Health Headlines


(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.


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.



(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.



(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.


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.


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.



(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.


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."


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.


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.



(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.



(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 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.



(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, 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


Prince Williams/WireimageBy DEENA ZARU, ABC News

(CHICAGO) -- By the time he was in the sixth grade, G Herbo had already started losing friends to gun violence and according to the Chicago rapper, for communities that deal with the brunt of the violence, the city has become a “mental illness war zone.”

The 24 year-old hip-hop artist, whose full name is Herbert Randall Wright III, has lost dozens of friends to gun violence and has reflected on the pain and loss in his music over the years.

In his latest album "PTSD," which was rereleased Friday with a cover to mark Mental Health Awareness Month, the rapper reflects on his own struggles with post-traumatic stress disorder -- a condition he realized he was dealing with after seeing a therapist about two years ago.


— G HERBO (@gherbo) May 28, 2020

“The album being called PTSD is because I walk around everything with post traumatic stress disorder. I come from the streets, I come from not knowing if you’re going to make it home and being okay with it,” G Herbo told ABC News, adding that the majority of people in his community who experience gun violence “are walking around with this illness” and “we don't we don't even realize it.”

Karen Sheehan, the medical director of Strengthening Chicago’s Youth which seeks a public health approach to addressing gun violence, told ABC News that “social isolation” in a segregated city has led to the “normalization of violence” and the trauma it causes.

“We often talk about PTSD that you’ve had this one bad experience and it’s hard to recover. The problem is it’s never relenting, it’s gone on for generations. That’s more challenging because there isn’t a place for safety to come home,” Sheehan said.

“... For our poor young people and families in Chicago there isn’t any time you can ever escape. I can’t imagine how that unrelenting experience of repeated trauma wears on them and that makes it a much more difficult problem to solve.”

Even amid the stay-at-home order due to the coronavirus pandemic, gun violence is still on the rise in Chicago.

According to a 2019 report
by the Erikson Institute, a graduate school in child development in Chicago, “the majority of Chicago’s youngest children live in communities with high homicide rates, increasing the likelihood of an adverse impact on their early development due to environmental trauma.”

G Herbo said that by opening up about PTSD on his album, he wanted to encourage others to “lean towards your fears to make your situation better so you can understand the reality of what we’re going through.”

The rapper’s hope of helping others in his community is already resonating.

Dr. Jaleel Abdul-Adil, a clinical psychologist and the Co-Director of the Urban Youth Trauma Center at the University of Illinois in Chicago, has been infusing traditional therapy methods with hip-hop for thirty years in an effort to connect with young people and when PTSD was first released in February, it immediately caught his attention.

“When PTSD first came out, it immediately jumped out … especially when you’re working with trauma programs, how can you not?” Abdul-Adil said.

The chorus of album’s title track "PTSD," which features Chance the Rapper, Juice WRLD & Lil Uzi Vert, begins with this: “I got a war zone inside of my head/ I made it on my own, they said I'd be in jail or dead/ I've seen my brothers fall, over and over again/ Don't stand too close to me, I got PTSD.”

Abdul-Adil, who trains mental health providers and caretakers around the country to utilize hip-hop to connect with children, said that he first used G Herbo’s music in his sessions when the rapper released “Red Snow” in 2017 -- a somber and evocative song about a particularly deadly winter in Chicago following a rash of shootings.

He said that although music “doesn't solve all the problems,” “it can certainly inspire you to think, behave, connect and begin to try to address your problems much better than the traditional means that often don't engage youth.”

“So what I do is I take the traditional programs, which are based on research and employ social sciences that are based on best practices, but I kind of season them, if you will, with rap music and hip hop language, examples and different things so that kids can hear what we're saying,” he added.

When told in a later interview that his music is being used in therapy sessions, G Herbo said “it feels great” to know that his songs are generating a conversation about mental health.

“That's the reason I do music -- one of the reasons -- to be able to help people because my music is a reflection of my life and the things that I’ve been through. I use it as a form of therapy to help me get through situations.”

Copyright © 2020, ABC Audio. All rights reserved.



(NEW YORK) -- If a second wave of the novel coronavirus emerges in the U.S. this fall, medical experts said patients arriving in American emergency rooms will likely have an entirely different experience than what urgently sick patients saw earlier this year -- the benefit of hard-learned lessons from the deadly disease.

“If there is a second wave in September, we will be protecting our patients and our staff in better ways, and will have the knowledge of the first wave to guide us in the best ways to treat patients,” said Dr. Bill Jaquis, president of the American College of Emergency Physicians.

Richard M. Schwartzstein, who heads pulmonary and critical care at Beth Israel Deaconess Medical Center in Boston, predicts there will be less anecdotal medicine and more evidence-based care than the first time around.

“The difference now is that these options are better refined and being studied more carefully,” Schwartzstein said. “Care is more rational with less sense of desperation.”

There is still no way to know whether COVID-19 cases will surge in the fall, as some have predicted. And it remains unclear if the U.S. could face a serious risk of hospitals being overwhelmed with patients if the outbreak roars back to life.

But public health officials said they do believe there has been a marked evolution from the chaotic early days of the coronavirus pandemic. And they say that even facilities that haven't been directly hit by the virus' first wave will have people to turn to, information available that wasn't before, and time to put surge plans in place.

As with most everything, practice helps. As of this report, the U.S. has seen more than 1.7 million cases of COVID-19 and more than 101,000 deaths. From that grim experience, hospitals have, through repetition and careful study, refined everything from the choice of early medications to the methods they use to position patients in bed, where doctors hope they'll be treated with powerful new therapies.

With more understanding, better preparation, better methods

One of the most challenging aspects of treating the outbreak was that it emerged quickly, before most hospitals could truly prepare.

Hospitals scrambled to scale up their supplies to meet the sudden and desperate need. At certain points nurses were asked to ration their use of critical gear -- storing their one respirator mask per day in a brown paper bag.

Dr. Josh Sharfstein, former state public health official and assistant dean at Bloomberg School of Public Health, told ABC News hospitals now have a better sense of their needs. To prepare for any surge, he said hospitals will be ordering large reserves of protective gear, and they will have designed plans to increase intensive care and ventilator capacity.

“The health care system was largely taken by surprise in the spring,” Sharfstein said. “It’s everyone’s shared responsibility to prevent a repeat in the fall.”

When patients started arriving in those early days, doctors were laying eyes on the novel coronavirus and its bizarre array of symptoms for the first time. Now many have strategies in place.

Health care experts realized, for instance, that they needed to check patients arriving at hospitals for early signs of blood clots, which has emerged as a common hallmark of a dangerous COVID-19 infection.

Caregivers have also found benefits of rolling even mildly ill coronavirus patients on their stomachs, finding that using prone positioning eases the stress on fluid-filled lungs.

And physicians have honed their ability to recognize the needs of patients with more serious infections.

“We understand better how to manage these patients on mechanical ventilators and the time it takes for many of them to improve,” Schwartzstein said.

Fine tuning medications

When it comes to drug treatment, health care officials said they have seen how some medications are in greater demand, such as Remdesivir, which proved helpful in reducing hospital stays for those with advanced cases of the illness during early testing.

Production of the drug is ramping up, and Health and Human Services Secretary Alex Azar told governors this week that, as of Saturday, initial shipments have now reached every American state and territory.

Azar told the state officials he had “more good news”: the company Gilead, which manufactures Remdesivir, agreed to donate an additional 333,000 vials to the U.S. government, bring the total to 940,000 vials -- enough to treat approximately 120,000 patients.

Other medications that attracted early interest in intensive care units have been set aside in many cases. Schwartzstein told ABC News medical centers in Boston had halted the use of hydroxychloroquine.

The once-promising drug had shown early signs of success in China, and been championed by President Donald Trump from the White House podium. But last week, the scientific journal Lancet published results from a 96,000-patient observational study that concluded that hydroxychloroquine had no effect on Covid-19 and may have even caused some harm.

"The scientific data is really quite evident now about the lack of efficacy," Dr.Anthony Fauci, the Trump administration official helping lead the pandemic response, told CNN.

Plasma, antibodies show promise

As pharmaceutical companies and public health researchers toil in labs in search of additional medications, many believe even more effective treatments for those who come down with COVID-19 will be on hand at American hospitals come fall -- even if a vaccine is still months away.

Azar told governors he sees a bright future for the various approaches doctors will use when confronting the virus in the months to come.

“On therapeutics, we continue to advance three strategies,” Azar said.

The first, he said, is the use of convalescent plasma, collected when someone who has recovered has donated their blood. The blood is then separated into plasma that contains virus-fighting antibodies that can be used for others who are sick.

It’s one of the few treatments showing early indications that it can help. Back in March, only a small number of facilities were able to perform convalescent plasma treatments. But in just three months, the treatment is now an option at over 2,300 hospitals across the country, according to the COVID-19 expanded access program.

Dr. Michael Joyner, an anesthesiologist at the Mayo Clinic, said experts are currently working on plans for how best to collect and distribute convalescent plasma if a second wave hits this fall.

“Where we are in the fall depends,” he said. If more evidence emerges showing the treatment is effective, he expects it to be more widely used.

The second strategy, Azar said, involves the use of what he called “hyper immunoglobulin,” which he said basically involves commercially processing plasma donations from multiple people to create a more consistent and powerful antibody treatment.

"You're giving thousands or millions of antibodies, but the problem is that once you need another dose you need to bleed more people and start over again,” explained Dr. James E. Crowe, who serves as the director of Vanderbilt Vaccine Center. "Hyper immunoglobulin" treatment with standardized serum could be more effective on a mass scale.

Transferring antibodies from recovered patients to those who are actively infected is not fool-proof, though. Since everyone's antibody production following infection can slightly differ, researchers try to identify ideal donor candidates -- those with the highest levels of neutralizing antibodies.

The technique, Crowe said, is an “old school” method, but “might well be the first antibody [treatment] we see used.”

With new therapies, a bridge to a vaccine?

Azar said the third strategy he expects to see widely deployed involves antibodies that are actually themselves produced outside of humans, what are known as monoclonal antibodies.

“We've got over 20 companies with monoclonal antibodies in development and working on prioritizing and focusing our development efforts and manufacturing capacities on those,” he said.

This approach -- similar to hyper immunoglobulin therapy -- is meant to simulate or mimic the antibodies made in your own body.

"Basically we can move immunity from one person to another and the person who receives it has instant immunity," said Crowe.

Crowe said this method is preferred over-hyper immunoglobulin therapy "because it's reproducible and much better defined."

But historically, it has been a more expensive approach because of the extensive process required to produce and purify the antibodies on such a large scale. Moreover, the benefits don’t last very long -- typically around 90 days -- so the value of these drugs is limited.

Still, if there was a viral surge that sent patients to the emergency room in the fall, there are indications that these drugs could be on hand, with some hope it could help halt disease progression.

At the Duke University Human Vaccine Institute in North Carolina, scientists are already developing a monoclonal antibody treatment that can be bottled and shipped out. Dr. Gregory Sempowski, the director of the Regional Biocontainment Laboratory at the Institute, called the potential treatment "a next-generation version of convalescent plasma."

Duke is one of four locations across the country working on this treatment. Their efforts have been financed by the Defense Advanced Research Projects Agency (DARPA), the nation’s premier military lab. Pharmaceutical companies are also in the hunt. One firm, Regeneron, has indicated it is just weeks away from starting clinical trials.

Crowe predicts that monoclonal antibody treatment will become available before vaccines -- as early as the end of this year or early 2021.

"Most people think of antibodies as a bridge because they give us immunity for a period of time until vaccines are ready," said Crowe.

But ultimately, a vaccine, if proven safe and effective, is still the endgame for the viral battle, experts said.

"When you're vaccinated, your body makes antibodies. It's like a factory that doesn't turn off,” Crowe said. “The durability and duration of immunity with vaccines is longer."

Copyright © 2020, ABC Audio. All rights reserved


George Floyd is pictured in an undated photo. (Courtesy Ben Crump Law)By AVERI HARPER, ABC News

(NEW YORK) -- For many black men, viral videos featuring the killings of other black men can weigh heavily. Watching the disturbing footage can impact the mental health of African American men, experts say.

For civil rights advocate and Georgetown Law Center professor Preston Mitchem, the images can lead to physical symptoms.

"My stomach is in knots, my heart is racing, my brain is pounding and none of that is hyperbolic, said Mitchem. "It is exhausting to think that you can be up next."

New York City Public Advocate Jumaane Williams offered a tearful statement during a press conference Wednesday. Though he couldn't bring himself to view the most recent killings, Williams said he was "not okay."

"I am tired," said Williams. "I have yet to watch the video of Ahmaud Arbery. It's too much. I have not watched the video of George Floyd. It's too much."

For others, the videos conjure mixed emotions like anger, despair and powerlessness.

"It hurts, but then also you're feeling anger, and then you have a feeling of helplessness, because, what can we do?" said Rwenshaun Miller, a Charlotte, North Carolina, psychotherapist and founder of the nonprofit Eustress, Inc. that aims to improve mental health in black communities.

Video of Ahmaud Arbery, the Georgia man who was shot by a father and son while jogging in February, and George Floyd, the black man who died after a Minneapolis police officer kneeled on his neck, are the latest incidents capturing the brutalization of black men. The trauma collectively experienced by the black community in the wake of the incidents dates much further back.

"Being shown and seeing images that really demonstrate violence on the black body is something that is not only traumatizing from a contemporary perspective but it also has historical trauma. It really does sort of play to these like larger issues that have been with us for hundreds of years," said Martine Hackett, a public health professor at Hofstra University.

The beating and mutilation of slaves as punishment was accepted practice by slave owners. Late into the 20th century, the threat of lynching in the South was commonplace. Following the 1955 torture and murder of Emmett Till, a 14-year-old boy killed by two white men in Mississippi, pictures of his unrecognizable, mutilated body were published. The images of Till's remains are widely considered a flashpoint that ushered in the Civil Rights movement of the 1960s.

According to health experts, repeated viewing of these images can trigger mental health conditions and impact overall health.

"We can experience PTSD, we can experience other mental health challenges as well anxiety, depression, all of these things may be a result of how we're in the world and as these images continue to circulate," said Miller. "That added stress, the trauma and the constant worry will weigh on you very heavily. It's similar to living in a war zone."

"The stress of viewing these disturbing images has a physical manifestation. Often times, people will say, 'this makes me sick to my stomach' or 'I feel like I'm gonna choke' and those are really, those are actually legitimate feelings that you are having," said Hackett. "And the truth is, that's one of the first things is to recognize that these stressors do play a role in our physical health."

Mitchum says that COVID-19 has only complicated the ways in which he and other black men would normally cope.

"Usually there's some kind of way for us to actually find joy, hanging out with your friends, engaging with your family, being able to experience a physical touch that's rooted in like love and affirmation, that's something that many of us are being denied because of COVID," said Mitchum.

Miller recommends taking a timeout from consuming media to alleviate the feeling of bombardment by these violent images.

"The first thing we do is pick up our phone and start to scroll and that's all you're seeing. So I would suggest that people take a break from the news, take a break from the (social media) feeds," said Miller. "You got to give yourself a break."

He suggests finding other outlets like talking to someone you trust, journaling, coloring or exercising to cope. He also encourages men to consider seeking therapy.

"Find ways to introduce self-care into your daily lifestyle, we can't wait until a traumatic event occurs and then we want to try to fix our mental health or take care of our mental health. We need to be proactive in doing these things," he said.

Copyright © 2020, ABC Audio. All rights reserved



As doctors and scientists continue to learn more about the novel coronavirus, researchers are laboring to figure out exactly who is the most susceptible to the virus. One vulnerable group that has not yet been extensively researched is people with cancer -- but a new study is helping to change that.

Cancer patients face specific circumstances that may place them at higher risk for severe COVID-19 symptoms. Their immune systems may be weakened by anti-cancer treatment, additional supportive medications like steroids, and by cancer itself.

Unfortunately, cancer patients are also frequently older and have other underlying health conditions, putting them at additional risk for severe coronavirus symptoms. But there aren't many studies describing the fate of people with cancer who also develop COVID-19.

"As oncologists we are accustomed to dealing with infectious complications, but the challenge with COVID-19 is that there is no specific treatment available at the time," said Dr. Wasif M. Saif, M.D., deputy physician-in-chief and medical director at Northwell Health Cancer Institute in Lake Success, New York.

It's a tricky situation as doctors must balance the risk of treating the cancer -- knowing it could put the patient at risk for worse COVID-19 symptoms or death -- versus delaying cancer treatment, which could allow the cancer to progress, resulting in worse cancer symptoms or death. In order to make the best decision, doctors needed more information.

Consequently, researchers from multiple institutions reviewed the records of more than 1,000 adult patients with cancer and confirmed COVID-19. The records were collected and cataloged by the COVID-19 and Cancer Consortium registry, a collaboration between academic and community oncology specialists in the United States and Canada. They investigated the association between numerous variables and death within 30 days of COVID-19 diagnosis. By the end of the study, 13% of the patients had died.

"The 30-day all-cause mortality was 13%, more than twice the mortality reported as the global average by Johns Hopkins," explained the co-lead author of the study, Dr. Toni K. Choueiri, director of the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute.

According to the study, if you're living with cancer, COVID-19 may be more dangerous for you than the average person. That means cancer patients should speak with their doctor about the risks of continuing treatment.

The researchers found several factors associated with an increased risk of death: older age, male sex, previous smoking history, having two underlying health conditions, active cancer, and treatment with azithromycin plus hydroxychloroquine. Of note, the researchers said they could not tell if hydroxychloroquine plus azithromycin gives any benefit or overall harm to the patients, because the study was not set up to look at that question, nor did it account for other potential variables.

Interestingly, race and ethnicity, obesity status, cancer type, type of anticancer therapy and recent surgery were not associated with increased death.

These important findings will guide oncologists in treating their patients during this pandemic.

"Taken together, these results suggest that fit patients with cancer and few comorbidities can and should proceed with appropriate anti-cancer treatment," noted Choueiri, "whereas those with poor performance status or progressing cancer need to have thoughtful conversations with their oncology providers about risk versus benefit of anti-cancer treatment."

There is no doubt that the COVID-19 pandemic has placed cancer patients at a higher risk. But progress is being made on determining how to best protect these vulnerable patients.

"We are already at more than 2000 patients in our database and accumulating more granular data about specific therapies to be able to answer important questions relevant to patients with cancer," Choueiri said.

The only way forward is with continued rigorous scientific study, experts say.

"Until the pandemic has ended, we have to rely upon the principles of safety and evidence-based piers of priority in individualizing patients care," said Saif. "The fluidity of the situation mandates us to adapt and modify as we learn more about this disease and its impact."

Angela N. Baldwin, M.D., M.P.H., is a pathology resident at Montefiore Health System in the Bronx and a contributor to the ABC News Medical Unit.

Copyright © 2020, ABC Audio. All rights reserved.


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