npr--2020-08-07--Coronavirus Cases Are Surging. The Contact Tracing Workforce Is Not

Coronavirus Cases Are Surging .
The Contact Tracing Workforce Is Not The country needs as many as 100,000 contact tracers to fight the pandemic , the director of the Centers for Disease Control and Prevention told Congress in June .
We need billions of dollars to fund them , public health leaders pleaded in April .
But in August , with coronavirus cases increasing in more than half of states , America has neither the staff nor the resources to be able to trace the contacts of every new case — a key step in the COVID-19 public health response @ @ @ @ @ @ @ 's just tested positive and track down their contacts to inform them of their risk so they can quarantine .
They also often connect people with services in order to safely isolate .
It takes manpower , time , and organization , but it 's proven effective in controlling infectious diseases .
Despite some enthusiasm about contact tracing early in the pandemic , the U.S. contact tracing workforce continues to fall short of projected need .
NPR 's latest survey of all 50 states , done in collaboration with the Johns Hopkins Center @ @ @ @ @ @ @ workforce has barely grown since mid June .
NPR 's previous survey found a total contact tracing workforce of 37,110 .
The new survey finds that as of the end of July , 45 states and Washington D.C. reported a workforce of 41,960 .
The real total is likely higher , since several states did not respond despite multiple requests , and 12 states indicated that their counts exclude county and local staff .
More than two thirds of states are using a bank of trained reserve staff to pick up contact tracing @ @ @ @ @ @ @ of reserve staff is a third smaller than it was six weeks ago .
Eleven states said that their contact tracing workforce includes unpaid volunteers .
`` Slow-ish growth '' is how Danielle Allen describes these workforce numbers .
She 's director of the Edmond J. Safra Center for Ethics at Harvard University , and a co-author of a handbook of COVID-19 policy .
`` We 've only gotten halfway to our national goal for the amount of personnel we should have in place , '' she says .
`` 100,000 [ contact @ @ @ @ @ @ @ needs and should always have going forward — forever .
COVID or no COVID . ''
Crystal Watson of the Center for Health Security , who collaborated with NPR on the survey agrees .
`` Contact tracing seems to have stalled — or become less of a priority in many places , '' she says .
`` That is — in a lot of cases — understandable , given the case numbers that we 're seeing , but I think it 's still very important to have these workforces in place . ''
@ @ @ @ @ @ @ , New Hampshire , and Vermont , along with Washington , D.C. — currently have enough workers to investigate their coronavirus cases , according to an NPR analysis of how contact tracing staffing matches up with need .
Three more states — Michigan , Montana , and Hawaii — have enough when reserve staff are included .
And 38 states do not have enough .
The analysis , based on state case counts over the past 14 days , was done using the Contact Tracing Workforce Estimator developed by The Fitzhugh Mullan Institute @ @ @ @ @ @ @ Washington University .
As in June , NPR assumed workers are calling 10 contacts per case and that tracers reach 45 % of contacts and follow up with them every other day .
It 's a conservative estimate , to reflect the real-world challenges health workers face .
High case counts in many states across the country are likely contributing to staffing shortfalls .
In Texas , Florida and California , for instance , NPR 's analysis suggests around 30,000 contact tracers would be needed in each state to keep up with the @ @ @ @ @ @ @ to expect that sort of workforce , '' Watson says .
`` What is really needed right now is for political leaders to take action to flatten the curve again — bringing those case numbers down to a place where we can meet the demand with the capacity for contact tracing . ''
Nine states reported that they have had to adjust contact tracing operations because of a surge in cases or testing delays .
Under those conditions , it 's much more difficult for health workers to identify people who might be @ @ @ @ @ @ @ .
`` Increasing case counts and turn around times are hindering our ability to slow the spread through contact tracing , '' Jane Yackley of the Tennessee Department of Health , wrote in response to NPR 's survey .
By NPR 's analysis , Tennessee would need seven times more contact tracers to keep up with the current amount of transmission .
Watson says she 's been hearing a lot of hopelessness from public health workers in recent weeks .
`` I think public health officials are exhausted and very discouraged and they @ @ @ @ @ @ @ contact tracing as a failure of public health , '' she says .
In the midst of a case surge , other tactics may be more important — such as mask mandates , stay-home orders and closing or restricting business .
But Watson is adamant that contact tracing is still critical in the long run .
Right now , she says , `` contact tracing is not 'the answer ' — it is one tool that we have to have in order to manage the pandemic in an ongoing way . ''
Contact @ @ @ @ @ @ @ slowing a virus 's spread , it 's also a valuable source of data about where transmission is happening , which can be used to inform policy and educate the public .
But the majority of states NPR surveyed are not publicly sharing the contact tracing data they are gathering .
`` There was a big push on testing data , there was a big push on demographic data , '' Allen says , noting that the quality and transparency of public data in those two areas has improved a lot .
Now @ @ @ @ @ @ @ needs a similar `` serious push to get to a place where there 's a standard set of indicators being reported , and everybody understands it 's as important to report that information publicly , in the same way that you report testing information publicly . ''
According to the survey , most states are gathering data about how quickly and completely contact tracers are able to successfully reach new cases and their contacts .
This data can offer clues about when more tracers , or public awareness campaigns , are needed .
@ @ @ @ @ @ @ collecting data about how many quarantined contacts end up testing positive for coronavirus , along with how many new cases are linked to known positives .
That information — along with data gathered from conversations with contact tracers about where people think they may have been exposed to the virus — can give valuable insight into what is driving transmission .
`` We 're all struggling to understand how to better control the spread of this virus , '' Watson says .
`` I think one really important reason to share this information @ @ @ @ @ @ @ it . ''
But only a handful of states reported to NPR that this information was publicly available on a government website .
One of them was Utah — there , the public information on transmission shows that 65 % of cases are linked to a known case , and of those , 59 % came from household contacts , rather than a workplace or social settings .
Louisiana 's public transmission information focuses on the location of community outbreaks , and shows that bars and restaurants are tied to the most outbreaks @ @ @ @ @ @ @ the most cases .
Allen notes that the public health system in this country is being pushed to adapt very quickly to the demands of the pandemic .
`` It takes work to keep your contact tracing programs going , to build up the expertise , '' she says .
`` [ We 're ] taking a conventional public health technique and doing it at scale .
I think of it as converting from using a network of country roads to using interstates . ''
She adds that governments — from the federal @ @ @ @ @ @ @ this work on top of continuing to build up testing capacity , developing effective therapies , and more .
`` It 's really hard work across a number of different dimensions , '' she says .
`` And we really just need to get our minds and hearts around accepting that — and steel our wills to doing that hard work . ''
One positive sign , Allen points out , is that nearly three quarters of states that responded to NPR 's survey report they are still planning to hire more contact @ @ @ @ @ @ @ building , '' she says .
`` We should definitely not stop here . ''
Jessica Craig , Blake Farmer , Anh Gray , Jake Harper , Natalie Krebs , Aviva Okeson-Haberman , Troy Oppie , Alex Smith , Ruth Talbot , Sam Whitehead , and Julia Wohl contributed to this report .

Coronavirus Cases Are Surging. The Contact Tracing Workforce Is Not
Enlarge this image toggle caption David J. Phillip/AP David J. Phillip/AP
The United States needs as many as 100,000 contact tracers to fight the pandemic, the director of the Centers for Disease Control and Prevention told Congress in June. We need billions of dollars to fund them, public health leaders pleaded in April.
But in August, with coronavirus cases increasing in more than half of states, America has neither the staff nor the resources to be able to trace the contacts of every new case — a key step in the COVID-19 public health response.
Contact tracers call each person who has just tested positive and track down their contacts to inform them of their risk so they can quarantine. They also often connect people with services in order to safely isolate. It takes workers, time and organization, but it's proven effective in controlling infectious diseases.
Despite some enthusiasm about contact tracing early in the pandemic, the U.S. contact tracing workforce continues to fall short of projected need. NPR's latest survey of all 50 states, done in collaboration with the Johns Hopkins Center for Health Security, finds the national workforce has barely grown since mid June. NPR's previous survey found a total contact tracing workforce of 37,110.
The new survey finds that as of the end of July, 45 states and Washington D.C., reported a workforce of 41,122. The real total is likely higher, since several states did not respond, despite multiple requests, and 12 states indicated that their counts exclude county and local staff.
More than two-thirds of states are using a bank of trained reserve staff to pick up contact tracing duties as needed; the 7,580 number of reserve staff is a third smaller than it was six weeks ago. Eleven states said that their contact tracing workforce includes unpaid volunteers.
"Slow-ish growth" is how Danielle Allen describes these workforce numbers. She's director of the Edmond J. Safra Center for Ethics at Harvard University, and a co-author of a handbook of COVID-19 policy. "We've only gotten halfway to our national goal for the amount of personnel we should have in place," she says. "One-hundred thousand [contact tracers] is the baseline the country needs and should always have going forward — forever. COVID or no COVID."
Crystal Watson of the Center for Health Security, who collaborated with NPR on the survey, agrees. "Contact tracing seems to have stalled — or become less of a priority in many places," she says. "That is — in a lot of cases — understandable, given the case numbers that we're seeing, but I think it's still very important to have these workforces in place."
Only three states — Maine, New Hampshire and Vermont — along with Washington, D.C., currently have enough workers to investigate their coronavirus cases, according to an NPR analysis of how contact tracing staffing matches up with need. Three more states — Michigan, Montana and Hawaii — have enough when reserve staff are included. And 39 states do not have enough.
The analysis, based on state case counts over the past 14 days, was done using the Contact Tracing Workforce Estimator developed by The Fitzhugh Mullan Institute for Health Workforce Equity at the George Washington University. As in June, NPR assumed workers are calling 10 contacts per case and that tracers reach 45% of contacts and follow up with them every other day. It's a conservative estimate, to reflect the real-world challenges health workers face.
Case surges and testing delays hinder efforts
High case counts in many states across the country are likely contributing to staffing shortfalls. In Texas, Florida and California, for instance, NPR's analysis suggests around 30,000 contact tracers would be needed in each state to keep up with the current spread.
"It's unreasonable to expect that sort of workforce," Watson says. "What is really needed right now is for political leaders to take action to flatten the curve again — bringing those case numbers down to a place where we can meet the demand with the capacity for contact tracing."
Nine states reported that they have had to adjust contact tracing operations because of a surge in cases or testing delays. Under those conditions, it's much more difficult for health workers to identify people who might be infectious and prevent them from exposing others.
"Increasing case counts and turn around times are hindering our ability to slow the spread through contact tracing," Jane Yackley of the Tennessee Department of Health, wrote in response to NPR's survey. By NPR's analysis, Tennessee would need seven times more contact tracers to keep up with the current amount of transmission.
Watson says she's been hearing a lot of hopelessness from public health workers in recent weeks. "I think public health officials are exhausted and very discouraged and they feel like some officials are pointing to contact tracing as a failure of public health," she says.
In the midst of a case surge, other tactics may be more important — such as mask mandates, stay-home orders and closing or restricting business. But Watson is adamant that contact tracing is still critical in the long run. Right now, she says, "contact tracing is not 'the answer' — it is one tool that we have to have in order to manage the pandemic in an ongoing way."
A failure to share vital data
Contact tracing isn't just a tool for slowing a virus's spread, it's also a valuable source of data about where transmission is happening, which can be used to inform policy and educate the public. But the majority of states NPR surveyed are not publicly sharing the contact tracing data they are gathering.
"There was a big push on testing data, there was a big push on demographic data," Allen says, noting that the quality and transparency of public data in those two areas has improved a lot. Now, she says, contact tracing data needs a similar "serious push to get to a place where there's a standard set of indicators being reported, and everybody understands it's as important to report that information publicly, in the same way that you report testing information publicly."
According to the survey, most states are gathering data about how quickly and completely contact tracers are able to successfully reach new cases and their contacts. This data can offer clues about when more tracers, or public awareness campaigns, are needed.
Just under half of states also reported collecting data about how many quarantined contacts end up testing positive for coronavirus, along with how many new cases are linked to known positives. That information — along with data gathered from conversations with contact tracers about where people think they may have been exposed to the virus — can give valuable insight into what is driving transmission.
"We're all struggling to understand how to better control the spread of this virus," Watson says. "I think one really important reason to share this information is so that others can learn from it."
But only a handful of states reported to NPR that this information was publicly available on a government website. One of them was Utah — there, the public information on transmission shows that 65% of cases are linked to a known case, and of those, 59% came from household contacts, rather than a workplace or social settings. Louisiana's public transmission information focuses on the location of community outbreaks, and shows that bars and restaurants are tied to the most outbreaks, though food processing outbreaks account for the most cases.
Allen notes that the public health system in this country is being pushed to adapt very quickly to the demands of the pandemic. "It takes work to keep your contact tracing programs going, to build up the expertise," she says. "[We're] taking a conventional public health technique and doing it at scale. I think of it as converting from using a network of country roads to using interstates."
She adds that governments — from the federal to local level — have to do this work on top of continuing to build up testing capacity, developing effective therapies, and more. "It's really hard work across a number of different dimensions," she says. "And we really just need to get our minds and hearts around accepting that — and steel our wills to doing that hard work."
One positive sign, Allen points out, is that nearly three-quarters of states that responded to NPR's survey report that they are still planning to hire more contact tracers. "We should definitely keep building," she says. "We should definitely not stop here."
Jessica Craig, Blake Farmer, Anh Gray, Jake Harper, Natalie Krebs, Aviva Okeson-Haberman, Troy Oppie, Alex Smith, Ruth Talbot, Sam Whitehead and Julia Wohl contributed to this report.


npr--2020-08-07--'We're Risking Our Lives': Front-Line Federal Workers Sue For Hazard Pay

'We 're Risking Our Lives ' : Front-Line Federal Workers Sue For Hazard Pay For the first few months of the coronavirus pandemic , correctional officer Kareen `` Troy '' Troitino says things were `` pretty relaxed '' at FCI Miami .
There were no cases of COVID-19 at the low-security federal prison , which currently houses some 1,000 inmates .
That all changed , he says , early last month .
`` And then on the week of the Fourth of July , we had one case , and then it just spread in one week .
I mean @ @ @ @ @ @ @ .
And you do n't even see the fire because you do n't know who has it until it 's too late . ''
Troitino , president of the union local that represents correctional workers at FCI Miami , is a plaintiff in a suit being brought against the Bureau of Prisons and several other federal agencies , seeking hazard pay for at-risk essential workers .
Troitino says the only protective equipment the Bureau of Prisons issued to workers in Miami were surgical masks .
`` One employee walked into work .
He @ @ @ @ @ @ @ passed our screening procedures .
He was positive .
And that one employee spread it to numerous inmates .
And then that 's it .
Ever since then , it 's been a disaster . ''
Some 6,000 federal employees are expected to have contracted COVID-19 on the job as of this week , and as many as 60 have died , according to a Department of Labor report issued last month .
Heidi Burakiewicz , a Washington , D.C. , attorney who brought the suit in collaboration with the American Federation of @ @ @ @ @ @ @ `` are risking their health and safety to go to work .
They have the types of jobs that are necessary to keep the country up and running and safe . ''
Burakiewicz says federal law requires that employees exposed to hazards , including `` a virulent biological disease such as COVID-19 , '' are entitled to hazardous duty pay , `` but the government 's not paying it to them . ''
NPR reached out to the Bureau of Prisons , which said it would not comment on the suit , citing @ @ @ @ @ @ @ of workers should be receiving the hazard pay , Burakiewicz says , which would amount to a 25 % increase in their salaries .
They include Veterans Affairs employees , Agriculture Department meat inspectors , Social Security employees who are processing Social Security benefits , Transportation Security Administration employees who are screening large numbers of people through airports , mine inspectors and security guards on military bases `` who have to come into contact with a large number of employees entering and exiting the military bases . ''
All of them , the @ @ @ @ @ @ @ hazardous pay differential .
In all , Burakiewicz estimates as many as 100,000 federal workers should be getting hazard pay .
Burakiewicz is concerned about employees who have been working from home and who may soon be called back into the office unnecessarily , she says , exposing the workers already there .
In Miami , Troitino says the average correctional worker makes $ 600 a week working in a dangerous environment that , he says , has become more dangerous .
`` It 's an enormous hazard .
And we 're risking @ @ @ @ @ @ @ on the table for our families but also to protect society .
And it seems like no one , no one cares . ''
The government has until next month to respond to the lawsuit .

'We're Risking Our Lives': Front-Line Federal Workers Sue For Hazard Pay
Enlarge this image toggle caption Scott McIntyre for The Washington Post via Getty Images Scott McIntyre for The Washington Post via Getty Images
For the first few months of the coronavirus pandemic, correctional officer Kareen "Troy" Troitino says things were "pretty relaxed" at FCI Miami. There were no cases of COVID-19 at the low-security federal prison, which currently houses some 1,000 inmates.
That all changed, he says, early last month. "And then on the week of the Fourth of July, we had one case, and then it just spread in one week. I mean, tremendously. It's like wildfire. And you don't even see the fire because you don't know who has it until it's too late."
Troitino, president of the union local that represents correctional workers at FCI Miami, is a plaintiff in a suit being brought against the Bureau of Prisons and several other federal agencies, seeking hazard pay for at-risk essential workers.
Troitino says the only protective equipment the Bureau of Prisons issued to workers in Miami were surgical masks. "One employee walked into work. He did not show a fever. He passed our screening procedures. He was positive. And that one employee spread it to numerous inmates. And then that's it. Ever since then, it's been a disaster."
Some 6,000 federal employees are expected to have contracted COVID-19 on the job as of this week, and as many as 60 have died, according to a Department of Labor report issued last month.
Heidi Burakiewicz, a Washington, D.C., attorney who brought the suit in collaboration with the American Federation of Government Employees, says such federal workers "are risking their health and safety to go to work. They have the types of jobs that are necessary to keep the country up and running and safe."
Burakiewicz says federal law requires that employees exposed to hazards, including "a virulent biological disease such as COVID-19," are entitled to hazardous duty pay, "but the government's not paying it to them."
NPR reached out to the Bureau of Prisons, which said it would not comment on the suit, citing the pending litigation.
We're risking our lives not just to put food on the table for our families but also to protect society.
A wide range of workers should be receiving the hazard pay, Burakiewicz says, which would amount to a 25% increase in their salaries.
They include Veterans Affairs employees, Agriculture Department meat inspectors, Social Security employees who are processing Social Security benefits, Transportation Security Administration employees who are screening large numbers of people through airports, mine inspectors and security guards on military bases "who have to come into contact with a large number of employees entering and exiting the military bases." All of them, the suit contends, should be receiving the hazardous pay differential.
In all, Burakiewicz estimates as many as 100,000 federal workers should be getting hazard pay.
Burakiewicz is concerned about employees who have been working from home and who may soon be called back into the office unnecessarily, she says, exposing the workers already there.
In Miami, Troitino says the average correctional worker makes $600 a week working in a dangerous environment that, he says, has become more dangerous. "It's an enormous hazard. And we're risking our lives not just to put food on the table for our families but also to protect society. And it seems like no one, no one cares."
The government has until next month to respond to the lawsuit.


npr--2020-08-07--'All Bark And No Bite': Trump Holds Prescription Drug-Pricing Order In Search Of Deal

'All Bark And No Bite ' : Trump Holds Prescription Drug-Pricing Order In Search Of Deal Two weeks after President Trump signed an executive order `` Lowering Drug Prices By Putting America First , '' the White House still has n't released the text of the order .
The unorthodox move is apparently a leverage play , an attempt to squeeze drug companies into offering concessions , but so far there 's little indication Trump is getting the deal he was after .
Trump had American flags and women in white lab coats behind him , his big presidential sharpie @ @ @ @ @ @ @ order July 24 .
`` This one will go into effect on Aug. 25 if we do n't make a deal , '' Trump said at the time as he held the order up for the cameras .
It was the fourth order he signed that day .
Language for the other three was posted online quickly and published in the Federal Register .
But this order remains something of a mystery .
The basic idea is that in other countries , prescription drugs cost less than they do in the United States @ @ @ @ @ @ @ for drugs administered in a doctor 's office or hospital setting , Medicare would start paying the lowest price in the world .
He calls it `` favored nations '' pricing .
`` No more will we have to suffer by saying , 'Gee , why is it so much cheaper for the exact same drug in some other country ? '
`` Trump said .
But first , Trump said , he was going to give drug companies a chance to come up with a better idea .
`` They do n't @ @ @ @ @ @ @ said a few days later .
`` I understand that . ''
This is n't how the process normally works .
`` I ca n't think of any case where the president has signed an executive order publicly and then not put it in the Federal Register , '' said Tara Lee Grove , a professor of constitutional law at the University of Alabama .
Grove said the process for executive orders varies from administration to administration , but publishing the order is the one big step no one skips , because that @ @ @ @ @ @ @ Usually if a president is going to issue an executive order the president wants the people who are supposed to abide by the executive order to know what they 're supposed to do , and you ca n't really know what you 're supposed to do if they do n't tell you , '' Grove said .
Asked what 's in the executive order or how it would achieve what Trump is promising , the White House just points back to a vague fact sheet and the president 's remarks .
So , @ @ @ @ @ @ @ the Pharmaceutical Research and Manufacturers of America , the pharmaceutical industry trade group , said its members zoomed in on a picture of Trump holding up the executive order to try to see what was in the text .
`` There is an AP picture where there is some language , that we were able to see some , but there 's a page missing and so that leaves questions , '' she said .
In fact , when NPR zoomed in on the photo , it discovered the obscured second page must @ @ @ @ @ @ @ what the proposal would actually do and how .
Reilly said the industry would be willing to talk about other ways of bringing down drug prices , but this proposal , as it 's understood , is a nonstarter .
`` We recognize there is a desire by many to find ways to lower costs for American consumers , but we 're steadfastly and strongly opposed to the idea that they have with regards to allowing foreign governments to dictate prices in the U.S. , '' she said , calling the president 's @ @ @ @ @ @ @ .
Multiple sources said some quiet conversations are happening now , but it 's not clear how serious they are .
In an earnings call , the CEO of Pfizer said if implemented the executive order would lead to American job losses and said he did n't see much need for a White House meeting .
The lack of urgency may come from experience .
Trump has been talking about variations on this idea for nearly two years .
He rolled out something called an `` international pricing index '' with much fanfare @ @ @ @ @ @ @ .
`` This is a revolutionary change , '' Trump said at the time .
`` Nobody 's had the courage to do it , or they just did n't want to do it . ''
But then it languished .
Nine months later , it still had n't gone into effect , and Trump said he would be `` announcing something very shortly , a 'favored-nations ' clause . ''
Now , another year later , Trump signed that executive order , but he 's telegraphing that he 's open to alternatives @ @ @ @ @ @ @ bark and no bite on drug pricing , '' said Chris Meekins , director of Washington health care policy at Raymond James Financial .
`` And despite the barks getting louder with executive orders , the bite is no harder . ''
Meekins served in the Department of Health and Human Services in the first two years of the Trump administration .
He said there 's clearly a reelection motive here .
Trump and his campaign want to be able to say they 've done something on drug prices , an issue about @ @ @ @ @ @ @ I think it 's just more noise , '' Meekins said .
`` As I describe it to clients , Trump on drug pricing feels a little bit like Charlie Brown , Lucy and the football .
`` Where the administration is Lucy , hey we 're going to do these drug-pricing executive orders .
We 're going to do these drug-pricing executive orders and everyone , the media , investors run up assuming the football is going to be there to be advanced .
And then at the last minute , it @ @ @ @ @ @ @ Trump moves forward with the executive order , that would just mark the beginning of what would likely be a lengthy process that could be further stalled or halted all together by drug industry lawsuits .

'All Bark And No Bite': Trump Holds Prescription Drug-Pricing Order In Search Of Deal
Enlarge this image toggle caption Alex Brandon/AP Alex Brandon/AP
Two weeks after President Trump signed an executive order "Lowering Drug Prices By Putting America First," the White House still hasn't released the text of the order. The unorthodox move is apparently a leverage play, an attempt to squeeze drug companies into offering concessions, but so far there's little indication Trump is getting the deal he was after.
Trump had American flags and women in white lab coats behind him, his big presidential sharpie marker in hand when he signed the order July 24.
"This one will go into effect on Aug. 25 if we don't make a deal," Trump said at the time as he held the order up for the cameras.
It was the fourth order he signed that day. Language for the other three was posted online quickly and published in the Federal Register. But this order remains something of a mystery. The basic idea is that in other countries, prescription drugs cost less than they do in the United States. So under Trump's plan, for drugs administered in a doctor's office or hospital setting, Medicare would start paying the lowest price in the world. He calls it "favored nations" pricing.
"No more will we have to suffer by saying, 'Gee, why is it so much cheaper for the exact same drug in some other country?' " Trump said.
But first, Trump said, he was going to give drug companies a chance to come up with a better idea. "They don't like 'favored-nations' clauses," Trump said a few days later. "I understand that."
This isn't how the process normally works.
"I can't think of any case where the president has signed an executive order publicly and then not put it in the Federal Register," said Tara Leigh Grove, a professor of constitutional law at the University of Alabama.
Grove said the process for executive orders varies from administration to administration, but publishing the order is the one big step no one skips, because that's what makes it real.
"Usually if a president is going to issue an executive order the president wants the people who are supposed to abide by the executive order to know what they're supposed to do, and you can't really know what you're supposed to do if they don't tell you," Grove said.
Asked what's in the executive order or how it would achieve what Trump is promising, the White House just points back to a vague fact sheet and the president's remarks.
So, Lori Reilly, chief operating officer at the Pharmaceutical Research and Manufacturers of America, the pharmaceutical industry trade group, said its members zoomed in on a picture of Trump holding up the executive order to try to see what was in the text.
"There is an AP picture where there is some language, that we were able to see some, but there's a page missing and so that leaves questions," she said.
In fact, when NPR zoomed in on the photo, it discovered the obscured second page must have contained all of the details about what the proposal would actually do and how.
Reilly said the industry would be willing to talk about other ways of bringing down drug prices, but this proposal, as it's understood, is a nonstarter.
"We recognize there is a desire by many to find ways to lower costs for American consumers, but we're steadfastly and strongly opposed to the idea that they have with regards to allowing foreign governments to dictate prices in the U.S.," she said, calling the president's proposal a distraction from battling the coronavirus.
Multiple sources said some quiet conversations are happening now, but it's not clear how serious they are. In an earnings call, the CEO of Pfizer said if implemented the executive order would lead to American job losses and said he didn't see much need for a White House meeting.
The lack of urgency may come from experience. Trump has been talking about variations on this idea for nearly two years. He rolled out something called an "international pricing index" with much fanfare right before the midterm elections in 2018.
"This is a revolutionary change," Trump said at the time. "Nobody's had the courage to do it, or they just didn't want to do it."
But then it languished. Nine months later, it still hadn't gone into effect, and Trump said he would be "announcing something very shortly, a 'favored-nations' clause."
Now, another year later, Trump signed that executive order, but he's telegraphing that he's open to alternatives.
"The Trump administration is all bark and no bite on drug pricing," said Chris Meekins, director of Washington health care policy at Raymond James Financial. "And despite the barks getting louder with executive orders, the bite is no harder."
Meekins served in the Department of Health and Human Services in the first two years of the Trump administration. He said there's clearly a reelection motive here. Trump and his campaign want to be able to say they've done something on drug prices, an issue about which polls show voters care.
"I think it's just more noise," Meekins said. "As I describe it to clients, Trump on drug pricing feels a little bit like Charlie Brown, Lucy and the football.
"Where the administration is Lucy, hey we're going to do these drug-pricing executive orders. We're going to do these drug-pricing executive orders and everyone, the media, investors run up assuming the football is going to be there to be advanced. And then at the last minute, it gets pulled out."
Even if Trump moves forward with the executive order, that would just mark the beginning of what would likely be a lengthy process that could be further stalled or halted all together by drug industry lawsuits.


npr--2020-08-06--Trump Signs Executive Order That Will Effectively Ban Use Of TikTok In the U.S.

Trump Signs Executive Order That Will Effectively Ban Use Of TikTok In the U.S. President Trump on Thursday invoked his emergency economic powers to impose broad sanctions against TikTok , a move that steps up pressure on the Chinese-owned app to sell its U.S. assets to an American company .
In the order , which takes effect in 45 days , any transactions between TikTok 's parent company , ByteDance , and U.S. citizens will be outlawed for national security reasons .
In practice , experts told NPR the order likely will mean the viral video service could no longer @ @ @ @ @ @ @ app could be removed from Apple and Google 's app stores .
For the more than 100 million Americans who have downloaded TikTok , experts say the app may no longer be sent software updates , rendering TikTok unmanageable , and eventually nonfunctional , with time .
`` When we talk about sanctions against Russian oligarchs and kleptocrats , well , the sanctions are that no American can do business with them , '' Stewart Baker , the former general counsel at the National Security Agency , told NPR last month when speculation @ @ @ @ @ @ @ .
Now , that same sanction has been used against TikTok .
In the order , the White House says TikTok captures vast swaths of information from its users , including location data and Internet search history .
TikTok is open about what data it collects , an amount that is on par with what is harvested by apps owned by American tech companies Google , Facebook and Apple .
`` While TikTok is being singled out in this executive order , their data collection and sharing practices are fairly standard in the @ @ @ @ @ @ @ Dame technology professor Kirsten Martin .
`` In fact , many fitness apps were banned from use in the military for tracking location data , but we did not ban them from all U.S .
citizens . ''
Yet the White House says what makes TikTok distinct is the theoretical possibility of it handing over data to Chinese authorities , as the Trump administration wages an intensifying trade war against China .
`` This data collection threatens to allow the Chinese Communist Party access to Americans ' personal and proprietary information — potentially @ @ @ @ @ @ @ Federal employees and contractors , build dossiers of personal information for blackmail , and conduct corporate espionage , '' the executive order reads .
TikTok has downplayed its ties to Beijing , saying data it captures on U.S. users is stored mostly in Virginia .
Officials at TikTok also insist the company has never turned over any data to Chinese authorities , despite the county 's broad national powers to request such data from private companies .
A federal class-action lawsuit involving dozens of American families claims an independent security review of TikTok @ @ @ @ @ @ @ , including the facial profiles of American children , and sending it to Chinese servers , though the suit does not provide evidence any information has ever been transferred to the Chinese Communist Party .
Since the Trump administration began turning up the heat on TikTok , software giant Microsoft has confirmed it is among a handful of companies in early talks to acquire the short-form video service .
For Microsoft , a $ 1.5 trillion company that has focused its business mostly on corporate clients by selling software and cloud computing services @ @ @ @ @ @ @ major foray into a social media platform popular among young users .
Officials at Microsoft say it is examining a TikTok acquisition that would potentially buy TikTok 's American , Canadian , Australian and New Zealand services , but officials close to the deal say the final offer may include operations in even more countries .
Trump 's executive order comes on the same day Facebook launched a new product Reels , a video-sharing app that mimics TikTok 's core features .
TikTok has accused Facebook of introducing a `` copycat '' service @ @ @ @ @ @ @ trying to capitalize on the administration 's zeal to punish China for its own benefit .
Trump on Thursday also signed an executive order to restrict the business between China-based Tencent Holdings , the owner of WeChat , and U.S. citizens .
More than a billion people in China use WeChat , an all-in-one app used for messaging , social media and making mobile payments .
It is a popular tool for chatting and transactions among Chinese citizens living in the U.S. , but the Trump administration says the app could have a @ @ @ @ @ @ @ `` Like TikTok , WeChat automatically captures vast swaths of information from its users , '' Trump 's separate executive order reads .
`` In addition , the application captures the personal and proprietary information of Chinese nationals visiting the United States , thereby allowing the Chinese Communist Party a mechanism for keeping tabs on Chinese citizens who may be enjoying the benefits of a free society for the first time in their lives . ''
On Thursday , the Senate unanimously passed a bill to ban TikTok on government-issued devices , as @ @ @ @ @ @ @ a national security threat to the U.S. gains new bipartisan support in Washington .
A spokeswoman for TikTok did not immediately return a request for comment about the executive order .
Editor 's note : TikTok helps fund NPR content that appears on the social media platform .

Trump Signs Executive Order That Will Effectively Ban Use Of TikTok In the U.S.
Enlarge this image toggle caption Alex Brandon/AP Alex Brandon/AP
Updated 10:55 a.m. ET Friday
President Trump on Thursday invoked his emergency economic powers to impose broad sanctions against TikTok, a move that steps up pressure on the Chinese-owned app to sell its U.S. assets to an American company.
In the order, which takes effect in 45 days, any transactions between TikTok's parent company, ByteDance, and U.S. citizens will be outlawed for national security reasons.
In practice, experts told NPR the order likely will mean the viral video service could no longer receive advertising from American companies and the app could be removed from Apple and Google's app stores.
For the more than 100 million Americans who have downloaded TikTok, experts say the app may no longer be sent software updates, rendering TikTok unmanageable, and eventually nonfunctional, with time.
"When we talk about sanctions against Russian oligarchs and kleptocrats, well, the sanctions are that no American can do business with them," Stewart Baker, the former general counsel at the National Security Agency, told NPR last month when speculation about the order first began to spread.
Now, that same sanction has been used against TikTok.
In a statement, TikTok says it is "shocked" by the executive order, claiming the Trump administration "paid no attention to facts, dictated terms of an agreement without going through standard legal processes, and tried to insert itself into negotiations between private businesses."
TikTok added that the order "sets a dangerous precedent for the concept of free expression and open markets."
It says all options are being reviewed to make sure the company and TikTok users are treated fairly "if not by the administration, then by the U.S. courts."
In the order, the White House says TikTok captures vast swaths of information from its users, including location data and Internet search history.
TikTok is open about what data it collects, an amount that is on par with what is harvested by apps owned by American tech companies Google, Facebook and Apple.
"While TikTok is being singled out in this executive order, their data collection and sharing practices are fairly standard in the industry," said University of Notre Dame technology professor Kirsten Martin. "In fact, many fitness apps were banned from use in the military for tracking location data, but we did not ban them from all U.S. citizens."
Yet the White House says what makes TikTok distinct is that the app's terms of service state that it can share data with its parent company, ByteDance.
The possibility that it could hand over data to Chinese authorities has officials on edge, as the White House wages an intensifying trade war against China.
"This data collection threatens to allow the Chinese Communist Party access to Americans' personal and proprietary information — potentially allowing China to track the locations of Federal employees and contractors, build dossiers of personal information for blackmail, and conduct corporate espionage," the executive order reads.
TikTok has downplayed its ties to Beijing, saying data it captures on U.S. users is stored mostly in Virginia. Officials at TikTok also insist the company has never turned over any data to Chinese authorities, despite the country's broad national powers to request such data from private companies.
A federal class-action lawsuit involving dozens of American families claims an independent security review of TikTok revealed that the app is siphoning data, including the facial profiles of American children, and sending it to Chinese servers, though the suit does not provide evidence any information has ever been transferred to the Chinese Communist Party.
Since the Trump administration began turning up the heat on TikTok, software giant Microsoft has confirmed it is among a handful of companies in early talks to acquire the short-form video service.
For Microsoft, a $1.5 trillion company that has focused its business mostly on corporate clients by selling software and cloud computing services, buying TikTok would be its first major foray into a social media platform popular among young users.
Microsoft already owns game console company Xbox, networking site LinkedIn and messaging service Skype.
Officials at Microsoft say it is examining a TikTok acquisition that would potentially buy TikTok's American, Canadian, Australian and New Zealand services, but officials close to the deal say the final offer may include operations in even more countries.
Trump's executive order comes on the same day Facebook launched a new product Reels, a video-sharing app that mimics TikTok's core features.
TikTok has accused Facebook of introducing a "copycat" service, arguing that the social network is trying to capitalize on the administration's zeal to punish China for its own benefit.
Trump on Thursday also signed an executive order to restrict business between China-based Tencent Holdings, the owner of WeChat, and U.S. citizens.
More than a billion people in China use WeChat, an all-in-one app used for messaging, social media and making mobile payments. It is a popular tool for chatting and transactions among Chinese citizens living in the U.S., but the Trump administration says the app could have a nefarious use by authorities in Beijing.
"Like TikTok, WeChat automatically captures vast swaths of information from its users," Trump's separate executive order reads. "In addition, the application captures the personal and proprietary information of Chinese nationals visiting the United States, thereby allowing the Chinese Communist Party a mechanism for keeping tabs on Chinese citizens who may be enjoying the benefits of a free society for the first time in their lives."
On Thursday, the Senate unanimously passed a bill to ban TikTok on government-issued devices, as the view that the app could pose a national security threat to the U.S. gains new bipartisan support in Washington.
Editor's note: TikTok helps fund NPR content that appears on the social media platform.


npr--2020-08-07--Ireland Finds U.S. Tourists During Pandemic May Be Trouble. But So Is Their Absence

Ireland Finds U.S .
Tourists During Pandemic May Be Trouble .
But So Is Their Absence Most international travel destinations are off-limits to Americans at the moment because of the United States ' high rate of coronavirus infections and its own restrictions on incoming visitors .
Ireland , however , has decided to let Americans in .
Even so , U.S. travelers heading to Ireland may not get the traditional Irish greeting of a `` hundred-thousand welcomes . ''
There 's a perception that Americans are resistant to wearing masks and are refusing to follow Ireland 's rule to self-isolate @ @ @ @ @ @ @ Rowland , a dual Irish-American citizen , says people frequently brought that up to her while she was vacationing off the coast of Donegal , northwest Ireland , where — she emphasizes — she spent two weeks in isolation .
`` I actually heard quite a bit from friends and relatives that there were Americans running around down south , '' she says , `` and they were pretty pissed off because [ the Americans ] are not quarantining . ''
Anecdotes like that led chef J.P. McMahon in Galway to announce his @ @ @ @ @ @ @ their date of entry into Ireland to show they were n't breaking quarantine by dining there .
Americans have long made up much of his clientele .
Now one of his restaurants gets `` hate email '' for serving them , McMahon wrote in The Irish Times last month .
`` I never thought I 'd see the day where I would be in the position , as a chef and restauranteur , to consider refusing Americans , or other foreigners , entry into my restaurants , '' he wrote .
`` But @ @ @ @ @ @ @ are now calling for .
On the door of one restaurant I have read the words : 'No British or American Tourists . '
Is this the new normal ? ''
But the concern may be disproportionate to the actual number of Americans availing themselves of the privilege .
Figures for U.S. visitors in Ireland between January and June of this year dropped by almost three-quarters compared with the same period last year , according to the Irish Central Statistics Office .
That 's a huge economic blow to the country , which @ @ @ @ @ @ @ from U.S. tourists .
At this time of the summer , the southwestern town of Killarney would typically be teeming with Americans .
But as of late July this year , Deros Tours manager Denis Spillane said he had n't had any U.S. bookings .
`` There were some reports that planeloads came in from Texas , '' he said , `` but I have n't seen them around .
Not in Killarney . ''
Margaret O'Brien , who works at Great Southern , one of the town 's most popular hotels , @ @ @ @ @ @ @ are occupied by U.S. visitors .
Not this summer .
`` We are missing the Americans greatly , '' she sighs , saying she 'd been downtown talking to some of the horse-cart drivers , `` jarveys '' for the jaunting cars , and they said the same : `` missing the Americans . ''
Spillane says since U.S. visitors are the `` bread and butter '' of Irish tourism , he 's basically given up for this year .
`` We 'll be delighted to see the Americans back , '' he @ @ @ @ @ @ @ safe to come back . ''
It 's hard to imagine when that will be , with the coronavirus still raging in much of the U.S. and resurging in most of Europe , including Ireland .
While Irish political analyst Daniel Keohane vehemently disagrees with his government 's decision to open the border — `` I do n't want someone from Florida or Texas coming near me ! ''
he exclaims — he also finds that incongruent with the official advice that Irish citizens should n't travel abroad .
Keohane thinks the government @ @ @ @ @ @ @ tiny number of American tourists to obscure the real problem .
`` All politics is local , as Tip O'Neill always said , '' he notes , referring to the late Irish-American politician .
`` Most people are really sticking to the rules , but it is much easier to blame an outsider for breaking the rules than it is to blame locals . ''
However , that 's just what government officials were recently forced to do , when they had to admit that the ongoing climb in infections is due to @ @ @ @ @ @ @ spreading the virus .

Ireland Finds U.S. Tourists During Pandemic May Be Trouble. But So Is Their Absence
Enlarge this image toggle caption Teri Schultz for NPR Teri Schultz for NPR
Most international travel destinations are off-limits to Americans at the moment because of the United States' high rate of coronavirus infections and its own restrictions on incoming visitors. Ireland, however, has decided to let Americans in.
Even so, U.S. travelers heading to Ireland may not get the traditional Irish greeting of a "hundred-thousand welcomes." There's a perception that Americans are resistant to wearing masks and are refusing to follow Ireland's rule to self-isolate for 14 days upon arrival.
JLisa Rowland, a dual Irish-American citizen, says people frequently brought that up to her while she was vacationing off the coast of Donegal, northwest Ireland, where — she emphasizes — she spent two weeks in isolation. "I actually heard quite a bit from friends and relatives that there were Americans running around down south," she says, "and they were pretty pissed off because [the Americans] are not quarantining."
Anecdotes like that led chef J.P. McMahon in Galway to announce his restaurants would require international customers to provide their date of entry into Ireland to show they weren't breaking quarantine by dining there.
Americans have long made up much of his clientele. Now one of his restaurants gets "hate email" for serving them, McMahon wrote in The Irish Times last month.
"I never thought I'd see the day where I would be in the position, as a chef and restauranteur, to consider refusing Americans, or other foreigners, entry into my restaurants," he wrote. "But this is what some in our industry are now calling for. On the door of one restaurant I have read the words: 'No British or American Tourists.' Is this the new normal?"
But the concern may be disproportionate to the actual number of Americans availing themselves of the privilege. Figures for U.S. visitors in Ireland between January and June of this year dropped by almost three-quarters compared with the same period last year, according to the Irish Central Statistics Office.
That's a huge economic blow to the country, which usually earns millions of dollars a year from U.S. tourists.
At this time of the summer, the southwestern town of Killarney would typically be teeming with Americans. But as of late July this year, Deros Tours manager Denis Spillane said he hadn't had any U.S. bookings. "There were some reports that planeloads came in from Texas," he said, "but I haven't seen them around. Not in Killarney."
Margaret O'Brien, who works at Great Southern, one of the town's most popular hotels, says usually three out of four rooms are occupied by U.S. visitors. Not this summer. "We are missing the Americans greatly," she sighs, saying she'd been downtown talking to some of the horse-cart drivers, "jarveys" for the jaunting cars, and they said the same: "missing the Americans."
Spillane says since U.S. visitors are the "bread and butter" of Irish tourism, he's basically given up for this year. "We'll be delighted to see the Americans back," he said, "but when it's safe to come back."
Enlarge this image toggle caption Teri Schultz for NPR Teri Schultz for NPR
It's hard to imagine when that will be, with the coronavirus still raging in much of the U.S. and resurging in most of Europe, including Ireland. While Irish political analyst Daniel Keohane vehemently disagrees with his government's decision to open the border — "I don't want someone from Florida or Texas coming near me!" he exclaims — he also finds that incongruent with the official advice that Irish citizens shouldn't travel abroad.
Keohane thinks the government has been allowing the controversy over a tiny number of American tourists to obscure the real problem. "All politics is local, as Tip O'Neill always said," he notes, referring to the late Irish-American politician. "Most people are really sticking to the rules, but it is much easier to blame an outsider for breaking the rules than it is to blame locals."
However, that's just what government officials were recently forced to do, when they had to admit that the ongoing climb in infections is due to Irish residents, and not visitors, spreading the virus.


npr--2020-08-07--Jerry Falwell Jr. On 'Indefinite Leave' From Liberty University After Racy Photo

Jerry Falwell Jr. On 'Indefinite Leave ' From Liberty University After Racy Photo Jerry Falwell Jr. , a prominent evangelical ally of President Trump 's , is taking `` an indefinite leave of absence '' from his positions as the president and chancellor of Liberty University in Virginia .
The move comes days after Falwell received criticism for posting a photo to social media that showed him with his pants unzipped alongside a woman who is not his wife .
In a brief statement , Liberty University said members of its board of trustees had met Friday and asked Falwell @ @ @ @ @ @ @ effective immediately , '' and that Falwell had agreed .
Falwell did not immediately respond to requests for comment from NPR .
Falwell faced criticism this week from both conservative and liberal commentators after posting the controversial photo to his Instagram account .
Meghan McCain , daughter of the late Republican Sen. John McCain , tweeted , `` How is this Jerry Falwell Jr. photo even real ?
Also if you 're running the largest Christian university in America maybe do n't put photos of yourself on social media with your pants undone @ @ @ @ @ @ @ in bad wigs .
So gross , so hypocritical . ''
Falwell told the Lynchburg , Va. , radio station WLNI on Wednesday that the photo , which was later removed , was taken in `` just in good fun '' during a costume party on vacation .
He said the woman in the photo was his wife 's assistant .
`` It was weird , '' Falwell told the interviewer .
`` She 's pregnant , so she could n't get her pants zipped .
I had on a pair of jeans @ @ @ @ @ @ @ time , so I could n't get mine zipped either .
So I just put my belly out like hers . ''
Falwell said the woman is a `` sweetheart '' and expressed regret about embarrassing her .
He said he 'd `` apologized to everybody '' and promised to `` try to be a good boy '' from now on .
Falwell is the son of the late Rev .
Jerry Falwell , who founded the evangelical Christian Liberty University and the conservative Moral Majority movement that rose to prominence in the @ @ @ @ @ @ @ the first prominent evangelicals to endorse Donald Trump during his campaign for the Republican presidential nomination in 2016 .

Jerry Falwell Jr. On 'Indefinite Leave' From Liberty University After Racy Photo
Enlarge this image toggle caption Chip Somodevilla/Getty Images Chip Somodevilla/Getty Images
Jerry Falwell Jr., a prominent evangelical ally of President Trump's, is taking "an indefinite leave of absence" from his positions as the president and chancellor of Liberty University in Virginia.
The move comes days after Falwell received criticism for posting a photo to social media that showed him with his pants unzipped alongside a woman who is not his wife.
In a brief statement, Liberty University said members of its board of trustees had met Friday and asked Falwell to step down from his positions "effective immediately," and that Falwell had agreed. Falwell did not immediately respond to requests for comment from NPR.
Falwell faced criticism this week from both conservative and liberal commentators after posting the controversial photo to his Instagram account. Meghan McCain, daughter of the late Republican Sen. John McCain, tweeted, "How is this Jerry Falwell Jr. photo even real? Also if you're running the largest Christian university in America maybe don't put photos of yourself on social media with your pants undone on a yacht - with random women in bad wigs. So gross, so hypocritical."
Falwell told the Lynchburg, Va., radio station WLNI on Wednesday that the photo, which was later removed, was taken in "just in good fun" during a costume party on vacation. He said the woman in the photo was his wife's assistant.
"It was weird," Falwell told the interviewer. "She's pregnant, so she couldn't get her pants zipped. I had on a pair of jeans I hadn't worn in a long time, so I couldn't get mine zipped either. So I just put my belly out like hers."
Falwell said the woman is a "sweetheart" and expressed regret about embarrassing her. He said he'd "apologized to everybody" and promised to "try to be a good boy" from now on.
Falwell is the son of the late Rev. Jerry Falwell, who founded the evangelical Christian Liberty University and the conservative Moral Majority movement that rose to prominence in the Reagan era.
Falwell Jr. was among the first prominent evangelicals to endorse Donald Trump during his campaign for the Republican presidential nomination in 2016.


npr--2020-08-07--Gov. Cuomo Clears The Way For In-Person Learning At Schools In New York State

Gov .
Cuomo Clears The Way For In-Person Learning At Schools In New York State Schools across New York state will be allowed to open for in-person learning this fall because of low coronavirus infection rates , Gov .
Andrew Cuomo announced Friday .
`` We 've been smart from day one .
We do the masks , we do the social distancing , we 've kept that infection rate down , '' Cuomo said during the announcement .
`` And we can bring the same level of intelligence to the school reopening that we brought to the economic reopening @ @ @ @ @ @ @ announced that schools can reopen if they are in a region that 's in Phase 4 reopening and where the 14-day average daily infection rate remains below 5 % .
That 's now true for the whole state .
It 's up to the discretion of local school districts to decide whether they want to have in-person learning .
The choice goes away if infection rates spike , Cuomo said .
New York City Mayor Bill de Blasio announced last month that the city 's schools would open in the fall with a @ @ @ @ @ @ @ New York was once the state with the largest coronavirus outbreak in the U.S. Then , new cases dropped to about 800 per day in mid-July , compared to about 10,000 in mid-April .
According to the governor 's office , of the 70,170 test results reported to state health officials on Thursday , 714 , or 1 % , were positive .
The New York State Department of Health will review reopening plans submitted by school districts to ensure they meet the department 's guidelines .
Cuomo said districts will be notified @ @ @ @ @ @ @ .
The governor also announced that school districts must publicly post their plans for distance learning and for testing and contact tracing , and hold three to five public meetings with parents before Aug. 21 and at least one with teachers .
Teachers have expressed concerns about returning to their classrooms too early .
`` We have been clear all along : Health and safety is the most important consideration in reopening school buildings .
Viral infection rates tell only one part of the story , '' said Andy Pallotta , president of @ @ @ @ @ @ @ represents more than 600,000 members .
`` Many educators and parents have anxiety about local school district reopening plans that have been submitted to the state — if they even have been yet , with 127 districts that did n't bother to submit them by last week and 50 considered incomplete by the state , '' Pallotta said .
`` Right now , there may be some areas where parents and educators are confident in their district 's plan , but in many others , we know they are n't .
No district @ @ @ @ @ @ @ until their plans are safe and everything in that plan meant to keep the school community safe is implemented . ''
Other large school districts , such as Chicago , Los Angeles and San Diego , have decided to stick with distance learning for the beginning of the school year .

Gov. Cuomo Clears The Way For In-Person Learning At Schools In New York State
Enlarge this image toggle caption Spencer Platt/Getty Images Spencer Platt/Getty Images
Schools across New York state will be allowed to open for in-person learning this fall because of low coronavirus infection rates, Gov. Andrew Cuomo announced Friday.
"We've been smart from day one. We do the masks, we do the social distancing, we've kept that infection rate down," Cuomo said during the announcement. "And we can bring the same level of intelligence to the school reopening that we brought to the economic reopening."
Last month, the governor announced that schools can reopen if they are in a region that's in Phase 4 reopening and where the 14-day average daily infection rate remains below 5%. That's now true for the whole state.
It's up to the discretion of local school districts to decide whether they want to have in-person learning. The choice goes away if infection rates spike, Cuomo said.
New York City Mayor Bill de Blasio announced last month that the city's schools would open in the fall with a mix of in-person and distance learning.
New York was once the state with the largest coronavirus outbreak in the U.S. Then, new cases dropped to about 800 per day in mid-July, compared to about 10,000 in mid-April. According to the governor's office, of the 70,170 test results reported to state health officials on Thursday, 714, or 1%, were positive.
The New York State Department of Health will review reopening plans submitted by school districts to ensure they meet the department's guidelines. Cuomo said districts will be notified Aug. 10 of the department's decision.
The governor also announced that school districts must publicly post their plans for distance learning and for testing and contact tracing, and hold three to five public meetings with parents before Aug. 21 and at least one with teachers.
Teachers have expressed concerns about returning to their classrooms too early.
"We have been clear all along: Health and safety is the most important consideration in reopening school buildings. Viral infection rates tell only one part of the story," said Andy Pallotta, president of New York State United Teachers, which represents more than 600,000 members.
"Many educators and parents have anxiety about local school district reopening plans that have been submitted to the state — if they even have been yet, with 127 districts that didn't bother to submit them by last week and 50 considered incomplete by the state," Pallotta said. "Right now, there may be some areas where parents and educators are confident in their district's plan, but in many others, we know they aren't. No district should consider themselves ready to reopen buildings until their plans are safe and everything in that plan meant to keep the school community safe is implemented."
Other large school districts, such as Chicago, Los Angeles and San Diego, have decided to stick with distance learning for the beginning of the school year.


npr--2020-08-07--Nasal Spray Is A New Antidepressant Option For People At High Risk of Suicide

Nasal Spray Is A New Antidepressant Option For People At High Risk of Suicide The Food and Drug Administration has approved a variant of the anesthetic and party drug ketamine for suicidal patients with major depression .
The drug is a nasal spray called Spravato and it contains esketamine , a chemical cousin of ketamine .
In 2019 , the FDA approved Spravato for patients with major depressive disorder who had n't responded to other treatments .
Now , the agency is adding patients who are having suicidal thoughts or have recently attempted to harm themselves or take their own @ @ @ @ @ @ @ approved antidepressant medication that 's been able to demonstrate a reduction in symptoms of major depressive disorder within 24 hours after the first dose , '' says Dr. Michelle Kramer , a psychiatrist and vice president of U.S. neuroscience , medical affairs at Janssen Pharmaceuticals , which makes the drug .
Janssen is part of Johnson & Johnson .
The drug 's quick action is potentially important for suicidal patients because `` existing drugs typically can take weeks or longer before you really get noticeable clinical benefit , '' says Dr. Gerard Sanacora @ @ @ @ @ @ @ University and director of Yale 's depression research program .
He was involved in the studies leading to the FDA approval and has consulted for Janssen .
So a dose of esketamine `` could potentially get a person out of a difficult , horrible situation when they 're feeling so overwhelmed , '' says Dr. Charles Conway , a professor of psychiatry at Washington University School of Medicine in St. Louis who was n't involved in the study .
`` This could be a significant improvement in how we can help people who @ @ @ @ @ @ @ have found that more than 40 % of suicidal patients who got the drug still had greatly reduced symptoms of depression a month later .
But esketamine was only partly responsible for that result .
Patients in the studies were hospitalized for at least several days , received other antidepressants , and attended twice-weekly therapy sessions for four weeks , Kramer says .
`` What we have to be careful of is not to interpret that this is a medication you give once or twice and the person 's fine , '' Sanacora @ @ @ @ @ @ @ that these studies showed such a big effect is that there was a very comprehensive follow-up plan built into this . ''
Although the drug comes in the form of a nasal spray , it is meant to be given in a hospital or clinic setting , not at home .
Esketamine , like ketamine , can cause changes in blood pressure and heart rate , as well as out-of-body experiences for an hour or so after it is administered .
`` Most patients describe it as feeling weird , '' Sanacora says @ @ @ @ @ @ @ get either waking up or going under anesthesia . ''
The patients who are candidates for esketamine will probably have been brought to an emergency room or psychiatric facility because of suicidal thoughts or behavior , Conway says .
And those who get the drug will also most likely be admitted to a psychiatric unit .
Even though esketamine is not intended to prevent hospital stays , it might be able to shorten them , Sanacora says .
`` It is a real possibility if people are starting to feel better quickly , @ @ @ @ @ @ @ led to Spravato 's approval were highly unusual because they included people at high risk of suicide .
`` It really is the first large scale clinical trial like this to be done in a population of patients that not only have severe depression , but are also expressing acute suicidal ideation , '' Sanacora says .
Until now , he says , antidepressant studies have usually `` excluded this patient population . ''
Spravato 's approval comes as many people are experiencing stress and anxiety related to the COVID-19 pandemic .
`` @ @ @ @ @ @ @ perfect cauldron of stress , '' Conway says , because it is leaving many people isolated , without jobs , and uncertain about the future .
And those are factors that can contribute to depression and suicidal thoughts , he says .

Nasal Spray Is A New Antidepressant Option For People At High Risk of Suicide
Enlarge this image toggle caption Sarah Silbiger/Getty Images Sarah Silbiger/Getty Images
The Food and Drug Administration has approved a variant of the anesthetic and party drug ketamine for suicidal patients with major depression.
The drug is a nasal spray called Spravato and it contains esketamine, a chemical cousin of ketamine.
In 2019, the FDA approved Spravato for patients with major depressive disorder who hadn't responded to other treatments. Now, the agency is adding patients who are having suicidal thoughts or have recently attempted to harm themselves or take their own lives.
"Spravato is the first approved antidepressant medication that's been able to demonstrate a reduction in symptoms of major depressive disorder within 24 hours after the first dose," says Dr. Michelle Kramer, a psychiatrist and vice president of U.S. neuroscience, medical affairs at Janssen Pharmaceuticals, which makes the drug. Janssen is part of Johnson & Johnson.
The drug's quick action is potentially important for suicidal patients because "existing drugs typically can take weeks or longer before you really get noticeable clinical benefit," says Dr. Gerard Sanacora, a professor of psychiatry at Yale University and director of Yale's depression research program. He was involved in the studies leading to the FDA approval and has consulted for Janssen.
So a dose of esketamine "could potentially get a person out of a difficult, horrible situation when they're feeling so overwhelmed," says Dr. Charles Conway, a professor of psychiatry at Washington University School of Medicine in St. Louis who wasn't involved in the study. "This could be a significant improvement in how we can help people who have intense suicidal thinking."
If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting 741741.
Studies have found that more than 40% of suicidal patients who got four weeks of treatment with the drug had greatly reduced symptoms of depression at the end of that period.
But esketamine was only partly responsible for that result. Patients in the studies were hospitalized for at least several days, received other antidepressants, and attended twice-weekly therapy sessions for four weeks, Kramer says.
"What we have to be careful of is not to interpret that this is a medication you give once or twice and the person's fine," Sanacora says. "Part of the reason that these studies showed such a big effect is that there was a very comprehensive follow-up plan built into this."
Although the drug comes in the form of a nasal spray, it is meant to be given in a hospital or clinic setting, not at home. Esketamine, like ketamine, can cause changes in blood pressure and heart rate, as well as out-of-body experiences for an hour or so after it is administered.
"Most patients describe it as feeling weird," Sanacora says, "similar to what you would get either waking up or going under anesthesia."
The patients who are candidates for esketamine will probably have been brought to an emergency room or psychiatric facility because of suicidal thoughts or behavior, Conway says. And those who get the drug will also most likely be admitted to a psychiatric unit.
Even though esketamine is not intended to prevent hospital stays, it might be able to shorten them, Sanacora says. "It is a real possibility if people are starting to feel better quickly," he says.
The studies that led to Spravato's approval were highly unusual because they included people at high risk of suicide.
"It really is the first large scale clinical trial like this to be done in a population of patients that not only have severe depression, but are also expressing acute suicidal ideation," Sanacora says. Until now, he says, antidepressant studies have usually "excluded this patient population."
Spravato's approval comes as many people are experiencing stress and anxiety related to the COVID-19 pandemic.
"The COVID environment is sort of the perfect cauldron of stress," Conway says, because it is leaving many people isolated, without jobs, and uncertain about the future. And those are factors that can contribute to depression and suicidal thoughts, he says.


npr--2020-08-07--Indian Jetliner Breaks In Two After Overshooting Runway; 17 People Dead

Indian Jetliner Breaks In Two After Overshooting Runway ; 17 People Dead An Air India Express flight overshot its landing in heavy rain Friday night , skidding off a runway and plunging down a 35-foot slope – and cracking the Boeing 737 in two .
At least 17 people died , officials said .
The jetliner had 190 people aboard on the flight from Dubai , United Arab Emirates , to Kozhikode in Kerala , a state in southern India .
`` I offer my heartfelt condolences to their next of kin & pray for speedy recovery of the injured @ @ @ @ @ @ @ Singh Puri said on Twitter .
`` Rescue operations are now complete , '' Puri said , adding that the injured had been taken to several city hospitals .
He did not specify how many people were hurt .
Flight IX-1344 was carrying 174 adult passengers , 10 infants , four cabin crew members and two pilots — both of whom were among the dead , the airline said .
Kozhikode International Airport – sometimes referred to as either Calicut Airport or Karipur Airport — has only one runway , but the setting @ @ @ @ @ @ @ a plateau , with deep gorges on either side – making it difficult to land .
Regular commercial flights to and from India have been halted during the pandemic , but this flight was part of a government program to repatriate Indians stranded abroad .
Millions of Indians live and work in the Persian Gulf region .
The crash occurred in the evening — around 7:40 local time .
India is in its monsoon season ; earlier Friday , heavy rains in Kerala triggered flooding and a landslide , killing at least 15 @ @

Indian Jetliner Breaks In Two After Overshooting Runway; 17 People Dead
Enlarge this image toggle caption AP AP
An Air India Express flight overshot its landing in heavy rain Friday night, skidding off a runway and plunging down a 35-foot slope – and cracking the Boeing 737 in two.
At least 17 people died, officials said. The jetliner had 190 people aboard on the flight from Dubai, United Arab Emirates, to Kozhikode in Kerala, a state in southern India.
"I offer my heartfelt condolences to their next of kin & pray for speedy recovery of the injured," Indian Civil Aviation Minister Hardeep Singh Puri said on Twitter.
"Rescue operations are now complete," Puri said, adding that the injured had been taken to several city hospitals. He did not specify how many people were hurt.
Flight IX-1344 was carrying 174 adult passengers, 10 infants, four cabin crew members and two pilots — both of whom were among the dead, the airline said.
Kozhikode International Airport – sometimes referred to as either Calicut Airport or Karipur Airport — has only one runway, but the setting is dramatic.
Its runway is on a plateau, with deep gorges on either side – making it difficult to land.
Regular commercial flights to and from India have been halted during the pandemic, but this flight was part of a government program to repatriate Indians stranded abroad. Millions of Indians live and work in the Persian Gulf region.
The crash occurred in the evening — around 7:40 local time. India is in its monsoon season; earlier Friday, heavy rains in Kerala triggered flooding and a landslide, killing at least 15 people.


npr--2020-08-07--'Not A Person Whatsoever': Michigan County Official Defends Use Of N-Word

'Not A Person Whatsoever ' : Michigan County Official Defends Use Of N-Word A county official in Michigan is defending his use of the N-word — by repeatedly saying the slur , and insisting that it does not imply he is a racist .
Leelanau County Road Commissioner Tom Eckerle has been facing calls to resign since Tuesday , when he reportedly used one of the most taboo words in U.S. society to explain why he would not be wearing a face mask .
`` Well , this whole thing is because of them n****** down in Detroit , '' @ @ @ @ @ @ @ Enterprise .
Commission Chairman Bob Joyce quickly challenged Eckerle 's use of the word : `` You ca n't say that ! ''
he is quoted saying .
`` I can say anything I want , '' Eckerle reportedly replied .
`` Black Lives Matter has everything to do with taking the country away from us . ''
Eckerle made the comments in the commission 's meeting room Tuesday , just before a public meeting was to begin .
Discussing the incident later in a phone interview with Interlochen Public Radio , Eckerle @ @ @ @ @ @ @ do n't regret calling it an n***** , '' Eckerle told IPR .
`` A n***** is a n***** is a n***** .
That 's not a person whatsoever . ''
IPR reports that the commissioner compared using the word to saying someone is German , or a `` Polack , '' a derogatory term for people of Polish descent .
`` No , it is not racism , '' Eckerle said .
Some of Michigan 's top officials disagree , and they 're urging Eckerle to resign .
Gov .
Gretchen Whitmer @ @ @ @ @ @ @ Eckerle 's departure Friday .
`` Governor Whitmer believes that Road Commissioner Tom Eckerle must resign immediately , '' said Tiffany Brown , the governor 's press secretary .
`` His comments are atrocious .
The Governor has been very clear – there 's no place for hate and racism in Michigan . ''
The road commission 's members are elected officials , holding office for six-year terms .
Eckerle , a Republican , was elected in 2018 .
State Rep. Jack O'Malley , a Republican whose district includes Leelanau County , says @ @ @ @ @ @ @ side of the story — and that after hearing it , he asked the commissioner to step down .
Eckerle refused , O'Malley says .
`` I did remind him he represents everyone in Leelanau County as I do , '' O'Malley said via Facebook , `` and his comments were and are beyond stupid . ''
O'Malley says there are at least two ways to remove a road commissioner .
Voters can petition for a recall , he said ; or the county 's board can ask the governor to remove him @ @ @ @ @ @ @ County Road Commission signed a joint letter on Thursday , asking him to resign immediately .
`` We will not tolerate any kind of racism in our meeting room or in our organization , '' the commission 's four other members wrote .
They added that Eckerle 's behavior has had `` a serious effect '' on the commission .
The Northern Michigan Anti-Racism Task Force , an advocacy group , is calling on county officials to seek Eckerle 's removal .
The group also says a recall petition is being set up @ @ @ @ @ @ @ community members to begin the recall petition effort , '' the task force said Friday , in an email to NPR .
`` There is no place for hate in our beautiful communities of Northern Michigan . ''
One day after Eckerle used the slur in a official setting , Whitmer signed an executive order declaring racism to be a public health crisis in Michigan .
The COVID-19 pandemic , Whitmer said , has exposed `` the deadly nature of pre-existing inequities caused by systemic racism . ''
The road commission 's next @ @ @ @ @ @ @

'Not A Person Whatsoever': Michigan County Official Defends Use Of N-Word
A county official in Michigan is defending his use of the N-word — by repeatedly saying the slur, and insisting that it does not imply he is a racist.
Leelanau County Road Commissioner Tom Eckerle has been facing calls to resign since Tuesday, when he reportedly used one of the most taboo words in U.S. society to explain why he would not be wearing a face mask.
"Well, this whole thing is because of them n****** down in Detroit," Eckerle said, according to the Leelanau Enterprise.
Commission Chairman Bob Joyce quickly challenged Eckerle's use of the word: "You can't say that!" he is quoted saying.
"I can say anything I want," Eckerle reportedly replied. "Black Lives Matter has everything to do with taking the country away from us."
Eckerle made the comments in the commission's meeting room Tuesday, just before a public meeting was to begin. Discussing the incident later in a phone interview with Interlochen Public Radio, Eckerle doubled down.
"No, I don't regret calling it an n*****," Eckerle told IPR. "A n***** is a n***** is a n*****. That's not a person whatsoever."
IPR reports that the commissioner compared using the word to saying someone is German, or a "Polack," a derogatory term for people of Polish descent.
"No, it is not racism," Eckerle said.
Some of Michigan's top officials disagree, and they're urging Eckerle to resign. Gov. Gretchen Whitmer added her name to those calling for Eckerle's departure Friday.
"Governor Whitmer believes that Road Commissioner Tom Eckerle must resign immediately," said Tiffany Brown, the governor's press secretary. "His comments are atrocious. The Governor has been very clear – there's no place for hate and racism in Michigan."
The road commission's members are elected officials, holding office for six-year terms. Eckerle, a Republican, was elected in 2018.
State Rep. Jack O'Malley, a Republican whose district includes Leelanau County, says he sought out Eckerle to hear his side of the story — and that after hearing it, he asked the commissioner to step down. Eckerle refused, O'Malley says.
"I did remind him he represents everyone in Leelanau County as I do," O'Malley said via Facebook, "and his comments were and are beyond stupid."
O'Malley says there are at least two ways to remove a road commissioner. Voters can petition for a recall, he said; or the county's board can ask the governor to remove him.
Eckerle's colleagues on the Leelanau County Road Commission signed a joint letter on Thursday, asking him to resign immediately.
"We will not tolerate any kind of racism in our meeting room or in our organization," the commission's four other members wrote. They added that Eckerle's behavior has had "a serious effect" on the commission.
The Northern Michigan Anti-Racism Task Force, an advocacy group, is calling on county officials to seek Eckerle's removal. The group also says a recall petition is being set up.
"We are working with other community members to begin the recall petition effort," the task force said Friday, in an email to NPR. "There is no place for hate in our beautiful communities of Northern Michigan."
One day after Eckerle used the slur in a official setting, Whitmer signed an executive order declaring racism to be a public health crisis in Michigan.
The COVID-19 pandemic, Whitmer said, has exposed "the deadly nature of pre-existing inequities caused by systemic racism."
The road commission's next meeting is slated for Aug. 18.


npr--2020-08-07--How The Coronavirus Has Affected Individual Members Of Congress

How The Coronavirus Has Affected Individual Members Of Congress The coronavirus pandemic has upended the daily work of Congress .
Starting in March , House and Senate leaders delayed bringing back members for several weeks as public health guidelines recommended social distancing because of the outbreak .
The Senate finally returned in May , but the much larger House still stayed mostly away as a result of advice from the attending physician to Congress .
That same month , the House approved historic rule changes allowing remote voting and hearings .
The virus has infected several lawmakers and forced many @ @ @ @ @ @ @ members of their staffs and Capitol Hill workers have tested positive .
And it remains an ongoing threat .
Two Republican lawmakers , Sen. Ted Cruz of Texas and Rep. Paul Gosar of Arizona , were the first members of Congress to announce self-quarantines on March 8 .
Both had attended the Conservative Political Action Conference in National Harbor , Md.
, a few days earlier .
An attendee at the conference had fallen ill , its organizers revealed .
The following week , the first two members of Congress said they tested @ @ @ @ @ @ @ Mario Diaz-Balart of Florida and Democratic Rep. Ben McAdams of Utah both said they developed symptoms after a March 14 vote on a coronavirus relief package .
Since that time , dozens more lawmakers entered self-quarantine as a result of exposure to someone who was sick , including fellow members of Congress , constituents and dignitaries .
And by late July , at least 85 Capitol workers have reported a positive test or were presumed so , including more than two dozen members of the U.S. Capitol Police .
On July 24 , @ @ @ @ @ @ @ Republican Rep. Vern Buchanan of Florida , died from COVID-19 .
And some lawmakers have taken antibody tests to see if they were previously ill .
Among them , Democratic Sens .
Tim Kaine of Virginia and Bob Casey of Pennsylvania , both said they tested positive months after experiencing symptoms in the spring .
To stem the flow of new cases , both chambers have issued new social distancing guidance .
Also , the U.S. Capitol remains closed to public tours and open only to members , staff , press and official @ @ @ @ @ @ @ House Speaker Nancy Pelosi also issued a new mask mandate after Rep. Louie Gohmert , R-Texas , who has often rejected mask protocols , tested positive for the coronavirus .
Gohmert had attended several hearings a day before testing and returned to the Capitol following a White House screening that caught his infection .
This story was originally published on April 15 , 2020 .

Congress and COVID-19: members' cases and quarantines
Enlarge this image toggle caption Al Drago/Bloomberg via Getty Images Al Drago/Bloomberg via Getty Images
Editor's note: This page is no longer updating as of Dec. 31, 2021.
A number of congressional lawmakers experienced breakthrough COVID-19 infections as coronavirus cases rose nationwide with the spread of the omicron variant.
Earlier in 2021, Congress went months with no coronavirus cases among its members. That came a halt amid a national surge driven by the delta variant, when Republican Reps. Vern Buchanan of Florida and Clay Higgins of Louisiana reported infections in July. Buchanan says he was fully vaccinated, but that was less clear for Higgins.
At least another dozen members followed throughout the fall with news they had also tested positive for coronavirus; many of those infections involving vaccinated Senate and House members.
Before these latest waves, Congress' nearly six-month case pause came after a majority of more than 500 lawmakers were fully vaccinated by January. The Capitol's attending physician then lifted much of the mask mandates that dominated the past year. However, a minority of House Republican members have refused to seek vaccination.
Lawmakers impact by the coronavirus
This new threat arrives after the coronavirus already exacted a large toll on the Capitol.
Last year, the pandemic upended daily work for months, sickening dozens of members and hundreds of workers. A sitting congressman, a member-elect and an aide died.
By February 2021, more than 60 lawmakers and 360 Capitol Hill workers had tested positive, or were presumed so, for the coronavirus, according to NPR's tracker and congressional aides.
Loading...
See a list of all members who tested positive or quarantined.
That same month, Rep. Ron Wright, R-Texas, became the first sitting member of Congress to die after a more than two-week battle with COVID-19. In December, Rep.-elect Luke Letlow of Louisiana died days before he was due to be sworn in for a seat that was later filled in April by his widow, Rep. Julia Letlow, following a special election.
And last summer, an aide to Buchanan died from COVID-19.
The rash of infections among members continued at a consistent pace since the pandemic began, with the longest stretch without any such cases lasting about three weeks during recess periods away from Washington, D.C.
But this past March, Capitol Hill began its first month-long stretch without any reported cases or quarantines among members. The most recent positive case before July was reported by Rep. Stephen Lynch, D-Mass., on Jan. 29, despite his having received his second dose of the vaccine days earlier.
Another member, House Oversight Committee Chair Carolyn Maloney, D-N.Y., reported that she quarantined on Feb. 1. It ended Feb. 8 without a report of a positive test.
January 6 insurrection caused spike in cases on Capitol Hill
Up until this summer, the most recent outbreak of cases on Capitol Hill for members was triggered by the Jan. 6 insurrection, which forced members to cluster together in rooms for several hours. Some House Republicans were seen refusing to wear masks during the ordeal.
Later, Monahan told Congress that at least one of these holding rooms for House members included a lawmaker who was already positive.
More than a half-dozen members quarantined as a result, and several tested positive, including Democratic Reps. Bonnie Watson Coleman of New Jersey and Brad Schneider of Illinois.
In all, January proved to be one of members' worst month for the coronavirus, with at least 16 lawmakers testing positive. Before the insurrection, the House met to launch a new session before reinstating rules allowing proxy voting.
This, as congressional leaders and lawmakers received the Pfizer-BioNTech COVID-19 vaccine, which became available to members in December. The doses were provided to meet long-standing requirements for continuity of government operations, Monahan told members in a Dec. 17 note.
Pandemic impacted congressional operations
Ahead of the vaccinations, both chambers of Congress recessed multiple times last year as the Capitol went largely without a widespread testing program.
The Democratic-controlled House installed emergency proxy voting and remote hearings in May 2020, and Pelosi extended the covered period several times due to the pandemic. It remains in place until at least until mid-August.
In November, Pelosi triggered a broader coronavirus testing program for Congress following new requirement for travelers to the Washington, D.C., area.
Pelosi has previously said with about 75% of House members vaccinated, and several Republicans who refuse to do so, she's unclear when Congress will fully get back to normal.
"One of the most substantial steps that can be taken is that everybody should be vaccinated," Pelosi told reporters in March, later adding, "We need 100% of the members vaccinated, because it just takes one to endanger others."
The pandemic delayed other rituals, such as President Biden's first address before a joint session of Congress, which was held with only 200 socially distanced guests on April 28.
Last year remains a reminder of how quickly outbreaks spiraled out of control among lawmakers.
In December, at least nine House members, including six Republicans, tested positive for the coronavirus. And November proved to be another one of the worst months of the pandemic for Congress, when at least 15 lawmakers said they were infected, including two of the oldest, Republicans Rep. Don Young of Alaska and Sen. Chuck Grassley of Iowa.
A previous outbreak in September was tied to a White House Rose Garden ceremony to announce Amy Coney Barrett as then-President Donald Trump's Supreme Court justice nominee. Trump, then-first lady Melania Trump and dozens of others in attendance tested positive, including Republican Sens. Mike Lee of Utah and Thom Tillis of North Carolina.
It was one of several instances forcing leaders to change the congressional schedule.
Starting in the first month of the pandemic, in March 2020, House and Senate leaders delayed bringing back members in light of public health guidelines recommending social distancing.
The Senate returned in May 2020, but the much larger House remained mostly away under the advice of Monahan, the Capitol's attending physician. That same month, the House approved its historic rule changes to allow remote voting and hearings.
The first spate of cases began March 8, 2020, when two Republican lawmakers, Sen. Ted Cruz of Texas and Rep. Paul Gosar of Arizona, were the first members of Congress to announce self-quarantines. Both attended the Conservative Political Action Conference in National Harbor, Md., where another guest fell ill.
The following week, the first two members of Congress said they tested positive for the coronavirus. Republican Rep. Mario Diaz-Balart of Florida and then-Democratic Rep. Ben McAdams of Utah both said they developed symptoms after a March 14 floor vote on a coronavirus relief package.
By last summer, dozens of Capitol workers reported a positive test or were presumed so, and Gary Tibbetts, a longtime staffer for Buchanan died from COVID-19 on July 24.
Some lawmakers also took antibody tests to see if they were previously infected. They include Democratic Sens. Tim Kaine of Virginia and Bob Casey of Pennsylvania, who both said they tested positive months after experiencing symptoms in the spring.
To stem the flow of new cases, both chambers early on issued new social distancing guidance. Also, the U.S. Capitol closed to public tours and remained open only to members, staff, the press and official business visitors, and aside from the Jan. 6 breach by pro-Trump extremists, it has remained so.
In late July 2020, Pelosi also issued a temporary, new mask mandate after Texas GOP Rep. Louie Gohmert, who often rejected such protocols, tested positive. Gohmert had attended several hearings a day earlier and returned to the Capitol following a White House screening that caught his infection.
Gohmert's case triggered quarantines for five House members, including Arizona Democratic Rep. Raúl Grijalva. Days later, Grijalva tested positive but fully recovered symptom free. Until recent changes lifting the mask mandates, members could be fined or be forcibly removed by Capitol Police if they are not wearing masks.