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Health

'Long-standing issues with health care disparities' lead health care workers to protests

JOSEPH PREZIOSO/AFP via Getty ImagesBy TOMMY BROOKSBANK, ABC News

(NEW YORK) -- Medical professionals across the country are going straight from their hospital shifts to demonstrations, offering aid to those injured outside city halls and police stations as ugly scuffles between law enforcement, civil rights advocates and looters continue over the death of George Floyd.

"Our nurses heard the clarion call on their own," Dr. Millicent Gorham, National Black Nurses Association's executive director, said. "That there needs to be a call to action by everybody. The violence against black men and people of color is nothing new, but our members have decided enough is enough. We're going to offer our services and support to Americans exercising their rights."

Anna Maria Ruiz is one of several nurses who joined thousands of Texans protesting in Austin Sunday, just before heading in for a long graveyard shift at North Austin Medical Center. After the peaceful protest took an unexpected violent turn, she jumped into action to address rubber bullet wounds and pepper spray afflictions among her fellow protesters.

"We take an oath to preserve life as best we can and stop preventable deaths," Ruiz said. "In this situation, it's too important not to tackle outside of the hospital."

Dr. Gigi Chawla is a pediatrician at Children's Minnesota in Minneapolis. She helped clean up her city last weekend after multiple buildings in the community burned down, before heading to a protest with hundreds of others outside a police precinct. The peaceful protest remained true to its name, but Chawla was ready to offer medical assistance to police officers and activists alike without hesitation.

"That's my duty," Chawla said. "I offer health care support to anyone in need, unexpected or not."

Children's Minnesota is one of several health systems in the Twin Cities honoring George Floyd's memory.

Dr. Julius Johnson is a nurse practitioner and president of the Greater New York City Black Nurses Association. He walked with thousands of others from Harlem to Brooklyn Monday and is organizing a march led by medical workers beginning in Union Square this Sunday, where he expects at least 50 other health care workers to join him.

"We're black before we're any kind of professional, and we have to stand up for our community," Johnson said. "We want to show that there are professionals that are protesting, we don't have the privilege of staying home during the coronavirus pandemic. We will absolutely be offering our medical services to our fellow protesters."

But it's not just medical services Johnson hopes to offer. He says he's on a mission to protect his community from looters as well.

"I understand why people are frustrated, especially in this city where most people are out of work and a $1,200 check doesn't even cover your rent," Johnson said. "But looting is unacceptable and solves nothing. I won't allow it to happen in my presence. It detracts from our cause."

The organized march among health care professionals comes on the heels of a larger movement within the medical community condemning the killing of George Floyd while in police custody. National Nurses United -- an organization of registered nurses throughout the country-- released a statement demanding "justice for George Floyd and a stop to the unnecessary death of black men at the hands of those who should protect them."

The American Hospital Association called the death of George Floyd and others, "a tragic reminder to all Americans of the inequalities in our nation" and claimed "America's hospitals and health systems condemn racism of any kind," in addition to recognizing the need for "addressing health care disparities."

Racial disparities in health care on display during COVID-19 pandemic


A myriad of studies have found that black and white Americans receive different treatment options within America's health care system, even when factors like identical symptoms and similar insurance plans are at play.

The American Heart Association has concluded white patients are far more likely to qualify for various heart surgery procedures and treatments than their black counterparts when exhibiting comparable symptoms. A study by the National Academy of Medicine gathered "race and ethnicity remain significant predictors of the quality of health care received" during patient diagnosis and Stanford University found black patients health outcomes improve considerably when treated by black doctors.

"I may have the same level of education and insurance a white male has, but that does not guarantee I will receive the same care and diagnostic tests in the emergency room," Dr. Marsha Dawson, National Black Nurses Association president, said. "That needs to change."

Two nurses fresh off a 12 hour shift come to protest outside the White House.

“White Supremacy is deadlier than COVID.” pic.twitter.com/po7RjgBqA5

— Rachel Scott (@rachelvscott) June 4, 2020


The Center for Disease Control and Prevention reported the COVID-19 death rate is notably higher among people of color, not to mention the fact that African Americans in coronavirus hot spots are twice as likely to die from the illness than their white counterparts.

It's a heartbreaking reality Art Gianelli, president of Mount Sinai Morningside, and his colleagues at Mount Sinai Health System in New York City know too well.

"We all saw first hand when black and brown patients came into our emergency departments, they came in sicker and were more apt to die from the virus," Gianelli said. "Our staff continues to see and feel it. But we don't have the tools right now to change that. These are long-standing issues with health care disparities that need to be addressed and not the virus itself."

Gianelli explained the significant number of lives lost at Mount Sinai hospitals contribute to a system-wide show of support for protesters Tuesday, with scrub-clad doctors and nurses holding a moment of silence to honor George Floyd before cheering on fellow New Yorkers protesting as they passed medical facilities throughout the city. It's a nod to those demanding action against decades of racial injustice-- an idea Gianelli says that pulls on the heartstrings of health care.

"Our roots are in caring for people who are discriminated against so in many ways, this was getting at the core values of this health system," Gianelli said. "Honoring George Floyd's memory with peaceful protesters is something many of us at Mt. Sinai are committed to."

That commitment appears to ring true for thousands of American healthcare workers and civilians too, perhaps characterized best by Johnson's answer to a police officer who asked why he's marching.

"I handed her a list of recommendations that we have," Johnson explained. "Yes, George Floyd died, and yes, the way it happened is common practice. We've seen the same type of incidents here in New York. We want more diversity among psychiatrists that do evaluations of officers before they are hired. More transparency from the Civilian Complaint Review Board. But mostly, we simply want the police to stop brutalizing us."

Copyright © 2020, ABC Audio. All rights reserved.

Trump administration to require race data in coronavirus lab results for first time

narvikk/iStockBy ANNE FLAHERTY, ABC News

(WASHINGTON) -- The Trump administration announced Thursday that beginning Aug. 1 it will require that any lab results for COVID-19 reported to the Centers for Disease Control and Prevention will include a person’s race, ethnicity, zip code, age and sex.

The move is intended to give the federal government a better picture of how the virus is impacting communities of color. Lawmakers have been demanding the data for several weeks, raising questions about why the administration waited until four months into the crisis to act.

“Data is the roadmap. It’s fundamentally the key first step we need to address the disparities” among communities, said Robert Redfield, director of the CDC, in testimony before the House Appropriations labor, health and education subcommittee.

Federal and state health officials have previously warned that communities of color have been disproportionally hit with the virus, experiencing more hospitalizations and deaths than white neighborhoods. Health officials say this is due in part to underlying health conditions like asthma and diabetes that are more common in black and Latino communities, as well as people of color more commonly working jobs that expose them, such as staffing nursing homes, grocery stores and public transportation.

While some states have released race data on coronavirus cases, the CDC has access to race and ethnicity information in only 42 percent of the cases reported, according to its website. Of those cases, 22 percent of people with COVID-19 were black and almost 33 percent were Latino.

The lack of hard data is due in part to data being collected by private doctors, hospitals and labs and then reported to state public health departments.

Lacking a better option, the White House has gone so far as to ask states to email coronavirus data daily. Thursday’s announcement -- several months into the crisis -- would be the first time that the federal government has demanded race and ethnicity be included in test results.

An initial report sent to Congress included limited information on the subject, and Redfield said he expects some additional data by mid-June when the next assessment will be delivered. After that though, Redfield said he expects states to begin offering richer details on COVID-19 patients.

Adm. Brett Giroir, assistant secretary for health who has been coordinating testing efforts, told reporters on Thursday: “We are dedicated to leading to America to healthier lives, regardless of race, ethnicity, gender, sex, geography, or sexual orientation.”

When asked about if protestors should be tested, particularly if they were detained, Giroir said it would fall within the federal guidelines for states to offer it.

Earlier this month, the CDC sent to Congress a report required by law that included what little data it had on communities of color and novel coronavirus.

The report mostly provided links to existing online data.

“The effects of COVID-19 on the health of racial and ethnic minority groups is still emerging,” the CDC wrote to Congress. “However, current data suggest a disproportionate burden of illness and death among racial and ethnic minority groups.”

In his testimony Thursday, Redfield promised subsequent reports will have more information, hopefully by July.

“I have every intent to get that data,” he said.

The CDC has increased its prediction of deaths related to to COVID-19, estimating Thursday it will rise between 118,000 and 143,000 by June 27.

Copyright © 2020, ABC Audio. All rights reserved.


How to be anti-racist: Experts discuss steps people can take to spark change

Pierre Crom/Getty ImagesBy DEBORAH ROBERTS, SARAH LANG and ANGELINE JANE BERNABE, ABC News

(NEW YORK) -- As the demonstrations and unrest continue in the wake of George Floyd’s death, the protests are hitting home for many across the country who are trying to understand and learn about the racial disparities and inequities that take place everywhere.

For Jamie Jones Coleman, a white mother to two biracial boys named Caleb and Gabriel, the protests, which are challenging the status quo, resonate more than ever.

“My boys are viewed in this world as black,” she told Good Morning America. “And as a white parent of a multiracial child is imperative for me to try and help prepare for their world the best that I can.”

“I will never purport to completely understand or understand really at all what it is to be a person of color in this country. But I do know what it feels like to love a person of color in this country,” she added. “I think the biggest thing that I’ve realized, being married to a Black man in the United States today is that when people meet me, they never fear me.”

Ibram X. Kendi, a professor at American University and the author of books like How to Be an Antiracist and Stamped from the Beginning: The Definitive History of Racist Ideas in America said that he knows Coleman’s comments all too well.

“Racial disparities and inequities are everywhere, are all around us, are in almost every neighborhood and institution,” Kendi told Good Morning America.

Defining anti-racism


In his book, How to Be an Antiracist, he offers a blueprint for creating a just society and says people need to learn and define terms such as racist and anti-racist, in order to understand and make changes.

“You know what it means, what it means to be to be antiracist, is to express antiracist ideas meaning all the racial groups are equals there's no racial group is better or worse than another. And so to advocate for antiracist policies which are, and these are policies that lead to racial equity and racial justice. “

According to Kendi, to be an anti-racist is to "express antiracist ideas, meaning all the racial groups are equals. There is no racial group that is better or worse than another." Kendi said it also means advocating for anti-racist policies. "These are policies that lead to racial equity and racial justice," he added.

For Jennifer Harvey, the author of Raising White Kids: Bringing Up Children in a Racially Unjust America, she describes the term anti-racist as denying there is a problem and sitting on the sidelines.

Let's see if we can save some black energy.
Below, post a resource white people who want to learn about racism can use instead of asking black people to educate them.

— andre ain't dying for wall street (@andrehenry) February 28, 2019

"A lot of white people believe all people are created equal and should be treated that way,” said Harvey. "But as white people are they working on challenging structures in institutions, equity outcomes and partnering with people of color to make institutions better to reflect a racially just society? That is anti-racism.”

“I think what’s critical for people to understand is, there’s no such thing as 'not racist,'” said Kendi. “In other words, we’re either being racist or anti-racist. We’re either expressing that the racial groups are equals and we believe that, or we’re thinking that certain racial groups are better or worse than others.”

Kendi also made a critical point that it isn’t about being a good or bad person but rather a person who challenges their thinking and ideas and works to admit and change racist tendencies to be actively anti-racist.

Steps toward change

For those invested in change, Harvey offers this advice: educate yourself, donated and understand your role.

In order to start making steps toward change in and work toward an equal society, Harvey said that conversations must take place. And she described that those conversations will get uncomfortable and mistakes will happen before it gets better.

“White people are afraid to talk about race with family in fear of getting it wrong, Black people talk about race in fear of their lives,” said Harvey. “So start talking, have conversations, mistakes will happen but if you make a mistake, then apologize and revisit-otherwise allowing it to continue.”

Harvey said that it’s also important that people educate themselves. However, there’s a right way to do so.

“Don’t reach out to Black friends and people of color right now to have them ‘help you,’" she said. "This is not the time for white Americans to be asking our black friends or neighbors what we need to know about racism. But we do need to learn about racism from people of color...Google, read texts and books on racism in America and not by white people. Become educated, learn, listen.”

Harvey said that another way to become involved is to protest by showing up in the community and supporting an end to racism and donating to organizations that support equality and advance social justice.

If you're in a position to make a financial donation, "actively support both locally and nationally organizations being led by people of color, including businesses racial justice groups and elected officials," she said. "Show up to stand with people of color in your community who are in the streets, fighting for change."

For Coleman, the past few days have been eye-opening for her, and she’s reflecting on the lessons she’s learned and educating herself day by day.

“For me to listen to people of color, to listen to their experiences, to know their truth as best as I can knowing that I will never be in their same world, but I can respect that world and I can listen to their words,” she said.

Copyright © 2020, ABC Audio. All rights reserved.


Reopening schools in the fall, an experiment for college and university leaders

Drazen_/iStockBy DR. DELARAM J. TAGHIPOUR, ABC News

(NEW YORK) -- With the fall semester approaching, college and university leadership are weighing the risks and benefits of reopening schools.

Without a cure or viable vaccine for COVID-19, universities are exploring a range of options, each bearing a hefty price tag and set of compromises.

Of 780 colleges tracked by the Chronicle of Higher Education, 67% are planning for in-person classes, 6% online, 7% are proposing a hybrid model, 9% are waiting to decide and the other 11% are considering a range of scenarios.

With scant evidence that any of these strategies will work, reopening amid the coronavirus is one big experiment.

The Centers for Disease Control and Prevention weighed in on this issue. According to the agency's guidance, it's risky for colleges and universities to host full-sized, in-person classes and events.

That means going virtual is the safest option, with the entire California State University system announcing it will be entirely virtual for the fall semester. But among those that have announced in-person classes in the fall, there is a range of proposed strategies for keeping students and staff safe, including social distancing in classrooms and dorms, frequent testing, face coverings and alternative scheduling options.

However, because of the high density of college campuses and the unprecedented nature of the global pandemic, experts say there's no guarantee that any of these strategies will protect against outbreaks.

"The primary consideration for me is obviously health and safety for everyone involved -- students, faculty, and staff alike," said Howard University President Dr. Wayne A. I. Frederick.

"A secondary factor is trying to deliver a high-quality educational product," he said, especially when weighing "the difference between in-person and true distance learning."

Frederick also serves as the chair of the Consortium of Universities of the Washington Metropolitan Area, which represents 17 member colleges and universities representing nearly 290,000 students,

He's working across several schools to ensure there's as much consistency as possible with various reopening strategies.

"We all have different populations, so our individual plans would be different, but the broad umbrella of what we all are trying to do is going to take a similar shape," he said.

The University of South Carolina has asked that employees and students wear face coverings at all times, in addition to adhering to CDC social distancing and frequent hand washing.

And many schools will stagger students returning to campus. For Boston University, one approach is a phased reopening that involves bringing medical and dental students back in late summer ahead of the undergraduate students.

Johns Hopkins University, meanwhile, will open research labs before opening the rest of campus. At the University of Notre Dame, school administrators are already thinking ahead to the second wave of infections in the fall, hoping that shifting the semester forward by two weeks to start in August and end before Thanksgiving might help.

Others are considering mass testing their students and staff. In a "Return to Learn" pilot program, UC San Diego began broadly testing its students for COVID-19 with intentions to expand when they reopen the campus in the fall.

Last month, Assistant Secretary for Health Adm. Brett Giroir, MD, proposed testing wastewater on campus for traces of the virus as an early warning system.

But mass testing and wastewater testing may be too expensive and logistically complex for some universities.

And what happens if students and staff get sick? Some universities are considering separate quarantine housing, and many are working in conjunction with local and state health departments to contact trace other potential people at risk.

Some schools are even considering controversial apps to trace staff and students' movement so anyone who may be exposed gets a notification.

All of these efforts are expensive, but perhaps less of a financial hit than the lost revenue from students who decide that virtual learning is not worth the hefty tuition price tag.

"I think it's likely many places will be thinking about virtual options for the appropriate settings," said Dr. Joshua M. Sharfstein, physician at the Johns Hopkins Bloomberg School of Public Health and director of the Bloomberg American Health Initiative.

For most, the pandemic will mean a mix of virtual and in-person learning. Sharfstein said this will likely include, "the ability to switch quickly if there is a lot of community spread to virtual."

University leaders will need to be flexible as they move forward with their plans to reopen. The pandemic has proven to be unpredictable and ever-evolving. Potential surges over the summer months may change what needs to be done without much notice.

"I think nobody really knows what the virus is going to do this fall, and so having all your eggs in one basket may not be the smartest strategy," said Sharfstein.

"Maybe some of our thinking for how we're going to do those things will evolve, as it has evolved over the last 90 days," said Frederick.

Copyright © 2020, ABC Audio. All rights reserved.


Physical distancing, masks can dramatically reduce COVID-19 transmission: Study

AnVr/iStockBy DR. AYODOLA ADIGUN and DR. JESSICA JOHNSON, ABC News

(NEW YORK) -- New research published in Lancet supports what public health officials have been advising since the pandemic began: To reduce the risk of transmitting COVID-19, cover your face and stay 3 to 6 feet away from other people.

The findings were released as mass demonstrations after the death of George Floyd have rocked the U.S. and have some experts warning there could be outbreaks of novel coronavirus.

In lieu of having substantial experience with the virus from which to draw, researchers looked at 172 studies from 16 countries describing transmission scenarios for the virus that causes COVID-19 as well as related coronaviruses SARS and MERS.

Staying 3 feet away from another individual can lower the risk of transmission to less than 3% from an estimated 12%, the researchers found. A distance of 6 feet could lower that risk to 1.5%. And wearing a mask can reduce the risk to about 3% from roughly 17%.

The study also reinforced guidelines set forth by the Centers for Disease Control and Prevention on the most effective types of masks, suggesting that multilayer masks -- those with 12- to 16-layer reusable cotton -- offer better protection for most of the general public than single-layer masks. And for health care providers, N95 masks and other respirators may be superior to surgical masks.

"Eye protection is often under-considered and not uniformly included in policies," said Dr. Derek Chu, an immunology and allergy fellow at McMaster University and co-author of the study. "Goggles, face shields or even large eye glasses may be important in preventing droplet spread through the eyes as well as self inoculation via the hands."

The study's authors emphasized that social distancing and wearing face coverings aren't 100% effective, meaning people still should wash their hands frequently. The study, which the authors noted was limited by the inclusion of some "low-certainty" evidence, still corroborated CDC guidelines overall.

"This article will reinforce the use of masks and physical distancing as a means of flattening the curve," said Dr. William Schaffner, professor of preventive medicine and infectious diseases at the Vanderbilt University Medical Center. "Certainly, the medical community will take heart. We constantly get questions regarding the validity of these public health measures. Having all the information together in a coherent fashion like this will be very helpful."

The study's findings may not only guide pandemic response efforts but could encourage policymakers around the world to address concerns over providing enough protective coverings for all people in all settings, Shaffner added.

"We will be living with COVID for the future," he said. "These fundamental public health measures are going to remain important and will become part of the new normal."

Copyright © 2020, ABC Audio. All rights reserved.


Mass protests could propel a second wave of coronavirus infections

AlxeyPnferov/iStockBy ERIN SCHUMAKER, ABC News

(NEW YORK) -- As thousands of demonstrators continue to protest the killing of George Floyd, health experts are worried that a second wave of COVID-19 infections could be sparked by the mass gatherings.

"What we have here is a very unfortunate experiment going on with COVID virus transmission," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

While there's lower risk for the virus to be spread outdoors, especially in a moving crowd, many of the weekend's protests culminated in police officers shooting tear gas and using pepper spray and protesters lighting fire to cars and buildings. Smoke, tear gas and pepper spray cause coughing, Osterholm explained, and coughing aerosolizes the virus, increasing the risk that it will spread.

"If people say, 'well, these are healthy folks,' we know that at least a third of COVID patients are asymptomatic according to the CDC," added Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases.

Not only are jails crowded indoor spaces, but protesters sat in vehicles at close range for an extended period of time, which increases the risk for onward transmission of the virus, Osterholm explained.

A 1918 a military parade sparked the second wave of flu infections


If history is any indication of how this might play out, we need look no further than the 1918 flu pandemic. In September of that year, after the first wave of spring flu infections subsided, Philadelphia decided to proceed with a military parade, which drew a crowd of 200,000. Within a day, every hospital bed in the city was filled and within six weeks more than 12,000 Philadelphians were dead, according to The Washington Post.

On Monday, mayors and governors urged demonstrators to stay home, and if they do go out, to wear a face mask and maintain social distancing.

"We don't want people out there where they might catch this disease or spread this disease," New York Mayor Bill de Blasio said at a Monday press conference.

"There's no question there's a danger [that] this could intensify the spread of the coronavirus just at a point when we were starting to beat it back profoundly," he said.

How mayors and public health departments are responding


Although government officials have warned demonstrators about the health risks posed by protesting during a pandemic, only a few have offered actionable guidance about the role COVID-19 testing can play in preventing the virus from spreading.

"If you were out protesting last night, you probably need to go get a COVID test this week," Atlanta Mayor Keisha Lance Bottoms said during a Sunday new briefing, "because there's still a pandemic in America that's killing black and brown people at higher numbers."

Since most people who are infected with coronavirus develop symptoms within 14 days of being infected and can spread the disease days before they feel sick, the window to get tested and avoid infecting others is small.

Getting tested within the next seven days might not be realistic depending on where you live, explained Dr. Jeanne Marrazzo, division director of infectious diseases at University of Alabama Medicine.

"Testing sites are still not set up in our most vulnerable community settings," Marrazzo said, pointing to poor and rural areas, particularly in the Deep South.

"If you are out protesting and return home, you may want to quarantine for a while," said Dr. Simone Wildes, an infectious disease specialist at South Shore Health. "You don’t know what you are going to bring home to your parents, grandparents, other members of the family who might have underlying conditions that place them at higher risk."

New York City's health department stopped short of telling protesters to get tested within a certain timeline, although the department did post to Twitter recommendations for how demonstrators could reduce their risk of spreading COVID-19.

"Health is our top priority, and with more testing capacity now available, we're inviting anyone who has participated in a demonstration over the past few days to come get tested at one of the more than 150 locations across the city," said Patrick Gallahue, a spokesperson for the New York City Department of Health and Mental Hygiene.

The next two weeks are going to give us a better sense about whether case counts will rise, according to Osterholm.

"Hospitalizations could be 20 days away before you really start seeing that picking up," he noted.

Of course, those timelines assume that people who get sick will get tested. They also assume that protests will start to diminish.

Continuing protests "could take transmission into a whole other week," Osterholm said.

Copyright © 2020, ABC Audio. All rights reserved.


In the race for a vaccine, children may be last to be vaccinated

MarianVejcik/iStockBy DR. MARK ABDELMALEK and SONY SALZMAN, ABC News

(NEW YORK) -- Even as scientists race to develop a COVID-19 vaccine, experts acknowledge that children could be among the last members of society to be vaccinated.

At least 10 vaccines are being tested in people across the globe, with the United States' top infectious disease doctor, Anthony Fauci, optimistically estimating we could have a viable vaccine by early 2021. While preliminary data on these vaccines has been encouraging, children have been excluded from early studies.

Fauci told ABC News it's possible that studies in children might "catch up" to those in adults, if they are done correctly.

"There is no reason not to believe that [a vaccine] wouldn't be available simultaneously for adults and children," Fauci said.

But other vaccine experts interviewed by ABC News said studies among children could take much longer to complete, and a hard look at the timeline of ongoing vaccine trials raises questions about whether families can expect their children to be vaccinated at some point in the upcoming academic school year.

"Children will be vaccinated, in time," said Dr. Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia, who sits on the Food and Drug Administration's vaccine advisory committee.

"To date, my sense is that children are not part of these initial studies," Offit added. "It would be unfathomable giving children a vaccine that has not been adequately tested in children."

The process for testing a COVID-19 vaccine in children could take "extra months and maybe years longer," according to Paul Duprex, PhD, director of the Center for Vaccine Research and professor of microbiology and molecular genetics at the University of Pittsburgh.

Throughout history, scientists have constantly been reminded that children are not simply small adults. Their bodies and immune systems work differently than adults, so they need to be studied separately -- preferably after safety has already been well-established in adults.

"Every person is special, but kids are especially special," said Duprex. "They are our charges. The emotional baggage that goes with something going wrong in clinical trials involving kids -- and I'm not saying adults are not important -- it's just different."

For now, vaccine trials remain laser-focused on members of society deemed to have the highest risk, such as front-line workers and adults. Although some groups have announced their intention to test vaccines in children, ABC News contacted four vaccine groups and none said they have actually started studies in children yet.

Typically, vaccines are tested in a stepwise approach: phase 1 for safety, phase 2 to start testing effectiveness and a massive phase 3 study with thousands of people.

The pharmaceutical company Pfizer told ABC News it will advance a vaccine into children once positive data from phases 1 and 2 is available in adults. Another company, Inovio said it plans "to assess pediatric populations in the future."

The University of Oxford, which has partnered with the pharmaceutical company AstraZeneca, is one of the few vaccine groups that has announced formal plans to start testing in children.

But a University spokesperson told ABC News that children will not be injected right away, and will only be given the vaccine once "all of the adults studies are moving along and have generated sufficient safety data."

In the United States, the National Institute of Allergy and Infectious Diseases (NIAID), which is collaborating with pharmaceutical companies for vaccine trials, told ABC News the agency would continue to work with the Centers for Disease Control and Prevention to better understand how the virus affects children.

In a statement, the agency said: "We will continue to plan for follow-on clinical trials to include younger age groups so such trials can commence if epidemiological CDC data indicate a need to test COVID-19 vaccines in children."

With vaccine skepticism on the rise, experts stressed that it will be important to proceed with caution. According to an ABC News/Washington Post poll, 27% of American adults said they were not inclined to get a vaccine -- even if it was available for free.

With any new vaccine, the ethical thing to do is test for safety in healthy adults first, and then begin testing it among people who need it the most, explained Jennifer Miller, Ph.D., an assistant professor at Yale School of Medicine and founder of Bioethics International and the Good Pharma Scorecard.

For COVID-19, that means older adults, front-line workers and people with underlying medical conditions. Children are far less likely to die of this disease.

"About 2% of the cases reported are in the pediatric population," said Dr. David Kimberlin, professor and co-director of the Division of Pediatric Infectious Diseases at the University of Alabama-Birmingham.

"It's about minimizing risks, it's about informed consent and it's about the population that needs it the most," Miller said.

Minimizing risk is important, especially when it comes to children and vaccines, experts agreed.

Very rarely have candidate vaccines caused a disease to become more severe when the individual is subsequently exposed to the natural infection.

This happened in 1966, when a chemically inactivated vaccine candidate for a childhood lung disease called RSV led to the death of several children.

"That tragic event set the RSV vaccine field back decades," said Duprex. "In fact, there still is no licensed RSV vaccine."

Fauci proposed that children might be tested in a so-called "bridging study," in which children are studied in a Phase I trial to ensure the vaccine is safe, and then quickly folded into a large phase 3 study.

Other experts noted it's theoretically possible that studies in children could "catch up" to those in adults, though unprecedented. But even if we do not have a vaccine for children right away, that doesn't necessarily mean children will have to remain socially distant indefinitely.

Eventually, widespread vaccination of adults could end up protecting children thanks to "herd immunity," which is when enough people are vaccinated to snuff out an ongoing chain of infections.

"Usually it's the older way around -- vaccinating children protects older adults," Kimberlin said. But in the case of COVID-19, if we find a successful vaccine and most adults become immune to the virus, "parents could still very legitimately look at that as a win for children because it's a win for society."

Copyright © 2020, ABC Audio. All rights reserved.


In first federal count, over 25,000 coronavirus deaths in nursing homes

Daisy-Daisy/iStockBy ALLISON PECORIN, KATHERINE FAULDERS and MATTHEW MOSK, ABC News

(WASHINGTON) -- The federal government has begun sharing its tracking data for nursing home fatalities for the first time since the novel coronavirus outbreak, a step long urged by members of Congress as an important way to guide efforts to protect the elderly and frail as the nation tries to reopen.

“Without this information, adequate testing and a full supply of [personal protective equipment], our seniors will continue to suffer,” U.S. Sen. Bob Casey, a Pennsylvania Democrat, said last month.

The new, initial numbers from the Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services were shared in a letter to U.S. governors dated Sunday and obtained by ABC News. The numbers document that at least 25,923 nursing home residents have died as a result of COVID-19, though the figure doesn't include reporting from some states prior to May and differs from state-by-state reports due to disparities in the way data is tracked.

The federal regulators also acknowledge their first release of figures may account for about 80% of the nation’s nursing homes, and that “data maybe inconsistent with state data, particularly state death data.”

Centers for Medicare and Medicaid Administrator Seema Verma said Monday afternoon that she expects the dataset to represent more nursing homes each week during a press call with reporters.

The survey is the first to include the number of nursing home staff killed in the outbreak, which federal officials list at 449 fatalities across the country. And it marks the first public accounting of deaths in 10 states that were not previously publishing any data about the outbreak’s severe impact on those in long-term care facilities during ABC News' most recent survey.

Along with the new figures, the federal agency that regulates nursing homes told governors they intend to step up penalties and enforcement of infection control efforts. Problems containing infections using trusted methods, like frequent hand-washing and changing gloves and masks, have surfaced frequently during inspections of facilities where there have been deadly coronavirus outbreaks. In inspections, multiple facilities have been shown not to be using certain infection control methods properly.

"Many of the surveys we have done we have found that hand washing continues to be a challenge, and many facilities are not prepared to adequately isolate and cohort patients that have COVID or are suspected of having it," Verma said.

The federal totals remain lower than the numbers gathered through a state-by-state analysis conducted by ABC News in mid-May. That survey found more than 37,600 deaths attributed to the coronavirus in nursing homes and long-term care facilities from 40 states and the District of Columbia stretching back to the beginning of the crisis.

Just over 100,000 total coronavirus deaths in the U.S. have been reported since the outbreak reached America's shores, according to a tally by Johns Hopkins University.

The new federal count shows that in the 10 states that were not reporting nursing home fatalities during ABC News' last survey of national data, an additional 794 residents and staff have died. Those states are Alaska, Arizona, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, Missouri and Utah.

Federal officials said one reason for the disparity in the counts is because some states only provided figures to the federal government starting in May, when they were first required to provide data specific to nursing homes. That means earlier staggering nursing home outbreaks like the ones that killed dozens in Seattle, Virginia, Massachusetts and New York may not be counted in the federal data.

Verma said Monday however, that she believes many nursing homes did report retrospectively despite the fact that they were not required too.

"My thought is that most of the nursing homes did report because I don't think the numbers would have been that high if they didn't," Verma told reporters. "I mean there's no way that we had 26,000 new cases in the week in nursing homes, but that being said, the requirement was only to report as of that week."

Also, when responding to ABC News inquiries, some states included deaths in assisted living centers, over which the federal government does not have authority, so they are not tracked by federal regulators and not included in their tally, officials said.

The omission of deaths from assisted living facilities in federal counting had already drawn criticism from Senate Democrats and advocates.

“The reality is this virus doesn’t care whether seniors are living in assisted living facilities or living in nursing homes it can affect them regardless,” Sen. Elizabeth Warren, D-Mass., said during a Senate hearing earlier this month.

University of Chicago Professor R. Tamara Konetzka, who studies nursing homes and assisted living facilities, said that the differences between nursing and assisted living facilities varies by state. Assisted living often allows for slightly more separation between residents, but still involved staff care that has shown to be a cause of outbreaks.

“They’re just older populations who probably are very vulnerable to the virus,” Konetzka said.

The release of this data has been long awaited by Senate Democrats who have for weeks called on the federal government to make more info about the affects of COVID-19 in nursing homes available.

Earlier this month, Casey said incomplete data was part of the reason Congress was struggling to provide appropriate aid to nursing homes.

"Still to this day, we are trying to help those residents and workers in nursing homes with one hand tied behind our backs because the Administration... is not releasing any data on outbreaks in these facilities," Casey said during a hearing last month. "This is unconscionable."

While this data set represents the first installment of national data, it is expected that more nursing homes will comply with their reporting requirement next week, when they would otherwise begin to face a daily fine for failure to do so.

Copyright © 2020, ABC Audio. All rights reserved.


How parents can talk to their kids about racism, George Floyd protests

shapecharge/iStockBy KATIE KINDELAN and SARAH LANG, ABC News

(NEW YORK) -- As protests and riots continue across the country in the wake of George Floyd's death, parents across the country are figuring out how to talk to their children about the protests and about fighting racism.

Sarah Smith, a mom of three black children in a predominantly white community in Connecticut, exemplifies what many black parents face, fear for her children, particularly her 12-year-old son.

"I'm scared for my son every single day that he leaves our house," Smith, a blogger, told Good Morning America. "Because I don't know what could happen to him."

Smith said conversations about race with not only her son but also her two daughters are nothing new in their household.

"We have to have these conversations every single day because they are African-American, living in America right now," she said.

Laura Zimmermann is a white mom with two kids who live in Oak Park, an area of Chicago she and her husband chose to raise their kids in because of its diversity. Still, she said she and her husband are "grappling" with how much to tell their children, ages 8 and 2.

"The conversations that we're having in our home honestly have been a little bit strange," she told GMA, adding, "I think this is the time in our history when white people need to step up and really engage. I think we have to start realizing that this isn't about us. It's actually about getting rid of this huge blind spot within our society that there is still systemic racism."

What the experts say


The most important thing for parents to do is to have honest conversations with their children and to be there to answer their questions, experts say.

"It is important to say conversation doesn't solve it by itself, but conversation, certainly with children, helps them make sense of the world," said Beverly Tatum, a psychologist and the author of Why Are All The Black Kids Sitting Together in the Cafeteria? And Other Conversations About Race. "You can have these conversations in an age-appropriate way with 3-year-olds or 13-year-olds."

Tatum added that it's important for white parents especially to remember that the conversations brought on by the death of George Floyd -- who was pinned down by a Minneapolis police officer, an act that was caught on camera -- is "not new information for African-American families."

"It's just a reminder that we haven't come as far as we need to go in order to really ensure everyone's safety," she said. "Racism is real. It's still with us."

For white parents who may not feel confident speaking with their children about race, or who may not feel as if they have all the answers, that can be an opportunity to learn with your children, according to Margaret Hagerman, a sociologist and the author of White Kids: Growing Up With Privilege in a Racially Divided America.

"In order to understand the present, we have to understand the past, and it might mean that you don't know all the answers and you don't feel confident even talking about this with your children. But that means that you could do some work to learn the answers to these questions," she said. "You can take the time to read up on this and this could be something even that you do with your children."

Dr. Janet Taylor, a psychiatrist and the mother of four black children, echoed Tatum and Hagerman. For parents at this moment in time, she said, "communication is key."

"Now is the time to talk to our children about the anxiety that we are feeling, which they are feeling as well, and teach them how to resolve that, how to soothe themselves," she told GMA. "Because what we don’t want is our children to associate their anxiety with the images that they’re seeing on the TV."

Here are three tips from Taylor, in her own words, on talking to kids about racism and the protests currently underway.

1. Tell the truth. "You say their names -- George Floyd, Ahmaud Arbery, Breonna Taylor, all black people. One was being arrested. One was jogging. The other one was killed by the police [in her home]. We use those words and say that the protests are happening because [people] want justice, they want change and there are peaceful ways to do that. It’s an opportunity to teach, when you have conflict, how to speak up and do the right thing instead of inflicting more pain."

2. Celebrate the differences.
"You can point out the differences in skin color, hair texture, things that our kids know anyway. . . . We need to celebrate differences and we also need to point out that we can come together and make a difference and it has to be that way. Black people cannot be the only ones teaching Americans about racism. It’s a combined effort."

3. Set the example as parents. "Look at mommy-and-me get togethers. You look at playdates. People need to look around and think, How diverse are those playdates? As important as it is to talk about racism, our children are not born racists. That is something that develops based on what they hear, what they see. It’s really important to teach our children as early as possible to be allies, to stand side by side with their classmates. Stand side by side by your playmates. Speak up when you see someone who is not involved or not invited to a birthday party and to support. We can teach that at birth by examples as parents."

Copyright © 2020, ABC Audio. All rights reserved.


Having high blood pressure may make coronavirus more dangerous

Chinnapong/iStockBy DR. NANCY A. ANORUO, ABC News

(NEW YORK) -- High blood pressure, a common disease affecting about 45% of Americans, is sometimes called the 'silent killer' because it can lead to early death even without symptoms. But new research shows that people with high blood pressure may be more likely to be hospitalized and become severely ill with the virus that causes COVID-19.

High blood pressure is blood pressure greater than 120/80. In fact, the most common underlying condition in hospitalized patients with COVID-19 is high blood pressure, or hypertension, according to studies in the Journal of the American Medical Association, the Lancet and by the Centers for Disease Control.

Though hypertension is quite common among Americans, in some studies a staggering number of patients with COVID-19 had underlying hypertension. In one study, 63% of patients with COVID-19 in the ICU had baseline hypertension.

Researchers are not sure why so many hospitalized and ICU patients with COVID-19 have underlying hypertension. However, as we learn more about this new illness, some experts suspect that the subtle organ damage caused by high blood pressure may be giving these patients an inherent disadvantage in their fight against the virus.

Hypertension can have damaging effects on many organs including the heart, blood vessels, lungs, brain and kidneys. Medical experts learning more about the novel coronavirus have found that this respiratory disease can also affect many organs, especially the heart and blood vessels -- bad news for those with hypertension.

“While pneumonia is the most common complication of the virus, it can also damage the cardiovascular system. That’s why people with high blood pressure, heart disease, and heart failure are at risk ... and [may be] less likely to weather the storm of COVID,” said Craig Smith, MD, interventional cardiologist and medical director of the Cardiac Intensive Care Unit at UMASS Memorial Medical Center.

Is everyone with high blood pressure at risk?

Not all hypertension is the same. Physicians make the distinction between "controlled" and "uncontrolled" hypertension. A person with "controlled" hypertension achieved a healthy blood pressure with medication or other means, while a person with "uncontrolled" hypertension still has a blood pressure above the healthy range.

To date, studies have not distinguished between controlled versus uncontrolled hypertension.

But Dr. Smith said, “Uncontrolled hypertension is more likely to be associated with long term damage to the heart and kidneys, which do make you more likely to be more sick if you are COVID positive.”

However, those with controlled hypertension should not consider themselves out of the woods.

What should those with high blood pressure do to stay safe?

During this time it is important to continue getting your routine check ups. Fears of getting infected when leaving the house and many offices being closed may make it more challenging to get this care. Telemedicine might be a good alternative if you can’t see you doctor in person.

And while public health measures like hand washing, wearing a mask and social distancing are important for everyone, those with hypertension should be particularly cautious: for them, a COVID-19 infection may be more dangerous.

“In addition to practicing safe measures to avoid virus exposure, the biggest issue would be to focus on the hypertension itself,” said Dr. Smith. “By all accounts, the most important thing is to make sure you continue to take the meds that have your blood pressure under control... other medical conditions are not on hold just because COVID is here!”

As the nation grows weary from pandemic isolation and states begin slowly opening up, those with high blood pressure have an extra reason to stay indoors a little longer.

Copyright © 2020, ABC Audio. All rights reserved.


Risk versus reward: How safe are popular summer outdoor activities?

Oks_Mit/iStockBy OLIVIA RUBIN and DR. MARK ABDELMALEK, ABC News

(NEW YORK) -- All 50 states have now reopened in some form, and after months staying inside, Americans are itching to experience the joys of summer.

"There's a tremendous urge for American's to get out," Dr. Andrew Noymer, a public health professor at University of California Irvine, told ABC News. "You can feel it."

And that's not necessarily a bad thing. Many experts said that there could be a resurgence of the coronavirus in the fall after a lull in the summer, so Noymer said this could be a time to take advantage, while taking prudent precautions.

"In the fall I'm expecting things to get worse, not better. Respiratory diseases always get worse in the fall," he said. "People need to have a summer break. We can't just stay in the basement for 24 months until the vaccine comes."

But can it be done safely? Americans have been left thinking about this question as beaches, outdoor bars, farmers markets and golf courses begin to reopen. According to health experts, the answer is both yes and no. All those activities are not created equal in the eyes of a virus -- outdoor bars especially present a health challenge relative to the others -- but ultimately, experts said it all comes down to how much risk one is willing to take.

"People should figure out how at risk they are, and then determine how risky they want to be," Dr. Noymer said, noting that the only way to completely avoid contracting the virus is by completely isolating inside -- an unrealistic expectation. "We're in the land of trade-offs now."

Noymer cautioned that people in high-risk populations, such the elderly and those with underlying conditions as well as those who are in close contact with members of high-risk populations, especially may want to reconsider activities that could further endanger them or their loved ones. Health officials said the virus can spread from seemingly healthy, even asymptomatic carriers to the more vulnerable.

"We're all in this together," Dr. Henry Raymond, an epidemiologist and associate professor at the Rutgers School of Public Health, added. "That is the nature of humanity and diseases."

Generally, the risk of transmitting the virus is much lower outdoors than it is indoors, experts say, a good thing when it comes to outdoor summer activities.

Dr. Erin Bromage, an associate professor of Biology at the University of Massachusetts Dartmouth who wrote a viral blog post on contracting the illness, broke it down in a simple formula: Getting sick is based on how much virus you are exposed to over what period of time. A person is less likely to be exposed to a large amount of virus droplets for a long amount of time when outside, where distancing measures and better air circulation can disperse the virus droplets.

"Outdoors is inherently safer than indoors, but its about the number of people around," Bromage said. "If you are outdoors and you can maintain at least 6 feet from anybody, your risk is very low."

"As soon as you put people inside, if you don't have good filtration, [virus droplets are] able to accumulate in that environment, so now its not a matter of six feet away -- potentially everybody can get a low dose," Bromage continued.

Studies seem to support the idea that indoor transmission is the most high risk.

So what does that mean for popular summer outings? Raymond said "it all comes down to the nature of the space, the number of people in it, and how much time you spend there."

ABC News asked these three experts to weigh in on the safety of several popular outdoor summer hotspots from beaches to outdoor bars to community fairs.

For all of them, they note social distancing measures are key, as is mask-wearing in many cases, though some activities are riskier than others. Overall though, these summer activities are in the "realm of tolerable risk," one expert said.

"Most of them are safe, but its how you behave when your in those spaces," Bromage said.

Beaches

For beaches, "it depends on the day," Raymond said. "A walk on a not-crowded beach is great."

But Bromage said even a more crowded beach, where distance is being maintained, "doesn't present a huge leap in risk compared to an empty one."

Noymer said that it's unavoidable that some people may catch coronavirus at the beach -- like just about any public place -- but "many less than shopping malls."

Sports: Tennis, golf, soccer

Noymer said outdoor recreation, including tennis and golf "is okay," given that they are non-contact sports where people maintain distance.

"If playing with household members you don't need to mask," he added, "but if with strangers, then mask up."

When it comes to other sports, such as soccer, the risk goes up. If people were to play soccer, Noymer said coaches, refs and substitute players should mask, though it would be difficult for players to do the same.

"Remember: we're in the land of trade-offs now. The only zero-risk activity is staying at home," Normer noted. "It's about balancing risk versus rewards. The reward is some semblance of a normal childhood."

Swimming

Noymer said swimming in both the ocean and a chlorinated pool is completely fine, as "the virus is adapted for respiratory droplet transmission, and it doesn't survive in water environments."

The problem arises with the social activity associated with swimming pools -- hanging around beach chairs and socializing.

"Where the problem comes is that swimming pools are social events," Noymer said. "That's what concerns me more than swimming its self. Some kind of social activity around the swimming pool is more of a concern."

Community fairs

Raymond said fairs are "tricky" as well "because they are so crowded." However, they can be doable. Since everyone is outside, and if everyone were to be masks, Raymond said, that would be okay.

"The eating part can happened with spaced-out tables," he added.

Farmers markets

Experts seem to agree that farmers markets, when appropriate social distancing is being maintained and masking is occurring, are safe.

"If the clients are masking and the farmers are masking, then I think outdoor farmers markets are fine," Noymer said.

Raymond also said he "would be comfortable" with people going if the crowds are limited and people were masked, "just like a grocery store."

But Bromage said the safer spaces are ones where you can physically distance further, and a farmers market "where you have many short interactions walking by [others]" can add to the risk.

Outdoor Bars

This is where experts have taken pause. Outdoor bars are "trickier," Noymer said, because they tend to be more crowded, despite the "best intentions" of everyone involved, and have more touch surfaces, which have a low but-not-zero possibility of transferring the virus.

"This is definitely for people with an appetite for greater risk," Noymer added.

"Bars present their own unique problem," Bromage added. "Even with a mask, it is higher risk."

One thing to keep in mind? The wind. It can be helpful in dispersing virus particles, but also has the potential to waft them into you.

"If you are directly downwind of someone infected, those respiratory droplets could be blowing directly at you," Bromade said. "That would be the same as talking face-to-face indoors."

Copyright © 2020, ABC Audio. All rights reserved.


Front-line doctors face a mental health crisis amid coronavirus: Can medicine overcome the culture of stoicism?

iStock/NanoStockkBy: ERIN SCHUMAKER, ABC News

(NEW YORK) -- The coronavirus pandemic has taken a toll on the American psyche, with a third of Americans now showing signs of clinical depression or anxiety, a rate twice as high as before the pandemic, according to Census Bureau data. Those grim statistics are likely even direr for the health care workers on the front lines of the crisis, experts say.

While it's too early to truly quantify the effect that treating patients under combat-like conditions will have on doctors in the coming months or years, preliminary research out of China highlights the mental health risk that American health care workers potentially face.

Of more than 1,200 health care workers surveyed in China, roughly half showed symptoms of depression or anxiety, according to a JAMA Network Open article published in March. More than a third of those surveyed reported insomnia. Some 70% said they were distressed. Nurses, women, health workers who had direct contact with COVID-19 patients and those in Wuhan, the epicenter of China's outbreak, reported the most severe symptoms.

The consequences of ignoring doctors' mental health during the pandemic are grave.

In April, Dr. Lorna Breen, medical director of a New York City emergency department, which had nearly been overwhelmed by COVID-19 patients, died by suicide at age 49. She had no prior history of mental illness.

"Make sure she’s praised as a hero, because she was," Breen's father told the New York Times. "She’s a casualty just as much as anyone else who has died."

"We have to see emotional and mental health support as being as important and vital as we see PPE [personal protective equipment]," said Dr. Samantha Meltzer-Brody, a psychiatry professor and director of the well-being program at University of North Carolina.

Every hospital and medical facility should be asking themselves, "what are we doing to prevent the emotional impact of being a health care provider in this environment?" she said.

"Health care workers are not starting with a baseline of zero. They had super elevated depression, suicide rates and burnout prior to COVID," explained Dr. Jessica Gold, an assistant professor of psychiatry at Washington University in St. Louis.

Depression, burnout and suicide plague the medical profession. While there hasn't been much recent research evaluating the incidence of physician suicide in the United States, studies from the 1990s found that the risk for suicide among male physicians was 40% higher than for men in the general population. For female physicians, that risk was 130% higher.

Newer research continues to indicate that suicide rates among physicians outpace rates in the general public.

Layered on top of an already stressful job is a public health emergency the likes of which our country hasn't seen in a century, compounding doctors' existing mental health risks.

The list of stressors for health care workers during COVID-19 is overwhelming even to read. They worried about not having enough PPE to protect themselves from the virus. They agonized over the prospect of running out of ventilators and having to withhold care from the dying. Many practiced outside of their field. They took on grueling shifts, with no sense of when the outbreak would crest. Burnout was brutal, they said. Colleagues fell ill and some died -- 63,000 and nearly 300 respectively according to the CDC. After finishing their COVID-19 duty, some were redeployed. They slept in hotels, isolated, to protect their families, or went home each night, and worried about putting their families at risk. Those far away from the front lines said they felt guilty and inadequate for not being there.

Then there was the helplessness inherent in being unable to save tens of thousands of patients.

"Early on, the predominant emotion was anxiety," said Dr. Michael Devlin, a clinical psychiatry professor at Columbia University, who led group sessions on Zoom for health workers during the pandemic. Hospitalizations in New York City were surging and the doctors he counseled were worried about exposing their families.

"You're putting people in between the two things they care most about — their work and their family," he said. "It's excruciatingly difficult for many people."

Over time, that anxiety gave way to grief over seeing so much loss and death.

Patients' families were barred from the hospitals. In many cases, doctors and nurses were the ones holding the iPad as patients said goodbye to their loved ones through a screen.

"There was all the awfulness of people not being able to say goodbye to loved ones and having to witness that," he said.

Traditionally, medical professionals have relied on a culture of stoicism and self-sacrifice in order to do their jobs. In some ways, it's necessary. "Doctors are trained to try not to have their emotions interfere with their judgement," said Donald Parker, a licensed clinical social worker and president of Hackensack Meridian Health Carrier Clinic, New Jersey's largest nonprofit behavioral health system.

But that same culture also puts doctors at risk of not taking care of, or hurting themselves, experts say.

"You want your doctor to be neutral in emotions and deep in their expertise. That creates an environment where they don't feel free sharing their emotions," said Parker, who has worked in behavioral health for more than four decades.

Without an outlet, even those who have been calm and reserved over the course of their careers can become overwhelmed.

"It spills over," Parker said. "You are left with an intensity in reaction that becomes dysfunctional."

Dr. Jo Shapiro's job is taking doctors' mental health and well-being seriously.

After three decades of practicing surgery, Shapiro spent 10 years at Brigham and Women’s Hospital in Massachusetts, directing a program to train physicians to support one another when they experience trauma on the job. She's given peer support training at more than 50 organizations in the United States and around the world, and when the pandemic hit there was even more interest among organizations who wanted to launch new programs or adapt their existing framework to the COVID-19 crisis.

But when Shapiro herself developed COVID-19 early on, she refused to take her own advice about self-care and self-sacrifice.

"Although I didn’t have to end up in the hospital, I have never been that sick," she said. As her health worsened, Shapiro continued to work on starting peer support programs when organizations reached out to her.

"The level of hypocrisy that I demonstrated to myself as I was getting sicker and sicker shows you how deep the culture is. I was doing exactly what I tell people not to do," she said.

The stigma attached to asking for support can lead doctors to suffer in silence or use negative coping mechanisms, like alcohol or drugs to self-medicate, experts say.

"Nobody wants to look like they are incompetent or like you can’t trust them in a battle," said David Pezenik, a licensed clinical social worker, who counseled first responders about grief and trauma after 9/11.

"It usually takes a little while for it to set in and manifest," he said of trauma.

"The patient might not even realize what they’re going through. The first part, before denial is shock. When you’re in shock you don’t even feel the pain."

Not everyone who experiences trauma or burnout will develop conditions like anxiety or depression, but there are some early signs to watch out for, Meltzer-Brody explained.

First it's important for doctors to pay attention to their stress levels, their emotions and the effect their work is having on them. "There are people who are very aware — and those who are less so," Meltzer-Brody said.

Positive coping strategies, like exercise, connecting with family, friends and colleagues, eating well, and taking physical and mental breaks, can help.

If those positive coping strategies fail and a doctor still feels depressed, anxious or can't sleep, it's a sign they may need more formal mental health support.

"Just being able to name it is one thing, having tools to deal with it is a different thing," Meltzer-Brody said.

While some people will bounce back from trauma, others will inevitably suffer long-term mental health consequences.

The worst concern, first and foremost is that someone will develop PTSD and clinical depression and have decreased functioning," Meltzer-Brody said.

Decreased functioning could mean not being able to interact with family members or being unable to go to work. Relationships with significant others or between parents and children could become strained. Developing addiction as a maladaptive coping strategy is another risk. Some may leave the workforce altogether, and others may feel increasingly hopeless and that life is not worth living.

When asked about the potential for doctors dying by suicide, Meltzer-Brody said, "People like me who run these programs think about it every day and worry about it every day."

COVID-19 has the potential to have a devastating impact on doctors' collective mental health in the U.S. But it could also be the catalyst needed to implement preventative mental health support programs in institutions that aren't investing in them.

Of the dozens of the programs Shapiro has helped launch, the majority began with an unsettling trigger point, such as a medical error in a hospital, the death of a colleague, or a mass casualty like the Boston marathon bombing.

"Things that a caring, compassionate person might be deeply affected by," Shapiro said.

Support programs vary, but the best ones are often multifaceted and involve proactively reaching out to doctors, rather than expecting them to ask for help when they need it, experts say.

UNC offers evidence-based stress first-aid training for front-line workers based on best practices from the military and first responders to lessen the effect acute stressors have on them in challenging situations. There are also virtual groups run by trained mental health providers and an anonymous helpline staffed by clinical social workers.

Doctors are encouraged to call in if, for example, they are increasingly scared to go to work, or if they've gotten in a fight with their spouse and are worried about how it's affecting them.

In her work, Shapiro has found that doctors feel most comfortable opening up with a physician colleague, rather than with a mental health professional, who might not be able to relate to their exact circumstances as intimately.

Her peer-to-peer programs train doctors to support one another during difficult circumstances. If there's any potential that an event could be emotionally traumatic, peer supporters reach out proactively to their colleagues.

"We should think of peer support as preventative," Shapiro said. "Some people, some physicians, some health care providers over the course of doing their work are going to become burnt out, depressed, or will develop PTSD, or become suicidal," she said.

"We know it. We have the data. Let’s not wait. Let’s know that there are certain circumstances, emotions, events that are especially emotionally stressful. Let’s reach out at those times and offer peer support rather than waiting for suffering."

The need is evident. Thousands of health care professionals have utilized UNC's online mental health resources and attended virtual forums since the pandemic began. Shapiro is seeing an uptick in requests for her help starting peer-to-peer support programs. At Columbia, after Dr. Breen died by suicide, demand for one-on-one counseling sessions skyrocketed.

But programs like the ones Meltzer-Brody and Shapiro run are the exception, not the rule.

"If we look at the United States broadly, a tiny handful of places are taking this as seriously as they should be. That’s grossly inadequate to take care of the huge number of health care providers who are facing this," Meltzer-Brody said.

There needs to be a call to arms that doctors' mental health needs are not being met, she stressed.

That call needs to be more than "call your employee assistance program," she said, referring to such assistance programs a good start, but far short of the proactive mental health support health care workers need. Instead, programs like hers should be widespread and available to everyone, which may be a real possibility if newly loosened rules about mental health treatment using telemedicine are extended beyond the pandemic.

"With virtual care there is no reason that it can’t be scaled up," Meltzer-Brody said.

"I think we have to see this as being as important as we see PPE," she reiterated. "Do we have adequate PPE to prevent physical transmission? This is the equivalent of emotional PPE."

If you are struggling with thoughts of suicide or worried about a friend or loved one help is available. Call the National Suicide Prevention Lifeline at 1-800-273-8255 [TALK] - for free confidential emotional support 24 hours a day 7 days a week. Even if it feels like it – you are not alone.

Copyright © 2020, ABC Audio. All rights reserved.


As states protect nursing homes from lawsuits, families fear they have little recourse

iStockBy: LAURA ROMERO and ALLISON PECORIN, ABC News

(NEW YORK) -- On Valentine’s Day of this year, Tosica Figueroa and her six sisters made the wrenching decision to move their father, Alonzo Matthews, into a nursing home. The sisters could no longer handle the care for Matthews, a former Washington, D.C. correctional officer who had been suffering from Alzheimer’s disease.

Within three months, Matthews died after testing positive for COVID-19. His anguished daughters said they began discussing filing a lawsuit against the Bethesda Health and Rehabilitation Center in Maryland alleging neglect after she said she heard about the condition he was in in his final days. They have not yet formally filed their complaint.

“When he was taken to the hospital, the doctor informed us that he had lost 30 pounds and that he was so dehydrated, his blood was like mud,” Figueroa said. “His sodium levels were so high from how severely dehydrated he was. There’s a difference between my father dying of coronavirus or dying with coronavirus.”

Figueroa also said their father went into septic shock two weeks before he died on May 6.

Bethesda Health and Rehabilitation Center did not respond to ABC News' requests for comment, but the company that owns the nursing home previously told ABC News' affiliate WJLA-TV, "We know that this is an unsettling and scary time for our residents."

"We understand and greatly appreciate family members’ concern for their loved ones and are doing everything in our power to keep our residents safe and protected," SavaSeniorCare Consulting LLC Chief Experience Officer Annaliese Impink said.

Figueroa and her family represent a growing number of families who are contemplating lawsuits against long-term care facilities across the nation as more than 37,000 residents have died in nursing care during the coronavirus pandemic, and amid some reports of under-staffing and inadequate protections.

But pursuing legal action during a pandemic could prove an uphill battle for Figueroa and many others.

Even before the COVID-19 outbreak, Maryland had legal provisions in place that protect health care providers of legal liability during a declared public health emergency. Now, as the virus invades nursing homes across the country, Congress is considering instituting similar protections for nursing homes nationwide.

Every case is different, said attorney Michael Brevda who is involved in several lawsuits against nursing homes in New York, Florida and Pennsylvania, and facilities could still be liable for wrongdoing. But he said that taking legal action during the pandemic "against nursing homes for COVID-19-related injuries or deaths may be challenging because of the protections."

While supporters of the measures, including Senate Majority Leader Mitch McConnell, say they protect front-line workers from "frivolous" legal action in the midst of an emergency, advocates for the elderly and their families say the ongoing and potential lawsuits are about protecting residents.

“With the limited accountability we have right now because of the lack of family visits, having this basic legal accountability is one of the few things that we have left to make sure that they keep peoples loved ones safe,” said David Certner the Legislative Counsel and Legislative Policy Director for Government Affairs at AARP. “The point is to maintain accountability especially at a time when there is none."

The potential congressional action comes as at least 15 states recently issued executive orders or new legal provisions to shield nursing homes from legal action related to the pandemic, according to a review of public records by ABC News.

State by state, protections for health care workers differ. Some states have no lawsuit shield, others guard only from civil suits while others still offer protection from criminal lawsuits as well. In many cases these protections are triggered by the declaration of a public health emergency.

In New York, for example, where nursing homes now account for almost 6,000 deaths -- 25% of all deaths from the virus in the state -- lawmakers inserted language into a budget bill, signed by the governor on April 3, that would grant nursing homes and medical providers protection from civil and criminal lawsuits.

“The furnishing of treatment of patients during such a public health emergency is a matter of vital state concern affecting the public health, safety and welfare of all citizens,” the new provision says.

To promote that, the language says, “broadly protecting the health care facilities and health care professionals in the state from liability that may result from treatment of individuals with COVID-19 under conditions resulting from circumstances associated with the public health emergency.”

Other states, like Massachusetts and Wisconsin, have approved similar COVID-19 lawsuit protections for nursing homes. In Connecticut, Arizona, Illinois, and several other states, similar protections have been imposed as executive orders by the governors.

In California, one woman is suing a nursing home there over the loss of her 84-year-old father, alleging that the facility forged his death certificate and hid a positive coronavirus test result. The woman, Kathryn Sessinghaus, said she learned the home was understaffed and failed to take proper infection control measures.

"This isn't going to bring my father back to life, but I can't imagine any other family going through this," she said in a statement provided to news outlets.

California, like Maryland, has limited laws protecting health care providers from liability during a declared health emergency. The state is considering broader immunity measures, given the current crisis.

Senate Majority Leader McConnell is now pushing for federal liability protections for all medical workers, calling it a “red line” issue – which he wants included in any new legislation aimed at providing additional coronavirus relief.

The costs and benefits of medical malpractice lawsuits has been the subject of decades of wrangling in Congress. McConnell, a Kentucky Republican, has long favored strict limits on those legal cases, and he has re-kindled the debate in the face of the pandemic. At one point, the senator said he feared health care workers could be facing a “second epidemic” in the form of protracted legal battles.

"It is crucial that as we continue to fight the pandemic itself we ensure it is not followed up by a job-killing epidemic of frivolous lawsuits," McConnell said. "This would be about the worst time in living memory to let trial lawyers line their pockets at the expense of the rest of the country."

The Majority Leader has made clear that the federal protections he intends to propose would not include total immunity.

"There will be accountability for actual gross negligence and intentional misconduct," McConnell said earlier this month. “We aren’t going to provide immunity. But we are going to provide some certainty."

Mark Parkinson, the President and CEO of the American Health Care Association, which represents more than 14,000 for-profit nursing homes, sees these protections as necessary for staff to do their jobs.

“Long term care workers and centers are on the front line of this pandemic response and it is critical that states provide the necessary liability protection staff and providers need to provide care during this difficult time without fear of reprisal,” Parkinson said in a statement.

But lawyers representing families who are suing nursing homes say lawsuits are not targeting workers. Rather, they are holding upper management accountable and will help promote the best care possible.

“For the most part, these front-line workers are the heroes in the facilities,” said Matt Morgan, an attorney with the firm Morgan & Morgan that has announced it intends to sue a nursing home where 16 residents died. “But upper management is telling them what to do and what not to do. These people are being put into harm's way without appropriate [protective gear], without getting tested, without all the things that they need to keep themselves safe.”

In early March, as COVID-19 began infecting rising numbers of nursing home residents, there were a series of actions that raised concerns among relatives of those living in long term care facilities.

The federal agency that regulates the industry announced they were rolling back their non-emergency inspections of facilities – a move they said would free up inspectors to focus more closely on infection control and safety precautions targeting the virus.

At the same time, nursing facilities were being locked down to prevent new infections. Relatives of residents were told they could no longer visit their loved ones.

Lawyers and advocacy organizations said both actions, while justified for safety reasons, also have restricted outsiders from having any first-hand view of the response inside the homes.

“You're particularly in a situation where there is no practical matter government enforcement of the regulations right now, and surveyors haven't been in nursing facilities for a couple months now,” said Eric Carlson, directing attorney of Justice in Aging, which advocates for impoverished seniors. “It’s a really bad time for facilities to be immune from any potential civil action for a provider's negligence.”

For Figueroa, who said she is concerned about the conditions leading up to her father’s passing from speaking with the doctors who treated her father, says she finds it deeply frustrating that she may be blocked from pursuing legal action.

“If there's a chance that my sisters and I won’t be able to get justice for my dad, I will be outraged,” Figueroa said.

Copyright © 2020, ABC Audio. All rights reserved.


Why people are flouting coronavirus social distancing precautions that we know save lives

Eblis/iStockBY: IVAN PEREIRA, ABC NEWS

(NEW YORK) -- People packed into a pool at Lake of the Ozarks, Missouri.

Parks in New York City, the epicenter of the outbreak, jammed with sunbathers

A crowded brunch spot in Colorado with diners celebrating Mother's Day.

With more than 100,000 Americans dead and rising from the novel coronavirus, health experts and other leaders have been pleading for people to adhere to their strict guidelines to keep people safe.

But all too recently, these and other examples, large and small, have emerged of people blatantly defying social distancing and face-covering rules. .

Psychology experts said they haven't been surprised by this type of behavior, since it's been a long-standing issue with public health: the ability for people to assess risk. Rajita Sinha, a professor of psychiatry at Yale University and the founding director of the Yale Stress Center, said the uncertainty about when the pandemic will end, access to information and one's underlying beliefs can influence someone to flout precautions.

"Those features of the current pandemic really put into gear people’s need for control which is an important aspect of coping," she told ABC News. "Gaining control is a basic way we cope."

Sinha and other health experts say there is no easy solution to the problem, but there are ways to help those individuals see the need for health precautions.

She noted that risk is a very abstract concept to people. While some people may look at the COVID-related news and feel fear from the images of sick patients, others may want to take their chances, Sinha said.

"If you’re in a bad scenario where there is a lot of danger…if you worried you may not be able to get yourself out, there is a mechanism where we just plow along," she said.

Joshua Ackerman, associate professor of psychology at the University of Michigan, who has studied behaviors related to infectious diseases, said individualism also plays a part in adhering to guidelines.

"If people think masks are self-protection and you don’t think you’ll need protection, you won’t wear them," he told ABC News.

Sten Vermund, the dean of Yale School of Public Health, likened the behavior to running a red light.

"They don’t perceive enough personal risk and they don’t have a sense of altruism that is acute," he told ABC News.

Attitudes on masks and social distancing are mixed in the U.S., according to polling from ABC News and Ipsos. At the end of April, a large majority of the country (82%) were concerned about coronavirus and just 14% thought stay-at-home orders restricted personal liberty. Earlier in April, an ABC News/Ipsos poll found that 55% of Americans had worn a mask in the last week.

While guidance on social distancing has largely been consistent and long-standing -- staying 6 feet away from others to prevent the transmission of respiratory droplets, avoiding large gatherings and staying home -- wearing a mask has been has been much murkier. Public health officials initially suggested that people not wear masks and instead reserve them for health workers, but on April 3, they recommended that people wear cloth masks in public to prevent asymptomatic transmission.

That message has been further confused by President Trump generally refusing to wear a mask, despite the CDC recommendation.

Information, particularly that which is circulating in one's immediate circle, is an important factor for people's behavior's during the pandemic, according to Ackerman. Even though the U.S. leads the world with over 1.7 million cases, there are whole counties, particularly in rural communities, where there are few or no cases. The pandemic looks very different in those places compared to hotspots such as New York City.

Ackerman said the lack of centralized and consistent health-related messaging from local, state and federal leaders and the polarization of news sources will lead people to make different choices.

"People listen to information and they use that to calculate their own risk. In situations like this, sometimes the accuracy of the information is far less

Sinha said that the sometimes lax response to COVID can be amplified where others act similarly for the same reasons. She pointed out the examples of rallies and other demonstrations of people who have expressed frustration with the rise in unemployment and the loss of other social norms.

"They’re worried about work and unemployment and other stressors affecting them and family. They’re not paying attention to everything else," Sinha said. Many protesters at reopening rallies around the country have, however, worn masks.

Vermund said there are also Americans who don't have direct connections with the people most vulnerable to COVID, like the elderly or immunocompromised, so it may take longer for them to grasp the need for precautions. Although the true number of infected is unknown, just a fraction of the country has had confirmed COVID cases and a vast number of those have been concentrated in the urban Northeast.

"We lived through this during the HIV era," he explained. "During the early years, 1981, 1982, people were not changing their behaviors because they weren’t so close to people who got ill. By 1985, the pandemic was so striking and so many people got to know people who got ill and died, that behaviors started to change."

Ackerman said there will likely be increasing cases of people not adhering to social distancing and face-covering precautions as states being to reopen their economies. He noted the psychological notion of "goal completion" -- in this case, the sense that the pandemic may be over because life appears to be returning to normal -- may give some people a false sense of security.

"If we think about the information provided to people...one of the goals given was that we have to flatten the curve. To the extent that people think that the curve has been flattened, they might think the worst is behind them," he said.

He and other health experts, however, said the public can still turn things around and increase compliance with social distancing rules. Sinha said people are more prone to comply with health orders if they have a clear understanding of how it affects the people around them.

Even if it is just one person articulating to a friend or family member that the face masks and distracting practices help the greater good, it could get them to change their minds and pass it on, according to Sinha.

"There is no reason it can’t be done if you can build a narrative around it. If you articulate the full narrative that we are shifting gears and preparing for the next phase, some people will listen," she said.



Copyright © 2020, ABC Audio. All rights reserved.


Doctor warns there could be 100,000 more American COVID-19 deaths by Labor Day, but models vary widely

narvikk/Getty ImagesBy ARIELLE MITROPOULOS, ABC NEWS

(NEW YORK) -- Infectious disease experts from the Emory University School of Medicine are warning that given the current rate of deaths per day, it is possible the U.S. death toll from the novel coronavirus could double by September as restrictions are lifted throughout the summer, and Americans begin to congregate again.

"Yesterday we passed over 100,000 deaths in this country. We are currently at a rate of about 1,500 deaths per day in the U.S. That means that by Labor Day, there will be another hundred thousand deaths in our country. That is a very sobering number," said Dr. Carlos del Rio, a professor of medicine and global health at Emory, during a virtual video briefing conducted on Thursday, as he urged people to be careful and practice social distancing.

In May, according to the European Centre for Disease Prevention and Control, there were between approximately 500 and 2,000 coronavirus-related deaths every day in the United States. However, coronavirus projection models vary widely.

The Centers for Disease Control and Prevention predict that although the rate of increase in cumulative COVID-19 deaths is continuing to decline, the total number of COVID-19 deaths is likely to exceed 115,000 by June 20.

However, a model created by Youyang Gu, an independent data scientist and Massachusetts Institute of Technology graduate who founded covid19-projections.com, forecasts the U.S. is likely to surpass 175,000 deaths by Aug. 8.

In another study, the Institute for Health Metrics and Evaluation, an independent global health research center at the University of Washington, has projected that the U.S. death toll will exceed 132,000 deaths by Aug. 4, but the upper limit of the organization's projection also suggests there is a possibility the U.S. could hit 173,000 by the same date.

"It is without a doubt that unfortunately more Americans will die through the Summer," Dr. Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University, and director of the Global Health Initiative at the Mailman School of Public Health, told ABC News. "It is inevitable that we will continue to see new infections with deaths amongst the most vulnerable populations, the elderly, the poor, African Americans, Latinx, those with other serious conditions."

However, she cautioned that she thinks it is still premature to estimate the number of Americans who will lose their lives to the virus by the fall.

"It is very difficult to make projections that far in advance, particularly as the U.S. is now going through a moment of high uncertainty in terms of the trajectory of the epidemic," El-Sadr told ABC News. "The next few weeks will be critical as more and more communities and states are easing mitigation measures and opening up businesses and activities. What happens next is dependent on what we are doing today in terms of easing of restrictions as well as our willingness to put back restrictions in the event that we see a blip in the number of cases. Right now is a critical time point. What we see in the next few weeks will be critical and how we act and react in the next few weeks will be equally critical."

During the Emory University briefing, del Rio, who was joined by his colleague, Dr. Colleen Kraft, an associate professor in the department of pathology and laboratory medicine and the director of the Clinical Virology Research Laboratory, discussed the current state of the coronavirus pandemic in Georgia, and across the country.

Both specialists stressed that the pandemic is far from over, despite the fact that the rates of infections and deaths are not as high as they could have been if measures such as social distancing, lockdowns and the shutdown of the economy had not been instituted.

Del Rio said that it was a mistake to think of the pandemic in terms of a curve, with a peak and a gradual descent.

"I think what we're beginning to see in the U.S. is a certain stabilization and plateauing in the number of cases," as well as in the number of deaths, he said.

Given the severe economic consequences of the pandemic, for states to reopen safely, he said it's important to track the number of deaths, the rate of hospitalizations and intensive care unit capacity.

Del Rio said it is essential, both at the state level and at the national level, to determine who is getting infected in order to isolate these individuals and stop the outbreak.

"I think we're going to see little outbreaks, but the idea is to make sure that those outbreaks don't become large outbreaks, and we can contain them so you can actually limit the spread of infection," del Rio said. "Because obviously as you're opening up the economy, you will have cases, there's no doubt."

All eyes have been on Georgia, one of the first states to aggressively move to resume economic operations.

There, Gov. Brian Kemp opted to lift many stay-at-home restrictions on businesses across the state on April 27. Gyms, barbers, hair and nail salons, theaters, bowling alleys and private social clubs were among the businesses allowed to reopen.

Although Georgia is still seeing an increase in positive coronavirus cases, and has experienced a few single-day spikes, the number of new cases has remained relatively steady over the past month. There is, however, a slight uptick in the seven-day moving average of the number of new cases, hospitalizations and deaths.

Georgia has more than 45,000 confirmed coronavirus cases, and nearly 2,000 deaths statewide, according to data compiled by Johns Hopkins University.

Kraft said that even though the number of cases has decreased, with schools and colleges reopening in the fall, and people getting back together, it is imperative to trust "our sources of truths," like the CDC and the Georgia Department of Health.

The reopening process, Kraft said, has been "stuttering," because "most" residents remain apprehensive about a return to normal activities, but believes the country will begin to see the implications of reopening in the next month due to the busy Memorial Day weekend.

"I think it's safe to say that we're going to have a continued increase in cases in the U.S., whether it's Memorial Day weekend, or just the fact that we are reopening. I think it's really going to be a matter of individual choices," del Rio said. "If you have a lot of people out, with a lot of contact, you're going to see a lot of cases, and if you have less people with less contact, you're going to have less number of cases, so I really think it's going to be a lot about individual behaviors and less about policies."

Further he said, "Science is going to be critical to get us out of this mess."

Kraft said despite many people's desire to move around with less restrictions, it is important to remember that there may be people around you who are asymptomatic.

"We're now moving into the stage where we're climbing our way out of it, but we're in a plateau, which could easily become a surge," Kraft added.

People should also decide how large they want their "coronavirus circle" to be, that is, the number of family, friends and colleagues they associate with, Kraft said. She also stressed the importance of using protective measures to shield those who are medically vulnerable until there is a sure vaccine and very good therapeutics. "Keep yourself safe so you can keep your circle safe," she said.

Del Rio concluded with a warning to Americans to still take the pandemic seriously.

"This pandemic is not over," he said. "Just because a politician is saying it's safe to get out or we want to reactivate the economy. Take care of yourselves, practice social distance. Be careful. These are not normal times. I don't want to see you become a statistic."

Copyright © 2020, ABC Audio. All rights reserved


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