Health

(BUFFALO, N.Y.) — Dr. Michael Manka had just finished his shift at Erie County Medical Center in Buffalo, New York, Saturday afternoon and was getting ready to head home.

Then the hospital received a call: a gunshot victim was being transported. Soon, the center learned that there had been a mass shooting with multiple victims.

In total, 13 people were shot at Tops Friendly Market, a supermarket 2.5 miles away, in what the Buffalo Police Department described as a racially motivated attack.

Of the victims, 10 were killed and the remaining three — identified by authorities as Zaire Goodman, 20; Jennifer Warrington, 50, and Christopher Braden, 55 — were rushed to ECMC.

“Initially, we did not know how many victims were going to be coming to the hospital and we were preparing for the worst like we typically do with mobilizing our teams, getting as many nurses, doctors, anesthesia teams ready for the arrival of multiple gunshot victims,” Manka, chief of emergency medicine at ECMC, told ABC News.

Goodman was the first victim who arrived at ECMC with a gunshot wound to the upper back and neck, according to the doctor and police.

Manka said Goodman underwent an initial assessment to make sure that his breathing, blood pressure and circulation were stable. Next was to make sure he didn’t have a spinal injury or any other internal injuries.

Doctors determined he had some shrapnel trapped under the skin but that it did not need to all be removed.

“Shrapnel or bullets will be — depending on where they’re located in the body — will be left alone because going searching and trying to dig them out can often do more harm than benefit if it’s in a joint, if it’s very near a major vascular structure,” Manka said. “More often than not, bullet fragments and shrapnel are left alone and, in the body, just heals over them.”

He added that because Goodman was stable enough, he was able to be discharged and sent home Saturday.

“He was unfortunate that he was involved in this incident and shot, but he was fortunate that he didn’t have any serious life-threatening injuries,” Manka said.

The second patient, Warrington, had a graze to the scalp, although it’s unclear whether it was a bullet or a piece of shrapnel that inflicted the injury.

Manka said she underwent the same initial assessment as Goodman, as well as CT scans to make sure nothing had penetrated the skull and into the brain.

“The patient was fortunate that the wounds were not life-threatening and did not require additional care really,” he said. “The patient was awake and alert and stable and … thankfully, was discharged home.”

Braden, the third patient, had the most serious injury: a gunshot wound to the lower leg.

“The third victim that came in … had a pretty bad fracture from the gunshot wound and thankfully was stable but did require an operation to try and fix his leg,” Manka said.

He said when a bullet hits a bone, such as in the leg, it can often shatter the bone as opposed to causing a clean break.

Manka said Braden’s injury may require an external fixator, a metal device that attaches to the bones of the arm, leg or foot with pins and holds the bones together to allow the injury to heal.

He added that he is not sure if Braden will need additional surgeries but that he is still hospitalized in stable condition.

“Typically, a fracture patient will be in the hospital for a handful of days, maybe getting some IV antibiotics to prevent infection and making sure that the extremity is healing OK, without any complications,” Manka said. “This patient may or may not be in the hospital for more than a few days. I think it depends on what the orthopedic plan is to definitively fix that fracture.”

Manka said recent U.S. military conflicts have shed light on the best practices for saving lives and have become standard among civilian paramedics.

“Probably the biggest one that we’ve seen have an impact would be the use and the encouraged use of tourniquets,” he said.

Tourniquets are tight bands that completely stop a traumatic wound from bleeding before or during transport for treatment.

Even though tourniquets have been around since the days of Alexander the Great, they fell into disuse during the end of the 20th century, Manka said, after experts claimed the devices were causing too many patients to have limbs amputated because the blood supply had been cut off for too long. However, recent studies have found that tourniquets “dramatically decrease death from uncontrolled hemorrhage” both on the battlefield and among civilians.

Of the Buffalo shooting victims, Braden had a tourniquet applied to his leg by EMTs before arriving at the hospital.

“It’s hard for me to tell you whether that patient was bleeding enough that [the tourniquet] is what made the difference, but certainly if he was bleeding profusely at the scene, which I suspect he must have been [since] EMS decided to put a tourniquet on, that may have helped maintain his stability on the way to the hospital,” Manka said.

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(NEW YORK) — COVID-19 vaccines could have prevented at least 318,000 virus-related deaths between January 2021 and April 2022, a new analysis found.

The analysis used real-world data from the Centers for Disease Control and Prevention and The New York Times and was done by researchers from Brown School of Public Health, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, and Microsoft AI for Health.

Their findings suggest that at least “every second person” who died from COVID since vaccines became available might have been saved by getting the shot.

“At a time when many in the U.S. have given up on vaccinations, these numbers are a stark reminder of the effectiveness of vaccines in fighting this pandemic,” said Stefanie Friedhoff, associate professor of the practice in health services, policy and practice at the Brown University School of Public Health, and a co-author of the analysis. “We must continue to invest in getting more Americans vaccinated and boosted to save more lives.”

Although the national average indicated that approximately 50% of deaths were preventable, researchers said there were large differences among states — ranging from 25% to 74% vaccine-preventable deaths.

West Virginia, Wyoming, Tennessee, Kentucky and Oklahoma lead the list of states where the most lives could have been saved by COVID-19 vaccines, while states with higher vaccination rates, such as Washington, D.C., Massachusetts, Puerto Rico, Vermont and Hawaii, showed the lowest numbers of vaccine-preventable deaths.

“This compelling data illustrates the trajectory of 50 states with 50 different fates during the COVID-19 pandemic, emphasizing the important role of vaccines in protecting lives in each state,” added Thomas Tsai, a surgeon at Brigham and Women’s Hospital and assistant professor in health policy and management at Harvard T.H. Chan School of Public Health.

The study comes just as the nation surpasses 1 million lives confirmed lost to COVID-19.

“It is really painful as a scientist, a physician and a public health official to see the overwhelming data that showed the difference between vaccinated versus unvaccinated and boosted when it comes to hospitalizations and deaths,” Dr. Anthony Fauci, the White House’s chief medical adviser, said during an interview with CNN last week. “You have this disparity of morbidity and mortality, that staring you right in the face and it’s amazing — 1 million deaths.”

To date, more than 220 million Americans have been fully vaccinated, 100 million of whom have received their first COVID-19 booster, according to CDC data. However, about 92 million eligible Americans — about half of those currently eligible — have yet to receive their first booster shot.

“Certainly, we could have prevented at least a few 100,000 of those deaths of people who were eligible to be vaccinated, gotten vaccinated,” Fauci said. “I just wish people would look at the data and believe the data it’s not made up. It’s real.”

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(WASHINGTON) — Inclined sleepers for babies and crib bumper pads will be banned from being manufactured and sold under legislation signed into law Monday by President Joe Biden.

Biden signed the bill, the Safe Sleep for Babies Act, into law less than two weeks after it was passed by Congress.

The legislation defines inclined sleepers as “those designed for an infant up to one year old and have an inclined sleep surface of greater than 10 degrees.” Crib bumpers are defined by the law as “padded materials inserted around the inside of a crib and intended to prevent the crib occupant from becoming trapped in any part of the crib’s openings.”

Rep. Carolyn B. Maloney, chairwoman of the U.S. House Committee on Oversight and Reform, which led an investigation on the infant sleep products, said the products now banned have been linked with “hundreds of infant deaths.”

“My Committee’s nearly two-year investigation revealed that deficient safety reviews, unscrupulous marketing practices, and flaws in our nation’s consumer product safety system allowed companies to keep these products on the market,” Maloney said in a statement. “Too many families have suffered an unimaginable and totally avoidable loss. While nothing will bring back their loved ones, with the passage of this law, we can at least ensure that babies will no longer be put at risk by these dangerous products.”

Erika Richter, of Portland, Oregon, said not wanting another parent to experience the loss of a child is what motivated her to speak out after her 2-week-old daughter, Emma, died in 2018 while using a Fisher-Price Rock ‘n Play sleeper, a type of inclined sleeper banned under the new law.

It was only after Emma’s death that Richter said she learned about reports of other infant deaths associated with Rock ‘n Play sleepers, which were recalled in 2019 by the Consumer Product and Safety Commission after being linked to over 30 deaths.

“I thought to myself, ‘If I had just known sooner,'” Richter told “Good Morning America” earlier this month, when the bill passed Congress. “I wish that somebody had done what I’m doing and what some of the other mothers are doing more publicly around the time that I had Emma.”

In 2020, Richter filed a lawsuit against Fisher-Price for wrongful death and gross negligence. The case is ongoing in Los Angeles County Superior Court and Richter declined to provide details on her daughter’s cause of death due to the litigation.

In its answer to the lawsuit, Fisher-Price has denied all of the allegations and specifically denied “that because of an act or omission by them, their agents, or independent contractors, Plaintiffs were injured or damaged in any sum, or at all.”

Last June, Richter shared her story publicly for the first time at a congressional hearing that followed up on a report from the House Committee on Oversight and Reform. The report found Fisher-Price ignored repeated warnings that its Rock ‘n Play sleeper was dangerous before the device was recalled.

The report found more than 50 infant deaths were linked to the sleeper, which puts infants at a 30-degree incline.

The cause of death for some of the babies was asphyxia, or the inability to breathe, due to the child’s position, the report said.

“We trusted a name brand, and we were wrong,” Richter said in her testimony, holding up baby clothes as a reminder of what she has left to remember her daughter.

When Richter first shared her story publicly last June, a spokesperson for Mattel, the parent company of Fisher-Price, told ABC News in a statement there “is nothing more important” to the company than the safety of its products and that its “hearts go out to every family who has suffered a loss.”

“The Rock ‘n Play sleeper was designed and developed following extensive research, medical advice, safety analysis and more than a year of testing and review,” a spokesperson said, adding that independent medical and other expert analyses verified that the sleeper was safe when used in accordance with its instructions and warning. “It met or exceeded all applicable regulatory standards. As recently as 2017, the U.S. Consumer Product Safety Commission (CPSC) proposed to adopt the ASTM voluntary standard for a 30-degree angled inclined sleeper as federal law.”

A Mattel spokesperson confirmed to ABC News Thursday the Rock ’n Play Sleeper is no longer on the market, noting it, “was sold from its introduction in 2009 up until its voluntary recall in April 2019.”

Guidelines from both the CPSC and the American Academy of Pediatrics say caregivers should always place infants to sleep on their backs on a firm, flat surface and should never add “blankets, pillows, padded crib bumpers, or other items to an infant’s sleeping environment.”

In addition, caregivers should not use infant sleep products with inclined seat backs of more than 10 degrees, and should not use infant car seats, bouncers and other inclined products for sleep, according to the guidelines.

Around 3,400 babies in the U.S. die each year while sleeping, in sudden and unexpected deaths, according to the AAP, which issued a statement Wednesday applauding the passage of the Safe Sleep for Babies Act.

“The message from pediatricians has long been clear: the safest sleep environment for babies is a firm, flat, bare surface,” AAP’s president, Dr. Moira Szilagyi, said in a statement. “Despite what the science shows, crib bumpers and inclined sleepers have remained on the market and store shelves, misleading parents into thinking they are safe and leading to dozens of preventable infant deaths.”

Experts say that padded crib bumpers, which are also banned under the new legislation, pose a particular potential danger because babies may turn their faces into the bumper’s padding, raising the risk of suffocation, may become entrapped underneath or around the bumper, or may become entangled in the bumper’s ties, increasing the risk of strangulation.

Even when federal crib standards changed in 2011, mandating a smaller distance between crib slats so babies would not get their heads stuck between them, crib bumpers — which arguably had lessened that risk — became unnecessary, but they remained on the market, despite the safety risk, according to Dr. Ben Hoffman, a professor of pediatrics at Oregon Health & Science University and chairman of the AAP’s Council on Injury, Violence, and Poison Prevention.

“There is an assumption that [products] are safe until they are proven dangerous, as opposed to what I think the public believes, which is if something is sold, it is safe,” Hoffman told ABC News last year.

Richter said she too has learned from her advocacy work since Emma’s death that parents need to be cautious consumers when it comes to the products they use with their kids.

“I have learned that we have a long way to go when it comes to consumer protections, and that legacy brands do not equal trust,” she said. “People die because they make assumptions that the brands themselves are doing their due diligence, and you cannot put that type of control in the hands of a profit maker or profit owner.”

Richter said she plans to continue to push for more consumer controls, including calling on Congress to repeal a provision, 6B, in the Consumer Product Safety Act that she claims allows companies to “self-regulate” when it comes to product safety.

Richter said she also plans to keep speaking out to raise awareness and make sure banned infant sleep products don’t end up in the hands of other mothers.

“I’m still a mom. I’m still Emma’s mom. I still have that responsibility, and I still think like a mom and I still want to protect other moms and other children,” she said. “That is so important to me.”

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(NEW YORK) — In the wake of the tragic milestone of 1 million official COVID-19 deaths in the United States, a new analysis found that without vaccines, the virus would have likely claimed more than 100,000 additional lives in 2021.

The analysis, sponsored by Pfizer, estimated that the Pfizer vaccine alone likely saved more than 110,000 lives in 2021, the first year of the vaccination campaign.

Though Pfizer sponsored the analysis, experts interviewed by ABC agreed it was reasonable, echoing prior estimates that the death toll would have been more than three times in 2021 in the absence of effective vaccines.

“With this model, I don’t see the numbers falling out of range and I do suspect that they are a reasonable representation of what could’ve happened in the absence of COVID-19 vaccines,” Dr. Amesh Adalja, FIDSA, infectious disease specialist at the Johns Hopkins University Center for Health Security, told ABC News.

The analysis did not include an estimate of lives saved from vaccines from Moderna or Johnson & Johnson.

“In some ways, it could even be a potential undercount,” John Brownstein, Ph.D., epidemiologist and chief innovation officer at Boston Children’s Hospital, and ABC contributor, said.

The analysis is significant, experts said, because it’s essential for everyday Americans to understand that vaccines save lives — especially in the face of ongoing vaccine skepticism and misinformation.

“We’ve seen in real-world analysis or modeling studies like this one that have shown the role that vaccines have played … and hopefully, this is one more additional data point to help reaffirm how these vaccines play such a pivotal role in changing the course of this pandemic,” Brownstein said.

The new Pfizer vaccine analysis estimates the company’s vaccine prevented 8.7 million symptomatic cases, 690,000 hospitalizations and 110,000 deaths in 2021. Included in these projections, are approximately $30.4 billion saved in health care costs.

The Pfizer vaccine is the most-utilized vaccine in the U.S., with more than 120 million Americans choosing Pfizer for their initial two-shot series, according to the Centers for Disease Control and Prevention.

When modeling the potential outcomes, researchers used data on projected infection rates, average times lost at work due to infection, vaccine efficacy, vaccination rates, and risks of being infected or hospitalized.

Although hundreds of Americans still die of COVID-19 every day, doctors on the frontlines said there is a marked difference in the pre-and post-vaccine era.

“I worked in the ICU in May 2020 and it was staggering the amount of patients — I only had three patients that made it out alive,” Dr. Katie Adib, internal medicine resident physician at The Ohio State University, told ABC News.

“Now there are nowhere near the amount of people,” Adib said. “Those in the ICU who have been vaccinated tend to make it out.”

The CDC recommends that everyone ages 5 and older get vaccinated against COVID-19, and those who are eligible to also seek booster shots for further protection.

“I 100% think the vaccines have saved lives,” Adib said.

Rebecca Fujimura is a Family Medicine resident physician at MedStar Health/ Georgetown-Washington Hospital Center and is a contributor to the ABC News Medical Unit.

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(AVON, Ind.) — An Indiana women who suffered a heart attack at age 14 is now celebrating a new start in her life after undergoing a heart transplant.

Jaelyn Kinchelow, of Avon, Indiana, was running at her middle school track practice nearly a decade ago when she said she felt a tightness in her chest.

“All I could remember was myself slowing down because I just couldn’t keep up,” Kinchelow told Good Morning America. “Shortly after that, my legs gave out and I fell to the ground.”

Kinchelow was transported by ambulance to a local hospital, where she was diagnosed with a heart attack and quickly underwent open-heart surgery.

Surgeons repaired a torn coronary artery wall using a vein from Kinchelow’s leg, but permanent damage to her heart remained.

“After surgery my heart was only functioning at about 5%. They put me on an ECMO machine,” Kinchelow said, referring to an extracorporeal membrane oxygenation machine, which removes carbon dioxide from the blood and sends back blood with oxygen to the body, giving the heart and lungs time to heal in critical care situations. “They didn’t think I was going to make it so they had to do all they could to keep me alive.”

After spending nearly one month in the hospital, including eight days in a coma, Kinchelow was able to go home.

She went on to high school, participating in show choir and roller skating, and earned her bachelor’s degree, with a dream of becoming a nurse, like the ones who had helped save her life.

At the start of her last semester of nursing school, in January, Kinchelow said she again began to feel a shortness of breath.

“I couldn’t do my daily activities. I was too tired to talk upstairs,” she said. “I went to the hospital and spent three weeks in the hospital in January and they decided I needed to be on the transplant list.”

Kinchelow was admitted to the hospital in mid-January and spent the next two months there, waiting for the right heart to become available.

“The call is the thing you look forward to when you’re waiting. You just never know when it’s going to come,” she said. “They were saying that with my blood type, it’s like one of the longest waits. That was one of the things I was just scared of.”

On March 27, Kinchelow got the call she had been waiting for from a woman named Debbie, who was Kinchelow’s transplant coordinator at the hospital.

“They handed me the phone and she said, ‘I have some good news for you,’ and I said, ‘Debbie, if you’re not calling about a heart I don’t want to hear it,'” recalled Kinchelow. “I just lost it after that.”

The next day, Kinchelow underwent a 12-hour surgery to receive her new heart. Her old heart was so enlarged she said doctors took around six hours to remove it.

“Her story is pretty unique,” said Dr. Robert K. Darragh, Kinchelow’s pediatric cardiologist at Riley Children’s Health and an associate professor of clinical pediatrics at Indiana University School of Medicine. “There are some questions medically that we still don’t have perfect answers for her about how she got to the point of needing a transplant.”

As Kinchelow recovered from the transplant, she said she received a letter from the family of her heart donor, something she said was surprised to receive since typically it takes over a year for a connection to be made.

“They said the family jumped through hoops to make sure they got a letter to me,” she said. “That was a huge surprise and so emotional for me.”

Kinchelow said she is now sharing her story to raise awareness about both organ donation and the risks of heart disease among women.

Heart disease is the leading cause of death for Black women in the United States, according to the Centers for Disease Control and Prevention.

Across all races, heart disease causes about one in every five female deaths each year, while only about half of women know that heart disease is their No. 1 cause of death, according to the CDC.

And in the U.S. alone, more than 100,000 adults and children are currently on the national transplant waiting list, according to the Department of Health and Human Services.

“If more people were donors, there wouldn’t be a waiting list, and some people don’t make it because there aren’t enough donors,” said Kinchelow. “I want to put it out there, just think about it and do your research.”

Kinchelow was discharged from the hospital in May, five months after she was first admitted and put on the transplant list.

She said she plans to “pick up where she left off” and finish her nursing degree and then begin her career helping to save other people’s lives.

“I would say to anybody, don’t take your health lightly,” said Kinchelow. “Although I was 14, I knew something was not right. It’s important to pay attention to anything that feels different.”

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(NEW YORK) — The United States has hit a grim milestone: 1 million COVID-19 deaths. During the past two years the virus has posed a deadly risk, but it hasn’t affected every person the same way. The pandemic has highlighted inequalities that have already existed — and exposed new disparities between age, race and political affiliation.

Jino Cabrera of Sherman Oaks, California, lost his brother to COVID-19 in January 2022.

Although Christian Cabrera was healthy, with no-pre-existing conditions, and his hospitalization was unexpected, he had been the only sibling in his Filipino family who had been against the vaccine.

“My other brother is somewhat of a conspiracy theorist,” said Jino Cabrera, who added that Christian had promised to get vaccinated after the holidays, but by that time it had been too late.

Christian Cabrera left behind a 17-year-old son, a 4-year-old son and his fiancée. In his final moments, Jino Cabrera said his brother regretted the decision to not get vaccinated.

“He [Christian] sent me a text message, um, and he had, uh, told me that he can’t breathe. Um, ‘I wish that I had gotten vaccinated. If I had, if I could do all again, I will, um, do it in a heartbeat to save my life,'” Jino Cabrera told ABC News Audio about his brother’s text.

According to December 2021 data from the Centers for Disease Control and Prevention, an unvaccinated person was 53 times more likely to die of a COVID-19-associated illness compared to a fully vaccinated person with a booster dose.

Dr. Richina Bicette-McCain is an emergency medicine physician and medical director of the McNair Emergency Department in Houston, Texas. Despite working the span of the pandemic, she said it never gets easier watching young patients fight for their lives.

“I had a young, Hispanic patient. I believe he was in his 40s,” said Bicette-McCain. “He initially came in with just a little bit of shortness of breath and within an hour of me arriving to my shift and seeing him, he had coded and died and we were not able to get this man back… and he was young and healthy.”

While age remains a factor, recent data from the Centers for Disease Control and Prevention showed a major difference in the risk of infection, hospitalization and death by race.

Native Americans are over 2.5 times more likely to die of COVID compared to white Americans, according to the CDC data, which also showed that African-Americans are more than 1.5 times more likely, and Hispanic Americans 1.1 times more likely.

Some of this is due to vaccine hesitancy among certain communities that have been historically wronged by medicine before, according to Bicette-McCain, who cited the Tuskegee Syphilis Study as an example.

“So many instances in medicine where Black bodies were used for experimentation, where Black people were not treated justly and were left to suffer and were left to die from diseases that were curable,” said Bicette-McCain. ”Not just with COVID and not just with vaccines, but there is a deep sense of unsureness when it comes to medical providers and the entire establishment.”

Bicette-McCain said that’s why it is so important to be vocal about the benefits of the COVID-19 vaccine to diverse communities beyond health care professionals.

“If the message is coming from someone who looks like you, it makes it a little bit more relatable,” said Bicette-McCain.

In New Jersey, Bergen County health officials pushed education campaigns to spread the word on the use of masks, washing hands and getting vaccinated.

Judah Zeigler is the Mayor of Leonia, a diverse town in Bergen County. She said communication is not a one-size-fits-all issue.

“We’re about 35% Asian and of that is predominantly Korean [and] we’re about 22% LatinX,” said Zeigler. “Every message that went out about the pandemic was sent out in Korean, English and Spanish.”

Gervonn Romney-Rice is a councilwoman for the Township of Teaneck of Bergen County. She said the COVID-19 pandemic hit close to home.

“In my church, I lost two members of my church who happened to also be a part of my community,” said Romney-Rice.

While Teaneck is very diverse, Romney-Rice said vaccination centers were not reflecting the town’s demographic.

“I would notice that there weren’t a lot of people of color in lines,” said Romney-Rice, who added that it wasn’t just a vaccine hesitancy problem.”[But also] an access issue in terms of the system, everything was done online.”

Lynn Algrat is the vice president of planning, development and communication at Greater Bergen Community Action. She said that her COVID-19 Equity team has pivoted to focus on access, including working with websites to reserve a block of appointments for the most vulnerable.

“We were filling those appointments through our grassroots network,” said Algrant. “All of them African-American, the Korean-American population, child care workers.”

Volunteers on the team would provide access to computers and even would create email addresses for residents so that they could sign-up for online appointments.

While some Americans were able to work remotely during the pandemic, Bicette-McCain said that not everyone had the luxury of doing their job from home.

“If you look early on in the pandemic, Black and Brown people may not have had jobs where they could have worked remotely, or may have been the sole breadwinner for their family and were feeling they were required to go back to work early thus exposing themselves and putting themselves at higher risk,” said Bicette-McCain.

She added that in-person jobs compounded with other risk factors like pre-existing conditions contributed to the COVID-19 death disparities among the U.S. population.

“Higher rates of diabetes, hypertension, certain types of cancers, all of those things put you at increased risk of succumbing to COVID-19 if you’re diagnosed with an infection,” said Bicette-McCain.

Polling showed that the emergence of the virus in 2020 exacerbated political polarization and has pushed Americans further apart on key response efforts.

An ABC News analysis of federal data found that, on average, the death rates in states that voted for Trump were more than 38% higher than in states that voted for Biden, even after vaccines were widely available.

Experts said other issues, including access to health care, misinformation and COVID-19 mitigation measures also played a role.

“We turned something that should have been a public health crisis into a political crisis and pitted our communities against each other,” said Bicette-McCain.

Moving forward, Bicette-McCain urges the U.S. to acknowledge the past to ensure equity is a pillar of response efforts in the future.

Back in California, Jino Cabrera lives on without his brother, wishing he could turn back time. “The unimaginable pain and suffering that we are going through right now could have been prevented,” he said. “Had our brother gotten vaccinated.”

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(NEW YORK) — Despite the U.S. recording more than 1 million COVID-19 deaths this week, few families have taken advantage of a government program to help cover the cost of funerals for victims.

In April 2021, the Federal Emergency Management Agency launched a funeral assistance program, offering to reimburse loved ones up to $9,000, which is the average cost of a funeral.

However, only about one-third of families who are eligible have received reimbursements.

In the year since the program began, FEMA has distributed $2.3 billion to 351,000 Americans to cover funeral costs for about 369,000 people who have died from the virus, averaging about $6,500 each, according to FEMA data released earlier this month.

To qualify for assistance, applicants are required to submit a death certificate that states the death “may have been caused by” or “was likely the result of” COVID-19 or COVID-19-like symptoms.

The death almost must have occurred on or after Jan. 20, 2020, which is the date the first laboratory-confirmed case of COVID-19 was reported in the U.S.

Applicants must apply over the phone and, following the call, can submit proof of funeral expenses — such as itemized receipts, invoices or funeral home contracts — or other assistance online, by mail or via fax.

Reimbursements can be used to cover any portion of funeral expenses including burial plots, caskets, preparation of the body, cremation, urns, clergy, services and headstones as well as costs related to state or local ordinances and producing death certificates.

Temporary tourist visa or work visa holders are not allowed to apply for assistance. Additionally, pre-planned or pre-paid funerals are not eligible for reimbursements even if the individual died of COVID-19.

“The majority of ineligibility decisions are due to funeral expenses being paid by another source, such as funeral or burial insurance,” FEMA Press Secretary Jeremy Edwards said in a statement to ABC News. “Any payment made specifically for a funeral prior to death is considered a duplication and is not eligible for reimbursement.”

An ABC News analysis comparing the number of FEMA applications to COVID-19 death tolls from the Centers for Disease Control and Prevention found North Carolina led the U.S. in applications for funeral assistance at 68%.

States in the South including Alabama, Kentucky, Mississippi and South Carolina had the highest rates with 58% or more deaths leading to applications. Meanwhile, states in the West had the lowest participation rates with Montana, Oregon and Washington seeing 37% or fewer deaths leading to applications.

To make more Americans aware of the program, FEMA launched an outreach campaign in March 2021 with paid advertisements and media roundtables held in several languages.

“FEMA will continue reaching out to all affected communities, including those that have been historically underserved, which is why we recently launched a targeted outreach campaign — in San Bernardino, California; Bronx County, New York; Philadelphia; and Hidalgo, Texas — all areas identified with high rates of COVID-19-related deaths, low funeral assistance application rates and high Social Vulnerability Index scores,” Edwards said in a statement.

The statement continued, “We’ve also sent over 780,000 letters, initiated nearly 190,000 auto-dialer contacts, and made 64,619 personal outreach calls to increase awareness of the COVID-19 Funeral Assistance Program.”

The agency also said it will provide special attention to California, New York, Pennsylvania and Texas, all of which saw high death rates from COVID-19.

Some local community groups have taken it upon themselves to educate people about the process of applying. COVID Survivors for Change, a group that supports those “directly impacted” by COVID held a Facebook Live about the program last year to answer some frequently asked questions about the funeral assistance.

FEMA has provided funeral assistance in the past for Americans killed during federally declared disasters such as Hurricane Maria in 2017 and Hurricane Florence in 2018. However, the agency says this program is the “largest offering of funeral assistance in FEMA’s history.”

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(NEW YORK) — Federal regulators warned months ago of potential problems at a manufacturing plant for baby formula, according to documents and a public timeline of the events, raising questions about whether more could have been done sooner by the government to address operational issues and prevent a nationwide shortage.

Inspection reports by the Food and Drug Administration, as well as a 34-page whistleblower report from a former employee of Abbott Laboratories, suggest the FDA first became aware last fall of suspected sanitation issues at an Abbott facility in Sturgis, Michigan. But it wasn’t until mid-February after the agency detected deadly bacteria inside the plant, that Abbott issued a voluntary recall – a drastic move that syphoned off a significant portion of the nation’s supply.

Months after that, concerns still remain about what is taking so long to get the facility running again safely, as families scramble for access to formula.

“We know there have been questions about the timeline,” the FDA said in a statement released Friday. “However, this remains an open investigation with many moving parts. We are continuing to investigate and will continue to update you as information becomes available. Once the immediate risk to the public has been addressed, we will conduct a review and, as outlined in our recently released Foodborne Outbreak Response Improvement Plan, we will build in performance measures across the FDA’s foods program to better evaluate the timeliness and effectiveness of outbreak and regulatory investigation activities.”

For its part, Abbott said it has been working to resolve the FDA’s concerns and, subject to federal approval, could restart operations at the Michigan plant within two weeks.

Abbott says there is no evidence its products contributed to the cases of two infant deaths.

“We are confident that we can continue to produce safe, high-quality infant formula at all of our facilities as we have been doing for millions of babies around the world for decades,” the company said.

Here’s what to know about the timeline of the agency investigation.

September 2019: The FDA conducts an inspection of the Sturgis plant, with one infraction on testing.

Sept. 20, 2021: The FDA conducts an inspection of the plant, noting that personnel working directly with formula didn’t properly wash their hands when needed and didn’t change gloves after touching “non-food” contact surfaces.

“You did not maintain a building used in the manufacture, processing, packing or holding of infant formula in a clean and sanitary condition,” the FDA concludes in its September 2021 report.

On the same day that FDA inspectors are inside the Sturgis plant, the Minnesota Department of Health alerts the agency that an infant was sickened by a bacteria called Cronobacter sakazakii after drinking formula produced in the Sturgis plant. Investigators later, however, do not find a substantive link between the plant’s formula and the child’s illness.

Oct. 20, 2021: In a 34-page document, a whistleblower at the plant alleges to the FDA that Abbott has been releasing untested infant formula, hiding information during past FDA audits and imposing lax cleaning practices. None of these claims have been independently verified. According to Rep. Rosa DeLauro, a Democrat from Connecticut, who later releases the whistleblower report, the FDA interviews that person in late December.

Feb. 1, 2022: The FDA collects samples at the plant that confirm the presence of the dangerous Cronobacter bacteria and cite several violations, according to an inspection report.

Feb. 17, 2022: The FDA says it is investigating reports of four illnesses in three states, including one baby who died. Abbott announces a voluntary recall of potentially affected products, including Similac, Alimentum and EleCare powdered formulas manufactured in its Sturgis facility.

Feb. 28, 2022: The FDA announces a second death and Abbott expands its recall.

ABC News’ Sony Salzman contributed to this report.

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(NEW YORK) — A new study is offering new clues in solving the medical mystery of Sudden Infant Death Syndrome (SIDS), which causes over 1,000 infant deaths per year in the United States, according to the Centers for Disease Control and Prevention (CDC).

The study, led by researchers in Australia and published this week in the medical journal eBioMedicine, found that babies who died due to SIDS had lower levels of an enzyme known as Butyrylcholinesterase (BChE).

The previously unidentified enzyme is thought to be involved in the brain pathways that drive a person to take a breath, according to ABC News chief medical correspondent Dr. Jennifer Ashton, a board-certified OBGYN.

“Potentially, this would represent a target for intervention,” Ashton said Friday on ABC’s Good Morning America. “If you could screen babies and found they had a low enzyme level, potentially you could improve that.”

Currently, there is no method to know an infant’s risk for SIDS, which is defined as the unexplained death of a baby younger than the age of 1. In most cases, a SIDS death occurs while a baby is sleeping.

Because of the risk of SIDS, medical experts, including the American Academy of Pediatrics (AAP), recommend that parent and caregivers place infants to sleep on their back, practice room-sharing without bed-sharing, avoid any soft objects or bedding in a baby’s sleep area and use only firm sleep surfaces such as a crib, bassinet or pack-and-play.

The AAP offers these additional sleep safety recommendations for babies:

1. Until their first birthday, babies should sleep on their backs for all sleep times — for naps and at night.

“We know babies who sleep on their backs are much less likely to die of SIDS than babies who sleep on their stomachs or sides. The problem with the side position is that the baby can roll more easily onto the stomach. Some parents worry that babies will choke when on their backs, but the baby’s airway anatomy and the gag reflex will keep that from happening. Even babies with gastroesophageal reflux (GERD) should sleep on their backs.”

2. Use a firm sleep surface.

“A crib, bassinet, portable crib, or play yard that meets the safety standards of the Consumer Product Safety Commission (CPSC) is recommended along with a tight-fitting, firm mattress and fitted sheet designed for that particular product. Nothing else should be in the crib except for the baby. A firm surface is a hard surface; it should not indent when the baby is lying on it. Bedside sleepers that meet CPSC safety standards may be an option, but there are no published studies that have examined the safety of these products. In addition, some crib mattresses and sleep surfaces are advertised to reduce the risk of SIDS. There is no evidence that this is true, but parents can use these products if they meet CPSC safety standards.”

3. Keep baby’s sleep area in the same room where you sleep for the first 6 months or, ideally, for the first year.

“Place your baby’s crib, bassinet, portable crib, or play yard in your bedroom, close to your bed. The AAP recommends room sharing because it can decrease the risk of SIDS by as much as 50% and is much safer than bed sharing. In addition, room sharing will make it easier for you to feed, comfort, and watch your baby.”

4. Only bring your baby into your bed to feed or comfort.

“Place your baby back in his or her own sleep space when you are ready to go to sleep. If there is any possibility that you might fall asleep, make sure there are no pillows, sheets, blankets, or any other items that could cover your baby’s face, head, and neck, or overheat your baby. As soon as you wake up, be sure to move the baby to his or her own bed … Bed-sharing is not recommended for any babies.”

5. Never place your baby to sleep on a couch, sofa, or armchair.

“This is an extremely dangerous place for your baby to sleep.”

6. Keep soft objects, loose bedding and other items out of the baby’s sleep area.

“These include pillows, quilts, comforters, sheepskins, blankets, toys, bumper pads or similar products that attach to crib slats or sides. If you are worried about your baby getting cold, you can use infant sleep clothing, such as a wearable blanket. In general, your baby should be dressed with only one layer more than you are wearing.”

7. Swaddle your baby safely.

“However, make sure that the baby is always on his or her back when swaddled. The swaddle should not be too tight or make it hard for the baby to breathe or move his or her hips. When your baby looks like he or she is trying to roll over, you should stop swaddling.”

8. Try giving a pacifier at nap time and bedtime.

“This helps reduce the risk of SIDS, even if it falls out after the baby is asleep. If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes 2-3 weeks. If you are not breastfeeding your baby, you can start the pacifier whenever you like. It’s OK if your baby doesn’t want a pacifier. You can try offering again later, but some babies simply don’t like them. If the pacifier falls out after your baby falls asleep, you don’t have to put it back.”

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(NEW YORK) — Heather-Elizabeth Brown feels grateful to have survived her bout with severe COVID-19. But more than two years after testing positive for the virus, she is still managing the physical and mental toll.

After contracting COVID-19 early in the pandemic and subsequently going on a ventilator for a month, she faced significant health challenges, from rehabilitation to chronic conditions including diabetes.

“COVID has taken a lot from me,” Brown, 37, a corporate training consultant in Detroit who is a COVID long hauler, told ABC News’ Good Morning America. “I took for granted how much I was just ‘go, go go’ before I became ill in April 2020.”

Doctors have made progress in treating people with lingering COVID-19 symptoms, though there is still much to still learn about who experiences it and why. With no test for long COVID, it also can be difficult to diagnose.

Studies so far estimate as many as 13% to 30% of people who get COVID-19 may later develop long COVID, which commonly include fatigue, shortness of breath and “brain fog” for weeks, months or, as in Brown’s case, years after the initial infection.

“I would be lying if I said that my life wasn’t irrevocably changed by this whole experience,” Brown said.

Admitted to the ICU

Brown first started showing symptoms in April 2020, though tested negative for COVID-19 twice, she said.

“I was starting to have trouble breathing,” she said. “I was so tired. I was barely able to perform basic functions to take care of myself.”

As her systems worsened, she went to the emergency department three times before she was admitted with symptoms including an elevated temperature.

An X-ray showed that Brown — who eventually tested positive for COVID — had COVID-induced pneumonia in both lungs, and she was put on the “highest level of oxygen,” she said.

Within two days of being admitted, doctors told her that her lungs were failing. She was put into a medically-induced coma and placed on a ventilator on April 18, 2020, she said. She remained on the ventilator for 31 days.

“It was an experience that I don’t think I can explain adequately,” Brown said. “I had a lot of vivid dreams and nightmares.”

When she woke up, she wasn’t able to talk due to a breathing tube and wasn’t able to walk.

“The whole left side of my body was so weak, I couldn’t even hit the call button for the nurses,” she said.

Due to COVID-19 protocols, she wasn’t allowed to see anyone beside the hospital staff.

“I was able to FaceTime with my mother but no one was able to visit me in the hospital,” she said.

Life post-COVID

For patients who have been on ventilators for a prolonged period of time, it’s common to use medications that may cause severe muscle weakness, according to Dr. Annas Aljassem, director of functional pain and rehabilitation at Beaumont Hospital in Royal Oak, who treated Brown.

“A lot of their post-recovery is retraining muscles,” he told Good Morning America. “On top of that, a lot of these long haulers will have debilitated lungs.”

That can translate to a “prolonged recovery time for the things that we take for granted, day-to-day kind of things,” Aljassem said.

Brown said she went to rehabilitation for about seven weeks due to her prolonged ICU stay, and has gone through months of physical therapy, pulmonary therapy and occupational therapy.

“You never think at 35 that you’ll be re-learning something so basic that we take for granted as walking,” she said.

Brown said she had to use a home healthcare company to help her do things around the home.

“I still walk with a limp. I’m still working on tackling the stairs, standing for long periods of time,” she said. “I haven’t started walking again in high heels yet but that’s on my list of things to do and I’m committed to that.”

In addition to recovering from an extensive ICU stay, Brown also now manages diabetes and high blood pressure — two health conditions she didn’t have before getting COVID-19.

“For a while, I was on a lot of insulin, but since I’ve been able to get it more managed,” she said of her diabetes.

Research has found that COVID-19 survivors are at an increased risk of being newly diagnosed with diabetes up to one year after recovering. There are several theories for why, though the exact cause has not yet been determined.

Brown said she has also had issues with nerve pain and brain fog, though the latter has gotten “infinitely better.”

Common long COVID symptoms include severe fatigue and impacts to thinking and breathing weeks or months after the initial infection, according to Dr. Jason Maley, the director of the Beth Israel Deaconess Medical Center’s Critical Illness and COVID-19 Survivorship Program and an assistant professor of medicine at Harvard Medical School.

For cognitive impacts, “We approach it in many ways similar to how we try to help patients who have had traumatic brain injury or concussion recover, because we see a lot of overlap in the symptoms and the ways it’s affecting people’s brain function,” Maley said.

Those experiencing fatigue may experience what’s known as post-exertional malaise, he said.

“They feel physical illness and worsening of all of their symptoms as a result of trying to be physically active, even if it’s just mild activity around the house,” Maley said. “That’s been described in other post-acute infectious illnesses prior to COVID-19.”

Other patients may be fatigued and weak due to an ICU stay and need to rebuild their muscles.

“That takes time and that’s really a more intensive rehab approach,” he said.

Mental toll, too

Long COVID has also been a mental struggle for Brown, as she’s often wondered, “Why me?” and has been frustrated by her extensive recovery. She said she also has post-traumatic stress disorder from her ICU experience.

“I want a normal week where I’m not constantly reminded in some way, shape or form of COVID. Of the struggle that I’ve had with COVID and the trauma that I’ve endured,” she said.

A study led by Maley that was published last month in Critical Care Explorations, the peer-reviewed journal of the Society of Critical Care Medicine, found that “significant symptoms” of post-traumatic stress were found in one-third of ventilated patients six months after they were discharged from the hospital.

Aljassem said he has seen COVID long haulers experience mental trauma from the prolonged isolation they experienced during their treatment and subsequent rehab.

“Mentally they may be in a place and physically their bodies are in another place,” he said. “Processing that mentally is a very important piece of your recovery.”

Maley said long haulers also may experience trauma if their illness is not recognized by their healthcare provider.

“It’s clear to us this is a real illness and there’s a lot of mounting scientific studies about this, but it doesn’t always show up easily on an X-ray, or it’s not showing up on a simple blood test,” he said. “When you can’t think straight and you’re exhausted all day and you were previously perfectly healthy before this, it’s really traumatizing to be searching for answers and have people largely ignoring you.”

Finding support and renewed faith

As she continues to battle COVID-19 symptoms, Brown said she is “getting back to the best parts of me” before she got sick. Part of that involves her faith.

“I definitely feel like my faith has been strengthened,” said Brown, who is a minister at her church. “I feel like I’ve gotten confirmation of the things that I was believing and professing in faith but then to have a moment to see it manifest in real life is much different.”

Seeing a therapist trained in PTSD has also helped Brown process the trauma she experienced and be patient in her healing journey, she said.

“She said you’ve been through so much, you have to be kind and you have to learn how to make sure that you’re gentle with yourself,” Brown said. “Something I had to remember and honor — I am still on a healing journey, and every day is not the same.”

Aljassem said that compared to where Brown is now versus when he first met her is “miraculous.”

“There’s always that discrepancy in how you view yourself, especially in how your healthcare team is viewing you,” he said. “I try to reinforce to her specifically on focusing on those little victories every day and not so much what I can’t do anymore.”

Brown has also devoted much of her time and emotional energy to long-hauler advocacy and being a voice for the community. She is involved with several support and advocacy groups for COVID-19 survivors, including the Body Politic Covid-19 Support Group and the COVID-19 Longhauler Advocacy Project.

“I am a fierce advocate for the COVID-19 long hauler community and for people who have survived this, and for families who are dealing with it in any capacity,” she said. “I take seriously the position I’ve been given to be able to just encourage people and to let people know that even though it can be difficult and even though it can be scary it’s definitely something that people can overcome.”

She does feel that there’s a lot more work to be done for the community and in understanding long COVID.

“[We’re] keeping our feet on the gas when it comes to research and when it comes to education and when it comes to really being vocal proponents for people who have been affected by COVID,” she said.

As more is learned about long COVID, doctors may be able to implement better strategies in treatment, Aljassem said.

“It’s tough to develop treatments without understanding disease, but at the same time, we as clinicians … feel the need and pressure to find things that will help people feel better,” Maley said.

Brown said it continues to be a challenge comparing herself to who she was before COVID-19, but that being a long hauler has made her more resilient and kinder to herself.

“I’m still thankful and I’m still grateful for my life,” she said. “I’m hopeful for my future but I just realized that I have to take it one day at a time.”

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