Health

(NEW YORK) — It’s been a school year like no other in recent memory — combining the challenge of remote and hybrid learning for millions with the agony and strain of a pandemic that has killed more than 600,000.

Mental health has taken a toll on many students and staff alike.

So as districts prepare for the fall after the first full year during the coronavirus pandemic, many are looking at ways to help best address the mental health needs of students, especially those who may have experienced trauma, anxiety or social isolation.

One Ohio school district will welcome back students with more counselors and social workers on hand. Hilliard City Schools in Columbus has added seven new school counselors, up to 42, and 10 more social workers, for 15 total, Director of Student Well-Being Mike Abraham told ABC News.

“Anxiety has always been high with this generation,” Abraham said. “With the pandemic, some students have become very comfortable with isolation, not having to deal with the anxiety that school might bring or their peers bring. That’s what all districts are dealing with coming back now that these kids are together — giving them strategies to be able to deal with their anxiety, to deal with whatever mental health issues that they’re struggling with.”

The school district, which has nearly 17,000 students, is tapping into federal relief money earmarked for K-12 public schools to pay for the new positions.

Last month, Iowa officials announced the state is launching a new pre-K-12 school mental health center that would expand training and resources that support mental health needs in schools.

The Iowa Department of Education is putting $20 million in federal pandemic relief toward the center, which aims to “address the impact pandemic-related disruptions have had on students and will focus on strengthening mental health support moving forward,” Iowa Department of Education Director Ann Lebo said in a statement.

And the Miami-Dade County school district is exploring using federal relief funds to hire more mental health clinicians as most of the district’s 334,000 students are expected to return to in-person learning this fall, the Miami Herald reported last month.

Other initiatives targeting school culture include adding mental health as an excused absence. That will be the case for Montgomery County Public Schools, Maryland’s largest school district, starting in the fall, Board of Education member Patricia O’Neill told ABC News Washington, D.C., affiliate WJLA-TV.

“I think coming off the pandemic this year, adults and students recognize the challenges that mental health has brought about,” O’Neill told the station. “We had to figure out how to make this change and elevate the importance of mental health, as it may be a barrier to learning.”

Range of mental health concerns

The full impact of the pandemic on students will take time to understand, Kelly Vaillancourt Strobach, director of policy and advocacy for the National Association of School Psychologists and a school psychologist, told ABC News. One area of concern is emergency department visits for attempted suicide or suicide ideation, she said.

In 2020, mental health-related emergency department visits among those aged 12 to 17 increased 31% compared to 2019, according to the Centers for Disease Control and Prevention. Visits for suspected suicide attempts in girls that age from Feb. 21 to March 20, 2021, were 50.6% higher than the same period in 2019, the agency reported.

A report published in Pediatrics also found “significant increases” in the number of emergency department visits for suicide ideation and attempts in youth for certain months in 2020 when compared to the previous year.

Isolation due to remote learning is another concern. A recent report from a team of researchers at the Graduate Center, City University of New York found that 91% of New York City parents surveyed agreed there should be “increased mental health supports for students due to social isolation from COVID-19.”

Meanwhile, some students may not have experienced any toll on their mental health, and may have even thrived virtually, Vaillancourt Strobach said.

“We don’t know the level of trauma that individual students have had. We don’t know their family situation, if they lost somebody, if parents have lost jobs,” she said. “So what we are encouraging schools to do is really in those first couple of weeks, just infuse a lot of social-emotional learning, give kids the opportunity to talk about what’s happened over the last year.”

“There’s a lot of focus and attention on learning loss, or lost instructional time. Certainly it’s important that we address student’s academic needs, but if we don’t have a handle on their social-emotional learning and their mental health needs, the academics are never going to come,” she added.

‘All about adjustment’

Summer to fall can often be a tough transition for students in general, Janine Domingues, a clinical psychologist at the Child Mind Institute and the manager of curriculum development and professional training for its school and community programs, noted.

“That first month of school is all about adjustment,” she told ABC News. “Now, even more so, it’s a whole different ball game.”

Students may experience anxiety and stress while getting acclimated to the classroom and a new routine, she said.

When Centennial High School in Corona, California, welcomed back students on campus for their last quarter this past school year, it was an adjustment for some students returning for in-person learning, Josh Godinez, a counselor at the school and chair of the board of the California Association of School Counselors, told ABC News.

“It was almost like the isolation allowed them to create almost somewhat of a fantasy of what they remembered about school. And then showing up to the social distancing partitions, only half their class being there, everybody in masks, it wasn’t that picture that they had created,” he said. “Things start to get back to normal, but aren’t really back to normal.”

As a counselor, Godinez said he worked with students on an individual level to address any anxiety, apprehension, grief or fears students had.

“There was no one response when they came back to school,” he said.

A call for lasting change

Come the fall, Centennial High School, which has about 3,300 students, will have brought on a new counselor, focusing on English learners, bringing them to nine total, Godinez said.

The pandemic has helped bring more attention to the importance of mental health support in school, particularly as districts have an infusion of federal funding that could be put toward more staffing or training, and how schools can foster a healing-centered environment “focusing on social-emotional well-being,” Domingues said.

“This year has kind of really helped propel that mission forward,” she said.

The attention and funding come as schools nationally are largely understaffed when it comes to support staff like social workers and psychologists, experts said.

The National Association of School Psychologists recommends a ratio of no more than 500 students per school psychologist. In the 2019-2020 school year, the national ratio was estimated to be more than double, and only one state met the recommended ratio, the organization said.

The National Association of Social Workers and American School Counselor Association both recommend a ratio of 250 students per social worker and counselor, which most states also fail to meet, according to a 2019 ACLU report.

“We’ve had 100,000 traumatized school communities in this country,” Robert Boyd, president of the School-Based Health Alliance, which promotes school-based health centers in the U.S., told ABC News. “We’re coming into this with not enough school behavioral health specialists. … We didn’t have it before the pandemic.”

The pandemic relief funds could help bring those ratios down, the experts ABC News spoke with said, though noted more rural areas often face a staffing shortage. Boyd’s organization is also focused on diversifying school support staff, which tends to be white women, he said.

Some schools may need to lean on community providers, Vaillancourt Strobach said. Trained grief counselors, for instance, may include pastors and morticians, Boyd noted.

Beyond dealing with staffing shortages, districts may build up their programs, only to not be able to sustain them in the long term.

“Are we going to make a lot of really good progress because there’s been so much attention paid to the importance of school mental health, and then with the American Rescue Plan dollars hit their limit, are we going to be back at square one?” Vaillancourt Strobach said.

Mental health professionals hope this spotlight leads to lasting change and funding support, beyond the pandemic.

“We don’t need to focus on student mental health just because of COVID,” Vaillancourt Strobach said. “The need has always been there; as a nation, we are finally paying attention to it.”

Copyright © 2021, ABC Audio. All rights reserved.

(NEW YORK) — One woman was prepared for every aspect of her daughter’s birth — except for the location.

Emily Geller Hardman, 35, was 37 weeks pregnant when she attended a family wedding in Lancaster, Pennsylvania, with her husband, Travis Hardman. Still far enough out from her projected due date, she figured it was fine to attend and felt nothing out of the ordinary during the wedding. Just hours later, when they were back in their hotel room, however, the opera singer said her water broke. But she didn’t rush to the hospital.

“The amniotic fluid was clear and there were no contractions,” Hardman told ABC News’ Good Morning America. “And this was a first-time labor for me. Statistically, most first-time labors are about 16 to 24 hours, so in my head we had plenty of time.”

When Hardman woke up to her first contraction around 3 a.m., she knew it was time to go even if it meant giving birth in the car.

“In my head I was thinking that I’ve been preparing for this for three years,” she said. “I can certainly do early labor in the car.”

Hardman’s firstborn, Wesley, 2, was born via cesarean delivery. She initially wanted to do a vaginal birth, but circumstances forced her into a C-section.

After what she described as a traumatic experience, she was determined to have an unmedicated vaginal birth at a hospital an hour away from their home in Briarcliff Manor, New York, with midwives and a doula on hand.

“I was very involved in the physiological birth world,” Hardman said, adding that she read books, listened to podcasts and did prenatal exercises to prepare herself mentally and physically for a second birth on her terms.

Armed with just her knowledge, signals from her body and the GentleBirth meditation app, Hardman guided herself through labor while her husband drove.

“My husband’s driving and the entire time I’m focusing on listening to the app to get me through each contraction,” she recalled. “I was just riding the waves and hoping we were going to make it back. We still didn’t realize how fast this was going.”

Around 5:30 a.m., they were able to pull over so Hardman could stand and stretch.

“At that point, once I stood up, I think gravity hit and I started bearing down,” Hardman said. “My water starts leaking again. But I knew that we had to get back in the car and get to the hospital so I willed myself back into the backseat.”

Hardman tried her best not to push so that she could hold on until they arrived at the hospital, but when her contractions started coming faster and even more intense, she knew she wouldn’t be able to help it.

“This baby was coming out of me one way or another,” she said. “I either needed to, for lack of a better word, get on board with what was happening and just allow my body to do what it was doing or I could fight it tooth and nail, which didn’t seem like it was going to be helpful.”

“I could feel myself bearing down and pushing,” Hardman continued. “I instinctively just reached down because I’m feeling so much pressure and I feel the top of a baby’s head starting to crown.”

She told her husband to pull over, but there was nowhere for them to do so safely.

“He’s trying to pull over anywhere he can and as he’s doing that, we’re still driving and her entire body just flies out in one contraction,” Hardman said. “There was no pushing stage of her head slowly coming and then waiting for the next contraction and resting. It was just a one-shot deal — she just flew out.”

What Hardman described is a phenomenon known as fetal ejection reflex, in which the body “expels” a baby involuntarily without any forced pushing on the person’s part.

Despite the circumstances surrounding her daughter’s birth, Hardman said the experience wasn’t stressful. As an opera singer, she’s used to high-stress situations and believes that experience, in addition to all the work she put in, helped her handle everything as smoothly as possible.

“You have to perform at a high level under stress, so you’re used to those types of situations and having to focus on what you’re doing and not how you’re doing,” Hardman said.

“I remember I felt relieved,” she said of her feelings after giving birth to her daughter, Rosemary Claire. “I thought something like, ‘I did it.’ It was empowering and a very healing experience. I do feel very lucky.”

Copyright © 2021, ABC Audio. All rights reserved.

(NEW YORK) — More than a week after the building collapse in Surfside, Florida, 24 people have so far been confirmed dead, with 126 still unaccounted for. As search and rescue crews race the clock to retrieve survivors and remains, they’ve had to contend with several barriers: falling debris, a tropical storm looming off the coast and limited time to recover hope from the rubble.

Undeterred, rescue workers in Florida have worked tirelessly, already moving millions of pounds of debris, with teams working up to 12-hour shifts every day — putting their own safety on the line, and with their own skin in the game. Thursday, the body of one of a first responder’s daughter was discovered among the ruins.

Mental wellness peer teams have been deployed to support the responders. When President Joe Biden arrived at Surfside Thursday, local officials called for increasing psychological supports for those affected by this tragedy.

“This isn’t just a Florida tragedy — it’s also a national and international event. We’re planning on appealing to the President for the best PTSD support possible for the men and women who are working in conditions that resemble more of a warzone than a normal search and rescue mission,” State Fire Marshal Jimmy Patronis said in a statement before Biden’s visit.

Dr. Nomi Levy-Carrick, a psychiatrist at Brigham and Women’s Hospital who previously worked in New York City with survivors of the 9/11 attacks, said that while first responders have been trained to deal with the physical and mental demands of their job, that training does not make them invulnerable to the trauma they witness — and may internalize — while on scene.

“In the aftermath of something traumatic like this, there is so much loss, grief, sadness, even anger. There can sometimes [be] levels of stress that approach toxic levels that make first responders vulnerable to PTSD and other mental health conditions like depression. And the risk to community members, who don’t even have this training or experience? It’s even greater” she said.

Post-traumatic stress disorder — meaning sustained symptoms of trauma that continue many months to years later — is a mental health condition that can develop in the aftermath of traumatic events. PTSD can include things like flashbacks of the traumatic event, nightmares, intense or prolonged psychological distress to stimuli that resemble or symbolize aspects of the traumatic events, and recurrent intrusive memories of the event.

With both workers and community members at risk, Levy-Carrick says that finding meaning can be essential, and protective. “Having a sense of meaning and purpose, whatever that may be, is a very important factor that supports resilience. … It’s important that people feel supported and maintain their social connections through this.”

“Rest and sleep are an essential component of physical and mental endurance, especially in situations with an uncertain end point” said Dr. Ripal Shah, a clinical assistant professor of psychiatry and behavioral sciences at Stanford University School of Medicine. She has worked in health care disaster settings in Puerto Rico, Nepal, Indonesia and Haiti.

Shah said it’s important that rescuers are given enough time to take care of themselves.

“If there is adequate manpower, limiting the number of shifts in a row, giving enough time in between in shifts, can be so important for mental health recovery,” she said.

The sense of responsibility to help survivors and clear the scene, can bring some measure of hope, comfort or information to the families — and all can drive rescuers to keep going, some have expressed.

“It’s not every day that you get to go help and do this,” Andrew Schmidt, a firefighter on Southwest Florida’s Urban Search and Rescue Task Force 6, told station WINK.

“We’re holding up because we’re all holding up for that hope, that faith that we are going to be able to rescue somebody,” Andy Alvarez, the Miami-Dade Fire Rescue’s deputy incident commander overseeing search and rescue efforts, said.

In the tent city set up for crews’ work, a community has come together: volunteers from Surfside and from around the country have brought food and water to support the rescuers, and the Surfside community has set up memorials and prayer circles for those waiting on news.

The massive search and rescue operation is not yet over; nor are all the answers about why this happened are apparent as of yet. And, experts say, the long-term psychological effects from the collapse and loss of life will have ripple effects over time. And while the risks for PTSD are there, Dr. Levy-Carrick said it does not mean it’s what is fated for these workers and the Surfside community.

“PTSD is not inevitable…The risks are very real though for the workers and communities; we should look for how people can support each other and how the community is coming together. It’s part of the way that you can retain hope amidst such tragedy,” Levy-Carrick said.

Jacinta Leyden, M.D., is a psychiatry resident physician at Harvard’s Brigham and Women’s Hospital and a contributor to the ABC News Medical Unit.

Copyright © 2021, ABC Audio. All rights reserved.

(NEW YORK) — Vaccine-hesitant Americans overwhelmingly reject the reported risks of the coronavirus delta variant, posing questions for the nation’s pandemic recovery on a Fourth of July the Biden administration has marked as a turning point in the nation’s long public health ordeal.

Three in 10 adults in the latest ABC News/Washington Post poll say they have not gotten a coronavirus vaccine and definitely or probably will not get one. In this group, a broad 73% say U.S. officials are exaggerating the risk of the delta variant — and 79% think they have little or no risk of getting sick from the coronavirus.

President Joe Biden, health officials and others have described the variant as more contagious than other strains, and as such a substantial risk to unvaccinated people. It now accounts for more than a quarter of new cases in the country.

But the government’s plan to address it through vaccinations looks to have hit a wall. Just 60% in this survey, produced for ABC News by Langer Research Associates, report having received at least one dose of a coronavirus vaccine. While that’s below official estimates (66.8%, per the Centers for Disease Control and Prevention), it confirms the failure to meet Biden’s target of having 70% with at least one dose by July 4. And among those not vaccinated, a growing share — 74%, up from 55% in April — say they probably or definitely won’t get a shot.

Partisan divisions are sharp, underscoring the politicization of the pandemic: Overall just 45% think the government is accurately describing the risk of the delta variant; 35% say it’s exaggerating it, with 18% unsure. Several groups are especially likely to say it’s being exaggerated, including Republicans (57%), conservatives (55%), evangelical white Protestants (49%) and rural residents (47%).

Even as things stand, emergence from the pandemic is far from complete. More than 15 months after it gripped the nation, just 16% of Americans say their community has recovered fully. Nor is the future assured: While 56% think the country has learned lessons that will help it through the next pandemic, a mere 18% are very confident of this.

Biden

Biden, for his part, enjoys broad approval, 62%, for handling the pandemic (including a third of Republicans) — but that isn’t enough to keep him aloft. Just 50% of Americans approve of his job performance overall, a comparatively weak score nearing his six-month mark in office.

Poor ratings on crime and on the immigration situation on the southern border are among Biden’s challenges, as is the hyperpartisanship that marks today’s politics.

His 50%-42% job approval rating is the fourth-lowest out of the last 14 presidents at about five months in office in polls by ABC and the Post and Gallup previously. Biden’s ahead of only Gerald Ford (after his unpopular pardon of Richard Nixon, among other challenges), Bill Clinton (in a struggling economy and with an otherwise rocky start to his presidency) and Donald Trump (who never achieved majority approval). It’s an unusually low rating in a time of strong economic growth.

Biden’s approval ratings tumble to 38% on crime — as reported Friday — and 33% on the immigration situation at the border with Mexico. In partisan terms, 88% of Democrats and independents who lean toward the Democratic Party approve of his job performance overall; 81% of Republicans and GOP-leaning independents disapprove.

Just among party adherents — excluding independents — Biden has 94% approval in his own party versus 8% from Republicans, an 86-point partisan gap. That’s grown steadily from the Clinton presidency forward, demonstrating heightened partisan divisions the past three decades.

Biden’s approval rating is similar to its level in an ABC/Post poll in April, 52%. There are some shifts among groups — a 16-point drop in approval among Hispanics, a 12-point drop in the Midwest (where this poll finds a larger-than-typical number of Republicans and GOP leaners) and a 7-point drop among liberals. Other slight shifts largely offset these.

Pandemic

Additional results show how partisanship has infected pandemic attitudes and behavior. Ninety-three percent of Democrats say they either have been vaccinated or definitely or probably will do so; that plummets to 49% of Republicans. Independents are between the two at 65%.

Vaccine hesitancy also stands out among Republican-leaning groups, such as conservatives, evangelical white Protestants and less-educated adults. And while Republicans are far less likely to get a shot, just 24% see themselves as at risk for infection.

As the table below shows, many groups that are vaccine hesitant are, at the same time, no more apt to see themselves at high risk of infection, and more likely than others to see the risk of the delta variant as exaggerated.

The survey also shows Black adults, at 79%, are more apt than others to say they either have gotten a shot or will do so; it’s 68% among whites and 70% among Hispanics. That’s a positive sign after earlier, higher vaccine hesitancy among Black people.

One further result on the pandemic points to the extent of COVID-19 in the United States. Eleven percent report testing positive for it; an additional 12% think they had it but never tested positive. The net total is 23%, notably higher among Republicans and GOP-leaning independents, 31%. Among people who say they never had it, 72% have been vaccinated or likely will do so; among those who know or think they’ve had it, this declines to 60%.

Voting

Lastly, on an unrelated topic, a Supreme Court decision released Thursday shows a contrast between public attitudes on voting access and the court upholding restrictions in an Arizona law. Americans, by a 2-1 margin, 62%-30%, call it more important to pass new laws making it easier to vote lawfully than to create laws making it harder to vote fraudulently.

There are sharp partisan and ideological differences. Eighty-nine percent of Democrats prioritize making it easier to vote lawfully, as do 62% of independents, dropping to 32% of Republicans. (Still, that means a third of Republicans hold this view, which is at odds with the national party’s focus on the issue.) Similarly, 86% of liberals and 70% of moderates put a priority on expanding lawful voting, compared with 40% of conservatives.

By race and ethnicity, 58% of whites say it’s more important to make lawful voting easier than to make fraudulent voting harder. This rises to 82% of Black people, with Hispanics in between, at 67%.

Methodology

This ABC News/Washington Post poll was conducted by landline and cellular telephone June 27-30, 2021, in English and Spanish, among a random national sample of 907 adults. Results have a margin of sampling error of 3.5 percentage points, including the design effect. Partisan divisions are 30-24-37%, Democrats-Republicans-independents.

The survey was produced for ABC News by Langer Research Associates of New York City with sampling and data collection by Abt Associates of Rockville, Maryland. See details on the survey’s methodology here.

Copyright © 2021, ABC Audio. All rights reserved.

(WASHINGTON) — The government took the first steps to end surprise medical billing on Thursday, getting the ball rolling on a law that was passed under former President Donald Trump’s administration and takes effect this January.

The law bans health care providers from issuing surprising bills that are shockingly high because patients unknowingly got out-of-network procedures even though they were at doctors’ offices or hospitals that take their insurance. One example of the practice is a patient getting surgery at a hospital that’s in-network but then being billed thousands of dollars because the anesthesiologist who put them under was out-of-network.

Starting in January, instead of being charged a high out-of-network rate without advanced notice, the new rule issued by the Department of Health and Human Services on Thursday mandates that hospitals and doctors’ offices notify patients when they’re receiving out-of-network care and charge people an in-network price for it. It also creates a complaint system to report surprise billing.

“It bans high out-of-network charges that come without advanced notice,” Health and Human Services Secretary Xavier Becerra said at a press conference on Thursday.

The enactment of this law is a big deal on both sides of the aisle. Becerra called it bipartisan hallmark legislation “only second to the Affordable Care Act” in the “major difference” it will make in Americans’ lives and healthcare. The bill, pushed by the Trump administration and written with Republican and Democrat input in Congress, was signed last year.

About one of every five trips to the emergency room and one of every six inpatient hospital stays result in care from an out-of-network provider and subsequent surprise medical bills, according to one 2020 study.

Thursday’s rule is the first of major regulatory interpretation of the new law and, along with future rules to come, will set the guidelines for how to eliminate surprise medical billing, both for patients and for health care providers.

“We’re striving to make everything as simple, straightforward and clear as we can so that everyone can assert their rights and know what they should and shouldn’t do,” Becerra said.

“But it’s all critical because it prevents people from being blindsided with some of these charges.”

Here’s what the first rule does:

• It forces health care providers to give notice of out-of-network care and get consent for it. In emergency situations, patients would be billed in-network rates for care, regardless of whether it’s in-network under their health insurance plan. “Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate,” HHS said in a statement.
• It sets up an arbitration process for patients to report hospitals and doctors who issue surprise medical bills. The health care providers can then be billed thousands of dollars in fines if they continue to issue those surprise bills.
• It sets up how much hospitals and doctors should be charging for out-of-network care in unexpected settings. It will be a standard, in-network rate, and while patients will still be responsible for paying it, rates aren’t expected to be as astronomically high. “Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates,” HHS said in the statement.

The rule also doesn’t address ambulance rides, which experts say remains a hole in surprise medical billing. Over half of all emergency ambulance rides were charged out-of-network rates in 2018, according to a Kaiser Family Foundation analysis of the data. Cynthia Cox, vice president of KFF, also pointed out on Thursday that patients might unknowingly give “consent” to hospitals for out-of-network charges by signing forms that are put in front of them.

“Still making my way through the rule, but there is some good and bad news for patients in here,” Cox tweeted. “The good includes that emergencies are defined broadly & retroactive ER coverage denial is no longer allowed. The bad is that some patients might inadvertently sign away their rights.”

Senior HHS officials described it as primarily focused on patients and their financial liabilities after surprise medical billing, acknowledging that many questions still need to be answered on how it will work for insurance companies and doctors offices or hospitals — clarity that is expected in future rules.

“We want to make sure that we put enough meat on this bone so that no one is surprised about how it needs to be implemented, not just the patients but also the providers and insurers. And so we certainly have to work on this whole issue of arbitration, and the cost, there will be a need to make further clarifications on definitions,” Becerra said.

Copyright © 2021, ABC Audio. All rights reserved.

(NEW YORK) — The delta variant now makes up more than 26% of new COVID-19 cases in the U.S. and has been detected in all 50 states, according to data from the Centers for Disease Control and Prevention.

Just a month ago, the variant, which was first identified in India, made up just 3% of new cases in the U.S.

In response to the worldwide threat posed by the variant, which is believed to be both more transmissible and more virulent than other strains, the World Health Organization shifted guidance, and now recommends that vaccinated individuals wear masks indoors. In the U.S., the CDC stayed the course, with health officials continuing to assert that fully vaccinated Americans do not need to wear masks inside.

According to CDC Director Rochelle Walensky, the United States’ strong vaccination rate and its use of highly effective vaccines enables it to do things differently. By comparison, much of the world is unvaccinated and evidence suggests that certain vaccines developed outside of the U.S. are less effective than Pfizer, Moderna and Johnson & Johnson.

“The vaccinated, we believe, still are safe,” Walensky told ABC News’ Good Morning America.

Given differences in vaccinations rates at the local level, however, local officials should decide whether to require vaccinated people to wear masks again, Walensky added.

Already, Los Angeles has reversed its guidance. Although the county dropped its mask mandate earlier this month, as of this week, the Los Angeles County Department of Public Health “strongly recommends” unvaccinated and vaccinated people wear masks inside public places, like restaurants, stores and movie theaters.

With that context in mind, here’s how to approach masking this summer, as the delta variant continues to spread:

I’m fully vaccinated. Should I wear a mask indoors while at restaurants or shopping?

No, unless local officials recommend or require it. (A caveat: If wearing a mask makes you feel more comfortable, or if you’re immunocompromised, you’re under no obligation to take yours off.)

According to the best evidence we have, it’s safe for fully vaccinated people to forgo masks indoors this summer. If you’re fully vaccinated, meaning you’ve received both doses of the Pfizer or Moderna vaccine, or the one-dose J&J vaccine and the final dose has fully vested, “you are highly protected from the delta variant and to even higher degree, you’re protected from severe disease or hospitalization,” said Dr. Vivek Cherian, an internal medicine physician with the University of Maryland Medical System.

A study the British government conducted in April and May, which analyzed more than 12,000 sequenced COVID-19 cases, found that two doses of Pfizer were 88% effective against symptomatic disease from the delta variant. Preliminary data released by Moderna, which has not yet been peer-reviewed, found that the vaccine was highly effective against the delta variant, but did not indicate an exact efficacy number. Like Pfizer, Moderna was slightly less effective against delta than against the original virus strain. Although more research needs to be done on J&J and the delta variant, preliminary research shows the vaccine performed well against the delta variant, the company said Thursday.

The guidance is completely different if you’re unvaccinated or partially vaccinated. In those instances, “there is a good chance you’re actually going to catch this variant,” Cherian said. “There’s no question that in those circumstances you want to be wearing a mask.”

In his own life, Cherian, who lives outside of Baltimore, wears a mask inside stores to set an example for his children, who are both under the age of 12 and too young to be vaccinated. When he shops alone, however, he goes maskless.

“We’re not really changing anything that we’re saying,” he said of the delta variant. “Yes, this is a little bit more serious, but only for individuals who are incompletely vaccinated, and especially for the unvaccinated. For the fully vaccinated, the story hasn’t really changed at all for you.”

Got it. So then why did Los Angeles strongly recommend masks for vaccinated people?

Los Angeles’ choice may be primarily about protecting the unvaccinated.

According to a statement issued by the Los Angeles County Department of Public Health on Wednesday, the department “strongly recommends everyone, regardless of vaccination status, wear masks indoors in public places as a precautionary measure.” The department acknowledged that “fully vaccinated people appear to be well protected from infections with Delta variants.”

“We have always said that this virus is an opportunist,” Walensky said. “We are still seeing uptick in cases in areas of low vaccination and in that situation, when you’re suggesting that policies be made at the local level, and those masking policies are really intended to protect the unvaccinated, the vaccinated we believe still are safe.”

Dr. Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security, pushed back on Los Angeles’ masking decision.

“The delta variant treats the vaccinated person very differently than it treats someone who’s not vaccinated,” he said. “I’m not sure why the Los Angeles County Health Department would treat people as if they’ve not been vaccinated when they have.”

For counties with very low vaccination rates, or for businesses, it might make operational sense to require masks for everyone, he added, in order to avoid having to figure out everyone’s vaccination status and ask the vaccinated to put on masks.

“My understanding is that Los Angeles County is not a low vaccination county,” Adalja added.

Indeed, Los Angeles’ vaccination rate appears to be in line with the national average. Sixty-eight percent of residents ages 16 and older have received at least one dose of the vaccine in Los Angeles County, according to the health department. Nationally, 64% of people ages 12 and older have gotten at least one dose, according to the CDC.

Rates are lower for younger Angelenos, with just 36% of those between the ages of 12 and 15 having received at least one dose.

I got the J&J vaccine. Am I safe to take my mask off inside?

People who got the J&J vaccine can behave the same way as those who received Pfizer or Moderna, health experts said.

“There’s no data to show that breakthrough infections with delta are more common with the J&J vaccine or that they’re more severe,” Adalja said.

And while scientists want to see more data from J&J, Adalja doesn’t think there’s enough evidence to support getting a Pfizer or Moderna booster shot to “top off” the J&J vaccine just yet.

Importantly, he thinks the public is looking at the vaccines wrong.

“This COVID zero idea keeps creeping into people’s minds,” he said. “People are still very focused on cases and not necessarily focused on severe disease, hospitalization and death. If you’re a fully vaccinated individual and you get a breakthrough with the delta or any of the other variants, it’s likely to be clinically meaningless.”

COVID is now an endemic respiratory virus in the U.S., Adalja stressed, and Americans need to learn to treat it that way.

“We’ve got to figure out a sustainable way to teach people to risk calculate and be able to cope with the fact that this is a new infectious disease that we have,” he said.

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(NEW YORK) — After 16 months of coronavirus-related restrictions and requirements — mask mandates, social distancing, extensive state of emergencies — nearly every jurisdiction in the country has now moved to ease up or, for some, completely lift them.

The move comes as many communities attempt to begin to return to some sense of pre-pandemic normalcy, following a 95% drop in the number of cases since the beginning of the year when infections peaked at over 250,000 cases a day.

Less than 12,000 patients are hospitalized with the virus across the country — a stark difference from the early months of 2021, when 10 times that amount were hospitalized nationwide.

Despite the hopeful news, health experts suggest that current metrics do not tell the full story of the United States’ continued struggle with COVID-19.

According to an ABC News survey of state COVID-19 information dashboards, more than two dozen states have now either opted to no longer offer daily statistical coronavirus updates or plan to end daily reports in the coming weeks, a choice which has been a source of great concern for health experts as the more virulent delta variant spreads.

“Without real-time reporting, we are essentially flying blind as to the state of the pandemic. Lack of timely surveillance data will create blind spots and potentially a false sense of security as we struggle with vaccination uptake and the rise of new variants,” said Dr. John Brownstein, chief innovation officer at Boston Children’s Hospital and an ABC News contributor.

Some of these states have moved to offer only weekday updates, others are reporting metrics every few days, and a few are now only offering weekly breakdowns. While state officials insist they will continue to monitor data, the frequency of public updates will be limited.

The importance of daily data cannot be overstated, said Beth Blauer, executive director of the Centers for Civic Impact at Johns Hopkins University, in a post earlier this month. Data provided by the states has “led to major policy decisions across all levels of government and influenced the behavior and decisions of many Americans.”

Blauer urged officials to “stay the course of daily reporting, and not allow their data to go ‘stale’ by releasing it infrequently.”

One of the states that has moved to shift to a more infrequent reporting schedule is Florida. Although it is still reporting the highest total number of coronavirus cases in the country, earlier this month it became the first large state to end its daily coronavirus report, and move to a weekly model.

“Florida has transitioned into the next phase of the COVID-19 response,” a spokesperson from the Florida Department of Health said in a statement to ABC News, stressing that the department remains committed to infectious disease control, surveillance and prevention.

The erratic data reporting comes as a growing list of states see upticks in their COVID-19 case metrics. In the last seven days, 19 states have reported an increase of 10% of more in their daily case average. Several states, including Alabama and Nevada, have seen their case metrics double over the last two weeks, although numbers still remain significantly lower than at their peak earlier this winter.

Some health experts are concerned that the lack of daily data, which plays a critical role in determining response to the virus, could mask potentially dangerous new outbreaks, particularly in areas of low vaccination rates.

“I’m extremely concerned that we’re repeating history,” said Maureen Miller, an infectious disease epidemiologist at Columbia University, pointing to the U.S.’s “failure to react” in early 2020, when the virus was first spreading across the globe.

“We saw it coming yet failed to react and prepare in a meaningful way. Now we’re watching the delta variant charge through countries like Israel and the U.K., which have much higher vaccination rates than the U.S. Why we think this variant won’t wreak havoc in the U.S. is beyond me,” she said.

Falling coronavirus metrics have led some officials to declare victory against the virus; however, a number of experts suggest the country’s current COVID-19 figure may be higher than reported.

“With fewer public health departments reporting daily, we risk relying on data that represents a distorted view of the true burden of illness. An undercount in cases undermines the legitimacy of public health reporting and may mask any early indications of a surge, especially in unvaccinated populations,” said Brownstein.

National data has been impacted as well. The Centers for Disease Control and Prevention aggregates state data as it is released, and thus, the agency’s totals are often impacted by delays in state updates. Additionally, the agency is no longer offering case and death data updates on weekends.

In recent months, as officials have reallocated resources and efforts to state vaccination drives, testing levels have also plummeted.

The nation is now recording around 600,000 coronavirus tests a day, significantly lower than the nearly two million tests a day the U.S. was reporting at the beginning of the year, another cause for concern for health officials who have repeatedly warned that drops in testing could lead to missed infections and subsequent spread.

“While we realized the value of testing and reporting at scale far too late in the pandemic, we are now repeating these mistakes by winding down public health efforts far too soon,” added Brownstein.

Even so, many states continue to close testing sites, including Iowa, which will cease operations of its statewide testing program later this month. Less than 50% of Iowa’s total population is fully vaccinated.

In other states, like Utah, health officials are still urging residents to get tested, as the state faces renewed concerns over rising coronavirus cases, with a 73% increase in cases over the last four weeks.

The number of people getting tested for COVID-19 has decreased dramatically in recent months, the Utah Department of Health reported on Tuesday, from over 32,000 weekly cases in mid-November, to approximately 5,900 tests conducted the week of June 14.

“The pandemic isn’t over yet. In fact, now that new variants are circulating and some are even more transmissible, finding out if you’re positive and isolating can prevent you from exposing others,” the department said in a press release on Tuesday.

Earlier this week, the CDC reported that the highly infectious delta variant, which has been found in all 50 states, is now estimated to account for 26.1% of new cases across the country.

It is still unclear exactly how widespread the delta variant is, because U.S. genomic sequencing also remains low across the country.

“I am disappointed that we’re not treating this adversary with the respect it deserves,” Miller said. “Now, when cases are low and traditional outbreak investigations and contact tracing could be a reality, we’re dropping the ball.”

Despite health officials’ pleas for more Americans to get vaccinated to curtail the spread of the delta strain and other concerning variants, the U.S. continues to struggle with falling vaccination numbers.

Over 45% of the total population has still yet to be vaccinated with their first dose of a COVID-19 vaccine, and according to CDC Director Dr. Rochelle Walensky, approximately 1,000 counties in the U.S. have vaccination coverage of less than 30%.

Current evidence suggests that full dosage of the mRNA COVID-19 vaccines is effective against the delta variant. According to a recent U.K. study, two doses of the Pfizer vaccine offered 88% protection, and earlier this week, Moderna had released new preliminary data, not yet peer reviewed, in which the company’s vaccine appeared to work against all concerning variants, including the delta variant.

In an effort to prevent potential outbreaks, the White House COVID-19 response team reported on Thursday that it would be intensifying efforts in some high-risk communities to help states prevent, detect and respond to hotspots among the unvaccinated by mobilizing COVID-19 surge response teams to be at the ready to deploy federal resources and, where needed, federal personnel.

Miller asserted, however, that the country’s current vaccination level “absolutely” does not provide enough protection to have shifted into a new phase of less testing and surveillance of the virus.

“Denial didn’t work when it first came to the U.S. or last summer when it hit the South or last winter when it hit everywhere. Sadly, it’s places with low vaccination rates that will bear the brunt of this round of infections. These are the same places that will lack testing. They won’t know that it’s hit them until it’s too late,” Miller concluded.

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(NEW YORK) — Two girls set up a lemonade stand to raise money for organ donations in honor of their late sister.

Makenzie Madsen was born with congenital heart disease and received a heart transplant at 17 months old. In 2019, her heart and kidneys started shutting down and she was taken to the hospital, where she went into cardiac arrest. She waited there for almost a year for a new heart and kidney transplant when she died on July 13, 2020, at age 14. Now, her sisters, Myleigh, 9, and Makayla, 7, have set up a lemonade stand in her honor.

“We just talked about what we could do because her anniversary is coming up,” the girls’ mother, Monica Madsen, told ABC News’ Good Morning America.

The idea was inspired by Makenzie herself, who would often set up a table and chair outside of their West Jordan, Utah, home to sell everything from baked goods to snow cones while growing up.

“She just loved to bake and cook,” Madsen said. “She even made her own snow cone flavors out of Kool-Aid.”

While she leaned toward making sweets, Madsen said Makenzie didn’t have a sweet tooth or like to eat them.

“I think she just loved interacting with people and seeing people smile,” she said.

The stand’s design is also an ode to Makenzie.

“Teal was our older sister’s favorite color,” Myleigh told GMA. “The other stripe is pink — Makayla’s favorite colors.”

Myleigh and Makayla want to use the stand to raise awareness on the importance of organ donation and how it can save lives.

“They want to open people’s eyes and hope people understand how important it is to say yes to organ donation,” their mother said. “They don’t want other kids to feel this — if their siblings have been waiting for a transplant and they didn’t make it. That’s what they talked to me about.”

According to data from the U.S. Department of Health and Human Services, around 17 people die each day while waiting for an organ transplant in the U.S. The average wait time for one is three to five years and, at the time of publication, the current amount of people on the waitlist for a heart is 3,601. For a kidney, that number soars to 90,567.

So far, the family has raised approximately $6,000 and will be donating all of the proceeds to DonorConnect, a nonprofit organization that assists families in the Mountain West with the organ donation process.

Myleigh said that she and her sister want to “get even more money to help other kids.”

In addition to lemonade, the girls are making cake pops to sell and will also try their hand at cotton candy.

“We’ve just tried to keep her spirit alive,” Madsen said. “She’s up there cheering them on and helping them out and rallying people to go see the stand.”

The family will be wrapping up the lemonade stand for the summer shortly, but plan to continue every year just like they said Makenzie would have.

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(NEW YORK) — In reassuring news for the more than 12 million Americans vaccinated with Johnson & Johnson, a new study indicates the single-shot vaccine will likely offer good protection against the delta variant, according to the company.

The highly transmissible delta variant is now predicted to become the dominant strain in the United States.

The findings are preliminary but promising. In a laboratory experiment, researchers analyzed the blood of 10 people who had been vaccinated with the single-shot Johnson & Johnson vaccine, and tested it against multiple concerning variants, including delta.

They found that the vaccine appeared to work against new variants, as indicated by so-called “neutralizing antibody titers” and other indications of immune system response.

Prior data has indicated that other vaccines, including those made by Pfizer and Moderna, are likely to hold up against the delta variant. But some experts worried the Johnson & Johnson vaccine, which unlike the others, only includes one dose, might not fare as well.

“I would say it’s reassuring,” Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, who helped lead the research, told ABC News. “We found the J&J vaccine induces neutralizing antibodies.”

In fact, Barouch said another reassuring finding of the study was that people vaccinated with the Johnson & Johnson shot appeared to have a strong immune system response up to eight months later.

“We saw surprisingly good durability of responses,” Barouch said. “We followed these individuals for eight months, and over eight months, the antibody and T cell responses were very stable.”

A growing body of evidence suggests that COVID-19 vaccines may offer longer-lasting protection than some scientists initially anticipated. That’s because other parts of the immune system, cells called memory B cells, continue to mature over time, and retain their ability to fight infection.

Barouch cautioned there are limitations to this research, which offers researchers helpful clues from laboratory experiments rather than real-world evidence from thousands of people.

“Our findings show that a single shot of the J&J vaccine raises robust neutralizing antibody levels against the delta variant. Our study does not show clinical protection,” he said.

But for those who were vaccinated with the single-shot Johnson & Johnson vaccine, this study is a reassuring indication that the vaccine is likely to work just as well against the delta variant as it does for other circulating variants.

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(LITTLE ROCK, Ark.) — As COVID-19 vaccination rollouts continue and the U.S. returns to a semblance of normality, Arkansas officials are warning of a third surge following a spike in cases.

Arkansas, which never issued an official stay-at-home order during the pandemic, reported 686 new probable and confirmed COVID-19 cases Wednesday — the largest one-day increase in more than four months.

The state’s COVID-19 hospitalizations also rose by 19 to 325, and deaths increased by four to 5,909.

Gov. Asa Hutchinson said in a statement that “the high number of cases today makes it clear that the delta variant is increasing the spread of the virus” in the state.

So far, 34.3% of the state’s population has been fully vaccinated, according to the Centers for Disease Control and Prevention.

Hutchinson touted the effectiveness of vaccines during a Tuesday coronavirus briefing, saying 90.5% of current active cases in the state are among the unvaccinated, who, officials noted, also account for 98.3% of Arkansas’ 3,765 hospitalizations and 99.6% of the deaths since Jan. 26.

University of Arkansas for Medical Sciences Chancellor Dr. Cam Patterson said at the press conference that the delta variant is driving up case numbers.

The delta variant, first detected in the state on May 1, makes up more than 25% of infections in the state and is projected to make up more than half of all infections within a matter of weeks, Patterson added.

“We have to be concerned that this would be a trend that could continue, and if it does, it would appear that we may be in the third surge of COVID-19 here in the state of Arkansas,” he said.

Hospitals see more younger patients

Doctors in Arkansas told ABC News that the highly transmissible new variant, low vaccination rates and infrequent mask-wearing are fueling the surge.

Hospitals are seeing more and younger patients arrive, many with more severe symptoms, Dr. Jason McKinney, a pulmonologist and the ICU medical director at Mercy Hospital Northwest Arkansas, told ABC News. He said this isn’t because younger people are more susceptible to the virus but because more older people have been vaccinated.

“Most definitely we are seeing the beginning of a third surge,” McKinney said. “And as far as our inpatient load of COVID, we’re at about 30% of where we were previously. And so that makes me very concerned, because we’re very early on.”

As of Thursday, Mercy Hospital Northwest was treating about 16 COVID-19 patients at the hospital.

“The misconception of younger people is that if I’m at low risk of dying, I’d rather risk getting the disease and just be sick than get the vaccine,” he said, referring to people in their 20s to 50s. “COVID is often a virus that keeps on giving after you’ve gotten rid of it. And the amount of chronic fatigue, the neurologic problems, the vascular problems, cardiac problems and the pulmonary problems that people suffer from this disease long term, it’s scary.”

Last week, UAMS Medical Center in Little Rock reopened a unit for COVID-19 patients after shuttering it in April.

Dr. Steppe Mette, CEO of UAMS Medical Center, told ABC News that the hospital has seen a “300 to 400% increase in the number of patients with COVID just over the last three to four weeks.”

“So,” he added, “we’re back to hospitalization numbers that we haven’t seen since February or March. And that’s happening around the state.”

UAMS last reported having 22 COVID-19 patients in hospital beds and nine in the ICU. Around the city, there are over 100 hospitalized with the virus, Mette added. Previously “about a quarter of our patients hospitalized in the ICU, and now we’re running more like 50 to 70% in the ICU.”

Failed incentives

The vaccination rate in Arkansas, one of the lowest in the U.S., has slowed further despite the introduction of several incentive efforts.

Last month, the state launched a million-dollar vaccine incentive program, giving out Arkansas Lottery Scholarship $20 scratch-off tickets or a $20 gift certificate for the Arkansas Game & Fish Commission for new first doses, but it’s failed to bring up vaccination numbers.

Only 2,482 lottery tickets and 926 Game & Fish Licenses have been given out as part of the program, a Health Department spokeswoman told ABC News.

Data from Johns Hopkins shows that the state’s seven-day average vaccination rate sunk from 27,298 on April 1 to 4,591 on June 30.

Mette said while earlier in the year there were issues of accessibility, now the real battle is vaccine refusal.

“It’s more that there is a resistance, refusal or hesitancy to get a vaccine,” Mette said. “It’s more that they’ve been influenced by somebody else, that the vaccines are not safe, or they’re not necessary, or that the pandemic isn’t even anything real or to worry about it. That degree of resistance is pretty concerning.”

Stepping backwards

In a bid to curb an outbreak, some facilities have stopped in-person visitations, an echo of earlier on in the pandemic.

The Conway Human Development Center, a state-run residence for people with disabilities, stopped visitations after 20 staffers and 13 residents tested positive for the virus within a two-week period, according to ABC Little Rock affiliate KATV.

Under the state’s recently passed “No Patient Left Alone Act” visitors will be allowed if a resident requires emergency care or hospice care.

Baxter Regional Medical Center in north Arkansas tried to ban visitations at its emergency department last week only to walk that back after realizing it could no longer enforce it.

“We’ve been through a lot over the past year and a half,” McKinney said. “We’re worried that we’re looking at a similar situation where we’ve all been working extra days and nights and taking care of a high volume of patients. We’re very worried that we’re going back in that situation.”

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