ABC - Health News

Bill Oxford/iStockBy LAURA ROMERO, ABC News

(NEW YORK) -- As the COVID-19 vaccine rollout reaches residents of nursing homes across the country, long-term care advocates remain concerned that many of the nation's most vulnerable citizens -- who are living in similar, high-risk congregate settings -- are being left to wait.

Assisted living facilities, which range from small homes to large complexes, are aimed at older people who are largely independent but still in need of medical or personal care. Because of the communal nature of the facilities, assisted living residents face many of the same increased risks for the coronavirus as those in nursing homes.

"The risk of community spread and transmission in an assisted living facility is just as high as it is in a nursing home," said Zach Shamberg, president of the Pennsylvania Health Care Association.

It is difficult to know the extent to which residents and staff in assisted living facilities have been affected by COVID-19 because assisted living facilities are not federally regulated, so many states do not publicly collect data. But the Kaiser Family Foundation reports that more than 100,000 residents and staff at long-term care facilities had died as of November.

Advocates say the facilities house a forgotten population of people vulnerable to the virus. As COVID-19 vaccine distribution plans were crafted and began rolling out, many states did not include assisted living facilities in the same high-priority first phase to receive the vaccine.

In Pennsylvania, for instance, assisted living and personal care residents were not originally in the first group to receive the vaccine, leaving those residents to wait up to several months to get the vaccine. Just last week, Pennsylvania Gov. Tom Wolf announced his administration is expanding vaccination to long-term care facilities, and requested assisted living residents and personal care residents be included in Phase 1A.

"If we don't change the pace that Pennsylvania is on currently, we would expect assisted living and personal care residents to receive the second dose sometime in April or May or even June," Shamberg said. "We are talking about potentially still vaccinating our most vulnerable residents in the summer months."

Mike Dark, an attorney for the California Advocates for Nursing Home Reform and a member of the California Vaccine Advisory Committee, told ABC News that assisted living facilities were not prioritized because states believed they only had enough vaccines for nursing homes.

"[Assisted living] facilities are largely falling through the cracks in the distribution program and the results will be catastrophic if this isn't addressed," Dark said.

In New Hampshire, Phase 1A includes both nursing homes and assisted living residents. But officials like Brendan Williams, the president of the New Hampshire Healthcare Association, told ABC News that it has been difficult to get all long-term care residents vaccinated, even in retirement communities where assisted living and nursing home residents are in the same location.

"Even where assisted living and nursing home residents are housed under the same roof, it has taken browbeating CVS to get them to follow the state policy that in such an instance all residents should be vaccinated," Williams said.

"We can't even efficiently vaccinate our most vulnerable, place-bound citizens," added Williams. "We have a very elderly assisted living population here in New Hampshire that has not been spared deadly outbreaks."

In Indiana, a spokesperson for the Indiana Health Care Association told ABC News that independent assisted living facilities are "understandably frustrated" because scheduling for the clinics began just two weeks ago.

The overall timeline for vaccine distribution in long-term care facilities has been pushed back since late last year, when former Secretary Alex Azar told CBS' Face The Nation that all nursing home residents could be vaccinated by Christmas.

"The vaccines are going out. As soon as they receive vaccine, this is according to the governors telling us to ship to them, we can have every nursing home patient vaccinated in the United States by Christmas," Azar said.

Then, on a call with LeadingAge, an elder advocacy group, former Surgeon General Jerome Adams said he believed vaccinations among nursing home residents and workers would be completed by the end of January.

"We're going to make sure we get our nursing home workers and residents vaccinated, and it is truly our hope to have that completed by the end of January," said Adams, adding, "I really think it is an achievable timeline."

Both Walgreens and CVS, the companies responsible for vaccinating the majority of long-term care residents, say they expect to complete the administration of the first doses of COVID-19 vaccines in skilled nursing facilities by Jan. 25, with the second doses to follow.

There is no projected date for when residents and staff at assisted living facilities will be completely vaccinated.

For Mike Wasserman, the past president of the California Association for Long Term Care Medicine and a member of the California's Vaccine Advisory Committee, vaccine rollout in assisted living facilities needs to be a priority for the Biden administration.

"The challenge will be, how do we turn the Titanic around?" Wasserman said.

Many assisted living facilities in California, Wasserman said, don't have an appointment to receive the vaccine until March.

"They are not being prioritized," said Wasserman. "Residents in assisted living facilities need the vaccine just as much as nursing home residents."

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Rattankun Thongbun/iStockBy DR. SEAN LLEWELLYN, ABC News

(NEW YORK) -- In recent months, new variants of the virus that causes COVID-19 have been popping up all over the world, and experts say even more will continue to be identified as this pandemic continues. In the United States, variants have been found in California and the Midwest in recent weeks, and last month, new variants from the U.K., South Africa and Brazil were identified.

All viruses naturally gain mutations, so these variants "are normal and expected," said Dr. Richard Kuhn, director of the Purdue Institute of Inflammation, Immunology and Infectious Disease and editor-in-chief of the journal Virology. For now, there's no evidence any of these new variants are more deadly or that existing vaccines won't work.

However, there is strong evidence that two of the variants -- those that were first identified in the U.K. and South Africa -- are more transmissible. Now, scientists are racing to understand exactly what it is about these two variants that makes them easier to jump from person to person, and whether we should be worried that other variants might do the same.

Although it's still unknown exactly what leads the virus to being more transmissible, there are many theories, and several of the leading theories have to do with how effectively the virus leaves your body in its search for another.

Increased virus shedding

When you cough, sneeze, talk or sing, little droplets of mucus and saliva go into the air. If you are infected with COVID-19, these droplets will contain the coronavirus. If you are infected with a variant that increases transmission, there could be more virus in each of these droplets.

“People who are infected with the variant could be shedding more [virus],” said Dr. Angela Rasmussen, a virologist and associate research scientist at the Center for Infection and Immunity at Columbia University's School of Public Health.

According to Rasmussen, preliminary data from the U.K. suggests people infected with the new variant tended to have higher viral loads -- meaning they had more volume of virus in their noses, which could be measured using a nasal swab.

With more virus in the respiratory droplets, it could be easier to get an infection if a droplet lands in your eyes, mouth or nose.

Prolonged virus shedding

In a related theory, scientists are investigating whether the new variant might somehow lengthen the number of days an infected person is contagious.

Right now, there is good evidence to show that when someone becomes infected with COVID-19, they typically shed virus for about 10 days. That's why the CDC asks people to isolate for 10 days after a positive test.

But if these variant viruses mutate to prolong this period, “they are shedding virus sooner and transmitting later, increasing the number of days [of being contagious],” Rasmussen said.

That could cause others to be infected, because you might not be quarantining when you should be and therefore exposing others unknowingly.

Increased environmental stability

Yet another idea is that the virus might have evolved to be sturdier and better able to withstand the harsh environment outside the human body.

Many viruses, including rhinovirus -- one of the culprits of the common cold -- and influenza can have alterations in their protective outer coat in cold, dry weather, making them more stable in the environment. This allows them to hang out in the air or on surfaces for longer periods of time and remain infectious, making transmission from person to person easier.

There currently is no evidence that the COVID-19 variants are more stable in the environment, as those studies have not been performed. But many other coronaviruses -- also culprits of the common cold -- have been shown to be more stable in cold, dry weather. If these variants are more stable than before, it would increase their ability to transmit.

Better able to "stick" to cells

One of the leading theories that has the most evidence behind it is the idea that the new, more transmissible COVID-19 variants are simply better at latching onto our cells.

Many scientists feel confident about this theory, because the mutations they found in the U.K. and South African variants are in those little "spikes" on the outside of the virus. The virus uses those spikes to bind to a specific site on our cells called the ACE2 receptor.

Most of the mutations “have predominantly been at the interface where the virus meets the cell receptor,” Kuhn said. "The mutations make the virus bind more efficiently to the [ACE2] receptor, resulting in great infections ... [enhancing] the spread.”

Think of the ACE2 receptor and the COVID-19 virus as a lock and key, respectively, to get into the cell. If the virus mutates to become a better fit for the lock, it will be easier to get in and infect the cell, and it will be able to infect more cells. This means that if you are exposed to a variant of COVID-19, you are more likely to get infected, because it will be easier for the virus to get into your cells.

Scientists say none of these four theories are a slam dunk, but the increased ability to "stick" to cells is the most likely culprit, given the mutations in the binding site of the spike protein. However, it could be any one of these theories, and it could be a combination of them.

There are still many questions regarding the COVID-19 variants and what they mean in the course of the pandemic, but scientists are working every day to learn about them. Each time a new variant is discovered, researchers will need to characterize the variant to understand what the mutations do and how they could alter the course of the pandemic. Researchers in the U.S. continue to recommend that everyone remain calm and wait to see what the research shows, because people might be worrying for no reason.

And they stress that the known safeguards -- physical distance and a simple face covering -- will still work to protect you.

"A mutation, no matter what, is not something that confers magical powers to the virus," Rasmussen said. "It can’t suddenly get through a physical barrier like a mask."

That means the best way to protect yourself and others from getting COVID-19 is to wear a mask, social distance and wash your hands often.

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Goodboy Picture Company/iStockBy DR. ALEXIS E. CARRINGTON, ABC News

(NEW YORK) -- Dementia and Alzheimer's disease may not be an inevitable part of aging, according to a recent Dutch study, which identified 100-year-olds with high cognitive performance despite risk factors for decline.

This six-year study of centenarians -- people who are over 100 years old -- found that despite high levels of a brain marker associated with cognitive decline, called amyloid beta, these centenarians were still sharp and performed well on cognitive tests. The researchers concluded these elderly subjects may have resilience mechanisms protecting them from memory loss.

In fact, they said the risk of dementia may not necessarily increase once you pass your 100th birthday.

"A person between 70 and 95 years old is exposed to the same dementia risk as a person who lives between age 100 and 102," said Henne Holstege, Ph.D., of Amsterdam University Medical College in the Netherlands, who was involved in the study.

These results provide a hopeful glimmer to some that although dementia and Alzheimer's is more likely to occur with an increase in age, it won't be everyone's fate.

"Age is the No. 1 risk factor for Alzheimer's, but these findings show us that it's possible for centenarians to thrive despite their advanced age," said Dr. Richard Isaacson, director of the Alzheimer's Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian Hospital, who headed the study.

Although these findings shed light on aging and cognitive function, it still remains a complex phenomenon that needs more exploration, according to some experts.

"Dementia and Alzheimer's tend to be multifactorial conditions, meaning that a mix of genetics, age, environment, lifestyle behaviors and medical conditions that coexist together and can lead a person toward or away from cognitive decline," said Isaacson.

Researchers still aren't sure exactly why some people are protected from cognitive decline, while others are spared. The researchers in the study proposed some of these protective factors associated with cognitive performance could be education, frequent cognitive activity and even IQ. But there can be more at play.

"There could be protective immunologic and cardiovascular risk factors that help keep their brains resilient and cognitively functional even in old age," said Dr. Gayatri Devi, a neurologist and psychiatrist at Lenox Hill Hospital in New York City.

The role the brain markers analyzed in the study play on memory, including a sticky plaque called amyloid beta typically found in the brains of people with Alzheimer's, is now hotly debated among experts. The varying presence of these markers in this study further contribute to this complicated process.

"It's important to understand that the presence of amyloid in the brain does not definitively mean a person will develop dementia," said Isaacson. "There are other factors and lifestyle behaviors that can make us resilient and resistant to cognitive decline."

Importantly, there are some caveats to this study. For instance, the brain markers were only analyzed in 44 of the participants, so the findings may not apply to everyone, and more research needs to be done to learn about the complexity of aging.

Other studies have investigated prevention of cognitive decline. According to the 2020 Lancet Commission Report, 40% of dementia cases may be preventable based on modifiable risk factors. Some of these previous studies have had success in improving cognitive function and reducing risk.

A study by Isaacson's team at the Alzheimer's Prevention Clinic found it was possible to improve cognitive function and reduce risk, especially in those who followed suggestions on lifestyle modification, such as exercise, nutrition, vascular risk and medications.

Even though more is being discovered and debated, experts still recommend maintaining a healthy lifestyle, including balanced eating, exercising and doctor visits, to maintain cognition during aging.

"It's essential for people at risk to see their doctors on a regular basis and consider cognitive screening tests," said Isaacson.

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MarsBars/iStockBy MEREDITH DELISO, ABC News

(NEW YORK) -- Appointments are being canceled, sites are temporarily closing, county waitlists are in the thousands and states are adjusting eligibility timelines as vaccines supplies dwindle nationwide.

With shipments coming weekly, officials say they don't have much visibility on their supplies as they simultaneously schedule first and second doses, and plan to expand vaccination sites.

"There's a lot of uncertainty right now," Dr. Amesh Adalja, a senior scholar with Johns Hopkins Center for Health Security, told ABC News. "Everybody knows that the supply chain will be coming, but nobody knows exactly when it is coming, how much of it is coming and how steady the supply chain will be. That makes it harder to plan."

With its current supply on track to be depleted by the end of this week, and a shipment of over 100,000 Moderna vaccines delayed, the New York City health department will close 15 vaccination hubs from Thursday through Sunday, officials said.

"This is crazy," Mayor Bill de Blasio said during a media briefing this week. "This is not the way it should be. We have the ability to vaccinate a huge number of people. We need the vaccine to go with it."

Some 23,000 people expecting to receive their first dose will need to reschedule, de Blasio said Wednesday.

New York City isn't alone. San Francisco Mayor London Breed said Tuesday that the city is projected to run out of vaccines by Thursday if more don't arrive.

"We simply need more vaccines," said Breed, noting that the city had set up a new dashboard to track vaccine allotment.

As Collin County, Texas, waits for more shipments, more than 144,000 people are currently on its vaccination waitlist. Just over 1,000 doses have been administered, and 7,000 new doses were expected this week.

Residents are frustrated.

"I don't want to die of COVID. It's that simple," Plano resident Pat Parker, who said she is no. 16,793 on the waitlist, told ABC News Dallas affiliate WFAA-TV. "What did I just register for? Nothing, nothing."

The supply concerns come as many regions are expanding vaccination eligibility. On Wednesday, Los Angeles County opened it up to residents ages 65 and up -- a group that includes over one million people -- though local health officials warned that supply remains scarce. Call centers were inundated, and websites crashed as residents attempted to schedule the limited number of available appointments.

"One of the issues that everyone has had around the allocation and distribution from the federal government is it has been week-to-week, which makes it difficult for our sites to do a lot of planning, and it really makes it difficult to extend appointments past a few days, which I think then makes it hard on the public," LA County Department of Public Health Director Dr. Barbara Ferrer said Tuesday at a media briefing.

States also have had to adjust their timelines after learning late last week that they wouldn't receive as many doses as anticipated from the federal reserve. Oregon health officials said they would have to delay the expansion of doses to seniors by several weeks. Instead of starting to vaccinate all seniors on Jan. 23, the state will begin vaccinating in waves, starting with those age 80 and older on Feb. 8.

"The approach completely depends on Oregon getting a reliable supply of doses from the federal government," Patrick Allen, director of the Oregon Health Authority, said during a press briefing Friday.

The certainty around the federal supply is making it difficult to open more vaccination sites and plan more than a few weeks out, health officials in Mississippi said.

"We don't know where we're going to be in a month," Dr. Thomas Dobbs, the state health officer, said Friday during a panel with the Mississippi State Medical Association. "Since we don't have 100% visibility of the vaccine on hand for a week from now, it's too far ahead of us to plan properly."

This lack of visibility led to some confusion last week, when the state health department announced new vaccine appointments wouldn't be available for a month out. After additional supplies became available, residents are now able to make appointments as early as Jan. 25, officials said.

"We can't depend on much stability," said Dobbs, noting he expects the situation to improve in the coming weeks.

As New York City runs out of available first doses, de Blasio floated freeing up the second doses the city has on reserve.

"We've got about 65,000 doses that we could put into play right away if we had that freedom," he said. "Let's be creative and let's do something to reach the most people as quickly as possible -- and then catch up in the days ahead."

With a new administration in the White House, many leaders are hoping for more transparency on available doses and ramped-up production of the Pfizer's and Moderna's vaccines. Other COVID-19 vaccine candidates, such as Johnson & Johnson's, also could help with supply shortages if authorized, health officials said.

"I know the Biden administration is going to intensify production," de Blasio said. "I have faith that the weeks ahead, we're going to see a whole different level of production of the vaccine happening."

Ferrer urged patience, saying that with a new federal administration, "We expect our situation to improve greatly."

For now, Adalja recommended that people continue to be "tenacious" about getting appointments if they're eligible, as the longer people go unvaccinated, the more time the virus has to spread.

"It's unfortunate that it's come to this," he said. "It shouldn't be this hard to get a vaccine."

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Christina Meredith By NICOLE PELLETIERE, ABC News

(NEW YORK) -- A Texas mother is sharing the story of her teenager's ongoing fight against COVID-19, in hopes to remind parents that young people are still at risk.

Christina Meredith, a resident of Kyle, Texas, told ABC News' Good Morning America that her 15-year-old daughter Katelynn Rodriquez, is still showing symptoms of the coronavirus after being hospitalized late last month.

Meredith said Katelynn is an active cheerleader, volleyball player and runner with no pre-existing health conditions.

"Katelynn wants to tell people to wear their mask and let them know that kids get sick," Meredith told Good Morning America. "Her main thing is it doesn't discriminate. It doesn't matter your age or gender."

Katelynn is a high school sophomore. Her family suspects she was exposed to COVID-19 in December from a fellow student.

Meredith said Katelynn tested positive for COVID-19 on Dec. 22. She experienced an itchy throat, runny nose and a fever of 105 degrees.

"On Dec. 28, I woke up and had to go to work that day," said Meredith, who is a certified nursing assistant. "I peeked in to check on her...she said, 'I can't breathe.' We were on day 10 so I was hoping this fever would break."

Meredith and her husband brought Katelynn to a local hospital, where an X-ray revealed she had pneumonia. Doctors told Meredith that she could bring her daughter home so long as her oxygen remains in the 90s level.

Meredith said that in 2012, she lost another daughter, Katelynn's sister, to the genetic lung disease cystic fibrosis and wasn't taking any chances.

"I was terrified. ...I work in the nursing field and I knew what could happen next," she said. "It was very hard for me but I had to hold it together for Katelynn. I think she looked for me for the strength, so I just held my composure. Deep down inside, I was thinking the worst."

Katelynn was then brought to Dell Children's Medical Center in Austin, Texas, where she was admitted for 13 days. There were talks of intubation, though Meredith said doctors never got that far.

She received medication for inflammation and high flow nasal cannula. Katelynn was also given the drug remdesivir, which is an antiviral med intended to treat COVID-19. She and her parents agreed to participate in a study so medical teams could learn more about administering the drug to pediatric patients hospitalized for COVID-19 without any underlying symptoms, Meredith said.

Katelynn was sent home on Jan. 8. Meredith said she is still experiencing headaches, tingling in her legs, bedwetting and fatigue. She is currently taking blood thinners and is beginning physical and occupational therapy.

Jay D. Bhatt, an ABC News medical contributor and Chicago-based primary care physician told GMA that little-known symptoms such as bed-wetting could be a complication of long-term COVID-19 exposure.

"We're learning every day of new symptoms that emerge," Bhatt said, adding that there's a long list of post-COVID symptoms.

Meredith said she and Katelynn would like to raise awareness on how young people can still contract COVID-19.

Bhatt echoed this.

"It finds infectious pathways through the nose and treats people the same, so if you're in the path of the virus, you're at risk of getting it," Bhatt said.

"We've seen completely healthy people be exposed to the virus and have severe consequences including death," he added. "We've seen people active and athletic who may have more of an ability to fight the virus if they're infected, but it doesn't keep them having severe symptoms."

Bhatt and Meredith reminded the public should keep taking health precautions to stay safe.

Meredith said she wants to thank her community and Katelynn's cheer team for launching the GoFundMe page, which will help the family cover medical bills.

As Katelynn recovers, her teammates have made signs reading "Kat Strong" and hold them at sporting events in her honor.

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mlleelizabethart/iStockBy GMA TEAM, ABC News

(NEW YORK) -- Erika Rischko is an 81-year-old mother of two, grandmother of one and, surprising to even herself, a fitness influencer.

Rischko, of Langenfeld, Germany, describes herself as a "late bloomer" when it comes to fitness, but she now is inspiring people decades her junior with the workouts she shares on TikTok and Instagram.

"I am really honored and humbled that younger people are being inspired by me," Rischko told ABC News' Good Morning America. "I love comments such as, 'You are so inspiring, life goals, couple goals, can you be my grandparents?'"

"If I can change the stereotype of old people being boring or not being active just a bit, that makes me very happy," she said.

Rischko, a homemaker, said she did not start regularly exercising until her mid-50s when her daughter signed her up at a local gym.

"As both kids were out of the house for the first time, I was lonely," Rischko said. "The first five years, I was not as 'addicted.' Then, I slowly started to do more and even joined some three to four-hour spin class challenges and rowing competitions."

More than 20 years later, Rischko said she works out twice a day, several days a week.

"My husband, who is also 81-years-old, goes to the gym with me during the week in the morning, but we do not train together," she said, adding that she usually bikes to and from the gym so her husband doesn't have to wait on her. "During the week, I also work out three to four times in the evening for an hour."

Rischko said she joined Instagram in February at the urging of her daughter, who wanted her to share her workouts with family and friends.

When the coronavirus pandemic closed gyms last spring, Rischko then started taking part in fitness challenges on Instagram.

"The response was just overwhelmingly positive, which I have found very uplifting as I have been very insecure all my life," she said. "And then my daughter discovered TikTok as some of the dance challenges were being featured on German TV and the app became very popular during the pandemic."

Rischko started taking part in some of the fitness challenges on TikTok and quickly developed a following. Her videos on the social media app now have more than two million likes.

 I would have never expected to get this many uplifting comments and followers," said Rischko, adding that her daughter helps her film and post her workout videos. "Both apps [Instagram and TikTok] have helped me to stay up to date with technology and what the younger generations are up to these days."

When it comes to her workouts, Rischko said she is always trying something different, a piece of advice she gives to her younger followers.

"I mix it up all the time, so that I get a different intensity and/or duration," she said. "It is important to change your workout routine to get stronger and not waste your time."

In addition to her active lifestyle, Rischko also credits her longevity to eating fresh foods, but not counting calories, rarely drinking alcohol and giving up smoking 30 years ago.

"I think my advice is fairly simple: Do not do anything extreme - there is no need to -- and start slowly," said Rischko. "Just eat healthy, but do not chastise yourself."

"And figure out what works for you," she added. "Find a sports activity that you enjoy because if you do not enjoy it you will not last, and if you are not as disciplined as I am, find a workout partner as it is not that easy to cancel on somebody."

Rischko's final advice is to start being active now.

"I just wish I had started even earlier, before I turned 55," she said.

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vchal/iStockBy ERIN SCHUMAKER, ABC News

(NEW YORK) -- When President-elect Joe Biden is sworn in on Jan. 20, he'll be inheriting more than the Oval Office. As the COVID-19 pandemic extends into another year, the United States is leading the world for all the wrong reasons.

With more than 24 million infections, the U.S. has reported more than twice as many COVID-19 cases as India, the second leading country with four times the population, and tragically, more than 401,000 deaths. That's more virus-related fatalities than any other nation on Earth, according to data from Johns Hopkins University, and exceeds the number of U.S. soldiers who died in battle during World War I, World War II and Vietnam combined, according to a data estimate compiled by the Department of Veterans Affairs.

The U.S. is also in the midst of the biggest surge of the pandemic to date, with 10 states reporting record numbers of new deaths this week, according to an ABC News analysis of data from The COVID Tracking Project.

To fight what some call the world's worst outbreak, the U.S., under the Trump administration's Operation Warp Speed has responded by wielding scientific and financial resources to develop two 95% effective COVID-19 vaccines, produced by Pfizer and Moderna, in record time.

"The good news and what’s in Biden's favor, is that we have some really great vaccines and more on the horizon," said Courtney Gidengil, a senior physician policy researcher at RAND.

But in addition to inheriting the vaccines themselves, Biden is inheriting the logistical challenge of getting those shots into millions of Americans' arms -- specifically enough to begin cutting down the infection rate as new and more transmissible variants of the virus spread.

"Operation Ward Speed achieved getting the vaccine up and running, but we never had an actual vaccination strategy to go with it," Gidengil said.

Instead, the federal government outsourced vaccine distributions to the states, she explained, who in turn pushed the responsibility on local health departments and ultimately on hospitals, which were already overburdened by treating COVID patients.

With no clear strategy in place, the Trump administration fell short of its goal of getting 20 million Americans vaccinated by the end of 2020. Instead, as the sun set on the Trump presidency, less than 13 million of the 31 million doses distributed so far had made it into Americans' arms, according to the Centers for Disease Control Prevention.

Biden spoke to the daunting task ahead during news conference last Friday in which he laid out a five-point plan to speed up vaccine distribution.

"This will be one of the most challenging operational efforts ever undertaken by our country," Biden said. "You have my word that we will manage the hell out of this operation."

Still, bumps in the road are expected, experts say. Beyond the high number of infections, hospitalizations, deaths and the missed vaccination goals is a set of interrelated obstacles that the Biden administration will inherit.

Here's what experts say Biden's key COVID-19 challenges are:

Underfunded public health infrastructure

According to Dr. Amesh Adalja, senior scholar at Johns Hopkins Center for Health Security, one of Biden's biggest and most enduring challenges didn't start with the Trump administration.

"It’s important to remember that even if everything went perfectly with vaccine rollout, we’re still dealing with a public health system that's been underfunded and undervalued for so long," Adalja pointed out. "No matter who is in charge, it's really hard to turn something like that around."

Instead of investing in public health as a national security priority, the United States is caught in a cycle of panic and neglect, funding efforts to battle past infectious disease outbreaks, like Zika, MERS, SARS and Ebola, in moments of acute crisis and then pulling public health funding once immediate danger subsides.

"When something recedes from the headlines it also recedes from priority," Adalja said. "The challenge will be building a sustainable system that’s not just for COVID."

Politicization of the pandemic and public health experts

While past infectious disease outbreaks, such as Ebola, H1N1 and the 1918 flu have been politicized, according to Adalja, none has been as politically charged as COVID-19.

"A large proportion of the population have utter and complete distrust of public health authorities," Adalja said.

Once among the most trusted health agencies in the world, the reputation of the Centers for Disease Control and Prevention is in tatters after a botched testing rollout early in the pandemic and a Politico investigation that found Trump officials interfered with the agency's Morbidity and Mortality Weekly Reports.

The Trump administration's refusal to wear masks and refrain from indoor gatherings became a sticking point for members of the White House coronavirus task force, who tried to encourage the public to adhere to COVID-19 mitigation measures even as members of the administration flouted them.

In some cases, distrust has jeopardized health officials' personal safety. Dr. Anthony Fauci, as well as less well-known public health officials, have been targeted, harassed and even received death threats from anti-mask opponents. Some were pushed to the point that they resigned.

Restoring lost trust won't be easy for the CDC.

"They are starting to get their courage back post-election, but a lot of damage has been done," Adalja said.

While White House coronavirus briefings during the Trump administration tended to feature Trump himself, experts recommend that the Biden administration let scientists take center stage, which Biden has already pledged to do.

Experts like the surgeon general will speak directly to the American people, Biden said Friday and promised to be transparent about "both the good news and the bad," when it came COVID-19 progress.

"You’re entitled to know," he said.

In addition to allowing CDC and FDA experts to airtime, Dr. Eric Toner, a senior scholar at Johns Hopkins Center for Health Security, recommended that the president and senior staff give daily encouragement to the public about stopping COVID-19's spread.

Faced with inheriting "a substantial portion of the populace that doesn’t believe in the pandemic or the vaccine," Biden needs a diverse national campaign to promote vaccination, Toner added, "including voices that resonate and are likely to be trusted by different segments of society."

In addition to making special efforts to reach historically discriminated against groups, "sophisticated, well-informed communication is key to go head to head with antivax organizations and convince youth who feel invincible to vaccinate themselves as an altruistic act," according to Cheryl Healton, dean at NYU's School of Global Public Health.

The U.S. bet it all on vaccines

In focusing narrowly on Operation Warp Speed, the Trump administration left only one option for escaping the pandemic: vaccination.

Other countries, such as Singapore and Taiwan, invested heavily in COVID-19 testing and contact tracing to control disease spread. But with largely unchecked community transmission in the U.S., that's no longer a viable mitigation option.

"The U.S. will never be Singapore or Taiwan," Adalja said. "That die was cast last year."

Other experts lamented lack of coordination in the current COVID strategy. The U.S. still doesn't have adequate testing or PPE, they said. Unlike the United Kingdom and South Africa, the U.S. has no national testing surveillance system to detect new virus variants. Instead, some states do rigorous surveillance, while others don't.

Given that the new variants first identified in the U.K. and South Africa are thought to be more transmissible than the old variant, not being able to actively check for emerging variants, "is definitely a sobering thought," Gidengil said.

Healton would like to see Biden's plan go further than what he's outlined so far. She urged the administration to try to obtain a court order to mandate public use of masks.

"It would be a heavy lift, but as things stand now we are allowing people to infect others routinely and what state you live in determines your risk," Healton said.

Among the dozens of executive orders Biden plans to sign on inauguration day is a 100-day national mask mandate, which will be enforced on all federal property and during interstate travel on planes, buses and trains. He's also promised to tap the Federal Emergency Management Agency (FEMA) to set up federally funded mass vaccination centers in school gyms and sports stadiums to ramp up vaccine distribution and to use mobile clinics to help reach hard-hit communities.

While experts acknowledged that the jury is still out on whether the Biden administration will be able execute and fund his big-picture COVID strategy -- the details are important, they agreed -- ultimately they're hopeful.

"Much of what’s in his plan for the pandemic are things people in my field have been advocating for a year now," Adalja said.

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Baptist Health System, San Antonio, TexasBy KATIE KINDELAN, ABC News

(SAN ANTONIO) -- Dr. Nayeli Rodulfo-Zayas, an emergency medicine physician in San Antonio, Texas, was 35 weeks pregnant when she received her second dose of the COVID-19 vaccine earlier this month.

Rodulfo-Zayas, also the mother of a 2-year-old, is speaking out about her decision in hopes of inspiring other pregnant women to have important, educated conversations with their health care providers about getting the vaccine.

Pregnant women have not been actively included in the late-stage clinical trials for any COVID-19 vaccines, including the Pfizer-BioNTech and Moderna vaccines in the U.S.

Both the Pfizer and Moderna vaccines use mRNA technology, which uses pieces of viral genetic material as a way for the body to learn and develop defenses against future infection. If approved, they would be the first mRNA vaccines, which are theoretically safer during pregnancy because they do not contain a live virus.

Rodulfo-Zayas said knowing the science of mRNA technology -- which does not enter the nucleus of the cells and doesn’t alter the human DNA -- helped inform her decision to get vaccinated against COVID-19.

"That in itself is one of the reasons why I decided to take the vaccine, because I understand the science and I’m confident in the science, and also because I’m at high risk of catching the disease," she said. "I’m a Hispanic woman and I work around COVID patients constantly."

"I had a discussion with my obstetrician-gynecologist and we decided that the best thing for me was to get the vaccine," she added.

The decision to get the vaccine was also a very personal one for Rudolfo-Zayas, who lost her 57-year-old mom to the virus last year.

"She contracted COVID probably in early June and unfortunately she was part of that vulnerable population," said Rudolfo-Zayas, explaining that her mom had diabetes, high blood pressure and was on dialysis. "She was doing OK for about a week and then she got really sick and ended up in the ICU."

"In six more months, she could have gotten her vaccine," she added of the timing of her mom's death. "It’s a huge loss for me. I miss her every day, but I know she would have wanted me to do good and push through and continue doing the work I do and that’s why I’m doing this and I’m educating people."

Rudolfo-Zayas received her first dose of the vaccination in mid-December and her second dose on Jan. 7. She said she did have some minor side effects from the second shot, including chills and a low-grade fever that went away in less than 24 hours.

"I just want people to know that the [vaccine] side effects are minimal, that they do exist, they do make some people feel sick, but it’s temporary, and it really doesn’t compare at all what I’ve seen people go through when they get COVID and they are hospitalized," she said. "They pale in comparison to what people go through when they get COVID and need oxygen."

The U.S. Centers for Disease Control and Prevention (CDC) says that women who are pregnant and in the priority groups recommended to receive the COVID-19 vaccine "may choose to be vaccinated" during pregnancy and can make an informed decision by speaking with their health care provider to better understand the potential risks and benefits.

The American College of Obstetricians and Gynecologists (ACOG), a professional membership organization for OB-GYNs, issued a practice advisory last month to say that both pregnant and breastfeeding women who are in the priority groups for the vaccine should receive doses as well.

Rudolfo-Zayas said she urges other pregnant people to speak with their health care providers about whether they should receive the COVID-19 vaccine and to consider the risks of not getting vaccinated.

Data shows that pregnant people with COVID-19 are at an increased risk for "intensive care unit admission, invasive ventilation, extracorporeal membrane oxygenation, and death," compared to nonpregnant people, according to the CDC.

"I would just encourage people to get vaccinated, especially if you’re immunocompromised or you have chronic medical conditions because catching COVID has a lot of repercussions," said Rudolfo-Zayas. "COVID itself is really dangerous. The vaccine side effects, not so much."

What to know about pregnancy and the COVID-19 vaccine


The question of whether a pregnant person should receive a COVID-19 vaccine will eventually come down to a number of factors, including everything from the trimester, risk factors for COVID-19, ability to remain socially distanced in her lifestyle and occupation, guidance from federal and state officials and recommendations from one's own physicians, experts say.

Health experts will need to rely on continuously incoming data to make decisions around how safe the COVID-19 vaccines are during pregnancy.

Officials are doing the same for the general population, considering the speed at which the COVID-19 vaccines were developed, and people who are pregnant should not be "unnecessarily alarmed," Dr. Ruth Faden, the founder of the Johns Hopkins Berman Institute of Bioethics and a bioethicist who studies the ethics of pregnancy and vaccines, told Good Morning America last year.

"Vaccines are coming, and they're coming before we have all of the information that we would like to have to make recommendations for pregnant people," she said. "But this is the context in which decisions are being made and recommendations are being made for the general population, without all of the evidence we would like to have, which is why the studies will continue."

The Society for Maternal-Fetal Medicine (SMFM) released a statement in December encouraging expecting parents to "engage in shared decision-making" about the vaccine with their doctors.

"In general, SMFM strongly recommends that pregnant women have access to COVID-19 vaccines in all phases of future vaccine campaigns, and that she and her health care professional engage in shared decision-making regarding her receipt of the vaccine. ... mRNA vaccines, which are likely to be the first vaccines available, do not contain a live virus but rather induce humoral and cellular immune response through the use of viral mRNA," the society said in its statement. "Health care professionals should also counsel their patients that the theoretical risk of fetal harm from mRNA vaccines is very low."

Health experts say pregnant people with or without the vaccine need to continue to remain on high alert when it comes to COVID-19 by following safety protocols, including face mask wearing, social distancing and hand washing.

"What I tell my patients is the one thing I know for sure is that pregnant women can get COVID," Dr. Rashmi Rao, a maternal-fetal medicine specialist at UCLA Medical Center in Los Angeles, told GMA last year. "We’re not seeing huge rates of any adverse fetal outcomes yet, but, again, that’s still to be determined, because we have a long way to go with collecting information."

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uschools/iStockBy DR. ROSE MARIE LESLIE, ABC News

(NEW YORK) -- Despite receiving one or two doses of a coronavirus vaccine, multiple members of Congress have tested positive for COVID-19 since the riot at the U.S. Capitol.

While currently available vaccines are highly effective against symptomatic illness, it takes about two weeks after the second dose to offer that high degree of protection, according to infectious disease experts. With some lawmakers exposed shortly after their first or second shot, those experts say it's not surprising they became infected after what's being described as a "superspreader" event.

Reps. Bonnie Watson Coleman (D-N.J.), Adriano Espaillat (D-N.Y.), Chuck Fleischmann (R-Tenn.), Pramila Jayapal (D-Wash.), Brad Schneider (D-Ill.) and Lou Correa (D-Calif.) have all reported positive test results since Jan. 6.

It is impossible to know exactly when and where these members of Congress became infected, especially since somebody can pick up the virus up to 14 days before getting a positive test. However, experts say that day at the Capitol was likely very risky for viral transmission.

Dr. Simone Wildes, an infectious disease physician and ABC News contributor, described the day as “the classic situation that we tell everyone to avoid .... a small space with a lot of people, poor ventilation, not wearing masks."

"We think of that kind of like a superspreader event," Wildes said.

Some of these lawmakers are now blaming their co-workers for risky exposure during the riot, reporting that they sheltered in rooms with multiple Republican lawmakers who refused to wear a mask. Video of lawmakers, some without masks and standing close together as they sheltered together during the events of Jan. 6, was posted by Punchbowl News. In the video, some members of Congress, including Rep. Markwayne Mullin, were seen refusing to accept a mask when offered.

The attending physician for Congress, Dr. Brian Monahan, notified all lawmakers about possible virus exposure and recommended that each person there that day get tested.

Many lawmakers who tested positive after Jan. 6 had already received one or two doses of the COVID-19 vaccine. However, this doesn’t guarantee them complete protection, especially if in a very risky situation.

Coleman, Jayapal and Schneider had only received one of the two required doses of the COVID-19 vaccine. After receiving one dose of the vaccine, research from the experimental trials published in the New England Journal of Medicine indicates a person is likely only about 50% protected.

Espaillat had received both doses of the vaccine. He reported getting the second dose the same week as the riot. Once someone gets their second dose of the vaccine, it takes time for immunity to develop. The Moderna vaccine reaches 94% effectiveness two weeks after the second dose, and the Pfizer vaccine reaches 95% effectiveness one week after the second dose.

“I received the second dose of the #COVID19vaccine last week and understand the [effects] take time," Espaillat wrote on his Twitter. "I have continued to be tested regularly, wear my mask and follow the recommended guidelines”.

If Espaillat was exposed to the virus on Jan. 6 and had received his second dose of the vaccine that same week, he may not yet have had maximum protection.

Wildes emphasized that even people who are fully vaccinated with both doses are still potentially at risk of contracting the virus. The vaccines are roughly 95% effective, according to the companies, meaning that about 5% of people who get the vaccine may still develop symptomatic disease after being exposed. Also, other groups of people, like those who are immunocompromised, may not develop as much immunity.

“We do get prevention when we get the vaccine, but it’s not 100%," Wildes said.

She also pointed out that some things are still unknown. For example, the large clinical trials demonstrating the vaccines' effectiveness only tested to see if the vaccines work to prevent COVID-19 illness with visible symptoms, like coughing, sneezing or fever.

But approximately 59% of COVID-19 transmission comes from people who have no symptoms, according to a study by CDC researchers published in JAMA Network Open, and scientists still don't have a solid understanding of how effectively the vaccine blocks asymptomatic illness.

That means, potentially, "you could still harbor the virus and possibly spread it to others," Wildes said.

This is why public health experts say that even after both shots, people need to keep wearing masks and staying socially distanced until science offers better answers about asymptomatic transmission after vaccination.

“Even though you have been vaccinated, that doesn’t mean you should drop your guard," Wildes said.

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Sorapop/iStockBy DR. NICK NISSEN, ABC News

(NEW YORK) -- Exercise is good for your health, but researchers are now finding that better cardiovascular fitness might save you from a trip to the hospital if you are diagnosed with COVID-19.

According a new study from Henry Ford Hospital, people with better cardiovascular fitness may be less likely to be hospitalized with the virus. This study looked at 246 patients who had undergone a heart exercise test known as a "stress test" and then stayed in touch with those patients to see which ones were later diagnosed with COVID-19 and hospitalized.

The researchers learned that patients who had better exercise capacity during their test were less likely to get hospitalized with COVID-19 later on, suggesting that people can decrease their chances of getting severely sick with COVID-19 by improving their cardiovascular fitness.

Here are five steps you can take now to boost your fitness and boost your chances of avoiding severe illness from COVID-19 in 2021:

1. Find your "why."

Many people start and stop new fitness routines. Let's make your new fitness goals stick. Firstly, why do you want to improve your fitness? What difference will better fitness make in your life?

Next, consider which obstacles will try to get between you and your goal (feeling too tired, limited on time, etc.). Knowing your challenges ahead of time will help you feel more prepared to carry out your new goal.

2. Consider your options.

It's important to assess your current state of health before you start exercising. If you have health issues, you'll want to consult your doctor first before starting a new routine.

Afterward, consider various levels of exercise, from walking to jogging to weights or fitness classes. Choose one that is appropriate for your state of health.

3. Create a plan that you can stick to.

In fitness, consistency is key. Many start the new year with ambitious goals of waking at dawn and spending hours at the gym, but these plans often fade as work responsibilities and sleep deprivation build after the holidays.

Instead, choose a time that you can block off every day and find efficient exercise routines of 30-60 minutes duration. Start easy and ramp up slowly.

4. Remove obstacles.

Avoid your common pitfalls. Do you often plan to go to the gym after work but lose your motivation once you get home? Bring your gym bag to work so you can go directly to the gym afterward.

Do you run out of time in the morning? Prepare your morning chores ahead of time (pack lunches, choose your outfits) so you can be more efficient in the morning.

5. Make it fun.

Cardiovascular exercise is easy if it's something you enjoy. If you abhor the treadmill, consider joining a COVID-safe dance class, playing tennis, or going for brisk hikes. Consider getting outside and making your exercise a bright spot in your day.

Improving our fitness is often a top New Year's resolution, but now more than ever, this goal is of utmost importance. Use the tips above to make 2021 a healthy new year and boost your chances of avoiding severe illness from COVID-19.

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Courtesy Mitayah DonerlsonBy KATIE KINDELAN, ABC News

(NEW YORK) -- Kasen Donerlson is being called a "miracle baby" after surviving both COVID-19 and a liver transplant, all before his first birthday.

"It's been very, very stressful," Kasen's mom, Mitayah Donerlson, told ABC News' Good Morning America. "But his recovery right now is going so sweet and so smooth that I can’t ask for anything more."

Kasen of Syracuse, New York, was born on Jan. 14, 2020, weighing a healthy 8 pounds, according to Donerlson. He spent a few days in the neo-natal intensive care unit (NICU) due to breathing issues and jaundice that Donerlson said doctors told her would improve as he got older.

When Kasen's health did not improve, Donerlson said she sought further evaluations for her son. Around two months after his birth, the infant was diagnosed with a severe case of biliary atresia, a condition in which bile ducts in and around the liver are scarred and blocked, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Just a few days after his diagnosis, Kasen underwent an emergency surgery to repair his bile ducts. But the surgery proved unsuccessful, according to Donerlson, who soon learned that her son would need a liver transplant.

"We had endless hospital visits and we would be there for five or seven or 10 days because of the severity of the disease and the complications that Kasen was having," said Donerlson, adding that Kasen had to be placed on a feeding tube. "He would have fevers that wouldn’t come down."

Donerlson, who also cares for her 4-year-old son and 5-year-old niece, was able to get Kasen onto the transplant waiting list at UPMC Children's Hospital of Pittsburgh, about a five-hour drive from the family's Syracuse home.

In November, as Kasen was waiting for a liver to become available, Donerlson said she, her significant other, her niece and Kasen all tested positive for COVID-19.

"On Nov. 21 he woke up that morning and was extremely hot. His body was like touching a stove," said Donerlson. "I just cried because I knew the hospital was going to admit us, but I didn’t know they were going to tell us that he was COVID-positive."

Kasen spent around three days in the hospital but his only complication was a fever, according to Donerlson, who, along with her family members, did not suffer any complications from COVID-19.

Just two weeks later, in early December, Donerlson got the call she had been waiting months for -- that a liver was available for Kasen.

"All I could do was cry. They were mommy tears and tears of joy. I was just so happy," said Donerlson. "I always knew he was going to get a transplant -- that was my faith -- but to finally get that call and get that message that the surgery was scheduled and to have that relief from the burden on my shoulders dropped, it felt so good."

She added: "I’m smiling from ear to ear right now because I can literally see that moment and feel that moment again."

When Kasen underwent the transplant in early January, he weighed only about 10 pounds more than his birth weight, according to Dr. George Mazariegos, chief of Pediatric Transplantation at UPMC Children’s Hospital of Pittsburgh.

"He was more the weight of a 3-month-old and that is all because of the severity of his condition," said Mazariegos, who added that Kasen received part of a liver from a young adult who died. "We were able to use the left portion of the liver which was the perfect size for a baby of Kasen’s size."

Donerlson said she noticed an immediate difference in Kasen after the nearly 10-hour transplant procedure.

"His eyes have always been greenish and yellowish, his entire life, and he woke up from surgery with clear eyes," she said. "I was overjoyed by seeing that."

After spending much of his first life sick and hospitalized, Kasen is expected to have a long, normal and healthy life with his new liver, according to Maraziegos.

He celebrated his first birthday in the hospital on Jan. 14 and is already gaining weight. He was described by Donerlson as more alert and "perkier" post-transplant.

"What I’m looking forward to is Kasen walking and talking," said Donerlson. "I’m so excited for him to get those skills and for my family to bond back together as we were before all the ups and downs and the hospital visits."

She said she is also grateful to the donor whose liver Kasen received, and to all people who volunteer to donate their organs, both living and deceased.

"They made a way for Kasen, a way for my baby, to have a second chance at life, a life that he was not promised to see," said Donerlson. "I’m just thankful for them."

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Bill Oxford/iStockBy DR. SEAN LLEWELLYN and SONY SALZMAN, ABC News

(NEW YORK) -- Two independent research groups published findings confirming what many scientists have long suspected: The U.S. has its own unique COVID-19 viral variants that are distinct from the U.K. and South African lineages making headlines in recent weeks.

On Wednesday, researchers from the Ohio State University Wexner Medical Center announced two distinct, newly identified variants. The next day, researchers at Southern Illinois University said they found a variant that may have emerged months ago and quickly spread across the country. The variant is likely the same or similar to one of the variants identified by the Ohio researchers.

While viruses mutate constantly, these mutations are not inherently dangerous, experts cautioned. More scientific experiments will be needed to show whether the newly identified U.S. variants are more transmissible, more deadly or if they might impact the vaccine.

And researchers predicted even more variants could be identified in the coming weeks as more scientists start looking for them.

"This should be a wakeup call that we’re not doing enough genomic surveillance," said Dr. Angela Rasmussen, a virologist and associate research scientist at the Center of Infection and Immunity at Columbia University's School of Public Health.

"We’re going to see a lot of these papers coming out," said Rasmussen, who was not involved in either study. "Whether [the variants] are associated with increased transmissibility or not remains to be seen."

Since the emergence of new variants around the globe, there has been fear that they will cause more severe disease and deaths, be more transmissible and render the vaccines ineffective. It first started with variants identified from U.K. and then South Africa, both of which are thought to be more transmissible but not more deadly. But they're unlikely to undermine the current vaccines, according to very preliminary research.

Researchers at Southern Illinois University are calling this U.S. variant 20C-US. The variant isn't new, just newly identified. Its origin was traced back to a patient sample in Texas from May 2020. Since then, the variant seems to have swept across the country. According to Dr. Keith T. Gagnon, one of the lead researchers of the study released by Southern Illinois, 20C-US now compromises about 50% of samples in the country. It is currently widespread in the Upper Midwest, which could be why researchers at Ohio State detected a strikingly similar variant.

Dr. Daniel Jones, one of the lead authors of the study from Ohio State, told ABC News that these variants could be from the same lineage but more research on each is needed.

While some researchers, including the White House Task Force's Dr. Deborah Birx, have speculated there might be a U.S. variant circling the nation, these two studies are the first ironclad evidence of one.

Gagnon said it has taken scientists in the U.S. months to identify this variant because the U.S. is not systematically monitoring and tracking the ever-changing genetic makeup of COVID-19 samples collected from patients.

Gagnon also said it's possible the 20C-US variant is more transmissible, especially with the surge of infections in the fall and winter. The variant could have gotten lucky and gained a foothold as people were spending more time indoors and seeing family and friends for the holidays without proper social distancing and mask wearing.

With multiple vaccines now available, there is the fear that this new U.S. variant will render the vaccines ineffective. But so far there is no evidence that the mutations impact the efficacy of the vaccines.

"Here it was, underneath our noses for months," Gagnon said, meaning volunteers who were vaccinated in the large, late-stage vaccine trials were likely exposed to it and a majority were protected.

“It doesn’t look like it’s going to get in the way of vaccines," Gagnon added. The researchers at Ohio State agreed with those sentiments in their press conference earlier this week.

The other variant that Ohio State researchers discovered was found in only one patient. It has similar mutations seen in the U.K. and South African variants but was not associated with travel and developed independently here in the U.S. It is unclear how much of the population has this variant and if it will be an important.

Both groups recommended to keep calm and wait for more experimental studies to determine what these variants will do.

“We’re not ready to overreact," said Peter Mohler, chief scientific officer and a co-author of the Ohio State University Wexner Medical Center study.

"We want to make sure we study these [variants] in the lab and get very good data” to determine if they change transmission and mortality, he added.

But researchers also warn that the longer COVID-19 is around, the more likely there will be mutations and variants. And each time we will have to determine if the variants are more transmissible or deadly.

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narvikk/iStockBy STEPHANIE RAMOS, KATIE O'BRIEN, and ARIELLE MITROPOULOS, ABC News

(WORCESTER, Ma.) -- Michael Gadbois, a first responder, was used to going the DCU Center for concerts and sporting events.

But his most recent trip there was as a COVID-19 patient.

"I never thought I would be going into the convention center on a stretcher," Gadbois told ABC News, which was given exclusive access to the UMass Memorial Medical Center's field hospital at the DCU Center in Worcester, Massachusetts.

Since Thanksgiving, the seven-day average of daily cases in Massachusetts has increased by 176%. The number of hospitalizations is the highest since May, and on Wednesday, the state surpassed 13,000 confirmed COVID-19-related deaths since the beginning of the pandemic.

Just last week, Massachusetts Gov. Charlie Baker announced that the state would escalate all hospitals to Tier 4 status, the "highest level of concern," which indicates active, ongoing constraints warranting Department of Health intervention. Officials also said on Thursday that "hospital capacity limits are being stretched to their limit."

Massachusetts first opened the UMass Memorial field hospital last spring at the onset of the virus, but when patient numbers began to dwindle in May, the facility closed. When the state began to see a resurgence in cases, Baker made the decision to reopen the facility in early December.

"This was a blank empty space when we started six, seven weeks ago," said John Broach, an emergency medicine specialist at UMass Memorial Hospital and the field hospital's medical director.

Since reopening, the field hospital has treated nearly 400 patients.

"The second surge has been much worse than the first," Broach told ABC News. "It's long hours, it's not a traditional work environment and everybody's sort of adjusting to that."

Converted from an indoor arena and convention center, the complex has been transformed into a full-fledged hospital operation with respiratory devices, X-ray machines while mobile pharmacies line curtain-drawn patient rooms.

The site was built specifically to safely accommodate the beds, equipment and medical supplies required by COVID-19 patients.

The DCU Center is caring for lower acuity patients to help allow the hospital to focus more on the seriously ill, including those who may require intubation. However, the facility is staffed 24 hours a day, and if a patient's condition worsens, front-line workers can rapidly escalate the patient's care before that person is transferred to the intensive care unit.

"The morale here is high," Broach added. "We're all on the same page that we're really wanting to be here, where we are on the front lines and trying to make a difference in terms of the pandemic."

"I have nothing but nice things to say about the work they have done here," Gadbois said. The first responder, who was on track to be discharged when he spoke with ABC News, admitted that he had not necessarily been taking proper precautions to avoid contracting the virus.

"I didn't like wearing the mask, and of course that's how I got it," he added. "It's definitely a scary experience. Once you get to a certain point and it's hard to breathe -- it's real scary."

John Volungias, 74, echoed Gadbois' sentiments. "It's pretty nasty stuff," he said.

Despite taking precautions, almost all of John's immediate family of nine contracted COVID-19, including his 47-year old daughter who remained hospitalized nearby.

"I don't know how anyone could not take it seriously," Volungias said.

The facility, one of two field hospitals in the state, will remain open for as long as needed.

Kelyn Branscon, a traveling nurse from Manchester-by-the-Sea, Massachusetts, who is on a local assignment, told ABC News the past several months have been difficult.

"COVID has definitely been very tough," Branscon said. "As nurses, I think we really love what we do. The most important thing to me, personally, is providing the best quality care I can for my patients. Just being able to help someone through their day. Taking care of people is really why we do what we do, so for us it's just kind of another day."

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Halfpoint/iStockBy ERIN SCHUMAKER, ABC News

(AUSTIN, Texas) -- Sky-high COVID-19 positivity rates at schools in Austin, Texas, have local health officials on edge.

In Travis County, where Austin is located, the COVID-19 testing positivity rate is 20.2% at high schools, 27.1% at middle schools, 19.8% at elementary schools and 10% at preschools.

All rates stand far higher than what the World Health Organization recommends, which is to get positivity testing thresholds below 5% for 14 days.

Part of the problem may be that schools in the area are nearly full. "Some of our superintendents reporting that some individual schools are at between 70% and 90% of occupancy," said Dr. Mark Escott, interim medical director and health authority for Austin Public Health.

"This is a recipe for disaster. It's a recipe for outbreaks in our schools," Escott said.

Escott and the Austin Independent School District are urging parents to keep their kids at home if they are able to, according to ABC News Austin affiliate KVUE.

"And in addition to the impact on our children's health, on our teachers and school staff, so is the continuity of education," Escott said. "We are going to quickly see that we are going to run out of teachers in order to provide in-person education."

At the same time, Austin is grappling with increasing hospitalizations and dwindling ICU space.

This week, the state opened the Austin Convention Center as a field hospital for less severe COVID-19 patients who need lower levels of care.

The site, which will have 25 beds, can expand to include more beds if needed, and is meant to "reduce the burden on local hospitals and help ensure that Texans diagnosed with COVID-19 receive the care they need," Gov. Greg Abbott said in a statement.

Texas surpassed 2 million COVID-19 infections this week, making it the only state other than California to hit that milestone, according to data from Johns Hopkins University. There have been 31,277 deaths from the virus in the state since the outbreak began.

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Dean Mitchell/iStockBy KATIE KINDELAN, ABC News

(NEW YORK) -- Flo, a widely used period and fertility-tracking app, has reached a settlement with the Federal Trade Commission over allegations the company shared users' health data it had promised to keep private.

The FTC alleges that Flo disclosed health information as sensitive as a user's pregnancy to third parties -- including Google and Facebook's analytics units, and mobile analytics services AppsFlyer and Flurry -- and did not limit how the third parties could use the health data.

The app had told users that their data would only be used to help provide the app's services to them, according to the FTC.

As part of the settlement, announced Wednesday, Flo Health, the developer of the app, is prohibited from misleading users about its data-handling practices and must obtain an independent review of its privacy practices.

Flo must also "notify affected users about the disclosure of their personal information and instruct any third party that received users' health information to destroy that data," according to the FTC.

"Apps that collect, use, and share sensitive health information can provide valuable services, but consumers need to be able to trust these apps," Andrew Smith, director of the FTC's Bureau of Consumer Protection, said in a statement. "We are looking closely at whether developers of health apps are keeping their promises and handling sensitive health information responsibly."

The Flo app is used by more than 100 million consumers, according to the FTC.

In addition to period and ovulation tracking, the app also offers its users health articles and insight, tools to track babies' development and connections with other women around the world, according to its website.

The app says it has 36 million monthly active users.

In its settlement with the FTC, Flo did not admit to any wrongdoing, saying in a statement, "We did not at any time share users' names, addresses, or birthdays with anyone. We do not currently, and will not, share any information about our users' health with any company unless we get their permission."

At Flo our highest priority is protecting our users’ data which is why we have cooperated fully throughout the FTC’s review of our privacy policy and procedures. See our full statement here: https://t.co/CPQadt0iUX

— Flo Period Tracker (@flotracker) January 13, 2021

"We are glad to have reached an agreement with the FTC and resolved the matter," Flo said in the statement. "We will be conducting a compliance review into our policies and procedures as requested as part of the Consent Agreement and providing the FTC with regular updates. We are committed to ensuring that the privacy of our users' personal health data is absolutely paramount."

The FTC shared tips this week for consumers using health apps.

#BREAKING: Developer of popular women’s fertility-tracking app settles FTC allegations that it misled consumers about the disclosure of their health data: https://t.co/zHWZz4Gvwz /1 pic.twitter.com/itHIjjY1aq

— FTC (@FTC) January 13, 2021

#BREAKING: Developer of popular women’s fertility-tracking app settles FTC allegations that it misled consumers about the disclosure of their health data: https://t.co/zHWZz4Gvwz /1 pic.twitter.com/itHIjjY1aq

— FTC (@FTC) January 13, 2021

When using apps like Flo, the FTC recommends users compare options on privacy, make sure the app is up to date and has settings that let you control your health information and know the risks of your personal information "getting into the wrong hands."

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