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Three Ft or Six? Distancing Guideline for Faculties Stirs Debate

The Centers for Disease Control and Prevention are clear and consistent in their recommendation on social distancing: To reduce the risk of contracting the coronavirus, people should stay at least three feet away from other people who are not in their households . The guideline applies whether you’re eating in a restaurant, lifting weights in a gym, or studying a long pitch in a fourth grade classroom.

The directive was particularly relevant to schools, many of which have not fully reopened because they do not have enough space to keep students three feet apart.

With a better understanding of the spread of the virus and growing concerns about the harm caused by keeping children out of school, some public health experts are calling on the agency to reduce the recommended distance in schools from six feet to three feet .

“I’ve never noticed that six feet is particularly sensual for the purposes of damage control,” said Dr. Ashish Jha, dean of Brown University School of Public Health. “I wish the CDC would just come out and say this isn’t a big problem.”

On Sunday, Dr. Anthony S. Fauci, the director of the National Institute for Allergy and Infectious Diseases, said on CNN that the CDC was up Review the matter.

The idea remains controversial, also because few studies have directly compared different distancing strategies. But the problem also boils down to a devilishly difficult and often personal question: How safe is safe enough?

“There is no magical threshold for any distance,” said Dr. Benjamin Linas, an infectious disease specialist at Boston University. “There’s a risk at six feet, there’s a risk at three feet, there’s a risk at nine feet. There is always a risk. “He added,” The question is, what is the risk. And what do you give up for it? “

The origin of the six foot long distancing recommendation is a mystery. “It’s almost like it was pulled out of nowhere,” said Linsey Marr, a virus transmission expert at Virginia Tech University.

When the virus first appeared, many experts believed that it was mainly transmitted through large respiratory droplets that are relatively heavy. Ancient scientific studies, some dating back more than a century, suggested that these droplets did not travel more than three to six feet. That observation, plus an abundance of caution, may have led the CDC to make their six-foot-long proposal, said Dr. Marr.

However, this recommendation was not universal. The American Academy of Pediatrics recommends three to six feet of social distancing in schools, but the World Health Organization recommends only one meter, or 3.3 feet.

And over the past year, scientists have learned that respiratory droplets are not the primary mode of coronavirus transmission. Instead, the virus mainly spreads through tiny droplets in the air known as aerosols. These can travel long distances and flow through rooms in unpredictable ways.

Data also suggest that schools appear to be a relatively low risk environment. Children under the age of 10 seem to be less likely to transmit the virus than adults.

There has been evidence in recent months that school may not require six feet of distance. Fall rates were generally low even in schools with loose distancing policies. “We know that many schools are less than six feet open and have not seen large outbreaks,” said Dr. Yeh.

Updated

March 16, 2021, 7:09 p.m. ET

In a 2020 analysis of observational studies in different environments, the researchers found that a physical distance of at least a meter significantly reduced the transmission rates of several different coronaviruses, including those that cause Covid-19. However, they found evidence that a two-meter guideline “might be more effective”.

“One of the really important data points that have been missing is a head-to-head, head-to-head comparison of locations that have been implemented three feet apart with six feet apart,” said Dr. Elissa Perkins, director of Infectious Diseases in Emergency Medicine Management at Boston University School of Medicine.

Dr. Perkins and her colleagues recently performed such a comparison using a natural experiment in Massachusetts. Last summer, the state’s Department of Education issued guidelines recommending three to six feet away in schools due to reopen in the fall. As a result, school policies were different: some districts enforced a strict six-foot distancing while others only required three. (The state required all staff, as well as second-grade students and above, to wear masks.)

The researchers found that the social distancing strategy had no statistically significant impact on Covid-19 case rates, the team reported in the journal Clinical Infectious Diseases last week. The study also found that Covid-19 rates in schools were lower than in surrounding communities.

The authors say the results reassure schools that schools can relax their distancing requirements and still be safe, provided they take other precautions, such as enforcing wearing a universal mask.

“The masking still appears to be effective,” said lead investigator Dr. Westyn Branch-Elliman, an infectious disease specialist with the VA Boston Healthcare System. “Assuming we have universal masking mandates, I think it very sensible to move to a three-foot recommendation.”

Class disturbed

Updated March 15, 2021

The latest on how the pandemic is changing education.

Not everyone finds the study so convincing. A. Marm Kilpatrick, an infectious disease researcher at the University of California at Santa Cruz, said the school district’s data was too loud to draw any definitive conclusions. “It doesn’t really allow you to get an answer that you can really feel confident about,” he said.

The study’s authors admitted that they couldn’t rule out that increased distancing was of little benefit.

With aerosol transfer, safety generally increases with distance. The further the aerosols move, the more dilute they become. “It’s like being near a smoker,” said Dr. Marr. “The closer you are, the more you will breathe in.”

And apart from the distance, the more people there are in a room, the higher the likelihood that one of them will get infected with the coronavirus. A six-foot rule helps reduce that risk, said Donald Milton, aerosol expert at the University of Maryland: “When people are six feet apart, you can’t wrap them up. So it’s safer just because it’s less dense. ”

Masks and good ventilation go a long way in reducing the risk. With these measures, the difference between three and six feet should be relatively small, scientists said. And if Covid-19 isn’t very common in the surrounding community, the absolute risk of contracting the virus in schools is likely to remain small as long as that protection is in place.

“There is always something we can do to further reduce our risks,” said Dr. Marr. “But at some point you will see declining returns and you will have to think about the cost of trying to achieve these additional risk reductions.”

Some experts say a small increase in risk will be outweighed by the benefits of fully reopening schools. “Trying to follow the 6-foot guideline shouldn’t prevent us from bringing children back to school full-time with masks at least 3 feet away,” said Dr. Marr.

Others said it was too early to relax CDC guidelines. “Ultimately, I think there might be a place for this changing guide,” Saskia Popescu, an infectious disease epidemiologist at George Mason University, said in an email. “But it’s not now when we’re struggling to vaccinate people we’re still seeing over 60,000 cases a day and we’re trying not to reverse the advances we’ve made.”

Even proponents of changing the guideline say that any switch to loose detachment must be done carefully and in combination with other precautionary measures. “If you are in an area where there is not a strong tendency to rely on masks, I don’t think it is advisable to extrapolate our data to that environment,” said Dr. Perkins.

Additionally, officials risk confusing the public health news by setting different standards for schools than other common spaces. “I’ve developed further,” said Dr. Linas. “Last summer I felt like, ‘How are we going to explain to people that it’s six feet everywhere except in schools? That doesn’t seem consistent and problematic. ‘”

But schools are unique, he said. They are relatively controlled environments that can enforce certain security measures, and they have unique benefits to society. “The benefits of school are different from the benefits of cinemas or restaurants,” he said. “So I’d be willing to take a little more risk just to keep it open.”

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GE Healthcare launches new wi-fi hand-held ultrasound as CEO eyes rising market

A handheld ultrasound (Vscan Air) that leads beyond highly specialized areas of medicine such as obstetrics and cardiology to general practitioners.

Source: GE

General Electric announced the launch of its new Vscan Air wireless portable ultrasound machine on Tuesday to take a leadership position in the growing market.

It is the company’s most recent entry into the emerging point-of-care ultrasound market, building on GE Healthcare’s first generation device, the Vscan, released in 2010. Since then, the market has grown rapidly, said Kieran Murphy, CEO of GE Healthcare in an interview with CNBC, the device maker launched the revamped, highly portable Vscan Air to strengthen its position in the market. It will be available in the US and Europe starting Tuesday. It is planned to introduce it in other countries and regions pending official approval.

GE Healthcare estimates that the handheld ultrasound machine market will grow by as much as $ 1 billion over the next decade, and the company plans to capture 30% of that with the Vscan Air by 2025.

The device is about the size of an iPhone, is completely wireless, and costs less than $ 5,000, although the price varies by region. It connects to a smartphone app to read the ultrasound, and GE says the images are safe to share with patients. The device can be used by trained health care providers to quickly assess blood flow, gallbladder disease, and assess and monitor Covid-19 through a lung exam.

Outpatient, ER used

Murphy explained that portable ultrasound devices like the Vscan Air should be used in time sensitive situations and when console-based ultrasound is not available. According to Murphy, the devices could be ubiquitous in emergency rooms, general practitioners’ offices, and all types of outpatient departments such as emergency centers for quick and inexpensive diagnosis. It can also be used in a home setting, as well as in road and air ambulances, as approved by the U.S. Food and Drug Administration.

Murphy also noted that the pivotal point towards telemedicine with the pandemic and increased use of ambulances could increase the demand for portable tools like the Vscan Air. He said GE will have to do “quite a bit” to increase market awareness through public relations, including on social media and various distribution channels.

“We have seen tremendous growth in the use of telemedicine, teleradiology and remote monitoring over the past year. For people who do not have access to specialized counselors, the fact that they can have access to a doctor armed with one of these resources is going to make a huge difference, “Murphy said of Vscan Air.” I think that’s going to show up everywhere. “

GE isn’t the only one operating in space. Competitors in the point-of-care ultrasound market include digital health company Butterfly Network, valued at $ 3.5 billion, and Koninklijke Philips, of the Netherlands. Murphy said GE plans to leverage its name recognition, ultrasound device track record, and medical device installation base connected through GE’s Edison artificial intelligence health platform to differentiate itself.

Doctor’s perspective

Dr. Yale Tung-Chen, head of the Department of Ultrasound in Internal Medicine at the Hospital Universitario Puerta de Hierro in Majadahonda in Madrid, is one of the doctors who had early access to the Vscan Air as a clinical reviewer.

He currently works at the Spanish Isabel Zendal Emergency Hospital Covid-19 and swears by portable ultrasound devices, especially for use in emergency rooms, where time is precious and rapid diagnosis can have serious consequences.

“How can I get 30 full exams in a short time? It’s impossible,” said Tung-Chen of examining patients in a busy emergency room. “I have to pull something out of my pocket and look at it for no more than a minute or two and then make the decision.”

Dr. Yale Tung-Chen, Head of the Department of Ultrasound in Internal Medicine at Universitario Puerta de Hierro Hospital in Majadahonda in Madrid, Spain, was a clinical reviewer for Vscan Air. He is currently working at the Spanish Covid-19 specialist Isabel Zendal Emergency Hospi

Source: Dr. Yale Tung-Chen

Tung-Chen has used many handheld ultrasound machines, including those from GE’s competitors, but said in an interview that he was impressed with the high quality imaging the Vscan Air was able to capture. The two-sided probe design allows technicians to switch between shallow and deep exams by simply flipping the device, he said. Normally the doctor would have to change the probes for this, which costs valuable time.

This feature is especially important in cardiac exams that Tung-Chen used to look for signs of infection that could be due to Covid-19 and to monitor the progression of the disease to see if the patient is getting seriously ill . He said the ultrasound machine can help doctors find early signs of life-threatening diseases such as Covid-19, but added that the device does not fully replace traditional diagnostic tools such as stethoscopes.

“Ultrasound makes bad doctors good and good doctors make good doctors,” he said.

2021 outlook

Murphy said he still sees strong growth in 2021. On GE Investor Day last week, the health unit reported free cash flow of $ 2.6 billion for 2020, up from $ 1.2 billion in 2019. Murphy said this was partly due to the delivery of 50,000 ventilators. which have been widely used in the past year to help seriously ill Covid-19 patients.

“We had a successful year. We handled an incredible number of headwinds well,” said Murphy, adding that the company’s role in the pandemic helped improve employee morale.

The company makes most of its money selling and servicing equipment for electoral processes that have been delayed in much of the world as hospitals focus on treating Covid-19 patients. As patients attempt to return to the hospital for x-rays, MRIs, procedures requiring anesthesia, and more, Murphy said it will all benefit business.

The health unit forecasts flat to slightly increasing free cash flow for 2021, based on slight sales growth and an expansion in profit margins.

“Everyone says well, Covid gave you a fantastic year, but Covid suppressed some of the things that come back this year,” he said. “We made a great start and I am very confident that we will have a good year.”

Correction: On GE Investor Day last week, the health unit reported free cash flow of $ 2.6 billion for 2020 compared to $ 1.2 billion in 2019. In an earlier version of this article, free cash flow was misrepresented .

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Health

How Kids Learn Otherwise From Books vs. Screens

Dr. Radesky, who with Dr. Munzer was involved in the research projects, spoke about the importance of helping children master reading that goes beyond certain details – words or signs or events – so that a child can “gain knowledge from history with life experience. “Again, she said, that’s not what is emphasized in digital design. “Things that get you thinking, make you slow down and process things deeply, don’t sell, don’t get the most clicks,” she said.

Parents can help with this when their children are young, said Dr. Radesky by discussing the story and asking the questions that will help children make those connections.

“When children enter digital spaces, in addition to the e-books they are supposed to read, they have access to an infinite number of platforms and websites,” said Dr. Radesky. “We have all been there and have helped our children through distance learning and observed how they cannot resist opening this tab, which is less demanding.”

“Throughout the fall, I’ve been helping families remove their child from YouTube,” said Dr. Radesky. “You’re bored, it’s easy to open a browser window,” adults know all too well. “I am concerned that, during distance learning, children have learned to orient themselves on devices with this very weak partial attention.”

Professor Baron said that in an ideal world children would learn “how to read coherent texts for pleasure, how to stop, how to reflect”.

In elementary school, she said, there is an opportunity to start a conversation about the benefits of the different media: “It’s about printing, it’s about a digital screen, it’s about audio, it’s about video, they all have their uses – us need to make children aware that not all media are best for all purposes. “Children can experiment with digital and print reading and be encouraged to talk about what they have noticed and what they enjoyed.

Dr. Radesky talked about helping children develop what she called “metacognition” by asking themselves questions like, “How does my brain feel, what does this mean for my attention span?” From the ages of 8-10, children develop the skills to understand how to stay at work and how to get distracted. “Children recognize when the classroom is getting too crowded. We want them to know when you are in a very busy digital space, ”she said.

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Europe’s suspension of AstraZeneca’s Covid vaccine is damaging

LONDON – The decision of many European countries to stop using the Oxford-AstraZeneca University coronavirus shot could have far-reaching ramifications, analysts say, as vaccine uptake and the wider vaccination program are already lagging behind in the region.

Sweden and Latvia were the last countries to stop using the Oxford-AstraZeneca vaccine on Tuesday over concerns about blood clots. The move follows, among others, Germany, France, Spain, Italy and Ireland to temporarily suspend use of the vaccine as a precautionary measure, while assessing whether there is a connection between the shot and an increased risk of blood clots.

The World Health Organization, drug regulators, and the vaccine maker itself have tried to downplay persistent safety concerns. There is currently no evidence to suggest that there is a link between the shot and an increased risk of developing blood clots, which are common in the general population.

In particular, the WHO has asked the countries not to pause with the shot in their vaccination rollouts. The Advisory Committee on Vaccine Safety has checked the available data and is in close contact with the EU Medicines Agency, the European Medicines Agency.

Additional expert guidance is expected to be announced shortly after the security reviews: the WHO Security Committee will meet on Tuesday, while the EMA will meet on Thursday.

EMA Executive Director Emer Cooke said in a news conference on Tuesday that EU member states’ decision to suspend use of the vaccine could result in lower public confidence in the shot, which affects vaccines confidence, but our job is to make sure that the products we approve are safe. “

It’s not the first time Oxford-AstraZeneca’s vaccine has come under pressure as the drug maker was previously asked about its testing method and data, the effectiveness of the shot in those over 65, and a publicized dispute with the EU Delivery of supplies to the block.

However, health experts and policy analysts are questioning whether much of Europe’s decision to suspend use of the AstraZeneca shot is misplaced and is likely to further damage or even cost lives confidence in the vaccine if a third wave of infections is observed is Paris to Prague, and the introduction of shots by the EU is already slow.

“At this stage, national regulators are likely to act conservatively and out of caution. A risk-averse approach will help reassure the public and limit the impact on future adoption. But the prospect of a longer review or an outright ban cannot be ruled out, “said Federico Santi, Senior Europe Analyst at Eurasia Group, in a statement on Monday.

“Either way, the damage has been done. Willingness to take the AstraZeneca vaccine has already been lower than that of mRNA vaccines available in the EU, as the effectiveness of the headlines and initial confusion about its suitability for those over 65 years of age initially began were confused, “he said.

Some wonder if there was a political element behind the decision to pause the vaccine, as there have been disputes about it in the past.

Several European countries initially decided not to recommend the vaccine for people over 65 as there wasn’t enough evidence that it was effective before reversing that decision as more data became available showing it was the number severe Covid infections and hospital stays were highly effective in reducing deaths.

Such decisions, which were not supported by derogatory remarks from some European heads of state and government (French President Emmanuel Macron once said the vaccine was “virtually ineffective” for those over 65), were viewed by some Europeans only as reluctant to Oxford -AstraZeneca viewed vaccine. The introduction of vaccination in the EU is already much slower than in the UK and US, and the bloc leadership has come under fire for its vaccination strategy.

“We know where this is going, it will lead to a loss of confidence in the vaccine,” Natasha Loder, health policy editor for The Economist, told the BBC’s “Today” program on Tuesday.

When asked whether the suspension had a political dimension, Loder said, “It could be that this vaccine feels bad.” Nevertheless, the decision has “no rational basis” and could be dangerous. “This precautionary principle is nonsense when you are in the middle of a pandemic,” Loder said.

“This is a safe vaccine and when they realize that this is a safe vaccine in Europe they will have to face the aftermath of all this media coverage.”

However, not all EU countries are following the same path. Belgium, Poland and the Czech Republic say they will continue to use the shot, saying the benefits outweigh the risks.

AstraZeneca has vigorously defended its vaccine, stating in a statement Sunday that the number of blood clots recorded after vaccination was fewer than would naturally be expected.

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A Secret Warfare. Many years of Struggling. Will the U.S. Ever Make Good in Laos?

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The article was produced in partnership with the Pulitzer Center.

It was a blazing-hot morning in October 2019 on the old Ho Chi Minh Trail, an intricate web of truck roads and secret paths that wove its way across the densely forested and mountainous border between Vietnam and Laos. Susan Hammond, Jacquelyn Chagnon and Niphaphone Sengthong forded a rocky stream along the trail and came to a village of about 400 people called Labeng-Khok, once the site of a logistics base inside Laos used by the North Vietnamese Army to infiltrate troops into the South. In one of the bamboo-and-thatch stilt houses, the ladder to the living quarters was made from metal tubes that formerly held American cluster bombs. The family had a 4-year-old boy named Suk, who had difficulty sitting, standing and walking — one of three children in the extended family with birth defects. A cousin was born mute and did not learn to walk until he was 7. A third child, a girl, died at the age of 2. “That one could not sit up,” their great-uncle said. “The whole body was soft, as if there were no bones.” The women added Suk to the list of people with disabilities they have compiled on their intermittent treks through Laos’s sparsely populated border districts.

Hammond, Chagnon and Sengthong make up the core of the staff of a nongovernmental organization called the War Legacies Project. Hammond, a self-described Army brat whose father was a senior military officer in the war in Vietnam, founded the group in 2008. Chagnon, who is almost a generation older, was one of the first foreigners allowed to work in Laos after the conflict, representing a Quaker organization, the American Friends Service Committee. Sengthong, a retired schoolteacher who is Chagnon’s neighbor in the country’s capital, Vientiane, is responsible for the record-keeping and local coordination.

The main focus of the War Legacies Project is to document the long-term effects of the defoliant known as Agent Orange and provide humanitarian aid to its victims. Named for the colored stripe painted on its barrels, Agent Orange — best known for its widespread use by the U.S. military to clear vegetation during the Vietnam War — is notorious for being laced with a chemical contaminant called 2,3,7,8-Tetrachlorodibenzo-P-dioxin, or TCDD, regarded as one of the most toxic substances ever created.

The use of the herbicide in the neutral nation of Laos by the United States — secretly, illegally and in large amounts — remains one of the last untold stories of the American war in Southeast Asia. Decades later, even in official military records, the spraying of Laos is mentioned only in passing. When the Air Force in 1982 finally released its partially redacted official history of the defoliation campaign, Operation Ranch Hand, the three pages on Laos attracted almost no attention, other than a statement from Gen. William Westmoreland, a former commander of U.S. forces in Vietnam, that he knew nothing about it — although it was he who ordered it in the first place. Laos remained a forgotten footnote to a lost war. To those who followed the conflict’s aftermath intimately, this was hardly surprising. Only in the last two decades has the United States finally acknowledged and taken responsibility for the legacy of Agent Orange in Vietnam, committing hundreds of millions of dollars to aiding the victims and cleaning up the worst-contaminated hot spots there.

While records of spraying operations inside Laos exist, the extent to which the U.S. military broke international agreements has never been fully documented, until now. An in-depth, monthslong review of old Air Force records, including details of hundreds of spraying flights, as well as interviews with many residents of villages along the Ho Chi Minh Trail, reveals that, at a conservative estimate, at least 600,000 gallons of herbicides rained down on the ostensibly neutral nation during the war.

For years, Hammond and Chagnon were aware of the spraying in Laos, but the remote areas affected were almost inaccessible. Finally, in 2017, with new paved roads connecting the main towns, and many smaller villages accessible in the dry season by rough tracks, they were able to embark on systematic visits to the villages of the Bru, the Ta Oey, the Pa Co and the Co Tu, four of the ethnic minorities whose homes straddle the Laos-Vietnam border. It was the first time anyone had tried to assess the present-day impact of the defoliant on these groups.

Of the 517 cases of disabilities and birth defects so far documented by the War Legacies Project in Laos, about three-fourths, like malformed limbs, are identifiable to the untrained eye as conditions of the sorts now linked to exposure to Agent Orange. “When we started the survey, I told American government officials we were doing it and said honestly that we didn’t know what we would find,” Hammond says. “In fact, I hoped we would find nothing. But as it turned out we’ve found a lot.”

Hammond’s requests for both the United States and Laos to acknowledge the long-term effects of the spraying have so far been met with bureaucratic rationalizations for inaction: Congress can do nothing without a clear signal from the Lao government; the Lao government has been hesitant to act without hard data; officials of the United States Agency for International Development in Vientiane have been sympathetic, but other senior embassy officials have waved away the problem. “One said that if we were so interested in what the U.S. had done in Laos, why didn’t we look at what the Soviets and the North Vietnamese had done?” Hammond recalls. “It was like being in a time warp, like dealing with an official in Vietnam in the 1990s. So we’ve been on this endless treadmill.”

So far, these conversations with officials have been informal, but this month she plans to submit the group’s findings to both governments, documenting the extent of the spraying recorded in the Air Force records and the number of disabilities the War Legacies Project has found. That’s when the governments of the United States and Laos will no longer have any reason to avoid taking action that is long overdue.

For Hammond and Chagnon, the personal connection to the war runs deep. Chagnon took time off from college in 1968 to work with Catholic Relief Services in Saigon, later living in a compound near the Tan Son Nhut air base. Even though public opinion had turned sharply against the war since the Tet offensive earlier that year, she wasn’t an antiwar activist. “I’d never been to a demonstration,” she says. “My parents were furious at me for going into a war zone.”

The first jolt to her innocence, she recalls, came when newspapers in Saigon published gruesome photographs of malformed babies and fetuses in Tay Ninh, a heavily sprayed province on the Cambodian border. By the late 1960s, Vietnamese doctors had strong indications that these congenital defects might be connected to the chemical defoliants. By the time Chagnon came home in 1970, the defoliation campaign was about to be shut down amid growing controversy over its possible health effects. But her anxiety increased. Many of the early spraying sorties had taken off from Tan Son Nhut, and she worried about her own exposure and the long-term effects if she had children. Those fears seemed to be confirmed when her daughter, Miranda, was born in 1985 with multiple birth defects. There was no proof that dioxin was responsible, and Miranda’s ailments were treatable with surgery and medication, but that hardly quelled Chagnon’s concerns about Agent Orange.

By this time Chagnon and her husband, Roger Rumpf, a theologian and well-known peace activist, were living in Vientiane and visited remote areas where few outsiders ever ventured. They had heard strange and unsettling stories in Xepon, a small town near the Vietnamese border. Doctors reported a rash of mysterious birth defects. A veterinarian told of farm animals born with extra limbs. There were anecdotal accounts of airplanes trailing a fine white spray. But it was impossible to find out more. “In those days there were no roads into the mountains,” Chagnon says. “You had to walk, sometimes for days.”

Hammond was born in 1965 while her father was serving at Fort Drum in upstate New York — a dark coincidence, she says, “since it was one of the first places they tested Agent Orange.” From there her father’s Army career took the family to Okinawa. Based in Danang, he was responsible for the construction of military installations in I Corps, the northernmost tactical zone in South Vietnam.

Hammond first went to Vietnam in 1991, when talk of normalizing relations was in the air. She fell in love with the place, abandoned thoughts of pursuing a Ph.D., moved to Ho Chi Minh City in 1996 to learn the language and spent the next decade organizing educational exchange programs and conferences to discuss Vietnam’s postwar humanitarian needs. It was at one of these events that she met Chagnon.

Since it began, their project has channeled modest amounts of material support to disabled people — things like a wheelchair ramp or a vocational training course or a brood cow to increase household income — in rural areas of Vietnam that were heavily sprayed. Then, in 2013, Chagnon’s husband died. “After Roger passed away, we started talking about the idea of doing a survey in Laos,” Hammond says. “I think Jacqui saw it as an opportunity to honor his memory.” After protracted negotiations with Lao authorities, the War Legacies Project signed a three-year memorandum of understanding, promising a full report by March 2021.

More than half the cases identified by the War Legacies Project are children age 16 and under. They are the grandchildren of those who were exposed during the war, and possibly even the great-grandchildren, since the people in these villages have traditionally married in their teens. Club feet are commonplace. So are cleft lips, sometimes accompanied by cleft palate. There are disturbing clusters: five babies born with missing eyes in Nong District; a family with five deaf-mute siblings; an inordinate number of short legs, malformed legs and hip dysplasia in Samuoi District — the latter a condition that is easily treatable in infancy, but if neglected will lead to severe pain, a waddling gait and more serious deformity. The rudimentary health care system in rural Laos means that few if any infants even get a diagnosis.

In each village the women visited, groups of elders assembled to share their stories, many in their 70s yet still with sharp memories. At first, they recounted, they had no idea who was spraying and bombing their villages, or why. But in time they learned the names of the airplanes: T-28, C-123, B-52. In most villages, dozens were killed by the bombings or died of starvation. The survivors lived for years in the forests or in caves. They dug earthen shelters, big enough to hide a whole family, and covered them with branches. “We had no rice for nine years,” one old man said. Sugar cane and lemongrass survived the spraying. So did cassava, though it swelled to an outlandish size and became inedible — Agent Orange accelerated the growth of plant tissue, killing most foliage.

For the most part, the old men told their stories dispassionately. But one Pa Co elder in Lahang, a place rife with birth defects, was bitter. He was an imposing 75-year-old named Kalod, tall, straight-backed, silver-haired, wearing a dark green suit with an epauletted shirt that gave him a military bearing. Like most of his people, Kalod saw the border as an artificial construct. During the war, people went back and forth between Laos and Vietnam, he said, depending on which side was being bombed and sprayed at the time. He leaned forward, gesticulating angrily. “Vietnamese people affected by the chemical spraying get compensation,” he complained. “In Laos, we need support from America, like they receive in Vietnam.”

The 600,000 gallons of herbicides dropped in Laos is a fraction of the roughly 19 million that were sprayed on Vietnam, but the comparison is misleading. Between 1961 and 1971, some 18 percent of South Vietnam’s land area was targeted, about 12,000 square miles; in Laos the campaign, which began on the Ho Chi Minh Trail between Labeng-Khok and the Vietnamese border, was compressed in time and space. It was focused on narrow, defined strips of the trail, 500 meters wide (about 1,640 feet), and on nearby crop fields, and the heaviest spraying was concentrated in a four-month period early in the war. It was as intense a ramping-up of the defoliation campaign as in any major war zone in Vietnam at the time.

To make matters worse, the newly examined Air Force records show that the first intensive period of spraying in Laos used not Agent Orange, but the much more toxic Agent Purple, the use of which was discontinued in Vietnam almost a year earlier. Tests showed that the average concentration of TCDD in Agent Purple, a different chemical formulation, was as much as three times higher than in Agent Orange.

Long before the first Marines came ashore in Vietnam in 1965, infiltrators from the North were trickling into the South from the still-rudimentary Ho Chi Minh Trail, and the loyalties of the tribal groups along the border were dubious. In response to the growing insurgency, U.S. Special Forces set up small camps near the border with Laos, notably at Khe Sanh, which later became a gigantic Marine combat base, and in the A Shau valley, later infamous for the battle of Hamburger Hill and seen by U.S. strategists as the most important war zone in South Vietnam.

Operation Ranch Hand was in its infancy. By July 1962, only a handful of missions had been flown, defoliating the perimeters of highways, power lines, railroads and the waterways of the Mekong Delta. The commander of U.S. forces in Vietnam, Gen. Paul D. Harkins, now requested authority to hit six new targets. One of them was the A Shau valley, and it would be the first mission aimed at destroying crops that might feed the enemy. The Joint Chiefs of Staff refused: The location was too sensitive; the valley was right on the border, and the neutrality of Laos was just days from being guaranteed under an international agreement. Harkins pushed back, arguing that the proximity of the unsecured border was precisely the point. Despite President John F. Kennedy’s strong reservations about crop destruction, the mission went ahead.

The following January, a 25-year-old Army captain from the South Bronx arrived at the A Shau base. In February, “We burned down the thatched huts, starting the blaze with Ronson and Zippo cigarette lighters,” he wrote later. “The destruction became more sophisticated. Helicopters delivered 55-gallon drums of a chemical herbicide to us, a forerunner of Agent Orange. … Within minutes after we sprayed, the plants began to turn brown and wither.” The young officer was Colin Powell, future chairman of the Joint Chiefs of Staff and secretary of state. The chemical was Agent Purple. By the end of the defoliation campaign, at least half a million gallons of herbicides would be used in the A Shau valley, making it one of the most heavily sprayed places in Vietnam; thousands eventually became sick or died.

The flow of North Vietnamese troops down the trail only increased, and by late 1965 the C.I.A. was reporting that hundreds of miles of new roads had been built or upgraded to carry trucks. The Air Force was already bombing North Vietnam, so the obvious answer was to escalate the bombing on the Ho Chi Minh Trail in Laos.

But in addition to Laos’s neutrality, there was a second problem: Where exactly was the trail? It ran through some of the most remote and inhospitable terrain on Earth, concealed by dense rainforest, largely invisible to U-2 spy planes, infrared sensors on other aircraft, even low-flying helicopters. The solution was to strip away the forest cover to expose the bombing targets: the truck convoys and logistics centers like Labeng-Khok.

In essence, the initial spraying of Laos was a mapping exercise, formally integrated into a massive bombing campaign called Tiger Hound. In early December 1965, the ungainly C-123 aircraft, the workhorses of the herbicide campaign, crossed the Lao border for the first time. Within a week, the first wave of B-52s hit the Ho Chi Minh Trail.

The details of these air operations in Laos remained largely unknown until 1997, when Chagnon and Rumpf were at a get-together at the U.S. Embassy residences in Vientiane. They were friendly with Ambassador Wendy Chamberlin, who was on her way to Washington, Chagnon recalls. Was there anything they needed? Yes, Rumpf said, you can get the Air Force bombing records for Laos. While you’re at it, said Chagnon, never one to be shy, how about the records on Agent Orange?

By then, Chagnon and Hammond had gotten to know Thomas Boivin, a scientist with a Canadian company called Hatfield Consultants that was completing a landmark study of Agent Orange on the Vietnam side of the border, in the heavily sprayed A Shau valley (today known as the A Luoi valley, named after its main town). The records were in the form of computer punch cards and needed to be painstakingly converted into a database that showed every recorded flight, with its date and the geographical coordinates of where each spray run began and ended. Boivin later calculated that more than half a million gallons of chemicals had been sprayed on Laos, but other declassified Air Force documents show additional amounts not found in those initial records, and several village elders gave persuasive accounts of flights that didn’t seem to conform to the official data.

“I’m sure the records are incomplete,” says Jeanne Mager Stellman, an emerita professor of health policy and management at the Mailman School of Public Health at Columbia University, who played a pivotal role in documenting the spraying in Vietnam and calculating the risks of dioxin exposure for American veterans. “And my understanding is that the guys who were assigned to missions in Laos were sworn to secrecy.” Boivin adds that “the C.I.A. also undoubtedly used herbicides in Laos, but their records have never been declassified.”

In her push to have the U.S. government take responsibility for its actions in Laos, Hammond has been well aware that it took many years for the plight of America’s own veterans and their offspring to be acknowledged, and much longer still before the same compassion was extended to the Vietnamese victims of dioxin. The Agent Orange Act of 1991 was passed only after a bitter 14-year fight by veterans campaigning for recognition that the chronic illnesses that tens of thousands of them were developing might be directly connected to dioxin exposure. Once the legislation passed, it was determined that if you set foot in Vietnam between 1962 and 1975 and suffered from one of the conditions on the growing V.A. list, you were eligible for compensation. This resolution was a matter of political pragmatism rather than hard science. Although there was growing evidence of the toxicity of the herbicides, studies of their health impacts were inconclusive and fiercely contested. But the veterans formed an angry and influential constituency, and politicians had to assuage a good measure of guilt, both their own and that of the general public, over the trauma of those who had fought in a lost war that most Americans preferred to forget.

Accepting responsibility for the horrors visited on the Vietnamese took much longer. Even after diplomatic relations were restored in 1995, Agent Orange was a political third rail. Vietnamese complaints about the effects of the herbicides on human health — raising issues of reparations, corporate liability and possible war crimes — were dismissed as propaganda. American diplomats were forbidden even to utter the words. It was not until around 2000 that the United States was finally forced to acknowledge its obligations, after Hatfield Consultants completed its study of the impact of dioxin and showed U.S. officials incontrovertible evidence of how TCDD moved up the food chain, entered the human body and was transmitted to infants through breast milk.

Reconciliation between the United States and Vietnam was an intricate dance that depended on reciprocal steps to untangle the three most contentious legacies of the war. Once Washington had secured full cooperation in accounting for Americans missing in action, it began to aid Vietnam’s efforts to remove the vast amount of unexploded ordnance that still littered its fields and forests, killing and maiming tens of thousands. These steps, plus Hatfield’s breakthrough study, set the stage finally for the two countries to deal with Agent Orange, the most intractable problem of all.

The United States’ relationship with Laos has followed a similar sequence. Since the late 1980s, joint American-Lao teams have conducted hundreds of missions searching for the remains of aircrew who went missing on bombing missions, and over the last quarter-century Washington has committed more than $230 million to ordnance removal and related programs. The missing step has been Agent Orange, but lacking any data on its human impact, the Lao government has had little incentive to raise such a historically fraught issue. Few government soldiers fought in the sprayed areas, which were controlled by the North Vietnamese, so there were no veterans clamoring for recognition of their postwar sufferings. “In Vietnam, the magnitude of the problem made it impossible to ignore,” Hammond says. “But in Laos it was on a smaller scale, and in remote places outside of the political mainstream.”

All these years later, the mountainous border strip in the southern Lao panhandle is still a landscape defined by war and disease. Unexploded bombs are everywhere. The road that follows the Ho Chi Minh Trail south is a kind of living archive of the conflict, in which its remnants and relics have been absorbed into the fabric of everyday life. Men fish in boats made from the jettisoned fuel tanks of American fighter-bombers. Bomb craters from B-52 strikes are everywhere. Some are now fish ponds in the middle of the rice paddies.

Cluster-bomb casings have morphed into vegetable planters or substitute for wooden stilts to support the thatched huts that store rice, frustrating the claws of hungry rats. Everywhere the village soundtrack is the dull clang of cowbells made from sawed-off projectiles. “These are our gifts from the villagers of America,” one old man told me.

Once or twice the War Legacies team had to turn back, defeated by roads that were impassable after recent monsoon floods. Halfway to the village of Lapid, the four-wheel-drive vehicle ground to a halt in the hardened mud. Chagnon climbed out and paced up and down the steep slope, inspecting ruts that were deep enough to swallow a person whole. There was no way through. It was frustrating, because Lapid had been hit hard. An Operation Ranch Hand plane with its full load of chemicals had been shot down in the nearby hills, and after the war villagers called the area the “Leper Forest” for the high incidence of cancers and birth defects. On an earlier visit to Lapid, the War Legacies Project found a paralyzed baby girl, a 4-year-old with a club foot, a teenager born without eyes.

The survey has been a slow and laborious process. Since 2017, the women have visited scores of villages in heavily sprayed districts in two of the four border provinces that were targeted: Savannakhet and Salavan. In each village, they note the age and gender of each person affected, a description of their condition — with a firm diagnosis where possible — and a comment on any who might benefit from referral to a hospital in the provincial capital or in Vientiane. They exclude disabilities that are clearly unrelated to dioxin exposure, like the large number of limbs lost to cluster-munition bomblets. Their October 2019 trip was designed mainly to check up on cases they had already recorded, but they also found several new ones, like the boy in Labeng-Khok.

Hammond recognizes the limitations of their work. Some of their findings need to be verified by medical experts. “We’re not doctors or geneticists,” she says. Yet she, Chagnon and Sengthong are the first to try in Laos what has long been routine in Vietnam, where dioxin-related disabilities are logged systematically through commune-level surveys and household questionnaires and where victims receive small government stipends, and in some cases humanitarian aid from the United States.

It was Hatfield Consultants who unlocked the door to that aid, first through its four-year investigation of the A Luoi valley and then through subsequent studies of the former Danang air base. There had never been any secret about the huge volume of defoliants used in Vietnam, and the evidence of congenital disabilities in the sprayed areas was inescapable. Hatfield joined up the dots, showing how the two were connected and how dioxin could be transmitted from one generation to the next. But that was not Hatfield’s only insight. According to what it called the “hot spot” theory, the ongoing risk of present-day exposure was greatest around former military installations like the Special Forces base at A Shau, where the chemicals had been stored or spilled. Boivin wondered whether there might be similar dioxin hot spots on the Lao side of the border.

In 2002, Laos signed the Stockholm Convention on Persistent Organic Pollutants, a class of 12 “forever chemicals” including the dioxin family. All signatories were obligated to report on the extent of contamination in their countries. Boivin got a small grant from a U.N. agency to investigate dioxin in Laos, as the nation had little scientific expertise of its own. He found very little, but pursuing his hunch about Agent Orange, he made an arduous trip into the remote border areas, where it was strongly suspected that the C.I.A. had built secret airstrips, the kind of facilities that might have been used by herbicide planes and that would have been routinely sprayed to keep down vegetation, as they were in Vietnam.

Near a village called Dak Triem, he noticed a strikingly flat piece of land. Yes, the village elders said, it had once been an airstrip. Scavenging for scrap metal after the war, they found some barrels painted with orange stripes. Boivin had time to do no more than some perfunctory sampling, but he found elevated concentrations of TCDD, enough to classify the site as a possible hot spot and recommend further investigation. He and Hammond had known each other for years, and in 2014, with funding from Green Cross Switzerland and the European Space Agency, they collaborated on a more detailed report, which included a chronological table of all the known herbicide flights in Laos and a list of hundreds of clandestine C.I.A. facilities that might pose an ongoing health risk.

Boivin submitted his reports to the Lao government, but they gained little traction. This lack of interest might seem startling, but to veteran Laos watchers it comes as no surprise. “Things move slowly and cautiously there,” says Angela Dickey, a retired foreign-service officer who served as deputy chief of mission in Vientiane. “For an overworked midlevel official, there’s no real incentive to act on something like this. Only people at the very highest level can consider or speak about controversial issues.”

But there was a deeper reason for the lack of action on Boivin’s findings. He had made a preliminary estimate of the volume of defoliants used in Laos and found one contaminated air base. But he had never set out to collect data on the human impact. That was the missing piece of the puzzle that had been assembled in Vietnam, and that the War Legacies Project, using further Green Cross funding, set out to find.

When the United States finally agreed to clean up the Danang and Bien Hoa air bases in Vietnam, the two main hubs of Operation Ranch Hand, and aid the victims of Agent Orange in that country, it was an integral part of building trust between former enemies who increasingly see themselves as strategic allies and military partners. (Today, Bien Hoa is an important Vietnamese Air Force base.) In one of the larger oddities of history, the most painful legacy of the war has become a cornerstone of reconciliation.

In 2019, U.S.A.I.D. made a new five-year commitment to provide another $65 million in humanitarian aid to Vietnamese people with disabilities “in areas sprayed with Agent Orange and otherwise contaminated by dioxin.” The funds are channeled through the Leahy War Victims Fund, named for its creator, Senator Patrick Leahy, a Democrat from Hammond’s home state, Vermont, who for years has led the effort to help victims of Agent Orange in Vietnam. So why would the same logic not apply in Laos? “We weren’t aware of significant spraying in Laos,” Leahy said by email, “Nor of people with disabilities in those areas that are consistent with exposure to dioxin. But if that is what the data shows, then we need to look at it and discuss with the government of Laos what could be done to help those families.”

Hammond has met several times with Leahy’s longtime aide Tim Rieser, who seems eager to see what the War Legacies Project has found when it presents its report to his boss this month. “We have our work cut out for us in Vietnam,” he says, “but we’d also want to know what was done in Laos, since clearly those who were involved” — meaning wartime political and military leaders — “have not made a point of making it widely known. I’ve always approached this as doing what’s necessary to solve the problem, and if there’s more to the problem than we knew, then we need to deal with it.”

Hammond is painfully aware that bureaucratic wheels turn slowly; that Leahy, after 46 years in the Senate, may not be there much longer; and that Vietnam will always be the front-burner issue. In principle, the smaller scale of what’s needed should make it easier to address. “Even $3 million, which is what the U.S. started off with in Vietnam, would go a long way in Laos,” Hammond says. Meanwhile, the affected people are running out of time. Nine children under the age of 9 on the War Legacies Project list have already died.

U.S.A.I.D. already has an active disabilities program in Laos, which includes help for people injured by unexploded bombs. “All we need to do,” Hammond says, “is add the language we use now for Vietnam, earmark some money for ‘areas sprayed by Agent Orange and otherwise contaminated by dioxin.’ That one little sentence. That’s all it takes.”

George Black is a British author and journalist living in New York. He is writing a book about the long-term human and political legacies of the Vietnam War, in Vietnam and Laos and in the United States. Christopher Anderson is the author of seven photographic books, including “Pia.” He lives in Paris.

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Docs react as EU international locations droop shot

A healthcare worker prepares a syringe with the dose of AstraZeneca Covid-19 in Coria City Hospital, Spain.

Gustavo Valiente | SOPA pictures | LightRocket via Getty Images

LONDON – Health professionals are disappointed and confused about the numerous suspensions of the coronavirus vaccine developed by AstraZeneca and Oxford University. They warn that there is not enough data to justify these decisions.

Germany, France, Italy and Spain joined a rapidly growing list of European countries on Monday that are stopping use of the vaccine as a precautionary measure after reports of blood clots.

Other countries such as Austria have temporarily stopped using certain lots of the Oxford-AstraZeneca vaccine. Thailand became the first Asian nation on Friday to stop using the shot because of safety concerns.

The UK, Canada and Australia, which continue to use the vaccine, are among the countries trying to reassure citizens about its benefits.

The World Health Organization, the European Medicines Agency and the International Society on Thrombosis and Hemostasis have recommended that countries continue to use the Oxford-AstraZeneca vaccine.

There is still no evidence of data to really justify these decisions.

Michael Head

Senior Research Fellow in Global Health at the University of Southampton

“The decisions made by France, Germany and other countries look amazing,” said Dr. Michael Head, Senior Research Fellow in Global Health at the University of Southampton, UK

“The data we have suggests that the number of blood clot-related adverse events is the same (and possibly fewer) in vaccinated groups compared to non-vaccinated populations,” he continued.

“Pausing the introduction of a vaccine during a pandemic has consequences. This creates delays in protecting people and a possible delay in vaccine due to people who have seen the headlines and are understandably concerned. There is still no evidence of data that really justify these decisions, “added Head.

WHO experts will meet on Tuesday to review the safety of the shot.

The European Medicines Agency, which also evaluates the drug’s safety, says there is no evidence that it causes blood clots and believes the benefits of the vaccine “continue to outweigh the risks”.

What did AstraZeneca say?

More than 17 million people in the European Union and the United Kingdom have received a dose of the Oxford AstraZeneca vaccine. As of last week, fewer than 40 cases of blood clots had been reported, AstraZeneca said in a statement.

The pharmaceutical company said that 15 events involving deep vein thrombosis and 22 events involving pulmonary embolism were reported among those vaccinated in the EU and the United Kingdom.

“This is much less than expected to occur naturally in a general population of this size, and it is similar to other approved COVID-19 vaccines,” said AstraZeneca.

The EMA has also said that the data available so far showed that the number of blood clots in vaccinated people is no higher than in the general population.

A bottle of the AstraZeneca vaccine.

Igor Petyx | KONTROLAB | LightRocket via Getty Images

Europe’s caution regarding the drug has exacerbated the problems of the battered vaccination campaign in the region and comes at a time when the German health department has warned that a third wave of coronavirus infections has already begun.

Dr. Stephen Griffin, associate professor in the University of Leeds School of Medicine, said the news that many countries in Europe had suspended the introduction of the Oxford-AstraZeneca vaccine was “disappointing”.

“With many European countries currently experiencing a resurgence of SARS-CoV2 infections and still lagging behind on adoption, the importance of continuing vaccination programs and the harm done by people having access to one should not be underestimated Vaccine denied will do. ” even the worst-case scenarios probably outweigh the odds, if at some point a connection to the coagulation disorders is found, “said Griffin.

“It should also be noted that nationwide gestures like these inevitably create hesitation or a more extreme sentiment towards vaccines and further undermine vaccination efforts,” he added.

How does the vaccine work?

The Oxford AstraZeneca vaccine is designed to prevent coronavirus in people aged 18 and over. It’s made up of an adenovirus that has been modified to contain the gene to make a protein from SARS-CoV-2, the virus that causes Covid-19. Therefore, the vaccine does not contain a virus and cannot cause Covid.

The most common side effects of the shot are typically mild or moderate and get better within a few days after vaccination.

In late clinical studies, the AstraZeneca Oxford shot was found to have an average of 70% effectiveness in protecting against the virus.

“We are carefully reviewing the reports, but the evidence available does not suggest that the vaccine is the cause,” said Dr. Phil Bryan, Vaccine Safety Director for the UK Medicines and Health Products Regulatory Agency.

“Blood clots can occur naturally and are not uncommon. In the UK, more than 11 million doses of the AZ vaccine have now been given and the number of blood clots reported after the vaccine is no more than the number that would have occurred naturally in the UK of the vaccinated population, “he continued.

“We are working closely with international colleagues to understand the global safety experience of COVID-19 vaccines and to share safety data and reports quickly. People should still get their COVID-19 vaccine when prompted,” said Bryan.

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Purdue Pharma Provides Plan to Finish Sackler Management and Mounting Lawsuits

In a message marking the beginning of the end of the most notorious prescription opioid maker in the country, Purdue Pharma unveiled its bankruptcy restructuring plan just before midnight on Monday. The blueprint requires members of the billionaire Sackler family to give up control of the company and transform it into a new business whose revenues are solely aimed at alleviating the addiction epidemic that caused its signature pain reliever, OxyContin.

The 300-page plan is the company’s formal offer to end thousands of lawsuits and includes the Sacklers pledge to pay $ 4.275 billion out of their personal assets – an additional $ 1.3 billion than their original offer – to reimburse states, communities, tribes and other plaintiffs for the costs associated with the epidemic.

If the plan is approved by a majority of the company’s creditors and Judge Robert D. Drain of Federal Bankruptcy Court in White Plains, NY, payments will flow into three buckets: one to compensate individual plaintiffs, such as families whose relatives have overdosed , or legal guardians of infants with newborn abstinence syndrome as well as hospitals and insurers; another for tribes; and the third – and largest – for state and local governments devastated by the cost of a drug epidemic that only worsened during the Covid-19 pandemic.

“With drug overdose still at record levels, it is time to use Purdue’s fortune to help tackle the crisis,” said Steve Miller, chairman of the Purdue board of directors, in a statement. “We are confident that this plan will achieve this important goal. ”

It remains to be seen whether the plan will be adopted. Since the company filed for bankruptcy in 2019, 24 states and the District of Columbia have denounced it, arguing that the lawsuit would preclude their ability to take legal action directly against individual Sackler family members who they consider to be inadequate contributions.

Although some details of the settlement terms are still being worked out, Purdue officials said the Sacklers would not be exempt from criminal investigations that could be launched by a handful of states for violating consumer protection laws. However, the plan exempts them from further civil litigation.

The new application, filed minutes before a court-set deadline, marks a milestone in Purdue’s long, troubled history as the maker and marketer of OxyContin, the prescription pain reliever that has become addicting hundreds of thousands of people. Federal and state agencies spent years trying to curb Purdue’s marketing tactics. In 2007, the Justice Department reached an agreement with Purdue and top executives on $ 634.5 million to resolve criminal charges related to its marketing practices.

As of 2015, when the opioid epidemic hit the country, the lawsuit engulfed cities, counties, states, tribes, families, hospitals and insurers, drug distributors, pharmacies and manufacturers, including Purdue boss. The cases almost consistently claim that OxyContin helped lay the foundation for the prescription and illicit drug addiction epidemic that killed more than 400,000 people over 20 years.

To halt the growing civil lawsuit that cost Purdue $ 2 million a week in legal costs, the company filed for bankruptcy protection in 2019.

The legal dispute before a federal court against other companies continues.

The biggest difference between Purdue’s earlier proposals and this latest plan is that the Sacklers increased their payments by $ 1.3 billion and extended their payment schedule by an additional two years (from seven to nine).

Another notable change concerns control of the new company. The original 2019 proposal called for it to be monitored by state-appointed officials. The restructuring plan now describes it as a private company run by independent managers selected by the states and local governments that sued Purdue. The largest groups of applicants – tribes and the government – own the company and would ensure that the proceeds are used solely for crisis management programs.

The company’s managers could sell to private owners by 2024, but those owners would also be bound by the same rules of conduct and income directions.

As it worked its way through the bankruptcy process, Purdue pleaded guilty in November of fraud against health officials and violating anti-kickback laws.

Individual members of the Sackler family agreed to pay the federal government civil fines of $ 225 million, but said in a statement that they “acted ethically and lawfully.” Although the Sacklers were not charged, the Justice Department reserves the right to file criminal charges later.

A key goal of the new Purdue plan is to install guard rails to ensure that settlement money is used to alleviate the epidemic, rather than being paid out more generally to cover budget constraints. Such payouts were a major criticism of the 1998 settlement that ended widespread legal disputes against the large tobacco companies that opioid disputes are sometimes compared to.

During the bankruptcy negotiations, pushed forward by the creditors, the company suggested in its plan that the payouts comply with the latest public health principles signed by at least two dozen major medical, drug policy, and academic institutions, and attention to drug prevention, youth education, and race set up justice and transparency.

Tens of thousands of parties vote on the plan. Confirmation hearings will follow and completion is expected in a few months. Since bankruptcy proceedings began 18 months ago, leaders of a large community bloc have signaled their support, as have 24 states.

Lloyd B. Miller, who represents numerous tribes including the Navajo Nation, said his customers were on board.

“It is critical that more funds go to the treatment of opioids in tribal communities, all the more given the extraordinary devastation tribes have suffered during the Covid pandemic,” he said.

But since 2019, when Purdue filed for bankruptcy, 24 other states – some controlled by Democrats, others by Republicans – and the District of Columbia have declined to take the move, finding that Purdue has continued to benefit from its OxyContin sales.

Maura Healey, the Massachusetts attorney general who was the first to sued individual members of the Sackler family, alleged that Sackler payments under this scheme would come from their investment returns rather than capital.

“The Sacklers became billionaires by causing national tragedy,” Ms. Healey said in a statement. “They shouldn’t be allowed to get away with paying a fraction of their investment returns over the next nine years and walking away richer than they are today.”

Opposing state attorneys general said the plan, while an improvement on previous proposals, still found it disappointing for several reasons. Among them, the plan should be amended to “achieve a speedy and orderly liquidation of the company that does not involve unduly states and other creditors”.

Two branches of the Sackler family – heirs to two brothers who founded the company – said: “Today is an important step in helping addicts and we hope that this proposed resolution signals the beginning of a far-reaching development. Make an effort to provide help where it is needed. “

The oldest brother, Dr. Arthur Sackler, sold his shares before OxyContin was launched, and his relatives are not part of the litigation.

A forensic review of the Sacklers’ finances commissioned by Purdue as part of bankruptcy investigations found that the family made more than $ 10 billion from the company from 2008 to 2017. Family lawyers said the full amount was illiquid: more than half went into taxes and investments in companies sold under the bankruptcy agreement.

Although states and other creditor blocs have protested vigorously against elements of the plan for the last 18 months, many factors seem to favor the likelihood of approval: the length of the litigation, the exorbitant costs for all parties, the urgency of the worsening opioid crisis, and the general depletion of public health resources due to the coronavirus pandemic.

The new company would continue to sell OxyContin, a pain reliever that is still approved by the Food and Drug Administration in limited circumstances. But it would diversify its products to include generics and a drug used to treat attention-deficit hyperactivity disorder, as well as new drugs to reverse overdose and treat addiction to be marketed as a public health initiative on a nonprofit basis.

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U.S. higher on Covid vaccines, European-like surge unlikely

Coronavirus developments in Europe are unlikely to be early signs of what will happen weeks later in the US, partly due to America’s advances in vaccinating its population, said Dr. Scott Gottlieb told CNBC on Monday.

Former Food and Drug Administration Commissioner’s comments on Squawk Box come a day after White House Chief Medical Officer Dr. Anthony Fauci said the situation in Europe shows why U.S. states shouldn’t completely abandon pandemic precautions right now.

Italy is putting stricter business restrictions in certain parts of the country after a surge in new infections, including an upcoming nationwide lockdown for the Easter weekend. Health officials in Germany have also warned of an increase in Covid cases.

“I used to say that we are four to maybe six weeks behind Europe, and we were,” said Gottlieb, referring to earlier phases of the global health crisis. “Everything that happened in Europe happened here at some point. Now the tables have turned. We are ahead of Europe.”

“I don’t think that the conditions in Europe and the situation in Europe inevitably predict what will happen here, as we in our population have much more immunity, both against previous infections – which they have – and now against vaccinations” added Gottlieb, a board member at Pfizer, which makes a Covid vaccine.

According to the European Center for Disease Prevention and Control, around 9.5% of the vaccine-able population in the member states of the EU and the European Economic Area had at least one Covid shot. About 7.5% of Italians aged 18 and over and 8.5% of Germans aged 18 and over had at least one dose of Covid vaccine, according to ECDC data.

In contrast, 27% of the American adult population have received at least one Covid shot, according to the U.S. Centers for Disease Control and Prevention.

Pfizer and Moderna vaccines both require two doses for complete protection of immunity. Johnson & Johnson’s vaccine, which requires only a single shot, was recently cleared for use by the European Union. US regulators gave J & J’s vaccine emergency approval late last month after clearing Pfizer and Moderna in December.

“I think we should worry that things may turn in a direction we cannot predict,” admitted Gottlieb, who previously urged states to continue wearing face masks to prevent coronavirus transmission. In fact, he said ending mask mandates should be the last public health measure to be lifted.

However, the former FDA head of the Trump administration said newly emerging strains of Covid, such as variant B.1.1.7, first discovered in the UK, have proven to be less of a problem in the US than in other parts of the world.

“Right now, B.1.1.7 is pretty common in the US. It’s more than 50% of cases in Texas, Florida, and Southern California, and you’re not seeing the big upsurge in cases that we might have expected once this variant in has found support in the United States, “said Gottlieb, attributing it to the extent of previous infection in the country and vaccination rates.

Last week, he estimated on CNBC that about 50% of Americans have “some form of immunity” to the coronavirus.

“The fact that we haven’t seen the rise in the coronavirus … even though B.1.1.7 is becoming the predominant burden in the United States is, in my opinion, a good sign,” Gottlieb said on Monday.

New York, where researchers discovered a new strain called B.1.526, is an area of ​​concern for Gottlieb. He said there was evidence that certain mutations of the virus in this strain “could make it more resistant to our vaccines and increase the chances of people being re-infected”.

“We really don’t understand this mutation very well, but this is cause for concern so we need to watch this pretty closely,” he said, adding that the next few weeks should give officials more responses.

Disclosure: Scott Gottlieb is a CNBC employee and a member of the boards of directors of Pfizer, genetic testing startup Tempus, healthcare technology company Aetion, and Illumina biotech. He is also co-chair of the Healthy Sail Panel for Norwegian Cruise Line Holdings and Royal Caribbean.

Clarification: This story has been updated to clarify the groups receiving vaccinations.

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Disenfranchised Grief in a Yr of Pandemic Losses

Lockdowns had an immediate financial impact on Annabelle Gurwitch, a Los Angeles writer who lost assignments and lectures. The advertisement for her new book “You go when ?: Adventure in downward mobility” has become virtual. But when her kid’s graduation from Bard College went online, she cried in her backyard. Her child had worked hard and even started a sobriety club on campus.

“I was so proud of them that they graduated from college in four years,” she said. “David Byrne should be the speaker. There is so much suffering going on and I felt like such a terrible person, upset that I couldn’t go to graduate school and see David Byrne. That is low on the level of suffering. But damn it, we got our kid through four years. The child sobered up while studying. May I say we were disappointed? “

Around the same time as graduation, Ms. Gurwitch developed a cough. She received a coronavirus test and a chest x-ray, which eventually led to a diagnosis of stage 4 lung cancer. After being diagnosed with cancer, Ms. Gurwitch noticed that her friends were starting to downplay their own struggles and grief. A friend was diagnosed with breast cancer and had a double mastectomy, but didn’t want to tell her because she felt that breast cancer wasn’t as bad as lung cancer.

“I had her from cancer,” said Ms. Gurwitch. “It’s terrible not to feel that your suffering has a place.”

38-year-old Erin, who asked that her full name not be used to protect her privacy, said she lost another year of fertility during the pandemic lockdowns. After miscarriage a few years ago, she tried to conceive, but her husband did not think it useful to start a pregnancy during a pandemic. “Mother’s Day came and I was close to my 38th birthday and it became clear that I didn’t have much time,” she said. “This biological clock – The tick is very noisy and it’s a very real thing. “

Erin said that their marriage was starting to fall apart and she realized that she would probably have to do it alone if she wanted to become a mother. She and her husband are now getting divorced, she is taking steps to freeze her eggs, and she is investigating adoption and promoting parenting. She said grief over infertility and miscarriages was only compounded by living in a pandemic as she gains insight into people’s family lives through video calls.

“A staff member, every time we talk, she talks about the Lamaze class,” she said. “This is great for her, but it’s not OK for me to say that I’m struggling with it. I lost a child. I’ve lost my fertile years. This is one area where I am really having trouble. As a society, we don’t talk about it openly. “

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Health

CDC chief warns of one other Covid surge as Individuals journey for spring break

Passengers arrive for American Airlines flights at O’Hare International Airport in Chicago, Illinois on February 05, 2021.

Scott Olson | Getty Images

The US could still see a renewed spike in coronavirus – even if vaccinations against Covid-19 surge across the country – as states relax restrictions and more Americans travel to spring break, the centers’ head warned disease control and prevention on Monday.

“With warmer weather coming, I know it is tempting to relax and lose our vigilance, especially after a harsh winter that unfortunately saw the most cases and deaths during the pandemic,” said CDC Director Dr . Rochelle Walensky said at a press conference.

The Transportation Security Administration (TSA) examined more than 1.34 million people on Sunday, 86,000 more than the same day a year ago, shortly after the World Health Organization declared Covid-19 a pandemic.

TSA screenings have exceeded 1 million every day since Thursday, the highest volume in a year. While air traffic is well below 2019 levels, despite the CDC’s warning of non-essential travel, more and more Americans are returning to heaven, even those who are fully vaccinated.

Although many colleges in the US have scaled back their spring break to curb parties and infection, Biden’s top government officials are still concerned about travelers “enjoying a maskless spring break,” Walensky said.

“I beg you, for the sake of the health of our nation,” Walensky said at the briefing on Monday. “The cases rose last spring, they rose again in the summer, they will climb now if we no longer take precautions, if more and more people are being vaccinated.”

Even with infections declining and vaccine adoption rapidly growing, the US continues to report a dangerously high baseline of daily cases that could be higher if Americans lose their vigilance, Biden’s top health officials have warned. Around 37.5 million people in the US, about 11% of the population, have been fully vaccinated to date, according to the CDC.

The U.S. has come a long way since early January when it hit a weekly average of just over 250,000 new cases per day. According to a CNBC analysis of data compiled by Johns Hopkins University, the nation reports an average of 53,670 new infections per day for the past week, a 10% decrease from the previous week.

– Leslie Josephs of CNBC and the Associated Press contributed to this report.