A committee of advisers to the Food and Drug Administration voted on Wednesday to update the formula for the Covid vaccine ahead of an anticipated fall immunization campaign, now an annual step to try to offer better protection against versions of the virus in circulation.

The unanimous vote by the 16 advisers recommends a formula aimed at combating the variant JN.1, which dominated infections in the United States in February, or a version of it. In recent weeks, JN.1 has been overtaken by descendants known as KP.2 and KP.3.

In the coming weeks, the F.D.A. is expected to formally recommend a variant target for vaccine makers for the next round of shots in the late summer or early fall. Any decision involves some educated guesswork, given that any new vaccine formula won’t be available until months after a variant becomes dominant.

“It’s becoming clear that the ideal timing for a vaccine composition decision remains elusive,” said Jerry Weir, an official with the F.D.A.’s vaccine division.

Dr. Peter Marks, who oversees that division, urged the committee to consider encouraging the mRNA vaccine makers to focus on the latest versions of the virus in broader circulation.

“We always say we shouldn’t be chasing strains, but we’re paying an incredibly high premium for mRNA vaccines to be able to have the freshest vaccines,” he said, referring to the technology used by Moderna and Pfizer. He compared the choice of a vaccine to selecting fresher milk at the grocery store.

“If this evolves further in the fall, will we regret not having been a little bit closer?” Dr. Marks asked.

But Dr. Sarah Meyer, a senior vaccines official at the Centers for Disease Control and Prevention, said that aiming at JN.1 was more appropriate because it was “further up on the tree” in the evolution of the coronavirus, possibly allowing the vaccines to better cover mutations in the virus later this year.

The federal government’s plans for a Covid inoculation campaign, she added, had assumed the distribution of a JN.1 option.

“I think it’s just really hard to predict what is going to happen and where things are going to go,” she said.

The decision by advisers on Wednesday aligned with guidance from the World Health Organization expert committee, which recommended in April that Covid vaccines switch to a JN.1 formulation.

The F.D.A. advisers reviewed data showing that as of late May, the KP versions of the virus accounted for roughly half of coronavirus cases across the nation, a sign that they would continue to spread more broadly than JN.1.

Representatives of Moderna and Pfizer said that the companies would be ready to produce either version of the vaccine.

Novavax, which uses a different vaccine-development technology, said that it would target JN.1. Dr. Robert Walker, the chief medical officer for the company, said it would be effective in neutralizing the KP strains.

Studies have shown that protection tends to improve as the vaccines more precisely target dominant variants, according to the F.D.A.

On Wednesday, federal officials presented an optimistic portrait of the nation’s fight against Covid. Cases were relatively low, said Natalie J. Thornburg, a C.D.C. official, with data showing that illnesses from JN.1 were not more severe than those from earlier variants.

Fewer than 400 Covid deaths a week have been recorded recently, down from a peak of roughly 2,500 a week over the winter, according to initial data collected by the C.D.C. Older Americans represented a significant portion of patients hospitalized with Covid.

Last year’s coronavirus vaccination rate was tepid. In March, C.D.C. researchers reported that only 18 percent of immunocompromised adults had received the updated vaccine, which provided increased protection against hospitalization. More broadly, just over 20 percent of adults received the shot, C.D.C. data show.

The lukewarm embrace of updated immunizations extended to nursing home residents, who have been among those most likely to suffer from severe illness, hospitalization or death. Data from the C.D.C. showed that in May, about 30 percent of nursing home residents were up-to-date on their Covid shots, down from 65 percent two years ago.

One of the nation’s premier medical advisory organizations has weighed in on long Covid with a 265-page report that recognizes the seriousness and persistence of the condition for millions of Americans.

More than four years since the start of the coronavirus pandemic, long Covid continues to damage many people’s ability to function, according to the National Academies of Sciences, Engineering and Medicine, a nongovernmental institution that advises federal agencies on science and medicine.

“Long Covid can impact people across the life span, from children to older adults, as well as across sex, gender, racial, ethnic and other demographic groups,” it said, concluding that “long Covid is associated with a wide range of new or worsening health conditions and encompasses more than 200 symptoms involving nearly every organ system.”

Here are some of the National Academies’ findings, drafted by a committee of 14 doctors and researchers:

How many people have long Covid?

The report cited data from 2022 suggesting that nearly 18 million adults and nearly a million children in the United States have had long Covid at some point. At the time of that survey, about 8.9 million adults and 362,000 children had the condition.

Surveys showed that the prevalence of long Covid decreased in 2023 but, for unclear reasons, has risen this year. As of January, data showed nearly 7 percent of adults in the United States had long Covid.

Diagnosis and consequences

There is still no standardized way to diagnose the condition and no definitive treatments to cure it. “There is no one-size-fits-all approach to rehabilitation, and each individual will need a program tailored to their complex needs,” the National Academies said, advising that doctors should not require patients to have a positive coronavirus test to be diagnosed with long Covid.

The report said that some of the most troublesome symptoms — like brain fog and chronic fatigue — can prevent people from returning to work and should make them eligible for disability payments, though their symptoms may not fit the Social Security Administration’s current disability categories.

“Long Covid can result in the inability to return to work (or school for children and adolescents), poor quality of life, diminished ability to perform activities of daily living, and decreased physical and cognitive function for six months to two years or longer,” the report said.

People most at risk

People who become more seriously ill from their initial coronavirus infection are more likely to have long-term symptoms. Those who were sick enough to be hospitalized were two to three times as likely to develop long Covid.

But, the report said, “even individuals with a mild initial course of illness can develop long Covid with severe health effects.” And “given the much higher number of people with mild versus severe disease, they make up the great majority of people with long Covid.”

Women are about twice as likely to develop long Covid. Other risk factors include not being adequately vaccinated against the coronavirus, having preexisting medical conditions or disabilities and smoking.

Long Covid in children

Children are less likely than adults to develop long Covid and are more likely to recover from it, but some children “experience persistent or intermittent symptoms that can reduce their quality of life” and “result in increased school absences and decreased participation and performance in school, sports and other social activities,” the report said.

Recovery from long Covid

Some people recover with time, and there’s some evidence that after a year, many people’s symptoms have diminished. But some research suggests that recovery slows down or plateaus after that first year, the report said.

Because long Covid varies so widely from person to person and affects so many body systems, each case must be approached individually.

For some people, “returning to work too early may result in health deterioration, and a gradual return to work plan may be advised,” the report said, especially for people with post-exertional malaise, a symptom that involves depleted energy or setbacks after doing activities that involve physical or mental exertion.

Employers may need to offer accommodations to returning employees, like allowing them to take frequent breaks or work remotely.

Some similarities to other chronic conditions

“Long Covid appears to be a chronic illness, with few patients achieving full remission,” the report said.

Some symptoms are like those of other conditions that emerge following infections, including myalgic encephalomyelitis/chronic fatigue syndrome, fibromyalgia and postural orthostatic tachycardia syndrome.

The biological cause of the symptoms is unclear. Theories include inflammation, fragments of remaining virus and immune system dysregulation.

Equity issues make long Covid worse

Long Covid presents more obstacles for people who face economic challenges or discrimination because of their race or ethnicity, where they live or how much education they have.

Such patients may encounter more skepticism about their symptoms, may be less able to take time off from work and may live farther from long Covid clinics or treatment programs.

Surgeons removed the kidney of a genetically engineered pig from a critically ill patient last week after the organ was damaged by inadequate blood flow related to a heart pump that the woman had also received, according to officials at NYU Langone Transplant Institute.

The patient, Lisa Pisano, 54, who is still hospitalized, went back on kidney dialysis after the pig’s organ was removed. She lived with the transplanted organ for 47 days, Dr. Robert Montgomery, director of the institute, said. The kidney showed no signs of organ rejection.

“Lisa is in stable condition, and her left ventricular assist device is still functioning,” Dr. Montgomery said, referring to the heart pump. “We are hoping to get Lisa back home to her family soon.”

“Lisa is a pioneer and a hero in the effort to create a sustainable option for people waiting for an organ transplant,” he added.

In April, Ms. Pisano became the second person to receive a kidney transplanted from a genetically modified pig. Hers was an especially complicated case: She has heart failure and kidney failure, and received the organ just eight days after receiving a mechanical heart pump.

Ms. Pisano was at risk of dying without the heart pump, a device implanted in patients who need a heart transplant. But there is an acute shortage of human kidneys available from donors, and her heart disease made her ineligible to receive one.

She is the first patient with a heart pump known to have received an organ transplant of any kind, NYU Langone Health officials said. Patients with kidney failure are usually ineligible to receive a heart pump because of the high risk of death.

The first patient to receive a kidney from a genetically engineered pig was Richard Slayman, 62, who underwent the procedure in March at Mass General Brigham in Boston.

He was well enough to go home from the hospital two weeks after the surgery, but he suffered from complex medical problems and died within two months.

Great strides have been made in recent years in the transplantation of organs from animals into humans following such technological innovations as cloning and gene-editing.

The procedures are still experimental, however, and so far only patients who are so sick that they are not eligible for a human organ and may die without treatment have been cleared to receive animal organs.

The two transplants of pig kidneys this year were approved under the Food and Drug Administration’s compassionate use, or expanded access, program for patients with life-threatening conditions.

Using her arms as a makeshift clapboard, a Sudanese woman in a black hijab and black-and-white caftan clapped her hands together, signaling the beginning of the rehearsal. The other amateur Thespians, wearing comic stick-on mustaches, moved to their marks, improvising a scene in a women’s beauty salon where one patron’s hair is accidentally dyed blue.

As the scene ended, all the women were in hysterics, ribbing each other over how they could better play their parts next time. Scenes like this are common at the Kuluhenna Creative Workshop, which is held at a community clubhouse on the outskirts of this Yorkshire city. The workshop is open to all local women, but with a focus on immigrant communities, including refugees and asylum seekers.

The 90-minute class, which the Mafwa Theater has held since 2019, is a happy space. Each week, some 15 women gather to tell stories, dance, act and gossip. They are provided with bus passes, a play area for their young children and an on-site health worker in case any of the women want to talk.

Eman Elsayed, a mother of three originally from Egypt, said before she joined the workshop in 2020, she was “depressed, isolated and fed up” with her life in Leeds. But eventually, especially after joining Mafwa Theater’s associate artists program in 2021, she felt her life change.

“Art, it’s a magic wand,” said Elsayed, who now has a paid job doing community outreach for the program. “But you need to believe, and you need to take the time to see what it will do.”

Mafwa’s project is just one example of a larger trend — as more and more groups and individuals worldwide are using the arts to empower, unite and even help heal people who have suffered trauma, from war and natural disaster, or discrimination, poverty and displacement.

The idea of healing through the arts is an overarching theme of this year’s Art for Tomorrow conference, an annual event convened by the Democracy & Culture Foundation with panels moderated by New York Times journalists.

At this year’s event, this week in Venice, the panel “Arts as the Ultimate Mediator” will examine how people and groups are using the arts in community and international development and in peace-building programs.

“What I observed is that the arts allow you to create a space of truth,” said Adama Sanneh, a conference panelist and the co-founder and chief executive of the Moleskine Foundation. Through its Creativity Pioneers Fund, the foundation gives grants to small community-based programs using the arts to inspire social change, including Mafwa, which received one last year.

“It’s neutralizing, and before the public, the political, there is that space that goes straight to the personal,” Sanneh said. “When you’re able to create that type of environment, even for a second, then things can really happen.”

Creative people have long understood the arts’ power to teach critical thinking and give people a sense of agency. Toni Shapiro-Phim, the director of Brandeis University’s Peacebuilding and the Arts program, noted that “communities the world over have long recognized the potency of the arts” to create constructive societal change.

For instance, she said, over a century ago in what is now Myanmar, the tales told through traditional puppetry were “sometimes the only stories that made fun of authorities or offered alternative ways to imagine what is possible, how to be a good person in the world.” Around the same time, in Russia, artists like Marc Chagall taught Jewish orphans art as a way of helping them work through their trauma.

“In a creative setting there is the encounter of the self, an awakening to your own unconscious, your own experiences,” said Tammy Federman, a filmmaker whose new documentary “Memory Game” is focused on a theater troupe of Holocaust survivors in Israel run by AMCHA, an Israeli social support services organization. “But there is also an encounter of the group because one person speaks about this very traumatic experience and another person can relate to it. It gives courage to open up, share their own experience, and there’s also joy in it, there’s humor in it, there is movement and creativity.”

And while research by Brandeis University and IMPACT, a nonprofit organization that grew out of a Brandeis initiative, found that creative sector efforts that address difficult challenges “are inadequately understood, under-resourced, and/or funded,” there is a growing understanding that through art, individuals and communities — including those who “have been suppressed or repressed” — can make themselves heard.

Recognizing this, mainstream institutions and donors have, according to Tiffany Fairey, a visual sociologist at King’s College London’s Department of War Studies, started taking the arts seriously as a “viable kind of soft power” peace-building tool. “The main critique of liberal peace is its neglect of people who are directly affected by conflict, the fact that communities themselves don’t get to have a say in peacebuilding policy and programing,” she said. Now, she said “people are relying on the arts for their capacity to engage communities.”

Ronen Berger, an Israeli drama therapist who will also be a panelist in Venice, said one reason the arts could be so successful in helping people deal with collective trauma was that creative practices like dance, storytelling and song go back to infancy.

“As babies, when we start our communication with the world it is through play, through voices, through songs, through rocking, which is dance,” he said. “So this way of working is very primal and very universal.”

Berger said when he worked in big groups, the easiest way to connect was through rhythms like clapping. “This way it bypasses language, cultural and age barriers,” he said, adding that performance is important because it not only can raise awareness of an issue, but it also allows participants to feel seen and a part of a wider community. “We can get to know each other and feel we are doing something together.”

That idea, of connecting around something simple, led Michael Lessac to found Global Arts Corps, which has produced plays in post-conflict areas including Northern Ireland, the Balkans and Cambodia. It started with “Truth in Translation,” a play that debuted in Kigali, Rwanda, in 2006 and told the story of South Africa’s Truth and Reconciliation Commission through the translators’ eyes.

The play traveled to a number of post-conflict zones, creating broader dialogue and debate. “I used to have people come up to me in rehearsal and say ‘Well, I don’t think I can join your project because I don’t believe in forgiveness,’” said Lessac, whose TV directing credits include “Taxi,” “Newhart” and “Everybody Loves Raymond.”

“And at the time we weren’t talking about forgiveness. I said, ‘I am not asking you to believe it, I am asking you to rehearse it.’” Lessac said he has often asked actors to play the opposite emotion of what they feel.

“So if it’s hate, you play love, and they pick up a lot of things as a result of jumping to the opposite,” he said. “In that sense, you’re going through the process that you can never go through if you’ve got three lawyers and the oppressor standing in the way.”

The arts can also draw attention to issues. “No Direction Home,” a London program providing workshops and gigs to empower people from refugee and migrant backgrounds to perform stand-up comedy, has presented shows that have entertained thousands.

Almir Koldzic, the director and co-founder of Counterpoints, which organizes both “No Direction Home” and Refugee Week in Britain, noted that art has “the capacity to improve our well-being, to help with our mental health, to enable people to use creativity to come to terms with loss.”

“On a wider level,” he said, “the arts have a huge potential to open up the spaces of connectedness, to invite people to develop empathy.”

Dr. Anthony S. Fauci, the former government scientist both celebrated and despised for his work on Covid, on Monday forcefully denied Republican allegations that he sought to cover up the possibility that the pandemic originated in a laboratory, calling the accusation “absolutely false and simply preposterous.”

In a tense appearance before the House Select Subcommittee on the Coronavirus Pandemic, Dr. Fauci read out an email from February 2020 in which he encouraged a scientist worried about the possibility of a lab leak to report his concerns to the F.B.I.

“It is inconceivable that anyone who reads this email could conclude that I was trying to cover up the possibility of a laboratory leak,” Dr. Fauci testified.

Republicans on the panel have spent 15 months rooting through emails, Slack messages and research proposals for evidence against Dr. Fauci. In half a million pages of documents and more than 100 hours of closed-door testimony, the panel has so far found nothing linking the 83-year-old immunologist to the beginnings of the Covid outbreak in China.

But the panel has turned up emails suggesting that Dr. Fauci’s former aides were trying to evade public records laws at the medical research agency he ran for 38 years until his retirement in December 2022.

Some of those emails paint Dr. Fauci as being preoccupied with his public image; one April 2021 message from an aide said that while Dr. Fauci “prides himself on being like teflon,” he appeared to be “getting worried about the brown stuff hitting the fan” over questions about research funded by his agency, the National Institute of Allergy and Infectious Diseases.

Over the years, the agency gave research grants to EcoHealth Alliance, an American nonprofit group that partnered with international scientists — including some at a coronavirus lab in Wuhan, China, the city where the pandemic eventually started — as part of efforts to anticipate disease outbreaks.

Dr. Fauci’s appearance on Monday had all the trappings of a Washington media show. He entered the room through a back door, flanked by two burly security guards, and took his seat wearing a somber expression as a horde of cameraman pointed their lenses at his face.

In the audience sat one person wearing a “Fire Fauci” T-shirt. Others wore shirts saying, “Got Ivermectin?” — a reference to anti-parasitic medicine that Dr. Fauci’s critics have claimed, without evidence, worked against Covid-19.

Monday is lawmakers’ first chance to ask him about his agency’s record-keeping practices. For Republicans on the committee, the hearing is also the pinnacle, so far, of a long campaign against American scientists and health officials who they have suggested helped start the Covid pandemic.

No new evidence for the pandemic emerging from a lab, with or without the help of American taxpayer funding, has emerged in a series of high-profile hearings over the past year. In a report on Monday, titled “Republicans’ Fauci Flop,” Democratic lawmakers said that the panel’s Republicans had failed to advance the case that the coronavirus, known as SARS-CoV-2, came from a lab leak.

“Select Subcommittee Republicans have dedicated time and taxpayer dollars to a probe of federally funded research that has failed to meaningfully advance our understanding of the origins of SARS-CoV-2 and instead inflicted significant damage on Americans’ trust in our nation’s public health officials,” the report said.

But Dr. Fauci, who spent more than 50 years in government service and advised presidents of both parties on outbreaks of infectious diseases such as AIDS, Ebola, anthrax and the flu, was always the panel’s most prized quarry. In working under President Donald J. Trump and then President Biden, Dr. Fauci became the face of a Covid response that generated both veneration and frustration from Americans.

Appearing frequently on television, Dr. Fauci became a hero to Mr. Trump’s critics for correcting his falsehoods about the coronavirus. In the pandemic’s early days, he also downplayed the importance of masks for the general public, seeking to preserve them for medical workers, but then later encouraged mask use — prompting his critics to say that he was flip-flopping. And he publicly celebrated the Covid shots, turning the anti-vaccine movement against him.

The House subcommittee is headed by two doctors: Representative Brad Wenstrup, Republican of Ohio, is the chairman and Representative Raul Ruiz, Democrat of California, is the ranking member. Dr. Fauci faced a polite but chilly reception from Republicans, who have studiously been trying to build a case that lab work funded by the institute Dr. Fauci used to run may have contributed to the start of the Covid pandemic.

Republicans have focused in particular on funding the institute awarded to EcoHealth Alliance that was passed on to Chinese scientists. They have accused those scientists of cooking up the coronavirus in their Wuhan lab.

“Covid-19 wasn’t created by bats in a wet market,” Representative Marjorie Taylor Greene, Republican of Georgia, asserted last year as the subcommittee’s work got underway. “It was manufactured in a lab funded by Fauci. He tried to cover it up.”

Scientists and health officials have repeatedly noted that the coronaviruses being studied at the Wuhan lab with American funding — as well as other such viruses known to be the subject of research there — bore little resemblance to the one that set off the pandemic. A National Institutes of Health official testified last year before a different House committee that comparisons between the two were like “saying that a human is equivalent to a cow.”

In closed-door testimony before the House coronavirus panel in January, Dr. Fauci said, as he has previously, that it was possible that lab research had sparked the pandemic and that he kept “an open mind” about the origins. But, he said, “Some people spin off things from that that are kind of crazy.” And he reiterated that, in his view, the weight of evidence pointed toward the virus originating from animals before spilling into humans outside a lab.

In that testimony, Dr. Fauci referred to studies relying on early cases and viral genomes as well as sampling at an illegal wild animal market in Wuhan that suggested the pandemic-causing virus leaped from animals into people there.

“When I read the papers written by an international group of highly, highly respected evolutionary virologists, I lean much more heavily that this is a natural occurrence,” Dr. Fauci said.

Republican lawmakers seized on other parts of Dr. Fauci’s January testimony in advance of the hearing on Monday to attack the American Covid response. In a memo circulated on Friday, the Republicans highlighted comments from Dr. Fauci about, among other things, six-foot separation rules, masking policies and vaccine mandates.

Dr. Fauci is also likely to come under intense scrutiny over recent revelations that two of his former aides — Dr. David Morens, a senior adviser, and Greg Folkers, a chief of staff — sent emails during the pandemic in which they appeared to be skirting public records laws. In opening remarks posted online Sunday evening, Dr. Fauci said he “knew nothing” of Dr. Morens’s email practices, and said that Dr. Morens, who helped him write scientific papers, “was not an adviser to me on institute policy or other substantive issues.”

Some of the emails suggested that agency officials whose job it was to produce records under transparency laws helped colleagues circumvent those regulations, a possibility that a government accountability expert said he found “extremely concerning.”

The emails suggested that agency officials were worried not about the emergence of evidence related to the origins of the pandemic, but rather about the disclosure of notes in which they bluntly discussed “political attacks” on their research.

Still, Dr. Morens suggested in the emails that Dr. Fauci, too, was careful to avoid putting sensitive comments in places where journalists or members of the public might eventually be able to find them.

“I can either send stuff to Tony on his private gmail, or hand it to him at work or at his house,” Dr. Morens wrote of Dr. Fauci in the course of reassuring several scientists in April 2021 that they need not worry about public records requests. “He is too smart to let colleagues send him stuff that could cause trouble.”

Dr. Fauci disputed this in his opening remarks, writing that “to the best of my knowledge I have never conducted official business via my personal email.”

Long before people develop dementia, they often begin falling behind on mortgage payments, credit card bills and other financial obligations, new research shows.

A team of economists and medical experts at the Federal Reserve Bank of New York and Georgetown University combined Medicare records with data from Equifax, the credit bureau, to study how people’s borrowing behavior changed in the years before and after a diagnosis of Alzheimer’s or a similar disorder.

What they found was striking: Credit scores among people who later develop dementia begin falling sharply long before their disease is formally identified. A year before diagnosis, these people were 17.2 percent more likely to be delinquent on their mortgage payments than before the onset of the disease, and 34.3 percent more likely to be delinquent on their credit card bills. The issues start even earlier: The study finds evidence of people falling behind on their debts five years before diagnosis.

“The results are striking in both their clarity and their consistency,” said Carole Roan Gresenz, a Georgetown University economist who was one of the study’s authors. Credit scores and delinquencies, she said, “consistently worsen over time as diagnosis approaches, and so it literally mirrors the changes in cognitive decline that we’re observing.”

The research adds to a growing body of work documenting what many Alzheimer’s patients and their families already know: Decision-making, including on financial matters, can begin to deteriorate long before a diagnosis is made or even suspected. People who are starting to experience cognitive decline may miss payments, make impulsive purchases or put money into risky investments they would not have considered before the disease.

“There’s not just getting forgetful, but our risk tolerance changes,” said Lauren Hersch Nicholas, a professor at the University of Colorado School of Medicine who has studied dementia’s impact on people’s finances. “It might seem suddenly like a good move to move a diversified financial portfolio into some stock that someone recommended.”

People in the early stages of the disease are also vulnerable to scams and fraud, added Dr. Nicholas, who was not involved in the New York Fed research. In a paper published last year, she and several co-authors found that people likely to develop dementia saw their household wealth decline in the decade before diagnosis.

The problems are likely to only grow as the American population ages and more people develop dementia. The New York Fed study estimates that roughly 600,000 delinquencies will occur over the next decade as a result of undiagnosed memory disorders.

That probably understates the impact, the researchers argue. Their data includes only issues that show up on credit reports, such as late payments, not the much broader array of financial impacts that the diseases can cause. Wilbert van der Klaauw, a New York Fed economist who is another of the study’s authors, said that after his mother was diagnosed with Alzheimer’s, his family discovered parking tickets and traffic violations that she had hidden from them.

“If anything, this is kind of an underestimate of the kind of financial difficulties people can experience,” he said.

Shortly before he was diagnosed with Alzheimer’s, Jay Reinstein bought a BMW he could not afford.

“I went into a showroom and I came home with a BMW,” he said. “My wife was not thrilled.”

At the time, Mr. Reinstein had recently retired as assistant city manager for Fayetteville, N.C. He had been noticing memory issues for years, but dismissed them as a result of his demanding job. Only after his diagnosis did he learn that friends and colleagues had also noticed the changes but had said nothing.

Mr. Reinstein, 63, is fortunate, he added. He has a government pension, and a wife who can keep an eye on his spending. But for those with fewer resources, financial decisions made in the years before diagnosis can have severe consequences, leaving them without money at the time when they will need it most. The authors of the New York Fed study noted that the financial effects they see predate most of the costs associated with the disease, such as the need for long-term care.

The study expands on past research in part through its sheer scale: Researchers had access to health and financial data on nearly 2.5 million older Americans with chronic health conditions, roughly half a million of whom were diagnosed with Alzheimer’s or related disorders. (The records were anonymized, allowing researchers to combine the two sets of data without having access to identifying details on the individual patients.)

The large amount of data allowed researchers to slice the data more finely than in past studies, looking at the impact of race, sex, household size and other variables. Black people, for example, were more than twice as likely as white people to have financial problems before diagnosis, perhaps because they had fewer resources to begin with, and also because Black patients are often diagnosed later in the course of the disease.

The researchers hoped that the data could eventually allow them to develop a predictive algorithm that could flag people who might be suffering from impaired financial decision-making associated with Alzheimer’s disease — although they stressed that there were unresolved questions about who would have access to such information and how it would be used.

Until then, the researchers said, their findings should be a warning to older Americans and their families that they should prepare for the possibility of a Alzheimer’s diagnosis. That could mean taking steps such as granting a trusted person financial power of attorney, or simply paying attention to signs that someone might be behaving uncharacteristically.

Dr. Nicholas agreed.

“We should be thinking about the possibility of financial difficulties linked to a disease we don’t even know we have,” she said. “Knowing that, people should be on the lookout for these symptoms among friends and family members.”

Pam Belluck contributed reporting.

Post-traumatic stress disorder diagnoses among college students more than doubled between 2017 and 2022, climbing most sharply as the coronavirus pandemic shut down campuses and upended young adults’ lives, according to new research published on Thursday.

The prevalence of PTSD rose to 7.5 percent from 3.4 percent during that period, according to the findings. Researchers analyzed responses from more than 390,000 participants in the Healthy Minds Study, an annual web-based survey.

“The magnitude of this rise is indeed shocking,” said Yusen Zhai, the paper’s lead author, who heads the community counseling clinic at the University of Alabama at Birmingham. His clinic had seen more young people struggling in the aftermath of traumatic events. So he expected an increase, but not such a large one.

Dr. Zhai, an assistant professor in the Department of Human Studies, attributed the rise to “broader societal stressors” on college students, such as campus shootings, social unrest and the sudden loss of loved ones from the coronavirus.

PTSD is a mental health disorder characterized by intrusive thoughts, flashbacks and heightened sensitivity to reminders of an event, continuing more than a month after it occurs.

It is a relatively common disorder, with an estimated 5 percent of adults in the United States experiencing it in any given year, according to the most recent epidemiological survey conducted by the Department of Health and Human Services. Lifetime prevalence is 8 percent in women and 4 percent in men, the survey found.

The new research also found a sharp rise in the prevalence of a similar condition, acute stress disorder, which is diagnosed less than a month after a trauma. Diagnoses rose to 0.7 percent among college students in 2022, up from 0.2 percent five years earlier.

Use of mental health care increased nationally during the pandemic, as teletherapy made it far easier to see clinicians. Treatment for anxiety disorders increased most steeply, followed by PTSD, bipolar disorder and depression, according to economists who analyzed more than 1.5 million insurance claims for clinician visits between 2020 and 2022.

PTSD was introduced as an official diagnosis in 1980, as it became clear that combat experiences had imprinted on many Vietnam veterans, making it difficult for them to work or participate in family life. Over the decades that followed, the definition was revised to encompass a larger range of injury, violence and abuse, as well as indirect exposure to traumatic events.

However, the diagnosis still requires exposure to a Criterion A trauma, defined in the Diagnostic and Statistical Manual of Mental Disorders as “death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.”

It is not uncommon for young adults to experience traumatic events. A 1996 study of Detroit residents found that exposure to traumatic events — such as violent assaults, injuries or unexpected death — peaked sharply between the ages of 16 and 20. It then declined precipitously after age 20.

Research suggests that less than one-third of people exposed to traumatic events go on to develop PTSD.

Shannon E. Cusack, an academic researcher who has studied PTSD in college students, said there was division within the field about whether the profound disruptions that young adults experienced during the pandemic — abrupt loss of housing and income, social isolation and fear about infections — amount to triggering events.

“They’re causing symptoms that are consistent with the PTSD diagnosis,” said Dr. Cusack, a clinical psychologist and an assistant professor of psychiatry at Virginia Commonwealth University. “Am I not going to treat them because their stressor doesn’t count as a trauma?”

The prevalence data, she said, points to a pressing need for PTSD treatment on college campuses. Short-term treatments developed for veterans, such as prolonged exposure therapy and cognitive processing therapy, have proved effective in managing PTSD symptoms.

Stephen P. Hinshaw, a professor of psychology at the University of California, Berkeley, said that the disruptions of the pandemic might have left college students emotionally depleted and less resilient when faced with traumatic events.

“Midway through this study, there may have been legitimately more trauma and death,” he said, adding that the lockdowns may have caused more general despair among young people. “With the general mental health deterioration, is it harder to cope with traumatic stressors if you do get exposed to them?”

Some changes to the diagnostic manual may have blurred the line between PTSD and disorders like depression or anxiety, Dr. Hinshaw said. In 2013, the committee overseeing revisions to the manual expanded the list of potential PTSD symptoms to include dysphoria, or a deep sense of unease, and a negative worldview, which could also be caused by depression, he said. But the changes, he added, do not account for the sharp increase in diagnoses.

A third farmworker in the United States has been found to be infected with bird flu, heightening concerns about an outbreak among dairy cattle first identified in March.

The worker is the first in this outbreak to have respiratory symptoms, including a cough, sore throat and watery eyes, which generally increase the likelihood of transmission to other people, federal officials said on Thursday.

The other two people had only severe eye infections, possibly because of exposure to contaminated milk.

All three individuals had direct exposure to dairy cows, and so far none has spread the virus to other people, Dr. Nirav Shah, principal deputy director of the Centers for Disease Control and Prevention, said at a news briefing.

That suggests that the virus, called H5N1, has not acquired the ability to spread among people and that the threat to the general public remains low, Dr. Shah said.

“This newest case does not change the C.D.C.’s H5N1 influenza risk assessment level for the general public,” he added. “We should remain alert, not be alarmed.”

But the case does highlight the ongoing risk to farm workers, Dr. Shah said: “Our top priority now across this response is protecting the health of farmworkers.”

This case is the second in Michigan, but the individual worked on a different farm than did the worker diagnosed last week. All three infected people so far have been treated with the antiviral medication oseltamivir, sometimes marketed as Tamiflu, officials said.

There were few other details available, disappointing some experts.

“There is no excuse for the lack of testing, transparency and trust,” said Rick Bright, the chief executive of Bright Global Health, a consulting company that focuses on improving responses to public health emergencies.

He noted that federal officials are “months behind sharing virus sequence data.”

“This is how pandemics start,” he said.

The identification of a third case is not surprising because farm workers interact closely with dairy cows, experts said. New flu viruses often provoke respiratory symptoms without further spread to other people, Dr. Shah said.

This latest patient may have had different symptoms because of the exposure dose, a different exposure route, predisposing genetic or medical factors or a combination of those attributes, said Angela Rasmussen, a research scientist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada.

Still, gaining more information about how the person was infected, and about whether the virus has evolved to infect people more readily, is crucial, she said.

Genetic analysis of the virus infecting the worker may be difficult because the amount obtained from the patient was very low.

“But every time the virus is able to replicate in a person, there is potential for the virus to adapt to humans and gain molecular features for replication in the respiratory tract and to spread person-to-person,” said Seema Lakdawala, a virologist at Emory University in Atlanta.

Officials are monitoring about 350 people who may have been exposed, about 220 of them in Michigan alone. So far relatively few farmworkers, about 40, have consented to testing.

The Agriculture Department announced on Thursday that it was setting aside $824 million in new funding to quickly detect cases in poultry and livestock. The department is also starting a voluntary program for producers to test bulk milk, enabling them to transport virus-free herds across state lines without having to test individual cows.

Federal researchers have completed their analysis of 109 beef samples, and found virus in just one, reported last week, officials said at the briefing.

Federal officials could be doing more to protect farm workers and the public, experts said.

“Vaccines from the national stockpile should be released for veterinarians and dairy farm workers willing to take it,” Dr. Lakdawala said. “We have an opportunity to reduce human infections and we need to do it now.”

The chairmen of two Senate committees overseeing health policy, concerned about companies “padding their own profits” at the expense of patients, are looking into the practices of a data analytics firm that works with big insurers to cut payments to medical providers.

The firm, MultiPlan, recommends what it says are fair payments for medical care, but the firm and the insurers can collect higher fees when payouts are lower. This business model could “result in an improper conflict of interest,” the chairmen of the two committees, Ron Wyden of Oregon and Bernie Sanders of Vermont, wrote in a letter to the firm’s chief executive that was released on Tuesday.

The senators called on MultiPlan to meet with the committees’ staffs to discuss an investigation last month by The New York Times that found the firm’s pricing tools could leave patients with unexpectedly large bills when they see doctors outside their health plans’ networks.

“Our committees are engaged in ongoing legislative work to put a stop to practices by plan service providers that drive up health care costs for consumers while padding their own profits,” the letter to Travis Dalton, the MultiPlan chief executive, said.

In a statement, MultiPlan said it was working with the Senate committees “to address their questions and explain the cost and complexity patients can face” when choosing high-priced care outside their networks. “We are committed to helping make health care transparent, fair and affordable for all,” the statement said.

The committees’ inquiry reflects growing scrutiny of the New York-based firm, which has largely remained out of the limelight even as it has staked out a dominant position in a lucrative corner of health care.

Another senator, Amy Klobuchar of Minnesota, this month asked federal antitrust regulators to investigate whether insurers and MultiPlan were colluding to fix prices, and multiple health systems have sued the firm, accusing it of similar anticompetitive behavior.

Separately, the Department of Labor said Tuesday that it had “a number of open investigations” into the type of pricing services MultiPlan provides, but declined to name specific companies. The agency, the primary regulator of employer-based health insurance, stressed in a statement that companies were legally obligated to ensure the firms processing medical claims acted in their employees’ best interest.

The letter from Mr. Wyden, a Democrat, and Mr. Sanders, an independent, also steps up attention on employer-based health insurance, which is the most common way Americans get coverage and a major component of MultiPlan’s business.

As health care costs climb, some employers are looking more closely at what they pay insurance companies to administer their plans, but they are often frustrated by contracts that limit access to their own claims data. To address this, a bipartisan group of senators, including Mr. Sanders, introduced legislation in December that would require insurers to turn over this data.

“Most businesses do their best to manage the ever-increasing cost of their group health plan, but it should be easier,” Senator Mike Braun, an Indiana Republican and cosponsor of the bill, said in a statement.

A majority of employers choose to pay medical claims with their own money and use an insurer to administer their plans. This setup, known as “self-funding,” can be lucrative for insurers like UnitedHealthcare, Cigna and Aetna, as well as specialized firms like MultiPlan.

The insurers pitch MultiPlan’s tools as a way to save employers money when their employees see a medical provider outside the plan’s network. The bills for these out-of-network providers are subject to negotiation, and insurers often send the claims to MultiPlan, which recommends an amount to pay.

Both MultiPlan and insurers typically collect a fee from the employer based on the size of what they call the “savings” — the provider’s list price minus the recommended payment. Lower payouts can mean bigger fees. Meanwhile, patients can be stuck with the unpaid balance, The Times investigation found.

Companies are legally obligated to ensure the insurers act in employees’ best interest, and a closely watched lawsuit filed last year could force them to become more active monitors.

A worker at Johnson & Johnson sued the company, saying it had failed to adequately oversee the administrator of its drug benefits plan. By paying too much — in one instance, $10,000 for a drug that was available for as little as $28.40 — the company had allowed the administrator, the Cigna subsidiary Express Scripts, to profit at employees’ expense, the suit claimed.

In a statement, Johnson & Johnson called the claims “meritless” and said, “We are committed to our employees and seek to provide the best coverage.”

A small industry of consultants, lawyers and data analysts has arisen to help companies step up monitoring and negotiate better deals with the insurers administering their plans.

Kraft Heinz last year sued Aetna, claiming the insurer improperly paid claims and kept millions in undisclosed fees. Trustees for a union health plan in Massachusetts sued Blue Cross Blue Shield of Massachusetts in 2021, accusing the insurer of repeatedly overpaying claims and then charging a fee to correct the errors. And in January the Department of Labor sued Blue Cross and Blue Shield of Minnesota, claiming the company forced multiple employers to pay medical providers’ tax bills without disclosing the charges.

(Aetna declined to comment on the case but said it worked with employers “to facilitate access to quality, affordable and convenient health care.” Blue Cross and Blue Shield of Minnesota said the government’s allegations were “without merit” and “based on unsupported interpretations” of the law. A court dismissed the Massachusetts case.)

The success of the employers’ efforts sometimes hinges on an unsettled legal question: Does a company’s duty to act solely in its employees’ best interest extend to insurers and firms like MultiPlan? Courts have reached different conclusions.

MultiPlan has argued that the answer is no, and in March a federal judge in California agreed, dismissing the company from a lawsuit filed by medical providers. The case against the insurer, Cigna, was allowed to go forward.

In pitches to investors, MultiPlan has highlighted its murky legal obligations. Because the firm doesn’t provide insurance or pay claims, it noted in a public filing, “we generally are not directly regulated and face significantly lower levels of regulatory complexity.”

Think for a minute about the little bumps on your tongue. You probably saw a diagram of those taste bud arrangements once in a biology textbook — sweet sensors at the tip, salty on either side, sour behind them, bitter in the back.

But the idea that specific tastes are confined to certain areas of the tongue is a myth that “persists in the collective consciousness despite decades of research debunking it,” according to a review published this month in The New England Journal of Medicine. Also wrong: the notion that taste is limited to the mouth.

The old diagram, which has been used in many textbooks over the years, originated in a study published by David Hanig, a German scientist, in 1901. But the scientist was not suggesting that various tastes are segregated on the tongue. He was actually measuring the sensitivity of different areas, said Paul Breslin, a researcher at Monell Chemical Senses Center in Philadelphia. “What he found was that you could detect things at a lower concentration in one part relative to another,” Dr. Breslin said. The tip of the tongue, for example, is dense with sweet sensors but contains the others as well.

The map’s mistakes are easy to confirm. If you place a lemon wedge at the tip of your tongue, it will taste sour, and if you put a bit of honey toward the side, it will be sweet.

The perception of taste is a remarkably complex process, starting from that first encounter with the tongue. Taste cells have a variety of sensors that signal the brain when they encounter nutrients or toxins. For some tastes, tiny pores in cell membranes let taste chemicals in.

Such taste receptors aren’t limited to the tongue; they are also found in the gastrointestinal tract, liver, pancreas, fat cells, brain, muscle cells, thyroid and lungs. We don’t generally think of these organs as tasting anything, but they use the receptors to pick up the presence of various molecules and metabolize them, said Diego Bohórquez, a self-described gut-brain neuroscientist at Duke University. For example, when the gut notices sugar in food, it tells the brain to alert other organs to get ready for digestion.

Dr. Breslin likens the system to an airport preparing for a plane landing.

“Think about if a plane landed at an airport terminal that wasn’t ready,” he said. No one would be prepared to guide the plane to the gate, clean it up or unload the luggage.

Taste, he said, gets things ready. It wakes up the stomach, stimulates salivation and sends a little insulin into the blood, which in turn transports sugars into the cells. Ivan Pavlov, a Russian physiologist who won a Nobel Prize for his studies on digestion in 1904, showed that lumps of meat placed directly into a hole in the dog’s stomach would not be digested unless he dusted the dog’s tongue with some dried meat powder to start things off.

Dr. Bohórquez was inspired to hunt for a gut-brain connection two decades ago, when he was in graduate school and a friend who had undergone bariatric surgery asked him why she no longer hated sunny side up eggs. Dr. Bohórquez thought that perhaps the taste receptors in her now-diminished gut were sensing that she wasn’t receiving enough nutrients and began signaling to her brain that, hey, eating runny egg yolks would be a good idea now.

He and his colleagues found a connection in the lab. Taste-receptor-bearing cells in the gut, which he called neuropods, make direct contact with nerve cells that let the brain know a nutrient is in the gut.

“Taste perception is more complex than just taste buds,” Dr. Bohórquez said.

Newer studies are only making the matter more complex. Umami, a savory taste found in foods like fish sauce and ketchup, began to be accepted as the fifth category of taste by researchers in the late 1980s and early 1990s, nearly 80 years after it was proposed by Kikunae Ikeda, a Japanese chemist. More than 2,100 research papers about umami are now listed by the National Library of Medicine.

Several years ago, an Australian research team suggested that there might be a special taste receptor for fat. Dr. Breslin and others are studying how taste receptor cells identify fat, information that could be useful in figuring out why some people overeat.