Health

(NEW YORK) — As the Israel-Hamas conflict continues — with food, water and fuel running out in Gaza — pregnant people and those who have just given birth are facing a crisis, experts and humanitarian organizations said.

About 50,000 people are estimated to be pregnant in Gaza with about 160 estimated to give birth every day, according to the United Nations Population Fund (UNFPA).

Additionally, an estimated 73,000 are pregnant in the West Bank, with more than 8,000 expected to give birth within the next month, the UNFPA said.

Experts said pregnant women and new mothers are facing life-threatening challenges to accessing safe care, putting their health and the health of their babies at risk.

“I think we have to start off with the basic premise, which is that war is bad for health,” Dr. Dabney P. Evans, an associate professor of global health in the Rollins School of Public Health at Emory University, told ABC News. “There’s no good health outcome that is going to come as a result of war and conflict.”

“And then from a public health perspective, we would tend to focus on vulnerable groups and so pregnant women and children … would be among the populations that we would want to pay special attention, to ensure that their health needs are being met,” she said.

Blocked access to care

One of the biggest problems facing pregnant and post-partum people right now is a lack of access to care.

An editorial in The BMJ on the risks pregnant women face in war discussed how there’s no transportation to get someone to a medical center or to a health care provider.

“You have to be able to provide some sort of prenatal care and, generally, that’s gonna be difficult to get them to a clinic unless they have some sort of transportation, depending on the type of zone that you’re in,” Dr. Harry Johnson, an OB/GYN at the University of Maryland Medical Center, who has experience practicing in war zones, told ABC News.

“If you’re house bound, because of the things that are going on around you, you’re not able to get to a health care facility, you don’t have access into to prenatal care, and you don’t have access to the hospital where you deliver the babies,” he continued. “So, you’re pretty much are limited to home care, which is not always adequate.”

This puts pregnant people at risk of having an infant with low birthweight or suffering a premature birth, stillbirth or even miscarriage, experts said.

He added that hospitals also have nurseries to care for newborns so, if someone gives birth at home, there’s no access to health care providers who can keep an eye on the infants’ health.

Even if a patient is able to get to a hospital, the medical center might be overwhelmed due to caring of those who have been injured, have underlying conditions or are even sheltering at the hospital due to losing their homes, experts said.

“There’s more attention, more resources being pooled into acute traumatic events, of injuries that are inflicted by war and in conflict,” Dr. Mimi Niles, an assistant professor at New York University Rory Meyers College of Nursing and a practicing midwife, told ABC News.

She added, “What does that do to the people who are seeking out health care for other reasons? Their lives do not stop when conflict [starts]. People don’t stop being pregnant, right? Or people don’t stop being in labor.”

Risk to safety

Another risk for pregnant people and new mothers’ is their immediate safety due to air strikes and raids.

With a potential ground offensive looming, Israel told more than one million people in northern Gaza last week to flee south to escape the fighting.

The UNFPA shared the testimony of a 30-year-old pregnant woman who been forced to evacuate her home four times, each time with only a small bag of clothes, who said “each time feels like a race against death.”

Pregnant women or those who just gave birth may not be able to move to safety depending on their condition.

“For anyone that has been pregnant, they will know that their doctor would suggest not flying or not traveling far from their local home base as their delivery draws nearer, and for people that are in conflict situations or humanitarian situations, they may not have the ability to control that,” Evans, the director of Emory’s Center for Humanitarian Emergencies, said.

Hospitals may also be at risk of attacks. Israel’s evacuation orders included 22 hospitals treating more than 2,000 patients in northern Gaza.

Experts told ABC News that health care facilities in any conflict zone should be neutral players.

“We’re medical providers, so we can’t really say what’s going on outside the hospital, but we would encourage that, and we would hope that, hospitals are protected and that they’re really safe zones,” Johnson said. “I think medical personnel are really neutral players in conflict zones and what we focus on really is taking care of patients — and in my particular case, would be pregnant women and newborns — and it’s just important that we respect that neutrality.”

Disputed family planning services

While the blockades may be preventing pregnant people and new mothers from accessing care, it’s also affecting access to family planning services.

This means people trapped in conflict zones may not be able to reach their health care providers to receive reproductive health care or have access to contraceptive, taking reproductive choices away from civilians.

“There are people who maybe were scheduled to get routine care or routine contraceptive care and routine abortion care, and they no longer have access to that care, because that clinic is closed or it’s been destroyed or there might be blockades,” said Niles. “These are all things that are part of what we call the reproductive justice framework, making sure that people have access to all the options that help them realize their own full humanity.”

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(NEW YORK) — Decreased levels of serotonin in the body may be a contributing factor in the development and persistence of so-called ‘long COVID’ symptoms, according to a new study.

Researchers suggest that, even after acute COVID symptoms subside, traces of the virus remain in the gastrointestinal tract, which is where the majority of circulating serotonin is produced, and where the virus reduces levels of the essential chemical. The low levels of serotonin might in turn lead to some of the more commonly reported long COVID symptoms, such as cognitive difficulties and memory problems, according to the study.

For the study, published Monday in the journal Cell, researchers at Penn Medicine conducted an analysis using questionnaire surveys and medical chart reviews of 1,540 patients hospitalized with long COVID.

Patients reported symptoms including fatigue, cognitive difficulties, headaches, anxiety, loss of endurance, problems with sleep and memory loss — all typically associated with long COVID diagnosis.

The study also analyzed blood samples taken from 58 long COVID patients and compared them to samples taken from 30 people who were fully recovered from COVID, as well as to samples taken from 60 people in the midst of an active COVID infection.

“These findings provide a possible explanation for neurocognitive symptoms associated with viral persistence in Long COVID, which may extend to other post-viral syndromes,” the authors wrote.

Researchers found that long COVID patients had different levels of chemicals in their body compared to those who had recovered, the most significant of which were levels of serotonin.

Serotonin is a neurotransmitter, sometimes referred to as the “feel good” chemical, that carries messages between nerve cells in the brain and throughout the body, helping to regulate mood. But serotonin also plays a significant role in digestion, sleep, bone health, wound healing, blood clotting and sexual desire, according to the Cleveland Clinic.

The researchers believe leftover bits of the virus in the gastrointestinal tract cause the body to produce proteins that lead to inflammation and an inability to absorb tryptophan, an amino acid that’s essential for the production and maintenance of neurotransmitters, including serotonin. The resulting low levels of serotonin lead to memory problems and other cognitive issues.

Serotonin levels also were predictive of whether a patient in the study fully recovered or developed long-term complications after COVID infection. Serotonin levels remained reduced in severe cases of long COVID. Long COVID patients also had higher levels of enzymes in the body that can break down serotonin, which in turn may also reduce levels of the neurotransmitter.

Researchers say further studies are needed to confirm a causal link between low serotonin levels and long COVID, with further, multiple steps needed before the research can result in a treatment.

Long COVID is a condition that occurs when patients still exhibit symptoms at least four weeks after they have cleared the infection. In some cases, long COVID symptoms can be experienced for months or years.

Though symptoms often vary, they can include fatigue, difficulty breathing, headaches, brain fog, joint and muscle pain, and continued loss of taste and smell, according to the Centers for Disease Control and Prevention.

Despite the new findings about serotonin’s possible role, it’s unclear what causes people to develop long COVID, and research is ongoing.

Earlier this year, the Biden administration announced it was forming a new Office of Long COVID Research and Practice to study the condition and help those who have been diagnosed with it.

The office, which will be under the Department of Health and Human Services, “is charged with on-going coordination of the whole-of-government response to the longer-term effects of COVID-19,” according to an HHS news release.

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(NEW YORK) — The U.S. Food and Drug Administration has issued a notice suggesting it may consider a proposal to ban the use of formaldehyde in hair straightening and hair smoothing products.

The FDA’s consideration of the proposal was entered in the Unified Agenda, a government registry of actions that administrative agencies plan to issue.

There is no set timeline on when the agency may consider the proposal or when, if it moves forward, a ban would go into effect.

Frequent use of hair-straightening products that include chemicals like formaldehyde has been found in studies to put women at a higher risk for uterine cancer.

One study published last year found an association that women who self-reported frequent use of hair straightening products were more than twice as likely to later develop uterine cancer than women who did not use the products. Scientists caution that it’s not clear yet if these products cause cancer. For now, research only hints at only a probable link.

Uterine cancer, a type of cancer that starts in the uterus, is a risk factor for anyone with a uterus, but the risk increases with age, especially during and after menopause, according to the Centers for Disease Control and Prevention.

Last year’s study found that Black women may be more affected by the increased risk of uterine cancer not because of their race, but due to the fact that they use chemical hair straightening products at a higher rate. Frequent use of the products was defined as more than four times in the previous year, according to the study, which included more than 33,000 women between the ages of 35 to 74.

Formaldehyde is described by the Environmental Protection Agency as a “colorless, flammable gas” that can cause “adverse health effects” with exposure. When used in hair smoothing products, the formaldehyde is released into the air as a gas when the products are heated.

The Department of Health and Human Services lists formaldehyde as a “known carcinogen.”

The FDA issued a warning last year stating that the use of hair smoothing products in an area that is not properly ventilated could lead to a risk of a person inhaling formaldehyde. In the warning, the agency acknowledged it began receiving “inquiries from consumers and salon professionals” about the safety of formaldehyde in products as far back as 20 years ago.

Melanie Benesh, vice president for government affairs at the Environmental Working Group, an environmental advocacy organization, described the FDA’s consideration of a ban on formaldehyde as a move that is “welcome, but long overdue.”

Benesh pointed out that the Environmental Working Group published a report as early as 2011 on the widespread use of formaldehyde in hair product brands and in salons across the U.S.

“The FDA has been aware of this issue for a long time,” Benesh told ABC News’ Good Morning America, adding, “There is no reason that the FDA shouldn’t have acted earlier on what is a real public health issue, particularly for salon workers.”

The FDA did not reply to ABC News’ request for comment in response to Benesh’s claim that the agency should have acted sooner.

Benesh added that salon workers are at increased risk of adverse health effects due to their prolonged exposure to the types of hair treatments that include chemicals, including keratin treatments and Brazilian blowouts.

“Consumers are going to be exposed if they get one of those treatments or if you’re in the salon while someone else is getting that same kind of treatment,” she said. “But salon workers are more likely to do multiple treatments a day or multiple treatments a week and over the course of a year, and so those repeat exposures can really add up to an increased risk.”

California and Maryland recently passed state legislation banning the use of formaldehyde in hair straightening products. Both laws are set to go into effect January 2025.

Benesh noted there are hair straightening and smoothing products currently on the market that do not use formaldehyde. She said her advice to consumers and salon workers is to not wait for regulatory action but instead refrain from using hair products with formaldehyde on their own.

“There’s no reason to wait until the law takes effect or until a proposed rule takes effect to switch to safer products, or to just no longer offer those services if you can’t find a hair smoothing or hair straightening treatment that you like that doesn’t use formaldehyde,” Benesh said. “It’s not worth the risk. It’s not worth your stylists or your consumers potentially getting cancer just to have straight hair.”

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(NEW YORK) — High-profile cases of unhoused people committing violent acts in U.S. cities like New York and San Francisco may have ignited fear and frustration around the homeless population of these areas, experts say.

But while those incidents tend to draw attention, they may create a false impression that homeless people are significantly more dangerous than the general population, according to research.

“Fear of danger far exceeds the actual risk of danger,” said Nyssa Snow-Hill, a researcher at the University of Illinois at Chicago.

Stigmas around people in marginalized groups contribute to the perception that people experiencing homelessness are a risk, Snow-Hills said. Some research shows that people view unhoused people with more disgust and as less human than other groups, for example.

“We view them as lacking in morality, being more dangerous, being more lazy, being less rational,” Snow-Hill said. “This contributes to those cognitive views that this is somebody who could present harm to me.”

Some people can be very uncomfortable with those that are different from them, according to Snow-Hill, and that can create increased anxiety.

“People don’t often have a lot of experience with those experiencing homelessness,” she says.

The visibility of unhoused people can increase that discomfort, experts say. An ABC News analysis found that while the number of people experiencing homelessness has been relatively stable over the past decade, the public’s visibility of unhoused people has increased. Some reasons include more urban construction and aggressive policing policies that have forced some people experiencing homelessness closer to where other people live and work.

Studies in recent decades have attempted to answer the question about whether unhoused people are more likely to be violent, but these studies have produced mixed results, and rely on inconsistent data sources.

Still, some research has found that unhoused people are arrested at higher rates than housed people, but that they’re arrested for non-violent behavior like public intoxication or shoplifting — not violence.

Researchers who study public perceptions of homelessness say people tend to have exaggerated fears of unhoused people. They also tend to assume that most have severe psychiatric disorders — which reinforces their fear.

“We tend to stereotype those experiencing homelessness as automatically having mental illnesses,” Snow-Hill says. “Then we often assume mental illness is severe and could pose a risk to the general public.’

Data suggests around 20% of people experiencing homelessness have severe mental illness, according to an ABC News analysis of data United States Department of Housing and Urban Development.

People with mental illness may have a slightly higher risk of committing violence than healthy people, research shows. But most violence is not committed by people with mental illness, and the things that predict violence in people with mental illness — like antisocial behavior and substance use — are the same qualities that predict violence in people without mental illness, according to the research.

Like unhoused people, people with mental illnesses are more likely to be the victim of violence than to be a perpetrator.

“There is this perception that people with severe mental illness are unpredictable and act violently … even though through research we know that they’re more likely to be victims,” says Jack Tsai, campus dean at the UTHealth Houston School of Public Health and research director for the U.S. Department of Veterans Affairs’ National Center on Homelessness Among Veterans.

Encouraging people to have more contact with people experiencing homelessness is one way to try changing attitudes and stereotypes around unhoused people, Snow-Hill says. Situations that offer meaningful contact between unhoused people and housed people — like in shelters through outreach — can help create those shifts. But disrupting deep-seated, often unconscious bias can be difficult, she says.

But changing those attitudes is important for creating the policy change that can actually address underlying causes of homelessness. People who have more negative views about people experiencing homelessness may be less likely to vote for policies that are less punitive and help provide housing, for example, Snow-Hill says.

“The issue of homelessness often comes down to these large systemic issues that will have to be addressed at policy level,” she says. “Unless attitudes change, we’re never going to get to that point where we have the change that’s needed to make a difference.”

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(NEW YORK) — There has not been a significant overall rise in the number of people experiencing homelessness over the past decade, according to a new ABC News analysis, though there has been a steady increase in the number of people experiencing homelessness with severe mental illness.

However, people experiencing homelessness may be much more visible in public spaces to a degree that outpaces the growth in overall numbers, experts told ABC News. This is due to a combination of factors, including a rising number of people who are homeless and living nearly full time on the street, increased real estate development in some cities, and police action in prohibiting and forcing the relocation of the homeless, all of which experts said can contribute to or exacerbate mental health problems.

“It’s more visible in a lot of these cities,” Chris Herring, an assistant professor of sociology at the University of California Los Angeles who studies homelessness, told ABC News. “People are moving to new parts of the city and often have to move around more, and are more unstable.”

That creates the perception of more people experiencing homelessness and the perception of more severe mental illness, even as the overall numbers are not rising dramatically.

“Homelessness has become more obvious without necessarily becoming worse,” Dr. Margot Kushel, M.D., director of the Benioff Homelessness and Housing Initiative at USCF and principal investigator of the California Statewide Study of People Experiencing Homelessness, told ABC News. “It’s much more in your face than it was before.”

Perception versus reality

The national landscape of homelessness is highly variable across the United States, according to data from the Annual Homelessness Assessment Report produced by the U.S. Department of Housing and Urban Development (HUD). More than half of all people experiencing homelessness in 2022 were in four states: California (30%); New York (13%); Florida (5%); and Washington (4%). California, Vermont, Oregon and Hawaii have the highest rates of homelessness relative to the number of residents, according to HUD data.

But overall numbers have been fairly steady over time. An ABC analysis of HUD data shows that in 2022 there were about 2,000 more people living in homelessness nationwide compared to 2020. Over the last five years, the total number of people experiencing homelessness has increased by 5.7%, but compared to a decade ago, there’s been a 6.3% decline. While HUD data is the most nationally representative available that measures the number of people experiencing homelessness, it is only collected on one day per year. Experts say that it’s a consistent metric but does not paint a complete picture of homelessness in the US.

However, the relatively stable number of homeless people in the U.S. may now be intersecting with the nation’s growing mental health crisis.

ABC News’ analysis does show some increase in the numbers of people living in homelessness who have a severe mental illness. In 2022, over 122,000 people living in homelessness had severe mental illness — this number has been rising slowly over the last decade, increasing from 108,378 in 2012.

That small increase of homeless led to a tsunami of calls to 311 and 911, experts said.

Despite overall stability in the population of people experiencing homelessness, people in some cities are more likely to raise concerns about homelessness.

“In many cities we’ve seen extraordinary growth in using 311 to complain about homelessness that go far beyond the number of people experiencing homelessness,” Herring said.

In San Francisco, for example, the number of people homeless and living on the street — considered “unsheltered” homeless — grew by around 1% between 2013 and 2017, according to HUD data.

In that same window of time, the number of 311 complaints for homelessness increased 781%, according to research from Herring published in the journal American Sociological Review. The number of 911 dispatches for homeless complaints increased 72%.

Those calls weren’t associated with any crime, Herring said. Based on how the city of San Francisco records 911 and 311 calls, they were calls just expressing “homeless concern.”

Similar patterns exist in other cities, he said.

“While annual HUD statistics are informative, the alarming increase in civic complaints in cities like San Francisco, not linked to criminal activities but rather societal concerns, accentuates the heightened visibility of this challenge,” John Brownstein, Ph.D., an epidemiologist at Boston Children’s Hospital and ABC News contributor, told ABC News.

More people who experience homelessness are living on the streets or unsheltered

The most visible group of people experiencing homelessness are “unsheltered homeless” — people who regularly sleep on the streets, in parks, or in vehicles. “Sheltered homeless,” on the other hand, includes people who stay in emergency shelters, transitional housing or other safe havens.

ABC News’ analysis shows that the numbers and proportion of people experiencing homelessness who are unsheltered, sometimes called “rough sleepers,” has been increasing.

“The rise of ‘unsheltered homeless’ individuals, particularly in states like California, brings to the fore the urgency of the situation,” Brownstein said.

Over the past decade, the number of people experiencing unsheltered homelessness has been rising and now accounts for 40.1% of the number of people experiencing homelessness — a historical high compared to 2007 when it reached 39.5%. This is also highly variable across states. For example, California and New York have the highest numbers of people experiencing homelessness in the U.S., but 67% of the unhoused in California were unsheltered in 2022 while 95% of the unhoused in New York were sheltered in 2022, according to HUD estimates.

Kushel says this is likely to play a part in people’s perception of homelessness because people experiencing homelessness may be more visible in some cities.

“When I give talks, I say, ‘who has more homeless people — New York, or Los Angeles,” she says. “Every single person says California or Los Angeles; it seems so obvious to them.”

That’s because in New York, a bigger portion of the homeless population is sheltered, Kushel says.

“They’re out of sight,” she said.

In 2022, Kushel led the most comprehensive homelessness survey done to date in California. This survey reported nearly 80% of people experiencing homelessness said that they had spent the most time while homeless in the prior six months in unsheltered settings (21% in a vehicle, 57% without a vehicle) and nearly all respondents (90%) reported at least one night in an unsheltered setting in the last six months.

“Such visibility, combined with an increased number of those without shelter, inevitably shifts public perception, underlining the need for multifaceted solutions that address both the root causes and the immediate concerns,” Brownstein said.

In addition to more people being unsheltered, more people experiencing homeless are chronically homeless — defined by HUD as continually homeless for a year or more, or with four episodes of homelessness in the past three years.

“Once people become homeless, they stay homeless a really long time,” Kushel says.

ABC analysis showed 12,768 people were experiencing chronic homelessness in 2022 which is a 47.4% increase in the past five years and a 27.9% increase compared to a decade ago. This now makes up 21% of the population experiencing homelessness, which is a historical high since 2007 when 18.5% of the homeless population experienced chronic homelessness.

Responses to homelessness can also make it more visible

New real estate development in places like San Francisco also contribute to the perception that more people are experiencing homelessness, Herring said.

“Certain areas where unhoused people could exist out of sight, or more safely, or more stably, are being eaten up by development,” he said.

That development increases the number of workers and commercial businesses in those areas — raising the chances that someone might encounter someone who is unhoused.

Businesses in those areas may be more likely to call 911 or 311 about a person experiencing homelessness. The data sometimes shows daily or weekly calls from the same address, Herring said. That could reflect a security guard calling regularly about a person sleeping nearby, for example, he said.

Increased policing in response to those types of calls, particularly on the West Coast, contributes further to visibility, Herring said. Much of the police response focuses on dispersing people experiencing homelessness and moving them out of certain areas. That forces people to move around more and disrupts sleep, which in turn could exacerbate visible mental health symptoms, he said.

“It could increase problematic behaviors that are more visible,” Herring said. “It’s different from when someone has a stable camp in a hidden spot.”

That visibility creates the impression there are more unhoused people behaving more erratically in U.S cities. However, Herring said that doesn’t reflect the underlying numbers — it reflects the changing circumstances that people experiencing homelessness encounter.

Those encounters are also the ones that people remember, and the ones that drive their perception of the underlying problem of homelessness in the US.

“People see the most extreme version of homelessness,” Kushel said. “But that doesn’t mean that’s the extent of the problem.”

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(NEW YORK) — Influenza and other respiratory viruses are starting to circulate but so far remain lower than this time last year, according to the Centers for Disease Control and Prevention.

As of Oct. 7, CDC’s FluView weekly report showed that the percent of flu cases were relatively unchanged, rising about 1% compared to the week prior.

In that same timeframe, 1,127 people were hospitalized with influenza, up from 1,050 people the week prior. About 35% of all flu hospitalizations were reported in the southeast of the U.S., which experts say is a typical trend at the start of the flu season.

Most of the flu cases detected were Influenza A and the most common subtype was Influenza A(H1N1), which is the strain of the virus that the flu vaccine usually offers better protection from, according to the CDC.

The percent of all reported respiratory viruses circulating over the past week have been relatively unchanged nationally, but there is regional variability. Region 9 — made up of Arizona, California, Hawaii, and Nevada — was the only region that saw an increase.

Still, the numbers in all regions of the U.S. remain below their baseline and outpatient respiratory illness activity is either minimal or low throughout most of the U.S., according to the CDC.

Alaska is the only state that is currently experiencing moderate respiratory illness activity. Influenza typically circulates this time of year and peaks between December and February for most of the U.S., according to the CDC.

Respiratory syncytial virus (RSV) numbers are on the rise and are projected to increase further, according to the CDC’s weekly surveillance. RSV typically circulates from October to April, according to the CDC.

How to prepare for this year’s cold and flu season

This time last year, the U.S. was bracing for a “tripledemic” amid rising cases of COVID-19, influenza and RSV after the seasons became more unpredictable during the COVID-19 pandemic.

Dr. John Brownstein, chief innovation officer at Boston Children’s Hospital and an ABC News contributor, said these early cases are behaving in a more predictable pattern.

“The data is pointing to something a little bit more par for the course. We’re seeing the early rise of RSV and flu at a time when you’d expect it,” Brownstein said.

Brownstein, however, cautioned that cases of respiratory viruses are expected to increase further, and higher levels still have potential to strain health systems and cause severe illnesses, Brownstein said.

“I think there’s still concern around the threat of all three respiratory viruses plus, of course, the rest of the seasonal mix [of viral illnesses], wreaking havoc on our health systems,” he said.

Experts are hopeful that new and updated immunizations that protect against COVID-19, influenza and RSV will stave off the strain on health care systems.

These viruses may only cause mild illness for many people, but young babies, pregnant women, people who are immunocompromised and the elderly are at highest risk for severe disease.

Everyone 6 months and older is eligible for an updated COVID-19 shot and the annual flu vaccine.

The Department of Health and Human Services told ABC News that, so far, more than 7 million updated COVID-19 shots have been administered. The CDC recommends getting the COVID-19 and flu vaccines by the end of October and encourages both to be given at the same time.

Adults who are 60 years and older can get an RSV vaccine and pregnant women who are in their third trimester can get an RSV shot that provides protection against RSV to their baby for the first 6 months of life.

Babies less than 8 months old who are born to mothers who did not get an RSV vaccine during pregnancy can get a protective shot called nirsevimab that offers about five months of protection against RSV.

Nirsevimab is a one-dose shot made of monoclonal antibodies, which are proteins manufactured in a lab and mimic the antibodies the body naturally creates when fighting an infection. This is different than a vaccine, which activates the immune system.

Brownstein said the pandemic has helped make many health systems better prepared for seasonal spikes in respiratory viruses and is hopeful that people are more motivated to stay up to date on shots that are available for protection and prevention this respiratory virus season.

“Now is really the time to get the protection advanced of the seasons really heating up,” Brownstein said.

Dr. Jade A Cobern, M.D., M.P.H, a licensed and practicing physician, is a member of the ABC News Medical Unit.

 

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(NEW YORK) — When Carolina Pino was pregnant, she discovered she lived in a so-called maternal care desert, a county with limited or no access to maternity care services.

Pino said the closest hospital where she could deliver her baby was more than 20 miles away, and the town where she lives in the San Francisco Bay Area had only one OB-GYN.

As a Hispanic woman, Pino said she especially wanted to find someone to guide her through her first pregnancy and childbirth with whom she related on a cultural level. So, Pino sought out a doula, a trained professional who provides support to moms before, during and after childbirth alongside doctors.

“Even though mothers are the ones going through the journey of delivering the baby, doulas contribute to keeping the environment more family-oriented,” Pino told “Good Morning America.” “So it’s not just that you’re in a hospital. You’re actually going through a transcendental time of welcoming your baby and starting a new family, becoming a mother.”

In Pino’s case, she found a Hispanic doula with whom she could not only communicate in Spanish, her first language, but who understood how she wanted her delivery to happen, which included a lot of family support.

Maria Antonieta Jandres, who also lives in the San Francisco area, said she too had a Hispanic doula in the delivery room with her during her 10-hour labor, someone with whom she could communicate in Spanish, her native language, and who made her feel safe and comfortable.

“My doula was so knowledgeable,” Jandres told “GMA.” “She spent 10 hours with me through my entire labor, and never left.”

After their own experiences giving birth with doulas by their side, both Pino and Jandres went onto become certified doulas themselves.

As doulas who are Hispanic, they are part of a growing movement in the San Francisco area and across the country to provide better support to Spanish-speaking women throughout pregnancy, during childbirth and postpartum through the use of doulas.

Both women work with Doulas Telar, a grassroots organization that offers free doula care to Latina immigrant women.

Like Jandres and Pino, all of the doulas who work with Doulas Telar are also Latina immigrant women themselves.

“Spanish is my first language so I can speak the language to these pregnant women that are going through the labor, the pain and also the stress that a labor can have by itself,” Jandres said. “Needing to communicate to a nurse that only speaks English or a midwife that only speaks English, it’s hard and the message is being displaced.”

Martha Franco created Doulas Telar in 2017 after seeing the need for Spanish-speaking doulas at hospitals in the San Francisco area. At the time, the organization provided volunteer doulas to women during delivery.

Now, the organization has expanded to include a center, Casa Doulas, where women can attend everything from free prenatal yoga classes to educational classes on topics like childbirth and breastfeeding. The doulas at the center offer support both before, during and after delivery, according to Franco.

“We become their family,” she said. “We come into their story and we want to know them so we can understand and support them not only as a doula, but as a family, as a human, so that they won’t feel they’re here by themselves.”

Diversifying care for pregnant patients through doulas

Part of the gap Franco said she and the doulas she works with are trying to fill is the lack of Hispanic health care workers in the United States, particularly in the maternal care sector.

A report released last year by the U.S. Health Resources & Services Administration found a “lack of racial and ethnic diversity” in the maternal workforce.” Specifically, the report found that Hispanics make up less than 8% of all maternal health physicians and less than 15% of maternal health registered nurses.

At the same time, over 80% of doulas in the U.S. are white, according to figures shared by the U.S. Department of Labor.

In June 2022, the Biden administration released a plan to reduce the maternal health crisis in the U.S. that called for increasing diversity in the maternal workforce. The plan cited doulas as a way to help both increase diversity and better support pregnant women, but noted there is a “short supply” of doulas that is compounded by an “exceptional lack of diversity in these professions and limited pathways for historically underrepresented communities to enter.”

The maternal health crisis the Biden administration seeks to address is one that is unique to the U.S., where around 700 women die each year from pregnancy-related complications, according to the Centers for Disease Control and Prevention, more than any other developed nation.

The crisis is one with huge racial disparities: Data released last year showed mortality rates nearly doubled among pregnant Hispanic women since March 2020, according to a study published by JAMA Network in June 2022.

Dr. Sheela Maru, an attending physician at NYC Health + Hospitals/Elmhurst and assistant professor at the Icahn School of Medicine at Mount Sinai, said immigrant women face additional disparities when it comes to maternal care.

“People who are not born in the United States, most of whom are of Hispanic origin, have a higher rate of maternal morbidity or near-misses, as well as pregnancy complications,” Maru told “GMA,” noting that many of the complications immigrant and minority pregnant women face come from a lack of respectful maternity care.

“About 1 in 5 moms describe mistreatment or violations of physical or verbal abuse during maternity care, and that number is even higher, about 30%, for Black, Hispanic and multiracial mothers,” Maru said, citing CDC data released in August. “Similarly, about 40% of Black, Hispanic and multiracial mothers experienced discrimination, and 45% reported holding back from answering questions or discussing concerns with their provider.”

Maru leads a joint initiative at Mount Sinai and NYC Health + Hospitals called the HoPE Doula Program, which provides free, community-based doula support to pregnant women at certain hospitals in New York. The doulas are matched with women based on their neighborhood, language and ethnicity.

The bridge doulas can build, according to Maru, is to be a voice for the patient in the delivery room and beyond.

“Even with excellent translation services and video translators and all the new technology that we have, nothing really replaces someone who is accompanying you, at your side, who speaks your own language and with whom you’re super comfortable when you’re in a medical setting,” she said. “That environment can be very scary and jarring and nothing really replaces that in-person accompaniment with someone you feel comfortable with.”

Anabel Rivera, a bilingual doula at Ancient Song Doula Services in New York City, said her experience of giving birth in the U.S. after moving from Puerto Rico motivated her to work as a community-based doula specializing in helping Hispanic women.

“I arrived to a completely new health care system. I was a Medicaid recipient, and the providers that I got were not responding to my questions. They couldn’t communicate in a cultural congruency towards me,” she said, noting that she believes the lack of communication led to a delayed diagnosis for preeclampsia, a pregnancy complication.

Now as a doula herself, Rivera said the most critical part of her job is to simply listen.

“The important thing is that we listen to their wishes, and not only that, but that we just listen to them,” she said. “When we’re working with a pregnant person or a birthing person, nobody knows best, just them, on what’s going on in their body, and treating someone with respect and listening is going to make a whole difference in their in their outcome.”

The struggle to recruit more Hispanic doulas, get fair pay

Both Rivera and Franco and her fellow doulas in San Francisco said the hardest part of their job is trying to recruit enough Spanish-speaking doulas to meet the need that exists across the country.

Currently, across all races, only around 6% of pregnant women receive doula care, according to a Department of Labor report on diversifying the doula workforce.

One of the biggest challenges, according to the doulas as well as Maru, is that doulas have traditionally not been well-compensated for the work they do, and it is a 24/7, unpredictable job in which they can only take on so many patients.

“We need space between client[s],” said Rivera. “We don’t want to leave someone unsupported through their journey … because then we will fall in the same circle of not being a solution, but being part of the problem.”

At Doulas Telar, Franco said the free doula services they offer to the community are a result of grants and donations. She said many of the organization’s doulas work in a volunteer capacity, most have other side jobs and many have other full-time jobs because they cannot live on a doula salary alone.

One of the biggest initiatives to help provide for doulas has been a push to have doula services adequately reimbursed by Medicaid and private insurers. Currently, fewer than one dozen states and the District of Columbia reimburse doula services through Medicaid, according to the Department of Labor.

“That has been an ongoing struggle, in terms of making sure that both people who need the services are able to afford them and obtain them at low or no cost, but then also that doulas are able to earn a living wage and be able to provide for themselves and their families and then provide high-quality care to their clients,” explained Maru.

Earlier this year, California became one of the latest states to offer doula reimbursement through its Medicaid program, a step that Franco and others said is slowly starting to help doulas in that state.

Franco has tried to ease another obstacle that blocks many Hispanic women from entering the doula field, the cost and lack of access to training, by offering free training classes at Doulas Telar, also supported by grants and donations.

The goal, she said, is to make sure that every Hispanic women who wants a doula has access to one.

“Nothing is going to stop us as long as the community needs us,” Franco said. “We always see more Latinas every time we go to take care of mothers. We want to go out there and let them know that we’re here and this is what we do.”

 

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(NEW YORK) — As the Israel-Hamas conflict continues, stories of devastation have emerged including injuries, disablement, destruction of buildings and loss of life.

However, experts say war is not just an international relations crisis but also a public health crisis that can result in long-term consequences.

Israelis and Palestinians — as well as residents in other conflict zones — may be cut off from food and water, and be under severe mental health stress. Those who flee may suffer from health risks because of being displaced.

What’s more, the physical distress and psychological effects are not just present of those living in war-torn areas but people abroad as well.

“One of the very disturbing things in virtually all wars nowadays is that civilians, noncombatant civilians, bear the brunt of war, be it the conventional war or terrorist attacks,” Dr. Barry Levy, a physician and an adjunct professor at Tufts University School of Medicine who studies the public health impacts of war and terrorism, told ABC News.

“Civilians are the ones who are caught in the middle, and not only by the direct effects of explosive weapons, but by the indirect health effects that sometimes linger long after the war is over,” he continued.

Lack of access to food, water

It’s common for those living in war-torn areas to be unable to have access to food, clean water and heat.

Israel declared a “complete siege” on the Gaza Strip, blocking food and water and cutting off power to the area.

Levy said that civilian infrastructure being attacked and destroyed often prevents people from being able to search for food and leaves them without shelter or sanitation.

This raises the risk of malnutrition, particularly among infants and young children, which can lead to abnormal development and even cognitive impairment.

Stress beyond the war zone

Research has shown people living in war zones are at increased risk of many mental health issues, including depression, anxiety, post-traumatic stress disorder (PTSD) and more.

However, there may be stress, anxiety, depression and PTSD experienced by the family and friends of loved ones in conflict areas and even the general population at large.

Dr. Jack Tsai, a professor and regional dean at UTHealth Houston School of Public Health in San Antonio, explained that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition — a diagnostic tool published by the American Psychiatric Association — now classifies PTSD as something that someone can experience directly but can also be witnessed.

“So, some people can get PTSD by witnessing horrific events and I think now with social media, we see it now with the conflicts in Middle East, is really facilitating a lot of visuals that most people in the past weren’t able to see,” he said.

“And so, I do think that is increasing risk for PTSD, not just for people there, but lots of people just watching and observing what’s happening,” Tsai said.

He added that people seeing the events unfold in the conflict may not meet the full criteria for PTSD but still have some of the symptoms, which can linger and have an effect on a person’s ability to function.

Health risks of displacement

Many Israelis and Palestinians have been forced to flee to other cities, and even neighboring countries, which can affect mental health.

“It can be very disruptive to their mental health in everyday activities,” Tsai said. “I imagine these folks that are being displaced are going to have to kind of reset, in new environments, new people and new cultures, and that can be unsettling in all kinds of ways they can affect their mental and physical health.”

However, people who are forcibly displaced are at greater risk of communicable diseases such as COVID-19 and measles, which could lead to an outbreak.

Amid Russia’s invasion of Ukraine, public health experts warned about the spread of COVID, particularly because Ukraine had a low vaccination rate prior to the war.

“Communicable diseases, infectious diseases are a major problem, mainly respiratory diseases, which often occur at increased rates during war, because people are crowded together,” Levy said. “You can imagine people crowded together in shelters, for example, or in refugee camps or other areas.”

He said another problem is the potential spread of diarrheal diseases, such as cholera, which often occur due to the lack of safe water supply.

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(NEW YORK) — Convinced social media platforms are fueling a mental health crisis among the nation’s youth, public officials in New York announced new legislation Wednesday that would restrict algorithms that target young users.

“Young New Yorkers are struggling with record levels of anxiety and depression, and social media companies that use addictive features to keep minors on their platforms longer are largely to blame,” New York Attorney General Letitia James said.

The legislation would, among other things, give her office new enforcement power over social media companies.

Algorithmic feeds are designed to harness personal data to serve users content that keeps them engaged for as long as possible. Sponsors of the legislation said that has increased the addictive nature of social media platforms and heightened the risk to young users’ well-being.

Facebook, Instagram, TikTok and YouTube would all be subject to the legislation that allows users under 18 to opt out of receiving algorithmic feeds, allow parents to allow algorithmic feeds to limit access between 12 a.m. and 6 a.m. and prohibit social media platforms from sending notifications to minors during those same hours without verifiable parental consent.

The attorney general’s office would be authorized to bring an action to enjoin or seek damages or civil penalties of up to $5,000 per violation.

Back in May, U.S. Surgeon General Vivek Murthy warned that excessive social media use can be a “profound risk” to the mental health of youth in the United States.

“I’m very concerned that social media has become an important contributor to the pain and the struggles that many of our young people are facing,” Murthy said in an interview on ABC News Live.

A surgeon general’s advisory is “reserved for significant public health challenges that require the nation’s immediate awareness and action,” according to the report released by the surgeon general’s office.

The surgeon general said that while we’re in the “middle of a youth mental health crisis” it’s important to identify possible causes. The advisory recognizes that social media has both positive and negative effects on young people, but that ultimately there’s not enough “research and clear data” to determine if it’s “safe” for adolescents to use.

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(BOSTON) — Harvard-affiliated scientists say they have been able to keep a monkey alive for two years with a genetically engineered pig kidney. Although preliminary, transplant experts say this research is an important milestone in the search for an alternative source of organs.

Scientists are hopeful that one day, genetically modified organs grown in pigs may be able to significantly extend the life of people with end-stage organ failure.

In recent months, other high-profile research teams at New York University and the University of Alabama at Birmingham announced successful transplants of genetically modified pig-kidneys into brain dead human donors. But those experiments ended after a few weeks.

“Duration of survival has been an Achilles heel of genetically modified pig organs to date due to a combination of rejection and opportunistic infections,” said Dr. Peter Chin-Hong, director of the transplant infectious disease program at University of California, San Francisco.

This new research, published in Nature, represents the longest period of time that scientists have been able to keep a non-human primate research animal alive.

“This proof-of-concept study provides real hope that transplantation of porcine [pig] donor kidneys into humans is very much on the horizon,” Chin-Hong said.

Still, experts cautioned that this new research was preliminary, and the idea of pig-grown organs is likely several years away from becoming a reality.

“If ultimately proved successful in human organ recipients – which is still years away at this point – this could be one of the key advances needed to make xenotransplantation a reality in clinical practice,” said Dr. Josh Levitsky, president of the American Society of Transplantation.

The new research was led by eGenesis, a company co-founded by Harvard geneticist George Church. In a press release, scientists at eGenesis said the new research will help lay the groundwork for formal clinical trials.

In prepared remarks, eGenesis CEO Michael Curtis, PhD, said the company is focused on “improving long-term survival for transplant recipients from months to years.”

Eventually, the hope is that transplant doctors will be able to use genetically modified pig organs instead of solely relying on deceased human organ donors.

“Among all solid organs transplanted, kidneys are most sought after, expected to increase in demand further, and there is a significant shortfall of organs leading to premature deaths,” Chin-Hong said.

Every day, 17 people die waiting on the organ transplant list, according to the Health Resources & Services Administration. There are currently more than 100,000 people waiting on the national transplant list and a new person is added to the list every 10 minutes.

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