Health

Anticipating a vaccine, supply chain preps for shortages, funding concerns

nevodka/iStockBy SASHA PEZENIK, ABC News

(NEW YORK) -- With the steady march toward a safe, effective and authorized coronavirus vaccine, another race now runs alongside: how to dispatch tens of millions of doses across every corner of the nation and globe, and do it safely, securely and swiftly. The solution will involve complicated logistical calculus, experts say, no matter which vaccine gets across the finish line first.

Pfizer's vaccine is likely to be the first to be granted authorization by the Food and Drug Administration, followed by one created by Moderna, and then possibly vaccines from AstraZeneca/Oxford and Johnson & Johnson, if the efficacy and safety data prove solid.

The U.S. government has promised a goal of "shots in arms" within 24 hours of FDA authorization of the first COVID-19 vaccine.

All about the money


Those responsible for the cross-country relay -- state and local public health officials and supply chain experts -- have hustled to marshal their resources, even as shortage concerns linger and officials warn the federal dollars they have received so far will not be enough.

"There's a light at the end, but that tunnel is still very long," Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, told ABC News. "We at the state level will soon be handed the baton and we need additional funding support from the federal government. What's at stake is nothing short of the velocity and equity with which we can get this vaccine to everyone in need."

More than a dozen states have told ABC News they will likely need additional funding, or are awaiting additional funding. In response to concerns raised by the National Governors Association, Operation Warp Speed has said it is in the process of planning to make additional funding and resources available to support vaccine operations, information systems and communications campaigns, though some officials still say more will be needed.

"Without those additional resources, it will be like putting up tent poles without having a tent," Shah said. "We've got to think through literally everything, from when the vaccine enters our borders to the time it goes into somebody's arm for injection."

That "last mile" of distribution may pose the rockiest stretch of the journey, experts say. Getting the vaccine from a central transportation hub to its final destination at local hospitals and pharmacies across the country will require unprecedented coordination and delicately calibrated conditions.

The U.S. government estimates having 40 million doses -- enough for 20 million Americans -- by the end of this year if the FDA provides authorization in early December. About half of those vaccine doses will be provided by Pfizer, with the other half by Moderna.

Cold storage, shortage fears


Pfizer's vaccine must be stored at temperatures colder than Antarctica in winter: roughly minus 94 degrees Fahrenheit. Doses would ship in dry ice thermal containers, stored either with replenished dry ice for up to roughly two weeks or stored in ultra-low temperature freezers. Moderna's vaccine also requires cold storage, though not as extreme: It can be stored around minus 4 degrees, the same as a commercial freezer.

Manufacturers, logistics providers, federal and state governments and health care systems have been shoring up their cold chain infrastructure for months, lining up equipment and transportation capacity.

"The clock starts ticking once those dry ice containers start shipping around," Dr. Mark Jarrett, chief quality officer of Northwell Health, New York's largest health system, told ABC News.

The Centers for Disease Control and Prevention told states and localities not to buy ultra-cold freezers for now, since the Pfizer vaccine will be shipped with dry ice "pizza boxes" that can keep it viable for up to 15 days, as long as there's fresh dry ice available. It can then last five additional days in a conventional freezer.

Dry ice faced "significant shortages" during the pandemic's spring surge, President and CEO of the Compressed Gas Association Rich Gottwald told ABC, warning in an April letter to Vice President Mike Pence.

In mid-October, the nation's governors penned a letter to the Trump administration with several concerns, including ultra-cold freezer and dry ice supply, and seeking clarity so that "no one is caught flat-footed when the time comes to vaccinate people."

The Compressed Gas Association now says they expect "sufficient" dry ice supply for COVID-19 vaccines.

"There may be issues with [the] COVID vaccine; the supply of dry ice will not be one of those issues," Gottwald said.

Still, some dry ice manufacturers and distributors are echoing those earlier warnings.

"Our system is already taxed beyond what the supply is right now," Tim Koerner, co-owner of the American Carbonation Corporation, told ABC News. "It could be close to sufficient, but it's gonna be tight."

UPS announced Wednesday it's ramping up dry ice production capabilities and launching a mobile freezer storage unit supply, noting "a major spike in demand" and the need to "plan for what some analysts fear may be a dry ice shortage" amid vaccine preparation.

Public health authorities and hospitals who can afford the investment are acquiring ultra-cold freezers, despite CDC guidance, to maintain supply chain agility.

Unsure how much vaccine they'll be receiving, David Reich, president of The Mount Sinai Hospital and Mount Sinai Queens, said they had bought a number of the freezers to be ready for whatever comes.

Henry Ford Health System in Michigan announced Wednesday it had received and begun installing six specialized freezers for the Pfizer vaccine, and six other freezers for the Moderna vaccine.

Distributing the vaccine


UPS Healthcare is collaborating with Stirling Ultracold, an Ohio company making laboratory-grade ultra-cold freezers, to supply portable models for storage of vaccines.

Demand has "dramatically increased," Stirling Ultracold CEO Dusty Tenney told ABC News. Sales are up 250% since the first quarter, with backorder times up to six weeks.

"There is a lot riding on everyone right now to make sure this is successful," Tenney said.

An onboard computer tracks temperature through the cold chain's many handoffs "to ensure that when they do arrive, there's no waste or loss associated with the vaccine's efficacy," Tenney said.

"Our job is to make sure nowhere in that process does it break down," Tenney added.

Stirling Ultracold hopes to have 2,000 portable freezer units in use by January. Each portable unit can hold 6,000 doses, allowing for 12 million of them throughout the country at a time.

"We were concerned about the freezers, and so we quickly purchased and pre-positioned them at certain sites along the health system," Jarrett, from Northwell Health, said. "That's one thing we've learned in COVID -- was try and be ahead of the curve."

Those freezers don't come cheap: each unit, depending on the model, ranges from $6,000 to more than $10,000.

"You can't strap [vaccine] on the back of 'Bob's truck,'" Shah said. Maine has received $800,000 in federal funding so far, and "significantly more will be needed," as they ramp up logistics and manpower.

Dry ice also has flight restrictions, which could further hamper distribution.

Who gets the vaccine and when?


Not all the vaccine candidates share the need for shipping in extreme temperatures. In addition to Moderna's, which can be held in most standard freezers, the vaccines from AstraZeneca/Oxford and Johnson & Johnson don't need to be frozen at all and can be safely stored for months in a standard refrigerator.

But all vaccine shipments will face logistical problems for one reason or another.

"We need to address the fact that all last miles in this country are not equal. If logistics work against our most-vulnerable populations, we will further exacerbate the impact of this pandemic," said Dr. John Brownstein, an epidemiologist at Boston Children's Hospital and ABC News Contributor.

"We've already seen the incredible divide when it came to testing -- increased travel times for counties with lower population density and higher percent of minority and uninsured. Will the challenges of cold storage and the requirement for two doses further exacerbate health inequities when it comes to immunizations?" Brownstein continued. "We'll need further analysis to understand how these logistical challenges intersect with fair and equitable access."

"We have to be ready for all of it," said Dr. Abinash Virk, infectious disease specialist at the Mayo Clinic. "It's a complicated process now happening at supersonic speed."

Figuring out which front-line staff has priority for the injection's first wave, organizing electronic medical systems and data communication must be done before the first shot and before knowing which vaccine will be the one they're giving, Virk said.

"Pfizer has the most restrictive storage and transport requirements," Virk said. "If we're able to handle that, then, the subsequent ones, hopefully, will be able to handle much easier."

Vaccines requiring two doses offer their own unique coordination: Pfizer's needs a booster after 21 days while Moderna's requires one after 28 days. That means ensuring the right shipment arrives in time for the patient who needs their second dose.

That could get harder in remote areas.

"All this will be unfolding as the vaccine is literally rolling in trucks to get there," Dr. Robert O. Williams III, of the University of Texas at Austin's Division of Molecular Pharmaceutics and Drug Delivery, said. "For rural areas that don't have the same infrastructure and cold infrastructure, that's an added challenge."

"We're the last mile. And that's sometimes the toughest mile," Jarrett said. "And there may be hurdles, but that's never going to stop us from doing the right thing."

Copyright © 2020, ABC Audio. All rights reserved.


Meet the ICU doctor who is going viral for embracing a COVID-19 patient

Go Nakamura/Getty ImagesBy THE GMA TEAM, ABC News

(HOUSTON) -- Dr. Joseph Varon, chief of staff at United Memorial Medical Center in Houston, was on his 252nd consecutive day working during the coronavirus pandemic when he took time to comfort a patient on Thanksgiving Day.

Varon, who leads the hospital's coronavirus unit, was dressed in full personal protective equipment (PPE) when he stopped to wrap his arms around a man being treated in the hospital's intensive care unit (ICU).

The photograph, taken by a Getty photographer, quickly went viral as the United States continues to see more than 100,000 newly diagnosed cases of COVID-19 daily.

"He was very sad because he's in a room where he knows nobody," Varon told "Good Morning America" of the patient, who was not identified. "We come in dressed like astronauts, and even though I usually have my picture with me so they can know who I am when I go to see them, it's very frustrating for the patients, and he was very emotional."

"And just when I heard [his emotion], I hugged him," Varon added.

Varon said the journey of fighting COVID-19 has been taxing not just for patients, but for medical staff like himself. He described working around-the-clock, day after day to care for patients.

"My days can be 16 hours ... and then when I get home, I get a million phone calls in the middle of the night," he said. "When I leave my home, I tell my wife, '[I'll] see you,' but I don't know when or what time. Sometimes I don't come back home the same day."

Hospitalizations of COVID-19 patients in the United States reached an all-time high of 93,238 on Sunday, according to the COVID Tracking Project. Current COVID-19 hospitalizations have gone up nearly every day since Oct. 25.

Our daily update is published. Our testing, case, and death statistics continue to be affected by the Thanksgiving holiday. Hospitalizations are less affected by the data slowdown and are at the record-high level of 93,238. pic.twitter.com/LVZnxVme4p

— The COVID Tracking Project (@COVID19Tracking) November 30, 2020

As the number of cases and hospitalizations continues to rise, Varon said he is particularly frustrated by people not practicing COVID-19 safety guidelines, including wearing a face mask and social distancing.

"We're frustrated because we see people, they come in very, very sick and when you ask them, 'How did you get [COVID-19]?,' they basically tell you that they didn't follow any of the things that we've been asking them to please follow -- no social distancing, no wearing masks, going to large gatherings," he said. "And then just coming to us near death."

"We are exhausted. We are tired," he said of his fellow doctors and nurses. "I have nurses [who] are in the middle of the day crying because they keep on getting patients and there are just not enough nurses that can help us."

Copyright © 2020, ABC Audio. All rights reserved.


Chrissy Teigen opens up about breastfeeding struggles

Matt Winkelmeyer/Getty Images for NetflixBy MEGAN STONE, ABC News

(NEW YORK) -- Chrissy Teigen is hoping she can help break down the stigma regarding breast milk versus formula by opening up about her own breastfeeding struggles.

In a lengthy Twitter thread on Sunday, the Cravings author called to "normalize formula."

"Normalize breastfeeding is such a huge, wonderful thing. But I absolutely felt way more shame having to use formula because of lack of milk from depression and whatnot," Teigen said, pointing out that pushing breastfeeding can have unintended consequences on a new mom's confidence.

"People have surrogates, people have trouble breastfeeding and all you hear as a new, anxious mom is how breast is best," the 35-year-old went on. "Your baby is gonna be BEAUTIFUL, PERFECT, AND OKAY."

Teigen then explained that when her children were infants, she used to spend a great deal of time pumping on the "highest mode," and "it drove me mad to the point I could only get an ounce. An ounce!"

"The stress of it, combined with the guilt that you cannot do nature's most natural thing for your own baby is too much," the model said. "I dunno why this is my crusade now. I just remember the sadness I felt and want you to know you are doing it right if your baby is fed, mama."

This isn't the first time Teigen has advocated for mothers. Most recently, she defended Meghan Markle from critics after the duchess opened up about her pregnancy loss, weeks after Teigen suffered a pregnancy loss of her own.

Teigen is the mom of Luna, 4, and Miles, 2, both of whom she shares with husband John Legend.

Copyright © 2020, ABC Audio. All rights reserved.


Moderna to seek FDA emergency authorization after COVID-19 vaccine shows 94% efficacy

STR/NurPhoto via Getty ImagesBy SONY SALZMAN, ABC News

(NEW YORK) -- Moderna announced Monday it will ask the Food and Drug Administration for emergency use authorization (EUA) for its COVID-19 vaccine, making it the second company, after Pfizer, to seek EUA for a COVID-19 vaccine in the United States.

Pfizer's public FDA hearing -- a crucial step in the authorization process -- is scheduled for Dec. 10, and the FDA could make its official authorization decision shortly thereafter.

In an early morning press release, Moderna announced that its FDA hearing will be held a week later, on Dec. 17. Moderna also announced its coronavirus vaccine is more than 94% effective, according to the final analysis of its massive Phase 3 trial.

Among the more than 30,000 volunteers in Moderna's Phase 3 trial, 196 ultimately developed COVID-19, but the vast majority of those COVID-19 cases happened among volunteers who had been given a placebo injection -- an imbalance hefty enough for biostatisticians to feel confident the vaccine is highly effective.

"The newly published results from Moderna confirm our enthusiasm for the prospects of their vaccine," said Dr. John Brownstein, an epidemiologist, chief innovation officer at Boston Children's Hospital and contributor to ABC News.

Pfizer said its vaccine was 95% effective in the final analysis, but it had a different number of COVID-19 cases in its trial, so the percentages shouldn't be compared head-to-head without context, experts say.

"The results of both trials are just amazing," said David Benkeser, an assistant professor of biostatistics and bioinformatics at Emory University Rollins School of Public Health.

He added that "94.1% and 95% are statistically indistinguishable at this point, probably coming down to a difference of just one or two cases of COVID-19."

"We do have to be careful not to over-interpret these data, especially when in comparison to the Pfizer analysis," Brownstein cautioned.

Moderna has promised to publish full details from the trial through a formal scientific review process. Additional details about the trial will become available through the FDA's review process, which the agency has pledged will be transparent to the public.

"While 94.1% efficacy is phenomenal, we are still dealing with small sample sizes and likely we will see differences in vaccine effectiveness when deployed in the population," Brownstein said.

But Monday's press release included some new details about Moderna's vaccine, including the fact that it appears to be equally effective among people of different races, ethnicities, ages and genders.

Among the 196 people who developed COVID-19 in the trial, 33 were older adults (ages 65 and up), 29 were Hispanic or Latino, six were Black or African American, four were Asian American and three were multiracial.

Moderna is also claiming that the Phase 3 data shows the vaccine was highly effective at preventing more severe cases of COVID-19. According to the press release, 30 out of the 196 volunteers developed severe illness, but all 30 were among the group of volunteers who got the placebo shot. This shows the vaccine demonstrated 100% efficacy at preventing severe COVID-19, according to the company.

According to Benkeser, this isn't enough data to prove Moderna's vaccine will prevent severe illness in every single person who receives it, "however, it is common for vaccines to be more effective against severe disease than mild disease," he said.

"The idea is that though a vaccine might not fully protect you against infection, it can make the subsequent illness less severe," he added. "Therefore, it really is quite plausible that the short-term efficacy against severe disease is indeed close to 100%."

Meanwhile, no serious safety concerns about the vaccine have been reported to date. People who get the vaccine may experience a sore arm, redness at the injection site, headache, fever, fatigue or other short-term adverse reactions.

Monday's announcement means Moderna is on track to see a possible FDA-authorized vaccine by the end of the year. The company is also on track to produce 20 million doses available for distribution around the U.S. by the end of December: enough doses to vaccinate 10 million people.

Moderna said it will also ask European regulators for a conditional approval, and the company is on track to manufacture 500 million to one billion doses globally in 2021.

Experts said that even the "final" analyses of both vaccine trials -- Pfizer's and Moderna's -- will not provide the final answer about just how well the vaccines will work, especially in the long term, but their results, both boasting greater than 90% efficacy, bode well for the future.

Benkeser said there is still a long way to go until vaccines are widely available, but when they are, Americans should trust the science.

"There's a light at the end of the -- as of yet -- very dark tunnel," he said, "but for the first time since March, I feel hopeful about turning a corner."

Copyright © 2020, ABC Audio. All rights reserved.


As 75 Hard fitness program trends on TikTok, experts raise red flags

Anatoliy Sizov/iStockBy LESLEY HAULER, ABC News

(NEW YORK) -- As the coronavirus pandemic rages on and quarantine orders are being extended, people have turned to new places to get workout inspiration at home.

Fitness videos on TikTok have grown exponentially since the pandemic began, as many looked for new ways to stay in shape. Fitness challenges like #DragonFlag, #OneMinuteFitness and #PlankChallenge have gone viral in recent months, and celebrities like Carrie Underwood have even joined in.

Experts urge those just starting out to take it slow before jumping into some of the advanced moves seen in popular TikTok videos, and the intense program called 75 Hard that’s trending on the platform is no exception.

The 75 Hard program, created by entrepreneur and podcaster Andy Frisella and described as a "mental toughness" program, outlines rules users must follow for 75 days. They are:

  • Do two 45-minute workouts a day, one of which must be outside
  • Follow a healthy diet with zero alcohol or cheat days
  • Take a progress picture every day
  • Drink one gallon of water daily
  • Read 10 pages a day of a nonfiction book
  • If you fail, you must start over again at Day One

75 Hard found life on TikTok during the pandemic after 22-year-old Rylee Ollearis documented her journey doing the program from May to July. Her first video about it has racked up more than four million views.

"I decided to post on TikTok for my five followers at the time... 'Hey guys, I'm doing this crazy challenge, this crazy program,' and the video started to blow up," Ollearis told ABC News' Good Morning America.

"I've almost given up myself a few too many times in the past," she explained about what drew her to the intense program. "I wanted to prove to myself for this time that I could be tough enough to complete something that I set my mind to."

Ollearis' audio from her Day One video is now used in more than 500 TikTok videos of other users trying out the program for themselves. The hashtag #75Hard itself has over 126 million views on the platform.

The recent college graduate is now a wellness coach and said many people have reached out to her about the program since finding her videos. While she recognized that the program is a major commitment, she said she chose to do it in the middle of quarantine because she could put the majority of her daily focus on making sure she was being mindful with her workouts and recovery.

"Understanding that two 45-minute workouts every single day is a lot. You're pushing your body, but you also have to ensure that you're getting the right recovery, that you're including active rest into those days to make sure that you're not hurting yourself in any way," she said.

Experts raise 'red flags' about 75 Hard


One of the concerns about 75 Hard, according to many experts, is many may opt to ignore the 75 Hard recommendations and begin the workout plan without seeking advice from a physician first, and this can be dangerous.

Nutritionist and dietician Maya Feller said when she first heard about the 75 Hard program, "some internal red flags went up."

"This just seems so dangerous in the wrong hands — and even in the right hands. It's just propelling this really dangerous culture," she told GMA. "It could absolutely set a person up for feeling like, either 'I am doing well, according to this plan,' or 'I'm failing.'"

"We're in the midst of a time where we've lost so much collectively ... So why do we want to put ourselves in a position every day where we have to become tougher and harder, when we're struggling with so much?" she said.

While Feller says there are major benefits of finding a routine and making healthy choices to improve your well-being, she doesn't think 75 Hard is the way for the majority of people.

"It is for a very specific subset of people. ...The program should really be focused on the individuals finding out how to engage in nutrition and intentional movement that is supportive of their metabolic health and their physical ability," she explained.

75 Hard founder Andy Frisella did not respond to Good Morning America's request for comment.

Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York who has treated patients for injuries from working out at home -- though not from TikTok -- voiced concerns particularly about 75 Hard's two-a-day workout schedule.

“I think the routine puts a lot of strain on your body, primarily your kidneys," Glatter said. "The risks include muscle breakdown.”

Along with the strenuous physical toll of 75 Hard, Feller said it may also have negative psychological effects for an impressionable young audience on TikTok.

Feller said she believes 75 Hard's "diet" rule, which she says she considers vague, using terminology like "cheat meals," as well as the mandatory daily progress photo, exemplify the harmful side of diet culture, "which is very strong and very profitable and mostly focused on encouraging people to restrict their food intake ... just for the sake of whittling themselves down to quite slender."

75 Hard's official website has a disclaimer says that "you should consult your physician or other health care professional before starting" the program. The company also told GMA it does not require high-intensity workouts and could include two walks a day. The company also said 75 Hard is "a mental toughness program. It's not promoted nor advertised as a fitness challenge."

TikTok said in a statement to GMA that the company works "to foster a supportive and body-positive environment for our community."

"We encourage people to use good judgement before trying new fitness routines and will remove content that promotes dangerous behaviors to lose weight or eating habits that are likely to cause health issues. We want our community to feel comfortable and confident to be exactly who they are," TikTok said.

Ollearis believes people should do their own research before trying 75 Hard, echoing the statement that the program is about mental toughness and building confidence more than weight loss.

"It's not about the after pictures," she said. "It's a mental toughness challenge to see if you can push yourself to the limit ...The program was created to build confidence, to build grit, to build mental toughness."

If you or someone you know is battling an eating disorder, contact the National Eating Disorders Association (NEDA) at 1-800-931-2237 or NationalEatingDisorders.org.

Copyright © 2020, ABC Audio. All rights reserved.


How state health departments might view Biden's COVID response plan

Heidi Gutman/ABC NewsBy IVAN PEREIRA, ABC News

(NEW YORK) -- With the novel coronavirus surging in states across the country, state leaders are scrambling to develop plans to contain the outbreak as many critics say the Trump administration remains largely disengaged.

But former health officials and experts told ABC News that those offices may have a stronger ally in their fight next year -- the incoming Biden administration.

Jeanette Kowalik, the director of policy development for the nonprofit health policy group Trust for America's Health and former health commissioner for Milwaukee, said state public health offices have been largely left to their own devices during the pandemic, and as a result, the country has developed a range of rules and regulations.

The pandemic has also become highly politicized, including the debate over mask mandates, with some states refusing to implement such measures despite evidence they can save lives.

President Donald Trump demurred from wearing a mask for months, jabbed President-elect Joe Biden for wearing one and questioned the efficacy of mask wearing. He has also sparred with and publicly contradicted the government's scientific experts.

Overall, the administration, while giving guidance through the Centers for Disease Control and Prevention (CDC), has largely deferred to the states on public health aspects of the pandemic and focused on economic recovery and vaccine development instead.

'Good start' but steep challenges for Biden

Kowalik and other experts predict that governors, mayors and health officials will be receptive to Biden's health policies, which include increased testing and a bigger push for masks across the nation.

"We're trained to adhere to whatever is at the national level," Kowalik told ABC News. "The fact that the Biden administration is committed to science is a good start."

While there may be some state leaders who, due to political ties, refuse to abide by the new administration's guidance, some of the experts said the rising COVID-19 dangers and the possible harsher winter will force them to reconsider.

The country is experiencing a daily caseload that is higher than ever and a death toll approaching the spring peak, and as a result, some leaders are already showing signs of following Biden's example, according to Dr. Georges Benjamin, the executive director of the nonprofit American Public Health Association.

Many health experts say the new administration's challenges are steep, but any amount of increased coordination will go a long way.

Benjamin said the CDC has released broad COVID-19 related guidance including wearing a mask, social distancing and limiting crowds. When it comes to having states enforce those protocols, the agency's members have been "keeping their heads down," because of the current administration's orders to focus on the economy over containing the spread, he said.

Kowalik, who left her position as Milwaukee's health commissioner in September, recalled how there was increased tension between state leaders and health offices over that debate.

State leaders who wanted to ease stay at home restrictions or not issue mask mandates would argue that the White House backed their proposals and move forward, she said.

An exit poll conducted by ABC News during the election found that a majority of Democratic voters favored containing the virus even if the economy took a hit while a majority of Republican voters favored the opposite.

'Major shift in tone' may help bring along opponents

Even though Biden won't assume office until January, many health experts say his announcements and plans during the campaign and transition show a more unified vision dedicated to keeping people healthy.

The president-elect has called for a national pandemic dashboard that breaks down COVID-19 data by ZIP code, expands the nation's testing capability and contact tracing, and for a national mask mandate.

"The Biden administration was clear that it would use science to guide how they manage the pandemic," Kowalik said. "That is a major shift in tone and a clear directive to health officials and leaders."

Experts who spoke with ABC News acknowledged the mask issue will be tough to enforce, especially since many Americans are still reluctant to wear them. However, Biden's continued promotion of the idea, both with his words and image of him wearing one during appearances, sends a strong message to the world, according to Benjamin.

"When you have a president wearing a mask, and encourage governors to do it in a way that is not threatening…that can change people's behavior," Benjamin said.

Kowalik added that the professionals that Biden has already chosen for his COVID-19 response give local health officials promise there will be a stronger direction from Washington.

Two days after he was projected to be the winner of the election, Biden announced a 13-member COVID-19 task board that included former Surgeon General Vivek Murthy and former Food and Drug Administration (FDA) Commissioner Dr. David Kessler.

"The majority of members are people who are well-known," Kowalik said of Biden's team. "That is definitely needed because the situation warrants hard science."

Prioritizing vaccine distribution

Michael Sparer, the chair of the department of health policy and management at Columbia University's Mailman School of Public Health, told ABC News the most important part of the Biden administration's COVID response will be eventual vaccine distribution.

Trump's Operation Warp Speed initiative laid out the groundwork for developing and delivering the vaccine in unprecedented time. However, the president was critical of the FDA's strict guidelines over the vaccine's approval.

Sparer said he expects Biden will build on this groundwork and provide states with a more detailed rollout, without any conflict with the FDA over approval or with the states over distribution.

"It will be distributed locally, but the effort by the Biden administration will be done under a national plan," Sparer said. "There will be efforts to straddle that middle ground."

Tailored reopening plans

Kowalik said the new administration's health departments would also offer state leaders a compromise by providing states with advisories and reopening plans that fit their specific needs.

She noted the Trump administration attempted this strategy in April with its reopening benchmarks offered to states that were contingent on increased testing and data that showed a continuous downward trend in cases.

However, the administration allowed several states to move forward with their reopenings in the spring despite not meeting the criteria. Biden had conference calls with governors and mayors and said he will continue to reach out during his transition and first weeks in office. He's also pushed for a "dimmer switch" method of reopening that is selective with restrictions.

"The CDC usually had a couple of options that were malleable," Kowalik said. "Having more than one plan for states to choose from and an overall outline of goals is key."

Benjamin acknowledged that partisan politics may prevent full cooperation, but the virus' growing threat has already forced some state leaders to rethink their strategies.

On Nov. 16, Iowa Gov. Kim Reynolds reversed her stance on a statewide mask mandate after her state saw a record 1,500 people hospitalized that day.

Around that same time in Wyoming, 21 health officials wrote a letter to Gov. Mark Gordon to implement a mask mandate as the seven-day average of new cases has jumped from 73.4 on Nov. 1 to 218.1 on Nov. 23, according to state health data.

"A vast majority of the people have not yet seen the disease affect somebody," Benjamin said. "I think as [the COVID-19 numbers] grow, there will be more recognition from those leaders that they need to listen to the science."

Copyright © 2020, ABC Audio. All rights reserved.


Here's how long Thanksgiving leftovers last

JodiJacobson/iStockBy NICOLE PELLETIERE, ABC News

(NEW YORK) -- Before making a Pilgrim sandwich or a turkey pot pie, be sure to check guidelines for the fridge life of your favorite Thanksgiving eats.

Here's how long your leftovers will last in the fridge, freezer or both, according to the U.S. Department of Health and Human Services:

Turkey

Lasts four days in the fridge. Four months in freezer for best quality -- after four months it can dry out and lose flavor.

How to store turkey: Cut leftover turkey into small pieces and store separately in small containers.

Gravy

Up to four days in fridge. Up to four months in freezer.

Reheat gravy by bringing to a rolling boil. Cover to heat all the way through.

Homemade cranberry sauce

A week to 10 days in fridge. Freezing not recommended.

Canned cranberry sauce

Refrigerate after opening. Lasts one to two weeks. Freezing not recommended.

Potatoes and yams

Four days in fridge. Up to two months in freezer.

Stuffing

Up to four days in fridge. Two to three months months in freezer.

Pies

Fruit pies can be kept at room temperature for two days, according to Bettycrocker.com. They can then be stored in the fridge, loosely covered, for up to two more days. An unbaked crust will keep for two months in the freezer, while a baked crust will keep for four months.

More tips...

  • Refrigerate all leftovers within two hours at 40 degrees Fahrenheit or colder.
  • Leftovers should always be reheated to 165 degrees Fahrenheit.

Copyright © 2020, ABC Audio. All rights reserved.


Mom's post about dolls with disabilities shows why 'representation matters'

Lindsay FilcikBy GENEVIEVE SHAW BROWN, ABC News

(NEW YORK) -- Representation matters.

That's the reason behind one mom's viral post about dolls with disabilities. Her daughter, Ivy, has Down syndrome and now has a doll that looks just like her.

Lindsay Filcik told ABC News' Good Morning America she believes it is important for children with disabilities to see themselves represented in the toys they play with.

Her post has nearly 18,000 likes so far. She wrote in part, "Every single human being deserves to see somebody who looks like them in movies, books, commercials, and toys. Unfortunately for far too long that has not been the case. People of all races, abilities, body types, genders, religions, etc. need to be represented in what we watch, read, and play with. Recently we are seeing steps to remedy this problem in the media and I appreciate that! Representation matters!"

She continued: "Imagine being a child with a disability and all you ever see are typical, able bodied children. What message does that send you about yourself? That you are ‘abnormal’. That you are not worthy of being shown to the world. I know you’re reading this cringing inside, because of course no child should ever be made to feel that way. Lack of representation also hurts those children who are represented. They grow up with the incredibly skewed perception that everybody looks like them. And anybody who doesn’t isn’t ‘normal’ and should be feared. That my friends is how racism and ableism can be perpetuated in our kids without us even realizing it. Representation matters!"

The Grand Rapids, Michigan, mom's post includes two other girls playing with dolls who have disabilities similar to their own.

She wrote, "Look at these beautiful girls. Each one is represented by a doll that looks like them. Ivy has Down syndrome. Her doll looks just like her with almond shaped eyes and a button nose! Our friend Eliza has Spina Bifida. Her doll has forearm crutches (or sticks as Eliza says) & AFOs just like her! Our friend Stella has Spinal Muscular Atrophy. Her doll has a wheelchair just like her! Representation matters! "

Filick told GMA the post has been well received by parents of both disabled and non-disabled kids.

"Several parents of children who don't have disabilities told me they are adding a doll with a disability to their kids' Christmas lists," she said. "They had just never thought of it before."

Copyright © 2020, ABC Audio. All rights reserved.


Anticipating a vaccine, supply chain preps for challenges ahead

nevodka/iStockBy SASHA PEZENIK, ABC News

(NEW YORK) -- With the steady march toward a safe, effective and authorized coronavirus vaccine, another race now runs alongside: how to dispatch tens of millions of doses across every corner of the nation and globe, and do it safely, securely and swiftly. The solution will involve complicated logistical calculus, experts say, no matter which vaccine gets across the finish line first.

Pfizer's vaccine is likely to be the first to be granted authorization by the Food and Drug Administration, followed by one created by Moderna, and then possibly vaccines from AstraZeneca/Oxford and Johnson & Johnson, if the efficacy and safety data prove solid.

The U.S. government has promised a goal of "shots in arms" within 24 hours of FDA authorization of the first COVID-19 vaccine.

All about the money

Those responsible for the cross-country relay -- state and local public health officials and supply chain experts -- have hustled to marshal their resources, even as shortage concerns linger and officials warn the federal dollars they have received so far will not be enough.

"There's a light at the end, but that tunnel is still very long," Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, told ABC News. "We at the state level will soon be handed the baton and we need additional funding support from the federal government. What's at stake is nothing short of the velocity and equity with which we can get this vaccine to everyone in need."

More than a dozen states have told ABC News they will likely need additional funding, or are awaiting additional funding. In response to concerns raised by the National Governors Association, Operation Warp Speed has said it is in the process of planning to make additional funding and resources available to support vaccine operations, information systems and communications campaigns, though some officials still say more will be needed.

"Without those additional resources, it will be like putting up tent poles without having a tent," Shah said. "We've got to think through literally everything, from when the vaccine enters our borders to the time it goes into somebody's arm for injection."

That "last mile" of distribution may pose the rockiest stretch of the journey, experts say. Getting the vaccine from a central transportation hub to its final destination at local hospitals and pharmacies across the country will require unprecedented coordination and delicately calibrated conditions.

The U.S. government estimates having 40 million doses -- enough for 20 million Americans -- by the end of this year if the FDA provides authorization in early December. About half of those vaccine doses will be provided by Pfizer, with the other half by Moderna.

Cold storage

Pfizer's vaccine must be stored at temperatures colder than Antarctica in winter: roughly minus 94 degrees Fahrenheit. Doses would ship in dry ice thermal containers, stored either with replenished dry ice for up to roughly two weeks or stored in ultra-low temperature freezers. Moderna's vaccine also requires cold storage, though not as extreme: It can be stored around minus 4 degrees, the same as a commercial freezer.

Manufacturers, logistics providers, federal and state governments and health care systems have been shoring up their cold chain infrastructure for months, lining up equipment and transportation capacity.

"The clock starts ticking once those dry ice containers start shipping around," Dr. Mark Jarrett, chief quality officer of Northwell Health, New York's largest health system, told ABC News.

The Centers for Disease Control and Prevention told states and localities not to buy ultra-cold freezers for now, since the Pfizer vaccine will be shipped with dry ice "pizza boxes" that can keep it viable for up to 15 days, as long as there's fresh dry ice available. It can then last five additional days in a conventional freezer.

Dry ice faced "significant shortages" during the pandemic's spring surge, President and CEO of the Compressed Gas Association Rich Gottwald told ABC, warning in an April letter to Vice President Mike Pence.

In mid-October, the nation's governors penned a letter to the Trump administration with several concerns, including ultra-cold freezer and dry ice supply, and seeking clarity so that "no one is caught flat-footed when the time comes to vaccinate people."

The Compressed Gas Association now says they expect "sufficient" dry ice supply for COVID-19 vaccines.

"There may be issues with [the] COVID vaccine; the supply of dry ice will not be one of those issues," Gottwald said.

Still, some dry ice manufacturers and distributors are echoing those earlier warnings.

"Our system is already taxed beyond what the supply is right now," Tim Koerner, co-owner of the American Carbonation Corporation, told ABC News. "It could be close to sufficient, but it's gonna be tight."

UPS announced Wednesday it's ramping up dry ice production capabilities and launching a mobile freezer storage unit supply, noting "a major spike in demand" and the need to "plan for what some analysts fear may be a dry ice shortage" amid vaccine preparation.

Public health authorities and hospitals who can afford the investment are acquiring ultra-cold freezers, despite CDC guidance, to maintain supply chain agility.

Unsure how much vaccine they'll be receiving, David Reich, president of The Mount Sinai Hospital and Mount Sinai Queens, said they had bought a number of the freezers to be ready for whatever comes.

Henry Ford Health System in Michigan announced Wednesday it had received and begun installing six specialized freezers for the Pfizer vaccine, and six other freezers for the Moderna vaccine.

Distributing the vaccine

UPS Healthcare is collaborating with Stirling Ultracold, an Ohio company making laboratory-grade ultra-cold freezers, to supply portable models for storage of vaccines.

Demand has "dramatically increased," Stirling Ultracold CEO Dusty Tenney told ABC News. Sales are up 250% since the first quarter, with backorder times up to six weeks.

"There is a lot riding on everyone right now to make sure this is successful," Tenney said.

An onboard computer tracks temperature through the cold chain's many handoffs "to ensure that when they do arrive, there's no waste or loss associated with the vaccine's efficacy," Tenney said.

"Our job is to make sure nowhere in that process does it break down," Tenney added.

Stirling Ultracold hopes to have 2,000 portable freezer units in use by January. Each portable unit can hold 6,000 doses, allowing for 12 million of them throughout the country at a time.

"We were concerned about the freezers, and so we quickly purchased and pre-positioned them at certain sites along the health system," Jarrett, from Northwell Health, said. "That's one thing we've learned in COVID -- was try and be ahead of the curve."

Those freezers don't come cheap: each unit, depending on the model, ranges from $6,000 to more than $10,000.

"You can't strap [vaccine] on the back of 'Bob's truck,'" Shah said.

Maine has received $800,000 in federal funding so far, and "significantly more will be needed," as they ramp up logistics and manpower.

Dry ice also has flight restrictions, which could further hamper distribution.

Who gets the vaccine and when?

Not all the vaccine candidates share the need for shipping in extreme temperatures. In addition to Moderna's, which can be held in most standard freezers, the vaccines from AstraZeneca/Oxford and Johnson & Johnson don't need to be frozen at all and can be safely stored for months in a standard refrigerator.

But all vaccine shipments will face logistical problems for one reason or another.

"We need to address the fact that all last miles in this country are not equal. If logistics work against our most-vulnerable populations, we will further exacerbate the impact of this pandemic," said Dr. John Brownstein, an epidemiologist at Boston Children's Hospital and ABC News Contributor.

"We've already seen the incredible divide when it came to testing -- increased travel times for counties with lower population density and higher percent of minority and uninsured. Will the challenges of cold storage and the requirement for two doses further exacerbate health inequities when it comes to immunizations?" Brownstein continued. "We'll need further analysis to understand how these logistical challenges intersect with fair and equitable access."

"We have to be ready for all of it," said Dr. Abinash Virk, infectious disease specialist at the Mayo Clinic. "It's a complicated process now happening at supersonic speed."

Figuring out which front-line staff has priority for the injection's first wave, organizing electronic medical systems and data communication must be done before the first shot and before knowing which vaccine will be the one they're giving, Virk said.

"Pfizer has the most restrictive storage and transport requirements," Virk said. "If we're able to handle that, then, the subsequent ones, hopefully, will be able to handle much easier."

Vaccines requiring two doses offer their own unique coordination: Pfizer's needs a booster after 21 days while Moderna's requires one after 28 days. That means ensuring the right shipment arrives in time for the patient who needs their second dose.

That could get harder in remote areas.

"All this will be unfolding as the vaccine is literally rolling in trucks to get there," Dr. Robert O. Williams III, of the University of Texas at Austin's Division of Molecular Pharmaceutics and Drug Delivery, said. "For rural areas that don't have the same infrastructure and cold infrastructure, that's an added challenge."

"We're the last mile. And that's sometimes the toughest mile," Jarrett said. "And there may be hurdles, but that's never going to stop us from doing the right thing."

Copyright © 2020, ABC Audio. All rights reserved.


Los Angeles officials consider stay-at-home order as coronavirus cases keep climbing

tuachanwatthana/iStockBy IVAN PEREIRA and CAMMERON PARRISH, ABC News

(LOS ANGELES) -- Los Angeles County is on the brink of ordering new restrictions to combat the rising coronavirus cases, but the latest proposal made by the Health Department won't bring the area to a complete lockdown.

Health officials presented their recommendations for a future stay-at-home order during a meeting with county supervisors Tuesday, though the LA County Board of Supervisors has not moved forward with the "Safer at Home" order as of Wednesday afternoon.

The county set a threshold of a five-day case average of 4,500 or higher for a stay-at-home order to go into effect. On Monday, the county surpassed that threshold, but on Tuesday, the average was around 4,200, according to the Health Department.

LA County health officials said a new "Safer at Home" order would not be as restrictive as the one issued in March that closed schools and barred travel outside a household, except for groceries.

Their new recommendations include a ban of all public and private gatherings involving people not in the same household, except for outdoor church services and outdoor protests, and a 50% capacity requirement at outdoor retail stores.

The Health Department also recommended a 35% capacity for essential indoor businesses and a 20% capacity for non-essential indoor businesses. Under the recommended order, shoppers, employees and people who attend permitted gatherings would be required to wear face masks, according to the Health Department.

Outdoor parks, beaches and trails will remain open, and outdoor recreation will be permitted as long as residents practice social distancing and wear a mask, the department said.

"I know for sure we're not going back to all of the restrictions that were in place in the original Safer At Home order,'' LA County Public Health Director Barbara Ferrer told reporters during a conference call Tuesday.

The Health Department recommendations come as both LA and California continue to see spikes in cases and pressure on its health care providers. On Wednesday, Los Angeles reported 4,311 new cases and 49 new deaths.

Los Angeles County surpassed the county that encompasses Brooklyn, New York, as the county with the most COVID-19 fatalities in the country, with 7,543 total deaths, according to the Health Department and John Hopkins University’s Coronavirus Resource Center.

Health officials said Wednesday during a virtual news conference that one out of every 145 Los Angeles County residents is currently infectious, and they are expecting shortages in hospital beds, including ICU beds, in the next two to four weeks.

Dr. Christina Ghaly, the director of the Los Angeles County Department of Health Services, said there will likely be a doubling of cases every two weeks, possibly even tripling.

Despite holding off on a full stay-at-home order, county supervisors have proceeded with a plan to prohibit in-person dining. Eateries and bars will be able to offer take-out options, but they cannot serve customers either indoors or outdoors for the next three weeks, according to the order.

“From Oct. 31 to Nov. 14, outbreaks at food facilities have increased by 200%," Dr. Muntu Davis, the LA County Public Health Officer, said during the news conference.

County business leaders, including the Chambers of Commerce for West Hollywood and Culver City, also held a news conference Wednesday to denounce the move. They warned they may have to make tough decisions.

"On the eve of the Thanksgiving holiday, our businesses may have to lay off hundreds, if not collectively thousands of employees," Genevieve Morrill, president and CEO of the West Hollywood Chamber of Commerce, said.

The business leaders called on the county and state to consider long-term solutions that would not harm their operations and asked for a COVID-19 emergency business interruption fund to offset their losses.

"Just checking the boxes off to show the public that you’re doing something is not enough," Morrill said.

Copyright © 2020, ABC Audio. All rights reserved.


Scotland becomes first nation to provide free period products for all

zoranm/iStockBy KATIE KINDELAN, ABC News

(NEW YORK) -- Scotland made history this week, becoming the first country in the world to provide period products to all women for free.

The Period Products (Free Provision) Scotland Bill was passed unanimously by the Scottish Parliament on Tuesday.

Its passage means the government will now set up a nationwide program to "allow anyone who needs period products to get them free of charge." Schools, colleges and universities also must make period products available for free in bathrooms and the Scottish Government will now have the power to "make other public bodies provide period products for free," according to the legislation.

Nicola Sturgeon, Scotland's first minister, wrote on Twitter after the bill passed that she was "proud to vote for this groundbreaking legislation," which she heralded as an "important policy for women and girls."

 

Proud to vote for this groundbreaking legislation, making Scotland the first country in the world to provide free period products for all who need them. An important policy for women and girls. Well done to @MonicaLennon7 @ClydesdAileen and all who worked to make it happen https://t.co/4lckZ4ZYIY

— Nicola Sturgeon (@NicolaSturgeon) November 24, 2020

 

Scotland began offering sanitary products for free in schools, colleges and universities two years ago.

Monica Lennon, sponsor of the Period Products (Free Provision) Scotland Bill, has said that her goal was to make offering free sanitary products a legal requirement.

"A proud day for Scotland and a signal to the world that free universal access to period products can be achieved," Lennon wrote on Twitter after the bill passed.

 

Thank you to everyone who has campaigned for period dignity and to my MSP colleagues for backing the Bill tonight.

A proud day for Scotland and a signal to the world that free universal access to period products can be achieved. #freeperiodproducts 🏴󠁧󠁢󠁳󠁣󠁴󠁿 https://t.co/NC3e97jPuQ

— Monica Lennon (@MonicaLennon7) November 24, 2020

 

Period poverty, when people cannot afford even the most basic of period supplies like pads and tampons, is an issue that affects women around the world.

At least half a billion women and girls globally lack facilities for managing their periods, according to a 2015 report from the World Health Organization and UNICEF.

In the United Kingdom, the lockdown due to the coronavirus pandemic has exacerbated period poverty, with 3 in 10 girls there struggling to afford or access products, according to a report released in May by Plan International, a girls' rights organization.

In the U.S., where women make up more than half of the population, women are more likely than men to live in poverty, and they spend an average of 2,535 days in their lifetime, or almost seven years, on their periods, according to UNICEF.

A survey released last year of low-income women in St. Louis found that nearly two-thirds couldn't afford menstrual hygiene products in the past year, and more than 1 in 5 said they had the same problem every month. The women said they instead had to use cloth, rags, tissues, toilet paper and sometimes diapers or paper towels, according to the report published in Obstetrics & Gynecology.

Poor menstrual hygiene poses health risks for women, including reproductive issues and urinary tract infections.

The taboo around menstruation and the lack of access to menstrual products also hurts women economically because it costs them money for products and may keep them from jobs and school, advocates say. It also sets women back mentally and in a society where something that happens to them naturally is demeaned or even not discussed.

"Most of us have been conditioned for all of our lives to not talk about menstruation," said Jennifer Weiss-Wolf, a lawyer and author of "Periods Gone Public," told Good Morning America last year. "And the things that keep us potentially from succeeding are often the things that happen to be what we don't talk about in polite society."

Copyright © 2020, ABC Audio. All rights reserved.


Potential COVID-19 surge following Thanksgiving could cause 'humanitarian crisis,' experts warn

izusek/iStockBy ARIELLE MITROPOULOS, ABC News

(NEW YORK) -- As Americans prepare for what will likely be an untraditional Thanksgiving, health experts and state officials are pleading with the public to heed their warnings to not travel and to avoid large gatherings and the mixing of households, as the country tries to get a hold on what experts call an "uncontrolled" spread of the coronavirus.

"If we layer in travel and large indoor gatherings which we know are drivers of transmission, we expect to see a massive surge on top of an already dire situation," said Dr. John Brownstein, chief innovation officer at Boston Children's Hospital and an ABC News contributor, warning that such a surge could result in a "humanitarian crisis."

Holidays have proven to be a catalyst of COVID-19 spread across the country. Earlier this year, after each summer holiday, the U.S. reported a significant uptick in infection across the country, and experts say Thanksgiving could have all the components of a potentially deadly event.

Prior to Memorial Day in May, the national seven-day average of new cases was hovering around 21,000 new cases a day. Five weeks later, that average had doubled, according to an ABC analysis of data compiled by the COVID Tracking Project.

A similar pattern occurred just over a month later following the Fourth of July weekend. Less than three weeks after Independence Day, the average number of new cases had risen by almost 40%, with nearly 60,000 patients hospitalized.

And after the summer surge began to decline, it was shortly after Labor Day that new cases began to rise again, bringing the country to its latest surge. As the weather got cooler, public health experts who had long warned against large gatherings began sounding the alarm that even small gatherings -- particularly those that are indoors, with poor ventilation -- could drive COVID-19 transmission.

Since mid-September, the number of daily coronavirus cases has increased by nearly 400%, and now the virus is significantly more widespread than it ever was during the summer.

The national average of daily new cases is now more than 100,000 higher than it was in July and five times higher than it was during the initial peak in April.

In the month of November alone, the U.S. has reported nearly over 3.2 million COVID-19 cases, making it by far the worst month on record for daily cases, with a quarter of the country's total cases.

Cases are rising in all but one state, Hawaii, while current hospitalizations are increasing in 48 states, Washington, D.C., and Puerto Rico.

Daily deaths in the U.S. are up by more than 30% from just last week, with 10,617 deaths recorded over the last seven days -- a rate of approximately one death reported every minute.

In preparation for the potential fallout, the Centers for Disease Control and Prevention released new guidance last week that strongly recommended postponing travel and staying home this year as "the best way to protect yourself and others."

"Celebrating virtually or with the people you live with is the safest choice this Thanksgiving," the CDC said.

Dr. Anthony Fauci, the nation's top infectious disease expert, has been taking to the airwaves, repeatedly advising Americans to limit Thanksgiving gatherings to members of the same household.

"The travel, the congregate setting, not wearing masks -- the chances are that you will see a surge superimposed upon a surge," Fauci warned. "What we're doing now is going to be reflected two, three weeks from now."

This message, to please stay home, has been echoed by governors and local officials across the country.

"We don't really want to see mama at Thanksgiving and bury her by Christmas," Mississippi State Medical Association President Dr. Mark Horne said during a virtual meeting last week.

"This year, if you love someone, it is smarter and better to stay away -- as hard as that is to say and hear," said New York Gov. Andrew Cuomo in a press release. "Because if I had to predict, you're going to see a significant spike post-Thanksgiving."

Massachusetts Gov. Charlie Baker is also advising residents to only gather with members of their own household.

"We are urging everyone to make a difficult choice this Thanksgiving," Baker said during a press conference last week. "We saw what happened in Canada when they had their Thanksgiving in October."

And seven Midwestern governors -- five Democrats and two Republicans -- joined forces in a video and opinion piece in the Washington Post to deliver a bipartisan message urging precautions during the upcoming holiday.

"Think about your last Thanksgiving and the people you were surrounded by," they said. "Picture their faces -- laughing with you, watching football with you or even arguing with you about politics. As hard as it will be to not see them this Thanksgiving, imagine how much harder it would be if their chairs are empty next year."

"We must make short-term sacrifices for our long-term health," the video concluded.

Despite the warnings, millions are still traveling this holiday, with the Transportation Security Administration this past Sunday screening over one million people for only the second time since the start of the pandemic.

And while the role of indoor gatherings in viral transmission cannot be fully quantified, experts stress that they greatly contribute to the spread of COVID-19.

"These gatherings are in conditions with poor adherence to social distancing and masking along with suboptimal ventilation," Brownstein said.

Experts also say that travelers getting tested before they head home does not mean they're protected.

"The confusion around testing also means that many false negatives will give an unwarranted sense of security to those asymptomatic cases or cases during the presymptomatic phase," Brownstein said, adding that "because of this significant countrywide population mixing, we expect hospitalizations will cross 100,000 and deaths to approach 300,000 by the end of the year."

But ultimately, for millions of Americans, these COVID-19 numbers are much more than just statistics; they represent family members and friends lost to the virus, who will be missing this holiday.

"I can understand the humans behind those numbers," Brandie Kopsas-Kingsley, an ICU Nurse from IU Health Indianapolis, Indiana, told ABC News. "Every single one of those was a life, and a person that mattered. As we celebrate Thanksgiving, that is an empty chair. And all of us have a great responsibility to quarantine, to stay safe, to not go see others."

Copyright © 2020, ABC Audio. All rights reserved.


Here are the top five ways climate change is already hurting your health

Toa55/iStockBy RAMIE FATHY, ABC News

(NEW YORK) -- With the COVID-19 pandemic dominating the headlines, President-elect Joe Biden has just released his administration's plan to address another potentially catastrophic global threat: climate change.

Scientists warn that it's not just plants and animals threatened by rising temperatures -- climate change is impacting humans as well. And for medical experts, this is particularly troubling.

"We're in it now," said Dr. Paul Auerbach, an emergency medicine physician at Stanford University and author of Enviromedics, the pioneering book on climate change and health. "It's happening, and it all boils down to health. This is a health care issue."

Though the effects of climate change on health are numerous, they remain unfamiliar to many. Climate change has now been linked to heat-related illnesses, the spread of infectious disease, physical harm from extreme weather, health complications related to poor air quality, and other individual and public health harms.

Perhaps most importantly, climate change could become one of the main drivers of future novel outbreaks, and may have contributed to the current COVID-19 pandemic.

"The next global pandemic could be, in some capacity, due to climate change," said Dr. Jesse Bell, professor of Health and Environment at the University of Nebraska Medical Center College of Public Health.

ABC News spoke with a variety of health experts to determine the top five ways climate change is affecting human health.

Heat-related illness

As the planet gets warmer, people across the globe are beginning to feel the heat.

"Right now, the clearest effects of climate change are through heat," said Dr. Aaron Bernstein, a pediatrician and interim director of the Center for Climate, Health, and the Global Environment at the Harvard T.H. Chan School of Public Health.

"More people die each year from heat -- more than from many medical problems," Bernstein said, noting that heat waves may aggravate a wide range of illnesses, from asthma to mental health disorder to diabetes and kidney disease.

So dire is the threat to human health that Bernstein helped compile guidelines for educating medical trainees about the health effects of climate change.

"Heat waves likely kill more people in the U.S. than any other climate-related disaster, because heat waves occur everywhere across the U.S., including places as different and distant as Nebraska, Los Angeles, New York City, and Seattle," said Bell.

Infectious disease

As anyone who has eaten leftovers that have been left out too long can attest, infectious agents -- and the bugs that carry them -- thrive in particular environments and conditions. And as climate change alters environmental conditions across the planet, so too does it affect the geographic distribution of infectious diseases.

"Some infectious diseases that were already present in North America, like Lyme disease, leishmaniasis, and various fungal infections, have already become an issue in areas that were previously unaffected by them," said Dr. Misha Rosenbach, a dermatologist and climate change activist at the University of Pennsylvania.

According to the Centers for Disease Control and Prevention, the number of Lyme cases in the U.S. has more than tripled since 1995, and rates continue to rise.

Meanwhile, climate change has also facilitated the spread of waterborne infectious diseases.

"Warmer temperatures around the globe cause rising sea levels, warmer seawater, and either more frequent or increasingly severe natural disasters like hurricanes and floods," said Rosenbach. "And each of these events is associated with a range of infectious diseases, including life-threatening diarrheal disease, respiratory infections, and skin infections."

Natural disasters, such as recent hurricanes Harvey and Sandy, brought diseases like cholera and bacterial infections in their wake, according to Dr. Saul Hymes, an assistant professor of clinical pediatrics and a specialist in pediatric infectious diseases at Stony Brook Children's Hospital.

Climate change is also a driving force behind "spillover" events, in which viruses leap from their animal hosts into humans, Hymes said.

"Climate change causes disruption to natural animal habitats, and also movement of people into new habitats to avoid flood regions or drought-prone areas," Hymes said. "This can bring humans and animals into more contact and lead to increased likelihood of disease crossover events like those we are seeing more often, including SARS-CoV-2."

Extreme weather events

Along with the ongoing pandemic, 2020 has also witnessed a record-breaking hurricane season as well as wildfires and floods across the globe -- and climate change is thought to be contributing to the severity of all of these extreme weather events.

Experts predict that these are not outlier events but rather the start of a new normal.

"These trends will likely continue over the next century," Bell said.

And extreme weather events have indirect health impacts by creating refugee areas.

"As with the Astrodome in Houston after Katrina, these can become overcrowded and thus are hotbeds for transmission of flu and other common person-to-person viral infections," Hymes said.

Air quality

Another way climate change affects human health is through its impact on air quality. While the burning of fossil fuels directly pollutes the air, global warming that's a byproduct of fossil fuel combustion also contributes to and exacerbates worsening air quality.

"For one, climate change has led to drought and to heat waves that have caused the California wildfires, and the smoke and particulates in the air directly harms those with respiratory issues like COPD or asthma," Hymes said.

Even without wildfires, rapid temperature swings and ozone depletion can exacerbate respiratory illnesses like asthma, according to Hymes. Meanwhile, climate change can influence air quality and human disease through an intermediary: plants.

"Warmer climate and longer summers have led to alterations in pollination and flowering cycles -- some plants now undergo a second flowering in a season, for example," said Hymes. "In general, there's been either a significant increase in pollen counts or a major shift in their timing, or both. And these are often significant asthma triggers as well as affecting other allergic conditions."

Mental health and trauma

According to Bell, extreme weather events can spur mental distress.

"The psychosocial impact of extreme weather events is huge," he said. "People have their possessions and homes destroyed. They must move and rebuild and often are doing so with much of their wealth obliterated. This can cause significant mental distress, rates of depression and anxiety, as well as PTSD rise in survivors of such events."

Some researchers have already begun documenting the psychological impacts of climate change, including major depression, anxiety, PTSD and adjustment disorders, as well as increases in drug and alcohol use and domestic violence. The chronic stress caused by climate disasters has also been associated with worse cardiovascular health.

"It is absolutely imperative that we address these psychological issues because they have impacts on everything: personally, socially, economically, politically," said Dr. Lise van Susteren, a psychiatrist and environmental activist.

But to van Susteren, climate change's effects on mental health extend far beyond the individual level.

"Injuries, deaths, houses being burned down or flood, the loss of possessions and general disruption of life -- these all have a psychological toll," van Susteren said. "In turn, all of these psychological damages have an impact on our physical health, and this has repercussions on all aspects of our lives."

Though climate change has already begun to impact our health and well-being, scientists and doctors say it's not too late to take action to combat it and to mitigate its effects -- through personal choices to reduce your carbon footprint, through community action, and through smart policy.

"Realize that everything you do is part of the collective, and realize that you're setting the social norm," said van Susteren. "It all begins at home."

Copyright © 2020, ABC Audio. All rights reserved.


Spending Thanksgiving alone this year? Here are five tips to combat loneliness

bhofack2/iStockBy KATIE KINDELAN, ABC News

(NEW YORK) -- As Americans are urged to stay home and celebrate Thanksgiving either alone or only with people in their household to help stop the spread of COVID-19, it's clear the holiday, normally a time of gathering, is going to look a lot different this year.

On Pinterest, searches for "Thanksgiving for one" are up nearly 70% this year, according to the social sharing site. Zoom, a video communications company, announced it will waive its 40-minute time limit on free accounts on Thanksgiving Day to help families stay in touch.

While some people may be home alone on Thanksgiving by choice, following safety guidelines, other families will be missing loved ones at the Thanksgiving table who are hospitalized with COVID-19 or who have passed away from the virus over the past nine months.

Still others may be coping with a deployment or a divorce, separation or estrangement that unfolded during the pandemic.

"What many people are going to experience this year, for a variety of reasons, is that their holiday table is not going to be as full as it normally is," said Kory Floyd, Ph.D., an author and professor of interpersonal communication at the University of Arizona. "Many American households are going to experience a sense of deprivation this year."

"Especially on a holiday, when it’s a time to celebrate and be around loved ones, that accentuates a sense of loneliness," he said.

Since we already know Thanksgiving will be different this year, there are things people can start to plan now to make the day less lonely, experts say.

Here are five tips to make Thanksgiving a joy-filled day regardless of who you are, or are not, spending it with:

1. Make a plan

Planning ahead the fun things you'll do on Thanksgiving, or the new traditions you'll start, can both help ease the stress and uncertainty of the day and help you from obsessing over what could have been, according to Floyd.

"Think now of things you’ll plan for that day that will be positive distractions," he said. "The benefit of [planning ahead] is we’re ready and we’re prepared, and we’re prepared to enjoy and find meaning and find joyfulness in whatever we do with that time."

Planning ahead can be as detailed as what time you'll eat meals and do activities to a more general list of the movies you want to watch or the activities you can do outside in fresh air, experts say.

Floyd recommends planning something that feels indulgent on what is still a special day of the year.

"What feels indulgent to people will vary from person to person," he said, giving examples of a bubble bath or a decadent dessert. "But make it something that goes beyond the ordinary and feels really special and allow yourself the freedom to enjoy it, to lean into it."

2. Find ways to help other people

Doing something good for someone else can take the focus off yourself and help ease feelings of loneliness or discontent, according to Nicole Beurkens, Ph.D., a holistic child psychologist and the founder and director of Horizons Developmental Resource Center in Caledonia, Michigan.

Amid the coronavirus pandemic, that could mean dropping items off at a nursing home, preparing boxed meals for neighbors or delivering books and needed items to women's and children's centers, recommends Beurkens.

"Sometimes the best way to soothe ourselves is to do something outside of ourselves," she said.

3. Phone a friend or loved one

Even if you can't physically be with your loved ones on Thanksgiving, it's important to find ways to stay in touch with people, recommend both Floyd and Beurkens.

"Over the course of the pandemic, we haven’t nationally seen an increase in average levels of loneliness, and in fact they’ve been trending slightly in the opposite direction," said Floyd. "One of the explanations for that is we have so adapted to all of the communication modalities that we have available to us. We have so many ways to connect now."

Plan ahead to make sure you can call, Skype or Zoom with friends and relatives on Thanksgiving, whether it's just talking to catch up or taking part in holiday traditions together via technology. If the technology is too much, spend the down time you may have that day writing letters to family and friends or simply thinking about who in your life you're grateful for.

4. Think ahead to next year

While it's normally important to stay in the moment and not look ahead or behind, experts say this year it is fine, and even healthier, to already look ahead to Thanksgiving 2021.

"It gives a sense of forward-looking motion that helps people not feel as heavy a sense of what is going on now," said Floyd. "It reminds people that this is temporary and things will get better."

Floyd said he is reminding his patients that no matter how bad this year feels, it is temporary, and it is okay to start thinking ahead to things like travel and gathering again in-person with family and friends.

His advice is to be specific when thinking about the future, picturing things like exactly where you want to travel to, who you will spend Thanksgiving with next year and what new traditions you may want to start.

5. Be okay with shedding some tears


The advice from experts like Floyd and Beurkens is not meant to make people feel like they should not feel sad or lonely, they say, but to help them see and get to what's next.

"It's not getting over the emotions, but getting through them," said Floyd. "The last thing people should do is be ashamed of those emotions."

Both experts say it's okay and perfectly normal to spend a few moments on Thanksgiving shedding tears or sitting for a bit with grief over what a strange holiday, and year, this has been.

"The strategies I’m talking about here are what to do next so that emotion doesn’t become the focus of the day," said Floyd. "We can still generate joy even though there’s a sense of sadness or a sense of loss."

If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting HOME to 741741. You can reach Trans Lifeline at 877-565-8860 (U.S.) or 877-330-6366 (Canada) and The Trevor Project at 866-488-7386.

Copyright © 2020, ABC Audio. All rights reserved.


COVID-19 patient recovers from double lung transplant: 'I'm thankful every day'

Courtesy of the Werner familyBy HALEY YAMADA and ROBERT HENAULT, ABC News

(NEW YORK) -- Carl Werden wants to serve as a warning for others who contract COVID-19 and may not be as lucky as him.

"I never realized how terrifying it is not being able to breathe," said the 57-year-old, who is currently recovering after a double lung transplant.

Werden developed lung fibrosis, a complication due to his battle with COVID-19, and said he was left with no other choice.

"[COVID-19] damaged my lungs so bad that I got to the point where there was no other option left but a lung transplant, because my lungs were just going to get worse," Werden told ABC News.

Werden contracted COVID-19 earlier this year and, although he recovered from the virus itself, he became critically ill while traveling from South Carolina to Connecticut in June.

On June 26, Werden was hospitalized in Hartford, but as his condition worsened he was transferred to Brigham and Women's Hospital in Boston.

"There's only about 120 hospitals in the country that do lung transplants so it's a very small number of hospitals," said Dr. Hari Mallid, program and surgical director of the lung transplant program at Brigham and Women's Hospital.

"When [Carl] arrived we repeated some of the CAT scans which confirmed the diagnosis that the COVID-19 had done pretty extensive damage to his lungs and really his only treatment at that point was a lung transplant," said Mallid.

Mallid told ABC News that the transplant was necessary if Werden was going to live.

"He would've ended up on a ventilator and gradually gotten worse and worse until there was basically nothing we could do to keep him alive," said Mallid, who performed Werden's operation on Oct. 29.

Werden is now recovering and working to gain strength in his new lungs. Mallid said that Werden is doing "remarkably well."

"He was taken off the ventilator fairly quickly after the transplant, he's walking around the hospital, even before he went to rehab, his appetite is coming back," Mallid told ABC News.

Werden said he has many things to be thankful for.

"I'm thankful to the person I got the lung[s] from. I'm thankful to the doctors that did the surgery. I'm thankful for my family because they were always there for me," said Werden, whose family has set up a GoFundMe page to help cover his medical expenses.

While Werden is doing well, he still has a long road to full recovery.

"I was a completely healthy person, nothing wrong with me, and look how [COVID-19] affected me," said Werden. "[People] need to take it seriously because all they have to do is look at me."

Copyright © 2020, ABC Audio. All rights reserved.


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