“This was practical science, designed by parents to get their kids back to school,” Dr. Paniz-Mondolfi said.

Then it was time to pilot the tests in a real school environment. In January, Mount Sinai connected with KIPP NYC, which had been offering remote instruction since last spring. But it was hoping to reopen its schools in March, and administrators knew they would need to do some kind of in-school virus testing.

“One of the biggest fears that we had was around what it would mean to keep students safe,” said Glenn Davis, the principal of KIPP Infinity Middle School.

Mount Sinai and KIPP NYC agreed to begin a pilot saliva-testing project at five schools. The testing program, which eventually grew to include nine KIPP schools, was free for the schools and mandatory for all students who opted to return to in-person learning. (Some families chose to continue with remote education.)

Students, teachers and staff members are tested once a week. Medical assistants from Mount Sinai supervise the saliva collection and pack the bar-coded tubes into coolers for transportation back to the laboratory. (The samples are currently being processed at an existing Mount Sinai lab, but will be sent to the new lab when it opens next month.)

During the pilot project, 99.2 percent test results were returned within 24 hours, Mount Sinai says. Students or staff members who test positive typically have to quarantine for 10 days.

If a student tests positive, Mount Sinai also offers to send a team of “swabbers” to his or her home to administer free coronavirus tests to their family members and close contacts.

“We’ve detected a few mini outbreaks in that fashion, and hopefully prevented them from spreading by virtue of this screening program in the schoolkids,” Dr. Reich said.

Between March 10, when the pilot project began, and May 9, Mount Sinai conducted 13,067 tests and identified 46 coronavirus cases, a positivity rate of 0.4 percent. There have been no false positives and no known false negatives, Mount Sinai says.

The Mount Sinai team has submitted the data to the Food and Drug Administration, hoping to receive an emergency use authorization for the test.

Later this week, Mount Sinai will submit a formal proposal to New York City to take its testing program to the city’s public schools when they reopen in the fall. Mount Sinai declined to disclose the terms of the proposal, including what it plans to charge schools for the tests, but says it hopes to attract commercial clients to help defray, or possibly even eliminate, costs for schools.

In the meantime, it is approaching other charter school organizations in the city about using its tests during their summer sessions and programs.

“We can’t just sit there when this lab goes live in June and say, ‘OK, we’re waiting for September,’” Dr. Reich said. “Before the fall, we need to be doing a lot of tests.” The lab will initially have the capacity to run 25,000 tests a day, with the ability to scale up to 100,000 if there is sufficient interest.

For its part, KIPP NYC plans to expand the program to all of its schools in the fall, although the testing frequency may change, said Efrain Guerrero, managing director of operations for KIPP NYC. “I think parents see it and staff see it as just an additional safety measure that they appreciate,” he said. “For us it’s a no-brainer to continue to test at some frequency.”

Olga Ramirez, Bradley’s mother, had not initially wanted him to return to in-person learning. “I was very afraid at first,” she said. But Bradley, who desperately wanted to go back to school, managed to convince her, with the help of an informational video about the Mount Sinai testing program.

Ms. Ramirez now thinks that returning to school was the right decision. Bradley’s virus tests have all come back negative, and his grades are up since returning to in-person learning.

“I’ve seen his grades improve quite a lot, and I feel that my son is in good hands,” she said. She’s not alone, she added. “There’s so many mothers who are feeling the way I do.”

Elda Cantú contributed translation.

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India Ramps Up Coronavirus Testing

The Indian government on Thursday said it had carried out 2.5 million coronavirus tests in 24 hours, the most in a single day since the pandemic began and part of an effort to try to help contain the spread of the country’s devastating second wave.

Balram Bhargava, the director general of the Indian Council of Medical Research, a top government body, said that in the last week, daily average testing had been between 1.6 million to 2 million tests. The government hopes to increase the number of daily tests to 4.5 million per day by the end of June.

India has been devastated by a surge in virus cases and deaths, many of which are believed by experts to have gone uncounted. The increase in testing has largely come from an uptick in use of rapid antigen tests. India’s health officials said they increased the share of antigen tests to 60 percent of the overall number of tests administered because labs have been overwhelmed and results from P.C.R. tests come with a longer wait.

Antigen tests are generally considered less reliable than P.C.R., and may mistakenly identify uninfected people as carrying the virus. But the virus is spreading to rural parts of the country where the health infrastructure is deeply underfunded. For some areas, rapid antigen tests are the only option because the distribution is in the hands of government.

said on Twitter. “Terribly worried that there is a Covid surge in rural India that is going largely unchecked & undetected.”

The council that Mr. Bhargava leads approved the use of a self-administered rapid antigen test kit that was developed by Mylab Discovery Solutions, an Indian company, and gives results in 15 minutes. The company is aiming to ramp up production to 60 million kits per month within the next few weeks.

“This easy-to-use test combines a mobile app so that a user can know positive status, submit the result to I.C.M.R directly for traceability, and know what to do next,” said Sujit Jain, the director of Mylab Discovery Solutions. “We are sure this small step will be a big leap in mitigating the second and subsequent waves.”

Vaccinating India’s population of 1.4 billion people is a challenge. At the current rate of administering about 1.8 million doses a day, it would take the country more than three years to vaccinate 80 percent of its population.

deaths from Covid-19 and Covid-related causes are likely to be two to three times the number that countries have recorded in their official data, because of the limited capacity of many countries to test their people and other weaknesses in official health data.

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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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Helen Murray Free Dies at 98; Chemist Developed Diabetes Test

Helen Murray Free, a chemist who ushered in a revolution in diagnostic testing when she co-developed the dip-and-read diabetes test, a paper strip that detected glucose in urine, died on Saturday at a hospice facility in Elkhart, Ind. She was 98.

The cause was complications of a stroke, her son Eric said.

Before the invention of the dip-and-read test in 1956, technicians added chemicals to urine and then heated the mixture over a Bunsen burner. The test was inconvenient, and, because it could not distinguish glucose from other sugars, results were not very precise.

Working with her husband, who was also a chemist, Ms. Free figured out how to impregnate strips of filter paper with chemicals that turned blue when glucose was present. The test made it easier for clinicians to diagnose diabetes and cleared the way for home test kits, which enabled patients to monitor glucose on their own.

People with diabetes now use blood sugar meters to monitor their glucose levels, but the dip-and-read tests are ubiquitous in clinical laboratories worldwide.

commemorative booklet produced by the American Chemical Society in 2010.

She received her bachelor’s degree in 1944 and went to work for Miles Laboratories in Elkhart, first in quality control and then in the biochemistry division, which worked on diagnostic tests and was led by her future husband, Alfred Free. They married in 1947.

He provided the ideas; she was the technician “who had the advantage of picking his brain 24 hours a day,” Ms. Free recalled in an interview for this obituary in 2011. They soon set their sights on developing a more convenient glucose test “so no one would have to wash out test tubes and mess around with droppers,” she said. When her husband suggested chemically treated paper strips, “it was like a light bulb went off,” she said.

American Chemical Society in 1993. In 2009, she was awarded a National Medal of Technology and Innovation by President Barack Obama, and in 2011 she was inducted into the National Women’s Hall of Fame in Seneca Falls, N.Y., for her role in developing the dip-and-read test.

Alfred Free died in 2000. In addition to her son Eric, Ms. Free is survived by two other sons, Kurt and Jake; three daughters, Bonnie Grisz, Nina Lovejoy and Penny Moloney; a stepson, Charles; two stepdaughters, Barbara Free and Jane Linderman; 17 grandchildren; and nine great-grandchildren.

Miles Laboratories followed the introduction of the dip-and-read glucose test with a host of other tests designed to detect proteins, blood and other indicators of metabolic, kidney and liver disorders. “They sure went hog wild on diagnostics, and that’s all Al’s fault,” Ms. Free said in the commemorative booklet. “He was the one who pushed diagnostics.”

It wasn’t all smooth sailing. Several years after the introduction of the dip-and-read test, Miles moved Ms. Free to another division, citing an anti-nepotism policy. But two years later, after a change in management, she was transferred back to her husband’s division.

“They realized that breaking up a team like this was interfering with productivity in the lab,” Ms. Free said.

Alex Traub contributed reporting.

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What the Coronavirus Variants Mean for Testing

In January 2020, just weeks after the first Covid-19 cases emerged in China, the full genome of the new coronavirus was published online. Using this genomic sequence, scientists scrambled to design a large assortment of diagnostic tests for the virus.

But the virus has mutated since then. And as the coronavirus has evolved, so has the landscape of testing. The emergence of new variants has sparked a flurry of interest in developing tests for specific viral mutations and prompted concerns about the accuracy of some existing tests.

“With these Covid diagnostics, we were on a time crunch, we had to get something out there,” said Lorraine Lillis, the scientific program officer at PATH, a global health nonprofit that has been tracking coronavirus tests. “Normally, diagnostics take a long, long time, and we’d normally challenge them with multiple variants.” She added: “And we’re doing that, but we’re doing it in real time.”

The Food and Drug Administration has warned that new mutations in the coronavirus could render some tests less effective. And last week, PATH launched two online dashboards to monitor how certain variants might affect the performance of existing diagnostic tests.

has listed four different molecular tests “whose performance could be impacted” by the variants, but notes that the tests should still work. Three of the tests have multiple targets; a fourth may be slightly less sensitive when the virus has one particular mutation and is present at very low levels. (The four tests are the TaqPath Covid-19 Combo Kit, the Linea Covid-19 Assay Kit, the Xpert Xpress and Xpert Omni SARS-CoV-2, and the Accula SARS-CoV-2 Test.)

“We don’t think that those four assays are significantly impacted,” said Dr. Tim Stenzel, who directs the F.D.A.’s office of in vitro diagnostics and radiological health. “It was more out of an abundance of caution and transparency that we made that information public.”

Antigen tests are less sensitive than molecular tests, but they are typically cheaper and faster, and they are being deployed widely in coronavirus screening programs. These tests detect specific proteins on the outside of the virus. Some genetic mutations could change the structure of these proteins, allowing them to escape detection.

in a recent paper, Dr. Izpisua Belmonte and his colleague, Mo Li, a stem cell biologist at King Abdullah University of Science and Technology in Saudi Arabia, described a new testing method that can identify mutations in up to five different regions of the coronavirus genome.

And Dr. Grubaugh and his colleagues have developed a P.C.R. test that can detect specific combinations of mutations that characterize three variants of concern: B.1.1.7; B.1.351, which was first detected in South Africa; and P.1, first found in Brazil. (The work has not yet been published in a scientific journal.)

Dr. Grubaugh said that researchers in Brazil, South Africa and elsewhere are already using the tests to sift through a mountain of coronavirus samples, identifying those that should be prioritized for full genomic sequencing. “Our group’s primary interest is enhancing genomic surveillance through sequencing, especially in resource-limited areas,” Dr. Grubaugh said. “If you want to know if there’s variants that are circulating, you need a way to triage.”

A number of companies are also beginning to release coronavirus tests that they say can differentiate between certain variants, although these are intended for research purposes only. Creating a test that can definitively diagnose someone with a particular variant is “infinitely harder,” Dr. Grubaugh said.

Similar mutations are springing up in different variants, which makes distinguishing among them more difficult. The mutations of interest will change as the virus does, and sequencing remains the best way to get a complete picture of the virus.

But tests that can screen for certain mutations could be an important public health tool, Ms. Agarwal said: “These newer diagnostics that are looking across the variants, I think will be really key in understanding the epidemiology of the virus and planning our next generation of efforts against it.”

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Argentina’s President Has Preliminary Positive Virus Test Despite Vaccination

BUENOS AIRES — President Alberto Fernández of Argentina had an initial positive test for Covid-19 and is awaiting the results of a more precise analysis to determine whether he has contracted the coronavirus despite being vaccinated earlier this year.

Mr. Fernández sent a series of tweets early Saturday morning saying he took a quick antigen test after suffering from a “light headache” and having a fever of 99.1 degrees.

The president, who received the test result on his 62d birthday, said he will remain in isolation while waiting for the results of the more rigorous PCR test.

“I am physically well, and although I would have liked to end my birthday without this news, I’m also in good spirits,” the president wrote on Twitter.

an efficacy rate of 91.6 percent, it is fully effective in preventing critical cases.

the institute wrote in a statement on Twitter. “We wish you a quick recovery!”

Word of Mr. Fernández’s test result comes shortly after Argentina tightened its borders amid an upsurge of Covid-19 infections. Several of its neighboring countries, particularly Brazil, are experiencing a sharp increase in cases as new, more contagious variants of the virus engulf the region.

Argentina recently canceled all direct flights with Brazil, Chile and Mexico in an effort to block the new strains.

Argentina was the first country in Latin America to approve the use of the Sputnik V vaccine in late December, but mass inoculations are taking longer than the government had initially predicted amid a global shortage of the vaccine. It has also been administering China’s Sinopharm vaccine and Covishield, the Indian version of the AstraZeneca vaccine.

Of the nation’s 45 million people, 683,771 have received two vaccine doses, and there have been 4.18 million doses injected over all.

Argentina said on March 26 it would delay applying the second dose of the Covid-19 vaccine for three months in an effort to ensure as many people as possible get at least one dose. The country has reported nearly 2.4 million Covid-19 infections and more than 56,000 deaths.

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The C.D.C. and N.I.H. launch a rapid, at-home testing initiative in Tennessee and North Carolina.

The Centers for Disease Control and Prevention and the National Institutes of Health announced a new initiative on Wednesday to help determine whether frequent, widespread use of rapid coronavirus tests slows the spread of the virus.

The program will make rapid at-home antigen tests freely available to every resident of two communities, Pitt County, N.C., and Hamilton County, Tenn., enough for a total of 160,000 people to test themselves for the coronavirus three times a week for a month.

“This effort is precisely what I and others have been calling for nearly a year — widespread, accessible rapid tests to help curb transmission,” said Michael Mina, an epidemiologist at Harvard University who has been a vocal proponent of rapid, at-home testing programs.

He added, “Taking 30 seconds out of your day three times a week to perform the test is something any person can do.”

testing remains essential, public health experts say.

“We have all hypothesized that testing at home, at scale could stop the chain of transmission of the virus and allow communities to discover many more cases,” said Bruce Tromberg, who directs the National Institute of Biomedical Imaging and Bioengineering and leads its rapid acceleration of diagnostics program, which is supplying the tests for the initiative. “All the mathematical models predict that. But this is a real world, real life example.”

Residents who decide to participate in the program can have the tests delivered to their homes or pick them up at local distribution sites. An online tool will guide participants through the testing process and help them interpret their results. Residents can also volunteer to complete surveys that will assess whether frequent testing has changed their behavior, knowledge about Covid-19, or opinions on vaccination.

Researchers at the University of North Carolina and Duke University will compare the test positivity, case and hospitalization rates in these two communities to those in other similar communities that are not participating in the program.

A. David Paltiel, a professor of health policy and management at Yale School of Public Health, called the launching of a real-world study of the effectiveness of rapid, at-home screening “just great news.” But he cautioned that the results will need to be interpreted carefully, especially if the residents who choose to participate in the initiative are not representative of the community at large.

“We know that self-selection tends to bring out the worried well and a disproportionate number of people who are already Covid-conscious or Covid-conscientious,” he said.

“It’ll be great to see how it works when in the hands of people who really care,” he added. But, he said, the results may not be widely generally applicable to screening programs in which participation is mandatory, as may be the case with some workplace and school programs.

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Virus Origins Remain Unclear in W.H.O.-China Inquiry

For 27 days, they searched for clues in Wuhan, visiting hospitals, live animal markets and government laboratories, conducting interviews and pressing Chinese officials for data, but an international team of experts departed the country still far from understanding the origins of the coronavirus pandemic that has killed nearly 2.8 million people worldwide.

The 124-page report of a joint inquiry by the World Health Organization and China — to be released officially on Tuesday but leaked to the media on Monday — contains a glut of new detail but no profound new insights. And it does little to allay Western concerns about the role of the Chinese Communist Party, which is notoriously resistant to outside scrutiny and has at times sought to hinder any investigation by the W.H.O. The report is also not clear on whether China will permit outside experts to keep digging.

“The investigation runs the risk of going nowhere, and we may never find the true origins of the virus,” said Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations.

The report, an advance copy of which was obtained by The New York Times, says that China still does not have the data or research to indicate how or when the virus began spreading. Some skeptics outside the country say that China may have more information than it admits.

new inquiry into the origin of the pandemic. They said such an inquiry should consider the possibility that the virus escaped from a laboratory in Wuhan or infected someone inside it.

The lab leak theory has been promoted by some officials in the Trump administration, including Dr. Robert Redfield, the former director of the Centers for Disease Control and Prevention, in comments to CNN last week. He offered no evidence and emphasized that it was his opinion; the theory has been widely dismissed by scientists and U.S. intelligence officials.

Matt Apuzzo and Apoorva Mandavilli contributed reporting. Albee Zhang contributed research.

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Advanced Cancers Are Emerging, Doctors Warn, Citing Pandemic Drop in Screenings

Yvette Lowery usually gets her annual mammogram around March. But last year, just as the pandemic was gaining a foothold and medical facilities were shutting down, the center where she goes canceled her appointment. No one could tell her when to reschedule.

“They just said keep calling back, keep calling back,” said Ms. Lowery, 59, who lives in Rock Hill, S.C.

In August, Ms. Lowery felt a lump under her arm but still couldn’t get an appointment until October.

Eventually, she received a diagnosis of Stage 2 breast cancer, started chemotherapy in November and had a double mastectomy this month.

an analysis of data by the Epic Health Research Network. Hundreds of thousands fewer screenings were performed last year than in 2019, according to the network data.

“We still haven’t caught up,” said Dr. Chris Mast, vice president of clinical informatics for Epic, which develops electronic health records for hospitals and clinics.

Another analysis of Medicare data suggested that as Covid cases spiked during certain periods in 2020, cancer screenings fell. The analysis — conducted by Avalere Health, a consulting firm, for Community Oncology Alliance, which represents independent cancer specialists — found that testing levels in November were about 25 percent lower than in 2019. The number of biopsies, used to diagnose cancer, decreased by about one-third.

While it is too early to assess the full impact of the delays in screenings, many cancer specialists say they are concerned that patients are coming in with more severe disease.

“There’s no question in practice that we are seeing patients with more advanced breast cancer and colorectal cancer,” said Dr. Lucio N. Gordan, the president of the Florida Cancer Specialists & Research Institute, one of the nation’s largest independent oncology groups. He is working on a study to see if, over all, these missed screenings resulted in more patients with later-stage cancers.

And even though the numbers of mammograms and colonoscopies have rebounded in recent months, many people with cancer remain undiagnosed, doctors are reporting.

Some patients, like Ms. Lowery, could not easily get an appointment once clinics reopened because of pent-up demand. Others skipped regular testing or ignored worrisome symptoms because they were afraid of getting infected or after losing their jobs, they couldn’t afford the cost of a test.

“The fear of Covid was more tangible than the fear of missing a screen that detected cancer,” said Dr. Patrick I. Borgen, the chair of surgery at the Maimonides Medical Center in Brooklyn who also leads its breast center. His hospital treated such large numbers of coronavirus patients early on that “we’re now associated as the Covid hospital,” he said, and healthy people stayed away to avoid contagion.

Even patients at high risk because of their genetic makeup or because they previously had cancer have missed critical screenings. Dr. Ritu Salani, the director of gynecologic oncology at the UCLA Health Jonsson Comprehensive Cancer Center said one woman, who was at risk for colon cancer, had a negative test in 2019 but didn’t go for her usual screening last year because of the pandemic.

When she went to see her doctor, she had advanced cancer. “It’s just a devastating story,” Dr. Salani said. “Screening tests are really designed when patients aren’t feeling bad.”

Ryan Bellamy felt no hurry last spring to reschedule a canceled colonoscopy, even though the presence of blood in his stool had prompted him to look up symptoms. “I really didn’t want to go to the hospital,” Mr. Bellamy said. He decided it was unlikely he had cancer. “They’re not following up with me so I’m OK with Googling,” he told himself.

A resident of Palm Coast, Fla., Mr. Bellamy said that after his symptoms worsened, his wife insisted that he go for testing in December, and he had a colonoscopy in late January. With a new diagnosis of Stage 3 rectal cancer, Mr. Bellamy, 38, is undergoing radiation treatment and chemotherapy.

Colon screening remained significantly lower in 2020, declining about 15 percent from 2019 levels, according to the Epic network data, although overall screenings were down 6 percent. The analysis looked at screenings for more than 600 hospitals in 41 states.

Lung cancer patients have also delayed seeking appropriate care, said Dr. Michael J. Liptay, chairman of cardiovascular and thoracic surgery at Rush University Medical Center in Chicago. One patient had imaging that showed a spot on his lung, and he was supposed to follow up, just as the pandemic hit. “Additional work-up and care was deferred,” Dr. Liptay said. By the time the patient was fully evaluated, the cancer had increased in size. “It wasn’t a good thing to wait 10 months,” Dr. Liptay said, although he was uncertain whether earlier treatment would have changed the patient’s prognosis.

Just as previous economic recessions led people to forgo medical care, the downturn in the economy during the pandemic has also discouraged many people from seeking help or treatment.

“We know cancers are out there,” said Dr. Barbara L. McAneny, the chief executive of New Mexico Oncology Hematology Consultants. Many of her patients are staying away, even if they have insurance, because they cannot afford the deductibles or co-payments. “We’re seeing that, particularly with our poorer folks who are living on the edge anyway, living paycheck to paycheck,” she said.

Some patients ignored their symptoms as long as they could. Last March, Sandy Prieto, a school librarian who lived in Fowler, Calif., had stomach pain. But she refused to go to the doctor because she didn’t want to get Covid. After having a telehealth visit with her primary care doctor, she tried over-the-counter medications, but they didn’t help with the pain and nausea. She continued to decline.

“It got to the point where we didn’t have a choice,” said her husband, Eric, who had repeatedly urged her to go to the doctor. Jaundiced and in severe discomfort, she went to the emergency room at the end of May and was given a diagnosis of Stage 4 pancreatic cancer. She died in September.

“If it wasn’t for Covid and we could have gotten her some place earlier, she would still be with us today,” said her sister, Carolann Meme, who had tried to persuade Ms. Prieto to go to an academic medical center where she might have gotten into a clinical trial.

When patients like Ms. Prieto are not seen in person but treated virtually, doctors may easily miss important symptoms or recommend medication rather than tell them to come in, said Dr. Ravi D. Rao, the oncologist who treated Ms. Prieto. Patients may downplay how sick they feel or neglect to mention the pain in their hip, he said.

“In my mind, telemedicine and cancer don’t travel together,” Dr. Rao said. While he also made use of telemedicine during the height of the pandemic, he says he worked to keep his offices open.

Other doctors defended the use of virtual visits as a critical tool when office visits were too hazardous for most patients and staff. “We were grateful to have a robust telemedicine effort when people simply couldn’t come into the center,” said Dr. Borgen of Maimonides. But he acknowledged that patients were frequently reluctant to discuss their symptoms during a telehealth session, especially a mother whose young children could be listening to what they were saying. “It’s not private,” he noted.

Some health networks say they took aggressive steps to try to counteract the effects of the pandemic. During the initial stay-at-home order last year, Kaiser Permanente, the large California-based managed care outfit, spotted a declining number of breast cancer screenings and diagnoses in the northern part of the state. “Doctors immediately got together” to begin contacting patients, said Dr. Tatjana Kolevska, medical director for the Kaiser Permanente National Cancer Excellence Program.

Kaiser also relies on its electronic health records to make appointments for women who are overdue for their mammograms when they book an appointment with their primary care doctor or even want to get a prescription for new glasses.

While Dr. Kolevska says she is waiting to see data for the system as a whole, she has been encouraged by the number of patients in her practice who are now up to date with their mammograms.

“All of those things put in place have helped tremendously,” she said.

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