Health

(NEW YORK) — A flurry of new scientific findings is prompting renewed concern among doctors about the long-term cognitive impacts of COVID-19 in some patients.

Several new studies presented at the Alzheimer’s Association International Conference, being held this week in Denver, have found that many COVID-19 patients experience “brain fog” and other cognitive impairments months after recovery. This adds to a growing body of research on COVID-19’s apparent long-haul symptoms, which can include confusion, forgetfulness and other worrying signs of memory loss.

“This research features the first data from an international consortium, which includes the Alzheimer’s Association, investigating the long-term consequences of COVID-19 on the brain,” Heather Snyder, the vice president of medical and scientific relations for the Alzheimer’s Association said in prepared remarks.

Not enough time has passed for researchers to know if these worrying symptoms eventually clear up. However, they’re pointing to these studies as renewed evidence that everyone — especially older people who are already vulnerable to cognitive decline — should get vaccinated.

“While we work together to further understand the lasting impacts of COVID-19 on the brain, the take home message is simple: don’t get COVID-19. And the best way to do that is by getting vaccinated,” Maria Carrillo, chief science officer for the Alzheimer’s Association, said in prepared remarks.

Researchers at the University of Texas Health Science Center studied the cognition and olfactory senses of 300 older adult Amerindians from Argentina who contracted COVID and found that 50% had persistent problems with forgetfulness and 25% had additional problems with language and executive dysfunction.

“A large portion of our patients in the COVID Recovery Program exhibit cognitive signs and symptoms long after the inflammatory phase of COVID has passed. We typically see many patients with naso-pharyngeal predominant illness come back to us with more neurocognitive deficits,” Dr. Thomas Gut, director of the Post-COVID Recovery Center at Staten Island University Hospital, told ABC News. Gut was not involved in any of the studies presented at the conference.

Researchers at the New York University Grossman School of Medicine studied blood samples of 310 patients admitted to NYU Langone Health with COVID for the presence of biomarkers that would indicate brain inflammation and damage. High levels of certain biomarkers were strongly associated with inflammation in the brain. Damage to the blood-brain barrier caused by inflammation can result in the brain’s inability to send messages from the brain to other parts of the body.

“So far, our efforts offering supportive therapies have shown improvement, but the recovery time is still measured in months. Finding a cause and mechanism for these inflammatory changes in the brain would be the first place to start in addressing how to reverse or prevent these inflammatory changes,” said Gut.

Researchers from the University of Thessaly reviewed the cognitive function and overall health of 32 patients with mild to moderate COVID infection two months post-hospitalization and found that more than 50% experienced cognitive decline, particularly with short-term memory. They also found that poorer memory and thinking scores were associated with lower level of oxygen saturation during a short walk test.

“Many of the cognitive changes that we see mirror in many ways Alzheimer’s disease or PTSD,” said Gut. “What is becoming clearer, is that the severity of acute infection does not directly predict neurocognitive changes after the acute phase has passed. We have many patients that had mild infection or illness struggle severely with memory or behavior changes.”

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(NEW YORK) — As COVID-19 cases surge across much of the United States and many vaccinated people return to indoor masking, a pattern appears to be emerging — the same states that are seeing the biggest increases in COVID-19 infections also have high rates of residents who don’t have health insurance.

While COVID-19 data changes daily, as of Wednesday, the 12 states with the highest seven-day new case rates also had higher than average uninsured rates, according to data from the American Community Survey and the Centers for Disease Control and Prevention.

“​​It lines up with everything we’ve seen during the pandemic,” said John Brownstein, Ph.D., the chief innovation officer at Boston Children’s Hospital and an ABC News contributor. “Uninsured communities have less access to testing, less access to vaccines and less access to care. So of course, you’re going to have increased overall risk among those populations,” he added.

“It’s playing out as we would have anticipated in a pandemic.”

COVID-19 Cases Surging in States with Higher Uninsured Rates

Florida, where Gov. Ron DeSantis has mocked the use of masks and issued an executive order to block government entities from requiring COVID-19 vaccines, has emerged as a cautionary tale. Along with Louisiana, Florida now has the country’s highest COVID-19 case rate, with more than 400 new cases per 100,000 residents as of Wednesday, according to CDC data.

“Florida is in the worst spot right now,” said David Radley, a senior scientist for The Commonwealth Fund, a New York City-based foundation that promotes better access to quality health care. “It has the highest emerging case rate and it has a high level of uninsured.”

Florida might hold the dubious distinction of having among the highest new COVID-19 case rates coupled with a 19% uninsurance rate, but a number of other states are struggling with increasing COVID burdens and a health system that’s not set up to easily handle — or pay for them.

Any state in the upper right quadrant of the graph is “in a tough spot,” Radley said.

Importantly, a correlation between high uninsurance rates and an increasing COVID-19 burden does not mean below-average insurance coverage is driving infections. Instead, a complex constellation of overlapping factors, including politics, might be at play.

“When we think about the policy choices states have made, which would leave a state in a place to have high uninsured rate — things like not expanding Medicare and Medicaid programs and having more restrictive Medicaid programs in the first place — are political choices that tend to align on the right side of the political spectrum,” Radley said.

“I think there are a lot of undercurrents that are driving high uninsured rates and the high case rate,” Radley added.

The reality of being uninsured during a pandemic

Having a high rate of uninsured residents is bad enough during normal times, experts say, but it’s especially harrowing during a pandemic.

Hospitals providing intense levels of COVID-19 care to uninsured patients won’t be reimbursed at the same rate that they would be for patients with insurance. Assuming they survive, those uninsured patients will likely face medical bills for their hospital stays, whether they can afford them or not, Radley explained.

There’s also a circular phenomenon in which people without insurance, or who are underinsured, may be less likely to seek timely care or get tested in the first place.

“I can see a scenario where it would create a spiral,” Radley said.

Compounding that delayed care is the fact that people who don’t have health insurance are more likely to be in high-risk groups, Brownstein explained. He pointed to a preprint study he worked on, which has not yet been published in a peer-reviewed journal, which found that “vaccine deserts have more residents with self-reported COVID-19 exposures and pre-existing conditions as well as more individuals who lack health insurance.”

“If you have increased risk in those populations, it’s not just about increased cases, it’s increased hospitalizations and deaths,” Brownstein said.

The most current data available on insurance rates from the American Community Survey data is from 2019, meaning it doesn’t include the pandemic. But while experts feared that job loss during the pandemic would lead to higher uninsurance rates, Radley said that based on informal surveys, it doesn’t appear that those fears have come to pass. He expects 2020 rates to reinforce similar patterns to the 2019 rates.

“I would bet you that these are vast underestimates, because those that are uninsured are unlikely to get testing — either have access or be able to get testing covered,” Brownstein said. “The patterns that you’re witnessing might be even stronger if testing was equitable.”

“If we’re not taking care of fundamental issues of access to care at the most basic levels, and then you have worse outcomes among those patients because they didn’t have that care or access to testing, and they end up in hospitals,” Brownstein said. The end result: overflowing hospitals, which impact patients of all socioeconomic groups.

“Everyone suffers when you don’t do the right thing in terms of equitable access to care.”

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(NEW YORK) — Bars and restaurants are once again at the forefront of a polarizing business decision 16 months into the pandemic: Whether or not they should require patrons to wear masks inside or show vaccination status in order to dine safely.

Parts of the country are bracing for change after the Centers for Disease Control and Prevention (CDC) recommended Wednesday that vaccinated Americans wear masks indoors in areas with high COVID-19 transmission rates due to the increasing spread of the delta variant. The agency did not publish new research but cited, “CDC COVID-19 Response Team, unpublished data, 2021.”

From coast to coast the restaurant industry has been hard-pressed to follow ever-changing health protocols throughout the pandemic to keep both staff and customers safe, but even with 49.5% of the country fully vaccinated, according to the Mayo Clinic, there is not a one-size-fits-all solution.

Restaurateur Danny Meyer, CEO and founder of Union Square Hospitality, announced Thursday that his restaurants in Washington, D.C., and New York City will require patrons dining and drinking inside to show they have been fully vaccinated starting Sept. 7. Guests can bring the physical COVID-19 vaccine card, a New York State Excelsior Pass, relevant state-provided vaccine pass, or a photo of their vaccination card to share upon arrival.

Although it’s also part of his group, the Shake Shack founder said the policy does not yet extend to the popular burger chain.

“As everything opened up, there was a lot of reason for cautious optimism, but the increase of the delta variant infection rates is causing alarm for many,” Andrew Rigie, executive director of the NYC Hospitality Alliance, told ABC News. “Some restaurants have or will implement vaccination policies for workers and in some cases customers, but that poses challenges.”

Proof of a vaccine or facial coverings are ultimately up to the business owners who are looking out for the best interests of workers and the communities they serve.

For specific restaurants such as ones in a community with lower vaccination rates, Rigie said “different restaurants are situated differently and have different abilities. If most of your customer base is vaccinated and you have resources to check vaccination status, it’s not easy, but it’s easier than being a small business in a community with hesitancy or lower vaccine rates.”

He added, “Collectively I think we understand we need to do everything possible not to revert to new mandates and restrictions after the restaurant industry has been economically devastated so far.”

For first-time restaurant owner Patricia Howard, who opened an intimate seafood restaurant Dame to rave reviews in June, she said she has “anxiously watched the infection rate creep back up” and wants to remain vigilant for both diners and staff.

“We can’t control whether the person next to us on the subway is wearing a mask, but we can control who gets to come through our doors at Dame,” she told ABC News. “With two members of our staff immunocompromised and the very small size of our space, it is better to air on the side of caution. We were nervous about potential backlash, but once the city announced all municipal workers are required to be vaccinated, we felt more confident that it’s the right thing to do regardless of the response.”

The small team at Dame emailed diners who had upcoming reservations earlier this week about requiring proof of vaccination and Howard said they “only had to cancel a few reservations, due to one or more guests being unvaccinated thus far.” She added that nearly all guests have been appreciative and supportive with hundreds of unexpected replies “thanking us for keeping our community safe, saying it makes them even more excited to dine at Dame, and hoping other restaurants follow suit.”

In California, even before the latest CDC guidance, some bars in Los Angeles County, as well as the Bay Area, have taken preventative steps, asking for proof of vaccination or a negative COVID test 72 hours before dining.

Starting Thursday, bars that are part of The San Francisco Bar Owner Alliance may ask customers who wish to be inside to show proof of vaccination. While not mandated by the government, Ben Bleiman, president of the local industry group and owner of Soda Popinski’s and Teeth bars, said this is a step they needed to take “to protect our staff and families.”

Other industry leaders like Oregon-based Erika Polmar, executive director of the Independent Restaurant Coalition, stressed that this new wave of rules and recommendations could become “confusing and burdensome” for both restaurants and diners.

“It’s really challenging to walk into one place and not see a mask mandate and then just a block or two away the mask rules are different,” Polmar explained. “The requirements vary county to county and the public doesn’t know where a county line is.”

Polmar emphasized that if diner attendance dips again, government financial assistance will be crucial and she is imploring Congress to quickly allocate money again for the Restaurant Revitalization Fund.

“I think if you were to talk to any restaurant owner across the country they would be even more heartbroken that they’re not seeing the replenishment of the RRF” despite support in the House and Senate, she said. “The urgency isn’t being acted upon.”

She continued, “Restaurants are accepting the hard truth that Congress might not act until September and that’s amplifying the devastation they’re feeling.”

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(NEW YORK) — With the country in the midst of a new nationwide resurgence of coronavirus infections and hospitalizations, misinformation about the effectiveness of the vaccines has been proliferating on social media, with increased attention falling on the rare number of vaccinated people ending up in the intensive care unit (ICU). However, according to dozens of hospitals across the nation surveyed by ABC News, very few fully vaccinated people are actually ending up severely ill and in the ICU with COVID-19.

And experts say that those that do, tend to be frail or have conditions that interfere with the vaccine’s effectiveness at producing protection.

ABC News contacted 50 hospitals in 17 states, and asked them to share data on their ICU wards’ current COVID-19 patients, including their vaccination status. In the surveyed hospitals, ABC News found that the overwhelming majority of COVID-19 patients currently being treated in ICUs were unvaccinated.

Of the 271 total COVID patients in the surveyed ICUs, 255 patients, or approximately 94%, were unvaccinated against COVID-19 in ABC News’ snapshot in time.

Further, of the 16 vaccinated individuals receiving care in the ICU, almost all suffered from comorbidities and other health problems, such as cancer or weakened immune systems. ABC News only heard of one otherwise healthy and fully vaccinated individual, with no reported underlying conditions, who was in the ICU.

According to the CDC, “vaccine breakthrough cases are expected,” and, as a result, “there will be a small percentage of fully vaccinated people who still get sick, are hospitalized, or die from COVID-19.” But data about ICU patients’ vaccination status is not regularly reported or readily available on the federal or state level.

“The current surge of COVID-19 is driven by those who have elected not to be immunized. We will continue to see the lopsided impact of COVID among the unvaccinated, as they represent the vast majority of severe illnesses, hospitalizations and deaths,” said ABC News contributor Dr. John Brownstein, chief innovation officer at Boston Children’s Hospital.

The hospital sampling also appears to be reflective of a national trend. According to the White House COVID-19 Task Force, severe breakthrough infections remain uncommon, and nearly all of the patients who are currently hospitalized with COVID-19 — 97% — are unvaccinated.

Dr. Lew Kaplan, past president of the Society of Critical Care Medicine and professor of surgery at the University of Pennsylvania’s Perelman School of Medicine, said that the ABC News survey data “provides crystal clear guidance regarding the SARS-CoV-2 delta variant — that vaccines work.”

Furthermore, said Kaplan, the very fact that “the overwhelming majority of hospitalized critically ill patients with this viral variant are unvaccinated, should drive our nation to relentlessly pursue vaccination of every eligible individual.”

“It is our duty and our privilege to save lives,” Kaplan said. “The COVID-19 vaccine is staggeringly effective in helping us keep people at home and alive.”

Front-line workers support the numbers

ABC News’ findings are also supported by local data. In Springfield, Missouri, county health officials reported this week that since vaccines became available, 96.5% of those who have died of COVID in the community were not fully vaccinated.

Mercy Hospital nurse Emily McMichael said the county’s findings are supported by what she’s been seeing.

“These patients are a lot sicker and a lot younger than what we saw the last go around, so it’s just really sad to see,” McMichael said. “And a lot of the population is unvaccinated.”

In Alabama, which has the lowest vaccination rate in the country, 94% of current COVID-19 hospitalized patients are unvaccinated according to state statistics — and hospital admissions are six times higher than they were just a month ago, as health care workers report an influx of COVID-positive patients in need of care.

The University of Alabama at Birmingham Hospital has seen “an explosion of cases,” with the number increasing tenfold in the last three weeks, according to Dr. Kierstin Kennedy, chief of hospital medicine.

The patients who are currently hospitalized, Kennedy said, are younger than those who were hospitalized during the last surge — but unfortunately, they are just as sick. The vast majority of those patients are unvaccinated, she said.

Similarly, in Florida, state statistics show virus-related hospitalizations are nearly at their highest point since the onset of the pandemic, with more than 1,200 COVID-19 patients being admitted to the hospital every day.

“This is heartbreaking because all this could have been avoided; this is unnecessary human suffering that we are witnessing right now,” said Dr. Seetha Lakshmi, medical director of the Global Emerging Diseases Institute at Tampa General Hospital, where she said “almost all” patients are currently unvaccinated.

Another Florida physician said he believes low vaccination rates are one of the driving factors behind the state’s significant increase in COVID-19 patients.

“The vaccine is really protective in terms of being hospitalized or in terms of dying, and the people we’re seeing that are sick, ending up on ventilators and ending up hospitalized, are unvaccinated patients,” Dr. David Wein, emergency room physician at Tampa General, told ABC News.

ABC News’ Sony Salzman, Eric Strauss, Alexis Carrington, Chidimma Acholonu, Odelia Lewis, Priscilla Hanudel, and Dr. Jay Bhatt contributed to this report.

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(NEW YORK) — Jamie Manning says she was excited earlier this month for a day of solo shopping in small towns outside her hometown of Washington, D.C.

It was something she would do frequently before the coronavirus pandemic, but this particular Saturday marked the first time she had done something like this in over one year.

As she sat down for lunch alone at a local restaurant and waited for her food, Manning said “my mind started to wander and I began to spiral.”

Describing the thoughts that raced through her mind, Manning, 32, explained: “There are a lot of people here. It’s really loud. I feel a little woozy. I hope my food gets here soon. I probably just need to eat something. I feel like I need to get out of here. I can’t leave because I need to eat. What if I pass out? I don’t know anyone here. DC feels so far away. Why did I come here alone? I can’t catch my breath.”

The panic attack Manning experienced was not one she expected. But as she recovered and thought about it later, she realized it was due simply to trying to reenter the world after more than a year spent socially distanced and isolated from people during the pandemic.

“I kind of felt sensory overload,” Manning told Good Morning America. “It wasn’t that I was as nervous about getting sick, it was more like, ‘Wow, I haven’t been in an environment for a very long time and it’s a lot to take in.'”

Manning shared her experience in a post on Instagram and received dozens of replies from people describing similar experiences.

“It used to be really normal for me, so I was surprised I had the reaction that I did, and I was surprised by the amount of messages I got,” said Manning. “Anything we can do to normalize these feelings and help people feel like they’re not alone is important.”

The struggle some people have faced as the country has reopened over the past several months is to be expected, according to Divya Robin, a New York City-based psychotherapist.

“For the last year to year-and-a-half we’ve been repeatedly told to stay home, wear a mask, social distance,” said Robin. “That’s been the message that’s completely wired in our brain. We were almost trained to be fearful of seeing people, fearful of the virus.”

“Now we have to give our brain time to adapt again, to shift again what we’re doing,” she said. “We have to think back to March, and the time it took then.”

The increased anxiety felt by many people mostly stems from the uncertainty and lack of control around the pandemic, according to Robin.

Those feelings may be even more intense now as the United States faces a COVID-19 summer surge as the delta variant spreads.

“We all have a fear system in our brains and that’s where anxiety stems from,” she explained. “We’re used to day-to-day there being a few times that it’s activated, like if you’re walking on the street and a car comes near you.”

“Over the past year of the pandemic and what’s going on now with the uncertainty around new variants coming and cases rising, it’s been activated nearly constantly,” Robin added. “That’s one of the reasons anxiety has shown up for more people.”

Anxiety can show up in different ways for different people, from overwhelming and worrisome thoughts to physical symptoms like chest tightness, fatigue, brain fog and difficulty concentrating and focusing, according to Robin.

While it’s important to know and expect that anxiety may arise, it’s just as important to have tools to handle it, she noted.

Here are five tips from Robin to help handle anxiety in a post-pandemic world.

1. Be patient with yourself:

Robin says to think of preparing yourself for a return to the office and social events in the same way you would think about getting back in shape after time away from the gym. In other words, patience.

“Two or three years ago, we’d be able to go three or four happy hours a night, and now many of us don’t have the energy,” she said. “It’s like if you go to the gym every day and run five miles and lift weights and then you don’t do it for a year-and-a-half, it’s hard to do.”

“But with time and training, it comes back,” added Robin.

2. Set small goals:

In order to train yourself to essentially be social again, Robin suggests setting small goals, like a new activity each weekend, or meeting a different friend weekly for coffee, for example.

“Don’t feel like you need to totally jump into things,” said Robin. “Start small and build your way up, just like any training program.”

Manning said she learned that lesson the hard way now looking back on her own experience.

“One of the learnings I took is I tried to do much at once,” she said. “It was easy to be like, ‘OK, great, everything is normal again,’ but I had to acknowledge that it was a lot for me to do a whole day outing and to be more intentional and ease into it.”

3. Try not to compare yourself to others:

Every person has a different perspective on and approach to post-pandemic life, so don’t compare yourself to others, recommended Robin.

“Be real with yourself about what your limits are instead of comparing yourself to other people,” she said. “Really resist the urge to compare, especially because that can cause more anxiety.”

“Instead, think about what feels right for you.”

4. Practice deep breathing:

If you feel yourself having anxiety thoughts or physical symptoms of an anxiety attack, Robin recommends practicing grounding and deep breathing techniques.

“Think about where you are in the moment,” said Robin. “If you’re sitting with a friend, feeling the sensation of your feet on the ground, your back leaning on the chair. Feeling grounded in where you are.”

“And for deep breathing, focus on really feeling your belly as you inhale. You want to feel like a balloon is being inflated inside your stomach.”

5. Pay attention to your thoughts:

Noticing the thoughts that you’re having can help you to not give into your anxious patterns, according to Robin.

“Anxiety a lot of the time stems from thinking of things that are outside our control,” she said. “Notice when those [anxious] thoughts come up and be aware of them, but don’t ruminate. Try to stay with one thought instead of ruminating and running away with all the worst case scenarios.”

Copyright © 2021, ABC Audio. All rights reserved.

(LONDON, HONG KONG and JAKARTA) — A perfect storm with the coronavirus appears to be brewing across the Asia-Pacific region: surges in the highly contagious delta variant combined with slow vaccination uptake.

Tight vaccine supplies are a major factor and experts caution that unless most of the global population is vaccinated, and richer countries share more of their vaccines, the world will face a far longer bout with the coronavirus than anticipated.

The issue extends from countries at the center of the current surge, like Indonesia, to those that fared relatively well with the disease early on in the pandemic, like South Korea.

Even as countries like the U.S. and U.K. face rising cases despite their largely vaccinated populations, hospitalizations and deaths have not yet risen to the same levels as 2020 due to the success of vaccination efforts, public health experts say. Yet the vast majority of the global population remains unvaccinated (just 3.7 billion out of 10-12 billion recommended doses have been distributed).

More people have died of COVID-19 since Jan. 4, 2021 than the whole of last year, according to an ABC analysis of WHO data.

The pandemic is not just far from over — it is in a “critical moment where we are all under threat,” due to rising new variants and vaccine inequality, according to WHO spokesperson Dr. Margaret Harris. The course of the virus, she said, is that it is likely to become “endemic” — meaning it will not disappear, but eventually could become manageable like the other coronaviruses in circulation.

But a true end to the pandemic will likely only happen with the artificial immunity conferred by mass vaccination, according to Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.

“You have countries that are making good progress toward building an immunity shield,” he told ABC News. “When you look at the rest of the world, a very small percentage of the population [is] being vaccinated.”

The stark vaccine disparity is far from lost on people in Indonesia, who in the last few months have seen the delta variant rip through their communities, overrunning hospitals, filling graveyards and leaving family and friends who’ve lost loved ones in anguish.

In scenes reminiscent of when India was at its devastating peak earlier this year, there is a clamor for oxygen canisters in Indonesia — now the coronavirus epicenter of the region. Afflicted families, turned away from hospital wards, are taking treatment into their own hands. For two weeks, Defitio Pratama, 27, a marketing salesman based just outside Jakarta, took care of his sick mother at home.

“We had no idea what to do at that time since we did not have oxygen tank at hand,” he told ABC News in Jakarta, where there are long lines for scarce oxygen cylinders. “I started contacting friends and families for oxygen tank, I even went all the way to other city when I found my mother’s friend offering to lend theirs. We could not take my mother to hospital because they kept rejecting us, we had no choice but to treat her at home.”

While Pratama has received one dose of the AstraZeneca vaccine, his mother, who is asthmatic, remains unvaccinated. In the week ending July 19, 9,696 deaths were recorded, an increase of 36% from the week before, according to the WHO. Just under 16% of the population has received at least one dose of vaccine.

In Indonesia, a combination of a lack of supply, vaccine hesitancy and concerns over the Chinese manufactured Sinovac have contributed to the slow rollout, but the country is by no means alone in the region.

Thailand, Australia, Vietnam and South Korea — all countries that were praised last year for their swift containment strategies — have reintroduced restrictions to deal with outbreaks of the Delta variant, which is estimated to be 60% more transmissible than the alpha variant, in recent months. According to Harris, the world’s richest countries are “basically holding the rest of the world hostage by not insisting that their manufacturers share.”

“This is why you’ve got massive outbreaks going on around the world,” she told ABC News. “But people don’t seem to hear it. What they’re hearing is possibly what they want to hear is ‘I’m vaccinated, now, I can go back to normal.’ You can’t. Not until you sort it out in the rest of the world.”

The Biden administration has pledged to donate more than 80 million doses to countries in need, with 23 million going to Asia. Some 3 million doses of Moderna arrived in Indonesia from the U.S. on July 11 — but the rollout needs to significantly increase in order to meet the WHO’s target to vaccinate at least 10% of every country in the world by the end of September.

For the pandemic to end and the virus to become manageable on a global level and COVID-19 to become manageable as with other coronaviruses, between 10 and 12 billion doses need to be administered around the world, Huang said, ideally with high effectiveness. That number currently stands at around 3.7 billion, according to the WHO.

“The best case scenario is that through these vaccination efforts that by the end of next year we have produced enough vaccines that can vaccinate a majority of the population worldwide, and that vaccination is effective in terms of preventing severe cases of death,” Huang said. “Previously I was more optimistic about how and when the pandemic is going to end. “But now, with that divide in terms of vaccine access, in terms of the strategies adopted by countries, in terms of the continued emergence of the new variants, I’m not that optimistic anymore.”

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(NEW YORK) — As contentious debates over vaccine mandates continue with new coronavirus cases on the rise among the unvaccinated, elected officials are starting to fine-tune the idea of a new incentive by requiring public employees to get a coronavirus test until they get their shots.

Barun Mathema, an assistant professor of epidemiology at Columbia University’s Mailman School of Public Health, told ABC News that the plan is a very effective incentive on paper, and it will have a bigger impact outside of the public sector when it comes to confidence in the vaccines.

“This is saying the government, unambiguously, supports vaccination. One can try things like lotteries to entice individuals, but to me, this is a serious and thoughtful approach,” he told ABC News.

New York City Mayor Bill de Blasio announced last week that employees of the city’s public hospital system, which included medical centers like Elmhurst Hospital, the epicenter of the first wave of hospitalizations in 2020, would have to show proof of vaccination or submit a weekly test until they got their shot. Exemptions are allowed for religious medical reasons.

De Blasio expanded that order on Monday to all city public employees, which included police officers, firefighters and teachers. Even though 59% of the city’s entire population and 70% of its adult population has at least one dose of the vaccine as of Tuesday, the numbers were lagging among the ranks of some New York agencies, city data showed.

The NYPD had a 43% vaccination rate, the Department of Correction had a 42% vaccination rate, the FDNY had a 55% vaccination rate, and public school employees and city hospital employees each had a 60% vaccination rate, according to data from city officials. Nationally, 56% of all residents and 69% of all adults have at least one shot, according to the U.S. Centers for Disease Control and Prevention.

The testing mandate will go into effect for unvaccinated public hospital workers next week, and goes into effect on Sept. 13, the first day of schools in New York, for other public employees.

De Blasio stressed that the delta variant is causing cases to rise in unvaccinated neighborhoods in the city and he wanted to ensure New Yorkers that their public employees were vaccinated or proven safe.

“We’re going to keep climbing this ladder and adding additional measures as needed mandates and strong measures, whenever needed to fight the delta variant,” the mayor said during a news conference Monday.

A few hours later, California Gov. Gavin Newsom announced that he would place a similar testing mandate for any state employee who can’t provide proof of vaccination. The mandate affects 249,000 employees and also provides exemptions for religious or medical reasons.

“California has committed to vaccination verification and or testing on a weekly basis,” Newsom said at a news conference.

California’s policy will take effect on Aug. 9.

Mathema said the policy will be most effective at swaying unvaccinated employees who were on the fence about getting the shot and needed an incentive to do so.

In this case, time spent on taking a COVID-19 test, submitting the paperwork to a boss and getting their OK week after week would take its toll, Mathema said.

“There will certainly be some people who find the constant testing inconvenient,” he said.

Dr. John Brownstein, an epidemiologist at Boston Children’s Hospital and an ABC News contributor, said the testing requirement will put extra pressure on an unvaccinated employee to get their shot.

“They’ll have to quarantine and put themselves out of two weeks of work,” he said.

Brownstein predicted that more states will follow New York City and California’s lead and there appears to be momentum at the federal level. President Joe Biden is expected to announce Thursday that all federal employees show proof of vaccination or submit to regular testing, ABC News has learned.

Brownstein added that some businesses have begun to implement rules that provide more benefits for customers. Some cruise ships, he noted, restrict their non-vaccinated passengers from the more popular dining areas and attractions.

“It’s a hybrid carrot and stick situation. You’re giving benefits to people who are vaccinated and punishing people who aren’t,” he said.

Mathema warned that there are likely to be a number of public employees who will submit to the weekly testing rather than get their shots. He reiterated that elected officials and businesses that implement a testing mandate for the unvaccinated needed to supplement their policy with a focused educational plan.

“I do believe this needs to be met with outreach, strong outreach and consistent outreach,” Mathema said. “We do need to be tactful, show empathy and address real issues that are out there: people’s concerns over the vaccine.”

Anyone who needs help scheduling a free vaccine appointment can log onto vaccines.gov.

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(WASHINGTON) — The Centers for Disease Control and Prevention on Tuesday reversed its mask guidance to specifically target areas of the country with the highest levels of the coronavirus and recommended that everyone in those areas, vaccinated or not, wear a mask as the delta variant continues to spread rapidly across the U.S.

The public health agency also recommended schools embrace universal masks, departing from guidance released earlier this month that suggested vaccinated students and staff were safe to go without.

“CDC recommends localities encourage universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status,” the CDC wrote in a summary of the new guidance. “Children should return to full-time in-person learning in the fall with proper prevention strategies are in place.”

CDC Director Rochelle Walensky cited new scientific data from a recent outbreak investigation, as well as data from other countries, to defend the agency’s decision to urge vaccinated people to return to wearing a mask in some parts of the country.

She said the data show the delta variant “behaves uniquely” from past strains of the virus.

The data indicate that on “rare occasions, some vaccinated people with the delta variant … may be contagious and spread the virus to others. This new science is worrisome and unfortunately warrants an update to our recommendations,” she said.

Last May, the CDC took the country by surprise when it announced guidance that all vaccinated Americans were safe to go without a mask indoors or in a crowd. Its guidance for schools followed that principle.

The CDC recommendations noted that individuals and schools could still opt to wear a mask even if fully vaccinated, but said the risk of illness and transmission was low.

On Tuesday, two months after the initial guidance was released, the agency told reporters that the risk of severe illness from COVID still remains low for Americans who are fully vaccinated and the vast majority of people hospitalized with COVID-19 are still unvaccinated.

But the delta variant, which has taken root in the U.S. over the last month and now represents 83% of all infections, is different than past mutations of the virus, the CDC said.

“In rare occasions, some vaccinated people can get delta in a breakthrough infection and may be contagious,” the CDC said.

Ahead of the CDC’s announcement, ABC News White House correspondent Karen Travers asked press secretary Jen Psaki what the White House’s message is to Americans who may now rethink even getting a vaccine with these conflicting recommendations.

“We continue to be at war with a virus, an evolving pandemic,” Psaki said in response. “Our responsibility here is to always lead with the science, and always lead with the advice of health and medical experts and we’re going to continue to provide information to all of you about how to protect yourself and save your lives. We’re not saying that wearing a mask is convenient, or people feel like it, but we are telling you that that is the way to protect yourself protect your loved ones and that’s why the CDC is issuing this guidance.”

ABC News’ Justin Gomez contributed to this report.

This is a developing story. Please check back for updates.

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(NEW YORK) — In the last decade, the popularity of traditional cigarettes — particularly among teenagers — has declined tremendously, while the use of electronic cigarettes has been on the rise.

But now a new smoke-free alternative called heated tobacco is slowly gaining a foothold in the U.S. market. Also known as heat-not-burn tobacco products, the devices heat up a cigarette without using an open flame.

The heated cigarette produces an aerosol that contains the nicotine as well as other chemicals and additives. The device is more similar to a traditional cigarettes than an e-cigarette or a vape device, which don’t contain tobacco, because the nicotine is coming directly from the cigarette.

Tobacco companies are attempting to glamorize these products, experts told ABC News.

“They’re attempting to make the packaging and the marketing look white and clear and clean and very modern,” said Erika Sward, assistant vice president for advocacy at the American Lung Association. “But we can’t afford to be fooled again on another tobacco product.”

“The tobacco industry is always looking for new ways to get new people to smoke and use nicotine products and be hooked for life,” said Dr. Maria Rahmandar, medical director of the Substance Use and Prevention Program at Lurie Children’s Hospital in Chicago.

So far, only one such device — made by one of the world’s largest tobacco companies, Philip Morris — has been approved by the U.S. Food and Drug Administration. Dr. Moira Gilchrist, vice president of strategic and scientific communications at Philip Morris, told ABC News that the company’s heated tobacco product “is not for youth at all.”

“We place a really high emphasis on making sure we’re selling a product only to the right people, and that we’re not attracting the wrong audience,” Gilchrist added.

Despite this sentiment, teens are still curious — and at risk.

While heated tobacco products only became legal in the United States in 2019, the device have already started to catch the attention of high school students. Nearly one in 10 of California’s 10th and 12th graders have heard of heated tobacco products, with the vast majority saying they first learned about them from the internet or social media, according to a study published in Pediatrics, the official peer-reviewed journal of the American Academy of Pediatrics.

Although the survey found that less than 1% of California teens have actually used heated tobacco products, researchers are worried.

“Our concern is that this is a new product and the design is kind of slick,” the study’s co-author, Dr. Shu-Hong Zhu, who is also the director of the Center for Research and Intervention in Tobacco Control at the University of California, San Diego, told ABC News. “Our goal was to raise the alarm. We fear this might be like the new e-cigarettes.”

Almost one in five students surveyed said they would try heated tobacco products if offered to them by a friend. This number doubled for students who have already used e-cigarettes or vape devices, according to the study.

Heated tobacco products have been marketed as a better alternative to smoking, but the American Academy of Pediatrics warns the devices contain about the same amount of nicotine as traditional cigarettes and give off secondhand aerosol that is unsafe to breath.

“If someone is interested in quitting smoking there are ways that are safe and effective,” Sward said. “This is a product that is aimed at continuing someone’s addiction.”

Moreover, the devices also contain chemicals like carbon monoxide (a poisonous gas), acetone (the active ingredient in nail polish remover), ammonia (commonly used in household cleaners) and benzene (a component of gasoline).

“Any time [parents] or their children are inhaling these kinds or any type of chemicals into their lungs, they’re putting their health at risk,” Sward warned.

As teens head back to school this fall, experts are urging families to be aware of these new, dangerous products.

“Nicotine is just so powerful,” Rahmandar said. “There is no safe tobacco product. There is no safe nicotine product. These products are certainly not safe and harmless — especially to the developing brain.”

Chidimma J. Acholonu, M.D. M.P.H. is a pediatric resident physician at the University of Chicago and a contributor for the ABC News Medical Unit.

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(NEW YORK) — Kayley Reese first noticed what seemed like a growing bump in her stomach over a year ago.

“The reason I really noticed it was because I own a clothing store and am in all the photos and it got to a point where I could see it in every single photo,” Reese, of Richmond, Virginia, told Good Morning America. “It looked like I was pregnant.”

Reese, 23, said she did not notice any other physical symptoms, so she did not do anything about it.

“On social media I would see some things like it’s your uterus protruding or everyone has it, it’s a protective layer,” she said. “So I kind of made it normal in my head.”

It was not until June when Reese flew home to Orlando, Florida, that she began to feel symptoms and sought treatment.

“I was nauseous and dizzy and my appetite wasn’t normal and I had shortness of breath, painful urination, all that,” said Reese. “My mom asked to feel the spot that I was complaining about and said, ‘That is not normal.'”

Reese went to a local emergency department, where she underwent testing that found a large cyst near her left ovary.

“The [doctors] weren’t sure how long it had been there but they said the symptoms I was having were from that,” she said. “At 23, I had no idea this could ever happen to me.”

Reese underwent a two-hour surgery to remove the cyst, which she said was eight inches in length, seven pounds in weight and was filled with two liters of fluid.

The cyst was diagnosed as a paratubal, or paraovarian cyst, a type of cyst that forms near an ovary or fallopian tube but does not adhere to an internal organ, like an ovary.

“It was the best possible case scenario because they were able to save both my ovaries,” she said. “When I went into surgery they said they were likely going to have to take out an ovary and my fallopian tube.”

While she was recovering, Reese said she saw a video on TikTok that prompted her to share her own story publicly.

“I saw someone else’s TikTok about having something similar and all the comments on her video were like, ‘That’s normal. Everyone has it,'” said Reese. “I thought this was exactly why I didn’t think much of my own [stomach bump].”

Reese posted a now-viral video sharing her own story, explaining, “I feel like if I had seen my own TikTok, I would have gone to the doctor a lot earlier.”

She said she was overwhelmed by the response, both from women thanking her for the information and women who also had paratubal cysts.

“When it started to get picked up I was very nervous because I’m like I’m not a doctor, but I saw that it brought awareness to a lot of women,” said Reese. “I got messages from women who had the same situation and they said was the first time they heard anyone even talk about it, so it was super emotional.”

The type of paratubal cyst Reese had differs from the more well-known ovarian cyst because a paratubal cyst does not attach to the ovary or fallopian tube.

While most paratubal cysts do not cause symptoms, some develop and become extremely large before causing symptoms including abdominal pain, frequent urination and feelings of fullness in the abdomen.

Problematic cysts can be removed through surgery.

Women with frequent or painful cysts, including paratubal cysts or ovarian cysts, may be advised by their doctor to take over-the-counter pain medication or hormonal birth control, according to the U.S. Office on Women’s Health.

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