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While scientists work to come up with a safe and effective COVID-19 vaccine, doctors across the country are watching closely. Many are helping guide their patients in making an informed decision about getting a vaccine."This was indeed a surprise to see that there would vaccines available by the 1st of November. It’s clearly an aspirational goal, because we all would like to see a safe and effective COVID-19 vaccine as soon as possible, but I think testing vaccines to make sure they’re safe and effective is of paramount importance," said Dr. Bali Pulendran, a microbiology and immunology professor at Stanford University.Dr. Pulendran says the process of developing a vaccine involves numerous steps, and scientists are getting closer to the end. Still, it's hard to put an end date on the third and final phase of a vaccine trial. This last phase determines whether the vaccine actually works."The way in which you can assess whether a vaccine works is to see how many of these people acquire the disease or become infected with COVID at some period of time," explained Dr. Pulendran.Phase three divides the trial participants into two groups. One group is given the vaccine, and the other is given a placebo."And then, you calculate the efficacy based on those numbers. So, if there were 200 people affected in the placebo group but there were only 100 people who were infected in the vaccinated group, then the efficacy is 50 percent" said Dr. Pulendran.The third phase is hard to time, as it depends on how quickly some of the trial participants become infected. If they live in areas where COVID-19 infection rates are higher, the phase will be completed faster.But there are some other ways to speed up the vaccine trial.Dr. Darria Long, an emergency room physician and clinical assistant professor at the University of Tennessee-Erlanger, says one way is by doing two of the phases at the same time. Another way is if officials prepare for the manufacturing and logistics side of producing the vaccine during the third phase of the trial."This is what we see the CDC saying is to get ready on the manufacturing and logistics side because even if you come up with the perfect target drug, making sure you can manufacture hundreds of millions and that you have the little glass vials that can keep it at the right temperature, those are all things that can be hang-ups,” said Dr. Long. “So, they're wanting to expedite that process, because the last thing you want is to say is we have the vaccine, but we can’t get it to people.”Dr. Long is already answering her patients' questions as news of a possible COVID-19 vaccine continues to be publicized."I do think a lot of people are wondering about this vaccine and it runs the gamut. There are those that say they really want the vaccine because they see it as this gateway to getting back to life as we know it," said Dr. Long.There are also those who are really concerned about the efficacy and safety of a COVID-19 vaccine. Doctors say a key piece in evaluating a vaccine when it does come out is the data surrounding it."The data that comes out in the public domain: is a particular vaccine efficacious? How effective is it what is the efficacy data? Is a particular vaccine safe? What are the side reactions? And they should talk with their physicians to ask each question. Ask doctors, ‘Could you tell me what the safety part of this vaccine is?" recommended Dr. Pulendran.And above all, doctors and scientists hope politics will stay out of the development of a COVID-19 vaccine in order to ease any concerns or hopes for a vaccine to be available as soon as possible. 3644

When asked at a press conference on Wednesday about the consequences of calling himself a "nationalist," President Trump refused to answer the question, calling the question "racist."Trump was asked by PBS reporter Yamiche Alcindor, who is black, about comments he made late last month at a political rally in which he called himself a nationalist. Alcindor asked if he thought his rhetoric was emboldening white nationalists across the country."That's such a racist question," Trump said. "I don't believe that."Trump went on to cite approval numbers among African-Americans as to why he didn't think white nationalism was on the rise."I love our country," Trump added. "You have nationalists, you have globalists. I also love the world. I would love to help the world, but we have to straighten out our country first. But to say, that, what you said, is so insulting to me. It's a very terrible thing you said."  947

WHAT HAPPENED:The U.S. Postal Service says it can’t meet a federal judge’s order to sweep processing centers for undelivered mail-in ballots. It is arguing that doing so would be disruptive to its Election Day operations and that it had “physical and operational limitations.”THE SIGNIFICANCE:Disputes about mail ballots, particularly those received after Election Day, could be the fuel for court fights over election results in some states.THE BACKGROUND:U.S. District Judge Emmet G. Sullivan’s order came after weeks of bruising court decisions for an agency that has become heavily politicized under its new leader, Postmaster General Louis DeJoy. DeJoy, a major GOP donor, made a series of controversial policy changes in the summer that delayed mail nationwide, fueling worry about the service’s ability to handle the unprecedented crush of mail-in ballots.At the same time, President Donald Trump has baselessly attacked mail voting as fraudulent throughout his campaign.Much of Sullivan’s order hinged on postal data showing roughly 300,000 mail-in ballots in several states had not received scans showing they had been delivered. The agency has disputed the accuracy of the figure, saying it has pushed to ensure same-day local delivery of ballots by circumventing certain processing steps entirely, leaving them without the final delivery scan.WHAT’S NEXT:Sullivan had given the agency until Tuesday afternoon to search 27 facilities in several battleground areas for outstanding ballots and send out those votes immediately.The Postal Service said it had already conducted rounds of morning checks at all its processing hubs. Further, the agency said has been performing daily reviews of all 220 facilities handling election mail and planned another sweep hours before polling places closed Tuesday.The judge accepted the agency’s response but set a Wednesday hearing “to discuss the apparent lack of compliance with the court’s order.” 1955

While scientists work to come up with a safe and effective COVID-19 vaccine, doctors across the country are watching closely. Many are helping guide their patients in making an informed decision about getting a vaccine."This was indeed a surprise to see that there would vaccines available by the 1st of November. It’s clearly an aspirational goal, because we all would like to see a safe and effective COVID-19 vaccine as soon as possible, but I think testing vaccines to make sure they’re safe and effective is of paramount importance," said Dr. Bali Pulendran, a microbiology and immunology professor at Stanford University.Dr. Pulendran says the process of developing a vaccine involves numerous steps, and scientists are getting closer to the end. Still, it's hard to put an end date on the third and final phase of a vaccine trial. This last phase determines whether the vaccine actually works."The way in which you can assess whether a vaccine works is to see how many of these people acquire the disease or become infected with COVID at some period of time," explained Dr. Pulendran.Phase three divides the trial participants into two groups. One group is given the vaccine, and the other is given a placebo."And then, you calculate the efficacy based on those numbers. So, if there were 200 people affected in the placebo group but there were only 100 people who were infected in the vaccinated group, then the efficacy is 50 percent" said Dr. Pulendran.The third phase is hard to time, as it depends on how quickly some of the trial participants become infected. If they live in areas where COVID-19 infection rates are higher, the phase will be completed faster.But there are some other ways to speed up the vaccine trial.Dr. Darria Long, an emergency room physician and clinical assistant professor at the University of Tennessee-Erlanger, says one way is by doing two of the phases at the same time. Another way is if officials prepare for the manufacturing and logistics side of producing the vaccine during the third phase of the trial."This is what we see the CDC saying is to get ready on the manufacturing and logistics side because even if you come up with the perfect target drug, making sure you can manufacture hundreds of millions and that you have the little glass vials that can keep it at the right temperature, those are all things that can be hang-ups,” said Dr. Long. “So, they're wanting to expedite that process, because the last thing you want is to say is we have the vaccine, but we can’t get it to people.”Dr. Long is already answering her patients' questions as news of a possible COVID-19 vaccine continues to be publicized."I do think a lot of people are wondering about this vaccine and it runs the gamut. There are those that say they really want the vaccine because they see it as this gateway to getting back to life as we know it," said Dr. Long.There are also those who are really concerned about the efficacy and safety of a COVID-19 vaccine. Doctors say a key piece in evaluating a vaccine when it does come out is the data surrounding it."The data that comes out in the public domain: is a particular vaccine efficacious? How effective is it what is the efficacy data? Is a particular vaccine safe? What are the side reactions? And they should talk with their physicians to ask each question. Ask doctors, ‘Could you tell me what the safety part of this vaccine is?" recommended Dr. Pulendran.And above all, doctors and scientists hope politics will stay out of the development of a COVID-19 vaccine in order to ease any concerns or hopes for a vaccine to be available as soon as possible. 3644

With health care costs on the rise, a growing number of Americans are throwing out the old way of seeing a doctor and turning to a membership model. A monthly or annual fee gets you direct access to a doctor, no insurance needed.Twenty years into her career, bogged down by red tape, too many patients and long days, Dr. Shaila Pai-Verma was looking for a better way to practice medicine.“I was just miserable,” she said. “The joy of medicine is gone and then you're just doing paperwork.”So, a year ago, she started a new primary care practice with a new business model.“The patient basically has a direct contract with the physician and they take insurance companies out of it,” she explained.Patients pay a flat monthly or yearly fee. In exchange, they receive a broad range of primary care services and quick, unlimited access to their doctor via in-person office visits, phone or by text.“Everyone wants everything immediate. And so, I think this is it. It's good, especially in this time for people to have access,” said Pai-Verma.Membership fees range from about 5 to 0 per month on average – about 0 less than having typical health insurance. Most patients still carry catastrophic coverage for emergency treatments and hospitalizations, but that insurance is usually only -100 a month, so patients still save money.For Bonnie Micheli and her family, it was all about access.“With this, it's just so much easier to just know that I can contact directly here within a few hours for any issues that I'm having,” said Micheli.In late September, a bipartisan proposal was introduced in Congress that would expand access to the model and allow people to use their health savings account for direct primary care (DPC).Because they see fewer patients than traditional practices, some critics say the model could worsen the shortage of primary care physicians, a trend that’s already driven by burnout.But according to a recent study, DPC members had 25% lower hospital admissions and the cost of emergency room claims was reduced by 54%.“There's less ER visits and you know, better health care for the patient,” said Pai-Verma.While there is still debate, for a growing number of Americans, like Micheli, it’s becoming a simplified health insurance alternative.“Honestly, it’s just so nice to know what I'm paying every month or if you do the annual, what you're getting for that money, and you know exactly who to go to when you have a problem.” 2467