dailyheraldchicago--2020-12-26--Nursing homes face daunting task of getting consent before they give coronavirus vaccines

More than 3 million elderly and infirm residents of nursing homes and other long-term-care facilities may face delays in getting coronavirus vaccines as the facilities confront the difficult task of obtaining consent , which consumer advocates , operators and some health officials say should have been simplified and started earlier by the federal government .
Obtaining consent presents one of the toughest hurdles as officials mobilize to inoculate residents of these facilities , many of whom have dementia or Alzheimer 's disease .
Facilities must track down relatives or attorneys in those cases , which could take days or weeks @ @ @ @ @ @ @ need to resolve disputes when family members disagree on whether their loved ones should receive a vaccine .
Even residents of sound mind may be anxious about a new vaccine and need time to weigh risks and benefits and consult with relatives .
Federal health officials gave top priority for vaccines to long-term-care residents and staff after outbreaks ravaged facilities , killing more than 113,000 residents and staff and accounting for more than a third of all U.S. COVID-19 deaths .
Health and Human Services Secretary Alex Azar recently said the government had @ @ @ @ @ @ @ by Christmas .
But the retail pharmacies administering the vaccines have indicated the process will likely take several months as a result of logistical and consent challenges that will require multiple visits to facilities .
That process will be occurring over what is projected to be the deadliest period of the pandemic .
`` It 's a mess , '' said Mike Wasserman , medical director of a California facility and past president of the California Association of Long Term Care Medicine who has talked to other nursing homes about the rollout .
@ @ @ @ @ @ @ provided good direction , and the direction keeps changing every day .
And you get different stories from different people at different levels . ''
Operators of nursing homes and other long-term-care facilities have been scrambling to resolve the conflicting directions .
The government 's partnership with Walgreens and CVS to distribute vaccines gave the companies discretion to secure permission however they wanted .
The Centers for Disease Control and Prevention , which oversees that partnership , advised that verbal consent is enough .
But the pharmacies wanted more , imposing onerous consent @ @ @ @ @ @ @ have used for seasonal flu shots , operators said .
The pharmacies eased up after complaints .
Advocates say the Trump administration could have prevented this confusion had they instructed pharmacies at the outset that verbal permission was sufficient .
`` We knew months ago , before any vaccine was approved , that these complex logistical issues were going to have to be dealt with once a vaccine was rolled out , '' said Mike Dark , a staff attorney with California Advocates for Nursing Home Reform .
`` If people who need @ @ @ @ @ @ @ we are going to see more deaths and more transmission . ''
Dark said the federal government could have taken steps to reach out to facilities ahead of the vaccinations with a coordinated education campaign and by encouraging safe family visits so residents could discuss the decisions in person .
CVS originally said it would require three hard-copy written consent forms from each resident or their proxy .
They planned to mail the forms to the facilities , which some nursing home operators fretted had n't arrived a week before the shots were @ @ @ @ @ @ @ complained that those requirements were burdensome , particularly when they would need to track down family members for signatures .
CVS now allows residents capable of decision-making to give verbal consent and will accept emailed consents from medical decision-makers for those who are not capable of giving permission , a spokesman said .
A Walgreens spokeswoman said forms are distributed to facilities several days ahead of vaccination clinics and can be marked to note verbal consent .
Walgreens executive Ed Kaleta said that the pharmacy has become more flexible about what it will @ @ @ @ @ @ @ number of long-term facilities have said the consent form can be done orally or electronically , so for those facilities that are allowing that to occur , we 're obviously complying with that because it is making it easier , '' he said during a webinar hosted by the Alliance for Health Policy .
Peter Van Runkle , executive director of the Ohio Health Care Association , a long-term-care trade group , said facilities that need ample time for consent were left confused by the changing directions .
`` A couple of days @ @ @ @ @ @ @ are talking about people who are there in person and capable , '' Van Runkle said .
`` When you have to go outside to find someone and get their consent , a couple of days does n't work .
It would have been helpful to have more time to get consent . ''
HHS and Operation Warp Speed officials , who are overseeing the distribution of vaccines , did not answer questions about whether the federal government should have streamlined consent rules at the outset .
Several HHS officials said they had @ @ @ @ @ @ @ consent in long-term-care facilities , especially because they were hearing that some residents and employees were hesitant to get the vaccine , according to two senior administration officials who spoke on the condition of anonymity because they were not authorized to discuss the issue .
They said they raised those concerns with Warp Speed officials and said there could have been high-level coordination ahead of the Food and Drug Administration 's authorization of the Pfizer-BioNTech vaccine that would have enabled nursing homes to begin the process earlier .
Scott Gottlieb , a former @ @ @ @ @ @ @ also said HHS could have been more proactive in confronting potential delays .
`` They could have started to get those consents in place sooner , but they would have needed to clear a fact sheet on the vaccine through FDA , to properly disclose the anticipated risks and benefits to the patients ' families , '' he said .
But some officials cautioned that such a fact sheet would not have helped the process if the FDA 's review of Pfizer 's vaccine produced additional data and risks that were not yet @ @ @ @ @ @ @ reviewing the terms of the authorization and Pfizer-BioNTech 's fact sheets -- which contain many important details that providers need , including risks providers must know prior to administering the vaccine to a patient -- up until the time of authorization , '' said Stephanie Caccomo , an FDA spokeswoman .
Warp Speed officials declined to address the issue on the record .
A senior Trump administration official said the rollout could have been even more chaotic had staff given out such fact sheets and then been forced to go back to relatives @ @ @ @ @ @ @ describe new side effects .
Some nursing home operators said they have found other ways to get things moving .
Sunrise Senior Living , which operates 275 U.S. facilities , sent a survey to residents and family members to gauge interest in vaccines , finding that 92 percent wanted them when available .
David Grabowski , a Harvard Medical School professor who has been monitoring nursing homes during the pandemic , said early conversations about consent are important for vaccine rollouts .
Lines of communication between facilities and families have been disrupted with @ @ @ @ @ @ @ on nursing home staff .
Some patients able to make their own decisions may resist the vaccine if they feel they are being rushed into it .
`` We should n't be figuring out how to fly the plane while we 're in the air , '' he said .
`` We should have been doing it before takeoff . ''

Nursing homes face daunting task of getting consent before they give coronavirus vaccines
Mike Wasserman, past president of the California Association of Long Term Care Medicine, says the coronavirus vaccination process for such facilities is "a mess." Washington Post
More than 3 million elderly and infirm residents of nursing homes and other long-term-care facilities may face delays in getting coronavirus vaccines as the facilities confront the difficult task of obtaining consent, which consumer advocates, operators and some health officials say should have been simplified and started earlier by the federal government.
Obtaining consent presents one of the toughest hurdles as officials mobilize to inoculate residents of these facilities, many of whom have dementia or Alzheimer's disease.
Facilities must track down relatives or attorneys in those cases, which could take days or weeks. In some instances, they may need to resolve disputes when family members disagree on whether their loved ones should receive a vaccine.
Even residents of sound mind may be anxious about a new vaccine and need time to weigh risks and benefits and consult with relatives.
Federal health officials gave top priority for vaccines to long-term-care residents and staff after outbreaks ravaged facilities, killing more than 113,000 residents and staff and accounting for more than a third of all U.S. COVID-19 deaths. Health and Human Services Secretary Alex Azar recently said the government had the capacity to inoculate all long-term-care residents by Christmas. But the retail pharmacies administering the vaccines have indicated the process will likely take several months as a result of logistical and consent challenges that will require multiple visits to facilities. That process will be occurring over what is projected to be the deadliest period of the pandemic.
"It's a mess," said Mike Wasserman, medical director of a California facility and past president of the California Association of Long Term Care Medicine who has talked to other nursing homes about the rollout. "The federal government just hasn't provided good direction, and the direction keeps changing every day. And you get different stories from different people at different levels."
Operators of nursing homes and other long-term-care facilities have been scrambling to resolve the conflicting directions.
The government's partnership with Walgreens and CVS to distribute vaccines gave the companies discretion to secure permission however they wanted. The Centers for Disease Control and Prevention, which oversees that partnership, advised that verbal consent is enough.
But the pharmacies wanted more, imposing onerous consent rules far stricter than what nursing homes have used for seasonal flu shots, operators said. The pharmacies eased up after complaints.
Advocates say the Trump administration could have prevented this confusion had they instructed pharmacies at the outset that verbal permission was sufficient.
"We knew months ago, before any vaccine was approved, that these complex logistical issues were going to have to be dealt with once a vaccine was rolled out," said Mike Dark, a staff attorney with California Advocates for Nursing Home Reform. "If people who need the vaccine don't get it, we are going to see more deaths and more transmission."
Dark said the federal government could have taken steps to reach out to facilities ahead of the vaccinations with a coordinated education campaign and by encouraging safe family visits so residents could discuss the decisions in person.
CVS originally said it would require three hard-copy written consent forms from each resident or their proxy. They planned to mail the forms to the facilities, which some nursing home operators fretted hadn't arrived a week before the shots were to be administered. Homes and advocates complained that those requirements were burdensome, particularly when they would need to track down family members for signatures.
CVS now allows residents capable of decision-making to give verbal consent and will accept emailed consents from medical decision-makers for those who are not capable of giving permission, a spokesman said.
A Walgreens spokeswoman said forms are distributed to facilities several days ahead of vaccination clinics and can be marked to note verbal consent. Walgreens executive Ed Kaleta said that the pharmacy has become more flexible about what it will accept to indicate consent.
"A number of long-term facilities have said the consent form can be done orally or electronically, so for those facilities that are allowing that to occur, we're obviously complying with that because it is making it easier," he said during a webinar hosted by the Alliance for Health Policy.
Peter Van Runkle, executive director of the Ohio Health Care Association, a long-term-care trade group, said facilities that need ample time for consent were left confused by the changing directions.
"A couple of days before the clinic works fine if you are talking about people who are there in person and capable," Van Runkle said. "When you have to go outside to find someone and get their consent, a couple of days doesn't work. It would have been helpful to have more time to get consent."
HHS and Operation Warp Speed officials, who are overseeing the distribution of vaccines, did not answer questions about whether the federal government should have streamlined consent rules at the outset.
Several HHS officials said they had warned it would take time to obtain consent in long-term-care facilities, especially because they were hearing that some residents and employees were hesitant to get the vaccine, according to two senior administration officials who spoke on the condition of anonymity because they were not authorized to discuss the issue. They said they raised those concerns with Warp Speed officials and said there could have been high-level coordination ahead of the Food and Drug Administration's authorization of the Pfizer-BioNTech vaccine that would have enabled nursing homes to begin the process earlier.
Scott Gottlieb, a former FDA commissioner under President Donald Trump, also said HHS could have been more proactive in confronting potential delays.
"They could have started to get those consents in place sooner, but they would have needed to clear a fact sheet on the vaccine through FDA, to properly disclose the anticipated risks and benefits to the patients' families," he said.
But some officials cautioned that such a fact sheet would not have helped the process if the FDA's review of Pfizer's vaccine produced additional data and risks that were not yet known.
"FDA's staff were reviewing the terms of the authorization and Pfizer-BioNTech's fact sheets -- which contain many important details that providers need, including risks providers must know prior to administering the vaccine to a patient -- up until the time of authorization," said Stephanie Caccomo, an FDA spokeswoman.
Warp Speed officials declined to address the issue on the record. A senior Trump administration official said the rollout could have been even more chaotic had staff given out such fact sheets and then been forced to go back to relatives and residents after the FDA evaluation to describe new side effects.
Some nursing home operators said they have found other ways to get things moving. Sunrise Senior Living, which operates 275 U.S. facilities, sent a survey to residents and family members to gauge interest in vaccines, finding that 92 percent wanted them when available.
David Grabowski, a Harvard Medical School professor who has been monitoring nursing homes during the pandemic, said early conversations about consent are important for vaccine rollouts.
Lines of communication between facilities and families have been disrupted with restricted visitations, which put greater demands on nursing home staff. Some patients able to make their own decisions may resist the vaccine if they feel they are being rushed into it.
"We shouldn't be figuring out how to fly the plane while we're in the air," he said. "We should have been doing it before takeoff."


dailyheraldchicago--2020-12-26--Condoleezza Rice keynote speaker for Barrington event open to all via Zoom

Barrington 's Town-Warming event will have its most prominent keynote speaker to date , former U.S. Secretary of State Condoleezza Rice , in a Zoom event with more affordable ticket prices than usual .
The theme of the Jan. 23 event will be `` What Now ?
Looking Ahead to the Post-Pandemic World . ''
Another keynote speaker will be William M. Daley , former U.S. Secretary of Commerce .
The event typically sells out quickly and is held at Barrington 's White House , where capacity is limited to about 200 people including the upstairs ballroom and a livestream @ @ @ @ @ @ @ Patty Dowd Schmitz said .
Because of the COVID-19 pandemic , this year 's event will be on Zoom .
`` There 's a nice element to the fact that we can open it up virtually to an unlimited amount of people who 'd like to see it , '' Dowd Schmitz said .
Tickets normally are $ 150 per person , but they will be $ 75 per household this year because multiple people can watch on one screen , she said .
The event is presented by Barrington 's cultural commission @ @ @ @ @ @ @ Greg Brown and his wife , Anna , who sponsor the keynote speakers , and Northern Trust , the presenting sponsor .
The Browns are Barrington Hills residents .
Greg Brown was a panel speaker in 2018 , then became actively involved in securing and sponsoring keynote speakers by leveraging his personal relationships , Dowd Schmitz said .
`` That has really benefitted the village , '' she said .
Brown will have a virtual `` fireside chat '' with Rice , who served as U.S. Secretary of State from 2005 to 2009 @ @ @ @ @ @ @ is director of the Hoover Institution in Stanford , California .
Brown will discuss post-election politics with Daley , who led the U.S. Department of Commerce under President Bill Clinton .
Daley also served for a year as chief of staff to President Barack Obama and unsuccessfully ran for mayor in Chicago in 2019 .
A four-person panel will discuss `` Future Trends After the Pandemic '' and will include Jessica Hector-Hsu of the Regional Transportation Authority , Ron Lunt of Hamilton Partners , Harper College President Avis Proctor and Joyce St. Clair @ @ @ @ @ @ @ historian Barbara Benson will give a perspective on the role of Barrington 's White House during the 1918 influenza pandemic .
This will be the fourth annual edition of the Town-Warming in its relaunched format .
Originally held in the late 1930s and 1940s , it was revived thanks to the efforts of Village President Karen Darch .
`` We are so pleased to be able to offer the Town-Warming once again in 2021 , albeit virtually , '' Darch said .
Previous keynote speakers were Chris Christie , former governor of New @ @ @ @ @ @ @ Goodwin , presidential historian , in 2019 ; and Hank Paulson , former secretary of the U.S. Treasury , and his wife , Wendy , in 2018 .
The event usually nets $ 7,500 to $ 10,000 for the village 's cultural commission , which in normal years takes on the expense of renting the space and offers a reception with catering .
The hope is this year 's proceeds will match or exceed a typical year , Dowd Schmitz said .
The commission has an annual budget of about $ 53,000 and @ @ @ @ @ @ @ throughout the village .
Barrington 's Town-Warming is 9 a.m. to 2:30 p.m. Jan 23 .
For information visit barringtonswhitehouse.com/events .

Condoleezza Rice keynote speaker for Barrington event open to all via Zoom
Former U.S. Secretary of State Condoleezza Rice will be the keynote speaker of Barrington's Town-Warming event Jan. 23. She is pictured here speaking in 2018 at the KPMG Women's Leadership Summit in Kildeer. Courtesy of KPMG Women's Leadership Summit
Barrington's Town-Warming event will have its most prominent keynote speaker to date, former U.S. Secretary of State Condoleezza Rice, in a Zoom event with more affordable ticket prices than usual.
The theme of the Jan. 23 event will be "What Now? Looking Ahead to the Post-Pandemic World." Another keynote speaker will be William M. Daley, former U.S. Secretary of Commerce.
The event typically sells out quickly and is held at Barrington's White House, where capacity is limited to about 200 people including the upstairs ballroom and a livestream on the first floor, village spokeswoman Patty Dowd Schmitz said.
Because of the COVID-19 pandemic, this year's event will be on Zoom.
"There's a nice element to the fact that we can open it up virtually to an unlimited amount of people who'd like to see it," Dowd Schmitz said.
Tickets normally are $150 per person, but they will be $75 per household this year because multiple people can watch on one screen, she said.
The event is presented by Barrington's cultural commission and is made possible by Motorola CEO Greg Brown and his wife, Anna, who sponsor the keynote speakers, and Northern Trust, the presenting sponsor.
The Browns are Barrington Hills residents. Greg Brown was a panel speaker in 2018, then became actively involved in securing and sponsoring keynote speakers by leveraging his personal relationships, Dowd Schmitz said.
"That has really benefitted the village," she said.
Brown will have a virtual "fireside chat" with Rice, who served as U.S. Secretary of State from 2005 to 2009 under President George W. Bush and now is director of the Hoover Institution in Stanford, California.
Brown will discuss post-election politics with Daley, who led the U.S. Department of Commerce under President Bill Clinton. Daley also served for a year as chief of staff to President Barack Obama and unsuccessfully ran for mayor in Chicago in 2019.
A four-person panel will discuss "Future Trends After the Pandemic" and will include Jessica Hector-Hsu of the Regional Transportation Authority, Ron Lunt of Hamilton Partners, Harper College President Avis Proctor and Joyce St. Clair of The Northern Trust Co.
Also, historian Barbara Benson will give a perspective on the role of Barrington's White House during the 1918 influenza pandemic.
This will be the fourth annual edition of the Town-Warming in its relaunched format. Originally held in the late 1930s and 1940s, it was revived thanks to the efforts of Village President Karen Darch.
"We are so pleased to be able to offer the Town-Warming once again in 2021, albeit virtually," Darch said.
Previous keynote speakers were Chris Christie, former governor of New Jersey, in 2020; Doris Kearns Goodwin, presidential historian, in 2019; and Hank Paulson, former secretary of the U.S. Treasury, and his wife, Wendy, in 2018.
The event usually nets $7,500 to $10,000 for the village's cultural commission, which in normal years takes on the expense of renting the space and offers a reception with catering.
The hope is this year's proceeds will match or exceed a typical year, Dowd Schmitz said. The commission has an annual budget of about $53,000 and uses its funds to provide cultural events throughout the village.
Barrington's Town-Warming is 9 a.m. to 2:30 p.m. Jan 23. For information visit barringtonswhitehouse.com/events.


dailyheraldchicago--2020-12-26--Lower and later liquor license fees among latest Arlington Heights relief measures

Arlington Heights will extend some additional financial relief to local businesses -- particularly restaurants -- amid the ongoing pandemic and resulting second ban on indoor dining .
The plan includes additional rebates on liquor license fees for most license holders and deferral of due dates , as well as allowing later repayments for emergency small business loans .
`` We know from our contacts in the restaurant community , and just our own observations , that with the forced closure of indoor dining , and with the elimination of outdoor dining due to the weather , cash flow is an @ @ @ @ @ @ @ '' Village Manager Randy Recklaus said .
The village board last week unanimously approved Recklaus ' set of COVID-19 business relief recommendations , which he called `` a first step , '' pending possible federal and state relief measures .
And , Recklaus said , his staff will be soliciting additional input from local businesses about ways to help .
The initiative calls for slashing annual liquor license fees by an additional 25 % -- on top of a 25 % cut the board approved in May -- for all license holders except @ @ @ @ @ @ @ , Recklaus said , those retailers are doing better than during a typical year .
The village will also extend the due date for new 2021 liquor license fees for all businesses from April 30 , 2021 , to June 30 , 2021 .
`` Sometimes that 's a large bill to pay , '' Recklaus said .
`` We know that some of our businesses kind of make up or save that money during the holiday season when they do a little better , and that 's been taken away from them @ @ @ @ @ @ @ little bit of leniency and say those payments can be due in June instead of April . ''
Last May , the village modified a small business zero-interest loan program , increasing the maximum individual loan amount of $ 5,000 to $ 10,000 , with a three-year payback period set to begin at the start of the new year .
But officials agreed this week to defer the loan payment due date to June 1 .
In total , the latest relief measures will cost the village $ 75,000 , and will be @ @ @ @ @ @ @ 2020 budget , Recklaus said .

Lower and later liquor license fees among latest Arlington Heights relief measures
Arlington Heights will extend some additional financial relief to local businesses -- particularly restaurants -- amid the ongoing pandemic and resulting second ban on indoor dining.
The plan includes additional rebates on liquor license fees for most license holders and deferral of due dates, as well as allowing later repayments for emergency small business loans.
"We know from our contacts in the restaurant community, and just our own observations, that with the forced closure of indoor dining, and with the elimination of outdoor dining due to the weather, cash flow is an issue for many of our restaurants," Village Manager Randy Recklaus said.
The village board last week unanimously approved Recklaus' set of COVID-19 business relief recommendations, which he called "a first step," pending possible federal and state relief measures. And, Recklaus said, his staff will be soliciting additional input from local businesses about ways to help.
The initiative calls for slashing annual liquor license fees by an additional 25% -- on top of a 25% cut the board approved in May -- for all license holders except packaged liquor stores. In some cases, Recklaus said, those retailers are doing better than during a typical year.
The village will also extend the due date for new 2021 liquor license fees for all businesses from April 30, 2021, to June 30, 2021.
"Sometimes that's a large bill to pay," Recklaus said. "We know that some of our businesses kind of make up or save that money during the holiday season when they do a little better, and that's been taken away from them. So we want to provide a little bit of leniency and say those payments can be due in June instead of April."
Last May, the village modified a small business zero-interest loan program, increasing the maximum individual loan amount of $5,000 to $10,000, with a three-year payback period set to begin at the start of the new year. But officials agreed this week to defer the loan payment due date to June 1.
In total, the latest relief measures will cost the village $75,000, and will be funded through general fund reserves in the 2020 budget, Recklaus said.


dailyheraldchicago--2020-12-26--Downtown Nashville explosion knocks communications offline

NASHVILLE , Tenn. -- A recreational vehicle parked in the deserted streets of downtown Nashville exploded early Christmas morning , causing widespread communications outages that took down police emergency systems and grounded holiday travel at the city 's airport .
Police were responding to a report of shots fired Friday when they encountered the RV blaring a recorded warning that a bomb would detonate in 15 minutes , Metro Nashville Police Chief John Drake said .
Police evacuated nearby buildings and called in the bomb squad .
The RV exploded shortly afterward , Drake said .
`` This morning 's @ @ @ @ @ @ @ create chaos and fear in this season of peace and hope .
But Nashvillians have proven time and time again that the spirit of our city can not be broken , '' Mayor John Cooper said at a news conference after issuing a curfew for the area .
Police believe the blast was intentional but do n't yet know a motive or target , and Drake noted that officials had not received any threats before the explosion .
The chief said investigators at the scene `` have found tissue that we believe could @ @ @ @ @ @ @ that examined and let you know at that time . ''
Police could not say whether it potentially came from someone inside the RV .
Three people taken to area hospitals for treatment were in stable condition Friday evening , Cooper said .
Surveillance video published on a Twitter account Friday that appeared to be across the street from the blast captured the warning issuing from the RV , `` ... if you can hear this message , evacuate now , '' seconds before the explosion .
The blast sent black smoke and @ @ @ @ @ @ @ Nashville 's tourist scene , an area packed with honky-tonks , restaurants and shops .
Buildings shook and windows shattered streets away from the explosion near a building owned by AT & T that lies one block from the company 's office tower , a landmark in downtown .
`` We do not know if that was a coincidence , or if that was the intention , '' police spokesman Don Aaron said .
He said earlier that some people were taken to the department 's central precinct for questioning but declined to @ @ @ @ @ @ @ the affected building is the central office of a telephone exchange , with network equipment in it .
The blast interrupted service , but the company declined to say how widespread outages were .
The AT & T outages site showed service issues in middle Tennessee and Kentucky .
Several police agencies reported that their 911 systems were down because of the outage , including Knox County , home to Knoxville about 180 miles ( 290 kilometers ) east of Nashville .
AT & T said that it was bringing in portable cell @ @ @ @ @ @ @ to get access to make repairs to its equipment .
The company noted that `` power is essential to restoring '' service .
The Federal Aviation Administration temporarily halted flights out of Nashville International Airport because of telecommunications issues associated with the explosion .
Later Friday , the Metropolitan Nashville Airport Authority said most flights were resuming but advised passengers to check with their airline for updates due to possible delays .
The FBI will be taking the lead in the investigation , agency spokesman Joel Siskovic said .
Federal investigators from the @ @ @ @ @ @ @ and Explosives were also on the scene .
The FBI is the primary law enforcement agency responsible for investigating federal crimes , such as explosives violations and acts of terrorism .
A Philadelphia man staying in a nearby hotel said that when he heard the blast , he was knew it was n't harmless .
`` We tried to rationalize it that it was an earthquake or something , but it was obvious it was n't an earthquake , '' Joseph Fafara said .
When he went to look at the damage , @ @ @ @ @ @ @ place .
Buck McCoy , who lives near the area , posted videos on Facebook that show water pouring down the ceiling of his home .
Alarms blare in the background along with cries of people in distress .
A fire is visible in the street outside .
McCoy said he heard gunfire 15 minutes before the explosion rocked his building , set cars in the street on fire and blew trees apart .
`` All my windows , every single one of them got blown into the next room .
If I @ @ @ @ @ @ @ been horrible , '' he said .
`` It felt like a bomb .
It was that big , '' he told The Associated Press .
President Donald Trump has been briefed , according to White House spokesperson Judd Deere .
The U.S. Justice Department said Acting Attorney General Jeff Rosen was also briefed and directed all department resources be made available to help with the investigation .
Tennessee Gov .
Bill Lee said on Twitter that the state would provide the resources necessary `` to determine what happened and who was responsible @ @ @ @ @ @ @ Tennessee announced that it was working with officials to open a shelter for victims .
Associated Press writer Thalia Beaty in New York contributed .
Balsamo and Tucker reported from Washington .

Downtown Nashville explosion knocks communications offline
Smoke billows from the site of an explosion in the area on Friday in Nashville. Buildings shook in the immediate area and beyond after a loud boom was heard early Christmas morning. (Andrew Nelles/The Tennessean via AP)
A building is damaged near the area where an explosion was reported on Friday in Nashville. Buildings shook in the immediate area and beyond after a loud boom was heard early Christmas morning. (Andrew Nelles/The Tennessean via AP)
Downtown windows are broken following an explosion in the area on Friday in Nashville. Buildings shook in the immediate area and beyond after a loud boom was heard early Christmas morning. (Andrew Nelles/The Tennessean via AP)
Smoke rises from downtown after a reported explosion on Friday in Nashvill. Buildings shook in the immediate area and beyond after a loud boom was heard early Christmas morning. (Andrew Nelles/The Tennessean via AP)
Plumes of smoke rise next to the Regions Building near the explosion reported in the area on Friday in Nashville. Buildings shook in the immediate area and beyond after a loud boom was heard early Christmas morning. (Andrew Nelles/The Tennessean via AP)
NASHVILLE, Tenn. -- A recreational vehicle parked in the deserted streets of downtown Nashville exploded early Christmas morning, causing widespread communications outages that took down police emergency systems and grounded holiday travel at the city's airport.
Police were responding to a report of shots fired Friday when they encountered the RV blaring a recorded warning that a bomb would detonate in 15 minutes, Metro Nashville Police Chief John Drake said. Police evacuated nearby buildings and called in the bomb squad. The RV exploded shortly afterward, Drake said.
"This morning's attack on our community was intended to create chaos and fear in this season of peace and hope. But Nashvillians have proven time and time again that the spirit of our city cannot be broken," Mayor John Cooper said at a news conference after issuing a curfew for the area.
Police believe the blast was intentional but don't yet know a motive or target, and Drake noted that officials had not received any threats before the explosion.
The chief said investigators at the scene "have found tissue that we believe could be remains, but we'll have that examined and let you know at that time." Police could not say whether it potentially came from someone inside the RV.
Three people taken to area hospitals for treatment were in stable condition Friday evening, Cooper said.
Surveillance video published on a Twitter account Friday that appeared to be across the street from the blast captured the warning issuing from the RV, "... if you can hear this message, evacuate now," seconds before the explosion.
The blast sent black smoke and flames billowing from the heart of downtown Nashville's tourist scene, an area packed with honky-tonks, restaurants and shops. Buildings shook and windows shattered streets away from the explosion near a building owned by AT&T that lies one block from the company's office tower, a landmark in downtown.
"We do not know if that was a coincidence, or if that was the intention," police spokesman Don Aaron said. He said earlier that some people were taken to the department's central precinct for questioning but declined to give details.
AT&T said the affected building is the central office of a telephone exchange, with network equipment in it. The blast interrupted service, but the company declined to say how widespread outages were.
The AT&T outages site showed service issues in middle Tennessee and Kentucky. Several police agencies reported that their 911 systems were down because of the outage, including Knox County, home to Knoxville about 180 miles (290 kilometers) east of Nashville.
AT&T said that it was bringing in portable cell sites and was working with law enforcement to get access to make repairs to its equipment. The company noted that "power is essential to restoring" service.
The Federal Aviation Administration temporarily halted flights out of Nashville International Airport because of telecommunications issues associated with the explosion. Later Friday, the Metropolitan Nashville Airport Authority said most flights were resuming but advised passengers to check with their airline for updates due to possible delays.
The FBI will be taking the lead in the investigation, agency spokesman Joel Siskovic said. Federal investigators from the Bureau of Alcohol, Tobacco, Firearms and Explosives were also on the scene. The FBI is the primary law enforcement agency responsible for investigating federal crimes, such as explosives violations and acts of terrorism.
A Philadelphia man staying in a nearby hotel said that when he heard the blast, he was knew it wasn't harmless.
"We tried to rationalize it that it was an earthquake or something, but it was obvious it wasn't an earthquake," Joseph Fafara said.
When he went to look at the damage, police barricades had already been put in place.
Buck McCoy, who lives near the area, posted videos on Facebook that show water pouring down the ceiling of his home. Alarms blare in the background along with cries of people in distress. A fire is visible in the street outside.
McCoy said he heard gunfire 15 minutes before the explosion rocked his building, set cars in the street on fire and blew trees apart.
"All my windows, every single one of them got blown into the next room. If I had been standing there it would have been horrible," he said.
"It felt like a bomb. It was that big," he told The Associated Press.
President Donald Trump has been briefed, according to White House spokesperson Judd Deere. The U.S. Justice Department said Acting Attorney General Jeff Rosen was also briefed and directed all department resources be made available to help with the investigation.
Tennessee Gov. Bill Lee said on Twitter that the state would provide the resources necessary "to determine what happened and who was responsible."
The American Red Cross of Tennessee announced that it was working with officials to open a shelter for victims.
Associated Press writer Thalia Beaty in New York contributed. Balsamo and Tucker reported from Washington.


dailyheraldchicago--2020-12-26--Facts Matter: Pelosi didn't fake COVID-19 vaccination

Members of Congress were among the first to receive the coronavirus vaccine earlier this month , and some , including Senate Majority Leader Mitch McConnell and Vice President Mike Pence , posted photos of the event to social media .
When speaker of the House Nancy Pelosi posted photos of herself receiving the vaccination , some online users falsely claimed she staged the scene .
`` How do you use a syringe with the cap still on ? ''
questioned a Facebook user in a Dec. 18 post , which included photos making it appear the needle was covered when @ @ @ @ @ @ @ was shared more than 1,400 times .
Pelosi received the vaccine Dec. 17 in her office , according to Snopes.com .
`` Today , with confidence in science and at the direction of the Office of the Attending Physician , I received the COVID-19 vaccine , '' Pelosi wrote on Twitter .
In photos with her Twitter post , it looks like the tip of the syringe is covered by an orange cap .
But other pictures of her receiving the shot show the needle protruding past an orange stopper , which is @ @ @ @ @ @ @ Pelosi also posted a photo of her vaccination record card , showing she received the COVID-19 immunization .
President Donald Trump , who lost his bid for a second term to Democrat Joe Biden , has not said where he 'll be for Biden 's inauguration Jan. 20 , but a Facebook post falsely claims he will be holding an `` inauguration '' for himself at his private Florida club Mar-a-Lago .
`` ( The Trump administration will ) look forward to the January 20th Inauguration of their continuation of power and Second @ @ @ @ @ @ @ will take place at the President 's residence at Mar-a-Lago , or the winter White House , '' the post stated .
There is no planned ceremony at the Florida club , according to PolitiFact.com .
`` Anonymous sources who claim to know what the president is or is not considering have no idea , '' White House spokesman Judd Deere told PolitiFact .
`` When President Trump has an announcement about his plans for Jan. 20 , he will let you know . ''
The false Facebook post said , `` Any @ @ @ @ @ @ @ require force . ''
But on Thanksgiving , Trump told reporters he would leave the White House if the Electoral College elected Biden .
`` Certainly I will , and you know that , '' the president said .
`` But I think that there will be a lot of things happening between now and the 20th of January , a lot of things .
Massive fraud has been found . ''
Traditionally , the departing president hosts the incoming leader at the White House and then attends the inauguration .
After health @ @ @ @ @ @ @ vaccines Dec. 15 in Alabama , social media posts began circulating false claims that a nurse had died as a result of the injection .
`` And so it starts ... A 42 y/o nurse in Alabama found dead 8-10 hours after the va ( ( ine , '' one Facebook post read .
No one has died from the vaccine , according to The Associated Press .
Officials from the Alabama Department of Health checked with hospitals that gave the injection and told the AP there have been no deaths as a @ @ @ @ @ @ @ also issued a statement on social media to say , `` The posts are untrue .
No persons who received a COVID-19 vaccine in Alabama have died . ''
A recent Facebook post falsely claims a mall Santa Claus in Wisconsin beat up a child molester after a young girl confided in him .
The post claimed Santa `` and four of his elves attacked the guy , who was waiting nearby , and pummeled him unconscious . ''
The story is a hoax that has been circulating since it was first being @ @ @ @ @ @ @ , according to USA Today .
The fake story attributed the information to Milwaukee police spokeswoman Holly Delgado and included a blurry mug shot and a photo of Santa being arrested .
Milwaukee police Sgt .
Tim Guarke told The Associated Press he had never heard of Delgado .
The mug shot is from a 2012 arrest in Jacksonville , Florida , and the photo of Santa was taken during a 2013 arrest of protesters outside a Walmart in Ontario , California .
• Bob Oswald is a veteran Chicago-area journalist and former @ @ @ @ @ @ @ Contact him at boboswald33 @ gmail.com .

Facts Matter: Pelosi didn't fake COVID-19 vaccination
Speaker of the House Nancy Pelosi receives a Pfizer-BioNTech COVID-19 vaccine shot from Dr. Brian Monahan, attending physician of the Congress of the United States. Associated Press
Members of Congress were among the first to receive the coronavirus vaccine earlier this month, and some, including Senate Majority Leader Mitch McConnell and Vice President Mike Pence, posted photos of the event to social media.
When speaker of the House Nancy Pelosi posted photos of herself receiving the vaccination, some online users falsely claimed she staged the scene.
"How do you use a syringe with the cap still on?" questioned a Facebook user in a Dec. 18 post, which included photos making it appear the needle was covered when Pelosi received the shot. This post was shared more than 1,400 times.
Pelosi received the vaccine Dec. 17 in her office, according to Snopes.com.
"Today, with confidence in science and at the direction of the Office of the Attending Physician, I received the COVID-19 vaccine," Pelosi wrote on Twitter.
In photos with her Twitter post, it looks like the tip of the syringe is covered by an orange cap. But other pictures of her receiving the shot show the needle protruding past an orange stopper, which is not a cap, Snopes said.
Pelosi also posted a photo of her vaccination record card, showing she received the COVID-19 immunization.
Inauguration won't be held at Mar-a-Lago
President Donald Trump, who lost his bid for a second term to Democrat Joe Biden, has not said where he'll be for Biden's inauguration Jan. 20, but a Facebook post falsely claims he will be holding an "inauguration" for himself at his private Florida club Mar-a-Lago.
"(The Trump administration will) look forward to the January 20th Inauguration of their continuation of power and Second Term! This celebration of our president will take place at the President's residence at Mar-a-Lago, or the winter White House," the post stated.
There is no planned ceremony at the Florida club, according to PolitiFact.com.
"Anonymous sources who claim to know what the president is or is not considering have no idea," White House spokesman Judd Deere told PolitiFact. "When President Trump has an announcement about his plans for Jan. 20, he will let you know."
The false Facebook post said, "Any attempt to remove the Trump administration will require force."
But on Thanksgiving, Trump told reporters he would leave the White House if the Electoral College elected Biden.
"Certainly I will, and you know that," the president said. "But I think that there will be a lot of things happening between now and the 20th of January, a lot of things. Massive fraud has been found."
Traditionally, the departing president hosts the incoming leader at the White House and then attends the inauguration.
Nurse didn't die after receiving vaccine
After health care workers were given the first COVID-19 vaccines Dec. 15 in Alabama, social media posts began circulating false claims that a nurse had died as a result of the injection.
"And so it starts ... A 42 y/o nurse in Alabama found dead 8-10 hours after the va((ine," one Facebook post read.
No one has died from the vaccine, according to The Associated Press.
Officials from the Alabama Department of Health checked with hospitals that gave the injection and told the AP there have been no deaths as a result of the shot. The department also issued a statement on social media to say, "The posts are untrue. No persons who received a COVID-19 vaccine in Alabama have died."
Santa wasn't arrested at Wisconsin mall
A recent Facebook post falsely claims a mall Santa Claus in Wisconsin beat up a child molester after a young girl confided in him.
The post claimed Santa "and four of his elves attacked the guy, who was waiting nearby, and pummeled him unconscious."
The story is a hoax that has been circulating since it was first being published by a satirical website in 2016, according to USA Today.
The fake story attributed the information to Milwaukee police spokeswoman Holly Delgado and included a blurry mug shot and a photo of Santa being arrested.
Milwaukee police Sgt. Tim Guarke told The Associated Press he had never heard of Delgado. The mug shot is from a 2012 arrest in Jacksonville, Florida, and the photo of Santa was taken during a 2013 arrest of protesters outside a Walmart in Ontario, California.
• Bob Oswald is a veteran Chicago-area journalist and former news editor of the Elgin Courier-News. Contact him at boboswald33@gmail.com.


dailyheraldchicago--2020-12-26--Grammar Moses: Comma, comma, comma, comma, comma chameleon

When you 're in the mood for a little grammatical navel-gazing , it 's fun to consider how the smallest things can have a large impact .
Commas wear many colors and can do many things .
There , did I justify my anachronistic headline ?
• I often admonish writers to include a second comma when putting attribution in the middle of a sentence .
Without it , the sentence can change meaning .
For instance : If you stand on your head and drink a grape Nehi , Bob said , you will get stomach cramps .
This @ @ @ @ @ @ @ with commas wrapped around the attribution .
Bob is describing the stomach cramps one will get as a result of drinking soda while standing on his head .
Now , remove the comma after `` said '' : If you stand on your head and drink a grape Nehi , Bob said you will get stomach cramps .
In this case , what the sentence says is that Bob 's warning about cramps is contingent upon someone standing on his head and shotgunning a grape soda .
In other words , Bob did @ @ @ @ @ @ @ he waited until you 'd done it .
It becomes a simple if/then statement rather than a statement attributed to Bob .
That was not the intention .
The truth is , if I stand on my head and shotgun a grape Nehi , I do n't get stomach cramps .
I do , however , get a horrible sinus headache , flash-frozen nostrils and sticky hair .
I know , because I tried it once .
I received a Grinch-themed postcard from my friend Bob that contains a typo .
`` So @ @ @ @ @ @ @ it began .
Without a comma separating `` dog '' and `` Max , '' the sentence means the Grinch gave his dog a name .
That 's not what Dr. Seuss intended .
What he meant was the Grinch summoned his dog , whose name is Max .
The one-word clause `` Max '' indicates which dog the Grinch summoned .
Your life depends on it Opinion Page Editor Jim Slusher , a fellow word nerd , inspired today 's topic by recommending I explore the use of the comma with dependent @ @ @ @ @ @ @ because '' phrases .
He provided two sentences whose meanings differ because of the comma .
`` I told my wife I 'd be on time , because my life depended on it . ''
And `` I told my wife I 'd be on time because my life depended on it . ''
`` In the first sentence , if I had n't told my wife I 'd be on time , I would have died .
In the second , if I had n't been on time , I 'd have @ @ @ @ @ @ @ of the subtle power of the comma , also from Slusher : Consider the title of Hemingway 's short story `` The Short Happy Life of Francis Macomber . ''
`` There is , of course , no comma there , and that 's significant to the meaning of the story , '' he said .
`` Francis Macomber does die as a comparatively young man , but the real point of the story is he is a cowardly and cuckolded wimp until he finally shows some courage at the end and suddenly @ @ @ @ @ @ @ time .
`` So , the point is not that his life was short and happy ; it 's that the happy portion of his life was short .
If Hemingway had titled it 'The Short , Happy Life of Francis Macomber , ' it would have missed a critical point . ''
I 'll concede that much of what I 've discussed here amounts to navel-gazing and likely will not change anyone 's life .
But what I 'm about to tell you just might .
There actually is a word for @ @ @ @ @ @ @ !
And , as always , write carefully .
• Jim Baumann is vice president/managing editor of the Daily Herald .
Write him at jbaumann @ dailyherald.com .
Put Grammar Moses in the subject line .
You also can friend or follow Jim at facebook.com/baumannjim .

Grammar Moses: Comma, comma, comma, comma, comma chameleon
A panther chameleon climbs on the branch of a small tree in its enclosure in a zoo in Frankfurt, Germany, on May 5, 2017. Associated Press
When you're in the mood for a little grammatical navel-gazing, it's fun to consider how the smallest things can have a large impact.
Let's focus today on the comma.
Commas wear many colors and can do many things. There, did I justify my anachronistic headline?
Attribution
• I often admonish writers to include a second comma when putting attribution in the middle of a sentence. Without it, the sentence can change meaning.
For instance: If you stand on your head and drink a grape Nehi, Bob said, you will get stomach cramps.
This sentence is properly attributed to Bob, with commas wrapped around the attribution. Bob is describing the stomach cramps one will get as a result of drinking soda while standing on his head.
Now, remove the comma after "said": If you stand on your head and drink a grape Nehi, Bob said you will get stomach cramps.
In this case, what the sentence says is that Bob's warning about cramps is contingent upon someone standing on his head and shotgunning a grape soda. In other words, Bob didn't warn you this would happen; he waited until you'd done it.
It becomes a simple if/then statement rather than a statement attributed to Bob.
That was not the intention.
The truth is, if I stand on my head and shotgun a grape Nehi, I don't get stomach cramps. I do, however, get a horrible sinus headache, flash-frozen nostrils and sticky hair. I know, because I tried it once.
Who's that?
I received a Grinch-themed postcard from my friend Bob that contains a typo.
"So he called his dog Max," it began.
Without a comma separating "dog" and "Max," the sentence means the Grinch gave his dog a name.
That's not what Dr. Seuss intended.
What he meant was the Grinch summoned his dog, whose name is Max. The one-word clause "Max" indicates which dog the Grinch summoned.
Your life depends on it
Opinion Page Editor Jim Slusher, a fellow word nerd, inspired today's topic by recommending I explore the use of the comma with dependent and independent clauses, especially with "because" phrases.
He provided two sentences whose meanings differ because of the comma.
"I told my wife I'd be on time, because my life depended on it."
And "I told my wife I'd be on time because my life depended on it."
"In the first sentence, if I hadn't told my wife I'd be on time, I would have died. In the second, if I hadn't been on time, I'd have died."
Emphasis
Here is another example of the subtle power of the comma, also from Slusher:
Consider the title of Hemingway's short story "The Short Happy Life of Francis Macomber."
"There is, of course, no comma there, and that's significant to the meaning of the story," he said. "Francis Macomber does die as a comparatively young man, but the real point of the story is he is a cowardly and cuckolded wimp until he finally shows some courage at the end and suddenly feels alive and free for the first time.
"So, the point is not that his life was short and happy; it's that the happy portion of his life was short. If Hemingway had titled it 'The Short, Happy Life of Francis Macomber,' it would have missed a critical point."
I'll concede that much of what I've discussed here amounts to navel-gazing and likely will not change anyone's life. But what I'm about to tell you just might.
There actually is a word for navel-gazing: omphaloskepsis.
Happy New Year! And, as always, write carefully.
• Jim Baumann is vice president/managing editor of the Daily Herald. Write him at jbaumann@dailyherald.com. Put Grammar Moses in the subject line. You also can friend or follow Jim at facebook.com/baumannjim.


dailyheraldchicago--2020-12-26--3 dead, 3 injured in shooting at Rockford bowling alley

ROCKFORD -- A gunman opened fire inside an Illinois bowling alley , killing three people and injuring three others Saturday @ @ @ @ @ was a random attack .
A `` person of interest '' was taken into custody @ @ @ @ @ Carter Lanes , Rockford Police Chief Dan O'Shea said during a news conference .
O'Shea @ @ @ @ @ information about the person of interest or the victims .
He said he did not @ @ @ @ @ weapons .

3 dead, 3 injured in shooting at Rockford bowling alley
ROCKFORD -- A gunman opened fire inside an Illinois bowling alley, killing three people and injuring three others Saturday night in what authorities believe was a random attack.
A "person of interest" was taken into custody after the shooting at Don Carter Lanes, Rockford Police Chief Dan O'Shea said during a news conference.
O'Shea did not immediately release additional information about the person of interest or the victims. He said he did not think any officers fired their weapons.


dailyheraldchicago--2020-12-27--Bucs rout Lions to clinch playoff spot; Dolphins top Raiders

DETROIT -- Tom Brady threw four touchdown passes in the only half he needed to play and the Tampa Bay Buccaneers went on to rout the Detroit Lions 47-7 Saturday , sealing a spot in the playoffs for the first time since 2007 .
The Bucs ( 10-5 ) set a franchise record with 588 yards and snapped the NFL 's second-longest postseason drought behind Cleveland 's 18-year run that can end Sunday .
Tampa Bay rested Brady ahead 34-0 , its largest halftime lead in franchise history .
Blaine Gabbert threw a 25-yard touchdown pass to Rob Gronkowski on @ @ @ @ @ @ @ Detroit running back D'Andre Swift fumbled , and a 22-yard pass to Mike Evans later in the third quarter .
Brady was 22 of 27 for 348 yards with a mix of passes deep down the field and darts in traffic .
The six-time Super Bowl-winning quarterback threw touchdown passes to Gronkowski , Evans , Chris Godwin , who made a one-handed catch , and Antonio Brown from 33 , 27 , 7 and 12 yards .
The 43-year-old Brady , who split time with Drew Henson in college at Michigan , started @ @ @ @ @ @ @ 's record for an NFL quarterback and played in his 300th game .
The Lions ( 5-10 ) started the game without interim coach Darrell Bevell along with assistants on the defensive staff because of COVID-19 contact tracing .
LAS VEGAS -- Ryan Fitzpatrick completed a 34-yard pass to Mack Hollins while being dragged down by the facemask and Miami moved one step closer to a playoff berth when Jason Sanders ' 44-yard field goal with 1 second remaining gave it a victory over Las Vegas .
The Raiders chose to run down @ @ @ @ @ @ @ instead of trying for a touchdown with Josh Jacobs going down on purpose at the 1-yard line and Derek Carr taking a knee to set up Daniel Carlson 's 22-yard field goal with 19 seconds left .
But the Dolphins had some late-game magic with Fitzpatrick launching the deep pass to Hollins while being dragged down by Arden Key .
The penalty moved the ball down to the Las Vegas 26 , setting up Sanders ' winning kick .
The Dolphins ( 10-5 ) moved a half-game ahead of Baltimore in the AFC @ @ @ @ @ @ @ berth with a win next week at Buffalo .
The Raiders ( 7-8 ) were eliminated with their fifth loss in six games and will be out of the postseason for the 17th time in 18 seasons .
GLENDALE , Ariz. -- Third-string quarterback C.J .
Beathard threw three touchdown passes , Jeff Wilson ran for 183 yards , and San Francisco dealt a brutal blow to Arizona 's playoff hopes .
Beathard was making his first start since 2018 and was 1-9 as a starting quarterback before he was pressed into action @ @ @ @ @ @ @ Jimmy Garoppolo and Nick Mullens .
The 27-year-old was n't amazing but avoided big mistakes .
He completed 13 of 22 passes for 182 yards , Wilson earned hard yards on the ground and the 49ers came up with two big defensive stops late in the fourth quarter , including Ahkello Witherspoon 's interception of Kyler Murray 's pass in the end zone .
The Cardinals ( 8-7 ) no longer control their own destiny in the playoff race .
If the Chicago Bears win their final two games , they will reach @ @ @ @ @ @ @ the Cardinals .
Arizona started the day positioned as the No .
7 and final team in the NFC playoff field , but the game was a struggle from the outset .
The 49ers ( 6-9 ) pulled ahead 14-6 in the third quarter on Beathard 's 9-yard touchdown pass to fullback Kyle Juszczyk .
Arizona scored its first and only touchdown early in the fourth quarter when Kenyan Drake jumped on top of a pile and stretched his arm just far enough for a 1-yard touchdown .
Murray could n't connect with @ @ @ @ @ @ @ the 49ers still led 14-12 .
The Cardinals ' next offensive drive stalled at their 35 when they went for it on fourth-and-2 .
Another Murray-to-Hopkins attempt could n't connect and the 49ers took over on downs .

Bucs rout Lions to clinch playoff spot; Dolphins top Raiders
Miami Dolphins kicker Jason Sanders (7) celebrates after making a game-winning field goal with seconds left during the second half of an NFL football game against the Las Vegas Raiders, Saturday, Dec. 26, 2020, in Las Vegas. Associated Press
San Francisco 49ers fullback Kyle Juszczyk (44) celebrates his touchdown against the Arizona Cardinals during the second half of an NFL football game, Saturday, Dec. 26, 2020, in Glendale, Ariz. Associated Press
San Francisco 49ers cornerback Ahkello Witherspoon (23) celebrates his interception against the Arizona Cardinals during the second half of an NFL football game, Saturday, Dec. 26, 2020, in Glendale, Ariz. Associated Press
Arizona Cardinals wide receiver Larry Fitzgerald (11) blows a kiss as he leaves the field after an NFL football game against the San Francisco 49ers, Saturday, Dec. 26, 2020, in Glendale, Ariz. The 49ers won 20-12. Associated Press
Miami Dolphins players celebrate after kicker Jason Sanders (7) made a game-winning field goal with seconds left during the second half of an NFL football game against the Las Vegas Raiders, Saturday, Dec. 26, 2020, in Las Vegas. Associated Press
Tampa Bay Buccaneers tight end Rob Gronkowski (87) pulls away from Detroit Lions strong safety Duron Harmon to score during the second half of an NFL football game, Saturday, Dec. 26, 2020, in Detroit. Associated Press
Tampa Bay Buccaneers wide receiver Mike Evans (13) prepares to step into the end zone for a touchdown as Detroit Lions cornerback Darryl Roberts (29) and strong safety Duron Harmon (26) defend during the second half of an NFL football game, Saturday, Dec. 26, 2020, in Detroit. Associated Press
Las Vegas Raiders defensive end Arden Key (99) commits a roughing the passer penalty on Miami Dolphins quarterback Ryan Fitzpatrick (14) during the second half of an NFL football game, Saturday, Dec. 26, 2020, in Las Vegas. Associated Press
Miami Dolphins wide receiver Isaiah Ford, left, celebrates with quarterback Ryan Fitzpatrick after defeating the Las Vegas Raiders in an NFL football game, Saturday, Dec. 26, 2020, in Las Vegas. Associated Press
Miami Dolphins center Ted Karras, right, embraces Miami Dolphins quarterback Ryan Fitzpatrick (14) after defeating the Las Vegas Raiders in an NFL football game, Saturday, Dec. 26, 2020, in Las Vegas. Associated Press
Tampa Bay Buccaneers quarterback Tom Brady throws during the first half of an NFL football game against the Detroit Lions, Saturday, Dec. 26, 2020, in Detroit. Associated Press
DETROIT -- Tom Brady threw four touchdown passes in the only half he needed to play and the Tampa Bay Buccaneers went on to rout the Detroit Lions 47-7 Saturday, sealing a spot in the playoffs for the first time since 2007.
The Bucs (10-5) set a franchise record with 588 yards and snapped the NFL's second-longest postseason drought behind Cleveland's 18-year run that can end Sunday.
Tampa Bay rested Brady ahead 34-0, its largest halftime lead in franchise history. Blaine Gabbert threw a 25-yard touchdown pass to Rob Gronkowski on his first snap, one play after Detroit running back D'Andre Swift fumbled, and a 22-yard pass to Mike Evans later in the third quarter.
Brady was 22 of 27 for 348 yards with a mix of passes deep down the field and darts in traffic. The six-time Super Bowl-winning quarterback threw touchdown passes to Gronkowski, Evans, Chris Godwin, who made a one-handed catch, and Antonio Brown from 33, 27, 7 and 12 yards.
The 43-year-old Brady, who split time with Drew Henson in college at Michigan, started his 298th game to tie Brett Favre's record for an NFL quarterback and played in his 300th game.
The Lions (5-10) started the game without interim coach Darrell Bevell along with assistants on the defensive staff because of COVID-19 contact tracing.
DOLPHINS 26, RAIDERS 25
LAS VEGAS -- Ryan Fitzpatrick completed a 34-yard pass to Mack Hollins while being dragged down by the facemask and Miami moved one step closer to a playoff berth when Jason Sanders' 44-yard field goal with 1 second remaining gave it a victory over Las Vegas.
The Raiders chose to run down the clock for a go-ahead field goal instead of trying for a touchdown with Josh Jacobs going down on purpose at the 1-yard line and Derek Carr taking a knee to set up Daniel Carlson's 22-yard field goal with 19 seconds left.
But the Dolphins had some late-game magic with Fitzpatrick launching the deep pass to Hollins while being dragged down by Arden Key. The penalty moved the ball down to the Las Vegas 26, setting up Sanders' winning kick.
The Dolphins (10-5) moved a half-game ahead of Baltimore in the AFC playoff race and can clinch a wild-card berth with a win next week at Buffalo.
The Raiders (7-8) were eliminated with their fifth loss in six games and will be out of the postseason for the 17th time in 18 seasons.
49ERS 20, CARDINALS 12
GLENDALE, Ariz. -- Third-string quarterback C.J. Beathard threw three touchdown passes, Jeff Wilson ran for 183 yards, and San Francisco dealt a brutal blow to Arizona's playoff hopes.
Beathard was making his first start since 2018 and was 1-9 as a starting quarterback before he was pressed into action against the Cardinals because of injuries to Jimmy Garoppolo and Nick Mullens.
The 27-year-old wasn't amazing but avoided big mistakes. He completed 13 of 22 passes for 182 yards, Wilson earned hard yards on the ground and the 49ers came up with two big defensive stops late in the fourth quarter, including Ahkello Witherspoon's interception of Kyler Murray's pass in the end zone.
The Cardinals (8-7) no longer control their own destiny in the playoff race. If the Chicago Bears win their final two games, they will reach the playoffs because of a tiebreaker over the Cardinals.
Arizona started the day positioned as the No. 7 and final team in the NFC playoff field, but the game was a struggle from the outset. The 49ers (6-9) pulled ahead 14-6 in the third quarter on Beathard's 9-yard touchdown pass to fullback Kyle Juszczyk.
Arizona scored its first and only touchdown early in the fourth quarter when Kenyan Drake jumped on top of a pile and stretched his arm just far enough for a 1-yard touchdown. Murray couldn't connect with DeAndre Hopkins on the 2-point conversion and the 49ers still led 14-12.
The Cardinals' next offensive drive stalled at their 35 when they went for it on fourth-and-2. Another Murray-to-Hopkins attempt couldn't connect and the 49ers took over on downs.
___
More AP NFL: https://apnews.com/NFL and https://twitter.com/AP_NFL


dailyheraldchicago--2020-12-27--AP source: Trump signs pandemic relief bill, averts shutdown

WEST PALM BEACH , Fla. -- President Donald Trump has signed a $ 900 billion pandemic relief package that will @ @ @ @ @ and individuals .
It also averts a government shutdown .
The massive bill includes $ @ @ @ @ @ agencies through September and contains other end-of-session priorities such as money for cash-starved transit systems @ @ @ @ @ stamp benefits .
Democrats are promising more aid to come once President-elect Joe Biden takes @ @ @ @ @ signaling a wait-and-see approach .
Trump blindsided members of both parties and upended months of @ @ @ @ @ week that the package -- already passed the House and Senate by large margins and @ @ @ @ @ support -- be revised to include larger relief checks and scaled-back spending .

Trump signs pandemic relief bill, averts shutdown
President Donald Trump rides in a motorcade vehicle as he departs his Mar-a-Lago resort, Sunday, Dec. 27, 2020, in Palm Beach, Fla. Trump is en route to Trump International Golf Club in West Palm Beach, Fla. Associated Press
WEST PALM BEACH, Fla. -- President Donald Trump has signed a $900 billion pandemic relief package that will deliver long-sought cash to businesses and individuals. It also averts a government shutdown.
Trump announced the signing in a statement Sunday night.
The massive bill includes $1.4 trillion to fund government agencies through September and contains other end-of-session priorities such as money for cash-starved transit systems and an increase in food stamp benefits.
Democrats are promising more aid to come once President-elect Joe Biden takes office, but Republicans are signaling a wait-and-see approach.
Trump blindsided members of both parties and upended months of negotiations when he demanded last week that the package -- already passed the House and Senate by large margins and believed to have Trump's support -- be revised to include larger relief checks and scaled-back spending.


dailyheraldchicago--2020-12-27--Authorities: Suspect died in Nashville blast on Christmas

NASHVILLE , Tenn. -- The man believed to be responsible for the Christmas Day bombing that tore through downtown Nashville blew himself up in the explosion , and appears to have acted alone , federal officials said Sunday .
Investigators used DNA and other evidence to link the man , identified as Anthony Quinn Warner , to the mysterious explosion but said they have not determined a motive .
Officials have received hundreds of tips and leads , but have concluded that no one other than Warner is believed to have been involved in the early morning explosion that damaged @ @ @ @ @ @ @ still following leads , but right now there is no indication that any other persons were involved , '' said Douglas Korneski , special agent in charge of the FBI 's Memphis field office .
`` We 've reviewed hours of security video surrounding the recreation vehicle .
We saw no other people involved . ''
In publicly identifying the suspect and his fate , officials disclosed a major breakthrough in their investigation even as they acknowledged the lingering mystery behind the explosion , which took place on a holiday morning well before @ @ @ @ @ @ @ was accompanied by a recorded announcement warning anyone nearby that a bomb would soon detonate .
No motive was disclosed by investigators nor was it revealed why Warner had selected the particular location for the bombing , which damaged an AT & T building and has continued to wreak havoc on cellphone service and police and hospital communications in several Southern states as the company worked to restore service .
Warner , who public records show had experience with electronics and alarms and who had also worked as a computer consultant for a @ @ @ @ @ @ @ the bombing since at least Saturday when federal and local investigators converged on a home in suburban Nashville linked to him .
Federal agents could be seen looking around the property , searching the home and the backyard .
A Google Maps image captured in May 2019 had shown an RV similar to the one that exploded parked in the backyard , but it was not at the property on Saturday , according to an Associated Press reporter at the scene .
On Sunday morning , police formally named Warner as being under @ @ @ @ @ @ @ Warner involved several key pieces of evidence , including DNA found at the explosion site .
Investigators from the Tennessee Highway Patrol also recovered parts from the recreational vehicle where the bomb was detonated among the wreckage from the blast , and were able to link the vehicle identification number to an RV that was registered to Warner , officials said .

Authorities: Suspect died in Nashville blast on Christmas
Nashville Chief of Police John Drake speaks at a news conference Sunday, Dec. 27, 2020, in Nashville, Tenn. Drake spoke before five officers told what they experienced when an explosion took place in downtown Nashville early Christmas morning. The officers are part of a group of six officers credited with evacuating people before the explosion happened. Associated Press
This image taken from surveillance video provided by Metro Nashville PD shows a recreational vehicle that was involved in a blast on Friday, Dec. 25, 2020 in Nashville, Tenn. An explosion shook the largely deserted streets early Christmas morning, shattering windows, damaging buildings and wounding some people. Police were responding to a report of shots fired when they encountered a recreational vehicle blaring a recording that said a bomb would detonate in 15 minutes, Metro Nashville Police Chief John Drake said. Police evacuated nearby buildings and called in the bomb squad. Associated Press
NASHVILLE, Tenn. -- The man believed to be responsible for the Christmas Day bombing that tore through downtown Nashville blew himself up in the explosion, and appears to have acted alone, federal officials said Sunday.
Investigators used DNA and other evidence to link the man, identified as Anthony Quinn Warner, to the mysterious explosion but said they have not determined a motive. Officials have received hundreds of tips and leads, but have concluded that no one other than Warner is believed to have been involved in the early morning explosion that damaged dozens of buildings.
"We're still following leads, but right now there is no indication that any other persons were involved," said Douglas Korneski, special agent in charge of the FBI's Memphis field office. "We've reviewed hours of security video surrounding the recreation vehicle. We saw no other people involved."
In publicly identifying the suspect and his fate, officials disclosed a major breakthrough in their investigation even as they acknowledged the lingering mystery behind the explosion, which took place on a holiday morning well before downtown streets were bustling with activity and was accompanied by a recorded announcement warning anyone nearby that a bomb would soon detonate.
No motive was disclosed by investigators nor was it revealed why Warner had selected the particular location for the bombing, which damaged an AT&T building and has continued to wreak havoc on cellphone service and police and hospital communications in several Southern states as the company worked to restore service.
Warner, who public records show had experience with electronics and alarms and who had also worked as a computer consultant for a Nashville realtor, had been linked to the bombing since at least Saturday when federal and local investigators converged on a home in suburban Nashville linked to him.
Federal agents could be seen looking around the property, searching the home and the backyard. A Google Maps image captured in May 2019 had shown an RV similar to the one that exploded parked in the backyard, but it was not at the property on Saturday, according to an Associated Press reporter at the scene.
On Sunday morning, police formally named Warner as being under investigation.
Officials said their identification of Warner involved several key pieces of evidence, including DNA found at the explosion site. Investigators from the Tennessee Highway Patrol also recovered parts from the recreational vehicle where the bomb was detonated among the wreckage from the blast, and were able to link the vehicle identification number to an RV that was registered to Warner, officials said.


dailyheraldchicago--2020-12-27--Illinois reports 3,767 more COVID-19 cases, 104 additional deaths

Figures released by the Illinois Department of Public Health Sunday showed an uptick in new COVID-19 cases and nearly double the number of deaths .
On Sunday , IDPH announced 3,767 new confirmed and probable cases , up from 3,293 the previous day .
Deaths also were up , with 104 additional deaths , an increase from Saturday 's toll of 66 .
Sunday 's deaths included 49 in Cook County , six in DuPage County , three in Kane County , six in Lake County and one in McHenry County .
Currently , IDPH is reporting a total of @ @ @ @ @ @ @ in 102 counties in Illinois .
The age of cases ranges from younger than one to older than 100 years .
Within the past 24 hours , laboratories have reported 46,226 specimens for a total 12,985,612 .
As of Saturday night , 4,083 were reported hospitalized with COVID-19 in Illinois , including 905 patients were in the ICU and 497 patients on ventilators .
Currently , IDPH is reporting a total of 937,909 cases , including 15,969 deaths , in 102 counties in Illinois .
The age of cases ranges from younger than @ @ @ @ @ @ @ Within the past 24 hours , laboratories have reported 46,226 specimens for a total 12,985,612 .
As of last night , 4,083 in Illinois were reported to be in the hospital with COVID-19 .
Of those , 905 patients were in the ICU and 497 patients with COVID-19 were on ventilators .
As of Thursday , 112,987 first doses of the vaccine have been administered throughout the state of Illinois , according to Gov .
J.B. Pritzker 's office .
The preliminary seven-day statewide positivity for cases as a percent of total test @ @ @ @ @ @ @ 2020 is 6.8 % .
The preliminary seven-day statewide test positivity from Dec. 20 to Dec. 26 is 8.5 % .

Illinois reports 3,767 more COVID-19 cases, 104 additional deaths
Figures released by the Illinois Department of Public Health Sunday showed an uptick in new COVID-19 cases and nearly double the number of deaths.
On Sunday, IDPH announced 3,767 new confirmed and probable cases, up from 3,293 the previous day.
Deaths also were up, with 104 additional deaths, an increase from Saturday's toll of 66.
Sunday's deaths included 49 in Cook County, six in DuPage County, three in Kane County, six in Lake County and one in McHenry County.
Currently, IDPH is reporting a total of 937,909 cases, including 15,969 deaths, in 102 counties in Illinois.
The age of cases ranges from younger than one to older than 100 years.
Within the past 24 hours, laboratories have reported 46,226 specimens for a total 12,985,612.
As of Saturday night, 4,083 were reported hospitalized with COVID-19 in Illinois, including 905 patients were in the ICU and 497 patients on ventilators.
Currently, IDPH is reporting a total of 937,909 cases, including 15,969 deaths, in 102 counties in Illinois. The age of cases ranges from younger than one to older than 100 years. Within the past 24 hours, laboratories have reported 46,226 specimens for a total 12,985,612. As of last night, 4,083 in Illinois were reported to be in the hospital with COVID-19. Of those, 905 patients were in the ICU and 497 patients with COVID-19 were on ventilators.
As of Thursday, 112,987 first doses of the vaccine have been administered throughout the state of Illinois, according to Gov. J.B. Pritzker's office.
The preliminary seven-day statewide positivity for cases as a percent of total test from Dec. 20 to Dec. 26, 2020 is 6.8%. The preliminary seven-day statewide test positivity from Dec. 20 to Dec. 26 is 8.5%.


dailyheraldchicago--2020-12-27--A battle that doesn't end: The pandemic's effect on health care workers

Nurse Samantha Mull felt helpless as she held the hand of a dying COVID-19 patient , trying to provide a sense of comfort as his family members said their goodbyes over the phone .
Her interactions with the man had been brief but strangely intimate since he was admitted to Elmhurst Hospital 's intensive care unit a week earlier .
She looked him in the eyes as he gasped for breath and told him everything would be OK. She talked him through the intubation process , which she performed while he was awake .
And in his final moments , @ @ @ @ @ @ @ bedside , sobbing over a man they barely knew as they watched him die .
For the last 10 months , health care workers have been carrying the weight of the pandemic on their shoulders , enduring anxiety , uncertainty , moral distress and fatigue as they fight a battle that 's out of their control .
Though that patient stands out in Mull 's mind , the scenario was in no way unique , she said .
At the height of the pandemic , both in the spring and over the last @ @ @ @ @ @ @ for front-line workers to witness multiple deaths a day , to deliver heartbreaking news virtually , to drop everything to be with a patient so nobody dies alone .
`` People do n't see this part of it , '' said Mull , of North Aurora , an ICU nurse for six years .
`` I 'm exhausted .
I 'm emotionally drained .
I feel like there 's still no end in sight . ''
Some health care workers take on extra shifts and report feeling guilty in their time off .
@ @ @ @ @ @ @ with additional stressors in their personal lives .
And with a front-row seat to the impact of the respiratory disease , many are growing increasingly frustrated by a lack of community compliance with public health guidelines .
`` They find themselves in two different worlds : One where they go to work at the hospital where people are dropping dead , and then they 're coming home and seeing people , frankly , be indifferent , '' said Dr. Clifton Saper , lead clinical psychologist with the Amita Health Behavioral Medicine Institute .
@ @ @ @ @ @ @ anger and a lot of feelings of despair . ''
In the early stages of a vaccine rollout , uncertainty remains over when front-line workers will be granted relief .
Mental health experts say they have a long road ahead , both in overcoming the virus and facing the residual effects of psychological trauma .
`` This is way , way more than anybody in health care has experienced before , '' Saper said .
Suburban health care workers can remember when a single positive case evoked feelings of overwhelming fear at their @ @ @ @ @ @ @ January for Amita Health St. Alexius Medical Center in Hoffman Estates , where the first confirmed COVID-19 patient in the Chicago area -- and the second in the United States -- was admitted , Saper said .
Weeks later , Edward Hospital in Naperville began caring for its first positive patient in the pulmonary medicine unit .
Nurse Jessica Bromley and her colleagues were tasked with treating an infection they did n't understand yet , with limited tools to help anticipate complications or perform interventions .
They did n't know if the hospital @ @ @ @ @ @ @ prevent the spread of the novel virus , said Bromley , a Plainfield resident .
She found herself at the center of a moral dilemma that pitted her patients ' care against the safety of her family .
That was the only time she has ever considered leaving the profession .
`` The compassionate and caring nature of a nurse is very hard to weigh with the fear and risk of what we were being asked to do , '' Bromley said .
As cases spiked across the suburbs , hospital systems ramped @ @ @ @ @ @ @ offered other mental health resources for employees at all levels .
Elective procedures were halted , and teams felt a collective rush of adrenaline as they adopted an all-hands-on-deck approach to combating the virus , said Dr. Sanjeeb Khatua , chief physician executive at Edward-Elmhurst Health .
The community embraced that mentality , too , pledging to stay home , rallying around their health care heroes , and sending daily meals and messages of encouragement .
The pressures of the pandemic began to subside over the summer as positivity rates trended down .
@ @ @ @ @ @ @ relief , hospitals were suddenly balancing COVID-19 cases with a backlog of patients needing elective surgeries and other care , Khatua said .
By the time a second surge hit this fall , health care workers had learned how to better care for virus patients .
But there was no operational pause in other units this time , no labor pool to fall back on , no rallying cry of community support -- and yet a greater case count and more community spread than ever before .
`` They just have n't had @ @ @ @ @ @ @ `` They still have the same issues at home as everybody else , and throw on top of that all this politicizing of simple scientific concepts that we should all be in together .
That 's a mixture for what we 'd call 'COVID fatigue . '
'' Nurse Jennifer Cohen felt like she reached her breaking point early last month as she watched COVID-19 cases rising again at NorthShore Glenbrook Hospital .
Her medical surgical unit had been filling up with positive patients when she left work on a Friday .
By @ @ @ @ @ @ @ other units at the Glenview medical center were full -- `` that 's how quick it was , '' she said .
`` It was difficult to accept that it was going to be as bad as it was before , or even worse .
...
There was just the reality of , 'Oh my gosh , we have to do this again , ' '' Cohen said .
`` I felt a little let down by the public . ''
The community spread has been more prevalent in the second wave of @ @ @ @ @ @ @ straining the workforce as more employees and their families test positive , said Jeff Murphy , 2021 president of the Schaumburg-based Emergency Nurses Association 's Illinois chapter .
Members have reported working longer hours and taking on extra shifts to ensure their units are fully staffed .
`` Trying to absorb that many people who are out sick and still take care of a lot of patients has made this last stretch particularly exhausting , '' Murphy said .
Advocate Aurora Health and Edward-Elmhurst Health are among the systems offering extra financial support @ @ @ @ @ @ @ child care reimbursement , to front-line workers .
Suburban hospitals also have activated special teams tasked with specifically addressing employees ' psychological needs .
Northwestern Medicine behavioral health staff members bring essential oils to medical floors , encourage stretch breaks , lead mindful breathing exercises and station a therapy dog at entrances to greet employees .
Many health centers offer healthy snacks , round-the-clock chaplains or therapists , and virtual or in-person support groups .
`` This is a marathon .
All our efforts are n't going to go away once everyone is @ @ @ @ @ @ @ Kathie Bender Schwich , Advocate Aurora chief spiritual officer .
`` We realize the emotional , mental and spiritual effects of all this will have a longer life , so we really are trying to change the culture of how we care for one another . ''
'Holding each other up' At the start of the pandemic , Mull transformed her living room into a yoga studio .
She makes a conscious effort to paint her nails , go for bike rides and take relaxing baths .
She even bedazzles her mask with @ @ @ @ @ @ @ In the midst of chaos , Mull quickly realized the importance of finding an outlet and creating small joys .
After a tumultuous year also full of unrest and political divide , self-care has never been more critical -- `` and do n't feel guilty about it , '' said Michael Scholl , vice president of behavioral health at The Josselyn Center , a mental health clinic in Northfield and Waukegan .
`` This is a situation where we have been met with more emotional needs than most humans can deal with , @ @ @ @ @ @ @ workers focus on moving forward through the pandemic , many find their strength from the doctors , nurses and others who understand what they 've been through , Bromley said .
They vent to one another in break rooms or call each other after they 've had a hard day at work .
`` None of us could 've done this without each other .
That 's the whole reason anybody 's able to get any care , '' she said .
`` We 've all been holding each other up , and @ @ @ @ @ @ @ It 's also important to focus on the wins rather than the losses , Mull said .
The 31-year-old patient who 's back home with his wife and kids after being on a ventilator for a month .
The man who got a tracheostomy days ago but is now awake and smiling and communicative .
`` That 's why I do my job , is to have those wins , '' Mull said .
`` We 're still in this together , and we 're going to beat this .
Even though we @ @ @ @ @ @ @ feel like there 's no end in sight , we 're trying to make one . ''

A battle that doesn't end: The pandemic's effect on health care workers
Nurse Samantha Mull, who works in the intensive care unit at Elmhurst Hospital, says the last 10 months have been emotionally and mentally draining. "I feel like there's still no end in sight," she says. Courtesy of Samantha Mull
Nurse Samantha Mull felt helpless as she held the hand of a dying COVID-19 patient, trying to provide a sense of comfort as his family members said their goodbyes over the phone.
Her interactions with the man had been brief but strangely intimate since he was admitted to Elmhurst Hospital's intensive care unit a week earlier. She looked him in the eyes as he gasped for breath and told him everything would be OK. She talked him through the intubation process, which she performed while he was awake.
And in his final moments, Mull and a co-worker were at his bedside, sobbing over a man they barely knew as they watched him die.
For the last 10 months, health care workers have been carrying the weight of the pandemic on their shoulders, enduring anxiety, uncertainty, moral distress and fatigue as they fight a battle that's out of their control.
Though that patient stands out in Mull's mind, the scenario was in no way unique, she said. At the height of the pandemic, both in the spring and over the last several weeks, it's not uncommon for front-line workers to witness multiple deaths a day, to deliver heartbreaking news virtually, to drop everything to be with a patient so nobody dies alone.
"People don't see this part of it," said Mull, of North Aurora, an ICU nurse for six years. "I'm exhausted. I'm emotionally drained. I feel like there's still no end in sight."
Some health care workers take on extra shifts and report feeling guilty in their time off. Others find it hard to balance work with additional stressors in their personal lives. And with a front-row seat to the impact of the respiratory disease, many are growing increasingly frustrated by a lack of community compliance with public health guidelines.
"They find themselves in two different worlds: One where they go to work at the hospital where people are dropping dead, and then they're coming home and seeing people, frankly, be indifferent," said Dr. Clifton Saper, lead clinical psychologist with the Amita Health Behavioral Medicine Institute. "That leads to a lot of anger and a lot of feelings of despair."
In the early stages of a vaccine rollout, uncertainty remains over when front-line workers will be granted relief. Mental health experts say they have a long road ahead, both in overcoming the virus and facing the residual effects of psychological trauma.
"This is way, way more than anybody in health care has experienced before," Saper said.
COVID fatigue
- Brian Hill | Staff Photographer Edward Hospital nurse Jessica Bromley says she has relied on her co-workers for support while working on the front lines of the COVID-19 pandemic for the last 10 months. "We've all been holding each other up, and we continue to do so."
Suburban health care workers can remember when a single positive case evoked feelings of overwhelming fear at their respective hospitals.
That moment came in January for Amita Health St. Alexius Medical Center in Hoffman Estates, where the first confirmed COVID-19 patient in the Chicago area -- and the second in the United States -- was admitted, Saper said.
Weeks later, Edward Hospital in Naperville began caring for its first positive patient in the pulmonary medicine unit. Nurse Jessica Bromley and her colleagues were tasked with treating an infection they didn't understand yet, with limited tools to help anticipate complications or perform interventions.
They didn't know if the hospital's protocols and personal protective equipment would prevent the spread of the novel virus, said Bromley, a Plainfield resident. She found herself at the center of a moral dilemma that pitted her patients' care against the safety of her family.
That was the only time she has ever considered leaving the profession.
"The compassionate and caring nature of a nurse is very hard to weigh with the fear and risk of what we were being asked to do," Bromley said.
As cases spiked across the suburbs, hospital systems ramped up incentives, instituted support groups and offered other mental health resources for employees at all levels.
Elective procedures were halted, and teams felt a collective rush of adrenaline as they adopted an all-hands-on-deck approach to combating the virus, said Dr. Sanjeeb Khatua, chief physician executive at Edward-Elmhurst Health. The community embraced that mentality, too, pledging to stay home, rallying around their health care heroes, and sending daily meals and messages of encouragement.
The pressures of the pandemic began to subside over the summer as positivity rates trended down. While the public breathed a sigh of relief, hospitals were suddenly balancing COVID-19 cases with a backlog of patients needing elective surgeries and other care, Khatua said.
By the time a second surge hit this fall, health care workers had learned how to better care for virus patients. But there was no operational pause in other units this time, no labor pool to fall back on, no rallying cry of community support -- and yet a greater case count and more community spread than ever before.
"They just haven't had a break," Khatua said. "They still have the same issues at home as everybody else, and throw on top of that all this politicizing of simple scientific concepts that we should all be in together. That's a mixture for what we'd call 'COVID fatigue.'"
'This is a marathon'
- Mark Welsh | Staff Photographer Therapy dog Shelby greets workers at Northwestern Medicine Central DuPage Hospital in Winfield. "It lifts spirits, makes them smile. People say it's a great way to start the day," owner Amy Wessel says.
Nurse Jennifer Cohen felt like she reached her breaking point early last month as she watched COVID-19 cases rising again at NorthShore Glenbrook Hospital.
Her medical surgical unit had been filling up with positive patients when she left work on a Friday. By the time she returned Monday, two other units at the Glenview medical center were full -- "that's how quick it was," she said.
"It was difficult to accept that it was going to be as bad as it was before, or even worse. ... There was just the reality of, 'Oh my gosh, we have to do this again,'" Cohen said. "I felt a little let down by the public."
The community spread has been more prevalent in the second wave of infections than in the initial outbreak, straining the workforce as more employees and their families test positive, said Jeff Murphy, 2021 president of the Schaumburg-based Emergency Nurses Association's Illinois chapter. Members have reported working longer hours and taking on extra shifts to ensure their units are fully staffed.
"Trying to absorb that many people who are out sick and still take care of a lot of patients has made this last stretch particularly exhausting," Murphy said.
Advocate Aurora Health and Edward-Elmhurst Health are among the systems offering extra financial support, such as raises, bonuses or child care reimbursement, to front-line workers. Suburban hospitals also have activated special teams tasked with specifically addressing employees' psychological needs.
Northwestern Medicine behavioral health staff members bring essential oils to medical floors, encourage stretch breaks, lead mindful breathing exercises and station a therapy dog at entrances to greet employees. Many health centers offer healthy snacks, round-the-clock chaplains or therapists, and virtual or in-person support groups.
"This is a marathon. All our efforts aren't going to go away once everyone is vaccinated," said the Rev. Kathie Bender Schwich, Advocate Aurora chief spiritual officer. "We realize the emotional, mental and spiritual effects of all this will have a longer life, so we really are trying to change the culture of how we care for one another."
'Holding each other up'
Elmhurst Hospital nurse Samantha Mull bedazzles her face masks differently at the start of every shift, one of several ways she practices self-care and tries to stay positive through the COVID-19 pandemic. "It's the little things," she says. - Courtesy of Samantha Mull
At the start of the pandemic, Mull transformed her living room into a yoga studio.
She makes a conscious effort to paint her nails, go for bike rides and take relaxing baths. She even bedazzles her mask with a different design before every shift.
In the midst of chaos, Mull quickly realized the importance of finding an outlet and creating small joys. After a tumultuous year also full of unrest and political divide, self-care has never been more critical -- "and don't feel guilty about it," said Michael Scholl, vice president of behavioral health at The Josselyn Center, a mental health clinic in Northfield and Waukegan.
"This is a situation where we have been met with more emotional needs than most humans can deal with," he said.
As health care workers focus on moving forward through the pandemic, many find their strength from the doctors, nurses and others who understand what they've been through, Bromley said. They vent to one another in break rooms or call each other after they've had a hard day at work.
"None of us could've done this without each other. That's the whole reason anybody's able to get any care," she said. "We've all been holding each other up, and we continue to do so."
It's also important to focus on the wins rather than the losses, Mull said. The 31-year-old patient who's back home with his wife and kids after being on a ventilator for a month. The man who got a tracheostomy days ago but is now awake and smiling and communicative.
"That's why I do my job, is to have those wins," Mull said. "We're still in this together, and we're going to beat this. Even though we feel like we're drowning and we feel like there's no end in sight, we're trying to make one."