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Some of the COVID-19 vaccine candidates call for more than one shot, so how do we make sure patients come back?Three experts all tell us preparing people for the side effects will be critical.A nursing researcher described those side effects in a JAMA article. She suspects she had the experimental vaccine as part of Pfizer’s Phase III clinical trials.After the second shot, she said she was light-headed, nauseous, had a headache, ran a fever, and was hardly able to lift her arm from muscle aches. She wasn't warned and it scared her into thinking she might have COVID-19.“The immune system is revving up,” said LJ Tan, Chief Strategy Officer at the Immunization Action Coalition. “It's responding to that vaccine, and I think we need to tell our patients that so that they expect that. Otherwise, they're going to say, ‘wow that thing hurt, I'm not coming back for that second dose.’”For comparison, a recent shingles vaccine also requires more than one dose and can be painful. Providers and advocates lead education efforts on what to expect. The return rate after the first shot for shingles is about 80%, which is considered high.One suggestion is to put information on side effects in COVID-19 vaccine distribution kits.The Centers for Disease Control and Prevention (CDC) has already said it plans to include index cards that tell patients what they had and when their next dose is due. That's on top of electronic reminders like email or texts.The federal government has also promised to cover most costs for the vaccine.One doctor says he'd take that a step further.“I feel extremely strongly that we should do everything we can in terms of customized, personalized patient support programs, and even recommend that the federal government go beyond free and provide small rewards or incentives for people who complete the two-dose program,” said Dr. A. Mark Fendrick, Director of the University of Michigan's Center for Value-Based Insurance Design.There's some protection for people who only get one dose of the Pfizer vaccine, but nearly full protection is better. The second dose also boosts antibodies.“That's important because of waning immunity. The higher your antibodies when you start, the longer it takes for that to decrease over time, and potentially make you more susceptible,” said Dr. Gregory Poland, Director of the Mayo Clinic's Vaccine Research Group.That means the best thing is to get both doses as was tested in the study. 2463

Some of the top scientists and doctors in the country are calling on leaders to do something different immediately to improve the state of the COVID-19 pandemic.The American Association of Medical Colleges released a road map to reset the country's approach to the crisis. It includes evidence-based actions to improve outcomes and overall health.Improvements include things the country still hasn't got a grip on, like critical supply and drug shortages, increasing testing, an setting national standards for face coverings.“There is literally no risk to wearing a mask for the average person. You may be uncomfortable, you may be hot, you may break out, but it is nowhere as uncomfortable as it would be for having me or one of my colleagues intubate you and put you on a ventilator for an extended period of time,” said Dr. Atul Grover, Executive Director at the AAMC Research and Action Institute.A recent study by Duke of various face masks found the N95 respirator with no valve is the most effective. But these should be reserved for health care workers.A disposable surgical mask made from a plastic material called polypropylene was the next best option.Third was a mask with two layers of cotton and one layer of synthetic material.Masks made from cotton fabric alone, as well as knit t-shirts, performed about the same.“So, you are also protecting yourself,” said Grover. “In fact, if we can get up to 80, 90% of us wearing masks in a community, you could start to reduce that transmission by 2 or 3% at a pretty steady rate.”The AAMC roadmap to reset also mentions an immediate need for something we haven't seen yet, a vaccine distribution plan.“But somebody needs to sit down and say within those high-risk groups of comorbidities, whether that’s diabetes, obesity, hypertension, heart failure, who should be vaccinated first? Is it by age? Is it by condition? And even among first responders, do I start with police doctors, paramedics?”The Centers for Disease Control and Prevention (CDC) has not released a vaccine distribution plan. It has asked four states and one city to draft plans for how they would distribute and who would get priority. Those plans will be shared with other states. 2215

Sparked by new records in California, Florida and Texas, Wednesday marks the most recorded coronavirus cases in a single day in the United States.Data compiled by Johns Hopkins University generally is not updated until the following morning, but official state-by-state data shows at least 37,000 new reported cases on Wednesday. That figure would make for the most cases reported in a single day, according to Johns Hopkins University data.The Atlantic’s COVID Tracking Project confirms a record of more than 38,000 US cases on Wednesday.The three largest US states set new records on Wednesday:California 7,149Florida 5,508Texas 5,489While Arizona did not set a new record on Wednesday, it did see a record for hospitalizations since the start of the pandemic.The reported cases is only a snapshot of the spread in the US, as there is a lag time between the onset of cases and when they’re reported to state departments of health.While President Donald Trump has suggested the rise in cases is due to an increase in testing, that alone does not explain the surge in cases in Florida, Texas and California.“Testing of course means finding cases, that is why we test,” said Dr. Ali Mokdad, Chief Strategy Officer for Population Health at the University of Washington. “But the increase in cases that we report is adjusted for testing and in many places we see a rise of cases due to increased spreading of the virus and not testing. We see a rise in Florida, California, and Texas that are true increases in cases. In other states, like NY, for example, they tested about 60K and now their % positive is coming down.”Tuesday marked the most recorded coronavirus cases in the US in nearly two months as cases dropped off in May amid stay at home orders. But with stay at home orders lifted throughout the US, cases have increased quickly. 1845

Small business owners are concerned that a federal loan program, the Economic Injury Disaster Loan, is providing too little money – too late. The delay, and the diminished funding, are leaving some business owners with questions, concerns and a fear that they’ll have to shut their doors.One of those businesses is GoPegasus, a transportation company based in Orlando, Florida. It’s been months since any of its dozens of buses have even moved, even though business should be booming right now.“There are days that it's really tough to wake up in the morning, I'm gonna tell you I... But you have to do it like us, 26 years. It's a life,” said Claudia Menezes, the vice president of GoPegasus said.And even though their business has stopped - Menezes said they’ve seen more than million in cancellations so far - their bills haven’t. Things like employees, bus maintenance and insurance all still have to be paid. Which is why Menezes said GoPegasus applied for an EIDL loan in the first place. In the 26 years GoPegasus has been in business, Menezes said they have received two such loans before, one immediately following September 11, 2001, and another after Hurricane Irma.The EIDL is a low-interest loan, separate from the Paycheck Protection Program, that the federal Small Business Administration awards after a disaster. EIDL funds can be paid back to the government over decades.The coronavirus pandemic means any business owner with 500 employees or fewer can apply for one of these loans.Menezes said that when they applied for a loan in March, the maximum cap was million, and the company was approved for a 0,000 loan, but before they got the money, the loan program was capped.In May, the SBA capped all EIDL loans at 0,000. An SBA representative said that decision was made “in order to help as many small businesses and nonprofit organizations as possible. However, most applicants will not be affected by the limit because loan amounts are calculated based on economic injury and 6-monts of actual working capital needs. As of June 29, 2020, the average EIDL loan for COVID-19 is well under the limit at approximately ,000.”Menezes said with the smaller loan, she doesn’t know if GoPegasus will be able to stay in business. She’s appealed the loan amount and said she’s called, written letters and reached out to her federal representatives but has no information on the status and is just waiting.“It’s almost impossible to plan and that's our situation at this point, so what are we gonna do? We're really running out of resources,” said Menezes.Kelly West and her family have a similar story. This is the first time her family’s company, Skydive Greene County, applied for a federal EIDL loan and she described the experience as “horrific.”“I might sound a little dramatic, but it's been an emotional roller coaster,” said West.She’s the operations manager for the company and said she originally filed a loan application in March. She said she needed to fix an error on that original application, but after she did, the nearly 60-year-old family business’ loan was only partially funded. She said she’s appealed, written to federal representatives and even got a senator involved but now she’s waiting – with no idea if or when she’ll learn moreTalking about small business owners and the importance of funding EIDL loans, West said that, “these are people, not just their income, but these are our dreams, our hopes, our dreams, our life’s work.”Menezes and West are not alone. In a July 1 meeting of the U.S. House of Representatives’ Small Business Committee, representatives from both sides of the aisle shared similar small business stories from each of their districts with James Rivera, an Associate Administrator for the Office of Disaster Assistance in the U.S. Small Business Administration. Most of the stories told by the representatives had similar themes – not enough money and not enough information.In reference to the 0,000 cap, Rep. Pete Stauber, (R-MN) told Rivera that “it seems that the SBA has taken some liberties to reduce the cap of loans given out from million to 0,000. While this is likely to ensure that the maximum number of businesses receive some sort of funding during this crisis, my constituents are rightfully upset. They feel like they are being cheated out of what they were promised by our government.”Rep. Angie Craig (D-MN) talked about the lack of information and customer service her constituents received from the SBA in the loan process, and told Rivera, “I have a lot of businesses in my district where if this was the level of customer service that they provided they would be out of business three months ago.”The SBA points to what they have done. Rivera told representatives that some wait times have been longer but the average time to get a loan filled is 41 days. While some representatives questioned how long that time frame was, Rivera said loans that are applied for now – after a new application portal was rolled out in June – have an even shorter turnaround time.A representative of the SBA said in an email that, “following the passage of the CARES Act, SBA created and implemented an entirely new online EIDL application portal and distribution system…This system has now handled more than eight million applications, allowing the SBA to distribute funds to those small businesses in less than two days.”Rivera also said in Congress that there’s a huge demand for funds – bigger than ever before, and that the SBA has awarded 6.8 million business about 7 billion, and still has about 0 billion left to award.Both Menezes and West said that if they knew back in March what they would have to go through – and are still going through -- they likely would have tried to get loan help elsewhere.“It's a one thing to have a yes or no answer and to know right away. So we could have made alternative plans to get different financing if we needed it,” said West. “But then when you're promised something and then it doesn't come through, and then you're promised by somebody else and it doesn't come with them, now what is three or four different times. You feel like you’re just beat up.”Menezes echoed that sentiment, and also said after 26 years in business, she doesn’t know if her company will make it through this one.“It is like it makes the situation even worse because you don't know what you do, what you can do, what to do. We’re in the mercy of something - a miracle to happen,” said Menezes. 6518

Several industries have been disrupted since the coronavirus pandemic hit the U.S., including the food supply chain. From dumped milk to piles of uneaten onions and potatoes, this was just some of the food going to waste on farms across America due to COVID-19-related shutdowns.“Really its impact on the food supply chain started in March,” said Jack Buffington, a supply chain expert currently developing the supply chain program at the University of Denver. “Most of us who have been in the supply chain have never seen an event like this happen.” While farmers were dumping or burying products, food banks were missing out on some much-needed supplies, and dealing with growing demand. So were grocery stores as restaurants were closed and consumer buying habits changed.“More of the retail food market went down and more of the consumer home food market went up,” Buffington explained. “This caused a major shock in the supply chain where you had this situation where some foods were going to waste and some foods were in high demand.”First, the federal government stepped in to help. The USDA was given up to billion through the Coronavirus Assistance Program to buy fresh produce, dairy, and meat from farmers and then distribute that to those in need.And then there were nonprofit organizations like FarmLink.“We matched a farm in Idaho, an onion farm, to or local food bank in Los Angeles,” Max Goldman with FarmLink explained. “We delivered 50,000 pounds of onions to them.” He said that was their proof of concept.Goldman is a student at Brown University. Him and a group of students saw the disruption in the supply chain, and decided to do something about it.“A lot of what we do is finding food that would’ve been sent to the dump,” he said.So, FarmLink was born to help with food waste.“We’ve done two million pounds in seven days,” Goldman said. In just two months, they’ve reallocated four million pounds of food. They pay farmers their cost with donations and grants they receive, and help get the good to food banks. Goldman said the farmers are generally grateful“One of the first farmers we worked with, he said the day he has to dump his food is the worst day of his life. He works all year to basically produce this food and for him to have to a dig a hole in his backyard and just take a dump truck and put all his potatoes and onions or whatever it is, he said it makes him cry and it’s the worst day of his life,” Goldman said. “Even if he lost money on it, he was glad he could send this food to people in need during this time.”So far, they’ve delivered food to approximately 30 states.“This is not a new issue and its been accelerated and made more public due to coronavirus, but every year there’s over 60 billion pounds of food waste,” Goldman said.Buffington said the work of FarmLink and organizations doing similar work is just a drop in the bucket, but it’s promising.“Small in scale of the overall supply chain, but it’s huge in this opportunistic saving of food,” he explained. Buffington sees this type of work as a Band-Aid on the bigger issue, but it could open eyes to solutions down the road.“Supply chains work really well on stability,” Buffington said. “It’s tough to think about innovation which is disruption, when you're worried about a disruption to your current model.”“I think when we pull out of this you’re going to see remarkable opportunities for innovation,” he said.For now, FarmLink and other organizations are working to make sure food doesn’t go to waste. Goldman’s goal is to move over a million pounds of food a day. “We’ve had tens of thousands of people reaching out wanting to help, and that’s just so uplifting and really gives you hope,” Goldman said. 3729