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A pediatrician's dilemma: Should a practice kick out unvaccinated kids?

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A pediatrician's dilemma: Should a practice kick out unvaccinated kids?

Orange County pediatrician Dr. Eric Ball still feels guilty about the Disneyland measles outbreak of 2014.

At the time, his office allowed children whose parents refused to vaccinate them to still remain as patients. Many took advantage of the policy, leaving the children in his practice well below the 95% threshold that experts say is needed to achieve herd immunity. In the end, a single measles case at the theme park spread to 145 people across the country; several were part of his practice.

“I was traumatized,” said Ball. “I felt that like we didn’t do enough as a practice, and I didn’t do enough as a pediatrician, to convince families to get vaccinated.” Not only were the children of his anti-vaccine parents left vulnerable to the measles, but they had also exposed other children in his waiting room who couldn’t receive the vaccine because they were too young or immunocompromised.

Noah, 9 months old, sees Dr. Eric Ball at Southern Orange County Pediatric Associates in Ladera Ranch in 2024.

(Christina House/Los Angeles Times)

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As a doctor, Ball felt torn: He had a moral obligation to care for all his patients, regardless of their parent’s vaccine choices. But he also had a duty to protect his other patients, as well as the rest of the community, from a deadly virus that was almost entirely preventable.

With another measles outbreak continuing to spread in Texas and New Mexico — bringing the first two U.S. measles deaths in a decade — and eight cases already in California this year, physicians are again facing a moral quandary: Should they refuse to see families who don’t want to vaccinate their children, or keep them in their practices in the hopes of changing their minds?

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After the Disneyland outbreak, the doctors at Ball’s practice decided to crack down. In 2015, they instituted a new policy: Southern Orange County Pediatric Associates would no longer accept patients who did not plan to immunize their children. Existing patients who didn’t want to vaccinate would need to find a new doctor.

A growing trend of dismissing unvaccinated patients

“Dismissal” policies were once discouraged by the medical establishment, both because pediatricians have a duty to care for all their young patients, and because some anti-vaccine parents can be convinced over time to change their minds.

But in 2016, the American Academy of Pediatrics came up with new guidance: Vaccines against preventable diseases like the measles were so important that if, after repeated attempts, a pediatrician couldn’t convince a parent to get their child immunized, a practice could righteously kick them out.

“I think that made a big difference to a lot of us. It gave us cover,” said Ball.

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Since then, dismissal policies have grown much more popular.

In 2013, some 21% of pediatricians reported that they often or always dismissed families who refused vaccination, according to a survey published in the journal Pediatrics. By 2019, the share had grown to 37%; the 2019 survey, published in the Journal of the American Medical Assn., also found that just over half of pediatricians said their office had a dismissal policy in place.

For families that seek to spread out vaccines with an alternative schedule, dismissals are much less common: just 8% of individual pediatricians reported often or always dismissing these families, while 28% reported that their office has such a dismissal policy, according to the academy.

Dismissal policies are much more common among private practices. Academic medical institutions, including UCLA, large health systems like Kaiser Permanente, rural clinics and safety net systems for low-income patients generally accept all patients, regardless of whether the parents intend to vaccinate their children. Cedars-Sinai Medical Center is an exception and discourages pediatricians in their clinics from treating unvaccinated patients.

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The question of whether to dismiss has become increasingly pressing amid growing anti-vaccine sentiment and a decline in coverage. The proportion of kindergartners nationwide who completed their measles, mumps, and rubella vaccine series dropped from about 95% — the federal coverage target — before the pandemic to less than 93% last school year.

In California, 96.2% of kindergartners were fully vaccinated against the measles in the 2023-24 school year, a slight decline from the year before.

“No matter what your policy, you feel ethically justified,” said Dr. Sean O’Leary, a professor of pediatrics at the University of Colorado Anschutz Medical Campus, who co-wrote the American Academy of Pediatrics’ latest guidance on vaccines. In January, the New England Journal of Medicine presented arguments on both sides of the debate, with O’Leary writing a statement in favor of accepting unvaccinated patients. “I personally understand both sides.”

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Why doctors dismiss vaccine-hesitant families

These days, many pediatric practices are upfront about their policies, and some announce it on their website, letting prospective patients know to stay away if they don’t want to vaccinate.

At Larchmont Pediatrics, for example, Dr. Neville Anderson requires all patients to be vaccinated. If parents refuse to vaccinate their infants after a final conversation at the 3-month visit, the practice sends them an official dismissal letter.

A doctor in front of  an upper-story office window.

Dr. Neville Anderson is photographed in between vaccinating young patients at Larchmont Pediatrics in Los Angeles on Tuesday.

(Allen J. Schaben / Los Angeles Times)

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“If a parent is truly anti-vax and does not want to vaccinate their child, our values and our goals and our beliefs are so antithetical to each other that we’re not a good team,” said Anderson. “I’m not the right doctor for them, and they’re not the right patient for me.” Larchmont dismisses only one to four patients each year, she said, since most anti-vaccine families know their reputation and tend to go elsewhere.

But for some patients, the dismissal policy is a real draw. “We get a lot of people who will come to us because we have this policy and we enforce it,” said Anderson. “They’re afraid of bringing their 7-month-old into a waiting room where there’s an unvaccinated child.”

Doctors should make every effort to convince a family to vaccinate before dismissing them, said Dr. Jesse Hackell, a retired pediatrician in New York who also co-wrote the pediatric academy’s report on improving vaccine communication. The problem, he said, is that these conversations are time-consuming and unpaid for busy pediatricians who often only have 20 minutes with a patient. “It’s frustrating, and it’s one of the issues that leads to moral injury and burnout.”

Hackell, 74, remembers a time before vaccination, when many of his young patients ended up hospitalized with measles and other vaccine-preventable diseases. “I don’t want to ever go back to those days of worrying about the 2 a.m. phone call about a kid with 105-degree fever. That’s that’s not good for me as a physician. It’s not good for the kid or the family.” His practice had a dismissal policy long before the pediatrics academy said it was acceptable.

One ethical argument in favor of dismissing is based on parents having a moral obligation to vaccinate their children to reduce the risk of infecting others, said Dr. Doug Opel, a bioethicist and professor of pediatrics at the University of Washington School of Medicine.

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Another point is that “vaccination is viewed as a social contract,” he said. “So it’s not fair to share in the collective benefits of vaccination without accepting the small burdens of vaccination by getting your child vaccinated themselves.”

1 Dr. Neville Anderson and nurse Breanna Kirby with a young patient Iris Behnam, and mother Haley Behnam.

2 Dr. Neville Anderson, Perry Roj, 4, and Breanna Kirby gives her DTap Polio vaccination while her mom, Devin Homsey holds her.

3 Dr. Neville Anderson, Arlo Vasquez, 7 months-old, held by his mom Christa Iacono, not pictured, at Larchmont Pediatrics.

1. Dr. Neville Anderson, right, tries to cheer up Iris Behnam, 4, while nurse Breanna Kirby, left, gives her DTap Polio and MMR Chickenpox (Varicilla) vaccinations while her mom, Haley Behnam, holds her. 2. Dr. Neville Anderson, right, tries to distract Perry Roj, 4, while nurse Breanna Kirby, left, gives her DTap Polio vaccination while her mom, Devin Homsey holds her. 3. Dr. Neville Anderson, left, with Arlo Vasquez, 7 months-old, held by his mom Christa Iacono, not pictured, while getting a flu, Covid, Hepatitis B vaccinations at Larchmont Pediatrics. (Allen J. Schaben / Los Angeles Times)

The moral case for accepting vaccine-hesitant families

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Opel said that, as a bioethicist, he comes down on the side of keeping families in a practice.

“In what other area of medicine even do we expect patients or parents to hold the same values and beliefs that we have?” he asked. “Instead, we approach differences with humility and respectfully explore those values as a way to find common ground and shared understanding.” Opel said about 30% of parents do end up changing their mind. “Vaccine hesitancy is a modifiable behavior.”

O’Leary said there is also little evidence that accepting unvaccinated children leads to the transmission of vaccine-preventable illnesses in an office setting. And it isn’t clear whether the threat of dismissal actually convinces parents to get vaccinated, or whether patients who get kicked out of a practice end up finding other sources of care.

ln San Diego County, Children’s Primary Care Medical Group — a large practice with 28 offices in the region — has a policy of accepting all patients, regardless of vaccination status.

“The basic philosophy is it’s not the kids who refuse, it’s the parents. And we don’t punish kids for the decisions of the parents,” said Dr. Adam Breslow, the group’s president and CEO.

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About 90% of the group’s patients are vaccinated on schedule, Breslow said. Of the 2-3% who refuse all vaccinations, most come from wealthier areas where parents can afford to homeschool or send their children to private school. He said it’s rare that he’s able to convince them to vaccinate in a single office visit, but over the course of several years in his practice, some parents do eventually change their minds.

“By keeping them in the practice, there’s a chance they’re going to get vaccinated,” said O’Leary. “But if you kick them out, who knows what’s going to happen?”

Where do parents who don’t vaccinate kids go?

Widespread dismissal policies can make it difficult for vaccine-hesitant families to find regular sources of care. In local Facebook groups, parents often exchange tips about practices that are more tolerant of spreading out or refusing vaccines.

Some advise using concierge practices, which charge thousands of dollars in annual fees on top of insurance payments but may allow more flexibility with vaccination schedules. Some of these practices offer unproven alternatives to vaccination with little or no evidence to back them up.

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Whitney Jacks, a mother in Escondido, recently posted in a moms group on Facebook for help finding a new pediatrician who would accept her preference to limit vaccines. With her older child, who is 7, she used to pay for a concierge doctor in Maryland whom she saw over Zoom. But her son doesn’t have a regular pediatrician and therefore skips his annual well visits, though he does see a specialist several times a year.

Now pregnant with her second child, she was hoping to find someone local who would accept her insurance and support her decision to wait until the baby turns 2 before starting vaccinating.

Other moms in the Facebook group were hesitant to share the names publicly for fear that the doctors could get into trouble, she said, preferring to direct message her instead. One mom sent her a list of names, which she used to set up meet-and-greet appointments with the four closest to her home.

But as she began to meet with them, one after another gave her the same response: “We won’t kick you out, but we don’t like this,” said Jacks, who is an acupuncturist. “So they’re already putting it at you that they disapprove of your point of view.” None made her feel welcome.

She picked the most convenient office. But Jacks worries that every visit will focus on vaccination instead of other issues like feeding and sleeping that are important in the first years.

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“It doesn’t give me any confidence or faith in the provider.”

This article is part of The Times’ early childhood education initiative, focusing on the learning and development of California children from birth to age 5. For more information about the initiative and its philanthropic funders, go to latimes.com/earlyed.

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Hantavirus strikes a cruise ship, Californians at risk: Is this the start of something much worse?

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Hantavirus strikes a cruise ship, Californians at risk: Is this the start of something much worse?

The voyage was marketed for explorers eager to venture to “the edges of the map,” from Antarctica to some of the most remote islands in the world.

It would be a tantalizing trip for tourists with an appetite for adventure — less about trips to the spa and lounging by the pool than a chance to see landscapes few humans have ever laid eyes upon.

But this call of the wild was ultimately among the factors that turned the MV Hondius into the epicenter of the first-ever deadly outbreak of hantavirus aboard a modern cruise ship. Eleven cases have been linked to the outbreak so far. Three people are dead, and two others are in intensive care.

The incident — with a few uncomfortable echoes of the onset of the COVID-19 pandemic — has sparked concerns and questions. Chief among them: Was this a freak occurrence, or a sign of things to come?

“I think it’s both,” said Dr. Peter Chin-Hong, an infectious diseases expert at UC San Francisco.

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Hantavirus had previously been an obscure illness. Typically spread through exposure to infected rodents’ urine and droppings, it’s notoriously difficult to diagnose and has no specified antiviral treatment. It was definitively identified relatively recently, in a field rodent near the Hantan River in South Korea in 1978, and finally explained the mystery cause of the “Korean hemorrhagic fever” that infected thousands of United Nations troops during the Korean War.

Though rare, the disease has drawn attention in the U.S. over the decades due to its incredibly high case-fatality rate: up to 50% among the strains that circulate in the Americas.

Western Hemisphere hantavirus strains are so deadly because they can attack the lungs and make them leak. The strains that circulate in Asia and Europe — where hantavirus is more common, and generally less deadly — attack the kidneys.

Those who are severely ill can only be treated by putting them on life-support machines that directly add oxygen to their blood.

Despite its severity, the overall impact of the disease in the Americas has remained muted for two main reasons. First, most strains of hantavirus do not spread directly from person to person. And second, many people will not come into contact with rodents carrying the virus during their daily lives.

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Excursions that attract people like those aboard the MV Hondius, however, blur the second line. Launched in 2019, the ice-strengthened vessel offered passengers opportunities for “maximum contact with the nature and wildlife you traveled so far to see,” according to its operator, Oceanwide Expeditions.

“The broader pattern is definitely not random,” Chin-Hong said, “which is more expedition tourism visiting remote areas.” Climate change, he added, is also increasing the range of certain infectious diseases.

“The hantavirus in the cruise ship is unprecedented, and reflects kind of like a perfect storm of the expedition cruise through a remote area, environmental exposure potentially during a short excursion, and the hantavirus — this particular Andes virus — being capable of going from person to person,” he said.

The Andes virus, which circulates in Argentina and Chile and is mainly spread among the long-tailed pygmy rice rat, is the only hantavirus strain known to be able to transmit from human to human.

Such inter-person spread occurred previously in a deadly outbreak in Argentina. From November 2018 through February 2019, the Andes virus infected 34 people there, killing 11, according to a study in the New England Journal of Medicine.

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There were 149 passengers and staff aboard the MV Hondius when the ship publicly disclosed that three of its passengers had died. Of the 18 U.S. citizens on the ship, one passenger initially tested positive for hantavirus overseas but also got a negative test result; a follow-up test is now being done in the U.S., and results are expected in a day or so, Dr. David Fitter, incident manager for the Centers for Disease Control and Prevention’s hantavirus response, told reporters in a briefing Wednesday.

That patient, who is not ill, is being monitored at a biocontainment unit at the University of Nebraska Medical Center.

Five California residents have been potentially exposed to the virus — four aboard the cruise ship, and the fifth while on a plane with an infected person in South Africa. All five are asymptomatic and appear healthy, the California Department of Public Health said Wednesday.

Most infected people actually don’t seem to spread the Andes virus, Chin-Hong said. But some do end up being “superspreaders,” infecting others at exceptional rates.

That’s what happened in 2018-19. A single person got the Andes virus from a rodent, and the outbreak was spread mainly by three sick people who attended crowded social events, the medical journal study said — including a birthday party and a wake for one of the hantavirus victims.

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In the case of the MV Hondius, the first person believed to have contracted the hantavirus was a man from the Netherlands who was possibly exposed to rodents while bird-watching prior to boarding the ship before it left for its transatlantic journey, according to authorities. He had spent the prior three months traveling through Argentina, Chile and Uruguay, the World Health Organization said. The man boarded the ship on April 1, developed symptoms on April 6 and died on board on April 11.

“At present, the thought is that it was an ornithologist who was visiting a dump, where many rare birds congregate, and was exposed to a rodent that was in the garbage dump,” said Dr. Elizabeth Hudson, regional physician chief of infectious diseases for Kaiser Permanente Southern California.

From there, she said, the realities of cruising at sea set the stage.

“Cruise ships are a perfect environment for the spread of infectious diseases, unfortunately,” Hudson said. “You have a population of people who are living together in a relatively small and confined space, with most folks spending a good part of their time indoors eating and socializing. This means that if there’s an infection that can spread easily from person to person, the very nature of the cruise ship allows this to happen more readily.”

It can also be difficult to isolate sick people aboard a cruise ship. The MV Hondius’ doctor fell ill with hantavirus, as did another crew member who was working as a guide. Among the symptoms people reported were gastrointestinal illness, fever, general malaise, pneumonia, fatigue, aches and respiratory symptoms.

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Extensive spread of the hantavirus outbreak is not expected, health experts say. Unlike COVID-19, the Andes virus is much harder to transmit from person to person.

In past outbreaks of the Andes virus, taking steps like isolating people who are sick — and asking those who aren’t sick but have been exposed to stay away from others — have brought outbreaks to an end.

It can take up to six weeks from the time a person has been exposed to the virus to the onset of illness. That “takes us to the 21st of June,” WHO Director-General Tedros Adhanom Ghebreyesus said at a news briefing Tuesday. “WHO’s recommendation is that they should be monitored actively at a specified quarantine facility or at home for 42 days from the last exposure.”

One Californian who was on the MV Hondius, but left the ship before the hantavirus outbreak was discovered, is back home in Santa Clara County and remains healthy. That person is being asked to limit trips outside the home during the 42-day period to see if they become ill, according to Dr. Erica Pan, director of the California Department of Public Health.

Another Californian, from Sacramento County, is also back at home after sitting within a couple of seats of a hantavirus-infected passenger who was briefly on a flight from South Africa to the Netherlands before being asked to deplane due to her illness. The Californian remains healthy, but is also being asked to limit activities with others.

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“They’re not to share a bed with someone else. … They shouldn’t attend social events, and they should not visit any crowded venues,” Pan said.

Two other Californians who were on board the MV Hondius are healthy and are being observed at the University of Nebraska Medical Center’s National Quarantine Unit, the only federally funded quarantine unit in the U.S. Thirteen others are also being observed there, while two are at Emory University in Atlanta.

The California Department of Public Health said it didn’t know when the Californians in Nebraska would return home.

California health officials Wednesday said that there was a fifth state resident who was potentially exposed to the hantavirus. That person left the cruise ship, returned briefly to California, then left for additional travel, all before the outbreak was announced.

That person, who remains healthy, is now in the remote Pitcairn Islands in the south Pacific Ocean — halfway between Peru and New Zealand.

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Despite concerns surrounding this latest outbreak, the Andes virus is considered a poor candidate to become the next pandemic. One thing that makes COVID spread so easily is that people can infect others even if they’re not personally experiencing symptoms.

With COVID, people could get sick just by breathing in aerosolized viral particles floating around and pushed across an entire room by an air conditioning vent.

With the Andes virus, by contrast, people probably need to be symptomatic to spread illness.

The 2018-19 Andes virus outbreak in Argentina also showed that close contact is needed for transmission, including “being seated very close” to the sick person, Chin-Hong said.

Those at highest risk of getting hantavirus from another human have “some direct exposure to bodily fluids,” Pan said.

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The first U.S. case of Andes virus actually occurred in January 2018, in a woman who had stayed in cabins and youth hostels in the Andes region of Argentina and Chile. She did not infect anyone else after her return despite taking two commercial flights in the U.S. when sick and before she was hospitalized in Delaware. She eventually recovered at home.

More morbidly, health experts note, the Andes virus is also too deadly for it to spread rapidly in a pandemic situation.

So why are we seeing this outbreak now?

Hantavirus appears to be expanding its range in Argentina. A report published in December noted that hantavirus’ range in that country was moving southward.

“This redistribution indicates either ecological shifts affecting rodent reservoir populations, increased human encroachment into previously untouched habitats, or improved surveillance detecting cases in areas with lower historical awareness,” said the report, published by the Biothreats Emergence, Analysis and Communications Network, or BEACON, based at Boston University’s Center on Emerging Infectious Diseases.

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From mid-June through early November, there were 23 confirmed cases in the country, with nine deaths. No human-to-human transmission was reported during that time period.

Another report suggested changing temperatures and rainfall also affected hantavirus transmission in Argentina.

Another well-documented example of that phenomenon is the rise of dengue viruses in Argentina, which are spread by mosquitoes. Rising temperatures are making the climate more suitable for transmission, one study suggested.

“Climate change has definitely had an impact on Argentina,” Chin-Hong said. “As it gets warmer, you potentially have more rats.”

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5 Great Stargazing Trains

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5 Great Stargazing Trains

Stargazing, it turns out, doesn’t have to be a stationary activity.

On railway lines around the world, from the Arctic Circle to New Zealand, a select set of evening train excursions take riders deep into dark-sky territory — some en route to remote station stops decked out with telescopes, others featuring onboard astronomers.

These five rail journeys (all of which are accessible) range from two- to three-hour desert outings to a hunt for the northern lights. One route even has a planetarium on rails. All promise a renewed appreciation of train travel — and of our pale blue dot’s improbable place in the cosmos.

Nevada

Any stargazing train worth its salt requires one thing: a dark sky. The Star Train resoundingly checks that box, traveling through a part of eastern Nevada that is one of the least-populated places in the lower 48.

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Run by the Nevada Northern Railway in partnership with nearby Great Basin National Park, the train departs the historic East Ely Depot, in Ely, Nev., early enough in the evening to catch the sunset over the Steptoe Valley, and then cruises through darkening skies to its destination: a remote corner of the desert appropriately called Star Flat, where a stargazing platform outfitted with telescopes awaits. There, riders disembark (equipped with red-light necklaces to help preserve their night vision) and take turns viewing the cosmos, guided by professional astronomers. (Last year’s onboard stargazing guides came from Caltech; in previous seasons, the National Park Service’s Dark Rangers, who specialize in night-sky activities, accompanied trips.)

The Star Train makes its two-and-a-half-hour round-trip journey most Friday evenings between mid-May and mid-September, and tickets ($65 for adults) can sell out almost a year in advance — though members of the Nevada Northern Railway Museum get early access. Alternatively, the railroad’s more frequent Sunset, Stars and Champagne excursions trade telescopes for desert sundowners but feature the same expert stargazers and the same Nevada night sky, which is often dark enough to see the Milky Way with the naked eye.

New Mexico

While plenty of heritage railroads across the United States offer twilight rides and nighttime excursions, at the moment there’s only one other dedicated, regularly scheduled stargazing train in North America besides the Star Train: the Stargazer, operated by Sky Railway, in Santa Fe, N.M.

Much like its Nevada counterpart, the Stargazer makes a two-and-a-half-hour round trip through dark-sky country, though in this case, the journey really is the destination, because it doesn’t make any stops. More of a rolling night-sky revue, the Stargazer features live music and professional astronomers who share their celestial knowledge and stories as the train rumbles into the vast Galisteo Basin south of Santa Fe. Sky Railway’s colorfully painted trains feature heated, enclosed passenger cars to stave off the evening chill and flatbed cars open to the night sky.

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Departing from the Santa Fe Depot downtown, the train normally runs once a month (adult tickets from $139, including a champagne welcome toast). Sky Railway also occasionally schedules excursions for special celestial events.

New Zealand

With its alpine landscapes and rugged coastline, New Zealand’s South Island is practically tailor-made for scenic daytime train journeys. But when night falls, the sparsely populated island — home to the Southern Hemisphere’s largest International Dark Sky Reserve — is heaven for stargazers, too.

This year, Great Journeys New Zealand, which operates the country’s tourist-centric long-distance trains, is offering a special nighttime run of the Coastal Pacific, whose route skirts the South Island’s northeastern coast. Timed to Matariki, the Maori new year, which is heralded by the first rising of the Pleiades star cluster, the eight-hour round trip from Christchurch is a cultural and astronomical celebration.

After the first half of a four-course onboard dinner, the train arrives in Kaikoura, in dark-sky country, for a guided stargazing stop with a range of telescopes — and fire pits and a night market. (The rain plan involves a virtual stargazing session at the local museum using virtual reality headsets.) Dinner resumes back on the train as it returns to Christchurch. This is a strictly limited engagement, on the rails for one night only: July 11, for 499 New Zealand dollars, about $295, per person.

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In the far northern reaches of Norway, inside the Arctic Circle, you can ride a train that chases another wonder of the night sky: the aurora borealis. Twice a week from October to March, the Northern Lights Train takes its riders into the dark polar night in pursuit of the aurora’s celestial light show.

From the remote town of Narvik, the train travels along the Ofoten Railway, the northernmost passenger rail line in Western Europe. The destination on this three-hour round-trip excursion (1,495 kroner, or about $160) is Katterat, a mountain village accessible only by rail and free of light pollution, making it an ideal place to spot the aurora. At the Katterat station, local guides and a campfire cookout await, as does a lavvu, the traditional tent used by the Sami people of northern Scandinavia, offering a respite from the cold (as well as hot drinks and an open fire for roasting sausages).

And aboard the train, the lights stay off, which means that on a clear night, you might even catch the northern lights on the way there and back.

Leave it to Japan to take the stargazing train to another level.

The High Rail 1375 train — so named because it runs along Japan’s highest-elevation railway line (the high point is 1,375 meters, or roughly 4,500 feet, above sea level) — is one of JR East’s deliberately unhurried Joyful Trains, which the railway company describes as “not only a means of transportation, but also a package of various pleasures.” This astronomy-themed train certainly packs plenty of joy into its two cars, with seat upholstery inspired by constellations, a snack bar, a souvenir shop and a planetarium car with a library of astronomy books and images of the night sky projected onto its domed ceiling.

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The train makes two daytime runs along the mountainous Koumi Line, taking a little over two hours to travel between Kobuchizawa (accessible by express train from Tokyo) and Komoro. But the main event is the High Rail Hoshizora (“Starry Sky”) evening trip, which includes an extended stop at Nobeyama Station (the highest in the country) for a guided stargazing session. A one-way ride on High Rail 1375, which runs on weekends and occasional weekdays, requires a seat reservation if you’re traveling on a Japan Rail pass, or a stand-alone ticket plus seat reservation (2,440 yen, or about $15). And remember to preorder a special “Starry Sky” bento box.


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A Physicist Who Thinks in Poetry from the Cosmic Edge

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A Physicist Who Thinks in Poetry from the Cosmic Edge

Much of the praise for Chanda Prescod-Weinstein’s debut book in 2021, “The Disordered Cosmos: A Journey Into Dark Matter, Spacetime, and Dreams Deferred,” lauded the way she used personal experiences in physics to discuss the social and political inequities that exist alongside scientific breakthroughs.

“It contains the narrative of dreams deferred,” Dr. Prescod-Weinstein, a physicist at the University of New Hampshire, explained in April at a bookstore in Chicago. But its very existence, she said, also “represented a dream deferred, because that was not the dream of what my first book was going to be.”

Her second book reclaims that dream. Released on April 7, “The Edge of Space-Time: Particles, Poetry, and the Cosmic Dream Boogie” is less pain and more play, a homage to the big questions that made Dr. Prescod-Weinstein want to become a physicist in the first place. She begins the book by asserting that it is humanity’s duty to uncover and share the story of our universe. Her latest offering toward that duty is a journey through physics that is tightly bound to her own cultural roots.

In the midst of a multicity book tour, Dr. Prescod-Weinstein spoke with The New York Times about guiding readers through the cosmos from her own point of view and about some of the art, poetry and literature she drew on to shape that journey. This conversation has been edited for brevity and clarity.

Why include so many references to poetry in a book about physics?

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I knew poetry before I knew physics. It was part of my upbringing. I loved A.A. Milne’s “Now We Are Six” and Edward Lear’s “Nonsense Limericks.” Both of my books draw their subtitles from Langston Hughes’s “Montage of a Dream Deferred.”

Adrienne Rich’s poem “The Burning of Paper Instead of Children” became a guiding light for how my work would move in the world. It also opened up for me that I need language. That’s true among physicists. Even an equation is a sentence; even an equation is telling a story.

As physicists, we’re always working in language to connect what we learn with what we know. Poetry is one of the first places that my brain goes to draw those links. Language, as it moves in my brain, is often in Hughes and Rich and Shakespeare. Those are the lines that flicker up for me.

What if we got away from the argument that doing cosmology and particle physics is practical or materially valuable? Then we have to accept that we’re like the poets. What we do is important culturally in the same way poetry is. A piece of this book is me saying there is value in banding with the poets, and fighting for the value of being curious and trying to articulate the world with whatever tools are available to us. Not for the purposes of selling something, but for the purpose of fulfilling our humanity.

Another theme throughout the book is the story of Lewis Carroll’s Alice and her adventures in Wonderland.

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Being a science adviser on future installments in The Legendborn Cycle, a fantasy series written by Tracy Deonn, is one reason Alice is in my book. It has allowed me to be open to the playful side that physics, as a Black queer person, can take from you. I wanted the book to be whimsical, because that’s who I was when I first arrived in physics, and that’s who I want to be when I die.

Part of the call of quantum physics is to change what our sense and sensibility are. When you look at the world through this framework — like the idea that particles have spin but don’t really spin — it sounds like nonsense. Except that’s literally how the universe works. Physics is our “through the looking glass.” It’s real.

Your first chapter invites readers to reflect on the metaphors used to describe the universe, like the “fabric” of space-time or electromagnetic “fields.” Why open in this way?

A lot of books about quantum physics start with its history. I wanted as much as possible not to just do that. I had actually planned to start it with the Stern-Gerlach experiment of 1922. But then I read an essay by the poet Natasha Trethewey about abiding metaphors and started to ask myself what the abiding metaphors of my physics training were.

We don’t ever take time in our classes to ask, “What do we mean when we say ‘space’? What do we mean when we say ‘space-time’?” There are these metaphysical questions that I often told myself were for the philosophers. This book was me letting myself think of them as physics.

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One metaphor you invoke is the “edge” — not only the edge of the universe and of scientists’ understanding, but also existing at the edge of certain identities.

In “Disordered Cosmos,” I talked a lot about being at the margin and looking toward the center. With “The Edge of Space-Time,” I’m choosing to make the margin the center of the story. Part of that was me fully embracing what makes me the physicist I am. I’m an L.A. Dodgers fan. I love “Alice in Wonderland.” I love “Star Trek.” There’s lots of all of that in the book.

Picking a metaphor is a culturally situated decision. I wrote a line that says black holes are the best laid edges in the universe. I did, at some point, think that only some people were going to get this. But for people who don’t understand the reference to Black hairstyles, the sentence is still legible. And for those who do, it will feel like we just had an in-group moment. Anyone who thinks about laying their edges deserves to have an in-group moment in a physics book. Because we are physics, too.

Black students are often told that if you want to be a physicist, then you will make yourself as close to such-and-such mold as possible. At a young age, we have this understanding that whiteness and science are associated with each other, but we are also witnessing in ourselves that this can’t be entirely correct. There’s this narration of, “Well, sure, you can be Black in physics, but that means you have to acclimate to the ‘in physics’ part, and never that physics has to acclimate to the Black part.”

I use the example of rapper Big K.R.I.T.’s song “My Sub Pt. 3 (Big Bang),” in which someone tries to wire up subwoofers in his car but fries the wires because he doesn’t ground them properly. I don’t know if Big K.R.I.T. would think of this as a science story, but I think we should learn to read it as one. Not to contain it in science, but to say it overlaps there. This can be a rap song. It can be about the cultural significance of subwoofers and the Big Bang as a metaphor for the beat. And it can also be about cosmology and about how everybody who wires up cars or does this kind of work is a scientist, too.

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How do you want readers to approach this book?

There is this feeling that you’re supposed to read a book like this and walk away an expert. That’s actually not the point of this book at all. The point is to wander through physics. Even if math terrifies you, you are entitled to spend some time with it.

And so here, I have made you a book with a bunch of tidbits on the oddities of the universe. The universe is stranger and more queer and more wonderful and more full of possibility than whatever limitations you might be experiencing right now. Physics challenges what we are told are social norms. For example, non-trinary neutrinos are fundamental to our standard model of physics.

“Non-trinary,” as in they shift between three different forms.

Non-trinary is natural. It’s such a challenge to the current anti-trans rhetoric that says people can only ever be one thing.

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I don’t need my book to be the most important thing that someone reads. But I want it to be a source of hope. If it reminds you that, as my mom says, the universe is bigger than the bad things that are happening to us, then that’s all you need to remember. I’m good with that.

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