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Who gets to be first in line for a COVID-19 vaccine? U.S. health authorities hope by late next month to have some draft guidance on how to ration initial doses, but it’s a vexing decision.“Not everybody’s going to like the answer,” Dr. Francis Collins, director of the National Institutes of Health, recently told one of the advisory groups the government asked to help decide. “There will be many people who feel that they should have been at the top of the list.”Traditionally, first in line for a scarce vaccine are health workers and the people most vulnerable to the targeted infection.But Collins tossed new ideas into the mix: Consider geography and give priority to people where an outbreak is hitting hardest.And don’t forget volunteers in the final stage of vaccine testing who get dummy shots, the comparison group needed to tell if the real shots truly work.“We owe them ... some special priority,” Collins said.Huge studies this summer aim to prove which of several experimental COVID-19 vaccines are safe and effective. Moderna Inc. and Pfizer Inc. began tests last week that eventually will include 30,000 volunteers each; in the next few months, equally large calls for volunteers will go out to test shots made by AstraZeneca, Johnson & Johnson and Novavax. And some vaccines made in China are in smaller late-stage studies in other countries.For all the promises of the U.S. stockpiling millions of doses, the hard truth: Even if a vaccine is declared safe and effective by year’s end, there won’t be enough for everyone who wants it right away -- especially as most potential vaccines require two doses.It’s a global dilemma. The World Health Organization is grappling with the same who-goes-first question as it tries to ensure vaccines are fairly distributed to poor countries -- decisions made even harder as wealthy nations corner the market for the first doses.In the U.S., the Advisory Committee on Immunization Practices, a group established by the Centers for Disease Control and Prevention, is supposed to recommend who to vaccinate and when -- advice that the government almost always follows.But a COVID-19 vaccine decision is so tricky that this time around, ethicists and vaccine experts from the National Academy of Medicine, chartered by Congress to advise the government, are being asked to weigh in, too.Setting priorities will require “creative, moral common sense,” said Bill Foege, who devised the vaccination strategy that led to global eradication of smallpox. Foege is co-leading the academy’s deliberations, calling it “both this opportunity and this burden.”With vaccine misinformation abounding and fears that politics might intrude, CDC Director Robert Redfield said the public must see vaccine allocation as “equitable, fair and transparent.”How to decide? The CDC’s opening suggestion: First vaccinate 12 million of the most critical health, national security and other essential workers. Next would be 110 million people at high risk from the coronavirus -- those over 65 who live in long-term care facilities, or those of any age who are in poor health -- or who also are deemed essential workers. The general population would come later.CDC’s vaccine advisers wanted to know who’s really essential. “I wouldn’t consider myself a critical health care worker,” admitted Dr. Peter Szilagyi, a pediatrician at the University of California, Los Angeles.Indeed, the risks for health workers today are far different than in the pandemic’s early days. Now, health workers in COVID-19 treatment units often are the best protected; others may be more at risk, committee members noted.Beyond the health and security fields, does “essential” mean poultry plant workers or schoolteachers? And what if the vaccine doesn’t work as well among vulnerable populations as among younger, healthier people? It’s a real worry, given that older people’s immune systems don’t rev up as well to flu vaccine.With Black, Latino and Native American populations disproportionately hit by the coronavirus, failing to address that diversity means “whatever comes out of our group will be looked at very suspiciously,” said ACIP chairman Dr. Jose Romero, Arkansas’ interim health secretary.Consider the urban poor who live in crowded conditions, have less access to health care and can’t work from home like more privileged Americans, added Dr. Sharon Frey of St. Louis University.And it may be worth vaccinating entire families rather than trying to single out just one high-risk person in a household, said Dr. Henry Bernstein of Northwell Health.Whoever gets to go first, a mass vaccination campaign while people are supposed to be keeping their distance is a tall order. During the 2009 swine flu pandemic, families waited in long lines in parking lots and at health departments when their turn came up, crowding that authorities know they must avoid this time around.Operation Warp Speed, the Trump administration’s effort to speed vaccine manufacturing and distribution, is working out how to rapidly transport the right number of doses to wherever vaccinations are set to occur.Drive-through vaccinations, pop-up clinics and other innovative ideas are all on the table, said CDC’s Dr. Nancy Messonnier.As soon as a vaccine is declared effective, “we want to be able the next day, frankly, to start these programs,” Messonnier said. “It’s a long road.”___The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content. 5581

With COVID-19 cases surging across the country, public health officials and ICU doctors are pleading with Americans to reconsider gathering with family members ahead of the Thanksgiving holiday for fear of spreading the virus even further.“We really don’t have a national or even multi-state plan, and that worries me,” said Dr. Stephen Morse with Columbia University.While he strongly recommends against it, Dr. Morse knows inevitably some people will still get together on Thursday. His advice is to have a multi-layered safety approach.The first layer involves testing. He’s urging people to avoid those rapid tests if they can because they’re less accurate.With so many Americans trying to get tested right now, officials also say it’s important to plan ahead and be prepared to potentially not get results back before Thanksgiving.“Testing is really important because it’s the only way we can find people who aren’t obviously sick and stop them,” Dr. Morse added.Health officials say if you are planning a small family gathering, get tested before you see high-risk family members. Americans are also being urged to consider virtual holiday gatherings whenever possible.If you are gathering with people outside your household, eat in separate rooms or consider eating outdoors.“What I’ve seen is once it gets into a family, because we let our guard down around our family, everybody gets infected,” explained Dr. John Coleman, who works in the ICU at Northwestern University’s teaching hospital in Chicago.Dr. Coleman says there are just too many variables to consider when it comes to gathering for Thanksgiving this year.“I think we are on the cusp of some very, very dark months. What we’ve seen is the increase of COVID across the nation is going to eventually stress the health system.” 1804

When professional team sports resume later this month, a number of MLB and NBA players have decided not to return to action.Over the weekend, pitchers Felix Hernandez and David Price became the latest MLB players top opt out for this year’s baseball season, which is slated to begin within three weeks.Hernandez said,” Never before has an entire MLB season depended so much on everyone in the league’s involvement. Let’s be responsible and keep each other safe. It’s not just for us, but for the game and our own families.”Price also cited concerns about his family on why he opted to sit out the 2020 season.“After considerable thought and discussion with my family and the Dodgers, I have decided it is in the best interest of my health and my family’s health for me to not play this season,” he said.Other professional athletes have expressed concern over the return to sports. Angels star Mike Trout has been seen wearing a mask during on-field workouts.MLS goalkeeper Matt Lampson said athletes aren’t as invincible to the coronavirus as it appears.“For everyone in the ‘These are pro athletes. There is no risk. Nothing happens to them if they get the virus camp - I am high risk,” Lampon tweeted. “And I know for a fact there are multiple others at MLS is Back that are as well - including other players on their way here. This is serious.”Other MLB players confirmed to not participate in the upcoming season include Ian Desmond, Ryan Zimmerman, Joe Ross and Nick Markakis.NBA players who have opted out include Victor Oladipo and DeAndre Jordan. With the MLB, NHL and NBA all scheduled to begin within the next four weeks, the leagues will be heavily relying on frequent COVID-19 testing in order to prevent spreading the virus to other players. 1762

When astronaut Victor Glover climbed aboard the International Space Station early Tuesday morning, he became the first Black astronaut arriving for a long-term stay.Glover, along with his fellow SpaceX Crew Dragon capsule crewmates, will stay on the ISS for six months.A handful of Black astronauts have visited the orbiting lab during space shuttle missions, their stays were a few weeks. More than 300 astronauts from NASA have reached space to date, and Glover is the 15th Black astronaut to do so, according to the New York Times.Glover was selected as an astronaut in 2013, at the time he was serving as a Legislative Fellow in the United States Senate, according to NASA.He is now the pilot and second-in-command on the Crew-1 SpaceX Crew Dragon capsule, named Resilience. While onboard the ISS, he will serve as the Flight Engineer. 847

What do you do during a day off while filming in quarantine? Apparently sing duets with your co-star, to the delight of fans.Actors Sam Neill and Jeff Goldblum shared musical selections on their social media accounts Monday. The two are reunited on the set of the latest Jurassic Park film, “Jurassic Park: Dominion.” The two starred in the original Jurassic Park film in 1993.It started with a video tweeted by Neill of the two singing “I Remember You,” as Goldblum remarks, “this is apropos to our reunion.”“Another #JamWithJeff . Hers (sic) the thing- #JeffGoldblum flatly refuses to rehearse. So every time is the first time,” Neill writes sharing a clip of the two singing “September Song” with Goldblum on piano. 726

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