Merck says pill cuts risk of Covid-19 hospitalization, death in half as many states see vaccinations increase

By Travis Caldwell | CNN

A pill has cut the risk of hospitalization or death from Covid-19 by half in a study, Merck and Ridgeback Therapeutic said Friday.

It would become the first oral antiviral for Covid-19 if approved by the US Food and Drug Administration for emergency use authorization.

“At the interim analysis, molnupiravir reduced the risk of hospitalization or death by approximately 50%,” Merck said in a news release. “7.3% of patients who received molnupiravir were either hospitalized or died through Day 29 following randomization (28/385), compared with 14.1% of placebo treated patients (53,377). Through Day 29, no deaths were reported in patients who received molnupiravir, as compared to 8 deaths in patients who received placebo.”

Merck said it will seek FDA emergency use authorization “as soon as possible.”

Experts have said that developing an oral antiviral could be the next chance to thwart Covid-19. A short-term regimen of daily pills would aim to fight the virus early after diagnosis and prevent symptoms from developing after exposure.

One antiviral drug has been approved to treat Covid. Remdesivir is given intravenously to sick patients in the hospital. It is not meant for early, widespread use.

Some states are seeing increased vaccinations

Meanwhile, as more states and health care systems move toward mandatory inoculations for certain workers, officials are hoping the incentive of employment will eliminate vaccine hesitancy — while one governor is arranging contingency scenarios.

Connecticut Gov. Ned Lamont has instructed the National Guard to prepare in case there are staffing shortages when a vaccine mandate and testing requirement goes into effect at the end of Monday, he said. State employees must provide proof of vaccination or submit to weekly testing requirements by the deadline, and those who don’t comply will be placed on unpaid leave.

As of Thursday, more than 63% — 20,000 employees — were fully vaccinated while 12% of employees have started weekly testing, Lamont said. More than 8,000 non-compliant employees remain, yet some 2,000 have updated their status in the last two days.

“We have provided most state employees with the option to get tested weekly instead of getting vaccinated, providing more flexibility than our neighboring states. We have also provided our employees with a compliance grace period. There is no reason all our employees should not be in compliance,” Lamont said.

Connecticut is just one of several states that face pushback over mandating vaccinations for critical workers, a move that has been highlighted by health experts as necessary to protect those at a higher risk for Covid-19, but which has been met with stiff resistance from a vocal minority who wish to remain both unvaccinated and in their current roles.

In Rhode Island, the department of health announced in August that “all employees, interns, and volunteers in RIDOH-licensed healthcare facilities” would be required to get their first dose of the Covid-19 vaccine by Friday.

Care New England, one of the largest hospital systems in the state, reported Thursday that over 95% of its healthcare workforce has been vaccinated. Staff vaccination “continues to climb by the day and the hour,” according to the system’s CEO James E. Fanale.

The deadline has already passed in other states. California’s 2 million health care workers needed to be vaccinated by Thursday or risk losing their jobs, with exemptions available for religious beliefs or qualifying medical reasons.

Many hospitals that CNN surveyed had high vaccination rates among employees, averaging over 90% at some of the state’s largest healthcare systems.

In New York, none of the health care facilities shut down as a result of vaccine mandates for workers, Gov. Kathy Hochul said Thursday. Earlier this week, it was reported that 92% of nursing home staff, 89% of adult care facilities staff, and 92% of hospital staff have received at least one dose statewide.

“You will see that number go higher quickly, because what we’re finding is, you know, as more people are furloughed or suspended, that that number is going to go up,” Hochul said.

Some area hospitals had reported suspending employees without pay or temporarily halting elective inpatient procedures due to shortages.

Vaccines for ages 5-11 may be available soon, but poll finds hesitancy remains

As the Delta variant continues to spread, health care employees are far from the only who deal with everyday risks on the job. The resumption of in-person learning in schools has already been complicated by Covid-19 outbreaks and the quarantining of exposed students and staff.

Yet despite evidence that vaccinations are lowering Covid-19 infections and severity among eligible age groups, there is still hesitancy among parents and guardians about inoculating children ages 5 to 11, according to a new survey.

Only around one-third of parents of 5- to 11-year-olds say that they will vaccinate their child as soon as a vaccine becomes available for that age group, according to the Kaiser Family Foundation Vaccine Monitor results published Thursday. A similar percentage, 32%, say that they will wait and see how the vaccine is working, and 24% say that they definitely won’t get their 5- to 11-year-olds vaccinated.

According to the report, 58% of parents said that K-12 schools should require masks in school for all students and staff, 4% said masks should be required only for unvaccinated students and staff, and 35% said there should be no mask requirements.

There is a split between vaccinated and unvaccinated parents polled, KFF found, with 73% of vaccinated parents saying schools should require masks for all students and 63% of unvaccinated parents saying there should be no mask requirements.

The bulk of interviews, conducted September 13 to 22 from a sample of more than 1,500 adults, were before Pfizer announced that clinical trials showed their Covid-19 vaccine was safe and generated an immune response in this age group.

The Pfizer/BioNTech vaccine is approved for people age 16 and older and has an emergency use authorization for people ages 12 to 15. On Tuesday, Pfizer and BioNTech announced they submitted data on children ages 5 to 11 to the FDA for initial review but are not yet seeking emergency use authorization.

A formal submission to request EUA for the vaccine is expected to follow in the coming weeks, the companies said in a statement.

Among those already eligible for vaccines, the latest data from the US Centers for Disease Control and Prevention shows that nearly 200 million US adults have gotten at least one dose of the vaccine. Nearly 67% of US adults are fully vaccinated.

Death rates in nonmetropolitan areas are higher, study finds

Meanwhile, researchers are looking at the effects the pandemic is having on different parts of the nation.

Deaths from Covid-19 in nonmetropolitan areas are now occurring at more than twice the rate of deaths from Covid-19 in metropolitan areas, according to an analysis of Johns Hopkins University data from the University of Iowa’s Center for Health Policy Analysis.

After analyzing data on average Covid-19 death rates at the county level, it was determined that in the two weeks ending September 15, 2021, nonmetropolitan areas had an average of 0.85 Covid-19 deaths for every 100,000 residents. Metropolitan areas had an average half that — 0.41 Covid-19 deaths for every 100,000 residents.

Deaths in nonmetropolitan areas have outpaced those in metropolitan areas consistently since the beginning of the study in April 2020, and the numbers from September 15 are the fourth time overall that the nonmetropolitan death rate has been at least double the metropolitan death rate. However, the nonmetropolitan rate had not been double that of metropolitan areas since December 1, 2020.

The researchers used US Department of Agriculture methodology to differentiate between metropolitan and nonmetropolitan areas. Counties were logged as metropolitan if they had an urban area with 50,000 or more people or were an outlying county with strong economic ties to an urban center. All other counties in the study were coded as nonmetropolitan.

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Pregnant during pandemic: COVID-19 fears fuel increased interest in home births

When Tameka Issartel went into labor shortly after midnight on Feb. 3, she found herself drifting into a trance-like state. She didn’t remember when her husband called their midwife or how she arrived with her assistant at her El Sereno home.

“I had an out-of-body experience,” she said.

As her pain intensified, Issartel spent several hours moving around her house, stepping into a shower, sitting in a bathtub and leaning up against the sofa in her living room, while midwife Racha Tahani Lawler massaged her back and encouraged her through labor. But the baby was still not coming out.

The pain grew so intense, Issartel said, she roared like a tiger.

That’s when the midwife told her husband to call 911.

Issartel kept pushing, changing her birthing positions several times with the assistance of midwives and her husband, who was also trying to take care of the couple’s three daughters patiently waiting nearby to meet the baby.

When Issartel’s son finally arrived around 9 a.m., she noticed that he was not breathing. Her daughters surrounded the baby as Lawler kneeled next to him, pulled off her N-95 mask and performed CPR, as Issartel stared in shock.

“Breathe, baby, breathe,” one of the girls said. “Come on, Tenshin.”

Midwife Racha Tahani Lawler describes Tameka Issartel’s difficult labor where she had to perform CPR on the baby all the way to the hospital after he had trouble taking his first breath during a coronavirus surge. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

FOURTH IN A SERIES: Pregnant during the Pandemic

Previous stories:

Programs, midwives step up to support Black mothers

Black midwives in demand; are there enough to handle influx of clients?

Birth centers grow in popularity, but owners say it’s difficult to qualify for state license

Rising interest in home births 

Home births have been on the rise across the Los Angeles region for the last couple of years, in part because of the prolonged COVID-19 pandemic.

More women have been opting for home birth as hospitals postponed or moved most of their health care online due to the pandemic, barring partners, canceling antenatal classes and often leaving women to deliver and recover alone. And many women chose home delivery because they were worried about being exposed to the virus at hospitals.

Another factor contributing to the rise of home birth, experts say, is the growing awareness of health disparities in maternal and infant mortality faced by Black women, who bear a greater risk of childbirth complications than any other demographic group, according to the Centers for Disease Control and Prevention.

It’s estimated that about 700 women die each year in the United States from pregnancy-related complications, including infections, severe bleeding and high blood pressure. Black, American Indian and Alaska Native women have been disproportionately affected by pregnancy- and birth-related complications, with the CDC reporting they are two to three times more likely to die from pregnancy-related causes than other demographic groups.

Interviews with more than two dozen midwives indicate they have attended double or triple the number of home births since the first days of the pandemic, with many of them unable to meet the demand and even turning clients away.

Lawler said she has been receiving dozens of inquiries each day from families inquiring about home birth. On some days, she visits her clients not to provide any prenatal or postpartum care, but just to hold their babies and listen.

“So many Black people are struggling with feeling whole because of everything that is going on,” she said. “They are piecing themselves together, worrying about the pandemic, worrying about their family, worrying about their housing, worrying about their food and struggling to hold it together.”

Nurse midwife Shadman Habibi, who works at UCLA Health Birth Place in Santa Monica, said at least 25 women of 150 patients who were planning their deliveries there changed their birthing plans in the past few months.

“They stopped coming to us and decided to have a home birth,” Habibi said.

The number of home births in Los Angeles County increased by 5.3% to a total of 631 from 2018 to 2020. During the same period, the numbers in San Bernardino County increased by nearly 25% to 186, according to preliminary data from the California Department of Public Health.

In Riverside County, that number rose by 121% to 310 from 2015 to 2020, according to the Riverside University Health System-Public Health.

In Orange County, the numbers have remained about the same from 2018 to 2020, according to the California Department of Public Health.

Licensed midwife Angelica Miller, who is based in Long Beach, said she has seen an uptick of inquiries about home birth since last year.

“A lot of moms choose home birth outside the pandemic because they can be active participants of their care,” she said. “With the pandemic, it’s a fear of COVID.”

Many of her clients, Miller added, choose a home delivery because they want to have control over their birth experience and make sure their needs are met.

One of her recent clients, MyLin Stokes Kennedy, decided to have an out-of-hospital birth after witnessing her wife, Lindsay, being pregnant with their son Lennox about two years ago. She watched in shock as an obstetrician failed to check on her wife while she was in pain.

Stokes Kennedy made up her mind to deliver her baby at home once she became pregnant with the couple’s third child.

  • Midwife Angelica Miller does a prenatal visit with MyLin Stokes Kennedy and her wife Lindsay at their Fountain Valley home on Tuesday, June 29, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Midwife Angelica Miller listens to the heart beat of MyLin Stokes Kennedy’s baby with her wife Lindsay and their child Lennox, 21 months, at their Fountain Valley home on Tuesday, June 29, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Midwife Angelica Miller does a prenatal visit with MyLin Stokes Kennedy and her wife Lindsay who plays with their son Lennox, 21 months, at their Fountain Valley home on Tuesday, June 29, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Lennox Stokes Kennedy, 21 months, plays with bubbles as his mom Lindsay watches during a midwife visit for his other mom at their Fountain Valley home on Tuesday, June 29, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)



“I’m just more aware of what’s happening to women like me in the hospital,” said the 34-year old resident of Fountain Valley, who is Black. “I didn’t want to be part of those statistics.”

Stokes Kennedy said she was drawn to home birth and midwifery care because of its focus on avoiding unnecessary interventions. The idea of receiving guidance and support from a midwife made her feel seen and heard. The pandemic was the final straw, she added, convincing her to opt for out-of-hospital delivery.

Lindsay Stokes Kennedy wrote her wife MyLin’s birth affirmations on a mirror where Mylin’s paintings are reflected as seen on Thursday, September 16, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

“With the pandemic, I wouldn’t want to be in the hospital,” she said.

It took her more than two months to find Miller, a Black midwife who attended home births in Orange County.

She envisioned delivering her baby in a birthing tub surrounded by candles, lavender scents and family members.

“I wanted a holistic, beautiful, spiritual journey and it has been like that so far,” Stokes Kennedy said. Miller, she added, encouraged her to ask questions during appointments that sometimes stretched to more than an hour — a type of care she believed she wouldn’t get with obstetricians.

MyLin Stokes Kennedy has her wife Lindsay feel their baby move at their Fountain Valley home on Tuesday, June 29, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

But once she went into labor in the late hours on Sept. 3, all her birthing plans went out of the window.

As her labor progressed quickly, her contractions became longer and more intense. She labored in the bathroom for a while before her water bag dropped. About 30 minutes later, with the midwife still on the way, Stokes Kennedy noticed the baby’s head popping out.

“I said: ‘My baby is coming,’ ” she said.

When Lindsay heard her wife’s voice, she ran over from the dining room, where she was filling the birthing tub with water, and encouraged her wife to breathe and keep pushing. Stokes Kennedy’s doula, mother, and 13-year-old son stood by her side.

She pushed and pushed. Then she rested for a minute and pushed again.

Maddox Levi was born before midnight on Sept. 3. He weighed 9 pounds, 3 ounces and was 23 inches long. Right after he was born, the family FaceTimed the midwife and stayed on the call until she arrived about 15 minutes later.

Stokes Kennedy said although her mother was nervous witnessing home birth without professional help, no one considered calling 911.

“I was safe at home,” she said. “It was never a terrible pain. … Once his head was out, he was fine. There was never any worry.”

Although Stokes Kennedy didn’t have a chance to experience a water birth or light $200 worth of candles, she said she would do a home birth again. “My wife caught the baby,” she said. “It was very calm, intentional and beautiful.”

MyLin Stokes Kennedy rests at home on Thursday, September 16, 2021 with her son Lennox and Maddox, who her wife Lindsay delivered in their Fountain Valley home days ago. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Maddox Stokes Kennedy, 13 days, sleeps in his cradle on Thursday, September 16, 2021 next to his mom MyLin in his Fountain Valley home where he was born. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

As the pandemic continued battering hospitals, midwives say they occasionally received phone calls from women who couldn’t afford to pay for midwifery care but needed advice preparing for an unassisted birth, also known as free birth.

Some expectant mothers turned to Facebook groups, seeking advice on unassisted birth where women shared pictures of themselves laboring in inflatable pools surrounded by candlelight and family members. They also asked questions on how to talk to neighbors about potential screaming during labor, whether free birth is possible with previous C-sections and if there’s a need to call 911 if labor doesn’t progress after a certain period of time.

Although free birth is not illegal in California, there have been instances in other states in which women who delivered stillborn babies at home have been prosecuted.

Doctors maintain that hospitals remain the safest option for pregnant women even amid the pandemic.

Dr. Amos Grunebaum, an obstetrician and gynecologist and a professor at the Zucker School of Medicine in New York, said out-of-hospital birth puts mothers and babies at risk.

“Complications can happen quickly and unexpectedly, even with people who have low-risk pregnancies,” he said. “People who deliver at home put their babies at an increased risk.”

Grunebaum and a team of researchers examined records from 2016-2018 and discovered that nearly 60% of women who planned a home birth had risk factors that could potentially end up in complications and neonatal mortality, according to a study published in the American Journal of Obstetrics & Gynecology and covered by Reuters.

“These significantly increased risks of neonatal mortality in home births must be disclosed by all obstetric practitioners to all pregnant women who express an interest in such births,” according to the study.

Grunebaum was among a group of researchers who analyzed National Center for Health Statistics data on 88,000 planned home births across the county and discovered that nearly 4% of births followed prior C-section, about 23% of the mothers were 35 or older, and nearly 5% were 40 or older.

He also found that expectant mothers chose home birth despite risk factors like older age, prior cesarean delivery or obesity — factors which whole disqualified them from home birth in other developed countries.

“You have only one or two babies in your life,” he said. “Why would you risk it?

Obstetrics Service Chief Dr. Mya Zapata says the birth center at Ronald Reagan UCLA Medical Center in Westwood supports all births from hypnotic to high-risk births. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Dr. Mya Zapata, an obstetrician and gynecologist and the chief of the obstetrics service at Ronald Reagan Medical Center at UCLA, said she would recommend having a baby in the hospital.

“Most patients who get COVID, get it in the community from people they interact with,” she said. “The risk is much higher of getting COVID going to other locations and gatherings. In the hospital, at least the health care workers are vaccinated and everyone is wearing a mask.”ase

No regrets

As the Issartel family was waiting for paramedics to arrive, Lawler continued performing CPR for at least 12 minutes.

During labor, Issartel learned that the baby was large and his shoulder was stuck inside her pelvis, a birth complication known as shoulder dystocia.

When paramedics arrived, they put Lawler on the gurney with the baby as she continued performing CPR.

“I was terrified that I was going break his ribs,” she said.

Issartel, 34, was transported to the hospital in a separate ambulance.

At the hospital, the boy received a cooling treatment, also known as therapeutic hypothermia, used to treat babies who were deprived of oxygen during birth. The treatment lowers the baby’s body temperature to prevent his or her health from deteriorating, by stopping the death of oxygen-deprived cells.

Because of pandemic-related restrictions, Issartel was not allowed to see her son until later in the afternoon. She was allowed to hold him for the first time only after three anxious days.

When doctors returned the boy’s temperature back to normal three days later, Issartel placed him on her chest, watching him latch onto her breast right away, with breathing tubes and oxygen still attached to his body. His MRI images showed no signs of trauma or injury.

Tameka Issartel poses with her husband Yukio Hoshi and their children Kalea, 10, Tenshin, 7 months, Nalani, 5, and Luana, 7, in their El Sereno living room on Thursday, September 9, 2021 where she birthed Tenshin. Midwife Racha Tahani Lawler pulled off her N95 and performed CPR all the way to the hospital after Tenshin struggled to take his first breath. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

“I was very blessed that we didn’t have any issues with nursing,” she said.

Before Tenshin was born, Issartel said she was debating whether to have a home birth. She even considered unassisted birth, but eventually decided to hire a midwife.

“I didn’t want to go to the hospital in the middle of the pandemic,” Issartel said.

Home birth allowed her and her son to avoid lengthy and painful recovery, which Issartel said took more than two months after her previous pregnancy.

“I do believe this is really meant to be,” she said. “If I was in the hospital, the healing journey for him and I would be worse. I have no regrets.”

Tameka Issartel and her daughter, Nalani, 5, laugh with Tenshin, 7 months, in their El Sereno living room on Thursday, September 9, 2021 where Issartel birthed Tenshin. Midwife Racha Tahani Lawler pulled off her N95 and performed CPR all the way to the hospital after Tenshin struggled to take his first breath. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Olga Grigoryants’ reporting on pregnancy during the pandemic was undertaken as a project for the USC Center for Health Journalism’s 2021 California Fellowship.

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Here are 5 countries that are opening up and living with Covid

By Laura Smith-Spark | CNN

More than 18 months into the coronavirus pandemic, a number of countries have decided it’s time to open up and adopt a “living with Covid” model.

Some have enviable vaccination rates; others have decided that the costs of continued economic and social restrictions outweigh the benefits.

Here are five nations to watch closely for how their new strategies play out.

Denmark: The country that declared precautions over

The Danish government lifted all remaining coronavirus restrictions in the country on September 10, saying Covid-19 was no longer “an illness which is a critical threat to society.”

Danes can now enter nightclubs and restaurants without showing a “Covid passport,” use public transport without wearing a face covering and meet in large numbers without restrictions — essentially returning to pre-pandemic life.

The key to Denmark’s success lies partly in its vaccination rollout: as of September 13, over 74% of Denmark’s population was fully vaccinated against Covid-19, according to Our World in Data.

The transmission rate, or R-rate, currently stands at 0.7, Health Minister Magnus Heunicke tweeted Wednesday, meaning that the epidemic is continuing to decline. If it’s above 1.0, Covid-19 cases will increase in the near future. If it’s below 1.0, cases will decrease in the near future.

“The vaccines and all citizens in Denmark’s great efforts over a long period of time are the basis for us to do so well,” Heunicke said.

Despite such optimism, Heunicke sounded a note of caution last month as the government announced the planned end date for restrictions. “Even though we are in a good place right now, we are not out of the epidemic. And the government will not hesitate to act quickly if the pandemic again threatens important functions in our society,” he said.

Singapore: Trying to live with Covid, but Delta isn’t helping

Singapore’s government announced in June that it was planning to move toward a living with Covid strategy — attempting to control outbreaks with vaccines and monitoring hospitalizations rather than restricting citizens’ lives.

“The bad news is that Covid-19 may never go away. The good news is that it is possible to live normally with it in our midst,” Singapore’s top Covid-19 officials wrote in an op-ed at the time.

Authorities began to ease some restrictions in August, allowing fully vaccinated people to dine in restaurants and to gather in groups of five, up from two.

But a surge in cases caused by the highly infectious Delta variant has put that strategy under strain, leading officials to pause further reopening. Officials warned last week that they might need to reimpose Covid-19 restrictions if the new outbreak was not contained.

Singapore’s Covid-19 taskforce said it would attempt to limit the outbreak through more aggressive contact tracing, “ring-fencing” cases and clusters, and more frequent mandatory testing for high-risk workers.

Despite such measures, Singapore reported its highest one-day Covid-19 case total in more than a year on Tuesday. So far, the number of people falling seriously ill remains low thanks to vaccination, authorities said.

Singapore pursued an aggressive “zero-Covid strategy” before shifting its approach, and has one of the highest Covid-19 vaccination rates in the world, with 81% of the population fully vaccinated.

Thailand: Slow vaccine takeup but it’s opening up anyway

Thailand plans to reopen Bangkok and other popular destinations to foreign visitors next month, officials said last week, as the southeast Asian nation tries to revive its crucial tourism industry despite rising infection numbers.

Under the expanded program, tourists who are fully vaccinated against Covid-19 and commit to a testing regime will be allowed to enter the capital, Hua Hin, Pattaya and Chiang Mai, according to Reuters.

The island of Phuket reopened to vaccinated foreign visitors on July 1 without quarantine requirements. On July 15, the country launched a similar program on the islands of Koh Samui, Koh Pha Ngan and Koh Tao, dubbed “Samui Plus.”

Although it kept infection numbers low in 2020 thanks to successful containment measures, Thailand has struggled to keep cases in check this year.

Vaccination rates are lagging behind those of some neighbors. Just under 18% of the Thai population were fully vaccinated against Covid-19 as of September 13, according to Our World in Data, with a further 21% partially vaccinated.

South Africa: Easing restrictions, but Delta’s still a threat

South Africa has started to ease several Covid-19 restrictions as infection rates decrease in the country.

Among other measures, the nationwide nighttime curfew has been shortened to 11 p.m. until 4 a.m., the size of gatherings allowed has increased to 250 people indoors and 500 outdoors, and restrictions on alcohol sales have been further reduced.

The easing of restrictions, announced by President Cyril Ramaphosa on Sunday, are notable in a country that passed much of the pandemic with extremely strict social distancing rules, even banning all gatherings except for funerals, at times — and where vaccination rates remain low.

Ramaphosa warned that a devastating third wave of infections driven by the more transmissible Delta variant was not over, but added that the country now has enough vaccine doses to cover the entire adult population, with more than a quarter of adults receiving at least one dose.

He encouraged everyone to get vaccinated and comply with remaining restrictions to allow the country to get back to normal.

“The third wave is not yet over, and it is only through our actions individually and collectively that we will be able to reduce the number of new infections,” he said.

Chile: High vaccination rates mean tourists can return

Chile has been internationally praised for its smooth and successful vaccination campaign. According to the health ministry’s latest reports, almost 87% of eligible Chileans are fully vaccinated.

The country has already started distributing booster shots to those who are fully vaccinated. Health authorities on Thursday approved the use of the Chinese vaccine Sinovac for children aged six and over; inoculations started on Monday.

Despite the threat posed by the Delta variant, the government on Wednesday announced moves to reopen the country to international tourism from October 1, just in time for the southern hemisphere nation’s summer season.

Foreign non-residents will be able to enter provided they meet certain requirements and isolate for five days on arrival.

“The fact that foreign tourists can come to Chile is an important step for the recovery of inbound tourism,” said Under-Secretary for Tourism José Luis Uriarte. “It’s important to point out that this is the first step, and we will be able to keep moving forward as long as we maintain the right health conditions.”

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Birth centers grow in popularity, but owners say it’s difficult to qualify for state license

When Racha Tahani Lawler opened the Community Birth Center in South Los Angeles 10 years ago, she wanted her clients to see that she was there to stay.

Midwife Racha Tahani Lawler sits in the space in her garden on Tuesday, July 6, 2021 where she meets with women. She once owned a community birth center but without insurance covering midwifery found it to be difficult to sustain and now does home births. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Lawler, then a single mother of three children, transformed an old building she found on Craigslist into a welcoming space with two birth rooms, a kitchen and garden. Her 80-year-old grandmother, who lived a few blocks away, could walk to the center to support women in labor.

Lawler offered generous discounts to families who couldn’t afford to pay thousands of dollars out of pocket for an out-of-hospital birth. Some clients, she said, “were putting all their little pennies together to have a birth” at her center.

Many of Lawler’s clients were eligible for MediCal coverage, but since her center was unlicensed, the state would not reimburse her services. Lawyer tried for months to obtain a license for the center, but eventually gave up because she couldn’t afford the $5,000 cost.

A building on W. Florence Avenue was midwife Racha Tahani Lawler’s first birth center down the street from her grandmother’s home. Her grandmother, a nurse, also assisted women at the center. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

“I was using my food stamps to provide snacks in the birth center and growing a garden to make sure my clients were eating,” she said.

Running the center without insurance reimbursements proved to be unsustainable and burdensome. Stressed and burned out, Lawler closed the birth center in 2016.

THIRD IN A SERIES: Pregnant during the Pandemic

Previous stories:

Programs, midwives step up to support Black mothers

Black midwives in demand; are there enough to handle influx of clients?

Licenses difficult to obtain

As a licensed midwife, it is not is not against the law to operate an unlicensed birth center. But to bill MediCal for its services, midwives are required to license their facilities. Experts, however, say stringent state laws are hurting birth center operators and the low-income families they serve.

“There are a lot of regulations and licensing for birth centers, which make it very difficult to become licensed,” said Kathleen Belzer, president of the California Nurse-Midwives Foundation.

The process is so convoluted, Belzer added, that it might take up to three years for some midwives to license their facilities. One example of the bureaucratic nightmare they face involves the Comprehensive Prenatal Service Providers program, or CPSP, designed to increase services available to women and boost reimbursement available to birth centers. To get a license, birth centers are required to be part of the program. But to become a CPSP provider, birth centers have to have a license.

A spokesperson for the California Department of Public Health wrote in an email that “alternative birthing centers must meet a set of requirements in order to receive a license. These requirements are designed per state legislation to ensure every mother and child receive safe, high-quality care while in the facility.”

Why birth centers?

Women opt for giving birth at birth centers because they offer a home-like setting where patients are allowed to move around during labor and bring family members and children. Giving birth at the birth centers typically saves up to $2,000 per family, although the amount depends on insurance coverage.

While operating independently, birth centers that meet the standards of the American Association of Birth Centers, or AABC, are integrated within the health care system so they can transfer clients to a hospital in case of emergency. Midwives who have hospital privileges can continue caring for their clients in such instances.

Nationwide, about 0.3% of births take place in birth centers, according to AABC. Only healthy and low-risk women are eligible for delivery at birth centers.

A 2013 study of about 22,400 women who planned to give birth in a birth center accredited by the Commission for the Accreditation of Birth Centers found that 94% of women who entered labor achieved a vaginal birth and only 6% were transferred to a hospital for a C-section.

In contrast, about 26% of healthy, low-risk pregnancies in hospitals end up with C-sections, according to a 2017 Consumer Report study.

Another study conducted by the Centers for Medicare and Medicaid Services from 2013 to 2017 discovered that birth centers, coupled with a midwifery model of care, resulted in lower rates of preterm birth, lower rates of low birth weight and lower rates of C-sections.

Neither the California Department of Public Health nor the Medical Board of California tracks the number of birth centers in Southern California. The Los Angeles County Department of Public Health also doesn’t collect that data.

Exasperation at state regulations

Across the state, midwives say they have grown weary of the roadblocks they face in California to license their birth centers.

When Bethany Sasaki opened her Midtown Nurse Midwives birth center in Sacramento, she tried to do everything by the book. She received national accreditation, but her California licensing application was still rejected by the state because the building that housed her center was too old.

“There are systems in place in California that make it almost impossible to have a birth center,” Sasaki said. “It’s like a never-ending cycle.”

The California Department of Public Health, which handles the licensure process, recently changed the building code criteria for birth centers, she added, requiring the same rigid standards for them as hospitals.

“No one is going to get a license until we change it,” she said. “It’s just a nightmare.”

When Sasaki was launching the California chapter of AABC, she reached out to birth centers to join the organization and discovered that out of 45 centers across the state, only nine had a license.

Sasaki, who is now president of the California chapter, said the difficult licensing process is hurting MediCal recipients.

“We have a big problem in the state of California with birth center licenses,” she said. “We need to be able to license birth centers so they can be medical providers, so they can serve underserved communities.”

Accreditation ensures safety

Still, the American College of Obstetricians and Gynecologists said accredited birth centers and hospitals are the safest places to give birth.

Obstetrics Service Chief Dr. Mya Zapata says the birth center at Ronald Reagan UCLA Medical Center in Westwood supports all births from hypnotic to high-risk births. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Dr. Mya Zapata, an obstetrician and gynecologist and the chief of the obstetrics service at Ronald Reagan Medical Center at UCLA, said she wouldn’t recommend attending an unlicensed birth center.

“Licenses mean oversight,” she said, “And that the individuals that are running that center are going to follow standards to keep that family safe. … And in the event of an emergency, they have the means to get that patient to a higher level of care in an expedited manner.”

She recommended asking birth center owners how they handle emergencies.

“In the case that there was something unexpected, an emergency such as bleeding or something happening with the baby,” she said, “how would you handle it? What are your tools and what is your plan when you need assistance to help with a complex situation?”

‘Sacrificing everything’

Lawler felt proud that she was able to open a birth center that predominantly served Black women, who are about four times more likely to die during pregnancy or childbirth than White women.

As she talks about the center closure, Lawler tries not to be bitter.

“The whole entire time it was open, it was there to serve the community,” she said. “It was to fill in where there wasn’t a place for so many people that were wanting out-of-hospital birth. It made out-of-hospital birth accessible for a lot of people, but I literally was sacrificing everything in order for it to exist.”

A painted yard sign sits outside a building on La Cienega Boulevard in Los Angeles which was once Midwife Racha Tahani Lawler’s dream, a birth center for the black community. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Belzer, of the California Nurse-Midwives Foundation, said she was putting together a group of midwives to push for easing the licensing process for birth centers.

The hurdles to obtain a license impact not just low-income women who want to give birth, she said, but also midwives who are willing to help them. Belzer’s foundation also advocates for sustainable MediCal reimbursement rates for birth centers.

“They lose money or break even on most MediCal patients so they do it because they know it’s the right thing to do,” she said. “But it often will put birth centers in jeopardy and often birth centers were closing because of that.

“We need to create quality within the birth center community without creating barriers that are unattainable. Traditionally, people think they are creating safety for people by making it impossible to even open your doors or stay open. These things have to change.”

Olga Grigoryants’ reporting on pregnancy during the pandemic was undertaken as a project for the USC Center for Health Journalism’s 2021 California Fellowship.   

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Why a Covid-19 vaccine for younger children is taking longer than a vaccine for adults

By Jen Christensen | CNN

Anxiety is high among parents as more kids head back to school without the protection of a Covid-19 vaccine for at least a few more months.

Parents have a reason to be concerned. After months of declining cases, the virus is finding the unvaccinated.

Adolescents as young as 12 can be vaccinated against Covid-19, but younger children aren’t eligible yet. Children made up nearly a quarter of the reported cases for the week ending August 26. The numbers have “increased exponentially,” reaching levels the United States hasn’t seen since last winter, the American Academy of Pediatrics said Tuesday.

Children have largely been spared the worst of Covid-19 — hospitalizations and deaths are more rare for children than for adults — although children’s hospitals are filling up in Covid-19 hotspots around the country.

A kids’ vaccine cannot come soon enough, but the process is taking longer than some initially expected.

“We had really hoped that maybe we would have something in place before we tried to bring kids back into the school classroom, but, unfortunately, we haven’t been able to do that,” said Dr. Emily Chapman, senior vice president and chief medical officer at Children’s Minnesota.

Timeline for younger children’s Covid-19 vaccines

Trial data are still being gathered for Covid-19 vaccines for younger children. Once the vaccine companies have trial results, they’ll need to submit the information to the US Food and Drug Administration, which will assess the vaccines for authorization.

Dr. Scott Gottlieb, a former FDA commissioner who now sits on the board of Covid-19 vaccine maker Pfizer, said Sunday on CBS’ Face the Nation that the company will likely be able to file the data for 5-11-year-olds for authorization “at some point in September” and then file the application for an emergency use of the vaccine “potentially as early as October.”

“That’ll put us on a time frame where the vaccines could be available at some point late fall, more likely early winter depending on how long FDA takes to review the application,” Gottlieb said.

There’s no official timetable once a company submits to the FDA. Emergency use considerations can take several weeks.

“There’s always something that makes things not the way we think,” said Dr. Stanley Perlman, who is on the FDA’s Vaccines and Related Biological Products Advisory Committee and is also a pediatrician and professor of microbiology and immunology at the University of Iowa Health Care. “Obviously, we want it done as soon as possible, but we want it done right.”

When asked Wednesday whether a Covid-19 vaccine will be authorized for young children before Thanksgiving, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN’s Wolf Blitzer that he hopes so, but he does not want to get ahead of the FDA.

“They should be getting the data, at least in one of the companies, by the end of September,” noted Fauci.

“Then the data will be presented to the FDA, and the FDA will make a determination whether they will grant that under an emergency use authorization or some other mechanism.”

CDC Director Dr. Rochelle Walensky said during a National Parent Teacher Association town hall Wednesday that she is hopeful the Pfizer vaccine will be available for kids in 2021.

“Everybody is looking at this with urgency. Everyone recognizes how important it is for those children to have access to vaccines,” she said when asked about the timeline. “My understanding of the timeline is pretty consistent with what is being said: the middle of fall is my understanding, early fall is when we will anticipate seeing the data, and then it will lie with the hands of the FDA. And I’m hopeful for the end of the year.”

Data for 2-to-5-year-olds could arrive soon after the older kids’ data. For the youngest children, Pfizer told CNN it could potentially have enough research by October or November, and shortly thereafter ask the FDA to authorize emergency use.

Moderna’s trial is underway, but is a few months behind Pfizer. Johnson & Johnson doesn’t expect its multiple trials in children to even start until the fall.

Why a vaccine for younger children takes longer

Hundreds of millions of adults have been vaccinated, proving that the Covid-19 vaccines are safe and effective, but those results are not a substitute for the research needed in kids.

“As much as we would like to go ahead and start vaccinating our children now, it’s most important that we take this time to ensure that the science is rigorous,” said Minnesota’s Chapman.

For the kid’s version of the Covid-19 vaccine, scientists use results from the adult trials and a full pediatric trial.

Having the adult research speeds up the process. For people as young as 12, Perlman explains, the companies didn’t have to enroll the 30,000 people it needed for adult trials because it could do what’s called “immunobridging.” The data showed that for this age group, the immune response was the equivalent of adults’.

Companies take a similar approach with the younger kids, but in early August, the FDA asked for six months of follow-up safety data, instead of the two months it asked for with adults. It also asked Pfizer and Moderna to double the number of children ages 5 to 11 in clinical trials.

Vaccine advisers to the CDC said in June there is a likely association between the mRNA Covid-19 vaccines and extremely rare cases of heart inflammation in adolescents and young adults, but the benefits of vaccination still clearly outweigh the risks. The inflammation cases appeared to be mild, and they resolved quickly on their own or with minimal treatment.

At Texas Children’s Hospital, interim pediatrician-in-chief Dr. James Versalovic said it was no problem to recruit more kids for the Pfizer and Moderna trials. Many trial sites have long waiting lists. The trial expansion, though, added at least a month more to the research process.

“We all agreed it was worthwhile, just to make the trials even more robust data to provide that additional level of reassurance to parents across the country. It does lengthen the trial, but just a bit,” Versalovic said.

‘Children are not small adults’

Children’s vaccine trials actually start in adults.

“Typically, every vaccine candidate, even for other conditions, would be evaluated first in adult patients and then in progressively younger ages,” explained Dr. Kari Simonsen, who is leading the trial of the Pfizer vaccine at Children’s Hospital & Medical Center in Omaha. “We can’t make assumptions about the safety or tolerability of medicines in children being the same as for adults,” she said.

It’s because of biology.

“As we are fond of saying in pediatrics: Children are not small adults. Children are children,” said Versalovic. “Their bodies are developing and will react differently, and we need to treat them differently.”

When it gets to the kids’ phase of the testing, scientists make their best educated guess on what dose would be safe and generate an immune response. The levels and timing is based on development stages.

“By and large our children have very active and responsive immune systems, and so we suspect that smaller doses of vaccine will trigger an adequate response in a child to successfully fight off infection,” said Chapman.

As with any vaccine testing, it must go through a three-phase trial before the FDA can authorize it. The first phase tests to see if the vaccine is safe in about 20 to 100 healthy kids.

Since these are expedited trials, scientists have combined phases 2 and 3 of the trials so they can do more steps in parallel, Versalovic said. In these phases, scientists monitor safety and test to see if the children’s immune systems respond to the vaccine. At this step, scientist recruit hundreds or even thousands of children. Some get vaccine, some get placebo and results are compared.

Only after these steps are complete can a company ask the FDA for authorization or approval.

If the FDA signs off on it, the vaccine gets another set of expert eyes with the CDC’s Advisory Council on Immunization Practices. That committee also puts together a formal recommendation around the delivery, storage, timing, distribution, and administration of the vaccine. The committee’s recommendation becomes official when the CDC director reviews and approves it.

In these intervening months, the experts say, children can stay Covid-19 free. Adults, though, will have to help them.

“Best thing we can do for them is surround them with adults who are vaccinated,” Chapman said. “And surround them with people who are masking and keep their masks on as much as possible.”

The-CNN-Wire™ & © 2021 Cable News Network, Inc., a WarnerMedia Company. All rights reserved.

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CDC adds 7 destinations to ‘very high’ Covid-19 travel risk list, including Puerto Rico and Switzerland

Switzerland and Puerto Rico are now among the highest-risk destinations for travelers, according to the US Centers for Disease Control and Prevention’s regularly updated travel advisories list.

People should avoid traveling to locations designated with the “Level 4: Covid-19 Very High” notice, the CDC recommends. Anyone who must travel should be fully vaccinated first, the agency advises.

Seven destinations moved up on August 30 from the “Level 3: Covid-19 High” list to Level 4:

  • Azerbaijan
  • Estonia
  • Guam
  • North Macedonia
  • Puerto Rico
  • Saint Lucia
  • Switzerland

The CDC’s evolving list of travel notices ranges from Level 1 (“low”) to Level 4 (“very high”).

Destinations that fall into the “Covid-19 Very High” Level 4 category have had more than 500 cases per 100,000 residents in the past 28 days, according to CDC criteria. The Level 3 category applies to destinations that have had between 100 and 500 cases per 100,000 residents in the past 28 days.

Switzerland has had 659 laboratory-confirmed Covid-19 cases per 100,000 inhabitants in the past four weeks, according to the country’s Federal Office of Public Health. On August 29, nearly a third of Switzerland’s intensive care units were occupied by people with coronavirus. In North Macedonia, slightly less than a quarter of residents were fully vaccinated against Covid-19 as of August 30, while 9% were partially vaccinated. And of Saint Lucia’s population of around 185,000 people, it has fully vaccinated 15.1% and partially vaccinated 4.8%.

New ‘Level 3’ destinations

Ten other destinations moved to the “Level 3: Covid-19 High” category on Monday.Bermuda, Canada, Germany and Moldova moved up from Level 2. Bahrain, Indonesia, Namibia, Oman, Rwanda and Zimbabwe moved down from Level 4.

CDC guidance for Level 3 destinations urges unvaccinated travelers to avoid nonessential travel to those locations.In its broader travel guidance, the CDC has recommended avoiding all international travel until you are fully vaccinated.

“Fully vaccinated travelers are less likely to get and spread Covid-19. However, international travel poses additional risks, and even fully vaccinated travelers might be at increased risk for getting and possibly spreading some Covid-19 variants,” the agency said.

You can view the CDC risk level of any destination on the agency’s travel recommendations page.

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Johnson & Johnson booster shot prompts large increase in immune response, company says

By Maggie Fox | CNN

Booster doses of Johnson & Johnson’s one-shot coronavirus vaccine generated a big spike in antibodies, the frontline immune system defenses against infection, the company reported Wednesday.

People who received a booster six to eight months after their initial J&J shots saw antibodies increase nine-fold higher than 28 days after the first shot, Johnson & Johnson said.

The data comes from two Phase 2 studies conducted in the United States and Europe, the company said in a statement. Some of the 2,000 or so people in the studies got booster doses six months after their first doses of J&J’s Janssen vaccine.

“New interim data from these studies demonstrate that a booster dose of the Johnson & Johnson COVID-19 vaccine generated a rapid and robust increase in spike-binding antibodies, nine-fold higher than 28 days after the primary single-dose vaccination,” the company said in its statement.

“We have established that a single shot of our COVID-19 vaccine generates strong and robust immune responses that are durable and persistent through eight months. With these new data, we also see that a booster dose of the Johnson & Johnson COVID-19 vaccine further increases antibody responses among study participants who had previously received our vaccine,” Dr. Mathai Mammen, global head of research and development for Janssen, said in a statement.

J&J said it was in discussions with the US Food and Drug Administration, US Centers for Disease Control and Prevention, European Medicines Agency, World Health Organization and other health authorities about the need for offering a booster dose of the Janssen vaccine.

“We look forward to discussing with public health officials a potential strategy for our Johnson & Johnson COVID-19 vaccine, boosting eight months or longer after the primary single-dose vaccination,” Mammen added.

Many people who received the J&J vaccine have been clamoring for information about whether they will need a booster shot. US federal government officials have said they are preparing to start offering a booster dose to people who got Moderna’s or Pfizer’s Covid-19 vaccine after data showed boosters can amp up the antibody response — and after studies started showing an uptick in infections in both vaccinated and unvaccinated people. The more transmissible Delta variant is partly to blame, experts say, as is a waning immune response.

The Janssen vaccine was authorized at the end of February, more than two months after Moderna’s and Pfizer’s vaccines were authorized. About 14 million Americans have received the J&J vaccine, according to the CDC.

Dr. Dan Barouch, a vaccine researcher at Beth Israel Deaconess Medical Center and Harvard Medical School who is not involved in the two clinical studies but is helping study J&J vaccines, said the findings support getting a booster shot, but only after a delay.

“The boost at six months is going to look very impressive and substantially greater than what has already been reported in terms of the two month boost, and that is significant because it, in my opinion, the boost should not be at two months, but it really should be at six months or later,” Barouch told CNN.

Neither of the studies looked at real-world efficacy, so the company has not demonstrated that people who get boosters will be less likely to become infected or to develop severe disease. But researchers are beginning to agree that antibody levels do indicate immune protection.

The Johnson & Johnson vaccine is made differently from Pfizer’s and Moderna’s. Those two vaccines use messenger RNA or mRNA, encased in little lipid particles, to carry instructions to the body to start an immune response.

The Janssen vaccine uses a crippled common cold virus called an adenovirus to carry in similar instructions. There had been worries that a booster dose of such a viral vector vaccine might not work effectively because of the possibility the body would generate an immune response against the vector, also.

“There was a theoretical concern that the generation of anti-vector antibodies by the first shot could impede the use of it again,” Barouch said.

“I think these data put that to rest.”

Federal health officials have said they believe a booster dose of the Janssen vaccine will be needed at some point.

“I’m quite certain that the FDA, CDC, NIH, White House will use these data to likely justify or recommend a booster for J&J-vaccinated people, probably with a second shot of J&J,” Barouch said.

The-CNN-Wire™ & © 2021 Cable News Network, Inc., a WarnerMedia Company. All rights reserved.

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Pregnant during pandemic: Programs, midwives step up to support Black mothers

| FIRST IN A SERIES: Pregnant during Pandemic | Coming Monday: Black midwives have been in high demand during pandemic. But is it enough of them to handle influx of clients? |

Aysha-Samon Stokes’ Mother’s Day went just as planned.

She arrived at Kindred Space LA birth center around 10 p.m. on May 9, stepped into a bathtub and shortly before midnight pushed her newborn son, Nikko, into the arms of her boyfriend, Dennis Richmond.

Minutes later, she climbed into a bed, wrapped her arms around the baby and breastfed him as “Heartbreak Anniversary” by Giveon played in the background and Richmond massaged her feet.

She felt relieved and happy, surrounded by her niece, boyfriend, sister and two midwives, who carefully guided her through labor. There was something else giving her peace of mind: Her childbirth bill was covered by the Victoria Project, a nonprofit that helps women in Los Angeles County pay their childbirth-related expenses.

Stokes found out about the Victoria Project during her last trimester from midwives Allegra Hill and Kimberly Durdin, who run Kindred Space LA.

Pregnant with her third child Aysha-Samon Stokes, 26, plays with her children Nyla Richmond, 6, and Wyatt Richmond, 17 months, at a Culver City park close to her daughter’s school on Thursday, April 8, 2021. Looking for a better birthing experience Stokes found a midwife to deliver her baby. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

It was not a single event that made her consider home birth, she said, but rather a series of memories from her previous two pregnancies: An obstetrician-gynecologist who couldn’t remember her name, a nurse who ignored her plea for an epidural when her pain became intolerable and a C-section with her first pregnancy that she felt was unnecessary.

Something else was at stake once she began learning about the high mortality rate among women like herself.

“A lot of Black women die in the hospital and that does concern me,” said Stokes, 26.

The coronavirus has wreaked havoc on many women’s birth plans, forcing them to adjust to quickly changing hospital policies, and in some cases labor in isolation and even opt for home birth. The pandemic has been especially hard on mothers like Stokes, who even before the pandemic had been part of terrifying statistics that show Black women in the U.S. have more than a three times higher risk of dying during pregnancy and childbirth than White women.

Black mothers and infants have been disproportionately affected by pregnancy- and birth-related complications. Nearly 700 women die each year in the U.S. as a result of pregnancy-related complications.

In Southern California…

  • In Los Angeles County, mortality rates among Black mothers from perinatal complications are four times higher compared to White women. Black infants are three times more likely to die before reaching their first birthday.
  • In Riverside County, Black newborns are three times more likely to die than their white counterparts.
  • Officials in Orange County reported in 2020 the death of one Black infant out of 392 African American births. So far in 2021, no infant or maternal deaths have been reported among Black infants or mothers, according to the Orange County Care Agency’s preliminary report.
  • San Bernardino County, meanwhile, reported 11.3 deaths for every 1,000 Black infants born, the 2011-15 data show.

In 2018, the Los Angeles County Department of Public Health pledged to work on reversing the trend and reducing the county’s gap in Black and White infant mortality rates by 30% by 2023.

Dr. Deborah Allen, deputy director of the Los Angeles County Department of Public Health, said “midwives are a very important voice but they are a very small group of people. They’re all wonderful, but they have to be part of something bigger. It has to go way beyond that. It has to include medical professionals.”

There needs to be a movement, Allen said, that would involve systematic changes on the part of hospitals, medical professionals, and federal and state government agencies to make sure Black women feel safe to deliver their babies, whether at home or at hospitals.

“When we really want to have equality in birth outcomes, we need more than equal health care — we need equal lives,” she said.

  • Dennis bathes Wyatt and Nyla on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha, who played basketball in high school, plays ball with her kids at home in downtown LA on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Wyatt watches his mom make healthy snacks at home in downtown LA on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha keeps her eye on Wyatt as she makes healthy snacks at home in downtown LA on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha makes Wyatt a carrot snack at home in downtown LA on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha helps Nyla with her homework while feeding Wyatt and her lunch at home in downtown LA on Thursday, April 19, 2021. Nyla is in a dual language Spanish immersion program. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha plays with Wyatt at home in downtown LA on Thursday, April 19, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Wyatt and Nyla jump in their father’s arms as he comes to their downtown LA apartment to have dinner and bath them after work on Thursday, April 28, 2021. Dennis Richmond is Aysha’s fiancé. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Dennis bathes Wyatt and Nyla on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Dennis and his children Nyla and Wyatt have dinner while Aysha takes time for herself in her room on Thursday, April 28, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha plays with Wyatt at home in downtown LA on Thursday, April 19, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)



Many of the county’s programs, Allen added, focus on addressing the consequences of intergenerational racism on the health of Black women.

The Los Angeles County African American Infant and Maternal Mortality Initiative, launched by the Los Angeles Department of Public Health and First 5 LA along with community partners, is offering no-cost doula care to Black pregnant people in Antelope Valley, San Fernando Valley, San Gabriel Valley and South L.A.

Doulas work with pregnant and birthing mothers before, during and after the delivery to provide emotional and physical support and guidance. Studies show that doula care proved to be effective with reductions in the use of C-sections and medications during labor along with promotion of breastfeeding.

“Having a well-informed, articulate, supportive person by your side, who knows the health care system and can be a buffer and a bridge when you’re dealing with medical providers and so on,” Allen said, “can really make the experience much more positive, much less stressful and, therefore, healthier for Black women.”

Aysha craves ice which she learned from her midwife was a sign of anemia. Her doula gave her a plant based iron supplement for her iron deficiency since she was not tolerating prescription iron from her obstetrician. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

The program, which just finished its first year of operations, has served 363 clients while supporting 199 births, and health officials say it can potentially become one of many aimed at reversing trends in high mortality rates among Black mothers.

“It’s time for Black women to stop feeling guilty when they have an adverse outcome and recognize it as a social phenomenon rather than a personal failing,” Allen said.

When the pandemic hit, Victoria Project co-founder Janelle Green couldn’t stop thinking about women who were afraid to go to the hospital to give birth and lacked the means to hire a midwife or doula to deliver their babies at home. As a trained midwife, she also knew that out-of-pocket expenses could easily become a financial burden for many families because insurance reimburses only a fraction of the costs.

She wanted to help women to have other options, she said.

Green reached out to a friend, Deja Rabb, and together they launched the nonprofit to finance midwifery and doula care, breastfeeding support, childbirth education services for pregnant women. The Victoria Project was born in September 2020.

“We named it after a victorious pregnancy that I hoped to one day have,” she said.

Green and Rabb connected with doulas and midwives in Los Angeles, offering assistance to their clients.

Currently, the nonprofit enrolls about 200 people and is close to its capacity, Green said. But as more families are hearing about the program, Green added, the goal is to start sponsoring more people, including those from Santa Barbara, where Green and Rabb now live.

Clients mostly learn about the nonprofit through word of mouth. Its funding comes from private donations and fundraising and is open to anyone who considers giving birth at home or a birth center, regardless of their income. The program, though, prioritizes requests from marginalized communities.

“We are trusting that they will put forward what they can and then they’ll ask for what it is that they need support with, so sometimes it’s a hundred percent and sometimes it’s the remaining balance,” Green said.

The Victoria Project covers birth center midwifery care, doula care, acupuncture, home birth and chiropractic care, lactation support, and doula care for pregnancy loss and miscarriage. In some circumstances, the nonprofit may cover therapy, especially in the postpartum period.

Some families reach out seeking not just emotional and physical support but food assistance and medication, Green said. And those types of requests are something the nonprofit will try to fulfill in the future.

“I imagine as we grow it might be one of the things we hope to do is connect with other organizations who are providing some support in other areas so that we have a good referral system in place,” she said.

During her third trimester, the pandemic was still raging, forcing hospitals to alter their visitation protocols, and Stokes worried about whether her sister and boyfriend would be allowed to be by her side at the hospital and whether she would be allowed to move freely during labor.

“I had a C-section with my daughter, vaginal with my son and I feel like in order to have a successful labor, I need to be able to roam around and move around and I’m not going to be able to do that at the hospital so then what are my chances of having the successful” vaginal birth after cesarean? she said. “Probably slim to none.”

In the spring, Stokes made up her mind to find a midwife who would help her deliver her baby at home.

“I told my partner if I can’t find what I want, to be prepared to deliver this baby at home with just me, him and our kids,” she said.

In April, as she was waiting for a response from The Victoria Project, Stokes, who has Medi-Cal, prepared to dig into her savings if her application wasn’t approved.

It was very important for her to find a Black midwife, she said, someone who would understand her and be “aware of the battles I face without me having to mention it.”

Beginning with her first visit to Kindred Space LA, Stokes noticed the difference between the care she received at obstetrician-gynecologist appointments during her first two pregnancies and what the midwives provided.

With her children Wyatt and Nyla in tow, Aysha has her first prenatal appointment with midwife Kimberly Durdin at Kindred Space LA, a birthing center Durdin opened during the pandemic with another midwife in South LA, on Thursday, April 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Meetings with Durdin and Hill sometimes stretched to more than an hour as Stokes’ 18-months-old son and 7-year-old daughter played on a patio. Midwives offered homemade lentil soup and asked whether she felt weepy, took her vitamins and consumed enough water. After each appointment, she received a bag filled with fresh produce grown at the center’s garden.

When she started having pain in her lower back, the midwives offered her free-of-charge acupuncture. A woman who volunteered with the center stopped by her apartment to bring a warm homemade meal. When the midwives offered to deliver the baby at the center, she agreed.

Those appointments with the midwives met all of her expectations, Stokes said.

“They listen and they care and it is everything I wanted,” she said. “They got my name right and the hospital couldn’t even do it.”

  • Wyatt jumps up on his mother as midwife Kimberly Durdin begins to check Aysha’s baby at Kindred Space LA, a birthing center Durdin opened during the pandemic with another midwife in South LA, on Thursday, April 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha has a prenatal appointment at Kindred Space LA in South LA on Thursday, April 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Midwife Kimberly Durdin picks greens for Aysha and Nyla to take home after her prenatal visit at Kindred Space LA on Thursday, April 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)



On the evening of Mother’s Day, Stokes began feeling her contractions grow intense. She asked her sisters to pick up her kids at her apartment and headed to the birth center in South L.A. When she arrived around 10 p.m., her pain grew so intense that she began crying.

“Each breath and each push brings you closer to the baby,” her sister, Lauri Powell, kept saying, taking turns with Richmond to massage Stokes’ back and shoulders.

When Nikko’s face finally emerged from the water as Stokes was sitting in a bathtub, she said could feel a wave of happiness and relief. “He was here and all my worries have gone out of the window,” she said.

  • Guided by her midwife Dennis catches the baby under water as Aysha delivers at Kindred Space LA’s South LA birthing center on Mother’s Day night, May 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Dennis massages Aysha as she labors at Kindred Space LA’s South LA birthing center on Mother’s Day night, May 9, 2021. Aysha’s sister Lauri Powell, right, and her 13-year-old daughter Leena were also there for the birth. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Dennis touches their son as Aysha rests in the birthing bath at Kindred Space LA’s South LA birthing center on Mother’s Day night, May 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Midwifes Kimberly Durdin and Allegra Hill help Aysha out of the birthing bath at Kindred Space LA’s South LA birthing center on Mother’s Day night, May 9, 2021. The two opened the center during the pandemic. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha’s sister Lauri Powell and her 13-year-old daughter, Aysha’s niece, and Dennis watch over Aysha after she delivered her son at Kindred Space LA’s South LA birthing center on Mother’s Day night, May 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Midwife Kimberly Durdin gives Aysha a tincture after she delivered her son at Kindred Space LA’s South LA birthing center on Mother’s Day night, May 9, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Student midwife Maryam Karim takes the heartbeat of Aysha’s baby during a postpartum visit to the South LA birthing center on Wednesday, May 26, 2021 where he was born on Mother’s Day night. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Midwife Allegra Hill checks Aysha during a postpartum visit to the South LA birthing center on Wednesday, May 26, 2021 where her son Nikko was born on Mother’s Day night. Student midwife Maryam Karim holds Nikko. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Nikko is weighed by midwife Allegra Hill as Aysha and her children Wyatt and Nyla join her for the postpartum visit at the South LA birthing center on Wednesday, May 26, 2021. Student midwife Maryam Karim is left. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

  • Aysha and Nyla watch midwife Allegra Hill and student midwife Maryam Karim take the heartbeat of two-week-old Nikko during a postpartum visit to the South LA birthing center on Wednesday, May 26, 2021 where he was born on Mother’s Day night. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)



Her entire $6,000 birth-related bill was covered by the Victoria Project.

Holly Smith, a health policy chair at California Nurse-Midwives Association, said it’s crucial to have a package of legislation that would contribute to systemic changes to support parents of color.

The so-called California Momnibus Act, authored by state Sen. Nancy Skinner, seeks to establish doula care for all pregnant and postpartum people enrolled in Medi-Cal. The bill, SB 65, will require medical investigations into maternal and child death, collecting data on socioeconomic factors that contribute to negative birth outcomes, expanding postpartum health care and offering options for doulas and midwives.

The bill would allow expecting mothers to have at least four appointments with a doula during the prenatal period and delivery, and at least eight appointments during the postpartum period. Doula care, which can cost from several hundred dollars to $2,000, also would also be available during miscarriage, stillbirth and abortion.

In addition, the bill would establish an advisory board to standardize competency requirements and certification for doulas.

The Legislature also would expand coverage for a postpartum period for people on Medi-Cal from two months to one year, invest in midwifery care and create a maternal mortality board, which would advise on how to close racial disparities in maternal health.

SB 65 has been passed by the state Senate and will head to the Assembly.

Earlier this year, Gov. Gavin Newsom said three pieces of the legislation will be part of his budget proposal, including Medi-Cal coverage for doulas, Medi-Cal postpartum coverage and a guaranteed minimum income pilot program for low-income families.

“Racial disparities are preventable and we can turn back the clock on that if we really want,” Smith said. “We have to have all hands on deck and we have to have multiple strategies.”

Aysha nurses three-month-old Nikko after he wakes from a nap at their home in downtown LA on Tuesday, August 10, 2021. (Photo by Sarah Reingewirtz, Los Angeles Daily News/SCNG)

Olga Grigoryant’s reporting on pregnancy during the pandemic was undertaken as a project for the USC Center for Health Journalism’s 2021 California Fellowship.   

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Should you cancel travel plans? A medical expert weighs in

By Katia Hetter | CNN

As Covid-19 cases are surging across the United States again, daily infection rates are at their highest levels since February, due in large part to the very contagious Delta variant.

The US Centers for Disease Control and Prevention has once again urged a return to indoor mask-wearing, citing that even vaccinated people can get infected and pass Covid-19 to others.

Meanwhile, many people have travel plans for the rest of the summer and the upcoming Labor Day holiday weekend. Should they cancel their vacations? Is air travel safe? What if they are getting together with extended family or friends over the holiday — what precautions need to be taken? And what about families with children too young to be vaccinated?

To help answer our many questions about travel and Covid-19 safety, we turned to CNN Medical Analyst Dr. Leana Wen. Wen is an emergency physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health. She’s also author of a new book, “Lifelines: A Doctor’s Journey in the Fight for Public Health,” and the mother of two young children.

CNN: What should people consider when deciding whether to continue, change or cancel their travel plans?

Dr. Leana Wen: The most important factor to consider is the medical risk of your household. Specifically, is everyone in your house vaccinated? If everyone is vaccinated and generally healthy, you are very well-protected from getting severely ill from Covid-19. Many people in this circumstance might decide that they could take the risk of mild symptoms if they were to contract coronavirus and proceed with all their original travel plans.

If someone in your home is unvaccinated or immunocompromised, you may decide differently. A very low risk trip may still be fine — for example, driving and then going camping and hiking with just your immediate family. But if the trip is going to involve spending a lot of time indoors with unmasked, unvaccinated people, I’d encourage the vulnerable individuals not to go on the trip. If some family members are still going to go, they could quarantine for at least three days upon return and then get tested before they get together indoors with vulnerable members of their household.

CNN: Would your advice depend on the location of the travel?

Wen: Yes, but in the US about 95% of the population lives in areas deemed by the CDC to have substantial or high levels of coronavirus transmission. I’d look at the specific area that you are thinking of traveling to and what you’d be doing there.

If you’re driving to a national park, and the plan is to spend all your time hiking outdoors, that’s very low risk. It doesn’t really matter if the community around the park has high Covid-19 transmission, if you don’t plan to interact with anyone there indoors.

That’s very different from if you’re planning a week of visiting museums, attending concerts, going to the theater and dining indoors. If those activities are taking place in a part of the country with a lot of virus transmission, you are being exposed constantly to Covid-19. The vaccines protect you well, but they are not 100%.

Risk is cumulative, and the more high-risk settings you are in, surrounded by people potentially carrying the virus, the more likely you are to experience a breakthrough infection even if you are vaccinated.

CNN: What’s your advice for people who have booked international travel? Should they go?

Wen: It depends. Again, make sure to look at your own medical risk and the risk of those in your family. Consider the location you’re going to. The CDC has updated information about Covid-19 by country divided into four levels of risk.

In addition, the US State Department has helpful information including the protocols that you need to follow in order to enter the country. Make sure to know the requirements. Some countries require proof of recent negative tests, for example, and some are beginning to require vaccination. Keep in mind that rules are constantly changing and stay flexible.

CNN: What about getting together for a wedding — would that be safe?

Wen: Once again, it depends. Many weddings involve people converging from different parts of the country or the world. That adds risk, especially since there are so many places with high levels of Covid-19 infection. It would certainly help if the hosts required that everyone attending is vaccinated.

Vaccinated people have an eight-fold reduced chance of contracting Covid-19 compared to unvaccinated people, according to estimates based on CDC data. If the ceremony and reception are both held outdoors, that would also reduce the risk. The opposite, of course, would be true of indoor gatherings of people of unknown vaccination status, who are eating and drinking and therefore not wearing masks. That would be a high-risk event.

CNN: Can we talk about modes of transportation — specifically plane travel. Is that still safe for vaccinated people? What about unvaccinated children?

Wen: Plane travel is still relatively safe for vaccinated people. Make sure to wear a high-quality mask at all times — ideally an N95 or KN95 mask. If you have to eat and drink, do so quickly, so as to minimize the amount of time you’re not wearing a mask.

Children too young to be vaccinated should also mask, if possible, with at least a 3-ply surgical mask. If they cannot keep on the mask for the duration of the trip, I would consider not bringing the child unless it’s an essential trip, such as moving across the country.

In my family, my husband and I will travel by plane and wear N95 or KN95 masks the entire time. Our son, who is almost four, is generally good about wearing masks, and if we had a short trip of a few hours’ flight, he’d be fine. But we have a 16-month-old daughter who is too young to mask. We would not feel comfortable bringing her on a flight right now.

Other families may make different decisions based on their level of risk tolerance as well as the value of the travel to them. For where we are in the pandemic, the risk is not worth the benefit to us.

CNN: Driving, going to rest stops, staying in a hotel en route — that’s all pretty safe from a Covid-19 standpoint, right?

Wen: Yes. Of course, use common sense — wear masks when going to the restroom in rest stops. Order carryout instead of eating indoors. Go directly to your room in the hotel, and don’t hang out in crowded hotel lobbies and bars.

CNN: What’s your advice for families who want to rent a house together?

Wen: The safest scenario is if everyone is fully vaccinated. If there are people who are unvaccinated, or if the people gathering want to reduce their risk further, everyone who wants to get together can essentially quarantine for three to five days and then get tested. By quarantine, I mean to reduce your risk by not getting together with other people indoors and not participating in higher-risk activities like indoor dining.

I know that this advice feels like we have taken a step backwards. It’s true — we have. Covid-19 cases are on the rise again, and we have the more contagious Delta variant to contend with.

Vaccination is the single most important step to protect us. In addition, depending on our individual circumstances, we should consider additional precautions to reduce risk and keep our families safe, while still enjoying travel.

The-CNN-Wire™ & © 2021 Cable News Network, Inc., a WarnerMedia Company. All rights reserved.

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COVID-19 ‘whiplash’ is messing with Southern California’s psyche

  • Nancy Sexton, owner of The Muse Rooms in Burbank and Hollywood, at one of her coworking spaces. (Courtesy)

  • People receive COVID-19 vaccinations at a Medi-Vaxx Program of the San Fernando Valley pop up clinic at the Montague Charter Academy in Arleta, Monday, August 2, 2021. The Fernandeno Tataviam Band of Mission Indians, as part of its participation in the Medi-Vaxx Program of the San Fernando Valley, held the clinic that administered first doses of the vaccine. Monday, August, 2, 2021. (Photo by Hans Gutknecht, Los Angeles Daily News/SCNG)

  • John Tsilimparis, a marriage and family therapist in Los Angeles, says clients have what is called “COVID-Whiplash,” or frustration over changing sets of health orders, just when life was starting to get back to “normal.” He was photographed in his office on Wednesday, August 4, 2021.
    (Photo by Axel Koester, Contributing Photographer)

  • John Tsilimparis, a marriage and family therapist in Los Angeles, says clients have what is called “COVID-Whiplash,” or frustration over changing sets of health orders, just when life was starting to get back to “normal.” He was photographed in his office on Wednesday, August 4, 2021.
    (Photo by Axel Koester, Contributing Photographer)

  • John Tsilimparis, a marriage and family therapist in Los Angeles, says clients have what is called “COVID-Whiplash,” or frustration over changing sets of health orders, just when life was starting to get back to “normal.” He was photographed in his office on Wednesday, August 4, 2021.
    (Photo by Axel Koester, Contributing Photographer)

  • Registered nurse Marie Piverger administers a dose of the Pfizer-BioNTech COVID-19 vaccine to Maria Villa, of Colton, at St. Catherine of Siena in Rialto on Thursday, July 22, 2021. (Photo by Watchara Phomicinda, The Press-Enterprise/SCNG)



It wasn’t that long ago that Southern California was gearing up for bidding the coronavirus a collective “good riddance.” On June 15, the state lifted the bulk of its COVID-era restrictions, setting off significant buzz about weddings, family reunions, music festivals and a general return to normal, pre-pandemic activity.

Finally, we sighed, we are starting to see each other’s faces again.

“We appreciate the hard work of everyone to keep each other safe and healthy; your efforts make it possible for us to look forward to a full reopening next week,” a hopeful Los Angeles County Public Health Chief Barbara Ferrer declared at the time.

President Joe Biden proclaimed:  “America is headed into a summer dramatically different from last year’s summer … A summer of freedom. A summer of joy. A summer of get-togethers and celebrations.”

What a difference a month makes.

As the pandemic creeps into its 18th month, Southern Californians are feeling whipsawed by new mask mandates, employer vaccination requirements, rising virus caseloads and spiraling hospitalizations. It’s left many people fraught with uncertainty. Should I be out in public? Should I travel? Will my job be moved back to my living room? Are my kids safe returning to school?

“That makes me so angry,” said Nancy Sexton, owner of The Muse Rooms, a Burbank-based company that rents co-working office space, bemoaning the still-worrisome number of people who’ve failed to get vaccinated. “Because the only reason we are back here is the mistrust in the vaccine and hesitancy.”

The uncertainty itself has sparked a kind of reluctant, clumsy pivot in the Southern California COVID-19 zeitgeist, with a our seemingly open path to normalcy suddenly tangled after five solid months of improving statistics and steadily building optimism.

Sexton is among local folks who forged ahead with her business and family, amid her fears. She’s getting ready to open a new site in Hollywood despite the economic toll of the COVID-19 outbreak and her husband Tim’s cancer diagnosis.

“The delta variant has really thrown a loop in things,” said Sexton. “I started to question, man, should I start wearing a mask now when I’m out walking the dog, now that this thing is more contagious than we’ve had before.”

Like many, she’d never stopped wearing a mask in public. “It was nice to walk into work knowing everyone is vaccinated and feeling very comfortable about that,” she said.

The whiplash culminated last week when public health reversals and mixed messaging at the highest levels of government rattled the core of what Americans — and some experts in the field — thought they knew about the virus.

While the vaccines developed under the Trump administration remain hugely effective against serious illness and death, the Centers for Disease Control and Prevention revealed that unvaccinated people might be able to spread the delta mutant to others, just as easily as unvaccinated people. The delta is much more contagious than the original virus — or even the seasonal flu — and could be as contagious as chickenpox, according to an internal document circulated within the CDC.

Such revelations, combined with rising caseloads and hospitalizations, inspired Los Angeles County to revive its requirement for residents to wear masks indoors when gathering in public. Pasadena, Los Angeles and Long Beach moved to require vaccinations for employees. Other communities and school districts shifted their restrictions, too.

L.A. Board of Supervisors Chair Hilda Solis followed suit with an executive order requiring shots for county’s more than 100,000 workers.  On the heels of a similar measure in New York City, L.A.’s City Council weighed a motion that would require proof of at least partial vaccination against COVID-19 to enter public indoor spaces, including restaurants, bars, gyms, concert venues and movie theaters.

Confusion erupted, too. In Orange County, school district officials said the state Department of Health confounded parents on July 13, when it issued two statements about masks at school. The agency said schools “must exclude” students if they come to class without a mask and refuse to wear one provided by the school. But later that same day, the agency issued a second statement that kept the mandate in place – and gave individual districts leeway on how to enforce it – but removed the words “must exclude” from its guideline. The county’s Board of Education voted to sue the state.

The drama has played out on a national scale, too. For example, Florida Gov. Ron DeSantis and other officials have defied the revival of mask mandates, even in the face huge caseload spikes.

While we desperately want to be done with this pandemic, COVID-19 is clearly not done with us,” Dr. Rochelle P. Walensky, director of the CDC, told reporters, “and so our battle must last a little longer.”

Walensky added: “This is hard. This is heavy. But we are in this together.”

Easier said than done.

Questions swirl about whether people can get back to their pre-pandemic lives — and when. Can we eat indoors? Should students wear masks when they go back to campus — or just return to learning from their homes? Should employers require workers to get shots?

The most complex factor: The evolving disease is itself a moving target.

“When you do have a shifting message that is not consistent, it makes it more difficult for a person to discern what’s true at any given moment and whether to trust the messaging if it’s going to change the next week,” said Marsha Godwin, professor of public administration at the University of La Verne and an expert in local government administration.

It’s one thing to order evacuations during a fire, or urge safety measures to manage a short-range calamity, but crisis communications have risen to a whole new level of complexity during this enduring outbreak, she said. It’s a challenge for experts to successfully communicate consistent, cohesive public-health messages.

“It is particularly hard to say ‘I do not know’ and ‘I will get back to you,’” Godwin said.

Andrew Noymer, professor of public health at UC Irvine, said it’s not the reversals that were notable out of the federal government’s shifts on COVID last week. Rather, it was the need for more transparency.

“I don’t mind the flip-flopping so much because of the data. It was a calculated risk to tell people that they can unmask if they are vaccinated,” said Noymer, an epidemiologist. “It’s the way flip-flopping has been communicated. I’d like transparency to be a hallmark of the public response.”

The reignited battle with the virus has taken an emotional toll, said area therapists, who have been counseling pandemic-weary clients who went from end-in-sight optimism to it’ll-never-end depression.

Uncertainty and emotion “encoded” in people’s minds from the worst days of the pandemic have resurfaced, said John Tsilimparis, a Los Angeles-based therapist.

“Most people really, really struggled with uncertainty,” he said, adding that addiction and underlying mental health problems were only compounded.

“What I’m hearing from people is that they are afraid of the delta variant, afraid of the economy returning to lockdown status, and they are afraid of the people who won’t get vaccinated,” he said.

Don Grant, director of Outpatient Services for Newport Healthcare, said not helping matters is also the re-emergence of anger.

“People are angry. People don’t know what to believe,” and that has manifested itself in fear and resentment, he said.

“We were let free (by improving statistics and eased restrictions), and now we’re being told we don’t know when this is going to end,” Grant said.

But, Grant said, that  doesn’t mean we’re altogether helpless when it comes to our mental health.

In an era of uncertainty, experts point to the need to preserve as best we can a sense of normalcy, even amid a resurgent crisis.

Telling ourselves, “It’s horrible, we’re going to go back into the lockdown,” can inspire a sense of powerlessness, Tsilimparis said. “But what I can control is the focus on my children, my work, my projects at home … .”

Tsilimparis also urged a pulling back from “emotional reasoning,” and our propensity to revert to the “fight-or-flight process” in our brains.

It’s important to pull back on that instinct of instant fear and to be able to assess, evaluate and prioritize concerns. Fear triggers are centered in the brain, having evolved over the centuries from our species’ days of shifting into action to flee saber-tooth tigers. But now, such responses can lead instead to substance abuse, Tsilimparis said, noting a troubling rise in drug and alcohol use during the pandemic, as well opioid-overdose deaths.

Grant also recommended easing up on our instinct to resent, even hate, the folks and factors they blame for the rekindled crisis.

“People who are vaccinated are becoming resentful of people who aren’t,” he said. “We need to be careful, mindful and respectful. We are all fighting a war. We need to really be kind to others and ourselves and to be flexible.”

Riverside residents Brent and Alice Bechtel were heeding that message as they prepared this week for a scuba diving trip to the Bahamas, where they will meet 20 friends from around the country.

The trip was supposed to be last year, times to the couple’s 40th wedding anniversary. But the pandemic grounded them.

Despite the resurgent virus — particularly in Florida where Bechtels will stop on their way — they feel confident enough to go. They’re vaccinated, prepared and optimistic.

“We’re set for it. We’re packed,” Brent Bechtel said, adding that they’re “pretty doggone excited.”

The Bechtel said they will take precautions, but also try to be understanding of those who haven’t been vaccinated.

“If someone is against the vaccine, that’s fine. But they’re the ones who are going to have to deal with the decision that they make,” he said. “My decision is to get a vaccine and be respectful of other people.”

Bechtel added: “As Americans, as people in this world, to be able to give respect and have compassion for others is what it’s going to take to get through this.”

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