Health

(NEW YORK) — Monday marks four years since the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.

Since the first cases in Wuhan, China, in 2019, there have been millions of infections and deaths around the world.

There have also been major successes including vaccines for nearly all age groups, the development of antiviral drugs to treat those at risk of severe illness and the proliferation of at-home tests.

ABC News takes a look back at the some of the most important moments over the last four-plus years:

Dec. 31, 2019

The World Health Organization office in China is notified about a mysterious pneumonia-like illness that originated in Wuhan and has been spreading.

Jan. 7, 2020

Chinese public health officials identify a new type of coronavirus as the source of the outbreak.

Jan. 10, 2020

WHO begins using 2019-nCoV to refer to the outbreak. Because the disease is similar to the SARS virus, it is called SARS-CoV-2.

Jan. 20, 2020

The U.S. confirms its first case in a man in his 30s in Washington state, who developed symptoms after a trip to Wuhan.

Jan. 30, 2020

The WHO declares the outbreak of the virus to be a Public Health Emergency of International Concern. The Centers for Disease Control and Prevention (CDC) confirms person-to-person transmission in the U.S.

Feb. 11, 2020

The WHO proposes calling the disease caused by the virus COVID-19, which stands for coronavirus disease 2019.

March 11, 2020

The WHO classifies COVID-19 as a pandemic.

March 13, 2020

President Donald Trump declares the COVID-19 outbreak a national emergency.

March 19, 2020

The U.S. Department of State issues a global Level 4 “Do Not Travel” health advisory.

April 2, 2020

More than 1 million people worldwide have confirmed cases of COVID-19.

April 3, 2020

The CDC announces new guidelines for mask wearing and advises all Americans to wear a mask outside of the home.

May 15, 2020

President Trump announces Operation Warp Speed, a national program to fast-track the development, manufacturing and distribution of COVID-19 tests, treatments and vaccines.

May 28, 2020

The U.S. surpasses 100,000 COVID-19 deaths, a little more than four months after confirming the first known case.

Aug. 6, 2020

The State Department lifts the global Level 4 “Do Not Travel” health advisory.

Aug. 28, 2020

The first case of COVID-19 reinfection in the U.S. is reported by the Nevada State Public Health Laboratory.

Sept. 28, 2020

Global COVID-19 deaths surpass 1 million.

Dec. 11, 2020

FDA grants Pfizer-BioNTech the first EUA for a COVID-19 vaccine for those aged 16 and older.

Dec. 14, 2020

Nurse Sandra Lindsay is the first person to receive a COVID-19 vaccine in the U.S. as distribution begins.

Dec. 18, 2020

The FDA grants the same EUA to Moderna for its vaccine for those aged 18 and older.

Jan. 12, 2021

The CDC says all air passengers entering the U.S. must present a negative COVID-19 test result.

Feb. 27, 2021

The FDA issues an EUA for the Johnson & Johnson COVID-19 vaccine for those aged 18 and older.

May 10, 2021

The FDA expands the EUA for the Pfizer-BioNTech COVID-19 vaccine to adolescents between ages 12 and 15.

May 13, 2021

CDC guidance is updated for fully vaccinated people, ending indoor mask requirements.

May 26, 2021

President Joe Biden issues a statement saying the U.S. intelligence community cannot determine whether COVID-19 originated in animals and jumped to humans or came from a laboratory accident, with some believing the former and others the latter.

Aug. 12, 2021

The FDA amends EUA for Pfizer-BioNTech and Moderna COVID-19 vaccines to authorize additional booster for certain groups with weakened immune systems.

Sept. 22, 2021

The FDA authorizes a booster dose of Pfizer-BioNTech COVID-19 vaccine for certain groups.

Oct. 6, 2021

The WHO publishes a clinical case definition of “post COVID-19 condition” or long COVID.

Oct. 20, 2021

The FDA authorizes a booster dose of the Moderna and J&J COVID-19 vaccines for certain groups.

Oct. 29, 2021

The FDA authorizes emergency use of Pfizer-BioNTech’s COVID-19 vaccine for children ages 5 to 11.

Nov. 8, 2021

All non-citizens who are traveling to the U.S. are now required to be fully vaccinated and provide proof of their vaccination status to fly to the U.S., the White House announces. All travelers will continue to be required to show a negative pre-departure COVID-19 test taken no more than three days before they board their flights.

Nov. 19, 2021

The CDC updates guidance to recommend everyone aged 18 and older to get a COVID-19 booster.

Dec. 9, 2021

The FDA expands eligibility to allow 16- and 17-year-olds to receive the Pfizer-BioNTech COVID-19 boosters.

Dec. 22-23, 2021

The FDA issues EUA for two oral antivirals to treat COVID-19 — Merck’s molnupiravir and Pfizer’s Paxlovid — for those with mild to moderate illness at high risk of severe disease.

Jan. 3, 2022

The FDA expands the EUA for Pfizer-BioNTech’s booster to include 12-to-15-year-olds and a third primary dose for some immunocompromised children ages 5 to 11.

Jan. 4, 2022

The U.S. reports the first day of more than 1 million daily COVID-19 cases during the omicron wave.

Jan. 15, 2022

The U.S. reaches a peak of weekly new hospital admissions for COVID-19 at 150,650 during the omicron wave.

Jan. 18, 2022

The White House launches a program to mail at-home COVID-19 tests directly to Americans’ homes with a new website.

March 8, 2022

The Biden administration announces the launch of “Test to Treat” so people at high-risk for developing severe COVID-19 and complications can get tested at a pharmacy and, if positive, receive antiviral pills on the spot for free.

March 29, 2022

The FDA authorizes a second booster dose of either the Pfizer-BioNTech or the Moderna COVID-19 vaccine for people aged 60 and older and certain immunocompromised groups.

May 12, 2022

COVID-19 deaths in the U.S. surpass 1 million. President Biden orders flags to be flown at half-staff.

May 17, 2022

FDA expands eligibility for a booster dose of Pfizer-BioNTech’s COVID-19 vaccine to children ages 5 to 11.

June 10, 2022

The CDC rescinds its order requiring a negative COVID-19 test result before boarding a flight to the U.S., taking effect on June 12.

June 17, 2022

The FDA grants EUA for Pfizer-BioNTech’s COVID-19 vaccine for children ages 6 months to 5 years and for Moderna’s COVID-19 vaccine for children ages 6 months to 6 years.

Aug. 31, 2022

The FDA authorizes Pfizer-BioNTech and Moderna bivalent COVID-19 vaccines to use as a booster dose for those ages 12 and older and those ages 17 and older, respectively.

Oct. 12, 2022

The FDA authorizes an updated bivalent COVID-19 vaccine for children aged 5 and older for the Pfizer-BioNTech vaccine and for children aged 6 and older for the Moderna vaccine.

Dec. 8, 2022

The FDA authorizes bivalent vaccines to use as a booster dose for children under age 5.

April 10, 2023

President Biden signs H.J.Res.7, ending the national emergency related to the COVID-19 pandemic.

May 5, 2023

The WHO downgrades COVID-19 from being a Public Health Emergency of International Concern but continues to classify it as a pandemic. The CDC says it will no longer track transmission levels.

Sept. 11, 2023

The FDA authorizes and approves an updated COVID vaccine for all Americans ages 6 months and older.

May 11, 2023

The public health emergency designation in the U.S. for COVID-19 expires.

Nov. 10, 2023

The WHO updates its COVID treatment guidance, including recommending use of the antiviral drugs remdesivir and molnupiravir for only severe cases.

March 1, 2024

People who are recovering from COVID-19 no longer need to remain isolated for five days after symptoms, according to new CDC guidance.

March 10, 2024

The Johns Hopkins Coronavirus Resource Center stops collecting data for its famous COVID-19 dashboard.

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(NEW YORK) — Each day, almost 800 women around the world die due to preventable pregnancy and childbirth-related causes, according to the World Health Organization.

Using artificial intelligence, or AI, to provide maternal health care to women, especially those in rural and low-income areas, could be a “game-changer” in saving the lives of pregnant women, Melinda Gates, chairperson of the Bill & Melinda Gates Foundation, told ABC News chief medical correspondent Dr. Jennifer Ashton.

Gates highlighted a specific tool, AI-enabled ultrasound, that is revolutionizing pregnant women’s access to ultrasounds, or sonograms, a prenatal test that uses sound waves to check a baby’s development during pregnancy, and check for pregnancy complications.

Ultrasounds are a routine part of prenatal care to which two-thirds of pregnant women around the world do not have access, according to the Gates Foundation.

“If you’re a mom, let’s say in the United States, when you go in and you get an ultrasound, it’s quite a large machine. You go into a special room to have it done,” Gates told Ashton, a board-certified OB-GYN and obesity medicine physician, in an interview to mark International Women’s Day, March 8. “We were able, with our partners, to come up with a very small AI-assisted ultrasound that literally can plug into your phone or plug into a tablet.”

The portable ultrasound device, which typically weighs less than a pound, can display the ultrasound images on the smartphone or tablet, so health care professionals — whether nurses, doctors or midwives — can read the ultrasound instantly, allowing for faster diagnoses and faster treatment.

“In these low-resource settings, [pregnant] women often … can’t get into a community health clinic. The lines are long. They don’t have the bus fare. They might walk. It might be shut down or not open at the right time of day,” Gates said. “A community health worker goes out to these women so she can have an AI-enabled ultrasound and, literally with a few scans of that mom’s belly, be able to see, is the child growing properly? Is the mom’s health OK in terms of what you can see in the ultrasound?”

Gates continued, “It’s a game-changer … it’s a pretty simple device, but again, it really can make a difference in terms of the mom and the baby.”

Gates said now that the technology exists, the Gates Foundation is working with partners to try to lower the price of the devices and get more health care workers trained so they can go to more underserved communities.

The AI ultrasound technology is one of several advancements that Gates said she sees as transformative for women’s health care, which has historically been underfunded and under-researched on a global level, data shows.

“We know that women can’t do well unless they are well, so you first have to start and be healthy to then be able to get an education and to work productively in society,” Gates said. “So when you think about how little funding is going into actually saving women’s lives, from diseases that are specific to women, to childbirth, which is very specific to women, that just shouldn’t be.”

Any advancements being made for women’s health — like a one-dose HPV vaccine to prevent cervical cancer and a drape that can reduce a woman’s chance of dying from postpartum hemorrhaging by 60% — can only make a difference, Gates noted, if they reach the women who need them.

The HPV vaccine, for example, was approved in the United States in 2006 by the Food and Drug Administration but is just now reaching millions of women in need in Africa as a one-dose vaccine. HPV is a common sexually transmitted infection that, if left untreated, can invade the cervical cells of the uterus and cause cancer.

In 2022, cervical cancer led to 350,000 deaths globally, with the highest rates of mortality in low and middle-income countries, according to the WHO.

Gates said for more than a decade, female leaders in Africa have asked her for the vaccine on her trips to the continent.

“They’re saying, ‘We have full communities where we see aunts, sisters dying of cervical cancer. You have this vaccine in the United States, when are we going to get it?'” Gates recalled. “And the issue has been it’s an expensive vaccine and it’s two doses.”

With the lower-priced one-dose vaccine now available, Gates said the HPV vaccine can be distributed in places like schools and community clinics.

“We can give it out in places where they gather,” Gates said. “So often a young girl never makes it into the clinic. She may not ever make it in clinic at all until after she’s had a child, or she might make it in at the time of birth, and that’s too late.”

Another women’s health advancement, longer-lasting and injectable contraceptives, have the potential to not only transform women’s health, but all aspects of their lives, including their economic well-being. According to the Gates Foundation, over 250 million women and girls globally who do not want to get pregnant are still not using modern contraceptive methods.

Gates said if she could make one change to women’s health, she would focus solely on contraceptives.

“It would be that every single girl and women on this planet who wants to have access to a contraceptive can have access,” Gates said. “We know that when women can time and space the birth of their children, women are healthier. The children are healthier. The family is wealthier.”

She continued, “So I would make sure every single woman had access to contraceptives so she could decide when and whether to have a child.”

How being a mom, grandmother motivates her work for women’s health

Gates, who lives in Seattle, is a mom of three, who became a first-time grandmother last year when her eldest daughter Jenn Gates Nassar gave birth to a daughter.

Gates said she was with her daughter while she was in labor, which made her reflect on the care her daughter received in the U.S., versus what she would have been able to receive if she delivered in a lower-income country.

“I could sit there … and think about all the places I’ve been in the developing world where I’ve been in the delivery room and think, ‘Oh my gosh, if my daughter didn’t have somebody here taking her blood pressure,’ or, ‘I know what hemorrhage looks like. I know what the pain of childbirth is like in these settings,'” Gates said. “So, to see that my daughter was getting good care, and still you’re concerned at the time of the birth of a baby, it’s a bit scary until that baby comes healthy, I could think about all those things.”

Even in the U.S., with its advanced health care, the state of maternal and infant health is dire, data shows.

Last year, the March of Dimes, a nonprofit organization focused on improving the health of pregnant people and babies, named the U.S. one of the “most dangerous developed nations” for childbirth. According to the Centers for Disease Control and Prevention, more than 80% of pregnancy-related deaths in the U.S. could have been prevented.

Gates said she believes “no mom” should die in childbirth anywhere in the world.

“Now having two healthy daughters and a healthy granddaughter, it makes me all the more passionate about let’s make sure no mom dies in childbirth,” she said. “That just shouldn’t happen in this day and age.”

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(NEW YORK) — After two weeks of agonizing limbo for families in the midst of fertility treatment in Alabama, the state legislature on Wednesday night passed the final version of a bill to restore halted access to in-vitro fertilization in the state.

Republican Gov. Kay Ivey signed the bill quickly after the legislature passed it. Lawmakers passed similar legislation last week, kicking off the process, but the state’s process requires a series of votes.

The legislation comes weeks after the Alabama state Supreme Court issued a decision that embryos are children, causing three of the state’s largest IVF treatment providers to halt care for fear of wrongful death lawsuits when handling embryos.

The ruling led to immense public outcry and an organizing effort at the State House to correct the fallout for women and families using fertility treatment to have children.

The bill that passed on Wednesday will provide “civil and criminal immunity” to patients and clinics during IVF services, giving doctors, patients and manufacturers legal cover to proceed with the treatments.

Doctors at Alabama Fertility Specialists, one of the Birmingham clinics where IVF is paused, told ABC News they plan to resume treatments as soon as the bill becomes law. Some patients are already scheduled for treatments at the clinic later this week.

“We have kept our lab fully operational so that we’d be positioned to resume care as soon as possible,” Dr. Janet Bouknight, a fertility physician at Alabama Fertility Specialists, said in an interview Wednesday.

“It has been incredibly stressful for everyone involved. So I am hopeful that this allows that extra anxiety to settle down and focus again on the right treatment for the couple that sits in front of us,” she said.

But doctors, lawmakers and patients involved in the legislative process were clear-eyed that the bill passage Wednesday would not be the final step.

Much of the debate over the bill among lawmakers stemmed from whether the bill provides too broad of protection to clinics in cases of malpractice. They also debated whether the bill goes far enough to protect IVF treatment should more lawsuits come forward in the future, since it does not address the root of the Supreme Court’s decision — the ruling that embryos are children.

“I’ve trusted the legislators to get something in place that gets us back to care as quickly as possible. And I think that’s what has been done,” Bouknight said.

“I think there’s things that absolutely remain to be seen,” she added.

Republican lawmakers who authored the legislation acknowledged that the issue will require more discussion, but for now, it allows patients to continue their IVF treatment.

“We know that we’ll continue the work, and we’ll see what we have to do in the future,” Speaker of the House Nathaniel Ledbetter said in a press conference after the House passed the legislation.

Ivey, the governor, also emphasized the need to identify and pass longer-term protection for IVF.

“IVF is a complex issue, no doubt, and I anticipate there will be more work to come, but right now, I am confident that this legislation will provide the assurances our IVF clinics need and will lead them to resume services immediately,” Ivey said in a statement.

Corinn O’Brien, an IVF patient in Birmingham and the lead organizer behind a 300-person rally of patients and families at the State House last week, said she would continue to push for a longer-term fix, likely in the form of a constitutional amendment.

“We haven’t addressed the core question, which is are embryos outside of the uterus considered life or potential life, and you’re gonna have to come back to that,” O’Brien said.

“It’s our next battle. We’re focused today on what we have in front of us, but we’re not done here,” O’Brien said.

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The House subcommittee tasked with investigating the nation’s response to the coronavirus pandemic on Tuesday subpoenaed former New York Gov. Andrew Cuomo in relation to his administration’s handling of nursing homes during the pandemic, according to documents first obtained by ABC News.

Specifically, the House Select Subcommittee on the Coronavirus Pandemic is seeking to question Cuomo about one of his administration’s most controversial COVID-era directives: instructing nursing homes to admit recovering COVID-positive patients from hospitals, a move that has faced criticism that it led to increased deaths in nursing homes.

The subpoena and letter from the Republican-led subcommittee is the latest development for the former New York governor, who has faced intense scrutiny into his administration’s handling of nursing homes during the pandemic. In 2021, ABC News reported that federal prosecutors in Brooklyn were investigating Cuomo’s coronavirus task force with a focus on nursing homes. No charges were brought.

“Accordingly, attached to this letter please find a subpoena for you to appear for a deposition,” Tuesday’s letter states.

The subpoena was signed by Republican Rep. James Comer, the chairman of the Oversight Committee, which authorizes the subcommittee to issue subpoenas. It requests a May 24 deposition in Washington.

Cuomo, who was at one point heralded for his leadership during the pandemic and became known for his daily briefings, has defended the March 2020 directive, which he reversed weeks later. He said it was based squarely on federal guidelines and accused those investigating the issue of “playing politics.”

In the seven-page letter to Cuomo that accompanied Tuesday’s subpoena, the committee said his testimony was “vital” as the panel continues it to investigate “the effectiveness of federal guidance and regulations” that were implemented during the pandemic.

An attorney for Cuomo did not immediately respond to ABC News’ request for comment.

The committee, chaired by Republican Rep. Brad Wenstrup, in its letter directly linked what it called Cuomo’s “misguided decision” to “predictable but deadly consequences” in nursing homes, and referenced “troubling evidence” that Cuomo’s administration “at best downplayed its impacts and at worst covered them up.”

“Former Governor Cuomo owes answers to the 15,000 families who lost loved ones in New York nursing homes during the COVID-19 pandemic,” said Chairman Wenstrup in a statement. “His testimony is crucial to uncover the circumstances that led to his misguided policies and for ensuring that fatal mistakes never happen again.”

A New York State Department of Health report that analyzed the effects of the directive found it “could not be the driver” of cases or deaths in nursing homes. An impeachment investigation into Cuomo later found that report had been “substantially revised by the Executive Chamber and largely intended to combat criticisms” about the directive.

Cuomo has also come under fire for allegedly misreporting the number of COVID-19 deaths in nursing homes. In early 2021, a report from New York State Attorney General Letitia James found that COVID deaths in New York state had been “undercounted” by as much as 50%.

Cuomo later said he “took responsibility” and that “we should have provided more information faster.”

The subpoena for Cuomo’s interview with the committee came after months of correspondence with his attorney in an effort to schedule a voluntary interview, which the committee alleges in the letter was an attempt by Cuomo to “delay and undermine our investigation.” The letter lays out dozens of emails and multiple meetings between Cuomo’s attorney and subcommittee staff throughout December, January, and February, culminating in Cuomo’s attorney saying he would be available in August.

“You have repeatedly and consistently dismissed, deflected, or ignored all questions and requests from the Select Subcommittee related to your handling of nursing homes,” the letter said. “Your unwillingness to seriously cooperate with our requests and to negotiate a reasonable date to participate in a transcribed interview has unjustifiably delayed our investigation. This is unacceptable.”

The House Select Subcommittee on the Coronavirus Pandemic was formed in 2020.

ABC News’ Aaron Katersky contributed to this report.

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(New York) — Medical debt across the U.S. is associated with worse physical and mental health, and even premature death. A new study from the American Cancer Society found that for every $100 increase in medical debt, there were eight more days of poor physical health and 6.8 more days of poor mental health reported in a month per 1,000 people.

As health care costs continue to rise nationwide, affording medical care remains a significant and enduring challenge for millions of Americans. According to the Centers for Medicare and Medicaid Services, health care spending reached $4.5 trillion in 2022 – roughly $13,5000 per person. Of that, out-of-pocket spending accounted for $471.4 billion.

Even though over 90% of Americans have some form of health insurance, out-of-network costs, high deductibles, and unexpected bills can lead to medical debt affecting both insured and uninsured adults, experts said.

To evaluate the impact of medical debt on health, researchers in this study looked at data across nearly 3,000 counties, 93% of the country.  Authors noted this is one of the first studies to look at the population-level effects of medical debt. The study did not show cause-and-effect, but it was a strong association, reinforcing existing studies suggesting that financial hardship can lead to poorer health outcomes.

They found that when just 1% more of a population has medical debt, it leads to 18 more physically unhealthy days, 18 more mentally unhealthy days, and an extra year of life lost for every 1,000 people.

“[Medical debt] is a problem that needs to be addressed systematically,” Dr. Xuesong Han, lead author of the study, told ABC News.

Counties with higher percentages of non-Hispanic Black people, populations with low educational attainment, higher percentages of people living below the poverty level, uninsured and unemployed people tended to have a higher share of people with medical debt, the study said. Across all counties, an average of 19.8% of Americans had medical debt in collections. Geographically, counties with the highest medical debt burden were in the South, according to the study.

Study authors said the data they used were from the years leading up to the COVID-19 pandemic, and that future research is needed to explore ongoing post-pandemic changes to the health system and public health.

Han stressed the importance of policy efforts focused on addressing this issue, including “increasing affordable and comprehensive health insurance coverage,” and “providing financial navigation and connecting patients with relevant resources to minimize any adverse consequences.”

Dr. Rebecca Yao is an internal medicine resident at the Mayo Clinic in Rochester, Minnesota, and a member of the ABC News Medical Unit.

Dr. Gabriela Cleary is an emergency medicine resident at Wyckoff Heights Medical Center in Brooklyn, New York, and a member of the ABC News Medical Unit.

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(WASHINGTON) — Opill, the first over-the-counter birth control pill that can be purchased without a prescription, will be available later this month online and in pharmacies for $19.99 a month, $49.99 for a three-month supply or $89.99 for a six-month supply, its parent company, Perrigo, said Monday.

Opill has been heralded as a potential game-changer for access to birth control because it eliminates the step of finding a doctor to write a prescription, which can be costly or burdensome depending on where women live and what health insurance coverage they have.

The drug has already been on the market for 50 years as prescription birth control and was determined safe and effective for over-the-counter use by the Food and Drug Administration in July.

It’s is expected to be available at major retailers like CVS and Walgreens nationwide in the coming weeks, as well as available for order directly through Opill’s website. Preorder from select retailers begins this week.

The cost of Opill, however, will play a major role in its accessibility.

Most insurance plans have to cover prescription birth control under the Affordable Care Act, but the laws differ state by state for birth control without a prescription — which is uncharted territory.

Those without insurance or who don’t want to use their insurance for privacy reasons will have to pay the $15-20 cost out of pocket per month, depending on which monthly supply plan they purchase.

Around 39% of women would be willing to pay $1-10 for birth control, but that number drops slightly to 34% for those who would be willing to pay $11-20 per month, according to a November 2022 survey from KFF.

Some 1 in 10 women — 11% — said they were unwilling or unable to pay anything for OTC birth control pills.

Opill said it will have a cost-assistance program available in the coming weeks to help “qualified low-income, uninsured individuals obtain Opill at low or no cost.”

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

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(WASHINGTON) — The brew of hot-button socio-medical issues litigated both in the public square and in the courts will “amplify the health care sector’s visibility as a potential target for attack” by domestic extremists, according to a new briefing memo issued by the Department of Homeland Security on Feb. 26.

The confidential analysis, obtained by ABC News, describes a diverse array of dangers these mounting threats could pose: from harm to patients through compromised care, to causing a chilling effect on clinicians through harassment and intimidation, to ideologically motivated cyber attacks targeting health care providers and networks.

“Violent extremist threats against the health care and public health sector have diversified since the height of the COVID-19 pandemic in 2021, and will likely remain elevated in the post-pandemic era due to the expansion of medical-related ideological grievances,” the DHS bulletin said.

A recent “escalation in threats of violence targeting health care facilities and personnel” has included “hoax bomb threats against hospitals, attempts to incite violence through doxing [public release of personal information like addresses and phone numbers] and calls to execute particular physicians, public officials, or pharmaceutical executives,” the bulletin said.

The “surge” in threats aligns with an increase in public dialogue surrounding medical issues that have been amplified by legislation and debate, according to the bulletin.

Since the pandemic upended life, the threat spectrum has “expanded” to “other ideological grievances, as highlighted by an increase in abortion or gender-affirming care-related threats” that are “explicitly based on narratives and conspiracy theories popular with violent extremists” keying in on those divisive issues, the bulletin said.

“Our society is very angry and very polarized — an increasing number of people in the US have come to believe that those who disagree are the enemy, and, that violence is an acceptable way to express their disagreement,” said John Cohen, the former intelligence chief at DHS and now an ABC News contributor.

For those who would seek to exploit societal fractures in America, an us-versus-them mentality is applied to the most contentious wedge issues and provides a handy crowbar, experts say.

“Violent extremists, terror groups, foreign intelligence services have purposely sought to exploit public policy issues being debated in the U.S. that are the most polarizing, that they believe will inspire a volatile reaction – and hopefully violent acts,” Cohen added.

Threats of violence have not remained hypothetical as real attacks have been directed at perceived epicenters of extremists’ grievances.

Last week, a California man pleaded guilty to firebombing a Planned Parenthood clinic with a Molotov cocktail in March 2022. It followed guilty pleas from others involved in the firebombing, which forced the clinic to temporarily close and reschedule roughly 30 patient appointments.

The defendant sought to “scare pregnant women away from obtaining abortions; deter doctors, staff, and employees at the clinic from providing abortions; and intimidate the clinic’s patients,” according to the Department of Justice. Following the Supreme Court decision overturning Roe v. Wade in June 2022, he and co-conspirators “planned to use a second Molotov cocktail to attack another Planned Parenthood clinic.” A year later, they were arrested two days before an LGBTQ “Pride Night” at Dodger Stadium, which they had planned to attack, the DOJ said.

It’s one among a growing list of criminal plots in recent years: from swatting calls and death threats on health officials and hospitals to assaults on clinic escorts, to vandalism and facility damage.

“If abortions aren’t safe th[e]n neither are you” has been graffitied on pregnancy resource centers – and abortion alternative advocacy group headquarters – across multiple states, surrounding the overturn of Roe. In May 2022, an “incendiary device” was used to start a fire at a “pro-life organization’s building” in Oregon.

In September 2023, a Massachusetts woman pleaded guilty to calling in a false bomb threat against Boston Children’s Hospital – which, among the wide range of health care services it provides, is home to a health care program focused on gender-diverse and transgender adolescents.

“There is a bomb on the way to the hospital, you better evacuate everybody you sickos,” the woman had threatened on the call, according to DOJ – prompting a bomb squad to be dispatched and forcing the hospital and the surrounding area to go into lockdown.

“It was obviously scary. This is not the kind of thing you want to have in a health system,” said John Brownstein, chief innovation officer at Boston Children’s Hospital and an ABC News contributor – adding that he was on the hospital campus that day.

“Part of the issue is there’s a ton of misinformation,” Brownstein said. “When someone takes it beyond just commentary – and makes an attempt to turn an internet-based conversation into a real-world threat.”

That health care has become a target poses a uniquely troubling concern, experts say: it directly attacks citizens’ well-being – and creates a ripple effect of bodily harm.

These threats have “compromised patient care and medical services across a broader cross-section of health care systems and other medical providers” since the pandemic era, the DHS bulletin said. Those “recurring threats” could “likely reduce the ability of clinicians and facilities to provide care,” the bulletin said.

The worst may be yet to come, the bulletin suggests: In a year of the first presidential election since the pandemic and the Jan. 6 attack on the U.S. Capitol, leading candidates are running on some of the most divisive issues – from reproductive rights to gender and culture wars, to immigration at the Southern border, to the multiple wars abroad – which authorities have said could prove to be flashpoints.

“Government action in the health care sector over the coming year, including in response to public health crises, and public discourse involving controversial medical issues may escalate threats of violence to acts of violence,” the DHS bulletin said, adding court decisions on “mail order access to abortion medication and state legislation prohibiting the provision of gender-affirming treatments to minors are especially likely to heighten the potential for violence against the sector.”

And for adversaries seeking to undermine U.S. societal stability – chipping away at a crucial bedrock like health care presents an appealing means.

“It’s the goal of U.S. adversaries to not only destabilize our society but to have people lose confidence in government,” Cohen said. “In the election process, in critical infrastructure – our power grid, financial institutions, and our health care systems – those are the fundamental things that people rely on each and every day to live their lives.”

In the wake of a pandemic that further fueled division, “the environment here in the U.S. has become more fertile for our adversaries,” Cohen said. “We anticipate this high level of threat-related activity is only going to increase as we get closer to the election.”

With the exponential power and pervasiveness of artificial intelligence and the internet – and as society relies more on both – the threat gets even more complex, even as online social media provides a platform for conspiracy theories and extremist thought.

“Ideologically-motivated cyber actors increasingly target health care entities during periods when socio-politically divisive topics are prevalent in public discourse,” the bulletin said.

Even “absent attacks, recurring threats of violence may still have a chilling effect” on providers, “resulting in more acute or widespread barriers to patient care,” the bulletin said.

“If the people engaging in these activities are successful, it will interrupt the ability of people to receive appropriate health care or protect themselves and their community from public health hazards. And when that occurs, people die,” Cohen said.

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(NEW YORK) — People who are recovering from COVID-19 no longer need to remain isolated for five days after symptoms end, according to new guidance from the U.S. Centers for Disease Control and Prevention.

Those sick with COVID-19 should stay at home and away from others until at least 24 hours after symptoms get better and they don’t have a fever, without medication, according to updated guidance from the CDC.

“Today’s announcement reflects the progress we have made in protecting against severe illness from COVID-19,” CDC Director Dr. Mandy Cohen said in a statement. “However, we still must use the commonsense solutions we know work to protect ourselves and others from serious illness from respiratory viruses — this includes vaccination, treatment, and staying home when we get sick.”

The CDC said during those five days after you are feeling better and without a fever you should still wear a well-fitting mask, keep distance from others, get tested and use enhanced hygiene practices.

It was also noted that the guidelines were intended for community settings, not health care setting, like hospitals or nursing homes, where the same five-day isolation guidance remains.

“We wanted to provide folks an easy and understandable way to protect themselves,” Cohen told ABC News in regard to the federal agency dropping the 5-day COVID isolation recommendations.

“Folks who are more vulnerable to these viruses were top of mind as we put this guidance together. We all know someone who is vulnerable, it’s in my own family. So, it was very top of mind for me,” Cohen said.

“Hand hygiene, ventilation masking, using tests…those are the things we want to use as additional strategies in those five days after your fever is gone, and after your symptoms are improving,” Cohen added.

Cohen also said the CDC found a way to have both guidance that is simple and also protect those that are vulnerable.

“We know if things are simple, and that people remember it and use it, that it actually means that we will have less virus spread overall,” Cohen said.

The newer guidelines are in line with what the CDC has recommended for the flu “for decades,” the agency said.

“The bottom line is that when people follow these actionable recommendations to avoid getting sick, and to protect themselves and others if they do get sick, it will help limit the spread of respiratory viruses, and that will mean fewer people who experience severe illness,” Dr. Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases, said in a statement. “That includes taking enhanced precautions that can help protect people who are at higher risk for getting seriously ill.”

The number of COVID-19 hospitalizations declined slightly in the most recent week, according to numbers released Friday. COVID-19 hospitalizations remain lower than at the same time last year, while adults over 65 continue to have the highest rates of hospitalization.

Still, there were 17,310 weekly hospitalizations for COVID-19 and 2.1% of deaths in hospitals could be attributed to COVID-19, according to the CDC.

ABC News’ Mark Osborne contributed to this report.

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(NEW YORK) — The Real Housewives of Salt Lake City star Heather Gay made headlines recently after she lost more than 20 pounds using semaglutide, the active ingredient found in popular drugs like Ozempic and Mounjaro.

Gay says she’s noticed a change outside of the scale when it comes to her self-confidence and how others perceive her.

“I have transitioned from accepting myself, to feeling powerless against food and weight, and to accepting myself as someone that needs medical intervention in order to maintain a weight that feels healthy and positive for me,” she told Impact x Nightline.

Gay isn’t the only user of these new weight loss drugs who has experienced those personal changes, with some users claiming that the drug and the resulting weight loss have changed their relationships and lives. Others say that weight loss has led to newfound self-confidence, inspiring them to step outside of their comfort zones in their personal lives — and even causing friction with loved ones.

For some, the societal pressure to be thin can also come with measurable health risks, including mental health problems such as eating disorders, depression, anxiety, and relationship problems, according to research.

An Impact x Nightline episode now streaming on Hulu examines the ever-growing popularity of weight loss drugs and their effect on user’s mental health and personal relationships.

Semaglutide mimics the GLP-1 hormone that prompts insulin production in the body, which in turn makes you feel full, according to medical experts.

Ozempic and Mounjaro were approved by the FDA in 2017 and 2022, respectively, as treatments for Type 2 diabetes. In some cases, people are using the drugs off-label to lose weight.

In the fall, Zepbound, was approved by the agency for weight loss specifically, as opposed to for type 2 diabetes.

There has been a more than 930% increase in patients getting prescription semaglutide in the past four years, according to data from Epic Research.

Some experts say that the rising popularity of drugs like these when used for weight loss is undoing years of progress in the body positivity and fat acceptance movements.

Dr. Fatima Cody Stanford is an obesity medicine physician-scientist and associate professor at Harvard Medical School. She has been treating patients for obesity using these drugs for years.

“A lot of people have thought about obesity as just a matter of lifestyle, a matter of calories in and calories out, and this has really failed us,” she told Impact. “We all respond to different things in different ways. We store Adipose or fat in different ways. Sometimes we need to go beyond just those lifestyle modifications.”

Pepper Schwartz, a professor of sociology at the University of Washington, told Impact that sometimes when people lose weight it isn’t just how others treat you that changes.

“I think it is important to recognize that looks and identity can be interwoven. And if you change your look so much that you feel like a different person, then your identity is changing,” Schwartz, who lost 30 pounds herself after using Ozempic, said. “And then the question is, how is this affecting you? How are you feeling? What are the things you need to express?”

Stephanie Smith, a nurse practitioner from Utah, told Impact that she started seeing a change in herself and her marriage after she started to take Mounjaro for weight loss.

“I have a lot more self-confidence and I feel like that is more attractive in general,” she said.

After seeing his wife’s weight loss success, Ethan Smith told Impact that he wanted to follow in her footsteps and improve his health.

“I wanted to be a good example for my kids. I want to be attractive for my wife. I know that my weight is affecting my health, with sleep apnea, and not being able to be very physically active,” he said.

The couple says their intimacy has improved since losing weight.

However, not everyone who has lost weight has had the same outcome.

Jason Wnuk told Impact that he struggled with weight issues since he was a child. After Trying traditional methods like dieting and exercise in the past, and even gastric sleeve surgery, he struggled to keep the weight off. He said his weight issues caused his wife to worry about his health, causing tension and ultimately affecting their marriage.

Last February, Wnuk started taking Mounjaro and he has since lost 80 pounds. Four months after he began his drug regimen, and after years of tension in his marriage, Wnuk filed for divorce.

“Forty-five-year-old Jason is a lot different than the Jason that met his wife at 20. So, when you realize you’re just at different points and that’s when you decide it’s just…it’s time,” he said.

Wnuk’s estranged wife said in a statement to Impact, “Yes, his weight was a point of contention… I also tried to encourage him for fear he would not be around for me or our daughters.”

Wnuk said that he is continuing on his personal growth journey and starting a new chapter in his life.

“I’m just amazed at not only the outer appearance, but how I also feel. Just simple things that I couldn’t do a few years ago like, you know, taking the dog for an extended walk,” he said.

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(NEW YORK) — Bachelor star Joey Graziadei is opening up about the reason behind his yellow-tinted eyes.

In a video he shared on Instagram, Graziadei addressed some of the comments he’s received recently about them, saying it was due to a liver condition called Gilbert Syndrome.

“Hi everyone, I hope you are having a beautiful day,” he began in the video. “I want to jump on here really quick and talk about something that I’m seeing a lot of comments about, which is Joey’s yellow eyes.”

“So to give some context on that I have to go all the way back to when I was in high school,” he continued. “I was sick for about a week and a half, and my mom thought it’d be a good idea to go to the doctor. When I went to the doctor, I had bloodwork done, and the bloodwork showed that my bilirubin count was very high. That means that there could be something wrong with my liver.”

“So we went and I got a liver ultrasound, I went to the doctors, they found out there was nothing that was necessarily wrong like hepatitis, but they diagnosed me with something called Gilbert syndrome,” Graziadei said.

According to the National Institutes of Health, Gilbert syndrome is an “autosomal recessive disorder of bilirubin metabolism within the liver.” This means that the liver does not process bilirubin properly, and this can cause your skin to turn yellow.

It’s a condition that can be discovered by accident, for instance when one gets a blood test done. Those who have Gilbert syndrome do not require specific treatment, according to NIH.

Graziadei said that at the end of the day, he’s healthy, but the condition does affect the whites in his eyes.

“It makes it have those jaundice levels, which is why they look a little bit more yellow,” he said.

He ended the video by saying that he wants to keep an eye on his health this year.

“It’s something I want to pay attention to more,” Graziadei said. “I want to get my health right and make sure that I’m all good. But I at least wanted to give some background that you know that to my knowledge, I am healthy.”

“It’s just something that I have to pay attention to drinking more fluids. It is worse when I have stress or lack of sleep, which happens on a TV show,” he continued. “And I do appreciate everyone looking out for me and wondering if I’m okay, but to my knowledge, I’m as okay as that can be and I will continue to look at it.”

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