Virginia marijuana legalization timetable has many confused

RICHMOND, Va. — Virginia’s road to legalizing simple possession of marijuana has had some twists and turns, so it’s not surprising that advocacy groups have been flooded with calls from people trying to understand exactly what will be allowed under state law as of July 1.

Legislators initially voted in February to legalize possession of up to an ounce of marijuana for adult recreational use, but not until 2024, when retail sales would begin. An outcry ensued over the three-year wait before ending pot possession penalties, so in April they voted to move up legalization to this July 1.

Adding to the confusion: lawmakers included a “reenactment clause,” which means the General Assembly will have to vote again next year on major portions of the law, mainly to establish a regulatory framework for the legal marijuana marketplace.

The process has resulted in some contradictions that may not get resolved until years after legalization begins.

Sen. Adam Ebbin, one of the lead sponsors, said people need to understand the law’s limits for now. Possession of up to one ounce (28.3 grams) with no intent to distribute will become legal for adults, 21 and older. Adults will also be allowed to grow up to four marijuana plants per household. But not much else will change.

“People still need to be careful — this is not an official open marijuana market,” Ebbin said.

Virginia is joining 17 other states with laws allowing adults to possess and consume marijuana. In each one, laws have legalized simple possession before establishing a legal marketplace for buying and selling marijuana, said Jenn Michelle Pedini, the development director for the National Organization for the Reform of Marijuana Laws.

Under Virginia’s law, buying and selling marijuana will remain illegal until Jan. 1, 2024, when retail sales are expected to begin. Smoking marijuana in public also remains against the law.

Pedini, who is also the executive director of Virginia NORML, said the organization fields questions every day from people who are surprised to learn that selling pot won’t be allowed for another three years.

“The only legal sale of cannabis in Virginia is through the medical (marijuana) program,” Pedini said.

Virginia NORML has a page on its website to answer frequently asked questions and clear up confusion. The state also launched a website to answer questions about the new law.

Although people can legally cultivate marijuana plants beginning July 1, it will still be illegal for anyone to buy cannabis seeds or cuttings needed to grow those plants. That’s one of the contradictions bothering Republican Sen. Ryan McDougle, who voted against the legislation.

“The biggest inconsistency is you cannot legally buy marijuana for recreational use in the commonwealth of Virginia,” McDougle said.

“Under federal rules you can’t transport it (into Virginia), but if you have it, you can possess up to one ounce of it in Virginia. How you get that is the inconsistency. You can’t legally get it, but you can possess it,” he said.

In the original bill, both possession and sales of marijuana would have been legalized in 2024. But many social justice advocates pushed to immediately end the disparate treatment of people of color under existing marijuana laws.

The General Assembly’s research and watchdog agency found that from 2010-2019, Black Virginians were 3.5 times more likely than white Virginians to be arrested for marijuana possession, and 3.9 times more likely to be convicted, even though both populations used marijuana at similar rates.

“We want to do this the right way, and what that means is ending the disparate enforcement, which is going to make a huge change in the lives of thousands of Virginians,” said Alena Yarmosky, Gov. Ralph Northam’s spokeswoman. She said the administration also recognizes the “reality” that “people have marijuana now,” even though it is illegal in Virginia.

According to New Frontier Data’s U.S. Cannabis Report, Virginia had the fourth-largest illicit market last year, encompassing about $1.8 billion, or 3%, of an estimated $60 billion in total illicit sales nationwide.

“Because marijuana remains illegal at the federal level and because Virginia needs time to stand-up the regulatory structure for safe sales, it will not be legal to sell seeds or other marijuana until 2024,” Yarmosky said.

People will be allowed to share small amounts of seeds with one another, but they can’t sell them.

“The primary objective of legalization is to reduce criminalization and then to regulate safe legal access, so we’re checking one box, but we’re not checking the other this year,” Pedini said.

Pedini said may states have expedited adult access to marijuana through their medical marijuana dispensaries, something advocates hope Virginia lawmakers will vote to do in 2022. “Most people aren’t going to grow cannabis, but most people who will want to participate in the adult use market will prefer to do so through a legal avenue,” she said.

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Library of Congress gets health workers' audio COVID diaries

WASHINGTON — The Library of Congress has acquired a digital archive of the real-time impressions of more than 200 frontline health care workers documenting the country’s descent into the coronavirus pandemic.

Calvin Lambert, a fetal medicine fellow in a Bronx hospital, recalls how a Black pregnant woman who came in for a checkup “became irate and became scared” even when he attempted to give her a COVID-19 test. She thought the nasal swab itself would give her the virus.

Lambert, who is Black, said he learned to understand “the deep distrust that the patient had and that many patients who are Black have for the medical system.”

The audio diaries from health care workers like Lambert were collected by The Nocturnists, a medical storytelling project, for its “Stories from a Pandemic” podcast series, which ran in spring 2020. The collection contains more than 700 audio clips documenting the chaotic conditions in overwhelmed hospitals as medical workers struggled with their own stress, exhaustion and grief.

The digital archive will be housed in the library’s American Folklife Center, which has been building up a collection of oral histories dating back to World War I, including testimonials from 9/11 first responders and survivors from hurricanes Katrina and Rita.

Folklife Center Director Elizabeth Peterson called the collection “really a remarkable gift” and said the audio medium and the intensity of the environment create a deeply intimate and sometimes exhausting portrait.

“You hear the sounds of the workplace, the exhaustion in their voices, and the big and small ways they try to cope and contribute,” she said.

Emily Silverman, a practicing internist and a founder of The Nocturnists, said in a statement that she “couldn’t imagine a better home for our audio library.”

“It captures the raw emotions of numerous health care workers in the first few months of the COVID-19 pandemic and will serve as a historical document for future generations,” Silverman said.

The Nocturnists, which produces live medical storytelling shows in addition to the podcasts, also plans to donate the recordings for its follow-up series, “Stories from a Pandemic: Part 2,” which launched Tuesday.

A sample of audio clips released by the Library of Congress contains a diverse array of medical professionals, from neurosurgeons in Los Angeles to medical students in Philadelphia.

Samuel Slavin, an internal medicine resident in Boston, reflected on the “unpredictable way these patients go down fast” and “how this is weighing on us as doctors.”

Sounding exhausted in his audio clip, Slavin recalled seeing a colleague struggle to finish a simple procedure, with shaking hands and frayed nerves. Slavin helped his colleague calm down, then stepped out to call his own parents, who he feared had started to display COVID symptoms.

“That was when I started to feel crushed. I could feel myself shaking and trembling and futzing with my own phone,” he said.

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Wisconsin priest who ignored COVID limits is asked to resign

LA CROSSE, Wis. — A priest in Wisconsin who has been ignoring COVID-19 gathering restrictions at his masses and criticized Democrats for their stance on the virus vaccines says the leader of the Diocese of La Crosse has asked him to resign.

The Rev. James Altman announced the request from Bishop William Callahan during his sermon Sunday at St. James the Less Catholic Church in La Crosse. The sermon was recorded and posted to YouTube.

“As the bishop has stated to me: I am ineffective. So for the record dear family, Bishop Callahan has asked me to resign as pastor as of this past Friday, two days ago, because I am divisive and ineffective,” Altman said.

Audible “no” sounds from the crowd can be heard during the video, the La Crosse Tribune reported.

Altman came under fire last fall for calling Democrats godless and warning they would go to hell if they don’t repent. Later, he called COVID-19 protocols “Nazi-esque controls.”

“Let us be clear, God damns every single one of those godless moves, whether it be in civil government or worse, in the complicity of many in the church,” Altman said during a Palm Sunday mass. “In fact, if hell itself has many levels, the lowest, hottest levels are the final burning place for those shepherds who were complicit in the godless restrictions.”

Altman said his lawyer is challenging the bishop’s request to resign. The priest told the congregation Sunday that Callahan could appoint a parish administrator while he remains “a pastor without duties until the appeal goes through Rome, which could take up to a year or more.”

A spokesperson for the diocese did not immediately respond to the newspaper’s request for comment. The diocese has chosen to handle the matter internally, stating earlier it was working with Altman privately.

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EXPLAINER: Why patents on COVID vaccines are so contentious

The Biden administration’s call to lift patent protections on COVID-19 vaccines to help poor parts of the world get more doses has drawn praise from some countries and health advocates. But it has run into resistance from the pharmaceutical industry and others, who say it won’t help curb the outbreak any time soon and will hurt innovation.

Here’s a look at what patents do and why they matter:

HOW DO DRUG PATENTS WORK?

Patents reward innovation by preventing competitors from simply copying a company’s discovery and launching a rival product. In the U.S., patents on medicines typically last 20 years from when they are filed, which is usually done as soon as a drugmaker thinks it has an important or lucrative drug. Because it often takes a decade to get a drug approved, companies typically end up with about a dozen years of competition-free sales. But drugmakers usually find ways to improve their product or widen its use, and they secure additional patents that can extend their monopoly for another decade or more.

WHY IS PATENT PRODUCTION SO IMPORTANT TO DRUGMAKERS?

Medicines are incredibly expensive to develop. Most experimental drugs fail at some point during what can be years of laboratory, animal and finally human testing. Averaging in the cost of all those flops, it typically costs more than $1 billion to bring a drug from discovery to regulatory approval. Without the prospect of years of sales without competition, that work is all the more risky.

WHY IS THE U.S. BACKING EFFORTS TO LIFT PROTECTIONS ON COVID-19 VACCINES?

The Biden administration has been under intense pressure, including from many Democrats in Congress, to get more COVID-19 vaccines to the rest of the world. Support for the waiver idea floated by India and South Africa in October has been growing in other countries while the outbreak worsens in some places, especially India.

WHY HAVE THE U.S. AND OTHERS OPPOSED LIFTING PROTECTIONS IN THE PAST?

The U.S. and some other wealthy countries lead the world in many areas of research and innovation. That’s particularly true for medicines. Aside from the prestige they confer, pharmaceutical companies provide millions of jobs that pay very well, pay taxes on their income and provide new medicines that can save or improve lives. Drugmakers and their trade groups spend millions every year lobbying governments to maintain the status quo on patents.

WHY IS THE INDUSTRY SO OPPOSED TO THE EFFORT?

In a word, money. In the U.S., pharmaceutical companies can charge whatever they want for their medicines. They can and do raise prices, typically twice a year, so that list prices often double or triple during a drug’s patent-protected years. That makes the big, long-established drugmakers among the world’s most profitable companies. But a huge amount of innovation comes from startup pharmaceutical and biotech companies. They must constantly raise money from venture capital firms and other investors to fund early research until they can get their medicine approved or, more often, get a big drugmaker to help fund the research and buy rights to that drug or the entire startup. Without the prospect of a big payday for the new drug, it would be much harder to attract the crucial early money.

WHAT WOULD BE THE PRACTICAL EFFECTS OF LIFTING PROTECTIONS ON COVID-19 VACCINES?

That’s not entirely clear, but drugmakers and some analysts say waiving their patent rights won’t do much to get COVID-19 vaccines to developing countries faster. That’s because making the vaccines is far more complex than following a recipe, requiring factories with specialized equipment, highly trained workers and stringent quality control — things that can’t be set up quickly. There’s little available factory capacity, as the companies with authorized vaccines already have hired many contract drug manufacturers to help them make their shots. In addition, many of the raw materials to make the vaccines, along with vials, stoppers and other components, are in very short supply, and that’s not expected to change soon.

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Follow Linda A. Johnson at https://twitter.com/LindaJ—onPharma

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76,000 California inmates now eligible for earlier releases

SACRAMENTO, Calif. — California is giving 76,000 inmates, including violent and repeat felons, the opportunity to leave prison earlier as the state aims to further trim the population of what once was the nation’s largest state correctional system.

More than 63,000 inmates convicted of violent crimes will be eligible for good behavior credits that shorten their sentences by one-third instead of the one-fifth that had been in place since 2017. That includes nearly 20,000 inmates who are serving life sentences with the possibility of parole.

The new rules take effect Saturday but it will be months or years before any inmates go free earlier. Corrections officials say the goal is to reward inmates who better themselves while critics said the move will endanger the public.

Under the change, more than 10,000 prisoners convicted of a second serious but nonviolent offense under the state’s “three strikes” law will be eligible for release after serving half their sentences. That’s an increase from the current time-served credit of one-third of their sentence.

The same increased release time will apply to nearly 2,900 nonviolent third strikers, the corrections department projected.

Also as of Saturday, all minimum-security inmates in work camps, including those in firefighting camps, will be eligible for the same month of earlier release for every month they spend in the camp, regardless of the severity of their crime.

The changes were approved this week by the state Office of Administrative Law.

“The goal is to increase incentives for the incarcerated population to practice good behavior and follow the rules while serving their time, and participate in rehabilitative and educational programs, which will lead to safer prisons,” department spokeswoman Dana Simas said in a statement.

“Additionally, these changes would help to reduce the prison population by allowing incarcerated persons to earn their way home sooner,” she said.

Simas provided the emergency regulations and estimates of how many inmates they will affect at the request of The Associated Press.

Simas said the department was granted authority to make the changes through the rulemaking process and under the current budget. By making them “emergency regulations” the agency could impose the new rules without public comment.

The department now must submit permanent regulations next year. They will be considered a public hearing and opportunity for public comment.

Kent Scheidegger, legal director of the Criminal Justice Legal Foundation that represents crime victims, said the notion that the credits are for good behavior is a misnomer.

“You don’t have to be good to get good time credits. People who lose good time credits for misconduct get them back, they don’t stay gone,” he said. “They could be a useful device for managing the population if they had more teeth in them. But they don’t. They’re in reality just a giveaway.”

Republican state Sen. Jim Nielsen, who once headed the state parole board, criticized Gov. Gavin Newsom’s administration for unilaterally deciding to make the changes.

“He’s doing it on his own authority, instead of the will of the people through their elected representatives or directly through their own votes,” Nielsen said. “This is what I call Newsom’s time off for bad behavior. He’s putting us all at greater risk and there seems to be no end to the degree to which he wants to do that.”

California has been under court orders to reduce a prison population that peaked at 160,000 in 2006 and saw inmates being housed in gymnasiums and activity rooms. In 2011, the U.S. Supreme Court backed federal judges’ requirement that the state reduce overcrowding.

The population has been declining since the high court’s decision, starting when the state began keeping lower-level felons in county jails instead of state prisons. In 2014, voters reduced penalties for property and drug crimes. Two years later, voters approved allowing earlier parole for most inmates.

Before the pandemic hit, the population had dropped to 117,00 inmates. In the last year, 21,000 more have left state prisons — with about half being held temporarily in county jails.

Meantime, officials announced in mid-April that they will close a second prison as a result of the dwindling population, fulfilling a promise made by Newsom. California Correctional Center in Susanville will close by July 2022. Officials announced last fall that Deuel Vocational Institution in Tracy, east of San Francisco, will close by this October.

Many Democratic lawmakers and advocacy groups have been calling for further releases or shorter sentences. Californians United for a Responsible Budget, for instance, earlier in April said the state should shutter at least 10 more of its 35 prisons.

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Oregon: CDC investigating woman's death after J&J vaccine

PORTLAND, Ore. — Oregon health officials said Thursday that federal officials are investigating the death of a woman in her 50s who developed a rare blood clot and low platelets within two weeks of receiving the Johnson & Johnson vaccine against COVID-19.

The Oregon Health Authority learned of the probe on Tuesday, two days after the U.S. Centers for Disease Control and Prevention began the investigation, the agency said. The woman, whose name was not released, received the dose before the CDC ordered a pause on the vaccine amid concerns it could cause dangerous clots.

The woman developed a “rare but serious blood clot in combination with very low platelets,” OHA said in a statement.

Dr. Shimi Sharief, senior health advisor for the state’s health authority, said the woman’s symptoms were consistent with other cases — severe headache, abdominal pain, leg pain or shortness of breath .

Health officials declined to release any further details, including the date the woman got the vaccine or where in Oregon she lived, citing patient privacy. The woman was hospitalized before her death and got the vaccine in early April, Sharief said.

Until the investigation is complete, which health officials predict will take a week or more, it’s not certain that her death is related to the vaccine, the agency said.

Federal and state agencies paused the J&J vaccine rollout on April 13 due to concerns about blood clots.

“For most people that received the (J&J) vaccine, we are nearing the end of that time of where they need to be monitoring for symptoms,” Sharief said. The CDC warned that if people have symptoms within three weeks after receiving the vaccine they should contact their health care provider.

Federal officials already were examining six reports of the unusual clots, including a death, out of more 8 million Americans given the one-dose vaccination so far.

The CDC also told Texas health authorities Thursday that a woman in that state was hospitalized with possible blood clots associated with J&J vaccine recipients.

A government advisory committee on vaccines is expected to meet Friday and could make a recommendation soon after on whether and how to resume use of the J&J vaccine.

Sharief said whether Oregon resumes distribution of the J&J vaccine will be a “reflection” of the committee’s decision.

“We have the utmost confidence that it would be a decision made with thorough investigation and consideration of the potential benefits and risks, in relation to each other, as we go through this pandemic,” Sharief said.

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Cline is a corps member for The Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

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Billions spent on coronavirus fight, but what happens next?

Congress has poured tens of billions of dollars into state and local public health departments in response to the coronavirus pandemic, paying for masks, contact tracers and education campaigns to persuade people to get vaccinated.

Public health officials who have juggled bare-bones budgets for years are happy to have the additional money. Yet they worry it will soon dry up as the pandemic recedes, continuing a boom-bust funding cycle that has plagued the U.S. public health system for decades. If budgets are slashed again, they warn, that could leave the nation where it was before the coronavirus: unprepared for a health crisis.

“We need funds that we can depend on year after year,” said Dr. Mysheika Roberts, the health commissioner of Columbus, Ohio.

When Roberts started in Columbus in 2006, an emergency preparedness grant paid for more than 20 staffers. By the time the coronavirus pandemic hit, it paid for about 10. Relief money that came through last year helped the department staff up its coronavirus response teams. While the funding has helped the city cope with the immediate crisis, Roberts wonders if history will repeat itself.

After the pandemic is over, public health officials across the U.S. fear, they’ll be back to scraping together money from a patchwork of sources to provide basic services to their communities — much like after the Sept. 11 attacks and the SARS and Ebola outbreaks.

When the mosquito-borne Zika virus tore through South America in 2016, causing serious birth defects in newborn babies, members of Congress couldn’t agree how, and how much, to spend in the U.S. for prevention efforts, such as education and mosquito abatement. The Centers for Disease Control and Prevention took money from its Ebola efforts, and from state and local health department funding, to pay for the initial Zika response. Congress eventually allocated $1.1 billion for Zika, but by then, mosquito season had passed in much of the U.S.

“Something happens, we throw a ton of money at it, and then in a year or two we go back to our shrunken budgets and we can’t do the minimum things we have to do day in and day out, let alone be prepared for the next emergency,” said Chrissie Juliano, executive director of the Big Cities Health Coalition, which represents leaders of more than two dozen public health departments.

Funding for Public Health Emergency Preparedness, which pays for emergency capabilities for state and local health departments, dropped by about half between the 2003 and 2021 fiscal years, accounting for inflation, according to Trust for America’s Health, a public health research and advocacy organization.

Even the federal Prevention and Public Health Fund, which was established with the Affordable Care Act to provide $2 billion a year for public health, was raided for cash over the past decade. If the money hadn’t been touched, eventually local and state health departments would have gotten an additional $12.4 billion.

Several lawmakers, led by Democratic U.S. Sen. Patty Murray of Washington, are looking to end the boom-bust cycle with legislation that would eventually provide $4.5 billion annually in core public health funding. Health departments carry out essential government functions — such as managing water safety, issuing death certificates, tracking sexually transmitted diseases and preparing for infectious outbreaks.

Spending for state public health departments dropped by 16% per capita from 2010 to 2019, and spending for local health departments fell by 18%, KHN and The Associated Press found in a July investigation. At least 38,000 public health jobs were lost at the state and local level between the 2008 recession and 2019. Today, many public health workers are hired on a temporary or part-time basis. Some are paid so poorly they qualify for public aid. Those factors reduce departments’ ability to retain people with expertise.

Compounding those losses, the coronavirus pandemic has prompted an exodus of public health officials because of harassment, political pressure and exhaustion. A yearlong analysis by the AP and KHN found at least 248 leaders of state and local health departments resigned, retired or were fired between April 1, 2020, and March 31, 2021. Nearly 1 in 6 Americans lost a local public health leader during the pandemic. Experts say it is the largest exodus of public health leaders in American history.

Brian Castrucci, CEO of the de Beaumont Foundation, which advocates for public health, calls Congress’ giant influx of cash in response to the crisis “wallpaper and drapes” because it doesn’t restore public health’s crumbling foundation.

“I worry at the end of this we’re going to hire up a bunch of contact tracers — and then lay them off soon thereafter,” Castrucci said. “We are continuing to kind of go from disaster to disaster without ever talking about the actual infrastructure.”

Castrucci and others say they need dependable money for high-skill professionals, such as epidemiologists — data-driven disease detectives — and for technology upgrades that would help track outbreaks and get information to the public.

In Ohio, the computer system used to report cases to the state predates the invention of the iPhone. State officials had said for years they wanted to upgrade it, but they lacked the money and the political will. Many departments across the country have relied on fax machines to report COVID-19 cases.

During the pandemic, Ohio’s state auditor found that nearly 96% of local health departments it surveyed had problems with the state’s disease reporting system. Roberts said workers interviewing patients had to navigate several pages of questions, a major burden when handling 500 cases daily.

The system was so outdated that some information could be entered only in a non-searchable comment box, and officials struggled to pull data from the system to report to the public — such as how many people who tested positive had attended a Black Lives Matter rally, which last summer was a key question for people trying to understand whether protests contributed to the virus’ spread.

Ohio is working on a new system, but Roberts worries that, without a dependable budget, the state won’t be able to keep that one up to date either.

“You’re going to need to upgrade that,” Roberts said. “And you’re going to need dollars to support that.”

In Washington, the public health director for Seattle and King County, Patty Hayes, said she is asked all the time why there isn’t a central place to register for a vaccine appointment. The answer comes down to money: Years of underfunding left departments across the state with antiquated computer systems that were not up to the task when the coronavirus hit.

Hayes recalls a time when her department would conduct mass vaccination drills, but that system was dismantled when the money dried up after the specter of Sept. 11 faded.

Roughly six years ago, an analysis found that her department was about $25 million short of what it needed annually for core public health work. Hayes said the past year has shown that’s an underestimate. For example, climate change is prompting more public health concerns, such as the effect on residents when wildfire smoke engulfed much of the Pacific Northwest in September.

Public health officials in some areas may struggle to make the case for more stable funding because a large swath of the public has questioned — and often been openly hostile toward — the mask mandates and business restrictions that public health officials have imposed through the pandemic.

In Missouri, some county commissioners who were frustrated at public health restrictions withheld money from the departments.

In Knox County, Tennessee, Mayor Glenn Jacobs narrated a video posted in the fall that showed a photo of health officials after referencing “sinister forces.” Later, someone spray-painted “DEATH” on the department office building. The Board of Health was stripped of its powers in March and was given an advisory role. A spokesperson for the mayor’s office declined to comment on the video.

“This is going to change the position of public health and what we can and cannot do across the country,” said Dr. Martha Buchanan, the head of the health department. “I know it’s going to change it here.”

A KHN and AP investigation in December found at least 24 states were crafting legislation that would limit or remove public health powers.

Back in Seattle, locally based companies have pitched in money and staff members for vaccine sites. Microsoft is hosting one location, while Starbucks offered customer service expertise to help design them. Hayes is grateful, but she wonders why a critical government function didn’t have the resources it needed during a pandemic.

If public health had been getting dependable funding, her staff could have been working more effectively with the data and preparing for emerging threats in the state where the first U.S. COVID-19 case was confirmed.

“They’ll look back at this response to the pandemic in this country as a great example of a failure of a country to prioritize the health of its citizens, because it didn’t commit to public health,” she said. “That will be part of the story.”

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KHN senior correspondent Anna Maria Barry-Jester and Montana correspondent Katheryn Houghton contributed to this report.

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Follow Michelle R. Smith on Twitter @MRSmithAP, Lauren Weber @LaurenWeberHP and Hannah Recht @hannah—recht.

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This story is a collaboration between The Associated Press and KHN (Kaiser Health News), which is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Brazil's hospitals running out of sedatives as COVID-19 rages

RIO DE JANEIRO (Reuters) – Hospitals in Brazil were running out of drugs needed to sedate patients on Thursday, with reports of the seriously ill being tied down and intubated without effective sedatives.

FILE PHOTO: Medical workers take care of patients in the emergency room of the Nossa Senhora da Conceicao hospital that is overcrowding because of the coronavirus outbreak, in Porto Alegre, Brazil, March 11, 2021.  REUTERS/Diego Vara

The scenes playing out across Brazil, one of the countries hardest hit by the COVID-19 pandemic, are placing growing international pressure on President Jair Bolsonaro.

Aid group Médecins Sans Frontières (MSF) said Brazil’s “failed response” had led to thousands of avoidable deaths and created a humanitarian catastrophe that could still get worse.

Brazil has recorded a total of 361,884 coronavirus deaths – only the United States has more – and 13,673,507 confirmed cases.

More Brazilians are currently dying of the virus each day than anywhere else in the world. Bolsonaro has opposed lockdowns and held large events in which he often does not wear a mask. He has only recently embraced vaccines as a possible solution.

Brazil’s hospitals are struggling to cope.

Rio de Janeiro and Sao Paulo have both sounded the alarm over shortages of sedatives, with Sao Paulo’s Health Secretary saying the city’s ability to care for seriously ill COVID-19 patients is on the verge of collapse.

“I never thought that I would be living through something like this after 20 years working in intensive care,” Aureo do Carmo Filho, an ICU doctor in Rio, told Reuters.

“Using mechanical restraints without sedatives is bad practice…the patient is submitted to a form of torture,” he said.

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Seriously ill COVID-19 patients struggling for breath are sedated in order to put them on ventilators, an intrusive practice the body can naturally resist.

With ICU beds at or near capacity across the country, hospitals are being forced to create improvised intensive care beds which often lack equipment or professional expertise.

Globo television network on Wednesday reported cases from a Rio hospital in which patients were intubated with a lack of sedatives, tied to beds.

The Albert Schweitzer hospital, through the press office of the city of Rio which runs it, said there was a shortage of intubation drugs but that substitutes were being used to ensure medical assistance was not compromised. It said mechanical restraints were only used when prescribed by a doctor.

The city of Rio added that a batch of intubation drugs was set to arrive on Thursday.

“FAILED RESPONSE”

Médecins Sans Frontières said Bolsonaro’s government had not done enough to prevent the tragedy.

“More than one year into the COVID-19 pandemic, the failed response in Brazil has caused a humanitarian catastrophe,” said Christos Christou, a medical doctor and president of MSF, called Doctors Without Borders in English.

“Each week there is a grim new record of deaths and infections – the hospitals are overflowing and yet there is still no coordinated centralized response,” Christou said in a briefing with reporters, adding that the situation was expected to become even worse in the weeks ahead.

Bolsonaro has openly fought against state and local governments seeking to institute lockdowns, saying Brazilians need to get on with normal life and that job losses are more dangerous than the virus.

MSF Director-General Meinie Nicolai said the surge in cases cannot be blamed only on the contagious Brazilian COVID-19 variant, known as P.1.

“The P.1 variant is certainly a problem, but this doesn’t explain the situation in Brazil,” she said.

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U.S. pauses J&J COVID-19 vaccine over rare blood clots

(Reuters) -U.S. federal health agencies on Tuesday recommended pausing the use of Johnson & Johnson’s COVID-19 vaccine after six women under 50 given the shot developed rare blood clots, dealing a fresh setback to efforts to tackle the pandemic.

FILE PHOTO: A woman receives a dose of the Johnson & Johnson coronavirus disease (COVID-19) vaccine during a visit of U.S. Vice President Kamala Harris to a vaccination center in Chinatown, in Chicago, Illinois, U.S., April 6, 2021. REUTERS/Carlos Barria

Following the news, Johnson & Johnson (J&J) said it was delaying the rollout of the vaccine to Europe, a week after regulators there said they were reviewing rare blood clots in four recipients of the shot in the United States.

The moves come after European regulators said earlier this month they had found a possible link between AstraZeneca’s COVID-19 vaccine and a similar rare blood clotting problem that led to a small number of deaths.

J&J’s single dose vaccine – most COVID-19 shots are delivered over two doses – and AstraZeneca’s low-cost vaccine are seen as vital tools in the fight against a pandemic that has claimed more than three million lives.

The White House said the pause would not have a “significant” impact on its plan to administer about three million shots per day and a total of 200 million shots before President Joe Biden’s 100th day in office.

The U.S. Food and Drug Administration (FDA) said one person had died from the rare blood clotting condition after taking the J&J vaccine and another was in a critical condition.

Immunology experts stressed the risk posed by the J&J vaccine appeared extremely low, and that the shot remained a valuable tool against the risks of COVID-19. However they acknowledged the need for health officials to proceed with caution to understand the best ways to mitigate any risk.

“Even if causally linked to the vaccine: 6 cases with about 7 million doses (lower than the risk of clots with oral contraceptives) is not something to panic about,” Dr. Amesh Adalja, an infectious disease expert at the Johns Hopkins Center for Health Security in Baltimore, said in an email.

“People are asking me if they should cancel their J&J vaccine appointments and I have told them not to but I know many will and this will stall progress in controlling the pandemic.”

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FDA acting commissioner Janet Woodcock said it expected the pause to be a matter of days, and it was aimed at providing information to healthcare providers so that they can diagnose, treat and report such blood clots.

FDA official Peter Marks said that part of the reason for the pause was to warn doctors that administering the standard treatments for clots can cause tremendous harm, or be fatal.

‘LESS THAN ONE IN A MILLION’

Most of the available J&J vaccine has been used in the United States due to production issues that have limited the company’s supply. As of April 12, more than 6.8 million doses of the J&J vaccine had been administered in the United States, compared with more than 180 million shots combined of the Moderna and Pfizer/BioNTech shots.

U.S. health officials said during a press briefing there had been no similar blood clot cases reported among recipients of the Pfizer/BioNTech of Moderna vaccines.

An advisory committee to the U.S. Centers for Disease Control and Prevention (CDC) will meet on Wednesday to review the cases, and the FDA will review the analysis, the agencies said in a joint statement.

All six cases involved women between the ages of 18 and 48, and the symptoms occurred six to 13 days after vaccination.

In the cases, a type of blood clot called cerebral venous sinus thrombosis (CVST) was seen in combination with low levels of blood platelets (thrombocytopenia).

J&J said it was working closely with regulators and noted no clear causal relationship had been established between the cases and the COVID-19 vaccine made by its Janssen unit.

“Even if all of the cases were caused by the vaccine, the risk of less than one in a million would have to be set against the benefits of protection from COVID-19 disease; a disease which, in itself, causes clotting in many cases,” said Peter English, a retired consultant in communicable disease control and a vaccine expert.

‘ABUNDANCE OF CAUTION’

“The FDA recommendation to pause the administration of the Johnson and Johnson vaccine out of an abundance of caution makes sense in terms of the nature of the unusual and serious side effect not seen with the other vaccines,” said Dr. Robert Klugman at the UMass Memorial Medical Center in Massachusetts in an email.

J&J’s shares were down 2.6% in early New York trade.

The J&J and AstraZeneca vaccines both use an adenovirus vector – a harmless cold virus that instructs human cells to produce a protein found on the surface of the coronavirus, thereby spurring the immune system to prepare an arsenal against the COVID-19-causing virus.

Among leading global COVID-19 vaccine developers, China’s CanSino Biological and Russia’s Gamaleya Institute with its Sputnik V vaccine are also relying on this approach. The Pfizer/BioNtech and Moderna vaccines use mRNA technology.

The rollout of J&J’s vaccine has been slowed by issues at production plants.

The company has supplied the United States with at least 20 million doses but is behind schedule on its deliveries. Problems at a Baltimore, Maryland plant run by outside contractor Emergent BioSolutions forced the companies to trash a batch of vaccine substance.

J&J only began delivering its COVID-19 vaccine to European Union countries this week. It has committed to delivering 55 million doses to the bloc by the end of June and another 120 million in the third quarter.

J&J has been doing vaccinations in South Africa to study the effects on health workers, and had vaccinated just under 300,000 people there as of Monday, according to data from the country’s health department. J&J recently struck a deal with the African Union for up to 400 million doses.

Europe’s drugs regulator continues to recommend the use of AstraZeneca’s COVID-19 vaccine, saying the benefits outweigh the risks. Several EU countries, however, have limited its use to certain age groups.

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German government seeks more powers to set pandemic rules

BERLIN — Chancellor Angela Merkel said Tuesday her government wants clear rules that include nighttime curfews imposed in all regions with high numbers of COVID-19 infections, ending the patchwork of measures that have characterized the pandemic response across Germany’s 16 states.

“The uniform, nationwide emergency brake is overdue because even though it’s difficult to hear this again, the situation is serious,” Merkel told reporters in Berlin after her Cabinet approved the plan.

Many Germans have expressed frustration and confusion in recent months as governors interpreted rules agreed with the federal government in different ways, despite having similar infection rates.

Merkel warned that Germany remains “firmly in the grip of the third wave” of infections, citing figures from the country’s disease control agency that showed 10,810 newly confirmed cases in the past 24 hours, and 294 deaths.

Since the start of the pandemic, Germany has registered more than 3 million infections and 78,746 deaths from COVID-19.

“If we were to wait until all the intensive care beds were occupied, then it would be too late,” Merkel said, adding that governments and citizens need to help doctors and nurses tackle the surge in cases.

The emergency brake, proposed in a bill that will be submitted to Parliament, will apply in regions with more than 100 new weekly cases per 100,000 inhabitants. It entails the closure of stores, cultural and sports facilities, limits on personal contacts and nighttime curfews.

States would be free to set more flexible rules in regions with fewer than 100 new cases each week per 100,000 inhabitants.

Merkel said she hoped Parliament would swiftly debate and pass the bill.

She again asked for Germans to show patience and noted that the country’s sluggish vaccine program had picked up with the recent start of vaccinations in GP practices. Last week, some 3.2 million shots were administered in Germany, compared with 1.9 million the previous week.

The Cabinet also agreed that companies will need to offer all employees who aren’t working from home at least one coronavirus test each week, and that parents will get more paid leave to care for children who cannot go to school due to the pandemic.

Separately, Germany’s top security official ordered an end to temporary border controls along with frontier with the Czech Republic. The checks, which caused lengthy tailbacks along the border and were a headache for commuters, had been in place for two months due to the high rate of infection in Germany’s eastern neighbor.

Interior Minister Horst Seehofer said the spot checks would continue to take place to ensure that people have a negative coronavirus test when entering Germany from the Czech Republic.

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Follow all of AP’s pandemic coverage at https://apnews.com/hub/coronavirus-pandemic, https://apnews.com/hub/coronavirus-vaccine and https://apnews.com/UnderstandingtheOutbreak

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