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(NEW YORK) -- Bars and restaurants are once again at the forefront of a polarizing business decision 16 months into the pandemic: Whether or not they should require patrons to wear masks inside or show vaccination status in order to dine safely.

Parts of the country are bracing for change after the Centers for Disease Control and Prevention (CDC) recommended Wednesday that vaccinated Americans wear masks indoors in areas with high COVID-19 transmission rates due to the increasing spread of the delta variant. The agency did not publish new research but cited, “CDC COVID-19 Response Team, unpublished data, 2021."

From coast to coast the restaurant industry has been hard-pressed to follow ever-changing health protocols throughout the pandemic to keep both staff and customers safe, but even with 49.5% of the country fully vaccinated, according to the Mayo Clinic, there is not a one-size-fits-all solution.

Restaurateur Danny Meyer, CEO and founder of Union Square Hospitality, announced Thursday that his restaurants in Washington, D.C., and New York City will require patrons dining and drinking inside to show they have been fully vaccinated starting Sept. 7. Guests can bring the physical COVID-19 vaccine card, a New York State Excelsior Pass, relevant state-provided vaccine pass, or a photo of their vaccination card to share upon arrival.

Although it's also part of his group, the Shake Shack founder said the policy does not yet extend to the popular burger chain.

"As everything opened up, there was a lot of reason for cautious optimism, but the increase of the delta variant infection rates is causing alarm for many," Andrew Rigie, executive director of the NYC Hospitality Alliance, told ABC News. "Some restaurants have or will implement vaccination policies for workers and in some cases customers, but that poses challenges."

Proof of a vaccine or facial coverings are ultimately up to the business owners who are looking out for the best interests of workers and the communities they serve.

For specific restaurants such as ones in a community with lower vaccination rates, Rigie said "different restaurants are situated differently and have different abilities. If most of your customer base is vaccinated and you have resources to check vaccination status, it's not easy, but it's easier than being a small business in a community with hesitancy or lower vaccine rates."

He added, "Collectively I think we understand we need to do everything possible not to revert to new mandates and restrictions after the restaurant industry has been economically devastated so far."

For first-time restaurant owner Patricia Howard, who opened an intimate seafood restaurant Dame to rave reviews in June, she said she has "anxiously watched the infection rate creep back up" and wants to remain vigilant for both diners and staff.

"We can't control whether the person next to us on the subway is wearing a mask, but we can control who gets to come through our doors at Dame," she told ABC News. "With two members of our staff immunocompromised and the very small size of our space, it is better to air on the side of caution. We were nervous about potential backlash, but once the city announced all municipal workers are required to be vaccinated, we felt more confident that it's the right thing to do regardless of the response."

The small team at Dame emailed diners who had upcoming reservations earlier this week about requiring proof of vaccination and Howard said they "only had to cancel a few reservations, due to one or more guests being unvaccinated thus far." She added that nearly all guests have been appreciative and supportive with hundreds of unexpected replies "thanking us for keeping our community safe, saying it makes them even more excited to dine at Dame, and hoping other restaurants follow suit."

In California, even before the latest CDC guidance, some bars in Los Angeles County, as well as the Bay Area, have taken preventative steps, asking for proof of vaccination or a negative COVID test 72 hours before dining.

Starting Thursday, bars that are part of The San Francisco Bar Owner Alliance may ask customers who wish to be inside to show proof of vaccination. While not mandated by the government, Ben Bleiman, president of the local industry group and owner of Soda Popinski's and Teeth bars, said this is a step they needed to take "to protect our staff and families."

Other industry leaders like Oregon-based Erika Polmar, executive director of the Independent Restaurant Coalition, stressed that this new wave of rules and recommendations could become "confusing and burdensome" for both restaurants and diners.

"It's really challenging to walk into one place and not see a mask mandate and then just a block or two away the mask rules are different," Polmar explained. "The requirements vary county to county and the public doesn't know where a county line is."

Polmar emphasized that if diner attendance dips again, government financial assistance will be crucial and she is imploring Congress to quickly allocate money again for the Restaurant Revitalization Fund.

"I think if you were to talk to any restaurant owner across the country they would be even more heartbroken that they're not seeing the replenishment of the RRF" despite support in the House and Senate, she said. "The urgency isn’t being acted upon."

She continued, "Restaurants are accepting the hard truth that Congress might not act until September and that's amplifying the devastation they're feeling."

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(NEW YORK) — With the country in the midst of a new nationwide resurgence of coronavirus infections and hospitalizations, misinformation about the effectiveness of the vaccines has been proliferating on social media, with increased attention falling on the rare number of vaccinated people ending up in the intensive care unit (ICU). However, according to dozens of hospitals across the nation surveyed by ABC News, very few fully vaccinated people are actually ending up severely ill and in the ICU with COVID-19.

And experts say that those that do, tend to be frail or have conditions that interfere with the vaccine's effectiveness at producing protection.

ABC News contacted 50 hospitals in 17 states, and asked them to share data on their ICU wards' current COVID-19 patients, including their vaccination status. In the surveyed hospitals, ABC News found that the overwhelming majority of COVID-19 patients currently being treated in ICUs were unvaccinated.

Of the 271 total COVID patients in the surveyed ICUs, 255 patients, or approximately 94%, were unvaccinated against COVID-19 in ABC News' snapshot in time.

Further, of the 16 vaccinated individuals receiving care in the ICU, almost all suffered from comorbidities and other health problems, such as cancer or weakened immune systems. ABC News only heard of one otherwise healthy and fully vaccinated individual, with no reported underlying conditions, who was in the ICU.

According to the CDC, "vaccine breakthrough cases are expected," and, as a result, "there will be a small percentage of fully vaccinated people who still get sick, are hospitalized, or die from COVID-19." But data about ICU patients' vaccination status is not regularly reported or readily available on the federal or state level.

"The current surge of COVID-19 is driven by those who have elected not to be immunized. We will continue to see the lopsided impact of COVID among the unvaccinated, as they represent the vast majority of severe illnesses, hospitalizations and deaths," said ABC News contributor Dr. John Brownstein, chief innovation officer at Boston Children's Hospital.

The hospital sampling also appears to be reflective of a national trend. According to the White House COVID-19 Task Force, severe breakthrough infections remain uncommon, and nearly all of the patients who are currently hospitalized with COVID-19 -- 97% -- are unvaccinated.

Dr. Lew Kaplan, past president of the Society of Critical Care Medicine and professor of surgery at the University of Pennsylvania's Perelman School of Medicine, said that the ABC News survey data "provides crystal clear guidance regarding the SARS-CoV-2 delta variant -- that vaccines work.”

Furthermore, said Kaplan, the very fact that "the overwhelming majority of hospitalized critically ill patients with this viral variant are unvaccinated, should drive our nation to relentlessly pursue vaccination of every eligible individual."

"It is our duty and our privilege to save lives," Kaplan said. "The COVID-19 vaccine is staggeringly effective in helping us keep people at home and alive."

Front-line workers support the numbers

ABC News' findings are also supported by local data. In Springfield, Missouri, county health officials reported this week that since vaccines became available, 96.5% of those who have died of COVID in the community were not fully vaccinated.

Mercy Hospital nurse Emily McMichael said the county's findings are supported by what she's been seeing.

"These patients are a lot sicker and a lot younger than what we saw the last go around, so it's just really sad to see," McMichael said. "And a lot of the population is unvaccinated."

In Alabama, which has the lowest vaccination rate in the country, 94% of current COVID-19 hospitalized patients are unvaccinated according to state statistics -- and hospital admissions are six times higher than they were just a month ago, as health care workers report an influx of COVID-positive patients in need of care.

The University of Alabama at Birmingham Hospital has seen "an explosion of cases," with the number increasing tenfold in the last three weeks, according to Dr. Kierstin Kennedy, chief of hospital medicine.

The patients who are currently hospitalized, Kennedy said, are younger than those who were hospitalized during the last surge -- but unfortunately, they are just as sick. The vast majority of those patients are unvaccinated, she said.

Similarly, in Florida, state statistics show virus-related hospitalizations are nearly at their highest point since the onset of the pandemic, with more than 1,200 COVID-19 patients being admitted to the hospital every day.

"This is heartbreaking because all this could have been avoided; this is unnecessary human suffering that we are witnessing right now," said Dr. Seetha Lakshmi, medical director of the Global Emerging Diseases Institute at Tampa General Hospital, where she said "almost all" patients are currently unvaccinated.

Another Florida physician said he believes low vaccination rates are one of the driving factors behind the state's significant increase in COVID-19 patients.

"The vaccine is really protective in terms of being hospitalized or in terms of dying, and the people we're seeing that are sick, ending up on ventilators and ending up hospitalized, are unvaccinated patients," Dr. David Wein, emergency room physician at Tampa General, told ABC News.

Few severe hospitalizations for fully vaccinated individuals

Just a month ago, 37-year-old Amanda Spencer, an unvaccinated mother of two from Ohio, became infected with the virus while on a family vacation in Florida. She spent 16 days in a Florida hospital, 11 of them in a medically induced coma.

"I never dreamed that I would go through what I did, and that I would be that close to leaving my family," Spencer told ABC News.

Spencer said that prior to her illness, she had not necessarily been against getting the vaccine, but had found it difficult to make time to get the shot -- and to some extent had been afraid of the side effects.

However, her illness has shifted her perspective.

"Having gone through what I've gone through, I would have much rather gotten the vaccine, and maybe had a couple of side effects," said Spencer, adding she now plans to get the vaccine as soon as she is able. "Everybody has a right to decide what's best for them, but my advice is that if you have an underlying condition, whether it be asthma or any type of respiratory issue, I would definitely consider getting the vaccine.”

Although patients with underlying conditions are typically at higher risk, Dr. Kennedy said that from what she has seen, "the patients that have comorbidities and are vaccinated are not getting sick enough to require intubation."

And several hospitals contacted by ABC News reported that often, vaccinated COVID-19 patients in the ICU are being hospitalized for reasons other than COVID-19.

"You may see COVID-vaccinated patients in the ICU, but many of them are not in the ICU for severe COVID," Dr. Jennifer Leonard, an ICU physician at Missouri's Barnes Jewish Hospital, told ABC News. "They have mild or asymptomatic COVID and they require an ICU bed for another disease or indication.”

Overall, Kaplan said the ABC News survey data demonstrates that "even if you are vaccinated you can still become ill, but it is so much less common that the benefit of being vaccinated is vast. It is incredibly protective and it protects you, the people you love, and the people with whom you work."

Although the vaccine may not prevent 100% of illness, it lessens the impact for most, Kaplan said.

"Fully vaccinated individuals are less likely to become severely ill because they've prepared their immune system," he said.

Kennedy said that she combats vaccine hesitation by explaining to patients that, at this point, there are millions of people around the world who have received the vaccines, with minimal side effects. The long-term side effect of vaccination, she tells her patients, is that they are not dying from COVID-19.

And what about the commonly stated concern of people who are waiting to get the vaccine because they don't want to be guinea pigs?

Kennedy said she tells her patients that "if you don't want to be a guinea pig, then don't get COVID."

ABC News' Sony Salzman, Eric Strauss, Dr. Alexis E. Carrington, Dr. Chidimma J. Acholonu, Dr. Odelia Lewis, Dr. Priscilla Hanudel, and Dr. Jay Bhatt contributed to this report.

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(WASHINGTON) -- The Biden administration’s vaccine mandate for federal workers could set the groundwork for more private sector organizations to follow along. But it also is likely to trigger an avalanche of lawsuits from those who say required vaccinations infringe on the civil liberties of Americans.

President Joe Biden is expected to announce on Thursday a plan requiring all federal workers to be vaccinated or comply with "stringent COVID-19 protocols like mandatory mask wearing -- even in communities not with high or substantial spread -- and regular testing."

The U.S. Equal Employment Opportunity Commission says that employers can require their employees to be vaccinated with exceptions being granted for religious and medical reasons.

Federal law does not bar organizations from mandating coronavirus vaccines even as the publicly available vaccines have yet to receive full authorization from the Food and Drug Administration, according to a Justice Department memo.

But some legal scholars say that full approval from the FDA would give companies increased legal cover from employees who refuse to comply with a vaccine mandate.

“There are many companies that are worried about pushback litigation and are waiting for full FDA approval,” said Larry Gostin, a professor of global health law at the Georgetown University Law Center and director of the World Health Organization Center on Public Health Law and Human Rights.

Full FDA vaccine approval is expected in September, according to a federal official. Normally, full approval takes up to a year following the submission of all required data.

Gostin added that employers also have the right to terminate employees who do not comply with their company’s vaccine mandate.

“A worker doesn’t have a legal or ethical entitlement to go unvaccinated or unmasked in a crowded workplace,” he said. “They can make decisions for their own health and well-being, but they can’t pose risk to others. Somebody who is unvaccinated and isn’t tested and unmasked poses a very substantial risk of transferring a very dangerous, if not deadly, disease.”

Similar to the legal arguments over state mask mandates, the debate surrounding vaccine mandates is an issue widely expected to end up in court.

“America is a very litigious society and there will be lawsuits,” said Gostin. “But employers and particularly hospitals are on very firm legal grounding and will win those lawsuits.”

While the Biden administration’s vaccine mandate for federal workers could inspire similar moves from large employers to local governments, some states are taking offensive measures.

Several states including Arkansas, Tennessee, Utah, and Montana have already passed legislation banning COVID-19 vaccine mandates and vaccine passports, according to the National Academy for State Health Policy.

And with return to school quickly approaching for millions of U.S. students, some legislatures have even sought to prohibit required COVID-19 vaccines for school attendance.

The Federal Law Enforcement Officer’s Association, which consists of FBI agents and U.S. Marshalls, however, sees the Biden administration’s vaccine mandate for federal employees as an attack on civil liberties.

“Forcing people to undertake a medical procedure is not the American way and is a clear civil rights violation no matter how proponents may seek to justify it,” said Larry Cosme, the association’s president, in a statement.

The idea of employer vaccine mandates is something that many public health experts increasingly agree on. A large number of companies are still allowing employees back to the office based entirely on voluntary employee disclosure of vaccination status as opposed to requiring actual proof of vaccination.

“An honor system can work in a situation where you don’t have an epidemic,” said Dr. Wafaa El-Sadr, a professor of epidemiology and medicine at Columbia Mailman School of Public Health. “We need to realize that we are in an emergency, and we have to do everything possible to ensure that the vast majority of people get vaccinated.”

Google, Apple and Facebook all postponed their return to office plans for mid-October as the delta variant continues to drive a dramatic rise in COVID-19 cases and hospitalizations nationwide.

Google's decision to require staff in their offices to be vaccinated comes after similar announcements impacting government workers in New York and California to curb the spread of the delta variant.

“The timing for these vaccine mandates is right and it’s actually a bit long overdue,” said El-Sadr.

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(NEW YORK) -- With the country in the midst of a new nationwide resurgence of coronavirus infections and hospitalizations, misinformation about the effectiveness of the vaccines has been proliferating on social media, with increased attention falling on the rare number of vaccinated people ending up in the intensive care unit (ICU). However, according to dozens of hospitals across the nation surveyed by ABC News, very few fully vaccinated people are actually ending up severely ill and in the ICU with COVID-19.

And experts say that those that do, tend to be frail or have conditions that interfere with the vaccine's effectiveness at producing protection.

ABC News contacted 50 hospitals in 17 states, and asked them to share data on their ICU wards' current COVID-19 patients, including their vaccination status. In the surveyed hospitals, ABC News found that the overwhelming majority of COVID-19 patients currently being treated in ICUs were unvaccinated.

Of the 271 total COVID patients in the surveyed ICUs, 255 patients, or approximately 94%, were unvaccinated against COVID-19 in ABC News' snapshot in time.

Further, of the 16 vaccinated individuals receiving care in the ICU, almost all suffered from comorbidities and other health problems, such as cancer or weakened immune systems. ABC News only heard of one otherwise healthy and fully vaccinated individual, with no reported underlying conditions, who was in the ICU.

According to the CDC, "vaccine breakthrough cases are expected," and, as a result, "there will be a small percentage of fully vaccinated people who still get sick, are hospitalized, or die from COVID-19." But data about ICU patients' vaccination status is not regularly reported or readily available on the federal or state level.

"The current surge of COVID-19 is driven by those who have elected not to be immunized. We will continue to see the lopsided impact of COVID among the unvaccinated, as they represent the vast majority of severe illnesses, hospitalizations and deaths," said ABC News contributor Dr. John Brownstein, chief innovation officer at Boston Children's Hospital.

The hospital sampling also appears to be reflective of a national trend. According to the White House COVID-19 Task Force, severe breakthrough infections remain uncommon, and nearly all of the patients who are currently hospitalized with COVID-19 -- 97% -- are unvaccinated.

Dr. Lew Kaplan, past president of the Society of Critical Care Medicine and professor of surgery at the University of Pennsylvania's Perelman School of Medicine, said that the ABC News survey data "provides crystal clear guidance regarding the SARS-CoV-2 delta variant -- that vaccines work."

Furthermore, said Kaplan, the very fact that "the overwhelming majority of hospitalized critically ill patients with this viral variant are unvaccinated, should drive our nation to relentlessly pursue vaccination of every eligible individual."

"It is our duty and our privilege to save lives," Kaplan said. "The COVID-19 vaccine is staggeringly effective in helping us keep people at home and alive."

Front-line workers support the numbers

ABC News' findings are also supported by local data. In Springfield, Missouri, county health officials reported this week that since vaccines became available, 96.5% of those who have died of COVID in the community were not fully vaccinated.

Mercy Hospital nurse Emily McMichael said the county's findings are supported by what she's been seeing.

"These patients are a lot sicker and a lot younger than what we saw the last go around, so it's just really sad to see," McMichael said. "And a lot of the population is unvaccinated."

In Alabama, which has the lowest vaccination rate in the country, 94% of current COVID-19 hospitalized patients are unvaccinated according to state statistics -- and hospital admissions are six times higher than they were just a month ago, as health care workers report an influx of COVID-positive patients in need of care.

The University of Alabama at Birmingham Hospital has seen "an explosion of cases," with the number increasing tenfold in the last three weeks, according to Dr. Kierstin Kennedy, chief of hospital medicine.

The patients who are currently hospitalized, Kennedy said, are younger than those who were hospitalized during the last surge -- but unfortunately, they are just as sick. The vast majority of those patients are unvaccinated, she said.

Similarly, in Florida, state statistics show virus-related hospitalizations are nearly at their highest point since the onset of the pandemic, with more than 1,200 COVID-19 patients being admitted to the hospital every day.

"This is heartbreaking because all this could have been avoided; this is unnecessary human suffering that we are witnessing right now," said Dr. Seetha Lakshmi, medical director of the Global Emerging Diseases Institute at Tampa General Hospital, where she said "almost all" patients are currently unvaccinated.

Another Florida physician said he believes low vaccination rates are one of the driving factors behind the state's significant increase in COVID-19 patients.

"The vaccine is really protective in terms of being hospitalized or in terms of dying, and the people we're seeing that are sick, ending up on ventilators and ending up hospitalized, are unvaccinated patients," Dr. David Wein, emergency room physician at Tampa General, told ABC News.

ABC News' Sony Salzman, Eric Strauss, Alexis Carrington, Chidimma Acholonu, Odelia Lewis, Priscilla Hanudel, and Dr. Jay Bhatt contributed to this report.

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(NEW YORK) -- While authorized vaccines have proven safe and effective in holding the line against COVID-19, they are not 100% effective. Reports of uncommon breakthrough cases among fully vaccinated Americans, coupled with the delta variant tearing through the country, threaten to undermine the fiercely fought wins against the pandemic.

For the fully vaccinated who do test positive, if you are at high risk for severe infection, health experts are now turning to Food and Drug Administration authorized, virus-fighting monoclonal antibodies in some cases. They are saying it's safe and beneficial for those who have been vaccinated, but get infected with COVID-19 nonetheless.

"Receiving antibody treatments in a timely manner could be the difference of ending up in the hospital or getting over COVID (quickly)," Dr. Shmuel Shoham, infectious disease physician at Johns Hopkins University School of Medicine, told ABC News.

Monoclonal antibodies are synthetic versions of the body's natural line of defense against severe infection, now deployed for after the virus has broken past the vaccine's barrier of protection. The therapy is meant for COVID patients early on in their infection and who are at high risk of getting even sicker to help keep them out of the hospital. This risk group includes people 65 and older, who have diabetes, high blood pressure, cardiac disease, obesity, asthma or who are immunocompromised.

It can be administered through an intravenous infusion, or a subcutaneous injection, which is less time-consuming and labor-intensive, and more practical in an outbreak situation.

The therapies still in use across the U.S., like Regeneron's antibody cocktail, has shown to hold up against the variants of concern, including delta.

It's a new use for a therapy whose authorization predates that of the vaccines.

"The trick is to proverbially cut the virus off at the pass," Dr. William Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, told ABC News. "An ounce of prevention is worth a pound of cure."

Though a fraction of breakthrough cases have symptoms, the few that do may need backup to fight off the infection, experts say.

"There are exceptions. Everyone has seen a handful of patients who are vaccinated, you get very, very sick. Those are by and large, people with many risk factors, and perhaps people were vaccinated longer ago, with people in whom we don't expect the vaccine to work as well," Dr. Andrew Pavia, Infectious Diseases Society of America fellow, NIH COVID treatment guidelines panel member and chief of pediatric infectious diseases at the University of Utah School of Medicine said.

Clinical trials for monoclonal antibody therapies were conducted prior to vaccines' authorization, before shots started going into arms and far before breakthrough infections were a part of daily discussion. But the Centers for Disease Control and Prevention specifies that for vaccinated people who have subsequently contracted COVID, a vaccine should not preclude seeking further treatment.

The chances of an allergic or adverse reaction is low, experts said. Regeneron's product targets the virus, not a protein produced by the body, a company spokesperson said -- so, it likely wouldn't trigger a haywire immune response with an antibody "overdose" from both the vaccine and the monoclonal therapy. And clinical trial data has shown authorized monoclonal antibody therapies can sharply reduce hospitalizations and deaths by as much as 70%.

A Regeneron spokesperson said as long as a patient has tested positive for COVID and meets the other criteria to receive the treatment, they can receive the therapy.

"We are not screening those patients out. If they have been vaccinated and come in testing positive and are at high risk for a more severe infection we are giving them monoclonals," Schaffner said. "I think that was decided pretty quickly."

It's a question of targeting the appropriate group of infected patients, experts said and it's not for anyone who has symptoms after testing positive. Doctors prescribe the therapy for patients with specific risk factors that make them unlikely candidates for fighting off the virus on their own. With your antibodies already being made to combat coronavirus, experts said another helping won't do as much good.

But Shoham calls it a "missed opportunity" for patients eligible to receive it -- who don't.

"If they had gotten a monoclonal antibody, their chance for hospitalization would have been significantly reduced," Shoham said.

"The vaccines are so good, that most people who have one or two risk factors that are vaccinated are less likely to become infected, and if they are -- the vast majority have done very well," Pavia said. "What we're trying to do is identify that small sliver of people with breakthrough infection that may get quite sick."

The antibody cocktail medications work best if it is delivered within days of a positive test or onset of symptoms. So, doctors recommend acting quickly after getting a positive test to seek treatment, if the high-risk criteria fit -- whether you have been vaccinated or not.

"This is a targeted treatment that is not for everyone -- it's not 'spaghetti at the wall' for when vaccines don't work," Schaffner said. "But this is good news on the therapeutic side."

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(NEW YORK) -- Jamie Manning says she was excited earlier this month for a day of solo shopping in small towns outside her hometown of Washington, D.C.

It was something she would do frequently before the coronavirus pandemic, but this particular Saturday marked the first time she had done something like this in over one year.

As she sat down for lunch alone at a local restaurant and waited for her food, Manning said "my mind started to wander and I began to spiral."

Describing the thoughts that raced through her mind, Manning, 32, explained: "There are a lot of people here. It's really loud. I feel a little woozy. I hope my food gets here soon. I probably just need to eat something. I feel like I need to get out of here. I can't leave because I need to eat. What if I pass out? I don't know anyone here. DC feels so far away. Why did I come here alone? I can't catch my breath."

The panic attack Manning experienced was not one she expected. But as she recovered and thought about it later, she realized it was due simply to trying to reenter the world after more than a year spent socially distanced and isolated from people during the pandemic.

"I kind of felt sensory overload," Manning told Good Morning America. "It wasn't that I was as nervous about getting sick, it was more like, 'Wow, I haven’t been in an environment for a very long time and it’s a lot to take in.'"

Manning shared her experience in a post on Instagram and received dozens of replies from people describing similar experiences.

"It used to be really normal for me, so I was surprised I had the reaction that I did, and I was surprised by the amount of messages I got," said Manning. "Anything we can do to normalize these feelings and help people feel like they’re not alone is important."

The struggle some people have faced as the country has reopened over the past several months is to be expected, according to Divya Robin, a New York City-based psychotherapist.

"For the last year to year-and-a-half we’ve been repeatedly told to stay home, wear a mask, social distance," said Robin. "That’s been the message that’s completely wired in our brain. We were almost trained to be fearful of seeing people, fearful of the virus."

"Now we have to give our brain time to adapt again, to shift again what we’re doing," she said. "We have to think back to March, and the time it took then."

The increased anxiety felt by many people mostly stems from the uncertainty and lack of control around the pandemic, according to Robin.

Those feelings may be even more intense now as the United States faces a COVID-19 summer surge as the delta variant spreads.

"We all have a fear system in our brains and that's where anxiety stems from," she explained. "We’re used to day-to-day there being a few times that it’s activated, like if you’re walking on the street and a car comes near you."

"Over the past year of the pandemic and what’s going on now with the uncertainty around new variants coming and cases rising, it's been activated nearly constantly," Robin added. "That’s one of the reasons anxiety has shown up for more people."

Anxiety can show up in different ways for different people, from overwhelming and worrisome thoughts to physical symptoms like chest tightness, fatigue, brain fog and difficulty concentrating and focusing, according to Robin.

While it's important to know and expect that anxiety may arise, it's just as important to have tools to handle it, she noted.

Here are five tips from Robin to help handle anxiety in a post-pandemic world.

1. Be patient with yourself:

Robin says to think of preparing yourself for a return to the office and social events in the same way you would think about getting back in shape after time away from the gym. In other words, patience.

"Two or three years ago, we’d be able to go three or four happy hours a night, and now many of us don't have the energy," she said. "It’s like if you go to the gym every day and run five miles and lift weights and then you don’t do it for a year-and-a-half, it's hard to do."

"But with time and training, it comes back," added Robin.

2. Set small goals:

In order to train yourself to essentially be social again, Robin suggests setting small goals, like a new activity each weekend, or meeting a different friend weekly for coffee, for example.

"Don't feel like you need to totally jump into things," said Robin. "Start small and build your way up, just like any training program."

Manning said she learned that lesson the hard way now looking back on her own experience.

"One of the learnings I took is I tried to do much at once," she said. "It was easy to be like, ‘OK, great, everything is normal again,' but I had to acknowledge that it was a lot for me to do a whole day outing and to be more intentional and ease into it."

3. Try not to compare yourself to others:

Every person has a different perspective on and approach to post-pandemic life, so don't compare yourself to others, recommended Robin.

"Be real with yourself about what your limits are instead of comparing yourself to other people," she said. "Really resist the urge to compare, especially because that can cause more anxiety."

"Instead, think about what feels right for you."

4. Practice deep breathing:

If you feel yourself having anxiety thoughts or physical symptoms of an anxiety attack, Robin recommends practicing grounding and deep breathing techniques.

"Think about where you are in the moment," said Robin. "If you’re sitting with a friend, feeling the sensation of your feet on the ground, your back leaning on the chair. Feeling grounded in where you are."

"And for deep breathing, focus on really feeling your belly as you inhale. You want to feel like a balloon is being inflated inside your stomach."

5. Pay attention to your thoughts:

Noticing the thoughts that you’re having can help you to not give into your anxious patterns, according to Robin.

"Anxiety a lot of the time stems from thinking of things that are outside our control," she said. "Notice when those [anxious] thoughts come up and be aware of them, but don’t ruminate. Try to stay with one thought instead of ruminating and running away with all the worst case scenarios."

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(NEW YORK) -- With the COVID-19 delta variant surge once again prompting the Centers for Disease Control and Prevention to recommend masks indoors for teachers and other vaccinated school employees, many parents are left wondering if the new landscape of the pandemic means it's safe for their still-unvaccinated young children to return to school this fall.

Early in the pandemic, epidemiologic data showed parents a reassuring trend: children were less likely to be infected and more likely to have mild infections. However, as COVID-19 vaccines were rolled out and the country made progress toward herd immunity, there came a shift: The viral spread is now predominantly among the unvaccinated, and of the largest unvaccinated populations is children under 12, who are not yet eligible for the available vaccines.

Data from the American Academy of Pediatrics has shown that children have made up a higher proportion of overall COVID-19 infections over the past couple of weeks.

"This increase is concerning, and yet not surprising, as the virus is going to infect those who are not protected," said Dr. Amanda D. Castel, pediatrician and professor of epidemiology and pediatrics at George Washington University. "Children are still at risk for developing severe complications from COVID-19."

Fall classrooms will be ground zero for a recipe that epidemiologists fear: Unvaccinated populations combined with close proximity and limited social distancing could become an avenue for disease spread.

While children are not necessarily more vulnerable than they were before, the biology of the disease has changed. The delta variant is more transmissible regardless of age and spreads more efficiently across unvaccinated populations.

"Make no mistake, this is a virus that can cause children to suffer and die," said Dr. Paul A. Offit, pediatrician and director of the Vaccine Education Center at Children's Hospital of Philadelphia.

An important question now circulates in parent and teacher circles: how do you mitigate risk and still give kids a normal school year? The CDC updated its prior guidance on Tuesday, saying that children and teachers should be wearing masks in school this fall.

Experts agree that a nuanced approach to preventing transmission and creating herd immunity with high vaccination rates is key.

"Teachers can enforce proper social distancing practices and keep extra personal protective equipment (PPE) for themselves and students in supply," said Kamon Singleton, M.Ed, a teacher at Heyward Gibbes Elementary School in Columbia, South Carolina. "Although most schools may provide some PPE, teachers may want to keep an excess of supplies."

Castel said she believes "layers of protection" are the answer.

"The first layer is to have everyone who can receive a vaccine do so," Castel said. "Parents of children age 12 and older can make an appointment now. The shots create a bubble of protection not just for kids who have been vaccinated but also for kids who cannot get the vaccine yet. For those that can't get vaccinated, wearing masks."

While the pandemic is now largely fueled by those who decide not to vaccinate, this fall and winter, the focus will shift to keeping children from becoming the pandemic's next target until vaccines are available for all.

Nancy A. Anoruo, MD, MPH, is an internal medicine physician at Brigham & Women's Hospital and public health scientist. John Brownstein, Ph.D., is chief innovation officer at Boston Children's Hospital and an epidemiologist. Both are faculty at Harvard Medical School and contributors to ABC News' Medical Unit.

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(LONDON, HONG KONG and JAKARTA) -- A perfect storm with the coronavirus appears to be brewing across the Asia-Pacific region: surges in the highly contagious delta variant combined with slow vaccination uptake.

Tight vaccine supplies are a major factor and experts caution that unless most of the global population is vaccinated, and richer countries share more of their vaccines, the world will face a far longer bout with the coronavirus than anticipated.

The issue extends from countries at the center of the current surge, like Indonesia, to those that fared relatively well with the disease early on in the pandemic, like South Korea.

Even as countries like the U.S. and U.K. face rising cases despite their largely vaccinated populations, hospitalizations and deaths have not yet risen to the same levels as 2020 due to the success of vaccination efforts, public health experts say. Yet the vast majority of the global population remains unvaccinated (just 3.7 billion out of 10-12 billion recommended doses have been distributed).

More people have died of COVID-19 since Jan. 4, 2021 than the whole of last year, according to an ABC analysis of WHO data.

The pandemic is not just far from over -- it is in a “critical moment where we are all under threat,” due to rising new variants and vaccine inequality, according to WHO spokesperson Dr. Margaret Harris. The course of the virus, she said, is that it is likely to become “endemic” -- meaning it will not disappear, but eventually could become manageable like the other coronaviruses in circulation.

But a true end to the pandemic will likely only happen with the artificial immunity conferred by mass vaccination, according to Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.

“You have countries that are making good progress toward building an immunity shield,” he told ABC News. “When you look at the rest of the world, a very small percentage of the population [is] being vaccinated."

The stark vaccine disparity is far from lost on people in Indonesia, who in the last few months have seen the delta variant rip through their communities, overrunning hospitals, filling graveyards and leaving family and friends who’ve lost loved ones in anguish.

In scenes reminiscent of when India was at its devastating peak earlier this year, there is a clamor for oxygen canisters in Indonesia -- now the coronavirus epicenter of the region. Afflicted families, turned away from hospital wards, are taking treatment into their own hands. For two weeks, Defitio Pratama, 27, a marketing salesman based just outside Jakarta, took care of his sick mother at home.

“We had no idea what to do at that time since we did not have oxygen tank at hand,” he told ABC News in Jakarta, where there are long lines for scarce oxygen cylinders. “I started contacting friends and families for oxygen tank, I even went all the way to other city when I found my mother’s friend offering to lend theirs. We could not take my mother to hospital because they kept rejecting us, we had no choice but to treat her at home.”

While Pratama has received one dose of the AstraZeneca vaccine, his mother, who is asthmatic, remains unvaccinated. In the week ending July 19, 9,696 deaths were recorded, an increase of 36% from the week before, according to the WHO. Just under 16% of the population has received at least one dose of vaccine.

In Indonesia, a combination of a lack of supply, vaccine hesitancy and concerns over the Chinese manufactured Sinovac have contributed to the slow rollout, but the country is by no means alone in the region.

Thailand, Australia, Vietnam and South Korea -- all countries that were praised last year for their swift containment strategies -- have reintroduced restrictions to deal with outbreaks of the Delta variant, which is estimated to be 60% more transmissible than the alpha variant, in recent months. According to Harris, the world’s richest countries are “basically holding the rest of the world hostage by not insisting that their manufacturers share.”

“This is why you've got massive outbreaks going on around the world,” she told ABC News. “But people don't seem to hear it. What they're hearing is possibly what they want to hear is 'I'm vaccinated, now, I can go back to normal.' You can't. Not until you sort it out in the rest of the world.”

The Biden administration has pledged to donate more than 80 million doses to countries in need, with 23 million going to Asia. Some 3 million doses of Moderna arrived in Indonesia from the U.S. on July 11 -- but the rollout needs to significantly increase in order to meet the WHO’s target to vaccinate at least 10% of every country in the world by the end of September.

For the pandemic to end and the virus to become manageable on a global level and COVID-19 to become manageable as with other coronaviruses, between 10 and 12 billion doses need to be administered around the world, Huang said, ideally with high effectiveness. That number currently stands at around 3.7 billion, according to the WHO.

“The best case scenario is that through these vaccination efforts that by the end of next year we have produced enough vaccines that can vaccinate a majority of the population worldwide, and that vaccination is effective in terms of preventing severe cases of death,” Huang said. “Previously I was more optimistic about how and when the pandemic is going to end. “But now, with that divide in terms of vaccine access, in terms of the strategies adopted by countries, in terms of the continued emergence of the new variants, I'm not that optimistic anymore.”

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(NEW YORK) -- New York Governor Andrew Cuomo on Wednesday announced that all patient-facing health care workers in hospitals run by the state will be required to get vaccinated. He said, “There will be no testing option.”
 
Additionally, as of Labor Day, all state employees must either be vaccinated or get tested on a weekly basis.
 
Governor Cuomo said the decision was made due to the “dramatic action” needed to control a surge in COVID-19 cases linked to the Delta variant. He said school districts in areas of high transmission should also consider taking a more aggressive approach.
 
“I understand the politics, but I understand if we don’t take the right actions, schools can become super-spreaders in September,” Cuomo said.
 
Calling on private sector businesses, Cumo said they should incentivize vaccinations by only allowing vaccinated people in. 
 
75% of adults in New York state have been vaccinated. 

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(NEW YORK) -- As contentious debates over vaccine mandates continue with new coronavirus cases on the rise among the unvaccinated, elected officials are starting to fine-tune the idea of a new incentive by requiring public employees to get a coronavirus test until they get their shots.

Barun Mathema, an assistant professor of epidemiology at Columbia University's Mailman School of Public Health, told ABC News that the plan is a very effective incentive on paper, and it will have a bigger impact outside of the public sector when it comes to confidence in the vaccines.

"This is saying the government, unambiguously, supports vaccination. One can try things like lotteries to entice individuals, but to me, this is a serious and thoughtful approach," he told ABC News.

New York City Mayor Bill de Blasio announced last week that employees of the city's public hospital system, which included medical centers like Elmhurst Hospital, the epicenter of the first wave of hospitalizations in 2020, would have to show proof of vaccination or submit a weekly test until they got their shot. Exemptions are allowed for religious medical reasons.

De Blasio expanded that order on Monday to all city public employees, which included police officers, firefighters and teachers. Even though 59% of the city's entire population and 70% of its adult population has at least one dose of the vaccine as of Tuesday, the numbers were lagging among the ranks of some New York agencies, city data showed.

The NYPD had a 43% vaccination rate, the Department of Correction had a 42% vaccination rate, the FDNY had a 55% vaccination rate, and public school employees and city hospital employees each had a 60% vaccination rate, according to data from city officials. Nationally, 56% of all residents and 69% of all adults have at least one shot, according to the U.S. Centers for Disease Control and Prevention.

The testing mandate will go into effect for unvaccinated public hospital workers next week, and goes into effect on Sept. 13, the first day of schools in New York, for other public employees.

De Blasio stressed that the delta variant is causing cases to rise in unvaccinated neighborhoods in the city and he wanted to ensure New Yorkers that their public employees were vaccinated or proven safe.

"We're going to keep climbing this ladder and adding additional measures as needed mandates and strong measures, whenever needed to fight the delta variant," the mayor said during a news conference Monday.

A few hours later, California Gov. Gavin Newsom announced that he would place a similar testing mandate for any state employee who can't provide proof of vaccination. The mandate affects 249,000 employees and also provides exemptions for religious or medical reasons.

"California has committed to vaccination verification and or testing on a weekly basis," Newsom said at a news conference.

California's policy will take effect on Aug. 9.

Mathema said the policy will be most effective at swaying unvaccinated employees who were on the fence about getting the shot and needed an incentive to do so.

In this case, time spent on taking a COVID-19 test, submitting the paperwork to a boss and getting their OK week after week would take its toll, Mathema said.

"There will certainly be some people who find the constant testing inconvenient," he said.

Dr. John Brownstein, an epidemiologist at Boston Children's Hospital and an ABC News contributor, said the testing requirement will put extra pressure on an unvaccinated employee to get their shot.

"They’ll have to quarantine and put themselves out of two weeks of work," he said.

Brownstein predicted that more states will follow New York City and California's lead and there appears to be momentum at the federal level. President Joe Biden is expected to announce Thursday that all federal employees show proof of vaccination or submit to regular testing, ABC News has learned.

Brownstein added that some businesses have begun to implement rules that provide more benefits for customers. Some cruise ships, he noted, restrict their non-vaccinated passengers from the more popular dining areas and attractions.

"It’s a hybrid carrot and stick situation. You’re giving benefits to people who are vaccinated and punishing people who aren't," he said.

Mathema warned that there are likely to be a number of public employees who will submit to the weekly testing rather than get their shots. He reiterated that elected officials and businesses that implement a testing mandate for the unvaccinated needed to supplement their policy with a focused educational plan.

"I do believe this needs to be met with outreach, strong outreach and consistent outreach," Mathema said. "We do need to be tactful, show empathy and address real issues that are out there: people's concerns over the vaccine."

Anyone who needs help scheduling a free vaccine appointment can log onto vaccines.gov.

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(SALINA, Kan.) -- NASA recently began new research to investigate how extreme summer weather may be affecting the upper layers of earth's atmosphere.

Kenneth Bowman, Ph.D., the principal investigator for the Dynamics and Chemistry of the Summer Stratosphere (DCOTSS) research project, spoke to reporters about the project during a press briefing on Tuesday. He said their goal is to understand how intense summer thunderstorms over the U.S. affect the stratosphere -- the second layer of earth’s atmosphere as you move toward space -- especially as climate change causes severe thunderstorms to occur more often.

“Most thunderstorms occur in the lower layer of the atmosphere, which we call the troposphere. But when we get particularly intense thunderstorms, the updrafts -- the rising air in the storm -- can actually overshoot into the layer above, which is the stratosphere,” Bowman said.

He said that when this happens, the air in the troposphere can rise up to the stratosphere in as little as 20 to 30 minutes. Those updrafts can transport pollutants and water that might not normally reach this level of the atmosphere in such a short amount of time.

The stratosphere is usually dry, according to the project’s website, and the water and pollutants may "have a significant impact on radiative and chemical processes" in the atmospheric layer.

David Wilmouth, Ph.D., a scientist at Harvard University who is working on the project, said the updrafts could potentially “change the chemical composition of the stratosphere, a process that would not otherwise happen.” Their work will determine if that’s the case.

Bowman explained that the stratosphere is important because it contains the Earth’s ozone layer, which protects us from harmful ultraviolet radiation that comes from the sun. About 90% of the world’s ozone layer exists within the stratosphere, according to Wilmouth.

Wilmouth said the ozone layer is “critical” for protecting life on earth. If its protective shield was to weaken, humans would be more susceptible to skin cancer, cataracts disease and an impaired immune system, according to NASA.

Dan Csziczo, Ph.D., a professor and head of the Department of Earth, Atmospheric and Planetary Sciences at Purdue University, said during the briefing that their goal is specifically to understand the composition and size of the particles that make their way up to the stratosphere, and how they might influence the earth’s climate. Csziczo said the research would also help scientists understand the process of cloud formation and subsequent precipitation.

Understanding the relationship between climate change and particulate matter in the air is critical because, ultimately, each of them might exacerbate the impact of the other on humans’ health and way of life.

For the project, NASA is working with several universities across the country, as well as the National Center for Atmospheric Research and the National Oceanic and Atmospheric Administration.

The mission consists of three eight-week-long deployments over the course of the 2021 and 2022 summer seasons. The DCOTSS will be using NASA’s ER-2 high-altitude research aircraft for the mission.

DCOTSS will be operated out of Salina, Kansas, a site chosen by the researchers due to its central location within the U.S. It’s also a region of the country that’s particularly prone to severe and intense thunderstorms during the summer.

The ER-2 aircraft is equipped with fully robotic, pre-programmed instruments that can measure the gases and particles that come out of the overshooting tops of the thunderstorms, as well as meteorological information, such as water vapor, Wilmouth said.

The aircraft can only transport its pilot, who must wear a pressurized suit to withstand the high altitudes, which can go as high as 70,000 feet -- about twice the altitude of typical commercial airlines, according to the project’s website.

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(NEW YORK) -- U.S. weightlifter Mattie Rogers set two records at the Pan American Weightlifting Championships, a qualifier event for the Tokyo Olympics, including a snatch lifting 245 pounds.

A week later, she had to lay down on the floor while training when the cramping she'd been feeling during those championships turned into an "overwhelming, stabbing feeling," she told Good Morning America.

Rogers, 25, was doing her job while also managing her reproductive health, and just as she was working to finally qualify for the Olympics, her body threw her "a perfect storm."

Her story represents what many go through trying to figure out which contraceptive method works best for their body and lifestyle, although many experience it silently due to stigma. Rogers, however, chose to share her story with hundreds of thousands of followers, helping to shed the idea that it's all smooth sailing for everyone just because few people talk openly about it.

Before the Pan Americans, Rogers said she had an IUD inserted. She'd been using a NuvaRing -- a hormonal contraceptive manually inserted for weekslong periods -- and "was super happy with it, but it was very inconvenient with traveling internationally" as it requires refrigeration and frequent prescriptions.

She and her coach also wanted to see if an IUD would help with her performance by reducing menstrual symptoms.

"I have the same symptoms everybody has: cramps, just fatigue, and I got a lot of lower back stiffness and tightness, which obviously interfered with training," Rogers told GMA.

Hormonal IUDs can help with period symptoms, according to Dr. Melissa Dundas, an adolescent medicine physician in New York and a fellow with Physicians for Reproductive Health.

After competing well enough to have her Olympic spot more or less guaranteed, Rogers went for the insertion, deciding at her doctor's recommendation to get the Kyleena IUD.

"(The doctor) was like, 'Oh, it shouldn't be bad, just a little bit of cramps, it's fine.' And it was the most miserable experience ever," Rogers laughed.

Dundas told GMA she often recommends patients take over-the-counter pain medication, like Motrin or Tylenol, before they come in for insertions.

Rogers took to Instagram to share her experience with her 651,000 followers, who are used to seeing updates on training and life in Florida with her three cats and husband.

She said she wanted to talk about her IUD because she felt unprepared, but also because she's had trouble finding easily digestible information for the average person -- or athlete -- on the real experiences of reproductive health options.

As a doctor who worked with many young athletes and was one herself, Dundas was "motivated" to hear an athlete shared her story, "because she's clearly not the only person that has questions or concerns." She recommends patients discuss contraceptive options with health care providers, especially because there are so many options to tackle a variety of issues and solutions.

"It's definitely a conversation that needs to be had, and more openly with everybody, because it is an additional factor that athletes who have a uterus need to deal with," she said, "and they need to be able to have support and information surrounding that so they can perform optimally at the sport they do."

Since she got the IUD, Rogers has kept her followers updated. Many responses, she said, have been thankful for her openness while they consider their own options, including trying to find what works best for athletes.

"I feel kind of bad cause I don't really have any answer," she said. "I can only say my personal experience."

Dundas echoed that sentiment, especially because contraceptive options affect different people in different ways.

"I think it is incredibly empowering for individuals to share those stories, but then also with the caveat that that's their own individual story and may not necessarily be the same outcome for somebody else," she said.

Rogers shrugs off the question of feeling comfortable talking about her reproductive health. For one thing, she openly discusses period management with her coach and they plan training around her cycle.

For another, "Growing up, my mom was an anatomy teacher at my high school, so we just had to hear all body things all the time and it's just not a weird thing in my world."

Plus, she added, "I mean, I definitely overshare all the time anyway, so it doesn't feel as weird as it probably is."

After she got the IUD, Rogers said she had cramps essentially every day for over a month, although it has "gotten better each month." Dundas recommends patients assess a new contraceptive for three to six months as your body adjusts to it.

Cramping and irregular spotting or bleeding are possible after an IUD insertion, Dundas said, although the severity varies widely for patients, spanning from a few days to up to six months.

"Unfortunately, we don't have a magic eight ball to see which individual is going to have cramping only for a few days versus a couple of months," she added.

Ultrasounds revealed the pain after the Pan American Championships was caused by "a giant ovarian cyst" rupturing, Rogers said, adding that she doesn't know if it was related to the IUD.

Cysts are listed as a possible side effect of Kyleena, although, Dundas notes, while cysts can happen in people who have IUDs, there's no known causal relationship between IUDs and cysts. Cysts are common for people with uteruses during reproductive years and a majority are benign. They can rupture during strenuous exercise.

By mid-May, Rogers was formally named to the USA weightlifting team for the Tokyo Olympics, which begin July 23.

When Rogers spoke with ABC News in late June, she was thinking she'd go through the Olympics with the IUD.

At that point, she was gearing up for the USA Weightlifting National Championships, which she and her coach joked would be "a good test run" as she expected to have her period during competition.

And how'd the "test run" go? Rogers set three American records.

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(WASHINGTON) — The Centers for Disease Control and Prevention on Tuesday cited new science on the transmissibility of the delta variant in revising its mask guidance to now recommend that everyone in areas with substantial or high levels of transmission -- vaccinated or not -- wear a mask in public, indoor settings.

The agency also called for universal masking in schools.

The new science, gathered from several states and other countries, shows that "in rare occasions, some vaccinated people infected with a delta variant after vaccination may be contagious and spread the virus to others," CDC Director Rochelle Walensky told reporters during a briefing on Tuesday afternoon.

"This new science is worrisome, and unfortunately warrants an update to our recommendation," Walensky said.

She said the new data emerged in the last week and showed that vaccinated people who are infected with the delta variant could carry the same viral load as unvaccinated, infected people. As a result, the CDC is asking that even the vaccinated wear masks in public, indoor settings "to help prevent the spread of the delta variants and protect others."

Walensky emphasized that the vast majority of transmission is still happening among unvaccinated people, and the best way forward is to increase vaccinations everywhere because the vaccines were still considered to be highly effective. The risk of a symptomatic infection is reduced sevenfold for fully vaccinated people, Walensky said, and the risk of hospitalization is reduced twentyfold.

"Getting vaccinated continues to prevent severe illness, hospitalization and death, even with delta. It also helps reduce the spread of the virus in our community. Vaccinated individuals continue to represent a very small amount of transmission occurring around the country," Walensky said.

The public health agency also recommended schools embrace universal masking, departing from guidance released earlier this month that suggested vaccinated students and staff were safe to go without a mask.

"CDC recommends localities encourage universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status," the CDC wrote in a summary of the new guidance. "Children should return to full-time in-person learning in the fall with proper prevention strategies are in place."

The revised guidance raised questions about the CDC's previous decision to no longer recommend masking, indoors or outdoors, for fully vaccinated people, and whether that was an overly confident move that relied too heavily on an honor system for unvaccinated Americans to continue to follow the rules.

But it also raises questions about how likely it is that fully vaccinated people can transmit the virus when infected, and whether that has changed with the onset of the delta variant -- a question that the CDC is still studying but has said with increasing confidence is much less likely to occur among vaccinated people as opposed to unvaccinated people.

Emerging science on that question was a key reason the CDC changed the mask guidance two months ago, in May, when it announced that all vaccinated Americans were safe to go without a mask indoors or in a crowd. Its guidance for schools followed that principle.

CDC recommendations noted that individuals and schools could still opt to wear a mask even if fully vaccinated, but said the risk of illness and transmission was low.

At the time, Walensky pointed to a "coalescence of more science that has emerged just in the last week" in three areas.

"One is the effectiveness of the vaccines in general in real world populations. One is the effectiveness against variants, which was just published last week. And then the effectiveness in preventing transmissibility," Walensky said in May.

But evolving factors have forced the CDC to take another look; chief among them, the delta variant, and as a close second, some Americans' unwillingness to get vaccinated. And while the CDC didn't predict those barriers, Walensky has consistently reminded Americans that guidance will have to change as the pandemic does.

"This past year has shown us that this virus can be unpredictable. So, if things get worse, there is always a chance we may need to make a change to these recommendations," she said on May 13.

On Tuesday, she said she was dismayed to come forward with a new recommendation that certain swaths of the country re-implement mask mandates indoors, but that experts agreed that the new data "required action."

"This weighs heavily on me. I know at 18 months through this pandemic, not only are people tired, they're frustrated," Walensky said. "And I know, in the context of all that, it is not a welcomed piece of news that masking is going to be a part of peoples lives who have already been vaccinated."

But she also pointed to low vaccination rates as the reason the delta variant was forcing the change in guidelines in the first place, urging people to step up and get a shot.

"This moment, and most importantly, the associated illness, suffering and death could have been avoided with higher vaccination coverage in this country," Walensky said. She warned, too, that if vaccinations don't increase, the "big concern" is that the virus will continue to spread, mutate and eventually "could potentially evade our vaccines."

As of Tuesday, about 69% of adult Americans had at least one shot, while 60% were fully vaccinated. The country missed President Joe Biden's goal to have at least 70% of adults with one shot by July 4.

And the story varies widely across the country, particularly in pockets in the southeast and midwest, where vaccination rates dip below the national average.

On Tuesday, the CDC told reporters that those factors didn't change the benefits of getting vaccinated: the risk of severe illness from COVID still remains low for Americans who are fully vaccinated and the vast majority of people hospitalized with COVID-19 are unvaccinated.

But the delta variant, which has taken root in the U.S. over the last month and now represents 83% of all infections, is different than past mutations of the virus, the CDC said.

Doctors and researchers who have been tracking the pandemic and working on the frontlines were largely supportive of the CDC's decision on Tuesday.

"We are seeing the delta variant cause a spike in hospitalizations in the U.S., just like it did in the U.K. and India earlier this summer. A return to indoor masking is a simple way to slow the spread," said Caitlin M. Rivers, an epidemiologist and senior scholar at The Johns Hopkins Hospital.

And on the question of transmission among vaccinated people, the question should be framed up against the much greater risk, which is transmission among people who have not gotten a vaccine and have ceased following any safety guidelines, said Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University in Nashville.

"The issue is the unvaccinated. That's where the transmission is like a four-lane highway with all that traffic. There's some spillover to the vaccinated, but that's like a bunch of side streets," Schaffner said.

"Yes, there is transmission among the vaccinated and from the vaccinated, but it's very low in comparison to the amount of transmission that is occurring among unvaccinated people."

But the unknowns still increases concerns for parents of young children who aren't eligible for vaccines yet.

"Parents of unvaccinated children should have their kids wear a mask, avoid crowds and continue to take the precautions we've been relying on throughout the pandemic to reduce risk," Rivers said.

Rivers said she had returned to wearing her mask indoors, regardless of whether she was in an area with high transmission -- and Schaffner said he'd never stopped.

"I am back in a mask when indoors in public, even though I'm fully vaccinated," Rivers said.

Schaffner compared it to wearing a belt and suspenders to hold up pants -- double protection.

"I'm an infectious disease doc, I really respect this virus, and I will take every layer of protection that I can get," he said.

He encouraged the general public, no matter where they live, to take up mask-wearing again when indoors.

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(NEW YORK) — In the last decade, the popularity of traditional cigarettes -- particularly among teenagers -- has declined tremendously, while the use of electronic cigarettes has been on the rise.

But now a new smoke-free alternative called heated tobacco is slowly gaining a foothold in the U.S. market. Also known as heat-not-burn tobacco products, the devices heat up a cigarette without using an open flame.

The heated cigarette produces an aerosol that contains the nicotine as well as other chemicals and additives. The device is more similar to a traditional cigarettes than an e-cigarette or a vape device, which don't contain tobacco, because the nicotine is coming directly from the cigarette.

Tobacco companies are attempting to glamorize these products, experts told ABC News.

"They're attempting to make the packaging and the marketing look white and clear and clean and very modern," said Erika Sward, assistant vice president for advocacy at the American Lung Association. "But we can't afford to be fooled again on another tobacco product."

"The tobacco industry is always looking for new ways to get new people to smoke and use nicotine products and be hooked for life," said Dr. Maria Rahmandar, medical director of the Substance Use and Prevention Program at Lurie Children's Hospital in Chicago.

So far, only one such device -- made by one of the world's largest tobacco companies, Philip Morris -- has been approved by the U.S. Food and Drug Administration. Dr. Moira Gilchrist, vice president of strategic and scientific communications at Philip Morris, told ABC News that the company's heated tobacco product "is not for youth at all."

"We place a really high emphasis on making sure we're selling a product only to the right people, and that we're not attracting the wrong audience," Gilchrist added.

Despite this sentiment, teens are still curious -- and at risk.

While heated tobacco products only became legal in the United States in 2019, the device have already started to catch the attention of high school students. Nearly one in 10 of California's 10th and 12th graders have heard of heated tobacco products, with the vast majority saying they first learned about them from the internet or social media, according to a study published in Pediatrics, the official peer-reviewed journal of the American Academy of Pediatrics.

Although the survey found that less than 1% of California teens have actually used heated tobacco products, researchers are worried.

"Our concern is that this is a new product and the design is kind of slick," the study's co-author, Dr. Shu-Hong Zhu, who is also the director of the Center for Research and Intervention in Tobacco Control at the University of California, San Diego, told ABC News. "Our goal was to raise the alarm. We fear this might be like the new e-cigarettes."

Almost one in five students surveyed said they would try heated tobacco products if offered to them by a friend. This number doubled for students who have already used e-cigarettes or vape devices, according to the study.

Heated tobacco products have been marketed as a better alternative to smoking, but the American Academy of Pediatrics warns the devices contain about the same amount of nicotine as traditional cigarettes and give off secondhand aerosol that is unsafe to breath.

"If someone is interested in quitting smoking there are ways that are safe and effective," Sward said. "This is a product that is aimed at continuing someone's addiction."

Moreover, the devices also contain chemicals like carbon monoxide (a poisonous gas), acetone (the active ingredient in nail polish remover), ammonia (commonly used in household cleaners) and benzene (a component of gasoline).

"Any time [parents] or their children are inhaling these kinds or any type of chemicals into their lungs, they're putting their health at risk," Sward warned.

As teens head back to school this fall, experts are urging families to be aware of these new, dangerous products.

"Nicotine is just so powerful," Rahmandar said. “There is no safe tobacco product. There is no safe nicotine product. These products are certainly not safe and harmless -- especially to the developing brain."

Chidimma J. Acholonu, M.D. M.P.H. is a pediatric resident physician at the University of Chicago and a contributor for the ABC News Medical Unit.

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(NEW YORK) -- Kayley Reese first noticed what seemed like a growing bump in her stomach over a year ago.

"The reason I really noticed it was because I own a clothing store and am in all the photos and it got to a point where I could see it in every single photo," Reese, of Richmond, Virginia, told Good Morning America. "It looked like I was pregnant."

Reese, 23, said she did not notice any other physical symptoms, so she did not do anything about it.

"On social media I would see some things like it’s your uterus protruding or everyone has it, it’s a protective layer," she said. "So I kind of made it normal in my head."

It was not until June when Reese flew home to Orlando, Florida, that she began to feel symptoms and sought treatment.

"I was nauseous and dizzy and my appetite wasn’t normal and I had shortness of breath, painful urination, all that," said Reese. "My mom asked to feel the spot that I was complaining about and said, ‘That is not normal.'"

Reese went to a local emergency department, where she underwent testing that found a large cyst near her left ovary.

"The [doctors] weren’t sure how long it had been there but they said the symptoms I was having were from that," she said. "At 23, I had no idea this could ever happen to me."

Reese underwent a two-hour surgery to remove the cyst, which she said was eight inches in length, seven pounds in weight and was filled with two liters of fluid.

The cyst was diagnosed as a paratubal, or paraovarian cyst, a type of cyst that forms near an ovary or fallopian tube but does not adhere to an internal organ, like an ovary.

"It was the best possible case scenario because they were able to save both my ovaries," she said. "When I went into surgery they said they were likely going to have to take out an ovary and my fallopian tube."

While she was recovering, Reese said she saw a video on TikTok that prompted her to share her own story publicly.

"I saw someone else’s TikTok about having something similar and all the comments on her video were like, 'That's normal. Everyone has it,'" said Reese. "I thought this was exactly why I didn’t think much of my own [stomach bump]."

Reese posted a now-viral video sharing her own story, explaining, "I feel like if I had seen my own TikTok, I would have gone to the doctor a lot earlier."

She said she was overwhelmed by the response, both from women thanking her for the information and women who also had paratubal cysts.

"When it started to get picked up I was very nervous because I’m like I’m not a doctor, but I saw that it brought awareness to a lot of women," said Reese. "I got messages from women who had the same situation and they said was the first time they heard anyone even talk about it, so it was super emotional."

The type of paratubal cyst Reese had differs from the more well-known ovarian cyst because a paratubal cyst does not attach to the ovary or fallopian tube.

While most paratubal cysts do not cause symptoms, some develop and become extremely large before causing symptoms including abdominal pain, frequent urination and feelings of fullness in the abdomen.

Problematic cysts can be removed through surgery.

Women with frequent or painful cysts, including paratubal cysts or ovarian cysts, may be advised by their doctor to take over-the-counter pain medication or hormonal birth control, according to the U.S. Office on Women's Health.

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