Health

(PRESIDIO COUNTY, Texas) — Americans remain deeply polarized over the renewed push to get the country vaccinated.

Nowhere is such a divide more evident than in Texas, where the vaccination rates tend to vary drastically from county to county.

Presidio County — a remote area of southwest Texas, home to approximately 7,800 people — while rural, boasts the state’s highest vaccination rate, with nearly every one of its eligible residents fully vaccinated.

In the county, cell service is often spotty, and the closest medical center is hours away from most homes, but residents who chose to get vaccinated said they saw it as a matter of life or death.

Rosendo Scott, a Vietnam veteran, who is battling amyotrophic lateral sclerosis, or ALS, was more than willing to roll up his sleeve when he became eligible for a vaccine.

“We’re so isolated that we could easily just fall like dominoes, if something wasn’t done,” he told ABC News.

Big Bend Regional Medical Center serves approximately 25,000 residents in a vast 12,000 square mile area, Dr. Adrian Billing, chief medical officer at the hospital, said.

“It’s a 90-to-150-mile one-way trip to get to the emergency room, so I think some of that, just recognizing how limited we are for health care, contributed to our high vaccination rates,” Billing said.

Given the extremely high demand for vaccination, Billing said, all of the county’s available health care workers were pulled away from other duties in order to assist with the shots.

“We had to shut down our medical and dental service lines, and our behavioral health service lines, on these days that we did 500 or 600 vaccines at a time,” Billing said, adding that he has not recently seen a single vaccinated patient wind up in the hospital.

Scott explained that he has a very high level of trust in his health care providers, and thus, in their recommendation that he get vaccinated.

“I’m a believer in science,” Scott said.

The county’s impressive vaccination rate has kept residents safer, local leaders said, especially the community’s youngest members.

Scott’s wife, Allison, who is the principal of Marfa High School, in Presidio County, told ABC News that thanks to the county’s high vaccination rate, there have not been any coronavirus cases in the K-12 public school system since school started.

“So far — and this is our eighth week of school — we haven’t had a positive case, so we’re remaining hopeful,” she said.

However, more than 620 miles away, in Lamar County, the story is very different. Despite the availability of vaccines, only 40% of the residents have been fully vaccinated.

Klark Byrd, the managing editor of The Paris News, a small town newspaper, said he believes vaccine hesitancy in Lamar has been largely driven by residents’ “distrust in the government, distrust in the vaccine makers, [and] distrust, based on misinformation that’s found on social media sites.”

Given the low rate of vaccination in the county, Byrd has been printing op-eds, urging residents to talk to their doctors.

Although Byrd himself has not been vaccinated, due to a pre-existing health condition, he said he is taking all the necessary precautions to keep himself safe, with hand sanitizer, masks and social distancing.

“Sometimes, I’m the only one with a mask, and that’s concerning, but I maintain my distance with people. If I turn down an aisle at Walmart, and there’s a bunch of people, I will avoid that aisle and wait till it clears out,” he said.

Among the many who have opted not to get the shot is Kacy Cole.

Despite the fact that he has seen firsthand how serious COVID-19 can be, with several close friends and family, including his wife, contracting the virus, Cole said he has not reconsidered his anti-vaccine stance.

“It did not,” Cole told ABC News. “We prayed about it and we firmly believe that a lot of faith is involved in a lot of things we do.”

The decision of Cole, and other residents not to get vaccinated has been a tough pill to swallow for many front-line workers.

Dr. Amanda Green, the Lamar County health director and the local hospital’s chief medical officer, explained she wants to do her utmost to keep her community healthy, and the public educated about vaccines, but she tries to be realistic in her awareness that she may never be able to convince everyone.

“There are some people that I think they’ll just never change, no matter what,” Green told ABC News.

From Green’s perspective, such vaccine hesitancy can be a fatal choice. She pointed to Ronnie Stanley, the husband of a local nurse who chose not to get vaccinated. After falling ill to COVID-19, he wound up in the ICU, and died late last month.

“No one is invincible to this disease, it doesn’t care, it doesn’t discriminate,” Stanley’s widow, Amanda, told ABC News. She had urged him to get the shot, from the very beginning, but he was set in his ways, she said.

“He knew that it was as real as what it is, (but) he didn’t know that he would have been affected the way he did. I think had he known, then absolutely, he would have vaccinated and, you know, saved us all the torment that we’ve seen the last month. But yes, he was unvaccinated, and others believe that plays a big role in his death,” Amanda said

She is now seeking to convince those who are still hesitant, by telling his story.

“I don’t believe it has anything to do with politics,” she said about the COVID-19 vaccine. “I believe that this vaccine was created by brilliant doctors and scientists, and God gave them those abilities. And that’s what people need to understand, it’s a selfless act when you get vaccinated. It’s not for yourself, but it’s for those that you need to protect.”

Copyright © 2021, ABC Audio. All rights reserved.

(NEW YORK) — Children can safely celebrate Halloween this year even as the coronavirus pandemic upends the holiday for the second straight year, according to the nation’s top infectious disease expert.

White House chief medical adviser Dr. Anthony Fauci told CNN Sunday that kids can “go out there and enjoy Halloween,” an approach he attributed to the fact that more and more people are now vaccinated against COVID-19 and that most Halloween activities, including trick-or-treating, are held outdoors.

“It’s a good time to reflect on why it’s important to get vaccinated,” he said, urging unvaccinated adults and teens to get shots before Halloween. “But go out there and enjoy Halloween.”

“This is a time that children love,” Fauci added. “It’s a very important part of the year for children.”

Fauci’s go-ahead on Halloween comes as COVID-19 hospitalizations, cases and deaths are declining nationwide.

But experts caution the virus could rebound if enough people remain unvaccinated.

Last week, Pfizer and BioNTech submitted a request to the Food and Drug Administration (FDA) for emergency use authorization for their vaccine for kids ages 5 to 11. But the timing means the vaccine will not be available for kids in that age group before Halloween.

The Pfizer vaccine is currently authorized for emergency use in children ages 12 to 15 and is approved by the FDA for people ages 16 and older.

Dr. John Brownstein, an epidemiologist and chief innovation officer at Boston Children’s Hospital, is the father of two young children. He said he plans to have a more “normal” Halloween with his kids this year, complete with outdoor trick-or-treating.

“It’s safe to say that trick-or-treating is an activity that all kids can partake in,” said Brownstein, who is also an ABC News contributor. “Kids can feel quite excited by the fact that I think they will have a generally normal Halloween compared to last year.”

Here are four questions answered by Brownstein about how to have a safe Halloween this year.

1. Does my child need to wear a mask while trick-or-treating this year?

In most cases, no, according to Brownstein.

“Every parent has to make their own sort of risk calculation, but given where we are in this pandemic, I think, generally, mask wearing outside is probably unnecessary,” he said, noting that data from nearly two years of the pandemic show that outdoor activities are “generally safe,” even for children who are not yet vaccinated.

“Of course, every family should make decisions that are right for them and the underlying risks of their kids and household members,” Brownstein added. “And luckily, Halloween costumes can make mask-wearing less stigmatizing.”

2. Are indoor Halloween events safe for my kids to attend?

While Brownstein is planning to trick-or-treat outdoors with his kids, he said they are planning to wait another year before attending big, indoor Halloween events.

“The bigger questions that come into play around indoor activities may involve unvaccinated people,” he said. “That’s where masking and good ventilation may be more appropriate.”

Brownstein added that people who do choose to attend indoor Halloween events this year should make sure that people at the event are vaccinated if they are eligible. He also suggests relying on additional layers of protection like social distancing and COVID-19 testing, in addition to masking and good ventilation.

3. Should my family use rapid tests? Are they reliable?

Brownstein said that in addition to vaccination, another major difference between this Halloween and last is that rapid tests are now widely available for use and are particularly smart for indoor events.

“Because rapid tests are becoming more and more pervasive, we should all be using them as a tool to limit the risk to unvaccinated people or the risk of breakthrough infections,” said Brownstein. “Within a short time frame of an event, taking a rapid test, while not 100% foolproof, will give some good reassurance that you’re not putting other people at risk by joining an indoor event.”

“I have a bunch on hand at home, ready to use as needed, so I think those are incredibly effective,” he said.

4. Does a ‘normal’ Halloween mean we’ll also have a ‘normal’ Thanksgiving and Christmas?

Brownstein said he is hopeful that more and more families and friends will be able to spend the holidays safely together this year, but stressed the importance of maintaining good public health practices to keep everyone safe, especially since the upcoming holidays typically involve more travel and time spent indoors.

“While this holiday means that we can gather more seamlessly and in a slightly more normal way, there are small things that we can all do to try to limit transmission,” he said, citing masking as a critical tool. “Transmission takes place through droplets and aerosols so whatever we can do to limit transmission will ultimately have a direct impact on whether we see a surge post-holiday.”

He added, “As we know, those surges can lead to even more significant public health measures that we’re all trying to avoid, so the small things we do during the holiday can mean even a more enjoyable life post-holiday.”

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(NEW YORK) — Selma Blair is getting candid about living with multiple sclerosis in a new documentary.

In Introducing, Selma Blair, the actress opens up about how she is embracing the disease and how she is feeling after undergoing a stem cell transplant in 2019.

“At this moment, I’m great,” Blair told Good Morning America’s Robin Roberts in an interview. “It is important to say, ‘at this very moment’ and I don’t want to be complaining although I — I always say, ‘I have no complaints but do you have a minute?’ It’s like my joyful thing.”

Blair added, “I have more gains than losses. And I do have things that can sometimes be embarrassing but this part of it that I do want to show ’cause that’s the part that’s healing, and perfect, and acceptance — the glitches, maybe some of the speech.”

The actress, who is known for her roles in films such as Cruel Intentions and Legally Blonde, first shared her MS diagnosis on Instagram in 2018. Months later, she spoke with GMA her daily battle with the disease.

Blair said that coming forward with her illness has meant a lot to others, including her fans and followers.

“What I saw when people came up after an Instagram post or especially your show that I was on — how much it meant,” she said. “And that moved me more than I had been moved by other things that I have achieved in my life or done.”

The documentary, which will show viewers what went into Blair’s decision to get the stem cell transplant, will show her fears about receiving the procedure, which is still experimental for MS and not a cure, and the intensive rounds of chemo she had to do to help “reboot” the immune system. Stem cell transplants are not yet FDA approved for the treatment of MS.

“I kinda got to a critical point and my nervous system and more symptoms and I couldn’t stay awake,” Blair said. “I was mortally afraid of chemo my whole life. I’m someone that’s always gone holistic when I can.”

But Blair said that after one dose of chemo, she was talking clearly and the inflammation started to go down. Now, she revealed her brain is free from forming new lesions, but she does have volume loss in some speech and movement areas and prefrontal damage — things she takes medicine for throughout the day.

“I chose this as a marker in my life to want to live, to want to be a person that can show other people with chronic illness, disabilities, an injury they couldn’t get over, a hit,” she said. “I just took a hit. And we take hits. … And that resilience is possible.”

As for acting, she hopes it’s something she can return to someday.

“If the right thing — I’m not looking, but God knows I would never say I wouldn’t dream of being a part of an amazing set one day.”

For now, she’s taking things one step at a time and finding joy.

“We have to take care of ourselves and be patient,” Blair said. “And better times come. Maybe not for good. Maybe it’s not a cure. But more than not, better times will come. We’re meant to have joy on this earth. I never felt that before.”

Introducing, Selma Blair will hit theaters Oct. 15.

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(NEW YORK) — For years, triple-negative breast cancer has been perceived as aggressive with little hope of treatment, but that thought appears to be changing among experts as more promising treatment options develop.

“I would say that the future is bright for triple-negative breast cancer,” said Dr. Erica Mayer, a medical oncologist and senior physician at Dana-Farber Cancer Institute in Boston. “We now have new treatment strategies that we didn’t have available before that definitely seem to be benefiting patients with triple-negative disease.”

Triple-negative breast cancer is the smallest category of breast cancer groups, only accounting for about 10-15% of all breast cancers, according to the American Cancer Society. Mayer says this doesn’t mean that it’s uncommon. “Because breast cancer is a very common cancer, there are actually tens of thousands of people who are diagnosed with triple-negative breast cancer every year.”

Triple-negative disease is a unique class of breast cancer because it lacks receptors that drug therapies can target for treatment. Breast cancer cells can have three different types of receptors — estrogen, progesterone and a protein called HER2 — that are each like the lock on the front door of a house. The keys to these locks are the different hormonal or drug therapies that can gain access and kill the cancer cells. But triple-negative breast cancer does not have those three types of receptors, hence the name. This makes it harder to treat than other types of breast cancers.

While lacking those receptors, triple-negative breast cancer still has the same symptoms as other types. Some of these symptoms are a new lump or mass in the breast or armpit, dimpling of the breast skin, abnormal nipple discharge or even the nipple turning inward.

Risk factors for triple-negative breast cancer are also the same as the other breast cancer types. Experts say breast cancer risk increases with things like increasing age, obesity, smoking, alcohol and a personal or family history of breast cancer. Although it’s not a definitive risk factor, triple-negative breast cancer is more commonly seen in Black and Hispanic women, as well as women under age 50; but it’s not understood by experts why that’s the case.

“Black women are also more likely to be diagnosed with cancer at a young age, so that’s how you might get that association, but it’s not necessarily causative,” said Dr. Kimberly Lee, a medical oncologist in the Breast Oncology Department at Moffitt Cancer Center in Tampa, Florida. “There’s no simple answer to that.”

Although completely eliminating these risk factors doesn’t guarantee you wont get breast cancer, doing so can help lower the risk. “Decreasing those risk factors as much as possible will decrease your risk,” said Lee. “Again, it doesn’t go to zero.”

New therapies for triple-negative breast cancer

According to experts, triple-negative can be a very treatable and potentially curable type of breast cancer, especially with recent research advances. Treatment of triple-negative breast cancer involves both local therapies, such as surgery and radiation, and can also include systemic therapies, like chemotherapy. Thanks to research in recent years, another category of medications is available, known as immunotherapy, where medicines help stimulate the immune system to destroy cancer cells. This category of medication is used with chemotherapy and is used depending on factors, such as the stage of the cancer.

New discoveries, such as immunotherapy, are starting to change the previous beliefs that triple-negative breast cancer is untreatable, experts say.

“We are incredibly gratified to see that offering immunotherapy before surgery not only helps to do a better job killing the cancer cells, but also seems to help prevent the cancer from coming back, which may help people live longer,” said Mayer. “So the introduction of immunotherapy into the treatment of triple-negative breast cancer may be a game changer.”

October is Breast Cancer Awareness Month, but experts say it’s important to be aware of any changes to your breasts and get year-round screening.

Experts recommend mammograms starting at age 40. How frequently and how early to be screened depends on your own individual risk, making it important to see a health care professional to determine your risk and when to begin screenings. In the meantime, everyone should be aware of any changing symptoms in their breasts.

“It’s also important to be aware of one’s body and notice any changes, pointing them out to one’s doctor if they arise,” Mayer said.

Finally, experts say that it is very important to know your family history, which could influence your own risk of breast cancer. “For a long time, cancer was taboo, and people didn’t talk about cancer,” said Lee. “But your family history is important, because again, that could put you at higher risk.”

Triple-negative breast cancer is becoming more treatable as more discoveries are being made, giving hope to experts and those living with the disease.

“I meet people every day and they think it’s the end that we don’t have treatment, that we can’t help them and as an oncologist, that’s not the case,” said Lee. “There is hope.”

Copyright © 2021, ABC Audio. All rights reserved.

(NEW YORK) — A number of pediatric hospitals across the country are warning about an increase in the number of cases of multi-system inflammatory syndrome in children, a rare condition in which different parts of the body, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs, become inflamed.

MIS-C, which most often appears four to six weeks after a COVID-19 infection, can be serious and potentially deadly, but most children who are diagnosed with it recover with medical care, according to the Centers for Disease Control and Prevention.

Federal data shows that there have been at least 46 confirmed MIS-C deaths and 5,217 confirmed MIS-C cases — and about 61% of the reported cases have occurred in children who are Hispanic/Latino or Black. Children between the ages of 6 to 11, who may soon be eligible for a COVID-19 vaccine, have reported the highest number of MIS-C cases since the onset of the pandemic.

Nearly 5.9 million children have tested positive for COVID-19, and MIS-C infections represent only 0.0009% of COVID-19 pediatric cases. However, between July and August, the average number of daily MIS-C cases nearly doubled.

“MIS-C happens about four to six weeks after a primary COVID infection, and we know that the delta variant has really impacted kids, more than previous waves have done, and so it’s not really that big of a surprise a couple weeks after your first cases of COVID start rolling, and then you start seeing your MIS-C cases roll in,” Dr. Amy Edwards, a pediatric infectious disease specialist at UH Rainbow Babies and Children’s Hospital in Cleveland, told ABC News Friday, in reference to the facility’s recent uptick.

Dayton Children’s Hospital told ABC News they too have seen an uptick in recent weeks. And it is not just in Ohio where officials are seeing increases. In Tennessee, the number of MIS-C cases has more than tripled since early February.

“We saw a dramatic increase in COVID-19 cases in children over the past two months with the delta variant surge in our region,” Dr. Sophie Katz, assistant professor of pediatric infectious diseases at Monroe Carell Jr. Children’s Hospital at Vanderbilt said in a press release on Wednesday. “Unfortunately, we anticipate an increase in MIS-C cases following this spike.”

Earlier this week, officials from Children’s Mercy Hospital in Kansas City, Missouri, said at a press conference that their physicians have seen an uptick in MIS-C in recent weeks as more children test positive.

“I saw three with MIS-C personally last week,” said Dr. Angela Myers, the division director of infectious diseases at Children’s Mercy. “I think we’ve had more [children] continue to get admitted to the hospital since then. That’s more than the zero we had multiple months before that.”

And on Wednesday, the University of Mississippi Medical Center, which houses Mississippi’s only pediatric hospital, reported that the state is still seeing acute cases of COVID-19 and MIS-C in children.

“What we have now is both MIS-C and severe acute COVID-19, and I think it’s because of schools dropping mask mandates,” Dr. Charlotte Hobbs, professor of pediatric infectious diseases and director of UMMC’s MIS-C clinic, said in a statement. “We saw this drop of acute COVID-19, and then MIS-C, and now acute COVID-19 is increasing again. Acute COVID and MIS-C at the same time is something that has not happened before, and it is preventable.”

Utah native Sharella Ruffin’s 6-year-old son, Zyaire, contracted the rare syndrome earlier this month.

“How can something like that take over your kid’s life in like a week? I’m not understanding that. It was like the most scariest things that ever happened in my life. No mother should ever have to hear that your baby might not make it,” Ruffin told ABC News Friday. “To see your 6-year-old son just laying there. And he’s scared and don’t know what’s going on.”

According to the CDC, the best way for a parent to protect their child is by taking “everyday actions” to prevent COVID-19, including mask-wearing and hand-washing.

At this time, severe illness due to COVID-19 remains “uncommon” among children, according to the American Academy of Pediatrics and the Children’s Hospital Association.

However, any acute illness from COVID-19 and death in a child is concerning, Dr. Richard Besser, a pediatrician and former acting director of the CDC, told ABC’s “Good Morning America” on Friday.

“One of the myths that is out there is that this COVID pandemic isn’t affecting children. There have been over 600 children who died. There have been thousands who have been hospitalized,” Besser said.

Experts continue to emphasize the urgency for not only children to be vaccinated, when eligible, but also for their parents and all of those in the communities around them to get the shot as soon as possible

ABC News’ Felicia Biberica, Kelly Landrigan and Kristen Red-Horse contributed to this report.

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(NEW YORK) — The COVID-19 pandemic has had a major impact on the mental health of the nation, according to a new study published in the Center for Disease Control and Prevention’s weekly journal, MMWR.

The CDC said that social isolation, coronavirus-related deaths and stress weighed heavy on Americans, forcing many to confront new mental health challenges.

Researchers noted that anxiety and depression scores fluctuated throughout the pandemic and reflected changes in COVID-19 cases. Throughout the study, they found that the more average daily COVID-19 cases there were, the more people experienced anxiety and depression symptoms.

From August 2020 to December 2020, there was a 13% increase nationwide in anxiety-related symptoms and a 14.8% increase in depression-related symptoms.

“We were really thinking about life or death,” said Dr. Panagiota Korenis, associate professor at the Albert Einstein College of Medicine. “The pandemic has certainly identified the need to not just take physical health in isolation and really needing to emphasize also people’s mental well-being.”

As the COVID vaccine has rolled out, from December 2020 to June 2021, anxiety-related symptoms decreased by 26.8% and depression-related symptoms fell by 24.8%.

However, the severity scores for both illnesses remain higher than pre-pandemic levels.

“As this is drawing out, we’re seeing the aftermath of a lot of burnout. … I do very much believe that we are in it for the long haul,” Korenis said. “If people take the time to self-reflect, and they’re open to getting help, getting treatment, and taking time to do things that bring them joy, I think that’s really critical.”

Researchers said this study emphasized the need to make mental health resources readily and easily accessible during the pandemic.

The study included more than 1.5 million adults, and took into account 19 different waves of COVID-19 to assess anxiety and depression symptoms with questionnaires and surveys.

Dr. Adela Wu, a contributor to the ABC News Medical Unit, contributed to this report.

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(MONTREAL) — A mom who went viral while sharing her battle with ovarian cancer on social media has died.

Dr. Nadia Chaudhri, 43, died on Oct. 5, according to Concordia University, where she worked as a neuroscientist and professor.

“Nadia was a force of nature,” Concordia president Graham Carr said in a statement. “She was an incredibly talented researcher with a passion for teaching and student success matched only by her commitment to diversity, equity and inclusion.”

Chaudhri, of Montreal, Canada, battled stage 3 ovarian cancer for the past year, undergoing a hysterectomy and several rounds of chemotherapy.

She gained more than 148,000 followers on Twitter during her cancer battle, which she bravely shared publicly.

@DrNadiaChaudhri passed away yesterday evening, having reached the end of her road with ovarian cancer. She leaves behind her Sun and Moon, a loving extended family, colleagues and students, friends around the world, and so many others who have been touched by her & her story 1/n pic.twitter.com/qf1q0Bfbj1

— Dr. Krista Byers-Heinlein (@Krista_BH) October 6, 2021

In May, when Chaudhri learned the cancer had returned, she shared on social media what it was like to tell her 6-year-old son that she was dying. On social media, she called her husband and son her Moon and Sun.

“My husband and I made the decision that we needed to tell our son what is going on because all the treatments are failing me,” she told “Good Morning America” at the time. “He already knew that I had cancer. He knew that I was still taking chemotherapy medication and trying to get better, but I don’t think he had a sense of how bad it is.”

Our hearts broke. We cried a lot. And then the healing began. My son is brave. He is bright. He will be okay. And I will watch him grow from wherever I am. Today was the hardest day of my life. Thank you for all for your love. pic.twitter.com/sCZFW9d8T5

— Dr. Nadia Chaudhri (@DrNadiaChaudhri) May 11, 2021

Several months later, in September, Chaudhri went viral again with a series of tweets detailing the many months it took for her to get a diagnosis of ovarian cancer and what she wanted other women to know.

“Know your bodies,” Chaudhri urged women. “Pay attention to fatigue and changes in bowel/urinary tract movements. Make sure you understand all the words on a medical report. Do not dismiss your pain or malaise. Find the expert doctors.”

As Chaudhri gained followers on social media, she used her platform to educate people on ovarian cancer and the work and causes near to her heart.

Chaudhri, who moved from Pakistan to the U.S. at age 17 to attend college, raised money to allow young scientists to be able to continue the research she was doing on drug addiction.

She also turned her frustration with not being able to work into an opportunity to raise money for underrepresented scholars in her field.

Her efforts raised more than $600,000 and became the Nadia Chaudhri Wingspan Award at Concordia University, an annual scholarship to “support the training of neuroscientists from underrepresented backgrounds and honor Nadia Chaudhri’s legacy of academic achievement and mentorship,” according to the university.

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(NEW YORK) — With COVID-19 vaccine mandates proliferating across the country in the public and private sectors as well as some school districts, the pushback from those unwilling or hesitant to get their shots is heating up.

The vaccination effort has raised new questions about exemptions because mandates for adults are generally rare outside of settings like healthcare facilities and the military, and the inoculations are relatively new.

While there is no overall data yet on exemptions for COVID-19 vaccines, a number of companies and state governments have seen interest in religious exemptions — a protection stemming from the Civil Rights Act of 1964.

This leaves employers in the difficult and legally precarious position of determining whether the requests are valid. As such, some states have tried to do away with non-medical exemptions overall for their employees.

In school settings, where vaccines have long been recognized as crucial to preventing communicable diseases, state-level mandates are common and have been tested in the courts.

“One of the most important public health practices we have to alleviate outbreaks and things like measles and whooping cough are vaccines required for school or for daycare entry,” Dr. Joshua Williams, an assistant professor of pediatrics at the University of Colorado School of Medicine, told ABC News.

In addition to California announcing that it is adopting a state-wide mandate, individual education boards in cities like Los Angeles have started adding the Pfizer vaccine, which was granted full FDA approval in September and is currently the only vaccine approved for children older than 12, to their list of immunization requirements.

Experts say other school districts are likely to follow suit and have strong legal ground to enforce the requirement set forth in the 1944 Supreme Court case Prince v. Massachusetts.

Here’s what to know about the debate over non-medical exemptions:

On the rise in schools

Data from the Centers for Disease Control and Prevention (CDC) shows that while requests for medical exemptions in schools remain low and fairly constant (around 0.3%), non-medical exemptions (including religious and personal belief exemptions) have risen from 1.4% in the 2011-’12 school year to 2.2% in the 2019-’20 school year (a 57% increase).

In Idaho, for instance, in the 2019-’20 school year, 7.2% of kindergarteners had non-medical exemptions, according to the CDC data. That contrasts with around 1% for states like Massachusetts, Louisiana and Alabama.

Ellen Wright Clayton, a professor of pediatrics, law and health policy at the Vanderbilt University Law School, believes that schools should take a stand against religious exemptions in the interest of protecting public health.

“The fact of the matter is, parents are not entitled, for any reason, to expose other people’s children or other people to [COVID-19] for religious reasons,” Clayton said.

Schools from all 50 states have historically required immunization starting in kindergarten level to curb the spread of contagious diseases such as measles.

Forty-four states and the District of Columbia currently offer religious exemptions to vaccines, of which 15 offer broader personal belief exemptions for personal, moral or spiritual ideologies. The remaining six states — California, Connecticut, Maine, Mississippi, New York and West Virginia — only offer medical exemptions.

More religious exemptions despite decreasing religiousness

Williams, from the University of Colorado, noted that despite a decrease in religiosity among Americans, there has been an increase in religious exemption requests for vaccination, implying that these exemptions are “no longer serving their original purpose.”

It has increased even as some religious leaders, including Pope Francis and Rabbi Chaim Kanievsky, a leading authority in Israel’s ultra-Orthodox Jewish community, have made clear that vaccines are necessary for the common good and take precedence over religious beliefs.

In his research, Williams also investigated the influence of the availability of personal belief exemptions in states on the rate of religious exemptions for childhood vaccinations. In 2016, Vermont eliminated its personal belief exemption policy which was followed by an increase in religious exemption applications from 0.5% to 3.7%.

This suggests that “perhaps people were increasingly using that religious exemption category, even though they might not necessarily have a religious objection to vaccines,” Williams said.

“One thing that people have done previously has shown that the harder it is to obtain an exemption, the lower the rate of exemptions becomes,” he added.

Unlike personal belief exemptions, which are relatively broad, religious exemptions have to be integrated into a holistic belief system, said Dorit Reiss, a professor of law at UC Hastings College of the Law.

“You can’t just grab onto a biblical verse when it’s convenient,” Reiss, who has written about the legality of vaccine mandates in law journals, said.

How the exemptions work

Individuals’ rights to claim a religious exemption from immunization is protected under Title VII of the Civil Rights Act of 1964. However, as seen in some states, this right can be overruled in the interest of public health.

In the wake of the 2019 measles outbreak in the states of New York and Washington, where most cases were reported among the unvaccinated, the states eliminated religious exemptions.

In the face of a religious exemption application, employers or schools have the right to probe the exemption and question the applicant. In other words, it is on them to assess the sincerity of the belief, not the accuracy or validity.

Employers can require their employees to explain the basis of their belief in detail and don’t need to accept a cursory attestation to grant the exemption, Reiss said.

“You can’t try and assess if the belief is rational,” Reiss clarified. “You can ask them a tough question to gauge sincerity.”

However, employers cannot discriminate in favor of organized religions and hence aren’t allowed to request letters from clergy or priests as proof. Employees’ rights to challenge accommodations provided by their employer are also protected by the Equal Employment Opportunity Commission with whom they can file an official complaint.

Employers can maintain high proportions of vaccinated individuals and still make accommodations for those with sincere religious beliefs as demonstrated by the Conway Regional Health System.

But allowing religious exemptions on the basis of how convincing the justification is, Reiss explained, is problematic because it opens the door for people who’ve attended anti-vaccine workshops or “people who are just better liars” to game the system.

Building trust for vaccinations

According to Williams, vaccine hesitancy and the misuse of religious exemptions can be attributed to not only a gap in knowledge caused due to vaccine misinformation and disinformation, but also due to a lack of trust between individuals and public health experts.

“It comes down to something scaring them of the vaccine and they’re using the religious exemption as a cover,” Reiss said.

A common concern among vaccine opponents is the use of fetal cell lines in vaccine research and development, although not an actual ingredient in the vaccine.

When asked about alternatives to curb the spread of misinformation regarding vaccine side effects and composition and the misuse of religious exemptions, Williams suggested a collaboration with religious and faith leaders whom individuals have already built trust with.

“All major faith traditions support vaccinations. And they all support COVID vaccines as well,” Williams said. Reverends and bishops across the country have started collaborating with governments to build trust in the COVID-19 vaccine. It then often comes down to individual interpretations of scripture that lead to religion-based anti-vaccine beliefs.

According to Williams, facilitating an ongoing conversation between faith leaders, public health experts and community members would provide for a safe space for individuals to voice their concerns and get answers in a comfortable environment.

With its relatively recent onset, experts agree that it might be too early to talk about the rate of religious exemptions on the COVID-19 vaccine mandate rollout.

It’s important to highlight how problematic it is to misuse religious exemptions is, Reiss pointed out. “Because in a real sense, it’s abusing religion. It’s making a mockery of real belief and encouraging people to lie about religion, which no religion I think supports.”

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(NEW YORK) — Shayla, a 22-year-old from Georgia, has had days during the coronavirus pandemic when she said it has been a struggle to get out of bed.

The part-time college student said she was out of work for a time due to restaurants being closed during the lockdown, and in addition to the financial stress, struggled with not being able to see friends and socialize.

As a person with an underlying health issue, she said she also struggled with fears about getting COVID-19 since she is at risk for complications from the virus.

“It has been very hard on my mental health,” said Shayla, who asked that her last name not be used. “I had a lot of things to think about already and then COVID just added to it, so it was a lot of pressure.”

Shayla turned to therapy to cope, the first time in her life she has sought professional help for her mental health.

“It was like I was just in this box and I didn’t know how to get out of it,” she said. “Mentally and physically, I was just exhausting myself.”

Shayla is not alone in her mental health struggles during the pandemic, research shows.

In the United States, rates of anxiety and depression remain higher than they were pre-pandemic, according to data released this week by the Centers for Disease Control and Prevention.

Mental health experts have described the pandemic as a kind of “perfect storm” in negatively impacting mental health.

In addition to the fear, grief and anxiety around the virus itself, for many people the pandemic has brought on financial instability, job loss, isolation, additional caregiving responsibilities, uncertainty around school and work and related political disagreements.

Now as the global community marks World Mental Health Day on Oct. 10, the pandemic has continued far beyond what people initially thought possible, for nearly two years.

“I’ve heard the pandemic described as a disaster of uncertainty because it seems like the finish line keeps moving,” said Dr. Erica Martin Richards, chair and medical director of the department of psychiatry and behavioral health at Sibley Memorial Hospital in Washington, D.C. “And that makes it harder to come up with a plan [to cope].”

The pandemic has also proven to disproportionately impact women’s mental health.

One study, published by the Kaiser Family Foundation in April, found that 55% of women across all age groups said their mental health had declined during the pandemic, compared to 38% of men. Another, published last month in Lancet Regional Health-Americas, also found women were more likely than men to report higher psychological distress during the pandemic, especially anxiety.

Richards, also an assistant professor of psychiatry and behavioral sciences at Johns Hopkins Medicine, said women’s mental health has suffered disproportionately during the pandemic for a number of reasons.

First, even in non-pandemic times women are already two to three times more likely than men to experience a major depressive episode in their lifetime, according to Richards.

Then during the pandemic, women took on additional caregiving responsibilities and were hit disproportionately hard by job loss, data shows.

Women, and especially women of color, also faced more barriers to accessing support during the pandemic, according to Richards.

“The pandemic uncovered a lot of things that people are typically able to cope with because they’ve had years to develop those coping strategies,” she said. “When you don’t have that anymore, a lot of people felt more isolated and felt like there was a lack of overall support.”

For some women, their mental health struggles may have played out during the pandemic in an increasing dependence on alcohol, or increased control over their food, according to Dr. Jessi Gold, an assistant professor in the department of psychiatry at Washington University School of Medicine.

Data shows that incidences of eating disorders and alcohol-related liver disease rose during the pandemic, particularly among young women.

“Those are easy coping mechanisms that people know work,” said Gold. “There are ways that people can deal. And there’s a lot of people who function to a point, until they can’t.”

Both Gold and Richards said they have seen an increasing need for professional mental health as the pandemic has continued on, at some points with seemingly no end in sight.

“Anxiety was the thing that emerged first for a lot of people because anxiety does not like uncertainty and that’s what we’ve been dealing with during the pandemic,” said Gold. “And the longer the anxiety goes on, the more people start to feel on the depressive side of things.”

Warning signs that it is time to seek professional help for mental health include everything from depressive and hopeless thoughts to undesired weight loss or weight gain, suicidal thoughts, excessive feelings of worry, irritability and changes to sleep patterns. They key is to notice if any of those things begin to affect your ability to function in your daily life, according to Richards.

“When stress is becoming overwhelming, ask for help from a professional,” she said. “That professional can come in a number of ways — religious leaders or groups, OB-GYNs, primary care doctors. Those people should be able to, if not help, point you in the right direction.”

There are also ways people can protect and strengthen their mental health on their own, tools that become even more critically important as the pandemic continues, according to Gold.

“There will be things that will continue to be frustrating about this experience,” she said. “Things will be up and down and we have to have some acceptance about that. Just think, ‘I’m just trying to do the best I can,’ and that’s where you have to land.”

Here are five mental health-boosting tips from Gold and Richards:

1. Get plenty of sleep: “It’s easier said than done but it makes a big difference,” said Gold. “Sleep is all about routine, which is why as a kid it worked that your parents gave you a bath, put you in your pajamas and read books. It works the same as an adult, we just don’t take time to do things like that.”

2. Take time for yourself, especially when you think there’s no time: “When you spend the majority of your life focused on other people, try to factor in time for yourself in some capacity,” said Gold. “Ask yourself how you’re doing and name the feelings and validate them and let them be something that you take the time to stop and acknowledge instead of powering through.”

“Doing self-assessments like that can make you stop and say, ‘I’m here, too. What am I feeling?'” added Gold. “Ask yourself, ‘Have I been sleeping? Have I been eating? What have I enjoyed about the day? What’s been hard?’ and listen to your body in moments like that, too.”

3: Keep the positives of the pandemic: “I think we have to embrace some of the changes that have come out of the pandemic,” said Richards. “For some people, it was I can stay home, I can bake more, I can take a walk with my loved ones twice a week, I can go check on my neighbor.”

“A lot of people have really made commitments to those sorts of things, and it’s important to continue that, but it is also important to understand what our social needs are as a community as well, and the importance of getting together, safely,” she said. “Everyone has to find their own balance, not only with what keeps them safe, but what really they find helps with their mental health as well.”

4. Say no when you need to: “It is sometimes important to really just say no and set limits,” said Richards. “Even though that might seem difficult, you’re actually able to help people more down the road if you’re able to really take time for your own mental health first.”

5. Do self-care you enjoy, not what you think you should do: “Look at self-care or coping skills as hobbies and things that you actually enjoy,” said Gold. “So do you like meditating or are you doing that because someone told you that’s the way to feel better? Do you like exercise, or do you want to watch a TV show instead? Figuring out what you like and what makes you feel better is more important than doing things you’re told you’re supposed to do.”

If you are in crisis or know someone in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting HOME to 741741. You can reach Trans Lifeline at 877-565-8860 (U.S.) or 877-330-6366 (Canada) and The Trevor Project at 866-488-7386.

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(NEW YORK) — Dr. Jennifer Ashton’s anxiety attacks started to happen after she had a severe allergic reaction to a food.

“I had a couple of episodes where I thought mistakenly that I had eaten that same food that I was allergic to,” said Ashton, ABC News’ chief medical correspondent and a board-certified OBGYN. “And even though I was not having any true physical symptoms of an anaphylactic reaction, once my mind went there, it was almost like a marble rolling off the edge of a table.”

“I started to feel dizzy. I started to feel chest tightness. My heart was racing. I was short of breath, but objectively, I was not having an allergic reaction,” she said. “And even though I recognized that I was having an anxiety attack, I was unable to stop it.”

Ashton spoke out about her own experience with anxiety during Mental Health Awareness Month to put a spotlight on a condition that is common but not always easily understood.

Anxiety is the feeling evoked when someone experiences fear of something bad happening, and it can lead to avoidance, attacks, excessive worrying or other symptoms. Everyone has anxiety sometimes, but when anxiety becomes overwhelming to the point it consistently interferes with daily life, or in the case of Ashton, prompts anxiety attacks that interfere with daily life, it can be an anxiety disorder, according to the U.S. Office on Women’s Health (OWH).

Anxiety disorders are so common they affect about 40 million American adults every year, according to OWH.

And women are more than twice as likely as men to get an anxiety disorder in their lifetime, a discrepancy not yet completely understood from a medical perspective. Some experts say it may be due, in part, to women’s changing hormones and different responses to stress, and women may report symptoms of anxiety more frequently than men.

The prevalence of anxiety underscores that it is a serious mental health concern and not something to be dismissed by doctors or patients, according to Ashton.

“What I learned from my own experience with anxiety attacks is that I think a stigma occurs in a lot of society with people thinking that it’s not real, or it’s not serious or it’s insignificant because we all know that there’s no actual situation occurring,” she said. “But none of that matters. The physical manifestations, the symptoms that I felt when I experienced these anxiety attacks, were absolutely real.”

Ashton noted the coronavirus pandemic, an anxiety-inducing global event that has now lasted more than one year, should have highlighted for people the importance of taking anxiety seriously and treating it just as one would any other medical condition.

“There was not a week that went by that I didn’t hear from patients that they were experiencing anxiety,” she said. “I think what needs to happen is a very objective assessment, not only of ourselves as individuals, but collectively, and what’s going on in the world, so then you can say, ‘This is not surprising, really … it’s common. It’s understandable.'”

What to know about anxiety disorders

Like most mental health conditions, anxiety falls on a spectrum, with differing degrees of severity.

Generalized anxiety disorder is described as worrying, “excessively about ordinary, day-to-day issues, such as health, money, work, and family,” according to OWH. Women with GAD may be anxious about just getting through the day, may have difficulty doing everyday tasks and may have stress-related physical symptoms, like difficulty sleeping and stomachaches, according to OWH.

Panic disorder, also twice as common in women as in men, may see people having panic attacks, described by OWH as “sudden attacks of terror when there is no actual danger.” People having panic attacks may feel like they’re having a heart attack, dying, or losing their minds.

A third type of anxiety disorder, social anxiety disorder, is diagnosed when people “become very anxious and self-conscious in everyday social situations,” including embarrassing easily, according to OWH. People with social anxiety disorder can often have panic attack symptoms around social situations.

The fourth type of disorder, specific phobia, is an intense fear of something, like heights, water, animals or specific situations, that poses “little or no actual danger,” according to OWH.

In addition to fearful thoughts, all four types of disorders also have physical symptoms that can include shortness of breath, chest tightness, nausea, sweating, numbness around the mouth and hands and hyperventilation, according to Ashton.

“There’s a spectrum of severity, so it can be mild, it can be severe. It can be intermittent or it can be constant,” she said. “Most people will admit to having anxious thoughts or feeling anxious at some point during their lives; however, people who really suffer from a true anxiety disorder find that those thoughts feelings or symptoms are occurring more frequently with greater severity.”

Ashton also pointed out that the causes of anxiety can range from the known to unknown.

“Sometimes there is an actual trigger and a clear-cut, rational explanation for where it started. For example, in my case, I had an anaphylactic reaction and experiencing that medical emergency triggered anxiety attacks in similar situations or what I thought were similar situations,” she said. “But other times, people develop an anxiety disorder and they have no known actual trigger. That doesn’t make it any less real. That doesn’t make it any less severe.”

Even with the number of people affected by anxiety during the pandemic, and with celebrities like Camilla Cabello and Prince Harry recently speaking out about their experiences, the topic of anxiety, like most mental health disorders, is still a taboo topic.

“Having an anxiety disorder is still something that’s whispered about, still something that has a societal bias or stigma,” said Ashton. “In a lot of ways, any psychological, emotional or psychiatric disorder still tends to be looked at as a sign of weakness.”

“It is definitely past time that we change that,” she said. “As a medical doctor, I literally do not look at anything that occurs from the neck up as any different than something that occurs from the neck down, so anxiety should be looked at no differently than asthma. As such, it should be managed with a full arsenal of approaches meaning support groups, talk therapy, behavioral therapy, modifying one’s environment or behavior and, if necessary, prescription medication.”

When it comes to medication, a prescription medication to treat and prevent future episodes of anxiety on a long-term basis is different than a medication like Xanax or Valium that is intended for infrequent treatment of acute anxiety, noted Ashton.

“I see this all the time in women where they think, ‘Well, it’s happening more and more frequently, so I’ll just take the medication more and more frequently,'” she said. “[Drugs like Xanax and Valium] are not meant nor are they really safe for long-term, chronic use on a daily basis. That’s why you really should be managed by a psychiatrist by a credentialed mental health professional.”

Treatment for anxiety disorders often includes a combination of counseling and medication — and both together is often most effective. When it comes to counseling, cognitive behavioral therapy (CBT) is often used to help people change thinking patterns around their fears, according to OWH.

The differing degrees of anxiety may make it difficult for people to determine whether they should seek treatment, but what matters is how it is affecting a person individually, according to Ashton.

“There is a big difference between someone who has one anxiety attack or a panic attack per year and someone who has one per day,” she explained. “There’s a big difference between someone who can manage their anxiety and still function at home and in the workplace, and someone who has to leave meetings at work or who has to go home from celebrations or social gatherings. So whether or not you have anxiety that is interfering in your life is very subjective, but in general, it’s whether or not it’s interfering to a degree that is not acceptable to you.”

Other factors like physical activity, nutrition and mindfulness can also play a role in coping with anxiety, although less is known about the role they play in treating anxiety disorders, according to the National Center for Complementary and Integrative Health, an entity of the National Institutes of Health (NIH).

Ashton said women can look to their gynecologist or family physician as their first point of contact in discussing the possible need for anxiety treatment.

“Bring this up with your gynecologist. He or she is very familiar with dealing with anxiety disorders in patients — we see it as women’s health experts on a daily basis,” she said. “This is something that you should bring up at your next well-woman checkup with your gynecologist, with your nurse practitioner, with your family practitioner, and talk about it just like you would talk about a change in your period or if you were having daily headaches.”

Speaking of what it should be like for a person to speak about their anxiety out loud, Ashton added, “We’re just admitting something as plainly as we’re saying it’s cloudy outside.”

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