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Health

Six Exercises to Help Avoid Slipping and Falling Down

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We typically train to go faster. But mastering how to slow down and stop is just as important.

Training deceleration—a series of movements that help you slow down, change direction, or stop—teaches the body how to control and safely absorb forces. For athletes like rugby players and soccer players who are constantly accelerating from zero to 100 then stopping on a dime, proper deceleration enhances performance and is key to mitigating injury. 

Being able to decelerate with control is just as valuable for nonathletes, says

Sylvia Braaten,

physical performance coach for USA Rugby women’s national team. 

“As we age, there is a tendency to lose our coordination, athleticism and body control,” says Ms. Braaten, who also serves as the assistant coach for Harvard University’s women’s rugby team. “If you can’t slow down with proper body mechanics while chasing your grandchildren in the yard or playing a pickup basketball game, injuries are more likely to occur. But, if we continue to train these qualities, we can remain athletic and that can have a lasting impact on our overall quality of life.” 

Being able to slow down to regain our balance is extremely helpful in the winter, when sidewalks and driveways are icy. “Improving coordination and deceleration mechanics can help us catch ourselves when we start to fall,” she says. And more than one out of four people ages 65 and older falls each year, according to the Centers for Disease Control and Prevention.

The following drills will reinforce deceleration mechanics, such as dropping the hips and shoulders as you slow down and keeping weight predominantly over the planted foot when you change direction. They are also a fun way to mix up your workout with multiplanar movements and balance and agility challenges, she says. 

Start slow and focus on proper technique and landing in a controlled and stable position, she says. “It is better to perform fewer reps and sets with proper form.” 

Reverse Eccentric Lunge

Why: Eccentric strength training, where the lowering phase of an exercise is slowed down to keep the muscles under tension for a longer period of time, is a great way to build strength, says Ms. Braaten. This lunge variation forces us to control the lowering motion while working the glutes and hamstrings.

How: Stand with your feet hip-width apart. Step your left foot backward and slowly lower your body for a count of 3 to 5 seconds, until the right thigh is parallel to the floor, knee over your shoe laces. Your torso and shin of the front leg should be parallel. Pause for 1 second then press into the heel of your front foot to come back up to the starting position for a count of 1 second. Perform 3 sets of 5 reps per leg. Rest 1 to 2 minutes per set.

Option: Hold weights for an added challenge. 

Ms. Braaten performs a reverse eccentric lunge.

Drop Lunge Snap Down

Why: The additional speed component of this exercise increases the intensity of the lunge and more closely mimics the demands of movements in a rugby match and real life, she says.

How: Stand tall on your tiptoes with arms overhead. Rapidly drop into a reverse lunge with your front foot flat and on the ball of the back foot, with your heel raised. Use a quick and sharp arm drive down toward the floor to help increase the speed of the drop. “Think about transitioning from fast to freezing like a statue,” she says. Slowly rise to the starting position. Perform 2 to 3 sets of 3 reps per side. Rest 30 seconds between sets.

Options: If your balance is difficult, start on flat feet and progress to tip toes. Add weights for more difficulty. 

Ms. Braaten does a drop lunge snap down.

Two-Step Falling Deceleration

Why: Being able to safely stop a fall is key to mitigating injury. This drill teaches the body to decelerate while building single-leg strength.

How: Stand tall, with feet hip-width apart. Begin to fall forward with a tall spine. Use two steps to stop. The first step is used to break and the second step is the stick or the leg to decelerate on. Landing on the full foot will help increase balance and allow for a quicker, more efficient deceleration. As you step to break, avoid any inward collapse of the knee. Perform 2 to 3 sets of 3 reps per side. Rest 30 to 45 seconds between sets.

Options: Have a friend stand in front of you as a spot or perform this exercise near a wall.

Ms. Braaten demonstrates how to perform a two-step falling deceleration.

Lateral Rebound Skater Jump

Why: Our body moves in different planes of motion. This drill trains single-leg deceleration in the frontal or side-to-side plane and improves our ability to absorb force.

How: Stand tall, balanced on your left foot. Sink your hips back to load your weight then push and powerfully jump off of that foot to the right. Swing the arms across the body for momentum as you jump. Land balanced on the right foot with a slight bend in the knees and hips.

“The emphasis should initially be on sticking the landing rather than on the distance of the jump,” she says. Reset for the next rep by hopping back to the left leg and repeating the movement. Perform 2 to 3 sets of 4 reps per side. Rest 30 to 45 seconds between sets.

Option: After you are able to consistently stick the landing, you can speed up the tempo to increase the difficulty and intensity for added cardio benefits. 

Ms. Braaten does a lateral rebound skater jump.

Deceleration With a Half Turn

Why: This exercise trains agility, coordination and balance. Great for weekend warriors playing cutting sports like basketball or soccer, the deceleration-with-a-half-turn drill reinforces getting into good deceleration positions from a run, she says.

How: Jog forward and after 10 to 15 feet, decelerate by dropping your shoulders slightly to the right and over the inside of your hips. As your right foot plants, complete a half turn to the right. Stop in an athletic ready stance with soft knees and torso and shins parallel. Stick and hold the position before jogging forward 10 to 15 feet again and decelerate in half-turn position to face the left. Alternate half turns to each direction for a total of 3 half-turn decelerations on each side. Perform 3 to 4 sets. Rest 30 to 60 seconds between sets. Increase the pace of the jog to a run to progress.

Ms. Braaten demonstrates the deceleration-with-a-half-turn drill.

Zigzag Tempos

Why: After the above exercises helped strengthen your deceleration positions, this drill will help improve your ability to get in and out of those positions and make you more agile, she says.

How: Place 6 to 8 cones or markers each about 10 to 15 feet apart in a zigzag pattern to get in 3 to 4 decelerations per side. Start at one cone and run at a controlled pace to the next. Decelerate by bending into the knee and flexing at the hip of the planted foot while maintaining a tall spine. Push down into the planted leg to push away from the cone and run to the next one. Decelerate as you reach each cone. Keep the shoulders facing square up field through the entire drill. Try to become a statue at each cone before running to the next. As you increase speed you will need to absorb more force to decelerate efficiently. Perform 3 to 4 sets resting 30 to 60 seconds in between.

Ms. Braaten performs zigzag tempos.

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Write to Jen Murphy at workout@wsj.com

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Business

High Turnover of Home Caregivers Makes Life Precarious for Many

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Mary Barket, a 66-year-old widow with a degenerative muscular disorder and no family around to help, has had seven different caregivers come through her home in the past six months.

On a recent Saturday morning, she was told by the home care agency that her caregiver wasn’t coming that day and that it couldn’t send a substitute, she says. Ms. Barket had one meal to last her until Monday, when the next caregiver was due.

“My hands don’t work. I can’t even open a box,” says Ms. Barket, who has ALS, or amyotrophic lateral sclerosis. “It’s a very tenuous situation.”

High turnover among in-home caregivers is straining the daily lives of America’s aging population, which relies on them to remain in their homes.

The median caregiver turnover rate—or the percentage of all caregivers who left or were terminated from jobs—was about 64.9% in 2021, according to a report by Home Care Pulse, a company that provides data and training to home care agencies. Though the number has improved from a peak of 81.6% in 2018, it represents a major supply gap, according to people in the home care industry.

Turnover among the 1,461 home care agencies participating in the 2022 HCP Benchmarking Report remained relatively stable during the pandemic, says Home Care Pulse president Todd Austin. Agencies increased wages and more offered benefits to recruit and retain workers, while also doing more to recognize workers as “care heroes” to improve job satisfaction, he says.

But the pandemic added to demand, as the high number of Covid deaths at long-term-care facilities contributed to the desire for people to remain in their homes.

Between 2008 and 2018, the number of home care workers more than doubled to 2.26 million from about 900,000, according to a 2022 report from the Home Care Association of America, an industry trade organization representing home care providers.

The Labor Department projects 25% employment growth in the next decade for home health and personal care aides, which includes those who work in group homes and day service programs, compared with an average expected growth rate of 5% for all occupations.

Even with rapid growth, home care agencies can’t meet demand. More than 85% of the home care agencies in the 2022 HCP Benchmarking Report turned down cases in 2021 due to the shortage, and 59.7% consistently turned down clients.

To help address the staffing problem, many home care agencies boosted incentives and bonuses and are offering training in areas like end-of-life care, meal planning and Alzheimer’s care, says Mr. Austin and others in the industry.

Ms. Espinosa helps Ms. Barket, who has ALS, change clothes.

Ms. Barket lives alone with no family in the area available to assist in her care. She relies on help from two home care agencies.

About 40% of agencies now offer signing bonuses, and 94% have increased pay, some by as much as $10 an hour based on experience, according to the 2022 report from the Home Care Association of America.

But wages remain relatively low. Median pay in 2021, the latest figure available, was $14.15 an hour, or $29,430 a year, for home health and personal care aides, according to the Labor Department.

The jobs are difficult in other ways, too—clients can be demanding, the work can be physically and emotionally taxing and the hours inconsistent.

Waiting list

In Lackawanna County, Pa., about 40 older adults are on a waiting list for in-home care, says

Jason Kavulich,

outgoing director of the county Area Agency on Aging, who was recently named Secretary of Aging for Pennsylvania. Six years ago, when he became director of the agency, there was no waiting list, he says.

“This is the postpandemic world,” says Mr. Kavulich. “People are not entering the help field. They have found other work.” To try to help meet demand, the county agency is working on a scholarship program at a local college for students to provide 15 to 18 hours of in-home care a week to older adults.

For families, high turnover adds a layer of uncertainty to the already stressful task of finding care for loved ones. Some families receive last-minute phone calls saying a worker isn’t coming, which leaves them scrambling to find a substitute so they themselves can go to work.

John Giurini, who shares a home with his 93-year-old mother and his sister in the Los Angeles area, says there had been times when he received a call the night before—or even the morning of—from the agency that provides full-time in-home care, saying the worker they expected for the next shift wasn’t available. Usually a substitute was sent but not always. 

“We would not know in the morning who was coming to the front door” other than a name, says Mr. Giurini, assistant director of public affairs at the J. Paul Getty Museum. 

He says rotating people in and out of the home is stressful for the family, but even more so for their mother, who has dementia and gets confused. One caregiver became combative with their mother about how much toothpaste she was using, and another young man ran personal errands instead of staying at the doctor’s office while their mother had a medical appointment, he says. He and his sister explored other options, including hiring a caregiver directly, rather than relying on an agency, but decided against it.

“Say you hire someone and are fortunate to find a good person. What happens when that person is sick?” he asks. An agency, at least, has other workers. Mr. Giurini says they have lucked out in the past six months with a caregiver from their agency who is attentive and professional.

They pay the agency $32 an hour and rates will increase to $35 an hour in February.

In-home care workers are generally employed by home care agencies, which are paid by individuals and families, or through private long-term-care insurance or Medicaid, Veterans Affairs or Medicare Advantage insurance, or by some nonprofit organizations.

Some home care companies have adopted technology to help provide consistent scheduling and care.

Jisella Dolan,

chief advocacy officer for Home Instead, which has 1,200 home-care franchises across the U.S., says the company uses a technology platform that coordinates scheduling and allows family members, using a downloaded app, to see who is coming each day, when, and if there are any changes.

Home Instead, which is a subsidiary of Honor Technology Inc., doesn’t guarantee it will find replacements if a scheduled worker isn’t available, but it strives to do so, she says. The company no longer has the waiting list for services that it did last year during the height of Omicron infections, she says.

Extra training

Home Instead also has training for those working with clients who have special conditions such as Parkinson’s and Alzheimer’s disease.

Routine and regularity are especially important for those with Alzheimer’s, says

Amy Goyer,

the family caregiving expert at AARP, who cared for and managed paid caregivers for her parents, including a father with Alzheimer’s, before they died.

“Every time you get a new paid caregiver, you have to train them,” she says. “ ‘This is what time my parents get out of bed. This is when they eat breakfast and lunch. These are the clothes my dad wears, the TV shows he watches and the music he listens to.’ ”

She advises families to have at least two caregivers, each with a different shift so one can fill in when the other can’t work, and to keep a checklist of daily routines with tasks and times listed for showers, meals, medications and getting in and out of bed, so those coming in on short notice know what to do. Families that can afford it can also hire a geriatric care manager to coordinate care and find backups, which is especially helpful if family members live out of town.

Ms. Espinosa, who was referred by the local ALS chapter, preps meals for Ms. Barket.

Frances Copeland says she had 10 caregivers in a 15-month-period between 2021 and 2022 for her 91-year-old mother, with the longest lasting eight months. “We had an occasion where two caregivers showed up and they stood outside arguing about whose day it was to be there,” she says.

Ms. Copeland, who is a certified nursing assistant and has been a caregiver for others, understands why some quit. “The pay isn’t great, and the clients can be demanding and critical,” she says. She recalls driving 45 minutes to one client’s house and being told to turn around and go back because she wasn’t needed that day.

Not all home healthcare agencies are comfortable working with people who have ALS or Alzheimer’s because of their advanced needs, says Jessie Meier, a social worker with the ALS Association Greater Philadelphia Chapter.

“The care is so personal and deeply intimate. You are helping a person shower, bathe and toilet,” she says, which makes familiarity even more important.

Ms. Barket, the widow, who lives in Bethlehem Township, Pa., says her family is small and distant. One brother lives in North Carolina and an aunt lives more than an hour away. Her daughter lives closer but has mental-health challenges and is unable to help with care.

Ms. Barket relies on caregivers from one agency, who come three hours a day, five days a week. Another caregiver, referred to her by the ALS Association, comes on a sixth day for three hours. The caregivers assemble meals in takeout containers, the lids laying across the top because she can’t get them off. She can’t carry a plate.

“My hands and wrists are too unstable at this point,” she says. If something falls to the floor, she tries to use a hangar to get it up to her. “I try to MacGyver everything,” she says. Unable to open drawers, she keeps clothes in a basket.

Each time a new caregiver arrives, she asks them if they know anything about ALS. If they don’t she tells them to Google it, so they understand her limitations. “I can’t fault caregivers, who are doing their best,” she says. “Ninety-five percent of them are wonderful.”

The unpredictability, though, is frightening, especially since her disease is progressive. On the recent Saturday when the caregiver couldn’t come, she says she had the “wherewithal” to call a friend who brought meals.

“Down the road, I won’t be able to speak,” she says. “Then what? It’s very scary at times.”

Ms. Barket says she has had seven different caregivers come through her home in the past six months.

Write to Clare Ansberry at clare.ansberry@wsj.com

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Health

For Future Viral Threats, Health Officials Look to Sewage

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When the virologist Kirsten St. George learned last summer that a paralyzed patient in New York’s Rockland County had tested positive for polio, she turned her attention to the state’s sewers.

Polio is particularly stealthy because most infected people never develop symptoms but can still spread the virus. A wastewater-surveillance network established during the Covid-19 pandemic helped officials at the New York State Department of Health’s Wadsworth Center track polio’s spread in several counties.

New York is now expanding wastewater monitoring and starting to look for flu, RSV, hepatitis A, norovirus and antibiotic-resistant genes in parts of the state, as health officials across the U.S. consider wastewater as a more permanent public-health tool for watching a variety of threats.

“Are we on the brink of another outbreak, if it’s rising? Is it just sort of holding steady?” asked Dr. St. George, Wadsworth’s director of virology. “These are all important public health questions.”   

Dr. Kirsten St. George of the Wadsworth Center is looking for clues in the state’s sewage.
An analysis conducted at the Wadsworth Center indicates the presence of the hepatitis A virus.

Dr. Kirsten St. George of the Wadsworth Center, which is starting to track the spread of pathogens including the hepatitis A virus.

For decades, researchers around the world used wastewater primarily to track poliovirus, which spreads through contact with an infected person’s feces. At the onset of the pandemic, scientists found that the Covid-19 virus’s genetic material could be detected in sewage. That meant sewage might help track other respiratory viruses, too.

Researchers built surveillance networks around the country to track Covid-19 and monitor for variants. 

Now they are starting to leverage that system to search for other pathogens they had wanted to track through the sewers for years including norovirus and antibiotic-resistant microbes, said Amy Kirby, program lead of wastewater surveillance at the Centers for Disease Control and Prevention. 

“Once you have this system, it’s much easier to activate it for a new pathogen,” Dr. Kirby said.

Sewage samples from treatment plants are sent to labs, where genetic material that can come from hundreds of thousands of people is isolated. Researchers usually test samples for pathogens with the PCR technology used in a Covid-19 lab test administered at the doctor’s office.  

Health officials use the data to track changing concentrations of a virus, which can help them monitor the spread of pathogens including flu and RSV for which many people might not be tested. The technique has yielded early evidence of Covid-19 outbreaks and helped officials tailor public messaging and decide where to open testing sites.

Biobot Analytics Inc., which works with the CDC to monitor Covid-19 and the renamed mpox, started tracking opioids in wastewater before the pandemic. It has collected data on substances including fentanyl in more than 100 counties across 47 states. Officials in Cary, N.C., used that data to encourage people to dispose of drugs properly and to distribute more overdose-reversal drugs, Biobot said.

Not everything can be tracked through sewage, and there isn’t a standard national system for collecting data and comparing readings from site to site. Privacy can be a concern in smaller communities or when tracking illicit substances, researchers said, though wastewater data is processed as an anonymous group sample. And some communities that collect wastewater data aren’t using it to guide public-health policy, researchers said. 

The wastewater treatment plant in Schenectady, N.Y., is participating in the study of sewage.
Workers at the Schenectady treatment plant collect samples and ship them for analysis.
Analysis of the wastewater samples is conducted at the Wadsworth Center in Albany, N.Y.

The wastewater treatment plant in Schenectady, N.Y., where workers collect samples and ship them for analysis at the Wadsworth Center in Albany, N.Y.

The National Academies of Sciences, Engineering, and Medicine said in a report Thursday that the U.S. should invest more in the CDC’s wastewater-surveillance network and expand its reach. The report recommended that the CDC should have an open process for picking which pathogens to track and establish an ethics committee, among other steps.  

“We’re at a critical juncture where it has gone from being a grass-roots effort to a more nationally recognized tool,” said Megan Diamond, head of the Rockefeller Foundation’s wastewater-surveillance program, who wasn’t involved with the report.

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After a polio case was confirmed in New York in July, health officials reviewed stored wastewater samples and found poliovirus in wastewater from several counties, including as far back as spring. Health officials urged people who weren’t vaccinated against polio to get the shots and alerted doctors.

The CDC extended poliovirus wastewater testing to a handful of counties with low vaccination rates or potential connections to New York’s polio case.

“What you might expect a virus to do when it starts circulating is exactly what we saw in the wastewater,” said Dan Lang, deputy director of New York’s Center for Environmental Health and head of the state’s wastewater-monitoring program.

No samples tested positive for poliovirus by the end of November, but it was detected again in Orange County last month. Health officials are planning to analyze past samples from additional counties for traces of the virus before deciding whether to widen poliovirus wastewater monitoring when the weather warms and the virus can spread more readily. 

“We’re worried about a big sort of roaring back,” said Dr. Eli Rosenberg, a lead epidemiologist who coordinates New York’s polio response. “We’re using this time now to prepare.”

Poliovirus was found in Orange County, N.Y., last month.

Write to Brianna Abbott at brianna.abbott@wsj.com

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Business

FTC Plan to Ban Noncompete Clauses Shifts Companies’ Focus

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Businesses and lawyers are beginning to assess what the Federal Trade Commission’s proposed ban of noncompete clauses in employment contracts could mean for worker mobility, wages and the way future compensation agreements are structured. 

While a full or partial ban could expand the pool of potential hires, it also would weaken a tool that employers have come to rely on to retain talent and protect trade secrets and other proprietary information, lawyers say. More companies likely would turn to a patchwork of alternative mechanisms to keep people from leaving and taking valuable information with them, including nondisclosure agreements and employment contracts that reward longevity, they say. 

“Employers have operated with an understanding that they can protect their interests through noncompetes,” said Matthew Durham, a Salt Lake City-based attorney with Dorsey & Whitney LLP who advises companies on employment matters. “What you’re seeing, reflected in the FTC proposal and elsewhere, is a growing hostility to the idea that there should be those kinds of restrictions, and it’s changing the environment that employers have been comfortable with in the last number of years.”

The FTC proposed a ban this month on nearly all noncompetes, saying that the clauses—which typically prohibit workers from moving to a new employer or starting new ventures of their own—hamper competition in the labor market, suppress wages and hold back innovation and entrepreneurship. The proposal came in response to an executive order from President Biden in 2021.

Businesses say they impose noncompete clauses on employees to protect trade secrets and other confidential information, including customer lists and financial data.

The FTC contends that noncompete clauses discourage innovation and entrepreneurship.



Photo:

Eric Lee for The Wall Street Journal

Mr. Durham and others say they believe the FTC may narrow its rule after hearing comments from the public, including employers and business organizations that have already signaled their opposition to the current proposal. The agency could, for example, allow noncompetes for highly compensated workers.

Noncompetes are common in employment contracts for senior employees like software engineers, sales representatives and top executives. Over time, they have been applied to many parts of the U.S. workforce, including some janitors, baristas, schoolteachers and entry-level workers. According to the FTC, one in five U.S. workers is currently subject to a noncompete clause.

Noncompetes are regulated at the state level, and many states have already taken action to limit use of the clauses by, in some cases, forbidding employers from imposing them on people earning under a particular wage threshold or for certain types of workers. 

“The vast majority of people in America can’t afford a lawyer to defend a noncompete case,” said Jonathan Pollard, an attorney in Florida who represents workers whose employers are trying to enforce noncompete clauses. “Just the threat of enforcement is often enough to restrain talent in the labor market.”

The Federal Trade Commission proposed a new ban on noncompete clauses, which the agency says hurts workers and competition. Companies argue they protect trade secrets. WSJ breaks down what a federal ban could mean for workers and businesses. Photo illustration: Jacob Reynolds

Some states, such as California and Oklahoma, hold that the clauses are unenforceable in all or nearly all employment contracts. 

A number of studies suggest noncompetes suppress wages and innovation. A review of Oregon’s 2008 ban on noncompetes for hourly workers found that wages rose an average of 2% to 3%. Another study, examining Hawaii’s 2015 ban on noncompete agreements for high-tech workers, found an 11% increase in job moves and a 4% increase in new-hire salaries.

The clauses restrain not just pay and entrepreneurship, but also professional development, workers and some attorneys say. 

Daniel Bachhuber had worked as a software consultant for years when he decided to take an in-house job in the fall of 2018. His new employer required that he sign a one-year noncompete agreement, which he said was so broad it would have prevented him from practicing his core skills if he were to leave the company or be fired.

Mr. Bachhuber balked. Earlier in his career, he had been laid off a few weeks into a new job, just after his first child was born. If that happened at the new job, he recalled thinking, he would be unable to earn a living for a year. “I’m always thinking, worst case scenario, what kind of downstream protection do I have?” the 35-year-old said. “Even if I was employed just one day, I couldn’t go back to the same clients I had.”

Daniel Bachhuber turned down a job after an employer wouldn’t change a noncompete clause.



Photo:

Mason Trinca for The Wall Street Journal

He consulted a lawyer and tried to renegotiate the contract, hoping to salvage a role that would have expanded his skills and given him a chance to work directly with the chief technology officer on special projects. The company declined to change the noncompete clause and, reluctantly, Mr. Bachhuber turned down the position. 

Employers have other tools to protect information besides noncompete agreements, including nondisclosure agreements, trade secret laws and nonsolicitation agreements, which prohibit workers from poaching customers or employees of their prior firm. 

But those tools generally can only be used after an employee violates the agreement, said Julie Levinson Werner, who represents employers as a partner with law firm Lowenstein Sandler LLP. “Once someone goes to another company, you’re really on the honor system. You have no way to monitor what information is being disclosed or not,” she said.

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Observers on both sides say that limitations on the clauses will compel employers to get more creative about how they retain talent, using everything from compensation to career advancement to keep workers engaged and loyal to the company. Some companies use deferred compensation—such as retention bonuses or rolling stock options that vest after, say, three years—to give people incentives to stay.

“Do you get better results with honey or vinegar?” said Ms. Werner. “If you want to motivate people and have them happy to stay, you have to look at compensation, the overall environment, how you treat them.”

The fate of the FTC’s final rule is up in the air. After a 60-day comment period, the commissioners will consider potential changes to the initial proposal and then issue a final rule. That rule will likely be challenged by business groups or individual companies, and courts will determine its trajectory, attorneys say.

Write to Lauren Weber at Lauren.Weber@wsj.com

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Health

RSV Hospitalizations Surge, Babies Hit Hardest

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High rates of hospitalization with RSV are hitting the youngest children especially hard, part of an unseasonably early surge in respiratory infections.

Some 3.0 people for every 100,000 were hospitalized with respiratory syncytial virus the week ended Nov. 5, according to federal data from 12 states. The rate is the highest since the winter just before the pandemic, when some 2.7 people per 100,000 were hospitalized in January 2020. The hospitalization rate declined from 3.4 hospitalizations per 100,000 in the week ended Oct. 29.

Babies under six months old have the highest RSV-related hospitalization rate, data from the Centers for Disease Control and Prevention show, at 145 hospitalizations per 100,000 infants. Infants six to 12 months old were hospitalized at a rate of 63 for every 100,000 children that age. For adults, the hospitalization rate is 0.6 per 100,000 people.

RSV is a common virus that most children encounter by their second birthday. Reinfections can occur at any age. Most people experience mild, cold-like symptoms and recover in a week or two. But RSV can be serious for some infants and older adults, causing bronchitis and pneumonia.

Younger children tend to be at higher risk, in part because their airways are smaller and get more easily clogged when they are inflamed, said Dana Free, a travel nurse with a company called Trustaff, working in a pediatric intensive-care unit in Danville, Pa.

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“If you think of it as a straw, and that’s your normal breathing, that’s fine,” Ms. Free said. “You coat it in congestion, essentially snot and mucus, you’re making that airway much smaller.”

Emergency rooms and pediatric hospitals across the U.S. have reported strain due to increased cases of RSV and other common respiratory viruses. Some recent closures of pediatric units have compounded the issue, doctors said, and staff are stretched thin.

Some hospitals in the Northeast are postponing elective surgeries or sending older children to adult hospitals, said Connecticut Department of Public Health Commissioner Manisha Juthani. Those strategies aren’t as effective for pediatric care because fewer children have elective surgeries than adults and hospitalization rates among older children are lower, she said.

Children’s Hospital New Orleans is getting calls from doctors in Mississippi, Alabama and Texas looking for beds for patients, said pediatric infectious disease specialist Mark Kline. “You’re talking about kids who have critical illness because they’re in respiratory failure,” Dr. Kline said. “They’re not occasional calls. It’s every day.”

Schools in states including Kentucky and Ohio temporarily suspended classes or switched to remote learning at least one day this week because students and staff were out sick.

RSV usually spreads from the fall through winter, peaking sometime between late December and mid-February. But with the onset of the Covid-19 pandemic, RSV cases practically disappeared, likely because of Covid-19 mitigation measures including masking that appear to have restricted the spread of a range of viruses.

RSV came back in the summer of 2021, unusual for that time of year, eventually reaching a hospitalization rate of 1.3 per 100,000 people in mid-December. The virus continued circulating this year throughout the spring and summer and surged in recent weeks.

Physicians are reporting high numbers of respiratory illnesses like RSV and the flu earlier than the typical winter peak. WSJ’s Brianna Abbott explains what the early surge means for the coming winter months. Photo illustration: Kaitlyn Wang

“RSV has done something similar in the previous two seasons where it started early, but nothing to this extent and nothing as widespread as now,” said William Schaffner, medical director at the National Foundation for Infectious Diseases.

Many younger infants might not have been exposed to RSV, in part because of Covid-19 mitigation efforts that kept other viruses in check, doctors said. Mitigation measures have largely been dropped at places including schools and daycare centers, and the relative lack of exposure compared with prior seasons created a wider pool of susceptible people, some public-health experts said.

“This increased number of cases is to be expected, given the number of individuals that are susceptible to the virus at this time,” José Romero, director for the National Center for Immunization and Respiratory Diseases at the CDC, said last week. There aren’t any indications at this time that the cases are more severe, Dr. Romero said.

There aren’t any specific RSV treatments, but some over-the-counter medications can help manage pain and fever, and patients should stay hydrated, doctors said. Most adults and infants without other health conditions don’t need to be hospitalized, the CDC said.

People should seek medical attention if they have trouble breathing, aren’t drinking enough fluids or have worsening symptoms, the CDC said. Some might need additional oxygen, fluids or a breathing tube. Hospitalization tends to last a few days.

Among children under the age of 5, an estimated 100 to 300 RSV-related deaths occur each year in the U.S. while some 6,000 to 10,000 deaths occur among adults 65 and older, according to the CDC. The RSV-hospitalization rate for people 65 and older is per 100,000 people, according to CDC data.

The CDC said it doesn’t have real-time death data because RSV reporting isn’t mandatory.

Areas including the Southeast and South-Central parts of the U.S. last week recorded declines in the proportion of tests positive for RSV, Dr. Romero said. In Connecticut, children’s hospitals reported a stable or slightly lower number of children admitted to the hospital compared with the week prior, the state health department’s Dr. Juthani said.

“I’m hoping that we’ve somewhat plateaued in the Connecticut area,” Dr. Juthani said. “The downside is that flu is taking off.”

Doctors and health officials said they are watching how flu and Covid-19 might collide with RSV trends this winter.  

“We likely have not peaked,” said Amanda Castel, an infectious-disease epidemiologist at the George Washington University Milken Institute School of Public Health.

Write to Brianna Abbott at brianna.abbott@wsj.com

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US

Debate on Police in Jackson, Miss., Adds Tension to City Divided by Water Crisis

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JACKSON, Miss.—State officials and some residents in Mississippi’s capital are at odds over how to address rampant violent crime, causing tensions to escalate in a city already rife with arguments over who was responsible for a breakdown that left many without clean drinking water.

Mississippi officials are planning to more than double the size of the police force that protects the Capitol and state office buildings to 170 officers by the end of next year. They gave the police force power to patrol a larger area of Jackson, which has one of the highest per capita homicide rates in the U.S. The Jackson Police Department, which has about 250 officers, will continue to oversee the remaining 92% of the city.

Officials in the state government, dominated by Republicans, say the move will make state buildings and the areas around them safer for workers and visitors. Some residents in the predominantly Black city say the mostly white Mississippi leadership is essentially creating a bubble around where they work and neglecting poorer communities with more violence.

“It’s like poor people are left out when it comes to fighting crime,” said

Willa Womack,

the president of the Battlefield Park Neighborhood Association, representing an area that isn’t part of the Capitol Police expansion plan.

Memorial murals in Jackson, Miss., which has one of the highest per capita homicide rates in the U.S.

Sean Tindell,

commissioner of the Mississippi Department of Public Safety, which oversees the Capitol Police, said he has started meeting with local residents to hear their concerns. 

“Sometimes it can be tense,” he said. “But really all we are trying to do is make the city of Jackson safer.”

Jackson, population 150,000, reported 154 homicides last year, up from 128 in 2020 and 82 in 2019. As of Oct. 26 this year, 114 homicides were reported—a rate of 76 per 100,000 residents. That compares with a homicide rate in Chicago of about 21 per 100,000 for the same period.

State and local officials in Jackson have been divided for years, often over the city’s failing water infrastructure, which left many residents without drinking water in late August and early September. The two sides have argued over whether the problems were caused by local mismanagement or inadequate state funding. The Environmental Protection Agency recently said it was investigating a complaint that state agencies discriminated against the city, which is more than 80% Black. 

A spokeswoman for the Mississippi Department of Environmental Quality said that the complaint filed by the NAACP contains inaccuracies, but that she couldn’t provide details for legal reasons.

State leaders have raised the possibility in recent years of taking over city operations including the airport. 

While Mississippi’s Republican-led legislature and GOP Gov.

Tate Reeves

gave the Capitol Police expanded authority last year, the department is still adding officers. Its budget grew to $11 million in the current fiscal year from $6.6 million in the fiscal year that ended in June, according to a spokeswoman. 

Jackson Mayor Chokwe Antar Lumumba and Mississippi Gov. Tate Reeves at a press conference last month.



Photo:

Rogelio V. Solis/Associated Press

New areas the Capitol Police are patrolling include downtown, universities and the affluent, predominantly white neighborhoods of Belhaven and Fondren. Before the expansion plan, the department was primarily responsible for the Capitol and other state office buildings. 

Andy Frame

of the nonprofit Jackson Association of Neighborhoods said he has seen little cooperation between the city and state on law enforcement.

“There’s no real coordinating effort,” said Mr. Frame. “The state has a negative view of how the city runs things, and neither side trusts the other.”

Jackson Democratic Mayor

Chokwe Antar Lumumba

declined to be interviewed through a spokeswoman, as did the city’s police chief.

In May, Mr. Lumumba said at a press conference that his administration was working to reduce violent crime, but that requests for state funding to supplement Jackson’s approximately $37 million police budget to add technology and new programs were rejected.

“We’ve asked for millions and millions of dollars, and the city of Jackson’s police department has not received any of it,” he said.

A spokesman for the governor said that the state has worked to support Jackson in its fight against crime and that the Capitol Police expansion is a one way it is doing that.

Maati Jone Primm, a Jackson bookstore owner, says she believes white Republican state politicians want to take over the city.

Jackson’s police department, like many across the country, is struggling with staffing shortages. It currently has about 100 fewer officers than its budget allows. The City Council recently voted to increase starting salaries for officers, but pay remains below that of nearby departments.

Lacey Glencora Loftin,

who analyzes crime statistics for the Jackson Police Department, provided data showing that the area to be overseen by the Capitol Police is wealthier and has less violent crime than other sections of the city.

Mr. Tindell, the state public-safety official, said the Capitol Police expansion is intended to protect the areas around state buildings better and make it safer for people to visit them. He said he hoped his department’s expansion would allow Jackson police to focus on more- troubled neighborhoods.

Maati Jone Primm,

a 61-year-old Jackson bookstore owner, said she believes white Republican state politicians want to take over the city, rather than cooperating with its leaders and Black residents.

“The message is, ‘I’m going to command all of your resources,’” she said.

Dane Lott,

29 years old, saw a shooting in 2019 near the coffee shop and bookstore she manages, which is located in the new Capitol Police zone. She said Jackson needs additional officers, and she doesn’t care whether they work for the city or state. 

“More presence is the most helpful thing,” she said.

Dane Lott, who manages a coffee shop and bookstore in Jackson, says she doesn’t care whether additional officers work for the city or the state.



Photo:

Timothy Ivy for The Wall Street Journal

Write to Cameron McWhirter at Cameron.McWhirter@wsj.com

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Business

Americans Take Ketamine at Home for Depression With Little Oversight

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Startups are prescribing ketamine online to treat serious mental-health conditions, raising concern among psychiatrists about the safety of taking the mind-altering anesthetic without medical supervision, sometimes at high doses that raise risks of side effects.

Ketamine is approved by the Food and Drug Administration to anesthetize people and animals and has been used safely in hospitals for decades. The out-of-body, hallucinogenic sensations it produces made it popular as a party drug known as Special K. Some doctors prescribe ketamine off-label to treat patients with conditions including severe depression, suicidal thoughts and post-traumatic stress disorder.

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Is there enough support available for people taking ketamine at home because of mental-health concerns? Join the conversation below.

Generic ketamine isn’t approved for those conditions. Studies have shown it can rapidly alleviate symptoms of severe depression when other treatments have failed.

There is less data on ketamine’s effectiveness for other conditions including anxiety and PTSD, and little data on its long-term use.

The FDA has approved a chemically related version of the drug, called esketamine, from

Johnson & Johnson

for treatment-resistant depression with suicidal thoughts.

Clinics that are certified to administer J&J’s nasal spray must monitor patients for two hours afterward.

People taking generic ketamine at home aren’t subject to the same oversight.

Clinics specializing in ketamine treatment for depression and other mood disorders have popped up across the U.S. in recent years. WSJ visits a clinic to learn why some entrepreneurs are betting that demand for ketamine will continue to rise. Photo illustration: Laura Kammermann

Mindbloom Inc., Nue Life Health PBC and Wondermed LLC are among around a dozen companies now selling ketamine tablets or lozenges online, making use of relaxed restrictions on the prescription of controlled substances during the pandemic.

The companies work with clinicians who prescribe ketamine to patients based on a questionnaire and virtual evaluation. The generic ketamine pills or lozenges are mailed to patients’ homes. The companies say they instruct people to take the medication with someone nearby, among other safety measures.

Taking ketamine at home without medical supervision increases risks of patients falling and hurting themselves or taking more of the drug than prescribed, doctors said. Ketamine can be addictive, and patients might not get the help they need if they have a distressing experience while taking the drug, psychiatrists said.

“Places that are doing virtual ketamine are negotiating a compromise between accessibility and safety,” said Dr.

Benjamin Yudkoff,

medical director of the ketamine and esketamine program at Brigham and Women’s Faulkner Hospital in Boston.

Ketamine increases heart rate and blood pressure, raising the risk of rare complications including stroke or heart attack at the higher doses that some telehealth patients have been prescribed, medical experts said.

“Giving any drug like that has the potential to cause general anesthesia at home in a completely unmonitored environment,” said Dr.

Michael Champeau,

president of the American Society of Anesthesiologists.

The companies said prescribing ketamine-assisted therapy at home can help fill a need for people who don’t respond to existing medications or can’t reach or afford treatment in person. Ketamine blocks a receptor in brain cells important for brain adaptability, which researchers say might help facilitate changes in mood and mind-set.

Ketamine was prescribed for Leon New Valentine, who said it alleviated symptoms of treatment-resistant depression and PTSD.



Photo:

Tara Pixley for The Wall Street Journal

Mindbloom and Nue Life cited peer-reviewed research they published suggesting that many patients reported feeling better after taking ketamine and that few reported problems related to taking the drug.

Mindbloom, Nue Life and Wondermed said they decline to treat people who have symptoms that are too severe or histories of conditions such as substance-use disorder, psychosis or uncontrolled hypertension. Nue Life said it sometimes consults with a patient’s doctor before prescribing ketamine, and Mindbloom said it often asks for medical records. Wondermed said patients can choose to have their doctors work with the company during treatment.

“‘Places that are doing virtual ketamine are negotiating a compromise between accessibility and safety.’”


— Dr. Benjamin Yudkoff, Brigham and Women’s Faulkner Hospital

Nue Life said it starts patients at around 125 milligrams and prescribes at most 750 milligrams for a dose. Wondermed said it prescribes patients between 100 milligrams and 400 milligrams for a dose. Mindbloom said that it starts patients at around 400 milligrams and that some patients graduate to doses of around 1,000 milligrams.

Doses of around 1,000 milligrams heighten risks for severe side effects including rare seizures, hemorrhages or strokes, said

Ari Aal,

a psychiatrist in Boulder, Colo., who prescribes ketamine at lower doses to patients who take it under supervision at his clinic.

“That’s way too much of a dose to be doing at home and probably at all, and way too much without a practitioner watching you,” Dr. Aal said.

Mindbloom and Wondermed said they provide blood-pressure monitors for patients to use before and during treatment. Nue Life said it instructs patients with controlled hypertension to monitor their blood pressure.

A ketamine kit provided by Mindbloom for Courtney Gable.



Photo:

Courtney Gable

Timothy Mitchell,

a 40-year-old patient advocate from Ballston Lake, N.Y., said Mindbloom started him on an 800-milligram dose last year. He said he is undergoing his third course of a six-dose regimen with Mindbloom at 1,200 milligrams a dose. The treatment helped quiet suicidal thoughts, he said.

Wondermed said it charges $399 for a month of ketamine tablets or lozenges and telemedicine treatment. Mindbloom said it charges around $1,000 for around three months of ketamine and telemedicine care. Nue Life said it charges as much as $2,999 for ketamine tablets and telemedicine treatment over four months. Health insurers usually don’t reimburse people for the off-label treatments.

Amanda Itzkoff,

a psychiatrist and chief executive of Curated Mental Health, which administers ketamine in clinics, said she declined to be on Mindbloom’s advisory board in part because she was concerned that at-home use might not include enough patient supervision.

Making a comparison with a crackdown on psychedelic-drug research decades ago, she said that if companies recklessly prescribe ketamine for home use, they could set back adoption of a valuable treatment. “We could blow it again,” Dr. Itzkoff said.

A spokesman said that Mindbloom ended its relationship with Dr. Itzkoff and that she didn’t raise safety concerns. Mindbloom’s medical director, Dr.

Leonardo Vando,

said striking the right balance between expanding access to ketamine and safe prescribing practices is critical to Mindbloom.

Courtney Gable,

47, said her husband checked on her when she took ketamine that Mindbloom prescribed for her this year to treat chronic pain and depression. The 400-milligram dose was higher than initial doses prescribed at a clinic where she works in Philadelphia, she said.

“There’s a safety net, but the spaces between the net are a little wider,” Ms. Gable said.

Leon New Valentine,

a 32-year-old actor and videogame model in Los Angeles, was prescribed 100 milligrams of ketamine online last year by Peak Health Global Inc., and took the medication with someone nearby. Mx. Valentine, who uses they as a pronoun, said they graduated to 150-milligram doses and took that alone. Ketamine alleviated symptoms of treatment-resistant depression and PTSD, Mx. Valentine said.

“Things are joyful again even though I’m in pain,” Mx. Valentine said. Peak said it would close in November because it expects rules allowing controlled substances to be prescribed remotely to be tightened soon.

Write to Brianna Abbott at brianna.abbott@wsj.com and Daniela Hernandez at daniela.hernandez@wsj.com

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Health

Six Exercises to Prevent or Relieve Lower-Back Pain

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Poor posture is a common culprit, says

Matt Nichol,

a Toronto-based strength and performance coach. But so is exercise. Lifting heavy weights might cause strain, when not done properly. And while a weak core can lead to back pain, so can performing hundreds of sit-ups in the quest for six-pack abs, he says.

Spinal-biomechanics expert

Stuart McGill,

a professor at the University of Waterloo in Ontario, conducted studies on commonly prescribed abdominal exercises. He found that while many were effective for strengthening the abs, they often caused damage to the spine and lumbar discs. 

“Holding planks for upwards of five minutes has become a fun social-media challenge, but really, less is more,” says Mr. Nichol, who has worked with National Hockey League stars including

Tyler Seguin

of the Dallas Stars and Florida Panthers captain

Aleksander Barkov.

“As with all exercises, the focus should be on quality versus quantity.”

When you try to hold a plank pose for too long and your form falls apart, you can actually do more harm than good. You might start feeling a pinch in the lower back, he says.

These exercises work to safely strengthen the abdominals and lower back, which make up the body’s core, Mr. Nichol says. Complementing body-weight exercises with resisted-strength exercises challenges the muscles so they grow stronger, he says. But don’t add weight until you have mastered proper technique, he cautions.

The Workout

Side Plank

Why: After studying common abdominal exercises, Dr. McGill found that the side plank provided high activation levels for the abdominals. It also causes the least damage to the lumbar spine, Mr. Nichol says. As a bonus, the side plank trains the muscles along the outside of the body, which are often neglected in exercise programs. 

How: Lie on your right side with your legs extended and the foot of the top leg placed in front of the foot of the bottom leg. With your right elbow directly below your right shoulder, engage your abdominal muscles and lift your hips up. At the top of the movement, your torso should be perfectly straight from your head to your hips. Your top hand can rest on your top hip or be raised straight in the air. Hold for six seconds, then lower down. Complete one to two sets of five to 10 repetitions on each side. Try to work your way up to a 10-second hold at the top.

Options: Make it easier by bending your legs to a 90-degree angle and stacking your knees, then lift your hips. For an extra challenge, balance on your bottom hand rather than on your forearm. For a true core burner, lift the top leg during the hold. 

Mr. Nichol holds a side plank.



Photo:

Steph Martyniuk for The Wall Street Journal

Front Plank

Why: Front plank hits all of the muscles along the front of the body, specifically the transverse abdominis, which is important for lower-back stability and can be difficult to target in many conventional exercises, Mr. Nichol says. It is a great core-strengthener, with low risk for aggravating the low back when performed properly, he says. The key is focusing on short holds versus attempting a plank marathon.

How: Lie face down with your elbows squeezed tight to the body and your hands placed directly underneath your shoulders. Press through the hands and forearms, contract your quadriceps, and extend through your heels to lift into a high plank. Keep your chin tucked and maintain level hips and a straight spine. Hold for five to 10 seconds. Repeat five to 10 times.

Options: Make it easier by dropping to your knees and keeping a straight line from head through hips to knees. Challenge yourself by breathing only through your nose while performing the exercise.

Mr. Nichol engages his core to hold a front plank.



Photo:

Steph Martyniuk for The Wall Street Journal

Glute Bridge

Why: Although not technically a back exercise, the bridge strengthens your glutes and stretches the hip muscles along the front of the body, such as the psoas. “Weak glutes and tight hips are major contributors to lower-back pain,” Mr. Nichol says. “Strong glutes help to stabilize the pelvis and dissipate some of the load from the lumbar spine when picking up or carrying heavy objects.”

How: Lie on your back with your knees bent and feet flat on the floor. Lift your toes and keep your weight in your heels to work the glutes more. Raise your hips without overextending your lower back. At the top of the movement, contract your glutes. Hold three to six seconds, then slowly lower. Perform eight to 12 sets. 

Option: Many athletes increase the challenge of the glute bridge by loading barbells or dumbbells atop the hips, Mr. Nichol says. He prefers the more spine-friendly single-leg hip thrust.

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What back exercises do you include in your workout routine? Join the conversation below.

Rest your shoulders on an exercise bench or couch. Your arms can extend out or you can bend your elbows to rest your head in your hands. Place your feet flat on the floor, knees bent. A pillow can be put underneath the glutes for padding. Lift your right foot off the ground and bend the right knee to 90 degrees. Contract the left glute as you press through the left foot to drive your hips up to full extension. At the top of the pose, squeeze your glute, then slowly lower the hips to the ground. Don’t let the right foot touch the floor. Perform two to three sets of seven to 10 repetitions on each leg.

Mr. Nichol performs a glute bridge.



Photo:

Steph Martyniuk for The Wall Street Journal

Bird Dog 

Why: The bird dog challenges many of the less-glamorous muscles of the back that create stability between the vertebrae of the spine, Mr. Nichol says. “This exercise is much more challenging than it looks when performed properly,” he says.

How: Start on your hands and knees with a flat back. Contract your abdominals as you slowly extend your right arm straight in front of you, in line with your head. Keep your chin tucked. Visualize a glass of water on top of your back and keep your hips level enough so it doesn’t spill. Hold for three to five seconds. Return to start and perform three to five repetitions. Switch sides.

Option: Make it more challenging by simultaneously extending the opposite leg. 

Mr. Nichol demonstrates the advanced version of bird dog.



Photo:

Steph Martyniuk for The Wall Street Journal

One-Arm Dumbbell Row

Why: The latissimus dorsi (lats) are huge muscles that take up the majority of our mid- to lower-back area. They connect the arm to the torso and “help stabilize the spine anytime someone is attempting to pull, lift or carry something heavy,” Mr. Nichol says. “This exercise strengthens your lats while also improving your core stability.” Unlike the standard row, it helps to prevent muscular imbalances since it is performed one side at a time.

How: This exercise will require a chair, bench or box for support. Put the dumbbell on the right side of the bench. Place your left knee and left hand firmly on the bench and your right foot on the floor. Find a neutral spine position. Keep your chin tucked and your shoulder blades pulled down and back as you reach down and pick up the dumbbell with the palm of your right hand facing inward. With a very slight arc motion, pull the dumbbell toward the top of your right hip. At the top of the movement, squeeze your back muscles, trying to pull the right shoulder blade back as much as possible. Lower with control, slightly slower than you lifted the weight, following the same slight arc motion. Perform two to three sets of eight to 10 repetitions. Switch sides.

Mr. Nichol does a one-arm dumbbell row.



Photo:

Steph Martyniuk for The Wall Street Journal

Pallof Press

Why: This exercise works the glutes, core, back, arms and shoulders. It trains the large and small muscles around the spine to resist rotation, so the next time your dog dashes to the right, you can stay stable, instead of getting tugged along.

How: Loop a resistance band around a stable anchor point at waist height. Kneel in a split stance perpendicular to the anchor point, far enough away to create tension in the band. Interlock the fingers of both hands around the band and keep your hands in contact with your torso at sternum height. Squeeze your shoulder blades down and back, and contract your core muscles as you press the band forward. Aim to keep the hands in line with the knee of the forward leg. Don’t let your torso twist from the resistance. Slowly return the band to your chest. Brace your core tight as you hold your arms in the extended position for five seconds. Perform two to three sets of six to eight repetitions.

Option: This can also be done using a cable machine.

Mr. Nichol uses a resistance band to perform a Pallof press.



Photo:

Steph Martyniuk for The Wall Street Journal

Write to Jen Murphy at workout@wsj.com

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World

Himars Transform the Battle for Ukraine—and Modern Warfare

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MYKOLAIV REGION, Ukraine—A global revolution in warfare is dramatically tipping the scales of the conflict between Ukraine and Russia, putting in the hands of front-line troops the kind of lethality that until recently required aircraft, ships or lumbering tracked vehicles. It also has the capacity to change battlefields far from Eastern Europe.

Able to pick off Russian military bases, ammunition depots and infrastructure far behind front lines, Ukraine’s 16 Himars helped its troops this summer halt a bloody Russian advance. Since last month, Ukrainians have seized back swaths of territory in their country’s east and ground down Russian troops in the south. Washington recently pledged to deliver another 18 Himars.

Within Kyiv’s arsenal, Himars offer a unique combination of range, precision and mobility that allows them to do the job traditionally handled by dozens of launchers firing thousands of shells.

By shrinking launchers and nearly guaranteeing hits on targets, Himars and the other equipment are upending century-old assumptions about how wars must be fought—and particularly about military supplies. Himars’s vastly improved accuracy also collapses the massive logistical trail that modern infantry has demanded.

“Himars is one part of a precision revolution that turns heavily equipped armies into something light and mobile,” said

Robert Scales,

a retired U.S. Army major general who was among the first to envision Himars in the 1970s.

Last month The Wall Street Journal gained rare access to a front-line Himars unit.

Lt. Valentyn Koval said the four Himars vehicles in his unit have destroyed about 20 Russian antiaircraft batteries.

Before a rocket hits its target the men can be on their way back to camp.

One evening at dusk the men in this unit were making dinner when orders for their fifth mission of the day arrived: to target Russian barracks and a river barge ferrying munitions and tanks 40 miles away.

Six men piled into their two Himars: a driver, targeter and commander in each, accompanied by the battery commander and a security detail in an armored personnel carrier. The commander plugged coordinate data into a tablet computer to determine the safest location for firing.

Within minutes, the two Himars rumbled out from cover under an apricot grove toward the launch spot in a nearby sunflower field. Thirty seconds after arriving, they fired seven missiles in quick succession. Before the projectiles hit their targets, the trucks were returning to base camp.

Ten minutes later came another pair of targets: Soviet-era rocket launchers some 44 miles away. Off rolled the Himars again and fired another barrage of missiles.

Soon after, the soldiers were back at camp and finishing their dinner. Some pulled up videos on Telegram showing the fruit of their labor: burning Russian barracks.

Ukraine’s Himars rockets, which can fly 50 miles, have hit hundreds of Russian targets, including command centers, ammunition depots, refueling stations and bridges, choking off supplies to front-line units. Since stopping Russia’s spring advance across Ukraine’s eastern Donbas region, they are now targeting retreating Russian forces.

Ukrainian commanders estimate that Himars are responsible for 70% of military advances on the Kherson front, the unit’s commander, Lt.

Valentyn Koval,

said. The four vehicles in his unit have killed hundreds of Russians and destroyed about 20 antiaircraft batteries, he said.

Lt. Koval poses next to a Himars.

Russian artillery—like most such systems since World War I—lacks precision. To destroy a target, troops generally level everything around it. Gunners following maps rain shells in a grid pattern that aims to leave no terrain in a quadrant untouched. Russian forces in Ukraine are lobbing dozens of shells per acre to hit one objective, analysts say.

Himars can do the job with one rocket carrying a 200-pound explosive warhead. Each Ukrainian Himars carries one six-rocket pod that can effectively land the punch of more than 100,000 lbs. of traditional artillery.

Artillery is cumbersome. During Operation Desert Storm in Iraq in 1991, it accounted for more than 60% of a U.S. division’s weight. Moving it demands soldiers, trucks, fuel and time, plus additional soldiers and vehicles to protect those supply operations.

All that support sucks resources and makes a juicy target, as the world saw in the opening days of the Ukraine war, when a Russian supply convoy halted by Ukrainian attacks outside Kyiv became a 40-mile-long sitting duck.

“It’s not just the precision of Himars that’s revolutionary,” said Gen. Scales. “It’s the ability to reduce the tonnage requirements by an order of magnitude or better.”

A sergeant dismounts from the Himars vehicle he commands.

Ukrainian soldiers prepare to load Himars munitions.

The supply chain for Himars units consists of factory-packaged rocket pods stashed at pickup points in the nearby countryside and usually hidden by foliage. A cargo truck deposits the camouflage-green pods—each a little bigger than a single bed—at a string of designated locations, not unlike a commercial delivery route.

Himars teams drive to the ammo drop spots, where a waiting three-man loading team removes spent pods and swaps in full ones within five minutes, using a crane integrated into the vehicle.

“Himars is one of, if not the most, efficient type of weapons on the battlefield,” said Lt. Koval, a jocular 22-year-old with a Pokémon ringtone on his cellphone. “This gives us an opportunity to react quickly, hit in one place, move to another, and destroy effectively.”

Russia’s best truck-based rocket launchers, by contrast, can require around 20 minutes to set up in the launch spot and 40 minutes to reload—critical time when the enemy tries to return fire. The Himars can drive faster and has an armored crew cabin.

Ukrainian Himars teams stay lean by spending weeks in the field without returning to a larger base. Lt. Koval’s unit, which received the first Himars in June, has spent the past three months sleeping in tents beside the launchers or inside nearby support vehicles.

Soldiers prepare food and coffee while waiting for the call to file more rockets.



Photo:

Adrienne Surprenant/MYOP for The Wall Street Journal

The men, trained by U.S. instructors outside Ukraine, remain on standby for new targets, switching into action and just as casually returning to mundane activities like making coffee or playing cards.

On the front armor of one Himars, the soldiers painted a white grin below the Ukrainian word for “workhorse.” On the other, whose odometer shows it has traveled over 13,000 miles, they stenciled 69 black skulls, commemorating significant confirmed hits.

Mission details arrive as geographic coordinates, with a target description and instructions on whether to use explosive missiles for armored targets or fragment charges for hitting personnel. Targeting tips come from sources including U.S. intelligence and partisans in occupied territories.

The Himars commanders then pick a suitable launch location and guide the vehicles into place. Inside the cab, the vehicle commander sits between the driver and the targeter, who feeds the mission data into a computer. When the vehicle reaches the launch site, the targeter presses one button to angle the missiles skyward and another button to fire.

The missiles roar into the night sky with a burst of flame, leaving a cloud of smoke over the field. The launcher is lowered and the vehicle speeds back to its tree cover.

“We are the juiciest target in the region,” said Lt. Koval. “So we need to maneuver to survive.”

A Himars on the road to an operating position in a field.

Smoke lingers in a sunflower field after a Himars fired a rocket.

Maneuverability is exactly why Himars was created as a downsized version of a tank-like weapon, the Multiple Launch Rocket System, which has also been provided to Ukraine by the U.K. and Germany. First used in Desert Storm, before the advent of precision artillery, massed batteries of the 12-rocket vehicles unleashed so much explosive force and shrapnel that Iraqi troops dubbed it “steel rain.”

MLRS’s heft means that only the largest military cargo jets can airlift it and they land far from the fighting. To move distances on land requires a flatbed truck. Himars was envisioned as a lighter, more agile version.

The push for nimble units equipped with lightweight gear became part of a broader effort to streamline the U.S. military after the Cold War that reached its peak under Defense Secretary

Donald Rumsfeld

starting in 2001, but was sidetracked by wars in Afghanistan and Iraq.


Max speed:

Firing range:

Weight:

In service:

Origin:

52.8 mph

19.9 to 186.4 miles

10.88 tons

2005

U.S.

6 MLRS series rockets

or 1 ATACMS missile

Max speed:

Firing range:

Weight:

In service:

Origin:

52.8 mph

19.9 to 186.4 miles

10.88 tons

2005

U.S.

6 MLRS series

rockets or 1

ATACMS missile

Max speed:

Firing range:

Weight:

In service:

Origin:

52.8 mph

19.9 to 186.4 m

10.88 tons

2005

U.S.

6 MLRS series

rockets or 1

ATACMS

missile

Himars, on wheels and with only six rockets, was a project that stayed on track. One initial shortcoming, the Pentagon discovered, was that six cluster bombs didn’t pack enough punch to destroy many targets. GPS-guided artillery, rolled out in the mid-1990s, gave Himars new life. Precision meant the rockets didn’t need to explode together for a giant blast. They could each pick off a different geolocated target.

“The precision revolution changes everything,” said Gen. Scales, who considers the transformation to be the kind of epoch-making military shift that redefines warfare and will now tip battlefield advantage from massed armies to small infantry units.

Such shifts were rare in the past, including the eclipse of infantry by horse-mounted warriors around the fourth century and the introduction of gunpowder to Europe a millennium later, said Gen. Scales, a military historian who served as commandant of the U.S. Army War College.

Others came around the U.S. Civil War with the introduction of precise rifles and artillery and machine guns, which proved so deadly in World War I, and at the start of World War II, when the German blitzkrieg merged motorized transportation with radio coordination of troops.

Now, inexpensive microprocessors are putting what Gen. Scales dubs “cheap precision” in the hands of Ukrainian soldiers.

“If I enter the coordinates of this hole,” said Lt. Koval, standing by a molehill the size of a shoebox, “it will hit this hole.”

One Himars has 69 skulls stenciled on it, one for every verified hit.

On one particularly busy day in late August, the two Himars under Lt. Koval’s command worked in tandem with two others. When his pair ran out of ammunition, they dropped back to reload while the other duo advanced to fire. Lt. Koval said they tag-teamed for 37 hours without stopping to sleep and hit roughly 120 targets, enabling Ukrainian infantry to break Russian lines around the southern city of Kherson.

Washington was initially reluctant to provide Ukraine with Himars, fearing such a move could cause Moscow to retaliate against the U.S. or its allies in the North Atlantic Treaty Organization. It has declined to supply more powerful rockets which can be fired up to 185 miles and would enable Ukraine to destroy sturdier targets, like concrete bridges that they have so far only been able to blow holes through.

In a sign that Ukraine’s additional firepower is taking a toll on Moscow’s forces, Russian Defense Minister

Sergei Shoigu

has told Russian troops to make Ukraine’s long-range weaponry a priority target.

Himars operators say the biggest threat comes from Russia’s kamikaze drones, buttressed recently by more effective Iranian systems, but they feel well protected by Ukrainian anti-air systems and special forces. Lt. Koval’s crew abandoned two firing missions this summer out of caution when a drone was spotted nearby, but he said no Himars have been hit.

“We’re always on the move,” said Lt. Koval.

So far no Himars have been hit by enemy fire, Lt. Koval said.

Write to Stephen Kalin at stephen.kalin@wsj.com and Daniel Michaels at daniel.michaels@wsj.com

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World

Russia Uses Iranian-Made Drones to Strike Military Base Deep Inside Ukraine

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BILA TSERKVA, Ukraine—Russia used suicide drones to strike a military base deep inside Ukraine on Wednesday, posing a growing challenge for Kyiv as its forces pressed advances in the south and east of the country.

The head of the Kyiv regional military administration said six explosions had been heard overnight in Bila Tserkva, about 50 miles south of the Ukrainian capital.

Oleksiy Kuleba

said the attack was carried out by Iranian-made Shahed-136 delta-wing drones, which Russia has begun deploying in recent weeks. Rescue workers were on scene extinguishing a fire and assessing damage, Mr. Kuleba said, adding that one person was wounded.

It was the closest drone attack to the capital since Russia began using the kamikaze-style munitions widely on the battlefield.

Smoke could be seen rising on Wednesday afternoon from the base housing Ukraine’s 72nd Brigade, which defended Kyiv against Russia’s assault in the early days of the invasion and is now fighting in the eastern city of Bakhmut. The roof of a building in the compound had caved in, its windows shattered from what appeared to be multiple strikes on the facility. Firefighters marched in and out of the compound.

Dozens of uniformed soldiers, including some who said they had recently returned from the fighting in eastern Ukraine, huddled in groups across the street from the complex. Their barracks now destroyed, they said they awaited orders for where they were heading next.

The drone attack began around 1:30 a.m. local time, according to several residents in the neighborhood around the base, with a buzzing sound that sounded like a motorcycle. Three residents said they didn’t understand the sound signaled an airstrike until they heard an explosion, which sent civilians and some soldiers from the barracks racing for their basement shelters.

The fact that drones were able to strike far inside the country is concerning for Ukrainian officials.

A building damaged by a Russian drone strike in Bila Tserkva, south of Kyiv in central Ukraine.



Photo:

GLEB GARANICH/REUTERS

A local resident looks through a hole in the wall near the site of the attack.



Photo:

GLEB GARANICH/REUTERS

At a meeting with representatives of the country’s security and intelligence apparatus convened on Wednesday, Ukrainian President

Volodymyr Zelensky

discussed how to counter “new types of weapons that the aggressor has begun to use.” They also discussed stabilization in newly recaptured territories and preparing the army for winter, he said in a post online.

The Iranian drones had previously been used mainly in the northern Kharkiv region and on the southern coast near occupied Ukrainian territory. They are relatively small and fly at a very low altitude, making it hard for Ukrainian air-defense systems to detect them.

Air-force spokesman

Yuriy Ihnat

said the drones used in Wednesday’s attack had been launched from Russian-occupied territory in the south of the country. Six other drones were shot down, he said, adding that Russia was probing Ukrainian air defenses for weak points.

“The threats are serious,” Mr. Ihnat told a Ukrainian TV broadcast.

An aide to a minister in a Moscow-backed quasi-statelet in eastern Ukraine confirmed Russia had carried out a strike on the base in Bila Tserkva using Iranian kamikaze drones.

The strikes came as Ukraine pushed back Russian forces in areas that Moscow last week said it was annexing following sham referendums aimed at legitimizing the land grab. So far, only North Korea has recognized the votes.

In his nightly address, Mr. Zelensky said dozens of towns and villages had since been retaken in regions seized by Moscow, including Kherson. “The Ukrainian army is carrying out a pretty fast and powerful advance in the south of our country as part of the current defense operation,” Mr. Zelensky said.

A stray dog in the center of Balakliya, in northeastern Ukraine.



Photo:

Serhii Korovayny for The Wall Street Journal

A torn banner that showed the Russian flag in the recently recaptured Ukrainian city of Izyum.



Photo:

Serhii Korovayny for The Wall Street Journal

Kremlin spokesman

Dmitry Peskov

said Wednesday that Moscow would retake territories it had lost since announcing their incorporation into Russia.

Russian President

Vladimir Putin

has threatened to use all means at Moscow’s disposal, including nuclear weapons, if Russian-claimed territory is attacked. Western officials played down the likelihood of Russia using nuclear weapons in retaliation for its losses on the battlefield.

After taking back the strategic town of Lyman over the weekend, Ukrainian forces are pushing further east toward the Luhansk region, most of which is occupied by Russia.

“Several settlements have already been liberated from the Russian army,”

Serhiy Haidai,

the Ukrainian governor-in-exile of the Luhansk region, said in a video on Wednesday, without specifying which ones. “The de-occupation of the Luhansk region has begun.”

The U.K.’s Ministry of Defense said Ukrainian forces were advancing toward the town of Svatove in Luhansk after consolidating substantial territory on the eastern bank of the Oskil River, which they crossed during a rapid offensive in the Kharkiv region. The gains could bring the road between Svatove and Kreminna within range of artillery fire, putting further strain on Russia’s ability to resupply its units in the east, it added.

“Politically, Russian leaders will highly likely be concerned that leading Ukrainian units are now approaching the borders of Luhansk [region], which Russia claimed to have formally annexed last Friday,” the defense ministry said.

Mr. Haidai said Russian forces were planting mines around Kreminna to slow an expected Ukrainian advance. Russia has also shut down mobile phone networks there to prevent residents who oppose Russia’s occupation from cooperating with Ukrainian forces, Mr. Haidai said.

As Ukrainian forces close in, civilians have been moved out of local hospitals to make space for wounded Russian soldiers, he added.

Russia’s Defense Ministry didn’t immediately respond to a request for comment on those allegations or on reports of further Ukrainian advances.

An offensive in the southern Kherson region has also gained momentum in recent days, with Ukraine’s armed forces saying they had recaptured eight villages.

Russian forces are seeking to slow Ukrainian advances there by destroying some bridges and crossings while bringing up reserves and falling back to safer positions, according to Ukraine’s southern operational command.

A filtration point for displaced people in Shevchenkove, Ukraine.



Photo:

Manu Brabo for The Wall Street Journal

A woman evacuated from near Kupyansk, in northeastern Ukraine.



Photo:

Manu Brabo for The Wall Street Journal

—James Marson and Olya Fokaf contributed to this article.

Write to Jared Malsin at jared.malsin@wsj.com and Isabel Coles at isabel.coles@wsj.com

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