Stat: CDC Expands Definition Of ‘Close Contacts,’ After Study Suggests Covid-19 Can Be Passed In Brief Interactions
The Centers for Disease Control and Prevention on Wednesday expanded how it defines a “close contact” of someone with Covid-19 as it released new evidence showing the coronavirus can be passed during relatively brief interactions. Previously, the CDC described a close contact as someone who spent 15 minutes or more within six feet of someone who was infectious. Now, the agency says it’s someone who spent a cumulative 15 minutes or more within six feet of someone who was infectious over 24 hours, even if the time isn’t consecutive, according to an agency spokesperson. (Joseph, 10/21)

The Washington Post: CDC Expands Definition Of Who Is A ‘Close Contact’ Of An Individual With Covid-19 
The change by the Centers for Disease Control and Prevention is likely to have its biggest impact in schools, workplaces and other group settings where people are in contact with others for long periods of time. It also underscores the importance of mask-wearing to prevent spread of the virus, even as President Trump and his top coronavirus adviser continue to raise doubts about such guidance. (Sun, 10/21)

AP: CDC Redefines COVID-19 Close Contact, Adds Brief Encounters
The definition change was triggered by a report on that case of a 20-year-old Vermont correctional officer, who was diagnosed with a coronavirus infection in August. The guard, who wore a mask and goggles, had multiple brief encounters with six transferred prisoners before test results showed they were positive. At times, the prisoners wore masks, but there were encounters in cell doorways or in a recreational room where prisoners did not have them on, the report said. An investigation that reviewed video footage concluded the guard’s brief interactions totaled 17 minutes during an 8-hour shift. (Stobbe, 10/21)

CNN: CDC Updates Its Guidelines For Close Covid-19 Contact After Prison Guard Gets Infected 
Redfield said it's an example of real-world science informing policy. The CDC has now updated its definition of what constitutes a close contact. "As we get more data and understand the science of Covid, we are going to incorporate that in our recommendations," Redfield said at a news conference held at CDC headquarters in Atlanta. (Fox and Mascarenhas, 10/21)

And Dr. Fauci addresses Americans' mistrust of public health agencies —

CNN: A 'Building Distrust' In Public Health Agencies Is 'The Elephant In The Room,' Fauci Says
There is a "building distrust" in public health agencies as the coronavirus pandemic resurges in large parts of the United States, said Dr. Anthony Fauci, the government's leading infectious disease official, in a recent interview. Public transparency in public health information is "absolutely essential," Fauci said in an interview with the Council of Inspectors General on Integrity and Efficiency, which was posted online Wednesday by the Project On Government Oversight. (Erdman, 10/22)

The Hill: CDC: 75 Percent Of US Seeing Increases In COVID-19 Cases In 'Critical Phase' Of Pandemic 
The number of COVID-19 cases is increasing in 75 percent of the country as the U.S. approaches a “critical phase” of the pandemic, Centers for Disease Control and Prevention (CDC) officials said Wednesday. “Unfortunately we're seeing a distressing trend here in the United States,” Jay Butler, the CDC’s deputy director for infectious diseases, said at a media briefing at the agency's headquarters in Atlanta. (Hellmann, 10/21)

AP: Virus Spikes Have Officials Looking To Shore Up Hospitals
Hospitals across the United States are starting to buckle from a resurgence of COVID-19 cases, with several states setting records for the number of people hospitalized and leaders scrambling to find extra beds and staff. New highs in cases have been reported in states big and small — from Idaho to Ohio — in recent days. The rise in cases and hospitalizations was alarming to medical experts. Around the world, disease trackers have seen a pattern: First, the number of cases rises, then hospitalizations and finally there are increases in deaths. Seeing hospitals struggling is alarming because it may already be too late to stop a crippling surge. (Pane, Johnson and Peters, 10/21)

Vox: America’s Third Wave Of Covid-19, Explained
With that, the much-feared fall and winter surge of coronavirus cases that experts warned of for months may now be here. Despite the US already suffering at least 220,000 Covid-19 deaths — the highest death toll in the world — it looks like things are getting worse. (Lopez, 10/22)

USA Today: COVID Cases May Surge After Thanksgiving, Christmas Gatherings
Dr. Eric Cioe-Peña and his wife come from large families and typically split the holiday festivities, getting together with one group of relatives for Thanksgiving and another one at Christmas. This year, they’ll reluctantly keep their distance from both. "We’re going to have to make sacrifices," said Cioe-Peña, an emergency room physician and director of Global Health at Northwell Health in New Hyde Park, New York. "My wife and I decided this year’s going to be nuclear family, and we’re not inviting anybody over." (Ortiz, 10/21)

From the Midwest —

Reuters: 'Please Stay Home:' COVID-19 Tightens Grip On U.S. Midwest 
Six U.S. states reported record day-over-day increases in COVID-19 deaths on Wednesday, according to a Reuters analysis, as infections rose across the Midwest and elsewhere, prompting new clampdowns on residents, schools and businesses. Deaths attributed to COVID-19 hit daily records in Iowa, Minnesota, Montana, Kansas, Hawaii and Wisconsin, Reuters found. Wisconsin, Illinois, Kentucky, Colorado and Ohio reported record daily increases in new infections, the tally showed. ... “Folks, please stay home,” Wisconsin Governor Tony Evers said in a statement on Wednesday. “Help us protect our communities from this highly-contagious virus and avoid further strain on our hospitals.” (Shumaker and Caspani, 10/21)

Detroit Free Press: Gov. Whitmer 'Sounding The Alarm' As COVID-19 Cases Surge In Michigan
Michiganders need to do everything they can to stop the spread of COVID-19 now if they want to avoid any drastic outcomes, Gov. Gretchen Whitmer said Wednesday during a press conference where she said she was "sounding the alarm bell." The governor, joined by the state's chief medical executive, Dr. Joneigh Khaldun, said the state is taking new action to fight the disease caused by the coronavirus. Asked about the possibility of a new shutdown anywhere in the state, she said she didn't want to cause additional anxiety but it is incumbent on everyone to do what they can to stop the spread of the disease. (Boucher and Shamus, 10/21)

Indianapolis Star: 'Very Stretched Right Now': Northern, Southern Indiana Hospitals Grapple With COVID Surge
Northern and Southern Indiana hospitals are struggling to handle a surge of patients amid all-time highs in COVID cases while their Central Indiana counterparts are not seeing as much of a rush as they did in the spring. (Rudavsky, 10/22)

The Washington Post: Purdue Pharma Pleads Guilty To Federal Criminal Charges
The Justice Department announced a historic $8.3 billion settlement Wednesday with OxyContin-maker Purdue Pharma, capping a long-running federal investigation into the company that, for critics, became a leading symbol of corporations profiting from America’s deadly addiction to opioid painkillers. As part of the deal — the largest such settlement ever reached with a pharmaceutical company, officials said — Purdue Pharma agreed to plead guilty to three felonies. (Kornfield, Rowland, Bernstein and Barrett, 10/21)

Stat: Purdue To Plead Guilty To Felony Charges As Part Of $8.3B Opioid Settlement
As part of the deal, Purdue admitted to lying to the Drug Enforcement Administration about a program to monitor diversion by physicians and reporting misleading information to the agency in order to boost manufacturing quotas, according to the plea deal. Purdue also admitted to violating anti-kickback laws in two ways: by paying doctors — through speaker programs — to write more prescriptions and also paying an electronic health records company to influence prescribing and ordering (that company reached a $145 million settlement earlier this year). (Silverman, 10/21)

The New York Times: Purdue Pharma Pleads Guilty To Criminal Charges For Opioid Sales 
Members of the Sackler family said in a statement that they “acted ethically and lawfully.” Issued on behalf of members who had served on the company’s board, the family statement added: “The board relied on repeated and consistent assurances from Purdue’s management team that the company was meeting all legal requirements. ”OxyContin, which came on the market in the mid-90s, is seen as an early, ferocious driver of the opioid epidemic and Purdue is regarded as the architect of muscular, misleading drug marketing. (Hoffman and Benner, 10/21)

CNN: Purdue Pharma Pleads Guilty To Federal Criminal Charges Related To Opioid Crisis 
The company doesn't have $8 billion in cash available to pay the fines. So Purdue will be dissolved as part of the settlement, and its assets will be used to create a new "public benefit company" controlled by a trust or similar entity designed for the benefit of the American public. (Isidore, 10/21)

AP: OxyContin Maker Purdue Pharma To Plead To 3 Criminal Charges
The deal does not release any of the company’s executives or owners — members of the wealthy Sackler family — from criminal liability, and a criminal investigation is ongoing. Family members said they acted “ethically and lawfully,” but some state attorneys general said the agreement fails to hold the Sacklers accountable. (Balsamo and Mulvihill, 10/21)

The Wall Street Journal: Purdue Pharma Reaches $8.34 Billion Settlement Over Opioid Probes 
Steve Miller, the chairman of Purdue’s board, said the company regrets and accepts responsibility for the misconduct cited by prosecutors, which includes illegal kickbacks and misrepresentations made to the Drug Enforcement Administration. “Purdue today is a very different company,” he said. “We have made significant changes to our leadership, operations, governance, and oversight.” (Randazzo, 10/21)

In other news about the opioid crisis —

Modern Healthcare: Walmart Must Disclose Opioid Documentation, Court Orders
A West Virginia court ordered Walmart to disclose internal opioid dispensing documentation supplied to state and federal agencies investigating the retail giant's alleged role in the opioid epidemic. The court rebuffed Walmart's arguments Tuesday, some of which included that its national dispensing practices were not relevant to West Virginia, the request was overly burdensome and that it couldn't reveal the documents because of an ongoing federal investigation. (Kacik, 10/21)

AP: GOP-Led Senate Panel Advances Barrett Despite Dems' Boycott
The Senate Judiciary Committee voted Thursday to advance Amy Coney Barrett’s Supreme Court nomination to the full Senate as Republicans powered past Democrats’ boycott of the session. Democratic senators refused to show up in protest of the GOP’s rush to install President Donald Trump’s nominee to replace the late Justice Ruth Bader Ginsburg. Never has the Senate confirmed a Supreme Court nominee so close to a presidential election. (Mascaro and Jalonick, 10/22)

Politico: Senate Judiciary Committee Approves Amy Coney Barrett’s Supreme Court Nomination
The vote went forward despite a Democratic boycott of the meeting — part of an effort to denounce Republicans’ confirmation drive as illegitimate coming just days before the presidential election. The full Senate is expected to hold a final vote on Barrett's nomination on Monday. (Levin, 10/22)

The Wall Street Journal: Amy Coney Barrett’s Nomination Advanced By Senate Judiciary Committee
Senate Majority Leader Mitch McConnell (R., Ky.) is expected to take the rare step of keeping the chamber in session over the weekend in order to limit the opportunities for Democrats to delay the vote. If confirmed as expected, Judge Barrett would give the Supreme Court a solid conservative majority that could affect the role of government, the rights of individuals, and the interpretation of such long-debated constitutional terms as equal protection, due process of law, and cruel and unusual punishment. (Hughes, 10/22)

What's at stake —

PBS NewsHour: How Barrett’s Confirmation Could Influence The Fight Over Abortion Access
Over her three-day confirmation hearing, Supreme Court nominee Amy Coney Barrett repeatedly declined to discuss her stance on abortion. But while there is no way to know for certain how she will rule on such cases, legal scholars say that her record, as well as a careful reading of certain answers she gave the Senate Judiciary Committee, gives clues about where the Supreme Court could be headed on issues of reproductive rights. (Vinopal, 10/21)

Scientific American: Upcoming Supreme Court Ruling Could Jeopardize Health Insurance For People With COVID
In a case on the Affordable Care Act next month, a conservative court could take away protections for preexisting conditions. (Lewis, 10/21)

NPR: Supreme Court Blocks Curbside Voting In Alabama, An Option During Pandemic
The Supreme Court has sided with Alabama state officials who banned curbside voting intended to accommodate individuals with disabilities and those at risk from the COVID-19 virus. The high court issued its order Wednesday night, without explanation, over the dissent of the court's three liberal justices. (Totenberg, 10/21)

The New York Times: Supreme Court Bars Curbside Voting In Alabama 
In dissent, Justice Sonia Sotomayor, joined by Justices Stephen G. Breyer and Elena Kagan, said the state’s policy discriminated against older and disabled voters. “If those vulnerable voters wish to vote in person,” Justice Sotomayor wrote, “they must wait inside, for as long as it takes, in a crowd of fellow voters whom Alabama does not require to wear face coverings,” referring to masks that help mitigate the spread of the coronavirus. (Liptak, 10/21)

In other news related to voter safety —

Politico: Government Watchdog Knocks Postal Service For Operational Changes 
The independent government watchdog for the United States Postal Service has concluded that a sweeping series of operational changes implemented at the agency by President Donald Trump’s postmaster general “negatively impacted the quality and timeliness of mail delivery” across the country. In a report released this week in response to various congressional requests, the USPS Office of Inspector General analyzed the cost-cutting measures Postmaster General Louis DeJoy put in place after assuming control of the agency in June — as well as the nearly six dozen strategies initiated by USPS operations executives to achieve financial targets. (Forgey, 10/21)

The Washington Post: In Five States, More Early Votes Have Been Cast Than Trump Received In 2016 
There are a lot of reasons that the country has seen a surge in early voting in 2020. The most obvious is the coronavirus pandemic, which has spurred voters to seek out ways to reduce or eliminate the need to interact with other people when voting. There’s also likely an element of partisanship. President Trump’s false assertions about the risk posed by mail-in voting has pushed a divide between Democrats and Republicans on the process. Polling has consistently shown that Democrats are embracing absentee and early voting, perhaps in part because Trump rejects it. And then there’s the other, subtler reason: A lot of voters appear to want to simply put this whole election behind them, casting ballots now just to be done with the whole thing. (Bump, 10/21)

The New York Times: Presidential Elections May Be Bad For Your Health
The stress of presidential elections may increase the incidence of heart attacks and strokes, researchers report. Scientists tracked hospitalizations for acute cardiovascular disease in the weeks before and after the 2016 presidential election among about three million adults who were enrolled in the Kaiser Permanente Southern California health care system. (Bakalar, 10/20)

Politico: Obama Skewers Trump As Former President Hits Campaign Trail
Former President Barack Obama unloaded on his successor Wednesday in Philadelphia as Democrats’ biggest luminary hit the campaign trail in support of his onetime vice president. Obama lambasted President Donald Trump’s handling of the coronavirus pandemic, which has killed more than 220,000 Americans and infected nearly 8.4 million — including the president, members of his family and many of his top aides. ... Obama also sought to reclaim credit for the economy that, prior to the virus’ arrival, Trump and his allies frequently touted and used it as a cudgel against the current president. “Now, he did inherit the longest streak of job growth in American history,” Obama said. “But just like everything else he inherited, he messed it up.” (Niedzwiadek, 10/21)

USA Today: Barack Obama Blasts Trump In Philly Speech Supporting Biden
Much of Obama's speech was leavened with humor. Obama said his administration left a pandemic playbook for how to respond to the emergency, but with the number of cases rising again after eight months, Trump “probably used it to prop up a wobbly table somewhere.” “Donald Trump isn’t suddenly going to protect all of us,” Obama said of the president who became infected. “He can’t even take the basic steps to protect himself.” Obama said the pandemic would have challenged any president. But he said other countries demonstrated how to deal with it better, including South Korea with 1.3% of the per capita U.S. death toll and Canada with 39%. “If he’d have been working the whole time, it never would have gotten this bad,” Obama said. “But this idea that somehow this White House has done anything but completely screw this up is just not true.” (Jansen, 10/21)

NPR: Entreating Pa. Residents To Vote, Obama Delivers Rebuke Of Trump 
He admonished the Trump administration for dismantling environmental protection programs and its efforts to repeal the Affordable Care Act. He also reprimanded Trump for his rhetoric and spreading misinformation. "America is a good and decent place," Obama said. "But we've just seen so much noise and nonsense that sometimes it's hard for us to remember. Philadelphia, I'm asking you to remember what this country can be." (Sprunt, 10/21)

In other news from the Biden campaign —

KHN: Biden’s Big Health Agenda Won’t Be Easy To Achieve 
If Joe Biden wins the presidency in November, health is likely to play a high-profile role in his agenda. Just probably not in the way he or anyone else might have predicted. Barring something truly unforeseen, it’s fairly certain that on Jan. 20 the U.S. will still be in the grip of the coronavirus pandemic — and the economic dislocation it has caused. Coincidentally, that would put a new President Biden in much the same place as President Barack Obama at his inauguration in 2009: a Democratic administration replacing a Republican one in the midst of a national crisis. (Rovner, 10/22)

San Francisco Chronicle: Bay Area Health Experts Weigh In On Joe Biden's Coronavirus Plan 
If he wins the election, Joe Biden’s pandemic plan calls for rejoining the World Health Organization and thrusting federal public health agencies that have been largely sidelined under the current administration back into the spotlight. That would be his first day in the White House, his campaign says. The next steps of his response, laid out in detail on his campaign website, include massively ramping up testing, increasing production of health care equipment like ventilators, and promoting widespread use of face coverings. (Allday, 10/21)

Stat: Democrats Want To Overhaul Warp Speed. But If Biden Wins, Should He?
For months, Democrats have called for the ouster of Moncef Slaoui, the former pharmaceutical executive who President Trump installed to run his multibillion-dollar vaccine development initiative, Operation Warp Speed. But if former Vice President Joe Biden wins the presidency, can he afford to fire him? (Florko, 10/22)

The Hill: Rising COVID-19 Cases Raise Worries About Trump Rallies 
The Trump campaign is facing criticism for holding packed outdoor rallies and some indoor events where people don’t wear masks, even as cases of COVID-19 increase in most states ahead of an anticipated winter surge. Outbreaks are particularly bad in midwestern states like Wisconsin, where the Trump campaign has ramped up its efforts as he seeks to win a second term. Wisconsin is one of the key states the president needs to win to secure four more years. (Hellmann, 10/21)

The Hill: Former Supporter: Trump 'Super-Spreader Events' Are 'Scaring The Dickens Out Of Folks' 
A former Trump supporter's advocacy group is erecting billboards near the president's rallies, dubbing them COVID-19 “superspreader” events and claiming they're causing concern for residents of rural communities. Christopher Gibbs, an Ohio farmer, voted for President Trump in 2016 but now argues that the trade war with China has hurt his industry and that Trump's rallies are endangering public health. As president of advocacy group Rural America 2020, a “non-profit that advocates for policies that benefit agriculture,” Gibbs says he is fighting to fix issues that most affect rural communities. (Polus, 10/21)

Politico: The Fear Behind Donald Trump’s Obsession With Immunity
Donald Trump has been talking a lot of late about immunity. “I’m immune,” he told Maria Bartiromo on Fox News six days after his release from the Walter Reed National Military Medical Center, where he had received treatment after falling ill with the coronavirus. “The president,” the president added, “is in very good shape to fight the battles.” (Kruse, 10/22)

The New York Times: Trump Promised Seniors Discount Cards For Prescription Drugs. They May Be Illegal.
A month ago, President Trump surprised much of his own government when he announced in North Carolina that he would soon send $200 discount cards to more than 30 million older Americans to offset the cost of prescription drugs. The promise set off a scramble among health and budget officials unaware that such a policy was being considered. At first, they rushed to figure out whether such a legally and logistically complicated plan could be delivered in October, as Mark Meadows, the White House chief of staff, had vowed in an interview the day of the speech. ... Now, less than two weeks before the election, officials acknowledge that Medicare recipients will not be getting their $200 cards this month. (Sanger-Katz and Weiland, 10/22)

Kaiser Health News and Politifact: Trump Says He Saved 2 Million Lives From COVID. Really?
President Donald Trump has repeatedly claimed to have saved 2 million lives from COVID-19 through his actions to combat the disease. ... Where did this number come from? And is there any truth to the idea that Trump is responsible for saving 2 million lives from COVID-19? Since Trump continues to use it to claim success, we decided to look into it. (Knight, 10/21)

FactCheck.Org: Trump's Misleading Medicare Boast
In a Florida speech about senior citizens, President Donald Trump made misleading comparisons of Medicare costs under his administration and his predecessor’s. Trump claimed “premiums for Medicare health plans went up” under the Obama administration, but his administration “lowered Medicare Advantage premiums” by 34%. He is talking about premiums for Medicare Advantage, a private Medicare option, that most Medicare beneficiaries don’t pay. For those who do pay them, the average national Medicare Advantage monthly premium went up by all of 46 cents under then-President Barack Obama. (Robertson, 10/21)

In other elections news —

Tampa Bay Times: It’s The Pandemic, Stupid: Florida Election Comes Down To COVID-19, Strategists Say
Democrats, buoyed by gains in the 2018 elections, at one point saw the future of Obamacare — with health coverage for millions of Floridians at stake — as a driving issue in this year’s campaigns. But with less than two weeks left before the Nov. 3 general election, Republican and Democratic strategists say the election isn’t about broad policy issues like health care, the environment, gun control or immigration. (Sexton, 10/22)

The Hill: Is There A Nurse In The 'House'? 
During this presidential election year, several nurses have joined the race for public office, vowing to use their expertise to improve the nation’s health. Incumbent Rep. Lauren Underwood (D-Ill.) is working to retain her seat as the youngest Black woman ever elected to the United States Congress. She serves along with long term Rep. Bernice Johnson (D-Texas), who is also running for reelection. They are the only two nurses currently serving in the United States House of Representatives. More nurses across the country hold seats in the House of Representatives or the Senate in their respective states. (Janice Phillips, 10/21)

The Washington Post: Trump Slams Democratic Leaders As Hopes For Pre-Election Stimulus Deal Fizzle 
President Trump accused congressional Democratic leaders Wednesday evening of blocking a new economic relief deal, further narrowing the path for any agreement to emerge ahead of the election. “Just don’t see any way Nancy Pelosi and Cryin’ Chuck Schumer will be willing to do what is right for our great American workers, or our wonderful USA itself, on Stimulus. Their primary focus is BAILING OUT poorly run (and high crime) Democrat cities and states … Should take care of our people,” Trump wrote on Twitter on Wednesday evening. (Werner and Min Kim, 10/21)

The Hill: GOP Coronavirus Bill Blocked As Deal Remains Elusive 
Senate Democrats blocked a scaled-down, GOP-only $500 billion coronavirus bill Wednesday, as talks continue on a bipartisan deal between House Speaker Nancy Pelosi (D-Calif.) and the White House. Senators voted 51-44 to end debate on the Republican proposal, falling short of the 60 needed to overcome the procedural hurdle. (Carney, 10/21)

Politico: Pelosi Suggests Coronavirus Relief Deal Could Slip Past November Elections 
Speaker Nancy Pelosi suggested Wednesday that a deal on a coronavirus relief package may not come together before the Nov. 3 elections. “I’m optimistic, because even with what Mitch McConnell says — we don’t want to do it before the election — but let’s keep working so that we can do it after the election,” she said on MSNBC. (Niedzwiadek, 10/21)

In related news about COVID's economic toll —

The Hill: Nearly 1 Million People Have Run Out Of Unemployment Payments: Analysis 
Nearly 1 million people have exhausted their unemployment benefits since March after losing their jobs to the coronavirus pandemic, according to an analysis published Wednesday by a progressive think tank. The Century Foundation calculated that 933,731 people received their maximum allotment of unemployment insurance payments by Aug. 31, according to Labor Department and Treasury Department data. The number and size of unemployment insurance payments are determined by each state. (Lane, 10/21)

USA Today: Jobs Near Me: Unemployed Workers Find Work In These Fields Amid COVID
Christian Meza, of Pacific, Washington, relished his job as a bartender -- the camaraderie, the glamour, the small pleasures of making an eye-catching drink. Even after the COVID-19 pandemic sidelined him during a monthlong state shutdown last spring and then shriveled his income, he held on, hoping the crisis would ease and business would bounce back. But by July, the 34-year-old realized, “My industry is not going to be the same. I can’t sit here making $25 a shift.” (Davidson, 10/22)

USA Today: COVID Vaccine Is Coming In 'A Matter Of Weeks Or Months,' HHS Says
At least one COVID-19 vaccine should be available as soon as the end of this year, and the general public should be able to get vaccinated by early spring, Health and Human Services Secretary Alex Azar said Wednesday. “There is hope on the way in the form of safe and effective vaccines in a matter of weeks or months,” said Azar, speaking in Atlanta at the U.S. Centers for Disease Control and Prevention. At the rare public briefing, Azar laid out a specific timetable that didn't exactly match what the government has previously said.  (Weintraub, 10/21)

Politico: An Angry Azar Floats Plans To Oust FDA’s Hahn
Infuriated by the FDA’s defiance in a showdown over the Trump administration’s standards for authorizing a coronavirus vaccine, health secretary Alex Azar has spent recent weeks openly plotting the ouster of FDA chief Stephen Hahn. Azar has vented to allies within the Health and Human Services Department about his unhappiness with the top official in charge of the vaccine process, and discussed the prospect of seeking White House permission to remove him, a half-dozen current and former administration officials said.During some of those conversations, he’s gone as far as to float potential replacements for Hahn, said one current and two former administration officials familiar with the talks, identifying HHS testing czar Brett Giroir and a pair of career civil servants – FDA Principal Deputy Commissioner Amy Abernethy and longtime regulator Janet Woodcock – as prime candidates to step in as acting commissioner should Hahn be removed. (Cancryn and Diamond, 10/22)

ABC News: Trump's Operation Warp Speed Adviser Says All Americans Could Be Immunized With COVID Vaccine By June 
Most Americans may have access to a COVID-19 vaccine by early this spring, one which could potentially immunize them by June, according to Operation Warp Speed's chief adviser, Dr. Moncef Slaoui. "It's not a certainty, but the plan -- and I feel pretty confident -- should make it such that by June, everybody could have been immunized in the U.S.," Slaoui told ABC News' Bob Woodruff Wednesday morning. (Salzman and Ordonez, 10/21)

In other COVID vaccine developments —

The Washington Post: Volunteer In Oxford Coronavirus Vaccine Trial Dies, Reportedly Did Not Receive Experimental Vaccine
A Brazilian who participated in the clinical trial of an experimental coronavirus vaccine has died, officials here said Wednesday. Brazil’s National Health Surveillance Agency, which is overseeing multiple vaccine trials in a country suffering one of the world’s worst outbreaks, said the individual volunteered to receive the vaccine candidate developed by Oxford University and produced by AstraZeneca. The Brazilian newspaper O Globo, citing unnamed sources, reported that the volunteer was in a control group that did not receive the experimental vaccine and died of covid-19. The news service G1 said the volunteer was a 28-year-old physician who treated coronavirus patients in Rio de Janeiro. (McCoy, Traiano and Johnson, 10/21)

The Washington Post: Unprecedented Vaccine Trials On Track To Begin Delivering Results 
In a matter of weeks, one of the most closely watched human experiments in history will start to report early results, with data on prospective coronavirus vaccines possibly coming this month or in November from the pharmaceutical giant Pfizer and the biotechnology company Moderna. Amid the turmoil, chaos and misinformation that have defined the U.S. response to the pandemic, progress toward a vaccine, or vaccines, has been steady, reassuring and scientific. Political meddling has so far been largely deflected. Drug companies, working closely with the U.S. government and fueled by an infusion of more than $10 billion of taxpayer money, have developed, tested and scaled up a half-dozen potential vaccines at unprecedented speed. (Johnson, 10/21)

AP: Next Up In Hunt For COVID-19 Vaccine: Testing Shots In Kids
The global hunt for a COVID-19 vaccine for kids is only just beginning — a lagging start that has some U.S. pediatricians worried they may not know if any shots work for young children in time for the next school year. Older adults may be most vulnerable to the coronavirus, but ending the pandemic will require vaccinating children, too. Last week, Pfizer Inc. received permission to test its vaccine in U.S. kids as young as 12, one of only a handful of attempts around the world to start exploring if any experimental shots being pushed for adults also can protect children. (Neergaard, 10/21)

The Hill: State Officials Plead For More Info On Vaccine Distribution Plans 
Governors and state health officials scrambling to develop comprehensive coronavirus vaccine distribution plans are pleading with the Trump administration for more clarity and more funding. State and local officials sent drafts of their plans to the Centers for Disease Control and Prevention (CDC) last week, just 30 days after the administration released its initial COVID-19 vaccination playbook. (Weixel, 10/21)

And the FDA advisory committee meets today —

ABC News: What To Expect From The Official COVID-19 Vaccine Committee 
As the race for an effective COVID-19 vaccine continues, the public will get inside look at one a crucial part of the Food and Drug Administration's decision-making process: the first meeting of its normally obscure advisory committee. Never before has much attention been paid this small group of vaccine experts whose job is to advise the FDA on whether a new vaccine should be green lighted. (Salzman, 10/21)

AP: Regulators, Experts Take Up Thorny Vaccine Study Issues
The U.S. regulators who will decide the fate of COVID-19 vaccines are taking an unusual step: Asking outside scientists if their standards are high enough. The Food and Drug Administration may have to decide by year’s end whether to allow use of the first vaccines against the virus. Thursday, a federal advisory committee pulls back the curtain on that decision process, debating whether the guidelines FDA has set for vaccine developers are rigorous enough. “We will not cut corners, and we will only use science and data to make that determination,” FDA Commissioner Stephen Hahn pledged at a meeting of the Milken Institute Wednesday. (Neergaard and Perrone, 10/22)

Stat: Watching This FDA Hearing Can Help Ease Your Covid-19 Anxieties 
The Covid-19 pandemic has turned obscure regulatory bodies into front-page news. Among these is the Food and Drug Administration’s Vaccine and Related Biological Products Advisory Committee, the group that reviews the safety and effectiveness of vaccine candidates and then makes recommendations to the FDA about whether to authorize and license vaccines. (Nachlis, 10/21)

CNN: How A Covid-19 Origin Theory Backed By Bannon Unraveled 
It was a blockbuster story. A respected Chinese virologist appeared on Tucker Carlson's show on Fox News in mid-September to share the results of her just-completed report. The conclusion: The novel coronavirus that causes Covid-19 was likely engineered in a Chinese lab. On Carlson's show, she claimed it was intentionally released into the world. (Kuznia, Bronstein, Griffin and Devine, 10/21)

AP: US Surgeon General To Plead Not Guilty In Hawaii Virus Case
A lawyer for U.S. Surgeon General Jerome Adams said Wednesday that his client, who is charged with illegally entering a Hawaii public park that was closed because of the coronavirus, will plead not guilty. The criminal complaint against Adams, who was on Oahu in August helping with surge testing amid a spike in coronavirus cases, says he and two other men were looking at the view and taking pictures at Kualoa Regional Park on the island’s northeastern coast. The rural park offers a view of the famed Mokolii island, also known as Chinaman’s Hat for its cone shape. (Jones, 10/21)

News on separated families —

The Washington Post: Hundreds Of Parents Separated From Children At Border In 2017 Still Have Not Been Found 
The ACLU has demanded the names of all separated parents and children and wants to work to confirm all reunifications. The organization, which filed the lawsuit that led to the judge’s order to reunite the families, estimates that as many as 5,400 children have been separated from their families since Trump took office. More than half were split up from May to June in 2018, when DHS and the Justice Department rolled out the administration’s official “zero tolerance” policy to deter a surge of asylum-seeking families at the southern border. The ACLU and others say the effort to locate the still-separated families has been hindered by incomplete government reports as well as conditions on the ground in the children’s native lands, including gang violence, remote villages, and now, the coronavirus pandemic. (Armus and Sacchetti, 10/21)

The New York Times: Parents Of 545 Children Separated At The Border Cannot Be Found
Radio spots are airing throughout Mexico and Central America. Court-appointed researchers are motorbiking through rural hillside communities in Guatemala and showing up at courthouses in Honduras to conduct public record searches. The efforts are part of a wide-ranging campaign to track down parents separated from their children at the U.S. border beginning in 2017 under the Trump administration’s most controversial immigration policy. It is now clear that the parents of 545 of the migrant children still have not been found, according to court documents filed this week in a case challenging the practice. About 60 of the children were under the age of 5 when they were separated, the documents show. (Dickerson, 10/21)

The Washington Post: Trump Administration Considers Labeling Top Humanitarian Groups ‘Anti-Semitic’
The Trump administration is considering labeling some of the most prominent humanitarian organizations in the world, including Amnesty International, Human Rights Watch and Oxfam, as “anti-Semitic,” according to two people familiar with the discussions. A declaration by the State Department could come as early as this week, the individuals said, adding that it might encourage other governments not to support the groups’ work. ... Amnesty International, Human Rights Watch and Oxfam each strenuously denied any accusation of anti-Semitism. “Any insinuation that Oxfam supports anti-Semitism is false, baseless, and offensive,” Noah Gottschalk of Oxfam America said. (Hudson, 10/21)

Stat: As Covid-19 Intensifies, Shortages Of Staple Drugs May Grow Worse
You can add a new worry to the health concerns caused by Covid-19: a sustained shortage of a medicines needed to combat the coronavirus and countless other illnesses. Across the U.S. and Europe, 29 out of 40 drugs used to combat the coronavirus are currently in short supply. And those shortages are expected to grow even worse as the number of Covid-19 cases and hospitalizations surge in the coming winter months, according to a new report by the Center for Infectious Disease Research and Policy at the University of Minnesota. (Silverman, 10/21)

NPR: Promising Antibody Drugs For COVID-19 Would Have To Be Rationed
The Food and Drug Administration is evaluating two potential drugs that could help keep people healthy after they've been infected with the coronavirus. So far, there's no clear system to make sure they would be allocated fairly or how to pay for these expensive drugs over the long haul. "Demand is going to far outstrip supply here," says Rena Conti at Boston University's Questrom School of Business. (Harris, 10/21)

CIDRAP: Report Details COVID-19 Drug Shortages—And Solutions
Researchers lay out not only how the US drug supply chain has been vulnerable for years, but how those vulnerabilities are exacerbated by the COVID-19 pandemic. To transform what the authors call a "fail and fix" approach to a "predict and prevent" paradigm, they offer nine specific recommendations that involve a more coordinated national policy framework to track, identify, mitigate, and prevent drug shortages using a transparent database of drug supply chains. This public database would encompass all prescription drug products in the US market, and analysis of the data would focus on the most critical drugs and the consequences that would likely be experienced if there is a shortage. (McLernon, 10/21)

In related news —

The California Health Report: For Medically Fragile Children, Pandemic-Induced Supply Shortages Continue
Suppliers and parents began reporting shortages — most notably of ventilator circuits — early in the pandemic. Now, they say the problem is ongoing and kids are paying the price. (Boyd-Barrett, 10/21)

Atlanta Journal-Constitution: Study: Mouthwash May ‘Inactivate’ Human Coronaviruses
Some oral antiseptics and mouthwashes might be able to inactivate human coronaviruses, making them possibly useful for reducing the amount of virus in the mouth after infection. This might help to reduce the spread of SARS-CoV-2, the coronavirus that causes COVID-19. A group of physicians and scientists at the Penn State College of Medicine tested a 1% solution of several oral and nasopharyngeal rinses — including baby shampoo, a neti pot, peroxide sore-mouth cleansers and mouthwashes — in a laboratory setting for their ability to inactivate human coronaviruses, which are similar in structure to SARS-CoV-2. (Clanton, 10/21)

The New York Times: No, Mouthwash Will Not Save You From The Coronavirus 
A rash of provocative headlines this week offered a tantalizing idea: that mouthwash can “inactivate” coronaviruses and help curb their spread. ... But outside experts warned against overinterpreting the study’s results, which might not have practical relevance to the new coronavirus that has killed more than 220,000 Americans. Not only did the study not investigate this deadly new virus, but it also did not test whether mouthwash affects how viruses spread from person to person. (Wu, 10/21)

In other research developments —

CIDRAP: COVID-19 Infectious Period Ranges From 10 To 20 Days, Study Finds
A study yesterday in Infection Control & Hospital Epidemiology found that individuals with mild or no COVID-19 symptoms may be infectious for no more than about 10 days, while those with severe illness may be able to spread the virus for as long as 20 days. The infectious periods align with US Centers for Disease Control and Prevention (CDC) recommendations for isolation time. An accurate understanding of the infectious period duration is vital for COVID-19 infection control practices, according to the study authors. The meta-analysis reviewed 77 studies worldwide that evaluated duration of viral shedding as detected via replication through polymerase chain reaction. (10/21)

Reuters: Japan Researchers Show Masks Do Block Coronavirus, But Not Perfectly
Japanese researchers showed that masks can offer protection from airborne coronavirus particles, but even professional-grade coverings can’t eliminate contagion risk entirely. Scientists at the University of Tokyo built a secure chamber with mannequin heads facing each other. One head, fitted with a nebulizer, simulated coughing and expelled actual coronavirus particles. The other mimicked natural breathing, with a collection chamber for viruses coming through the airway. (Swift, 10/22)

Modern Healthcare: Healthcare Workers Could Delay Retirement Over COVID-19 Financial Concerns
On top of the mental and emotional pressures of being a healthcare worker during a global pandemic, caregivers also are feeling financially stressed, according to a new report. The TIAA Institute's 2020 Healthcare Sector Financial Wellness Survey found that the financial condition of 45% of the healthcare workers surveyed had worsened since the COVID-19 pandemic began. And 27% of those workers expected to see their finances get worse in the next year. (Christ, 10/21)

Bloomberg: Doctors Fight ‘Infodemic’ With Americans Seeing Virus As A Hoax
There’s a no shortage of what President Donald Trump might call fake news about the coronavirus floating around social media, with plenty of it coming from his own Twitter account. That’s a problem for a growing number of U.S. doctors. When the virus first hit the U.S., Trump said it would disappear “like a miracle.” He’s since touted unproven therapies, cast doubt on government scientists and denigrated masks. After his own recent bout with Covid-19, he told his audience, “you’re going to beat it,” referring to a disease that’s killed more than 220,000 Americans. (Tozzi, 10/21)

San Francisco Chronicle: Eight Black Workers Sue S.F. Health Department For Racial Discrimination 
San Francisco has been hit with another workplace race discrimination suit, this one by eight Black female employees of the Department of Public Health who said they were wrongly denied training and promotions granted to their co-workers and were subjected to a “hostile working environment.” The suit, filed Tuesday in federal court, quoted the city’s own findings in the latest annual workforce report by the city Department of Human Resources and the Office of Racial Equity: Compared to employees of other races, San Francisco’s African American municipal employees “have lower-paying jobs, are less likely to be promoted, and are disciplined and fired more frequently.” (Egelko, 10/21)

ABC News: Defense Seeks To Dismiss 25 Murder Charges Against Doctor Accused Of Killing Patients 
Defense attorneys for a former Ohio doctor charged with 25 counts of murder for allegedly ordering fatal doses of pain medication for patients are looking to have the charges dismissed. William Husel, a former critical-care physician for Mount Carmel Health in Columbus, was arrested in June and pleaded not guilty to the charges stemming from 2015 to 2018. The criminal investigation began after detectives received information that "numerous patients" had died while being treated by Husel while he was at Mount Carmel Health in December 2018. (Jacobo, 10/21)

In other health industry news —

WBUR: Nation's Largest Eating Disorder Treatment Facility Opens In Dedham Amid Pandemic-Fueled Rise In Cases 
During the pandemic, advocates say more people have struggled with eating disorders like anorexia, bulimia and binge eating. The National Eating Disorders Association says its helpline saw a 94% increase in calls and messages from March through September compared to the same time last year. (Mullins and Joliocoeur, 10/21)

WBUR: For-Profit Nursing Homes' Pleas For Government Money Brings Scrutiny 
Nursing homes have been overwhelmed by the coronavirus. Residents account for more than a quarter of all COVID-19 deaths nationwide. The industry says that facilities have also been overwhelmed by costs, and they're asking for billions in aid from the federal government. But recent studies suggest that for-profit ownership may have endangered residents by skimping on care, while funneling cash to owners and investors. (Jaffe, 10/22)

Modern Healthcare: COVID-19 Surges May Dull For-Profit Hospitals' Q3 Finances
If Tenet Healthcare Corp. is any indication, continued COVID-19 surges may have made the third quarter particularly challenging for investor-owned hospital chains. Florida and Texas, both of which are home to many for-profit hospitals, were major coronavirus hot spots in July and August. Responding to COVID spikes is expensive for hospitals, and the spikes tend to dissuade patients from seeking care for non-COVID issues. Tenet is the only for-profit hospital company that's released its full results for the third quarter, which ended Sept. 30. Two of its peers are scheduled to do so next week. (Bannow, 10/21)

Detroit Free Press: Online Child Exploitation Reports Are Up During The COVID-19 Pandemic
While the world has battled the health and economic effects of the coronavirus, another global issue has raged in tandem with little notice — and without the additional money and resources needed to effectively battle it, experts said. Online child abuse and exploitation, already one of the biggest and growing crime challenges nationally, has spiked as COVID-19 has forced more people indoors with abusers and children spending more time on the internet.  (Racioppi, 10/22)

New Orleans Times-Picayune: Archbishop Aymond Asking All Diocesan Priests Credibly Accused Of Child Sex Abuse To Leave The Clergy Entirely 
In his most aggressive action to date while managing the fallout of an ongoing clerical molestation scandal, New Orleans Archbishop Gregory Aymond is asking all diocesan priests on his list of religious men credibly accused of molesting children to leave the Catholic clergy entirely. (Hammer and Vargas, 10/21)

AP: Advocates File Complaint Over Texas Youth Prison Conditions
Detainees in Texas’ juvenile prisons suffer from frequent physical and sexual abuse, inadequate mental healthcare and high rates of staff turnover, two youth advocacy groups wrote in a federal complaint Wednesday. The rights of the hundreds of youths detained in five secure facilities around the state continue to be violated, despite recent and long-standing efforts at reform, according to Texas Appleseed and Disability Rights Texas. The groups are asking the U.S. Department of Justice to investigate conditions in Texas Juvenile Justice Department lockups, which they say have become harder to monitor because of the coronavirus pandemic. (Bleiberg, 10/21)

In other public health news —

AP: Wanna Go For A Walk? Westminster Dog Show Leaves NYC For '21
The Westminster dog show is set to take a long walk. The nation’s top pooch pageant will be held outdoors at an estate about 25 miles north of Manhattan on June 12-13 because of the pandemic, the Westminster Kennel Club said Wednesday. The shift to the Lyndhurst site along the Hudson River in Tarrytown, New York, will mark the first time in more than 100 years that best in show at Westminster hasn’t been awarded at Madison Square Garden. In 1920, the top prize was presented at Grand Central Palace in New York. (10/22)

Stateline: Tough Fire Season Takes Toll On Firefighters' Mental Health
Being a wildland firefighter has always involved long hours, personal risk and weeks away from home. But this year has been something else: More than 4 million acres burned in California alone. Entire towns were torched in Washington and Oregon. Smoke was so thick the sky turned orange over West Coast cities. Now state and federal officials and mental health experts are bracing for firefighters to come home and start processing what they’ve been through. It’s not uncommon for wildland firefighters, even in a less-intense year, to develop depression, post-traumatic stress disorder, unhealthy substance use or suicidal thoughts. (Quinton, 10/22)

Fox News: Coronavirus Surge In North Dakota Leaves Contact Tracing Up To Residents
North Dakota health officials are asking residents to conduct their own contact tracing if they have tested positive for COVID-19 as a surge in cases of the novel coronavirus has left contact tracers in the state overwhelmed and strapped for resources. There is a backlog in COVID-19 case investigations, according to a post on Twitter from the North Dakota Department of Health (NDDoH) on Monday. (Farber, 10/21)

KHN: Analysis: Winter Is Coming For Bars. Here’s How To Save Them. And Us. 
If we really want to stem the spread of the coronavirus as winter looms and we wait for a vaccine, here’s an idea: The government should pay bars, many restaurants and event venues to close for some months. That may sound radical, but it makes scientific sense and even has a political precedent. We pay farmers not to cultivate some fields (in theory, at least, to protect the environment), so why not compensate owners to shut their indoor venues (to protect public health)? (Rosenthal, 10/22)

CNN: Paul Kruse: Former Blue Bell Creameries CEO Faces Charges In Connection With Alleged Listeria Contamination Coverup 
A Texas grand jury charged Paul Kruse, Blue Bell Creameries' former CEO and president, was charged with wire fraud and conspiracy in connection with an alleged cover-up of the company's 2015 listeria outbreak, the Department of Justice announced on Wednesday. Kruse, who served as the company's CEO and president from 2004 to 2017, was charged with seven counts of wire fraud and conspiracy for an alleged scheme to cover up what the company knew about the listeria contamination in Blue Bell products, according to the Department of Justice. (Goodwin, 10/22)

Boston Globe: ‘Missing A Year Affects Us A Lot’: Families Respond With Anguish After Boston Public Schools Cancel In-Person Learning 
After another jump in Boston’s coronavirus positivity rate, the city’s public school district said it has canceled in-person instruction for thousands of high-needs students — the only group to return to school buildings so far this fall — starting Thursday. The cancellation affects about 2,600 students, including those with disabilities, students still learning English, and children living in foster care, who had resumed in-person instruction part time at the start of October. (Gans, 10/21)

The New York Times: As Schools Across The U.S. Move To Reopen Doors, Boston Does An About-Face
One moment Boston parents were looking forward to school doors reopening sooner or later for kindergartners and pre-kindergarteners. The next they were learning that those few students who had already been allowed back in person were being sent back home. “I am heartbroken that today we have to close our doors to our highest-need students,” Boston’s schools superintendent, Brenda Cassellius, said Wednesday. (10/22)

In other school news —

KQED: What The Research Says About School Reopening And COVID-19 Transmission
Despite widespread concerns, two new international studies show no consistent relationship between in-person K-12 schooling and the spread of the coronavirus. And a third study from the United States shows no elevated risk to childcare workers who stayed on the job. Combined with anecdotal reports from a number of U.S. states where schools are open, as well as a crowdsourced dashboard of around 2,000 U.S. schools, some medical experts are saying it's time to shift the discussion from the risks of opening K-12 schools to the risks of keeping them closed. (Kamenetz, 10/21)

The Washington Post: Amid Wisconsin Coronavirus Outbreak, Researchers Explore Link Between College Cases, Nursing Home Deaths 
Mayor Tim Kabat was already on edge as thousands of students returned to La Crosse, Wis., to resume classes this fall at the city’s three colleges. When he saw young people packing downtown bars and restaurants in September, crowded closely and often unmasked, the longtime mayor’s worry turned to dread. Now, more than a month later, La Crosse has endured a devastating spike in coronavirus cases — a wildfire of infection that first appeared predominantly in the student-age population, spread throughout the community and ultimately ravaged elderly residents who had previously managed to avoid the worst of the pandemic. (Eilperin, Dennis and Mooney, 10/21)

Los Angeles Times: California Homeless Student Numbers Surge Past 269,000
There were at least 269,000 K-12 students in California experiencing homelessness at the end of the 2018-19 school year — enough children and teens to fill Dodgers Stadium five times over — and that number was likely a gross underestimate, a UCLA report said. (Newberry, 10/21)

The Washington Post: U Of Michigan Hit With Emergency Stay-At-Home Order Amid Coronavirus Spike. But The Football Team Will Play On.
As health officials in Washtenaw County, Mich., recorded hundreds of new coronavirus cases in recent weeks, they found a common thread: the University of Michigan campus, where officials have blamed the rising infections on students ignoring coronavirus restrictions. On Tuesday, local health authorities issued an emergency stay-at-home order for the campus in Ann Arbor, Mich. ... Athletics, though, are exempt — meaning that the Wolverines’ football team will keep preparing for a road game in Minnesota on Saturday and an Oct. 31 home opener against rival Michigan State University. (Elfrink, 10/21)

The Washington Post: Fresno City College Professor Told Student She Can’t Breastfeed During Virtual Class 
One month into the semester, Marcella Mares got an email from her professor at Fresno City College. It said that going forward, cameras and microphones would have to be turned on for her virtual statistics class. Mares knew that would be a difficult adjustment with her then-10-month-old baby at home with her during the pandemic. “I emailed him back privately and I had told him that I didn’t have a problem with turning on my camera and microphone, but I would need to turn it off if I needed to feed my baby,” Mares said of the Sept. 23 incident. His email reply, she says, shocked her: It said she shouldn’t breastfeed during class and should instead wait until after the four-hour instruction is over. (Youn, 10/21)

AP: 2 Dead From COVID-19 Cases Tied To N Carolina Church Event
A COVID-19 outbreak linked to a multi-day church event in North Carolina has left at least two people dead, health officials said Wednesday. Mecklenburg County authorities said there are now 68 cases since the local health department initially reported the outbreak on Saturday, The Charlotte Observer reported. That was one week after the conclusion of the Oct. 4-11 event at the United House of Prayer for All People in Charlotte. The county said at least four people have been hospitalized. (10/21)

In news from New Jersey and New York —

Politico: Murphy Begins Self-Quarantine After Senior Staffer Tests Positive For Covid
New Jersey Gov. Phil Murphy abruptly left a press event in Camden County on Wednesday minutes after learning that one of his senior staffers had tested positive for the coronavirus. Though Murphy has tested negative for the virus, he and First Lady Tammy Murphy will quarantine until the end of the weekend, Communications Director Mahen Gunaratna said in a statement. (Landergan and Sutton, 10/21)

The New York Times: Is A Second Wave Starting? New Yorkers Are Steeling Themselves 
A father of three in Brooklyn is back to stockpiling medicine and rubbing alcohol. A publicist has put her plan to return to her office in Manhattan on hold indefinitely. And a mother in Central Park has again — and again — delayed taking her 15-month-old daughter back to the toddler music classes she loved. “Big groups of kids, we’re not doing any of that,” said the mother, Aneya Farrell, 34. “She hasn’t seen a lot of babies over the past six months.” (Wilson, 10/21)

The New York Times: Cuomo Lifts Some Lockdown Rules In N.Y.C. Hot Spots As Rates Drop
Gov. Andrew M. Cuomo announced on Wednesday that some lockdowns in New York City neighborhoods with rising coronavirus cases would be eased, allowing the reopening of schools and businesses that had been shuttered. But stringent restrictions remained in place for other neighborhoods at the heart of the outbreaks in Brooklyn, as well as for several communities in Rockland and Orange Counties. Another neighborhood, Ozone Park in Queens, was added to the list requiring limitations on activity. (McKinley and Goodman, 10/21)

In news from Kentucky and California —

Lexington Herald Leader: COVID-19 Impacts Have Killed Up To 3,073 In KY, Experts Say 
COVID-19 may have killed – directly or indirectly – as many as 3,073 people in Kentucky, according to the Centers for Disease Control and Prevention.The CDC has estimated that anywhere from 1,249 to 3,073 “excess deaths” have occurred in Kentucky as a result of the coronavirus pandemic. The CDC’s estimate includes the 1,363 COVID-19 deaths which have been reported by Gov. Andy Beshear and the state Department for Public Health. But the CDC’s estimate, which lags real counts in the states by several weeks, also includes additional deaths that would not have happened if it weren’t for the pandemic. (Chisenhall, 10/21)

Sacramento Bee: Many Californians Would Delay Getting COVID-19 Vaccine 
Even as the world anxiously awaits a vaccine to end the COVID-19 pandemic, 40% of Californians remain unconvinced they would get immunized if a shot was available today, a new survey released Wednesday found. One-in-five Californians said they would “probably not” and another 20% said they would “definitely not” get the COVID-19 vaccine, according to a Public Policy Institute of California survey of 1,701 adult residents. (Wiley, 10/21)

KHN: Californians Asked To Pony Up For Stem Cell Research — Again 
In an election year dominated by a chaotic presidential race and splashy statewide ballot initiative campaigns, Californians are being asked to weigh in on the value of stem cell research — again. Proposition 14 would authorize the state to borrow $5.5 billion to keep financing the California Institute for Regenerative Medicine (CIRM), currently the second-largest funder of stem cell research in the world. Factoring in interest payments, the measure could cost the state roughly $7.8 billion over about 30 years, according to an estimate from the nonpartisan state Legislative Analyst’s Office. (Bluth, 10/22)

AP: Brazil's Bolsonaro Rejects Coronavirus Vaccine From China
Brazilian President Jair Bolsonaro on Wednesday rejected the announced purchase of 46 million doses of a potential vaccine against the coronavirus being developed by a Chinese company and tested in a state governed by a political rival, prompting some to question if he was allowing politics to steer public health decisions. “The Brazilian people will not be anyone’s guinea pig,” Bolsonaro said on his social media channels, adding that the vaccine has not yet completed testing, which is the case with all potential vaccines for the virus. “My decision is to not purchase such a vaccine.” (Savarese, 10/21)

The Wall Street Journal: As Covid-19 Cases Rise Across Europe, Hospitals Are Rushing To Prepare For Winter 
Europe’s second wave of the coronavirus pandemic is reviving the pressure on hospitals in the worst-hit cities, and forcing health-care systems around the continent to devise contingency plans that draw on the lessons of this spring’s deadly first wave. Hospitals in Paris are stockpiling drugs and protective equipment to avoid a repeat of shortfalls that plagued them earlier this year. Hospitals across Spain have drawn up “elasticity plans” to increase the number of beds for Covid-19 patients as cases multiply. In Lombardy, the northern Italian region where Europe’s outbreak began in early 2020, the health-care system is preparing to move patients to where there is space for them, to prevent intensive-care units from being overwhelmed as happened in coronavirus hot spots this spring. (Bisserbe, Sylvers and Martinez, 10/21)

Reuters: South Korea Sticks To Flu Vaccine Plan Despite Safety Fears After 13 Deaths 
South Korean officials refused on Thursday to suspend a seasonal influenza inoculation effort, despite growing calls for a halt, including an appeal from a key group of doctors, after the deaths of at least 13 of those vaccinated. Health authorities said they found no direct links between the deaths and the vaccines. (Shin and Cha, 10/21)

AP: Pope Reverts To Mask-Less Old Ways Amid Growing Criticism
A day after donning a face mask for the first time during a liturgical service, Pope Francis was back to his mask-less old ways Wednesday despite surging coronavirus infections across Europe and growing criticism of his behavior and the example he is setting. Francis shunned a face mask again during his Wednesday general audience in the Vatican auditorium, and didn’t wear one when he greeted a half-dozen mask-less bishops at the end. He shook hands and leaned in to chat privately with each one. While the clerics wore masks while seated during the audience, all but one took his mask off to speak to the pope. Only one kept it on, and by the end of his tete-a-tete with Francis, had lowered it under his chin. (Winfield, 10/21)

AP: Czechs Enter 2nd Lockdown To Avoid Health System Collapse
Czechs had been assured it wouldn’t happen again. But amid a record surge of coronavirus infections that’s threatening the entire health system with collapse, the Czech Republic is adopting on Thursday exactly the same massive restrictions it slapped on citizens in the spring. Prime Minister Andrej Babis had repeatedly said these measures would never return. “We have no time to wait,” Babis explained Wednesday. “The surge is enormous.” (Janicek, 10/22)

CIDRAP: Kidney Disease Tied To High Death Rates In COVID Patients 
COVID-19 patients who have chronic kidney disease (CKD) or develop coronavirus-related kidney injury in the intensive care unit (ICU) face higher odds of death than their otherwise-healthy peers, according to a study published late last week in Anaesthesia. Led by researchers at Imperial College London, the retrospective study involved 372 adult COVID-19 patients in four ICUs in the United Kingdom from Mar 10 to Jul 31. Of the 372 patients, 216 (58%) had kidney impairment, 22% of which was CKD (48 patients) and 78% of which developed during hospitalization (168 patients). (Van Beusekom, 10/19)

PLOS One: Continuous Positive Airway Pressure (CPAP) Face-Mask Ventilation Is An Easy And Cheap Option To Manage A Massive Influx Of Patients Presenting Acute Respiratory Failure During The SARS-CoV-2 Outbreak: A Retrospective Cohort Study
Because of the COVID-19 pandemic, intensive care units (ICU) can be overwhelmed by the number of hypoxemic patients. This single centre retrospective observational cohort study took place in a French hospital where the number of patients exceeded the ICU capacity despite an increase from 18 to 32 beds. Because of this, 59 (37%) of the 159 patients requiring ICU care were referred to other hospitals. From 27th March to 23rd April, consecutive patients who had respiratory failure or were unable to maintain an SpO2 > 90%, despite receiving 10–15 l/min of oxygen with a non-rebreather mask, were treated by continuous positive airway pressure (CPAP) unless the ICU physician judged that immediate intubation was indicated. We describe the characteristics, clinical course, and outcomes of these patients. The main outcome under study was CPAP discontinuation. (Alviset et al, 10/14)

PLOS One: Association Between COVID-19 Prognosis And Disease Presentation, Comorbidities And Chronic Treatment Of Hospitalized Patients
The objective of this study was to analyze the relationship between the prognosis of COVID-19 and the form of presentation of the disease, the previous pathologies of patients and their chronic treatments. (Rodriguez-Molinero et al, 10/15)

PLOS One: Physiological And Socioeconomic Characteristics Predict COVID-19 Mortality And Resource Utilization In Brazil
Given the severity and scope of the current COVID-19 pandemic, it is critical to determine predictive features of COVID-19 mortality and medical resource usage to effectively inform health, risk-based physical distancing, and work accommodation policies. Non-clinical sociodemographic features are important explanatory variables of COVID-19 outcomes, revealing existing disparities in large health care systems. (Wollenstein-Betch et al, 10/14)

CIDRAP: Trial Finds No Significant COVID Effect Of Pre-Exposure Hydroxychloroquine
A randomized, controlled clinical trial involving high-risk healthcare workers found that pre-exposure prophylaxis with hydroxychloroquine once or twice weekly did not significantly reduce COVID-19 compared with placebo, researchers reported late last week in Clinical Infectious Diseases. The randomized, double-blind trial, led by researchers with the University of Minnesota, enrolled 1,483 healthcare workers in the United States and Manitoba from Apr 6 to May 26. Participants were assigned in a 2:2:1:1 ratio to receive 400 milligrams of hydroxychloroquine once weekly or twice weekly for 12 weeks or placebo prescribed in a matched fashion. High-risk healthcare workers were defined as working in an emergency department or intensive care unit, on a dedicated COVID-19 ward, or as a first responder. Overall, 79% of the healthcare workers reported performing aerosol-generating procedures. (10/19)

PLOS One: Residual Clinical Damage After COVID-19: A Retrospective And Prospective Observational Cohort Study
Data on residual clinical damage after Coronavirus disease-2019 (COVID-19) are lacking. The aims of this study were to investigate whether COVID-19 leaves behind residual dysfunction, and identify patients who might benefit from post-discharge monitoring. (De Lorenzo et al, 10/14)

ScienceDirect: Engineered T Cells Directed At Tumors With Defined Allelic Loss 
We describe an approach to cancer therapy based on exploitation of common losses of genetic material in tumor cells (loss of heterozygosity) (Basilion et al., 1999; Beroukhim et al., 2010). This therapeutic concept addresses the fundamental problem of discrimination between tumor and normal cells and can be applied in principle to the large majority of tumors. It utilizes modular activator/blocker elements that integrate signals related to the presence and absence of ligands displayed on the cell surface (Fedorov et al., 2013). We show that the targeting system works robustly in vitro and in a mouse cancer model where absence of the HLA-A*02 allele releases a brake on engineered T cells activated by the CD19 surface antigen. This therapeutic approach potentially opens a route toward a large, new source of cancer targets. (Hamburger et al, 10/1)

New England Journal of Medicine: Redoubling Efforts To Help Americans Quit Smoking — Federal Initiatives To Tackle The Country’s Longest-Running Epidemic
The 2020 U.S. Surgeon General’s report on smoking cessation1 is the first such report to focus on this topic since 1990. Its release came as the Department of Health and Human Services was investigating an outbreak of deadly lung injuries linked to the use of e-cigarette, or vaping, products. Although these products pose a new public health challenge, we cannot lose sight of the fact that the burden of death and disease associated with tobacco use in the United States is still overwhelmingly caused by combusted tobacco products, especially conventional cigarettes. The rate of cigarette smoking among U.S. adults is 13.7%, its lowest point since monitoring of smoking rates began in 1965, yet smoking remains the country’s leading preventable cause of death and disease, and it costs the United States more than $300 billion annually. Increasing smoking-cessation rates among adults is the fastest way to reduce this health and economic burden. As leaders of three of the federal agencies responsible for reducing tobacco-product use, we are committed to intensifying our efforts to help Americans quit smoking. (Robert R. Redfield, Stephen M. Hahn, and Norman E. Sharpless, 10/21)

Los Angeles Times: OxyContin Settlement No Fix For Harm Purdue Pharma Has Caused
The prescription opioid crisis that has taken well over 100,000 American lives and ruined hundreds of thousands more wasn’t just an accident of time or the byproduct of a dysfunctional society. It was in good part the deliberate result of unethical and occasionally illegal machinations by the pharmaceutical industry, particularly by Purdue Pharma, which paid kickbacks and willfully misled physicians and the public to boost sales of its addictive signature drug, OxyContin. The company has now pleaded guilty to criminal charges in a federal settlement that doesn’t even begin to make up for the harm Purdue has caused. It takes back hardly any of the billions the company has made while addicting a nation. In fact, despite Purdue’s admission of guilt and a settlement purportedly worth $8.3 billion, the agreement is a whole lot less than it seems. (10/22)

Dallas Morning News: New Rules For Texas Social Workers Allow Discrimination And Imperil Those In Need
The Texas State Board of Social Worker Examiners recently changed its Code of Conduct to no longer prohibit social workers from turning away clients on the basis of disability, sexual orientation or gender identity. This new rule is not only inhumane but also contradicts what social work professionals stand for. As social workers, we have a responsibility to serve everyone in need and to uphold the dignity of all. It is not often that the deans of a leading school of social work in Texas object publicly to a decision made by a state licensing board. But this decision warrants it. This decision threatens the practice of licensed professional social workers and the many Texans they are dedicated to serving. This is a moment that calls for us — and all Texans — to speak out. (Luis H. Zayas and Allan Hugh Cole Jr., 10/22)

Los Angeles Times: Why The Pope's Words About Civil Unions For Gay Couples Matter 
No sooner had it been reported that Pope Francis had endorsed civil unions for same-sex couples that Vatican-watchers started arguing about whether this was a big deal. The answer is yes, but not because it’s a sign that the Roman Catholic Church will change its mind about same-sex marriage or renounce its teaching that “man and woman were created for one another.” Catholics and others who see the pope’s comments as a harbinger of such a dramatic change in doctrine will be disappointed. (Michael McDough, 10/21)

Stat: It's Time To Map Medicine's Sexual And Gender Harassment Iceberg 
Gender harassment happens every day in health care organizations, academic medicine, research labs, and other corners of the science, technology, engineering, and math worlds. It’s largely hidden — except to those experiencing it — unlike its more egregious counterpart, sexual harassment, which often makes headlines. (Holly G. Atkinson, Anu Anandaraja and Stella Safo, 10/21)

Stat: Children And Families Need Resources To Address Trauma At Its Roots 
Like many nations across the globe, the U.S. continues to combat the devastation of the coronavirus pandemic. The Trump administration’s deficient response has elevated the emotional, physical, and economic harm suffered by families in America. As we move through this moment of collective trauma, we must adopt focused, evidence-based approaches to make our country whole again and ensure that these approaches prioritize a precious responsibility — our children’s future. (Ayanna Pressley and Carolyn B. Maloney, 10/21)

The Wall Street Journal: I Should Have Worn A Mask
For seven months I was very careful about mask wearing, social distancing and hand washing. As someone with asthma, I knew I faced heightened risk. Then, at the Rose Garden nomination event for Judge Amy Coney Barrett, and during debate preparations with President Trump, I let my guard down and left my mask off. I mistook the bubble of security around the president for a viral safe zone. I was wrong. There is no safe zone from this virus. (Gov. Chris Christie, 10/21)

The New York Times: America And The Coronavirus: ‘A Colossal Failure Of Leadership’
One of the most lethal leadership failures in modern times unfolded in South Africa in the early 2000s as AIDS spread there under President Thabo Mbeki. Mbeki scorned science, embraced conspiracy theories, dithered as the disease spread and rejected lifesaving treatments. His denialism cost about 330,000 lives, a Harvard study found. None of us who wrote scathingly about that debacle ever dreamed that something similar might unfold in the United States. But today, health experts regularly cite President Trump as an American Mbeki. (Nicholas Kristof, 10/22)

The Washington Post: Suicide Rates During The Pandemic Remained Unchanged. Here’s What We Can Learn From That.
In late March, right as the crest of the first wave of the novel coronavirus approached, President Trump was pushing to reopen the economy. There would be “suicide by the thousands” within weeks if businesses stayed closed and people were out of work, he argued.The notion that economic shutdowns themselves could pose a greater threat to the health and safety of communities than the uncontrolled spread of a disease that has now killed more than 1 million people worldwide was and remains an important idea to consider.But asserting a fact doesn’t make it true. (Jeremy Samuel Faust, 10/21)

Stat: Hefty Price Tag For Remdesivir Ignores NIH Investment In Its Creation
Throughout the Democratic presidential primary, candidates cast a spotlight on the broken U.S. health care system and the high cost of prescription medicines. Bernie Sanders presented a sweeping plan that would allow the government to negotiate lower drug prices with pharmaceutical companies. Elizabeth Warren pledged to lower the price of several “critical public health drugs,” including insulin. An Andrew Yang campaign ad focused on high drug prices, suggesting taxpayers may be paying twice for medicines, an argument drawn from research I did with several colleagues. (Ekaterina Cleary, 10/22)

CNN: Anti-Vaxxers Use Century-Old Arguments In Covid-19 Pandemic
As we get closer to an effective vaccine for Covid-19, we should expect to see a renewed push of disinformation and vocal resistance from the anti-vaccination movement. Over the past year, seemingly endless conspiracy theories and misinformation campaigns have gained traction online amid rising Covid-19 infection rates worldwide. (Paula Larsson, 10/22)

Houston Chronicle: Death And Childcare — More Men Die But More Women Lose Work From COVID-19 
COVID-19 has changed all our lives, but not equally for men and women. Two of the many differences fall in the areas of mortality and child care. Men in Harris County have died of COVID-19 in numbers 50 percent higher than women, per death certificates, though infection rates run parallel. By early October, we saw 1,161 male and 749 female reported COVID-19 deaths here, not including undiagnosed cases, and men are hospitalized at higher rates. (Elizabeth Gregory, 10/22)