– Advertisement – Us Weekly has affiliate partnerships so we may receive compensation for some links to products and services.Most of us are constantly struggling to get enough sleep. We’re unable to fall into dreamland when we want to, and the result is that we end up drifting off throughout the day. But when bedtime finally rolls around? Our body just won’t give in — suddenly it has things to do. Those things are worry, stress, roll from side to side, nervously shake a leg, think about that inconsequential thing someone did or said 15 years ago…the works.- Advertisement – A lot of people tend to go without PJ sets entirely, opting for old, oversized T-shirts and athletic shorts from a sport they haven’t played in years. We’ve been there too, but we have to tell you why we think that’s a mistake. It’s the same reason that people say not to hang out in bed before it’s time to drift off, or to stop using your phone the second you’re supine. You have to mentally and physically put yourself in a situation made for sleeping. That means putting on your sleep uniform!Of course, we won’t blame you if you end up wearing these PJs well into the morning. They’re warm, soft and skin-friendly. Up top, you have a long-sleeve tee with a round neckline and dropped shoulders, and on the bottom, you have long pants with an elasticized drawstring waistband. These pants also have pockets and tapered ankles to prevent the fabric from dragging across the floor. It’s a cuter, jogger-inspired look too!AmazonSee it!- Advertisement – Get the AKEWEI Two-Piece Jogger PJ Set starting at just $23 at Amazon! Please note, prices are accurate at the date of publication, November 4, 2020, but are subject to change.This matching set comes in five tie-dye color variations, and we’re loving the watercolor effect. The sky blue shade really does look like puffy clouds partly covering a gorgeous blue sky, while pink and light purple have more of a sunrise or sunset effect. The remaining purple and orange shades look like straight-up paintings! These pajamas will seriously make you feel like a work of art.We love these PJs as a set, but don’t forget you can always mix and match should you feel like it’s a night for shorts or a tank top. Take them out on the town too, pairing the top with jeans or the bottoms with a mock-neck top! Just make sure to schedule some time for a nap. See it!Get the AKEWEI Two-Piece Jogger PJ Set starting at just $23 at Amazon! Please note, prices are accurate at the date of publication, November 4, 2020, but are subject to change.Not your style? Check out more from AKEWEI here and shop more sleep and loungewear here! Don’t forget to check out all of Amazon’s Daily Deals!Check out more of our picks and deals here!This post is brought to you by Us Weekly’s Shop With Us team. The Shop With Us team aims to highlight products and services our readers might find interesting and useful, such as face masks, self tanners, Lululemon-style leggings and all the best gifts for everyone in your life. Product and service selection, however, is in no way intended to constitute an endorsement by either Us Weekly or of any celebrity mentioned in the post.The Shop With Us team may receive products free of charge from manufacturers to test. In addition, Us Weekly receives compensation from the manufacturer of the products we write about when you click on a link and then purchase the product featured in an article. This does not drive our decision as to whether or not a product or service is featured or recommended. Shop With Us operates independently from advertising sales team. We welcome your feedback at [email protected] Happy shopping! Now, are we going to imply that a cute, comfy pair of pajamas can fix all of those things? Well, not necessarily. But it might help! Feeling physically comfortable and happy with your bedtime outfit could ease your mind. When you set yourself up for a good night’s sleep with a soft (or firm) pillow, cozy blankets and an A+ pair of PJs, your body just might find that bedtime is not so bad after all!AmazonSee it!Get the AKEWEI Two-Piece Jogger PJ Set starting at just $23 at Amazon! Please note, prices are accurate at the date of publication, November 4, 2020, but are subject to change.- Advertisement –
Still growing! Candace Cameron Bure opened up about how her relationship with husband Valeri Bure evolved during the quarantine caused by the coronavirus pandemic.“It totally tested us but in the best of ways,” the actress, 44, exclusively told Us Weekly on Wednesday, November 4, while discussing her partnership with The Salvation Army. “I’ll be honest because we try. We both travel so much. So we were like, ‘This might be the most amount of time we’ve actually spent together in years. This is either going to make us or break us.’ And you know what? It’s made us.”Valeri Bure and Candace Cameron Bure. Richard Shotwell/Invision/AP/Shutterstock- Advertisement – Candace noted how thankful she was for the extra time with Valeri, 46. “So many things are put in perspective just being at home, and then you talk through a lot of things and you realize, ‘What are the things we have to work on? What are the things that are working well?’” she explained. “I’m really grateful that it’s the one thing that I can look at 2020 — as crazy as this year has been and difficult — and I’m so grateful for my family time because I’ve reevaluated my work schedule, the time that I’m away from my family, and realized that that was not a good balance for me. So I’m thankful that it happened in that way because it’s made our relationship stronger.”The couple tied the knot in June 1996 and are parents of daughter Natasha, 22, and sons Lev, 20, and Maksim, 18.The Let It Snow actress got real earlier this year about how her family dynamic shifted during the quarantine. “I started 2019 off as an empty nester and now I’ve got a full house again,” she told Us in April. “I am very happy that I have my kids home and spending time with my husband too. Because a lot of times we’re like two ships passing in the night with our work schedule. So that part has been the biggest blessing for me.”- Advertisement – “They do so much good work throughout the year, and this year, because of the pandemic and COVID, things are different,” she told Us on Wednesday. “You always see around the holidays the red kettles and the Red Kettle Campaign supports so much of Salvation Army’s work that they do through the year — helping families in need through shelter and food and job training and daycare. And this year, because we’re not out as much, we’re not out and about, those kettles are gonna suffer. So we’re asking everyone to go to rescuechristmas.org and donate there or drop a few dollars in when you do see the red kettle or set up a monthly donation. They’re expecting 155 percent more families will be in need this holiday season.”With reporting by Christina GaribaldiListen to Us Weekly’s Hot Hollywood as each week the editors of Us break down the hottest entertainment news stories! The Fuller House alum emphasized that she had “incredible” conservations with her brood while detailing other activities they did to pass the time at home. “We’ve been taking lots of walks and playing lots of board games and we’re in sunny California. We have a pool and we’ve been enjoying that too because the weather’s been nice,” she said. “It’s just been concentrated family time [with] lots of cooking and eating.”Now, Candace has partnered up with The Salvation Army for the third consecutive year to help millions in need during the holiday season.- Advertisement – – Advertisement –
An F1 spokesperson said: “Our calendar will be announced tomorrow [Tuesday] and we are not going to give a running commentary before its publication.- Advertisement –
Stocks making the biggest moves premarket: Beyond Meat, Lowe’s, Microsoft, Tesla & more Search quotes, news & videos
The “Middle” singer took home three trophies at the CMAs on Wednesday, November 11: Single of the Year, Song of the Year and Female Vocalist of the Year.Morris used her last acceptance speech of the night to shout-out Black female musicians in country music who weren’t nominated or performing at the awards show.- Advertisement – Confidence boost. Maren Morris admitted she doesn’t always feel accepted in the country music industry, but her big night at the 2020 Country Music Association Awards made her feel less insecure.The “Bones” singer, 30, got candid about her self-doubt via Twitter on Friday, November 13.- Advertisement – “I want to give recognition to, because I’m just a fan of their music, and they’re as country as it gets,” she said. “I just want them all to know how much we love them back and just check out their music after this. It’s Linda Martell, Yola, Mickey Guyton, Rissi Palmer, Brittney Spencer, Rhiannon Giddens.”Morris added, “There are so many amazing Black women that pioneered and continue to pioneer this genre, and I know they’re going to come after me, and they’ve come before me, but you’ve made this genre so, so beautiful. I hope you know that we see you. Thank you for making me so inspired as a singer in this genre.”Maren Morris attends The 54th Annual CMA Awards on November 11, 2020 in Nashville’s Music City Center. ABCThe Texas native has been bonding over music with her 7-month-old son, Hayes, with whom she shares with husband Ryan Hurd. In March, Morris reacted after Hozier tweeted a video of a crying infant calming down after hearing her song “The Bones.”“This is too much for words,” she replied. “I will say, the same thing doesn’t work for my baby. 😂😂😂.”During her pregnancy, the “80s Mercedes” singer even attempted to go into labor by dancing to Harry Belafonte‘s “Jump in the Line (Shake, Senora)” in an Instagram video. “Harry Belafonte issuing an eviction notice for this baby. 👶🏻,” she captioned the clip.However, the first-time mom isn’t planning on filtering her music just because she’s now a parent. “I am always going to say ‘s–t’ in songs probably,” she told E! News earlier this month.Listen to Us Weekly’s Hot Hollywood as each week the editors of Us break down the hottest entertainment news stories! “Coming down from the other night. I am still in awe,” she tweeted. “Thank you to my friends and family, my fans and my Nashville peers for this honor.”Morris added that people’s negative comments about her place in country music affect her, but her success has helped her feel better.“I still can get hurt when people claim I’m ‘not country’ but when I stood there accepting@cma Song of the Year, I realized it is much harder to forge your own path & sound than attempt to be a knock off of someone who’s already pioneered the genre,” she continued. “Thank you for accepting me.”Courtesy Maren Morris/Twitter- Advertisement – – Advertisement –
– Advertisement – Mr. Biden also said that he wanted to see a mask mandate in the United States, reiterating his request for state and local officials to require citizens to wear face coverings as cases surge during the cold winter months. Aiming fire at the Trump administration, he criticized the president and his advisers for attacking leaders of states like Michigan who have imposed new restrictions on businesses to contain rising case numbers.“What the hell’s the matter with these guys?” Mr. Biden said. “It’s totally irresponsible.”Vice President-elect Kamala Harris, speaking before Mr. Biden, said they were focused on “opening this economy responsibly and rebuilding it so it works for working people.”- Advertisement – “More people may die, if we don’t coordinate,” he said. – Advertisement – His speech came at a perilous moment for the recovery.Credit card data and other indicators suggest that consumers began to pull back spending this month as infection, hospitalization and death rates from the virus surge nationwide. States have begun to impose new restrictions on economic activity in an effort to tamp down the spread.But stock markets were rising again on Monday, encouraged by news that Moderna’s vaccine for the virus appears to be highly effective. Still, widespread distribution of a vaccine that would allow Americans to resume anything close to normal levels of travel, dining out and other types of spending on services that have been crushed by the pandemic is likely months away. Economists continue to call for a new and immediate round of aid from Congress to help people and businesses weather the difficult time before the rebound is complete. Earlier on Monday, Mr. Biden and Ms. Harris spoke with business and union leaders to discuss the recovery, including Mary Barra, the chief executive of General Motors; Sonia Syngal, the chief executive of Gap; Satya Nadella, the head of Microsoft; Richard Trumka of the A.F.L.-C.I.O. and Rory Gamble, president of the United Auto Workers. “They represent very different perspectives, but I’m convinced we can all come together around the same table to advance areas of common ground,” Mr. Biden said. He underscored the importance of unity between business leaders and unions and said that unions would have more power under his watch.Mr. Biden said he supported a robust stimulus package such as the $3 trillion bill that House Democrats passed earlier this year, and he insisted that funding for states and cities needs to be included in such legislation. The president-elect said that sick leave and money for child care were also priorities, arguing that people should not have to choose between working and caring for others. “For millions of Americans who’ve lost hours and wages or have lost jobs, we can deliver immediate relief and it need be done quickly,” Mr. Biden said. “Congress should come together and pass a Covid relief package” along the lines of the $3 trillion bill that House Democrats passed earlier this year.Mr. Biden said that combating the virus remained the most urgent matter, however, and called on President Trump to begin the transition process quickly. President-elect Joseph R. Biden Jr. warned that a “very dark winter” was ahead and called on Congress to pass an economic stimulus package immediately to help workers struggling to cope with the coronavirus pandemic. In his first economic address since winning the election this month, Mr. Biden said he supported a national mask mandate to help curb the rise of the virus and that Congress should provide trillions of dollars in fiscal support to workers, businesses and state and local governments.- Advertisement –
Nov 10, 2005 (CIDRAP News) – Scattered shortages of influenza vaccine have occurred this fall in the face of increased demand, but everyone who wants a shot should be able to get one before long, the nation’s top disease-control official said today.At least 71 million doses of flu vaccine have been distributed so far, and another 10 million to 12 million will likely be shipped by the end of this month, said Dr Julie Gerberding, director of the Centers for Disease Control and Prevention (CDC).”We might actually end up with the most ever influenza vaccine for the country,” she said at a teleconference from Atlanta this afternoon. That could happen if 81 million doses have been distributed by the end of November and production continues into December, as it often does, she explained.Some clinics and companies have had trouble getting doses, in part because Chiron Corp. has not been able to produce as much or as fast as expected, Gerberding said.But with distribution continuing, “People still have many opportunities to get vaccine,” she said.Market forces mostly determine the flow of flu vaccine, and the CDC doesn’t own much vaccine itself, Gerberding said. However, “We’re getting about 800,000 doses of vaccine from Chiron at the end of November” and will use it to alleviate spot shortages, she added.She also said local health departments are working with healthcare providers to make sure people at highest risk for flu complications can get their shots.Current flu activity is less than at this time last year, with most states reporting sporadic cases or none at all, Gerberding said.But demand for vaccine is probably higher than it was last year, though the CDC doesn’t have any solid data yet, she reported. The increase may be driven by last year’s vaccine shortages and by the current heavy publicity about H5N1 avian flu and the threat of a flu pandemic, she said.The seasonal flu vaccine would not protect people from a new pandemic strain, but media coverage of the pandemic issue reminds people of the importance of flu and may motivate them to seek vaccination, Gerberding said.Vaccine doses distributed so far include about 55 million doses from Sanofi Pasteur, 7.5 million from GlaxoSmithKline, 1 million from MedImmune, and 8 million from Chiron, she reported.”We expect 10 to 12 million more doses by the end of November,” including some from Sanofi, MedImmune, and Chiron, she said.Gerberding said her own mother had called her to ask for advice after she was unable to get a flu shot from her doctor. Gerberding asked if there were any flu cases in the community, and when her mother said no, she advised her to wait until her doctor gets some vaccine, rather than traveling elsewhere to get a shot.Eventually, President Bush’s plan to increase domestic flu vaccine production and spur new production technologies should help eliminate seasonal flu vaccine shortages, Gerberding said. Those proposals are part of the pandemic preparedness strategy announced by Bush last week.”In the long run the solution is in sight,” she said. “We wish we had that solution today; we’re sorry that we don’t. But this year, unlike last year, we expect many more doses of flu vaccine. Be patient, check with your physician—you may be able to get your shot a little later this month.”See also:Transcript of Nov 10 CDC teleconferencehttp://www.cdc.gov/media/transcripts/t051110.htm
This finding could mean that the Capitol area generally was contaminated with anthrax, which fits with certain environmental sampling data, or it could mean that some subjects were exposed to the anthrax envelope before it was opened or had contact with those in groups 1 and 2, the article says. The other three groups, enrolled for comparison, were from outside the Capitol area and consisted of (5) 2 people who had contracted anthrax infections as a result of previous attacks in 2001, (6) 12 with no anthrax exposure, and (7) 7 who were unexposed but had previously been vaccinated against anthrax. Among nonimmunized people, anthrax antibodies were found only in those who were in the building at the time of the attack, mostly in those who were in Daschle’s offices (when tested before vaccination). Anthrax was found in the nasopharyngeal samples of slightly less than half (47.5%) of workers in groups 1 and 2, including all 13 who were in the office where the letter was opened and lesser proportions of those in adjoining offices. None of the people outside the building had positive samples. All the volunteers in groups 1, 2, and 3 (those in the building when the letter was opened) were given antibiotic treatment immediately, and 10 of the 20 people in group 4 (those outside the building but in the vicinity) also opted to take antibiotics. In addition, 51 of the 59 people in groups 1 and 2 received 3 doses of anthrax vaccine starting several weeks after the attack. The postexposure 3-dose vaccination schedule was “highly immunogenic,” given that anti-PA antibodies were found in more than 94% of subjects and CMI responses were seen in more than 86%, the researchers write. In other studies, 99% to 100% seroconversion was seen with a preventive 3-dose schedule. The standard anthrax vaccination schedule, used in the US military, involves 6 doses over 18 months. The researchers studied 124 people, divided into seven groups. The first four groups consisted of (1) 28 people who were in or near Daschle’s office and had positive nasopharyngeal cultures for anthrax, (2) 31 who were in or near the office but had negative cultures, (3) 24 who were elsewhere in the Hart Senate Office Building, and (4) 20 who were outside the building but in the Capitol area (and were presumed to be unexposed). Scientists who prospectively studied people who were in the vicinity when the letter was opened report that even people who were outside the building showed immune responses to anthrax, suggesting that the deadly spores spread more widely than expected. The letter was one of several mailed to two US senators and several media offices in the fall of 2001, resulting in 22 cases of anthrax, 5 of them fatal. Two tests (enzyme-linked immunosorbent assay and fluorescence-activated cell sorting) were used to examine the subjects’ antibody and cell-mediated immune (CMI) responses to two anthrax proteins: protective antigen (PA) and lethal factor (LF). They conclude that antibiotic treatment protected the infected subjects, who were generally young, from becoming clinically ill. “We do not know whether higher exposure could result in clinical disease even with antibiotics or what happens in immunocompromised or immunologically immature populations,” they state. “Despite postexposure prophylaxis with antibiotics, inhalation of B[acillus] anthracis spores resulted in stimulation of the immune system and possibly subclinical infection, and the greater the exposure, the more complete the immune response,” says the report by Denise L. Doolan of the Naval Medical Research Center in Silver Spring, Md., and associates from there and several other institutions. “Our data demonstrate that exposure to B. anthracis spores primed antibody and cellular responses in a dose-dependent and antigen-specific manner in immunized and unimmunized subjects, enhanced AVA-boost responses, and boosted recall responses in previously immunized subjects,” the researchers write. No significant differences in symptoms were seen between subjects with and without anthrax exposure and with and without immune responses, except for headache, which was more common in exposed people but correlated with the duration of antibiotic use. Jan 10, 2007 (CIDRAP News) The anthrax-laced letter sent to Sen. Tom Daschle’s office in 2001 may have affected more people than was recognized at the time, but the antibiotics and vaccinations given to potentially exposed people were highly effective, according to an immunologic study of the event. See also: The researchers, writing in the Journal of Infectious Diseases, also report that those who were exposed showed immune responses to anthrax even though they were immediately put on preventive antibiotic treatment. Further, they found that 3 doses of anthrax vaccine adsorbed (AVA)versus the standard 6-dose regimentriggered a strong immune response in those who were vaccinated after the attack. The researchers also report an inverse relationship between CMI responses and antibiotic treatment, which suggested that the treatment impeded anthrax spore germination, the report says. In the previously vaccinated volunteerswho were revaccinated during the studyimmune responses were strong even after a single new dose of vaccine. Doolan DL, Freilich DA, Brice GT, et al. The US Capitol bioterrorism anthrax exposures: clinical epidemiological and immunological characteristics. J Infect Dis 2007 Jan 15;195(2):174-84 [Full text] In the tests for CMI, the researchers found a direct relationship between presumed anthrax exposure and response rate. Unexpectedly, however, they found evidence of CMI in some people who were outside the building (group 4). For example, monocytic responses were detected in more than 70% of groups 1 and 2, 37.5% of group 3, and 30% of group 4. Monocytic responses for group 4 were significantly higher than those for unexposed controls (group 6). Hadler JL. Learning from the 2001 anthrax attacks: immunological characteristics. (Editorial) J Infect Dis 2007 Jan 15;195(2):163-4 [Full text] The data suggest, they add, that low-level anthrax exposure induces asymptomatic cellular immune responses without antibodies and that intermediate exposure induces both cellular and antibody responses.
Mar 17, 2008 (CIDRAP News) – In the early stages of an influenza pandemic, cases are spreading among migrant workers in Michigan. The state’s health department has a supply of antiviral drugs from the federal stockpile and is using them to treat the sick, but, concerned about breaking federal rules, is withholding them from others exposed to the virus—thereby missing a chance to help contain it.Meanwhile, cases are spreading among homeless people in Washington, DC, and authorities are getting ready to close the schools, but they want to know what to do about children who depend on the school lunch program and those whose parents can’t take time off work to care for them.Those were two of the many dilemmas raised in a major pandemic simulation exercise staged at the Centers for Disease Control and Prevention (CDC) in Atlanta last week. Others included how to keep travelers from spreading the virus and what to do in the face of serious side effects caused by the leading antiviral drug.It was the fourth in a series of exercises based on a scenario that puts the United States at the epicenter of an evolving pandemic featuring an H5N1 strain of flu. Instead of watching anxiously as a pandemic emerges on some other continent, the scenario goes, the United States has about 75% of the world’s cases, all stemming from a traveler from Southeast Asia who brought the virus into the country. The series of exercises began in January 2007.Although the event was only an exercise, it offered a close-up look at the CDC’s expectations about the kinds of challenges it will face in the early stages of a real pandemic and how it might be likely to respond.The simulation involved a total of roughly 1,000 people, most of them from the CDC but also a number from other government agencies, according to Von Roebuck, a CDC spokesman who hosted reporters witnessing the drill.CDC emergency center buzzingThe 2-day event took place in the Director’s Emergency Operations Center (DEOC) on the third floor of the gleaming CDC headquarters building on the Atlanta campus. There, specialists from many CDC branches and a few other agencies staffed computer stations laid out in long rows, with 60 stations in all, most of them occupied. They faced a wall filled with a dozen or more electronic displays that charted data on influenza cases and deaths, distribution of antivirals, deployment of CDC personnel, CDC goals and objectives, and various other dimensions of the pandemic and response. Flanking the data displays were two TV news feeds.A similar but smaller control room a couple of buildings away was occupied by the CDC’s Exercise Control Group, consisting of 51 people who designed and monitored the exercise, adding new wrinkles that the CDC had to respond to as it evolved. Some played roles as representatives of other federal agencies or state health departments.As played out in the first exercise last year, the pandemic scenario began with an apparently healthy but infectious man from Southeast Asia who traveled to the United States, exposing other travelers on the way. After falling ill, he exposed household contacts, healthcare workers, and some members of a university sports team.Soon, as depicted in subsequent exercises, cases linked to the index patient surfaced in 10 states, plus Washington, DC, the Marshall Islands, Guam, and several foreign countries, including Australia, India, the United Kingdom, Panama, Japan, and Canada. Early on, the CDC determined that the prepandemic H5N1 vaccine in the US stockpile was not of much use against the pandemic strain. But the agency began shipping antivirals, mainly oseltamivir (Tamiflu), to the states, allocating them in proportion to population.By the time last week’s exercise opened on Tuesday, which was termed the sixth day of the CDC’s emergency response, there were 273 US cases and 27 deaths. The exercise began with a meeting involving CDC Director Dr. Julie Gerberding and about 25 senior staff members in a glass-walled conference room adjoining the DEOC. Sound from the meeting was piped—not always very audibly—into the main room.As the exercise unfolded over the 2 days, cases mounted, slowly here, in spurts there. CDC officials hashed out responses in the early morning briefings and in conference calls with state officials; they announced decisions and recommendations at mock press briefings each morning and afternoon.School closing confusionThe question of school closings and related “community mitigation” (CM) measures (also known as nonpharmaceutical interventions, or NPIs) arose early and often. At the first morning press briefing, Gerberding said, “As of this morning we’re not recommending widespread school closures or other measures to reduce spread in crowds, but those measures are likely.” She added that actual closings would be local decisions.When she was asked what should trigger CM measures, Gerberding said, “When a community begins to see acceleration in the number of cases that suggests that transmission is really taking off, that’s when closing schools and avoiding crowds can help. It’s important to do it early, because if you wait till you have 1,000 or 10,000 cases, it’s too late.”Hesitation and concerns about CM measures emerged in an hour-long Tuesday afternoon teleconference between senior CDC staffers and health officials from states affected by the pandemic. (The state officials were mostly played by CDC staffers in the Exercise Control Group, but three people from state health departments had joined the group for the exercise, according to Jerry Jones, director of the group.)The Michigan official wanted to know if the CDC could recommend any particular NPIs as better than others. He said the state had a case-fatality rate of 7% in its 100 cases, signaling a severe pandemic under the CDC’s community mitigation plan, so the state needed to launch mitigation steps. “But the local health departments are telling us they don’t want to do all that work,” he said. “So if there’s one thing working better than others, we’d like to recommend it.”The answer from the CDC team was negative. “We need to really discourage people from picking and choosing different things. They need to be implemented simultaneously,” said one official. However, the officials said mitigation steps could be limited to specific communities rather than covering the whole state.Another official cited last year’s report in the Journal of the American Medical Association on the effectiveness of NPIs in the 1918 pandemic, including school closures, banning public gatherings, isolation of patients, and quarantine of contacts. “If you need ammunition, that’s what to use,” he said.A few minutes later, a Washington, DC, official raised concerns. “We get a lot of pushback about the need to wait to work on these school closures,” she said. The three main issues, she said, had to do with children dependent on the school lunch program, children whose parents can’t take time off work, and what to do about teachers’ salaries.The CDC officials deferred to others on that issue, saying the Department of Education was supposed to be developing relevant guidance. “These problems require resources that we don’t have authority over,” said Dr. Stephen Redd, the CDC’s influenza team leader.School closures came up again on Wednesday, the second day of the exercise.In response to questions at the morning press conference, Redd said, “There will not be a federal decision on school closings. This needs to be a local decision.” He added that schools were already closed in affected areas of Michigan and Arkansas.But in another conference with state health officials that afternoon, uncertainty was still evident. Ohio, which was reporting 18 cases, was getting a lot of questions and concern about whether schools would close, especially in Toledo, a state official reported. He expressed concern that parents would start keeping their children home and said he wasn’t sure what the state’s trigger for closing schools was.CDC officials responded by repeating the criteria for launching NPIs and said a document explaining them would be posted on the government’s pandemic flu Web site later in the day.Debating guidance on antiviralsWith no effective vaccine available, health authorities were forced to rely on antiviral drugs to fight the virus, under the scenario. Earlier chapters in the exercise brought the news that the prepandemic H5N1 vaccine in the US stockpile was too poor a match for the pandemic virus to be of much use. The CDC decided to distribute antivirals from the national stockpile to all the states in proportion to population. Roebuck, the CDC spokesman, said the real stockpile currently contains 39.8 million treatment courses of oseltamivir and 9.9 million courses of zanamivir (Relenza).The drugs were being shipped to the state health departments in stages, with each state first receiving 25% of its share and then getting another 50% later. The CDC planned to hold the last 25% in reserve. At the Wednesday news briefing, Redd said about 30% of the stockpile had been delivered so far, and the expectation was that the 75% mark would be reached within the ensuing week. In a real pandemic, state health departments will be responsible for distributing the antivirals to healthcare providers according to their preexisting plans, said Dr. Richard Besser, director of the CDC’s Coordinating Office for Terrorism Preparedness and Emergency Response.Because of the limited supply, the CDC’s recommendation was to use the antivirals to treat sick people, not to prevent flu in their contacts, although small amounts could be used for “initial containment in some locations,” Gerberding said at the Tuesday morning news conference. “The deployment is to make sure that hospitals have drugs available when people are sick,” she said.Whether to use antivirals for prophylaxis sparked a lively discussion at the Wednesday teleconference of CDC leaders and state health officials. A Michigan official said the state was calling for community mitigation measures in affected migrant worker camps and neighboring towns, but some of the neighboring towns were reluctant to take those steps. As a result, he said, state officials were worried that the virus would move from the camps to the nearby communities and start spreading. In response, a CDC official recommended that the state use antivirals for prevention in those areas.”We’ve been using them only for treatment so far,” the Michigan official replied. “We would be happy to use them for prophylaxis at this time, but we need more clarification from the SNS [Strategic National Stockpile]” on policy.Another CDC official observed that the official guidance was that the antivirals should be used only for treatment. But in further discussion the CDC conferees agreed it would be appropriate for Michigan to use the antivirals for prophylaxis under the circumstances.”I’ll make a decision,” one CDC official volunteered. “Go ahead and give them some.””Can I get that in writing?” the Michigan official asked. He was assured that he would, and the CDC officials concluded it was time to issue specific guidance to the states on how and when to use their antivirals.A few minutes later, two other states reported no hesitation in using antivirals preventively. An Ohio official reported “a lot of success” in treating both the sick and their healthy contacts with the drugs. And an Arkansas health official told the CDC people that state authorities had decided several days earlier to give preventive antiviral treatment to everyone in the town of Pea Ridge, where the state’s cases were concentrated.But the prophylactic use of antivirals had a serious downside in the exercise scenario. At the Wednesday morning press conference, Dr. Carolyn Bridges of the National Center for Immunization and Respiratory Diseases reported that two Arkansas teenagers had committed suicide after receiving oseltamivir.She noted that a label warning about possible neuropsychiatric side effects of oseltamivir had been added after reports of such events in young patients in Japan, though there has been very little information to directly link the drug with such reactions.Calling the suicides “tragic,” Bridges urged healthcare providers to report any adverse events through the MedWatch system. But in the face of a rapidly spreading virus that causes severe illness, the CDC was not changing its recommendations on the use of oseltamivir, she said.A plan to screen travelersAnother containment strategy invoked in the exercise, though in a limited way, was to screen incoming travelers in areas not yet affected by the pandemic. At the Tuesday afternoon press conference, Dr. Francisco Averhoff of the CDC Division of Global Migration and Quarantine announced a screening program designed to slow the spread of flu into Alaska, Hawaii, and Puerto Rico, which were not yet reporting cases.The plan, he said, was to funnel all airline flights to one airport for each of those jurisdictions—Anchorage, Honolulu, and San Juan—and to screen all arriving passengers with a visual check, health questionnaire, and physical exam. Sick passengers were to be isolated and treated, and their contacts quarantined.This plan had aroused considerable concern in state officials when it was described at the CDC conference call with state officials earlier the same afternoon. The Department of Homeland Security was to conduct the primary visual check of incoming passengers, and the CDC was to do the medical screening, with an interview and physical exam. Each state health department was asked to provide 20 staffers to help out with evaluating passengers, isolating and treating patients, and quarantining contacts, CDC officials said.”You’re asking us to give up 20 of our staff?” replied a Dr. James from Alaska. “That’s just not realistic for us to give up that many. That’s practically our whole staff.” Similarly, a Hawaiian official added that it would “extremely difficult” for his state to provide the help the CDC was requesting.The state officials said they would try to assign staff members to help with the effort, but they needed information on what kinds of workers the CDC wanted. CDC officials promised to send a list.At the news conference, a “reporter” asked how much good the screening program could do, given that the virus had a 2-day incubation period and apparently healthy travelers could be infected.”The screening isn’t foolproof,” acknowledged Dr. Stephen Redd, the influenza team leader. “What we’re trying to do is decrease the numbers and the burden of disease in a community. We know it’s not going to completely keep the virus out of these areas. We know that complete closure of the borders does not work. You would only slow the introduction.”When he was asked about screening at land border stations, Redd said the government had no major plans for enhanced screening. “We’re working in collaboration with Canada and Mexico. We feel that activities at land ports of entry would not be effective. It would be a misuse of our resources,” he said.Similarly, at the Tuesday morning news conference Gerberding reported there were no plans for increased screening of incoming international travelers other than places like Alaska and Puerto Rico. “The fact is we have the most cases of anywhere in the world. It’s not likely that doing things to keep people out will make much difference,” she said.However, the CDC was taking action when incoming international travelers with suspicious symptoms were identified during normal screening. At the Wednesday afternoon teleconference with state health officials, Averhoff said 300 airline passengers from Europe had been quarantined on arrival in Georgia after three people on the flight were found to be ill with possible pandemic flu.At the Wednesday morning news conference, Redd was asked about screening of travelers leaving the United States. He replied that the CDC was consulting with the WHO about exit screening at airports, adding, “We think the measures we’re using in the U.S. would be more effective than exit screening, so we hope not to go that way.” He explained that self-isolation of patients and voluntary quarantine of contacts seemed to be paying off in Michigan and Arkansas.Other observationsThe exercise covered many other issues and concerns. Here are a few:The 10% case-fatality rate in the scenario was worse than in the 1918 pandemic and “out of bounds of our planning scenarios,” said Gerberding.While noting the high fatality rate, Redd said, “Really the question is how widespread is this going to become?” Would it spread fairly slowly, like SARS, or would it travel much faster, like seasonal flu? “There’s kind of a sense that in some areas the local control measures are being effective,” he said.In the scenario, the pandemic virus was spreading while seasonal flu was still active. However, not much was said about how clinicians might distinguish the two illnesses, aside from laboratory testing. One official said current tests can identify an H5N1 virus in 3 to 4 hours after a sample reaches the lab.In one of the staff conferences, Gerberding called for creation of a video on how to use a simple face (surgical) mask, recommended for flu patients to protect others from their respiratory droplets. She also said the CDC should advise the public what could be used as a substitute if masks run short. “We need to lean forward with the expectation that we’re going to run out of masks,” she said.At one of the news conferences, Redd advised the public to stockpile enough food and water to last 2 weeks. The scenario did not include any major economic repercussions such as shortages of food, fuel, medicine, or other commodities.
PCA sells peanut butter to food processors and institutions such as schools, nursing homes, and hospitals, but does not sell it directly to consumers. However, the outbreak has led to a growing list of recalls of products containing peanut butter or peanut paste made by PCA, such as sandwich crackers, cookies, and ice cream. Major national brands of peanut butter sold in jars are not affected by the recalls, according to the FDA. Minnesota officials had previously tied Salmonella found in some PCA-made peanut butter to the outbreak, but the container had been opened, leaving the possibility of cross-contamination. The finding of the outbreak strain in an unopened container “has now led FDA to confirm that the source of this outbreak is peanut butter and peanut paste produced by PCA at its Blakely, Ga., processing plant,” the FDA said in an update on the investigation. According to the news release, FDA official Roberta F. Wagner told Connecticut officials, “Thus far, Connecticut’s King Nut peanut butter sample is the only intact sample that has been found with a PFGE [pulsed-field gel electrophoresis pattern] that matches the outbreak strain as determined by clinical sample analysis.” Jan 20, 2009 (CIDRAP News) Salmonella found in an unopened container of peanut butter in Connecticut has been genetically matched to the nationwide disease outbreak, confirming that it stems from a Peanut Corp. of America (PCA) facility in Georgia, the Food and Drug Administration (FDA) announced late yesterday. Even though national peanut butter brands appear to be safe, the FDA is advising consumers not to eat peanut butter, commercial products containing peanut butter or paste, or institutionally served peanut butter if they can’t determine whether those items contain PCA peanut butter or paste. PCA has recalled all peanut butter and peanut paste produced at the Blakely facility since Jul 1, 2008. The products were distributed to institutions, food services, and companies in 24 states, Canada, Korea, and Haiti, according to the CDC. The FDA said the company has stopped production at the plant as the outbreak investigation continues. The Salmonella outbreak case count has risen to 485 in 43 states and Canada, according to a Centers for Disease Control and Prevention (CDC) update posted late today. As reported previously, about 23% of patients were hospitalized, and the illness was a possible factor in six deaths. The latest illness onset date was Jan 9. The FDA is advising consumers to check its searchable online list of products and brands associated with the PCA recall (see link below) to find out if commercially made products containing peanut butter or peanut paste are subject to recall. If consumers can’t find the product on the FDA list, they should consider calling the toll-free number listed on the product package or check the company’s Web site, the FDA said. Connecticut news release on findings linking King Nut peanut butter to outbreakhttp://www.ct.gov/dph/cwp/view.asp?Q=432242&A=3659 See also: At least 10 companies making a wide range of products with peanut butter or peanut paste have issued recall press releases that have been posted on the FDA Web site. Some companies have issued recalls that have not yet been listed by the FDA. For example, Cub Foods, a division of Supervalu Co., based in Eden Prairie, Minn., today recalled five peanut butter cookie products sold in Minnesota and Iowa because they may contain peanut butter made by PCA, though there were no reports of illness. CDC outbreak updatehttp://www.cdc.gov/salmonella/typhimurium/ In Connecticut, the outbreak strain of Salmonella was found in an intact 5-pound container of King Nut peanut butter at a distributor in West Haven, the state Department of Consumer Protection reported in a news release today. King Nut Cos. distributes peanut butter made by PCA. FDA’s searchable list of recalled productshttp://www.accessdata.fda.gov/scripts/peanutbutterrecall/index.cfm FDA updatehttp://www.fda.gov/oc/opacom/hottopics/salmonellatyph.html#update