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May 29, 2023

2001 Anthrax Attacks Fast Facts | CNN

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CNN
—

Here’s a look at the 2001 anthrax attacks, also referred to as Amerithrax.

There are four types of anthrax infection: cutaneous (through the skin), inhalation (through the lungs; the most deadly), gastrointestinal (through digestion) and injection anthrax. Injection anthrax is common in heroin-injecting users in northern Europe. This has never been reported in the United States.

Anthrax can be contracted by handling products from infected animals or by breathing in anthrax spores and by eating undercooked meat from infected animals.

It has been blamed for several plagues over the ages that killed both humans and livestock. It emerged in World War I as a biological weapon.

The Centers for Disease Control and Prevention categorizes anthrax as a Category A agent: one that poses the greatest possible threat for a negative impact on public health; one that may spread across a large area or need public awareness and requires planning to protect the public’s health.

Five people died and 17 people were sickened during anthrax attacks in the fall of 2001; outbreak is often referred to as Amerithrax.

Anthrax was sent via anonymous letters to news agencies in Florida and New York and a congressional office building in Washington, DC.

Of the five victims who died of inhalation anthrax, two were postal workers. The other three victims were an elderly woman from rural Connecticut, a Manhattan hospital worker from the Bronx and an employee at a Florida tabloid magazine who may have contracted anthrax through cross-contamination.

The letters were sent to NBC anchor Tom Brokaw, Sen. Majority Leader Tom Daschle, Sen. Patrick Leahy, and the New York Post offices. The letters were postmarked Trenton, New Jersey.

No arrests were made in the attacks.

The FBI has interviewed more than 10,000 people and issued more than 6,000 subpoenas in the case.

4.8 million masks and 88 million gloves were purchased by the Postal Service for its employees, and 300 postal facilities were tested for anthrax.

Over 32,000 people took antibiotics after possible exposure to anthrax.

Stevens, Bob – photo editor at American Media Inc, died of inhalation anthrax, October 5, 2001

Morris, Thomas Jr. – DC postal worker, died of inhalation anthrax, October 21, 2001

Curseen, Joseph Jr. – DC area postal worker, died of inhalation anthrax, October 22, 2001

Nguyen, Kathy – employee at Manhattan hospital, died of inhalation anthrax, October 31, 2001

Lundgren, Ottilie – Connecticut woman, died of inhalation anthrax, November 22, 2001

October 5, 2001 – Sun photo editor Stevens dies of inhalation anthrax.

October 12, 2001 – NBC News announces that an employee has contracted anthrax.

October 15, 2001 – A letter postmarked Trenton, New Jersey, opened by an employee of Senate Majority Leader Daschle contains white powdery substance later found to be “weapons grade” strain of anthrax spores. More than two dozen people in Daschle’s office test positive for anthrax after the envelope is discovered.

October 19, 2001 – An unopened letter tainted with anthrax is found in the offices of the New York Post. One Post employee is confirmed to have a cutaneous infection and a second shows symptoms of the same infection.

October 21, 2001 – DC postal worker Morris Jr. dies of inhalation anthrax.

October 22, 2001 – DC postal worker Curseen dies of inhalation anthrax.

October 31, 2001 – Nguyen, a stockroom worker for the Manhattan Eye, Ear and Throat Hospital, dies of inhalation anthrax.

November 9, 2001 – The FBI releases a behavioral profile of the suspect, who is probably a male loner and might work in a laboratory.

November 16, 2001 – A letter sent to Senator Leahy is found to contain anthrax. The letter is among those at the Capitol that has been quarantined. The letter contains at least 23,000 anthrax spores and is postmarked October 9, in Trenton, New Jersey.

November 22, 2001 – Lundgren, a 94-year-old Connecticut woman, dies of inhalation anthrax.

January 2002 – FBI agents interview former US Army bioweapons scientist Steven Hatfill as part of the anthrax investigation.

June 2002 – Bioweapons researcher Hatfill is named a “person of interest” by the FBI.

June 25, 2002 – The FBI searches Hatfill’s Maryland apartment and Florida storage locker with his consent.

June 27, 2002 – The FBI says it is focusing on 30 biological weapons experts in its probe.

August 1, 2002 – The FBI uses a criminal search warrant to search Hatfill’s Maryland apartment and Florida storage locker a second time; anthrax swab tests come back negative.

August 6, 2002 – Attorney General John Ashcroft refers to Hatfill as a “person of interest.”

August 11, 2002 – Hatfill holds a press conference declaring his innocence. He holds a second one on August 25, 2002.

September 11, 2002 – The FBI searches Hatfill’s former apartment in Maryland for the third time.

August 26, 2003 – Hatfill files a civil lawsuit against Attorney General John Ashcroft, the Justice Department and the FBI claiming his constitutional rights have been violated. The suit alleges violations of Hatfill’s Fifth Amendment rights by preventing him from earning a living, violations of his Fifth Amendment rights by retaliating against him after he sought to have his name cleared in the anthrax probe and the disclosure of information from his FBI file. The suit also seeks an undetermined amount of monetary damages.

July 11, 2004 – The former headquarters of American Media, Inc. in Boca Raton, Florida, where Stevens contracted the anthrax is pumped full of chlorine dioxide gas for decontamination. This was the last building exposed to anthrax in the fall of 2001.

June 27, 2008 – The Justice Department reaches a settlement with Hatfill. The settlement requires the Justice Department to pay Hatfill a one-time payment of $2.825 million and to buy a $3 million annuity that will pay Hatfill $150,000 a year for 20 years. In return, Hatfill drops his lawsuit, and the government admits no wrongdoing.

July 29, 2008 – Bruce Ivins, a former researcher at the Army’s bioweapons laboratory at Fort Detrick, Maryland, dies after overdosing during a suicide attempt on July 27.

August 6, 2008 – Judge unseals and releases hundreds of documents in the 2001 FBI Anthrax investigation that detail Ivins’ role in the attacks.

August 8, 2008 – The Justice Department formally exonerates Hatfill.

September 25, 2008 – The court releases more documents including emails that Ivins sent to himself.

February 19, 2010 – The Justice Department, FBI and US Postal Inspection Service announce its investigation into the 2001 anthrax mailings is at an end.

March 23, 2011 – A report, entitled The Amerithrax Case, is released through the Research Strategies Network, a non-profit think tank based in Virginia. According to the report, old mental health records suggest Ivins should have been prevented from holding a job at a US Army research facility in Maryland. The report was requested by the US Department of Justice.

October 9, 2011 – The New York Times reports indicate there are scientists questioning the FBI assertions regarding Ivins. Possibly Ivins, if he was involved, worked with a partner. Also, the scientists say the presence of tin in the dried anthrax warrants that the investigation be reopened.

November 23, 2011 – The Justice Department settles for $2.5 million with Stevens’ family. The family originally sued for $50 million in 2003, arguing that the military laboratory should have had tighter security.

December 19, 2014 – The Government Accountability Office releases a 77-page report reviewing the genetic testing used by the FBI during the investigation into the anthrax attacks.

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May 27, 2023

Zika Virus Infection Fast Facts | CNN

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CNN
—

Here’s a look at Zika virus, an illness spread through mosquito bites that can cause birth defects and other neurological defects.

Sources: Centers for Disease Control and Prevention (CDC), World Health Organization (WHO) and CNN

Zika virus is a flavivirus, part of the same family as yellow fever, West Nile, chikungunya and dengue fever.

Zika is primarily transmitted through the bite of an infected female Aedes aegypti mosquito. It becomes infected from biting an infected human and then transmits the virus to another person. The Aedes aegypti mosquito is an aggressive species, active day and night and usually bites when it is light out. The virus can be transmitted from a pregnant woman to her fetus, through sexual contact, blood transfusion or by needle.

The FDA approved the first human trial of a Zika vaccine in June 2016. As of May 2022, there is still no available vaccine or medication.

Cases including confirmed, probable or suspected cases of Zika in US states and territories updated by the CDC.

Most people infected with Zika virus won’t have symptoms. If there are symptoms, they will last for a few days to a week.

Fever, rash, joint pain and conjunctivitis (red eyes) are the most common symptoms. Some patients may also experience muscle pain or headaches.

Zika virus infection during pregnancy can cause microcephaly, a neurological disorder that results in babies being born with abnormally small heads. Microcephaly can cause severe developmental issues and sometimes death. A Zika infection may cause other birth defects, including eye problems, hearing loss and impaired growth. Miscarriage can also occur.

An August 2018 report published by the CDC estimates that nearly one in seven babies born to women infected with the Zika virus while pregnant had one or more health problems possibly caused by the virus, including microcephaly.

According to the CDC, there is no evidence that previous infection will affect future pregnancies.

(Sources: WHO, CDC and CNN)

1947 – The Zika virus is first discovered in a monkey by scientists studying yellow fever in Uganda’s Zika forest.

1948 – The virus is isolated from Aedes africanus mosquito samples in the Zika forest.

1964 – First active case of Zika virus found in humans. While researchers had found antibodies in the blood of people in both Uganda and in Tanzania as far back as 1952, this is the first known case of the active virus in humans. The infected man developed a pinkish rash over most of his body but reported the illness as “mild,” with none of the pain associated with dengue and chikungunya.

1960s-1980s – A small number of countries in West Africa and Asia find Zika in mosquitoes, and isolated, rare cases are reported in humans.

April-July 2007 – The first major outbreak in humans occurs on Yap Island, Federated States of Micronesia. Of the suspected 185 cases reported, 49 are confirmed, and 59 are considered probable. There are an additional 77 suspected cases. No deaths are reported.

2008 – Two American researchers studying in Senegal become ill with the Zika virus after returning to the United States. Subsequently, one of the researchers transmits the virus to his wife.

2013-2014 – A large outbreak of Zika occurs in French Polynesia, with about 32,000 suspected cases. There are also outbreaks in the Pacific Islands during this time. An uptick in cases of Guillain-Barré Syndrome during the same period suggests a possible link between the Zika virus and the rare neurological syndrome. However, it was not proven because the islands were also experiencing an outbreak of dengue fever at the time.

March 2015 – Brazil alerts the WHO to an illness with skin rash that is present in the northeastern region of the country. From February 2015 to April 29, 2015, nearly 7,000 cases of illness with a skin rash are reported. Later in the month, Brazil provides additional information to WHO on the illnesses.

April 29, 2015 – A state laboratory in Brazil informs the WHO that preliminary samples have tested positive for the Zika virus.

May 7, 2015 – The outbreak of the Zika virus in Brazil prompts the WHO and the Pan American Health Organization (PAHO) to issue an epidemiological alert.

October 30, 2015 – Brazil reports an increase in the cases of microcephaly, babies born with abnormally small heads: 54 cases between August and October 30.

November 11, 2015 – Brazil declares a national public health emergency as the number of newborns with microcephaly continues to rise.

November 27, 2015 – Brazil reports it is examining 739 cases of microcephaly.

November 28, 2015 – Brazil reports three deaths from Zika infection: two adults and one newborn.

January 15 and 22, 2016 – The CDC advises all pregnant women or those trying to become pregnant to postpone travel or consult their physicians prior to traveling to any of the countries where Zika is active.

February 2016 – The CDC reports Zika virus in brain tissue samples from two Brazilian babies who died within a day of birth, as well as in fetal tissue from two miscarriages providing the first proof of a potential connection between Zika and the rising number of birth defects, stillbirths and miscarriages in mothers infected with the virus.

February 1, 2016 – The WHO declares Zika a Public Health Emergency of International Concern due to the increase of neurological disorders, such as microcephaly, in areas of French Polynesia and Brazil.

February 8, 2016 – The CDC elevates its Emergency Operations Center for Zika to Level 1, the highest level of response at the CDC.

February 26, 2016 – Amid indications that the mosquito-borne Zika virus is causing microcephaly in newborns, the CDC advises pregnant women to “consider not going” to the Olympics in Rio de Janeiro. The CDC later strengthens the advisory, telling pregnant women, “Do not go to the Olympics.”

March 4, 2016 – The US Olympic Committee announces the formation of an infectious disease advisory group to help the USOC establish “best practices regarding the mitigation, assessment and management of infectious disease, paying particular attention to how issues may affect athletes and staff participating in the upcoming Olympic and Paralympic Games.”

April 13, 2016 – During a press briefing, CDC Director Thomas Frieden said, “It is now clear the CDC has concluded that Zika does cause microcephaly. This confirmation is based on a thorough review of the best scientific evidence conducted by CDC and other experts in maternal and fetal health and mosquito-borne diseases.”

May 27, 2016 – More than 100 prominent doctors and scientists sign an open letter to WHO Director General Margaret Chan, calling for the summer Olympic Games in Rio de Janeiro to be postponed or moved “in the name of public health” due to the widening Zika outbreak in Brazil.

July 8, 2016 – Health officials in Utah report the first Zika-related death in the continental United States.

August 1, 2016 – Pregnant women and their partners are advised by the CDC not to visit the Miami neighborhood of Wynwood as four cases of the disease have been reported in the small community and local mosquitoes are believed to be spreading the infection.

September 19, 2016 – The CDC announces that it has successfully reduced the population of Zika-carrying mosquitoes in Wynwood and lifts its advisory against travel to the community.

November 18, 2016 – The WHO declares that the Zika virus outbreak is no longer a public health emergency, shifting the focus to long-term plans to research the disease and birth defects linked to the virus.

November 28, 2016 – Health officials announce Texas has become the second state in the continental United States to confirm a locally transmitted case of Zika virus.

September 29, 2017 – The CDC deactivates its emergency response for Zika virus, which was activated in January 2016.

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May 26, 2023

Avian Flu Fast Facts | CNN

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CNN
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Here’s a look at avian flu.

Avian influenza, also called avian flu or bird flu, is an illness that usually affects only birds.

There are many different strains of avian flu: 16 H subtypes and 9 N subtypes. Only those labeled H5, H7 and H10 have caused deaths in humans.

The most commonly seen and most deadly form of the virus is called “Influenza A (H5N1),” or the “H5N1 virus.”

Most cases of human bird flu infections are due to contact with infected poultry or surfaces that are contaminated with infected bird excretions: saliva, nasal secretions or feces.

Symptoms of avian flu include fever, cough, sore throat and sometimes severe respiratory diseases and pneumonia.

The CDC recommends oral oseltamivir (brand name: Tamiflu), inhaled zanamivir (brand name: Relenza) and intravenous permavir (brand name: Rapivab) for the treatment of human illness associated with avian flu.

The mortality rate is close to 60% for infected humans.

Early 1900s –The avian flu is first identified in Italy.

1961 – The H5N1 strain is isolated in birds in South Africa.

December 1983 – Chickens in Pennsylvania and Virginia are exposed to the avian flu and more than five million birds are killed to stop the disease from spreading.

1997 – Eighteen people are infected by the H5N1 strain in Hong Kong, six die. These are the first documented cases of human infection. Hong Kong destroys its entire poultry population, 1.5 million birds.

1999 – Two children in Hong Kong are infected by the H9N2 strain.

February 2003 – Eighty-four people in the Netherlands are affected by the H7N7 strain of the virus, one dies.

February 7, 2004 – Twelve thousand chickens are killed in Kent County, Delaware, after they are found to be infected with the H7 virus.

October 7, 2005 – The avian flu reaches Europe. Romanian officials quarantine a village of about 30 people after three dead ducks there test positive for bird flu.

November 12, 2005 – A one-year-old boy in Thailand tests positive for the H5N1 strain of avian influenza.

November 16, 2005 – The World Health Organization confirms two human cases of bird flu in China, including a female poultry worker who died from the H5N1 strain.

November 17, 2005 – Two deaths are confirmed in Indonesia from the H5N1 strain of avian influenza.

January 1, 2006 – A Turkish teenager dies of the H5N1 strain of avian influenza in Istanbul, and later that week, two of his sisters die.

January 17, 2006 – A 15-year-old girl from northern Iraq dies after contracting bird flu.

February 20, 2006 – Vietnam becomes the first country to successfully contain the disease. A country is considered disease-free when no new cases are reported in 21 days.

March 12, 2006 – Officials in Cameroon confirm cases of the H5N1 strain. The avian flu has now reached four African countries.

March 13, 2006 – The avian flu is confirmed by officials in Myanmar.

May 11, 2006 – Djibouti announces its first cases of H5N1 – several birds and one human.

December 20, 2011 – The US Department of Health and Human Services releases a statement saying that the government is urging scientific journals to omit details from research they intend to publish on the transfer of H5N1 among mammals. There is concern that the information could be misused by terrorists.

July 31, 2012 – Scientists announce that H3N8, a new strain of avian flu, caused the death of more than 160 baby seals in New England in 2011.

March 31, 2013 – Chinese authorities report the first human cases of infection of avian flu H7N9 to the World Health Organization. H7N9 has not previously been detected in humans.

December 6, 2013 – A 73-year-old woman infected with H10N8 dies in China, the first human fatality from this strain.

January 8, 2014 – Canadian health officials confirm that a resident from Alberta has died from H5N1 avian flu, the first case of the virus in North America. It is also the first case of H5N1 infection ever imported by a traveler into a country where the virus is not present in poultry.

April 20, 2015 – Officials say more than five million hens will be euthanized after bird flu was detected at a commercial laying facility in northwest Iowa. According to the US Department of Agriculture, close to eight million cases of bird flu have been detected in 13 states since December. Health officials say there is little to no risk for transmission to humans with respect to H5N2. No human infections with the virus have ever been detected.

January 15, 2016 – The US Department of Agriculture confirms that a commercial turkey farm in Dubois County, Indiana, has tested positive for the H7N8 strain of avian influenza.

January 24, 2017 – Britain’s Department for Environment, Food & Rural Affairs releases a statement confirming that a case of H5N8 avian flu has been detected in a flock of farmed breeding pheasants in Preston, UK. The flock is estimated to contain around 10,000 birds. The statement adds that a number of those birds have died, and the remaining live birds at the premises are being “humanely” killed because of the disease.

February 12, 2017 – A number of provinces in China have shut down their live poultry markets to prevent the spread of avian flu after a surge in the number of infections from the H7N9 strain. At least six provinces have reported human cases of H7N9 influenza this year, according to Chinese state media, Xinhua.

March 5-7, 2017 – The USDA confirms that a commercial chicken farm in Tennessee has tested positive for the H7N9 strain of avian flu, but says it is genetically different from the H7N9 lineage out of China. The 73,500-bird flock in Lincoln County will be euthanized, according to Tyson Foods.

February 14, 2018 – Hong Kong’s Centre for Health Protection announces that a 68-year-old woman has been treated for the H7N4 strain. This is the first case of this strain in a human.

June 5, 2019 – Since 2013 there have been 1,568 confirmed human cases and 616 deaths worldwide from the H7N9 strain of avian flu, according to the Food and Agriculture Organization of the United Nations.

December 2019 – The United Kingdom Department for Environment, Food & Rural Affairs confirms that a case of H5N1 avian flu has been detected at a poultry farm in Suffolk. 27,000 birds are humanely killed because of the disease.

April 9, 2020 – The USDA confirms that a commercial turkey flock in Chesterfield County, South Carolina has tested positive for the H7N3 strain of avian flu.

January 2021 – India culls tens of thousands of poultry birds after avian influenza is detected in ducks, crows and wild geese in at least a dozen locations across the country.

February 18, 2021 – Russian authorities notify WHO that they have detected H5N8 in humans. “If confirmed, this would be the first time H5N8 has infected people,” a WHO Europe spokesperson says in a statement.

June 1, 2021 – China’s National Health Commission announces the first human case of H10N3.

February 2022 – The USDA confirms that wild birds and domestic poultry in the United States have tested positive for the H5N1 strain of avian flu. By May 17, 2023, the CDC reports there are 47 states with poultry outbreaks.

April 26, 2022 – China’s National Health Commission announces the first human case of H3N8.

April 28, 2022 – The CDC announces a case of H5 bird flu has been confirmed in a man in Colorado.

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May 20, 2023

Opioid Crisis Fast Facts | CNN

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CNN
—

Here’s a look at the opioid crisis.

Experts say the United States is in the throes of an opioid epidemic. An estimated 9.2 million Americans aged 12 and older misused opioids in 2021, including 8.7 million prescription pain reliever abusers and 1.1 million heroin users.

Opioids are drugs formulated to replicate the pain-reducing properties of opium. Prescription painkillers like morphine, oxycodone and hydrocodone are opioids. Illegal drugs like heroin and illicitly made fentanyl are also opioids. The word “opioid” is derived from the word “opium.”

Nearly 110,000 people died of drug overdoses in 2022, and more than two-thirds of those deaths involved a synthetic opioid.

Overdose deaths have been on the rise for years in the United States, but surged amid the Covid-19 pandemic: Annual deaths were nearly 50% higher in 2021 than in 2019, CDC data shows.

Prescription opioid volumes peaked in 2011, with the equivalent of 240 billion milligrams of morphine prescribed, according to the market research firm, IQVIA Institute for Human Data Science.

Alabama, Arkansas, Louisiana and Tennessee had the highest opioid dispensing rates in 2020.

Opioids such as morphine and codeine are naturally derived from opium poppy plants more commonly grown in Asia, Central America and South America. Heroin is an illegal drug synthesized from morphine.

Hydrocodone and oxycodone are semi-synthetic opioids, manufactured in labs with natural and synthetic ingredients.

Fentanyl is a fully synthetic opioid, originally developed as a powerful anesthetic for surgery. It is also administered to alleviate severe pain associated with terminal illnesses like cancer. The drug is up to 100 times more powerful than morphine. Just a small dose can be deadly. Illicitly produced fentanyl has been a driving factor in the number of overdose deaths in recent years.

Methadone is another fully synthetic opioid. It is commonly dispensed to recovering heroin addicts to relieve the symptoms of withdrawal.

Opioids bind to receptors in the brain and spinal cord, disrupting pain signals. They also activate the reward areas of the brain by releasing the hormone dopamine, creating a feeling of euphoria or a “high.”

Opioid use disorder is the clinical term for opioid addiction or abuse.

People who become dependent on opioids may experience withdrawal symptoms when they stop using the medication. Dependence is often coupled with tolerance, meaning that users need to take increasingly larger doses for the same effect.

A drug called naloxone, available as an injection or a nasal spray, is used as a treatment for overdoses. It blocks or reverses the effects of opioids and is often carried by first responders.

More data on overdose deaths

The 21st Century Cures Act, passed in 2016, allocated $1 billion over two years in opioid crisis grants to states, providing funding for expanded treatment and prevention programs. In April 2017, Health and Human Services Secretary Tom Price announced the distribution of the first round of $485 million in grants to all 50 states and US territories.

In August 2017, Attorney General Jeff Sessions announced the launch of an Opioid Fraud and Abuse Detection Unit within the Department of Justice. The unit’s mission is to prosecute individuals who commit opioid-related health care fraud. The DOJ is also appointing US attorneys who will specialize in opioid health care fraud cases as part of a three-year pilot program in 12 jurisdictions nationwide.

On October 24, 2018, President Donald Trump signed opioid legislation into law. The SUPPORT for Patients and Communities Act includes provisions aimed at promoting research to find new drugs for pain management that will not be addictive. It also expands access to treatment for substance use disorders for Medicaid patients.

State legislatures have also introduced measures to regulate pain clinics and limit the quantity of opioids that doctors can dispense.

1861-1865 – During the Civil War, medics use morphine as a battlefield anesthetic. Many soldiers become dependent on the drug.

1898 – Heroin is first produced commercially by the Bayer Company. At the time, heroin is believed to be less habit-forming than morphine, so it is dispensed to individuals who are addicted to morphine.

1914 – Congress passes the Harrison Narcotics Act, which requires that doctors write prescriptions for narcotic drugs like opioids and cocaine. Importers, manufacturers and distributors of narcotics must register with the Treasury Department and pay taxes on products

1924 – The Anti-Heroin Act bans the production and sale of heroin in the United States.

1970 – The Controlled Substances Act becomes law. It creates groupings (or schedules) of drugs based on the potential for abuse. Heroin is a Schedule I drug while morphine, fentanyl, oxycodone (Percocet) and methadone are Schedule II. Hydrocodone (Vicodin) is originally a Schedule III medication. It is later recategorized as a Schedule II drug.

January 10, 1980 – A letter titled “Addiction Rare in Patients Treated with Narcotics” is published in the New England Journal of Medicine. It looks at incidences of painkiller addiction in a very specific population of hospitalized patients who were closely monitored. It becomes widely cited as proof that narcotics are a safe treatment for chronic pain.

1995 – OxyContin, a long-acting version of oxycodone that slowly releases the drug over 12 hours, is introduced and aggressively marketed as a safer pain pill by manufacturer, Purdue Pharma.

May 10, 2007 – Purdue Pharma pleads guilty for misleadingly advertising OxyContin as safer and less addictive than other opioids. The company and three executives are charged with “misleading and defrauding physicians and consumers.” Purdue and the executives agree to pay $634.5 million in criminal and civil fines.

2010 – FDA approves an “abuse-deterrent” formulation of OxyContin, to help curb abuse. However, people still find ways to abuse it.

May 20, 2015 – The DEA announces that it has arrested 280 people, including 22 doctors and pharmacists, after a 15-month sting operation centered on health care providers who dispense large amounts of opioids. The sting, dubbed Operation Pilluted, is the largest prescription drug bust in the history of the DEA.

March 18, 2016 – The CDC publishes guidelines for prescribing opioids for patients with chronic pain. Recommendations include prescribing over-the-counter pain relievers like acetaminophen and ibuprofen in lieu of opioids. Doctors are encouraged to promote exercise and behavioral treatments to help patients cope with pain.

March 29, 2017 – Trump signs an executive order calling for the establishment of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. New Jersey Governor Chris Christie is selected as the chairman of the group, with Trump’s son-in-law, Jared Kushner, as an adviser.

July 31, 2017 – After a delay, the White House panel examining the nation’s opioid epidemic releases its interim report, asking Trump to declare a national public health emergency to combat the ongoing crisis

September 22, 2017 – The pharmacy chain CVS announces that it will implement new restrictions on filling prescriptions for opioids, dispensing a limited seven-day supply to patients who are new to pain therapy.

November 1, 2017 – The opioid commission releases its final report. Its 56 recommendations include a proposal to establish nationwide drug courts that would place opioid addicts in treatment facilities rather than prison.

February 9, 2018 – A budget agreement signed by Trump authorizes $6 billion for opioid programs, with $3 billion allocated for 2018 and $3 billion allocated for 2019.

February 27, 2018 – Sessions announces a new opioid initiative: The Prescription Interdiction & Litigation (PIL) Task Force. The mission of the task force is to support local jurisdictions that have filed lawsuits against prescription drugmakers and distributors.

March 19, 2018 – The Trump administration outlines an initiative to stop opioid abuse. The three areas of concentration are law enforcement and interdiction; prevention and education via an ad campaign; and job-seeking assistance for individuals fighting addiction.

April 9, 2018 – The US surgeon general issues an advisory recommending that Americans carry the opioid overdose-reversing drug, naloxone. A surgeon general advisory is a rarely used tool to convey an urgent message. The last advisory issued by the surgeon general, more than a decade ago, focused on drinking during pregnancy.

May 1, 2018 – The Journal of the American Medical Association publishes a study that finds synthetic opioids like fentanyl caused about 46% of opioid deaths in 2016. That’s a three-fold increase compared with 2010, when synthetic opioids were involved in about 14% of opioid overdose deaths. It’s the first time that synthetic opioids surpassed prescription opioids and heroin as the primary cause of overdose fatalities.

May 30, 2018 – The journal Medical Care publishes a study that estimates the cost of medical care and substance abuse treatment for opioid addiction was $78.5 billion in 2013.

June 7, 2018 – The White House announces a new multimillion dollar public awareness advertising campaign to combat opioid addiction. The first four ads of the campaign are all based on true stories illustrating the extreme lengths young adults have gone to obtain the powerful drugs.

December 12, 2018 – According to the National Center for Health Statistics, fentanyl is now the most commonly used drug involved in drug overdoses. The rate of drug overdoses involving the synthetic opioid skyrocketed by about 113% each year from 2013 through 2016.

January 14, 2019 – The National Safety Council finds that, for the first time on record, the odds of dying from an opioid overdose in the United States are now greater than those of dying in a vehicle crash.

March 26, 2019 – Purdue Pharma agrees to pay a $270 million settlement to settle a historic lawsuit brought by the Oklahoma attorney general. The settlement will be used to fund addiction research and help cities and counties with the opioid crisis.

July 17, 2019 – The CDC releases preliminary data showing a 5.1% decline in drug overdoses during 2018. If the preliminary number is accurate, it would mark the first annual drop in overdose deaths in more than two decades.

August 26, 2019 – Oklahoma wins its case against Johnson & Johnson in the first major opioid lawsuit trial to be held in the United States. Cleveland County District Judge Thad Balkman orders Johnson & Johnson to pay $572 million for its role in the state’s opioid crisis. The penalty is later reduced to $465 million, due to a mathematical error made when calculating the judgment. In November 2021, the Oklahoma Supreme Court reverses the decision.

September 15, 2019 – Purdue files for bankruptcy as part of a $10 billion agreement to settle opioid lawsuits. According to a statement from the chair of Purdue’s board of directors, the money will be allocated to communities nationwide struggling to address the crisis.

September 30, 2019 – The FDA and DEA announce that they sent warnings to four online networks, operating a total of 10 websites, which the agencies said are illegally marketing unapproved and misbranded versions of opioid medicines, including tramadol.

February 25, 2020 – Mallinckrodt, a large opioid manufacturer, reaches a settlement agreement in principle worth $1.6 billion. Mallinckrodt says the proposed deal will resolve all opioid-related claims against the company and its subsidiaries if it moves forward. Plaintiffs would receive payments over an eight-year period to cover the costs of opioid-addition treatments and other needs.

October 21, 2020 – The Justice Department announces that Purdue Pharma, the maker of OxyContin, has agreed to plead guilty to three federal criminal charges for its role in creating the nation’s opioid crisis. They agree to pay more than $8 billion and close down the company. The money will go to opioid treatment and abatement programs. The Justice Department also reached a separate $225 million civil settlement with the former owners of Purdue Pharma, the Sackler family. In November 2020, Purdue Pharma board chairman Steve Miller formally pleads guilty on behalf of the company.

March 15, 2021 – According to court documents, Purdue files a restructuring plan to dissolve itself and establish a new company dedicated to programs designed to combat the opioid crisis. As part of the proposed plan, the Sackler family agrees to pay an additional $4.2 billion over the next nine years to resolve various civil claims.

September 1, 2021 – In federal bankruptcy court, Judge Robert Drain rules that Purdue Pharma will be dissolved. The settlement agreement resolves all civil litigation against the Sackler family members, Purdue Pharma and other related parties and entities, and awards them broad legal protection against future civil litigation. The Sacklers will relinquish control of family foundations with over $175 million in assets to the trustees of a National Opioid Abatement Trust. On December 16, 2021, a federal judge overturns the settlement.

February 25, 2022 – Johnson & Johnson and the three largest US drug distributors – McKesson Corp, Cardinal Health Inc and AmerisourceBergen Corp – finalize a $26 billion nationwide opioid settlement.

March 3, 2022 – The Sackler families reaches a settlement with a group of states the first week of March, according to court filings. The settlement, ordered through court-ordered mediation that began in January, requires the Sacklers to pay out as much as $6 billion to states, individual claimants and opioid crisis abatement, if approved by a federal bankruptcy court judge.

November 2, 2022 – CVS and Walgreens agree to pay a combined $10 billion, over 10 and 15 years, to settle lawsuits brought by states and local governments alleging the retailers mishandled prescriptions of opioid painkillers.

November 15, 2022 – Walmart agrees to the framework of a $3.1 billion settlement, which resolves allegations from multiple states’ attorneys general that the company failed to regulate opioid prescriptions contributing to the nationwide opioid crisis.

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May 18, 2023

When older parents resist help or advice, use these tips to cope | CNN

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KFF Health News
—

It was a regrettable mistake. But Kim Sylvester thought she was doing the right thing at the time.

Her 80-year-old mother, Harriet Burkel, had fallen at her home in Raleigh, North Carolina, fractured her pelvis and gone to a rehabilitation center to recover. It was only days after the death of Burkel’s husband, 82, who had moved into a memory care facility three years earlier.

With growing distress, Sylvester had watched her mother, who had emphysema and peripheral artery disease, become increasingly frail and isolated. “I would say, ‘Can I help you?’ And my mother would say, ‘No, I can do this myself. I don’t need anything. I can handle it,’ ” Sylvester told me.

Now, Sylvester had a chance to get some more information. She let herself into her mother’s home and went through all the paperwork she could find. “It was a shambles — completely disorganized, bills everywhere,” she said. “It was clear things were out of control.”

Sylvester sprang into action, terminating her mother’s orders for anti-aging supplements, canceling two car warranty insurance policies (Burkel wasn’t driving at that point), ending a yearlong contract for knee injections with a chiropractor and throwing out donation requests from dozens of organizations. When her mother found out, she was furious.

“I was trying to save my mother, but I became someone she couldn’t trust — the enemy,” Sylvester said. “I really messed up.”

Dealing with an older parent who stubbornly resists offers of help isn’t easy. But the solution isn’t to make an older person feel like you’re steamrolling them and taking over their affairs. What’s needed instead are respect, empathy and appreciation of the older person’s autonomy.

“It’s hard when you see an older person making poor choices and decisions. But if that person is cognitively intact, you can’t force them to do what you think they should do,” said Anne Sansevero, president of the board of directors of the Aging Life Care Association, a national organization of care managers who work with older adults and their families. “They have a right to make choices for themselves.”

That doesn’t mean adult children concerned about an older parent should step aside or agree to everything the parent proposes. Rather, a different set of skills is needed.

Cheryl Woodson, an author and retired physician based in the Chicago area, learned this firsthand when her mother — whom Woodson described as a “very powerful” woman — developed mild cognitive impairment. She started getting lost while driving and would buy things she didn’t need, then give them away.

Chastising her mother wasn’t going to work. “You can’t push people like my mother or try to take control,” Woodson said. “You don’t tell them, ‘No, you’re wrong,’ because they changed your diapers and they’ll always be your mom.”

Instead, Woodson learned to appeal to her mother’s pride in being the family matriarch. “Whenever she got upset, I’d ask her, ‘Mother, what year was it that Aunt Terri got married?’ or ‘Mother, I don’t remember how to make macaroni. How much cheese do you put in?’ And she’d forget what she was worked up about, and we’d just go on from there.”

Woodson, author of “To Survive Caregiving: A Daughter’s Experience, a Doctor’s Advice,” also learned to apply a “does it really matter to safety or health?” standard to her mother’s behavior. It helped Woodson let go of her sometimes unreasonable expectations.

One example she related: “My mother used to shake hot sauce on pancakes. It would drive my brother nuts, but she was eating, and that was good.”

“You don’t want to rub their nose into their incapacity,” said Woodson, whose mother died in 2003.

Barry Jacobs, a clinical psychologist and family therapist, sounded similar themes in describing a psychiatrist in his late 70s who didn’t like to bend to authority. After his wife died, the older man stopped shaving and changing his clothes regularly. Though he had diabetes, he didn’t want to see a physician and instead prescribed medicine for himself. Even after several strokes compromised his vision, he insisted on driving.

An adult child needs to show empathy and respect for the autonomy of an aging parent.

Jacobs’ take: “You don’t want to go toe-to-toe with someone like this, because you will lose. They’re almost daring you to tell them what to do so they can show you they won’t follow your advice.”

What’s the alternative? “I would employ empathy and appeal to this person’s pride as a basis for handling adversity or change,” Jacobs said. “I might say something along the lines of, ‘I know you don’t want to stop driving and that this will be very painful for you. But I know you have faced difficult, painful changes before and you’ll find your way through this.’ “

“You’re appealing to their ideal self rather than treating them as if they don’t have the right to make their own decisions anymore,” he said. In the older psychiatrist’s case, conflict with his four children was constant, but he eventually stopped driving.

Another strategy that can be useful: “Show up, but do it in a way that’s face-saving,” Jacobs said. Instead of asking your father if you can check in on him, “Go to his house and say, ‘The kids really wanted to see you. I hope you don’t mind.’ Or ‘We made too much food. I hope you don’t mind my bringing it over.’ Or ‘I wanted to stop by. I hope you can give me some advice about this issue that’s on my mind.’ “

This psychiatrist didn’t have any cognitive problems, though he wasn’t as sharp as he used to be. But encroaching cognitive impairment often colors difficult family interactions.

If you think this might be a factor with your parents, instead of trying to persuade them to accept more help at home, try to get them medically evaluated, said Leslie Kernisan, author of “When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide to Memory Loss, Resistance, Safety Worries, and More.”

“Decreased brain function can affect an older adult’s insight and judgment and ability to understand the risks of certain actions or situations while also making people suspicious and defensive,” she noted.

This doesn’t mean you should give up on talking to an older parent with mild cognitive impairment or early-stage dementia, however. “You always want to give the older adult a chance to weigh in and talk about what’s important to them and their feelings and concerns,” Kernisan said.

“If you frame your suggestions as a way of helping your parent achieve a goal they’ve said was important, they tend to be much more receptive to it,” she said.

A turning point for Sylvester and her mother came when the older woman, who developed dementia, went to a nursing home at the end of 2021. Her mother, who at first didn’t realize the move was permanent, was furious, and Sylvester waited two months before visiting. When she finally walked into Burkel’s room, bearing a Valentine’s Day wreath, Burkel hugged her and said, “I’m so glad to see you,” before pulling away. “But I’m so mad at my other daughter.”

Sylvester, who doesn’t have a sister, responded, “I know, Mom. She meant well, but she didn’t handle things properly.” She learned the value of what she calls a “therapeutic fiblet” from Kernisan, who ran a family caregiver group Sylvester attended between 2019 and 2021.

After that visit, Sylvester saw her mother often, and all was well between the two women up until Burkel’s death. “If something was upsetting my mother, I would just go, ‘Interesting,’ or ‘That’s a thought.’ You have to give yourself time to remember this is not the person you used to know and create the person you need to be your parent, who’s changed so much.”

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May 9, 2023

Covid-19 Pandemic Timeline Fast Facts | CNN

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CNN
—

Here’s a look at the coronavirus outbreak, declared a worldwide pandemic by the World Health Organization. The coronavirus, called Covid-19 by WHO, originated in China and is the cousin of the SARS virus.

Coronaviruses are a large group of viruses that are common among animals. The viruses can make people sick, usually with a mild to moderate upper respiratory tract illness, similar to a common cold. Coronavirus symptoms include a runny nose, cough, sore throat, possibly a headache and maybe a fever, which can last for a couple of days.

WHO Situation Reports

Coronavirus Map

CNN’s early reporting on the coronavirus

December 31, 2019 – Cases of pneumonia detected in Wuhan, China, are first reported to WHO. During this reported period, the virus is unknown. The cases occur between December 12 and December 29, according to Wuhan Municipal Health.

January 1, 2020 – Chinese health authorities close the Huanan Seafood Wholesale Market after it is discovered that wild animals sold there may be the source of the virus.

January 5, 2020 – China announces that the unknown pneumonia cases in Wuhan are not SARS or MERS. In a statement, the Wuhan Municipal Health Commission says a retrospective probe into the outbreak has been initiated.

January 7, 2020 – Chinese authorities confirm that they have identified the virus as a novel coronavirus, initially named 2019-nCoV by WHO.

January 11, 2020 – The Wuhan Municipal Health Commission announces the first death caused by the coronavirus. A 61-year-old man, exposed to the virus at the seafood market, died on January 9 after respiratory failure caused by severe pneumonia.

January 17, 2020 – Chinese health officials confirm that a second person has died in China. The United States responds to the outbreak by implementing screenings for symptoms at airports in San Francisco, New York and Los Angeles.

January 20, 2020 – China reports 139 new cases of the sickness, including a third death. On the same day, WHO’s first situation report confirms cases in Japan, South Korea and Thailand.

January 20, 2020 – The National Institutes of Health announces that it is working on a vaccine against the coronavirus. “The NIH is in the process of taking the first steps towards the development of a vaccine,” says Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases.

January 21, 2020 – Officials in Washington state confirm the first case on US soil.

January 23, 2020 – At an emergency committee, WHO says that the coronavirus does not yet constitute a public health emergency of international concern.

January 23, 2020 – The Beijing Culture and Tourism Bureau cancels all large-scale Lunar New Year celebrations in an effort to contain the growing spread of coronavirus. On the same day, Chinese authorities enforce a partial lockdown of transport in and out of Wuhan. Authorities in the nearby cities of Huanggang and Ezhou Huanggang announce a series of similar measures.

January 28, 2020 – Chinese President Xi Jinping meets with WHO Director General Tedros Adhanom in Beijing. At the meeting, Xi and WHO agree to send a team of international experts, including US Centers for Disease Control and Prevention staff, to China to investigate the coronavirus outbreak.

January 29, 2020 – The White House announces the formation of a new task force that will help monitor and contain the spread of the virus, and ensure Americans have accurate and up-to-date health and travel information, it says.

January 30, 2020 – The United States reports its first confirmed case of person-to-person transmission of the coronavirus. On the same day, WHO determines that the outbreak constitutes a Public Health Emergency of International Concern (PHEIC).

January 31, 2020 – The Donald Trump administration announces it will deny entry to foreign nationals who have traveled in China in the last 14 days.

February 2, 2020 – A man in the Philippines dies from the coronavirus – the first time a death has been reported outside mainland China since the outbreak began.

February 3, 2020 – China’s Foreign Ministry accuses the US government of inappropriately reacting to the outbreak and spreading fear by enforcing travel restrictions.

February 4, 2020 – The Japanese Health Ministry announces that ten people aboard the Diamond Princess cruise ship moored in Yokohama Bay are confirmed to have the coronavirus. The ship, which is carrying more than 3,700 people, is placed under quarantine scheduled to end on February 19.

February 6, 2020 – First Covid-19 death in the United States: A person in California’s Santa Clara County dies of coronavirus, but the link is not confirmed until April 21.

February 7, 2020 – Li Wenliang, a Wuhan doctor who was targeted by police for trying to sound the alarm on a “SARS-like” virus in December, dies of the coronavirus. Following news of Li’s death, the topics “Wuhan government owes Dr. Li Wenliang an apology,” and “We want freedom of speech,” trend on China’s Twitter-like platform, Weibo, before disappearing from the heavily censored platform.

February 8, 2020 – The US Embassy in Beijing confirms that a 60-year-old US national died in Wuhan on February 6, marking the first confirmed death of a foreigner.

February 10, 2020 – Xi inspects efforts to contain the coronavirus in Beijing, the first time he has appeared on the front lines of the fight against the outbreak. On the same day, a team of international experts from WHO arrive in China to assist with containing the coronavirus outbreak.

February 10, 2020 – The Anthem of the Seas, a Royal Caribbean cruise ship, sets sail from Bayonne, New Jersey, after a coronavirus scare had kept it docked and its passengers waiting for days.

February 11, 2020 – WHO names the coronavirus Covid-19.

February 13, 2020 – China’s state-run Xinhua News Agency announces that Shanghai mayor Ying Yong will be replacing Jiang Chaoliang amid the outbreak. Wuhan Communist Party chief Ma Guoqiang has also been replaced by Wang Zhonglin, party chief of Jinan city in Shandong province, according to Xinhua.

February 14, 2020 – A Chinese tourist who tested positive for the virus dies in France, becoming the first person to die in the outbreak in Europe. On the same day, Egypt announces its first case of coronavirus, marking the first case in Africa.

February 15, 2020 – The official Communist Party journal Qiushi publishes the transcript of a speech made on February 3 by Xi in which he “issued requirements for the prevention and control of the new coronavirus” on January 7, revealing Xi knew about and was directing the response to the virus on almost two weeks before he commented on it publicly.

February 17, 2020 – A second person in California’s Santa Clara County dies of coronavirus, but the link is not confirmed until April 21.

February 18, 2020 – Xi says in a phone call with British Prime Minister Boris Johnson that China’s measures to prevent and control the epidemic “are achieving visible progress,” according to state news Xinhua.

February 21, 2020 – The CDC changes criteria for counting confirmed cases of novel coronavirus in the United States and begins tracking two separate and distinct groups: those repatriated by the US Department of State and those identified by the US public health network.

February 25, 2020 – The NIH announces that a clinical trial to evaluate the safety and effectiveness of the antiviral drug remdesivir in adults diagnosed with coronavirus has started at the University of Nebraska Medical Center in Omaha. The first participant is an American who was evacuated from the Diamond Princess cruise ship docked in Japan.

February 25, 2020 – In an effort to contain the largest outbreak in Europe, Italy’s Lombardy region press office issues a list of towns and villages that are in complete lockdown. Around 100,000 people are affected by the travel restrictions.

February 26, 2020 – CDC officials say that a California patient being treated for novel coronavirus is the first US case of unknown origin. The patient, who didn’t have any relevant travel history nor exposure to another known patient, is the first possible US case of “community spread.”

February 26, 2020 – Trump places Vice President Mike Pence in charge of the US government response to the novel coronavirus, amid growing criticism of the White House’s handling of the outbreak.

February 29, 2020 – A patient dies of coronavirus in Washington state. For almost two months, this is considered the first death due to the virus in the United States, until autopsy results announced April 21 reveal two earlier deaths in California.

March 3, 2020 – The Federal Reserve slashes interest rates by half a percentage point in an attempt to give the US economy a jolt in the face of concerns about the coronavirus outbreak. It is the first unscheduled, emergency rate cut since 2008, and it also marks the biggest one-time cut since then.

March 3, 2020 – Officials announce that Iran will temporarily release 54,000 people from prisons and deploy hundreds of thousands of health workers as officials announced a slew of measures to contain the world’s deadliest coronavirus outbreak outside China. It is also announced that 23 members of Iran’s parliament tested positive for the virus.

March 4, 2020 – The CDC formally removes earlier restrictions that limited coronavirus testing of the general public to people in the hospital, unless they had close contact with confirmed coronavirus cases. According to the CDC, clinicians should now “use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.”

March 8, 2020 – Italian Prime Minister Giuseppe Conte signs a decree placing travel restrictions on the entire Lombardy region and 14 other provinces, restricting the movements of more than 10 million people in the northern part of the country.

March 9, 2020 – Conte announces that the whole country of Italy is on lockdown.

March 11, 2020 – WHO declares the novel coronavirus outbreak to be a pandemic. WHO says the outbreak is the first pandemic caused by a coronavirus. In an Oval Office address, Trump announces that he is restricting travel from Europe to the United States for 30 days in an attempt to slow the spread of coronavirus. The ban, which applies to the 26 countries in the Schengen Area, applies only to foreign nationals and not American citizens and permanent residents who’d be screened before entering the country.

March 13, 2020 – Trump declares a national emergency to free up $50 billion in federal resources to combat coronavirus.

March 18, 2020 – Trump signs into law a coronavirus relief package that includes provisions for free testing for Covid-19 and paid emergency leave.

March 19, 2020 – At a news conference, officials from China’s National Health Commission report no new locally transmitted coronavirus cases for the first time since the pandemic began.

March 23, 2020 – United Nations Secretary-General António Guterres calls for an immediate global ceasefire amid the pandemic to fight “the common enemy.”

March 24, 2020 – Japan’s Prime Minister Shinzo Abe and International Olympic Committee (IOC) president Thomas Bach agree to postpone the Olympics until 2021 amid the outbreak.

March 25, 2020 – The White House and Senate leaders reach an agreement on a $2 trillion stimulus deal to offset the economic damage of coronavirus, producing one of the most expensive and far-reaching measures in the history of Congress.

March 27, 2020 – Trump signs the stimulus package into law.

April 2, 2020 – According to the Department of Labor, 6.6 million US workers file for their first week of unemployment benefits in the week ending March 28, the highest number of initial claims in history. Globally, the total number of coronavirus cases surpasses 1 million, according to Johns Hopkins University’s tally.

April 3, 2020 – Trump says his administration is now recommending Americans wear “non-medical cloth” face coverings, a reversal of previous guidance that suggested masks were unnecessary for people who weren’t sick.

April 8, 2020 – China reopens Wuhan after a 76-day lockdown.

April 14, 2020 – Trump announces he is halting funding to WHO while a review is conducted, saying the review will cover WHO’s “role in severely mismanaging and covering up the spread of coronavirus.”

April 20, 2020 – Chilean health officials announce that Chile will begin issuing the world’s first digital immunity cards to people who have recovered from coronavirus, saying the cards will help identify individuals who no longer pose a health risk to others.

April 21, 2020 – California’s Santa Clara County announces autopsy results that show two Californians died of novel coronavirus in early and mid-February – up to three weeks before the previously known first US death from the virus.

April 28, 2020 – The United States passes one million confirmed cases of the virus, according to Johns Hopkins.

May 1, 2020 – The US Food and Drug Administration issues an emergency-use authorization for remdesivir in hospitalized patients with severe Covid-19. FDA Commissioner Stephen Hahn says remdesivir is the first authorized therapy drug for Covid-19.

May 4, 2020 – During a virtual pledging conference co-hosted by the European Union, world leaders pledge a total of $8 billion for the development and deployment of diagnostics, treatments and vaccines against the novel coronavirus.

May 11, 2020 – Trump and his administration announce that the federal government is sending $11 billion to states to expand coronavirus testing capabilities. The relief package signed on April 24 includes $25 billion for testing, with $11 billion for states, localities, territories and tribes.

May 13, 2020 – Dr. Mike Ryan, executive director of WHO’s health emergencies program, warns that the coronavirus may never go away and may just join the mix of viruses that kill people around the world every year.

May 19, 2020 – WHO agrees to hold an inquiry into the global response to the coronavirus pandemic. WHO member states adopt the proposal with no objections during the World Health Assembly meeting, after the European Union and Australia led calls for an investigation.

May 23, 2020 – China reports no new symptomatic coronavirus cases, the first time since the beginning of the outbreak in December.

May 27, 2020 – Data collected by Johns Hopkins University reports that the coronavirus has killed more than 100,000 people across the US, meaning that an average of almost 900 Americans died each day since the first known coronavirus-related death was reported nearly four months earlier.

June 2, 2020 – Wuhan’s Health Commission announces that it has completed coronavirus tests on 9.9 million of its residents with no new confirmed cases found.

June 8, 2020 – New Zealand Prime Minister Jacinda Ardern announces that almost all coronavirus restrictions in New Zealand will be lifted after the country reported no active cases.

June 11, 2020 – The United States passes 2 million confirmed cases of the virus, according to Johns Hopkins.

June 16, 2020 – University of Oxford scientists leading the Recovery Trial, a large UK-based trial investigating potential Covid-19 treatments, announce that a low-dose regimen of dexamethasone for 10 days was found to reduce the risk of death by a third among hospitalized patients requiring ventilation in the trial.

June 20, 2020 – The NIH announces that it has halted a clinical trial evaluating the safety and effectiveness of drug hydroxychloroquine as a treatment for the coronavirus. “A data and safety monitoring board met late Friday and determined that while there was no harm, the study drug was very unlikely to be beneficial to hospitalized patients with Covid-19,” the NIH says in a statement.

June 26, 2020 – During a virtual media briefing, WHO announces that it plans to deliver about 2 billion doses of a coronavirus vaccine to people across the globe. One billion of those doses will be purchased for low- and middle-income countries, according to WHO.

July 1, 2020 – The European Union announces it will allow travelers from 14 countries outside the bloc to visit EU countries, months after it shut its external borders in response to the pandemic. The list does not include the US, which doesn’t meet the criteria set by the EU for it to be considered a “safe country.”

July 6, 2020 – In an open letter published in the journal Clinical Infectious Diseases, 239 scientists from around the world urge WHO and other health agencies to be more forthright in explaining the potential airborne transmission of coronavirus. In the letter, scientists write that studies “have demonstrated beyond any reasonable doubt that viruses are released during exhalation, talking, and coughing in microdroplets small enough to remain aloft in air and pose a risk of exposure at distances beyond 1 to 2 meters (yards) from an infected individual.”

July 7, 2020 – The Trump administration notifies Congress and the United Nations that the United States is formally withdrawing from WHO. The withdrawal goes into effect on July 6, 2021.

July 21, 2020 – European leaders agree to create a €750 billion ($858 billion) recovery fund to rebuild EU economies ravaged by the coronavirus.

July 27, 2020 – A vaccine being developed by the Vaccine Research Center at the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, in partnership with the biotechnology company Moderna, enters Phase 3 testing. The trial is expected to enroll about 30,000 adult volunteers and evaluates the safety of the vaccine and whether it can prevent symptomatic Covid-19 after two doses, among other outcomes.

August 11, 2020 – In a live teleconference, Russian President Vladimir Putin announces that Russia has approved a coronavirus vaccine for public use before completion of Phase 3 trials, which usually precedes approval. The vaccine, which is named Sputnik-V, is developed by the Moscow-based Gamaleya Institute with funding from the Russian Direct Investment Fund (RDIF).

August 15, 2020 – Russia begins production on Sputnik-V, according to Russian state news agency TASS.

August 23, 2020 – The FDA issues an emergency use authorization for the use of convalescent plasma to treat Covid-19. It is made using the blood of people who have recovered from coronavirus infections.

August 27, 2020 – The CDC notifies public health officials around the United States to prepare to distribute a potential coronavirus vaccine as soon as late October. In the documents, posted by The New York Times, the CDC provides planning scenarios to help states prepare and advises on who should get vaccinated first – healthcare professionals, essential workers, national security “populations” and long-term care facility residents and staff.

September 4, 2020 – The first peer-reviewed results of Phase 1 and Phase 2 clinical trials of Russia’s Covid-19 vaccine are published in the medical journal The Lancet. The results “have a good safety profile” and the vaccine induced antibody responses in all participants, The Lancet says.

October 2, 2020 – Trump announces that he and first lady Melania Trump have tested positive for Covid-19. He spends three nights at Walter Reed National Military Medical Center receiving treatment before returning to the White House.

October 12, 2020 – Drugmaker Johnson & Johnson announces it has paused the advanced clinical trial of its experimental coronavirus vaccine because of an unexplained illness in one of the volunteers.”Following our guidelines, the participant’s illness is being reviewed and evaluated by the ENSEMBLE independent Data Safety Monitoring Board (DSMB) as well as our internal clinical and safety physicians,” the company said in a statement. ENSEMBLE is the name of the study. The trial resumes later in the month.

December 10, 2020 – Vaccine advisers to the FDA vote to recommend the agency grant emergency use authorization to Pfizer and BioNTech’s coronavirus vaccine.

December 14, 2020 – US officials announce the first doses of the FDA authorized Pfizer vaccine have been delivered to all 50 states, the District of Columbia and Puerto Rico.

December 18, 2020 – The FDA authorizes a second coronavirus vaccine made by Moderna for emergency use. “The emergency use authorization allows the vaccine to be distributed in the U.S. for use in individuals 18 years and older,” the FDA said in a tweet.

January 14, 2021 – The WHO team tasked with investigating the origins of the outbreak in Wuhan arrive in China.

January 20, 2021 – Newly elected US President Joe Biden halts the United States’ withdrawal from WHO.

February 22, 2021 – The death toll from Covid-19 exceeds 500,000 in the United States.

February 27, 2021 – The FDA grants emergency use authorization to Johnson & Johnson’s Covid-19 vaccine, the first single dose Covid-19 vaccine available in the US.

March 30, 2021 – According to a 120-page report from WHO, the novel coronavirus that causes Covid-19 probably spread to people through an animal, and probably started spreading among humans no more than a month or two before it was noticed in December of 2019. The report says a scenario where it spread via an intermediate animal host, possibly a wild animal captured and then raised on a farm, is “very likely.”

April 17, 2021 – The global tally of deaths from Covid-19 surpasses 3 million, according to data compiled by Johns Hopkins.

August 3, 2021 – According to figures published by the CDC, the more contagious Delta variant accounts for an estimated 93.4% of coronavirus circulating in the United States during the last two weeks of July. The figures show a rapid increase over the past two months, up from around 3% in the two weeks ending May 22.

August 12, 2021 – The FDA authorizes an additional Covid-19 vaccine dose for certain immunocompromised people.

August 23, 2021 – The FDA grants full approval to the Pfizer/BioNTech Covid-19 vaccine for people age 16 and older, making it the first coronavirus vaccine approved by the FDA.

September 24, 2021 – CDC Director Dr. Rochelle Walensky diverges from the agency’s independent vaccine advisers to recommend boosters for a broader group of people – those ages 18 to 64 who are at increased risk of Covid-19 because of their workplaces or institutional settings – in addition to older adults, long-term care facility residents and some people with underlying health conditions.

November 2, 2021 – Walensky says she is endorsing a recommendation to vaccinate children ages 5-11 against Covid-19, clearing the way for immediate vaccination of the youngest age group yet in the US.

November 19, 2021 – The FDA authorizes boosters of the Pfizer/BioNTech and Moderna Covid-19 vaccines for all adults. The same day, the CDC also endorses boosters for all adults.

December 16, 2021 – The CDC changes its recommendations for Covid-19 vaccines to make clear that shots made by Moderna and Pfizer/BioNTech are preferred over Johnson & Johnson’s vaccine.

December 22, 2021 – The FDA authorizes Pfizer’s antiviral pill, Paxlovid, to treat Covid-19, the first antiviral Covid-19 pill authorized in the United States for ill people to take at home, before they get sick enough to be hospitalized. The following day, the FDA authorizes Merck’s antiviral pill, molnupiravir.

December 27, 2021 – The CDC shortens the recommended times that people should isolate when they’ve tested positive for Covid-19 from 10 days to five days if they don’t have symptoms – and if they wear a mask around others for at least five more days. The CDC also shortens the recommended time for people to quarantine if they are exposed to the virus to a similar five days if they are vaccinated.

January 31, 2022 – The FDA grants full approval to Moderna’s Covid-19 vaccine for those ages 18 and older. This is the second coronavirus vaccine given full approval by the FDA.

March 29, 2022 – The FDA authorizes a second booster of the Pfizer/BioNTech and Moderna Covid-19 vaccines for adults 50 and older. That same day, the CDC also endorses a second booster for the same age group.

April 25, 2022 – The FDA expands approval of the drug remdesivir to treat patients as young as 28 days and weighing about seven pounds.

May 17, 2022 – The FDA authorizes a booster dose of Pfizer/BioNTech’s Covid-19 vaccine for children ages 5 to 11 at least five months after completion of the primary vaccine series. On May 19, the CDC also endorses a booster dose for the same age group.

June 18, 2022 – The CDC recommends Covid-19 vaccines for children as young as 6 months.

August 31, 2022 – The FDA authorizes updated Covid-19 vaccine booster shots from Moderna and Pfizer. Both are bivalent vaccines that combine the companies’ original vaccine with one that targets the BA.4 and BA.5 Omicron sublineages. The CDC signs off on the updated booster shots the following day.

May 5, 2023 – The WHO says Covid-19 is no longer a global health emergency.

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May 6, 2023

The way the US government tracks Covid-19 is about to change | CNN

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CNN
—

When the US public health emergency ends May 11, the US Centers for Disease Control and Prevention will have to change some of the ways it tracks Covid-19 in the United States, but the agency says it won’t lose its sightlines on the infection as it continues to be part of American life.

On Thursday, for the first time in three years, the CDC will stop posting a national count of Covid-19 cases. The agency’s color-coded maps of county-level transmission and disease burden will be retired, the CDC will no longer track variants down to the state level, and it will update its genomic surveillance estimates every two weeks instead of weekly.

“Though our data going forward will be different, they will continue to provide timely insights for CDC, for local health officials, as well as for the public to understand Covid-19 dynamics,” CDC Principal Deputy Director Dr. Nirav Shah said.

“In short, we will still be able to tell that it’s snowing, even though we’re no longer counting every snowflake.”

Instead of following Covid-19 cases, the agency will track the burden and spread of disease primarily through hospitalizations and deaths.

The move to stop posting a national case count is largely symbolic. The number of Covid-19 cases known to public health officials has long been undercounted. The percent of detected cases has only fallen further as people have turned to rapid home testing for a diagnosis. At some points in the pandemic, experts estimated that the true number of cases was more than 14 times higher than official counts.

Other metrics that people are used to seeing on the CDC’s Covid Data Tracker are also going to go away. As CNN previously reported, the CDC will stop publishing detailed, color-coded Covid-19 Transmission Levels and Covid-19 Community Level maps that have been tied to recommendations about when to wear masks, when it’s a good idea for people to test to prevent the spread of disease and when to avoid large indoor public gatherings.

When the public health emergency ends, more states are expected to stop reporting Covid-19 cases to CDC. Iowa, for example, has already stopped. So the CDC says it won’t be feasible to maintain a national count or update its maps.

Future recommendations for precautions like masking will instead be tied to hospitalization levels.

Covid-19 will retain its designation as a nationally notifiable disease, but that’s just a recommendation, says Dr. Brendan Jackson, who leads the CDC’s Covid-19 response. It doesn’t carry any authority for required reporting. When the public health emergency ends, it will be a state-by-state decision whether to share those numbers, Jackson said Thursday.

The CDC says it will still publish the case counts it gets from states, but that will be in a different section of its website, and the numbers won’t be totaled.

Some experts say they’re disappointed to see that the CDC will have to go back to an older, fragmented system of having to ask states to share data.

“We’re kind of reverting back to a system where the CDC kind of independently negotiates all these data sharing agreements with the states and they make it more voluntary,” said Beth Blauer, associate vice provost for public sector innovation at Johns Hopkins University.

“I think having the states do this all independently doesn’t make a ton of sense because it doesn’t help us understand, in the aggregate, the impact that disease is having on our communities,” Blauer said.

She also said it will be very difficult to scale this system back up should another large, immediate public health threat emerge.

Starting next week, vaccination counts will become discretionary. Jackson said that most, but not all, of the 64 jurisdictions that report to the CDC have signed data use agreements to share their vaccine administration numbers. They may not share as much as they have in the past about who is getting vaccinated or do it as frequently, which may limit the nation’s ability to spot widespread racial, ethnic or socioeconomic disparities for future vaccination campaigns. Starting in June, the CDC says, it will update its vaccination data on a monthly basis.

Laboratories will no longer be required to send testing data to the CDC, which will hamper the ability to understand test positivity rates, a metric that, early in the pandemic, helped public health officials know whether they were doing enough testing or if transmission in a community was going up or down. Positivity rates were used in the transmission maps but also for the CDC’s tracking of variants.

The CDC will still get some lab testing data from another system called the National Respiratory and Enteric Virus Surveillance System, a network of about 450 labs that help it track illnesses like influenza and respiratory syncytial virus, or RSV.

Variant tracking will continue, but the CDC will have to adjust some of the metrics it uses to model variant proportions. State-level estimates of variant proportions with go away, but regional levels will remain. Those will be updated twice a month going forward instead of weekly, as they are now.

The way the CDC will collect data on deaths will change, too. Instead of scraping numbers from state website and getting direct reports from states, which counted deaths based on the date they were reported, the CDC will switch to a national system that counts deaths based on death certificate data. The agency says this system has become much more timely and will be a more stable way to count Covid-19 deaths going forward. It will also add a new metric to its death reporting: the percentage of all deaths reported that week that are caused by Covid-19.

Hospitals will still have to report Covid-19 data through April 2024, but they won’t track as many metrics or submit that information as frequently. Hospitals have shared information daily through most of the pandemic, but now that reporting will be weekly.

Hospitalizations and deaths are known as lagging indicators because they increase only after people have gotten sick. Studies released Friday from CDC epidemiologists show that hospitalizations may not lag behind cases as much as we once thought they did.

The new studies, published in the CDC’s Morbidity and Mortality Weekly Report, show that Covid-19 hospitalizations lagged one day behind increases in reported cases and four days behind increases in emergency room visits.

The research also shows that the new system the CDC will be using to track deaths will show trends 13 days earlier than data collected from states, the system that’s being discontinued.

With case levels low across most of the country, the need for these kinds of insights has gone away, or scientists have found other ways to get the information, such as testing of wastewater, which begins to increase about a week before testing data reflects an uptick in spread. Wastewater testing is available in some places, but not all areas have this capability.

The CDC will also maintain traveler surveillance, testing wastewater on airplanes in an effort to spot new incoming threats.

The CDC will also maintain what it calls sentinel systems: smaller, but nationally representative networks of hospitals and laboratories that will feed in more detailed data. This is much the same way the agency tracks patterns in other respiratory diseases, such as the flu and RSV. The CDC says recent investments in these sentinel systems will help it maintain eyes on Covid-19.

Instead, it will be using hospitalizations and emergency room visits as the primary ways it tracks Covid-19 and as the basis for its recommendations. When hospitalization rates in an area are high, for example, it will be recommending that people wear masks, said Jackson.

CDC Director Dr. Rochelle Walensky acknowledged some of these data changes in a Senate committee hearing this week, although she emphasized that the CDC was not “changing the steam” of its work on Covid-19.

“As the public health emergency is set to end next week, I do want to just reiterate that we at CDC are not changing the steam at which we are working through resolving this public health emergency,” Walensky said at a hearing of the Senate Committee on Health Education, Labor and Pensions.

“It is the case at the end of the public health emergency, we will have less window as to the data,” she said. “We won’t get laboratory reporting. We won’t get case reporting. So we’ll lose some of that.”

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April 30, 2023

New approach gets newborns with opioid withdrawal out of the hospital sooner and with less medication | CNN

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CNN
—

Rates of neonatal abstinence syndrome surged in recent years, but a newer approach to caring for newborn babies exposed to opioids during pregnancy gets them out of the hospital sooner and with less medication, according to a study published on Sunday in the New England Journal of Medicine.

Newborns in opioid withdrawal may experience upset stomach, inconsolable crying, seizures and extreme discomfort. The study looked at the impacts of the Eat, Sleep, Console care approach on 1,300 infants at 26 US hospitals, and compared them with the current standard for caring for infants exposed to opioids.

Eat, Sleep, Console encourages involvement from parents, and prioritizes care that doesn’t involve medication, such as swaddling, skin-to-skin contact and breastfeeding. The usual approach involves a nurse measuring a baby’s withdrawal symptoms – such as their level of irritability, pitch of crying, fever or tremors – before providing treatment such as methadone or morphine.

“Compared to usual care, use of the Eat, Sleep, Console care approach substantially decreased time until infants with neonatal opioid withdrawal syndrome were medically ready for discharge, without increasing specified adverse outcomes,” the researchers wrote in the study.

The infants assessed with the Eat, Sleep, Console care method were discharged after eight days on average, compared with almost 15 days for the infants who were cared for by the standard approach, the researchers said. Additionally, infants in the Eat, Sleep, Console care group were 63% less likely to receive opioid medication – 19.5% received medication compared with 52% in the group receiving usual care.

The current approach to usual care “is a very comprehensive and nurse-led way of assessing the infant, whereas the Eat, Sleep, Console approach involves the mom in the way that you assess the infant, and allows the mom to take part in trying to soothe the infants and see if the infant is able to be soothed or is able to eat or is able to sleep,” according to Rebecca Baker, the director of the NIH HEAL Initiative, which provides grants to researchers studying ways to alleviate the country’s opioid health crisis.

“So, in that way, it’s a little bit more functional, like looking at the abilities of the infants versus how severely the infant is affected.”

Assessment results determine whether a baby should receive medication to control withdrawal symptoms, Baker said.

“So even with Eat, Sleep, Console, some infants that were exposed to a lot of opioids during a mother’s pregnancy, they’ll still need medication-based treatment for withdrawal. It’s just fewer of them need it and when they need it, they need less medication to manage the withdrawal symptoms,” she said.

The Eat, Sleep, Console method was developed about eight years ago, and some hospitals have already implemented it. But Baker said the study’s findings could change how more hospitals practice caring for infants with neonatal abstinence syndrome, which primarily occurs in infants who were exposed to opioids while in utero.

“The rise of really powerful fentanyl, the synthetic opioid, means that if a mother has used drugs during pregnancy, the baby will be exposed to more powerful drugs, which likely has an effect. We haven’t had a chance to study it in detail yet, but it will affect how they feel when they’re born and separated from the mom,” Baker said.

Findings from the study, which were presented at the PAS 2023 Meeting on Sunday, could have a big impact on hospitals by freeing up bed space in the neonatal intensive care unit and boosting morale among nurses at risk of burnout.

“We trained over 5,000 nurses as part of the study. They felt really empowered to help the mom care for the infant to help the infant recover, and so I think from a morale perspective, that’s incredibly important and valuable,” Baker said. “And as you know, nurses are facing really severe staffing shortages and morale challenges so having this tool available to them where they are kind of able to do something positive in the life of the infant and the connection with the mom is really important.”

The researchers are currently following up with a subgroup of the infants from the study for up to two years to see how they grow and develop.

“One of the things that we want to be really sure of is that there are no negative consequences associated with taking less medication, so we’ll be looking for that,” Baker said.

The United States has seen an explosion in the number of infants born with neonatal abstinence syndrome in recent years, swelling by about 82% between 2010 and 2017, according to the US Centers for Disease Control and Prevention. The number of maternal opioid-related diagnoses is also on the rise, increasing by 131% during that same time frame.

Nearly 60 infants are diagnosed with NAS each day, based on data from the U.S. Agency for Healthcare Research and Quality in 2020.

The United States’ opioid epidemic has been expanding in recent years and opioid deaths are the leading cause of accidental death in the US.

More than a million people have died of drug overdoses – mostly opioids – in the two decades since the US Centers for Disease Control and Prevention began collecting that data. Deaths from opioid overdoses rose more than 17% in just one year, from about 69,000 in 2020 to about 81,020 in 2021, the CDC found.

Most are among adults, but children are also dying, largely after ingesting synthetic opioids such as fentanyl. Between 1999 and 2016, nearly 9,000 children and adolescents died of opioid poisoning, with the highest annual rates among adolescents 15 to 19, the CDC found.

Opioid use during pregnancy has been linked to maternal mortality and risk of overdose for the mother, according to the CDC, while infants risk preterm birth, low birthweight, breathing problems and feeding problems.

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April 29, 2023

US cigarette smoking rate falls to historic low, but e-cigarette use keeps climbing | CNN

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CNN
—

The percentage of adults who smoked cigarettes in the United States fell to a historic low last year, the US Centers for Disease Control and Prevention found. However, e-cigarettes are becoming even more popular.

About 11% of adults told the CDC last year that they were current cigarette smokers, according to the latest preliminary data from the National Health Interview Survey, a biannual survey that provides general information about health-related topics. The survey includes responses from 27,000 people age 18 and older. In 2020 and 2021, about 12.5% of adults said they smoked cigarettes.

This is a significant drop from when surveys like these started. Surveys of Americans in the 1940s found that about half of all adults said they smoked cigarettes. Rates began to decline in the 1960s, and more recently, in 2016, 15.5% of adults said they smoked cigarettes.

Recent studies have shown some groups are still at higher risk. While the latest CDC survey doesn’t capture this level of detail, cigarette smoking rates among some communities – including Native Americans, Alaska Natives and members of the LGBTQ community remain “alarmingly high” according to the 2023 State of Tobacco Control report from the American Lung Association.

The general drop in cigarette smoking among adults should have a positive impact on public health.

Cigarette smoking is still the leading cause of preventable death and disability in the US. So many people have died from smoking, the CDC finds, that more than 10 times as many US citizens have died prematurely from cigarette smoking than have died in all the wars fought by the US.

Smokers are 90% of the lung cancer cases in the United States, but smoking can also cause someone to have a stroke, coronary heart disease, and COPD, as well as other cancers including bladder, colon, kidney, liver, stomach and other cancers. People who live with smokers also are at a greater risk of death, because of secondhand smoke.

This latest survey does not capture why fewer people smoked cigarettes, but the number has been on the decline since the 1960s, after the US surgeon general released the first report on smoking and health that concluded that smoking causes serious health problems.

Experts credit a variety of efforts for the decline in cigarette smoking – anti-smoking campaigns, programs that educate children about the danger of smoking, laws that severely restrict where people could smoke and where cigarette companies could advertise, as well as better access to smoking cessation programs and higher taxes that make cigarettes expensive.

However, Congress hasn’t raised federal tobacco taxes in 14 years. The federal cigarette tax remains $1.01 per pack, and taxes vary for other tobacco products. No state increased its cigarette taxes in 2022.

The pandemic may also have had an influence. Smokers were much more vulnerable to the severe consequences of Covid-19 and that gave some people the extra motivation they needed to quit – and may have given doctors the extra motivation they needed to help them too, according to Dr. Panagis Galiatsatos, a volunteer medical spokesperson with the American Lung Association. At some level, the pandemic also made the medical establishment easier to access.

“The pandemic, I think, really allowed physicians time they never probably had in the past to conduct these telemedicine visits that were appropriate just for smoking cessation strategies, helping them help patients quit and stay quit,” said Galiatsatos, who is a pulmonary and critical care medicine physician and is director of the Tobacco Treatment Clinic with Johns Hopkins Medicine.

Galiatsatos points to the US Surgeon General report released during the Trump administration, just prior to the start of the pandemic. The report detailed that of the patients they have now that smoke, the few that are left are going to be the most resistant to quitting. Then-Surgeon General Jerome Adams’ report encouraged more doctors to help their patients quit. The report found that 40% of smokers are not routinely told by their doctors to stop.

Still, the culture has changed. Smoking is much less socially acceptable in some cultures in the US.

E-cigarette use, though, seems to be more socially acceptable, especially among younger people studies show, and that may explain why those numbers are up.

The current survey found that e-cigarette use rose to nearly 6% last year, that’s up from about 4.9% the year before.

Some argue that e-cigarettes are a good substitute for regular cigarettes, and in some countries they are even promoted as a smoking cessation devices, but the CDC says that “e-cigarettes are not safe for youth, young adults, and pregnant women, as well as adults who do not currently use tobacco products.”

A BMJ study published in February found that people who used e-cigarettes to quit smoking found them to be less helpful than more traditional smoking cessation aids.

The US Food and Drug Administration says there is not enough evidence to support claims that these products are effective tools to help people quit smoking. None are approved for this purpose. The FDA says there are no safe tobacco products, including e-cigarettes, vapes, and other electronic nicotine delivery systems.

“I always hold no stigma or judgment when anyone wants to smoke a traditional cigarette or use electronic cigarettes, but as a lung doctor, I will always promote only air to come into the lungs,” said Galiatsatos. “From my standpoint, I think we should still have a public health mindset around e-cigarette usage because for some individuals, they’re going to have health consequences from this product.”

He said people may choose to vape instead of smoke cigarettes, but clinicians should be prepared to help this population if they do want to quit.

E-cigarettes can, though, produce a number of chemicals that are not good for human health, including acrolein, acetaldehyde, and formaldehyde. Studies show these chemicals are known as aldehydes and can cause lung and heart disease, according to the American Lung Association.

Among teens, nicotine exposure can harm the developing brain, according to the US surgeon general.

E-cigarettes are much more popular than cigarettes among teens, so the adult e-cigarette user numbers will likely continue to grow.

About 14% of high school students said they used e-cigarettes, and 2% of high school students smoked cigarettes last year, according to separate CDC data.

The rate of kids that use e-cigarettesis high, the American Academy of Pediatrics says.

Specifically, in 2022, nearly 5% of middle school and about 17% of high school students reported some form of current tobacco use, according to CDC data from an earlier survey. In 2021, about 11% of middle schoolers and 34% of high schoolers said they had ever tried tobacco.

These “try rates” are important because most adult smokers started at young ages, according to the CDC.

The AAP continues to encourage pediatricians to screen for tobacco use as part of a child’s regular checkup. A talk about tobacco should start no later than age 11 or 12, the report says.

For adult smokers, the CDC encourages encourages people to call 1-800-QUIT-NOW where people can get free confidential coaching. The government also offers free online resources and even text programs that can help people quit.

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April 26, 2023

Amid contradictory laws, hospitals in one state were unable to explain policies on emergency abortion care, study finds | CNN

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CNN
—

Oklahoma’s laws restricting abortions have created a confusing, contradictory environment that may have a chilling effect on health care, new research says.

After the US Supreme Court overturned the right to an abortion last year with the Dobbs v. Jackson Women’s Health Organization decision, several states quickly passed laws that restricted such procedures. A report released Tuesday and described in the medical journal the Lancet finds that the laws in at least one state left workers at many hospitals confused about how to proceed.

When the court made its decision, the Oklahoma law that criminalized abortion in 1910 went back into effect, according to the state’s attorney general. Lawmakers then created multiple overlapping laws that further criminalized abortion and increased penalties for those who performed or assisted in an abortion procedure, according to the new report from Physicians for Human Rights, Oklahoma Call for Reproductive Justice and the Center for Reproductive Rights.

The Oklahoma laws allow abortion in the case of a medical emergency, but one doesn’t define a medical emergency. Another says it allows for the “preservation of life in a medical emergency,” defined as causing “substantial and irreversible body of bodily impairment” – which is not a medical term, experts say.

To understand exactly how well Oklahoma hospitals understood the laws, the researchers used a “secret shopper method,” study co-author Dr. Michele Heisler said.

Researchers posed as prospective patients and called 34 hospitals to ask about the emergency pregnancy care they offered.

Heisler said that when the researchers designed the study, she expected the hospitals to tell the patients that they could get help in an emergency but that a second provider might have to sign off on an abortion or that a doctor would have to get the decision past an “onerous” hospital oversight committee.

“What we weren’t expecting is that there would be so much confusion and contradictory information and really not clear information,” said Heisler, who is medical director at Physicians for Human Rights and a professor of internal medicine and public health at the University of Michigan.

The researchers said that none of the hospitals they contacted in Oklahoma was totally able to articulate clear, consistent policies for emergency obstetric care to potential patients.

Specifically, 65% – 22 of the 34 hospitals – were unable to provide information about policies, procedures or the support provided to doctors when it is clinically necessary to terminate a pregnancy to save the life of a pregnant patient.

In 14 of the 22 cases, hospital representatives provided unclear and/or incomplete answers about whether doctors require approval to perform a medically necessary abortion.

Three of the hospitals said they do not provide abortions at all, even though it remains legal in the case of a medical emergency or to “preserve the life” of the pregnant person. Four others provided information that was factually wrong, the report says.

Four hospitals said they had formal approval processes that clinicians must go through if they have a situation in which it is medically necessary to terminate a pregnancy; they cannot make that decision on their own.

Three hospitals indicated that they have policies for these situations but refused to share any information about them.

“Unfortunately, it is being just left up to individual health systems and clinicians to try to make sense of these laws and provide guidance and support,” Heisler said.

The Oklahoma Hospital Association said it has been in conversations with Oklahoma’s medical licensure boards to seek clarity about the state’s conflicting abortion laws.

The association sent guidance to its members in September to explain what it interpreted as “saving the life of a pregnant woman” and what the laws would mean for a person made pregnant through rape or incest, among other issues. The guidance explains that the state’s criminal laws do not make an exception for these circumstances unless it is to save the life of someone who is pregnant in a medical emergency.

The guidance also warns that a person convicted of “administering, prescribing, advising, or procuring a woman to take any medicine drug or substance, or a person convicted of using or employing any instruction or ‘other means whatever,’ with the intent to procure an abortion, shall be guilty of a felony punishable by two (2) to (5) years imprisonment. From August 27, 2022, forward, a person convicted of performing or attempting to perform an abortion shall be guilty of a felony punishable by a fine not to exceed One Hundred Thousand ($100,000.00) and/or imprisonment not to exceed ten (10) years.”

The guidance says the “persons potentially liable” are the provider, not the pregnant person.

Study co-author Rabia Muqaddam, a senior staff attorney at the Center for Reproductive Rights who is working on multiple cases challenging the abortion bans in Oklahoma, called the overlapping laws a “bizarre” situation.

“Aside from the fact that there are so many of them is that they all conflict,” she said. “All of the laws have inconsistent definitions, which is where a lot of the confusion comes from for health care providers. What’s most dangerous for patients is the fact that the definitions of medical emergency and life-preserving abortions is unclear and inconsistent.”

“If I was the hospital general counsel and I was looking at these laws, I have absolutely no idea what my physician could or could not do in any particular circumstance,” she said.

When there is a lack of clarity and when penalties are involved, “what you get is massive chill.”

“Physicians are terrified. They’re terrified that if they make the wrong decision, they’re going to go to jail. They’re going to lose their license. And at the other end of that is that patients are being seriously harmed,” Muqaddam said.

Sonia M. Suter, a professor of law at George Washington University who was not involved in the new research, said recent abortion laws have created “such a mess.”

“You are telling physicians that they have two conflicting obligations,” said Suter, whose scholarship focuses on issues at the intersection of law, medicine and bioethics, with a particular focus on reproductive rights.

There is an obligation to stabilize patients in emergencies that may not always qualify as “life-threatening,” but doctors and hospitals could also risk being sued because the doctors are not following the standard of care, “which you can’t do with how some of these exceptions are worded.”

She said hospitals also don’t know how the laws will be applied. Lawyers typically will instruct institutions to interpret the law as conservatively as possible, and physicians may be equally conservative because they don’t want to risk their licenses or face stiff penalties.

“It’s just devastating for everybody,” Suter said. “It’s just cruel.”

Molly Meegan, general counsel for the American College of Obstetricians and Gynecologists, said state laws to restrict abortion with emergency exceptions are not comprehensive.

“They can’t be applied in a medical situation. They just aren’t practical,” she said. “They have an ethical and personal duty to their patients to do what is best for their patients. It can at times be in direct conflict with whatever the laws are, especially if they’re vague, and most of the ob/gyns throughout the country, including in Oklahoma, are in an impossible situation.”

Meegan and Suter both believe the confusion will lead to the deaths of more women. Those who survive may be left with dire health problems, including losing the ability to have children in the future.

“They already have horrific maternal mortality and infant mortality rates,” Suter said. “It feels like the end of evidence-based medicine.”

According to the US Centers for Disease Control and Prevention, Oklahoma persistently ranks among the states with the worst rates of maternal deaths, even before the new abortion laws went into effect. The state had a maternal mortality rate of 25.2 deaths per 100,000 live births for 2018-20, well above the national average.

For communities of color, the rate is significantly worse, according to the Oklahoma Health Department.

White women had 23.2 maternal deaths per 100,000 live births for 2018-20, the lowest rate overall in Oklahoma. The rates for Black women and Native American women were about twice as high: 49.4 and 44.4, respectively.

Oklahoma is not alone. The 13 states where most abortions are banned generally have some of the highest infant and maternal mortality rates in the country, Heisler said. Even more states could be restricting abortion access soon, the experts believe, with potentially more problems to come.

“The hostile climate many states are creating for the health care field by enacting criminal and other penalties for abortion care is an outcome whose reverberations we are only just beginning to see,” said Kelly Baden, vice president for public policy at the reproductive health nonprofit Guttmacher Institute.

Heisler noted that the researchers don’t blame the hospitals or the doctors for this confusion. Overall, she said, the staffers who talked to the researchers “were wonderful,” despite the circumstances.

“They were empathetic. They said, ‘I completely understand.’ They tried to give answers. They acted in good faith. But really, none of the hospitals were really able to say what we were hoping for, which is to unequivocally state that they would stand behind their clinicians and that clinicians at their facilities would be able to use their best clinical judgment for the individual case and that it would be made as medical decisions should be in collaboration with the patient, taking into account to their needs, their preferences and their values,” she said.

“We are recognizing that hospitals and clinicians are in an untenable situation,” Heisler added.

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