How Exercise Enhances Aging Brains
Sedentary, older adults who took aerobic dance classes twice a week showed improvements in brain areas critical for memory and thinking.
Exercise can change how crucial portions of our brain communicate as we age, improving aspects of thinking and remembering, according to a fascinating new study of aging brains and aerobic workouts. The study, which involved older African-Americans, finds that unconnected portions of the brain’s memory center start interacting in complex and healthier new ways after regular exercise, sharpening memory function.
The findings expand our understanding of how moving molds thinking and also underscore the importance of staying active, whatever our age.
The idea that physical activity improves brain health is well established by now. Experiments involving animals and people show exercise increases neurons in the hippocampus, which is essential for memory creation and storage, while also improving thinking skills. In older people, regular physical activity helps slow the usual loss of brain volume, which may help to prevent age-related memory loss and possibly lower the risk of dementia.
There have been hints, too, that exercise can alter how far-flung parts of the brain talk among themselves. In a 2016 M.R.I. study, for instance, researchers found that disparate parts of the brain light up at the same time among collegiate runners but less so among sedentary students. This paired brain activity is believed to be a form of communication, allowing parts of the brain to work together and improve thinking skills, despite not sharing a physical connection. In the runners, the synchronized portions related to attention, decision making and working memory, suggesting that running and fitness might have contributed to keener minds.
But those students were young and healthy, facing scant imminent threat of memory loss. Little was known yet about whether and how exercise might alter the communications systems of creakier, older brains and what effects, if any, the rewiring would have on thinking.
So, for the new study, which was published in January in Neurobiology of Learning and Memory, Mark Gluck, a professor of neuroscience at Rutgers University in Newark, N.J., and his colleagues decided to see what happened inside the brains and minds of much older people if they began to work out.
In particular, he wondered about their medial temporal lobes. This portion of the brain contains the hippocampus and is the core of our memory center. Unfortunately, its inner workings often begin to sputter with age, leading to declines in thinking and memory. But Dr. Gluck suspected that exercise might alter that trajectory.
Helpfully, as the director of the Aging & Brain Health Alliance at Rutgers, he already was leading an ongoing exercise experiment. Working with local churches and community centers, he and his collaborators previously had recruited sedentary, older African-American men and women from the Newark area. The volunteers, most of them in their 60s, visited Dr. Gluck’s lab for checks of their health and fitness, along with cognitive testing. A few also agreed to have their brain activity scanned.
Some then started working out, while others opted to be a sedentary control group. All shared similar fitness and memory function at the start. The exercise group attended hourlong aerobic dance classes twice a week at a church or community center for 20 weeks.
Now, Dr. Gluck and his research associate Neha Sinha, along with other colleagues, invited 34 of those volunteers who had completed an earlier brain scan to return for another. Seventeen of them had been exercising in the meantime; the rest had not. The groups also repeated the cognitive tests.
Then the scientists started comparing and quickly noticed subtle differences in how the exercisers’ brains operated. Their scans showed more-synchronized activity throughout their medial temporal lobes than among the sedentary group, and this activity was more dynamic. Portions of the exercisers’ lobes would light up together and then, within seconds, realign and light up with other sections of the lobe. Such promiscuous synchronizing indicates a kind of youthful flexibility in the brain, Dr. Gluck says, as if the circuits were smoothly trading dance partners at a ball. The exercisers’ brains would “flexibly rearrange their connections,” he says, in a way that the sedentary group’s brains could not.
Just as important, those changes played out in people’s thinking and memories. The exercisers performed better than before on a test of their ability to learn and retain information and apply it logically in new situations. This kind of agile thinking involves the medial temporal lobe, Dr. Gluck says, and tends to decline with age. But the older exercisers scored higher than at the start, and those whose brains displayed the most new interconnections now outperformed the rest.
This study involved older African-Americans, though, a group that is underrepresented in health research but may not be representative of all aging people. Still, even with that caveat, “it seems that neural flexibility” gained by exercising a few times a week “leads directly to memory flexibility,” Dr. Gluck says.
How to Get a Peloton-Style Workout Without Splurging
Don’t want to pay $1,900 for a Peloton bike, plus a subscription fee for classes? Here are ways to reduce the cost of using tech to exercise at home.
Lisa Whitney, a dietitian in Reno, Nev., came across the deal of a lifetime about two years ago. A fitness studio was going out of business and selling its equipment. She scored an indoor exercise bike for $100.
Ms. Whitney soon made some additions to the bike. She propped her iPad on the handlebars. Then she experimented with online cycling classes streamed on YouTube and on the app for Peloton, a maker of internet-connected exercise devices that offers interactive fitness classes.
Ms. Whitney had no desire to upgrade to one of Peloton’s $1,900-plus luxury exercise bikes, which include a tablet to stream classes and sensors that track your speed and heart rate. So she further modified her bike to become a do-it-yourself Peloton, buying sensors and indoor cycling shoes.
The grand total: about $300, plus a $13 monthly subscription to Peloton’s app. Not cheap, but a significant discount to what she might have paid.
“I’m happy with my setup,” Ms. Whitney, 42, said. “I really don’t think upgrading would do much.”
The pandemic, which has forced many gyms to shut down, has driven hordes of people to splurge on luxury items like Peloton’s bikes and treadmills so they can work out at home. Capitalizing on this trend, Apple last year released Apple Fitness Plus, an instructional fitness app that is exclusively offered to people who own an Apple Watch, which requires an iPhone to work.
But all of that can be expensive. The minimum prices of an Apple Watch and iPhone add up to $600, and Apple Fitness Plus costs $10 a month. Then to stream classes on a big-screen TV instead of a phone while you exercise, you need a streaming device such as an Apple TV, which costs about $150. The full Peloton experience is even pricier.
With the economy in a funk, many of us are trying to tighten our spending while maintaining good health. So I experimented with how to minimize the costs of doing video-instructed workouts at home, talked to tinkerers and assessed the pros and cons.
Here’s what I learned.
To start my experiment for working out at home on the cheap, the first question I tackled was whether to subscribe to a fitness app or stream classes from YouTube for free. Both largely provide videos of instructors guiding you through workouts.
So I bought an $8 yoga mat and a $70 pair of adjustable dumbbells and turned on my TV, which includes the YouTube app. I then subscribed to three of the most popular YouTube channels that have free content for exercising at home: Yoga With Adriene, Fitness Blender and Holly Dolke.
One immediate downside was almost too much content — often hundreds of videos per YouTuber — making it difficult to pick a workout. Even when I finally chose a video, I learned I had to brace myself for some quality issues.
In the Yoga With Adriene channel, for instance, I selected the video “Yoga for When You Feel Dead Inside,” which felt appropriate for the time we are living in. The video looked good, but at times the instructor’s voice sounded muffled.
Production problems were more visible in the Holly Dolke channel, which has a collection of intense workouts that you can do without any equipment. When I tried the video “Muffin Top Melter,” an instructor in the background demonstrated how to do a more challenging version of each exercise, but the other instructor, in the foreground, constantly blocked her.
Then there were the ads. As I lifted weights while following a 10-minute fat-burning workout from Fitness Blender, YouTube interrupted the video to play an ad for Dawn soap. That left me holding a dumbbell above the back of my neck while I waited for the ad to end.
Those issues aside, I was able to do all of the exercises demonstrated by these YouTubers, and they left me winded and sweaty. For the cost of free, I can’t complain much. Most important, Yoga With Adriene succeeded in making me feel less dead inside.
To compare the free YouTube exercise videos with the paid experience, I subscribed to Peloton and Apple Fitness Plus on my Apple TV set-top box. I did workouts using both products for the last two months.
Peloton and Apple Fitness Plus addressed many of the problems plaguing the free exercise content.
For one, workouts were organized into categories by the type of workout, including yoga, strength training and core, and then by the difficulty or duration of the workout. It took little time to choose a workout.
In both Peloton and Apple Fitness Plus, video and audio quality were very clear, and the workouts were shot at various angles to get a good look at what the instructors were doing. The bonus of Fitness Plus was that my heart rate and calories burned were displayed on both my Apple Watch and the TV screen.
In short, paying those subscriptions provided convenience and polish, which led to a more pleasant workout. I concluded that Peloton’s videos were worth paying $13 a month. And $10 a month is reasonable for Apple Fitness Plus, but only if you already have an Apple Watch and iPhone.
So what about exercise equipment like spin bikes? If you want the tech frills of a Peloton but don’t want to spend on the equipment, there were two main approaches.
To go the cheapest route, you can make use of a bicycle you already have. Here’s where home tinkerers can be especially crafty and resourceful.
Take Omar Sultan, a manager at the networking company Cisco. He modified his road bike with a few add-ons: a bike trainer, which secured the rear wheel and bike frame and costs roughly $100; a $40 Wahoo cadence sensor that tracked his energy output and speed and transmitted the data to a smartphone; and a heart rate monitor that strapped around his chest, such as the $90 Polar H10. Then he used a streaming device to follow Peloton classes on his TV.
“The D.I.Y. setup is 80 percent of the way there” to a Peloton, Mr. Sultan said.
The more expensive option was to buy an indoor exercise bike and use a tablet or phone to stream cycling classes via YouTube or the Peloton app, as Ms. Whitney did. The $700 IC7.9, for example, includes a cadence sensor and a holder for your tablet. You could then buy a heart rate monitor and a pair of $100 indoor cycling shoes that clip into the pedals.
But if you use your own bicycle or a modified spin bike and try Peloton’s app, you won’t be able to participate in the app’s so-called leader board, which shows a graphic of your progress compared with other Peloton users online.
With a D.I.Y. bike, it can also be difficult to figure out how to shift gears to simulate when the instructor is telling you to turn up the resistance — like when you are pretending to ride up a hill.
Nicole Odya, a nurse practitioner in Chicago who modified a high-end indoor bike, the Keiser M3i, said there were major upsides to the D.I.Y. route. Using her own iPad, she has the flexibility to choose whatever fitness apps she wants to use, such as Zwift and mPaceLine. It also gave her the freedom to customize her bike, so she swapped out the stock pedals for better ones.
“I didn’t want to be locked into their platform,” she said of Peloton.
Biden Vows Enough Vaccine ‘for Every Adult American’ by End of May
The pharmaceutical giant Merck & Co. agreed to help manufacture Johnson & Johnson’s coronavirus vaccine, in a deal partly brokered by the White House.
Sheryl Gay Stolberg, Sharon LaFraniere, Katie Thomas and
WASHINGTON — President Biden said on Tuesday that the United States was “on track” to have enough supply of coronavirus vaccines “for every adult in America by the end of May,” accelerating his effort to deliver the nation from the worst public health crisis in a century.
In a brief speech at the White House, Mr. Biden said his administration had provided support to Johnson & Johnson that would enable the company and its partners to make vaccines around the clock. The administration had also brokered a deal in which the pharmaceutical giant Merck & Co. would help manufacture the new Johnson & Johnson coronavirus vaccine.
Merck is the world’s second-largest vaccine manufacturer, though its own attempt at a coronavirus vaccine was unsuccessful. Officials described the partnership between the two competitors as historic and said it harks back to Mr. Biden’s vision of a wartime effort to fight the coronavirus, similar to the manufacturing campaigns when Franklin D. Roosevelt was president.
“As a consequence of the stepped-up process that I’ve ordered and just outlined, this country will have enough vaccine supply — I’ll say it again — for every adult in America by the end of May,” Mr. Biden said. “By the end of May. That’s progress — important progress.”
He also said he wanted all teachers to receive at least one shot by the end of this month.
The president’s timetable, if it comes to pass, provides a bright light at the end of a long, dark tunnel, though he acknowledged that the nation remained in a tenuous situation. The announcement on Tuesday came days after the Food and Drug Administration gave Johnson & Johnson emergency authorization for its vaccine, which unlike the two others that are available requires just one dose.
Public health officials fear a fourth surge of the coronavirus pandemic, fueled by worrisome new variants, as states like Texas and Mississippi rush to fully reopen. While daily caseloads have undergone a steep drop since January, the decline appears to be leveling off, and top federal health officials warned governors last week against relaxing coronavirus restrictions.
“We cannot let our guard down now or assure that victory is inevitable,” Mr. Biden said. “We can’t assume that.”
He had previously said that there would be enough coronavirus vaccines for every American by the end of July. While the president’s remarks on Tuesday set a new marker against which he will be measured, his administration and his predecessor’s had already laid the groundwork to cover the 260 million eligible adults by the end of May.
Two other vaccine manufacturers, Moderna and Pfizer BioNTech, pledged last month to deliver together enough to cover 200 million Americans by that date. Johnson & Johnson’s $1 billion contract, negotiated last year when Donald J. Trump was president, calls for the company to deliver enough doses for another 87 million Americans by the end of May, which would have given the country enough vaccine for all adults 18 and older.
But Johnson & Johnson and its partners fell behind in their manufacturing. The company was supposed to deliver its first 37 million doses by the end of March, but it has said it would be able to deliver only 20 million doses by that date, which made Biden aides nervous.
In late January, Jeffrey D. Zients, Mr. Biden’s coronavirus response coordinator, and Dr. David Kessler, who is managing vaccine distribution for the White House, reached out to top officials at the company, including Alex Gorsky, its chief executive, with a blunt message: This is unacceptable.
That led to a series of negotiations in February in which administration officials repeatedly pressured Johnson & Johnson to accept that they needed help, while urging Merck to be part of the solution, according to two administration officials who participated in the discussions.
In a statement on Tuesday, Merck said the federal government would pay it up to $269 million to adapt and make available its existing facilities to produce coronavirus vaccines. Michael T. Nally, the executive vice president of human health at Merck, said in an interview that the company had been in talks with multiple companies and governments, including officials in the former Trump administration.
“I think we all recognize that every day counts,” he said.
Mr. Nally declined to provide an estimate for how many doses of vaccine the company could ultimately produce, saying only that it would be “substantial.” The expanded supply from Merck, though, is not likely to become available for months.
One federal official, who spoke on the condition of anonymity, said other steps the administration took would move up Johnson & Johnson’s manufacturing timeline.
Those steps, said Jen Psaki, the White House press secretary, included providing a team of experts to monitor manufacturing and logistical support from the Defense Department. In addition, the president will invoke the Defense Production Act, a Korean War-era law, to give Johnson & Johnson access to supplies necessary to make and package vaccines.
Mr. Biden said he would also invoke the law to help Merck retrofit one of two manufacturing plants that would be used in the production process.
Vaccine manufacturing is a notoriously finicky and unpredictable process, especially in the early stages. Merck makes vaccines for 11 of the 17 diseases on the federal government’s immunization roster — including measles, mumps, rubella and chickenpox — and the company has been searching for a role to play in the coronavirus program for nearly a year.
“The only party that really understood vaccine manufacturing and had a stellar record of it is now having to be brought in to manufacture someone else’s vaccine,” said Steve Brozak, the president and managing director of WBB Securities, which invests in companies that focus on infectious diseases.
Trump and Biden administration officials had explored enlisting Merck’s help in manufacturing vaccines developed by other companies. Federal officials said talks about a possible partnership between Merck and Johnson & Johnson had been underway for months. But Ms. Psaki said the Biden White House deserved credit for getting the deal “across the finish line.”
The arrangement is not without precedent. Johnson & Johnson signed a deal late last month with the French manufacturer Sanofi, which is also developing a coronavirus vaccine, to help fill and pack the Johnson & Johnson vaccines in Europe. Sanofi and the Swiss pharmaceutical giant Novartis have also signed deals with Pfizer to help manufacture its vaccine in Europe.
“This is a type of collaboration between companies we saw in World War II,” Mr. Biden said at the White House. He thanked Merck and Johnson & Johnson for “stepping up and being good corporate citizens during this crisis.”
Under the agreement, Merck will dedicate two of its facilities to production of the Johnson & Johnson vaccine.
One will provide “fill-finish,” the final phase of the manufacturing process during which the vaccine is placed in vials and packaged for shipping. The other will make the “drug substance”: the vaccine itself.
Mr. Biden has already committed to purchasing a total of 600 million doses — enough for every American — of the Pfizer-BioNTech and Moderna vaccines, and said those doses would be available by the end of July.
If Johnson & Johnson shipments come in later, and the United States ends up with a surplus, the administration could sell or donate doses to other countries where supply is scarce. That would be in keeping with Mr. Biden’s publicly stated commitment for the United States to take a stronger leadership role in fighting the pandemic.
But giving away vaccines too quickly, before all Americans have access, would carry a substantial political risk. Ms. Psaki said the president’s current priority was to vaccinate all Americans.
After that, she said, “of course we want the global community to be vaccinated. That makes us all safer.”
The pace of the nation’s vaccination effort has been steadily accelerating. As of Tuesday, about 51.7 million people had received at least one dose of a coronavirus vaccine, including about 26.1 million people — about 8 percent of Americans ages 18 or older — who have been fully vaccinated, according to the Centers for Disease Control and Prevention.
Pfizer’s and Moderna’s vaccines both require more stringent storage conditions than Johnson & Johnson’s, which can also keep for three months at normal refrigeration temperatures, making it easier to distribute and easier for pharmacies and clinics to stock. At $10 a dose, it is also cheaper than the other two.
This week, states will receive 3.9 million Johnson & Johnson doses that were manufactured at a Dutch plant and bottled in Grand Rapids, Mich. Johnson & Johnson is expected to mass produce the vaccine at a new plant in Baltimore that is operated by a company called Emergent BioSolutions. Catalent, a pharmaceutical company, will bottle the doses in Indiana.
The Food and Drug Administration’s authorization for emergency use, granted late Saturday, covered the Dutch production lines and the Grand Rapids bottling operation. In about two weeks, federal regulators are expected to decide whether to amend that authorization to include the plants in Baltimore and Indiana, according to two people familiar with Johnson & Johnson’s operations who were not authorized to speak publicly.
At least until then, they said, supply would be uneven and limited.
If all the anticipated doses come through, the United States could have a glut of vaccines by the summer. In the next few weeks, Moderna is expected to submit a formal proposal to the Food and Drug Administration to put as much as 50 percent more vaccine into each of its vials, a simple and comparatively quick way to bolster supply. In behind-the-scenes discussions with the company, the F.D.A. has recommended an increase of up to 40 percent.
On the other hand, the nation’s needs could rise. The emergence of worrisome variants of the virus could require booster shots for those who have already been vaccinated. And federal health officials are hoping that continuing tests will show the vaccines are safe for children, which will mean tens of millions of more shots are needed.
Regardless of how the additional supply of vaccines is used, shoring up manufacturing for the long term is a smart move, Mr. Brozak said. “This is going to be a long and rugged war,” he said. “You’ve got to be prepared, not just for the next iteration, but the next-next iteration.”
Noah Weiland contributed reporting.
In L.A. County, Covid Is Hitting Black and Latino Residents Hardest
In Los Angeles County, this winter’s Covid surge revealed a stark racial and economic divide.
The disease killed Black and Latino residents at two to three times the rate of white Angelenos.
We went inside the homes and hospital rooms of those hit hardest hit by the pandemic.
Photographs by Meridith Kohut
Text by Fernanda Santos
With more than 10 million residents, Los Angeles County is the most-populous county in the United States. It is a world of extremes, with multimillion-dollar mansions at one end and cramped apartments housing multiple generations of the same family at the other. As the coronavirus once again tightened its grip around the region late last fall, it struck with stark precision the county’s poorest and neediest residents: older Black people in South Los Angeles, Pacific Islanders in Inglewood, Latinos toiling in obscurity in essential jobs throughout the city. In the Boyle Heights neighborhood, east of downtown Los Angeles, where half of all residents live in poverty, the number of coronavirus infections in a 14-day period last month was six times as high as it was in Bel Air, one of Los Angeles’s wealthiest neighborhoods.
The holidays unleashed the surge, and by Jan. 11, 10 residents in the county, on average, were testing positive for coronavirus every minute. One person was dying every eight minutes. Hospitals were overwhelmed; ambulances circled for hours, struggling to find emergency rooms that could take one more patient. That month, Barbara Ferrer, the county’s health director, called it “the worst disaster our county has experienced for decades.” But it has been an unequal one.
By mid-February, the virus had killed Black residents at nearly twice the rate and Latinos at nearly three times the rate of white Angelenos. It had exposed not just a sharp racial and ethnic divide but also the longstanding neglect of people who clean homes, care for the elderly and people with disabilities, sort and deliver packages and prepare, cook and serve the food we eat. “This is a public-policy conundrum and systems failure of a whole other level because of the economic and the public-health consequences,” said Sonja Diaz, founding director of the Latino Policy & Politics Initiative at the University of California, Los Angeles. “Ultimately, we’ve failed to respond and to stop the bleeding because we’ve made decisions that either willfully or because of the lack of understanding have excluded the very populations that are critical to the state’s functioning and are also the ones that need our help the most.”
Huntington Park is one of the “Gateway Cities” in southeastern Los Angeles County, a cluster of Black, brown and Asian communities that embody the pandemic’s lopsided devastation. It is the 14th-most-densely-populated city in the country, with 61,348 residents packed inside three square miles. The area is split by the 710 freeway, a congested transportation corridor for goods offloaded at the ports of Long Beach and Los Angeles, the busiest container terminals in the Americas. The air is thick with pollution. The streets are full of meatpacking plants, warehouses, factories and distribution centers.
Many residents are undocumented and were automatically excluded from much of the federal relief efforts. (The aid package approved by Congress in December allowed for benefits to children and spouses in mixed-status families, though children with two undocumented parents still did not qualify. President Biden’s proposed $1.9 trillion package could extend benefits to all U.S.-born children, regardless of their parents’ immigration status.) Eleni Pappas, assistant fire chief in the Los Angeles County Fire Department division that serves the area, said paramedics have responded to three times as many medical calls a day in recent months in Huntington Park and surrounding communities. They’re summoned, Pappas said, by residents who are “hard-working people that do not have the ability to stay and work from home,” who “need a paycheck every two weeks to make ends meet” and who, out of tradition, necessity or both, have “grandmothers and aunts and uncles and everybody living together to share expenses and support each other.”
Cipriano Estrada most likely brought the coronavirus home from a garment factory in South Central Los Angeles, where he spent hours sewing buttons on clothes. Estrada lives in a one-bedroom apartment in Huntington Park with five other family members, and the virus soon spread to his wife, Ofelia González, and to a granddaughter and another relative. Estrada, who is 58, most likely knew about the dangers of working in the factory, but necessity outweighed risk, as it often does for people living on the fringes. Black and Latino Angelenos are overrepresented among essential workers and have been disproportionately affected by the recovery’s seesawing pattern, as the businesses that employ them have closed, reopened and closed again. “What that means is a lot of economic desperation,” said Manuel Pastor, a professor of sociology and the director of the Equity Research Institute at the University of Southern California. “People then might be willing to take on work that would be risky because they haven’t been working, or that they’re having to stand in lines to get food, or that they’re at risk of losing their dwellings because they’re not able to make rent.”
Estrada and González’s youngest daughter, Violeta Estrada, who is 34, took time off from her job as a supervisor at a school cafeteria to care for her family as best as she could, giving them sips of electrolyte fluids to prevent dehydration and wrapping them in blankets when they shivered. Three masks, a face shield and disposable gloves were her sole protection.
On Feb. 10, paramedics took González, feeble and breathless, to a nearby community hospital. She resembled nothing of the “hard-working little lady that never gives up,” as Violeta described her, that woman who was “always helping without asking for a favor in return.” Estrada joined González on Feb. 12; husband and wife wound up in the same hospital room, fighting for their lives.
Days later, in a text message, Violeta said, “I remain strong and with a lot of faith that my parents will heal and come out of that hospital soon with God’s willing.” By late February, only her father had returned home, and the fear of the unknown was very real. Her mother was still in the hospital, on supplemental oxygen.
Black and brown patients have consistently filled the beds of the Covid-19 ward at LAC+USC Medical Center. It is one of four hospitals and 26 health centers operated by the county and one the largest public hospitals in the United States, a place where doctors and nurses, schooled by the chaos of the first onslaught last spring, provide whatever help they can, in some cases prolonging life just enough so relatives can witness a loved one’s final moments. Those relatives most often appear as faces on a screen. If they are lucky, they might be there in person.
María Salinas Cruz rested her hands against the glass door of her husband’s hospital room on Jan. 28 as a respiratory therapist disconnected the ventilator that kept Felipe Cruz alive. “Don’t be afraid, Felipe,” she said in Spanish as he lay dying. “Be brave, my love, brave until the last moment.” Felipe Cruz worked as an air-conditioning technician for most of his adult life, cleaning and repairing commercial and residential systems. His family is convinced that this is how the coronavirus found him. He eventually infected his wife and their three daughters, Maritza, 22; Esmeralda, 15; and Brisa, 14.
Cruz didn’t have health insurance or a retirement plan. His only choice to keep his girls housed and fed was to keep working. “The whole pandemic, he worked as normal, which was something that we were grateful for, honestly, because, you know, the bills don’t stop, the rent doesn’t stop,” Maritza said. He was admitted to the medical center on Jan. 1, his 48th birthday, and clung to life for 27 days, making progress until suddenly he wasn’t.
In a hospital room nearby, Gabino Tlaxcala, 74, held on, lucid as he locked eyes with a doctor and initially told her he did not want to be intubated if his lungs stopped doing their job. “Que sea lo que Dios diga,” he said afterward. Whatever God says. Tlaxcala sounded exhausted, his voice barely rising over the swish of oxygen flowing into his body. He had been a cleaner at a hotel in Beverly Hills for 18 years while providing for his wife and raising their nine children. He died on Jan. 30. What would become of his family now? What would become of Cruz’s family?
Though the numbers of new infections and deaths have been dropping in recent weeks, the pandemic has had a profound impact on Latinos in Los Angeles County. They have been pummeled by high rates of unemployment in the hospitality and leisure industries, where many of them work; they are among those who have received the lowest number of vaccines, despite the staggering infection rates within their communities; and according to research published in February in the journal Proceedings of the National Academy of Sciences, their life expectancy has been reduced three to four times as much as that of white residents over the past year. The state has taken a step toward addressing these disparities, unveiling the health equity metric, a set of standards on reopening that would require counties to close the gap on coronavirus positivity rates between the most affluent and disadvantaged enclaves. “Covid-19 is a once-in-a-century pandemic,” said Diaz, of the Latino Policy & Politics Initiative. “But wildfires and natural disasters are not, income inequality is not, housing insecurity is not. How do we make the investments now that these vulnerable communities not only survive Covid-19 but thrive in recovery?”
Even at the height of the surge, as the number of coronavirus cases multiplied exponentially around him, Cruz, the air-conditioning technician, never brought up the possibility of not going to work. He knew his family needed him. “For us,” Maritza said, “it was completely necessary for him to continue to work.” The weeks passed, and he held on to hope — hope that the pandemic would not last. But that is meaningless now, meaningless to a lot of families like his, because the end of the pandemic wouldn’t bring back those they have lost. “There are many daughters waiting for fathers who are not going to return, many wives waiting for husbands who are not going to return,” his wife said. She is one of them.
Reporting by Meridith Kohut. Additional design and development by Jacky Myint.
Meridith Kohut is a freelance photojournalist who has documented humanitarian issues and global health for The New York Times for more than a decade. Her five-month investigation and photo essay exposing that hundreds of children had died from severe malnutrition in public hospitals in Venezuela was a finalist for the Pulitzer Prize in Feature Photography in 2018. Fernanda Santos is a journalism professor at the Walter Cronkite School of Journalism and Mass Communication at Arizona State University, a contributing columnist for The Washington Post and the author of “The Fire Line: The Story of the Granite Mountain Hotshots.”
In Their Own Words: Why Health Experts Say Elementary Schools Should Open
Photographer Captures 'Last Stop' in Britain's Covid War
After receiving access to hospitals, nursing homes and burial sites, I saw up close the nation’s agony, and grit.
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I had covered wars before, in the Balkans and Afghanistan. They were shooting wars where journalists — often foolishly — convinced themselves that they had a chance of identifying and sidestepping danger.
But in Britain’s war against Covid-19, the days I spent as a freelance photojournalist covering the intensive care unit of the Homerton hospital in East London involved danger with every breath. The project for The New York Times documenting the nation’s fight against the coronavirus was terrifying and awe-inspiring. Terrifying because of potential exposure to an invisible killer that has claimed over 120,000 lives in Britain and more than 2.5 million globally. Awe-inspiring because I could witness the remarkable courage, professionalism and sheer grit of medical personnel whose daily routines placed them on the very cusp of life and death.
Even the most advanced modern medicine offers no magic cures. For those who can’t make it out of the I.C.U., there is only death. This is the last stop. What stayed with me afterward was the fear in people’s eyes as they joined what could be the final battle. For the medical staff, the burden of responsibility is enormous.
As Britain approaches a gradual loosening of its most draconian lockdown, and with millions of people securing access to vaccines, images of this terminal conflict do not fit easily into the official narrative.
Many Britons are probably unaware of the brutal reality of the I.C.U.: the constant bleeps of monitors everywhere; the staff hurrying to flip over, or “prone,” patients to help them breathe; the all-too-brief respites that give way to frenetic activity.
Raising this awareness took months. My editors — Gaia Tripoli in London and David Furst in New York — and the researcher Amy Woodyatt and I called hospitals, mortuaries, crematories, funeral parlors and ambulance depots seeking access to chronicle this moment in the pandemic, only to be turned down. Often, we were told that photography was incompatible with the dignity of the dead.
Finally, some were willing to cooperate, and after I was able to observe their toil, we began to assemble a portfolio to tell the story of Britain’s struggle. We wanted our images to reflect more than one area of London or one ethnic group. The list of subjects grew from a care home in Scarborough on the northeastern coast, to a funeral director in the English Midlands, to those dealing with Islamic and other rites in the capital.
With this assignment came a new and unfamiliar set of ground rules and procedures designed to protect not only me but also those around me — both at work and at home.
In the Homerton I.C.U., they called it “donning and doffing” of personal protective equipment. I switched my day clothes for scrubs and a surgical gown; a close-sealing mask and goggles; overshoes; and a hair covering. I pared down my equipment to two cameras. And at the end of the day’s shooting, I followed a very strict protocol developed by the I.C.U. staff for removing protective gear.
Once home, I laundered all my clothes, showered, cleaned equipment with anti-viral wipes and exposed it to a UVC light sanitizer. I was not eligible to be vaccinated, but I had a precautionary coronavirus test during the assignment that came up negative.
Ultimately, I told myself, I just had to trust my equipment. But there is always gnawing doubt. The coronavirus frightens you twice over: first by its ability to infect you personally, and second by the overwhelming fear that you might inadvertently pass it on to your family.
There is never any question about its power. On my second day in the Homerton I.C.U., two people died within 25 minutes of each other. Usually, the medical authorities try to provide access for family members to say goodbye. But with patients in induced comas and beyond hope, it is a cruelly one-sided exchange of farewells.
And yet the counter-imagery of dedication is always there, too, just as evident in these images as the losses. As one survivor remarked, the medical teams always go the extra mile. “They are blessed,” he said.
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Here is What We Know About the Rollout of the Johnson & Johnson Vaccine.
When Johnson & Johnson’s coronavirus vaccine won emergency use authorization on Saturday from the Food and Drug Administration, the move augmented the nation’s vaccination effort with a third major tool — one that differs markedly from the first two authorized vaccines, made by Pfizer-BioNTech and Moderna.
Most notably, it is administered in a single dose instead of two, and can be kept unfrozen in an ordinary refrigerator for up to three months — features that promise greater flexibility as public health officials try to immunize Americans as quickly as possible.
Much is still to be determined about how this new tool will be used. Here is what we know so far.
Within the next few days. Johnson & Johnson started shipping out doses on Monday, and they can be used as soon as they reach vaccination sites starting on Tuesday.
At first, the increase in availability will be limited. The company had about 3.9 million doses on hand to ship right away, but after that, deliveries could be patchy for a few weeks. (For comparison, the nation is using up that many doses of the Pfizer-BioNTech and Moderna vaccines in a little more than two days.)
By the end of March, Johnson & Johnson says it will ship roughly 16 million more doses. Even so, the Pfizer-BioNTech and Moderna vaccines will continue to make up the majority of the nation’s supply.
The same way the two earlier vaccines are: in proportion to each state or territory’s population.
That’s still under discussion. The Centers for Disease Control and Prevention has said that the vaccine can be given to people 18 and over, and state officials are working out what their policies will be.
Because the new vaccine is given in a single shot and doesn’t require cold storage, some experts and officials have suggested directing it toward hard-to-reach segments of the population (like rural residents or homeless people), or to people who might not keep an appointment for a second shot (like college students or those with mobility issues).
But there is concern about appearing to favor or disfavor some groups, and the Biden administration has said it will insist that the new vaccine be distributed equitably.
That’s not clear. Right now, people are getting whichever vaccine the site has on hand when their turn comes, and appointment scheduling systems generally don’t tell users beforehand which it will be. Depending on how states decide to deploy the Johnson & Johnson vaccine, though, it may be possible to effectively choose what you get by choosing where you sign up to get it.
Health experts say the best shot is the one you can get the soonest, whichever one it turns out to be. All three authorized vaccines are highly protective, and the differences among them pale in comparison, they say, with the risk you would run by being picky and passing up a chance to get a shot because it was not your top choice.
An adenovirus helps prime the immune system to fight the coronavirus.
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