Health

(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.”

Copyright © 2022, ABC Audio. All rights reserved.

(LOS ANGELES) — The sound of construction around Cedars-Sinai Marina del Rey Hospital is hard to miss. Crews are essentially building a new hospital because the old one, just south of Los Angeles, isn’t big enough. For the staff, it is a sign of rebirth after an exhausting two years. The long-delayed construction is finally underway, after being postponed due to COVID-19, and it is a sign that the fight against the virus is better.

Only a few months ago, the parking lot outside of Cedars-Sinai Marina del Rey was essentially a battlefield hospital. There was a giant tent used for patient triage. Today, the big tent is gone and once again cars are filling parking spots.

The doctors and nurses at Cedars-Sinai, like their counterparts around the country, have seen the worst of the pandemic. They have witnessed countless patients unable to breathe and the heartbreaking goodbyes of family members to their loved ones who were dying from the coronavirus.

Now that the United States has hit one million dead, the staff at Cedars-Sinai is remembering the battle they have gone through.

“Certainly there were a lot of patients that were waiting to be seen,” said Dr. Oren Friedman, a pulmonologist and medical director of the Cedars-Sinai ICU. “Just the amount of patients that we had that needed hospital support and ICU support. There’s never been anything like that. It was just such a huge number. We never felt that way before.”

The staff remembers the early months when there was no test for the virus and treatments were extremely limited. Their colleagues were getting seriously ill. Patients were streaming in unable to catch their breath.

“It was overwhelming, I think, for anyone in the health care field. However, we relied on each other. We relied on as much of the literature that was coming out,” Friedman explained during a recent visit to the hospital. “We formed groups and committees of people who constantly reviewed the literature and the latest. I don’t think any of us have ever been in a situation where so many people that we were taking care of with a disease that was so novel and the information was coming out at lightning speed.”

Friedman, 44, has a unique perspective. Not only is he a pulmonologist who could see what was happening to patients’ lungs as they suffered with COVID-19, but he caught the virus early in the pandemic while on the job and struggled for weeks to recover. And once he was feeling better he went to New York City to help while the region was being overwhelmed by the virus.

“The last two years have been the most challenging time for anyone, certainly in my generation, in pulmonary and critical care medicine,” he said. “In some sense when we all look back at it, it’s like being in an alternate universe. I don’t think any of us ever saw so many patients coming in with such a volume of one particular disease. And certainly none of us ever saw the health care system so impacted and so overwhelmed.”

In the early months, so much was unknown. The virus was spreading so rapidly without a vaccine and without many precautions being taken by the American public. In mid-March of 2020, President Donald Trump declared a national emergency. Medical experts’ predictions that 100,000 people could die were instantly discounted by skeptics. But the numbers of people dying kept growing. Doctors and nurses on the frontlines were at war, while politics played out in the national spotlight.

“In the last two years it’s been very overwhelming and frightening,” said ICU nurse Morgan Roverud. “At the beginning of the pandemic everything was unknown. So we didn’t know how to deal with COVID.”

“It was definitely scary,” Roverud remembered. “A lot of the times I felt like: ‘How can I do this?’ But I think with the teamwork aspect here at [Cedars-Sinai] Marina del Rey and the friendships that you form with the staff and other leadership it just makes everything easier.”

It was that teamwork that hospital staff says got them through it. The staff became one, working around the clock. Doctors and nurses were perpetually exhausted as they worked to save lives. Still, many patients would be overtaken by the virus.

“There was a cohesiveness, I suppose, because everyone was on the same mission together to take care of all of these patients. But it was also sad and, at times, it felt hopeless,” said Friedman.

Friedman said he knew the wave of death that he witnessed in New York was likely heading to California and elsewhere. He was right. The halls at Cedars-Sinai Marina del Rey became full during several waves of the pandemic. The sound of ventilators pumping air into patients’ lungs filled the hallways. COVID-19 was killing Americans.

“We had never seen that many patients who were that critically ill on ventilators,” Friedman said. “It was exhausting. The days were long. Everybody was working extra shifts, extra hours. People were doubling up on shifts. People had to be creative marshalling resources.”

As the pandemic claimed more victims, there were the doubters, including high-profile politicians and media figures, who claimed COVID-19 wasn’t real or wasn’t serious. For the health care providers in the ICU at Cedars-Sinai, there was nothing more aggravating than those who claimed the virus was not serious.

“There was a temptation from all of us to run out there and scream and shake people and tell people, ‘do you realize how bad this could be? Do you realize what it looks like inside of the hospital? You should be wearing masks, you should be getting vaccinated.’ It was enormously frustrating,” said Friedman.

Friedman said after the first surge, medical staff could feel that the general population wanted to move on from the virus but the virus was not done with Americans.

“It made our jobs that much more difficult. It felt like you were fighting a war, but when you returned home from the battle people just simply didn’t believe that war was even occurring,” he said.

Today, after so much heartache and after so many Americans were lost to the virus, maybe the worst of COVID-19 is over and now we must learn to live with it.

“With the vaccines that still work well against variants, and the increase in antiviral medications that we now have,” Friedman said, “we should be able to control some of those numbers better than we have in the past.”

Now with the large tent gone and fewer COVID-19 patients, things are quieter at the hospital. But the team has scars from the past two years or so and the one million lives lost in the U.S.

“It’s a staggering number. It’s a number that most people have a hard time fathoming,” Friedman said. “Even what a million would look like. It’s also really disappointing as a medical provider to realize that many of those probably didn’t need to have happened.”

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(NEW YORK) — The past few years have seen a growing mental health crisis, prompting an increasing number of Americans to seek help through confidential telephone support lines.

But no two support lines are exactly the same. Crisis lines are intended for those undergoing an urgent mental health crisis and in imminent danger, like someone considering suicide. Helplines are designed for non-urgent needs, such as those seeking support and resources for depression, anxiety and other mental health disorders.

Experts said knowing the right one to call can help get you the specific help you need faster.

Everyone in the U.S. should feel empowered to call 911 if they experience distress, crisis or suicidal ideation, experts said. But for those experiencing suicidal thoughts, another option is 1-800-273-8255 [TALK], the National Suicide Prevention Lifeline, a crisis line that consists of a network of more than 200 crisis centers. In July, 988 will replace the 10-digit number as the new 24/7 Lifeline number.

“We are trained to de-escalate a situation,” Mary Givelber, executive director of Caring Contact, a member of the National Suicide Prevention Lifeline located in New Jersey, told ABC News.

She said that “we listen, we do not fix,” and volunteers “encourage them to take charge of where they are in that moment.”

However, if someone is in imminent danger, crisis lines can sometimes activate emergency services that send a mobile crisis unit or ambulance, but experts said this is rare.

“When police and ambulances show up and fire trucks often come out and the lights are on, this becomes a very traumatic experience for that individual,” Givelber said. “So we are trained to try and find the safest, least intrusive way of keeping somebody, we call it, ‘safe for now.’”

Additional resources are available for people who need help but are not experiencing an immediate crisis, such as suicidal thoughts.

Helplines offer information on where to find local mental health resources. One option is the National Alliance for Mental Illness (NAMI) HelpLine (1-800-950-6264), where volunteers are on standby to connect people to mental health services.

“The crisis call counselors can address the immediate crisis, but we want an individual to get well and stay well,” Hannah Wesolowski, chief advocacy officer for NAMI, told ABC News. “And so it’s those local call centers that can connect an individual to resources and services in their communities.”

The resources offered vary by location.

“There are some call centers that have the capacity to make same-day or next-day appointments with community mental health providers or refer them to services within the community,” Wesolowski said.

There are also helplines that focus on the needs of specific populations like the new National Maternal Mental Health Hotline launched this week by the U.S. Health and Human Services Department. It’s available by calling or texting 1-833-9-HELP4MOMS.

Then there are warm lines, a service growing in availability, which is a middle ground between crisis lines and helplines. People can call in to discuss non-urgent matters and are offered emotional support.

“The warm line is actually a phone line where they have volunteers, peer support volunteers, who will just talk to people. There’s no urgency around the conversation. They just get to listen reflectively and help people process and offer emotional support,” Dawn Brown, the national director of NAMI HelpLine Services, told ABC News.

Many call centers are staffed by volunteer peer-support specialists, “that means someone with a mental health condition and they’re now long into their recovery, or the family member supporting a loved one who’s in recovery,” said Brown.” Others are staffed by paid employees. Volunteers and employees undergo weeks of standardized training and quality assurance measures are in place.

What happens if you call the ‘wrong’ line?

In some states like New York and Georgia, one number serves not only as a crisis line, but also a helpline and warm line. But in locations where they are distinct, efforts will be made to direct you to the correct service.

For example, Brown explains at the NAMI HelpLine they “do a suicide risk assessment and if the person is deemed to be at imminent risk, we attempt what we call a warm transfer where we will keep the caller on the line and connect with the Lifeline to hand the person off to a crisis worker.”

But not all calls are transferred. If someone calls a crisis line and is specifically looking for resources, they may only be referred to a helpline.

Calling the appropriate line could help ease the burden on crisis centers. On average, 15% of calls to the National Suicide Prevention Lifeline don’t go through because of extended wait times, resulting in callers dropping the call.

According to Wesolowski, more federal funding is needed to increase staffing, “upgrade technology, data collection, developing training, and operating those back-up centers.”

“Time and time again, what we hear is thank you for listening to me. Thank you for hearing my story,” Givelber said.

If you are struggling with thoughts of suicide or worried about a friend or loved one, help is available. Call the National Suicide Prevention Lifeline at 1-800-273-8255 [TALK] for free, confidential emotional support 24 hours a day, seven days a week.

If you or someone you know needs help, contact NAMI HelpLine from 10 a.m. – 10 p.m. ET Monday to Friday at 1-800-950-NAMI [6264] or info@nami.org.

Adjoa Smalls-Mantey, M.D., D.Phil., is a psychiatrist, trained in immunology, and a contributor to the ABC News Medical Unit.

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(NEW YORK) — As a growing number of states continue to pass strict abortion laws, Americans are facing more barriers when it comes to accessing the procedure.

However, one of the greatest obstacles pregnant people are often met with is the cost of obtaining an abortion.

An abortion can cost anywhere from $0 to more than $1,000, and it’s not just the medical costs that patients face, according to a study from the Guttmacher Institute, a research group focusing on sexual and reproductive health.

Those seeking an abortion may also have out-of-pocket costs for traveling out of town — or, in some cases, out of state — as well as food, lodging, gas, coordinating child care and accessing medication.

Now, with the Supreme Court potentially set to overturn or severely gut Roe v. Wade, attention has turned to abortion funds, which can help arrange and pay for abortion care, as well as other costs associated with the procedure.

What is an abortion fund?

An abortion fund is a nonprofit organization that provides direct funding to those seeking an abortion who may not be able to afford it.

Some funds completely or partially cover the costs strictly related to the procedure, such as for pills for medication abortions — which make up more than half of all abortions in the U.S. — or for an in-office procedure.

“We also provide what we call practical support,” Chasity Wilson, executive director of the New Orleans Abortion Fund, which helps provide funding for people living in the Gulf South, told ABC News.

This includes surrounding costs such as transportation to and from abortion clinics, translation services, gas, lodging and child care — and emotional support.

In addition to local funds, there are 92 abortion funds — as of October 2021 — that are members of the National Network of Abortion Funds, which helps connect organizations across the country.

How do they work?

Some funds, such as the NOAF, allow women to call directly to ask for help paying for an abortion.

“The patient reaches out by calling our hotlines,” Wilson said. “Sometimes we also participate in solidarity funds when another fund that provides these services may reach out and say, ‘Hey, we have a person whose procedures cost $1,300 so we can spend $500, how much can you help?'”

Other funds, such as the Women’s Reproductive Rights Assistance Project — a nonprofit that helps provide funds to people seeking abortion services or emergency contraception — speak directly with clinics and providers.

“We have a network of over 700 clinics, doctors and hospitals that are networked with our fund that contact us on a daily basis to let us know that they have a patent in need of an abortion and that patient needs funding,” Sylvia Ghazarian, executive director of WRRAP, told ABC News. “When a clinic calls us, we return the call and make a pledge commitment to that clinic.”

Ghazarian said the fund will then receive the invoice from the clinic and cover the cost within the week.

WRRAP’s statistics from 2021 showed that 73% of the fund’s patients were people of color and 76% received public assistance. Additionally, NOAF’s 2021 report found that 71% of patients were Black or African American and about two-thirds were on Medicaid.

“A lot of these populations have traditionally less access to health care, but by no means does this mean these are the populations that receive abortions most frequently,” Wilson said.

Who can access them?

Some abortion funds have no requirements. Ghazarian said WRRAP helps provide funding for abortions across the U.S.

Other funds help specific groups of women based on where they live, their racial/ethnic makeup, or how far along they are in their pregnancies.

For example, the Midwest Access Coalition helps cover costs for people seeking abortions in the Midwest, while the Northwest Abortion Access Fund does the same for those living in Alaska, Idaho, Oregon and Washington.

Meanwhile, the Indigenous Women’s Fund provides support for Native or Indigenous Americans seeking to end their pregnancies.

Others, like the Brigid Alliance, help fund those who have to travel long distances to receive late-term abortions.

How do abortion funds get their funding?

Most abortion funds receive support through individual donations. Since the leak of the draft opinion, first reported by Politico, there has been a substantial increase in donations to abortion funds across the country.

The National Network of Abortion Funds told Good Morning America it received more than $1.5 million in donations within three days of the leak reporting.

Ghazarian said news of the leaked draft has left many patients confused. She said she spoke with an abortion clinic earlier in the week that was receiving calls from patients asking if their abortion appointments were still on.

Because of this, another part of WRRAP’s work is community outreach so people can know what the abortion laws are in the part of the country they live in.

“We’re trying to generate information out there not just to clinics but to communities, so that individuals know we’re still here and we will still support them no matter what,” Ghazarian said.

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(NEW YORK) — Last July, a tearful Felicia Croft sat in her car after a long shift in the COVID-19 intensive care unit, and expressed her deep despair about watching young patients die of the virus.

“People are younger and sicker, and we’re intubating and losing people that are my age and younger people with kids that are my kids’ age that are never going to see their kids graduate. They’re never gonna meet their grandkids,” the nurse from Willis-Knighton Medical Center, in Louisiana, told ABC News at the time.

With vaccination rates lagging in Louisiana — fewer than 40% then — Croft said she was frustrated to see preventable deaths occurring.

“We have seen people [in the hospital] that have been vaccinated, but they usually go home to raise their kids, and to hug their husband or their wife. I can’t explain the feeling of defeat. When you do everything you pour everything into a patient and it’s not enough,” Croft explained.

Now, as the nation mourns the loss of 1 million lives to COVID-19, Croft shared a new video diary reflecting on the milestone and the last two years, expressing her relief that fewer patients are dying of the virus at her hospital.

“Today, I am standing here, and I am doing an empty room, in our empty COVID Unit, at the hospital, which is really, really exciting,” Croft said.

Reflecting on earlier experiences caring for a dear family friend, Croft described the pain of seeing people steadily deteriorate as they were intubated, and terribly sick with COVID-19.

As she spoke to the mother of her friend on the phone, Croft recalled feeling helpless as she was not able to truly comfort to his family.

“I remember his mom crying, and me not being able to go to her, and not being able to just love on and comfort somebody that I love, because we’re trying to save another life. That was so difficult,” Croft said.

And although at Willis-Knighton, the need for COVID-19 related care has slowed, Croft said she and her colleagues are still mourning the losses of all of the patients, friends, and family members that died of COVID-19.

“COVID has thankfully dwindled down, but we are still mourning losses, and seeing the effects of just how it’s changed a lot of people, a lot of people’s long-term health, a lot of people’s outlook and it’s just very humbling. It’s been a very humbling experience,” Croft said.

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(NEW YORK) — Since Roe v. Wade legalized abortion nationwide, advocates and opponents of abortion rights have argued over how safe abortion is, how it’s performed and even where the public stands on whether it should be legal.

Now, the Supreme Court may be set to overturn the landmark 1973 decision, according to a leaked draft opinion initially reported by Politico last week.

Ahead of the final decision, which is expected in either June or July, ABC News spoke to public health experts about five common myths surrounding abortion and what the statistics actually show.

Myth: Most abortions happen in-office

Data from the Guttmacher Institute, a research group focusing on sexual and reproductive health, showed at-home medication abortions, not in-office procedures, make up most abortions in the U.S.

Drugs for medication abortions were first developed in the late 1970s as an alternative, non-surgical, form of abortion in which someone takes two pills to end a pregnancy.

The first pill is mifepristone, which was authorized by the U.S. Food and Drug Administration in 2000. It works by blocking the hormone progesterone, which the body needs to continue a pregnancy.

This causes the uterine lining to stop thickening and to break down, detaching the embryo. The second drug, misoprostol, taken 24 to 48 hours later, causes the uterus to contract and dilates the cervix, which will expel the embryo.

​​In the U.S., the drugs are approved up to 10 weeks’ gestation, although the World Health Organization says they can be taken up until the 12-week mark.

As of 2020, medical abortions account for 54% of abortions performed in the U.S., up from 24% a decade ago, according to the Guttmacher Institute.

Otherwise, patients can get an in-office procedure, including, in earlier pregnancy, one in which suction is used to empty the uterus. Contrary to beliefs that abortion is a prolonged procedure, most take less than 10 minutes, according to Planned Parenthood.

Patients may choose to have an in-office procedure rather than a medication abortion for many reasons, including the availability of abortion appointments, Dr. Evelyn Nicole Mitchell, an obstetrician and gynecologist with Keck Medicine of the University of Southern California, told ABC News.

“By the time [some women] see a provider, it’s past the nine- or 10-week mark, and the only option at that point is surgical abortion,” she said.

Myth: Many abortions happen in the second and third trimester

According to a Centers for Disease Control and Prevention report published in November 2021, 629,898 abortions occurred in the U.S. in 2019, the latest year for which data is available.

Of those abortions, the overwhelming majority occurred before 13 weeks’ gestation, which is the beginning of the second trimester.

The CDC report found 79.3% of abortions in 2019 were performed at 9 weeks’ gestation or earlier. What’s more, nearly all abortions in 2019 occurred at or before 13 weeks’ gestation, at 92.7%.

The report also showed from 2010 to 2019, abortions performed later than 13 weeks’ gestation was either at 9% or lower. Just 1% of abortions were performed after 20 weeks.

Public health experts told ABC News the majority of women who have abortions in the second trimester largely fall into one of two groups.

One group is made up of pregnant people who come from backgrounds with traditionally less access to health care, such as living in rural areas or being of lower socioeconomic status, according to Mitchell.

The other group is made up of those who choose to have an abortion because of diagnoses the fetus will be born with severe disabilities, or because their own health is in jeopardy.

“By the 15th week or so, many women are fully committed often to having that pregnancy,” said Dr. Paula Tavrow, a professor of community health sciences at the University of California, Los Angeles Fielding School of Public Health. “And then they may get dire news such as there are fetal abnormalities, or it might impair their health or well-being in some way to continue with the pregnancy.”

Myth: Abortions are more dangerous than childbirth

Two women died following complications from legal-induced abortions in the U.S. in 2018, the latest year for which data is available, according to the CDC’s Pregnancy Mortality Surveillance System.

Between 2013 and 2018, the CDC reported the national case-fatality rate was 0.41 abortion-related deaths per 100,000 legal abortions.

This represents a nearly 8-fold decrease from the case-fatality rate of 3.2 deaths per 100,000 legally induced abortions in 1972, the year before abortion was legalized nationwide, according to a CDC report at the time.

“​​So long as abortions are performed in a clean environment with properly trained people, they’re extremely safe,” said Tavrow.

By comparison, an analysis showed pregnancy and childbirth are far more dangerous in the U.S.

Over the same period, the mortality rate was 17.35 pregnancy-related deaths among mothers per 100,000 live births. Causes of death included cardiovascular conditions, sepsis, hemorrhaging and embolism.

“By the nature of getting pregnant, someone automatically puts themselves into a higher risk category,” said Dr. Deborah Bartz, an obstetrician-gynecologist at Brigham & Women’s Hospital in Boston. “It is absolutely false to claim it is equally safe or even more risky to have an abortion” than to continue with a pregnancy.

Experts said the risk with abortions occurs when they are performed unsafely, with the World Health Organization stating unsafe abortions are a “leading cause” of maternal deaths worldwide.

Myth: Abortions have only risen since Roe v. Wade was decided

Following the decision of Roe v. Wade, legal abortions in the U.S. did increase from a rate of 16.3 per 1,000 women, reaching its peak in the early 1980s before falling.

“Abortion temporality spiked because it was now safe, but the rate of abortion has really decreased,” said Tavrow.

As of 2017, the rate of legal abortions sits at 13.5 per 1,000 women, the lowest rate ever recorded, according to the Guttmacher Institute.

The experts said the rate has decreased due to several reasons, including greater access to contraceptives as well as more birth control methods with higher efficacy rates.

Additionally, the Guttmacher Institute noted, abortion rates have declined as births and pregnancies have fallen overall in the U.S.

Myth: Majority of Americans support the end of Roe v. Wade

Despite the Supreme Court being poised to overturn or severely gut Roe v. Wade, most Americans believe just the opposite should happen.

An ABC News/Washington Post poll conducted in advance of the leaked draft opinion found 58% of U.S. adults said abortion should be legal in either all or most cases.

By comparison, just 37% of adults said they believed abortion should be illegal in all or most cases.

What’s more, 70% of those polled said the decision on whether a woman can have an abortion should be left to the woman and her doctor while 24% said it should be regulated by law.

More than three-quarters of adults said abortion should be legal when the pregnancy is a result of rape or when a woman’s life is threatened by continuing the pregnancy.

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