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Adene Sanchez/iStockBy HALLEY FREGER, ALLISON PECORIN, and MATTHEW MOSK, ABC NEWS
 
(AUSTIN) -- The senior citizens who populate Texas nursing homes were not jammed into bars or packed onto beaches on Memorial Day, but officials there now fear that coronavirus that began spreading among younger people over the past month is imperiling the lives of the state’s most vulnerable.

It was a grim but predictable development for a state with more nursing homes – 1,218 – than any state in the nation, experts told ABC News. Some said they already suspect a link between the recent spread of the virus and a rise in deaths in the state's nursing homes over the past weeks, and said they fear the worst could be yet to come.

Back in mid-May, nursing homes in the state had reported 561 deaths from COVID-19, according to an ABC News review of state data. By last week, that number had nearly doubled at 1,035 deaths.

“As [the infections] continue to grow in numbers in the community, we would expect it to continue to grow in numbers in nursing facilities,” said Amanda Fredriksen, the Associate State Director for Advocacy for AARP Texas.

While nursing homes nationwide are continuing to experience casualties from the virus, some states that have seen decreases in their case rates are also seeing fewer nursing home deaths. Connecticut, for example, was reporting over 80 probable deaths in congregate care facilities daily in April, when the state was at its peak number of coronavirus cases. Now, Connecticut is reporting fewer than five deaths in these facilities daily as case counts decline.

Derrick L. Neal is the executive director of Williamson County and Cities Health District in Texas, near Austin. That district is home to Trinity Care Center, the facility in Texas that has reported one the highest number of fatalities to the federal government. In mid-June the facility had reported 138 resident deaths.

The region has also seen a rise in cases in the wider community, which he attributes to the state’s late-April opening and Memorial day festivities. Now, Neal said, he’s fearful that what he described as a continued failure by residents to adhere to social distancing guidelines could have a devastating impact on those living in congregate care facilities.

“The overarching concern is really a community, not everyone, but a large segment of society refusing to care for their neighbor by masking up and social distancing,” Neal said. “The same things that kept me up in March keeps me up in July.”

Since the beginning of the pandemic, nursing homes have been at the epicenter of the coronavirus crisis. Nationwide, those who’ve died in nursing homes account for nearly a third of all COVID-19 deaths, according to a recent survey of state-by-state data by ABC News – a figure that advocates believe may actually be undercounted.

In part, that is because national statistics have not fully accounted for some of the fatalities during the early days of the pandemic. Local news outlets in Texas also report that nursing homes in Texas have been among the worst in reporting conditions to federal officials tracking the outbreak.

The official count of the federal agency responsible for regulating nursing homes and tracking coronavirus cases in nursing homes says that 35,517 nursing home residents have died nationwide.

That number has continued to grow despite an evolving toolkit of preventative measures that began in March with the federal guidance to nursing homes to restrict visitors, isolate the sick, and require staff wear protective equipment.

In June, Texas followed the lead of Maryland and other states in forming “strike teams,” which could mount a rapid response when a nursing care facility showed the early signs of an outbreak.

Representatives for the Texas Department of State Health Services did not immediately respond to ABC News' request for comment for this report. The Texas governor has previously stated that protecting seniors in nursing facilities is a priority and earlier this month encouraged nursing homes to apply to receive parts of over $9 million in federal funding being allocated to Texas nursing homes.

"We know that older Texans are more susceptible to COVID-19, and Texas is committed to ensuring that nursing facilities have the tools they need to keep their residents and staff safe,” Abbott said in a press release. “We must continue to protect our most vulnerable populations, mitigate the spread of COVID-19 in Texas, and protect public health.”

But last month, when the state started seeing a rise in infection among young people, advocates for the elderly began to worry that their defenses would not be strong enough to prevent the virus' spread into nursing homes. That, said Patty Ducayet, the State Long-Term Care Ombudsman for the Texas Health and Human Services Department, appears to be happening now.

“We are still seeing new cases identified in both our nursing facilities and assisted living facilities,” Ducayet said.

Neal said he’s also concerned that staff, many of whom are low paid and lack the luxury of social distancing in their own living situations, are proving to be a vulnerability in the chain of transmission.

“It's really extremely difficult to stabilize a group of patients when you have a lower pay individual going in there to support them,” Neal said.

Organizations that advocate on behalf of nursing homes are urging that the rise in cases be met with a surge in testing and personal protective equipment for nursing homes. According to a survey by the Association for Health Care Associations, nursing homes report that they are still struggling to get tests processed in a timely fashion, and many report they do not have adequate access to protective equipment.

Testing is once again becoming a challenge nationwide as some facilities report being overwhelmed by the recent surge in cases. Jo Lynn Garing, a spokesperson for a leading high-volume test manufacturing company Roche Diagnostics, said the company is focusing on vulnerable states like Texas.

Garing said the company not only has been expanding its production capacity but also continues to be “very intentional” on its allocation and distribution of supplies, “prioritizing labs with the broadest geographic reach and highest patient impact.” Garing said the current priority areas are the same areas seeing surges, including Florida, Arizona, Texas and California.

On Friday, Governor Abbott announced a new partnership with Omnicare, a CVS health company, to provide COVID-19 point-of-care testing for assisted living facilities and nursing homes throughout the state. A release states that this partnership will help the state meet its goal of processing up to 100,000 tests in the first month it is operational.

"Our collaboration with public and private entities is crucial to ramping up testing in Texas and mitigating the spread of this virus—especially among our most vulnerable populations," Gov. Abbott said in a statement provided to ABC news after an inquiry for this report.

Aggressive use of preventive measures now could help, advocates say. But while community spread continues, nursing homes remain vulnerable.

“As long as those cases keep rising and as long as they're active in the community where these facilities are, it's going to be a concern for all of these nursing home residents,” Fredriksen said.

Copyright © 2020, ABC Audio. All rights reserved.

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PeopleImages/iStockBy ANASTASIA ELYSE WILLIAMS, KATIE KINDELAN and KATE HODGSON, ABC News

(NEW YORK) -- The death of a 26-year-old Black woman during an emergency C-section is putting a spotlight on the disparities women of color face during childbirth, and leading to calls for change.

Sha-asia Washington died earlier this month during an emergency C-section at NYC Health Hospitals/Woodhull, a city-run hospital in Brooklyn, New York.

"If you know shaasia she wanted to be a mom and she was gonna be an amazing one," reads a GoFundMe page that has raised more than $67,000 for Washington's daughter, Khloe, and her partner, Juwan Lopez. "She left behind so many hurt people with this sudden tragic los[s]. No one was expecting this."

Washington's death led to a protest Thursday outside the hospital in Brooklyn, and is drawing the attention of celebrities like Amy Schumer, who posted about Washington's death on Instagram, writing, "We need to wake up and do better every day."

The hospital where Washington passed away is now conducting an internal review of the incident.

"NYC Health Hospitals/Woodhull is committed to the maternal health and welfare of our patients," the hospital told ABC News in a statement. "We are saddened by this death and our condolences go out to the family of the deceased. The City's public health system recognizes the disproportionate increased burden that black and brown patients face during childbirth. We are devoted to understanding the causes, and are committed to addressing this unacceptable disparity."

About 700 women die each year in the U.S. as a result of pregnancy or its complications, according to the Centers for Disease Control and Prevention (CDC).

Black women, as well as American Indian and Alaska Native women, are two to three times more likely to die from pregnancy-related causes than white women, according to data released last year by the CDC.

The inequities for women of color increase by age and are not affected by education levels or location, according to the CDC.

"It's not tied to income. It's not tied to education. . . . It's something about the lived experience of being African-American," Dr. Neel Shah, assistant professor at Harvard Medical School and an OB-GYN at Beth Israel Deaconess Medical Center in Boston, told ABC News in 2018.

The majority of pregnancy-related deaths in the U.S., 60% or more, could have been prevented, CDC research shows.

Bruce McIntyre, who is raising his 2-month-old son Elias as a single dad, said that was the case with the death of his partner, Amber Rose Isaac.

Isaac, 26, also died following an emergency C-section in a New York City hospital. She passed away just days after posting on social media about her experience with what she called "incompetent doctors" during her pregnancy.

"She was ignored," McIntyre told Good Morning America of his son's late mother. "Time and time and time again, she's voiced her concerns."

The hospital where Isaac died, Montefiore Medical Center in the Bronx, told ABC News in a statement, "Ninety-four percent of our deliveries are minority mothers, and Montefiore's maternal mortality rate of 0.01 percent is lower than both New York City and national averages. Any maternal death is a tragedy."

The CDC points to several factors that lead to pregnancy-related deaths in America, including, "access to appropriate and high-quality care, missed or delayed diagnoses, and lack of knowledge among patients and providers around warning signs."

The agency calls the disparities in pregnancy-related deaths for women of color a "complex national problem."

Dr. Jennifer Lincoln, a Portland, Oregon–based OBGYN, is using the social media platform TikTok to draw attention to the issue.

"We have so many other studies that show that Black people are undertreated for pain," Dr. Lincoln told GMA. "They wait longer in the emergency room. They are less likely to be taken seriously."

Dr. Lincoln said she hopes other doctors follow her lead in checking their implicit bias when treating patients, particularly pregnant women.

"I still have to stop myself every time I'm caring for somebody who looks different than me," she said. "And I always check and I say, ‘Am I delivering the same level of care here?’"

Alreema Vining launched her own career in women's health after she felt her race impacted her treatment while pregnant.

"Not only was I a mother of color, I was also a mother of color and I had Medicaid so I didn't have the top, top-of-the-line insurance," said Vining, who said she was left temporarily paralyzed from an epidural while giving birth to her third child. "So right then and there, I have the two going against me."

Vining now works as a doula, hoping to create a comfortable and safe experience for future mothers.

"A part of me loves the fact that I went through it because if I hadn’t gone through it, I wouldn't be following my passion," she said.

Copyright © 2020, ABC Audio. All rights reserved.

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smolaw11/iStockBy DR. SABINA BERA, ABC News

(NEW YORK) -- While the Trump administration is urging schools to open in the fall, many parents remain concerned about the safety of their children.

Amid the coronavirus pandemic, is going back to school safe?

The American Academy of Pediatrics has some answers. The nation's top pediatrician group made headlines last month after releasing clinical guidance saying this year's goal should be for students to be "physically present in school."

The guidance highlights the negative impact on children since school closures. More time away from school can result in social isolation, abuse and untreated mental health disorders. Kids also experience food insecurity and less physical activity, and school closures can worsen racial and social inequities. Together, this could put children at higher risk of developing diseases.

"We absolutely need to open schools. There's no question school is important for children -- not just for education purposes, but for their development, for their mental health, for nutrition and even for health care," said Dr. Edith Bracho-Sanchez, a practicing pediatrician and assistant professor of pediatrics at Columbia University.

She said that health care in schools is especially important for children that live in vulnerable communities or have complex medical needs.

Still, doctors acknowledge there are clear risks to sending children back to school amid the COVID-19 crisis. Without proper precautions in place, the virus could spread quickly in schools.

"While a laudable goal and crucially important for restarting the economy, reopening the schools cannot be rushed into, especially for political reasons," said Dr. Matthew Heinz, a hospital physician in Arizona, which is one of the states now being hit the hardest by the virus. "It is neither good policy nor good politics to recklessly push for reopening of states or schools on an accelerated, dangerous timeline that will result in many thousands of new infections and eventual deaths."

While children seem to be largely protected from severe illness from the virus, there are reports of a rare multi-system inflammatory syndrome currently developing in children. Plus, schools are run by adults -- teachers, counselors and administrators -- who are much more vulnerable to severe disease.

Pediatricians recently advocated that schools open in the fall in a recent publication in the scientific journal Pediatrics. They acknowledged that despite the many unanswered questions, early evidence indicates that young children do not spread the virus as readily as adults.

Although data is limited, studies done in Switzerland and China suggest that children do not easily infect others with the virus, offering "early reassurance" that transmission at school could be a "manageable problem."

But when it comes to older children, particularly teenagers, the limited evidence we have seems to point to the fact that they are more capable of spreading the virus. Scientists are still working to understand how and why people of different age groups seem to have different capacities to spread the virus.

For now, pediatricians are urging schools to reopen, but with extremely well-thought-out infection control measures in place and a remote learning fallback plan in the event that an outbreak springs up.

For parents, weighing the risks and benefits of sending children to school can be daunting. Bracho-Sanchez encourages them to learn about the preventative measures their child's school is taking, and also whether the virus is under control in their community.

Dr. Tom Frieden, former CDC director and president and CEO of Resolve to Save Lives, stressed the importance of flexibility when reopening schools, discouraging a one-size-fits-all approach.

There are scenarios that should be considered individually, such as when children live with their grandparents, who are more likely to die if they become exposed to the virus, Frieden said at a teleconference briefing earlier this week.

Frieden also shared that the goal of the school should be to reduce risk, which may result in a different school experience. For example, schools may install hand washing stations, keep windows open for ventilation, suspend use of cafeterias and stop certain high-risk group activities such as assemblies.

Many pediatricians and public health experts have stressed that the steps adults take now will directly impact our children's ability to go to school in the fall. They encourage rigorous social distancing measures, mask wearing and abiding by other CDC guidelines to stop the surge of cases in many communities, most recently in Arizona, Florida and other sunbelt states.

"For states like Arizona, Florida and Texas, school reopening should not be seriously considered until early 2021, and the decision should be based on the best available public health data at that time," Heinz said.

Experts say schools will have a difficult time reopening if the virus in the local community is not under control. Frieden said the "single most important thing is to control COVID in the community."

"I don't think we get to say, 'Everyone back to school no matter what,' without taking into consideration some communities in this country really don't have these fires under control," Bracho-Sanchez said.

Bracho-Sanchez emphasized that children do not exist inside a vacuum, and the health of the adults in their community is very important when considering reopening schools.

"It doesn't have to be school or their health, it can be both school and their health, if we get the [virus] under control in our community," she said.

Copyright © 2020, ABC Audio. All rights reserved.

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Bill Oxford/iStockBy SOO RIN KIM, OLIVIA RUBIN and ALI DUKAKIS, ABC News

(NEW YORK) -- As coronavirus cases surge in much of the country, issues with testing availability and access have once again arisen in nearly every aspect of the testing supply chain, local officials and hospital leaders in several states told ABC News -- a troubling echo of the shortages that plagued the nation's initial response to the virus months ago.

Testing issues have manifested differently in different parts of the country, from states in the midst of a renewed battle against COVID-19 and those who still fear one might be coming, officials said.

In California and Nebraska, some testing sites were forced to close down because of a shortage in testing kits, chemical reagents, and other supplies. Arizona and South Carolina reported slower turnaround times for test results from labs due to lack of capacity. In New York, private labs now take up to a week to return test results. In Oregon, supply shortages with certain testing machines are slowing the volume of tests that can be done in at least nine hospitals, and one has stopped testing all together, according to a state health department report.

State, local and hospital officials at 13 states said they are experiencing some sort of issue with testing, and in all instances, the shortages and delays contribute to effectively limiting the number of Americans with access to coronavirus testing, which experts have long said is a first key step to stemming the spread of the virus.

“The cornerstone of our response to COVID-19 has always been about testing capacity,” said Dr. John Brownstein, chief innovation officer for the Boston Children’s Hospital and a professor of epidemiology at the Harvard Medical School.”

“Our lack of initial testing prevented early intervention,” added Brownstein, an ABC News contributor. “Our inability to ramp up testing prevented us from mitigating the impact on morbidity and mortality. And now our lack of test availability and timely diagnosis five months into the pandemic will directly contribute prolonging this first wave.”

Nearly 65,000 new cases of the virus were reported across the country on Thursday, a new record, and while the U.S. has dramatically ramped up its testing capacity since the beginning of the pandemic nearly five months ago, it may not be enough to keep up with the new pace of the virus.

According to a new report from Democratic staff of the Senate Health, Education, Labor and Pensions committee, coronavirus testing labs said supply chain issues in testing are a current challenge. One company called the existing issues "a giant Jenga running in front of a freight train."

And the challenge may only become greater looking toward the fall as the strain could be exasperated by the coming flu season, according to labs cited in the report.

Asked for comment on the obstacles states are reporting with testing, a spokesperson for Health and Human Services told ABC News Thursday, “HHS and FEMA [Federal Emergency Management Agency] send states COVID-19 testing supplies, namely, swabs and transport media -- to each state and territory based on what the state or territory has requested each month."

Spokespeople for HHS and FEMA said those supplies are then distributed to localities at the direction of the state. The FEMA spokesperson added the agency is committed to supporting states and urged them to coordinate closely with the federal government.

"FEMA remains committed to providing maximum support and critically needed testing supplies in a timely manner to our state and local partners in response to the coronavirus (COVID-19)," the FEMA spokesperson wrote. "We encourage state, local, tribal and territorial governments to coordinate closely with FEMA Regional Offices to determine the type and level of federal support needed."

In South Carolina, a soaring positivity rate; in California, a reversal on universal testing

As of Wednesday, more than 30 states reported a test positivity rate -- the number of total tests that come back positive -- over 5%, a threshold recommended by the World Health Organization.

The positivity rate is a key indicator that experts from Johns Hopkins University say provides insights into “whether a community is conducting enough testing to find cases.” According to the experts, “If a community’s positivity is high, it suggests that that community may largely be testing the sickest patients and possibly missing milder or asymptomatic cases.”

Currently, the national positivity rate is a whopping 9%, according to an internal Federal Emergency Management Agency memo from Wednesday obtained by ABC News. South Carolina on Wednesday reported a test positivity rate of 20%, and Arizona's number has been around 30% in recent days. By contrast, in New York, which suffered the worst of the outbreak early on, about 1% of tests currently come back positive.

“We haven’t been able to surge the testing supplies as much as nature has been able to surge cases,” Dr. Helmut Albretch, chair of Department of Internal Medicine Prisma Health Midlands in South Carolina, told ABC News. “The more cases you have the more you have to test -- we don’t have that surge capability with testing.”

Albretch emphasized testing needs to be “massively” ramped up to help flatten the curve, adding the test turnaround time from both commercial and public labs has gone up. It usually takes about a week to get a test result back in the state, which is “just not usable,” Albretch said, as it makes containing infections incredibly difficult.

The resurgence of the coronavirus in some areas, and the renewed strain on testing, is starkly illustrated in California, which previously reported a steady positivity rate and where local leaders were confident enough in the states' testing capability that they urged those without symptoms to be tested.

Now the state has reimposed lockdowns in 19 counties with record numbers of cases, and Gov. Gavin Newsom last week urged hospitals and testing labs to prioritize testing for those most at risk for spreading the virus to others, including those already showing symptoms and vulnerable populations like nursing homes.

"As more states begin to scale their testing capabilities, new constraints are materializing within the supply chain,” California’s Health and Human Services Secretary, Dr. Mark Ghaly, wrote in a statement, referring to the rising demand for testing across the country. “Simultaneously, laboratories are becoming overwhelmed with high numbers of specimens, slowing down processing timelines."

Testing turnaround time for some commercial labs in California has gone from three to five days, to five to seven days, or even longer, San Diego County's health agency spokesperson Tim McClain said. In Sacramento, five community sites are reportedly closing due to supply shortages. And in Los Angeles, where the city was providing free testing to all residents regardless of symptoms, the city and the county are now moving to prioritize testing to symptomatic patients again, local officials said.

In Louisiana, shortages have officials considering reimposing restrictions on testing not seen since earlier in the pandemic -- when it was limited to those with symptoms or at high risk. In an interview with ABC News, Dr. Alex Billouix, the state’s assistant secretary of Health, said the state has been expanding testing capacity more rapidly than the supply chain’s ability to expand production.

He floated the possibility, like California, of limiting testing availability to symptomatic patients if the shortage in supplies continues, though he said the state is not there yet.

“And the worst-case scenario is having to limit testing to only individuals who are hospitalized because it makes an impact on PPE [personal protective equipment] utilization and potentially treatment with things like [the antiviral medication] remdesivir. We are not there yet and we hope to not get there," Billouix said.

In Arizona, where nearly one in every three tests performed is returning positive, the state’s health department spokesperson, Chris Minnick, said there’s been “quite a bit of a high demand for testing” and the turnaround time has been “slightly slower" but the state currently isn’t facing a major supply shortage issue.

But Phoenix Mayor Kate Gallego said her city is facing a “huge testing shortage,” saying people are waiting in line for as long as 12 hours to get tested.

She said the state requested assistance from the federal government, but a lack of medical staff and testing materials has been a challenge.

U.S. Assistant Secretary for Health Adm. Brett Giroir said during a White House Coronavirus Task Force briefing on Wednesday that the federal government will help add high volume test sites in west Phoenix.

Jo Lynn Garing, a spokesperson for a leading high-volume test manufacturing company Roche Diagnostics, said the company is aware the "demand for diagnostic tests and the instruments [to] conduct them has continued to outstrip supply since the beginning of the pandemic."

Garing said the company not only has been expanding its production capacity but also continues to be “very intentional” on its allocation and distribution of supplies, “prioritizing labs with the broadest geographic reach and highest patient impact.” Garing said the current priority areas are the same areas seeing surges, including Florida, Arizona, Texas and California.

Darcy Russ, a spokesperson for Abbott, another leading test manufacturing company that provides both rapid point-of-care tests as well as larger capacity lab tests, said the company has a “consistent supply of reagents,” touting the company’s supply of nearly 4.7 million of its rapid tests known as ID NOW, the majority of which has been allocated to outbreak hotspots with the focus on front line healthcare workers and first responders. The company has also shipped nearly four million of its high-volume molecular lab tests across the U.S., Russ said.

In states seeing relatively little to no resurgence, testing issues remain

Officials say shortages are not contained to states where outbreaks are currently raging. Other states that seem to have gotten a relative handle on the virus are worrying about their ability to prepare for the worst as national resources are funneled into hotspots.

In New York, where cases mostly remain flat and just above 1% of tests are returning positive, private labs, which process the majority of tests conducted in the state, now take up to a week to return results due to an increased demand from the rest of the country after the federal government asks those labs to prioritize high-risk states, according to state officials. Some hospital labs in New Jersey, too, reported they are starting to see a testing chemical shortage, a state health department official said.

New York had served as the deadly epicenter of the pandemic in the U.S. early in the outbreak but then saw a drop in cases for weeks. But the downward trend has diminished in recent days, worrying local officials.

In Oregon, Charles Boyle, the press secretary for Gov. Kate Brown, on Tuesday told ABC News he is “concerned” that surges in the south and west will begin to hinder testing capabilities there, and spoke out against what he said was “lack of equal support” from the federal government in ensuring that all states have the ability to properly test.

“We also continue to be frustrated that Oregon has received a small fraction of testing equipment and supplies from the federal government compared to other states," Boyle said. "While we understand that states like Florida and Arizona with greater numbers of infections and hospitalizations than Oregon are taking priority, from the beginning of this pandemic we have essentially been punished for working proactively to contain Oregon’s COVID-19 outbreaks."

Last month, Gov. Brown, a Democrat, who has previously criticized the Trump’s administration’s lack of support, urged the federal government to fill her entire request for supplies so the state can continue testing nursing homes and long-term care residents, one of the most at-risk populations for the coronavirus.

What the state has received, Brown wrote in a letter to Health and Human Services Secretary Alex Azar, is "not adequate and will slow down our plan to implement our universal long-term care testing program. Meanwhile, other states are receiving dramatically more testing transport media and swabs.”

A FEMA spokesperson told ABC News the agency has provided Oregon with 206,000 swabs and 185,550 media as of Thursday.

In Omaha, Nebraska, a county-supported testing site primarily serving a highly impacted Hispanic population -- which is already hard hit by the virus -- closed shop earlier this week because of a supply shortage, in an example of how the testing shortage may be disproportionately affecting vulnerable or underserved populations. Cases have not been rising steeply in Nebraska, but testing has been going down, and a higher percentage of tests are returning positive.

"There are all sorts of different links in the chain that can break down,” said Dr. Anne O’Keefe, a senior epidemiologist at Douglas County Health Department.

O’Keefe told ABC News that despite the high needs in the area, there has been a supply chain blockage because test manufacturing companies are prioritizing states with a bigger case surge.

Michigan, where cases are going up at a slower rate than the harder-hit states and the positivity rate has remained steady under 3%, echoed the concerns.

Michigan Department of Health and Human Services spokesperson Lynn Sutfin told ABC News FEMA supplies “have not met the overwhelming demand” the state is “still working through supply shortages,” which have limited the number of tests that can be run per day and have caused some laboratories or medical providers to restrict the types of individuals eligible for testing.

FEMA has provided Michigan with nearly 1.1 million swabs and 846,407 media as of Thursday, the agency's spokesperson said.

In June, Dr. Anthony Fauci, the nation's top infectious disease official, appeared to justify the fears of the lesser hit states, as COVID-19 does not respect interstate borders.

"If we don't extinguish the outbreak, sooner or later, even ones that are doing well are going to be vulnerable to the spread," Fauci said. "So we need to take that into account because we are all in it together, and the only way we're going to end it is by ending it together."

Copyright © 2020, ABC Audio. All rights reserved.

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simon2579/iStockBy DR. SABINA BERA, ABC News

(NEW YORK) -- Novavax, a vaccine development company, was recently awarded over $1.6 billion by the United States government to support commercial-scale manufacturing of their potential coronavirus vaccine.

According to Stanley Erck, CEO of Novavax, the company was selected to be part of the government's Operation Warp Speed program because of its prior experience with two related coronavirus vaccines (SARS and MERS), as well as other infectious diseases such as Ebola.

"We use the same platform," Erck told ABC News' Bob Woodruff. "In all of these different diseases, we take a surface protein on the virus and when you inject it into the body, the body sees it as flu or it sees it as coronavirus -- we add it to an adjuvant which sets off a more powerful immune response and sets off, not just antibodies, but T cells against it."

Three other vaccine companies -- Johnson & Johnson, Moderna and AstraZeneca -- have also received funding through Operation Warp Speed. Each will produce its own coronavirus vaccine, which will be distributed to the population if it proves successful in large-scale clinical trials.

Erck said each company's vaccine is targeting the same virus, but using a different type of vaccine technology. It's still not clear if any of them will prove safe and effective in the long run -- but Erck claims Novavax's candidate must have shown the most promise considering how much funding the company received.

"They saw our [data] and I have to infer that our data must have been as good as or better than the others," Erck said. "Some of the vaccines require freezing them at minus 80 degrees, and ours happens to be stable at room temperature and at refrigerator temperature, so there are a few characteristics of our vaccine that make it more attractive."

Novavax's vaccine has been tested in animals, and the company has already started testing it in humans. Erck expects phase 1 trials to be completed by the end of this month, which should help establish if the vaccine is safe enough to proceed to larger studies. This will be followed by phase 2 and phase 3 trials to make sure it is effective and stable. He estimates that the cost of all these trials will amount to about $1 billion.

Like many vaccine companies, Novavax is ramping up manufacturing before it knows if its vaccine is effective. That way, the company hopes to have 100 million doses ready to go as soon as positive data becomes available.

"We concluded early on," Erck told ABC News, "if we delayed -- if we decided to wait until we saw how the mouse [tests] worked and the non-human primate [tests] worked -- and didn't start the manufacturing investment, which is a huge investment, you'd lose six months. And in a pandemic every day counts."

If the vaccine proves effective, Erck hopes to be able to vaccinate front-line health care workers as early as the end of this year.

"The first people to get it are going to be the front-line health care workers and they'll get the first 50 million doses or however many doses," Erck said. "And then it'll start to spread out for people who are most at risk of getting seriously ill."

When asked about the effectiveness of the vaccine, Erck said early animal studies are promising. While most vaccines take about 10 to 15 years to develop, Erck said the process can be sped up safely.

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filadendron/iStockBy DR. SHANTUM MISRA, ABC News

(NEW YORK) -- As cases of coronavirus continue to skyrocket around the country, new details are emerging from New York City -- once the epicenter of the domestic pandemic. A recent study suggests that in some communities in the city, over 60% of residents tested positive for COVID-19 infection.

And low-income communities seemed to be hit the hardest, with zip codes in Queens, Brooklyn and the Bronx reporting the highest rates of positive results.

"We found that test positivity rates were higher in lower income areas," and "among the Black population," said Dr. Jim Crawford, co-author of the study and chair of the Department of Pathology at the Long Island Jewish Medical Center and North Shore University Hospital.

Prior research has shown that non-Hispanic Black people have a rate of infection that is approximately five times that of non-Hispanic white people. This discrepancy is consistent with overall trends in severe illness and death rates during public health emergencies for racial and ethnic minorities.

This study, which was conducted by Northwell Health's Feinstein Institute for Medical Research and published in Clinical Infectious Diseases, offers a snapshot in time of some of the worst weeks in New York City's epidemic.

Specifically, the study found that cases of infection emerged rapidly and broadly across a widespread area in the greater New York City region, possibly suggesting that the infection was already quietly smoldering throughout communities prior to the onset of testing.

Residents were tested in real time using a nasal swab test that looks for active infections.

The first case of coronavirus in New York City was confirmed on March 1, 2020, after which there was an exponential growth of cases which rapidly overwhelmed the established health care infrastructure and many of the city's hospitals. Now, over four months later, the city is gradually reopening as the number of new cases continues to decline.

However, lessons can be learned from the pandemic's early course in the city. This study looked at all symptomatic patients with positive test results between March 8 and April 10. Authors found that the contagion spread was evident across numerous, widespread zip codes in the greater New York City metropolitan region.

Among those who tested positive, men were more affected than women -- and these differences grew more pronounced among the elderly. However, less than 1% of individuals younger than 25 had positive test results.

The CDC has found that the risk of being hospitalized for COVID-19 increases with age and 80% of COVID-19 deaths in the United States have been in adults 65 and older.

Despite the high rate of positive test results throughout the greater New York City region, it's difficult to use this study's findings to extrapolate whether enough of the local population has been infected to render herd immunity: the concept that a large enough portion of the community is immune to a disease to stop it in its tracks.

To answer whether herd immunity could exist in the city, we'd need a different kind of study that uses antibody tests to determine what portion of the population has been infected in the past. Recent antibody research found that about 20% of New Yorkers have had prior infections -- a far cry from the 60% experts say would be needed to achieve herd immunity.

For Crawford, the main takeaway from his study is that low-income communities were hit disproportionately hard during those dark weeks at the start of the city's epidemic.

"Further studies are needed to understand how populations are at risk of becoming infected," and to better understand the socioeconomic determinants of infection, he said.

Moving forward, Crawford hopes that the "information out of New York can help our colleagues to identify populations that are at risk in this country" as rates of infection climb in several areas of the country. He and other researchers at Northwell Health want to better understand the "genetic predispositions of patients and characteristics of the virus, in order to identify better ways to tailor treatment."

"The story is still being written in terms of the COVID contagion," Crawford said. "Time is of the essence in trying to stay ahead of the virus."

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andresr/iStockBy ANNE FLAHERTY, ABC News

(NEW YORK) -- Everyone agrees it’s not healthy to keep kids stuck at home, with the American Academy of Pediatrics encouraging school districts to resume in-person class time for the health of the nation's children.

But when it comes to the virus and its potential to spread quickly, it’s less clear what will happen when they return.

Here are three things to know about kids, schools and COVID-19:


It’s rare for kids to get really sick. But there’s limited evidence on how easily they spread it.


If there’s one clear finding among researchers, it’s that young people infected with the virus are less likely to get really sick, and the inflammatory syndrome that some children experience is considered very rare.

But it’s also become widely accepted that asymptomatic teens and young adults in general are driving transmission of the virus in the U.S. because of work or attending social gatherings.

In one county in Virginia, for example, health officials said 150 teens between the ages of 16 and 18 tested positive for the virus in the last week -- most of them after having traveled to Myrtle Beach, South Carolina. On Monday, a county in Missouri announced that 82 children, counselors and staff tested positive at a local summer camp despite promises by the facility that it would take reasonable steps to prevent the spread.

Less evident, though, is whether much younger children -- under age 10 or so -- are more or less likely to spread the virus than adults.

Initial studies in China and a small study by the American Academy of Pediatrics concluded children probably aren’t "drivers" of the virus. And there are other studies based on modeling that assume children aren’t spreading COVID-19 because they are less likely to test positive.

But health experts warn there are caveats. Much of the research is small in scale and not peer reviewed. Also, kids in the U.S have mostly been at home since the spring.

"We haven’t been able to really watch kids in their natural habitat," said John Brownstein, chief innovation officer at Boston Children’s Hospital and a professor at Harvard Medical School.

"Even if they are less capable of getting or transmitting the virus, you are countering that (in schools) with closer proximity and contacts over longer periods of time," added Brownstein, an ABC News contributor. "We don’t have evidence of them in school settings … There aren’t a lot of kids who have had a normal day in the past four months."

Comparisons with Europe don’t really work.


Trump this week compared the U.S. to Germany, Denmark, Norway and Sweden that he insisted reopened schools with "NO PROBLEMS" and suggested that Democrats were standing in the way of reopening schools because it would benefit them politically to stall the country.

The picture in Europe, though, might not be so straightforward, including new data from Germany that found infections among children and teens under age 19 went from about 10% in early May to nearly 20% in late June.

There’s counter evidence in other parts of the world too: In Israel -- where social distancing is reportedly an issue -- schools have struggled to remain open because of outbreaks.

Meanwhile, Anthony Fauci, the nation’s top infectious disease expert, warns the U.S. isn’t like Europe because it remains stuck in its "first wave" of infections after so many states and communities either couldn’t -- or wouldn’t -- lock down.

"In reality only about 50 percent of the nation shut down with regard to other things that were allowed" besides schools, Fauci told Congress last week. "In many of the European countries, 90 percent, 95 percent of all activities were shut down. So that is one of the reasons why you saw -- particularly in Italy, which shut down to a much greater extent than we did -- the cases came way down in a sharp curve downward and then stayed."

In other words, activities -- including camps and schools -- resumed in Europe under very different circumstances than the U.S. in which kids were less likely to encounter the virus in the first place.

"It is the fact that the countries in Europe and the other countries that you have there had a much more uniform response," Fauci said.

As of Tuesday, the United States had the ninth-worst mortality rate in the world, with 39.82 deaths per 100,000 people, according to Johns Hopkins University. The COVID Tracking Project reported Wednesday a new daily high in cases in the U.S., with 62,197 total cases. Fauci has warned numbers top 100,000 cases a day, which "puts the entire country at risk."

Dr. Ashish Jha, director of the Harvard Global Health Institute, said how American act now and what safety precautions they take will impact school openings.

"We need to close bars, we need to close indoor large gatherings and have everybody wearing masks," he said this week. "If we start all that now I think there is a pretty good shot we can open schools and keep them open all fall."

The CDC guidelines might change, even if the science doesn’t.


Robert Redfield, director of the Centers for Disease Control and Prevention, has long recommended that schools space children six-feet apart, open windows when possible and avoid kids mingling in cafeterias or sharing playground equipment.

That advice was based on findings that the virus primarily was transmitted from person-to-person contact and that commonly touched surfaces would need to be disinfected between uses. Fauci, Redfield and others also have made clear that indoor gatherings are likely to spread the virus.

The CDC also helped to develop a White House plan that called for schools only to open after cases in a community decline for 14 days -- allowing the area to enter "phase 2."

Then came Trump’s tweet.

"I disagree with @CDCgov on their very tough & expensive guidelines for opening schools," the president wrote. "While they want them open, they are asking schools to do very impractical things. I will be meeting with them!!!"

I disagree with @CDCgov on their very tough & expensive guidelines for opening schools. While they want them open, they are asking schools to do very impractical things. I will be meeting with them!!!

— Donald J. Trump (@realDonaldTrump) July 8, 2020

By that afternoon, Vice President Mike Pence was before the cameras with Education Secretary Betsy DeVos, announcing that the CDC and Dr. Redfield -- a political appointee -- would issue new guidance by next week, including a set of five new documents.

"They must fully open, and they must be fully operational and how that happens is best left to education and community leaders," DeVos said of schools.

Redfield offered: "We really don’t have evidence that children are driving the transmission cycle of this."

Redfield later told ABC’s Good Morning America that "our guidelines are our guidelines but we are going to provide additional reference documents." He said he was concerned his agency’s initial advice was being used "as a rationale" to keep schools closed and said "these decisions about schools are local decisions."

.@ABC NEWS EXCLUSIVE: @CDCDirector Dr. Robert R. Redfield speaks one-on-one to @GStephanopoulos after Pres. Trump blasts their school guidance and weighs in on when it will be safe to open schools. https://t.co/gXeRpIX7D6 pic.twitter.com/1OS0cZ75Rz

— Good Morning America (@GMA) July 9, 2020

When asked if the White House had pressured the CDC to change its public health advice for political reasons, White House Press Secretary Kayleigh McEnany told reporters Wednesday: "No, not at all. But the President made his opinion quite clear publicly this morning on Twitter for all to see."

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areeya_ann/iStockBy KATIE KINDELAN, ABC News

(WASHINGTON) -- The Supreme Court's ruling Wednesday to allow an employer or university with a religious or moral objection to opt out of covering contraceptives could cost women hundreds of dollars each year in out-of-pocket expenses, experts say.

The court ruled 7-2 to uphold President Donald Trump's move to let more employers opt out of the Affordable Care Act mandate guaranteeing no-cost contraceptive services for women.

Conservatives hailed the decision as a resounding win for religious liberty, while groups that support reproductive rights slammed the ruling, saying it threatens birth control access, particularly for low-income workers and people of color.

"As a result of today's ruling, a person could lose birth control coverage simply because their boss has a personal religious objection to it," Dr. Kristyn Brandi, board chair of Physicians for Reproductive Health, said in a statement Wednesday. "As an OB/GYN providing the full spectrum of reproductive health care, I see every single day how contraception is a critical part of our collective health and wellbeing."

Here are five questions answered about what the ruling means for women's access to contraceptive care.

1. Does the Supreme Court's decision mean birth control is no longer covered by insurance?


No.

The Supreme Court decision centers on a 2018 rule issued by the Trump administration that expanded the types of employers who could opt out of the requirement that contraception be included in an employee's health insurance plan. If an employer does not opt out of the requirement, insurance coverage of birth control will continue.

The Affordable Care Act (ACA) requires insurers to include "preventive care and screenings" as part of "minimal essential coverage" for Americans. Since 2010, all FDA-approved contraceptives have been included.

And while the Supreme Court upheld the 2018 rule in its decision this week, it also returned the case to lower courts for consideration of other challenges, according to Emily Nestler, senior staff attorney for the Center for Reproductive Rights in Washington, D.C.

"It's important to keep in mind that while today's decision is frustrating and disappointing, it is not the end of the story," Nestler told "Good Morning America" on Wednesday. "There's a lot of space still for a number of things to be decided."

2. Who will be impacted?


As many as 126,400 women would "immediately lose access to no-cost contraceptive services" under the Supreme Court judgment, Justice Ruth Bader Ginsburg wrote in the dissent, joined by Justice Sonia Sotomayor, citing government estimates.

Nestler points out that any person who has an insurance provider that is connected to their employer or school is at risk of losing their contraceptive coverage under the 2018 Trump administration rule.

"It is unilateral, meaning [an employer or university] can just opt-out and they don't have to tell anyone," she said. "All of a sudden you could lose coverage and you wouldn't even know it is happening to you until it's done."

The people hardest hit by having to pay out-of-pocket for contraceptives would be those who already face the greatest barriers to quality health care, including low-income women, women of color and LGBTQ people, advocacy groups say.

One in three Latina and four in 10 Black women of reproductive age say they cannot afford to pay more than $10 for contraception, according to data shared in an amici curiae brief filed in the Supreme Court case.

3. How much does birth control cost women?


Insurance co-pays for birth control pills typically range between $15 and $50 per month, which adds up to over $600 per year, according to Planned Parenthood. Nearly 13% of women in the U.S. between the ages of 15 and 49 currently use the pill, according to the Centers for Disease Control and Prevention (CDC).

The out-of-pocket costs for other types of contraceptives, like IUDs, can cost thousands of dollars.

"It's important to bear in mind that any cost is a tremendous burden to people who already face huge barriers to access," said Nestler. "Any amount of money that you pay for your birth control is money that's not going to other things, like your rent and your food and taking care of your family."

"That is a barrier from the outset and layered on top of that is then the woman is put in a position about what she can take from [in her budget] in order to get this preventative care," she said. "Another layer on top of that is if the woman is able to find some way to get some sort of preventative care, is she forced to make a choice about a type of contraception that she is going to get that is not the best choice for her because it's cheaper."

The birth control benefit in the ACA saved women an estimated $1.4 billion on birth control pills in 2013 alone, according to the National Women's Law Center.

4. How do I know if my employer is opting out of birth control coverage?


"You certainly should look carefully at your insurance policy and pay attention if you receive any notification that your policy has changed," said Nestler. "If you're still not sure, call your insurance carrier or write a letter to your employer."

"If you find out that you are not receiving access, you of course have your voice," she said. "You can tell your employer that you are not OK with this discriminatory treatment continuing."

Groups that support reproductive rights, like the Center for Reproductive Rights and Planned Parenthood, have information available online on rights for accessing birth control.

WomensHealth.gov, a website operated by the Department of Health and Human Services (HHS), also has information on obtaining low-cost or free birth control.

5. What happens next?


The legal battle will continue in courts in states, including Pennsylvania and New Jersey, which initially challenged the Trump administration rules.

"The rules will continue to be litigated. This is not at all resolved," said Nestler, who added though that she believes there is a "distinct possibility" the rules could go into effect for at least some period of time while the legal battle continues.

Nestler said Congress also has the power to step in and end the ongoing legal battle by requiring that contraceptives be considered as part of "minimal essential coverage" for Americans under the ACA. The Department of Health and Human Services currently defines what services qualify, which led to the Supreme Court case.

"Congress really should take action to ensure that the administration can't enforce these discriminatory rules anymore," said Nestler. "These cases have been languishing in the courts for a really long time and these rules that we now have are clearly not what Congress intended. They certainly could and should step in."

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AlexSava/iStockBy DR. YALDA SAFAI, ABC News

(NEW YORK) --  In the midst of the COVID-19 pandemic, health experts are warning about the risk of prolonged grief disorder among people who lose loved ones. Older adults are especially at risk, according to a study published in the Journal of Geriatric Psychiatry.

Prolonged grief disorder, also known as complicated grief, is characterized by persistent yearning for and preoccupying thoughts and memories of the deceased, as well as emotional pain that causes impairment in everyday activities.

This disorder can last at least six months and is different from normal bereavement, which can still be painful and overwhelming. However, even with normal bereavement, most people eventually adapt to the loss of the loved one and changes in life circumstances.

"Bereavement is the normal process of reacting to a loss," Dr. Divya Jose, a psychiatrist in New York City, told ABC News. "The symptoms can include feelings of sadness, anger, guilt, changes in sleep, appetite and energy levels."

In contrast, Jose, said, "complicated grief is an inability to accept the loss and move forward. The symptoms become debilitating and don't improve with time."

Prolonged or complicated grief affects about 2-3% of the population worldwide and is more likely to occur after the loss of a child or life partner and after a sudden death.

People are more likely to develop prolonged grief disorder if they have a history of prior trauma or loss, a history of mood and anxiety disorders, unexpected or violent deaths, if they were the primary caregiver for the deceased or if they experience a lack of social support after the loss.

The pandemic has changed the experience of death for many by changing the way terminally ill patients are being cared for, how bodies are buried and what bereavement rituals performed, due to physical distancing restrictions. Other pressures associated with COVID-19, such as unemployment, have further disrupted the normal grieving process.

"In addition to the unexpected nature of coronavirus-related deaths, the disruption in traditional grieving processes -- such as the practice of religious rituals, the limitation of visitors and the practice of social isolation -- could potentially interfere with normal grieving, causing a rise in complicated grief," Jose said.

COVID-19 deaths are also happening with stay-at-home orders in place, which can worsen the sense of isolation and loneliness that is a part of the natural experience of many mourners.

"There is a pressing need to implement measures that lessen the adverse consequences of COVID-19-era bereavement," the authors of the study wrote.

They also called for health care providers to pay closer attention to patients experiencing a loss at this time and mentioned that it is important for clinicians to have a better understanding of the natural grieving process and the unique challenges faced by the bereaved during this time.

Recognizing prolonged grief disorder is important because it can cause impairment in physical and mental health and lead to drug use, suicide, reduced quality of life and premature mortality, the authors added.

"Health care providers can help with active listening, helping patients understand and process their grief," Jose said. "Physicians can monitor symptoms to identify any treatable disorder such as depression or anxiety and provide appropriate medication management if indicated."

It is important to note that bereavement can trigger depression, anxiety and trauma-related disorders without slipping into prolonged grief disorder. It is important for health care professionals to be able to identify these treatable disorders and know when and how to appropriately manage them or refer to mental health services. Virtual grief counseling or psychotherapy services can also aid in the healing process.

Awareness of this risk, for healthcare providers, can lead to timely preventive or treatment interventions that may mitigate the development of prolonged grief disorder.

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Cecilie_Arcurs/iStockBy KRISTOFER RIOS, CHO PARK, MATTHEW MOSK and LAUREN EFFRON, ABC News

(NEW YORK) -- Mary Winnet was overjoyed at the sight of seeing her husband. It was the first time the couple was able to reunite in two months.

“Do I get to touch you? You’re healthy?” she asked her husband before reaching out for an embrace.

Like many residents in senior living communities, Winnet and her husband were separated and placed in quarantine to keep them safe from the coronavirus, COVID-19.

But the measures meant to save their lives have also been isolating. In addition to each other, they’ve been kept apart from their other loved ones, including their daughter, Katie Nelson.

“Can you imagine living in a room that's maybe 200 square feet for two months,” Nelson said. “When you talk[ed] to them, you could hear there was gonna be a breaking point really, really soon.”

Winnet was able to reunite with her family because Thrive Senior Living Communities in Virginia, where she and her husband live, created a simple but effective plexiglass barrier to allow families to see each other while talking through a phone hook-up.

A whole range of communal living arrangements for seniors have presented significant health challenges in the age of the coronavirus. Facilities of all sorts have been searching for new ways to address those concerns in the face of an unexpected and deadly pandemic. The primary goal: keep residents in isolation in order to keep a vulnerable population safe.

“If you have people in your life that have underlying conditions or are susceptible to having COVID, [that’d] be really bad for them. So that's really scary,” Nelson said. “I want to see my people so badly, and I know that the families do, too. ... But I would still rather wait ... to make sure that these people are safe. So I mean, that's hard.”

As the pandemic continues, many communities have started experimenting with creative ways to combat their residents’ loneliness, such as allowing family members to talk to residents through closed windows, setting up chairs in entrances or setting up plastic “hug” barriers.

One facility in Maryland has developed a novel approach to monitor the health of its residents. Layhill Center in Silver Spring has partnered with medical data company Megadata to track residents’ vitals in hopes that the data they collect will eventually allow for more accurate screening before visits.

With 123 residents, Layhill Center has had 18 positive COVID-19 cases. Seven of them have died from the virus but most have fully recovered.

“We knew that it was an infectious process, and we needed to make sure that we were on board with handwashing, we were on board with utilizing the [personal protective equipment], and just the standard practice for infection control,” said Jennifer Kelly, who directs the nursing facilities at the center.

The facility has been using Megadata’s program in addition to these precautions since the onset of the pandemic, and they believe it’s been vital to saving lives.

Dr. Priya Vasdev, an internist associated with the center, said that during every shift each patient undergoes a pulse oximetry to measure oxygen in the blood.

“The concern being that pulse ox has a direct relationship to what may be going on in the lungs, and the lungs are one of the major organ systems affected by COVID-19,” Vasdev said.

Megadata president and CEO Shalom Reinman said what they found was that a patient’s oxygen levels “in most cases” was a better indicator of whether they had contracted the virus than their temperature and other symptoms, “which seemed to be later developing.”

Venus Ann McAndrews, a resident at Layhill, has an underlying health condition. She said the pulse oximetry system helped save her life.

“I thought I was a goner, for sure,” McAndrews said. “If they wouldn't have caught it when they did and got me the help that they did, I would probably have died, and that's the truth. They really saved my life by ... finding out so quick and sending me to the hospital.”

Kelly said being able to monitor the data for subtle changes in patient vitals has benefited every one of their residents because it has allowed the medical staff to react and treat them much faster, as well as isolate residents who were becoming ill much earlier.

She hopes that this monitoring system will eventually allow them to clear residents for visits on a case-by-case basis.

“It's been hard. You know, the things that you took for granted as normal, you can no longer take it for granted,” Kelly said. “Before, you can hug your patient, sit there and have a conversation without a face mask on. And now you're not doing that... The intimacy is no longer there.”

“We have to be vigilant,” she added, “and we have to make sure that we're following the standard of care right now and the practice that is required.”

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narvikk/iStockBy ERIN SCHUMAKER, ABC NEWS

(NEW YORK) -- Silent transmission of the novel coronavirus could account for more than half of infections, according to one new mathematical model by U.S. and Canadian researchers.

The researchers utilized data on asymptomatic and presymptomatic transmission from two different epidemiological studies and estimated that more than 50% of infections were attributable to people not exhibiting symptoms.

Since the study is based on a mathematical model, the 50% finding is an estimation based on probabilities and approximations, rather than a precise figure.

The findings were published this week in the Proceedings of the National Academy of Sciences of the United States of America.

A different study, published in June in the journal Nature, found that in one Italian town in which the majority of residents were tested for COVID-19 while the town was under a 14-day quarantine, approximately 40% of individuals who tested positive had no symptoms.

The findings could have real-world implications for leaders deciding how to rein in outbreaks in their respective countries or regions.

Widespread testing, isolating infected people, and ordering a community lockdown stopped the Italian outbreak in its tracks, the authors of the Nature study concluded.

"Even if all symptomatic cases are isolated, a vast outbreak may nonetheless unfold," the PNAS study's authors wrote.

"Understanding how silent infections that are in the presymptomatic phase or asymptomatic contribute to transmission will be fundamental to the success of postlockdown control strategies," they said.

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iStock/ipopba(NEW YORK) -- BY: DR. DANIELLE WEITZER

Thanks to modern medicine, we now have a once-daily pill that can prevent HIV, a virus that interferes with the body's ability to fight infections. However, experts say the pill doesn't work for everyone's lifestyle, and it's important for people to have other options so they can better protect themselves from HIV infection.

Now, a new study finds that a long-acting injectable medication given as a shot every eight weeks is significantly more effective than a HIV prevention pill taken every day called Truvada.

The study, which comes from the HIV Prevention Trials Network and was published at the 23rd International AIDS Conference, builds on prior research showing the shot was equally effective to the pill. The shot, called cabotegravir, has not yet been FDA approved.

"This study is important -- it is the first to try something that is not an oral medication for prevention of HIV, it is the first one looking at HIV prevention that is comparing two active drugs," said Dr. Carlos del Rio, one of the investigators involved with the study.

"We know that if you take Truvada every day the effect is very good, so here we were hoping that results of a new agent would be just as good," said Del Rio, the Executive Associate Dean of Emory University School of Medicine at Grady Health System. "What we showed at the end of the study was that cabotegravir was superior to Truvada."

The study enrolled 4,570 cisgender men and transgender women (people who were born male but identify as a woman) who had sex with men. The research was conducted at sites located in the United States, Argentina, Brazil, Peru, South Africa, Thailand and Vietnam. People were randomized into two groups: one that used injectable cabotegravir for HIV prevention and the other that used the daily pill Truvada.

Overall, 52 people became HIV positive during the course of the study. There were 39 incident infections in the Truvada group, but only 13 in the cabotegravir group. In other words, cabotegravir had a significantly lower rate of HIV infections and was a more successful agent in preventing the transmission of HIV overall.

"The main message is that there is clearly a new option for HIV prevention," del Rio said. "Some people prefer to take pills, and they will work -- but if you're someone who cannot take pills every day, maybe reluctant, there is an option now to use an injection."

The study team is also investigating cabotegravir to see if the same results can be applied to cisgender women. With more research, del Rio is hopeful that the frequency of injections can be decreased from every eight weeks to every 3-6 months.

The new drug means people may soon have more options to safety get treated to reduce the risk of HIV transmission and can therefore significantly decrease the chance of its subsequent development.

"This shows the power of well-conducted clinical trials," del Rio said. "This is a game changer -- we can really impact HIV acquisition for people at risk."

Dr. Monica Saxena contributed to this report.

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FilippoBacci/iStockBy EDEN DAVID and DR. MARK ABDELMALEK, ABC News

(NEW YORK) -- A group of 239 scientists from over 30 countries have published a letter urging the World Health Organization (WHO) and other public health agencies to more seriously consider the potential spread of COVID-19 through inhalation of small particles lingering in the air.

The WHO said in a press briefing on Tuesday that it would consider "emerging evidence" that the virus may be spread through small aerosolized particles -- sometimes called airborne transmission. The debate around whether or not the virus can be spread through particles in the air has been ongoing for months but the current WHO guidance states that the virus spreads "primarily through droplets of saliva or or discharge from the nose when an infected person coughs or sneezes."

"The World Health Organization acknowledges that transmission is mainly by large respiratory droplets when you cough or talk and fly through the air and land directly on someone's eyes or nose or mouth," said Dr. Linsey Marr, professor of civil and environmental engineering at Virginia Tech, who specializes in aerosol science and contributed to the letter. "But there's been increasing evidence that transmission is happening also by inhalation of much smaller droplets that we call aerosols and some public health organizations have recognized this but we wanted to make the WHO more aware of this so they can put out guidance worldwide."

In Tuesday's press briefing WHO technical lead for the infection prevention task force Professor Benedetta Allegranzi said, "We acknowledge there's emerging evidence in this field - as in all other fields regarding the COVID-19 virus and pandemic -- and therefore we believe we have to be open to this evidence and understand its implications regarding the modes of transmission and regarding the precautions that need to be taken."

But WHO's epidemiologist Dr. Maria Van Kerkhove was still more cautious in her response saying that the WHO has been been looking into these reports since April. Now, the focus is on "the possible role of airborne transmission in other settings ... particularly close settings where you have poor ventilation."

"We've got clusters of person to person transmission happening indoors and there is asymptomatic transmission going on, no coughing, no sneezing, no large droplets being generated and splashed into people's face," said Dr. Lisa Brosseau, an aerosol specialist and research consultant at the Center for Infectious Disease Research and Policy at the University of Minnesota. She said that in these scenarios the most likely mode of transmission is inhalation of particles in the air.

Droplet transmission describes the situation when a person spreads the virus through directly sneezing or coughing on someone. Sometimes these large respiratory droplets may also land on surfaces and a person can be indirectly infected through touching their face after coming in contact with a contaminated surface.

Although experts generally agree the virus can be spread through respiratory droplets there is less consensus around aerosolized -- or airborne -- transmission, or the how long and how far these tiny infectious particles can travel in the air.

In the letter scientists point to a mounting body of evidence that supports the potential of airborne transmission. They cite a Chinese case study of video records where the virus was transmitted between three parties in a restaurant without any evidence of "direct or indirect contact," suggesting that the virus must have been spread through the air.

They also point out that particles from viruses of the same family, such as Middle Eastern Respiratory Syndrome (MERS), can be exhaled and detected in indoor environments of infected patients, posing a risk to people sharing this environment and breathing in the same air.

Additionally, several hospital-based studies have detected the coronavirus' genetic material in air samples collected from isolation rooms of COVID-19 patients -- although it's not clear yet if these samples are capable of infecting people.

Scientists acknowledge that more evidence is needed. According to Marr, studying airborne particles is much harder because you "need specialized techniques and special equipment to collect aerosols and measure them," which is only fully understood by a small subfield of aerosol scientists. The standards, she said, for proving airborne transmission are set much higher than that for other types of transmission.

"We have as much evidence for airborne transmission as we do for any other form of transmission at this point," Marr said.

Experts say that outdated definitions and arbitrary dichotomies are also adding unnecessary hurdles in further clarifying how the virus is actually transmitted.

"Traditionally the word airborne has been associated with traveling long distances, but really what we are trying to say is that it seems that inhalation of aerosol happens at short and close contact ranges too," said Marr. Some experts have taken issue with the WHO's technical definition of 'airborne,' arguing it is too narrow and relies on methods derived from the 1930s and 40s.

The WHO says a virus is 'airborne' if it can be spread by particles that are smaller than 5 microns -- smaller than an invisible grain of dust -- and viable over a distance greater than approximately 3 feet.

Brosseau said that the definition of airborne completely overlooks the potential inhalation of particles near the source and has previously pushed WHO along with other public health organizations to expand their definition. "It doesn't meet common sense. You don't need to be a physicist."

According to Dr. Donald Milton, professor of environmental health at the University of Maryland School of Public Health and co-author of the letter, "You can have particles as big as 10 or 20 or even 30 microns that can float quite a long distance indoors."

Experts say that the 6 feet rule may not always be enough.

"In a poorly ventilated environment 6 feet is not gonna mean very much," said Milton. "Indoor air is still and being stirred up by air conditioning system and heat/thermal plumes from people, lamps, and computer screens. This will keep aerosols much bigger than 5 microns floating around and carry them much farther than 6 feet, even if it's just people talking and singing nobody with explosive coughs."

"We should replace the 6 foot rule with distance and time matters," added Brosseau. "Distance and time is key. The further you are from the source and the shorter period of time, the lower the concentration will be. I can't say what the distance is, but make it as great as possible."

Milton emphasized that "the virus is no different today than it was yesterday. What's different is our understanding of how it transmits." As a respiratory virus, some of it is indeed still transmitted through direct contact of respiratory droplets secreted through sneezes and coughs or contaminated surfaces, so washing hands and disinfecting surfaces is still important.

The Centers for Disease Control and Prevention in their criteria on how the virus spread, say the virus is spread"mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks" and that some of these droplets can "possibly be inhaled into the lungs." ABC reached out to the CDC for comment.

There is concern about creating fear, said Milton, but acknowledging the potential mode of transmission through aerosol particles may help us learn how to stay safer in the long run.

Experts are still determining how many infectious particles a person must be exposed to in order to actually get sick. "We don't know the infectious dose," said Brosseau and it may vary based on your current medical condition, or whether or not the particles are being inhaled or droplets are coming in direct contact directly with your face.

Dr. Lydia Bourouiba, an associate professor at MIT who studies fluid dynamics and the spread of pathogens, published an article in the Journal of the American Medical Association in March calling for the rethinking of coronavirus transmission -- pointing to her research that showed that sneezes and coughs could spread gas clouds of droplets much further than 6 feet.

In an interview on Tuesday, she called the dispute over droplet and aerosol transmission a "false debate," that limited efforts to craft effective safety guidelines.

"In terms of reopening, guiding everything based on this social distancing rule of one to two meters, or three to six feet in different countries … reopening based on that is not sufficient for indoor spaces," she told ABC News.

Bourouiba, who did not sign the letter to the WHO, citing "gaps in the way the science and solutions" were presented, said the CDC should implement different distancing guidelines based on categories of indoors spaces, that also take airflow and circulation into account.

And while the science of airborne COVID-19 transmission is still being studied, experts including WHO officials agree that an enclosed, crowded, poorly ventilated room is riskier than the outdoors and recommend optimal ventilation, physical distancing, face coverings, among other precautions to reduce risk of infection.

All experts also say to avoid the 3 Cs: closed, poorly ventilated environments, crowded spaces, and close contacts. "When the three overlap, that's where you get outbreaks," said Milton.

Milton added, "I think if you are careful with the messaging you can make it clear there are things you can do, it's not out of your hands, you can empower people with that knowledge."

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Media Trading Ltd/iStockBy TONYA SIMPSON, ABC News

(LOS ANGELES) -- The novel coronavirus is now infecting American prison inmates at a rate more than five times higher than in the overall U.S. population, and those numbers are escalating rapidly, according to a new analysis by the UCLA School of Law’s COVID-19 Behind Bars Data Project.

When adjusted for age, those infected while incarcerated were over than three times more likely to die from coronavirus than those on the outside, the review of available data from state and federal prisons showed, according to the UCLA report released Wednesday.

“We were surprised by the size of the gap,” Professor Sharon Dolovich, director of the project, told ABC News. “I think we knew that we were going to find numbers that were disproportionate, but we were all surprised that the disparity is so great.”

Dolovich said she believes the disparity is likely even worse because many prison facilities are still only performing COVID-19 tests on inmates who are already showing symptoms of the virus.

“If you’re a facility that’s only testing people with overt symptoms, then you’re going to miss all of the asymptomatic people,” Dolovich said.

The new findings come as the viral pandemic has been resurgent in nearly two dozen states, and many are being forced to re-impose precautions that help prevent further spread. But in the thousands of jails and prisons across the country where coronavirus has crept inside, inmates and corrections officers are finding it far more difficult to enforce social distancing and other preventive measures.

Some of the worst viral hot spots in the nation have been in prisons and jails. More than 2,400 inmates at the Marion Correctional Institution in Ohio tested positive, according to figures compiled by The New York Times. The San Quentin State Prison in California has seen 1,587 positive cases, and the Harris County jail in Houston, Texas has reported 1,390 with the illness, the Times data says.

The initial strategy in fighting the virus behind bars involved suspending the movement of inmates from facility to facility within the federal prison system and modified operations to maximize social distancing, according to the Bureau of Prisons. Both federal and state facilities have also instituted the targeted release of inmates to reduce population -- though to varying degrees.

According to an internal memo obtained by ABC News, the Bureau of Prisons extended what it called its phase 7 of the COVID-19 plan. The memo says that inmate intakes are resuming somewhat normally, after removing quarantine sites. The BOP now says that institutions are supposed to designate specific quarantine and isolation areas, where inmates will be held for 14 days and then tested.

BOP is also starting to resume moving inmates between short distances. They say inmates will be quarantined for 14 days before and after the moves as well as tested at each facility. These policies will be in place until July 31. A BOP spokesperson did not immediately respond to ABC News' request for comment for this report.

The Prison Policy Initiative, a non-profit that advocates against mass criminalization, analyzed pandemic responses at local jails and state prisons and found jails reduced populations by an average of about 30%, while state prisons showed an average reduction rate of 5%. Some advocates for inmates have promoted the approach, saying reducing inmate populations will not only help keep prisoners and staff safe, but could be crucial to protecting entire communities.

“We have correctional officers, health workers, and other staff going in and out of these facilities every day,” said Sarah Gersten, Executive Director and General Counsel for the Last Prisoner Project. “There’s a risk that they’re going to then spread the virus into their own communities and overwhelm the already overwhelmed healthcare systems.”

Gersten said inmates who are released do not pose the same threat because they are under strict quarantines and are screened prior to getting out.

The Last Prisoner Project is a nonprofit whose mission is to reform marijuana-related laws and advocate for the release of people incarcerated on marijuana-related charges. With the onset of coronavirus, Gersten said the group has widening its focus.

“We’ve expanded our program to capture anyone that might be particularly at risk of dying because of COVID,” she told ABC News.

Despite the growing number of coronavirus cases inside prisons, legal advocates told ABC News that the number of inmates being released to help stop the spread does not appear to be increasing. Gersten and her team have been advocating for the early release of prisoners such as Michael Thompson, an inmate Muskegon Correctional Facility in Michigan.

Doctors diagnosed Thompson, 69, with Type 2 diabetes, placing him in a high risk category for the virus. He has been incarcerated in 1996 and has served more than half of a 42- to 60-year sentence for three counts of selling marijuana and two counts of illegal possession of a firearm. He was 45-years-old at the time of his arrest.

Thompson told ABC News in a telephone interview that he worries day and night about contracting the virus.

“I’m concerned when you don’t have a way to fight it back,” he said.

The Michigan Department of Corrections provided face coverings for inmates, but Thompson said he considered them flimsy, so he and other inmates have become creative.

“I made my own mask out of undershorts,” he said. “One of the guys here who sews really good I gave him some brand new undershorts and he made it for me.”

A spokesperson for the Michigan Department of Corrections says the masks initially provided to inmates were made from excess prisoner clothing, but the department has since started using a custom cotton material.

The virus has changed life inside the prison walls. Inmates have less freedom and fewer contacts with loved ones on the outside.

“It’s a lot of controlled movement,” he said. “No visits for one, and only one unit goes out on a yard at a time.”

The latest information from the Michigan Department of Corrections says nearly 1,300 inmates at Muskegon Correctional Facility were tested for COVID-19. The state says 1,282 tests were negative, none were positive, and nine are pending results. Michigan has not released information for individual facilities, but UCLA data shows just under 2,000 of Michigan’s 38,000 prison inmates have been released since the pandemic began.

Professor Dolovich says she hopes her team’s work will help lead to increased release rates nationwide.

“People inside are scared and the ones who are sicker are often not getting good health care,” she said. “I’m hoping that with the publication of our findings there will be a refocusing on what I think is one of the most urgent crises facing the country right now.”

The Michigan Department of Corrections spokesperson said inmates there are provided adequate healthcare. "We have a duty and obligation to care for all prisoners that the courts send to us," Chris Gautz told ABC News. "We spend a lot of time and care and money and energy providing medical care to prisoners."

But Thompson says he’s not sure if he would survive COVID-19 if he contracted the virus.

“Oh no. Prison don’t work that way,” he laughed. “You know, as far as trying to save people. It’s cheaper to let you die.”

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Oks_Mit/iStockBy ANGELINE JANE BERNABE, ABC News

(NEW YORK) -- With the coronavirus pandemic putting a pause on summer vacations and camps this year, many families have turned to purchasing pools for their homes to cool down and still have fun.

This year alone, pool sales have increased more than 160%, according to industry estimates. In addition, the NPD Group reported that sales of outdoor and sports toys surged by $193 million in April.

"I'm pretty sure we got the last above-ground pool in North America," said Ashley Best-Raiten, a mother of two from Pennsylvania, describing the high demand for pools this summer.

Best-Raiten added that she is also taking pool safety seriously this summer, even if hers is an above-ground pool.

"It's still a pool," she said. "It still has regular pool rules."

With the uptick in sales, the American Academy of Pediatrics (AAP) is putting a spotlight on how child drownings may increase.

In a May news release, the American Academy of Pediatrics noted how caregivers may be distracted while juggling work, responsibilities and childcare.

"With parents working from home and trying to provide that supervision of their children while working, it leads to more opportunities for children to get out of the house and to get to a pool or a body of water," Dr. Patrick Mularoni, an emergency physician at Johns Hopkins All Children's Hospital, told ABC News' Good Morning America.

This year so far, All Children's Hospital in St. Petersburg, Florida, has reported a 150% increase in child drowning incidents compared to the same time period in the last two years.

Emily Friske, of California, was faced with that nightmare just last month.

Friske said she thought her daughter, Addie, was inside with Friske's husband, who was working from home at the family's home in Valley Center, California. Unbeknownst to her parents, Addie had wandered into the family pool.

"It's every parent's worst nightmare," Friske told GMA. "She was on her side. She wasn't breathing."

For more than 20 minutes, Friske's daughter was without a pulse. Friske, a former EMT, performed CPR with her husband until an ambulance arrived.

Addie's doctors figured that she would have brain damage, but she miraculously survived, according to Friske, who is now working to raise awareness about pool safety.

Friske's advice to adults is to, "Please learn CPR."

Experts say that in addition to learning CPR and making sure children know how to swim, other ways to implement safety around pools this summer include never leaving a child unattended in or near water.

Also, make sure there are proper barriers, like covers and alarms, on and around any pool or spa that kids might have access to and tell children to stay away from pool drains.

Copyright © 2020, ABC Audio. All rights reserved.

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