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Federal regulators are likely to approve a Covid-19 booster shot for vaccinated adults starting at least six months after the previous dose rather than the eight-month gap they previously announced, a person familiar with the plans said, as the Biden administration steps up preparations for delivering boosters to the public. Data from vaccine manufacturers and other countries under review by the Food and Drug Administration is based on boosters being given at six months, the person said. The person said approval for boosters for all three Covid-19 shots being administered in the U.S.—those manufactured by Pfizer Inc. and partner BioNTech SE, Moderna Inc. and Johnson & Johnson —is expected in mid-September. (Armour and Hopkins, 8/26)

Pfizer/BioNTech have initiated an application for full FDA approval of its COVID-19 vaccine booster shot for individuals aged 16 and up, the companies announced Wednesday, noting plans to complete the application later this week. The request for the so-called supplemental biologics license application draws on Phase 3 clinical trial data among 306 participants aged 18 to 55 who received a third dose between 4.8-8 months following the initial two-dose series, with some 2.6 months of follow-up. The companies said levels of neutralizing antibodies were 3.3 times higher following the third dose, versus the second dose. (Rivas, 8/25)

Planning for the rollout begins —

U.S. grocery chain Kroger is gearing up to administer 1 million Covid-19 booster shots a week once they are available to the general public, and plans to offer vaccines in nursing homes for those who cannot go to its stores. (8/25)

Michigan Gov. Gretchen Whitmer signed an executive directive Wednesday that orders state departments to begin preparing for the Sept. 20 distribution of booster shots, with a priority placed on delivery of the shots to long-term care facilities. The state has been administering booster shots since mid-August to immunocompromised individuals but will expand the injections Sept. 20 to all residents who are at least eight months out from receiving a second dose of the Pfizer and Moderna vaccines. The initial boosters for the general public set to begin Sept. 20 will go to long-term care facilities, Whitmer said Wednesday. (LeBlanc, 8/25)

In related news —

For five months, Chris Brummett has ignored his wife’s pleas that he get a coronavirus vaccine. He cares even less that federal regulators finally issued a long-awaited approval for one of them. “My wife is on me all the time to do it,” said Brummett, 43, from Jackson County, Ind., who followed news this week of the Food and Drug Administration’s approval of Pfizer-BioNTech’s coronavirus vaccine. But Brummett, a libertarian critical of both the Biden and Trump administrations, said he’s struggling to trust any government messages about the virus. “I guess for now it’s a no for me.” (Diamond, 8/25)

It was the Food and Drug Administration's Monday announcement that it has granted full approval to Pfizer and BioNTech for their COVID-19 vaccine that convinced 19-year-old Cailin Magee to line up at a vaccine clinic at the University of Louisiana at Lafayette and get the shot. "I was being ignorant. There's really no running away from it anymore," Magee told CBS News' David Begnaud. After the approval, President Biden encouraged more people who were waiting for the FDA's approval to get the vaccine—calling the FDA's approval the "gold standard." (8/24)

Military troops must immediately begin to get the COVID-19 vaccine, Defense Secretary Lloyd Austin said in a memo Wednesday, ordering service leaders to “impose ambitious timelines for implementation.” More than 800,000 service members have yet to get their shots, according to Pentagon data. And now that the Pfizer vaccine has received full approval from the Food and Drug Administration, the Defense Department is adding it to the list of required shots troops must get as part of their military service. (Baldor, 8/25)

In other news about vaccine mandates —

Gov. Greg Abbott issued a new executive order on Wednesday clarifying that no localities or school districts can require their employees to get the COVID vaccine, after the federal approval of the Pfizer doses earlier this week muddied his previous directive on the matter. Abbott’s new order, like the previous one, prohibits public institutions — including state agencies, universities, local governments, public schools and any other entities that receive public funding — from compelling employees to get the shots or asking people who use their services for proof of vaccination. (Harris, 8/25)

The Episcopal Diocese of Maine is mandating COVID-19 vaccines for all clergy and diocesan staff. Maine Bishop Thomas Brown's decision marks one of the first vaccine mandates for clergy in the U.S., per the Religious News Service. Brown issued the directive on Monday for some 240 clergy and 14 staff members to be fully vaccinated against the coronavirus by Sept. 30, unless they provide medical exemption documentation. (Falconer, 8/25)

The Roman Catholic Diocese of Las Vegas will not issue letters of exemption for the Covid-19 vaccine on religious grounds, the diocese told pastors Monday. After "careful and prayerful consideration" based on reports from pastors in the diocese that they have received a small amount of such requests, Bishop George Leo Thomas said he believed that issuing vaccine exemptions would contradict guidance from Pope Francis, according to a communication obtained by CNN. (Holcombe and Boyette, 8/26)

Northwestern Medicine is the latest Chicago-area health system to require that workers be fully vaccinated against COVID-19. The announcement follows full FDA approval for Pfizer’s two-dose vaccine and mandates at 11 of the largest local health systems. Northwestern workers must be fully vaccinated by Oct. 31, the 11-hospital system said in a statement today, noting that nearly 80 percent of doctors and staff already got their shots. Employees can apply for medical and religious exemptions. (Goldberg, 8/25)

KHN: New Montana Law Sows Confusion, Defiance Over School Quarantines 
As classes get underway this week and next, Montana school and county health officials are grappling with how a new state law that bans vaccine discrimination should apply to quarantine orders for students and staffers exposed to covid-19. It’s the latest fallout from the law that says businesses and governmental entities can’t treat people differently based on vaccination status. The law makes Montana the only state that prohibits both public and private employers — including hospitals — from requiring workers to get vaccinated against covid. (Bolton, 8/26)

CMS will not immediately remove nursing homes from Medicaid and Medicare if they do not adhere to the employee staff vaccination requirement announced last week, administrators said during a call with industry stakeholders on Wednesday. Instead, CMS will take a stepwise approach to enforcing the mandate. Nursing homes will first be notified they are not in compliance with the regulation, then assessed civil monetary penalties, then denied payment, and ultimately removed from the program if they do not comply. (Christ, 8/25)

In related news about nurses and nursing homes —

Nebraska's veterans affairs agency is facing questions from a state lawmaker after it published job advertisements for nurses touting the fact that the state doesn't require its employees to get coronavirus vaccinations. The ads on a state jobs website prominently note the lack of vaccination requirements for state employees, right after mentioning a $5,000 hiring bonus. In a separate mail advertisement, the state lists "No mandated COVID-19 vaccination" as one of the "many great benefits" of its nursing jobs. (8/25)

Nursing homes have a long-term care problem: 18 months after the Covid-19 crisis began, their staffs are still shrinking. While employment in nearly every occupation has been recovering from the shock of the pandemic, the number of people working in nursing homes and other long-term-care facilities has continued to drop, according to federal data. (Weber, 8/25)

And in updates about New York's nursing homes —

Gov. Kathy Hochul, in one of her first acts as the new leader of New York, overhauled how the state releases Covid-19 death data to ensure that it is more consistent with federal reporting standards — an issue that dogged former Gov. Andrew Cuomo administration and sparked allegations of a coverup. The Hochul administration’s first Covid-19 update released Tuesday recognized an additional 12,000 Covid deaths that had been previously excluded from the state’s official tally. It showed both the deaths that health care facilities report through the state’s Health Electronic Response Data System — a total of 43,415 — as well as those reported to and compiled by the Centers for Disease Control and Prevention — a total of 55,395. (Young, 8/25)

New Yorkers, many of whom were still grieving, were not thrilled with Gov. Kathy Hochul's, D., answer Wednesday regarding how she plans to investigate last year's COVID-19 nursing home tragedy and the Cuomo administration's reported cover-up. Former Gov. Andrew Cuomo, D., was condemned for enforcing a mandate that forced COVID patients into nursing homes last year, which critics alleged led to the staggering death toll in those facilities, and reports later revealed his administration blocked the release of the true death toll. Hochul was asked what she would do to get to the bottom of the sweeping tragedy. (O'Brien, 8/25)

During a Wednesday interview on MSNBC’s “Morning Joe,” New York Gov. Kathy Hochul (D) — at that point on the job for less than 40 hours — announced that her state was going to provide a more accurate accounting of fatalities related to covid-19 moving forward. “We’re now releasing more data than had been released before publicly, so people know the nursing home deaths and the hospital deaths are consistent with what’s being displayed by the [Centers for Disease Control and Prevention],” Hochul said. “There’s a lot of things that weren’t happening, and I’m going to make them happen. Transparency will be the hallmark of my administration.” (Bump, 8/25)

Delta Air Lines said Wednesday that it will require employees to be vaccinated against the coronavirus or face the alternative of weekly testing and a $200 monthly surcharge for health insurance. Chief executive Ed Bastian outlined the new policies in a memo to the airline’s 68,000 employees, saying that with the Food and Drug Administration’s full approval of the Pfizer-BioNTech coronavirus vaccine this week, “the time to get vaccinated is now.” (Duncan, 8/25)

Unvaccinated Delta Air Lines employees will soon be forced to pay an additional $200 per month for the company's health care plan, making the Georgia-based airline the first such major U.S. company to tie vaccination status to health care costs, a move other industries could soon follow. Delta CEO Ed Bastian, in a memo to employees published online Wednesday, said the $200 surcharge for unvaccinated Delta employees is meant to offset medical costs from a coronavirus infection, which is more likely to occur in unvaccinated individuals. Health care costs for Covid, especially those who need to be hospitalized, can be steep; Delta said the average hospital stay for Covid has cost the airline $50,000 per person. (Mueller, Pawlyk and Monnay, 8/25)

Air Canada on Wednesday joined other major airlines in implementing a vaccine mandate for its employees, giving workers until the end of October to get fully vaccinated or risk losing their job. The Montreal-based airline said in a press release that all employees will need to provide proof of vaccination by Oct. 30, noting that regular testing “will not be offered as an alternative.” (Castronuovo, 8/25)

Joel Steckler was eager for his first cruise in more than a year and a half, and he chose the ship that just two months ago became the first to accept passengers again after a long pandemic shutdown. Steckler was fully vaccinated against COVID-19 and that was enough to resume cruising, under initial guidance from the U.S. Centers for Disease Control and Prevention. Now, the 63-year-old from Long Island, New York, is going to postpone the trip he had planned for Saturday amid new, tighter guidelines prompted by the delta-variant-fueled surge in cases and breakthrough infections. (Licon and Koenig, 8/26)

President Biden this week responded to the Food and Drug Administration’s full authorization of the Pfizer coronavirus vaccine by calling on employers around the country to mandate it for their employees — which it seems many will. And Republicans as a party don’t seem to know what to do with that. In the days since the FDA’s authorization and Biden’s call, Republicans who have otherwise fought tooth and nail against vaccine mandates have been surprisingly quiet about the prospect of employer mandates. And the few who have spoken out have generally said employers should be allowed to implement them. (Blake, 4/25)

And the NFL is also cracking down on the unvaccinated —

The NFL has mandated that only fully vaccinated personnel, with a maximum of 50 people, will have access to locker rooms while players are present on game days. In a memo sent to the 32 teams and obtained by The Associated Press, the policy becomes effective immediately. The personnel covered by the policy includes coaches, athletic trainers, equipment staffers, one general manager, one team security representative, three club communications media workers and one clubhouse support staffer. (Wilner, 8/25)

The New England Patriots gathered for practice Tuesday in Foxborough, Mass., without quarterback Cam Newton, who is barred from in-person team activities for much of this week because of what the team called a “misunderstanding” about testing and the NFL’s coronavirus protocols. Coach Bill Belichick provided few details about Newton’s situation. But Belichick acknowledged that the circumstances created an on-field opportunity for Newton’s rookie understudy, Mac Jones, while representing a competitive disadvantage for Newton. (Maske, 8/25)

Just over half of Florida’s 2.8 million public school students now face mandates to wear masks in classrooms as a courtroom battle continues over efforts by Gov. Ron DeSantis to leave such decisions up to parents. A majority of school board members in Orange County told the superintendent on Tuesday to require most students to wear masks, and agreed with her recommendation to keep the mandate through Oct. 30. (Anderson, 8/26)

Orange County and Indian River County on Tuesday became the ninth and 10th school districts in the state to enact mask mandates with only medical exemptions. The decisions are in opposition to the governor's executive order requiring parents to decide whether their children wear face coverings in school. Neither county will allow for parental opt-outs. Enforcement begins Monday in both counties. (Mayer and Prieur, 8/25)

A Florida hospital said it removed a local doctor who posted on social media that he would provide mask opt-out letters at a price of $50 each for parents who did not want their children to be required to comply with school mask mandates. The Capital Regional Medical Center (CRMC) in Tallahassee said it had been notified of Facebook posts by Brian Warden, a recent medical school graduate who moved from Philadelphia to Tallahassee to work for a physicians group that contracted with the hospital, according to the Tallahassee Democrat.  (Castronuovo, 8/25)

In other news about mask mandates —

Massachusetts public school students and staff are required to wear masks inside school buildings effective immediately, regardless of vaccination status, according to a mandate issued Wednesday by Education Commissioner Jeffrey Riley. Under the requirement, most people will be required to wear masks until at least Oct. 1, with just a handful of exceptions. After that date, schools that have 80 percent or more of their students and staff fully vaccinated will be allowed to drop the mandate for vaccinated people only; unvaccinated students and staff would still be required to wear masks. (Gans, 8/25)

Iowa Gov. Kim Reynolds (R) is facing two lawsuits over a ban on mask mandates and her decision to cut federal pandemic unemployment benefits. Frances Parr, a mother of two boys, filed a lawsuit in state court on Monday seeking to require the state to issue a universal mask mandate for schools, at least temporarily, according to a copy of the complaint published by The Des Moines Register. (Williams, 8/25)

The Maryland state school board will vote Thursday on whether to institute a statewide mandate requiring every child and adult to be masked in schools. Although most Central Maryland school districts have mandated all students and faculty to wear masks to prevent the spread of COVID-19, five counties, including Carroll, do not have a similar requirement in place. (Bowie, 8/25)

Anti-mask protesters disrupted Connecticut Gov. Ned Lamont’s (D) back-to-school event Wednesday evening, that eventually resulted in him being followed to his vehicle. Lamont was hosting a back-to-school roundtable Wednesday with education and public health officials about returning to schools safely. All of the attendees at the roundtable, including the governor, were wearing masks. (Williams, 8/25)

As children head back to the classroom, a "vocal minority" in the U.S. have resorted to violence or disruptive measures to protest against mask mandates in schools. While the majority of Americans support the mandates, per a recent Axios/Ipsos poll, back-to-school confrontations across the U.S. have gotten so hot that teachers and other officials have been punched, hit and screamed at. (Saric, 8/26)

As mask mandates have spurred heated debates at school board meetings nationwide, one Texas man took a bold approach to showing his support: He stripped down to his swim trunks. The stunt occurred during a meeting Monday for the Dripping Springs Independent School District, near Austin. (Deliso, 8/25)

There are more than 100,000 people hospitalized with covid-19 in the United States, a level not seen since Jan. 30 — when coronavirus vaccines were not widely available — as the country grapples with the delta variant’s spread. Hospitalizations are highest across the South, where every state in the region has a higher portion of its population currently hospitalized with covid-19 than the national level, according to a Washington Post database. More than 17,000 people are currently hospitalized with covid-19 in Florida, which has the most hospitalizations for covid-19 of any state in the country, followed by Texas, which has more than 14,000. (Pietsch and Dupree, 8/26)

Hospitals report that three-quarters of the intensive care units in the United States are full, as COVID-19 continues to rampage the country. Federal data shows almost 77.3 percent of all ICU beds are occupied with 28 percent of those beds filled with confirmed COVID-19 patients, according to the Department of Health and Human Services (HHS). Almost half of all states report their hospitals’ ICUs have exceeded 75 percent capacity. (Coleman, 8/25)

In news about children and pregnant women —

There's never been a worse time in the pandemic for US kids. And things could get worse quickly. As millions of kids flock back to school, child hospitalizations for Covid-19 are at record levels. Some schools have already opened and then closed in the South, where infections are raging due to a comparatively low vaccine rate and the extra-infectious Delta variant. Thousands of children are quarantined. (Collinson, 8/25)

More than 180,000 COVID-19 cases in US children were recorded in the week ending on Aug 19, reaching levels of the winter surge, according to the latest data from the American Academy of Pediatrics (AAP). More than one in five (22.4%) reported cases that week were in children. "After declining in early summer, child cases have increased exponentially, with over a four-fold increase the past month, rising from about 38,000 cases the week ending July 22 to 180,000 the past week," the AAP said in their report. (Soucheray, 8/25)

As the delta variant drives a surge in hospitalizations across the South, doctors say they’re seeing an unprecedented number of pregnant women critically ill with Covid-19."None of us has ever seen this magnitude of really, really sick women at one time," said Dr. Akila Subramaniam, an associate professor at the University of Alabama’s Birmingham Division of Maternal-Fetal Medicine. Subramaniam and her colleagues estimate a tripling — or even quadrupling — of pregnant patients hospitalized with Covid. (Edwards, 8/25)

The covid surge continues unabated —

New Mexico's top health officials have had to establish a waiting list for intensive care unit beds for the first time ever and they're warning that the state is about a week away from having to ration medical care as coronavirus infections climb and nurses are in short supply. Health and Human Services Secretary Dr. David Scrase said there was a 20% increase in COVID patients in just the last day, and that New Mexico is on pace to surpass its worst-case projections for cases and hospitalizations. Data shows 90% of the cases since February have been among the unvaccinated. (Hayes, 8/26)

In a sweltering shopping center parking lot off Interstate 45 Thursday morning, Houston Fire Department paramedic Josh Walls tried to find a hospital to take his patient. “Negative,” came the reply on the radio. “All of TMC is on divert.” The six hospitals in the Texas Medical Center with emergency departments were asking ambulances to take patients elsewhere because they were at capacity. The patient, a 29-year-old construction worker with chest pain, asked to be taken to Northwest Houston Hospital. The dispatcher said it, too, was on divert status. Walls and his partner Valentin “Beau” Beauliere took him there anyway. (Despart, 8/25)

Earlier this month, Mississippi ICU nurse Nichole Atherton resigned, worn down by the stress, young patients and preventable deaths that have overwhelmed the state's hospitals during the Covid-19 pandemic. "It looks heroic," Atherton, of Singing River Ocean Springs Hospital, told CNN. "But that's not what it is. It's sweaty and hard and chaotic and bloody. And it's hard to live in this every day and then go home and live a normal life." (Holcombe, Hill and Dolan, 8/25)

Exhausted nurses are pleading with the unvaccinated in Oklahoma to do their part as the state faces a surge in coronavirus hospitalizations that is forcing officials to expedite medical licenses to increase the number of front-line workers. At SSM Health St. Anthony Hospital in Oklahoma City, half of the covid-19 patients were on ventilators, reported KFOR-TV. Amy Petitt, an ICU charge nurse at the hospital, fought through tears during a tour of a hospital pushed to its limits by the highly transmissible delta variant. Ninety percent of the 79 covid patients in St. Anthony’s ICU are unvaccinated, Tammy Powell, president of the hospital, told The Washington Post. (Bella, 8/26)

More people in Florida are catching the coronavirus, being hospitalized and dying of Covid-19 now than at any previous point in the pandemic, underscoring the perils of limiting public health measures as the Delta variant rips through the state. This week, 227 virus deaths were being reported each day in Florida, on average, as of Tuesday, a record for the state and by far the most in the United States right now. The average for new known cases reached 23,314 a day on the weekend, 30 percent higher than the state’s previous peak in January, according to a New York Times database. Across the country, new deaths have climbed to more than 1,000 a day, on average. (Levin, 8/26)

Dr. Nitesh Paryani, a third-generation radiation oncologist in Tampa, Florida, recently was forced to make a decision that he says he and his family have never had to make in 60 years of treating patients. A nearby hospital was working to transfer a cancer patient to a location that had adequate treatment options. Paryani said he regularly accepts such patients, but for the first time, could not do so due to the number of those sick from Covid-19. "We just didn't have a bed. There was simply no room in the hospital to treat the patient," he told CNN's Chris Cuomo in an interview Wednesday. (Caldwell, 8/26)

The University of Georgia has reported its COVID-19 cases for the first week of classes. For the week of Aug. 16-22, UGA reported there have been 231 positive COVID-19 cases submitted through DawgCheck, the campus’s system for tracking cases for students and employees. People on campus are required to report a positive COVID-19 test. The data report states that the data is not “an accurate barometer of the current status of COVID-19 at any point in time at any one of UGA’s campuses," due to delays in reporting and the inclusion of individuals who have recovered or who have not been on campus recently. (Allen, 8/25)

A Covid-19 outbreak sweeping through a small West Texas town has shut down businesses and forced staff and students in its school district to quarantine for at least two weeks. Students had returned to classrooms in Iraan, Texas, for only a week when they were told their schools would have to be closed because of a Covid outbreak, said Tracy Canter, superintendent of the Iraan-Sheffield Independent School District, in a letter to the community posted on the district's Facebook page. (Planas, 8/25)

Los Angeles school officials on Wednesday confirmed the first coronavirus outbreak in the district at Grant Elementary School in Hollywood, sending home an entire classroom of children. “The cases are concentrated in a single classroom and Los Angeles Unified is fully cooperating with the Department of Public Health,” the district said in a statement. “The district has alerted all those potentially impacted and the quarantined class has been provided with instructional materials to continue their studies.” (Blume, 8/25)

In other news about outbreaks —

Two weeks after the annual motorcycle rally in Sturgis, South Dakota, reported Covid infections in the state have risen nearly sixfold. South Dakota counted 3,819 new cases in the past two weeks, including seven deaths, up from 644 cases in the 14 days preceding it. That makes it the state with the largest percent increase in Covid cases in the past two weeks. (Kesslen and Murphy, 8/25)

The Los Angeles Police Department said over 80 of its employees have tested positive for Covid-19 in the past week, nearly doubling its case numbers from the previous week as its vaccination rate hovers below 50 percent. Of the 84 cases, 26 were at the city's Central Division station, NBC Los Angeles reported. The data from the department show that the overall weekly numbers have doubled as the vaccination rate within the police department remains around 47 percent, according to NBC Los Angeles. (Fitzsimons, 8/25)

The National Rifle Association has canceled its annual meeting in Houston because of concerns about the rising rate of COVID-19 infections in Texas, the organization announced Wednesday. Texas, like much of the U.S., is experiencing a surge in cases driven by the highly-contagious Delta variant. (Saric, 8/25)

KHN: What Missouri Learned The Hard Way About Rapid Covid Testing In Schools
Early in the tumultuous 2020-21 school year, Missouri officials made a big gamble: set aside roughly 1 million rapid covid tests for the state’s K-12 schools in hopes of quickly identifying sick students or staff members. The Trump administration had spent $760 million to procure 150 million rapid-response antigen tests from Abbott Laboratories, including 1.75 million allotted for Missouri, telling states to use them as they saw fit. Nearly 400 Missouri charter, private and public school districts applied. Given supply constraints, each was offered one test per person, according to interviews with school officials and documents KHN obtained in response to a public records request. What began as an ambitious plan landed with a thud. Few of the tests were used; according to state data updated in early June, schools reported using just 32,300. (Pradhan, 8/26)

Poison control centers across the nation have received an uptick in calls about the drug ivermectin, an anti-parasitic medicine often used to treat cattle and pigs. Gaylord Lopez, executive director for the Georgia Poison Control Center, told USA TODAY they have already received 15 to 16 calls in August compared to the typical one call a month. Lopez said one woman called the center after purchasing the sheep version but didn't have any side effects. Others have called the center and reported significant symptoms ranging from extreme vomiting to blurred vision, he added. (Gilbert, 8/25)

The North Texas Poison Center reports they’ve received 52 poisoning calls for ivermectin this year, compared to six through August of last year. The numbers are increasing, too. Sixteen of the 52 calls this year have been in August. In August of 2020, Texas received two reports about ivermectin poisoning statewide. This August, they’ve received 55.Last year, the state received 23 ivermectin reports from January through August. This year, there have been 150, an increase of 552%. (Joy, 8/25)

An Arkansas jail and its health-care provider are facing criticisms of “medical experimentation” because the jail’s medical staff has been treating covid-19 patients with ivermectin, a drug commonly used for deworming livestock. Washington County Justice of the Peace Eva Madison (D) said she heard reports of the practice Tuesday after a county employee visited a Karas Health Care coronavirus testing site at the Washington County Detention Center in Fayetteville and was prescribed ivermectin despite testing negative for the coronavirus. (Bellware, 8/25)

An Alaska borough mayor, who says he is not a medical professional, has promoted a debunked treatment for COVID-19 that is intended more for farm animals. Kenai Peninsula Borough Mayor Charlie Pierce has publicly backed the use of ivermectin, an anti-parasitic deworming drug, the Peninsula Clarion reported Wednesday. (8/25)

It has now been 90 days since President Joe Biden ordered the intelligence community to investigate the origins of Covid-19, but the public may have to wait a few more days to view an unclassified version of that report. In May, Biden told US intelligence agencies to "redouble" their efforts in investigating the origins of the Covid-19 pandemic, including the possibility that it emerged from a lab accident, and report back to him in 90 days. After months of work, that review ended Tuesday. The President was briefed on the findings of the report Tuesday, two administration officials told CNN. (Collins, Sullivan and Cohen, 8/25)

Chinese state-owned media has pushed aggressive claims of U.S. "propaganda" aimed to "scapegoat" the communist nation ahead of a report by American intelligence agencies into the origins of COVID-19. Efforts to uncover more information about how the virus first spread continue to face difficulties as the Chinese government maintains a tight grip on lab records, genomic samples and other data that could shed light on the pandemic. It has also been spreading misinformation about the United States. (Aitken, 8/25)

Time is running out for conducting crucial studies into the origin of the coronavirus that caused the Covid-19 pandemic, a group of scientists involved in the inquiry warned on Wednesday. Eleven members of an international group led by the World Health Organization said it would soon be “biologically impossible” to get reliable information about animals and people who might have been exposed to the virus in 2019, when reports of the novel coronavirus began to emerge, according to the scientists’ commentary in the journal Nature. They called on researchers and governments to expedite those studies. (McKay and Marcus, 8/25)

In other covid research —

The Pfizer-BioNTech Covid-19 vaccine is associated with an increased risk of myocarditis, an inflammation of the heart muscle, a large new study from Israel confirms. But the side effect remains rare, and Covid-19 is more likely to cause myocarditis than the vaccine is, scientists reported on Wednesday. The research, which is based on the electronic health records of about two million people who are 16 or older, provides a comprehensive look at the real-wold incidence of various adverse events after both vaccination and infection with the coronavirus. (Anthes and Weiland, 8/25)

Venous thromboembolism (VTE), a dangerous complication of surgery, is 50% more likely to occur in current COVID-19 patients and nearly twice as likely in those with recent infection, according to an international study yesterday in Anaesthesia. The researchers also found that this type of blood clot, the top cause of preventable death in hospitalized patients, poses a fivefold increased risk of death in the first 30 days after surgery relative to patients without VTE (pulmonary embolism or deep vein thrombosis). (Van Beusekom, 8/25)

It was when the second person with unusual clots came in that Phillip Nicolson knew something was wrong. Blood clots are uncommon in young people, and it’s even rarer to see a combination of blood clots and alarmingly low levels of platelets — cell fragments that help to form clots. Yet in the space of one week in March, two young people with this pairing of symptoms had arrived at the Queen Elizabeth Hospital in Birmingham, UK, where Nicolson works as a haematology specialist. And both had recently been given the Oxford–AstraZeneca COVID-19 vaccine. (Ledford, 8/24)

Vaccinated Americans are facing a disheartening reality: Even after getting the shot, they'll have to live with some level of risk from the coronavirus for the foreseeable future. A glut of data released over the past few weeks supports the idea that coronavirus vaccine effectiveness against infection begins to wane over time, although it remains effective against severe disease. (Owens, 8/26)

President Joe Biden on Wednesday signed into law a pilot program to connect veterans struggling with post-traumatic stress disorder with service dogs. The Puppies Assisting Wounded Servicemembers for Veterans Therapy Act — PAWS — requires the Department of Veterans Affairs to establish a five-year program to provide service dogs and training to veterans with PTSD. (Gregorian, 8/26)

In other government news —

The federal government plans to expand its use of facial recognition to pursue criminals and scan for threats, an internal survey has found, even as concerns grow about the technology’s potential for contributing to improper surveillance and false arrests. Ten federal agencies — the departments of Agriculture, Commerce, Defense, Homeland Security, Health and Human Services, Interior, Justice, State, Treasury and Veterans Affairs — told the Government Accountability Office they intend to grow their facial recognition capabilities by 2023, the GAO said in a report posted to its website Tuesday. (Harwell, 8/25)

The trove of documents requested Wednesday by the House committee investigating the Jan. 6 attack shows an interest in former President Trump’s mental health and whether he was considering using the military to remain in power. In addition to seeking records on Trump’s family members and a long list of former aides, the panel is asking the White House and federal agencies to relay any conversations about removing the former president from office and whether he planned to enact martial law. (Beitsch, 8/25)

In other public health news —

Overall rates of drug use among American adolescents held stable six months into COVID-19 pandemic, however shifting trends indicated an uptick in nicotine and prescription drug misuse while alcohol use fell. Federally-backed research published in the Journal of Adolescent Health drew from surveys of over 7,800 kids aged 10-14 enrolled in the Adolescent Brain Cognitive Development study (ABCD), said to be the largest-ever long-term U.S. study of brain development and pediatric health. Results also suggested young teens who experienced severe stress, anxiety or depression, or familial economic hardship were at highest risk of using substances. (Rivas, 8/25)

A dozen people have been hospitalized with salmonella and two dozen sickened as of August 24 in multistate outbreaks of two different strains of salmonella, the US Centers for Disease Control and Prevention announced Wednesday. People who became sick reported eating salami, prosciutto and other deli meats that can be found in antipasto or charcuterie assortments before their illness. (LaMotte, 8/25)

The disparity has reemerged as an urgent issue for both lawmakers and health care providers after a slate of bills to combat the crisis were introduced in Congress earlier this year. New data also shows that Black women continue to face a greater risk of childbirth complications than White women. The US has the highest maternal mortality rate among developed countries. About 700 women die each year in the US due to a pregnancy-related complication either during pregnancy or within the year after delivery, says Dr. Wanda Barfield, Director of the CDC’s Division of Reproductive Health. (Ellis and Broaddus, 8/25)

Headspace and Ginger, two of the most prominent companies in the increasingly competitive mental health space, on Wednesday announced plans to merge. The new company, called Headspace Health, will have a reported value of $3 billion, placing it in the top echelon of companies vying to own significant chunks of the mental health market. (Aguilar, 8/25)

Intermountain Healthcare will increase its minimum wage to $15 for clinical and non-clinical workers effective Sept. 19, the company announced Wednesday. About 2,200 employees who make less than $15 per hour will get a pay boost. Intermountain also will give raises to 12,800 workers who currently earn more than $15 per hour. Most wage hikes will be between 3%-7%, resulting in a total cost of $29 million, according to Salt Lake City-based Intermountain Healthcare. All employees already received raises in April, and some nurses received another in June. (Christ, 8/25)

HCA Healthcare has expanded its nurse pipeline with a new campus located in its headquarter city of Nashville, Tennessee. The move, announced on Wednesday, marks the third new campus the Galen College of Nursing has opened since being acquired by HCA in January 2020. Other campuses are in Miami and Austin. Galen now has a total of eight campuses, with existing ones in Louisville and Hazard, Kentucky, San Antonio, Texas, Tampa Bay, Florida, and Cincinnati, Ohio. (Ross Johnson, 8/25)

Jacksonville-based GuideWell Mutual Holding Corp., the parent company of Florida Blue, announced Tuesday it is acquiring the Blue Cross Blue Shield plan of Puerto Rico called Triple-S Management for $900 million in equity value. GuideWell expects to close on the deal in the first half of 2022 by acquiring all outstanding shares of Triple-S Management common stock for $36 per share in cash. (8/25)

Patient advocates, unions and business groups are urging President Joe Biden's administration to make clear that arbitration should only be used as a "last resort" in out-of-network billing disputes. In a letter to HHS Secretary Xavier Becerra and other cabinet officers, AFL-CIO, the American Benefits Council and dozens of other groups representing large employers, union members and patients expressed concern that providers could abuse the arbitration process under the new surprise billing ban to inflate costs. (Hellmann, 8/25)

Flu shot makers delivered a record 194 million doses to the U.S. last season as public health experts warned against the dreaded overlap between the two pathogens. Flu vaccine demand skyrocketed. ... This season, flu shot makers are again gearing up for another record year, with deliveries set to match the historic figures reported in 2020. Despite the widely deployed COVID-19 vaccines from Pfizer, Moderna and Johnson & Johnson, this flu season could prove just as precarious as society tries to roar back to pre-pandemic life, vaccine execs contend. (Higgins-Dunn, 8/25)

In other pharmaceutical and biotech news —

Sesen Bio, a small biotech firm whose investigational cancer treatment once seemed poised for approval, said Wednesday that it had withdrawn its application to market the drug in Europe. The news follows the Food and Drug Administration’s decision to reject Sesen’s drug, called Vicineum, on Aug. 13. (Garde, 8/25)

This could have been Elizabeth Holmes’ moment. When the then-19-year-old founded Theranos in 2003, she promised to put patients in control of their own health. Her Edison machine would allow anyone to go to the pharmacy, order a cheap diagnostic test, and walk out knowing answers were on the way — no doctor’s note required. That future is now. During the pandemic, millions of people ordered up their own Covid-19 tests. As testing appointments became scarce, they swabbed their own noses at home and shipped their samples to labs. And with the Delta variant surging, 15-minute, over-the-counter antigen tests are flying off pharmacy shelves. (Palmer, 8/26)

KHN: Apple, Bose And Others Pump Up The Volume On Hearing Aid Options, Filling Void Left By FDA
Spurred by decades of complaints about the high cost of hearing aids, Congress passed a law in 2017 to allow over-the-counter sales, with hopes it would boost competition and lower prices. Four years later, federal regulators have yet to issue rules to implement the law. But changes in the industry are offering consumers relief. In August 2017, President Donald Trump signed the legislation that called for the Food and Drug Administration to issue regulations by 2020 for hearing aids that could be sold in stores without a prescription or a visit to an audiologist or other hearing specialist. That hasn’t happened yet, and President Joe Biden last month ordered the FDA to produce those rules for over-the-counter (OTC) purchases by mid-November. That means it will likely take at least until next summer for consumers to feel the direct effects of the law. (Galewitz, 8/26)

Smoke from the raging wildfires in the West Coast was so severe that it created an air quality alert as far as Reno, Nevada, on Tuesday. Several Nevada counties reported their worst recorded air quality index numbers in the two decades they’ve been monitoring air quality. (Pereira, 8/25)

The air around Lake Tahoe in California and Reno, Nevada, is thick with brown smoke this week, and the region is experiencing the worst air quality in the country by far, as the Caldor Fire torches its way through the El Dorado National Forest. The wildfire smoke alone would be enough to trigger a health emergency, but combined with the spread of the coronavirus, health experts are concerned the region downwind from the Caldor Fire could be thrust into a crisis. (Ramirez, 8/25)

The Lake Tahoe region, the pristine getaway for generations of visitors from California's urban coast, is in the midst of a big-city problem of its own: terrible air quality. The culprit is the 126,182-acre Caldor Fire to the south, and possibly spot fires from the 82 percent-contained Tamarack Fire, also to the south, officials said. Purple Air, a company that sells home air quality monitors and publishes regional results from the resulting virtual network, reported Wednesday that the area had the worst air quality in the world. (Romero, 8/25)

In other news from North Carolina and Maryland —

A law that would limit the use of restraints on pregnant people who are incarcerated in North Carolina’s jails and prisons is one step closer to becoming law after it passed the North Carolina Senate on Wednesday. The Dignity for Women who are Incarcerated Act, primarily sponsored by House Reps. Kristin Baker (R-Concord), Ashton Wheeler Clemmons (D-Greensboro), Donna McDowell White (R-Clayton) and Kyle Hall (R-King), would limit prison and jail staff from shackling pregnant people in their second and third trimesters, labor and delivery, and during postpartum recovery. (Thompson, 8/26)

Three members of Maryland Gov. Larry Hogan’s team have tested positive for the coronavirus and an alert went out to thousands of people who attended a political conference in Ocean City last week. “While we cannot disclose any personal health information, three members of Governor Hogan’s staff recently tested positive for COVID-19,” said Kata D. Hall, a spokeswoman for the Republican governor, in a statement Wednesday. “All those affected are feeling fine.” (Oxenden and Wood, 8/25)

President Biden, who has pledged to fight the coronavirus pandemic by making the United States the “arsenal of vaccines” for the world, is under increasing criticism from public health experts, global health advocates and even Democrats in Congress who say he is nowhere near fulfilling his promise. Mr. Biden has either donated or pledged about 600 million vaccine doses to other countries — a small fraction of the 11 billion that experts say are needed to slow the spread of the virus worldwide. His administration has also taken steps to expand Covid-19 vaccine manufacturing in the United States and India, and is supporting production in South Africa and Senegal to expand access to locally produced vaccines in Africa. (Stolberg, 8/25)

In other global developments —

Japan suspended the use of 1.63 million doses of Moderna Inc's COVID-19 vaccine on Thursday, more than a week after the domestic distributor received reports of contaminants in some vials. Both Japan and Moderna said that no safety or efficacy issues had been identified and that the suspension was just a precaution. But the move prompted several Japanese companies to cancel worker vaccinations planned for Thursday. (8/26)

Japan’s worst Covid-19 outbreak yet has thrown a spotlight on the inability of the country’s otherwise highly regarded medical system to adapt quickly to emergencies and its lack of reform to meet such needs. As new cases surged to more than 25,000 a day this month driven by the delta variant, the number of medical emergencies nationwide that required an ambulance dispatch, but had difficulty finding a hospital to accept the patient, rose for six straight weeks to a historic high, according to data from Japan’s Fire and Disaster Management Agency. (Du and Huang, 8/26)

As thousands of Afghans flee the Taliban takeover, thronging the Kabul airport and huddling in camps, aid agencies are warning that the overcrowded conditions could bring a new surge in coronavirus cases. The turmoil, the United Nations said this week, has already hindered its ability to respond. The compounding health and security crises come as the country’s already struggling health-care system reels under the weight of conflict, supply shortages exacerbated by the choke point at Kabul airport, widespread displacement and a long-standing lack of resources. (Cunningham, 8/25)

Australia's new daily cases of COVID-19 topped 1,000 on Thursday for the first time since the global pandemic began, as two major hospitals in Sydney set up emergency outdoor tents to help deal with a rise in patients. Sydney, the country's largest city and the epicentre of the current outbreak, is struggling to stamp out a surge in the fast-spreading Delta variant, with daily infections hitting record levels even after two months under lockdown. (Jose, 8/25)

New Zealand Prime Minister Jacinda Ardern said a nationwide lockdown is working and she remains committed to stamping out a delta outbreak of coronavirus even as case numbers continue to grow. “Overall, lockdown is having an impact,” Ardern told a news conference Thursday in Wellington. “No one wants to use lockdowns forever and I can tell you now that is not our intention. But for now, while we vaccinate, elimination is the goal, and we can do it.” (Brockett, 8/26)

Hospitalization and respiratory complications were more frequent in children and adolescents with COVID-19 during the early months of the pandemic than in those diagnosed as having influenza in past flu seasons, an international team of researchers reported today in Pediatrics. (8/20)

Almost 85% of COVID-19 patients hospitalized said they were not back to their pre-COVID health 1 month after discharge, and even short hospital stays were tied to prolonged symptoms, according to survey results published in the Journal of Hospital Medicine yesterday. The researchers interviewed US adults hospitalized for COVID-19 a median of 47 days after their hospitalization, which took place from Aug 24, 2020, to Jan 26, 2021. Respondents were a median of 60 years old and stayed a median of 5 days. More than half (54.9%) reported new or worsened cardiopulmonary symptoms, 16% had new or increased oxygen use, and 52.8% had problems with daily living. Overall, 84.2% said their health was not what it was pre-COVID, and 16.8% said that on a scale of 0 to 100, with 100 being pre-COVID health, they were at 50 or less. (8/20)

A study today in Morbidity and Mortality Weekly Reports (MMWR) highlights high excess mortality from COVID-19 among racial and ethnic minorities in the United States. Using data from the National Vital Statistics System, US researchers assessed US excess mortality incidence rates (IRs) by race/ethnicity and age-group from Dec 19, 2019, through Jan 2, 2021. Among all racial/ethnic groups, excess mortality IRs were higher in those ages 65 and older (426.4 to 1,033.5 excess deaths per 100,000 person-years) than in those ages 25 to 64 (30.2 to 221.1) and those 25 years of age and younger (2.9 to 14.1). (8/20)

Exposure to wildfire smoke during pregnancy increases the risk that a baby will be born too early, a new Stanford University study suggests. The study, published Aug. 14 in Environmental Research, finds there may have been as many as 7,000 extra preterm births in California attributable to wildfire smoke exposure between 2007 and 2012. These births occurred before 37 weeks of pregnancy when incomplete development heightens risk of various neurodevelopmental, gastrointestinal and respiratory complications, and even death. (Stanford University, 8/23)

Atogepant is an oral, small-molecule, calcitonin gene–related peptide receptor antagonist that is being investigated for the preventive treatment of migraine. ... Oral atogepant once daily was effective in reducing the number of migraine days and headache days over a period of 12 weeks. Adverse events included constipation and nausea. Longer and larger trials are needed to determine the effect and safety of atogepant for migraine prevention. (Ailani et al, 8/19)

Mosquitoes spread viruses that cause potentially deadly diseases such as Zika, dengue fever and yellow fever. New U.S. Army-funded research uses gene editing to render certain male mosquitoes infertile and slow the spread of these diseases. (U.S. Army Research Laboratory, 8/23)

Aducanumab, marketed as “Aduhelm,” is an antiamyloid monoclonal antibody and the latest in a procession of such drugs to be tested against Alzheimer’s disease. Over the last several decades, billions have been spent targeting the amyloid that clumps together to form the neuritic plaques first documented by German psychiatrist Alois Alzheimer in 1906. This class of drugs has reduced amyloid aggregation; however, since 2000, there has been a virtual 100 percent fail rate in clinical trials, with some therapies actually worsening patient outcomes. (Daniel R. George, Peter J. Whitehouse, 8/25)

A major confrontation on the abortion battlefield looms this fall, when the Supreme Court is expected to hear arguments on whether Mississippi can ban abortion after 15 weeks. That’s roughly nine weeks before viability, the point at which states are now allowed to forbid abortion. To uphold Mississippi’s law, the court would have to eliminate its own viability rule or reverse Roe v. Wade altogether. (Mary Ziegler, 8/26)

One of the many hard lessons learned from Covid-19 has been that a robust and resilient domestic public health industrial base is essential to the health and security of the United States. Early in 2020, as the pandemic emerged in the U.S., hospital executives; nursing home directors; clinicians; federal, state, and local officials; and so many others scrambled to get shipments of masks, gowns, and other personal protection supplies from around the world. Companies racing to develop diagnostic tests, therapeutics, and vaccines competed against each other for raw materials and supplies necessary for manufacturing. (Gary Disbrow and Ian Watson, 8/26)

For most of human history, the majority of people died of infectious disease. Scourges like tuberculosis, typhoid, plague, smallpox, and (in some places) malaria carried most people to their graves, many as infants or children. As public health and biomedicine advanced, cancers and organ diseases replaced microbes as the main causes of mortality. The control of infectious disease, and consequent doubling of average life expectancy, helped to bring the modern world as we know it into being. But paradoxically, the control of infectious disease also helped to widen health inequities, both within and between societies. (Kyle Harper, 8/25)

Where you live shouldn't dictate the care you receive, but unfortunately, that's the reality of our healthcare system. A large part of our health is determined by our ZIP codes—not our genetic codes. A major cause of this trend is a critical shortage of primary-care physicians—the doctors patients rely on as the first point of comprehensive care. (Dr. Margot L. Savoy, 8/25)

As an attorney who has concentrated in elder law and long-term care rights for more than two decades, I was only too happy to help my aunt, who suffers from numerous illnesses and requires significant assistance with all of her activities of daily living, to apply to Medicaid for the home care services she greatly needs. Little did I know that her request would lead us to file a class action lawsuit in a New York federal court seeking to obtain fair treatment for hundreds of thousands of New York Medicaid recipients, and to an appeal before the U.S. Court of Appeals for the Second Circuit. (Aytan Y. Bellin, 8/26)

Over the past month, as China has struggled to contain an outbreak of the Delta variant of Covid-19, the government has deployed every tool at its disposal, from shutting down ports to imposing lockdowns that quarantined millions. Some of the strictest measures came in Beijing, which will host the 2022 Winter Olympics in February, including a ban on visitors from regions with even a single case. (Adam Minter, 8/25)

Our children’s hospitals are facing a perfect storm. The resurgence of COVID-19 in the form of the delta variant, the rapid increase in patient visits for viral conditions and mental health, and staffing shortages is placing major strains on the capacity of children’s hospitals to serve children. The increased demand for care in children’s hospitals is not just an issue in a few cities or states; it is a national problem. (Mark Wietecha, 8/26)

It was nearly a year after the first cases of COVID-19 in the United States that I received an invitation to receive the vaccine, due to a nursing clinical placement at Abbott Northwestern Hospital in Minneapolis. When my date and time were selected I felt anxiety melt away. Suddenly there was hope of things going back to normal, but this idea quickly proved faulty. The concept of "anti-vaxxers" was not new to me, especially as a nursing student. But what was new to me was the public outcry of health care professionals — especially nurses — resisting the vaccine. In my eyes, front-line health care professionals must take care of their patients in the most effective way possible, and taking all measures to prevent the spread of such a deadly virus seemed like a no-brainer. (Lucy Moe, 8/25)

I have bad news for the willfully unvaccinated: COVID-19 vaccine mandates are coming, and your world is about to shrink to the size of a tweet. Vaccine mandates, with medical and religious exemptions, had been popping up at companies and universities even before the FDA granted full approval to Pfizer-BioNTech’s coronavirus vaccine this week. But that announcement knocked down one of the anti-vaxxers’ main lame excuses — “It’s an experimental drug!” — and paved the way for corporations, venues, restaurants and schools to more comfortably require proof of vaccination. (Rex Huppke, 8/26)

As of last week, in spite of an extremely high level of confidence among policy officials and public health experts that any of the three Covid-19 vaccines with emergency use authorization are safe and effective, about 70 million adults in the U.S. remained unvaccinated, as well as nearly 50 million children under age 12 who aren’t yet eligible for inoculations. (Dr. Irwin Redlener, 8/25)

Now that the US Food and Drug Administration has approved the Pfizer/ BioNTech Covid-19 vaccine for people age 16 and older, it's time for all governments across the country to mandate the vaccine for people taking part in indoor activities. There are no more valid excuses for not being vaccinated other than health reasons. One frequently heard pushback against vaccine mandates is that there is a "constitutional right" to choose whether to be vaccinated or not for adults and a right to determine whether children can be vaccinated. That is a non-starter in the midst of a pandemic. (Marci Hamilton and Paul Offit, 8/25)

Heidi Lucas, director of the Missouri Nurses Association, says families are demanding unproven treatments for their loved ones with COVID-19, and don’t always take it well when those requests are turned aside. “After working to the point of exhaustion and witnessing needless deaths,” tweeted a woman whose stepdaughter is a nurse in the area, “she is now advised by the hospital to take off her scrubs while in public because of threats. ”It isn’t just nurses. In Springfield, an anti-vaccine protest threatened Walmart pharmacists. “What they’re doing is crimes against humanity,” anti-vaxxer Christopher Key wrote on Facebook. “And if they do not stand down immediately, then they could be executed.” (8/26)

I’m a respiratory therapist. With the fourth wave of the pandemic in full swing, fueled by the highly contagious Delta variant, the trajectory of the patients I see, from admission to critical care, is all too familiar. When they’re vaccinated, their COVID-19 infections most likely end after Stage 1. If only that were the case for everyone.Get vaccinated. If you choose not to, here’s what to expect if you are hospitalized for a serious case of COVID-19. (Karen Gallardo, 8/26)

Life expectancy in the United States fell by one and a half yearsin 2020, the largest annual decline in life expectancy since World War II. Now, one and a half years into the COVID-19 pandemic, with over 626,000 American lives lost, we have an abundance of safe, accessible Covid vaccines, and the Pfizer-BioNTech vaccine just received full approval beyond emergency use by the U.S. Food and Drug Administration (FDA). Summer 2021 was supposed to be a return to normalcy, a "hot vax" summer of connection and prosperity. Instead, we saw a fourth wave of the COVID-19 pandemic and the return of Center for Disease Control (CDC) mask mandates, largely due to the over 90-million eligible Americans who remain unvaccinated in the setting of the highly infectious Delta variant. (Shoshana Ungerleider and Jesse O'Shea, 8/25)

Warren Buffett famously remarked that “Only when the tide goes out do you discover who’s been swimming naked.” Of course, Buffett was talking about his industry — the quacks and frauds who surf the surging boom market, only to get beached when the waves of easy money recede. But his adage could easily be applied to the Food and Drug Administration and the Centers for Disease Control and Prevention, whose bureaucratic procedures looked fine right up to the point when the pandemic showed them to be disastrous. By now, most people paying attention to the agencies seem to have conceded there is something very wrong with the CDC — recall the early coronavirus testing debacles, its slowness in embracing masks or acknowledging airborne transmission, the apparent politicization of guidance surrounding schools, the decision to stop tracking breakthrough covid cases, the inability to provide real-time data on infections. (Megan McArdle, 8/25)