A spike in texts and calls to crisis hotlines reflects Americans' growing anxiety about the coronavirus and its impact on their lives.; Credit: Richard Bailey/Getty Images

Normally, Laura Mayer helps the most acutely suicidal callers find the nearest hospital emergency room. But in a pandemic, that has become a crisis counselor's advice of last resort.

"It's a difficult decision because we do know that by sending them into an overburdened health care system, they may or may not get the treatment that they need," says Mayer, who is director of PRS CrisisLink in Oakton, Va., which also takes calls for the National Suicide Prevention Lifeline. "The resources may or may not be there, and we're exposing them to the illness."

So instead, counselors are devoting more time to each caller, offering ad hoc therapy and coaxing them to talk through their pain. These days, that pain often has many sources: lost jobs, severed relationships and sick family.

"The type of call and the seriousness of the call is very different this year than it was in previous years," Mayer says. "There's environmental issues, internal issues, family issues. ... It's never one thing."

America's crisis centers and hotlines are themselves in crisis. As people grapple with fear, loneliness and grief, on a grand scale, those stresses are showing up at crisis hotlines. Not only are the needs greater, but their clients' problems are more acute and complex and offer a window into the emotional struggles Americans face.

Across the board, hotlines of all kinds are reporting increases in volume.

The Substance Abuse and Mental Health Services Administration saw a fivefold increase at its National Helpline in March. The Crisis Text Line says its volumes are up 40% in the pandemic, to about 100,000 conversations a month.

Volunteer counselors and good Samaritans are responding by lining up to help.

But Mayer says the heaviness takes its toll. Those offering this kind of support end up needing support themselves.

"This illness is starting to impact each of our crisis workers and counselors themselves personally," she says. "So everyone is kind of a client right now, and that's been really challenging."

Nancy Lublin, CEO and co-founder of the Crisis Text Line, says she is bracing for sustained need. "This echo of the physical virus, the mental health echo, we fear it's going to last a very long time and that the intensity will remain," she says.

Over the last two months, the focal point of the emotional pain has shifted, she says. Initially, the spike in traffic was over anxiety about the virus itself. That shifted to complaints of isolation. Now, texters talk of depression and grief.

"So we've doubled the number of conversations that are about grief, and there the top two words that we see are 'grandma' and 'grandpa,' " she says.

And it's no longer just young people texting. Adults are complaining of loneliness, sexual abuse and eating disorders.

"As the quarantines go on and continue, we're seeing it's the people over the age of 35 who are increasing at a higher percentage of our volume," Lublin says. "For the first time, we're seeing people over the age of 60 texting us."

Texting is an ideal medium, she says, for those stuck at home with no personal space: "You don't have to find a quiet space where no one else can hear you."

And for some, that might be the only form of escape. The text line has seen a 74% increase in references to domestic violence. "We see words like 'trapped' [and] 'hurt,' " says Lublin.

Many shelters have shut down, and some of those in-person centers, including the Salvation Army in Philadelphia, now rely on their own hotlines instead.

Arielle Curry, director of the Salvation Army's anti-human trafficking program, says many of her clients can't afford cell phones and have lost touch; those who remain in contact are in dire straits, searching for a shorter supply of money or drugs, and are often suicidal. Curry says addressing those acute emotional needs by phone is frustrating; sometimes she doesn't even know where they are and can't send help to intervene.

"You can't ... comfort someone and look them in their eyes and support them face-to-face," she says. That makes it hard, Curry says, not to feel helpless and hopeless herself.

This content is from Southern California Public Radio. View the original story at SCPR.org.

As millions of Americans have lost their jobs, Congress is trying to figure out what to do to help those who have also lost their health insurance.; Credit: South_agency/Getty Images

Mayra Jimenez had just lost the job she loved — and the health insurance that went along with it.

The 35-year-old San Francisco server needed coverage. Jimenez has ulcerative colitis, a chronic condition. Just one of her medications costs $18,000 per year.

"I was just in panic mode, scrambling to get coverage," Jimenez said.

A recent estimate suggests the pandemic has cost more than 9 million Americans both their jobs and their health insurance.

"Those numbers are just going to go up," MIT economist Jon Gruber said. "We've never seen such a dramatic increase in such a short period of time."

House Democrats introduced a bill in mid-April to help the millions of people, like Jimenez, who find themselves unsure of where to turn.

The Worker Health Coverage Protection Act would fully fund the cost of COBRA, a program that allows workers who leave or lose a job to stay on their former employer's insurance plan. COBRA currently requires workers to pay for their entire premium, including their employer's share.

The Worker Health Coverage Protection Act is one bill being considered as Congress tries to figure out what to do about the very real health care gap for those millions who have lost their jobs. Sponsors of the COBRA legislation say they hope their plan gets rolled into the next relief bill. But it's unclear when, how and whether the problem will get addressed in upcoming coronavirus relief measures.

Jimenez learned COBRA would run her $426 a month.

"I was kind of shocked to hear the number," she said. "That's almost half my rent."

The idea of allowing laid-off workers to stick with their coverage at no cost in a pandemic has clear appeal, says Gruber.

But he warns, "COBRA is expensive, and for many employees, it won't be there."

Only workers who get insurance through their employer are eligible for COBRA, leaving out more than half of the 26 million who have lost jobs in the last few weeks. Many of the industries hit hardest by COVID-19, including retail and hospitality, are among those least likely to offer employees insurance.

And even if someone had insurance through work, the person loses COBRA coverage if the former employer goes out of business.

Funding COBRA costs, federal dollars also wouldn't go as far as they could. Unpublished Urban Institute estimates show that an employer plan costs, on average, about 25% more than a Gold plan on the Affordable Care Act exchanges.

"We need to be all hands on deck, spending whatever we can to help people," Gruber said. "But that doesn't mean we shouldn't be thinking about efficient ways to do it."

Congress has tried this move before. In response to the Great Recession, lawmakers tucked a similar COBRA subsidy into the massive stimulus bill a decade ago. That legislation paid for 65% of COBRA premiums, leaving laid-off workers to cover the rest.

A federally commissioned study found that COBRA enrollment increased by just 15%. Mathematica senior researcher and study co-author Jill Berk said workers skipped the subsidy for two main reasons.

First, only about 30% of eligible workers even knew the subsidy existed.

"For those that were aware," Berk said, "their overwhelming response was that COBRA was still too expensive."

At that time, the average premium for a single worker — even with the subsidy — ran about $400 per month for a worker with family coverage.

"When you're actually facing those choices, choosing between rent and food and other bills," Berk said, "that COBRA bill looks quite high."

Berk's team also discovered that people who reported using the subsidy were four times more likely to have a college degree and a higher income than those who passed on it. In other words, Berk found that the COBRA subsidy was least helpful to those with the greatest need.

Several economists, including Gruber, and some Democrats in Washington are kicking around alternatives to COBRA. Among their ideas is a plan to have the federal government pick up more of a person's premium and other expenses on the Affordable Care Act exchanges. Another proposal would extend ACA subsidies to people who earn too much to qualify for any aid and to lower-income people who live in states yet to expand Medicaid.

Compared with funding COBRA, beefing up ACA subsidies could potentially help millions more people, including the pool of laid-off workers who did not get health insurance from their employer.

The ACA ties subsidies to people's income, giving more help to those at the bottom end of the wage scale and spending less on those who are better off. In contrast, the current COBRA plan would cover 100% of COBRA for everyone, regardless of the person's income.

There are some downsides to this approach. Making ACA subsidies more generous could end up costing the federal government more overall, because it gives more help to a lot more people.

Chris Holt from the American Action Forum, a conservative think tank, points out that the ACA already increases federal support when people's earnings fall and questions how much more of the tab Washington should pick up.

"If that subsidy would have been good enough for someone six months ago, why is it not good enough now?" he asked.

Maybe the biggest challenge to building on the ACA: The 10-year-old law remains a political football.

"There's just so much both emotion and, frankly, bitterness tied up in debates," Holt said, adding that this makes it hard to move anything forward.

Holt notes that COBRA is not free of political hang-ups either. He expects a fight over whether subsidy money can be spent on employer plans that cover abortion services, for example.

Holt and Gruber agree that perhaps the easiest idea is to leave the ACA alone with one minor tweak: allow people to take the ACA subsidy they're already eligible for and use it on COBRA if they choose.

As for Jimenez, she did not have time to wait for Congress. She brought in too much from unemployment to qualify for Medicaid. And she couldn't afford COBRA, so she picked out a plan on the ACA exchange, where she's eligible for generous existing subsidies. It will cost her $79.17 per month, and she gets to keep her doctors. Not everyone does.

This is the first time she has ever purchased insurance on her own, rather than gotten it through work — and that has delivered one other unexpected benefit.

"Freedom," Jimenez said. "It feels so freeing to take charge of my health care and to know that no one can take this away from me. I don't have to rely on a job to give me what they want to give me. I can make my own choices."

Policymakers, providers, employers and health-industry executives have been fighting over whether the United States should tie insurance to work since the end of World War II.

Subsidizing COBRA preserves the status quo, while doubling down on the ACA might just start to drive a real wedge between work and health insurance.

As states begin reopening businesses, some laid-off workers will get back their jobs, as well as their insurance. But many will remain unemployed and uninsured. A decade ago, faced with the same challenge, Congress chose to subsidize COBRA. It proved to be a narrow solution with limited impact.

Lawmakers now have the ACA at their disposal, a tool that may be a better fit for this moment. Whether they choose to use it may be a choice grounded more in political realism than policy idealism.

Dan Gorenstein is the creator and co-host of the Tradeoffs podcast, and Leslie Walker is a producer on the show, which ran a version of this story on April 23.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Deputy Chief Patricia Cassidy of the Jersey City Police Department has blood drawn to test for coronavirus antibodies in Jersey City, N.J., on Monday.; Credit: Seth Wenig/AP

The Food and Drug Administration is stiffening its rules to counteract what some have called a Wild West of antibody testing for the coronavirus.

These tests are designed to identify people who have been previously exposed to the virus. The FDA said more than 250 developers have been bringing products to the market in the past few weeks.

In a rush to make antibody tests available as quickly as possible, the FDA had set a low standard for these tests. Manufacturers were supposed to submit their own information about the accuracy of their wares, but the agency had no standards for what would be acceptable. Companies weren't allowed to claim the tests were authorized by the FDA, under initial guidance issued in mid-March.

Now the FDA is telling manufacturers that if they want their tests to remain on the market, they must meet minimum quality standards and submit a request for emergency use authorization, a temporary route to market for unapproved products when others aren't available. The EUA involves a lower standard than the usual FDA clearance or approval.

The FDA said 12 manufacturers have already opted to request EUA's for their products. More than 100 other producers have been talking to the agency about using this process, said FDA Commissioner Stephen Hahn. He spoke on a press call Monday. Companies have 10 days to submit that request.

"Our expectation is that those who can't [meet the new standard] will withdraw their products from the market and we will be working with them to help them do that," he said.

These tests are now so widespread that people can order them from lab giants Quest or LabCorp. The tests can cost more than $100. Though the FDA's original guidance calls for these tests to be run by a certified lab, the kits themselves are simple to use and have been readily available.

Despite the enthusiasm surrounding these tests, they have substantial limitations. Though people who test positive for antibodies have in most cases been exposed to the coronavirus, scientists don't know whether that means those people are actually immune from the coronavirus, and if so for how long.

"Whether this is the ticket for someone to go back to work [based solely on an antibody test result], my opinion on that would be no," Hahn said.

The tests may be more useful when combined with information from a standard coronavirus diagnostic test, or in someone who has symptoms, or if the results have been confirmed with a different antibody test. That "would dramatically increase the accuracy of those tests," said Jeffrey Shuren, director of the FDA's Center for Devices and Radiological Health

Antibodies are a potentially valuable research tool, and can be used to determine the prevalence of a disease in a population. In that circumstance, individual false results are less important. New York State used antibody tests to determine that about 20 percent of people in New York City have already been exposed to the coronavirus.

In California, researchers have attempted to measure the prevalence of the coronavirus in Los Angeles County and Santa Clara County in the Bay Area. Those unpublished results have garnered criticism because even a test that's more than 99 percent accurate can produce many false positive results when used to survey hundreds or thousands of people.

In the face of this criticism, the authors of the Santa Clara study have posted revised results acknowledging the high degree of uncertainty in their findings. Those findings haven't been peer-reviewed.

The emergency use authorization is only valid during the time of the national emergency. "Once the national emergency ends, the EUA authorizations end as well," Shuren said. Companies that want to keep marketing these tests will need to get them approved through the regular, more stringent FDA process.

FDA officials say they will continue to crack down on companies that falsely claim their tests are approved by the FDA, or that market them for home use, which isn't currently allowed.

You can contact NPR Science Correspondent Richard Harris at rharris@npr.org.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Rick Bright, former director of the Biomedical Advanced Research and Development Authority, is seen here in 2018.; Credit: Toya Sarno Jordan/Bloomberg via Getty Images

Updated at 6:14 p.m. ET

The federal scientist who was ousted from his role as director of the Biomedical Advanced Research and Development Authority has filed a whistleblower complaint with the U.S. Office of Special Counsel.

Rick Bright was a high-ranking federal scientist focused on vaccine development and a deputy assistant secretary with the Department of Health and Human Services. Last month, Bright said he was transferred to a "less impactful position" at the National Institutes of Health after he was reluctant to promote the use of drugs such as hydroxychloroquine to treat COVID-19 patients.

In the complaint, Bright alleges a range of government wrongdoing by Dr. Robert Kadlec, the assistant secretary of preparedness and response at the U.S. Department of Health & Human Services, and others. Bright's boss was Kadlec, who in turn reported to HHS Secretary Alex Azar.

At the time of his removal, Bright said he had been ousted because of his "insistence" that the government spend funds on "safe and scientifically vetted solutions" to address the coronavirus crisis and not on "drugs, vaccines and other technologies that lack scientific merit."

Bright says in the complaint that he raised concerns about the need to prepare for the coronavirus in January but encountered opposition from Trump administration officials. He says he was transferred out of BARDA in retaliation.

According to the complaint, relations between Bright and Kadlec had been strained since 2018 or so, when Bright began "raising repeated objections to the outsized role Dr. Kadlec allowed industry consultants to play in securing contracts that Dr. Bright and other scientists and subject matter experts determined were not meritorious."

"Once the COVID-19 pandemic hit, however, Dr. Bright became even more alarmed about the pressure that Dr. Kadlec and other government officials were exerting on BARDA to invest in drugs, vaccines, and other technologies without proper scientific vetting or that lacked scientific merit," the complaint continues. "Dr. Bright objected to these efforts and made clear that BARDA would only invest the billions of dollars allocated by Congress to address the COVID-19 pandemic in safe and scientifically vetted solutions and it would not succumb to the pressure of politics or cronyism."

The complaint alleges that Bright made repeated efforts to get the U.S. government to make adequate preparations for coronavirus, but was stymied by political appointees leading the HHS, including Azar.

HHS did not immediately respond to NPR's request for comment.

Bright says that in an effort to get the word out to the public about the risks associated with hydroxychloroquine, he shared with a reporter nonclassified emails between HHS officials that "discussed the drug's potential toxicity and demonstrated the political pressure to rush these drugs from Pakistan and India to American households." He says Azar and Kadlec removed him from his post within days of publication of an article about chloroquine because they suspected he was the article's source.

Bright says he stopped receiving a paycheck on April 20 and has not been assigned any further duties.

News of the whistleblower complaint was made public by his attorney on Tuesday.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Physical and occupational therapists carry bags of personal protective equipment on their way to the room of a COVID-19 patient in a Stamford Hospital intensive care unit in Stamford, Conn., on April 24. This "prone team" turns over COVID-19 to help them breathe.; Credit: John Moore/Getty Images

Intensive care teams inside hospitals are rapidly altering the way they care for patients with COVID-19.

The changes range from new protective gear to new treatment protocols aimed at preventing deadly blood clots.

"Things are moving so fast within this pandemic, it's hard to keep up" says Dr. Angela Hewlett, an infectious diseases physician at University of Nebraska Medical Center in Omaha and medical director of the Nebraska Biocontainment Unit. To stay current, she says, ICUs are updating their practices "on an hourly basis."

"We are learning at light speed about the disease," says Dr. Craig Coopersmith , interim director of the critical care center at Emory University. "Things that previously might have taken us years to learn, we're learning in a week or two. Things that might have taken us a month to learn beforehand, we're learning in a day or two."

The most obvious changes involve measures to protect ICU doctors, nurses and staff from the virus.

"There is a true and real probability of infection," says Dr. Tiffany Osborn a critical care specialist at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis. "You have to think about everything you touch as if it burned."

So ICUs are adapting measures used at special biocontainment units like the one at the University of Nebraska. These units were designed to care for patients affected by bioterrorism or infected with particularly hazardous communicable diseases like SARS and Ebola.

The Nebraska biocontainment unit "received several patients early on in the pandemic who were medically evacuated from the Diamond Princess cruise ship," Hewlett says. But it didn't have enough beds for the large numbers of local patients who began arriving at the University of Nebraska Medical Center.

So the nurses, respiratory therapists and physicians from the biocontainment team have "fanned out and are now working within those COVID units to make sure that all of our principles and protocols are followed there as well," Hewlett says.

Those protocols involve measures like monitoring ICU staff when they remove their protective gear to make sure the virus isn't transmitted, and placing infected patients in negative pressure rooms, which draw air inward, when possible to prevent the virus from escaping.

One of the riskiest ICU procedures is inserting a breathing tube in a COVID-19 patient's airway, which creates a direct path for virus to escape from a patient's lungs. "If you're intubating a patient, that's a much higher risk than, say, going in and doing routine patient care," Hewlett says.

So ICU teams are being advised to add several layers of protection beyond a surgical mask.

Extra personal protective equipment may include an N95 respirator, goggles, a full face shield, a head hood, an impermeable isolation gown and double gloves.

In many ICUs, teams are also placing a clear plastic box or sheet over the patient's head and upper body before inserting the tube. And as a final safety measure, the doctor may guide the tube using a video camera rather than looking directly down a patient's airway.

"It usually takes 30 minutes or so in order to get all of that equipment together, to get all of the right people there," says Dr. Kira Newman, a senior resident physician at UW Medical Center in Seattle. "and that would be a particularly fast intubation."

But most changes in the ICU are in response to an ongoing flood of new information about how COVID-19 affects the body.

There's a growing understanding, for example, that the infection can cause dangerous blood clots to form in many severely ill patients. These clots can kill if they block arteries supplying the lungs or brain. But they also can prevent blood from reaching the kidneys or even a patient's arms and legs.

Clots are a known risk for all ICU patients, Cooperman says, but the frequency and severity appears much greater with COVID-19. "So we're starting them on a higher level of medicine to prevent blood clots and if somebody actually develops blood clots, we have a plan B and a plan C and a plan D," he says.

ICU teams are also recalibrating their approach to ensuring that patients are getting enough oxygen. Early in the pandemic, the idea was to put patients on mechanical ventilator quickly to make sure their oxygen levels didn't fall too far.

But with experience, doctors have found that mechanical ventilators don't seem to work as well for COVID patients as they do for patients with other lung problems. They've also learned that that many COVID-19 patients remain lucid and relatively comfortable even when the oxygen levels in their blood are extremely low.

So many specialists are now recommending alternatives to mechanical ventilation, even for some of the sickest patients. "We're really trying now to not intubate," Osborn says.

Instead, ICU teams are relying on devices that deliver oxygen through the nasal passages, or through a mask that fits tightly over the face. And there's renewed interest in an old technique to help patients breathe. It's called proning.

"Instead of them being on their back, we're turning them on their front," Osborn says. The reason, she says is to open up a part of the lung that is collapsed when a patient is on their back.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Coronavirus deaths in the U.K. have passed those in Italy. Workers in the intensive care unit at the Royal Papworth Hospital in Cambridge are shown gearing up to care for COVID-19 patients.; Credit: Neil Hall/AP

Over 32,000 people have died from the new coronavirus in the United Kingdom, according to the Office for National Statistics, marking the first time in the pandemic that it has led Europe in the number of deaths.

The country has surpassed Italy in COVID-19 deaths. The U.S. still leads the world in the highest number of coronavirus deaths; over 70,270 had died from the disease as of Tuesday.

The number of total deaths recorded in the U.K. is "higher than we would wish, I think is all I can say," Angela McLean, chief scientific adviser of Ministry of Defence said during the country's press briefing Tuesday.

McLean also emphasized that deaths in U.K. care homes have been steadily rising and said the trend was something the country "need[s] to get to grips with."

"I don't think we'll get a real verdict on how well countries have done until the pandemic is over," British Foreign Secretary Dominic Raab said Tuesday. "And particularly until we have comprehensive international data on all causes of mortality."

Since different countries collect and report coronavirus data using different methods, the comparisons between regions are not perfect. As more time passes and more tests are conducted and more data comes in, coronavirus death rates will become more precise.

The peak in deaths comes as other European countries, including Italy and Spain, are easing shelter-in-place restrictions, while U.K. Prime Minister Boris Johnson is expected to modify Britain's orders in the next week.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Two workers approach the entrance to Life Care Center in Kirkland, Wash., on March 13. An association that represents nursing homes is asking for billions of dollars in federal relief funds to cope with the coronavirus crisis.; Credit: Ted S. Warren/AP

With more than 11,000 resident deaths, nursing homes have become the epicenter of the COVID-19 crisis. Now, they're asking the federal government for help — $10 billion worth of help.

The American Health Care Association, the trade organization for most nursing homes, called the impact on long-term care facilities "devastating." In a letter sent this week to the Federal Emergency Management Agency and Health and Human Services Secretary Alex Azar, they ask for the federal government to designate relief funding from the CARES Act for nursing homes the way it has for hospitals.

The money would be used for personal protective equipment, salaries for expanded staff, and hazard pay. In addition, some of the funds would make up lost revenue for nursing homes that have been unable to admit new residents because of the outbreak.

The AHCA also wants nursing homes to have more access to testing and some members of Congress want that too. This week, 87 members of the House of Representatives sent their own letter to Azar, as well as to Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, which regulates nursing homes. The letter asks those agencies to direct states — which have received billions of dollars for increased testing — to give priority to long-term care facilities.

The letter also notes that nursing homes are now required to report their numbers of COVID-19 infections and deaths to the Centers for Disease Control and Prevention, but that they can't meaningfully do this unless they can test everyone in the facility.

Democrats in both the House and the Senate have also introduced legislation intended to make things safer for both nursing home staff and residents. The bill would require nursing homes to take a range of actions, from providing better infection prevention, to supplying sufficient protective gear, to protecting a resident's right to return to the nursing home after they've been treated for COVID-19 at a hospital.

This content is from Southern California Public Radio. View the original story at SCPR.org.

; Credit: Alyson Hurt/NPR

To safely phase out social distancing measures, the U.S. needs more diagnostic testing for the coronavirus, experts say. But how much more?

The Trump administration said on April 27 the U.S. will soon have enough capacity to conduct double the current amount of testing for active infections. The country has done nearly 248,000 tests daily on average in the last seven days, according to the nonprofit Covid Tracking Project. Doubling that would mean doing around 496,000 a day.

Will that be enough? What benchmark should states try to hit?

One prominent research group, Harvard's Global Health Institute, proposes that the U.S. should be doing more than 900,000 tests per day as a country. This projection, released Thursday, is a big jump from its earlier projection of testing need, which was between 500,000 and 600,000 daily.

Harvard's testing estimate increased, says Ashish Jha, director of the Global Health Institute, because the latest modeling shows that the outbreak in the U.S. is worse than projected earlier.

"Just in the last few weeks, all of the models have converged on many more people getting infected and many more people [dying]," he says.

But each state's specific need for testing varies depending on the size of its outbreak, explains Jha. The bigger the outbreak, the more testing is needed.

Thursday Jha's group at Harvard published a simulation that estimates the amount of testing needed in each state by May 15. In the graphic below, we compare these estimates with the average numbers of daily tests states are currently doing. (Jump to graphic)

Two ways to assess whether testing is adequate

To make their state-by-state estimates, the Harvard Global Health Institute group started from a model of future case counts. They calculated how much testing would be needed for a state to test all infected people and any close contacts they may have exposed the virus. (The simulation estimates testing 10 contacts on average.)

"Testing is outbreak control 101, because what testing lets you do is figure out who's infected and who's not," Jha says. "And that lets you separate out the infected people from the non infected people and bring the disease under control."

This approach is how communities can prevent outbreaks from flaring up. First, test all symptomatic people, then reach out to their close contacts and test them, and finally ask those who are infected or exposed to isolate themselves.

Our chart also shows another testing benchmark for each state: the ratio of tests conducted that come back positive. Communities that see around 10% or fewer positives among their test results are probably testing enough, the World Health Organization advises. If the rate is higher, they're likely missing a lot of active infections.

What is apparent from the data we present below is that many states are far from both the Harvard estimates and the 10% positive benchmark.

Just nine states are near or have exceeded the testing minimums estimated by Harvard; they are mostly larger, less populous states: Alaska, Hawaii, Montana, North Dakota, Oregon, Tennessee, Utah, West Virginia and Wyoming.

Several states with large outbreaks — New York, Massachusetts and Connecticut among others — are very far from the minimum testing target. Some states that are already relaxing their social-distancing restrictions, such as Georgia, Texas and Colorado, are far from the target too.

Jha offers several caveats about his group's estimates.

Estimates are directional not literal

Researchers at the Global Health Initiative at Harvard considered three different models of the U.S. coronavirus outbreak as a starting point for their testing estimates. They found that while there was significant variation in the projections of outbreak sizes, all the models tend to point in the same direction, i.e. if one model showed that a state needed significantly more testing, the others generally did too.

The model they used to create these estimates is the Youyang Gu COVID-19 Forecasts, which they say has tracked closely with what's actually happened on the ground. Still the researchers caution, these numbers are not meant to be taken literally but as a guide.

If social distancing is relaxed, testing needs may grow

The Harvard testing estimates are built on a model that assumes that states continue social distancing through May 15. And about half of states have already started lifting some of those.

Jha says, that without the right measures in place to contain spread, easing up could quickly lead to new cases.

"The moment you relax, the number of cases will start climbing. And therefore, the number of tests you need to keep your society, your state from having large outbreaks will also start climbing," warns Jha.

Testing alone is not enough

A community can't base the decision that it's safe to open up on testing data alone. States should also see a consistent decline in the number of cases, of two weeks at least, according to White House guidance. If their cases are instead increasing, they should assume the number of tests they need will increase too.

And Jha warns, testing is step one, but it won't contain an outbreak by itself. It needs to be part of "a much broader set of strategies and plans the states need to have in place" when they begin to reopen.

In fact, his group's model is built on the assumption that states are doing contact tracing and have plans to support isolation for infected or exposed people.

"I don't want anybody to just look at the number and say, we meet it and we're good to go," he says. "What this really is, is testing capacity in the context of having a really effective workforce of contact tracers."

The targets are floors not goals

States that have reached the estimated target should think of that as a starting point.

"We've always built these as the floor, the bare minimum," Jha says. More testing would be even better, allowing states to more rapidly tamp down case surges.

In fact, other experts have proposed the U.S. do even more testing. Paul Romer, a professor of economics at New York University proposed in a recent white paper that if the U.S. tested every resident, every two weeks, isolating those who test positive, it could stop the pandemic in its tracks.

Jha warns that without sufficient testing, and the infrastructure in place to trace and isolate contacts, there's a real risk that states — even those with few cases now — will see new large outbreaks. "I think what people have to remember is that the virus isn't gone. The disease isn't gone. And it's going to be with us for a while," he says.

Daniel Wood contributed to this report.

This content is from Southern California Public Radio. View the original story at SCPR.org.

The serious inflammatory syndrome sending some children and teens to the hospital remains extremely uncommon, doctors say. But if your child spikes a high, persistent fever, and has severe abdominal pain and vomiting that doesn't make them feel better, call your doctor as a precaution.; Credit: Sally Anscombe/Getty Images

Sixty-four children and teens in New York State are suspected of having a mysterious inflammatory syndrome that is believed to be linked to COVID-19, the New York Department of Health said in an alert issued Wednesday. A growing number of similar cases — including at least one death — have been reported in other parts of the U.S. and Europe, though the phenomenon is still not well-understood.

Pediatricians say parents should not panic; the condition remains extremely rare. But researchers also are taking a close look at this emerging syndrome, and say parents should be on the lookout for symptoms in their kids that might warrant a quick call to the doctor — a persistent high fever over several days and significant abdominal pains with repeated vomiting, after which the child does not feel better.

"If [the child is] looking particularly ill, you should definitely call the doctor," says Dr. Sean O'Leary, a pediatric infectious disease specialist at Children's Hospital Colorado Anschutz Medical Campus and member of the infectious disease committee for the American Academy of Pediatrics.

The new condition associated with COVID-19 is called Pediatric Multi-System Inflammatory Syndrome. Symptoms include persistent fever, extreme inflammation, and evidence of one or more organs that are not functioning properly, says cardiologist Jane Newburger, a professor of pediatrics at Harvard Medical School and director of the Kawasaki Program at Boston Children's Hospital.

"It's still very rare, but there's been a wave of cases. Physicians and scientists are working hard to understanding the mechanisms at play, and why only some children are so severely affected," Newburger says.

Some symptoms can resemble features of Kawasaki Disease Shock Syndrome. Kawasaki Disease is an acute illness in children involving fever, together with symptoms of rash, conjunctivitis, redness in the lips, tongue and mucous membranes of the mouth and throat, swollen hands and/or feet, and sometimes a large group of lymph nodes on one side of the neck, says Newburger. Some children with the condition develop enlargement of the coronary arteries and aneurysms in those blood vessels.

A small percentage of Kawasaki cases go on to develop symptoms of shock – which can include a steep drop in systolic blood pressure and difficulty with sufficient blood supply to the body's organs. Kawasaki disease and KDSS more often affect young children, although they can sometimes affect teens, Newburger says.

Some cases of the new inflammatory syndrome have features that overlap with KD or with KDSS — including rash, conjunctivitis, and swollen hands or feet. The new inflammatory syndrome can affect not only young children but also older children and teens.

But patients with the new syndrome have lab results that look very different, in particular, "cardiac inflammation to a greater degree than we typically see in Kawasaki shock syndrome," which is usually very rare, O'Leary says. In New York City and London, which have seen large numbers of cases of COVID-19 cases, "those types of patients are being seen with greater frequency."

Some patients "come in very, very sick," with low blood pressure and high fever, O'Leary says. Some children have had coronary artery aneurysms, though most have not, he adds.

Other patients exhibit symptoms more similar to toxic shock syndrome, with abdominal pain, vomiting and diarrhea and high levels of inflammation in the body, as well as the heart, O'Leary says. Most cases are treated in the intensive care unit, he says. Treatment includes intravenous immunoglobulin, which can "calm the immune system," says Newburger, as well as steroids and cytokine blockers.

The evidence so far from Europe, where reports of the syndrome first emerged, suggests most children will recover with proper supportive care, says O'Leary, though one adolescent, a 14-year-old boy in London, has died, according to a report published Wednesday in The Lancet.

Most children with the syndrome, O'Leary and Newburger note, have either tested positive for a current infection with the coronavirus, or for antibodies to the virus, which would suggest they were infected earlier and recovered from it.

And, according to case reports, some of the kids with the inflammatory syndrome who tested negative on coronavirus tests had been exposed at some point to someone known to have COVID-19. The inflammatory syndrome can appear days to weeks after COVID-19 illness, doctors say, suggesting the syndrome arises out of the immune system's response to the virus.

"One theory is that as one begins to make antibodies to SARS-COV-2, the antibody itself may be provoking an immune response," says Newburger. "This is only happening in susceptible individuals whose immune systems are built in a particular way. It doesn't happen in everybody. It's still a really uncommon event in children."

In late April, the U.K.'s National Health Service issued an alert to pediatricians about the syndrome. Reports have also surfaced in France, Spain and Italy, and probably number in the dozens globally, Newburger and O'Leary say, though doctors still don't have hard numbers. Newburger says there needs to be a registry where doctors can report cases "so we can begin to generate some statistics."

"Doctors across countries are talking to each other, but we need for there to be some structure and some science so that everybody can interpret," she says.

Earlier this week, the New York City Health Department issued an alert saying 15 children ranging in age from 2 to 15 had been hospitalized with the syndrome. Newburger says that she's been contacted about cases in New Jersey and Philadelphia, as well.

While the syndrome's precise connection to the coronavirus isn't yet clear, O'Leary says the fact that the children in most of these cases are testing positive for exposure to the virus, one way or another, provides one point of evidence. The sheer number of cases — small in absolute terms, but still "much higher than we would expect normally for things like severe Kawasaki or toxic shock syndrome" — provides another, he says.

And then there's the fact that most reports of the syndrome have come out of the U.K. and New York City, places that have been hit with large numbers of COVID-19 cases.

"It's pure speculation at this point," he says, "but the U.K. cluster kind of went up about a month after their COVID-19 infections went up, which would suggest that it is some kind of an immune phenomenon."

This content is from Southern California Public Radio. View the original story at SCPR.org.

President Trump has said he wants to see the country begin to reopen. The pandemic crashed the economy by keeping people at home, leading to millions of job losses.; Credit: Pool/Getty Images

The White House coronavirus task force rejected detailed guidance drafted by the Centers for Disease Control and Prevention on how workplaces ranging from schools to bars to churches should resume operations to prevent the spread of the virus because it was viewed as "overly prescriptive."

President Trump has said he wants to see the country begin to reopen. The pandemic crashed the economy by keeping people at home, leading to millions of job losses. The White House task force issued guidelines on how to gradually and safely reopen but left decisions up to governors based on conditions in their states.

Experts have warned that a rush to reopen could have disastrous implications for containing COVID-19. Many businesses have said they want more details about how to do things safely.

The draft detailed guidance was provided to the task force in late April, a couple of weeks after it released its April 16 guidance to states for reopening.

The task force sought "certain revisions" to the CDC's detailed guidance, two administration officials told NPR. But revised recommendations were never returned to the task force.

The Associated Press first reported on the task force decision to shelve the detailed guidance. Copies obtained and published by the AP, The New York Times and The Washington Post revealed detailed, staged directions for child care centers, schools, camps, restaurants and bars, churches and mass transit providers about how to safely resume operations.

"I think many people would argue that it is not the role of the federal government to tell specific entities — whether they be schools or churches or businesses — how they should go about doing things because the nation is so diverse," one of the administration officials said.

The task force said that some of the points may be helpful, but they needed to "zoom out a little bit and not be so prescriptive," according to the official. The task force said they would welcome a new set of recommendations, but that never happened, the official said.

"Issuing overly specific instructions — that CDC leadership never cleared — for how various types of businesses open up would be overly prescriptive and broad for the various circumstances states are experiencing throughout the country," the second administration official said. "Guidance in rural Tennessee shouldn't be the same guidance for urban New York City."

The United States last month reached 1 million known coronavirus cases, representing one-third of all coronavirus cases worldwide. Nearly 74,000 Americans have been felled by the disease as of Thursday, according to data compiled by the Johns Hopkins Coronavirus Resource Center.

This content is from Southern California Public Radio. View the original story at SCPR.org.

The East Bay Municipal Utility District Wastewater Treatment Plant in Oakland, California. Stanford researchers are testing sewage in hopes of tracking the emergence and spread of COVID-19 outbreaks.; Credit: Justin Sullivan/Getty Images

With coronavirus testing still lagging behind targets, many health officials are searching for other ways to assess the spread of the outbreak. One possibility? Looking at what we flush.

SARS-Cov-2 is often spread through sneezes and coughs, but it also leaves the human body through our waste. Scientists around the world are now testing sewage for the virus, using it as a collective sample to measure infection levels among thousands of people.

While the field of "wastewater epidemiology" existed before the coronavirus pandemic began, it's now rapidly expanding in the hope that it can become a front-line public health tool.

"Normally when I tell people I work with poo, they're not super interested," Stephanie Loeb, a post-doctoral researcher at Stanford University, told NPR in an interview over Skype. But, she says: "There's really a lot of information in our waste."

In the basement of a university building, Loeb pulls samples from freezers filled with vials of raw sewage, collected regularly from 25 wastewater treatment plants around California. Each is a snapshot of that community's health.

"It's this perfect mix, you know," says Krista Wigginton, a professor of environmental engineering at the University of Michigan, also working on the Stanford project. "The entire community is putting samples in at the same time."

She says by the time the virus reaches wastewater treatment plants, it's still possible to read its RNA.

"These are virus particles that are mostly intact, but that are no longer infective," Wigginton says. "That's what it looks like at this point."

The idea is that measuring overall virus levels in sewage over time could indicate whether an outbreak is growing or shrinking, potentially showing that trend earlier than patient testing would.

"That's a real-time measurement of what's happening in the community," says Wigginton. "Whereas some other tools we have, like the number of confirmed cases in clinics, sometimes those are delayed by quite a bit of time because people don't go get checked until maybe their illness has progressed by quite a bit."

The approach is already used for other diseases, such as polio. Health officials are working to eradicate polio around the globe and in Israel, an outbreak was spotted early through the wastewater system.

Stanford University isn't the only group working on coronavirus detection in sewage.

"We have a lot of nicknames," says Newsha Ghaeli, co-founder of the start-up Biobot. "I think some of our customers joke around that we're the 'sewer girls.'"

Biobot is currently testing sewage from about 150 communities across the U.S. Originally, the company was using sewage to monitor the opioid crisis, but quickly started offering coronavirus testing.

"It really caught fire," says Ghaeli. "Within ten days, we hit internal capacity."

Ghaeli says in some cities, they've been able to detect coronavirus in sewage the same week the first cases appeared. Other projects in France and the Netherlands have produced similar results.

In a more challenging scientific feat, the team is also working to estimate the number of individuals who have coronavirus in a community, based on the levels found in sewage.

Calculating that depends on knowing how much virus individuals shed, and some people seem to shed for a longer time than others, complicating the math. Other things could also affect the virus levels, such as how long it takes for the wastewater to reach the treatment plant and rainy weather, which causes runoff to flow in the sewage system in some communities, diluting the samples.

"There's a lot of research that needs to be done before we can say this number in wastewater means this many cases in the community," says Wigginton.

The advantage of testing sewage is that it may capture individuals who are less likely to go to a doctor's offices.

"Every person that is using the toilet has a voice," says Mariana Matus, Biobot's other cofounder. "And they can be taken into account for public health resources and prioritization of resources."

While it's still early in the technology's development, some see it being helpful in detecting new waves of the outbreak.

"I think it is potentially a new role that utilities can play," says Doug Yoder, deputy director of the Miami-Dade Water and Sewer Department in Florida, which serves 2.3 million people. "There has been, at the community level, not a whole lot of data about conditions community-wide."

Miami-Dade County has been sending sewage samples to Biobot for six weeks now, which have shown their virus levels going up and down a bit.

"We've seen in a couple instances the virus counts increase by a factor of six," he says. "And then the week following, it went back down. This data may not yet be ready for primetime in terms of community decision-making, but it has potential and promise for being able to see trends."

Health officials are eager for the information, he says, as one more way to gauge what's really happening with their local outbreak.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Most people infected with the novel coronavirus develop antibodies in response.

But scientists don't know whether people who have been exposed to the coronavirus will be immune for life, as is usually the case for the measles, or if the disease will return again and again, like the common cold.

"This to me is one of the big unanswered questions that we have," says Jeffrey Shaman, a professor of environmental health sciences at Columbia University, "because it really says, 'What is the full exit strategy to this and how long are we going to be contending with it?' "

He's one of many scientists on a quest for answers. And the pieces are starting to fall into place.

Antibodies, which are proteins found in the blood as part of the body's immune response to infection, are a sign that people could be developing immunity. But they are by no means a guarantee they will be protected for life – or even for a year.

Shaman has been studying four other coronaviruses that cause the common cold. "They're very common and so people seem to get them quite often," Shaman says. Ninety percent of people develop antibodies to those viruses, at least in passing, but "our evidence is those antibodies are not conferring protection."

That may simply because colds are relatively mild, so the immune system doesn't mount a full-blown response, suggests Dr. Stanley Perlman, a pediatrician who studies immunology and microbiology at the University of Iowa. "That's why people get colds over and over again," he says. "It doesn't really tickle the immune response that much."

He's studied one of the most severe coronaviruses, the one that causes SARS, and he's found that the degree of immunity depended on the severity of the disease. Sicker people remained immune for much longer, in some cases many years.

For most people exposed to the novel coronavirus, "I think in the short term you're going to get some protection," Perlman says. "It's really the time of the protection that matters."

Perlman notes that for some people the symptoms of COVID-19 are no worse than a cold, while for others they are severe. "That's why it's tricky," he says, to predict the breadth of an immune response.

And it's risky to assume that experiences with other coronaviruses are directly applicable to the new one.

"Unforutunately, we cannot really generalize what kind of immunity is needed to get protection against a virus unless we really learn more about the virus," says Akiko Iwasaki, a Howard Hughes Medical Institute investigator at the Yale University School of Medicine.

An immunobiologist, she is part of a rapidly expanding effort to figure this out. She and her colleagues are already studying the immune response in more than 100 patients in the medical school hospital. She's encouraged that most people who recover from the coronavirus have developed antibodies that neutralize the coronavirus in a petri dish.

"Whether that's happening inside the body we don't really know," she cautions.

Research like hers will answer that question, eventually.

But not all antibodies are protective. Iwasaki says some can actually contribute to the disease process and make the illness worse. These antibodies can contribute to inflammation and lead the body to overreact. That overreaction can even be deadly.

"Which types of antibodies protect the host versus those that enhance the disease? We really need to figure that out," she says.

The studies at Yale will follow patients for at least a year, to find out how slowly or quickly immunity might fade. "I wish there was a shortcut," Iwasaki says, "but we may not need to wait a year to understand what type of antibodies are protective."

That's because she and other immunologists are looking for patterns in the immune response that will identify people who have long-term immunity.

Researchers long ago figured out what biological features in the blood (called biomarkers) correlate with immunity to other diseases, says Dr. Kari Nadeau, a pediatrician and immunologist at the Stanford University School of Medicine. She expects researchers will be able to do the same for the new coronavirus.

Nadeau is working on several studies, including one that seeks to recruit 1,000 people who were previously exposed to the coronavirus. One goal is to identify people who produce especially strong, protective antibody responses. She says the antibody-producing cells from those people can potentially be turned into vaccines.

Another critical question she's zeroing in on is whether people who become immune are still capable of spreading the virus.

"Because you might be immune, you might have protected yourself against the virus," she says, "but it still might be in your body and you're giving it to others."

That would have huge public health implications if it turns out people can still spread the disease after they've recovered. Studies from China and South Korea seemed to suggest this was possible, though further studies have cast doubt on that as a significant feature of the disease.

Nadeau is also trying to figure out what can be said about the antibody blood-tests that are now starting to flood the market. There are two issues with these tests. First, a positive test may be a false-positive result, so it may be necessary to run a confirmatory test to get a credible answer. Second, it's not clear that a true positive test result really indicates a person is immune, and if so for how long.

Companies would like to be able to use these tests to identify people who can return to work without fear of spreading the coronavirus.

"I see a lot of business people wanting to do the best for their employees, and for good reason," Nadeau says. "And we can never say you're fully protected until we get enough [information]. But right now we're working hard to get the numbers we need to be able to see what constitutes protection and what does not."

It could be a matter of life or death to get this right. Answers to these questions are likely to come with the accumulation of information from many different labs. Fortunately, scientists around the world are working simultaneously to find answers.

You can contact NPR Science Correspondent Richard Harris at rharris@npr.org.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Remdesivir, an experimental antiviral drug made by Gilead Sciences, has been authorized by the Food and Drug Administration for emergency use in treating severely ill COVID-19 patients.; Credit: Ulrich Perry/POOL/AFP via Getty Images

Now that the Food and Drug Administration has authorized remdesivir for emergency use in seriously ill COVID-19 patients, the experimental drug is another step closer to full approval. That's when most drugs get price tags.

Gilead Sciences, which makes remdesivir, is donating its initial supply of 1.5 million doses, but the company has signaled it will need to start charging for the drug to make production sustainable. It's unclear when that decision might be made.

"Going forward, we will develop an approach that is guided by the principles of affordability and access," Gilead CEO Daniel O'Day told shareholders during the company's annual meeting Wednesday.

In a quarterly financial filing made the same day, Gilead said its investment in remdesivir this year "could be up to $1 billion or more," much of it for scaling up manufacturing capacity.

The company also acknowledged that it's in the spotlight. "[G]iven that COVID-19 has been designated as a pandemic and represents an urgent public health crisis, we are likely to face significant public attention and scrutiny about any future business models and pricing decisions with respect to remdesivir," Gilead said in the quarterly filing.

How will the company balance its business calculations with the drug's potential value to society?

"Gilead has not yet set a price for remdesivir," company spokeswoman Sonia Choi wrote in an email to NPR. "At this time, we are focused on ensuring access to remdesivir through our donation. Post-donation, we are committed to making remdesivir both accessible and affordable to governments and patients around the world."

Among potential treatments for COVID-19, remdesivir, an intravenous drug that was once studied for Ebola, is one of the furthest along.

"It's hard to imagine a situation in which there will be more public scrutiny," said Michael Carrier, a professor at Rutgers School of Law who specializes in antitrust and pharmaceuticals. "On the one hand, Gilead will try to recover its R&D in an atmosphere in which it is able to potentially make a lot of money. On the other hand, the pressure will be intense not to charge what's viewed as too high a price."

Breaking with its usual practices, the Institute for Clinical and Economic Review, or ICER, an influential nonprofit that analyzes drug pricing, issued an expedited report on remdesivir.

"Under normal circumstances, we would be unlikely to do a report when the evidence is this raw and immature," ICER President Steven Pearson said in an interview with NPR. "But it was quite clear that the world is moving at a much quicker pace."

If the price is based just on the cost of making the drug, then a 10-day course of remdesivir should cost about $10, according to the ICER report. (Gilead said results of a recently completed study suggest a five-day course of treatment may be just as effective.)

But if the drug is priced based on the drug's effectiveness, ICER estimates it should cost around $4,500 — assuming the drug is proven to have some benefit on mortality. If it doesn't and the drug only shortens hospital stays, that value-based price goes down to $390.

Results from a federally funded study described by Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, suggested that remdesvir could reduce recovery time by a median of four days — 11 days to recovery for patients treated with remdesivir compared with 15 days for those who got a placebo. A potential survival benefit is less clear.

Rutgers's Carrier said he expects Gilead to set the remdesivir price somewhere between the $10 and $4,500 that ICER estimated. The company has already shown that it can respond to public pressure when it asked the FDA to rescind the orphan drug status it won for remdesivir, he pointed out.

"When you see that $10 figure, that sets a benchmark for a figure that is eminently affordable," Carrier said. Ultimately, he said a price more than $1,000 per treatment course would be unpopular.

Gilead "will be watched very carefully," he said, because of its prior history of pricing. He referred to two other Gilead drugs that drew scrutiny over high price tags. The company charged $1,000 per pill for Sovaldi, a cure for hepatitis C. And its HIV drug Truvada can cost $22,000 per year.

But there is such a thing as pricing remdesivir too low, said Craig Garthwaite, who directs the health care program at Northwestern University's Kellogg School of Management.

"We don't think this is the only drug we need," he said, adding that remdesivir doesn't appear to be a "home run" against the coronavirus, based on existing data. "The thing that would worry me the most is that we're somehow telling people that if you take the risky bet to try, and you'll go after a coronavirus cure and you do it, you're not going to get paid."

Instead, he said he would like to see acceptance of a generous price for remdesivir to send the message to drug companies that the best thing they can do is "dedicate every waking moment to trying to develop that cure, and that if they do that, we will pay them the value they create," he said.

During a Gilead earnings call on April 30, analysts asked executives whether they could expect similar financial returns on remdesivir as they've seen with Gilead's other drugs.

"There is no rulebook out there, other than that we need to be very thoughtful about how we can make sure we provide access of our medicines to patients around the globe," Gilead CEO O'Day said. "And do that in a sustainable way for the company, for ... shareholders, and we acknowledge that."

On May 1, the FDA authorized remdesivir for emergency use, meaning it will be easier to administer to hospitalized patients with severe disease during the pandemic, but the drug is not yet officially approved. The federal government is coordinating distribution of the treatment.

Day acknowledged on the recent earnings call that the company "could" charge for remdesivir under an emergency use authorization, but he stressed that Gilead is donating its current supply, which should last through "early summer."

To date, the National Institutes of Health said it has obligated $23 million toward its COVID-19 remdesivir trial. And the U.S. Army Medical Research Institute of Infectious Diseases did some of the early in vitro and animal studies with the medicine prior to the pandemic.

"Taxpayers are often the angel investors in pharmaceutical research and development, yet this is not reflected in the prices they pay," Reps. Lloyd Doggett, D-Texas, and Rosa DeLauro, D-Conn., wrote in a April 30 letter to Health and Human Services Secretary Alex Azar.

Concerned about remdesivir's price, they asked for a full breakdown of taxpayer funds that have gone toward the development of the medicine. "An unaffordable drug is completely ineffective," they wrote in the letter. "The substantial taxpayer investments in COVID-19 pharmaceutical research must be recognized."

This content is from Southern California Public Radio. View the original story at SCPR.org.

Emily Quinn speaks from the TED stage at TEDWomen 2018; Credit: /TED

Part 1 of the TED Radio Hour episode The Biology Of Sex

Artist Emily Quinn is intersex. She's one of over 150 million people in the world who don't fit neatly into the categories of male or female. She explains how biological sex exists on a spectrum.

About Emily Quinn

Emily Quinn is an artist and activist. She worked at Cartoon Network on the Emmy Award winning show, Adventure Time. While there she partnered with interACT and MTV to develop the first intersex main character in television history. She came out publicly as intersex in a PSA alongside the character's debut. She later worked as the Youth Coordinator for interACT: Advocates for Intersex Youth.

As an activist, she speaks about intersex issues before audiences and through her YouTube channel: intersexperiences. As an artist, her most recent projects include a genderless puberty guidebook and a portrait series of intersex people that will be exhibited at medical schools across the U.S. in 2020.

This content is from Southern California Public Radio. View the original story at SCPR.org.

Among those protesting stay-at-home orders this week at the California Capitol in Sacramento were activists who oppose governments requiring vaccinations for school children.; Credit: Katie Orr/KQED

Protests over stay-at-home orders because of COVID-19 have become more common around the country. In California, a surprising group is behind some of them: those who oppose mandatory vaccinations.

On Thursday, a mash-up of people mingled on the sidewalk in front of California's state Capitol in Sacramento. There were Trump supporters wearing MAGA hats and waving American flags. There were Christians, singing along to religious rock songs and raising their hands in prayer. The event's MC. urged Gov. Gavin Newsom to tune into their event.

"Everybody up at the Capitol, tell Gavin Newsom [to tune in to] 107.9 FM, if he wants to hear what we have to say," the MC told the crowd over loudspeakers. "It could be kind of good for him!"

There were also mothers with their children at the rally. Many people were not wearing face masks or observing social distancing protocols.

They'd all come out to protest California's stay-at-home order, put in place to slow the spread of COVID-19. This week's event was built around the National Day of Prayer, and featured pastors and sermons. But it was organized by a group called Freedom Angels, which was originally formed to fight mandatory vaccine laws in the state.

At the beginning of the rally, the group's founders took the stage, including Denise Aguilar.

"Hello everybody, my name is Denise, I'm one of the founders of Freedom Angels," Aguilar said to a cheering crowd. "Thank you guys for being out here to let Gov. Newsom know we're not going away! We've said this for years!"

The group has become a fixture at the Capitol ever since California passed a law requiring school students to be vaccinated and a second law tightening restrictions on medical exemptions for those vaccines. But another Freedom Angels founder, Stefanie Fetzer, said they're not a single-issue group. She said these events are about promoting personal freedom.

"I think what we're seeing now is the predictive modeling that they came out with in the beginning didn't hold true. We aren't seeing the numbers that they predicted," Fetzer said. "And instead of backing off of the shutdown and the restrictive measures that Gov. Newsom implemented, he seems to be doubling down."

Attention-seeking strategy

Public health advocates point out that the reason those early predictions didn't come true is that aggressive social distancing measures — including stay-at-home orders — worked. Democratic state Senator Richard Pan, who authored California's vaccine laws, believes this anti-vaccine group is aligning with others protesting the stay-at-home order as a way to promote their cause. After all, Pan said, a vaccine would eventually allow the economy to reopen.

"They have staged these protests to basically find a way to get media attention for themselves. They fund raise off of their activities as well," Pan said. "So, frankly, many of the anti-vaxxers who are involved in this are really there for their own interests."

It's common for anti-vaccine groups to latch onto other controversial issues, according to epidemiologist and vaccine educator René Najera. For instance, he points to abortion.

"They try to say that there are aborted fetal cells in vaccines — which there are not — to try to get the anti-abortion people on their side," he said. "And then they flip it around and say, also, 'My body, my choice.'"

Najera said those tactics can have dangerous outcomes, including making people think twice about getting vaccines. In fact, he said, in 2019 the World Health Organization named vaccine hesitancy, or people's reluctance to consider vaccination, as one of the world's top 10 public health challenges.

"And we saw the effects of that," Najera said. "We saw a rise of measles in the United States to the point where the elimination status of the United States for measles was in jeopardy."

Najera is confident vaccine opponents aren't going away. He says, if anything, the rise of social media has made it easier for them to spread their message. What he finds most frustrating is that these anti-vaccines protesters aren't just making choices that affect their own families. Najera says choosing not to vaccinate their children and joining other large protests to spread their message puts the health of everyone at risk.

This content is from Southern California Public Radio. View the original story at SCPR.org.

A woman wearing a mask walks past closed store fronts in the Astoria neighborhood of Queens on April 15 in New York City. States are beginning to implement phased reopening plans, in part to help businesses hit hard by the coronavirus.; Credit: Johannes Eisele/AFP via Getty Images

President Trump wants states to begin relaxing stay-at-home orders and reopen businesses after the spread of the coronavirus pummeled the global economy and killed millions of jobs.

The White House coronavirus task force released guidelines on April 16 to encourage state governors to adopt a phased approach to lifting restrictions across the country. Some states have moved ahead without meeting the criteria.

The task force rejected a set of additional detailed draft recommendations for schools, restaurants, churches and mass transit systems from the Centers for Disease Control and Prevention that it considered "overly prescriptive."

A number of states have already begun to lift restrictions, allowing for businesses including hair salons, diners and tattoo parlors to once again begin accepting customers. Health experts have warned that reopening too quickly could result in a potential rebound in cases.

States are supposed to wait to begin lifting any restrictions until they have a 14-day "downward trajectory" of influenza-like illnesses and confirmed virus cases, as well as sufficient hospital capacity and testing for health care workers.

Below is a summary of the three phases as outlined by the task force (read the full guidance here):

Don't see the graphic above? Click here.

This content is from Southern California Public Radio. View the original story at SCPR.org.

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A new class of drugs called HIF-2 inhibitors is more effective and better tolerated than the standard of care drug sunitinib in treating kidney cancer, researchers with the Kidney Cancer Program at Harold C. Simmons Comprehensive Cancer Center have found.

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A new Cochrane Review, published in the Cochrane Library today and presented at the ERS International Congress, has found evidence from randomised trials, that taking an oral vitamin D supplement in addition to standard asthma medication is likely to reduce severe asthma attacks.

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More people are eating gluten-free, although the prevalence of celiac disease appears to have remained stable in recent years, according to an article published online by JAMA Internal Medicine.

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Using electric fans to relieve high levels of heat and humidity may, surprisingly, have the opposite effect for seniors, a study by UT Southwestern Medical Center heart specialists suggests.

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Acute exacerbations of chronic obstructive pulmonary disease, or COPD, are associated with significant long-term lung function loss, according to research published online, ahead of print in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

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University of Oregon researchers have found links between the levels of antimicrobial chemicals and antibiotic-resistance genes in the dust of an aging building used for athletics and academics.

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This year, the U.S. reported for the first time that a patient had been infected by bacteria resistant to colistin, an antibiotic of last resort. The announcement followed several years of warnings that current antibiotics aren't diverse enough to fight pathogens as drug resistance spreads. The cover story of Chemical & Engineering News (C&EN), the weekly newsmagazine of the American Chemical Society, sums up how researchers are trying to stay ahead of the bugs.

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Farber Cancer Institute investigators report they have discovered a type of immune antibody that can rapidly evolve to neutralize a wide array of influenza virus strains - including those the body hasn't yet encountered.

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For the first time, abnormal brain development following a Zika infection during pregnancy has been documented experimentally in the offspring of a non-human primate.

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Soccer is an increasingly popular sport in the United States, both professionally and recreationally, with over 3 million registered soccer players under 19 years of age playing in leagues every year. A new study conducted by the Center for Injury Research and Policy of the Research Institute at Nationwide Children's Hospital found that with the increase in the number of players there has been a rise in the number and rate of injuries.

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Using archival documents, a new report published online by JAMA Internal Medicine examines the sugar industry's role in coronary heart disease research and suggests the industry sponsored research to influence the scientific debate to cast doubt on the hazards of sugar and to promote dietary fat as the culprit in heart disease.

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A research team from the University of Bonn has succeeded for the first time in using light stimuli to stop life-threatening cardiac arrhythmia in mouse hearts. Furthermore, as shown in computer simulations at Johns Hopkins University, this technique could also be used successfully for human hearts. The study opens up a whole new approach to the development of implantable optical defibrillators, in which the strong electrical impulses of conventional defibrillators are replaced by gentler, pain-free light impulses. The Journal of Clinical Investigation has now published the results.

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The study, published today in Nature Microbiology, holds promise for a new treatment method against antibiotic-resistant bacteria (commonly known as superbugs).

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Driving up the long curved path up to The Grove always feels like a treat, and none more so than on last Friday evening when I was invited to try the hotel’s newly refurbished restaurant.