NPR: Biden Says Goal Of 200 Million COVID-19 Vaccinations In 100 Days Has Been Met
President Biden announced Wednesday that Americans have received 200 million COVID-19 vaccinations since he took office, double his initial goal of 100 million vaccinations in his first 100 days, and what he called "an incredible achievement for the nation." Biden, who will officially cross the 100-day mark next week, also announced the availability of tax credits to employers who give their workers paid leave to get a shot. (Naylor, 4/21)

Politico: Biden: 200 Million Americans Have Been Vaccinated
The administration also unveiled a new tax credit designed to encourage businesses with fewer than 500 employees to give paid time off to workers for getting vaccinated — a policy included in Biden’s $1.9 trillion coronavirus relief package, which was signed into law last month. Businesses and nonprofits may receive a tax credit for up to $511 per day of paid sick leave that employees take to get the shot or recover from its side effects from April 1 through Sept. 30. (Forgey and Roubein, 4/21)

CNN: Biden Calls For Businesses To Give Paid Time Off For Employees To Get Vaccinated As He Touts 200 Million Shots
"As we move into the vaccination campaign focused on working age adults, one concern I've heard from so many Americans is that they can't afford to take the time off to get vaccinated or lose a day's work because they are feeling slightly under the weather after their shot," Biden said in remarks Wednesday afternoon. He added, "I'm calling on every employer, large and small, in every state to give employees the time off they need -- with pay -- to get vaccinated, and any time they need -- with pay -- to recover if they're feeling under the weather after the shot. No working American should lose a single dollar from their paycheck because they chose to fulfill their patriotic duty of getting vaccinated." (Diamond, Sullivan, Collins, Mattingly and Vazquez, 4/21)

In related news —

The Washington Post: U.S. Vaccinations Dropped 11 Percent Over The Past Week — The Biggest Decline Since February 
Daily coronavirus vaccinations have slowed significantly for the first time since February, a sign that demand is slipping even though every American adult is now eligible for the shots. About 3 million Americans are getting vaccinated daily, an 11 percent decrease in the seven-day average of daily shots administered over the past week. The unprecedented drop is rivaled only by a brief falloff that occurred in February, when winter storms forced the closure of vaccination sites and delayed shipments nationwide. (Keating, Nirappil and Stanley-Becker, 4/21)

Stateline: Vaccination Outreach Shifts As Demand Drops In Some States
Four months into the largest vaccination campaign in U.S. history, roughly half of all adult Americans have received at least one shot against COVID-19 and the nation is vaccinating more than 3 million people daily. But those nationwide averages belie looming standstills in pockets of the country where people aren’t showing up for appointments and vaccines are piling up in refrigerators. “We’ve harvested the low-hanging fruit, now we’ve got to do the hard work,” said Dr. William Schaffner, professor of preventive medicine at the Vanderbilt University School of Medicine. “For every incremental increase in the number of people vaccinated, it’s going to get harder and harder.” (Vestal, 4/21)

CNN: US Has The Opportunity To Overcome The Pandemic But A Major Challenge Lies Ahead, Expert Says
On the road toward a return to normalcy, the rapidly climbing number of Covid-19 vaccinations is good news. But a major challenge may lie ahead, a leading health expert says. Tens of millions of Americans haven't started their vaccinations yet, National Institutes of Health Director Dr. Francis Collins told CNN on Wednesday, and "a lot of those folks are still not sure that they want to take part in this amazing opportunity to put this virus behind us." "We have to really figure out how to get the messages out there so that those who are still undecided get the information they need to see why this is really something they would want to do." (Maxouris, 4/22)

Bloomberg: Biden Says He’ll Send Vaccines Overseas Once Supply Sufficient
President Joe Biden said the U.S. wants to share coronavirus vaccines with other countries but won’t begin sending doses abroad until it has sufficient supply at home.“ We’re looking at what is going to be done with some of the vaccines that we are not using. We’ve got to make sure they are safe to be sent,” Biden said at the White House Wednesday. “And we hope to be able to be of some help and value to countries around the world.” (Wingrove and Sink, 4/21)

Bloomberg: U.S. Weighs Global Vaccine-Expansion Move Opposed By Drugmakers
The Biden administration is weighing an appeal from progressive Democrats to accelerate global access to Covid-19 vaccines by supporting a waiver of intellectual-property protections, a move opposed by big drugmakers. Lawmakers led by senators Bernie Sanders and Elizabeth Warren last week called on President Joe Biden to back a proposal before the World Trade Organization that seeks a broad waiver from obligations on the protection of intellectual property rights, including patents, copyrights and trade secrets. The aim is to ease rules regarding the production and export of vaccines and other critical medical goods needed to combat the Covid-19 virus. (Martin and Decker, 4/22)

And first lady Jill Biden is on a vaccine outreach tour —

AP: Jill Biden Visits US Southwest Amid Vaccine Push
First lady Jill Biden has kicked off a three day visit to the U.S. Southwest on Wednesday with a tour of a vaccination clinic in New Mexico, where early efforts to get people registered for shots helped to propel the state’s standing as a national leader in vaccine distribution. The tour includes stops in Albuquerque and later the Navajo Nation as the United States is set to meet President Joe Biden’s goal of administering 200 million coronavirus doses in his first 100 days in office. The president also outlined his administration’s latest plans to motivate more Americans to get shots as demand diminishes. (Bryan and Lee, 4/21)

AP: Jill Biden To Visit Navajo Nation, Once Floored By COVID-19
Jill Biden is traveling to the country’s largest Native American reservation, the Navajo Nation, which was hit hard by the coronavirus but is outpacing the U.S. in vaccination rates while maintaining strict pandemic restrictions. The trip Thursday and Friday will be Biden’s third to the reservation that spans 27,000 square miles (70,000 square kilometers) in the Four Corners region, and her inaugural visit as first lady. (Fonseca, 4/22)

AP: Navajo Nation Reports Its First COVID-19 Death In 11 Days
The Navajo Nation on Wednesday reported its first COVID-19 related death after 10 consecutive days of no such fatalities. The tribe reported one death and eight new confirmed coronavirus cases on the vast reservation that covers parts of Arizona, New Mexico and Utah. The latest numbers bring the Navajo Nation’s pandemic case total to 30,388 with the known death toll now at 1,263. (4/22)

CBS News: FDA Inspectors Find "Brown Residue" And Other Violations In Plant Making Johnson & Johnson Vaccine 
The Baltimore factory contracted to make Johnson & Johnson's COVID-19 vaccine was dirty, didn't follow proper manufacturing procedures and had poorly trained staff, resulting in contamination of material that was going to be put in the shots, U.S. regulators said Wednesday. The Food and Drug Administration released a statement and a 13-page report detailing findings from its recent inspection of the now-idle Emergent BioSciences factory. Agency inspectors said a batch of bulk drug substance for J&J's single-shot vaccine was contaminated with material used to make COVID-19 vaccines for another Emergent client, AstraZeneca. That batch, reportedly enough to make about 15 million J&J vaccine doses, had to be thrown out. (4/21)

NPR: FDA Inspection Finds Numerous Problems At Facility Intended To Make J&J Vaccine
Peeling paint. Cracked buckets. Employees dragging unsealed bags of medical waste. Procedures ignored. Inadequately trained staff. All of these were problems noted by U.S. Food and Drug Administration inspectors at the Emergent BioSolutions factory in Baltimore – a facility that is intended to produce materials for the Johnson & Johnson COVID-19 vaccine. That plan is on hold, following a problem last month with a batch of a vaccine ingredient there, and now a range of documented issues at the facility. (Wamsley, 4/21)

The New York Times: Federal Inspectors Fear More Vaccines Were Exposed To Contamination
“There is no assurance that other batches have not been subject to cross-contamination,” the F.D.A.’s 12-page report states. The report amounted to a harsh rebuke of Emergent, which had long played down setbacks at the factory, and added to problems for Johnson & Johnson, whose vaccine had been seen as a game changer because it requires only one shot, can be produced in mass volume and is easily stored. (LaFraniere, Stolberg and Hamby, 4/21)

Politico: FDA Inspection Report Casts Doubt On J&J Vaccine Contractor's Ability To Restart Production 
Emergent said that it is working with FDA and J&J to resolve the issues quickly. "While we are never satisfied to see shortcomings in our manufacturing facilities or process, they are correctable and we will take swift action to remedy them," the company said in a statement. It added that "the issuance of findings by the FDA is normal following a facility inspection and provides direction on the necessary steps to improve operations." But it is rare for the agency to move so quickly —releasing a report on an inspection concluded just a day earlier — and to accompany its findings with a statement by top FDA officials. (Owermohle and Banco, 4/21)

CNN: Pfizer And Moderna Covid-19 Vaccines Do Not Appear To Pose Serious Risk During Pregnancy, Research Shows 
The mRNA Covid-19 vaccines made by Pfizer/BioNTech and Moderna do not appear to pose any serious risk during pregnancy, according to new data published Wednesday in the New England Journal of Medicine. Pregnant women with Covid-19 are at increased risk for severe illness and may be at increased risk for adverse outcomes, such as preterm birth, according to the US Centers for Disease Control and Prevention. The study, along with existing research showing mRNA vaccines are effective in pregnant and lactating women, suggests that the benefits of the vaccines outweigh the risks. (Mascarenhas and Firger, 4/21)

AP: New Data Reassuring For COVID-19 Vaccination In Pregnancy
One of the largest reports on COVID-19 vaccination in pregnancy bolsters evidence that the shots are safe, although the authors say more comprehensive research is needed. The preliminary results are based on reports from more than 35,000 U.S. women who received either the Moderna or Pfizer-BioNTech shots while pregnant. Their rates of miscarriage, premature births and other complications were comparable to those observed in published reports on pregnant women before the pandemic. (Tanner, 4/21)

In other vaccine news —

CNN: Only 2 "Breakthrough" Infections Among Hundreds Of Fully Vaccinated People, New Study Finds 
For fully vaccinated people, the risk of still getting Covid-19 -- described as "breakthrough infections" -- remains extremely low, a new study out of New York suggests. Among 417 employees at Rockefeller University who were fully vaccinated with either the Pfizer or Moderna shots, two of them or about .5%, had breakthrough infections later, according to the study published on Wednesday in the New England Journal of Medicine. (Howard, 4/21)

NBC News: Breakthrough Infections With Coronavirus Variants Reported, But Cases Appear Mild
Two reports of so-called coronavirus breakthrough infections — in which fully vaccinated people get the illness anyway — suggest that the vaccines still offer strong protection against severe disease even in the face of variants. The cases, which were detailed Wednesday in the New England Journal of Medicine, were those of two women out of more than 400 fully vaccinated study participants who were tested for Covid-19 weekly. Both women developed mild cases and recovered quickly. (Sayal, 4/21)

Philadelphia Inquirer: The COVID-19 Vaccine Won’t Give You Herpes. Here’s What The Science Says
“It’s called a logical fallacy,” said William Schaffner, an infectious-disease specialist at Vanderbilt University Medical Center in Nashville and also a liaison to the CDC’s immunization advisory committee, which makes vaccine recommendations that shape insurance coverage. “The Israeli doctors fell into this trap because the COVID-19 vaccination and the shingles outbreaks were related in time.” Even the Israelis, who published in the journal Rheumatology, acknowledge that “the study design is not structured to determine a causal relationship.” (McCullough, 4/21)

The Atlantic: Vaccines Are Making COVID-19 A Young Person's Disease
Like many parents, Jason Newland, a pediatrician at Washington University in St. Louis and a dad to three teens ages 19, 17, and 15, now lives in a mixed-vaccination household. His 19-year-old got vaccinated with Johnson & Johnson’s shot two weeks ago and the 17-year-old with Pfizer’s, which is available to teens as young as 16. The 15-year-old is still waiting for her shot, though—a bit impatiently now. “She’s like, ‘Dude, look at me here,’” Newland told me. “‘Why don’t you just tell them I’m 16?’” But because certain pharmaceutical companies set certain age cutoffs for their clinical trial, she alone in her family can’t get a COVID-19 shot. She’s the only one who remains vulnerable. She’s the only one who has to quarantine from all her friends if she gets exposed. (Zhang, 4/21)

Des Moines Register: Iowa Prison Staff Gives Overdoses Of COVID-19 Vaccine To 77 Inmates
Staff from the Iowa Department of Corrections incorrectly gave 77 inmates overdoses of the Pfizer COVID-19 vaccine, the department confirmed to the Des Moines Register. The incident happened Tuesday at the state maximum-security prison at Fort Madison, according to Cord Overton, a spokesperson for the department. Overton did not say how much extra vaccine each inmate was given. (May Sahouri and Leys, 4/21)

Dallas Morning News: Dallas Kicks Off First In-Home COVID Vaccination Program For Homebound Seniors
The program is the next step in the goal to vaccinate vulnerable residents and comes three months after Dallas County’s vaccine hub opened at Fair Park in South Dallas. Initial efforts to inoculate Black and Latino people in the county had fallen short, complicated by transportation issues and internet access because of an online registration system. Now, as doses have become more widely available and an increasing number of people are getting inoculated, the city and county have streamlined the vaccination process. (Cooper, 4/21)

Anchorage Daily News: Alaska Will Have Enough COVID-19 Vaccine For Every Eligible Resident By The End Of May, Health Officials Say
Alaska will soon have enough COVID-19 vaccine available in the state for every eligible resident, the state’s top doctor said Wednesday. “By the end of May, we will have enough vaccine for every Alaskan to get vaccinated who’s 16 and above,” Dr. Anne Zink, the state’s chief medical officer said during a public information call. That estimate is based on how much vaccine the state has already received, as well as projected allocation numbers for May, she said. Data available from the state shows that Alaska will have received just over 508,000 first doses of vaccine by the end of April. (Berman, 4/21)

The Washington Post: New Yorkers Can Get Vaccinated Under The Natural History Museum’s Iconic — Now Bandaged — Blue Whale
Starting Friday, New York’s American Museum of Natural History will open a mass vaccination site, allowing New Yorkers to register to get a jab under the institution’s iconic 94-foot-long model of a blue whale. (Firozi, 4/20)

Des Moines Register: Gov. Kim Reynolds Implores Unvaccinated Iowans To Take COVID Vaccine
Iowa Gov. Kim Reynolds said Wednesday that "vaccine hesitancy is beginning to become a real factor" in Iowa and across the country. The governor noted during her weekly press conference that 43 of Iowa's 99 counties have declined some or all of next week's COVID-19 vaccine allocation due to decreasing demand for the shots. The Republican governor implored Iowans to take the vaccine, as she did. (Coltrain and Richardson, 4/21)

Philadelphia Inquirer: More Coronavirus Vaccinations Are Key To Fully Reopening Pennsylvania And New Jersey, Governors Say
Pennsylvania Gov. Tom Wolf said Wednesday that he would like to see more Pennsylvanians get vaccinated against the coronavirus, saying inoculations are key to fully reopening the state and avoiding the spread of virus variants. “If you haven’t made an appointment, make one,” said the governor, who received his first dose Monday. “Come in. There are openings.” (McCarthy, McDaniel and Steele, 4/21)

Los Angeles Times: Not All Asian Americans Are Being Vaccinated At High Rates. A Chinatown Clinic Shows Why
Before the pandemic, Sissy Trinh ran after-school programs as founder and executive director of the Chinatown-based youth organization Southeast Asian Community Alliance. But since last year, the organization of five people pivoted to COVID-19 relief, delivering food and other resources to vulnerable residents in Chinatown and Lincoln Heights. She soon realized that existing government programs weren’t accessible to the families her group served: those with language and technology barriers. (Tseng, 4/21)

KHN: California And Texas Took Different Routes To Vaccination. Who’s Ahead?
California and Texas, the country’s two most populous states, have taken radically different approaches to the pandemic and the vaccination campaign to end it. California has trumpeted its reliance on science and policies it says are aimed at improving social equity. Texas state officials have emphasized individual rights and protecting the economy, often ignoring public health warnings but encouraging vaccination — while calling it a personal choice. (Almendrala and West, 4/22)

CIDRAP: Study: B117 Variant 45% More Transmissible Than Wild-Type COVID-19
A study yesterday in Cell Reports Medicine shows the B117 variant, first identified in the United Kingdom in December, is 45% more transmissible than the original, wild-type COVID-19 virus, but Pfizer's mRNA vaccine protected elderly populations against infections caused by the variant. The study was based on cases documented in Israel from Dec 6, 2020, through Feb 10, 2021. Within 3.5 weeks of detection, B117 was the dominant strain in Israel. But the nation took a three-pronged approach to controlling a spike in cases, including expanded polymerase chain reaction (PCR) testing, focused surveillance in nursing homes, and prioritized vaccination of those 60 years and older with BNT162b2, the two-dose Pfizer-/BioNTech vaccine. (4/21)

San Francisco Chronicle: California Coronavirus Variants 20% More Infectious, Resistant To Antibodies, New Study Finds
Two California-bred coronavirus variants are about 20% more infectious than the original virus, according to a study published Tuesday by researchers at UCSF, UC Berkeley and the California Department of Public Health. The study results, published in the journal Cell, support previously released research out of UCSF and the Chan Zuckerberg Biohub that had not yet been vetted by peer review. (Arredondo, 4/21)

Fox News: Coronavirus Outbreak In Kentucky Nursing Home Linked To R.1 Variant, Prompts Concern Over Vaccine Impact
A so-called R.1 coronavirus lineage variant was detected in an outbreak at a Kentucky nursing facility where nearly all residents were vaccinated, according to one of the latest reports from the Centers for Disease Control and Prevention (CDC). Health departments noted that coronavirus infections cropped up in a quarter of vaccinated residents, raising concerns about vaccine impact. The unnamed skilled nursing facility offered all residents and staff vaccinations beginning in January, with 90.4% of 83 residents taking up a vaccine and just over half of staffers accepting doses as well. (Rivas, 4/21)

In other updates on the spread of the coronavirus —

Detroit Free Press: COVID-19 Case Rate In Michigan Appears To Have Peaked As Surge Slows
Michigan's coronavirus case rate has begun to fall, dropping 12.5% over the last week, suggesting the state's third surge — the worst in the U.S. — may be waning. The U.S. Centers for Disease Control and Prevention reported Wednesday that the seven-day average of new cases in Michigan fell from 551.8 per 100,000 people on April 14 to 483 per 100,000 Wednesday. "It's pretty early in the dip to say it's going to be sustained," said Ryan Malosh, an infectious disease epidemiologist at the University of Michigan School of Public Health, "but it does look like we have peaked." (Jordan Shamus, 4/21)

AP: Texas COVID-19 Cases, Deaths Continue An Above-Average Pace
New Texas COVID-19 cases and deaths continued to register Wednesday at an above-average pace. The Texas Department of State Health Services reported 4,518 new cases and 82 COVID-19-related deaths, compared to the rolling seven-day daily average of more than 3,247 new cases and 55 deaths as calculated by Johns Hopkins University researchers. (4/21)

Las Vegas Review-Journal: New COVID-19 Cases, Deaths In Nevada Remain Above Recent Averages
Nevada on Wednesday reported 436 new coronavirus cases and 11 additional deaths over the preceding day, continuing a recent streak of above-average daily updates. Figures posted to the Department of Health and Human Services’ coronavirus website brought totals in the state to 311,750 cases and 5,388 deaths. The new cases and deaths reported on Wednesday remained well above the moving 14-day averages for both metrics. The average daily recorded cases for the period fell slightly to 269, while average daily fatalities stood three, state data shows. (Newberg, 4/21)

Modern Healthcare: Navigators To Get Record-Breaking $80 Million To Boost ACA Enrollment
The Biden administration will provide federal marketplace navigators with $80 million in funding to help people enroll in health coverage during the 2022 open enrollment period, HHS said Wednesday. That's an eightfold increase compared to last year and the largest pot of money ever earmarked for navigators. HHS expects the increase in outreach, education and enrollment assistance to ramp up enrollment in health coverage. "Navigators play a key role in helping us educate consumers about health plan options. Today's announcement builds upon the steps the administration has taken to ensure individuals and families can access quality, affordable health coverage during the COVID-19 pandemic," HHS Secretary Xavier Becerra said in a statement. (Brady, 4/21)

In other news on the Affordable Care Act —

The Hill: Becerra Calls On Hispanic Americans To Sign Up For ACA 
Health and Human Services (HHS) Secretary Xavier Becerra called on Hispanic Americans to sign up for medical insurance under the Affordable Care Act (ACA) in order to take advantage of a special enrollment period and low premiums. In a call with reporters Wednesday, Becerra said his department's top priority is "helping the community take advantage of reduced costs on health care." (Bernal, 4/21)

The Hill: Bipartisan Lawmakers Weigh In On Post-Pandemic Health Care Costs
Reps. Lisa Blunt Rochester (D-Del.) and Rodney Davis (R-Ill.) said Tuesday that lowering health care costs should be one of the top priorities as the U.S. emerges from the coronavirus pandemic. Speaking at The Hill’s “Policy Prescription for Cost & Coverage” event, Rochester said she hopes there will be a greater focus on access to care and the cost of assistance. Rochester, a member of the House Energy and Commerce Committee, told The Hill’s Steve Clemons that the pandemic has shown the impact of the Affordable Care Act and “how important having access to that care really is.” (Benbrook, 4/20)

Pennlive.Com: Federal COVID-19 Rescue Plan Fuels ‘Life-Altering’ Health Insurance Expansion And Savings In Pa.
The American Rescue Plan has given Pennsylvania $270 million toward expanding health insurance coverage and also lowering the cost for many people who already have coverage. The help is available to people with coverage through Pennsylvania’s electronic health insurance marketplace, called Pennie. Pennie is Pennsylvania’s new, state-run version of the marketplace that came about as a result of the Affordable Care Act, or Obamacare. (Wenner, 4/21)

NPR: Health Insurance For $10 Or Less A Month? You May Qualify For New Discounts
Signing up for health insurance can be a confusing headache. At the same time, the need for a financial safety net if someone in your family gets sick is incredibly important. With the ongoing pandemic and economic crunch, the stakes are even higher. Now, during a special enrollment period, the Biden administration is trying to make getting health insurance irresistible — and simpler, too. (Simmons-Duffin, 4/22)

Roll Call: House Passes Temporary Extension For Regulating Fentanyl As Schedule 1 Drug 
The House passed legislation by voice vote Wednesday to extend an expiring provision related to the deadly synthetic opioid fentanyl, which was responsible for a large share of drug overdoses in recent years, although senators prefer a different approach. Both chambers have introduced multiple bills that would extend the regulation of fentanyl for varying lengths of time. Currently, fentanyl is listed as a Schedule 1 drug, meaning it has a high potential to be abused and does not have a medical use. (Raman, 4/21)

Lawmakers turn their attention to drug pricing —

The Washington Post: House GOP Is Preparing For A Drug Pricing Fight
House Republicans are gearing up for a fight over a drug pricing proposal expected soon from the White House. Their argument is this: It’s hardly the time to crack down on the pharmaceutical industry just as Americans are relying on coronavirus vaccines made by it. (Cunningham and Ellerbeck, 4/21)

Stat: Worried About Drug Pricing, Democrat Pushes Biden To Pledge Support
At least one Democratic lawmaker is openly pushing President Biden to include drug pricing reform in his next big legislative package, after rumors swirled on Capitol Hill this week that the forthcoming legislation might not include provisions on the subject. Rep. Peter Welch of Vermont told STAT he plans to call the White House Wednesday night and is urging his colleagues to pressure the administration in a letter, too. “Anytime there’s even a whisper of a rumor, if it affects something you are passionate about, you get anxious,” Welch told STAT in an interview. (Florko and Cohrs, 4/21)

Axios: How The Pandemic Changed Prescription Drug Spending
Spending on prescription drugs rose even during the pandemic, when many people delayed care. And it will probably continue its rise this year. Why it matters: Prescription spending is yet another source of financial uncertainty for hospitals hit hard by plummeting volumes last year. Details: Overall drug spending in the U.S. rose $535.3 billion, or by nearly 5%, between 2019 and 2020, according to the latest trends report from the American Society of Health-System Pharmacists. (Reed, 4/22)

In other news from Capitol Hill —

CNN: Three House Democrats Joined Protesters In Minnesota But Used Proxy Voting Instituted During Covid To Vote In Washington
Three House Democrats were in Minnesota Monday participating in protests around the Derek Chauvin murder trial while the House of Representatives was in session back in Washington, DC. All three used a new option to vote by proxy to cast ballots remotely, citing the "ongoing health emergency." Reps. Ihan Omar of Minnesota, Joyce Beatty of Ohio and Shelia Jackson-Lee of Texas were all seen at protests Monday and visiting with protesters and activists. (Grayer and Nobles, 4/20)

ABC News: How Some Republican Lawmakers Are Fighting Conservatives' COVID-19 Vaccine Hesitancy 
In his eastern Maryland congressional district, conservative GOP Rep. Andy Harris is vaccinating his constituents against COVID-19. He's co-chair of a caucus of physicians-turned-lawmakers on Capitol Hill volunteering to give shots to Americans in their communities, as part of the broader effort to bring the country closer to herd immunity. (Parks, Siegel and Selsky, 4/20)

NBC News: Survey By Ohio Regulator Shows Stress, Fatigue Among Pharmacists At Chain Stores
Roughly half of pharmacists in the nation's seventh most populous state say they do not have adequate time to complete their job safely, according to a report released by Ohio's pharmacy regulator Tuesday. The state's 4,000-person survey on pharmacist working conditions found the greatest concerns among pharmacists employed at large chain retail pharmacies. The findings echo NBC News reporting in March that overworked, understaffed pharmacists at chain drug stores say they are reaching a breaking point. (Kaplan, 4/21)

Stat: More Surveillance Is Coming To The OR. Surgeons Warn That's Risky
Though hospitals track patient outcomes for surgeons, most of today’s reporting and analysis falls short of the insights that could be possible with more sophisticated data from the operating room. There’s a growing movement to change that, guided by research linking what happens under the knife to patient outcomes. More rigorous evaluation of surgical technique is on the horizon, aided by technology companies turning laparoscopic cameras and other surgical tools into sources of ground truth. There’s immense promise in using robust data and artificial intelligence to improve the practice of surgery. But surgeons caution that using video and other tech for board certification or performance reviews can be risky. (Aguilar, 4/22)

Cincinnati Enquirer: COVID-19 Made Nursing-Home Work A Deadly Job. How Many Ohioans Died?
Thirty-four Ohio nursing home workers have died of COVID-19 through the week ending April 4, according to data released by Centers for Medicare and Medicaid Services (CMS) and Enquirer research. The number of nursing homes that reported deaths is small: 24 out of the total 954 facilities that submitted data to CMS. The Enquirer and the Repository reached out to all the nursing homes with reported deaths for comment; 15 didn't respond. However, the CMS data has significant flaws, including the fact deaths are self-reported by nursing homes. Current reporting guidance for staff deaths also doesn't take into account if an employee contracted a case at work. Workers have the potential to be exposed to COVID-19 both inside and outside nursing homes. (Hine, 4/21)

In other health care industry news —

Modern Healthcare: New Project Eyes Building Climate Resilience At Community Health Clinics
Harvard University is spearheading a new project to create a first-of-its-kind clinical framework focused on protecting the ability of safety-net clinics to provide care for patients during and after a climate-related disaster. The university's Center for Climate Health and Global Environment has partnered with Cambridge, Mass.-based biotechnology firm Biogen and global relief and development organization Americares on a multiyear pilot program to develop a climate resilience toolkit for community health clinics. (Ross Johnson, 4/21)

CIDRAP: Antibiotic Development, Stewardship Advocates See Window Of Opportunity 
The pandemic isn't over yet, but with more and more Americans getting vaccinated against COVID-19 and the light at the end of the pandemic tunnel becoming a little brighter every day—at least in the United States—many clinicians, scientists, and public health advocates are calling for renewed attention to an infectious disease threat that was in the spotlight before the pandemic arrived. Prior to the pandemic, antimicrobial resistance (AMR) was considered one of the major looming health threats facing the world, if not the looming threat. But over the past year, COVID-19, and its multifaceted impact on society, has pushed AMR further back on the agenda, both for the public and policy makers. (Dall, 4/21)

KHN: Doctors Scramble To Understand Long Covid, But Causes And Prognosis Are Elusive
One night in March 2020, Joy Wu felt like her heart was going to explode. She tried to get up and fell down. She didn’t recognize friends’ names in her list of phone contacts. Remembering how to dial 9-1-1 took “quite a bit of time,” she recalled recently. Wu, 38, didn’t have a fever, cough or sore throat — the symptoms most associated with covid-19 at the time — so doctors at the hospital told her she was having a panic attack. But later she developed those symptoms, along with difficulty breathing, fatigue and neurological issues. (Andrews and Zuraw, 4/22)

Bay Area News Group: California Theme Parks Can Allow Out-Of-State Visitors, According To New State Guidelines
Disney, Universal and other theme parks in the state that had been forced to limit attendance to California residents can now allow out-of-state visitors under revised state guidelines — but not all parks are swinging open their gates to interstate travelers just yet. Revised guidelines in Gov. Gavin Newsom’s Blueprint for a Safer Economy now allow fully vaccinated out-of-state visitors to attend activities or events that are currently limited to California residents only. California theme parks can allow fully vaccinated visitors from out of state, according to California Department of Public Health officials. (MacDonald, 4/21)

Orange County Register: Why 30+ Disneyland And DCA Rides, Attractions And Shows Will Remain Closed When The Parks Return 
Disneyland and Disney California Adventure will return without three dozen of their 80+ rides, attractions and shows when the Anaheim theme parks reopen later this month after a yearlong coronavirus closure. Most of the shuttered Disneyland and DCA rides, attractions and shows will remain closed due to COVID-19 health and safety guidelines issued by the state. More than three-quarters of the closed attractions will be shuttered for five coronavirus-related reasons: High-touch environments, social distancing, large crowds, time constraints and a ban on live shows. The rest of closures are due to regular seasonal maintenance or ride renovations. (MacDonald, 4/20)

WDW News Today: Guests Once Again Allowed To Fill Their Own Beverages At Self-Service Refill Stations At Walt Disney World 
Another COVID-19 safety procedure has been updated. Disney changed their website to reflect the new protocol, allowing guests to use self-service stations to fill their refillable mugs and beverages. (Francis, 4/21)

In other public health news —

USA Today: Vitafusion Recall: Church & Dwight Recall Select Gummy Vitamins After Reports Of 'Metallic Mesh'
A popular vitamin brand recalled some of its gummy products because they could contain metal. In a recall notice posted on the Food and Drug Administration website Tuesday, New Jersey-based Church & Dwight said it "initiated a voluntary recall of select vitafusion gummy products after the Company’s investigation of two consumer reports identified the possible presence of a metallic mesh material." The products were manufactured from Oct. 29 to Nov. 3, the notice said, and the company is not aware of any reports of consumer illness or injury. However, it said, in "some severe cases, ingesting a metallic material could lead to damage of the digestive tract." (Tyko, 4/21)

Axios: Pew: Over 80% Of Asian Adults Say Violence Against Them Is Increasing
More than 80% of Asian adults say that violence against them is increasing, according to a new Pew Research Center survey. The big picture: The survey, conducted April 5-11, comes after the recent shootings in Atlanta in which eight people, including six Asian women were killed, as well as a yearlong spike in hate incidents against the Asian American and Pacific Islander (AAPI) community. By the numbers: 32% of Asian adults say they fear someone might threaten or physically attack them, "a greater share than other racial or ethnic groups," Pew writes. (Gonzalez, 4/22)

AP: Burning Man Mulling Mandatory COVID-19 Vaccines For August
Burning Man festival organizers have said that they are considering requiring attendees to prove they have been vaccinated for COVID-19 if the organizers move forward with plans to hold this year’s counter-culture festival in the Nevada desert. (Sonner, 4/22)

Albuquerque Journal: Ex-Salon Owner In ‘Vampire Facials’ Case Is Indicted
In August 2018, a person contracted HIV after getting a “vampire facial” at an Albuquerque salon. When officials inspected the business a month later, they discovered unwrapped needles strewn about, unlabeled blood tubes in the kitchen area and phony certificates – for Botox and “vampire facial” training – hanging on the walls. Now, the former owner of the salon has been indicted on two dozen felonies, including fraud and practicing medicine without a license. (Reisen, 4/21)

KHN: After Accident, Patient Crashes Into $700,000 Bill For Spine Surgery 
Mark Gottlieb’s life changed in an instant when another driver crashed into his car, damaging four vertebrae in his upper spine and smashing six teeth. In the months following that January 2019 crash, Gottlieb got the teeth crowned and, for debilitating neck pain, tried injections, chiropractic care and physical therapy. The treatments were all covered by his car insurance. (Appleby, 4/22)

In sports news —

USA Today: Justin Fields Has Revealed Epilepsy Diagnosis To NFL Teams, Per Report
Former Ohio State quarterback and NFL hopeful Justin Fields has confirmed to the league's teams that he has been treating epilepsy, according to a report. NFL Network reported that teams became aware of Fields' condition during the pre-draft process and that the condition has not had any effect on Fields' football career. The report also added that doctors are confident that Fields will grow out of the condition, as other members of his family have. (Reyes, 4/21)

AP: AP Source: NFL Exploring Changes To Scouting Combine
The NFL is exploring changes to the annual NFL scouting combine to improve the professional and medical experience for draft prospects, a person familiar with those discussions told The Associated Press on Wednesday. The combine in Indianapolis was canceled this year because of the coronavirus pandemic, so prospects displayed their talents for scouts, coaches and general managers at their college pro days instead. Teams interviewed players virtually and most medical and psychological testing was done by video. About 150 draft prospects did in-person medical evaluations in Indianapolis earlier this month. (Maaddi, 4/22)

Axios: North Dakota Governor Vetoes Transgender Sports Bill
North Dakota Gov. Doug Burgum (R) on Wednesday vetoed a bill passed to prevent transgender students from taking part in K-12 school sports. Why it matters: The bill was one of over 50 in 28 states introduced introduced this year to exclude transgender youth from playing sports on teams that align with their gender identity. Details: The bill stipulated that public schools couldn't "knowingly allow an individual of the opposite sex" to join an all-boys' or all-girls' team. (Falconer, 4/22)

Houston Chronicle: Texas Transgender Sports Bill Will Likely Die In Committee, Chairman Says
A bill that would dictate on which sports teams transgender athletes can compete in public schools was declared all but dead on Wednesday by Rep. Harold Dutton, the Public Education Committee chair who presided over an emotionally charged debate over it a day earlier. The bill drew criticism from more than 1,000 employers across the state and the NCAA, which threatened to cancel future sports championships in the state if it were enacted. (Goldenstein, 4/21)

USA Today: Tennessee Transgender Student 'Bathroom Bill' Clears State Senate
A bill allowing Tennessee students, teachers and school employees to refuse to share bathrooms and locker rooms with their transgender peers cleared the state Senate 21-7 on Wednesday. A similar measure passed the House 65-24 on Monday. The Senate bill, which includes slightly different language, is expected to pass the House and head to Gov. Bill Lee's desk. (Stella Yu, 4/21)

AP: Arkansas Lawmakers Vote Transgender Athlete Ban Expansion
Arkansas lawmakers on Wednesday voted to expand the state’s new ban on transgender girls and women competing on school sports teams consistent with their gender identity. The House voted 74-17 to authorize the attorney general to sue schools that violate the ban. The measure now heads to Republican Gov. Asa Hutchinson, and his office said the governor planned to sign it into law. (4/21)

The New York Times: Arizona Governor Vetoes Bill Restricting L.G.B.T.Q. Education 
Gov. Doug Ducey of Arizona on Tuesday vetoed legislation that would have imposed some of the country’s most restrictive rules regarding L.G.B.T.Q. education, calling the bill “overly broad and vague.” The bill, which was sponsored by eight Republicans and passed the Arizona Senate on a party-line vote, would prohibit schools from teaching about sexual orientation, gender identity and expression and L.G.B.T.Q. history unless a student received “signed, written consent” from a parent or guardian opting them in to the lessons. (Pietsch, 4/21)

In news about marijuana —

Axios: Virginia Governor Signs Bill Legalizing Marijuana Possession Starting July 1
Virginia Gov. Ralph Northam on Wednesday signed a bill that legalizes the possession and growth of small amounts of recreational marijuana starting this summer. Why it matters: Virginia is the first Southern state to legalize recreational marijuana, and the 16th state in the country to do so. Details: Under the law, effective July 1, adults 21 and older can possess up to 1 ounce of marijuana. (4/21)

AP: Medical Marijuana Legal In Utah, But Not Always Affordable
Pain left from oil-field work defeated traditional pain pills and dominated William Adams’ life — until he tried medical marijuana. But even as he began venturing outside his home for the first time in years, Adams discovered he couldn’t afford the cost. Medical cannabis typically isn’t covered by insurance or Medicaid because it remains federally illegal. The group that led the push to legalize it in conservative Utah says that has kept it unreachable for many patients who need it. (Eppolito, 4/21)

In Medicaid news from Arkansas and Oklahoma —

Arkansas Democrat-Gazette: Medicaid Funding Gains House's OK
The appropriation for the state Division of Medical Services -- which includes the Medicaid program -- passed on its fifth try Tuesday in the House, and with that bill out of the way, lawmakers received copies in the evening of the legislation that sets spending priorities in the next fiscal year. (Wickline and Herzog, 4/21)

Oklahoman: Gov. Kevin Stitt, Oklahoma House At Odds On Medicaid Plan
The Oklahoma House passed legislation that seeks to halt Gov. Kevin Stitt’s plan to outsource Medicaid care management to four major insurance companies. On a vote of 73-17, the House late Tuesday evening approved legislation for the Oklahoma Health Care Authority, which oversees the state’s Medicaid program, to better manage health care in-house. “Let’s start with reforming the system we have before tearing it apart,” said Republican Rep. Marcus McEntire, the bill’s author. (Forman, 4/21)

In other news from the states —

AP: Idaho 'Fetal Heartbeat' Abortion Ban Bill Heads To Governor
Legislation outlawing nearly all abortions in conservative Idaho by banning them once a fetal heartbeat can be detected headed to Republican Gov. Brad Little on Wednesday. The Republican-dominated Senate voted 25-7 to approve the measure that makes providing an abortion to a woman whose embryo has detectible cardiac activity punishable by up to five years in prison. It would also allow the woman who receives the abortion to sue the provider. (Ridler, 4/21)

Indianapolis Star: Indiana General Assembly OKs Bill Limiting Local Health Departments
Lawmakers approved a bill that would limit local health departments' ability to issue public health orders and enforce them — a move that could threaten the mask mandate still in place in Indianapolis. The bill now heads to Gov. Eric Holcomb's desk. Any health orders more stringent than Gov. Eric Holcomb's during an emergency would have to be approved by the local legislative bodies and, in the case of local cities, by the mayor. (Lange, 4/22)

USA Today: California Deputy Suspected Of Burning Inmate In Mental Health Unit
A sheriff's deputy in Southern California is accused of burning an inmate with hot water at a jail's mental health center, according to authorities Wednesday. The deputy, who was not identified in a statement by the Orange County Sheriff's Department, was working in the mental health housing module in the Orange County Jail on April 1 when he was serving an inmate with a disciplinary notice for a rule violation. The inmate refused multiple times to sign the notice and stuck his hands in the open hatch in the door, the statement adds. (Aspegren, 4/21)

Reuters: India Records World’s Biggest Single-Day Rise In Coronavirus Cases 
India recorded the world's highest daily tally of 314,835 COVID-19 infections on Thursday as a second wave of the pandemic raised new fears about the ability of crumbling health services to cope. Health officials across northern and western India including the capital, New Delhi, said they were in crisis, with most hospitals full and running out of oxygen. (Miglani, Arora and Pal, 4/22)

AP: EXPLAINER: Why India Is Shattering Global Infection Records
Authorities were lulled into believing the worst was behind them when cases started to recede in September. Cases dipped for 30 consecutive weeks before starting to rise in mid-February, and experts say the country failed to seize the opportunity to augment healthcare infrastructure and aggressively vaccinate. “We were so close to success,” said Bhramar Mukherjee, a biostatistician at the University of Michigan who has been tracking India’s pandemic. Despite warnings and advice that precautions were needed, authorities were unprepared for the magnitude of the surge, said K Srinath Reddy, president of the Public Health Foundation of India. (Ghosal and Pathi, 4/22)

In other global news about covid —

Fox News: Pfizer Confirms Fake COVID Vaccines Found In Mexico, Poland Black Markets
Bogus COVID-19 vaccines – some selling for $1,000 a shot and some using an anti-wrinkle substance as an ingredient – were found in black markets around the world, Pfizer confirmed to The Wall Street Journal. "Pfizer has identified counterfeit versions of its COVID-19 vaccine in Mexico and Poland," the company said in a statement. "We are cognizant that in this type of environment – fueled by the ease and convenience of e-commerce and anonymity afforded by the internet – there will be an increase in the prevalence of fraud, counterfeit and other illicit activity as it relates to vaccines and treatments for COVID-19." (Miles, 4/21)

Reuters: Syria Gets 200,000 Doses Of AstraZeneca Vaccine Under COVAX Scheme - U.N. Officials 
Syria's government has received its first delivery of COVID-19 vaccines through the global COVAX initiative, with almost 200,000 doses of the AstraZeneca (AZN.L) shot, U.N officials said on Thursday. A joint statement by UNICEF, the World Health Organization (WHO) and the GAVI vaccine alliance said the delivery was "critical and timely" and would help health workers "to continue delivering life-saving services in an already exhausted health system as a result of the decade-long war." (Al-khalidi, 4/22)

Politico: EU Preparing Legal Case Against AstraZeneca Over Vaccine Shortfalls 
The European Commission is getting ready to launch legal proceedings against vaccine producer AstraZeneca, according to five EU diplomats. The Commission raised the matter at a meeting of ambassadors Wednesday, during which the majority of EU countries said they would support suing the company over complaints it massively failed to deliver pledged doses to the bloc. (Deutsch and Barigazzi, 4/21)

Politico: UK Coronavirus Contracts Raise Corruption Alarm, Report Warns 
The U.K. government is facing tough questions over its approach to procurement during the pandemic after an investigation found over 20 percent of the £18 billion spent in response to the crisis was linked to at least one red flag indicating corruption. Between February and November last year, 73 COVID-19 contracts, amounting to more than £3.7 billion in public spending, triggered at least one of six standard measures warranting closer scrutiny for corruption, according to a Transparency International report released Thursday. (Collis, 4/22)

AP: Chile Vets Fined For Giving Dog Vaccines Against COVID-19
Health authorities in northern Chile have fined two veterinarians they say were giving or promoting canine vaccines as false protection against COVID-19.Roxana Díaz, deputy health secretary for Antofagasta province, said her agency’s workers had gone to the veterinary practice of Maria Fernanda Muñoz in the city of Calama over a report that people there weren’t using masks and were told it was because they were vaccinated. (4/21)

Bloomberg: Where Covid Kills The Young: Brazil Shows What May Await Others
Like in most countries, the pandemic in Brazil hit the elderly and immuno-compromised first and hardest. But in the past couple of months, the nation that has stood out as nearly a worst-case-scenario for caseloads, deaths and public policy, has shown where the global plague may be headed: for the young. In March, 3,405 Brazilians aged 30 to 39 died from Covid, almost four times the number in January. Among those in their 40s, there were about 7,170 fatalities, up from 1,840, and for those 20-29, deaths jumped to 880 from 245. Those under 59 now account for more than a third of Covid deaths in Brazil, according to research firm Lagom Data. As the elderly get vaccinated, their deaths have fallen by half. (Rosati, Viotti Beck and Preissler Iglesias, 4/22)

In updates on the Tokyo Olympics —

AP: Tokyo Olympics Torch Relay Has First Positive COVID-19 Case
Tokyo Olympics organizers said Thursday that a policeman tested positive for COVID-19 a day after his assignment last week at the Olympic torch relay. It is the first positive test connected to the relay since it began March 25 from northeastern Fukushima prefecture. (4/22)

ScienceDaily: COVID-19: Scientists Identify Human Genes That Fight Infection
Scientists have identified a set of human genes that fight SARS-CoV-2 infection, the virus that causes COVID-19. Knowing which genes help control viral infection can greatly assist researchers' understanding of factors that affect disease severity and also suggest possible therapeutic options. The genes in question are related to interferons, the body's frontline virus fighters. (4/16)

CIDRAP: Some Dietary Supplements May Cut Risk Of COVID-19 Infection
Use of certain dietary supplements may reduce the risk of testing positive for COVID-19, according to a large observational study of people in the United Kingdom who used a COVID-19 symptom tracking app. UK-based researchers detailed their findings in the latest issue of BMJ Nutrition, Prevention, & Health. Supplements associated with risk reduction included multivitamins, omega-3, probiotics, and vitamin D. Dietary supplements have the potential to support the immune system, but it's not known which ones are associated with a lower risk of getting sick with COVID-19. Sales of supplements rose steeply during earlier pandemic months. (4/21)

CIDRAP: More Evidence That Overweight, Obesity Is Tied To Severe COVID-19
Overweight and obese people are more likely to suffer severe symptoms of COVID-19 and require supplementary oxygen and invasive mechanical ventilation than healthy-weight peers, according to a new study in Diabetes Care that further spotlights these key risk factors. But according to the study—based on 7,244 COVID-19 patients from 18 hospitals in 11 countries—being overweight or obese was not associated with an increased risk of death. (4/20)

CIDRAP: Study: ICU ECMO Experience A Factor In COVID-19 Patient Survival
An analysis of extracorporeal membrane oxygenation (ECMO) use at 17 intensive care units (ICUs) in the greater Paris area during France's first COVID-19 wave reveal that 90-day survival was strongly linked to a hospital's earlier experience with the procedure. Investigators from France detailed their findings yesterday in The Lancet Respiratory Medicine. During France's first surge, clinicians in Paris organized ECMO indications and pooled resources, which consisted of six mobile ECMO teams to cover the region. For the study, the group looked at the outcomes of all 302 COVID-19 patients who received ECMO from Mar 8 through Jun 3, 2020, finding a survival rate of 46%. (4/20)

CIDRAP: COVID Vaccine May Trigger Less Immune Response In Blood Cancer Patients
mRNA COVID-19 vaccines may not fully protect people with the blood cancers chronic lymphocytic leukemia (CLL) and multiple myeloma (MM), according to two studies released late last week in Blood. The first study found that only 39.5% of 167 Israelis studied who had CLL had a positive antibody-mediated response to the Pfizer/BioNTech COVID-19 vaccine, compared with 100% of 53 controls. (4/19)

Also —

ScienceDaily: Joyful Screams Perceived More Strongly Than Screams Of Fear Or Anger
The human scream signals more than fear of imminent danger or entanglement in social conflicts. Screaming can also express joy or excitement. For the first time, researchers have demonstrated that non-alarming screams are even perceived and processed by the brain more efficiently than their alarming counterparts. (4/13)

CIDRAP: University Of Minnesota Researchers Deploy Novel Field Test For CWD
Researchers with the University of Minnesota have successfully deployed a novel, nanotechnology-based approach to field testing chronic wasting disease (CWD), according to a university press release. The approach developed by the Minnesota Center for Prion Research (MNPRO) uses a technique known as RT-QuIC (real-time quaking-induced conversion) to identify CWD prions in deer tissue samples. The test, named MN-QuIC, generates a color change of red for positive CWD result and blue for negative, and uses field deployable equipment to garner results within 24 hours. (4/20)

New England Journal of Medicine: Dexmedetomidine Or Propofol For Sedation In Mechanically Ventilated Adults With Sepsis 
Guidelines currently recommend targeting light sedation with dexmedetomidine or propofol for adults receiving mechanical ventilation. Differences exist between these sedatives in arousability, immunity, and inflammation. Whether they affect outcomes differentially in mechanically ventilated adults with sepsis undergoing light sedation is unknown. (Hughes et al, 4/15)

CIDRAP: Study: MERS Antibodies Persist Up To 6 Years
A study of antibodies in 48 people in Saudi Arabia who survived their MERS-CoV infections found that some neutralizing antibodies persisted 6 years, a Saudi-led team reported yesterday in Emerging Infectious Diseases. Scientists are closely watching for new information about the durability of antibody response to coronavirus infections, given that three diseases involving them have emerged in humans over the past couple decades: SARS (severe acute respiratory syndrome), MERS-CoV (Middle East respiratory syndrome coronavirus), and now SARS-CoV-2, which causes COVID-19. (4/15)

The Washington Post: The U.S. Has Vaccinated Half Of Adults. The Problem Is The Second Half. 
Now that more than half of the adult population of the United States has been vaccinated with at least one dose, and eligibility is open nationwide to all over age 16, the next monumental task is to vaccinate as much of the remaining half as possible. The goal is to reach some kind of herd immunity, when enough people are immune through either vaccines or previous infection that the coronavirus can’t spread fast or far. That threshold might be 70 or 80 percent, a moving target as new variants take hold. To get there, vaccine hesitancy remains an enormous hurdle, born of fear about side effects, denial about the disease, historic neglect by health-care systems, feelings of invincibility or fatalism, and the pernicious impact of disinformation and conspiracy theories. (4/1)

Stat: Needed For Long Covid: A Less Authoritarian Approach
The public has become increasingly concerned about long Covid — ongoing symptoms and disabilities after an acute Covid-19 infection has passed — thanks in part to an intense stream of news and long-form journalism about the condition. Most of this coverage has focused on the largest group of people with long Covid, who often have milder initial infections, and who are generally younger and healthier than those threatened by acute infections. People with long Covid describe the condition as debilitating, with everyday activities like work or mild exercise difficult or impossible to do months after the initial infection. Because symptoms are variable and wide-ranging, this form of long Covid is difficult to characterize. One group of British physicians described it as a “non-specific clinical picture, often dominated by fatigue and breathlessness.” (Diane O'Leary, 4/22)

The New York Times: What Can You Do With Unvaccinated Kids? 
Many families will soon face a complicated choice about how quickly to resume their pre-pandemic activities. More than 50 percent of American adults have already received at least one Covid-19 vaccine shot. At the current pace, virtually all adults who want to get vaccinated will have been able to get a shot by July. Yet relatively few children, especially younger children, will have been vaccinated by then. While the Pfizer-BioNTech vaccine may be authorized for children ages 12 to 15 as early as next month, younger children appear to remain months away from being eligible for any vaccine. (David Leonhardt, 4/22)

New England Journal of Medicine: Interleukin-6 Receptor Inhibition In Covid-19 — Cooling The Inflammatory Soup 
Viruses cannot replicate by themselves. Instead, they rely on the host for almost all their replicative functions. Similarly, many viruses are unable to cause damage without the host immune system. Because of this, two strategies can often ameliorate disease — antivirals, which block replication, and antiinflammatories, which can limit the damage induced by infection. In the lung, this latter strategy is exemplified by the treatment of Pneumocystis jiroveci, in which treatment with glucocorticoids reduces the severity of disease and the risk of death.1,2 However, because blocking inflammatory pathways raises the possibility of diminishing the host response and increasing replication of the pathogen, antibiotics or antivirals are used simultaneously. (Eric J. Rubin, M.D., Ph.D., Dan L. Longo, M.D., and Lindsey R. Baden, M.D., 4/22)

Stat: Investments In Climate Change Solutions Will Pay Off For Global Health 
World leaders, beckoned by President Biden, are assembling on Earth Day, April 22, to create greater urgency to fight climate change. The summit is taking place during the worst infectious disease pandemic in a century. World leaders need to pay heed to the climate change warning signs that have been flashing for decades. Scientists and policymakers have long predicted that as human migration due to weather extremes brings people into closer contact with animals harboring novel pathogens, humanity will face increasingly grave health risks, including future epidemics and pandemics. (Alice Hill and Wayne C. Koff, 4/22)

The Baltimore Sun: Fentanyl Deaths: America’s Epidemic Worsens In The Pandemic. What Do We Do About It? 
After listening to April Babcock speak and weep about the son she lost to a fentanyl overdose in 2019, I went to reports for that year and learned that Austen Babcock of Dundalk was one of the country’s 70,630 drug overdose victims. Reports for 2020 are out and they’re even worse — staggering, really, and almost too much to bear after a year when hundreds of thousands died from a virus. But here it is, from the Centers for Disease Control and Prevention: There were 87,203 overdose deaths across the country and 2,773 of them in Maryland. Our opioid epidemic continues. (Dan Rodricks, 4/20)

Modern Healthcare: The Power Of Partnership In Improving Behavioral Health Access
America is in a behavioral health crisis. Long before the pandemic, poor reimbursement and budget cuts led to psychiatric hospital closures and a steady contraction in the number of behavioral health beds at acute-care facilities. Now we're facing a historic spike in behavioral health problems and our healthcare system has less capacity than ever to address it. Consider that more than 42% of people surveyed by the U.S. Census Bureau in December reported symptoms of anxiety or depression, an increase from just 11% the prior year. Additional research has shown pandemic-related spikes in alcohol and drug use, including an increase in opioid overdoses. (Stuart Archer, 4/21)

Houston Chronicle: Biden's Swift Kick On Medicaid Expansion Gives Hope To 1 Million Uninsured Texans
We regret to say that Medicaid expansion, even if begrudgingly approved by the Texas Legislature, is unlikely to cover the self-administered nose jobs that Texas Republican lawmakers have been flaunting for the past decade. Cutting off their noses to spite their faces, to quote the old proverb, the lawmakers have proudly rejected opportunities to provide health coverage to more of their fellow Texans, despite the fact that the federal government was offering to pay for nearly all of it and despite the fact that Lone Star State is home to the largest number of uninsured Americans of any state in the country. (4/22)

CNN: Asian Americans Face Barriers And Bigotry In Medicine 
For so long, Asian Americans have been left out of critical conversations about race, despite longstanding barriers that impede their lives and careers. At the academic medical institution in New York City where I work, Asians and Asian Americans make up 32% of the student body and 24% of faculty and staff. Many of us, whether immigrants or US-born, may seem to fit the myth of the "model minority" -- successful, industrious, proof of the American dream. But we are far from a homogenous group, and Asian Americans of all classes and backgrounds are vulnerable to discrimination and violence. Asians around the country -- including doctors, scientists, technicians and medical secretaries -- are routinely harassed because of the way we look, our presumed inability to speak English and other stereotypes. (Augustine M.K. Choi, 4/21)

Los Angeles Daily News: California Shouldn’t Scrap ‘Safeguards’ In End Of Life Options Act 
Assisted suicide is already legal in California through the so-called End of Life Option Act, narrowly passed by the California Legislature and signed by then-Gov. Jerry Brown in 2015. The bill received opposition from both Democrat and Republican Assembly members and state senators but was passed, many feel inappropriately, during a Special Legislative Session focused on Medi-Cal funding. Despite the bill’s narrow passage, now just a few years into the new law, proponents of this law want to eliminate the very “safeguards” they used as arguments for its passage. The new bill, Senate Bill 380 by Sen. Susan Eggman will get rid of the scheduled 2025 review process that doctors, patient advocates, and legislators allowed for an examination of California’s experience with this controversial law. This new bill will also eliminate the 15-day safety period to receive the deadly prescription drugs. (Matt Valliere, 4/21)

New England Journal of Medicine: Microbial Nourishment For Undernutrition 
Hippocrates wrote “let food be thy medicine.” Although access to nourishing food seems to be an obvious solution to the global health crisis of childhood undernutrition, the solution is not simple from a social or metabolic perspective, or even from the perspective of a microbiologist. To effectively address childhood undernutrition, clinicians need to be mindful that both our human and microbial selves need specific nourishment to restore and maintain healthy development and growth. (Wendy S. Garrett, M.D., Ph.D., 4/22)