Every week,students at KIPP Infinity Middle School, in West Harlem, file into a large auditorium and take their places on the designated floor markings, making sure to stand six feet apart. Then they pull down their masks and fill sterile tubes with their spit.
The school’s teachers try to make the experience fun, running competitions to see who can fill their tube fastest and holding dance contests while students wait for their classmates to finish.
“It’s kind of enjoyable,” said Bradley Ramirez, a seventh grader at the school who likes math and Minecraft. “It’s way better than just sticking a stick up your nose.”
Bradley and his classmates are participants in a coronavirus testing pilot program created by the Mount Sinai Health System, the nonprofit Pershing Square Foundation and KIPP NYC, a network of 15 local charter schools. Since early March, the program has conducted more than 13,000 saliva-based tests of KIPP students, teachers and staff members, identifying several dozen cases of the virus.
planned to fully reopen schools, eliminating remote learning, in the fall.
“The way you keep a school safe, the way you make teachers feel comfortable with the reopening of schools, the way you make parents feel comfortable sending their kid, is you have a testing program,” said William A. Ackman, a hedge fund manager who founded the Pershing Square Foundation.
The testing program originated in December, when Mr. Ackman decided that he wanted to find a way to get New York City children back to school and approached Mount Sinai with a proposal: What if he provided funding for the hospital to build a laboratory that could process 100,000 coronavirus tests a day? The hope was that the lab could devote some of that capacity to corporate clients, such as businesses that wanted to test their employees, and use the revenue to fund wide-scale testing for New York City schoolchildren.
Mount Sinai quickly agreed. “We began on a concerted effort that people at Mount Sinai have really rallied around,” said Dr. David Reich, president and chief operating officer of Mount Sinai Hospital. “It’s just one of those projects where you never have to worry about people wanting to show up for your Zoom meeting — they’re all there, and they’re all smiling.”
saliva-based coronavirus tests. The gold standard diagnostic tests are known as P.C.R. tests, which can detect even minute amounts of the virus in biological specimens.During the early months of the pandemic, these tests generally required medical professionals to stick a swab deep into a patient’s nasopharynx, a procedure that can be deeply uncomfortable and put clinicians at risk.
Saliva-based P.C.R. tests, many scientists came to believe, would be safer and less invasive.They would also be much more suitable for young children than the deep, nasopharyngeal swabs. “A brain scoop, for a kid? Really? That’s a no-no,” said Dr. Alberto Paniz-Mondolfi, a pathologist at Mount Sinai who led development of the new saliva test.
As the partnership between Mount Sinai and Pershing Square began to take shape, Dr. Paniz-Mondolfi and his colleagues accelerated their work, validating their saliva test in 60 adult patients. But they knew that in the real world, children could not always be relied upon to follow clinical procedures to the letter.
“When we start getting this from the schools, we’re going to have pieces of pretzels, old gum floating in the saliva,” Dr. Paniz-Mondolfi said.
So Dr. Paniz-Mondolfi and his colleagues asked their own children to make a sacrifice for science: to snack on an array of junk food, including pizza and Oreos, and then spit into some testing tubes.Using these samples, the researchers confirmed that even if a student’s sample was contaminated with one of these foods, the tests should still work properly.
“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.”
With vaccination spreading across the United States, social life has begun to bend toward a semblance of normalcy: dinner parties, restaurants, spontaneous encounters with strangers, friends and colleagues on the street or in the office. It’s exciting but also slightly nerve-racking.
“I think there will be a period of heightened anxiety as we meet people face-to-face again,” Adam Mastroianni, a fifth-year Ph.D. student in psychology at Harvard, told me (over the phone). “I’ve heard this from a lot of my friends, that we’re worried: Have we forgotten how to be with other people?”
I’d called Mr. Mastroianni for some help in rediscovering this ancient calculus. In March, he and his colleagues Daniel Gilbert, Gus Cooney and Timothy Wilson published a paper in the Proceedings of the National Academy of Sciences — “Do conversations end when people want them to?” — on one of the stickier aspects of human interaction. Our conversation has been edited for brevity and clarity.
Prisoner’s Dilemma, and the prison is politeness.
When Your Company is Named Covid, You’ve Heard All the Jokes.”
How and when to go about viewing the Super Flower Blood Moon of 2021. (Hint: It helps if you live in Oceania, Hawaii, eastern Asia or Antarctica.)
According to researchers at the University of California, Los Angeles, there are at least 65 creatures, including humans, that make a laugh-like sound: “There could be more that, we think, are out there. Part of the reason they probably aren’t documented is because they’re probably really quiet, or just in species that aren’t well studied for now.”
Some of us were wondering — and now we know — why the iPhone’s “snooze” button provides exactly nine minutes of snoozing.
Jill Lepore, in The New Yorker, provides a brief and compelling history of burnout: “May there one day come again more peaceful metaphors for anguish, bone-aching weariness, bitter regret, and haunting loss.”
What went wrong in the Suez Canal, from a fluid dynamics perspective, courtesy of the Practical Engineering channel on YouTube.
All about the “cartoonishly evil-looking” amblypygid, sometimes known as the whip spider or tail-less whip scorpion but which, as Eric Boodman writes in Undark, is “neither spider nor scorpion.”
If you prefer true spiders, there’s this BBC video segment on how some make use of electric fields to get around.
It also had an unusual genetic mutation, a deletion in what is commonly known as the N gene, which codes for an important structural protein. This deletion has not been documented in other canine coronaviruses, Dr. Vlasova said, but similar mutations have appeared in the viruses that cause Covid and SARS. “So what does this mean?” Dr. Gray asks. “Well, you know, we don’t know exactly.”
Although much more research is needed, one possibility is that the mutation may help animal coronaviruses to adapt to human hosts, the researchers said.
It is too soon to say whether this virus poses a risk to humans. Researchers have not yet proved that this virus is the cause of the pneumonia that sent patients to the hospital. And they have not yet studied whether people who may contract the virus from animals can spread it to other people.
“We have to be careful, because things show up all the time that don’t become outbreaks,” said John Lednicky, a virologist at the University of Florida who was not an author of the study.
Nevertheless, the study is “extremely important,” he said. “The fact that it’s a coronavirus again once again tells us this is a group of viruses that deserves further study.” He added, “We should take this seriously and look for it, because if we start seeing more cases, that’s when the alarm bells should go off.”
Indeed, one possibility is that coronaviruses may be spreading between humans and other species, including dogs, far more frequently than has been known.
“At this moment we do not really have any reason to believe that this virus is going to be causing a pandemic,” Dr. Vlasova said. “What kind of attention we want to draw to this research is that transmission of coronaviruses from animal sources to humans is probably a very, very, very common event. And up until now it was mostly ignored.”
In late 1910, a deadly plague started spreading in the northeast reaches of China, reaching the large city of Harbin. Tens of thousands of people coughed up blood; their skin pruned and turned purple. They all died.
This outbreak sent the Qing government into a tailspin: They didn’t know what illness was causing these deaths, let alone how to control it. So they brought in one of the best trained doctors in Asia at the time, Dr. Wu Lien-Teh. After performing autopsies, Dr. Wu found Yersinia pestis, a bacterium similar to the one that had caused bubonic plague in the West. He recognized Manchuria’s plague as a respiratory disease and urged everyone, especially health care professionals and law enforcement, to wear masks.
Chinese authorities, heeding his call, coupled masking with stringent lockdowns enforced by the police. Four months after the doctor was summoned, the plague ended. Although often overlooked in Western countries, Dr. Wu is recognized in world history as a pioneer of public health, helping to change the course of a respiratory disease spread by droplets that could have devastated China in the early 20th century, and perhaps spread far beyond its borders.
While the Chinese of that era complied with these strategies, public health professionals in the United States and other Western countries have struggled to get people to listen to themduring the Covid-19 pandemic. China, too, ran into challenges early on, but the country’s institutional memory from previous viral outbreaks helped turn the tide. And as many Americans abandon masking, push to restore normality in places where risks of infection remain high and hesitate to get vaccinated, some public health experts have looked to Dr. Wu’s success, seeking lessons on handling not only Covid, but also future epidemics.
masks became a political flash point in the United States and elsewhere during the Spanish flu pandemic, the idea of using them persisted in China, and gauze masks became an important tool in the political agenda of the Nationalist Party when it took over in 1928. Public health officials recommended all citizens wear gauze masks in public spaces during outbreaks of meningitis or cholera.
Kyle Legleiter, the senior director of policy advocacy at The Colorado Health Foundation.
Another factor that might have contributed to Dr. Wu’s success in China would be the reverence residents and officials had for him as a figure of authority, Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations, said.
In some ways, Dr. Anthony Fauci, the chief medical adviser on Covid to President Biden and a prominent public health figure since the 1980s, served in a role similar to the one Dr. Wu played in China, Dr. Huang said. But, his message perhaps didn’t always get through because Americans are more polarized in their political identities and beliefs.
Dr. Legleiter added that public health messaging only penetrates if the public identifies with or trusts that figure of authority.
“An individual person is a stand-in for a broader set of institutions or systems that they’re speaking on the behalf of,” Dr. Legleiter said. Those who lean conservative, for instance, may put Dr. Fauci and other scientists in the category of “the elites.” As such, they’re more likely to flout public health policies that such authority figures promote, and comply with proclamations from individuals they identify with the most.
Others say that public health is intrinsically tied to the legitimacy of the state promoting it. At the turn of the 20th century, China was in distress, Dr. Hanson said. Dr. Wu helped bring China out of a tumultuous period, and the enforcement of public health measures gave the country more legitimacy.
Similarly, because the current pandemic has laid bare shortcomings in the public health systems in the United States, Britain and other Western countries, some experts believe it can be a catalyst for change.
“Since the mid-19th century, the West has generally seen its ability to control infectious disease as a marker of their civilizational superiority over much of the rest of the world,” Dr. White said. While China was seen as the sick man of the world then, some commentators in China now attempt to brand the United States with that label.
Ruth Rogaski, a medical historian at Vanderbilt University who specializes in studying the Qing dynasty and modern China, believes that the coronavirus crisis similarly offers an opportunity for reflection, which can be very motivating.
“Epidemics can serve as inflection points,” Dr. Rogaski said. “Opportunities to rethink, retool and even revolutionize approaches to health.”
The vaccines produced similar responses in all three groups of women, eliciting both antibody and T-cell responses against the coronavirus, the scientists found. Of particular note, experts said, was the fact that the shots produced high levels of neutralizing antibodies, which can prevent the virus from entering cells, in both pregnant and nonpregnant women.
“Clearly, the vaccines were working in these people,” said Akiko Iwasaki, an immunologist at Yale University who was not involved in the research. “These levels are expected to be quite protective.”
The researchers also found neutralizing antibodies in the breast milk of vaccinated mothers and in umbilical cord blood collected from infants at delivery. “Vaccination of pregnant people and lactating people actually leads to transfer of some immunity to their newborns and lactating infants,” said Dr. Ai-ris Y. Collier, a physician-scientist at Beth Israel who is the first author of the paper.
The results are “really encouraging,” Dr. Iwasaki said. “There is this added benefit of conferring protective antibodies to the newborn and the fetus, which is all the more reason to get vaccinated.”
The scientists also measured the women’s immune responses to two variants of concern: B.1.1.7, which was first identified in Britain, and B.1.351, which was first identified in South Africa. All three groups of women produced antibody and T-cell responses to both variants after vaccination, although their antibody responses were weaker against the variants, especially B.1.351, than against the original strain of the virus, according to the study.
“These women developed immune responses to the variants, although the asterisk is that the antibody responses were reduced several-fold,” said Dr. Dan Barouch, a study author and virologist at Beth Israel.(Dr. Barouch and his colleagues developed the Johnson & Johnson vaccine, which was not included in this study.)
“Overall, it’s good news,” he added. “And it increases the data that suggests that there is a substantial benefit for pregnant women to be vaccinated.”
The American public’s willingness to get a Covid vaccine is reaching a saturation point, a new national poll suggests, one more indication that achieving widespread immunity in the United States is becoming increasingly challenging.
Only 9 percent of respondents said they hadn’t yet gotten the shot but intended to do so, according to the survey, published in the April edition of the Kaiser Family Foundation’s Vaccine Monitor. And with federal authorization of the Pfizer vaccine for adolescents ages 12 through 15 expected imminently, the eagerness of parents to let their children be vaccinated is also limited, the poll found.
Overall, slightly more than half of those surveyed said they had gotten at least one dose of the vaccine, a finding that matches data from the Centers for Disease Control and Prevention.
“We’re in a new stage of talking about vaccine demand,” said Mollyann Brodie, executive vice president of Kaiser’s Public Opinion and Survey Research Program. “There’s not going to be a single strategy to increase demand across everyone who is left. There will be have to be a lot of individually targeted efforts. The people still on the fence have logistical barriers, information needs, and lots don’t yet know they are eligible. Each strategy might move a small number of people to get vaccinated, but all together, that could matter a lot.”
With a growing number of scientists and public health experts concluding that it is unlikely that the country will reach the threshold of herd immunity, the Biden administration has stepped up efforts to reach those who are still hesitant. On Tuesday, the administration announced steps to encourage more pop-up and mobile vaccine clinics and to distribute shots to primary care doctors and pediatricians as well as local pharmacies.
The survey also showed that confidence in the Johnson & Johnson vaccine had suffered a significant blow after the 10-day pause in dispensing it while the authorities examined rare incidents of life-threatening blood clots in people who had taken it. While 69 percent of people said they had confidence in the safety of the vaccines made by Pfizer and Moderna, only 46 percent felt confident about the safety of the Johnson & Johnson vaccine. Among adults who have not been vaccinated, one in five said that the news about the Johnson & Johnson shot had prompted them to change their minds about getting a Covid-19 vaccine.
The survey did show that there had been some progress among Republicans, who have been among the firmest holdouts. Among that group, 55 percent said they had gotten a shot or intended to do so, up from 46 percent in March. The percentage who will “definitely not” get the vaccine is shrinking as well, down to 20 percent from 29 percent in March.
The results were based on telephone surveys of a nationally representative sample of 2,097 adults from April 15 through April 29.
A consortium of universities that includes Harvard, Northeastern and Rutgers has been conducting online polls during the pandemic and recently focused on parents. The group’s latest survey, conducted throughout April and reaching 21,733 adults across 50 states, found that the divide between mothers and fathers in views about the vaccine for children had widened.
Fathers are becoming more accepting, with their resistance falling to 11 percent from 14 percent since February. But over a quarter of mothers, researchers said, still say they are “extremely unlikely” to vaccinate their children. Both genders are more resistant to the vaccine for younger children than for teenagers. Other research shows that mothers tend to have more sway over the final decision than fathers.
The responses from parents may well change over time, experts say. Just as adults were far more reluctant last summer when the vaccine was still a concept, parents surveyed several weeks ago, when imminent authorization for children under 16 had not been widely discussed, might also have been reacting to a hypothetical situation rather than a reality.
But pediatricians and others who are seen as trusted sources of information are already aware that they have considerable work to do to instill vaccine confidence in this latest cohort.
Dr. Sean O’Leary, a pediatrician in Denver who is vice chairman of the committee on infectious diseases for the American Academy of Pediatrics, predicted that just as adults had swarmed Covid vaccine providers during the initial weeks of distribution, parents and pent-up young teenagers would rush for it at the start, too.
But Dr. O’Leary, who often gives talks to pediatricians about how to motivate patients to accept vaccinations, worries that a slowdown will inevitably follow. To persuade hesitant parents, he said, “we have to make the vaccine available in as many places as possible.”
He added, “If parents and patients are in the pediatrician’s office and the doctor can say, ‘Hey, I’ve got it,’ that may be enough of a nudge for them to say, ‘Let’s go ahead and do this.’”
The second new study, which was published in The Lancet, was conducted by researchers at the Israel Ministry of Health and Pfizer. It is based on more than 230,000 coronavirus infections that occurred in Israel between Jan. 24 and April 3. During that period, B.1.1.7 accounted for nearly 95 percent of all coronavirus cases in the country, which has vaccinated more than half of its population.
The researchers found that the vaccine was more than 95 percent effective at protecting against coronavirus infection, hospitalization and death among fully vaccinated people 16 and older. It also worked well in older adults. Among those 85 or older, the vaccine was more than 94 percent effective at protecting against infection, hospitalization and death.
As the percentage of fully vaccinated people in each age group grew, the incidence of coronavirus infections in that cohort fell, the researchers found. The declines in infection rates matched the timing of increasing vaccine coverage in each age group better than the start of a nationwide lockdown. The results suggest that Israel’s rapid pace of vaccination has been responsible for the decline in infections in the country.
“I’m just really happy to see this data that in the real world these vaccines are having such an amazing impact on curtailing infection and disease,” said Akiko Iwasaki, an immunologist at Yale University.
Both studies also reported that two doses of the vaccine provided significantly more protection than one dose did. In the Israel study, for example, one dose of the vaccine was 77 percent effective against death, while two doses were 96.7 percent effective.
“It absolutely emphasizes the need for the second dose,” said Dr. Kathleen Neuzil, who directs the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine.
Together, the studies suggest that even with the new variants, vaccination remains a plausible path out of the pandemic, experts said. “If we can get vaccines to the world and get coverage up,” Dr. Neuzil said, “I believe we can get on top of this and we can get on top of the emergence of new variants.”
Sitting on a stool several feet from a long-armed robot, Dr. Danyal Fer wrapped his fingers around two metal handles near his chest.
As he moved the handles — up and down, left and right — the robot mimicked each small motion with its own two arms. Then, when he pinched his thumb and forefinger together, one of the robot’s tiny claws did much the same. This is how surgeons like Dr. Fer have long used robots when operating on patients. They can remove a prostate from a patient while sitting at a computer console across the room.
But after this brief demonstration, Dr. Fer and his fellow researchers at the University of California, Berkeley, showed how they hope to advance the state of the art. Dr. Fer let go of the handles, and a new kind of computer software took over. As he and the other researchers looked on, the robot started to move entirely on its own.
With one claw, the machine lifted a tiny plastic ring from an equally tiny peg on the table, passed the ring from one claw to the other, moved it across the table and gingerly hooked it onto a new peg. Then the robot did the same with several more rings, completing the task as quickly as it had when guided by Dr. Fer.
how surgeons learn to operate robots like the one in Berkeley. Now, an automated robot performing the test can match or even exceed a human in dexterity, precision and speed, according to a new research paper from the Berkeley team.
The project is a part of a much wider effort to bring artificial intelligence into the operating room. Using many of the same technologies that underpin self-driving cars, autonomous drones and warehouse robots, researchers are working to automate surgical robots too. These methods are still a long way from everyday use, but progress is accelerating.
where there is room for improvement — by automating particular phases of surgery.
significantly improved the power of computer vision, which could allow robots to perform surgical tasks on their own, without such markers.
The change is driven by what are called neural networks, mathematical systems that can learn skills by analyzing vast amounts of data. By analyzing thousands of cat photos, for instance, a neural network can learn to recognize a cat. In much the same way, a neural network can learn from images captured by surgical robots.
inserting a needle for a cancer biopsy or burning into the brain to remove a tumor.
“It is like a car where the lane-following is autonomous but you still control the gas and the brake,” said Greg Fischer, one of the Worcester researchers.
Many obstacles lie ahead, scientists note. Moving plastic pegs is one thing; cutting, moving and suturing flesh is another. “What happens when the camera angle changes?” said Ann Majewicz Fey, an associate professor at the University of Texas, Austin. “What happens when smoke gets in the way?”
For the foreseeable future, automation will be something that works alongside surgeons rather than replaces them. But even that could have profound effects, Dr. Fer said. For instance, doctors could perform surgery across distances far greater than the width of the operating room — from miles or more away, perhaps, helping wounded soldiers on distant battlefields.
The signal lag is too great to make that possible currently. But if a robot could handle at least some of the tasks on its own, long-distance surgery could become viable, Dr. Fer said: “You could send a high-level plan and then the robot could carry it out.”
The same technology would be essential to remote surgery across even longer distances. “When we start operating on people on the moon,” he said, “surgeons will need entirely new tools.”
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 identifymutations 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.”
Long before the coronavirus hit, nutrition programs that served the nation’s older adults struggled to keep up with a growing demand. Often, they could not.
In Charlotte, N.C., and nine surrounding counties, for example, the waiting list for Meals on Wheels averaged about 1,200 people. But Linda Miller, director of the Centralina Area Agency on Aging, which coordinates the program, always assumed the actual need was higher.
She knew some clients skipped meals because they couldn’t travel to a senior center for a hot lunch every weekday; some divided a single home-delivered meal to serve as both lunch and dinner.
Some never applied for help. “Just like with food stamps, which are underused,” Ms. Miller said, “people are embarrassed: ‘I worked hard all my life; I don’t want charity.’”
5.4 million older recipients.
For years, advocates for older adults have lobbied Congress for more significant federal help. Although the Older Americans Act has enjoyed bipartisan support, small annual upticks in appropriations left 5,000 local organizations constantly lagging in their ability to feed seniors.
From 2001 to 2019, funding for the Older Americans Act rose an average of 1.1 percent annually — a 22 percent increase over almost two decades, according to an analysis by the AARP Public Policy Institute. But adjusted for inflation, the funding for nutrition services actually fell 8 percent. State and local matching funds, foundation grants and private donations helped keep kitchens open and drivers delivering, but many programs still could not bridge their budget gaps.
food insecure,” meaning they had limited or uncertain access to adequate food.
And that shortfall was before the pandemic. Once programs hastily closed congregant settings last spring, a Meals on Wheels America survey found that nearly 80 percent of the programs reported that new requests for home-delivered meals had at least doubled; waiting lists grew by 26 percent.
Along with money, the Covid relief legislation gave these local programs needed flexibility. Normally, to qualify for Meals on Wheels, homebound clients must require assistance with activities of daily living. The emergency appropriations allowed administrators to serve less frail seniors who were following stay-at-home orders, and to transfer money freely from congregant centers to home delivery.
Even so, the increased caseloads, with people who had never applied before seeking meals, left some administrators facing dire decisions.
In Northern Arizona, about 800 clients were receiving home-delivered meals in February 2020. By June, that number had ballooned to 1,265, including new applicants as well as those who had previously eaten at the program’s 18 now-shuttered senior centers. Clients were receiving 14 meals each week.
By summer, despite federal relief funds, “I was out of money,” Ms. Beals-Luedtka said. She faced the grim task of telling 342 seniors, who had been added to the rolls for three emergency months, that she had to remove them. “People were crying on the phone,” she recalled. “I literally had a man say he was going to commit suicide.” (She reinstated him.) Even those who remained started receiving five meals a week instead of 14.
diminish loneliness and help keep seniors out of expensive nursing homes. They also may help reduce falls, although those findings were based on a small sample and did not achieve statistical significance.
Interestingly, Dr. Thomas’s research found daily meal deliveries had greater effects than weekly or twice-monthly drop-offs of frozen meals, a practice many local organizations have adopted to save money.
Frail or forgetful clients may have trouble storing, preparing and remembering to eat frozen meals. But the primary reason daily deliveries pay off, her study shows, is the regular chats with drivers.
“They build relationships with their clients,” Dr. Thomas said. “They might come back later to fix a rickety handrail. If they’re worried about a client’s health, they let the program know. The drivers are often the only people they see all day, so these relationships are very important.”
a prepandemic evaluation found.
So while program administrators relish a rare opportunity to expand their reach, they worry that if Congress doesn’t sustain this higher level of appropriations, the relief money will be spent and waiting lists will reappear.
“There’s going to be a cliff,” Ms. Beals-Luedtka said. “What’s going to happen next time? I don’t want to have to call people and say, ‘We’re done with you now.’ These are our grandparents.”