CBS News: The CDC And FDA Are Leaning Toward Resuming Use Of The Johnson & Johnson Vaccine, Sources Say 
The Centers for Disease Control and Prevention and the Food and Drug Administration are leaning toward resuming use of the Johnson & Johnson vaccine with a warning about blood clots, sources told CBS News. A decision is expected Friday, more than a week after the vaccine's distribution was paused following reports of rare but dangerous blood clots in eight people under the age of 50. "I think too many people may be scared off by taking the vaccine. They shouldn't be, but perception is everything when it comes to vaccines," said Dr. Peter Hotez, who works at the Texas Children's Hospital Center for Vaccine Development. (Shamlian, 4/22)

Fox News: Walensky 'Hopeful' Johnson & Johnson COVID-19 Vaccine 'Can Be Used Again Soon'
A day before a Centers for Disease Control and Prevention (CDC) committee is set to meet regarding the Johnson & Johnson COVID-19 vaccine, the agency’s director said she is "really hopeful" that the one-shot jab "can be used again soon." Speaking to TODAY, Dr. Rochelle Walensky, whose agency along with the FDA recommended a pause in the vaccine’s rollout after six cases of a rare blood clot occurred in the more than 7 million vaccine recipients, said the agency will "need to make a decision quickly" regarding its use. (Hein, 4/22)

Politico: White House Writes Off Johnson & Johnson Vaccine After String Of Production Failures 
The Biden administration has stood by Johnson & Johnson as the vaccine maker struggled to deliver promised doses of its Covid-19 vaccine — but privately, frustrated senior health officials have largely written off the shot, according to seven people with knowledge of the matter. Johnson & Johnson, which has a long history of successful vaccine development, was one of the government’s first and biggest bets in the coronavirus vaccine race. But the company has faced an unrelenting series of setbacks, including a contractor mix-up that ruined 15 million doses and revealed serious safety and hygiene lapses, and concerns that the vaccine may be linked to recent reports of rare, severe blood clots among recipients. (Banco, Cancryn and Owermohle, 4/22)

AP: Feds Report Texas Woman With Clots After Getting J&J Vaccine
Federal health officials have informed state officials that a Texas woman has been hospitalized with possible blood clots associated with Johnson & Johnson COVID-19 vaccine recipients, a state spokesman said Thursday. The U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention informed the Texas Department of State Health Services of the situation Wednesday afternoon through the federal Vaccine Adverse Event Reporting System, said DSHS spokesman Chris Van Deusen. (4/22)

AP: Oregon: CDC Investigating Woman's Death After J&J Vaccine
Oregon health officials said Thursday that federal officials are investigating the death of a woman in her 50s who developed a rare blood clot and low platelets within two weeks of receiving the Johnson & Johnson vaccine against COVID-19.The Oregon Health Authority learned of the probe on Tuesday, two days after the U.S. Centers for Disease Control and Prevention began the investigation, the agency said. The woman, whose name was not released, received the dose before the CDC ordered a pause on the vaccine amid concerns it could cause dangerous clots. (Flaccus and Cline, 4/23)

Also —

The New York Times: South Africa Decides To Resume Use Of Johnson & Johnson Vaccines.
South Africa will resume the use of the Johnson & Johnson vaccine to inoculate health care workers next week, offering some relief to the country that has suffered a series of blows to its vaccination efforts in recent months, according to South African authorities. The country suspended an early-access Johnson & Johnson vaccination program last week after health officials in the United States put a pause on the vaccine amid concerns of rare blood clots that emerged in a handful of people who received it. (Goldbaum, 4/23)

The New York Times: Vaccines Are Effective Against The New York Variant, Studies Find
For weeks, New Yorkers have witnessed the alarming rise of a homegrown variant of the coronavirus that has kept the number of cases in the city stubbornly high. City officials have repeatedly warned that the variant may be more contagious and may dodge the immune response. On that second point, at least, they can now breathe easier: Both the Pfizer-BioNTech and Moderna vaccines will effectively prevent serious illness and death from the variant, two independent studies suggest. Antibodies stimulated by those vaccines are only slightly less potent at controlling the variant than the original form of the virus, both studies found. (Mandavilli, 4/22)

Axios: Coronavirus Cases Aren't Budging — Even After Vaccinations Doubled
The U.S. is pumping out coronavirus vaccines by the millions, but the coronavirus isn’t slowing down. The big picture: This spring has seen a surge in vaccinations but almost no change in the coronavirus’ spread, leaving the U.S. with an outbreak that’s still too big. Where it stands: In the last week of February, the U.S. was averaging 65,686 new coronavirus cases per day. Now, eight weeks later, we’re averaging 64,814 new cases per day. And yet, over the same eight-week period, the U.S. has administered more than 65 million vaccine doses — roughly doubling the number of Americans who have gotten at least one shot. (Baker and Witherspoon, 4/22)

The Baltimore Sun: About 800 Moderna COVID Vaccine Doses Improperly Stored At Fort Meade; Recipients Will Likely Need Third Shot
Approximately 800 Department of Defense employees and members of the military community who received COVID-19 vaccines at Fort George G. Meade on two days this month will likely need to get a third dose after officials discovered some Moderna vaccine vials were improperly stored. Eighty vials of the vaccine were stored outside of the temperature range recommended by Moderna, which affects the viability, according to a statement released Thursday from Kimbrough Ambulatory Center, the main medical facility at Fort Meade. The doses were administrated on April 7 and April 12. (Mongilio, 4/22)

KHN: Only One Vaccine Is OK For Older Teens. It’s Also The Hardest To Manage In Rural America.
As states expand covid-19 vaccine eligibility to allow shots for 16- and 17-year-olds, teens in rural America may have trouble getting them. Of the three vaccines authorized in the U.S., currently only one can go to that age group: the Pfizer-BioNTech shot. That vaccine comes in 1,170-dose packages at minimum and expires after five days in a fridge, meaning too many doses on too tight a deadline for many rural communities to manage. (Houghton, 4/23)

The Motley Fool: Could This Little-Known Company's Vaccine Candidate Leapfrog Moderna And Pfizer?
Investors looking for exposure to the COVID-19 vaccine market may naturally lean toward Moderna, which developed mRNA-1273, and Pfizer, which developed BNT162b2 in collaboration with BioNTech. These companies were the first to earn Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration for their respective products. But there is a small-cap company looking to make waves in this space: Ocugen, a biotech headquartered in Pennsylvania. ... Ocugen is developing Covaxin -- an experimental coronavirus vaccine -- in collaboration with India-based Bharat Biotech. The two entities penned an agreement earlier this year that stipulated that Ocugen would be responsible for the clinical development and commercialization of the candidate in the U.S. Consequently, Ocugen is set to keep 45% of the profits Covaxin will make in the country. Of course, all of this is contingent on the vaccine earning emergency authorization. (Bakiny, 4/22)

And the prospect of a third covid booster shot gains speed —

Fox News: Hawaii Man Receives Third Pfizer COVID-19 Vaccine Dose In Booster Study: Report
A Hawaii man participating in a Pfizer-led study looking at third doses of its COVID-19 vaccine as booster shots said he joined the trial to help others, according to a local report. Gary Lahens of Honolulu took part in the company's vaccine trials for the safety of his family and community, he told news outlet KHON2. He rolled his sleeve before the cameras to show the bandage on his arm. "I did this study in the beginning because of my mom and my aunties, they’re all in their eighties," Lahens told the outlet. "I think it was a good thing for me to do." (Rivas, 4/22)

CNBC: Scientist Who Helped Develop Pfizer-BioNTech Covid Vaccine Agrees Third Shot Is Needed As Immunity Wanes
The chief medical officer of BioNTech told CNBC on Wednesday that people will likely need a third shot of its two-dose Covid-19 vaccine as immunity against the virus wanes, agreeing with previous comments made by Pfizer CEO Albert Bourla. Dr. Ozlem Tureci, co-founder and CMO of BioNTech, which developed a Covid vaccine with Pfizer, said she also expects people will need to get vaccinated against the coronavirus annually, like for the seasonal flu. That’s because, she said, scientists expect vaccine-induced immunity against the virus will decrease over time. (Lovelace Jr., 4/21)

AP: US Drop In Vaccine Demand Has Some Places Turning Down Doses
Louisiana has stopped asking the federal government for its full allotment of COVID-19 vaccine. About three-quarters of Kansas counties have turned down new shipments of the vaccine at least once over the past month. And in Mississippi, officials asked the federal government to ship vials in smaller packages so they don’t go to waste. As the supply of coronavirus vaccine doses in the U.S. outpaces demand, some places around the country are finding there’s such little interest in the shots, they need to turn down shipments. (Willingham, Hollingsworth and Smith, 4/23)

Bay Area News Group: California Vaccinations Decline At Turning Point In Rollout
The pace of vaccinations in California has declined for the first time in weeks, mirroring a national trend that has experts worried about slowing demand for the life-saving vaccine. On average last week, just over 360,000 doses were administered daily across California, an 8% drop from mid-April when the seven-day average peaked at about 391,000 doses, according to data compiled by this news organization. Nationwide, doses have dipped about 11% over the past week. (Kelliher, 4/22)

The Washington Post: D.C., Maryland Have Vaccine Appointment Offers For All Who Register
Officials are shifting their attention to people who have yet to sign up for shots in an effort to reach vaccination levels needed to control the virus. Maryland has launched a “No arms left behind” initiative, with expanded walk-up options, mobile clinics and direct outreach to the elderly and college students. D.C. opened 10 walk-up clinics this week and is organizing a May 1 day of service that will focus on encouraging unvaccinated residents to get the shots. (Fadulu and Portnoy, 4/22)

Bloomberg: Covid Vaccine Battle Pivots To New Tactics To Get Shots To All Americans
Having made its way through those who lined up eagerly to get vaccinated for Covid-19, the campaign to inoculate every American is now slowing down with surplus supply and open appointments appearing in pockets nationwide. While 3 million shots a day are being administered, that’s down from a peak of 3.4 million. And only 75% of about 28 million doses being shipped out weekly will be used at the current pace. All of this suggests the vaccine effort is evolving, from the megasites that inoculated thousands a day toward a slower grind designed to reach the half of Americans who haven’t yet received a dose. (LaVito and Armstrong, 4/22)

Also —

CNN:  New Study Shows Why Vaccinating Everybody Is Essential 
Although there's a growing sense that normalcy is within reach after the devastating Covid-19 pandemic, experts are continuing to push for more vaccinations -- particularly as new research details the long-term consequences for those who are diagnosed with the virus. In what the authors say is the largest study to date of the long-term impact, researchers from Washington University in St. Louis found that people who had Covid-19 seem to face a much greater risk of death and need more medical care in the six months after their diagnosis, even if they had a milder form of the disease. "We have to think about the burgeoning health crisis this is going to cause for years to come," CNN Chief Medical Correspondent Dr. Sanjay Gupta told Anderson Cooper on Thursday. (Holcombe, 4/23)

The New York Times: What Do Women Want? For Men To Get Covid Vaccines. 
Holly Elgison and Len Schillaci are a mixed vaxxed couple, and they are far from alone. “I was always going to get the vaccine, 100 percent,” said Ms. Elgison, a medical claims auditor in Valrico, Fla. Her husband, a disaster insurance adjuster, said he will pass. “To be honest with you, I think that the worst of Covid is behind us,” Mr. Schillaci said. “I’m good.” As the Biden administration seeks to get 80 percent of adult Americans immunized by summer, the continuing reluctance of men to get a shot could impede that goal. (Steinhauer, 4/22)

NBC News: Divine Intervention: Pastors Tapped To Help Get Skeptical Churchgoers Vaccinated
The thrust of a new campaign to persuade mostly white born-again and evangelical Christians who have been unwilling to get Covid-19 vaccinations is a variation on the Golden Rule — do it for others if you won't do it for yourself. And the main driver behind the Christians and the Vaccine project backs up his contention that that is what Jesus would do by both citing the Bible and tapping the expertise of secular public health experts like Dr. Francis Collins, who heads the National Institutes of Health. (Siemaszko, 4/23)

CBS News: Cigna Offers Workers $200 And Paid Time Off To Get Vaccinated 
Cigna on Thursday joined other major corporations looking to coax workers into getting the COVID-19 vaccine by offering its roughly 65,000 U.S. employees $200 each and paid time off to get the shots. Fully vaccinated workers will get $200 in their health-spending accounts, along with emergency PTO to get vaccinated, according to the health insurance company, which is not requiring employees to get immunized. (Gibson, 4/22)

Houston Chronicle: Houston Methodist Says It Will Fire Hospital Workers Who Refuse To Take COVID Vaccine
Four out of five Houston Methodist employees are vaccinated against COVID-19. The sliver who are not will be suspended or fired if they refuse the shot, according to company policy. The hospital required managers to be vaccinated by April 15 and all other employees — about 26,000 workers in total — by June 7, said Stefanie Asin, a Houston Methodist spokesperson. With 84 percent of the staff vaccinated, the hospital is close to herd immunity, CEO Marc Boom wrote in a letter to employees this month. (Wu and Garcia, 4/22)

In related news about the vaccine rollout —

Los Angeles Times: UC And Cal State Schools To Require COVID-19 Vaccinations
The University of California and California State University announced Thursday that they will require COVID-19 vaccinations for all students, faculty and staff on campus properties this fall once the Food and Drug Administration gives formal approval to the vaccines and supplies are sufficiently available. The directive is the largest of its kind in U.S. higher education, affecting more than 1 million members of the two public university systems. More than five dozen colleges nationwide have already announced they will require vaccination for enrollment this fall, including Yale, Princeton, Columbia and, in Claremont, Pomona and Claremont McKenna. (Agrawal, Watanabe and Shalby, 4/22)

NBC News: In Michigan, A Record-Breaking Number Of Children Have Been Hospitalized With Covid
Among the many alarming consequences of Michigan’s recent Covid-19 surge is one that has doctors particularly concerned: a record-breaking spike in child hospitalizations. Data from the Michigan Health & Hospital Association shows that the number of children hospitalized with severe Covid-19 symptoms hit a high of 70 this week — twice as many as were hospitalized during the worst days of the wave that swept the state in November. (Einhorn, 4/22)

KHN: Michigan’s Outbreak Worries Scientists. Will Conservative Outposts Keep Pandemic Rolling?
When Kathryn Watkins goes shopping these days, she doesn’t bring her three young children. There are just too many people not wearing masks in her southern Michigan town of Hillsdale. At some stores, “not even the employees are wearing them anymore,” said Watkins, who estimates about 30% of shoppers wear masks, down from around 70% earlier in the pandemic. “There’s a complete disregard for the very real fact that they could wind up infecting someone.” Her state tops the nation by far in the rate of new covid cases, a sharp upward trajectory that has more than two dozen hospitals in the state nearing 90% capacity. The nation is watching. (Appleby, 4/23)

Axios: Washington State Enters 4th COVID-19 Surge, Says Governor
Washington state has entered its fourth wave of the COVID-19 pandemic, Gov. Jay Inslee (D) announced during a press conference on Thursday. Why it matters: Washington — like other states such as Michigan — is experiencing a surge in COVID cases driven largely by variants of the virus, predominantly the one first discovered in the U.K. What they're saying: "The virus is not done with us," warned Inslee. (Saric, 4/22)

Bloomberg: New York State Surpasses 2 Million Covid-19 Cases
New York state surpassed 2 million recorded Covid-19 cases, crossing a milestone for the pandemic in the state where the disease hit hard a year ago and became a worldwide center of infection. As of April 21, New York reported 2,012,806 cases. That puts it third behind Texas, with 2.9 million, and California with more than 3.7 million reported cases, according to Bloomberg data. (Goldman, 4/22)

Some states are seeing progress —

Salt Lake Tribune: Utah Cases Of COVID-19 Have Hit ‘A Clear Plateau,’ Gov. Spencer Cox Says, Stalling Their Decline
Utah’s number of new cases of COVID-19 fell back below 500 on Thursday, and the seven-day rolling average of new cases has gone down in the last month. But that decline has stalled in the last two weeks, at between 375 and 406 cases per day — about the level the state was seeing last August, before the surge in cases in fall and winter. “We’re in a plateau right now, a clear plateau,” Gov. Spencer Cox said Thursday at his weekly COVID-19 briefing. Cox noted that the state’s case counts for three of the last four days were slightly higher than the week before. Still, that plateau “is really good news,” said state epidemiologist Dr. Angela Dunn, because things could be worse. (Means and Pierce, 4/22)

The Boston Globe: Encouraging Signs Are Beginning To Emerge In Mass. And R.I. Coronavirus Data. Still, Experts Urge Caution
In Boston, COVID-19 cases and deaths continue to decline as mobile vaccination teams fan out across the city. Statewide, the seven-day average of deaths recently dipped to the lowest level since the early days of the pandemic. In Rhode Island, where one-third of the population has been vaccinated, the governor announced that capacity limits on businesses will be gone by Memorial Day, heralding the promise of a resurgent summer. (Andersen, Finucane and Gagosz, 4/22)

The Wall Street Journal: Covid-19 Rates In Los Angeles Have Gone From Worst To Among The Best 
At the start of the year here, hospitals were full, restaurants were empty, and three times more Covid-19 cases were being reported every day than in any other U.S. county. Now Los Angeles County has one of the lowest rates of infection per capita of the nation’s 10 most populous counties. Restaurants are packed, hospitals have open beds, and researchers are studying possible reasons for one of the pandemic’s biggest turnarounds, which has occurred despite vaccination rates lower than the national average. Their theories include high immunity caused by previous spikes and a common variant in California that may be keeping out more infectious strains. (Ansari and Lovett, 4/22)

In other news about the spread of the coronavirus —

Fox News: COVID-19 Antibodies Found In Dogs In Washington State, Officials Say
More than a dozen dogs in Washington state have tested positive for COVID-19 antibodies, indicating they were once exposed to SARS-CoV-2, the virus that causes a COVID-19 infection. Some 23 dogs tested as part of a study by the University of Washington were found to be positive for SARS-CoV-2 antibodies, marking the first instance among pets in the state, officials with the Washington State Department of Agriculture (WSDA) said in a news release. (Farber, 4/22)

The Washington Post: First Covid-19 Cases Reported Among Climbers At Everest Base Camp 
When Nepal welcomed foreign climbers back to Mount Everest for the spring climbing season, many feared it was only a matter of time before the coronavirus made its way to the world’s highest peak. Sure enough, just weeks into the season, symptoms of the virus have been found at Everest’s base camp, sparking a renewed debate about whether Nepal’s reliance on the mountain as a source of revenue is getting in the way of safety. On Wednesday, Outside magazine first reported a climber at base camp had been evacuated by helicopter for what was believed to be high-altitude pulmonary edema and tested positive for the coronavirus upon arriving at a hospital in Kathmandu last week. The New York Times subsequently revealed that in fact there had been multiple climbers who tested positive after being flown out of base camp. (Farzan, 4/22)

NBC News: Senate Passes Hate Crime Bill Responding To Wave Of Violence Against Asian Americans
The Senate passed legislation Thursday targeting anti-Asian hate crimes after an uptick of incidents during the Covid-19 pandemic. Lawmakers approved the measure in a 94-1 vote. Sen. Josh Hawley, R-Mo., was the only member to oppose the bill. The legislation, introduced by Sen. Mazie Hirono, D-Hawaii, in March, would direct the Department of Justice to expedite the review of hate crimes related to Covid-19 that were reported to law enforcement agencies and help them establish ways to report such incidents online and perform public outreach. (Shabad, 4/22)

The Washington Post: Asian American Hate Crime Bill Passes Following Atlanta Spa Shootings 
With Rep. Grace Meng (D-N.Y.) as the lead House sponsor, the legislation would assign an official in the Justice Department to review and expedite all reports of hate crimes related to the coronavirus, expand support for local and state law enforcement agencies responding to these hate crimes, and issue guidance on mitigating the use of racially discriminatory language to describe the pandemic. Meng, in a statement after Thursday’s vote, said the House is expected to take up the legislation next month. President Biden has vowed to sign it when it reaches his desk. (Kane, 4/22)

HuffPost: Josh Hawley Pummeled For Being Sole Vote Against Anti-Asian Hate Crimes Bill 
[Josh] Hawley, the senator who was seen raising a fist to pro-Trump insurrectionists just before the deadly Jan. 6 riot at the U.S. Capitol, said he was against the bill because “it’s too broad.” “As a former prosecutor, my view is it’s dangerous to simply give the federal government open-ended authority to define a whole new class of federal hate crime incidents,” he said in a statement. (Harvey, 4/22)

In other news from Capitol Hill —

Roll Call: Lawmakers Propose Bipartisan Bill To Address Border Influx
A bipartisan group of lawmakers unveiled legislation on Thursday to address the recent influx of migration to the U.S.-Mexico border by ramping up staffing at immigration agencies and streamlining immigration court proceedings. ... The bill would establish at least four regional processing centers along the border to speed up the government’s ability to process migrants arriving in the U.S. to seek protection. It would also call for migrants’ asylum cases to be prioritized in the current 1.3 million case-long backlog during “an irregular migration influx event.” The measure would ramp up protections for unaccompanied minors who are placed with sponsors, and increase staffing at the border, including 150 new immigration judges and related staffers and 300 additional asylum officers. (Monyak, 4/22)

Fox News: GOP Doctors, Health Care Providers Ask Pelosi When House COVID Restrictions Will Be Lifted With Members Vaxxed
Eighteen Republican doctors and health care providers in Congress sent a letter to House Speaker Nancy Pelosi asking when the COVID-19 restrictions will be lifted from the chamber, now that most members have been vaccinated. (Keene, 4/22)

Fox News: Hawley-Braun Bill Would Force Biden To Declassify Wuhan Coronavirus Leak Intelligence 
Sens. Josh Hawley, R-Mo., and Mike Braun, R-Ind., on Thursday introduced a bill that would force the Biden administration to declassify intelligence related to COVID-19 origins. Since April of 2020, experts have voiced concerns that the novel coronavirus may have originated from the Wuhan Institute of Virology in China. More than a year later, the world has yet to determine exactly where and how the outbreak that killed millions around the world and devastated the global economy began. (Conklin, 4/22)

The Hill: Pelosi Pushes For Drug Pricing Measure Amid Uncertainty From White House
Speaker Nancy Pelosi (D-Calif.) is pushing for the inclusion of a measure to lower drug prices in President Biden's forthcoming American Families Plan, amid indications that the White House will not include it. Advocates and Democratic lawmakers are increasingly concerned that health care measures, including lowering drug prices and expanding health coverage, are being left out of Biden's spending package, which is coming next week and is expected to include measures like paid leave and child care. (Sullivan, 4/22)

Modern Healthcare: House Democrats Back Medicare Drug Price Negotiations In Infrastructure Talks
House Democrats introduced a bill Thursday that would allow the federal government to negotiate with pharmaceutical companies for lower prices on drugs covered by Medicare, a long-held goal for the party that has its best chance in passing Congress in years. Still, substantial drug pricing reform appears to be an uphill battle with Democrats' narrow majorities in the House and Senate, mixed signals on whether President Joe Biden is ready to back such legislation this year and lobbying by the powerful pharmaceutical industry. (Hellmann, 4/22)

Also —

Modern Healthcare: Most Broker Sites Advertise Less Than 50% Of Medicare Plans
Just 43% of available Medicare Advantage products, and 65% of Part D plans, were showcased on broker plan selection tools, according to a report released by The Commonwealth Fund on Thursday. Additionally, when researchers searched online for health coverage options, they found that web results primarily showcased information directly from health plans — not from neutral government, or third-party, sources. After looking through multiple large brokerage sites, researchers found one page that included information about Medigap plans, and only 18% of those available benefits were showcased. (Tepper, 4/22)

Modern Healthcare: Premier Asks CMS To Give ACOs More Time To Prep For New MSSP Quality Reporting Requirements
Accountable care organizations need more time to adjust to new quality reporting requirements for the Medicare Shared Savings Program set to take effect in 2022, group purchasing and consulting organization Premier told CMS in a letter last week. The organization, which serves about 4,100 hospitals and health systems, said the COVID-19 pandemic has made it difficult for providers to devote the time and resources necessary to make the required changes. (Brady, 4/22)

St. Louis Post-Dispatch: Prospects For Medicaid Expansion In Missouri Dim As Key Senate Committee Says No
Supporters of expanding Medicaid in Missouri are now looking to the full Senate to provide funding for the program after a key budget committee narrowly rejected a pared-down compromise late Wednesday. On a 7-7 vote, the GOP-controlled Appropriations Committee dumped a proposal to bankroll at least half of the cost of adding an estimated 275,000 more low-income adults to the government health care program known as MO HealthNet. (Erickson, 4/23)

AP: Missouri Senate Panel Votes Down Medicaid Expansion Funding
Missouri voters last year amended the state Constitution to extend access to government health care to thousands more low-income adults, but now the Republican-led Legislature is arguing over whether to fund it. Many Republican lawmakers have for years resisted expanding access to Medicaid, citing the expense of expanding it and waste within the current program. (4/22)

The Texas Tribune: Texas House Rejects Possible Medicaid Expansion Or Similar Program
The Texas House rejected an attempt Thursday to direct the governor and state health officials to use billions in federal dollars to expand health care coverage for uninsured Texans, including working poor who earn too much to qualify for Medicaid but too little to afford their own health insurance. On a vote of 80-68, lawmakers voted down the proposal, which was floated as a two-page amendment to the state budget Thursday. (Brooks Harper, 4/22)

Houston Chronicle: Texas House Republicans Snuff Out Growing Call For Medicaid Expansion
Thursday’s defeat sets up an uncertain year ahead for state health officials, who must now begin renegotiating a deal with the Biden administration for billions of dollars to cover the cost of emergency care for uninsured Texans. Federal health officials last week threw out an eleventh-hour approval by the Trump administration for that funding — money that does not promote routine care but has long given Republicans cover to forgo Medicaid expansion. (Blackman, 4/22)

Modern Healthcare: Molina To Pay $60 Million For Cigna's Texas Medicaid Plans
Through the acquisition, Molina will add approximately 50,000 Medicaid enrollees, including those from Cigna's STAR+PLUS program in the Hidalgo, Tarrant and Northeast service areas. It will also bump up the payer's revenue: In 2020, Cigna's Texas Medicaid contracts generated $1 billion in premium revenue. Molina currently operates six managed-care plans in the state and, at the end of the year, counted 357,000 members in Texas. Last year, it successfully protested its initial omission from the state's $10 billion Medicaid program and was able to keep its Medicaid contracts in Texas. (Tepper, 4/22)

In news about Medicaid coverage for transgender people —

Axios: ACLU Files Suit Against Iowa Over Medicaid Payments For Gender Transition Surgery
The American Civil Liberties Union filed suit Thursday against the state of Iowa over a law that allows Medicaid to deny payments for gender transition surgery. Why it matters: The suit is the latest volley in nationwide fight over transgender rights, ranging from access to medical care to the ability to compete on sports teams. Details: The ACLU plans to argue that denying the surgery to transgender people violates equal protection rights, the Associated Press reports. (Reed, 4/22)

Des Moines Register: Transgender Iowan, ACLU File Lawsuit Over Transition Care Law In Iowa
The ACLU of Iowa filed a lawsuit Thursday on behalf of transgender Iowan Aiden Vasquez, seeking to have an Iowa law exempting transition-related surgery from coverage under public health insurance systems like Medicaid deemed unconstitutional. The lawsuit, filed jointly with the national ACLU's LGBTQ & HIV Project, follows a similar suit filed in 2019 on behalf of Vasquez and another transgender Iowan, Mika Covington, that also asked the courts to end the state's practice of denying Medicaid coverage for transition-related care. (Fleig, 4/22)

Politico: CDC Reassigns Official Who Drew Spotlight For Pandemic Warning
CDC respiratory disease chief Nancy Messonnier has been reassigned from her position heading the agency's Covid-19 vaccine task force, according to three people familiar with the move. Messonnier is being absorbed into an incident management response team headed by CDC Director Rochelle Walensky. But the situation remains fluid as CDC restructures teams under Walensky's leadership. (Owermohle, Banco and Cancryn, 4/22)

Politico: HUD Scraps Trump Proposal On Transgender Access To Single-Sex Homeless Shelters 
The Department of Housing and Urban Development is withdrawing a Trump-era proposed rule giving federally funded single-sex homeless shelters the choice to house only people whose biological sex, rather than gender identity, matches the sex of the shelter. The Trump rule, proposed last July, would have rolled back transgender protections included in HUD’s 2016 Equal Access rule, which mandated access to shelter based on a person’s self-expressed gender identity. (O'Donnell, 4/22)

KHN: KHN’s ‘What The Health?’: Picking Up The Pace Of Undoing Trump Policies
The Biden administration is speeding up the pace of efforts to undo Trump administration health policies. The two most recent: overturning a ban on fetal tissue research funded by the National Institutes of Health and canceling a last-minute extension of a Medicaid waiver for Texas. (4/22)

In other news about the Biden administration —

AP: Jill Biden Hears From Navajo Women On Needs, Priorities
Jill Biden spent the first day of a trip to the Navajo Nation listening to female tribal leaders whom she referred to as her “sister warriors,” on the needs and priorities of the country’s largest Native American reservation. Biden sprinkled in phrases in Navajo that point to the holistic nature of the culture that interconnects all things, living in balance, beauty and harmony. She said she was proud to address the Navajo Nation on a day that highlights the protection of Mother Earth, a reference to Biden’s climate change agenda. (Fonsec, 4/23)

NBC News: Medical Debt Is Engulfing More People As Pandemic Takes Its Toll
Andréa Ceresa said she may have to declare bankruptcy soon. She has paid off about $23,000 in medical bills so far, but she faces $133,000 more for a nine-day hospital stay in November. Since she tested positive for Covid-19 a year ago, Ceresa has joined the ranks of those who still struggle with various manifestations of the coronavirus. She's also one of a growing number of Americans who can't afford their medical bills. (McCausland, 4/23)

CBS News: Unemployment Claims Fall To Pandemic-Era Low 
The number of Americans filing for first-time jobless aid last week fell to its lowest level since the COVID-19 pandemic erupted in 2020, a sign layoffs are easing as the economy recovers. Some 547,000 people applied for unemployment benefits in the week ended April 17, the Labor Department said Thursday. That's 39,000 fewer than the previous week and the lowest weekly number since March 14, 2020. About 133,000 others applied for Pandemic Unemployment Assistance, a federal program for self-employed and gig workers. (Ivanova, 4/22)

Capital & Main: Winners And Losers After Gov. Newsom Signs California's Worker-Rights Bill
Last fall, Gov. Gavin Newsom vetoed a bill designed to protect workers in certain industries who’d been laid off during the COVID-19 crisis. In doing so, Newsom practically invited state legislators to make another run at a worker-rights law. “I recognize the real problem this bill is trying to fix – to ensure that workers who’ve been laid off during the COVID-19 pandemic have certainty about their rehiring and job security,” the governor wrote in his veto letter to the California Assembly. But as drafted, he said, the legislation would create “a confusing patchwork of requirements” that could vary from county to county. (Kreidler, 4/20)

In other health-related news about the reopening of the economy —

AP: Topless Clubs Among Businesses That Can Reopen In Vegas
Topless dancers can shed coronavirus restrictions next weekend in Las Vegas and get face-to-face with patrons again, under rules accepted Thursday by a state COVID-19 task force. But masks still will be required for adult entertainment employees and recommended for customers. Sin City strip clubs that went dark when Nevada Gov. Steve Sisolak ordered casinos, clubs and nonessential businesses closed in March 2020 will be able to open May 1 at 80% of fire code capacity under strict social distancing guidelines. (Ritter, 4/23)

AP: Kentucky State Fair Will Be Open To The Public This Year
The Kentucky State Fair will be open to the public this year, officials said. The Kentucky State Fair Board voted Thursday to hold the event Aug. 19-29, according to a statement from Kentucky Venues. Tickets will go on sale in July. Last year, the event was closed to the public due to the coronavirus pandemic. Some events were held but only participants were allowed to attend. (4/23)

NBC News: Is It Still Necessary To Wear Masks Outdoors? CDC 'Looking At' Revising Mask Guidance
On Thursday, the director of the Centers for Disease Control and Prevention told "TODAY" the agency is considering revising its mask guidance. “We’ll be looking at the outdoor masking question, but also in the context of the fact that we still have people who are dying of Covid-19,” Dr. Rochelle Walensky said. (Syal, 4/22)

The Washington Post: Should I Wear A Mask Outside? Experts Weigh In. 
As more Americans are vaccinated against the coronavirus and a growing body of scientific evidence suggests that the risk of outdoor transmission is low, many people are wondering: Do we need to keep wearing face masks outside? The short answer is that masking outdoors can be “optional,” says Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital in Boston. While he says people should still generally don masks indoors, Sax believes statewide mandates for wearing masks outdoors may no longer be necessary. “The science of the viral transmission is advanced enough that we really don’t want to be kind of confusing people by forcing them to wear masks in places where really they’re at minimal risk,” he says. (Chiu, 4/22)

Fox News: More Than 4 In 10 In US Breathing 'Unhealthy' Air, Report Says
A new report on air quality found that more than 4 in 10 people are breathing in unhealthy air, with the American Lung Association pointing to climate change as a driving factor. The report, which analyzes data collected by the Environmental Protection Agency (EPA) from 2017, 2018 and 2019, also found people of color were 61% more likely to live in a county with unhealthy air than white people. (Hein, 4/22)

NBC News: Tiny Smoke Particles Could Make Wildfires Particularly Harmful To Human Health
When the San Francisco Bay Area experienced a record 30 consecutive days of worrisome air quality alerts in August and September, Mary Prunicki began taking blood samples from firefighters. The sky had turned orange from nearby wildfires. Thousands of firefighters would spend months battling the blazes, which would eventually scorch more than 4 million acres and kill 31 people. (Chow, Patterson and Ryan, 4/23)

KQED: Doctors Find Wildfire Smoke May Damage The Skin
Wildfire smoke may not only be choking people’s lungs. It could also be irritating their skin, according to a new UCSF and UC Berkeley study published in JAMA Dermatology. Tiny particles floating in wildfire smoke can wreak havoc on the body, and it’s well documented that pollutants can trigger a scratchy throat, coughing fits or even a heart attack. Exposure to air pollutants contributed to 3.7 million to 4.8 million deaths across the globe in 2015. Previous research has found that skin conditions like eczema may be exacerbated by cigarette smoke or heavy air pollution in dense cities. Smoky days may also cause the skin to flare up. (McClurg, 4/22)

In other public health news —

The Washington Post: Children’s National Doctors Warn They’re Seeing More Children With Self-Harm-Related Injuries
There is no data showing that suicides among adults and teens have increased in the country during the pandemic, but mental health workers in Washington, D.C., say they are seeing a notable increase in children who are experiencing anxiety, depression and loneliness. Children’s National doctors told D.C. Council members last month at an education hearing that its emergency rooms are experiencing an uptick of children with self-harm-related injuries. They are seeing children experiencing panic attacks and admitting more patients with eating disorders, the doctors said.

AP: Texting Option Weighed For Upcoming '988' Suicide Hotline
Recognizing that many Americans rely on texting, U.S. regulators are weighing whether to require that phone companies allow people to text a suicide hotline. The Federal Communications Commission last summer voted to require a new “988” number for people to call to reach a suicide-prevention hotline. Phone companies have until July 2022 to implement it. (Arbel, 4/22)

The Washington Post: Treating Panic Attacks: Advice From Experts 
There hasn’t been much research examining the pandemic’s effect on panic attacks. But surveys have shown that Americans are experiencing elevated levels of stress and anxiety, which, experts say, could contribute to panic attacks. “Once the baseline levels of anxiety increase, if you think about it like a roller coaster, you’re that much closer to the top where you’re going to go over and go into a panic attack,” said Ludmila De Faria, chair of the American Psychiatric Association’s Committee on Women’s Mental Health. (Chiu, 4/22)

NBC News: Heavy Marijuana Use During Pregnancy Linked To Premature Birth, Early Infant Death
Women who use marijuana during pregnancy are putting their babies at risk, a study published Thursday finds. Babies born to women who were heavy cannabis users during pregnancy are more likely to have health problems, including premature birth and death within a year of birth, compared to babies born to women who did not use cannabis during pregnancy, according to an analysis of nearly 5 million California women who gave birth between 2001 and 2012. (Carroll, 4/23)

AP: Florida Court Deals Blow To Marijuana Ballot Initiative
The Florida Supreme Court on Thursday dealt a potentially fatal blow to supporters of a proposed constitutional amendment aimed at legalizing recreational marijuana under certain circumstances. The justices ruled that the initiative's ballot summary is “misleading” in part because it does not spell out that recreational marijuana possession and distribution remains a federal crime. (4/22)

Philadelphia Inquirer: Pennsylvania 2022 Elections Show Marijuana Legalization Going From Fringe To Front-Runner
Not long ago, a candidate for statewide office in Pennsylvania would have been seen as fringe for backing the legalization of recreational marijuana. Now the issue looks like a winner for Democrats. The party’s major candidates for U.S. Senate and governor all favor legal weed. Lt. Gov. John Fetterman, the early Senate front-runner, flooded the internet with pro-pot messaging this week. He got on board after a 2019 statewide tour, where he spoke to voters about the issue. (Brennan, 4/23)

In other news about drug use and the opioid epidemic —

AP: California Senate OKs Supervised Sites For Drug Users
Instead of putting opioid-users in jail, a proposal moving through the California Legislature would give them a place to inject drugs while trained staff watch them to make sure they don’t die from accidental overdoses. The state Senate passed a bill on Thursday by just one vote that would allow the programs in Oakland, San Francisco and Los Angeles County. But the bill must still pass the state Assembly before it can go to Democratic Gov. Gavin Newsom, who would decide whether to sign it into law. (Beam, 4/22)

San Francisco Chronicle: Mayor Breed Wants An Answer From Biden Administration: Are Sanctioned Drug Use Sites Legal?
Mayor London Breed, facing yet another deadly month of overdoses in San Francisco, asked for clarity from the Biden administration Wednesday over whether opening a sanctioned drug use site would violate federal law. In a letter to Attorney General Merrick Garland, Breed — and several other mayors, including Oakland Mayor Libby Schaaf — said the “threat of federal enforcement” is one of their “greatest disincentives” to opening a site where people can use drugs around health professionals and also access services like drug treatment. “And we ask that you end that threat,” they wrote. (Thadani, 4/22)

NPR: During Pandemic, Fentanyl's Spread Made Illicit Drug Use Far More Treacherous
Researchers gathered for a conference on addiction this week received a grim update on the growing spread of street drugs laced with deadly synthetic opioids including fentanyl. The trend contributed to a stark rise in overdoses that left more than 90,000 Americans dead during the 12-month period ending in September 2020, according to the latest data. "We've seen a very significant rise in mortality," said Dr. Nora Volkow, head of the National Institute of Drug Abuse, who spoke Thursday as part of an on-line gathering of the American Society of Addiction Medicine. (Mann, 4/22)

Philadelphia Inquirer: Fatal Overdoses Among Black Philadelphians Rose Through COVID Pandemic, New Data Show
Fatal overdoses among Black Philadelphians skyrocketed in the first three quarters of 2020, new data from the city health department show. And overdoses have risen at alarming rates in several communities outside the neighborhoods typically considered “hot spots” for drug deaths. City officials say the spike in deaths, noted in a city report on its Opioid Response Unit, was likely made worse by the effects of the COVID-19 pandemic. And the latest data show how Philadelphia’s overdose crisis is changing, affecting more people of color — who also have suffered the most from COVID-19 — across the city. (Whelan, 4/22)

Bloomberg: ‘Long Hauler’ Study Shows Covid Can Kill Months After Infection
One of the largest studies of Covid-19 “long haulers” has proved what many doctors suspected: Not only are many patients suffering a raft of health problems six months after infection, they’re also at significantly greater risk of dying. Survivors had a 59% increased risk of dying within six months after contracting the SARS-CoV-2 virus, researchers reported Thursday in the journal Nature. The excess mortality translates into about 8 extra deaths per 1,000 patients -- worsening the pandemic’s hidden toll amid growing recognition that many patients require readmission, and some die, weeks after the viral infection abates. (Gale, 4/22)

NPR: People With Severe COVID-19 Have More Long-Term Effects, Study Finds
Ziyad Al-Aly and his colleagues used the databases of the U.S. Department of Veterans Affairs to examine health outcomes in more than 73,000 people who'd had COVID-19 and were not hospitalized, comparing them with nearly 5 million users of the VA health system who did not have COVID-19 and were not hospitalized. Six months later, those who'd had COVID-19 were found to be at higher risk of new onset heart disease, diabetes, mental health disorders including anxiety and depression, substance use disorders, kidney disease and other problems. (Wamsley, 4/22)

Smithsonian Magazine: How Opera Singing Is Helping Long-Haul Covid-19 Patients Recover 
Frustrated that she wasn’t getting better, Sheeba, whose last name has been withheld upon request, turned to the internet for answers and stumbled upon ENO Breathe. Launched in June, ENO Breathe began as a pilot program in partnership with the English National Opera (ENO) and the Imperial College Healthcare NHS Trust, part of one of the largest healthcare networks in the United Kingdom. Working together, a team of doctors, therapists and vocal coaches developed a breathing and well-being program for people like Sheeba who were recovering from Covid-19 but still suffering from breathlessness and anxiety. Their idea was simple: Take the same vocal techniques and breathing exercises used by opera singers and apply them to Covid-19 patients in a group setting. The program is structured into hour-long sessions that take place via Zoom once a week over the course of six weeks. (It’s also entirely free.) (Nalewicki, 4/19)

Science Magazine: How Scientists Are Teasing Apart The Biology Of Long COVID 
Emilia Liana Falcone, an infectious disease specialist at the Montreal Clinical Research Institute, and Michael Sneller, an infectious disease specialist at the National Institute of Allergy and Infectious Diseases (NIAID), are each leading a large Long COVID clinical trial. They are recruiting volunteers who’ve had COVID-19—some with ongoing symptoms and some without—along with a control group of people who never caught the virus. Volunteers come in regularly for medical tests, and scientists probe their blood for immune abnormalities. The goal: a biological explanation of chronic symptoms after COVID-19. The pair spoke with Science about their work, their thoughts on Long COVID, and their efforts to let the data guide them. (Couzin-Frankel, 4/13)

In other science and research developments —

Stat: Scientists Unlock The Key To Scar-Free Skin Healing, In Mice
Now, researchers at Stanford University have decoded the chemical and physical signals that trigger a particular type of skin cell to produce scars. And they have discovered a way to reprogram these cells, transforming them into another cell type capable of regenerating tissues intact. Mice that received this tweak healed from wounds with no scars, scientists reported Thursday in Science. The animals regrew hair, glands, and other critical structures. Their recovery was so complete that an image-classifying algorithm couldn’t tell the healed wound apart from the animals’ healthy, unmaimed skin. (Molteni, 4/22)

Stat: As Pfizer Discontinues An Old Glaucoma Drug, Patients Struggle To Cope
Next month, an eye drop that Carol Vaghar has taken for the past few years to manage a rare form of glaucoma will no longer be available, leaving her little choice but to consider potentially risky surgery to maintain the pressure in her eyes. The 62-year-old real estate agent developed cataracts in both eyes many years ago and after surgery, developed aphakic glaucoma, which causes intraocular pressure to rise dramatically. Vaghar tried various medications, but only one — a decades-old eye drop called Phospholine Iodide — has been effective. But Pfizer (PFE), which is the only supplier, will soon stop distributing the product. (Silverman, 4/22)

Bay Area News Group: Kaiser Permanente To Pay Black Employees In $11.5 Million Settlement
Health care giant Kaiser Permanente has agreed to pay $11.5 million to settle claims going back 15 years that it illegally discriminated against thousands of Black employees — half of them in the Bay Area — by denying them equal pay and promotions. The 111-page settlement, which requires court approval, would resolve a class-action lawsuit claiming Kaiser’s alleged bias affected 2,225 Black workers in administrative support and consulting services in California. (Baron, 4/22)

In other news from the states —

USA Today: Kansas Governor Vetoes Ban On Transgender Athletes In Women's Sports
Kansas Gov. Laura Kelly vetoed legislation Thursday that would have banned transgender athletes from competing in girls' and women's sports, calling the bill "a devastating message" to families and a threat to the state's economic standing. Kelly raised concerns over the impact such legislation would have on the state's economy but also argued in her veto message that Senate Bill 55 would have an impact on the mental health of transgender youth and was counter to Kansas' status as "an inclusive state." (Bahl, 4/22)

AP: Feds Say California Jail Violates Rights Of Mentally Ill
Alameda County in Northern California violated civil rights by failing to provide proper mental health services, especially in a jail where dozens of people have committed suicide, according to federal report released Thursday. The U.S. Department of Justice took aim at conditions for people with serious mental health issues, specifically in the Santa Rita Jail, where a woman killed herself April 2. It was the second suicide at the jail this year and the 50th since 2014. (Jablon, 4/23)

AP: Ex-Michigan Health Chief Ordered To Testify About Departure
Former Michigan health director Robert Gordon will testify next week before a legislative committee about his abrupt departure from Gov. Gretchen Whitmer’s administration, following the panel’s vote to subpoena him Thursday. Gordon ordered coronavirus restrictions for more than three months after the Democratic governor lost powers in a court ruling. He resigned in January as director of the state Department of Health and Human Services and received $155,000 in a separation agreement signed by the chief lawyer in Whitmer’s office. (Eggert, 4/23)

Dallas Morning News: DeSoto Receives Nearly $2 Million From Dallas County To Launch Mental Health Crisis Team
A $1.89-million grant from Dallas County will help DeSoto launch a team to respond to mental health emergencies, the city announced. The killing of George Floyd by Minneapolis police prompted county to launch the New Directions in Public Safety Grant program in July 2020, according to the city’s monthly newsletter. The grant money will help cover extra resources such as first responders to address mental health. (Carter, 4/22)

The Washington Post: Mormon Sex Therapist Natasha Helfer Has Been Expelled From The LDS Church 
A sex therapist who publicly challenged her church’s teachings on sexuality has been expelled as a member of the Church of Jesus Christ of Latter-day Saints, according to a letter she received Wednesday. Natasha Helfer, 49, who has been a national face for mental health advocacy among Mormons and attracted an audience especially among more progressive Mormons and ex-Mormons for her frankness around sex, came under fire from her church’s leadership in recent months. (Pulliam Bailey, 4/22)

Modern Healthcare: Mass. Project Pushes Telehealth Use In Community Health Centers
Stakeholders in Massachusetts are waging a campaign to accelerate telehealth use among the state's network of community health centers. The Massachusetts Federally Qualified Health Center Telehealth Consortium has launched the second phase of an initiative to increase access to telehealth services in under-resourced and medically vulnerable communities. The program received nearly $5 million from the Federal Communications Commission's Connected Care Pilot Program, as well as support from private donations and the state's public health department. (Ross Johnson, 4/22)

KHN: Virtual Care Spreads In Missouri Health System, Home To ‘Hospital Without Beds’
When Tom Becker was diagnosed with an irregular heartbeat in March 2020, the 60-year-old EMS helicopter pilot from Washington, Missouri, worried he would never fly again. But his cardiologist, Dr. Christopher Allen, had served in the Air Force and knew aviation physiology. So Becker felt reassured when Allen told him he didn’t expect any problems, because Becker was still fairly young. (Berger, 4/23)

AP: Indian Hospitals Plead For Oxygen, Country Sets Virus Record
India put oxygen tankers on special express trains as major hospitals in New Delhi on Friday begged on social media for more supplies to save COVID-19 patients who are struggling to breathe. More than a dozen people died when an oxygen-fed fire ripped through a coronavirus ward in a populous western state. India’s underfunded health system is tattering as the world’s worst coronavirus surge wears out the nation, which set another global record in daily infections for a second straight day with 332,730. (Mehrotra and Sharma, 4/23)

Reuters: Mass Cremations Begin As India’s Capital Faces Deluge Of COVID-19 Deaths 
Delhi resident Nitish Kumar was forced to keep his dead mother’s body at home for nearly two days while he searched for space in the city’s crematoriums - a sign of the deluge of death in India’s capital where coronavirus cases are surging. On Thursday Kumar cremated his mother, who died of COVID-19, in a makeshift, mass cremation facility in a parking lot adjoining a crematorium in Seemapuri in northeast Delhi. "I ran pillar to post but every crematorium had some reason ... one said it had run out of wood," said Kumar, wearing a mask and squinting his eyes that were stinging from the smoke blowing from the burning pyres. (Siddiqui, 4/22)

CNN: As Bodies Pile Up, India's Leaders Face Rising Public Anger Over Second Covid-19 Wave
State ministers and local authorities, including those in hard-hit Maharashtra, have been warning about the second wave and preparing action since February. In jarring contrast, there appears to have been a vacuum of leadership within the central government, with Prime Minister Narendra Modi staying largely silent on the situation until recent weeks. In intermittent statements throughout April, Modi discussed the national vaccination effort and acknowledged the "alarming" rise in cases, but was slow to take containment measures besides ordering states to increase testing and tracking, and asking the public to stay vigilant. (Yeung, Suri and Gupta, 4/23)

Nature: India's Massive COVID Surge Puzzles Scientists 
The pandemic is sweeping through India at a pace that has staggered scientists. Daily case numbers have exploded since early March: the government reported 273,810 new infections nationally on 18 April. High numbers in India have also helped drive global cases to a daily high of 854,855 in the past week, almost breaking a record set in January. ... Researchers in India are now trying to pinpoint what is behind the unprecedented surge, which could be due to an unfortunate confluence of factors, including the emergence of particularly infectious variants, a rise in unrestricted social interactions, and low vaccine coverage. Untangling the causes could be helpful to governments trying to suppress or prevent similar surges around the world. (Mallapaty, 4/21)

AP: Canada Bans Flights From India, Pakistan
Canada on Thursday said it is banning all flights from India and Pakistan for 30 days due to the growing wave of COVID-19 cases in that region. Transport Minister Omar Alghabra said the ban would start late Thursday, speaking hours after India reported a global record of more than 314,000 new infections in the previous 24-hours. Cargo flights from India and Pakistan will continue. (Gillies, 4/22)

Bloomberg: Singapore To Bar Visitors From India On Worsening Situation
Singapore said it will further tighten border controls with India, including a ban on visitors from the country, because of a “rapidly deteriorating situation” there. Authorities are also stepping up measures to prevent a wider outbreak within Singapore, officials said at a press conference on Thursday. Foreign workers and those working in the construction and marine sectors, who had previously been infected with Covid-19 and recovered, are no longer exempted from measures like routine testing, the health ministry said in a statement Thursday. (Heijmans, 4/22)

Bloomberg: Herd Immunity Hard To Achieve As Covid Variants Grow, Experts Say
Long before herd immunity became humanity’s shared obsession, the phrase referred to sick cows. More than a century ago, veterinarians observed that outbreaks of a highly contagious bacterial infection menacing cattle died down once they’d burned through a certain percentage of a herd, so long as new animals weren’t introduced. Soon the concept was extended to a variety of human outbreaks, where it became a staple of epidemiology. Since the beginning of the pandemic, exactly when the U.S. might reach herd immunity for Covid-19 has been furiously debated in congressional hearings, on TV shows, and among the many armchair epidemiologists on Twitter. In the popular imagination, the phrase has become shorthand for the end of the pandemic—a finish line that will suddenly cause the virus to subside and allow maskless normalcy to resume. (Langreth and Court, 4/22)

Undark: Sewage Has Stories. Can The U.S. Learn To Listen?
In early March 2020, as Covid-19 cases were accelerating across the globe, the American aircraft carrier U.S.S. Theodore Roosevelt made its way to Da Nang, Vietnam for a scheduled stop to celebrate the 25th anniversary of diplomatic relations between the nations. Nearly 100,000 cases of Covid-19 had been confirmed worldwide, and more than 3,000 people had died from it, when thousands of sailors poured off the ship for five days to mingle with locals, posing shoulder to shoulder for photos, overnighting in local hotels, and shooting hoops with Vietnamese kids.Less than two weeks after pulling anchor, three crew members tested positive for SARS-CoV-2, the virus that causes Covid-19. In the ensuing weeks, the illness zipped through the vessel, eventually infecting 1,271 of the nearly 5,000 sailors, along with the ship’s captain. Twenty-three sailors were hospitalized, with four admitted into intensive care. One died. The acting secretary of the Navy fired the captain for skirting the chain of command when he begged for help with the crisis, before the acting secretary himself resigned. (Weiss, 4/21)

The New York Times: A New Bird Flu Jumps To Humans. So Far, It's Not A Problem 
When a bird flu virus struck a major poultry farm in Russia earlier this year, it was a reminder that the coronavirus causing the pandemic was not the only dangerous virus out there. The authorities quickly tested the birds and moved into high gear, killing 800,000 chickens, disposing of the carcasses and cleaning the farm to stop the potential spread to other chicken farms. But they were also concerned for humans. (Gorman, 4/21)

The Washington Post: Many Veterans Don’t Trust Coronavirus Vaccines. For A VA Crew In The Rural West, That Means Changing Minds, One By One.
On the morning he was scheduled to get his first shot of coronavirus vaccine, Mike Jellesed woke in a fury and wheeled his pickup out of his trailer park, headed for the Veterans of Foreign Wars post in town. A giant star-spangled bus that had crossed 160 miles of the Rocky Mountains from Spokane, Wash., was waiting for him in the parking lot. Inside were three Department of Veterans Affairs workers and 26 Moderna syringes ready to go. Jellesed, a 61-year-old Air Force veteran with scarred lungs that left him vulnerable to covid-19, had driven there with his 11-year-old son to tell the VA crew all the reasons — despite his scheduled appointment — he didn’t believe in the vaccine. He felt like a lab rat: “That’s what I am,” he said. “I don’t like being told what to do.” (Rein, 4/17)

Also —

The Wall Street Journal: The Importance Of Friendship For Alzheimer’s Patients 
Abbe Smerling and Judy Roeder, close friends for 30 years, raised their children, vacationed and celebrated holidays together. Abbe hosted the wedding rehearsal dinner for Judy’s daughter. “It was one of the best parties we ever had at our house,” Abbe says. Now, after sharing many milestones in their lives, the two, who both live in the Boston area, have entered a new chapter in their friendship. About eight years ago, Judy, 75 years old and a former psychotherapist, was diagnosed with mild cognitive impairment, which progressed to Alzheimer’s. Abbe, 70, has remained at her side, taking her on road trips, on weekend retreats, and to events at their temple. (Ansberry, 4/19)

The Washington Post: Fitness Drones Are Coming, If Inventors Can Get All The Kinks Out Of Them 
In the past 20 years, drones have become a fixture of modern life. From photography and journalism to package delivery and crop monitoring, companies of all kinds are increasingly turning to unmanned flying devices to cut costs, increase efficiency, decrease workload or simply do what humans cannot. Where the world hasn’t seen drones play a prominent role, however, is in the world of health and fitness. But that may be changing. (Debusmann Jr., 4/18)

Vanity Fair: Josh Hawley Proudly Declares Himself Pro-Hate Crimes 
Fleeing to Cancún in the middle of a state of emergency and then blaming it on a 10-year-old and 12-year-old. Blocking a Supreme Court nominee because of a fake rule about needing to wait until a new president is installed, and then going against said rule on an even shorter timeline. Voting to overturn the results of a free and fair election. Publicly declaring someone “practically and morally responsible for provoking” an attack on the U.S. Capitol but voting to acquit him anyway. ... There are some things that most of the human race would never do, and then you have Republicans, who were born without the gene for shame. That shamelessness was on full display on Thursday when Senator Josh Hawley, late of pushing the voter-fraud lies that led to the storming of the Capitol, decided for some reason to vote against the COVID-19 Hate Crimes Act, making him the only senator to do so. (Bess Levin, 4/23)

The New York Times: After Covid, Your Health May Depend On Living With Germs 
The video is intended to comfort and reassure, but it feels undeniably dystopian. A person clad in goggles, a mask and a reflective vest dusts a plane’s cabin with a fine mist of disinfectant. The chemical spray is charged with “breakthrough” electrostatic technology that helps it coat every surface and lay waste to any microscopic threats that may be lurking, specifically the coronavirus. United Airlines produced and uploaded this particular video last April, but the sanitization regimen is not unique. Mass transportation authorities and countless businesses have gone to similar lengths in an effort to abide by guidelines and to mollify a rightly fearful public. And for the most part, the efforts have been welcome. One of the top comments posted to the United video reads, “Even after this pandemic you guys should keep this up.” (Markham Heid, 4/23)

Modern Healthcare: Healthcare Leaders: Help Your People Get Comfortable With Uncomfortable Conversations
The jury rendered a guilty verdict this week on all counts in the murder of George Floyd, a killing that stirred international outrage and the most significant civil rights protests in America since the 1960s. We understand the deep-seated frustration of many Americans and I share in their pain because of the horrific murder of Mr. Floyd. Hopefully, the verdict can help start the healing process for the Floyd family, the community and the nation. (Robert C. Garrett, 4/22)

The Baltimore Sun: There Is No Vaccine For The Opioid Epidemic
For the past year, our nation has been focused on fighting the coronavirus. Rightly so. Today, hope in the form of a vaccine vial is reaching individuals and communities across the country. But no vaccine for the opioid epidemic is coming. It’s the crisis raging in the background, with opioid deaths surging over the past year as economic opportunities, isolation and mental health declined amid COVID-19. More than half a million people have died from opioid overdose since 1999, and more than 800,000 from drug overdoses of any kind. Fighting this crisis requires emergency services to prevent the loss of life, treatment, education and prevention so people do not become addicted in the first place. With bold leadership from states, including states’ attorneys general and urgent funding from Congress, we can do it. (Mike Moore and David Trone, 4/22)

Stat: Congress Needs To Abolish Prescription Paper Labeling For Clinicians 
There’s no place in health care for practices that fail to serve the best interests of patients and their clinicians. One such obsolete and harmful practice is providing outdated and wasteful paper prescribing information to pharmacists and prescribers when they can — and do — obtain the most up-to-date prescribing information online. FDA-approved information for prescribers includes detailed technical information about a drug’s molecular structure, along with its approved uses, dosing, expected side effects, warnings, contraindications, and precautions. The prescribing information is different than patient labeling, which is written in non-technical language and contains practical information about how to take a drug and what side effects to watch out for. (Jane A. Axelrad, 4/23)

The New York Times: Biden, The World Needs Your Help To End The Pandemic 
Last July, during the presidential campaign, Joe Biden promised the universal health care advocate Ady Barkan that he wouldn’t let intellectual property laws stand in the way of worldwide access to coronavirus vaccines. “The World Health Organization is leading an unprecedented global effort to promote international cooperation in the search for Covid-19 treatments and vaccines,” said Barkan. “But Donald Trump has refused to join that effort, cutting America off from the rest of the world. If the U.S. discovers a vaccine first, will you commit to sharing that technology with other countries, and will you ensure there are no patents to stand in the way of other countries and companies mass-producing those lifesaving vaccines?” (Michelle Goldberg, 4/23)

Stat: Use Real-World Data, Not Predictions, To Inform School Openings 
The United States has exceeded 31 million Covid-19 infections (a messy data point) and is approaching 570,000 Covid-19 deaths (a more robust data point). Yet despite the abundance of data about the pandemic, the best available information is not usually what guides policymakers. Some policies are senselessly cruel, such as keeping family members from visiting loved ones dying of Covid-19. Others heighten disparities in income, health, and education. (Leslie Bienen, Eric Happel, and Monica Gandhi , 4/23)

Scientific American: How Real-World Data Can Help Us Better Prepare For The Next Pandemic 
When we look back at the COVID pandemic, what will hindsight tell us? Will we remember the turn of the decade as the year that finally brought real change to pandemic preparedness, or will our eventual return to “normal” stymie our progress?Although epidemiologists have long warned about the potential for global pandemics, their admonitions have largely gone unheeded. However, industrialized animal farming practices, increased human-animal contact, globalization, decreasing biodiversity and other factors all point to the likelihood of another zoonotic disease (one transmitted from animals to humans) with pandemic potential. (Joseph Menzin and Peter Nuemann, 4/22)

New England Journal of Medicine: Covid-19 Vaccines And Pregnancy — A Conversation With CDC Director Rochelle Walensky 
The continuing spread of SARS-CoV-2 remains a Public Health Emergency of International Concern. What physicians need to know about transmission, diagnosis, and treatment of Covid-19 is the subject of ongoing updates from infectious disease experts at the Journal. In this audio interview conducted on April 16, 2021, the editors are joined by CDC director and infectious disease physician Rochelle Walensky to discuss a new study of Covid-19 vaccination in pregnancy, as well as a phase 3 trial of Ad26.COV2.S. (Eric J. Rubin, M.D., Ph.D., Lindsey R. Baden, M.D., Rochelle P. Walensky, M.D., M.P.H., and Stephen Morrissey, Ph.D., 4/22)