again and again.”

Case and Deaton, who are Princeton professors, argue that behind these trends is a “coming apart” of the working-class experience. For many people, life lacks the structure, status and meaning that it once had.

Frequently, people are not officially employed by the company where they work, which robs them of the pride that comes from being part of a shared enterprise. They don’t belong to a labor union, either. The timing of their work shifts can change unexpectedly. Many parents are trying to raise children without a partner.

These challenges can interfere with Covid vaccination in multiple ways. Carving out the time — to do the logistical research, get the shot, cope with side effects and schedule a second shot — can be hard. Working-class Americans also have less reason to trust public health officials; if you had suffered the damaging “coming apart” of the past few decades, would you trust people in positions of authority?

After I described the vaccination trends to Case and Deaton, they sent me some broader data on life expectancy, by both race and class. It shows a significant Black-white gap. But that gap has not grown over the past decade. What has grown is the life expectancy gap between college graduates and non-graduates, among both Black and white Americans.

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C.D.C Confirms More Cases of Rare Blood Clot Disorder Linked to J.&J. Vaccine

Federal health officials have now confirmed 28 cases, including six in men, of a rare blood clotting disorder in adults who have received the Johnson & Johnson Covid-19 vaccine.

Dr. Tom Shimabukuro, the deputy director of the immunization safety office at the Centers for Disease Control and Prevention, presented the new cases on Wednesday at a meeting of a panel of advisers to the C.D.C.

The figure is an increase from the 15 confirmed cases, all of which were in women, that were reported at last month’s meeting.

Although officials have now identified a handful of cases in men, women — especially those between the ages of 30 and 49 — appear to remain at elevated risk. “The trend is that the reporting rates are higher in females compared to males in all age categories,” Dr. Shimabukuro said at the meeting.

lifted the suspension 10 days later and added a warning about the potential risks to the vaccine’s label, which notes that a connection between the vaccine and the condition is “plausible.”

Twenty-two of the confirmed cases so far have been in women, and six have been in men. All were in adults between the ages of 18 and 59 who received the vaccine before the national pause. (There was also one additional case recorded in a 25-year-old man who participated in the clinical trial.)

Three people have died and four remain hospitalized, including one who is in intensive care. No new deaths have been documented since last month’s meeting, Dr. Shimabukuro said.

The overall risk remains exceedingly low. More than 9 million doses of the Johnson & Johnson vaccine have now been administered in the United States.

There have been 12.4 cases per million doses among women between the ages of 30-39 and 9.4 cases per million doses among women between 40 and 49, the two demographic groups that appear to be at highest risk. Among older women and men of all ages, there were fewer than 3 cases per million doses.

Among the 28 confirmed cases, 12 people who developed the disorder had obesity, 7 had high blood pressure, 3 had diabetes, and 3 were taking estrogen, though it is not yet clear whether any of those factors might substantially increase the risk of the disorder.

Officials will continue to monitor for cases of the clotting disorder in people who have been vaccinated, Dr. Shimabukuro said.

There have been no confirmed cases of the clotting disorder following the Pfizer-BioNTech or Moderna vaccines, which employ a different technology, Dr. Shimabukuro said.

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Covid-19 Live Updates: U.S. Calls for Pause on Johnson & Johnson Vaccine, Complicating Rollout

Johnson & Johnson’s single-dose coronavirus vaccine after six recipients in the United States developed a rare disorder involving blood clots within about two weeks of vaccination.

All six recipients were women between the ages of 18 and 48. One woman died and a second woman in Nebraska has been hospitalized in critical condition.

Nearly seven million people in the United States have received Johnson & Johnson shots so far, and roughly nine million more doses have been shipped out to the states, according to data from the Centers for Disease Control and Prevention.

“We are recommending a pause in the use of this vaccine out of an abundance of caution,” Dr. Peter Marks, director of the Food and Drug Administration’s Center for Biologics Evaluation and Research, and Dr. Anne Schuchat, principal deputy director of the C.D.C., said in a joint statement. “Right now, these adverse events appear to be extremely rare.”

On a media call later on Tuesday morning, Dr. Marks said that “on an individual basis, a provider and patient can make a determination whether or not to receive the vaccine” manufactured by Johnson & Johnson.

While the move was framed as a recommendation to health practitioners in the states, the federal government is expected to pause administration of the vaccine at all federally run vaccination sites. Federal officials expect that state health officials will take that as a strong signal to do the same. Within two hours of the announcement, Gov. Mike DeWine of Ohio, a Republican, advised all health providers in his state to temporarily stop giving Johnson & Johnson shots. In New York, the health commissioner, Dr. Howard Zucker, said the state would halt the use of the vaccine statewide while federal officials evaluate the safety risks. Appointments for Johnson & Johnson’s shot on Tuesday at state mass sites would be honored with Pfizer doses, Dr. Zucker said.

The authorities in New Jersey, Connecticut, Massachusetts, Maryland, Nebraska, Georgia, Indiana, Texas and Virginia also said that they would follow the call from federal health agencies.

Scientists with the F.D.A. and C.D.C. will jointly examine possible links between the vaccine and the disorder and determine whether the F.D.A. should continue to authorize use of the vaccine for all adults or limit the authorization.

In the media call, federal health officials tried to reassure recipients of Johnson & Johnson’s vaccine while at the same time describing symptoms that they should watch out if they received a shot within the past month.

Dr. Schuchat said that the risk of dangerous blood clots is “very low” for people who received the vaccine more than a month ago.

“For people who recently got the vaccine within the last couple of weeks, they should be aware, to look for any symptoms. If you receive the vaccine and develop severe headaches, abdominal pain, leg pain or shortness of breath, you should contact your health care provider and seek medical treatment,” she said. She emphasized that an emergency meeting of the C.D.C.’s outside advisory committee, which has been scheduled for Wednesday, to discuss how to handle the vaccine in the future is made up of independent experts.

Dr. Janet Woodcock, acting commissioner of the Food and Drug Administration, said she expects the pause in distributing and administrating the vaccine will last for “a matter of days” while officials investigate the cases. Officials also stressed that no serious safety problems have emerged with either of the other two federally authorized vaccines, developed by Pfizer-BioNTech and Moderna.

The move could substantially complicate the nation’s vaccination efforts at a time when many states are confronting a surge in new cases and seeking to address vaccine hesitancy. Regulators in Europe and elsewhere are concerned about a similar issue with another coronavirus vaccine, developed by AstraZeneca and Oxford University researchers. That concern has driven up some resistance to all vaccines, even though the AstraZeneca version has not been authorized for emergency use in the United States.

The vast majority of the nation’s vaccine supply comes from two other manufacturers, Pfizer-BioNTech and Moderna, which together deliver more than 23 million doses a week of their two-shot vaccines. There have been no significant safety concerns about either of those vaccines.

But while shipments of the Johnson & Johnson vaccine have been much more limited, the Biden administration had still been counting on using hundreds of thousands of doses every week. In addition to requiring only a single dose, the vaccine is easier to ship and store than the other two, which must be stored at extremely low temperatures.

Jeffrey D. Zients, the White House Covid-19 response coordinator, said Tuesday the pause “will not have a significant impact” the Biden administration’s plans to deliver enough vaccine to be able to inoculate all 260 million adults in the United States by the end of May. With the Johnson & Johnson setback, federal officials expect there will only be enough to cover fewer than 230 million adults. But a certain percentage of the population is expected to refuse shots, so the supply may cover all the demand.

Mr. Zients said the administration will still “reach every adult who wants to be vaccinated” by the May 31 target.

Federal officials are concerned that doctors may not be trained to look for the rare disorder if recipients of the vaccine develop symptoms of it. The federal health agencies said Tuesday morning that “treatment of this specific type of blood clot is different from the treatment that might typically be administered” for blood clots.

“Usually, an anticoagulant drug called heparin is used to treat blood clots. In this setting, administration of heparin may be dangerous, and alternative treatments need to be given,” the statement said.

In a news release, Johnson & Johnson said: “We are aware that thromboembolic events including those with thrombocytopenia have been reported with Covid-19 vaccines. At present, no clear causal relationship has been established between these rare events and the Janssen Covid-19 vaccine.” Janssen is the name of Johnson & Johnson’s division that developed the vaccine.

In the United States alone, 300,000 to 600,000 people a year develop blood clots, according to C.D.C. data. But the particular blood clotting disorder that the vaccine recipients developed, known as cerebral venous sinus thrombosis, is extremely rare.

All of the women developed the condition within about two weeks of vaccination, and government experts are concerned that an immune system response triggered by the vaccine was the cause. Federal officials said there was broad agreement about the need to pause use of the vaccine while the cases are investigated.

The decision is a fresh blow to Johnson & Johnson. Late last month, the company discovered that workers at a Baltimore plant run by its subcontractor had accidentally contaminated a batch of vaccine, forcing the firm to throw out the equivalent of 13 million to 15 million doses. That plant was supposed to take over supply of the vaccine to the United States from Johnson & Johnson’s Dutch plants, which were certified by federal regulators earlier this year.

The Baltimore plant’s certification by the F.D.A. has now been delayed while inspectors investigate quality control issues, sharply reducing the supply of Johnson & Johnson vaccine. The sudden drop in available doses led to widespread complaints from governors and state health officials who had been expecting much bigger shipments of Johnson & Johnson’s vaccine this week than they got.

A Kent State University student getting his Johnson &amp; Johnson vaccination in Kent, Ohio, last week.
Credit…Phil Long/Associated Press

The authorities in Ohio, New York, New Jersey, Connecticut, Massachusetts, Maryland, Nebraska, Georgia, Indiana, Texas and Virginia said on Tuesday that they would follow the call from federal health agencies to pause the administration of Johnson & Johnson’s vaccine after six women in the United States developed a rare disorder involving blood clots within about two weeks of vaccination.

CVS, the nation’s largest retail pharmacy chain, also said that it would immediately stop its use of Johnson & Johnson vaccinations and was emailing customers whose appointments would be canceled. A spokesman said that CVS would reschedule appointments “as soon as possible.”

Gov. Mike DeWine of Ohio and the state’s chief health official said they were advising all state vaccine providers to temporarily halt use of the single-dose vaccine. New York’s health commissioner, Dr. Howard Zucker, said the state would stop using the Johnson & Johnson vaccine, while the Food and Drug Administration and the Centers for Disease Control and Prevention evaluate the safety risks.

Connecticut health officials said they told vaccine providers to delay planned appointments and give an alternative option if they had the supply.

The C.D.C.’s outside advisory committee has scheduled an emergency meeting for Wednesday.

Jeff Zients, the White House Covid coordinator, said on Tuesday that the pause will not have a significant impact on the country’s vaccination campaign, which has accelerated in recent weeks as a rise in new virus cases threatens a fourth possible surge. Many states have already opened vaccination eligibility to all adults and others plan to by next week.

“Over the last few weeks, we have made available more than 25 million doses of Pfizer and Moderna each week, and in fact this week we will make available 28 million doses of these vaccines. This is more than enough supply to continue the current pace of vaccinations of 3 million shots per day,” Mr. Zients said in a statement.

Even though the reaction to the Johnson & Johnson shot is rare, any questions about the safety of the shots could bolster vaccine hesitancy.

Nearly seven million people in the United States have received Johnson & Johnson shots so far, and roughly nine million more doses have been shipped out to the states, according to data from the Centers for Disease Control and Prevention. The six women who developed blood clots were between the ages of 18 and 48. One woman died and a second woman in Nebraska has been hospitalized in critical condition.

“Right now, these adverse events appear to be extremely rare,” Dr. Peter Marks, director of the Food and Drug Administration’s Center for Biologics Evaluation and Research, and Dr. Anne Schuchat, principal deputy director of the C.D.C., said in a joint statement on Tuesday. “People who have received the J&J vaccine who develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their health care provider.”

Like many states, New York had already prepared for a significant drop in its supply of the Johnson & Johnson vaccine after federal officials said that supplies would be limited because of a production issue at a Baltimore manufacturing plant. On Friday, Gov. Andrew M. Cuomo said that New York expected to receive 34,900 Johnson & Johnson shots, a decrease of 88 percent from the previous week.

Dr. Zucker, New York’s health commissioner, said that the state would honor appointments made at state-run mass vaccination sites for the Johnson & Johnson vaccine by giving people the Pfizer-BioNTech vaccine instead. That vaccine requires two doses, and it was not immediately clear how the state would handle the additional strain on its supply.

Mayor Bill de Blasio of New York City said that the city would work to reschedule appointments at city-run vaccine sites, giving those people the Pfizer or Moderna vaccines instead.

“Every site has been told this morning to stop giving the J&J shots,” he said at a news conference.

Mr. Cuomo received the Johnson & Johnson vaccine at a public appearance last month in Harlem, which he framed as an effort to boost confidence in that vaccine’s efficacy rate and to address vaccine hesitancy.

Regulators in Europe and elsewhere are concerned about a similar issue with another coronavirus vaccine, developed by AstraZeneca and Oxford University researchers. That vaccine has not been authorized for emergency use in the United States.

Students line up for vaccines at Oakland University on Friday in Rochester, Mich. Coronavirus cases in the state have continued to rise in recent weeks.
Credit…Emily Elconin for The New York Times

The virus is again surging in parts of the United States, but it’s a picture with dividing lines: ominous figures in the Northeast and Upper Midwest, but largely not in the South.

Experts are unsure what explains the split, which doesn’t correspond to vaccination levels. Some point to warmer weather in the Sun Belt, while others suspect that decreased testing is muddying the virus’s true footprint.

The contours of where the virus is resurgent can be drawn around one figure: states that are averaging about 15 new cases a day for every 100,000 people. The 23 states — including Alabama, Mississippi and Arkansas — that have averaged that or fewer over the past week seem to be keeping cases relatively low, according to a New York Times database. Nationally, the country is averaging 21 new cases per 100,000 people.

In the 27 states above that line, though, things have been trending for the worse. Michigan has the highest surge of all, reporting the most drastic increase in cases and hospitalizations in recent weeks. Illinois, Minnesota and others have also reported worrisome increases.

Nationally, reported cases in the United States are growing again after a steep fall from the post-holiday peak in January. In the past two weeks, new confirmed cases have jumped about 11 percent, even though vaccinations picked up considerably, with an average of 3.2 million doses given daily.

Some Southern states, like Alabama and Mississippi, are lagging in vaccinations. Only about 28 percent of people in each state have received at least one shot, according to a New York Times vaccine tracker. Still, case counts continue to drop in both states.

Health experts say cases are rising in the Northeast and Upper Midwest for several reasons, including pandemic fatigue, the reopening of schools and the resumption of youth sports.

Hospitalizations tend to follow the trend line in cases by a few weeks, and have been rising in some states, most notably in Michigan.

Officials are also concerned about the spread of more contagious virus variants, especially B.1.1.7, first identified in Britain. The variant is now the leading source of new coronavirus infections in the United States, the director of the Centers for Disease Control and Prevention said last week.

Just why those factors might affect some states more than others is hard to pinpoint, experts say.

Dr. David Rubin, the director of PolicyLab at the Children’s Hospital of Philadelphia, said warmer weather in Southern states and California was probably playing a role, because it allows people to gather outdoors, with less risk of transmission.

New case reports have fallen by about 11 percent in Georgia over the past two weeks. And in Alabama, new cases are down roughly 29 percent, with a 17 percent decline in hospitalizations.

Some experts say, though, that reduced testing in some states could be obscuring the true picture. Testing in Alabama, for instance, has started to dip, but the share of tests that come back positive has remained high, at 11.1 percent, compared with a nationwide average of 5.1 percent, according to data compiled by Johns Hopkins University.

“People who are symptomatic and go to their provider are going to get a test,” said Dr. Michael Saag, the associate dean for global health at the University of Alabama at Birmingham, but “the desire for people to go get tested just because they want to know what their status is has dropped off dramatically.”

Still, Dr. Saag said, there is probably not a hidden spike in cases in Alabama right now, since hospitalizations in the state remain low.

The first dawn prayers of Ramadan around the Kaaba at the Grand Mosque in Mecca, Saudi Arabia, on Tuesday.
Credit…Amr Nabil/Associated Press

Millions of Muslims on Tuesday began celebrating a second Ramadan in the middle of the pandemic, although in many countries the first day of the holy month offered the promise of a Ramadan with fewer restrictions than last year.

Mosques across the Middle East and other parts of the world were closed for prayer last year, and lockdowns prevented festive gatherings with friends and family. In Jerusalem, for instance, the Old City was largely empty and the Aqsa Mosque compound was closed to the public, as coronavirus cases were surging.

But a large degree of normalcy was back on Tuesday: The Old City’s narrow alleys were crowded, sweet shops were preparing Ramadan desserts, clothing stores were open and the Aqsa compound was welcoming worshipers.

“Last year, I felt depressed and I didn’t know how long the pandemic would last,” said Riyad Deis, a co-owner of a spice and dried fruit shop in the Old City, while selling whole pieces of turmeric and Medjool dates to a customer. “Now, I’m relaxed, I have enough money to provide for my family and people are purchasing goods from my shop — it’s a totally different reality.”

The enthusiasm of some didn’t mean the Ramadan would go as normal. Across several countries in the Middle East, the authorities imposed limitations on customs and festivities, requiring that mosques enforce social distancing and telling worshipers to bring their own prayer rugs and to wear face masks.

In Dubai, Saudi Arabia and Egypt, taraweeh, the optional extra prayers that worshipers can observe at night, were capped at half an hour. No one will also be allowed to spend the night in a mosque, as is common during the last 10 days of Ramadan.

Mosques around the region were also prohibited from serving the fast-breaking meal of iftar or the predawn meal of suhoor. Though Muslims could still gather for those meals with friends and family, the authorities asked them to limit those gatherings this year.

In Jerusalem, Omar Kiswani, the director of Al Aqsa Mosque, said he was overjoyed that the compound was open to worshipers, but still urged caution.

“These are times of great happiness — we hope the blessed Aqsa Mosque will return to its pre-pandemic glory — but these are also times of caution because the virus is still out there,” Mr. Kiswani said.

In Egypt, government officials and prominent television hosts linked to the authorities warned Egyptians of a third wave of infections as Ramadan approached, hinting that another curfew or other lockdown restrictions could be imposed if cases rose.

“If you want the houses of God to remain open,” Nouh Elesawy, an official who oversees mosques at the Egyptian Ministry of Endowments, said earlier this month, “adhere to the precautionary procedures and regulations.”

The Ramadan restrictions may hit the hardest in poor neighborhoods, where residents depend on iftar banquets usually sponsored by wealthy individuals or organizations. For those people, feasting and Ramadan gifts are likely to be rarer, with tourism still at a trickle and many small businesses still suffering from the economic effects of the pandemic.

In Lebanon and Syria, the pandemic has worsened economic crisis that will likely squeeze people’s ability to enjoy the holy month, more than the governments’ limited restrictions aimed at curbing the spread of the coronavirus.

In Syria, where experts say the official infection and death numbers for Covid-19 are far below the reality, the government has few restrictions in place. Worshipers will even be allowed to stand in line inside of mosques to pray together after breaking their fast, the Syrian Ministry of Religious Affairs said.

In Lebanon, which emerged recently from a strict lockdown, shops and restaurants can operate regularly during the day but must offer only delivery service during a nighttime curfew from 9:30 p.m. to 5 a.m.

Global Roundup

Administering a coronavirus vaccine to a frontline worker in New Delhi, last week.
Credit…Rebecca Conway for The New York Times

India said on Tuesday that it would fast-track the approval of vaccines in use in other countries, a move aimed at rapidly increasing the country’s vaccine supply as it battles what is currently the world’s biggest coronavirus outbreak.

The Indian government said that it would grant emergency authorization to any foreign-made vaccine that had been approved for use by regulators in the United States, the European Union, Britain or Japan, or by the World Health Organization. The move had been recommended by a panel of Indian scientists and eliminates a requirement for drug companies to conduct local clinical trials.

“The decision will facilitate quicker access to such foreign vaccines” and encourage imports of materials that would boost India’s vaccine manufacturing capacity, the government said in a statement.

Earlier on Tuesday, India’s top drug regulator granted emergency approval to Sputnik V, the Russian-made vaccine, adding a third vaccine to the country’s arsenal on the same day that health officials recorded 161,736 new coronavirus infections in 24 hours.

It was the seventh straight day that India has added more than 100,000 cases, according to a New York Times database. Only the United States has seen a faster rise in infections during the pandemic.

India has administered about 105 million domestically produced vaccine doses for a population of 1.3 billion, but it is widely believed that the country needs to scale up inoculations rapidly because other measures have failed to control the virus. Many states have reimposed partial lockdowns and weekend curfews. In the country’s financial hub, Mumbai, health officials are racing to erect field hospitals as facilities report shortages of oxygen, ventilators and coronavirus testing kits.

And there is the risk of a superspreading event with the gathering of millions of Hindu pilgrims for the annual Kumbh Mela festival on the banks of the Ganges River, where the authorities say they are powerless to enforce social distancing.

India’s outbreak is reverberating worldwide as its pharmaceutical industry — which was supposed to manufacture and export hundreds of millions of doses of the AstraZeneca vaccine — is keeping most supplies at home. The approval of the Sputnik vaccine, whose first doses are expected to be available for use in weeks, offers hope that India could speed up its inoculation drive.

But it is unclear at this stage whether India will be able to procure significant quantities of other vaccines, including the Pfizer, Moderna and Johnson & Johnson shots in use in the United States. Major Western nations have accumulated much of the global supply of those vaccines and manufacturers are struggling to meet the surging demand.

India will import millions of Sputnik doses from Russia and then begin manufacturing the vaccine domestically, officials said. More than 850 million doses will be made, with some intended for export, Kirill Dmitriev, chief executive of the Russian Direct Investment Fund, a sovereign wealth fund that has financed the vaccine’s development, said in an interview with India’s NDTV channel.

“India is a vaccine-manufacturing hub and our strategic partner for production of Sputnik V,” Mr. Dmitriev said.

India has more than 13.6 million confirmed coronavirus cases, the second most after the United States, and 171,058 deaths, the fourth highest toll.

In other news around the world:

Chancellor Angela Merkel, center, at a cabinet meeting in Berlin on Tuesday. Her government’s proposal on coronavirus restrictions would place half the country over the threshold for lockdown.
Credit…Pool photo by Andreas Gora

BERLIN — Chancellor Angela Merkel’s government moved a step closer on Tuesday to securing the right to force restrictions on areas where the coronavirus is spreading rapidly, overriding state leaders reluctant to take action.

Ms. Merkel and her ministers approved a legislative proposal that would make it easier for the national government to enforce lockdowns and other limits on movement in regions where infection levels pass a set threshold. At current levels, it could lock down more than half of the country.

Under Germany’s decentralized leadership structures, the 16 state leaders have been meeting regularly with the chancellor to agree on nationwide coronavirus response policies. But with different regions experiencing different rates of infection, some state leaders have been reluctant to enforce the agreed limitations, leading to confusion and frustration among many Germans.

“I believe this amendment is as important as it is an urgent decision about how to proceed in the coronavirus pandemic,” the chancellor told reporters after meeting with her ministers.

Parliament still has to debate and approve the proposal, which would take the form of an amendment to the Protection Against Infection Act, and that process is expected to begin this week.

“We are in a situation where an emergency mechanism is necessary,” Ralph Brinkhaus, the leader of the Christian Democratic Union in Parliament, told reporters, before a meeting of his party lawmakers to discuss the amendment.

Under the proposed amendment, the federal government could force stores and cultural institutions to close and enforce limits on the number of people allowed to meet up in any region where infections surpass 100 new cases per 100,000 residents over a period of seven days.

More controversially, the law would also allow Ms. Merkel’s government to order that schools and day care centers close if the number of new infections reaches more than 200 per 100,000 inhabitants. Schools fall under the jurisdiction of the states, and local leaders are reluctant to relinquish that control.

Germany has registered more than three million infections and more than 78,700 deaths from Covid-19 since the virus began moving through the country last spring. It recorded 10,810 new cases of infection on Tuesday, bringing the national rate of infection to more than 140 per 100,000.

The number of patients in intensive care is expected to hit a record this month, as the country struggles to vaccinate enough people to get ahead of the spread of the highly contagious B.1.1.7 variant.

Vaccinations at a mosque in London earlier this month. Britain’s program has reached over 32 million people, more than half the adult population.
Credit…Andrew Testa for The New York Times

Britain has now offered vaccinations to everyone in the country age 50 and older, the government announced late on Monday, and is extending its program to another age group, the latest sign that the national rollout is continuing at pace.

On Tuesday, the authorities opened vaccinations to anyone 45 or older, yet the announcement came with a small hiccup: The website for the country’s National Health Service crashed for a short time after the younger cohort was invited to book appointments online.

The new step in the country’s vaccine rollout comes as the authorities eased several restrictions in England on Monday after months of stringent lockdowns, with pubs and restaurants opened for drinks and dining outside, and nonessential shops once again opening their doors.

Prime Minister Boris Johnson called the moment a “hugely significant milestone” and in a statement thanked those involved with the vaccine rollout. Mr. Johnson said the country was on track to offer all adults a vaccination by the end of July. More than 32 million people across Britain have received their first dose of one of the vaccines, according to government data.

The government said it had also already offered vaccinations to every health or care worker, and to everyone with a high-risk medical condition.

England has also began rolling out the Moderna vaccine, which will be offered as an alternative alongside the Pfizer BioNTech vaccine for those under 30, instead of AstraZeneca’s, which has been the mainstay of Britain’s program so far.

There have been concerns about a possible link between the AstraZeneca vaccine and very rare blood clots, and last week British regulators said an alternative should be provided for younger people. Potential infection still poses much greater risks than any vaccine side effect for all those over 30, they said, and could do so for younger people if cases surged again.

“The Moderna rollout marks another milestone in the vaccination program,” Stephen Powis, the medical director of the National Health Service, said in a statement. “We now have a third jab in our armory.”

The vaccination program, he added, “is our hope at the end of a year like no other” as he encouraged people to book their appointments.

But despite the hopeful vaccine news and the return to public life, the country is still battling new cases of the virus, and a cluster in two London neighborhoods of a worrisome variant first discovered in South Africa has prompted mass testing. Health workers have gone door to door to urge residents to get tested, even if they are not showing symptoms, as dozens of cases have emerged. Similar measures were carried out elsewhere in the city earlier this month.

Studies have shown that the variant contains a mutation that diminishes the vaccines’ effectiveness against it. Dr. Susan Hopkins, the chief medical adviser for the country’s test and trace campaign, said the cluster of cases in parts of South London was “significant.”

“It’s really important people in the local area play their part in stopping any further spread within the local community,” she said in a statement.

Pacific Palace, a dim sum restaurant on a commercial strip in the Sunset Park section of Brooklyn, has seen revenue plunge.
Credit…Victor J. Blue for The New York Times

More than a year after the coronavirus first swept through New York, the streets of Sunset Park in southern Brooklyn reflect the pandemic’s deep and unhealed wounds intertwined with signs of a neighborhood trying to edge back to life.

The sidewalks are filling with shoppers and vendors. More businesses are welcoming customers. But owners still struggle to pay rent and keep their enterprises afloat, while many workers laid off after the city locked down last year remain without jobs.

And while the rate of vaccination in New York has increased significantly, the coronavirus still percolates through this densely packed neighborhood. The ZIP code that includes Sunset Park had the highest rate of positive cases in Brooklyn in early April, nearly double the citywide rate. Some residents have expressed skepticism about the vaccines, spooked by false information circulated over TikTok and other social media.

Adding to the stress is a spate of hate crimes and violence against people of Asian descent in New York and around the country, fed in some cases by racist claims that Asian-Americans are responsible for spreading the virus.

About a third of the residents in Sunset Park have received at least one dose of the vaccine, roughly the same level as the city overall, according to the city health data. But local leaders say they want to push that number much higher.

Kuan Neng, 49, the Buddhist monk who founded Xi Fang Temple on Eighth Avenue, said that people had come to him in recent weeks to express concerns over vaccines.

“Why do I need to do that?” is a common refrain, according to Mr. Kuan, followed by: “I’m healthy now. The hard times are over, more or less.”

“Many people want to delay and see,” Mr. Kuan said, himself included.

The owner of the Cinerama Dome in Hollywood and 15 other movie theaters said it would not reopen after the pandemic.
Credit…Kate Warren for The New York Times

ArcLight Cinemas, a beloved chain of movie theaters based in Los Angeles, including the Cinerama Dome in Hollywood, will permanently close all its locations, Pacific Theaters announced on Monday, after the pandemic decimated the cinema business.

ArcLight’s locations in and around Hollywood have played host to many a movie premiere, in addition to being favorite spots for moviegoers seeking out blockbusters and prestige titles. They are operated by Pacific Theaters, which also manages a handful of theaters under the Pacific name, and are owned by Decurion.

“After shutting our doors more than a year ago, today we must share the difficult and sad news that Pacific will not be reopening its ArcLight Cinemas and Pacific Theaters locations,” the company said in a statement.

“This was not the outcome anyone wanted,” it added, “but despite a huge effort that exhausted all potential options, the company does not have a viable way forward.”

Between the Pacific and ArcLight brands, the company owned 16 theaters and more than 300 screens.

The movie theater business has been hit particularly hard by the pandemic. But in recent weeks, the majority of the country’s largest theater chains, including AMC and Regal Cinemas, have reopened in anticipation of the slate of Hollywood films that have been put back on the calendar, many after repeated delays because of pandemic restrictions. A touch of optimism is even in the air as a result of the Warner Bros. movie “Godzilla vs. Kong,” which has generated some $70 million in box office receipts since opening over Easter weekend.

Still, the industry’s trade organization, the National Association of Theater Owners, has long warned that the punishing closures were most likely to affect smaller regional players like ArcLight and Pacific. In March, the Alamo Drafthouse Cinema chain, which operates about 40 locations across the country, announced that it had filed for Chapter 11 bankruptcy protection but would keep most of its locations operational while it restructured.

That does not seem to be the case for Pacific Theaters, which, according to two people with knowledge of the matter, fired its entire staff on Monday.

The reaction to ArcLight’s closing around Hollywood has been emotional, including an outpouring on Twitter.

Firefighters at the site of COVID-19 hospital Matei Bals, after a fire broke out in one of its buildings in Bucharest, Romania, in January.
Credit…Robert Ghement/EPA, via Shutterstock

Three people infected with the coronavirus died at a hospital in Bucharest on Monday evening after the oxygen supply stopped functioning, according to the authorities, the latest incident involving oxygen failure, which in many countries has driven up the virus death toll.

It was also another fatal setback for Romania’s ageing and overwhelmed health care system, which has suffered two fires in Covid-19 wards in recent months, killing at least 15 people.

Ventilators shut down at a mobile intensive care unit set up at the Victor Babes hospital in Bucharest after oxygen pressure reached too high a level, the country’s health authorities said in a statement, depriving patients of a vital supply. In addition to the three patients who died, five others were evacuated and moved to other facilities in the city.

Romania has recorded its highest rate of Covid-19 patients in intensive care units since the pandemic began, and on Sunday Prime Minister Florin Citu said that there were just six intensive care beds available across Romania, out of nearly 1,600.

Intensive care units in Hungary and Poland have also been at risk of being overwhelmed, as much of Eastern Europe has struggled to cope with a third wave of infections across the continent. Some Hungarian hospitals have sought medical students and volunteers to assist in Covid-19 wards, giving training to those without previous medical experience.

The mobile unit struck by the oxygen problem on Monday had only been in operation since Saturday, and it has epitomized long-running concerns over the country’s fragile health care system. In January, five patients died and a further 102 were evacuated from a different hospital in Bucharest after a fire broke out. In November, 10 patients hospitalized with the coronavirus died after a fire broke out in a hospital in the northeastern city of Piatra Neamt.

Romania’s spending on health care is among the lowest in the European Union, with just over five percent of gross domestic product allocated toward it, compared with 10 percent on average among other countries of the bloc.

More than 25,000 people who tested positive for the virus have died in Romania, and the authorities have closed schools and kindergartens throughout April as part of an extended Easter holiday.

The authorities have so far administered more than 3.5 million vaccine doses, in a population of about 19 million.

Alisa Stephens, a biostatistician at the University of Pennsylvania in Philadelphia, had to manage work and taking care of her children after the city went into lockdown last year.
Credit…Hannah Yoon for The New York Times

Studies have found that women in academia have published fewer papers, led fewer clinical trials and received less recognition for their expertise during the pandemic.

Add to that the emotional upheaval of the pandemic, the protests over structural racism, worry about children’s mental health and education, and the lack of time to think or work, and an already unsustainable situation becomes unbearable.

Michelle Cardel, an obesity researcher at the University of Florida, worries that this confluence of factors could push some women to leave the sciences.

“My big fear is that we are going to have a secondary epidemic of loss, particularly of early career women in STEM,” she said.

Female scientists were struggling even before the pandemic. It was not unusual for them to hear that women were not as smart as men, or that a woman who was successful must have received a handout along the way, said Daniela Witten, a biostatistician at the University of Washington in Seattle.

Women in academia often have little recourse when confronted with discrimination. Their institutions sometimes lack the human resources structures common in the business world.

Compounding the frustration are outdated notions about how to help women in science. But social media has allowed women to share some of those concerns and find allies to organize and call out injustice when they see it, said Jessica Hamerman, an immunologist at the Benaroya Research Institute in Seattle.

In November, for example, a study on female scientists was published in the influential journal Nature Communications suggesting that having female mentors would hinder the career of young scientists and recommending that young women seek out male help.

The response was intense and unforgiving: Nearly 7,600 scientists signed a petition calling on the journal to retract the paper — which it did on Dec. 21.

The study arrived at a time when many female scientists were already worried about the pandemic’s effect on their careers, and already on edge and angry with a system that offered them little support.

Alisa Stephens found working from home to be a series of wearying challenges. Dr. Stephens is a biostatistician at the University of Pennsylvania, and carving out the time and mental space for that work with two young children at home was impossible.

Things eased once the family could safely bring in a nanny, but there was still little time for the deep thought Dr. Stephens had relied on each morning for her work.

Over time, she has adjusted her expectations of herself. “Maybe I’m at 80 percent as opposed to 100 percent,” she said, “but I can get things done at 80 percent to some extent.”

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Could the Pandemic Prompt an ‘Epidemic of Loss’ of Women in the Sciences?

Like many women during the pandemic, Alisa Stephens found working from home to be a series of wearying challenges.

Dr. Stephens is a biostatistician at the University of Pennsylvania, and the technical and detail-oriented nature of her work requires long uninterrupted stretches of thought. Finding the time and mental space for that work with two young children at home proved to be an impossibility.

“That first month was really hard,” she recalled of the lockdown. Her infant daughter’s day care was closed, and her 5-year-old was at home instead of at school. With their nanny unable to come to the house, Dr. Stephens tended to her children all day and worked late into the evening. In the fall, when her daughter was set to begin kindergarten, the schools did not reopen.

Things eased once the family could safely bring in a nanny, but there was still little time for the deep thought Dr. Stephens had relied on each morning for her work. Over time, she has adjusted her expectations of herself.

studies have found that women have published fewer papers, led fewer clinical trials and received less recognition for their expertise during the pandemic.

Add to that the emotional upheaval and stress of the pandemic, the protests over structural racism, worry about children’s mental health and education, and the lack of time to think or work, and an already unsustainable situation becomes unbearable.

“The confluence of all of these factors creates this perfect storm. People are at their breaking point,” said Michelle Cardel, an obesity researcher at the University of Florida. “My big fear is that we are going to have a secondary epidemic of loss, particularly of early career women in STEM.”

Female scientists were struggling even before the pandemic. It was not unusual for them to hear that women were not as smart as men, or that a woman who was successful must have received a handout along the way, said Daniela Witten, a biostatistician at the University of Washington in Seattle. Some things are changing, she said, but only with great effort, and at a glacial pace.

steep for mothers. Even during maternity leave, they are expected to keep up with lab work, teaching requirements, publications and mentoring of graduate students. When they return to work, most do not have affordable child care.

Women in academia often have little recourse when confronted with discrimination. Their institutions sometimes lack the human resources structures common in the business world.

it will be far from enough.

“It’s sort of like if you’re drowning, and the university tells you, ‘Don’t worry if it takes you an extra year to get back to shore,’” Dr. Witten said. “It’s like, ‘Hey, that’s not helpful. I need a flotation device.’”

study on female scientists was published in the influential journal Nature Communications, suggesting that having female mentors would hinder the career of young scientists and recommending that the young women instead seek out men to help them.

The response was intense and unforgiving.

Hundreds of scientists, male and female, renounced the paper’s flawed methods and conclusions, saying it reinforced outdated stereotypes and neglected to take structural biases in academia into account.

“The advice from the paper was basically similar to advice your grandmother may have given you 50 years ago: Get yourself a man who will take care of you, and all will be fine,” Dr. Cardel said.

Nearly 7,600 scientists signed a petition calling on the journal to retract the paper — which it did on Dec. 21.

The study arrived at a time when many female scientists were already worried about the pandemic’s effect on their careers, and already on edge and angry with a system that offered them little support.

“It’s been an incredibly difficult time to be a woman in science,” said Leslie Vosshall, a neuroscientist at Rockefeller University in New York. “We’re already on the ground, we’re already on our knees — and then the paper just comes and kicks us to say: ‘We have the solution, let’s move the graduate students to a senior man.’”

reconsidered their dude walls, Dr. Vosshall said. “There are some traditions that should not be perpetuated.”

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Michigan to Widen Vaccine Access to Residents 16 and Older

Michigan is expanding vaccine eligibility to everyone age 50 and over as of March 22 and adding everyone 16 and over as of April 5, Gov. Gretchen Whitmer said Friday. The announcement came a day after President Biden’s prime-time address, in which he directed states to expand eligibility to all adults by May 1.

“Nearly 1 million Michiganders of all races have already been safely vaccinated,” Ms. Whitmer, a Democrat, said in a statement. “I urge all eligible Michiganders to get one of the three Covid-19 vaccines.”

Currently, everyone in Michigan 65 and older is eligible for vaccination, as are people over 50 who have health conditions that would increase their risk of serious complications from Covid-19, including obesity, hypertension or diabetes. On March 22, all adults with such health conditions will also be eligible.

According to a New York Times database, 19 percent of Michiganders have received at least one dose of vaccine and 11 percent have been fully vaccinated, putting the state’s pace roughly at the U.S. average.

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Hope as a Public Health Tool

The early coronavirus mistakes were mostly mistakes of excessive optimism. Many scientists, including Dr. Anthony Fauci, did not immediately grasp the threat. Neither did we in the media. President Donald Trump made the extreme version of this mistake, with a series of false statements minimizing the problem. Some politicians continue to show undue optimism, ending mask mandates and allowing full restaurants.

But overoptimism isn’t the only type of error in public health. Pessimism can also do damage. And at our current stage in the pandemic — as the United States finishes its first year of life dominated by Covid-19 — pessimism has become as much of a problem as optimism.

Thousands of schools remain closed, to children’s detriment, even though epidemiologists say that many can safely open. Irrationally negative talk about the vaccines has fed hesitation about getting them. The widespread notion that normal life won’t return anytime this year — if ever — has caused some people to give up on social distancing and mask wearing. They seem to be saying: What’s the point?

Difficult truths can sometimes be a vital public-health tool. But so can optimism. Optimism can help people to get through tough times and make sacrifices, in the belief that better days are ahead.

In a White House address last night, President Biden tried to balance realism and hope. He began with a somber recitation of Covid’s costs, including job loss, loneliness, canceled gatherings, missed time in school and, most of all, death. At one point, he reached into his jacket pocket and removed a card — which he always carries, he said — with the current American death toll printed on it. The past year, he said, had been one “filled with the loss of life and the loss of living for all of us.”

Yet when it came time for Biden to tell Americans what he wanted them to do — to wear masks, maintain social distancing and get vaccinated — he did not use darkness as motivation. He used July 4.

“If we do all this, if we do our part, if we do this together, by July the 4th, there’s a good chance you, your families and friends, will be able to get together in your backyard or in your neighborhood and have a cookout or a barbecue and celebrate Independence Day,” he said, standing alone at a podium in the White House’s East Room. “Finding light in the darkness is a very American thing to do.”

The speech included plenty of caveats, about virus variants, uncertainty and more. Biden’s political strategy on the virus is clearly to underpromise so he can overdeliver. But that’s part of what made the July 4 vision memorable. Even Biden, with all of his caution, seems to grasp the power of hopefulness at this moment.

After 12 months of a pandemic, it’s hard to inspire people to action with only grim warnings of all that could still go wrong. People need to know the full picture, both bad and good. They need a source of motivation beyond fear.

all adult Americans eligible to receive a Covid vaccine by May 1.

  • He announced several new actions to speed up vaccinations, including the use of dentists, veterinarians, medical students and others to give the shots.

  • He condemned hate crimes against Asian-Americans, who he said have been “attacked, harassed, blamed and scapegoated” during the pandemic. “It’s wrong, it’s un-American, and it must stop.”

  • Go deeper: On his Times Opinion podcast, Ezra Klein talks with Dr. Ashish Jha of Brown University about the tensions between pandemic optimism and pessimism. Ezra suggests that some politicians, especially in liberal parts of the country, are undermining their own pandemic response by being so negative: “They’re not giving people a way out of this they can hold on to.”

    In response to Monday’s newsletter about the mystery of the relatively low Covid death tolls in Africa and Asia, several researchers wrote to me to add a potential explanation that had not been on my list: obesity.

    Countries with higher obesity rates have suffered more Covid deaths on average, as you can see in this chart that my colleague Lalena Fisher and I put together:

    Dr. David L. Katz told me, and oxygen deprivation has been a common Covid symptom. A paper by Dr. Jennifer Lighter of New York University and other researchers found that obesity increased the risk of hospitalization among Covid patients.

    It’s a particularly intriguing possibility because it could help explain why Africa and Asia have suffered fewer deaths than not only high-income countries but also Latin American countries. Latin Americans, like Europeans and U.S. residents, are heavier on average than Africans or Asians.

    an evangelical phenomenon.

    Modern Love: A woman takes a vow of celibacy.

    From Opinion: American pop culture used to celebrate the natural world. Taylor Swift is reviving the tradition.

    Lives Lived: Lou Ottens and his team at Philips, the Dutch electronics company, introduced the cassette tape in 1963 as a way to play music in a portable fashion. The invention revolutionized the music business. He died at 94.

    The four-part series “The Test Kitchen” — a production of the popular Gimlet Media podcast “Reply All” — was supposed to tell the story about workplace racism at the food magazine Bon Appétit.

    Halfway through the series, it was overshadowed by a story about Gimlet’s own culture. Former Gimlet employees accused the show of hypocrisy, saying its host, Sruthi Pinnamaneni, and her editor, P.J. Vogt, contributed to the kinds of workplace conditions that they aimed to expose.

    wrote on Twitter about a “toxic dynamic” at the company. Both Pinnamaneni and Vogt, along with some other Gimlet executives, had been critical of unionization efforts at Gimlet. Among other things, the union sought to address accusations of racial inequity at the company, Katherine Rosman and Reggie Ugwu write in The Times. (Gimlet executives declined to comment for the Times article.)

    Gimlet’s story isn’t unique, Nicholas Quah writes in Vulture. “There were very few Black employees at the company,” Quah writes, “and the ones who were there had the kind of experiences that made them feel their perspectives were trivialized.”

    Pinnamaneni and Vogt went on leave and Gimlet canceled “Test Kitchen.”

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    Severe Obesity Raises Risk of Covid-19 Hospitalization and Death, Study Finds

    Over the past year, many scientific teams around the world have reported that obese people who contract the coronavirus are especially likely to become dangerously ill.

    Now, a large new study, of nearly 150,000 adults at more than 200 hospitals across the United States, paints a more detailed picture of the connection between weight and Covid-19 outcomes.

    The study, performed by a team of researchers as the Centers for Disease Control and Prevention, has confirmed that obesity significantly increases the risk for hospitalization and death among those who contract the virus. And among those who are obese, the risk increases as a patient’s body mass index, or B.M.I., a ratio of weight to height, increases. Patients with a B.M.I. of 45 or higher, which corresponds to severe obesity, were 33 percent more likely to be hospitalized and 61 percent more likely to die than those who were at a healthy weight, the researchers found.

    “The findings of the study highlight the serious clinical public health implications of elevated B.M.I., and they suggest the continued need for intensive management of Covid-19 illness, especially among patients affected by severe obesity,” said the lead author, Lyudmyla Kompaniyets, a health economist at the Division of Nutrition, Physical Activity and Obesity at the C.D.C.

    But the relationship between weight and outcomes is nuanced. Covid-19 patients who were underweight were also more likely to be hospitalized than those who were at a healthy weight, although they were not more likely to be admitted to the intensive care unit or to die.

    Dr. Kompaniyets and her colleagues used a database of Covid-19 cases to identify 148,494 adults who received a diagnosis of the disease at American hospitals from last March to December. They calculated the B.M.I. of each patient and looked for correlations between B.M.I. and a variety of serious outcomes, including hospitalization, I.C.U. admission, mechanical ventilation and death.

    They found that obesity, which is defined as a B.M.I. of 30 or higher, increased the risk of both hospitalization and death. Patients with a B.M.I. of 30 to 34.9 were just 7 percent more likely to be hospitalized and 8 percent more likely to die than people who were at a healthy weight, but the risks increased sharply as B.M.I. rose.

    Providing evidence for this kind of “dose response” relationship makes the study particularly compelling, said Dr. Anne Dixon, the director of pulmonary and critical care medicine at the University of Vermont Medical Center, who was not involved in the research. “What it shows is the more severe your obesity, the worse the effect is. And the fact that goes up stepwise with increasing levels of obesity, I think, adds sort of biological plausibility to the relationship between obesity and the outcome.”

    The connection between obesity and poor outcomes was strongest among patients under 65, but it held even for older adults. Previous, smaller studies have not found strong links between obesity and severity of Covid-19 in older adults.

    “Potentially because they had more power from this large sample size, they’ve demonstrated that obesity remains an important risk factor for death in older adults as well,” said Dr. Michaela R. Anderson, an expert in pulmonary and critical care medicine at Columbia University Medical Center, who was not involved in the study. “It’s a beautifully done study with a massive population.”

    Dr. Kompaniyets and her colleagues also documented a linear relationship between B.M.I. and the likelihood of needing mechanical ventilation; the higher the B.M.I., the more likely a patient was to require such intervention, which is invasive and can come with serious complications.

    The study also found that patients who were underweight, with a B.M.I. below 18.5, were 20 percent more likely to be hospitalized than those who had a healthy weight. The reasons are not entirely clear, but may stem from the fact that some of these patients were malnourished or frail or had other diseases.

    The B.M.I. range associated with the best outcomes, the researchers found, was near the dividing line between what is considered healthy and overweight, consistent with some prior research suggesting that a few extra pounds might help protect people when they contract an infectious disease.

    “Exactly why that association exists is currently unknown,” said Dr. Alyson Goodman, a pediatrician and medical epidemiologist at the C.D.C. and a co-author of the study. One possibility is that having a bit of extra fat may provide much needed energy reserves over the course of a long illness.

    The findings highlight the importance of carefully managing the care of patients who are severely obese and of ensuring that people who are obese have access to vaccines and other preventive measures.

    “This just provides further evidence for the recommendation to vaccinate those with a high B.M.I. as early as feasible,” said Sara Y. Tartof, an infectious disease epidemiologist at the Department of Research & Evaluation at Kaiser Permanente, who was not involved in the study.

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