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Far from having vanquished Covid-19, the outside doctors said, Mr. Trump is most likely still struggling with it and entering a pivotal phase — seven to 10 days after the onset of symptoms — in which he could rapidly take a turn for the worse. He’s 74, male and moderately obese, factors that put him at risk for severe disease.

severe form of Covid-19, with impairment of the lungs and a blood oxygen level below 94 percent, which is a cutoff for severe disease.

Some experts said that the decision to give Mr. Trump dexamethasone could be a sign that he was struggling with more serious Covid-19 than his doctors were revealing, or that his doctors had inappropriately prescribed him the drug.

For many, it was a political stunt. For Dr. King of UCSF, who was watching on C-SPAN, the return to the White House was an opportunity to observe how the president breathed.

paused twice while walking across the lawn — whether to wave to cameras or to catch his breath, he said was not clear — and then appeared to be gasping for breath at the top of the stairs. He and others said Mr. Trump used his neck muscles to help him breathe, a classic sign that someone’s lungs are not taking in enough oxygen.

A different plague strain enters Europe through Genoa, brought by another Caffan ship that docks there. The Genoans attack the ship and drive it away, but they are still infected. Italy faces this second strain while already battling the previous one.

Y. pestis also heads east from Sicily into the Persian Empire and through Greece, Bulgaria, Romania and Poland, and south to Egypt, as well as Cyprus, which is also hit with destruction from an earthquake and deadly tidal wave at the same time.

The plague also moves through Austria and Switzerland, where a fury of anti-Semitic massacres follow it along the Rhine after a rumor spreads that Jews had caused the plague by poisoning wells

The plague awakes an anti-Semitic rage around Europe, causing repeated massacres of Jewish communities, with the first one taking place in Provence, where 40 Jews were murdered.

The plague enters England through the port of Melcombe Regis, in Dorset. As it spreads through the town, some escape by fleeing inland, inadvertently spreading it further.

A group of religious zealots known as the Flagellants first begin to appear in Germany. These groups of anywhere from 50 to 500 hooded and half-naked men march, sing and thrash themselves with lashes until swollen and bloody. Originally the practice of 11th-century Italian monks during an epidemic, they spread out through Europe. Also known for their violent anti-Semitism,

the plague kills 60 percent of the Venetian population.

An English ship brings the Black Death to Norway when it runs aground in Bergen

While waiting on the border to begin the attack, troops became infected, with 5,000 dying. Choosing to retreat, the soldiers bring the disease back to their families and a third of Scotland perishes.

The plague’s spread significantly begins to peter out, possibly thanks to quarantine efforts, after causing the deaths of anywhere between 25 to 50 million people, and leading to the massacres of 210 Jewish communities. All total, Europe has lost about 50 percent of its population.

With the Black Death considered safely behind them, the people of Europe face a changed society

It becomes easier to get work for better wages and the average standard of living rises.

The temperature check is inexpensive and quick and has a reasonable error rate. It will not catch the false negatives

However, this simple test will catch the true positives, thus keeping them from the public sphere.

The temperature check is a cheap, noninvasive procedure that will catch some but not all people who have Covid but are well enough to attend public events. To my ears, that is a public good.

This CDC advisory group had previously recommended that health care workers and residents of long-term care facilities should be the first to receive a vaccine when it receives EUA. The first shipments of the vaccine will be limited, so states will have to prioritize who should receive the vaccine first.

Keeping doctors and nurses healthy will be important for the continuing fight against the virus, which will stretch on for months, even after a vaccine is authorized. But Romero said that first group includes other people working in health care institutions, like those who deliver food and perform housekeeping.

Residents of long-term care facilities like nursing homes also need the protection. So far, they account for about 40% of coronavirus deaths in the US.

"I would project by the time you get to April, it will be ... 'open season,' in the sense of anyone, even the non-high priority groups could get vaccinated," Fauci said.

"We'll be in facilities that day in states that choose to begin as soon as possible," spokesman Ethan Slavin said.

The FDA is set to make a decision on a separate vaccine candidate by Moderna in the coming days

it's possible that 20 million people could get vaccinated in the next several weeks

Phase 1a would be followed by Phases 1b and 1c, which could include essential workers at high risk of infection, other emergency personnel and people with underlying conditions who are at a higher risk of Covid-19 complications and death.

Army Gen. Gustave Perna, chief operating officer of the federal government vaccine initiative Operation Warp Speed, previously said he believed vaccine administration will be able to begin vaccinations within 96 hours of authorization.

In the meantime, it's important that people continue to wear masks and social distance. JUST WATCHEDDr. Fauci explains importance of vaccine approval processReplayMore Videos ...MUST WATCH Play</

It's important to note, however, that Pfizer's vaccine requires two doses administered several weeks apart to reach 95% efficacy. So 100 million doses would vaccinate half the number of people.

Azar said earlier this month that 6.4 million doses of Pfizer vaccine would be allocated for shipment the first week. The initial shipment would include half of the doses, followed by the second half three weeks later.

Slaoui said he believes most doses will be injected within three to four days, but after that, "I think it will take a week."

The first shipments of the vaccine departed a Pfizer plant in Michigan on Sunday morning. A total of 189 boxes of vials are expected to arrive in all 50 states Monday. Another 3,900 vials are expected to ship later Sunday to US territories. Another 400 boxes packed with about 390,000 vials are expected to ship Monday and arrive at their destinations on Tuesday.

The vaccines will then be flown across the country, and the Federal Aviation Administration has said its air traffic controllers will prioritize flights carrying the vaccines.

But Pfizer's vaccine needs to be stored at incredibly cold temperatures, making the logistics of delivery even more complicated.

According to a briefing document released by the FDA's vaccine advisory committee, the most common side effects were reactions at the point of injection on the body, fatigue, headache, muscle pain, chills, joint pain and fever.

Health authorities in the UK, where the vaccine roll out began earlier this week, said Wednesday that people with "significant history of allergic reactions" should not receive the vaccine. The advice came after two health care workers "responded adversely" following their shots.

that’s what I felt back in those days,” he said, “that everything was for sale — it was all about distraction, it didn’t seem serious. It all felt foolish and headed for a crash.”

Younger viewers do not have to fear Chase’s wrath, because they are not so obviously its object. They are also able to watch the show for hours on end, which makes the subtext and themes more apparent. Perhaps all of this has offered clarity that was not possible when the show aired. Perhaps it is easier now to see exactly who — or what — Chase was angry at.

it is easily one of the most written-about TV shows in the medium’s short history. But more than the shows that have emerged in its wake, which are subjected to close readings and recaps in nearly every major publication, “The Sopranos” has a novelistic quality that actually withstands this level of scrutiny. It’s not uncommon to hear from people who have watched the series several times, or who do so on a routine basis — people who say it reveals new charms at different points in life

Perhaps the greatest mystery of all, looking back on “The Sopranos” all these years later, is this: What was Chase seeing in the mid-’90s — a period when the United States’ chief geopolitical foe was Serbia, when the line-item veto and school uniforms were front-page news, when “Macarena” topped the charts — that compelled him to make a show that was so thoroughly pessimistic about this country?

“I don’t think I felt like it was a good time,” he told me. He is 76 now, and speaks deliberately and thoughtfully. “I felt that things were going downhill.” He’d become convinced America was, as Neil Postman’s 1985 polemic put it, “Amusing Ourselves to Death,” not an easy thing for a journeyman TV writer to accept.

“There was nothing but crap out there. Crap in every sense. I was beginning to feel that people’s predictions about the dumbing-down of society had happened and were happening, and I started to see everything getting tawdry and cheap.”

Expanded access to credit had cut into what mobsters call the shylock business; there’s no need to go to a loan shark when the payday lender will offer you similarly competitive rates. Gambling was legalized in many states and flourishes on many reservations; nearly every state in the Union has a lottery, which decimated the numbers racket. Italian American neighborhoods have emptied out — as Jacobs writes, “radically diminishing the pool of tough teenagers with Cosa Nostra potential”; this is dramatized brilliantly in the final episode of the series, when a mobster from a New York family hurries through Little Italy on an important phone call and, when the call ends, looks around to see he’s wandered into an encroaching and vibrant Chinatown. And, Jacobs notes, union membership has been decimated. “In the mid-1950s, about 35 percent of U.S. workers belonged to a union,” he writes. “In recent years, only 6.5 percent of private-sector workers have been union members.”

I was about to change the subject when he hit on something. “Have you noticed — or maybe you haven’t noticed — how nobody does what they say they’re going to do?” he said, suddenly animated. “If your sink gets jammed up, and a guy says he’s going to be out there at 5:30 — no. Very few people do what they say they’re going to do. There is a decline in goods and services that is enormous.”

Chase told me the real joke of the show was not “What if a mobster went to therapy?” The comedic engine, for him, was this: What if things had become so selfish and narcissistic in America that even the mob couldn’t take it? “That was the whole thing,” he said. “America was so off the rails that everything that the Mafia had done was nothing compared to what was going on around them.”

In “The Mafia: A Cultural History,” Roberto M. Dainotto, a professor of literature at Duke, writes that one thing our cinematic Mafiosi have that we admire, against our better judgment, is access to structures of meaning outside of market forces: the church, family, honor. The Mafia movie often pits these traditional values against the corrosive and homogenizing effects of American life.

What “The Sopranos” shows us, Dainotto argues, is what happens when all that ballast is gone, and the Mafia is revealed to be as ignoble as anything else. “Life is what it is,” he writes, “and repeats as such.”

The show puts all this American social and cultural rot in front of characters wholly incapable of articulating it, if they even notice it.

What is, for me, one of the show’s most memorable scenes has no dialogue at all. Tony and his crew have just returned from a business trip to Italy, during which they were delighted with the Old Country but also confronted with the degree of their alienation from their own heritage. They’re off the plane, and in a car traveling through Essex County. As the camera pans by the detritus of their disenchanted world — overpasses, warehouses — Tony, Paulie and Christopher are seeing their home with fresh eyes, and maybe wondering if their ancestors made a bad trade or if, somewhere along the line, something has gone horribly wrong. But we don’t know: For once, these arrogant, stupid and loquacious men are completely silent.

Around the time “The Sopranos” premiered, the N.Y.U. Law professor James B. Jacobs wrote a paper, along with a student, arguing that the Mafia, though weakened by decades of prosecutions, could come roaring back. By 2019, though, he had published a new paper called “The Rise and Fall of Organized Crime in the United States,” declaring the Mafia all but finished. “The world in which the Cosa Nostra became powerful is largely gone,” he wrote. And he cites a litany of factors that aided its collapse, a mix of technological advances, deregulation and financialization — many of the same forces that have created the stratified economy of today.

In his first therapy session with Dr. Melfi, Tony tries to explain why he thinks he has panic attacks, why he suffers from stress. “The morning of the day I got sick, I’d been thinking: It’s good to be in something from the ground floor,” he says. “I came too late for that, I know. But lately, I’m getting the feeling that I came in at the end. The best is over.” Melfi tells him that many Americans feel that way. Tony presses on: “I think about my father: He never reached the heights like me, but in a lot of ways he had it better. He had his people, they had their standards, they had their pride. Today, what do we got?”

You can see this world — one in which no one can be squeezed because everyone is being squeezed — starting to take shape from the very beginning of the show. In the pilot, Tony is fending off competition from a new waste-hauling business undercutting his company’s extortionate fees, and trying to figure out how he can get a piece of the similarly extortionate costs his health insurer paid for his M.R.I. — a procedure he had because the stress in his life had given him a panic attack.

The bien-pensant line on Tony remains that he’s a sociopath, and only used therapy to become a better criminal. This is an idea spoon-fed to the viewer in the final episodes by a contrite Dr. Melfi, in a show that spoon-feeds almost nothing to the viewer. Melfi herself might call this a coping mechanism to avoid the messier reality, which is that Tony lives in an immoral world nestled within another immoral world, both of which have only grown more chaotic because of forces outside his control.

Because of this, you can see how he reasons himself into more and more heinous crimes, justifying each and every one of them to himself. Perhaps to you too — at least, up to a point. That sympathy for Tony led contemporaneous critics to ask if people were watching the show in the wrong way, or if our enjoyment pointed to a deficiency of the heart.

t is this quality of Tony’s — this combination of privilege and self-loathing — that I suspect resonates with a younger generation, whether we want to admit it or not. He’s not so different from us, after all. He has an anxiety disorder. He goes to therapy and takes S.S.R.I.s, but never really improves — not for long, anyway. He has a mild case of impostor syndrome, having skipped some key steps to becoming boss, and he knows that people who hold it against him are sort of right. He’s still proud of his accomplishments in high school. He does psychedelics in the desert, and they change his perspective on things. He often repeats stuff he half-remembers someone smarter than him saying. He’s arguably in an open marriage with Carmela, if a rather lopsided one. He liked listening to “Don’t Stop Believin’” in 2007. He’s impulsive and selfish and does not go to church, though he does seem open to vaguer notions of spirituality. He wishes his career provided him with meaning, but once he had the career, he discovered that someone had pulled the rug out at some point, and an institution that had been a lodestar to him for his whole life was revealed to be a means of making money and nothing more. Does this sound at all familiar to you?

Like many young people, Tony is a world-historically spoiled man who is nevertheless cursed, thanks to timing, to live out the end of an enterprise he knows on some level to be immoral.

It gives him panic attacks, but he’s powerless to find a way out. Thus trapped — and depressed — it’s not so hard for him to allow himself a few passes, to refuse to become better because the world is so rotten anyway.

Tony’s predicament was once his to suffer alone, but history has unfolded in such a way as to render his condition nearly universal.

That the people in power truly had insulated themselves in a fantasy environment — not just in the realm of foreign policy, but also, more concretely, in the endless faux-bucolic subdivisions that would crater the economy. We were living in a sort of irreality, one whose totality would humiliate and delegitimize nearly every important institution in American life when it ended, leaving — of all people — the Meadows and A.J.s of the world to make sense of things.

if people still see a monster in Tony, then the monster is themselves: a twisted reflection of a generation whose awakening to the structures that control them came in tandem with a growing aversion to personal accountability in the face of these systems.

Whether that’s true or not, it offers us all permission to become little Tonys, lamenting the sad state of affairs while doing almost exactly nothing to improve ourselves, or anything at all.

This tendency is perhaps most pronounced online, where we are all in therapy all day, and where you can find median generational opinions perfectly priced by the marketplace of ideas — where we bemoan the wrongs of the world and tell ourselves that we can continue being who we are, and enjoy the comforts we’ve grown accustomed to.

In the show’s finale, as the extended Soprano family gathers to mourn the death of Bobby Baccalieri, we find Paulie Walnuts stuck at the kids’ table, where A.J., newly politically awakened, charges into a rant. You people are screwed, he says. “You’re living in a dream.” Bush let Al Qaeda escape, he tells them, and then made us invade some other country? Someone at the table tells him that if he really cares, he should join up. A.J. responds: “It’s more noble than watching these jackoff fantasies on TV of how we’re kicking their ass. It’s like: America.” Again, he’s interrupted: What in the world does he mean? He explains: “This is still where people come to make it. It’s a beautiful idea. And then what do they get? Bling? And come-ons for [expletive] they don’t need and can’t afford?”

However inartfully, A.J. was gesturing at something that would have been hard for someone his age to see at the time, which is that the ’00s were a sort of fever dream, a tragic farce built on cheap money and propaganda.

The notion that individual action might help us avoid any coming or ongoing crises is now seen as hopelessly naïve, the stuff of Obama-era liberalism.

. The “leftist ‘Sopranos’ fan” is now such a well-known type that it is rounding the corner to being an object of scorn and mockery online.

One oddity that can’t be ignored in this “Sopranos” resurgence is that, somewhat atypically for a TV fandom, there is an openly left-wing subcurrent within it

years of painstakingly worded treaties, high-level visits and cutting-edge disease surveillance—all meant to encourage good-faith cooperation—have only bitten around the edges of the problem.

“It can’t demand entry into a country because they think something bad is happening.”

Nearly 200 countries were counting on an agency whose budget—roughly $2.4 billion in 2020—is less than a sixth of the Maryland Department of Health’s. Its donors, largely Western governments, earmark most of that money for causes other than pandemic preparedness.

In 2018 and 2019, about 8% of the WHO’s budget went to activities related to pandemic preparedness

It took those experts more than four months to agree that widespread mask-wearing helps, and that people who are talking, shouting or singing can expel the virus through tiny particles that linger in the air. In that time, about half a million people died.

To write its recommendations, the WHO solicits outside experts, which can be a slow process.

the agency’s bureaucratic structure, diplomatic protocol and funding were no match for a pandemic as widespread and fast-moving as Covid-19.

As months rolled on, it became clear that governments were reluctant to allow the U.N. to scold, shame or investigate them.

In particular, The Wall Street Journal found:

* China appears to have violated international law requiring governments to swiftly inform the WHO and keep it in the loop about an alarming infectious-disease cluster

—there are no clear consequences for violations

* The WHO lost a critical week waiting for an advisory panel to recommend a global public-health emergency, because some of its members were overly hopeful that the new disease wasn’t easily transmissible from one person to another.

* The institution overestimated how prepared some wealthy countries were, while focusing on developing countries, where much of its ordinary assistance is directed

Public-health leaders say the WHO plays a critical role in global health, leading responses to epidemics and setting health policies and standards for the world. It coordinates a multinational effort every year to pick the exact strains that go into the seasonal flu vaccine, and has provided public guidance and advice on Covid-19 when many governments were silent.

The world’s public-health agency was born weak, created in 1948 over U.S. and U.K. reluctance. For decades, it was legally barred from responding to diseases that it learned about from the news. Countries were required to report outbreaks of only four diseases to the WHO: yellow fever, plague, cholera and smallpox, which was eradicated in 1980.

SARS convinced governments to retool the WHO. The next year, delegates arrived in the Geneva palace where the League of Nations once met to resolve a centuries-old paradox: Countries don’t report outbreaks, because they fear—correctly—their neighbors will respond by blocking travel and trade.

Nearly three times that amount was budgeted for eradicating polio, a top priority for the WHO’s two largest contributors: the U.S. and the Bill &amp; Melinda Gates Foundation.

“Everybody pushed back. No sovereign country wants to have this.”

China wanted an exemption from immediately reporting SARS outbreaks. The U.S. argued it couldn’t compel its 50 states to cooperate with the treaty. Iran blocked American proposals to make the WHO focus on bioterrorism. Cuba had an hourslong list of objections.

Around 3:15 a.m. on the last day, exhausted delegates ran out of time. The treaty they approved, called the International Health Regulations, imagined that each country would quickly and honestly report, then contain, any alarming outbreaks

In return, the treaty discouraged restrictions on travel and trade. There would be no consequences for reporting an outbreak—yet no way to punish a country for hiding one.

The treaty’s key chokepoint: Before declaring a “public health emergency of international concern,” or PHEIC, the WHO’s director-general would consult a multinational emergency committee and give the country in question a chance to argue against such a declaration.

Delegates agreed this could give some future virus a head start but decided it was more important to discourage the WHO from making any unilateral announcements that could hurt their economies.

Over the next few years, emergency committees struggled over how to determine whether an outbreak was a PHEIC. It took months to declare emergencies for two deadly Ebola epidemics

On Jan. 3, representatives of China’s National Health Commission arrived at the WHO office in Beijing. The NHC acknowledged a cluster of pneumonia cases, but didn’t confirm that the new pathogen was a coronavirus, a fact Chinese officials already knew.

That same day, the NHC issued an internal notice ordering laboratories to hand over or destroy testing samples and forbade anyone from publishing unauthorized research on the virus.

China’s failure to notify the WHO of the cluster of illnesses is a violation of the International Health Regulations

China also flouted the IHR by not disclosing all key information it had to the WHO

The WHO said it’s up to member states to decide whether a country has complied with international health law, and that the coming review will address those issues.

While Chinese scientists had sequenced the genome and posted it publicly, the government was less forthcoming about how patients might be catching the virus.

WHO scientists pored over data they did get, and consulted with experts from national health agencies, including the CDC, which has 33 staff detailed to the WHO.

Then a 61-year-old woman was hospitalized in Thailand on Jan. 13.

The next day, Dr. van Kerkhove told reporters: “It’s certainly possible that there is limited human-to-human transmission.” MERS and SARS, both coronaviruses, were transmissible among people in close quarters. Epidemiological investigations were under way, she said.

On Jan. 22, a committee of 15 scientists haggled for hours over Chinese data and a handful of cases in other countries. Clearly, the virus was spreading between people in China, though there was no evidence of that in other countries. The question now: Was it mainly spreading from very sick people in hospitals and homes—or more widely?

The committee met over two days, but was split. They mostly agreed on one point: The information from China “was a little too imprecise to very clearly state that it was time” to recommend an emergency declaration,

On Jan. 28, Dr. Tedros and the WHO team arrived for their meeting with Mr. Xi

Leaning across three wooden coffee tables, Dr. Tedros pressed for cooperation. In the absence of information, countries might react out of fear and restrict travel to China, he repeated several times throughout the trip. Mr. Xi agreed to allow a WHO-led international team of experts to visit. It took until mid-February to make arrangements and get the team there.

China also agreed to provide more data, and Dr. Tedros departed, leaving Dr. Briand behind with a list of mysteries to solve. How contagious was the virus? How much were children or pregnant women at risk? How were cases linked? This was vital information needed to assess the global risk, Dr. Briand said

Back in Geneva, Dr. Tedros reconvened the emergency committee. By now it was clear there was human-to-human transmission in other countries. When it met on Jan. 30, the committee got the information the WHO had been seeking. This time the committee recommended and Dr. Tedros declared a global public-health emergency.

President Trump and New York Gov. Andrew Cuomo both assured constituents their health systems would perform well. The U.K.’s chief medical officer described the WHO’s advice as largely directed at poor and middle-income countries. As for keeping borders open, by then many governments had already closed them to visitors from China.

The WHO shifted focus to the developing world, where it believed Covid-19 would exact the heaviest toll. To its surprise, cases shot up just across the border, in northern Italy.

the WHO’s health emergencies unit should report to the director-general and not member states, and its budget should be protected so it doesn’t have to compete with other programs for money.

If there were one thing the WHO might have done differently, it would be to offer wealthier countries the type of assistance with public-health interventions that the WHO provides the developing world

the WHO’s warning system of declaring a global public-health emergency needs to change. Some want to see a warning system more like a traffic light—with color-coded alarms for outbreaks, based on how worried the public should be

Emergency committees need clearer criteria for declaring a global public-health emergency and should publicly explain their thinking

The WHO should have more powers to intervene in countries to head off a health crisis

Lessons learned

Implementing many of those ideas would require herding diplomats back for another monthslong slog of treaty revisions. If and when such talks begin, new governments will likely be in place, and political priorities will float elsewher

“Unfortunately, I’m very cynical about this,” he said. “We are living through cycles of panic and neglect. We’ve been through all of this before.”

Biden versus Trump forces us to decide, or at least to clarify, who we think we are and what we strive to be.

Trump is running as an overtly authoritarian candidate — the illusion of pivots, of adults in the room, of a man molded by the office, is long gone. He is dismissive of the law, except when he can harness it for his benefit; of open expression, except when it fawns all over him; and of free elections, except when they produce victories he likes

in a new term he would use the Justice Department as an instrument of vengeance against political opponents. We know who Trump is and what he offers.

Biden’s case to the electorate — for 2020, 2022 and 2024 — has been premised on the preservation of American democratic traditions. In the video announcing his 2020 campaign, he asserted that “our very democracy” was at stake in the race against Trump.

And the video kicking off his 2024 re-election bid featured multiple scenes of the assault on the Capitol on Jan. 6, 2021. “The question we are facing,” Biden said, “is whether in the years ahead we have more freedom or less freedom.” That is our choice in 2024.

When half the country believes democracy isn’t working well, when calls for political violence have become commonplace, when the speaker of the House is an election denier, it is time to face what we risk becoming and to accept or reject it. We have no choice but to choose.

The protection of American democracy offers a potentially resonant message for Biden, precisely among parts of the Democratic coalition that he can ill afford to lose.

Of course, we already faced this choice — and made it — in 2020. Why insist on a do-over? Because a country approaching its 250th birthday does not have the luxury of calling itself an experiment forever; this is the moment to assess the results of that experiment.

Because a lone Trump victory in 2016 could conceivably be remembered as an aberration if it were followed by two consecutive defeats, but a Trump restoration in 2024 would confirm America’s slide toward authoritarian rule and would render Biden’s lone term an interregnum, a blip in history’s turn.

And we must choose again because the fever did not break; instead, it threatens to break us.

One of the first questions experts asked me was whether my family was vaccinated. Yes, I said: My husband and I are vaccinated and boosted, and our kids are vaccinated but not yet boosted. This is a relevant question because, if you’re exposed to the virus that causes Covid-19, “your immune system kicks into action a lot faster if you’re vaccinated versus not vaccinated,”

First, the swift immune reaction slows the rate of viral reproduction and spread. “This is what the vaccines are there for — to educate your immune system so that it gets a jump on the invaders before they are able to replicate out of control,”

Because the virus doesn’t replicate as quickly in vaccinated people, they may be less likely to test positive for Covid-19 after coronavirus exposure, because their immune system “keeps the viral load below the level of detection,”

It’s possible, then, that my husband and son did catch Covid-19, but their vaccinated immune systems fended off the infection so well that they never had enough viral proteins in their nose or throat to test positive. And their continual negative tests probably meant that they were never that contagious

If my husband and son never tested positive, why did they feel sick? Even if a vaccinated person doesn’t have much virus in their body, they can still have powerful Covid symptoms

That’s because many illness symptoms — fever, malaise, runny nose, fatigue — are actually caused by the immune system’s response to the virus, rather than the virus itself

And as for why I felt fine, Dr. Morrison said that perhaps my immune system fought off the incoming virus so quickly that I didn’t even have a chance to feel sick. “It sounds to me like you were definitely exposed,”

maybe I had high levels of vaccine antibodies or immune cells called T cells that were able to kill the invading virus before it had a chance to alert the parts of my immune system that would incite symptoms.

All this said, nobody really knows what happened to me, my son or my husband. When it comes to understanding how Covid-19 affects the body, “there are so many open questions,”

people can have different experiences for many different reasons. For instance, Dr. Andino said, it’s possible that the virus was replicating in parts of my husband’s or my son’s body that the tests didn’t reach

Research suggests that the coronavirus can replicate in the pancreas, heart, brain, kidneys and other organs, although vaccination may reduce the chance that the virus spreads outside the respiratory system.

Dr. Andino said that he and his colleagues have been conducting studies in which they follow and repeatedly test entire households after one person in the home tests positive for Covid-19. “What we see is exactly what you described — that some people in the household don’t test positive,”

The U.S. logs fewer than 1,000 annual deaths out of millions of documented cases

this is more a nauseating nuisance than a public-health crisis. In most people, norovirus triggers, at most, a few miserable days of GI distress that can include vomiting, diarrhea, and fevers, then resolves on its own; the keys are to stay hydrated and avoid spreading it to anyone vulnerabl

norovirus is the most common cause of foodborne illness in the United States.)

the virus is far more deadly in parts of the world with limited access to sanitation and potable water.

Still, fighting norovirus isn’t easy, as plenty of parents can attest. The pathogen, which prompts the body to expel infectious material from both ends of the digestive tract, is seriously gross and frustratingly hardy. Even the old COVID standby, a spritz of hand sanitizer, doesn’t work against it—the virus is encased in a tough protein shell that makes it insensitive to alcohol.

At an extreme, a single gram of feces—roughly the heft of a jelly bean—could contain as many as 5.5 billion infectious doses, enough to send the entire population of Eurasia sprinting for the toilet.

norovirus mainly targets the gut, and spreads especially well when people swallow viral particles that have been released in someone else’s vomit or stool.

direct contact with those substances, or the food or water they contaminate, may not even be necessary: Sometimes people vomit with such force that the virus gets aerosolized; toilets, especially lidless ones, can send out plumes of infection

If the spittle finding holds for humans, then talking, singing, and laughing in close proximity could be risky too.

Once emitted into the environment, norovirus particles can persist on surfaces for days—making frequent hand-washing and surface disinfection key measures to prevent spread

Handshakes and shared meals tend to get dicey during outbreaks, along with frequently touched items such as utensils, door handles, and phones.

One 2012 study pointed to a woven plastic grocery bag as the source of a small outbreak among a group of teenage soccer players; the bag had just been sitting in a bathroom used by one of the girls when she fell sick the night before.

Once a norovirus transmission chain begins, it can be very difficult to break. The virus can spread before symptoms start, and then for more than a week after they resolve

Once the virus arrives, the entire family is almost sure to be infected. Baldridge, who has two young children, told me that her household has weathered at least four bouts of norovirus in the past several years.

Roughly 20 percent of European populations, for instance, are genetically resistant to common norovirus strains. “So you can hope,” Frenck told me. For the rest of us, it comes down to hygiene

Altan-Bonnet recommends diligent hand-washing, plus masking to ward off droplet-borne virus. Sick people should isolate themselves if they can. “And keep your saliva to yourself,” she told me.

The family fastidiously scrubbed their hands with hot water and soap, donned disposable gloves when touching shared surfaces, and took advantage of the virus’s susceptibility to harsh chemicals and heat. When her son threw up on the floor, Cameron sprayed it down with bleach; when he vomited on his quilt, she blasted it twice in the washing machine on the sanitizing setting, then put it through the dryer at a super high temp

After three years of COVID, the world has gotten used to thinking about infections in terms of airways. “We need to recalibrate,” Bhumbra told me, “and remember that other things exist.”