Health

(NEW YORK) — It’s the critical aspect of the fight against the pandemic that the U.S. is still figuring out nearly two years after the first documented cases of COVID-19, which has claimed more than 700,000 American lives: coronavirus testing.

At first, testing supply was extremely limited with long lab turnaround times, and only a handful of Americans could access them before things improved as tests became more widely available. Then suddenly, testing demand dropped as mass vaccinations began.

Now, despite billions of dollars in federal investment and more than 20 months into the pandemic, COVID-19 tests are getting harder to find as millions return to offices and schools.

The struggle to keep up with demand also comes amid shifting federal guidance on who should be tested and when as some companies and schools conduct extensive testing, even in situations that may not require it.

The nation’s largest COVID-19 test manufacturers say they have seen a significant increase in the demand for coronavirus tests. Some major test manufacturers — including Abbott Laboratories — scaled back their production in the spring and early summer when daily testing numbers declined.

Many large test-producing companies say their rapid testing products are quickly flying off store shelves nationwide and are out of stock for online shoppers.

“We’ve ramped up our capacity significantly and, by the end of October, we’ll be producing as many or more rapid tests as we were at the height of our production,” said John Koval, an Abbott spokesperson. “To get there, we’ve hired additional employees and have turned on parts of our self-established manufacturing network.”

Although there is a faster result turnaround for rapid antigen tests, they are not as accurate as PCR (polymerase chain reaction) tests, which often involve a nasal swab. PCR tests are widely considered the gold standard for COVID-19 testing, due to their sensitivity, as they provide a more definitive answer as to whether someone may have active coronavirus.

More than 51 million coronavirus tests were administered in the month of September only the second time this year, after January, when test numbers were comparably high.

According to the Johns Hopkins Coronavirus Resource Center, testing in September increased by a record 82% compared to that period last year when many schools and workplaces were still fully virtual.

The U.S. now conducts nearly 2 million tests a day on average after hitting its peak for the year on Sept. 27 with 3.6 million.

Tests can be administered in a variety of locations, including testing sites, doctor’s offices and even at home and new technology is being developed to make the process easier, more available and cost-effective.

Here’s what we know about the testing landscape in the U.S.:

Return to work and school, in person

The return of Americans to work and school, along with the spread of the delta variant and a small but rising number of breakthrough infections among the vaccinated, created an increase in test demand that many suppliers are only now beginning to catch up with.

“It’s incredibly frustrating that we find ourselves back in this situation that we were in pretty much at the start of the pandemic,” said Dr. Jennifer Nuzzo, lead epidemiologist for the Johns Hopkins Coronavirus Resource Center. “Employers really haven’t pulled back on screening testing that they’re doing even among vaccinated workforce, so that all added together stacks up to a fairly sizable demand for tests.”

Preparing for the return of employees back to the workplace, many U.S. employers have already purchased thousands of COVID-19 tests in bulk.

Prominent investment bank Goldman Sachs, which is based in New York, now requires staff in all of its U.S. offices to take weekly coronavirus tests, even if they’re fully vaccinated.

Other large employers, such as banks, retail stores and supermarkets have begun testing as well, with some using rapid tests and others using self-administered PCR tests.

Labcorb, a U.S. medical diagnostics company, insisted to ABC News that it didn’t reduce its capacity when demand dwindled, and that it has enough supply.

Labcorp sells large quantity collection kits to businesses, which are processed in their labs. Companies can distribute them to their employees to mail in for results.

The company says that equipping businesses both large and small with coronavirus tests is a key priority.

“By making it easier for employees to get tested, we are supporting communities and small businesses across the country,” said Dr. Brian Caveney, chief medical officer and president of Labcorp Diagnostics.

The U.S. Food and Drug Administration, for example, partnered with Labcorp in March to implement a voluntary COVID-19 testing program for agency employees and contractors doing in-person work at government buildings or elsewhere.

Approximately 3,000 PCR tests a month are expected to be provided to FDA employees over the course of the program’s year-long contract.

As vaccinations increased among the general population in early spring, the Centers for Disease Control and Prevention (CDC) loosened mask policies for vaccinated individuals indoors and said that the vaccinated didn’t have to get tested.

Testing companies heeded that guidance, and significantly rolled back their production as their stock prices dipped in response to the lower demand.

But the rapid spread of the delta variant in the summer coinciding with a lull in vaccinations, compelled the CDC to update its guidelines.

The CDC now advises that vaccinated people who come in contact with others who have a confirmed case of COVID-19 get tested regardless of whether they have symptoms, and quarantine only if their test results are positive.

More than 186 million people — 56% percent of the U.S. population — have been fully vaccinated.

Testing protocols driving demand

Public health experts say that testing protocols for students returning to the classroom, employer testing mandates, in addition to continued spread of the virus, even in a limited way among the vaccinated, is part of what’s driving the demand for COVID-19 tests.

“We’re coming out of a fairly substantial surge of infections, so that has clearly prompted a need for more testing,” said Dr. Nuzzo, from Johns Hopkins. During the summer, the 7-day average of infections surged to levels not seen since the fall and winter spike of last year, when vaccines were not widely available.

When President Biden first took office, he committed to establishing a national pandemic testing board to “massively surge” and guarantee free access to coronavirus testing. But much remains unknown about the goals of the board, particularly when it comes to developing a national testing strategy.

A Health and Human Services spokesperson told ABC News that the board is comprised of officials from across the federal government and “includes a focus on addressing supply issues – the supply group meets regularly to review testing capacity.” Testing strategy has been left largely up to states.

The Biden administration has awarded billions in contracts to private sector companies to surge testing, with the goal of eventually getting those tests widely distributed. But industry experts have observed those actions have not been nearly enough to keep up with the pace of the demand to effectively change the ground game on testing access.

“I don’t know why it wasn’t obvious to everyone that with the fall there would be an increasing demand for testing, particularly because of the push to return kids back to school,” said Nuzzo. “We never had enough tests for that.”

The White House has promised to double the number of rapid tests on the market over the next 60 days with a special focus on reducing test prices, which is still a significant barrier to access for many Americans.

In September, the White House said it plans to spend $2 billion to purchase nearly 300 million rapid tests.

On top of that, the Biden administration recently announced plans for another $1 billion in spending on at-home rapid COVID-19 tests, which officials believe will increase the number of tests available to Americans to 200 million a month, beginning in December.

“The manufacturing is scaling up significantly, doubling across the next couple of months, and we’re just going to keep at it to encourage those manufacturers to increase capacity and to drive down the cost of those tests,” said White House COVID-19 Coordinator Jeff Zients.

Cost a factor

The cost of COVID-19 tests in the U.S. varies, as the price often depends on factors including where you live and the type of labs where tests are processed.

While some COVID-19 tests are free and lowly priced, others are not, and even the insured could be left with a sizable bill.

Many rapid antigen tests, which can provide results in a matter of minutes, cost at least $12 at many U.S. retail stores, compared to prices less than half of that in many European Union countries, including Germany and the U.K.

“We have made a fair amount of progress there. Is it enough? No,” said Mara Aspinall, an advisor to the Rockefeller Foundation and professor of practice in the biomedical diagnostics program at Arizona State University. “It’s still too expensive for many Americans who’ve got two kids to buy $65 worth of tests.”

Many retailers including Amazon, CVS, and Walmart are out of stock of Abbott’s Binax Now COVID-19 antigen self-test, which sells for $24.

Testing experts believe that even amid the current COVID-19 testing supply problems, there are other under-utilized tools that can be applied to mitigate the spread of the virus.

“Our focus is surveillance and then outbreak control, and when you do that, we’ll be doing more wastewater testing, more air monitoring, I think we need to be using more COVID sniffing dogs, and scratch-and-sniff tests,” said Aspinall. “We can’t be short-sighted, we need to be thinking about the U.S. and around the world.”

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(NEW YORK) — Ellume is recalling nearly 200,000 rapid at-home COVID-19 antigen tests out of concerns over an abnormally high rate of false positives observed from certain lots of its tests.

Roughly 427,000 test kits, including thousands sent to retailers and some provided to the Department of Defense, have been impacted by the issue.

About 195,000 of these kits are still unused and subject to the recall. About 202,000 have already been used, the company said. Of those, there have been around 42,000 positive results, of which as many as a quarter of those positives could have been inaccurate. However, the company said it’s difficult to determine an exact ratio.

Ellume is removing the affected product from store shelves and said distributors should cease distribution and quarantine those products immediately.

This recall yanks hundreds of thousands of rapid COVID-19 tests off the shelves at a time when demand for these tests has already skyrocketed. Amid shortages, many of the major retail pharmacy stores announced they are limiting purchases to contend with supply constraints.

Meanwhile, Ellume is notifying consumers, retailers and distributors affected by the recall. It’s warning those consumers who have tested positive to take confirmatory tests, as their initial Ellume results may have been incorrect.

Ellume CEO Sean Parsons apologized for the incident, acknowledging how much rides on accurate test results during this pandemic.

“We understand that trust is central to fulfilling our purpose as a company, and we recognize that this incident may have shaken the confidence of some of those who trusted Ellume to help them manage their health and to take back a bit of control of their lives during this pandemic,” Parsons said in a statement. “To those individuals, I offer my sincere apologies – and the apologies of our entire company – for any stress or difficulties they may have experienced because of a false-positive result.”

“You have my personal commitment that we have learned from this experience, we have implemented additional controls to ensure our product meets our high quality standards and we are going to do everything in our power to regain your trust,” Parsons said in the statement.

Ellume said it has identified the root cause as an issue in variation with one of its test kit’s components, and said it has “implemented additional controls” and are “continuing to work on resolving the issue that led to this recall.”

While the recall was triggered by false positives, the company said the reliability of negative results from its kits is unaffected by this issue: approximately 160,000 tests from affected lots produced negative results.

 

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(LOS ANGELES) — California Gov. Gavin Newsom signed the “Momnibus Act” into law on Monday to address racial disparities in maternal and infant health, a victory especially for families of color.

The law will create a fund to grow and diversify the midwifery workforce, extend California’s Medicaid coverage for doulas — trained professionals who support mothers through pregnancies — and extend Medicaid eligibility for mothers experiencing postpartum depression from two to 12 months.

The law is part of a sweeping effort to change stark numbers in the state.

Black women in California are four to six times more likely to die within a year of pregnancy than white women, according to data from 2014 to 2016 compiled by the California Department of Public Health. Nationally, Black and American Indian women are two to three more likely to die from pregnancy-related causes compared with white women, according to a 2019 Centers for Disease Control and Prevention report.

In California, even though the state’s infant mortality is lower than the national average, Black babies still die at more than double the statewide average, lawmakers said in the bill.

Mashariki Kudumu, director of maternal and infant health initiatives for the March of Dimes in Los Angeles, helped work on “Momnibus.”

“We know in California, there’s about nine counties that don’t have an obstetric provider, areas known as maternity deserts. Especially during COVID, we’re seeing hospitals shut down their maternity units. Getting care has been a barrier for a lot of people during this time. And so being able to have more midwives that can provide prenatal care throughout the state, especially in these maternity deserts, will be a great benefit,” Kudumu said.

“Everyone deserves a healthy and joyous and dignified pregnancy birth. And this bill really does help do that,” she added.

The bill was authored by Democratic Sen. Nancy Skinner with support from statewide maternal health and racial justice groups.

A major part of the “Momnibus Act” is to have a committee improve data collection and reviews of maternal deaths in the state, including interviews of affected family members affected, to better study what contributes to maternal and infant mortality rates. The committee plans to publish findings and recommendations every three years.

Some of the bill’s provisions already had been included in the 2021-22 state budget, including the establishment of a guaranteed income pilot program for pregnant low-income Californians and extensions of Medicaid coverage.

The legislation applies to all women who need but can’t afford the services, regardless of immigration status.

Tiffany Sagote, an obstetric medical assistant in San Francisco who’s pregnant with her third child, told ABC News the law is “super special for women of color who have often been overlooked in health care, professionally and emotionally, during such a beautiful milestone in our life.”

“The most exciting thing,” she added, “is receiving an extension of postpartum management with Medi-Cal, like mental health services, which at times are often cut short for women of color … there is an idea in the Black community where, like, needing help is kind of taboo or a sign of failure. But in reality, it is the best thing to help us maintain a solid foundation and give our children the best version of ourselves.”

She said having diverse doulas and midwives will help expectant mothers be able to advocate for themselves, especially when they aren’t listened to.

“I have unfortunately experienced it myself, seen and dealt with racism and mistreatment in the health care field that leads to the statistics among black mothers and infants,” Sagote continued. “Having more access to Black and Indigenous doulas will help mothers not feel intimidated to stand up for themselves in a medical setting.”

Kudumu said the bill’s services will lessen stress among mothers of color or those who come from low-income backgrounds.

“We know Black women have a preterm birth rate that’s higher than other women in California. Adjusting some of the reasons behind that — in terms of stress, in terms of racism, economic opportunities — is important,” she said.

Nourbese Flint, executive director of the Black Women for Wellness Action Project, joined the signing ceremony with her 7-week-old baby and called the bill signed on Monday her “second baby.”

While she called the law “a win,” she said that “there’s still more work to do.”

Stacey Stewart, president and CEO of March of Dimes, said the organization is pushing for a federal version of California’s “Momnibus,” a version of which was reintroduced this session with the support of Senate Majority Leader Chuck Schumer, D-N.Y.

“California passing its ‘Momnibus’ is also a model for what other states can do as well. And we hope we hope other states will look to California for that leadership,” Stewart said. “If fully implemented, and fully funded [on a federal level], we should have every expectation that there should be a significant increase in health outcomes for moms and babies of color.

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(NEW YORK) — A North Carolina school board voted Monday to make masks optional for students and staff indoors, even as 430 students are under quarantine.

The Harnett County School Board voted 4 to 1 for the optional mask policy Monday and it takes effect Tuesday.

Prior to Tuesday, masks were mandatory in the school district, which has more than 19,600 students.

The board also voted to pass an amended quarantine policy allowing students exposed to COVID-19 who haven’t tested positive to return after seven days instead of 10 days. The U.S. Centers for Disease Control and Prevention recommends that those who are unvaccinated should quarantine at home for 14 days after exposure. However, 10-day or seven-day quarantines are acceptable if combined with testing and a negative test result.

According to the school district’s COVID-19 dashboard, as of Monday there are 53 positive virus cases among students and 13 among staff. Further, seven staff and 430 students are currently under quarantine.

The school district has not responded to ABC News’ request for comment.

Mask mandates in schools have been an ongoing heated debate as more than 48 million children under the age of 12 are still ineligible to be vaccinated.

Pediatrician Dr. Lori Langdon spoke at the boarding meeting, saying: “Your students are my patients. I want you to remember that not all students in Harnett County are healthy … Some of them live in homes with immunocompromised parents and grandparents.”

“Our concern is that if we don’t have a mask mandate, we’re just going to be on the countdown back to virtual school and that’s not what any of us want,” she added. “My mask protects you and your mask protects me from you.”

Local residents shared their opinions both for and against the mask during the virtual meeting Monday night.

Parent Gina Carucci said during the meeting, “Obviously this is very political. Masks and virus has nothing to do with the virus, it has to do with complying with the government.”

“You’re taking away their freedom of speech, their freedom to talk to their friends, their freedom to show their smiles,” she said. “These children … it should be their choice.”

Board member Vivian Bennett was the lone member to vote against making masks optional.

“I think the best interest for the people of this county is for there to be masks,” she said before the vote. “My neighbor died, and her sister is taking care of her daughter. She says that she wears a mask every minute, even sleeps in one … I could never vote to think that I might hurt some of the people that I know and don’t know in this county.”

The move by Harnett County Schools comes as a slew of other school districts have imposed mask requirements for students and staff, at times in defiance of state -level bans on mask mandates.

Vaccinations for students will likely be the next frontier of debates. In California, Gov. Gavin Newsom announced Friday a state requirement for COVID-19 vaccines for all school children between 12 to 17 once the U.S. Food and Drug Administration grants full approval of the vaccine for that age group.

 

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(NEW YORK) — The Pfizer COVID-19 vaccine remains 90% effective at reducing a person’s risk of hospitalization from the virus six months after it is administered, a new study has found. This is true even in the face of the delta variant as well as if the person has not received a booster shot.

Still, when it comes to preventing infections, the vaccine’s effectiveness wanes rapidly as time passes, the study found. After five months, it is just 47% effective at preventing infection.

In the study, funded by Pfizer, researchers assessed data from Kaiser Permanente and calculated the percentages of fully vaccinated patients who contracted COVID-19 on a monthly basis after vaccination. Data from roughly 3.4 million people was analyzed between December 2020 and August 2021.

The results of the study are in line with previously published data from Israel and the U.S. Centers for Disease Control and Prevention that looked at vaccine effectiveness over time, but the Pfizer-funded study is the first to consider how the delta variant may impact Pfizer vaccine effectiveness over time.

“The effectiveness of the vaccine against the delta and non-delta variants remained high during the study, suggesting that the vaccines worked well even when a variant was present,” Dr. Simone Wildes, an infectious disease specialist and ​​ABC News contributor, said.

The delta variant was virtually non-existent in the United States when mass vaccinations began in the winter, but it now comprises more than 99% of all coronavirus cases in the country.

Vaccines might be less effective for older adults and people with underlying medication conditions, the study found.

The new data is particularly timely given that the Food and Drug Administration and the CDC recently authorized Pfizer vaccine booster shots in people who fall into certain risk categories — many of whom are over six months past their first dose.

“Our findings support policymakers who continue to monitor vaccine effectiveness over time,” Sara Y. Tartof, PhD, MPH, an infectious disease epidemiologist with the Kaiser Permanente Southern California Department of Research & Evaluation, and a lead author on the study, said. “Given the observed waning, it will be vital for policymakers to assess whether recommendations for booster doses may be warranted … to help control heightened transmission of delta, especially as we enter the upcoming fall/winter viral respiratory season.”

The study followed patients for nearly half a year, but experts still don’t know if Pfizer vaccine effectiveness continues to decrease over time or plateaus. It is also unclear what happens to vaccine effectiveness after the third shot or how factors such as adherence to mask mandates and social distancing measures could impact the data.

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(NEW YORK) — Northwell Health, the largest hospital system in New York state, announced Monday that all of its employees have been vaccinated against the coronavirus.

The move comes just one week after the state issued a vaccine mandate for all health workers.

Northwell Health representatives said in a statement that all of the company’s 76,000 employees, from 23 hospitals and more than 830 outpatient facilities, have received their shots.

“Northwell believes that having a fully vaccinated workforce is an important measure in our duty to protect the health and safety of our staff, our patients and the communities we serve,” the company said in a statement.

A spokesman for the hospital system told ABC News that 1,400 employees were laid off because they did not comply with the mandate.

“Northwell regrets losing any employee under such circumstances, but as health care professionals and members of the largest health care provider in the state, we understand our unique responsibility to protect the health of our patients and each other,” the hospital said. “We owe it to our staff, our patients and the communities we serve to be 100% vaccinated against COVID-19.”

As the deadline for the mandate approached, Gov. Kathy Hochul said that thousands of unvaccinated health care workers got their doses. No hospital in the state was forced to close its doors following the termination of employees who didn’t comply with the mandate.

New York hospitals were the epicenter of the pandemic during the spring of 2020, with bed space scarce in several locations in New York City. Hospital admissions peaked 18,825 on April 12, 2020, according to the New York State Health Department.

Hospitalization rates in the state have seen a jump since the summer, when they hit a low of 349 on July 13, state health data showed. As of Oct. 2, 2,151 people are hospitalized throughout the state, most of whom are unvaccinated patients, according to state health officials.

As of Oct. 4, 71.9% of all New York residents have received at least one dose of the vaccine, according to the U.S. Centers for Disease Control and Prevention.

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(NEW YORK) — Stanley Tucci is opening up about how his cancer battle three years ago affected his ability to enjoy one of his greatest passions — food.

The 60-year-old actor, who previously revealed he was diagnosed with a tumor at the base of his tongue three years ago, opened up about undergoing chemotherapy and radiation in a new interview with The New York Times.

Noting that he developed ulcers in his mouth in addition to losing his appetite, Tucci said food began to taste like “wet cardboard slathered with someone’s excrement.”

The “Devil Wears Prada star” admitted one of his fears during his fight with cancer was losing his ability to taste, adding, “I mean, if you can’t eat and enjoy food, how are you going to enjoy everything else?”

The actor said he was shooting his show, “Stanley Tucci: Searching for Italy,” at the time and his ability to swallow was affected.

“It was hard because I could taste everything, but I couldn’t necessarily swallow,” he explained.

In order to eat steak Florentina, “I had to chew it for 10 minutes to get it down my throat,” he added.

To comfort himself, Tucci admitted to binge-watching cooking shows, which he said he found “weird because even the smell of food then would just make me want to throw up.”

But he said he would “live vicariously through them” so he could have the experience of enjoying food again.

Tucci previously said he is now in remission and his cancer is unlikely to return.

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(WASHINGTON) — As the U.S. sees its first notable decline in COVID-19 metrics in more than three months, with coronavirus-related hospital admissions and average daily new cases dropping by more than 30% over the last month, Dr. Anthony Fauci says the country is making progress against the current surge, but warned we’re not out of the woods yet during an interview on ABC’s This Week.

“We certainly are turning the corner on this particular surge, Jon,” the nation’s top infectious disease expert told This Week co-anchor Jonathan Karl on Sunday. “But we have experienced over now close to 20 months surges that go up and then come down, and then go back up again. The way to keep it down, to make that turnaround continue to go down, is to do what we mentioned: Get people vaccinated.”

“When you have 70 million people in the country who are eligible to be vaccinated, who are not yet vaccinated, that’s the danger zone right there,” he added. “So it’s within our capability to make sure that that turnaround that we’re seeing — that very favorable and optimistic turnaround — continues to go down and doesn’t do what we’ve seen multiple times before, where it goes down and then it comes back up.”

Despite the positive signs, the U.S. also marked a grim milestone this week in the pandemic, surpassing 700,000 deaths from COVID-19 on Friday, according to data compiled by Johns Hopkins University.

“This is the most formidable virus,” Fauci said, reflecting on the staggering death toll.

“There are certain elements about this that were just unavoidable, in the sense that there were going to be deaths, there were going to be a lot of infections globally, no matter what anyone did. But there were situations where we could have done better, and we can do better, and I think we’re living through that right now,” Fauci said, again pointing to eligible Americans who have not gotten vaccinated.

“When you say ‘Are some of those deaths avoidable?’ They certainly are. In fact, looking forward now, most of the deaths could be avoidable if we get people vaccinated,” he said.

One state taking action to increase vaccinations is California, where Gov. Gavin Newsom announced a new requirement for all eligible students in the state to get vaccinated without a testing opt-out.

While some parents have expressed their outrage over the move, Fauci argued that the requirements are really nothing new.

“I have been and I still am in favor of these kinds of mandates. You can make some exceptions to them, but in general, people look at this like this is something novel and new, when in fact, throughout, you know, years and years, decades, we have made it a requirement for children to get into schools to get different types of vaccines — measles, mumps, rubella and others,” he said.

“So when people treat this as something novel and terrible — it isn’t. A requirement for children to come to school, to be vaccinated with certain vaccines, is not something new. It’s been around for a very long time,” Fauci continued.

While increasing vaccinations remain the priority for the Biden administration, Fauci also noted the positive preliminary results of a new antiviral drug from the pharmaceutical company Merck, which showed it could lower the risk for hospitalization or death for someone infected with COVID by 50%.

Fauci stressed the drug would “absolutely not” be a replacement for getting vaccinated but said the future implementation of the drug held a lot of promise.

“It’s a big deal, Jon, I mean you have now a small molecule drug that can be given orally,” he said, “and the results of the trial that we just announced yesterday and the day before, are really quite impressive.”

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(NEW YORK) — The skin care ingredient retinol has been receiving a lot of attention lately, especially on social media apps like TikTok.

But what does retinol actually do and should you be using it?

According to the Journal of America Academy of Dermatology: “retinoids, chemicals that have vitamin A activity, have become important therapeutic agents for a variety of cutaneous disorders, including acne.”

Below, dermatologist Dr. Whitney Bowe answers five questions about retinol.

1. What is retinol?

“Retinol is an over-the-counter form of topical vitamin A. It is one of the most researched and effective skin care ingredients that you can use without getting a prescription.

In fact, retinol is considered by many dermatologists and experts in skin health to be the gold standard in terms of ingredients that deliver clinically evident results and lead to healthier skin.

Retinol can increase skin cell turnover, boost collagen production over time, regulate oil production, even out skin texture, and help brighten dark spots on the skin resulting in a more even skin tone. It can even help fight acne and brighten those dark marks left over after acne pimples go away (post inflammatory hyperpigmentation).”

2. Should you be using retinol?

“Anyone looking to smooth out wrinkles, smooth skin texture, minimize the appearance of pores, or brighten skin can use retinol.

I do not recommend that pregnant women, or women who are breastfeeding, use retinol.

I also advise my patients with eczema or rosacea flares to hold off on retinol until their skin is under better control. Then, they can reintroduce this ingredient, but slowly and carefully.”

3. How do you use retinol?

“I recommend what I call ‘skin care cycling,’ which means cycling on and off powerful but potentially irritating ingredients like retinol.

I usually recommend that my patients start using a pea-sized amount once every fourth night.

If their skin is tolerating it well after a few weeks (no stinging, burning, redness, flaking) then they can graduate to every third night.”

4. Is retinol a new ingredient?

“It’s definitely not new! It’s finally getting the attention it deserves, though.

People are more skin savvy than ever these days, and I believe that dermatologists like myself, taking a more active role on social media, is playing a large role in that evolution.

I’m personally blown away by the sophisticated questions I get about skin care ingredients on my TikTok and Instagram channels. My social media followers are incredibly informed, and demand science-backed, scientifically proven recommendations from me, which I love!”

5. What should you look for when purchasing retinol products?

“Studies, studies, studies. Reputable brands will take the time to put their final formulations to the test in clinical studies.

Just because an ingredient performs well in a test tube doesn’t mean it will translate into meaningful results on someone’s skin.

Furthermore, especially with retinol, it’s not just about that single ingredient or what percentage that ingredient is being used in the product. You must also look at studies done on the final formula. Results from the formula should be greater than the sum of its parts.

Retinol can be unstable, or irritating. However, when formulated by someone who really understands the ingredient and how it will ‘play’ with other ingredients in the cream, gel, or lotion, that’s when you can see beautiful results and minimize side effects.”

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(NEW YORK) — When Sarah Smith experienced three miscarriages in less than two years, she suffered through each of them while at work.

“I didn’t ever feel like there was a space to talk about it with anybody,” Smith, now a mom of three, told “Good Morning America.” “It’s not listed like in your benefits, like if you suffer pregnancy loss, you can take time off, so nobody’s even talking about it.”

During one miscarriage, Smith, of Washington, D.C., remembers sitting at her desk in an open office, trying to pretend like nothing was wrong.

“I went through the day having meetings and talking to people while in excruciating pain, just waiting for the day to be over,” she said. “And every time I got up to go to the bathroom, I was petrified that there would be blood.”

During another, Smith said she sat at work while awaiting a scheduled dilation and curettage (D&C), a medical procedure performed to clear the uterine lining after a miscarriage, because she did not know how to talk about it with her employer.

Smith said the experience of suffering three miscarriages at work led her to change careers. She now works for the March of Dimes, a nonprofit organization focused on the health of moms and babies.

“You’re just in this place where you’re like, ‘I don’t know what I’m supposed to do here,'” she said of her past experiences. “You just are kind of suffering in silence.”

When Hannah Crowder, of California, suffered her first miscarriage, she said she continued to work because she had no available time off.

“I remember going [to the doctor] at 9:30 in the morning, not hearing a heartbeat, knowing it was going to be a miscarriage and having to go back in to to teach my afternoon classes,” said Crowder, a teacher and now the mom of a 4-year-old daughter. “I ended up having to have a D&C, so that was a day of missed work and then had to go back to the work the next day.”

“I don’t think people who haven’t experienced loss understand how invasive it really is if you end up having to have a D&C,” she said. “I had to wake up the next day like, ‘OK, I have 12 fourth-graders I have to go teach about American history today,’ and just turn that switch back on in my brain.”

As many as 20% of known pregnancies end in miscarriage, according to the Mayo Clinic.

Stillbirth, the loss of a baby after 20 weeks of pregnancy, happens in around 24,000 births each year, according to the Centers for Disease Control and Prevention (CDC).

Both forms of loss are emotionally devastating and physically painful for those who endure them, yet there is relatively little support around pregnancy loss in society today, and especially in the workplace.

U.S. Sen. Tammy Duckworth (D-Ill.) recalled going through 10 years of failed cycles of in-vitro fertilization (IVF) and a miscarriage while continuing nonstop at work.

“I would find out that morning that I wasn’t pregnant or in the case of a miscarriage that I had, and I had to go right back on the campaign trail,” she told “GMA.” “I was still working my job and in the Senate and I was campaigning at the same time, so it just became so overwhelming and so emotional.”

“I thought, ‘This is crazy that women have to go through this and try to deal with all of this,'” added Duckworth, who in 2018 became the first U.S. senator to give birth while in office, when she delivered her second daughter.

Duckworth is now the co-author of the Support Through Loss Act, a bill she introduced in the Senate in July that would require U.S. employers to provide at last three days of paid leave to workers to address their own health needs or the health needs of a partner following a pregnancy loss, as well as an unsuccessful assisted reproductive technology procedure, a failed adoption or surrogacy arrangement or a medical diagnosis or event that impacts pregnancy or fertility.

The bill, introduced in the U.S. House by Rep. Ayanna Pressley (D-Mass.), also proposes a $45 million annual investment in pregnancy-loss research at the National Institutes of Health (NIH) and a federal public information campaign to share information on both how common pregnancy loss is, and how people can be supported.

“I remember being in my doctor’s office after he said my pregnancy had failed. I was devastated and at the same time my doctor was saying, ‘It’s fine. It’s perfectly normal,'” recalled Duckworth. “I didn’t know that so many pregnancies could fail. Having that information I think would really help all our families who are going through the process of trying to get pregnant.”

Duckworth and Pressley’s legislation calls for employers to provide “at least” three days of paid leave, and advocates say it’s a step in the right direction towards employers recognizing the long recovery for a pregnancy loss.

“As a federal mandate, it’s at least a good start because in too many situations some workers have no accommodations,” said Stacey D. Stewart, CEO of March of Dimes, which has endorsed Pressley and Duckworth’s legislation. “We have to understand that when we don’t provide these accommodations, there’s a real cost in productivity.”

“The idea that women go through a miscarriage or stillbirth and just bounce back immediately and go back to work is just simply unrealistic,” said Stewart.

The emotional, physical pain of pregnancy loss

Many of the causes of miscarriage and stillbirth are still not known or understood.

People who have gone through either form of pregnancy loss though know the toll it takes on the body, in addition to the emotional trauma.

In the case of a stillbirth, a person goes through childbirth, delivering the baby.

“I still delivered a four-pound baby,” said Elizabeth O’Donnell, a former teacher who said she was denied paid leave after her daughter, Aaliyah Denise, was born stillborn in December, after a 48-hour labor. “I wanted to be recognized as having a baby, which I still did, and have the time to heal my body back.”

“But these things are just not spoken about,” she said.

With miscarriage, people may experience bleeding, cramping, diarrhea and nausea while the pregnancy tissue is expelled. Some people may need a surgical treatment like a D&C, which is done in an operating room under anesthesia to remove pregnancy tissue, according to the American College of Obstetricians and Gynecologists (ACOG).

In many cases, it takes as long as four to six weeks for a person’s body to recover from a miscarriage.

“It can be an extremely painful experience for a family and it not only takes time for a pregnant person’s body to recover from a miscarriage or stillbirth, it can take even longer sometimes to recover emotionally,” said Stewart. “It’s often painful for families to even share with others what they’ve been going through.”

For people who are not comfortable sharing with their employer that they are trying to get pregnant, a fearful topic of conversation that can keep people silent in the workplace, Duckworth noted the Support Through Loss Act would provide them a layer of protection on the federal level.

“It’s important that it’s federal [in] that it does offer that protection much earlier in the process,” she said. “This is just sort of bringing the humanity back into our leave policies and more protections for families that are trying to get pregnant.”

Introduced four months ago, the legislation is still far from becoming law. If it were to be enacted, it would leap frog the U.S. from among the worst countries in the world on paid family leave to a pioneering role.

Earlier this year, New Zealand passed legislation that is believed to be among the first of its kind globally and would also require three days of paid leave after pregnancy loss for both the mother and her partner or spouse.

While a federal paid family leave policy is currently being debated in Congress, under current U.S. policy, the Family and Medical Leave Act (FMLA), employees who qualify can take time off to care for a newborn or loved one or recover from illness without fear of losing their job, but in most cases the leave is unpaid.

Only about one-fifth of employees in the private sector have access to paid family and medical leave, according to the National Partnership for Women and Families.

And data shows that access to paid leave is lower for Black workers than their white counterparts, while the risk of miscarriage is 43% higher for Black women, according to a study published this year in The Lancet, a medical journal.

According to Pressley, the Support Through Loss Act would apply to both federal and private employers and would supplement current paid leave policy.

“These three days would be a separate layer of leave protections than those set in paid family and medical leave,” she said. “We have to ensure within those paid leave policies … that we’re not leaving behind families who have experienced pregnancy loss.”

Pressley, one of the founding members of the Black Maternal Health Caucus, said her goal with the Support Through Loss Act is to not only ensure people have time to recover, but also have support and information.

“I was unaware of the fact that there are doulas who can support you through pregnancy loss, and I’d be willing to bet that there are many healthcare professionals that might not be aware of that resource,” she said. “So we have to close that gap, make sure the information is more easily accessible, again, to better support those when they’re already in the midst of what is a traumatic and very isolating experience, and make sure that those supports are culturally responsive and holistic.”

The potential for not only paid time off but also recognition from the government and employers that pregnancy loss is both common and serious cannot come soon enough for people like Abby Mercado, who suffered a miscarriage three years ago while working in a nearly all-male office.

“I went to work because why wouldn’t I? Experiencing a pregnancy loss is just not something we talk about,” said Mercado, who went on to co-found Rescripted, an online infertility support community. “But my miscarriage was one of the hardest things I’ve ever had to go through in my life. From a grief perspective, I still grieve it, and from a physical perspective, it hurt.”

“With an effort like [the Support Through Loss Act], it elevates the conversation and one by one the dominoes start to fall and women are finally able to really advocate for themselves and have the government backing them up as they’re advocating for themselves,” she said.

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