An injured person facing a very long wait. A colleague exhausted from dealing with fed-up patients. But until a special training a few months ago, O’Mara didn’t consider whether there were ways to be more compassionate in her response.

The training taught the doctor to pause and listen, and not jump to fix or respond defensively if an angry patient is on the offense. She said it has helped her focus better and find a deeper well of sympathy, even as she deals with trying situations at MedStar Washington Hospital Center in the nation’s capital.

“You want to get patients from Point A to Point B with compassion, and also not internalize and feel badly yourself,” she said. “To approach someone who is sad, scared, angry – to approach someone who is angry with compassion is the Holy Grail of emergency medicine.”

Defined as the ability to notice suffering (in ourselves and others) and then the desire to take action to alleviate it, “compassion” has become the buzzword for an angry nation. It is increasingly being held up by neuroscientists, corporations, business schools and psychologists as a concrete, powerful health strategy – and a successful business model.

Universities have opened centers devoted to compassion. Marianne Williamson and Cory Booker talked about it as an urgent American need during their presidential campaigns. Job networker LinkedIn and wealth manager Brighton Jones both recently created a director of compassion position.

Experts say this shift is the result of new research showing compassion’s impact, as well as an urgent desire to address rising rates of depression and anxiety among young people, and a steep climb of rates of suicide among all ages.

The idea that it’s good to be “compassionate” to yourself or someone else is obviously not new. But these uber-studied, emerging methods are very deliberate, part of a generation of neuroscience and genetic research into how the brain and body interact, and how relations with others have an impact on our health. The research looks at how compassion influences everything from the length of your life to how much you contribute to your employers’ bottom line.

Techniques used to train people to practice compassion range from O’Mara’s deep listening of others to hugging yourself, stroking your skin, and talking to yourself in a calming way. Experts use teachings, including about the interconnectedness of all people; exercises such as deep breathing or having a dialogue with a hurting body part, and practices like volunteering.

A group at the University of Helsinki studying compassion at work asks employers to run through a checklist about their employees: Am I showing interest? Understanding? Respect? Fairness? Offering the person a sense of control?

The focus on compassion comes more than a decade after the explosion in the U.S. of “mindfulness” – practices focused on attention, awareness and breathing. Health experts say compassion is the next phase, kind of mindfulness 2.0.

Stanford University neurosurgery professor James Doty, whose 2016 best-selling memoir about compassion became the subject of a hit Korean pop song, said the compassion center he runs was the only one of its kind when it opened 12 years ago. Now, he said he has research collaborations worldwide. “Millions of dollars are being given to support this research,” he said. “Compassion is no longer a ‘soft’ science.”

No one is saying the country or the world is getting more compassionate. In fact, some widely cited research says young Americans are becoming less empathetic. But a compassion industry is rising in opposition.

The movement is fueled by a belief that “the level of suffering and the visibility of suffering has made compassion essential,” said Jane Dutton, a professor at the University of Michigan who studies compassion in the workplace. Traditionally nurturing institutions like family and church are disintegrating at the same time social media is exploding, Dutton said, “compelling a certain level of urgency – and maybe some optimism, that this can be learned and facilitated.”

At the same time, Silicon Valley is leading a quest for higher productivity, complete with research about group psychology and values and what makes people work well (the best-known example is Project Aristotle, part of Google’s multimillion-dollar dive into what makes teams thrive).

Elina Lampinen, a bank executive in Helsinki, spent a year taking classes and doing exercises aimed at understanding and improving emotional skills around compassion. Lampinen, 55, now works in risk management, and she said she feels much more compassionate and better able to have difficult conversations with employees.

“I’ve always had a positive understanding of people, but I’d say I’m more tolerant and understand why people do things the way they do – including myself,” she said. “What I learned is that between stimulus and reaction, there is freedom of choice. And for me, that’s a big change.”

Nearly 100,000 people signed up for a 10-day online “compassion challenge” launched this month by popular Washington-area meditation and mindfulness author and teacher Tara Brach, who recently changed one of the acronyms she uses in her teaching to include the compassion-related concept of nurturing.

” ‘We’re not survivors of the fittest, we’re survivors of the nurtured,’ ” Brach said in an interview, citing a quote by psychologist Louis Cozolino.

The word “compassion” conjures different images. It can be a broad synonym for, essentially, being nice, being empathetic. And “self-compassion” can be shorthand for “taking care of yourself.” The new movement seeks to narrow the word to more specific skills and actions.

Doty, Brach and others say the compassion movement is a recognition that mindfulness – however healthy – is limited, focused on being aware in a nonjudgmental way about your thoughts, feelings and narratives.

“You could be a Type A ruthless person, and mindfulness could make you more self-absorbed, for some people,” Doty said. “In mindfulness, compassion is implicit. And in my view, it needed to be more explicit.”

The movement also aims to define the difference between empathy – the ability to put ourselves in someone else’s shoes, in situations positive or negative – and compassion, which includes the motivation to do something to ease suffering.

Compassion debates have emerged. Is there such a thing as too much compassion? In workplaces, can compassion undercut other imperatives such as efficiency? Is compassion a feeling or a learned practice?

Joan Brown Campbell, a minister and interfaith activist who has been involved with pro-compassion campaigns for decades, said she worries about the term getting trendy and superficial.

” ‘Compassion’ is a very hard word. Some see being compassionate as easygoing, not challenging. For many, ‘compassion’ seems not risky enough. It’s not something you wake up and say: ‘I think I’ll be compassionate,’ ” she said. “Compassion is a way of living in a diverse world.”

For a year now, Scott Shute has been head of mindfulness and compassion at the 16,000-person LinkedIn. As part of its focus on compassion, the firm decided to shift its primary success metric of its job list from how many jobs are on LinkedIn to how many people get jobs on LinkedIn. “It’s from a self-centered metric to an other-centered metric,” Shute said.

He teaches a class called “From Me to We,” which at times is about putting all company stakeholders – not just shareholders – in equal regard. Other times, it’s something that sounds like corporate self-help.

“The ‘me’ part is having a growth mind-set. The ‘we’ is compassion,” he said. “No matter what’s happening you can do something. Going from pessimistic to optimistic.”

A 2017 review of Harvard graduates who had been followed for 80 years concluded connection and relationships were the best indicators of longevity. A similar correlation is made about volunteering, a University of Michigan study found. Other compassion-related research is more neurological or genetic.

Parneet Pal is chief science officer at Wisdom Labs, which consults workplaces on how to improve resiliency and decrease stress. New MRIs, she said, are being used to show which brain networks or hormone levels are affected when someone is being empathetic, which are affected when someone is being compassionate, and the importance of learning the difference when working with others’ pain.

Doty studies how heart-rate variability is associated with being able to handle caring for those who are suffering without getting physically or psychologically overwhelmed yourself.

O’Mara, of Washington Hospital Center, decided to study compassion in her early 50s. With kids leaving the house and a new big job, she was looking closely at self-care. Aside from exercise and eating, she realized she needed a plan that would help patients and her staff thrive while keeping her from “drowning in other people’s difficulties.”

When she first heard of an intensive training through Georgetown University’s School of Medicine, “I asked: ‘Is there crying?’ My friend said: ‘There’s 100% crying.’ I thought: vulnerability is not my thing.”

She aims now for some daily yoga or meditation, and feels the compassion training has changed her interactions with patients and colleagues.

“I had felt my mind and body were not connected, and I want to move into the second half of my life aware,” she said. “I see that as the next frontier.”

Another candidate vaccine – developed when a similar virus terrified the world – sits in deep freeze in a repository in Houston, ready to be thawed and formulated into thousands of vials for further testing. Yet another is being put together at facilities in San Diego and Houston, with projections that it could be tested in people by summer.

To scientists, the work to create a vaccine against the new coronavirus is advancing with a speed they could barely have imagined a decade ago. At the same time, it’s not even close to quick enough to contain the spreading infection – and in many ways, the outbreak will test the capacity of science to react in real time to a new and unknown “pathogen X” that takes the world by surprise.

“Traditional vaccine development efforts have usually taken decades, not months,” said Barney Graham, deputy director of the Vaccine Research Center at the National Institutes of Health, which hopes to have a vaccine in human testing by April. “This is, first, a response to this new virus, but it’s also a drill for pathogen X . . . press the system, to see how rapidly we can go.”

When a mysterious new illness emerges and public alarm is at its peak, there’s a race to develop a way to prevent or treat the disease. But by the time a promising candidate is ready, it’s often too late for it to be helpful against the outbreak that triggered the rush. Public interest, funding and the urgency that drove the early vaccine development can quickly taper.

“We were getting candidate vaccines, the epidemics would die down and they’d get put back on the shelf,” said Jacqueline Shea, chief scientific officer of Inovio, a biotech company that has been developing vaccines for Zika, Ebola and Middle East respiratory syndrome.

That’s what happened with severe acute respiratory syndrome (SARS), to the dismay of Peter Jay Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development. Eight years ago, he and his co-director, Maria Elena Bottazzi, won federal funding to create a vaccine against SARS, a coronavirus that emerged in 2002 and infected 8,000 people and killed nearly 800. By 2016, they had manufactured enough of the potential vaccine to get through toxicology tests and human safety trials.

But the team tried and failed to win various grants to bring their experimental vaccine through further testing. They say about $2 million could have funded essential and time-consuming toxicology studies and ready it for phase 1 trials – the technical term for the first-in-human studies that typically determine the dosing and safety of a drug. Although the threat of SARS has receded, it was becoming increasingly clear that coronaviruses, long thought to cause mild illness, were able to cause serious pandemics.

When the new coronavirus genome sequence was posted to an online genetic databank in early January, Hotez immediately saw the close similarity to SARS and realized that the samples sitting in storage had the potential to defend against the new coronavirus.

“Had we been able to secure the investment, we could have done all the phase 1 trials. We could have potentially been ready to vaccinate in China, now,” Hotez said. “This is the problem with the whole vaccine infrastructure – it’s reactive, not anticipatory enough. ‘Oh, SARS is gone now, let’s move on.’ ”

What the scientific response to the new coronavirus has shown so far is how the first step in the process – designing and even beginning to manufacture the vaccine – can happen nearly overnight, due to the emergence of new technologies.

Scientists at the National Institutes of Health were strategizing with a Massachusetts biotech company, Moderna, over the winter holiday break, about collaborating to build a vaccine for the virus. As soon as the genome of the virus was posted online in early January, the NIH designed the piece of the vaccine that should trigger the immune system to recognize and disable the virus. NIH sent their design to Moderna, which could integrate it into its virus platform and rapidly scale up manufacturing. The NIH hopes to have the vaccine in the first safety trials by April.

At Inovio, a biotech company headquartered outside Philadelphia, a team began working on designing a vaccine hours after the sequence appeared, said Shea, Inovio’s chief operating officer. The company farmed out production of one piece of its vaccine to a contract laboratory in Houston and is making the other component at its facility in San Diego. The company is gearing up for the lab and animal tests that will be necessary before safety trials in people.

Pharmaceutical giant Johnson & Johnson has also jumped into the vaccine effort and estimates that it will be eight to 12 months before their candidate is ready for testing in people. Many countries are also working on different approaches, in parallel.

“The actual technical feat of making a vaccine against this virus is probably not going to be that hard,” Hotez said. “The problem is you can’t avoid, or even compress the timelines very much for safety testing.”

That means scientists are flooded with public interest in their vaccine efforts right now and must temper their excitement with the reality that there will be a months-long wait, at minimum, for a vaccine that’s ready for its first tests in people.

“What is the value of a vaccine if development takes a year in the context of the current situation, which seems to be moving very rapidly? The value of a vaccine is we don’t actually know what the trajectory of the epidemic could be,” said Richard Hatchett, chief executive of the Coalition for Epidemic Preparedness Innovations, a global alliance that is funding the Inovio and Moderna efforts and another vaccine being created by researchers at the University of Queensland in Australia.

For example, if the outbreak is still raging after initial safety tests, it is possible that experimental vaccines could be used to protect people on the front lines of treating the disease or in emergency situations, before they are approved for the general population, as happened with Ebola. When Ebola devastated west Africa in 2014, a vaccine was not ready. But when Ebola resurfaced in 2019 in Congo, more than 200,000 people were vaccinated.

If the infections have begun to subside by the time vaccines are through the first round of safety testing, getting a vaccine approved would still be useful in case the virus flares again – but showing that it is safe for healthy people in the general population will take time and continued effort.

In the meantime, researchers are also looking at ways of quickly repurposing existing antiviral drugs to see whether any might work against the coronavirus. Paul Stoffels, chief scientific officer of Johnson & Johnson, said the company had donated 100 boxes of an HIV medication, Prezcobix, to clinicians in Shanghai to see whether it showed any efficacy against the illness. Purdue University researchers hope to test experimental drugs that were initially developed against SARS. At the University of North Carolina at Chapel Hill, researchers have been gearing up to test remdesivir, an experimental antiviral drug that has shown promise against other coronaviruses but failed against Ebola.

But every step takes time. Even having the right laboratory tests, ingredients and animal models of the disease are crucial and time-consuming steps. Laboratories have been waiting for the viral genome to be synthesized by companies and are anxious to get samples of the actual virus.

A decade after SARS, another coronavirus emerged that caused Middle East Respiratory Sydrome (MERS). Many think the coronavirus in China is a lesson that this family of viruses will continue to cross from animals into humans and cause potential pandemics. That means they would like to be prepared, with vaccine platforms that can be readily adapted to new infections, and antiviral drugs that work broadly for multiple diseases.

“Emerging viruses, they’re a moving target. They come and they go, and sometimes they come and they don’t go. But it’s impossible to predict the trajectory of an emerging virus,” said Timothy Sheahan, assistant professor at the Gillings School of Global Public Health at UNC. “So one way we’re trying to maximize the utility of a given antiviral drug is to develop broad-spectrum antivirals. Rather than have one drug for one bug, we want one drug for many bugs.”

The study by the AAA Foundation for Traffic Safety suggests the growing use and acceptance of marijuana could be increasing the risks of driving, AAA officials said.

“If a state were to legalize marijuana for recreational use, it’s reasonable to assume that THC-positive drivers will start to show up more in fatal crashes,” said Jacob Nelson, AAA director of traffic safety advocacy and research.

But AAA officials also acknowledge that the study found only a correlation, not a causative link. Over the study period, traffic fatalities declined overall. The study also reflects some of the unknowns and difficulties that remain in consistently analyzing marijuana’s effects on drivers and creating the sort of legal framework and law enforcement methods used to combat drunken driving.

Yet safety activists said the more researchers learn, the greater the urgency in assessing the impact of marijuana’s legalization on highway safety and taking government action to address it.

“We know that marijuana impairs drivers,” said Helen Witty, president of Mothers Against Drunk Driving (MADD). “And while MADD doesn’t take a position on the legalization of recreational marijuana, we do strongly take a position on driving after using marijuana or alcohol, or any drug, simply because it kills people.”

The AAA Foundation found that the percentage of Washington state drivers in fatal crashes who tested positive for THC increased from about 9 percent in the five-year period before legalization to about 18 percent in the five years afterward. About 1 in 5 drivers involved in fatal crashes in 2017 tested positive for THC, which stands for tetrahydrocannabinol, the psychoactive ingredient in marijuana.

Initiative 502 legalized possession of small amounts of marijuana for recreational use in Washington as of December 2012. The law also set a legal threshold for marijuana use for drivers that is similar to the blood alcohol limits of 0.08 percent in most states. It prohibits driving at 5 or more nanograms of THC per milliliter of blood, AAA says. There is zero tolerance, however, for drivers under the age of 21.

The AAA study, relying on 10 years of Washington state traffic data, expands on a previous look at the possible effects on traffic safety there after marijuana became legal for recreational use.

There were 6,721 drivers involved in fatal crashes in the state over the 10-year period, and nearly 90 percent of them died. AAA says the study accounts for variations in the percentage of victims who were tested for drugs and alcohol, and further variations as to whether authorities conducted blood or urine tests. By 2017, 89 percent of all those who died were subjected to blood tests, the study says.

Other studies have provided evidence that legalizing marijuana for recreational use has increased the dangers of driving. The Insurance Institute for Highway Safety reported in 2018 that, on the basis of collision claims, the crash rates in Colorado, Nevada, Oregon and Washington rose by as much as 6 percent since the first of those states legalized marijuana in 2012, compared with neighboring states that had not legalized it.

And yet Washington state’s fatal crash rate per miles traveled has been lower than the national average and generally has followed the same downward trend since 1980, according to annual collision data from the Washington State Transportation Department. There were 480 fatal crashes in 2008, compared with 403 in 2012.

Meanwhile, developing a consistent method of testing for and assessing a person’s level of impairment has been difficult. Science is still not clear on a consistent link between THC blood levels and impairment, which can vary widely depending on a user’s habits, body type and other factors. Metabolism can diminish the psychoactive effects from anywhere to 90 minutes to three hours or so after use.

There is no testing device for marijuana that’s widely accepted by law enforcement or thought to be as generally reliable as the Breathalyzer or other breath-testing methods.

“The scary thing about marijuana is we don’t have the standard for impairment on marijuana as we do for alcohol,” Witty said. But she also said the same simple message that applies to alcohol applies to marijuana or opioids and other powerful, mind-altering prescription drugs: If you use them, don’t drive.

Nelson, citing a 2018 AAA driver survey, said about 27 percent of respondents thought it was very likely that a driver would be caught by police if the person was driving with a blood alcohol level above the legal threshold for being intoxicated. But only about 10 percent thought that would be true of someone driving an hour after using marijuana. Too many people, he said, apparently think they can avoid getting busted – or having a crash – after getting high on weed.

“It’s not surprising then to see what we see in Washington state,” Nelson said. “We have a lot of work to do.”

A decline in the death rate from cancer is the single largest driverof the small increase in life expectancy,the CDC reported. Five of the other nine leading causes of death also showed declines in death rates, including the top cause, heart disease, as well as unintentional injuries (which include overdoses), chronic lower respiratory diseases, stroke and Alzheimer’s disease. Two more, diabetes and kidney disease, were essentially unchanged. Deaths from suicide and influenza and pneumonia increased.

Despite the encouraging elements of the CDC mortality report, the broader pattern for American health remains sobering. Life expectancy improved by the tiniest of increments, from 78.6 to 78.7 years. That figure remains lower than the peak in U.S.life expectancy, at 78.9 years,in 2014.

It is also identical to life expectancy in 2010, and it appears unlikely that U.S. longevity will show any significant improvement over the entire decade of the 2010s. The United States is continuing to fall behind similarly wealthy countries – a phenomenon that experts refer to as the U.S. “health disadvantage.”

“It’s good news that there was an increase in life expectancy. That’s what we want to see, but it doesn’t really alter the long-term picture. We still have a very bleak situation at this point,” said Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University.

Woolf was the co-author of a report published in November in the JAMA, the American Medical Association’s journal, that revealed a long-term increase in death rates in the United States for people in the prime of life – from 25 to 44. That study was based on mortality data from 1959 to 2017, and showed that improvements in life expectancy and a lowering of death rates peaked in the 1970s, with more gradual increases after that. In 1998, the United States for the first time fell behind the average life expectancy in peer nations, Woolf said.

“As a country, we are not doing as well as we should, and other high-income countries are outperforming us and continue to outperform us. There is a lot of American exceptionalism at work here. The U.S. is on a very distinct path when it comes to our health, our well-being and our survival,” said Laudan Aron, senior fellow at the Urban Institute, a Washington-based nonpartisan research organization.

She said the long-term health trends are driven by socioeconomic factors “that are really proving to make life very challenging for many Americans.”

Another new overview of American health, released early Thursday by the Commonwealth Fund, a health-care research organization based in New York, noted that the United States has a lower life expectancy than 10 peer nations – Germany, Britain, Canada, Australia, France, the Netherlands, New Zealand, Norway, Sweden and Switzerland – despite spending far more per capita on health care than any of them. The suicide rate, at 14 per 100,000 people, is twice that of Britain, the report said.

“We live sicker and die younger than our counterparts around the world – despite spending around twice as much as other nations on health care,” said Roosa Tikkanen, a research associate at the Commonwealth Fund and the lead author of the report.

“We can do better,” she added.

David Blumenthal, president of the Commonwealth Fund, said Wednesday that the poor health outcomes are due to a “very inadequate primary care system” in which too few people have access to medical care, with costly consequences such as trips to the emergency room and preventable illnesses. The report said the United States, compared with peer countries, has the highest rate of hospitalization from preventable causes and the highest rate of “avoidable deaths.”

In recent years, obesity has increased death rates for heart disease, diabetes and other ailments: About 4 out of 10 adults age 20 and older in the United States are considered obese, and another 3 out of 10 are overweight, according to the CDC.

The CDC’s annual report on life expectancy had been dismaying the previous three years, with the number dropping or remaining flat each year as the United States dealt with a wave of drug overdoses from illicit fentanyl flooding communities with high levels of opioid addiction. The CDC has linked the addiction epidemic of the past two decades to the widespread marketing and distribution, starting in the late 1990s, of prescription opioids.

As the epidemic blew up into a national crisis, doctors in 2013 began prescribing fewer painkillers, and deaths from pill overdoses gradually declined. But deaths from street drugs soared.

Governments and public health groups have dramatically increased the amount of naloxone, an anti-overdose medication, in communities across the nation. Billions of dollars have been poured by federal, state and local governments into drug treatment and other support services. The new report shows the first drop in the death rate per 100,000 people from overdoses since 2012 and the first decline in the raw number of deaths since 1990 – from 70,237 in 2017 to 67,367 in 2018.

That remains a staggering death toll, higher than the fatalities from motor vehicle accidents. The figure includes deaths from opioids, 46,802, a slight drop from the previous year’s total of 47,600. By comparison, a decade earlier, in 2008, fatal opioid overdoses had not yet topped 20,000.

Still rising: fatal fentanyl overdoses, a subset of the opioid number. There were 31,335 in 2018, up from 28,466 in 2017 and a 10-fold increase from the number five years earlier.

Also up are overdose deaths from cocaine and psychostimulants such as methamphetamine – 14,666 and 12,676, respectively. The latter number is about triple the number from just four years earlier.

The American drug abuse crisis continues to evolve, with meth a growing cause of fatalities. There are ominous indications that the downward trend in fatal overdoses will not hold when the 2019 mortality data comes out. (The CDC usually takes about one year to produce final mortality data.) Earlier this month, the CDC released provisional drug overdose data – numbers that include “predicted” deaths, using an algorithm that adjusts for likely undercounts – that showed a slight increase nationally in drug deaths over the first six months of 2019.

Most of that increase has been seen in states west of the Mississippi. Experts on drug use in the West say that fentanyl, which became widespread initially in the eastern United States, has begun to play a bigger role in the western U.S. drug supply.

Drug overdoses play an outsize role in life expectancy because they often claim the lives of young people, cutting off many years of life, whereas a disease such as cancer typically affects people who are much older, noted Otis Brawley, an oncologist at Johns Hopkins University School of Medicine. “The average age of someone who dies from cancer is in their early 70s,” he said.

Life expectancy at birth for females in 2018 remained five years greater than that of males: 81.1 and 76.1, respectively. That gap narrows with age because men are more likely than women to die young. At the age of 65, men have a life expectancy of 18 additional years and women 20.6.

The patient is a 56-year-old female Chinese national from Wuhan who arrived in Singapore with her family on Jan 18.

The case was confirmed at 2pm on Monday (Jan 27), said MOH.

The patient was asymptomatic during the flight to Singapore.

She subsequently developed symptoms on Friday and was conveyed by ambulance to Tan Tock Seng Hospital on Sunday. She was classified as a suspect case and immediately isolated at the National Centre for Infectious Diseases (NCID).

Subsequent test results confirmed Wuhan virus infection on Monday, said MOH. She has no known links to the other confirmed imported cases.

Before being admitted to hospital, the patient stayed with her family at their home in Ceylon Road.

Since the onset of symptoms on Friday, she had remained in her home until she was brought to the hospital on Sunday, MOH said.

She is currently warded in an isolation room at the NCID and her condition is stable.

MOH said it has started epidemiological investigations and contact tracing to identify individuals who had close contact with the patient.

In its statement, the MOH also provided updates on other suspected cases.

It said that as of 2pm on Monday, 62 of the patients previously classified as suspected cases have tested negative for the coronavirus and five tested positive.

Test results for the remaining 57 suspected cases are still pending.

The MOH said contact tracing for the confirmed cases is still ongoing, adding that it has identified 115 close contacts from the first four confirmed cases.

Of the 86 contacts who are still in Singapore, 75 have been contacted and are being quarantined or isolated, the ministry said, adding that efforts are ongoing to contact the remaining 11.

“Once identified, MOH will closely monitor all close contacts. As a precautionary measure, they will be quarantined for 14 days from their last exposure to the patient.

“In addition, all other identified contacts who have a low risk of being infected will be under active surveillance, and will be contacted daily to monitor their health status.”

The ministry also advised the public to defer all travel to Hubei Province and all non-essential travel to mainland China.

It also said all travellers should monitor their health closely for two weeks upon return to Singapore and seek medical attention promptly if they feel unwell. They should also inform their doctors of their travel history.

If they have a fever or respiratory symptoms such as cough or shortness of breath, they should wear a mask and call the clinic ahead of the visit, the ministry said.

The MOH also advised the public to avoid contact with live animals, including poultry and birds, and consumption of raw and undercooked meats.

Why wasn’t she coloring it? In an Instagram post, she explained: In her 20s, she began graying, and she covered it with various shades of dye until she could no longer tolerate the chemicals.

Grant is among a growing throng of women who are naturally fading to gray. More than 350,000 women have posted Instagram photos using the #grannyhair hashtag. Between 2017 and 2018, Pinterest saw a significant jump in the search term “going gray.”

“With influential people like Billie Eilish dyeing their hair gray, people of all ages are incorporating the look, and many who are naturally gray are no longer trying to cover it up,” Swasti Sarna, Pinterest’s insights manager, told The Washington Post.

Gray’s the new blonde, or black, style writers began declaring five years ago. Last year, L’Oreal Paris and Vogue crowned silver the hair color of the year. In addition to teenage musician Eilish, celebrities from Lady Gaga to Jennifer Lawrence have walked the red carpet in silver dos.

Ironically, while young women spend as much as $1,000 to bleach and color their hair titanium, blue steel, smoky gray and gunmetal, older women continue to feel compelled to cover up their silvers.

At the same time, longtime slaves to hair color are ditching the dye.

In Facebook groups called Gray and Proud, Going Gorgeously Gray and Silver Revolution, tens of thousands of women share photos and tips on how to quit color and avoid looking like a raccoon. They ask if revealing their true color would mean losing their sex appeal, their credibility at work, their clients, their jobs?

New research adds another question. Is there a risk of harm from the chemicals?

A study published last month in the International Journal of Cancer reported that African American women who colored their hair with permanent dye every five to eight weeks were 60 percent more likely to be diagnosed with breast cancer than women who didn’t color. No cause and effect was established, and all of the women in the study had a family history of breast cancer.

For white women, the numbers were less striking but still elevated. Those who dyed their hair every five to eight weeks were 8 percent more likely to be diagnosed with breast cancer, researchers found.

Researchers and breast cancer specialists were circumspect about the findings.

“I have to say I’m not overwhelmingly convinced. This isn’t a slam dunk by any means,” said Laura Esserman, a breast surgeon who directs the Carol Franc Buck Breast Care Center at the University of California at San Francisco. She was not involved with the study. “It’s worth looking into. But this is a very small effect.”

Researchers followed 46,709 women between the ages of 35 and 74 over an average of eight years. All participants had at least one sister who had been diagnosed with breast cancer but none had been diagnosed themselves when they enrolled in the study. The majority, 55 percent, reported using permanent hair dye.

During the course of the study, 2,794 African American and white women were diagnosed with breast cancer. Black women who colored their hair with permanent dye at any point in the year before joining the study were 45 percent more likely to be diagnosed, while white women were 7 percent more likely.

To put the numbers in context, study co-author Alexandra White estimated the heightened risk as five additional cases of breast cancer for every 100 black women and one additional case of breast cancer for every 100 white women.

Breast cancer rates generally are similar for black and white women. But black women tend to be diagnosed with more aggressive forms of the disease, and it is more likely to kill them.

White, an epidemiologist who heads the National Institutes of Environmental Health and Cancer Epidemiology Group, described the new findings as “concerning” but far from definitive.

“We wouldn’t make any recommendations off these findings,” she said. “We need more evidence.”

“It’s not as clear as smoking and lung cancer,” said Doris Browne, a medical oncologist and a former president of the National Medical Association. Two of her six sisters had breast cancer, and she participated as a subject in the study.

She sees the results as a warning. “But I can’t say if you dye your hair and are African American, you are going to get breast cancer. It heightens our awareness, but we still need more data before we can say to women that it may increase breast cancer risk,” she said.

“Hair dye is just all chemicals,” said Stephanie Bernik, chief of breast surgery at Mount Sinai West in New York. “You’ve got to think something’s not good for you. We know some of these chemicals are carcinogenic.”

Yet Bernik, who was not involved with the study, and Esserman both said the findings had not persuaded them to counsel their patients on hair-dye use unless they asked.

Other recent studies also have reported increased risk for breast cancer, as well as bladder cancer, in women who dyed their hair. Although the American Cancer Society says the research is not definitive, it also points out that the U.S. National Toxicology Program has classified some chemicals used in hair dye as “reasonably anticipated to be human carcinogens.”

Some doctors advise women not to color their hair while pregnant, or at least not during the critical first trimester, according to the American Cancer Society.

White and her team found little to no increase in breast cancer risk in women who colored their hair with anything except permanent dye. But women who reported applying semi-permanent color to their friends’ or relatives’ hair at home experienced an elevated risk of breast cancer.

Permanent dye causes lasting changes to the hair shaft and stays in the hair until it grows out. Temporary dye washes out after a shampoo or two, while semi-permanent tends to hold for up to 10 shampoos.

Researchers did not ask women whether they had their hair dyed in a salon or at home. They only asked if participants dyed other people’s hair nonprofessionally. So the question remains whether black women could be more vulnerable because they are more likely than white women to color their hair at home.

Bernik suggested that women concerned about hair dye and breast cancer risk have a professional stylist color their hair with semi-permanent dye.

“If it’s done at home, you’re wearing gloves that are probably not necessarily the greatest,” she said. “The person who’s doing it nonprofessionally is getting it all over. It’s all about exposure and absorption.”

Even professionals struggle to follow manufacturer guidelines while handling dye, said Whitney Murphy, a hairstylist who advises other stylists about chemical safety and owns the Parlor Seattle.

“No one’s really taking the chemical safety part seriously,” Murphy said. She blames the chemicals in hair products for her own breathing problems, migraines and rashes and believes stylists need higher quality protective gear than what they use.

“Beauty professionals are overexposed and underprotected from harsh chemicals,” said Janette Robinson Flint, executive director of Black Women for Wellness, a Los Angeles nonprofit group.

Congress has charged the Food and Drug Administration with regulating the safety of cosmetics, including hair dye. But the FDA does not approve every ingredient and generally leaves the responsibility for product safety to manufacturers. Companies are allowed to omit chemicals from product labels if they are fragrances and if they consider them a secret ingredient in the product formula.

“Just because something is on the shelf does not make it safe,” warned Tamarra James-Todd, an epidemiologist and professor at the Harvard T.H. Chan School of Public Health in Boston.

“Chemicals are not like people, but that’s the way they’re treated,” said Jayne Matthews, co-owner of Edo Salon in Oakland, California. “They’re innocent until proven guilty.”

James-Todd, who was not involved in the study, researches the effect of hair products on black women’s health. She says that research should be done into products African American women may use daily, such as shampoos, conditioners, oils and styling products.

“We have to think about the full pattern of exposure people have,” she said.

The lack of clarity leaves some women in a quandary. Ingrid DeMoss, an African American relocation director for a luxury real estate company outside of Dallas, covers her grays with dye every six weeks.

“That is a must,” said DeMoss, who declined to state her age. “I work with relocating people in a high-end luxury brand. I have to have a corporate or professional look.”

Her mother, who is 72 and plans to go to her grave with her gray covered, has been treated for breast cancer. Consequently, DeMoss said the new study cranked up her own anxiety.

“I definitely have been thinking about it because I would rather be healthy and live than look great and die,” she said.

On the other hand, she can’t imagine walking into her office with gray hair, even though she knows attitudes are changing. Her older sister, Traci DeMoss Byerly, has scored modeling gigs with her mostly salt with a little pepper Afro and wrote a book titled “Unapologetically Gray.”

Her hair started turning when she was 18, said Byerly, who is 52 and lives in Fort Worth. “People said, ‘You really should dye your hair; you’re too young for that.’ Guys would say, ‘You’re so beautiful, but you should do something about your hair.’ ”

Then one day she looked in the mirror and said to herself: “This is me. If a man cannot appreciate me in my natural state now, he never will.”

“I began to picture my gray hair as my tiara,” she said.

Regina Berenato Tell, 52, found her first gray hair at 19 and zealously covered it from 25 through 50. Then, rather than break a date with her hairdresser, she missed her best friend’s birthday party. That is when she realized she could no longer stand the thought of being stuck in a salon chair every three weeks.

Tell, who works as a stenographer on Capitol Hill, said letting the dye grow out hasn’t led to the ageism some professional middle-aged women fear.

“As a matter of fact,” she said, “I think people take me more seriously now.”

And it didn’t stop there. Although Carol suffered from coronary artery disease, severe osteoporosis, spinal compression fractures and unsteady balance, she didn’t want assistance. When Solie brought in aides to help after a bad fall and subsequent surgery, his mother soon fired them.

“In her mind, she considered it a disgrace to have anybody in her home,” Solie said. “This was her domain for over 50 years, a place where she did everything by herself and in her own way.”

Conflicts of this sort often threaten relationships between aging parents and their adult children just when understanding and support are needed the most. Instead of working together to solve problems, families find themselves feuding and riven by feelings of resentment and distress.

Solie got so worked up, he considered going to court and asking for a conservatorship – a legal arrangement that would have given him control over his mother’s affairs. (The situation was complicated because Solie’s brother, who has Down syndrome, lived at the family home.) But Solie’s lawyer advised that this course of action would destroy his relationship with his mother.

Today, Solie, a health-care consultant and writer with a well-regarded blog about aging, sounds the same theme when he consults with adult children caring for parents. Make preserving trust and keeping your relationship intact – not winning arguments – a priority, he says. What your parents most need is confidence that you’ll listen to them, take their concerns seriously and stay by their side no matter what happens, he says.

How adult children communicate with parents can go a long way toward easing tensions, Solie says. Instead of telling your parent what to do, ask how they would prefer to solve problems. Elicit their priorities and recognize their values when making suggestions. Give them choices whenever possible. Be attuned to their unexpressed needs and fears.

When Lee Lindquist, chief of geriatrics at Northwestern University’s Feinberg School of Medicine, asked 68 older adults in eight focus groups why they resisted help, the answers varied. They said they were afraid of losing their independence, becoming a burden on loved ones, being taken advantage of and relinquishing control over their lives.

Asked what might make a difference, the older adults said they liked the idea of “interdependence” – acknowledging that people need one another from childhood to older age. And they found it helpful to think that “by accepting help, they were in turn helping the person providing the help,” according to Lindquist’s study, published in the Journal of the American Geriatrics Society in August 2018.

Unfortunately, no amount of patience, compassion or forbearance will work in some conflict-ridden circumstances. But here are some of the lessons experts learned:

Be patient. Give your parents time to adjust. At first, Jane Wolf Frances’ 87-year-old mother, Lillian Wolf, wouldn’t consider moving with Jane’s father from New York to the Los Angeles area, where Frances, her only child, lived.

Although Lillian had Alzheimer’s disease and Frances had planned to give her one-story house to her parents, “I deferred to my mother’s fear that she was going to be losing something essential,” she said.

During three years of caregiving, Frances had learned to not rush her parents. She knew they had slowed down and needed time to process change.

So Frances waited until her parent’s home health aide called with concerns about their ability to live independently. After discussing the situation with their physician, Frances approached her mother again. A move to assisted living would be a fresh start, allowing the family to spend more time together, she said. After several conversations, her mother finally agreed.

Frances, a psychologist, is the author of a new book, “Parenting Our Parents: Transforming the Challenge Into a Journey of Love,” and founder of ParentingOurParents.org.

Stay calm when disagreements arise with your elderly parents and tamp down your emotional reactions, she tells families. Listen carefully to your parents’ concerns and let them know you’re trying to help them accomplish their goals, not impose your agenda.

“It’s often helpful to say to your parents: ‘I’m doing this for you. I’d like you to do something for me,’ ” Frances said. “People who are good parents perk up on that one and will ask, ‘OK, what can I do for you?’ Then, you can tell them, ‘You can let me help you more.’ ”

Let them know you’re on their side. Denise Brown was convinced her parents, Roger and Sally Loeffler, were making a terrible decision.

In the previous year, Roger, 84, had been diagnosed with bladder and prostate cancer and undergone extensive surgery. Sally, 81, had suffered three internal bleeds and had one-third of her stomach removed.

Brown didn’t think they could live on their own anymore, and her parents had moved into a retirement community upon her recommendation. But then, at a family meeting, her mother stood up and said: “I’m not dying in this dump. I hate it here.” As Brown and her siblings turned to their father, he said, “I’ll do whatever your mom wants.”

When her parents decided to move to an apartment, Brown was confrontational. “I raised my voice and said, ‘This is not good, this is terrible,’ ” she said. “They were shocked, but they said, ‘It doesn’t matter; this is what we’re going to do.’ ”

As Brown thought about her reaction, she realized she thought her parents would be safer and have a more “gentle” death in the retirement community: “Then it occurred to me – this wasn’t what my parents wanted. They valued their independence. It’s their decision about how the end of life plays out.”

Brown let her parents know she would respect their wishes but would need to set limits. Her work – Brown is the founder of CareGiving.com – had to be a priority, and her parents would need to arrange other assistance if she couldn’t be available. (Brown’s two brothers and sister help out.) And they’d have to be willing to talk openly about how their choices were affecting her.

What doesn’t work: trying to communicate when any one of them is tired or angry. “We never get anywhere,” Brown said. “Everybody gets defensive and shuts down.”

What does work: “Asking them questions like how do you think we should try to solve this problem? It’s interesting to hear their answers, and it makes working together so much easier.”

Stop expecting your parents to be as they used to be. After her father’s death, Loi Eberle was distraught when her mother, Lucille Miller, became involved with a man she and her siblings didn’t like. With his encouragement, Miller invested in real estate and lost a great deal of money.

But nothing Eberle or her siblings said could convince her mother that this relationship was destructive.

Eberle struggled with resentment and anger as her mother’s needs escalated after a heart attack and a diagnosis of myasthenia gravis, a severe neurological disease.

“Mom and I had this love/hate relationship all my life, and there was a huge need for healing in this relationship,” she said.

In 2012, Eberle moved Miller, then 89, from her longtime home in Minneapolis to a nursing home in northern Idaho, near where Eberle lives. Gradually, she realized that her mother “had transitioned to being someone else” – someone who was vulnerable and at her life’s end.

“I think for a long time I had this idea that I was going to help Mom come back to who she was, and I spent a lot of time trying to do that,” Eberle said. “I finally had to forgive myself for failure and understand that this is the life process.”

With this shift in perspective, emotional tension dissipated.

“When I’d visit, my mother was always so happy to see me,” Eberle said. Miller died in March 2017 at 94.

Letting go of unrealistic expectations can defuse conflicts.

This is the final stage of your journey with your parents. Try to put angst to one side and help make this time meaningful for them and for you. Most of all, your parents want to feel emotionally connected and accepted, even in a diminished state.