Health Headlines

andresr/iStockBy ANNE FLAHERTY, ABC News

(NEW YORK) -- Everyone agrees it’s not healthy to keep kids stuck at home, with the American Academy of Pediatrics encouraging school districts to resume in-person class time for the health of the nation's children.

But when it comes to the virus and its potential to spread quickly, it’s less clear what will happen when they return.

Here are three things to know about kids, schools and COVID-19:


It’s rare for kids to get really sick. But there’s limited evidence on how easily they spread it.


If there’s one clear finding among researchers, it’s that young people infected with the virus are less likely to get really sick, and the inflammatory syndrome that some children experience is considered very rare.

But it’s also become widely accepted that asymptomatic teens and young adults in general are driving transmission of the virus in the U.S. because of work or attending social gatherings.

In one county in Virginia, for example, health officials said 150 teens between the ages of 16 and 18 tested positive for the virus in the last week -- most of them after having traveled to Myrtle Beach, South Carolina. On Monday, a county in Missouri announced that 82 children, counselors and staff tested positive at a local summer camp despite promises by the facility that it would take reasonable steps to prevent the spread.

Less evident, though, is whether much younger children -- under age 10 or so -- are more or less likely to spread the virus than adults.

Initial studies in China and a small study by the American Academy of Pediatrics concluded children probably aren’t "drivers" of the virus. And there are other studies based on modeling that assume children aren’t spreading COVID-19 because they are less likely to test positive.

But health experts warn there are caveats. Much of the research is small in scale and not peer reviewed. Also, kids in the U.S have mostly been at home since the spring.

"We haven’t been able to really watch kids in their natural habitat," said John Brownstein, chief innovation officer at Boston Children’s Hospital and a professor at Harvard Medical School.

"Even if they are less capable of getting or transmitting the virus, you are countering that (in schools) with closer proximity and contacts over longer periods of time," added Brownstein, an ABC News contributor. "We don’t have evidence of them in school settings … There aren’t a lot of kids who have had a normal day in the past four months."

Comparisons with Europe don’t really work.


Trump this week compared the U.S. to Germany, Denmark, Norway and Sweden that he insisted reopened schools with "NO PROBLEMS" and suggested that Democrats were standing in the way of reopening schools because it would benefit them politically to stall the country.

The picture in Europe, though, might not be so straightforward, including new data from Germany that found infections among children and teens under age 19 went from about 10% in early May to nearly 20% in late June.

There’s counter evidence in other parts of the world too: In Israel -- where social distancing is reportedly an issue -- schools have struggled to remain open because of outbreaks.

Meanwhile, Anthony Fauci, the nation’s top infectious disease expert, warns the U.S. isn’t like Europe because it remains stuck in its "first wave" of infections after so many states and communities either couldn’t -- or wouldn’t -- lock down.

"In reality only about 50 percent of the nation shut down with regard to other things that were allowed" besides schools, Fauci told Congress last week. "In many of the European countries, 90 percent, 95 percent of all activities were shut down. So that is one of the reasons why you saw -- particularly in Italy, which shut down to a much greater extent than we did -- the cases came way down in a sharp curve downward and then stayed."

In other words, activities -- including camps and schools -- resumed in Europe under very different circumstances than the U.S. in which kids were less likely to encounter the virus in the first place.

"It is the fact that the countries in Europe and the other countries that you have there had a much more uniform response," Fauci said.

As of Tuesday, the United States had the ninth-worst mortality rate in the world, with 39.82 deaths per 100,000 people, according to Johns Hopkins University. The COVID Tracking Project reported Wednesday a new daily high in cases in the U.S., with 62,197 total cases. Fauci has warned numbers top 100,000 cases a day, which "puts the entire country at risk."

Dr. Ashish Jha, director of the Harvard Global Health Institute, said how American act now and what safety precautions they take will impact school openings.

"We need to close bars, we need to close indoor large gatherings and have everybody wearing masks," he said this week. "If we start all that now I think there is a pretty good shot we can open schools and keep them open all fall."

The CDC guidelines might change, even if the science doesn’t.


Robert Redfield, director of the Centers for Disease Control and Prevention, has long recommended that schools space children six-feet apart, open windows when possible and avoid kids mingling in cafeterias or sharing playground equipment.

That advice was based on findings that the virus primarily was transmitted from person-to-person contact and that commonly touched surfaces would need to be disinfected between uses. Fauci, Redfield and others also have made clear that indoor gatherings are likely to spread the virus.

The CDC also helped to develop a White House plan that called for schools only to open after cases in a community decline for 14 days -- allowing the area to enter "phase 2."

Then came Trump’s tweet.

"I disagree with @CDCgov on their very tough & expensive guidelines for opening schools," the president wrote. "While they want them open, they are asking schools to do very impractical things. I will be meeting with them!!!"

I disagree with @CDCgov on their very tough & expensive guidelines for opening schools. While they want them open, they are asking schools to do very impractical things. I will be meeting with them!!!

— Donald J. Trump (@realDonaldTrump) July 8, 2020

By that afternoon, Vice President Mike Pence was before the cameras with Education Secretary Betsy DeVos, announcing that the CDC and Dr. Redfield -- a political appointee -- would issue new guidance by next week, including a set of five new documents.

"They must fully open, and they must be fully operational and how that happens is best left to education and community leaders," DeVos said of schools.

Redfield offered: "We really don’t have evidence that children are driving the transmission cycle of this."

Redfield later told ABC’s Good Morning America that "our guidelines are our guidelines but we are going to provide additional reference documents." He said he was concerned his agency’s initial advice was being used "as a rationale" to keep schools closed and said "these decisions about schools are local decisions."

.@ABC NEWS EXCLUSIVE: @CDCDirector Dr. Robert R. Redfield speaks one-on-one to @GStephanopoulos after Pres. Trump blasts their school guidance and weighs in on when it will be safe to open schools. https://t.co/gXeRpIX7D6 pic.twitter.com/1OS0cZ75Rz

— Good Morning America (@GMA) July 9, 2020

When asked if the White House had pressured the CDC to change its public health advice for political reasons, White House Press Secretary Kayleigh McEnany told reporters Wednesday: "No, not at all. But the President made his opinion quite clear publicly this morning on Twitter for all to see."

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areeya_ann/iStockBy KATIE KINDELAN, ABC News

(WASHINGTON) -- The Supreme Court's ruling Wednesday to allow an employer or university with a religious or moral objection to opt out of covering contraceptives could cost women hundreds of dollars each year in out-of-pocket expenses, experts say.

The court ruled 7-2 to uphold President Donald Trump's move to let more employers opt out of the Affordable Care Act mandate guaranteeing no-cost contraceptive services for women.

Conservatives hailed the decision as a resounding win for religious liberty, while groups that support reproductive rights slammed the ruling, saying it threatens birth control access, particularly for low-income workers and people of color.

"As a result of today's ruling, a person could lose birth control coverage simply because their boss has a personal religious objection to it," Dr. Kristyn Brandi, board chair of Physicians for Reproductive Health, said in a statement Wednesday. "As an OB/GYN providing the full spectrum of reproductive health care, I see every single day how contraception is a critical part of our collective health and wellbeing."

Here are five questions answered about what the ruling means for women's access to contraceptive care.

1. Does the Supreme Court's decision mean birth control is no longer covered by insurance?


No.

The Supreme Court decision centers on a 2018 rule issued by the Trump administration that expanded the types of employers who could opt out of the requirement that contraception be included in an employee's health insurance plan. If an employer does not opt out of the requirement, insurance coverage of birth control will continue.

The Affordable Care Act (ACA) requires insurers to include "preventive care and screenings" as part of "minimal essential coverage" for Americans. Since 2010, all FDA-approved contraceptives have been included.

And while the Supreme Court upheld the 2018 rule in its decision this week, it also returned the case to lower courts for consideration of other challenges, according to Emily Nestler, senior staff attorney for the Center for Reproductive Rights in Washington, D.C.

"It's important to keep in mind that while today's decision is frustrating and disappointing, it is not the end of the story," Nestler told "Good Morning America" on Wednesday. "There's a lot of space still for a number of things to be decided."

2. Who will be impacted?


As many as 126,400 women would "immediately lose access to no-cost contraceptive services" under the Supreme Court judgment, Justice Ruth Bader Ginsburg wrote in the dissent, joined by Justice Sonia Sotomayor, citing government estimates.

Nestler points out that any person who has an insurance provider that is connected to their employer or school is at risk of losing their contraceptive coverage under the 2018 Trump administration rule.

"It is unilateral, meaning [an employer or university] can just opt-out and they don't have to tell anyone," she said. "All of a sudden you could lose coverage and you wouldn't even know it is happening to you until it's done."

The people hardest hit by having to pay out-of-pocket for contraceptives would be those who already face the greatest barriers to quality health care, including low-income women, women of color and LGBTQ people, advocacy groups say.

One in three Latina and four in 10 Black women of reproductive age say they cannot afford to pay more than $10 for contraception, according to data shared in an amici curiae brief filed in the Supreme Court case.

3. How much does birth control cost women?


Insurance co-pays for birth control pills typically range between $15 and $50 per month, which adds up to over $600 per year, according to Planned Parenthood. Nearly 13% of women in the U.S. between the ages of 15 and 49 currently use the pill, according to the Centers for Disease Control and Prevention (CDC).

The out-of-pocket costs for other types of contraceptives, like IUDs, can cost thousands of dollars.

"It's important to bear in mind that any cost is a tremendous burden to people who already face huge barriers to access," said Nestler. "Any amount of money that you pay for your birth control is money that's not going to other things, like your rent and your food and taking care of your family."

"That is a barrier from the outset and layered on top of that is then the woman is put in a position about what she can take from [in her budget] in order to get this preventative care," she said. "Another layer on top of that is if the woman is able to find some way to get some sort of preventative care, is she forced to make a choice about a type of contraception that she is going to get that is not the best choice for her because it's cheaper."

The birth control benefit in the ACA saved women an estimated $1.4 billion on birth control pills in 2013 alone, according to the National Women's Law Center.

4. How do I know if my employer is opting out of birth control coverage?


"You certainly should look carefully at your insurance policy and pay attention if you receive any notification that your policy has changed," said Nestler. "If you're still not sure, call your insurance carrier or write a letter to your employer."

"If you find out that you are not receiving access, you of course have your voice," she said. "You can tell your employer that you are not OK with this discriminatory treatment continuing."

Groups that support reproductive rights, like the Center for Reproductive Rights and Planned Parenthood, have information available online on rights for accessing birth control.

WomensHealth.gov, a website operated by the Department of Health and Human Services (HHS), also has information on obtaining low-cost or free birth control.

5. What happens next?


The legal battle will continue in courts in states, including Pennsylvania and New Jersey, which initially challenged the Trump administration rules.

"The rules will continue to be litigated. This is not at all resolved," said Nestler, who added though that she believes there is a "distinct possibility" the rules could go into effect for at least some period of time while the legal battle continues.

Nestler said Congress also has the power to step in and end the ongoing legal battle by requiring that contraceptives be considered as part of "minimal essential coverage" for Americans under the ACA. The Department of Health and Human Services currently defines what services qualify, which led to the Supreme Court case.

"Congress really should take action to ensure that the administration can't enforce these discriminatory rules anymore," said Nestler. "These cases have been languishing in the courts for a really long time and these rules that we now have are clearly not what Congress intended. They certainly could and should step in."

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AlexSava/iStockBy DR. YALDA SAFAI, ABC News

(NEW YORK) --  In the midst of the COVID-19 pandemic, health experts are warning about the risk of prolonged grief disorder among people who lose loved ones. Older adults are especially at risk, according to a study published in the Journal of Geriatric Psychiatry.

Prolonged grief disorder, also known as complicated grief, is characterized by persistent yearning for and preoccupying thoughts and memories of the deceased, as well as emotional pain that causes impairment in everyday activities.

This disorder can last at least six months and is different from normal bereavement, which can still be painful and overwhelming. However, even with normal bereavement, most people eventually adapt to the loss of the loved one and changes in life circumstances.

"Bereavement is the normal process of reacting to a loss," Dr. Divya Jose, a psychiatrist in New York City, told ABC News. "The symptoms can include feelings of sadness, anger, guilt, changes in sleep, appetite and energy levels."

In contrast, Jose, said, "complicated grief is an inability to accept the loss and move forward. The symptoms become debilitating and don't improve with time."

Prolonged or complicated grief affects about 2-3% of the population worldwide and is more likely to occur after the loss of a child or life partner and after a sudden death.

People are more likely to develop prolonged grief disorder if they have a history of prior trauma or loss, a history of mood and anxiety disorders, unexpected or violent deaths, if they were the primary caregiver for the deceased or if they experience a lack of social support after the loss.

The pandemic has changed the experience of death for many by changing the way terminally ill patients are being cared for, how bodies are buried and what bereavement rituals performed, due to physical distancing restrictions. Other pressures associated with COVID-19, such as unemployment, have further disrupted the normal grieving process.

"In addition to the unexpected nature of coronavirus-related deaths, the disruption in traditional grieving processes -- such as the practice of religious rituals, the limitation of visitors and the practice of social isolation -- could potentially interfere with normal grieving, causing a rise in complicated grief," Jose said.

COVID-19 deaths are also happening with stay-at-home orders in place, which can worsen the sense of isolation and loneliness that is a part of the natural experience of many mourners.

"There is a pressing need to implement measures that lessen the adverse consequences of COVID-19-era bereavement," the authors of the study wrote.

They also called for health care providers to pay closer attention to patients experiencing a loss at this time and mentioned that it is important for clinicians to have a better understanding of the natural grieving process and the unique challenges faced by the bereaved during this time.

Recognizing prolonged grief disorder is important because it can cause impairment in physical and mental health and lead to drug use, suicide, reduced quality of life and premature mortality, the authors added.

"Health care providers can help with active listening, helping patients understand and process their grief," Jose said. "Physicians can monitor symptoms to identify any treatable disorder such as depression or anxiety and provide appropriate medication management if indicated."

It is important to note that bereavement can trigger depression, anxiety and trauma-related disorders without slipping into prolonged grief disorder. It is important for health care professionals to be able to identify these treatable disorders and know when and how to appropriately manage them or refer to mental health services. Virtual grief counseling or psychotherapy services can also aid in the healing process.

Awareness of this risk, for healthcare providers, can lead to timely preventive or treatment interventions that may mitigate the development of prolonged grief disorder.

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Cecilie_Arcurs/iStockBy KRISTOFER RIOS, CHO PARK, MATTHEW MOSK and LAUREN EFFRON, ABC News

(NEW YORK) -- Mary Winnet was overjoyed at the sight of seeing her husband. It was the first time the couple was able to reunite in two months.

“Do I get to touch you? You’re healthy?” she asked her husband before reaching out for an embrace.

Like many residents in senior living communities, Winnet and her husband were separated and placed in quarantine to keep them safe from the coronavirus, COVID-19.

But the measures meant to save their lives have also been isolating. In addition to each other, they’ve been kept apart from their other loved ones, including their daughter, Katie Nelson.

“Can you imagine living in a room that's maybe 200 square feet for two months,” Nelson said. “When you talk[ed] to them, you could hear there was gonna be a breaking point really, really soon.”

Winnet was able to reunite with her family because Thrive Senior Living Communities in Virginia, where she and her husband live, created a simple but effective plexiglass barrier to allow families to see each other while talking through a phone hook-up.

A whole range of communal living arrangements for seniors have presented significant health challenges in the age of the coronavirus. Facilities of all sorts have been searching for new ways to address those concerns in the face of an unexpected and deadly pandemic. The primary goal: keep residents in isolation in order to keep a vulnerable population safe.

“If you have people in your life that have underlying conditions or are susceptible to having COVID, [that’d] be really bad for them. So that's really scary,” Nelson said. “I want to see my people so badly, and I know that the families do, too. ... But I would still rather wait ... to make sure that these people are safe. So I mean, that's hard.”

As the pandemic continues, many communities have started experimenting with creative ways to combat their residents’ loneliness, such as allowing family members to talk to residents through closed windows, setting up chairs in entrances or setting up plastic “hug” barriers.

One facility in Maryland has developed a novel approach to monitor the health of its residents. Layhill Center in Silver Spring has partnered with medical data company Megadata to track residents’ vitals in hopes that the data they collect will eventually allow for more accurate screening before visits.

With 123 residents, Layhill Center has had 18 positive COVID-19 cases. Seven of them have died from the virus but most have fully recovered.

“We knew that it was an infectious process, and we needed to make sure that we were on board with handwashing, we were on board with utilizing the [personal protective equipment], and just the standard practice for infection control,” said Jennifer Kelly, who directs the nursing facilities at the center.

The facility has been using Megadata’s program in addition to these precautions since the onset of the pandemic, and they believe it’s been vital to saving lives.

Dr. Priya Vasdev, an internist associated with the center, said that during every shift each patient undergoes a pulse oximetry to measure oxygen in the blood.

“The concern being that pulse ox has a direct relationship to what may be going on in the lungs, and the lungs are one of the major organ systems affected by COVID-19,” Vasdev said.

Megadata president and CEO Shalom Reinman said what they found was that a patient’s oxygen levels “in most cases” was a better indicator of whether they had contracted the virus than their temperature and other symptoms, “which seemed to be later developing.”

Venus Ann McAndrews, a resident at Layhill, has an underlying health condition. She said the pulse oximetry system helped save her life.

“I thought I was a goner, for sure,” McAndrews said. “If they wouldn't have caught it when they did and got me the help that they did, I would probably have died, and that's the truth. They really saved my life by ... finding out so quick and sending me to the hospital.”

Kelly said being able to monitor the data for subtle changes in patient vitals has benefited every one of their residents because it has allowed the medical staff to react and treat them much faster, as well as isolate residents who were becoming ill much earlier.

She hopes that this monitoring system will eventually allow them to clear residents for visits on a case-by-case basis.

“It's been hard. You know, the things that you took for granted as normal, you can no longer take it for granted,” Kelly said. “Before, you can hug your patient, sit there and have a conversation without a face mask on. And now you're not doing that... The intimacy is no longer there.”

“We have to be vigilant,” she added, “and we have to make sure that we're following the standard of care right now and the practice that is required.”

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narvikk/iStockBy ERIN SCHUMAKER, ABC NEWS

(NEW YORK) -- Silent transmission of the novel coronavirus could account for more than half of infections, according to one new mathematical model by U.S. and Canadian researchers.

The researchers utilized data on asymptomatic and presymptomatic transmission from two different epidemiological studies and estimated that more than 50% of infections were attributable to people not exhibiting symptoms.

Since the study is based on a mathematical model, the 50% finding is an estimation based on probabilities and approximations, rather than a precise figure.

The findings were published this week in the Proceedings of the National Academy of Sciences of the United States of America.

A different study, published in June in the journal Nature, found that in one Italian town in which the majority of residents were tested for COVID-19 while the town was under a 14-day quarantine, approximately 40% of individuals who tested positive had no symptoms.

The findings could have real-world implications for leaders deciding how to rein in outbreaks in their respective countries or regions.

Widespread testing, isolating infected people, and ordering a community lockdown stopped the Italian outbreak in its tracks, the authors of the Nature study concluded.

"Even if all symptomatic cases are isolated, a vast outbreak may nonetheless unfold," the PNAS study's authors wrote.

"Understanding how silent infections that are in the presymptomatic phase or asymptomatic contribute to transmission will be fundamental to the success of postlockdown control strategies," they said.

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iStock/ipopba(NEW YORK) -- BY: DR. DANIELLE WEITZER

Thanks to modern medicine, we now have a once-daily pill that can prevent HIV, a virus that interferes with the body's ability to fight infections. However, experts say the pill doesn't work for everyone's lifestyle, and it's important for people to have other options so they can better protect themselves from HIV infection.

Now, a new study finds that a long-acting injectable medication given as a shot every eight weeks is significantly more effective than a HIV prevention pill taken every day called Truvada.

The study, which comes from the HIV Prevention Trials Network and was published at the 23rd International AIDS Conference, builds on prior research showing the shot was equally effective to the pill. The shot, called cabotegravir, has not yet been FDA approved.

"This study is important -- it is the first to try something that is not an oral medication for prevention of HIV, it is the first one looking at HIV prevention that is comparing two active drugs," said Dr. Carlos del Rio, one of the investigators involved with the study.

"We know that if you take Truvada every day the effect is very good, so here we were hoping that results of a new agent would be just as good," said Del Rio, the Executive Associate Dean of Emory University School of Medicine at Grady Health System. "What we showed at the end of the study was that cabotegravir was superior to Truvada."

The study enrolled 4,570 cisgender men and transgender women (people who were born male but identify as a woman) who had sex with men. The research was conducted at sites located in the United States, Argentina, Brazil, Peru, South Africa, Thailand and Vietnam. People were randomized into two groups: one that used injectable cabotegravir for HIV prevention and the other that used the daily pill Truvada.

Overall, 52 people became HIV positive during the course of the study. There were 39 incident infections in the Truvada group, but only 13 in the cabotegravir group. In other words, cabotegravir had a significantly lower rate of HIV infections and was a more successful agent in preventing the transmission of HIV overall.

"The main message is that there is clearly a new option for HIV prevention," del Rio said. "Some people prefer to take pills, and they will work -- but if you're someone who cannot take pills every day, maybe reluctant, there is an option now to use an injection."

The study team is also investigating cabotegravir to see if the same results can be applied to cisgender women. With more research, del Rio is hopeful that the frequency of injections can be decreased from every eight weeks to every 3-6 months.

The new drug means people may soon have more options to safety get treated to reduce the risk of HIV transmission and can therefore significantly decrease the chance of its subsequent development.

"This shows the power of well-conducted clinical trials," del Rio said. "This is a game changer -- we can really impact HIV acquisition for people at risk."

Dr. Monica Saxena contributed to this report.

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FilippoBacci/iStockBy EDEN DAVID and DR. MARK ABDELMALEK, ABC News

(NEW YORK) -- A group of 239 scientists from over 30 countries have published a letter urging the World Health Organization (WHO) and other public health agencies to more seriously consider the potential spread of COVID-19 through inhalation of small particles lingering in the air.

The WHO said in a press briefing on Tuesday that it would consider "emerging evidence" that the virus may be spread through small aerosolized particles -- sometimes called airborne transmission. The debate around whether or not the virus can be spread through particles in the air has been ongoing for months but the current WHO guidance states that the virus spreads "primarily through droplets of saliva or or discharge from the nose when an infected person coughs or sneezes."

"The World Health Organization acknowledges that transmission is mainly by large respiratory droplets when you cough or talk and fly through the air and land directly on someone's eyes or nose or mouth," said Dr. Linsey Marr, professor of civil and environmental engineering at Virginia Tech, who specializes in aerosol science and contributed to the letter. "But there's been increasing evidence that transmission is happening also by inhalation of much smaller droplets that we call aerosols and some public health organizations have recognized this but we wanted to make the WHO more aware of this so they can put out guidance worldwide."

In Tuesday's press briefing WHO technical lead for the infection prevention task force Professor Benedetta Allegranzi said, "We acknowledge there's emerging evidence in this field - as in all other fields regarding the COVID-19 virus and pandemic -- and therefore we believe we have to be open to this evidence and understand its implications regarding the modes of transmission and regarding the precautions that need to be taken."

But WHO's epidemiologist Dr. Maria Van Kerkhove was still more cautious in her response saying that the WHO has been been looking into these reports since April. Now, the focus is on "the possible role of airborne transmission in other settings ... particularly close settings where you have poor ventilation."

"We've got clusters of person to person transmission happening indoors and there is asymptomatic transmission going on, no coughing, no sneezing, no large droplets being generated and splashed into people's face," said Dr. Lisa Brosseau, an aerosol specialist and research consultant at the Center for Infectious Disease Research and Policy at the University of Minnesota. She said that in these scenarios the most likely mode of transmission is inhalation of particles in the air.

Droplet transmission describes the situation when a person spreads the virus through directly sneezing or coughing on someone. Sometimes these large respiratory droplets may also land on surfaces and a person can be indirectly infected through touching their face after coming in contact with a contaminated surface.

Although experts generally agree the virus can be spread through respiratory droplets there is less consensus around aerosolized -- or airborne -- transmission, or the how long and how far these tiny infectious particles can travel in the air.

In the letter scientists point to a mounting body of evidence that supports the potential of airborne transmission. They cite a Chinese case study of video records where the virus was transmitted between three parties in a restaurant without any evidence of "direct or indirect contact," suggesting that the virus must have been spread through the air.

They also point out that particles from viruses of the same family, such as Middle Eastern Respiratory Syndrome (MERS), can be exhaled and detected in indoor environments of infected patients, posing a risk to people sharing this environment and breathing in the same air.

Additionally, several hospital-based studies have detected the coronavirus' genetic material in air samples collected from isolation rooms of COVID-19 patients -- although it's not clear yet if these samples are capable of infecting people.

Scientists acknowledge that more evidence is needed. According to Marr, studying airborne particles is much harder because you "need specialized techniques and special equipment to collect aerosols and measure them," which is only fully understood by a small subfield of aerosol scientists. The standards, she said, for proving airborne transmission are set much higher than that for other types of transmission.

"We have as much evidence for airborne transmission as we do for any other form of transmission at this point," Marr said.

Experts say that outdated definitions and arbitrary dichotomies are also adding unnecessary hurdles in further clarifying how the virus is actually transmitted.

"Traditionally the word airborne has been associated with traveling long distances, but really what we are trying to say is that it seems that inhalation of aerosol happens at short and close contact ranges too," said Marr. Some experts have taken issue with the WHO's technical definition of 'airborne,' arguing it is too narrow and relies on methods derived from the 1930s and 40s.

The WHO says a virus is 'airborne' if it can be spread by particles that are smaller than 5 microns -- smaller than an invisible grain of dust -- and viable over a distance greater than approximately 3 feet.

Brosseau said that the definition of airborne completely overlooks the potential inhalation of particles near the source and has previously pushed WHO along with other public health organizations to expand their definition. "It doesn't meet common sense. You don't need to be a physicist."

According to Dr. Donald Milton, professor of environmental health at the University of Maryland School of Public Health and co-author of the letter, "You can have particles as big as 10 or 20 or even 30 microns that can float quite a long distance indoors."

Experts say that the 6 feet rule may not always be enough.

"In a poorly ventilated environment 6 feet is not gonna mean very much," said Milton. "Indoor air is still and being stirred up by air conditioning system and heat/thermal plumes from people, lamps, and computer screens. This will keep aerosols much bigger than 5 microns floating around and carry them much farther than 6 feet, even if it's just people talking and singing nobody with explosive coughs."

"We should replace the 6 foot rule with distance and time matters," added Brosseau. "Distance and time is key. The further you are from the source and the shorter period of time, the lower the concentration will be. I can't say what the distance is, but make it as great as possible."

Milton emphasized that "the virus is no different today than it was yesterday. What's different is our understanding of how it transmits." As a respiratory virus, some of it is indeed still transmitted through direct contact of respiratory droplets secreted through sneezes and coughs or contaminated surfaces, so washing hands and disinfecting surfaces is still important.

The Centers for Disease Control and Prevention in their criteria on how the virus spread, say the virus is spread"mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks" and that some of these droplets can "possibly be inhaled into the lungs." ABC reached out to the CDC for comment.

There is concern about creating fear, said Milton, but acknowledging the potential mode of transmission through aerosol particles may help us learn how to stay safer in the long run.

Experts are still determining how many infectious particles a person must be exposed to in order to actually get sick. "We don't know the infectious dose," said Brosseau and it may vary based on your current medical condition, or whether or not the particles are being inhaled or droplets are coming in direct contact directly with your face.

Dr. Lydia Bourouiba, an associate professor at MIT who studies fluid dynamics and the spread of pathogens, published an article in the Journal of the American Medical Association in March calling for the rethinking of coronavirus transmission -- pointing to her research that showed that sneezes and coughs could spread gas clouds of droplets much further than 6 feet.

In an interview on Tuesday, she called the dispute over droplet and aerosol transmission a "false debate," that limited efforts to craft effective safety guidelines.

"In terms of reopening, guiding everything based on this social distancing rule of one to two meters, or three to six feet in different countries … reopening based on that is not sufficient for indoor spaces," she told ABC News.

Bourouiba, who did not sign the letter to the WHO, citing "gaps in the way the science and solutions" were presented, said the CDC should implement different distancing guidelines based on categories of indoors spaces, that also take airflow and circulation into account.

And while the science of airborne COVID-19 transmission is still being studied, experts including WHO officials agree that an enclosed, crowded, poorly ventilated room is riskier than the outdoors and recommend optimal ventilation, physical distancing, face coverings, among other precautions to reduce risk of infection.

All experts also say to avoid the 3 Cs: closed, poorly ventilated environments, crowded spaces, and close contacts. "When the three overlap, that's where you get outbreaks," said Milton.

Milton added, "I think if you are careful with the messaging you can make it clear there are things you can do, it's not out of your hands, you can empower people with that knowledge."

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Media Trading Ltd/iStockBy TONYA SIMPSON, ABC News

(LOS ANGELES) -- The novel coronavirus is now infecting American prison inmates at a rate more than five times higher than in the overall U.S. population, and those numbers are escalating rapidly, according to a new analysis by the UCLA School of Law’s COVID-19 Behind Bars Data Project.

When adjusted for age, those infected while incarcerated were over than three times more likely to die from coronavirus than those on the outside, the review of available data from state and federal prisons showed, according to the UCLA report released Wednesday.

“We were surprised by the size of the gap,” Professor Sharon Dolovich, director of the project, told ABC News. “I think we knew that we were going to find numbers that were disproportionate, but we were all surprised that the disparity is so great.”

Dolovich said she believes the disparity is likely even worse because many prison facilities are still only performing COVID-19 tests on inmates who are already showing symptoms of the virus.

“If you’re a facility that’s only testing people with overt symptoms, then you’re going to miss all of the asymptomatic people,” Dolovich said.

The new findings come as the viral pandemic has been resurgent in nearly two dozen states, and many are being forced to re-impose precautions that help prevent further spread. But in the thousands of jails and prisons across the country where coronavirus has crept inside, inmates and corrections officers are finding it far more difficult to enforce social distancing and other preventive measures.

Some of the worst viral hot spots in the nation have been in prisons and jails. More than 2,400 inmates at the Marion Correctional Institution in Ohio tested positive, according to figures compiled by The New York Times. The San Quentin State Prison in California has seen 1,587 positive cases, and the Harris County jail in Houston, Texas has reported 1,390 with the illness, the Times data says.

The initial strategy in fighting the virus behind bars involved suspending the movement of inmates from facility to facility within the federal prison system and modified operations to maximize social distancing, according to the Bureau of Prisons. Both federal and state facilities have also instituted the targeted release of inmates to reduce population -- though to varying degrees.

According to an internal memo obtained by ABC News, the Bureau of Prisons extended what it called its phase 7 of the COVID-19 plan. The memo says that inmate intakes are resuming somewhat normally, after removing quarantine sites. The BOP now says that institutions are supposed to designate specific quarantine and isolation areas, where inmates will be held for 14 days and then tested.

BOP is also starting to resume moving inmates between short distances. They say inmates will be quarantined for 14 days before and after the moves as well as tested at each facility. These policies will be in place until July 31. A BOP spokesperson did not immediately respond to ABC News' request for comment for this report.

The Prison Policy Initiative, a non-profit that advocates against mass criminalization, analyzed pandemic responses at local jails and state prisons and found jails reduced populations by an average of about 30%, while state prisons showed an average reduction rate of 5%. Some advocates for inmates have promoted the approach, saying reducing inmate populations will not only help keep prisoners and staff safe, but could be crucial to protecting entire communities.

“We have correctional officers, health workers, and other staff going in and out of these facilities every day,” said Sarah Gersten, Executive Director and General Counsel for the Last Prisoner Project. “There’s a risk that they’re going to then spread the virus into their own communities and overwhelm the already overwhelmed healthcare systems.”

Gersten said inmates who are released do not pose the same threat because they are under strict quarantines and are screened prior to getting out.

The Last Prisoner Project is a nonprofit whose mission is to reform marijuana-related laws and advocate for the release of people incarcerated on marijuana-related charges. With the onset of coronavirus, Gersten said the group has widening its focus.

“We’ve expanded our program to capture anyone that might be particularly at risk of dying because of COVID,” she told ABC News.

Despite the growing number of coronavirus cases inside prisons, legal advocates told ABC News that the number of inmates being released to help stop the spread does not appear to be increasing. Gersten and her team have been advocating for the early release of prisoners such as Michael Thompson, an inmate Muskegon Correctional Facility in Michigan.

Doctors diagnosed Thompson, 69, with Type 2 diabetes, placing him in a high risk category for the virus. He has been incarcerated in 1996 and has served more than half of a 42- to 60-year sentence for three counts of selling marijuana and two counts of illegal possession of a firearm. He was 45-years-old at the time of his arrest.

Thompson told ABC News in a telephone interview that he worries day and night about contracting the virus.

“I’m concerned when you don’t have a way to fight it back,” he said.

The Michigan Department of Corrections provided face coverings for inmates, but Thompson said he considered them flimsy, so he and other inmates have become creative.

“I made my own mask out of undershorts,” he said. “One of the guys here who sews really good I gave him some brand new undershorts and he made it for me.”

A spokesperson for the Michigan Department of Corrections says the masks initially provided to inmates were made from excess prisoner clothing, but the department has since started using a custom cotton material.

The virus has changed life inside the prison walls. Inmates have less freedom and fewer contacts with loved ones on the outside.

“It’s a lot of controlled movement,” he said. “No visits for one, and only one unit goes out on a yard at a time.”

The latest information from the Michigan Department of Corrections says nearly 1,300 inmates at Muskegon Correctional Facility were tested for COVID-19. The state says 1,282 tests were negative, none were positive, and nine are pending results. Michigan has not released information for individual facilities, but UCLA data shows just under 2,000 of Michigan’s 38,000 prison inmates have been released since the pandemic began.

Professor Dolovich says she hopes her team’s work will help lead to increased release rates nationwide.

“People inside are scared and the ones who are sicker are often not getting good health care,” she said. “I’m hoping that with the publication of our findings there will be a refocusing on what I think is one of the most urgent crises facing the country right now.”

The Michigan Department of Corrections spokesperson said inmates there are provided adequate healthcare. "We have a duty and obligation to care for all prisoners that the courts send to us," Chris Gautz told ABC News. "We spend a lot of time and care and money and energy providing medical care to prisoners."

But Thompson says he’s not sure if he would survive COVID-19 if he contracted the virus.

“Oh no. Prison don’t work that way,” he laughed. “You know, as far as trying to save people. It’s cheaper to let you die.”

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Oks_Mit/iStockBy ANGELINE JANE BERNABE, ABC News

(NEW YORK) -- With the coronavirus pandemic putting a pause on summer vacations and camps this year, many families have turned to purchasing pools for their homes to cool down and still have fun.

This year alone, pool sales have increased more than 160%, according to industry estimates. In addition, the NPD Group reported that sales of outdoor and sports toys surged by $193 million in April.

"I'm pretty sure we got the last above-ground pool in North America," said Ashley Best-Raiten, a mother of two from Pennsylvania, describing the high demand for pools this summer.

Best-Raiten added that she is also taking pool safety seriously this summer, even if hers is an above-ground pool.

"It's still a pool," she said. "It still has regular pool rules."

With the uptick in sales, the American Academy of Pediatrics (AAP) is putting a spotlight on how child drownings may increase.

In a May news release, the American Academy of Pediatrics noted how caregivers may be distracted while juggling work, responsibilities and childcare.

"With parents working from home and trying to provide that supervision of their children while working, it leads to more opportunities for children to get out of the house and to get to a pool or a body of water," Dr. Patrick Mularoni, an emergency physician at Johns Hopkins All Children's Hospital, told ABC News' Good Morning America.

This year so far, All Children's Hospital in St. Petersburg, Florida, has reported a 150% increase in child drowning incidents compared to the same time period in the last two years.

Emily Friske, of California, was faced with that nightmare just last month.

Friske said she thought her daughter, Addie, was inside with Friske's husband, who was working from home at the family's home in Valley Center, California. Unbeknownst to her parents, Addie had wandered into the family pool.

"It's every parent's worst nightmare," Friske told GMA. "She was on her side. She wasn't breathing."

For more than 20 minutes, Friske's daughter was without a pulse. Friske, a former EMT, performed CPR with her husband until an ambulance arrived.

Addie's doctors figured that she would have brain damage, but she miraculously survived, according to Friske, who is now working to raise awareness about pool safety.

Friske's advice to adults is to, "Please learn CPR."

Experts say that in addition to learning CPR and making sure children know how to swim, other ways to implement safety around pools this summer include never leaving a child unattended in or near water.

Also, make sure there are proper barriers, like covers and alarms, on and around any pool or spa that kids might have access to and tell children to stay away from pool drains.

Copyright © 2020, ABC Audio. All rights reserved.

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simon2579/iStockBy DR. JAY BHATT and PARAG DEVEN PARIKH, ABC News

(NEW YORK) -- On June 26, Dr. Anthony Fauci announced it's "unlikely" that a COVID-19 vaccine with 70-75% efficacy taken by two-thirds of Americans can provide herd immunity to the SARS-CoV-2 coronavirus.

His statement has since stirred discussion about America's anti-vaccine movement.

A crucial question remains unanswered, however: Is COVID-19 even subject to herd immunity? From universities to sports teams, top experts are still debating this issue.

While the world anxiously awaits a vaccine, the length and durability of the protective immunity it would provide is far more in doubt than one might think.

A new study from China shows that antibodies can disappear in two to three months. The study further found that immunity is shorter for asymptomatic patients than symptomatic ones: The less symptomatic a person is, the weaker the immune response and antibody strength.

"Young people who have mild disease or asymptomatic disease, their antibodies may never rise very high," said Sankar Swaminathan, chief of infectious diseases at the University of Utah. "We don't even know if those antibodies are protective."

How does herd immunity work?

Herd immunity occurs when a sufficient proportion of a population is immune to an infectious disease -- either through prior illness or vaccination -- so that contagion from person to person is unlikely.

According to Johns Hopkins, 70%-90% of the population (230-300 million Americans) needs to develop protective antibodies to COVID-19 to achieve herd immunity.

Approximately 2.74 million Americans have tested positive for the coronavirus, over 130,000 of which have died (case fatality of 4.74%). By contrast, the case fatality of the flu in the U.S. is roughly 0.1%.

Absent the existence of a COVID-19 vaccine, any reasonable extrapolation of the data -- even at half the current case fatality rate, means we will see a seven-figure body count that exceeds five million deaths before we can attain herd immunity.

How does a COVID-19 vaccine impact herd immunity?

There are three factors that determine if and how well a vaccine can safely bring us along to herd immunity without exposing individuals to the life-threatening consequences of the disease itself.

First is the vaccine's efficacy -- for example, the measles vaccine is 97-98% effective. Dr. Fauci believes that for COVID-19, we are unlikely to get a vaccine that is more than 75% effective.

Second is the vaccine's prevalence of use -- this is where Dr. Fauci's concern about the anti-vaccine movement comes into play.

Fauci noted that "there is a general anti-science, anti-authority, anti-vaccine feeling among some people in this country -- an alarmingly large percentage of people, relatively speaking."

He said given the power of the anti-vaccine movement, "we have a lot of work to do" to educate people on the truth about vaccines.

Third is the durability and longevity of the vaccine's induced antibody immuno-response. This is where the two-month to three-month life span of antibodies becomes a concern.

An executive at AstraZeneca, one of the companies working to develop an effective vaccine, told a radio station that he thinks his vaccine might only offer protection for one year.

What do we know about COVID-19 antibodies?

Antibodies are proteins that specifically bind to invading pathogens to neutralize them so they cannot infect the host cell. They trigger a mechanism known as phagocytosis which destroys the virus. IgG antibodies are the most common and can protect us against bacterial and viral infections.

IgG antibody immunity to COVID-19 occurs through contracting SARS-CoV-2, or through a vaccine that produces an immuno-protective response.

Here's where things get dicey. In a scientific brief from April 24, the World Health Organization said, "there is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection." They described the notion of an acquired immunity from further infections of the disease for those who had already contracted the coronavirus an unproven and unreliable theory.

"It isn't a uniformly robust antibody response, which may be a reason why, when you look at the history of the common coronaviruses that cause the common cold, the reports in the literature are that the durability of immunity that's protective ranges from three to six months, to almost always less than a year," Fauci said in an interview with JAMA Editor-in-Chief Howard Bauchner.

Consequences

The United Kingdom, Sweden and Brazil have each allowed herd immunity to inform their approaches to COVID-19 in one way or another -- with severe consequences.

In mid-March, Patrick Vallance, the British government's chief scientific adviser, announced they were taking an approach to COVID-19 that would "build up some kind of herd immunity," but quickly reversed course due to fatal risks.

Similarly, Sweden attempted to attain herd immunity through an approach that ultimately yielded the highest per capita death rates from COVID-19 in the world, with no measurable associated economic gain, according to the European Commisison. Only 6.1% of Sweden's population developed coronavirus antibodies by late May -- a number much lower than predicted.

For reference, a large-scale study out of Spain indicates that just 5% of its population has developed antibodies. This study shows that even though Spain was one of the countries hardest hit by the virus, the presence of antibodies is still only around 5%, which is not high enough to achieve herd immunity.

Most experts say that herd immunity requires at least 60-70% of the population to have antibodies, though this number varies depending on the virus. Because of the toll that this degree of infection would take on the health care system and on the population, the safest way to achieve herd immunity would be through a widely available, widely utilized, effective vaccine.

The poor results from Sweden's controversial approach have led to a formal investigation into the government's actions in response to the public health crisis.

Brazil has fared no better with the second highest number of coronavirus cases in the world.

Conclusions

Surgeon General Dr. Jerome Adams recently advised a leading national physicians' organization that the U.S. is far from reaching the 70% infection rate needed to begin having a real discussion about herd immunity. For reference, Adams mentioned his home state of Indiana was currently at an approximate 3% infection rate.

Dr. Adams further reiterated Dr. Fauci's concerns that antibodies appear to be limited in robustness, so it is unknown how significant or effective acquired immunity to COVID-19 may be. While it's still unclear whether or not a person can get infected with COVID-19 more than once, the limited durability of immuno-protective IgG antibodies may suggest an answer the world does not want to hear.

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Courtesy Covey DentonBy KATIE KINDELAN, ABC News

(NEW YORK) -- When Lydia Denton learned about kids dying of hot car deaths because they are accidentally left behind, she decided to find a solution.

Two years later, the 12-year-old from North Carolina won a $20,000 prize for her invention, a car seat device that measures the temperature of a car and alerts parents and emergency officials when the temperature inside the car reaches 102 degrees.

"I got really emotional about it because it's something that's happening in the real world that I knew could be fixed," Lydia, who will enter seventh grade in the fall, told ABC News' Good Morning America. "And no one has come up with a cheap way to fix it that people can afford."

Last year, more than 30 children in the U.S. died because someone forgot them in a car seat in a car, according to data shared by the National Highway Safety Traffic Administration (NHSTA).

Lydia's invention, the Beat The Heat Car Seat, is designed with a pressure pad that registers when something five pounds or greater is placed in the car seat and begins to check the temperature. It is portable, so it can be transferred to other car seats and would cost around $50, according to Lydia.

Her invention won her the grand prize in this year's CITGO Fueling Education Student Challenge, a competition that "invites elementary and middle school students to apply STEM skills to develop a solution for a better, more sustainable world," according to a spokeswoman.

Lydia is using part of her $20,000 in prize money to continue to develop the Beat The Heat Car Seat with the hopes of getting it to market.

"That's why I tried to enter it in as many contests as I could and really get it out there so it can be something that will save lives and be something that most people can afford and be able to get," she said.

Lydia also shared some of her prize money with her 14-year-old brother and 10-year-old sister, who also helped her fine-tune the car seat device.

"Once I made the prototype, I called in my brother, who is really great at coding, and my sister, who's a good peacemaker," she said. "When we would get frustrated, she would help bring us snacks and she helped us design it to make it better."

Lydia's mom, Covey Denton, a science teacher, said it was inspiring to watch her three kids work together to come up with a solution to a problem that has been around for years.

"Kids don't know what impossible is. They dream so big," she said. "[Lydia] has proven that to me time and time again and told me, 'It's not impossible, Mom, you just think it's going to be. I can do this.'"

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BrianAJackson/iStockBy HALEY YAMADA, ABC News

(WASHINGTON) -- The Environmental Protection Agency just approved two disinfectant sprays that can kill SARS-CoV-2, the virus that causes COVID-19, on surfaces.

The agency said that Lysol Disinfectant Spray and Lysol Disinfectant Max Cover Mist were effective, based on laboratory testing, in preventing the spread of the virus on surfaces.

"EPA is committed to identifying new tools and providing accurate and up-to-date information to help the American public protect themselves and their families from the novel coronavirus," said EPA Administrator Andrew Wheeler in a statement.

An EPA spokesperson told ABC News in March that companies had to demonstrate their products are effective against viruses that are even "harder-to-kill" than the novel coronavirus. They also noted that any products without an EPA registration number haven't been reviewed by the agency, ABC News reported in early March. According to the Centers for Disease Control and Prevention, a way to prevent COVID-19 is to clean and disinfect "frequently touched surfaces daily."

Along with wiping down surfaces, the CDC continues to ask the public to practice social-distancing, wear protective face coverings in public and wash hands thoroughly and often in order to effectively prevent the spread of COVID-19, according to its website.

As America enters its fifth month since the beginning of the COVID-19 pandemic, there has been at least 2.9 million identified cases and 130,000 deaths due to the novel virus, with the number of new cases on the rise in at least 23 U.S. states.

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suratoho/iStockBy DR. ALEXIS E. CARGGINTON, ABC News

(NEW YORK) -- COVID-19 could bring a 20-30% increase in firearm suicides this year, a new study has found.

The uncertainty brought on by the pandemic has been impacting people's mental health and increasing feelings of anxiety and depression. The pandemic has also led to increases in gun purchases with an estimated 1.9 million additional guns sold during March and April 2020 compared to the same time period last year. Having access to a firearm in the home triples the risk of death by suicide.

Now, a new study finds that the economic downturn caused by COVID-19 could cause about 20 more lives lost per day by suicide, this year alone.

The study comes from the research arm of Everytown for Gun Safety, a non profit organization which advocates for gun control. Researchers at Everytown looked back at prior crises that led to massive unemployment, including the Great Depression of the 1930s and the Great Recession that ended in 2010.

The Great Recession, for example, led to an estimated 4,750 additional deaths by suicide -- though not all specifically by firearms. Based on Everytown's research of the impacts of unemployment on suicide from past recessions, the researchers estimate this economic downturn could lead to a 20 to 30% increase in the number of lives lost to suicide in the United States in 2020: an additional 5,000 to 7,000 lives.

"We know with unemployment brings all sorts of financial hardships that lead to emotional mental health issues," said Dr. Jeff Gardere, a clinical psychologist and associate professor at Touro College of Osteopathic Medicine in New York City.

"Our unemployment rates will most likely lead to more mental health issues, which will most likely lead to higher suicide rates, especially to people with pre-existing mental health histories and preexisting suicidality," Gardere said.

Experts emphasized that the Everytown analysis is only an estimate, and there's no way to know for sure if history will repeat itself.

"Similarities to prior eras may provide some insights into what to expect, but history does not always dictate the future," said Dr. Jack Rozel, a psychiatrist and professor of law at University of Pittsburgh Medical Center Western Psychiatric Hospital.

"It is worth noting that in the years of 1918-1920 (i.e., the years of peak mortality for the last major flu pandemic), the suicide rate went down," Rozel said.

Given the increase in firearm purchases during the pandemic and the increase in feelings of anxiety and depression, estimates like this one can help doctors and policy makers prepare for what might happen in the near future.

"While this link is not surprising, the quantification of impact provides a more meaningful assessment to help drive policy and prevention efforts," said ABC News contributor Dr. John Brownstein, the chief innovation officer for the Boston Children's Hospital and a professor of epidemiology at Harvard Medical School.

According to Brownstein, the study authors didn't account for the role social isolation might play in suicide risk, so these figures might even be an underestimate.

Everytown researchers said public health experts should take steps to minimize the risk of suicide, including encouraging secure storage practices, advertising crisis support resources and informing gun owners about the risks of firearms in the home.

In the coming months and years, medical professionals are likely to play an important role in ensuring that people have access to mental health and medical and suicide prevention services, according to Everytown.

Thankfully, experts say positive coping skills can help people make it through difficult times.

"Suicide is preventable and there are effective measures that can be taken to reduce those risks for gun owners," Rozel said.

Positive coping skills like resting, eating balanced foods and importantly prioritizing exercising (as simple as walking 30 minutes a day) can boost endorphins to help improve mood.

And experts said it's important to remember that even small gestures can make a big difference for someone experiencing suicidal thoughts.

A friend, family member or even acquaintance are only a phone call, or nowadays, a Zoom call away. Now is a great time to stay in touch and strengthen our social groups and connections, given that there's fewer things distract us from our loved ones. Connection is key.

Health care professionals are also here to help and provide resources to manage these common emotions.

"It's important that we stay connected to our providers," Gardere said. "Follow the protocol that physicians give us and follow the side effects. Stay connected with your clinician and get consistent care."

The clinician can also, with the patient's permission, include family and friends to have a network of people to work with them.

"We may not know how bad the mental health crisis will be from COVID-19, but we know that there are effective resources and strategies that can mitigate that impact," Rozel said.

If you are struggling with thoughts of suicide, or worried about a friend or loved one, help is available. Call the National Suicide Prevention Lifeline at 1-800-273-8255 [TALK] for free confidential emotional support 24 hours a day, 7 days a week. Even if it feels like it, you are not alone.

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narvikk/iStockBy IVAN PEREIRA, JANET WEINSTEIN and JP KEENAN, ABC News

(NEW YORK) -- After showing some signs of progress in flattening the COVID-19 curve, America saw a jump in cases throughout June, especially in states that eased back their pandemic safeguards early.

Over the course of the month, the country saw over 820,000 new cases and lost nearly 22,000 lives to the virus, according to health data. In total there were over 2.6 million confirmed cases and over 126,000 deaths in the U.S.

June kicked off with massive protests in major cities calling out police violence and racism following the death of George Floyd. Health officials expressed concern about the pandemic's spread as video of large crowds in New York City, Minneapolis, Atlanta and Los Angeles appeared daily.

John Brownstein, an epidemiologist at Boston Children's Hospital, told ABC News that social gatherings, in general, are a leading cause for the rise in COVID-19 cases; however, risks were mitigated with facial coverings and social distancing. Increased testing in those locations also helped to track the disease.

"These are important activities that people are undertaking and it is possible to do so in a safe way and in a broad sort of effort to protect those who are practicing their right to protest," he told ABC News.

At the same time the protests were going on, states continued to ease their coronavirus precautions, allowing more businesses such as indoor restaurants, malls and factories to reopen. New York City, which is the epicenter of the outbreak with over 212,000 cases at the end of June, saw significant progress as the number of new cases dropped exponentially from the beginning of the month.

The progress prompted hundreds of thousands of city employees to return to work.

Cities in other parts of the country, however, have a different story.

Areas of Texas, Florida, Arizona, Georgia and other states saw the number of new cases skyrocket. Texas in particular had 93,418 cases in June, an average of 3,113 cases a day, according to its health department. On June 30, it saw a record of 6,975 cases, the health department said.

Those states were some of the first locations to reopen their business and relax their safety restrictions when it came to crowds. Leaders of municipalities such as San Antonio, Tampa, Florida and Houston pushed for tougher restrictions, including mandatory face coverings and a reduction of crowds, but governors only started issuing new health safeguards by the end of the month.

"In states that are experiencing real sort of resurgences, unfortunately that does mean that gatherings should really be limited," Brownstein said.

By the middle of the month, the U.S. crossed a grim milestone: two million confirmed cases.

Despite the troubling data, President Trump pushed on with his campaign plans and held a rally in Tulsa, Oklahoma, just as the number of new cases was going up. On the day of the rally, two campaign staffers tested positive and although the crowd was sparse, several of Trump's supporters were seen not wearing a face covering.

Trump and Vice President Mike Pence didn't support a mandatory face covering order for the country and left the decision to local leaders.

Brownstein said face coverings "can actually have a real impact on population health" as the pandemic increases.

As the summer progresses, Brownstein warned that the country could see the increases throughout the coming weeks and Americans need to take the health precautions seriously.

"There's been a lot of talk about waves. Are we out of the first wave? When is the second wave? I think we have to remove that from our discussion because I think it creates confusion," he said. "It makes us safe to assume that the summer is going to save us and that's clearly not happening."

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Larkin Community HospitalBy LAURA ROMERO, BENJAMIN SIEGEL and DR. JAY BHATT, ABC News

(NEW YORK) -- After losing his job abruptly amid the coronavirus in March, Alejandro Curbelo saw a TV ad for a unique volunteering opportunity to help with contact tracing in the U.S.

At the time Curbelo, a Cuban native, was living in Cancun, Mexico, and had been working in the tourism industry before being laid off.

Without any experience in the medical field, or any knowledge of what the opportunity would entail, Curbelo told ABC News he signed up to become a contact tracer for a community hospital in South Florida -- more than 500 miles from his home in Mexico. But he quickly noticed a problem: Most contact tracing training resources were in English, which could hamper efforts to reach out to Latino communities in the U.S.

Now, nearly four months later, Curbelo, along with 70 volunteers from around the world, have completed their work on a Spanish-language contact tracing course from Larkin Community Hospital in Miami, Florida. It's adapted from the Association of State and Territorial Health Officials’ program into Spanish to better include the Latino community in the race to slow the spread of COVID-19.

As the country sets new daily infection records fueled by outbreaks in Florida, Arizona and Texas -- all states with large Latino populations -- efforts to corral the virus using contact tracing are coming up short. Contact tracing is a classic public health technique used to control outbreaks of sexually transmitted disease and foodborne illnesses by tracing the past contacts of the infected.

Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials, told ABC News that efforts to reach non English-speaking communities has been replicated in other parts of the country as local officials increasingly recognized the need to effectively communicate -- especially with regard to Latino communities that have been hit disproportionately hard.

"In some cases, there is a gap [in outreach], and people are trying to fill that gap," she said.

In Texas, for example, health officials in Harris and Tarrant Counties have translated their website and information about COVID-19 into Spanish, held tele-town halls with bilingual staff, and run advertising campaigns in Spanish to better communicate with local residents.

The outreach to South Florida’s Spanish-speaking community comes at what experts say is a dangerous inflection point of the pandemic in the U.S.

“It’s not going well,” Dr. Anthony Fauci, the nation’s top infectious disease expert, said of contact tracing efforts to contain the virus in an interview aired by the Milken Institute late last month.

In a subsequent press conference on June 26, Fauci said that many Americans aren’t picking up the phone when health officials call. The problem is pronounced in minority communities where trust between community and institutions can be fractured or virtually non-existent, he said.

“When it’s done by phone, maybe half of the people don’t even want to talk to someone they think is a government representative,” Fauci said. “If you live in a community that is mostly brown or black, you’re in a different situation … maybe 70% don’t really want to talk to you.”

Even in Miami, where many local government employees are native Spanish speakers, officials must also navigate language barriers for Latinos, and other populations.

Limited non-English language resources from the federal government has also added to the challenge, according to experts. The Centers for Disease Control and Prevention does have a website including Spanish-language resources on the coronavirus and contact tracing, as does Florida's state department of health.

"In the beginning, everything was in English," said Curbelo, the contact tracing volunteer. "But I knew that people who spoke Spanish and were sick wouldn't want to take part in contract tracing because of the language barriers. Contact tracers need to speak with people and learn as much as they can for it to work."

Curbelo was one of 400 volunteers to take the English-language course with Miami’s Larkin Community Hospital, which has a campus in Hialeah where 95% of the residents are Hispanic.

"If you speak to me in my native language, I will understand you and empathize with you," Curbelo said.

It can take about 20 minutes for an investigator to conduct a thorough contact tracing interview, according to Larkin Community Hospital executive physician Jack Michel.

Using text messages, phone calls, calendars and emails, investigators work to reconstruct an infected person’s schedule in order to map every potential interaction -- before repeating the process with each close contact.

Tracers must also work to map out a person’s contacts soon after their test results are known, in order to limit potential spread. The time-intensive and exhaustive work underscores the need for large numbers of tracers in every community -- and for those who speak their language.

The Latino community is also disproportionately effected by COVID-19. Current statistics released by the CDC show the percentage of Hispanic/Latino Americans making up coronavirus cases is almost equal to whites -- around 34% -- despite Latinos being a significantly smaller portion of the population.

"We felt there was a necessity to bring this to the community and to the rest of the country," said Laura Salazar, a volunteer. "Our Hispanic population is getting sick and they are Spanish speakers."

"This was a huge effort," Michel said during a Zoom town hall related to the effort on Wednesday. "It turns out, there's so much that goes into it. But we had volunteers who would immediately volunteer to take on and create videos and what they did is amazing."

The Spanish-language course translated by Larkin Community Hospital was released publicly last week, and takes about three hours to complete online.

The course, together with a digital platform designed by the hospital, are available for use by contact tracers and health care officials in Central and South America, Michel told ABC News. It's already in use at Larkin Community Hospital, and could be rolled out by the Association of State and Territorial Health Officials (ASTHO) to the greater U.S. later this month.

"The more we could get native Spanish speaking contact tracers, we would be better off in managing the virus," Marcus Plescia, the chief medical officer for the ASTHO, told ABC News. "Larkin was an opportunity to have a partner to help us do that."

"I am very proud of what we have done," said Curbelo. "This is going to help save so many lives.”

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WJTN Headlines for Thurs., July 9, 2020

BPU says it's ready for Summer peak load during heat advisory... With Heat Advisories issued for most of Western New York -- including Chautauqua County -- air conditioners and fans will be worki...

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