[[GRETA]]
On Plugged In....
Surges and Vaccines.
U.S. infectious disease experts ...
warn of a possible spike …
in coronavirus infections ...
following a long holiday weekend …
with the most travel...
since the beginning of the pandemic.
[[SOT DR. MORRISON]] “We’re just sort of holding our breath to see what’s going to happen in the coming weeks”
Several vaccines …
are being considered …
for emergency …
use government approval …
after trials show …
better than 90 percent effectiveness.
[[SOT DR. COLLINS ]] "These will probably be amongst the most highly tested vaccines ever in terms of their safety and efficacy"
Important questions…
about the vaccines …
Who gets them?
and when?
And what happens …
until then?
On Plugged In ...
Surges and Vaccines.
###
[[GRETA]]
Hello and welcome …
to Plugged In.
I’m Greta Van Susteren …
reporting from Washington.
“A surge upon a surge.”
That is the way …
the top U.S. …
infectious disease expert...
Dr. Anthony Fauci …
suggested the next few weeks …
could play out.
This after the Thanksgiving holiday …
saw more Americans traveling …
since the start …
of the coronavirus pandemic.
The warning comes …
as the number of infections …
worldwide is spiking.
The United States …
is headed toward 14-million cases …
four million more …
than any other nation.
But there is good news:
a vaccination is coming.
The U.S. government’s …
Food and Drug Administration ...
is considering COVID-19 vaccines …
from two companies …
for emergency use.
Pfizer and Moderna …
both say their vaccine …
is more than 90 percent effective.
We begin our look …
at the prospect of COVID vaccines …
amid the biggest surge of cases …
with VOA’s Michelle Quinn.
[[QUINN PKG]]
((NARRATOR)) ((BROLL:))
Many Americans return to work this week after taking time off for Thursday’s Thanksgiving holiday. While many people chose to stay home for the holiday, others traveled and gathered with loved ones. Health officials and elected leaders are worried that may prompt greater spread of the coronavirus. With more than 4 million cases reported in the United States in November, double October’s count, there could be a surge on top of the current surge, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
((Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases))
((mandatory cg ABC “This Week”))
(( 3:30))
“We don't want to frighten people, but that's just the reality. We said that these things would happen as we got into the cold weather and as we began traveling. And they've happened. It's going to happen again.”
((NARRATOR)) ((BROLL: ))
Facing an increase in cases, Los Angeles County, the nation’s most populated, ordered new shutdown measures including a three-week stay-at-home order beginning this week. In its final stretch of the regular season, the National Football League has ordered team facilities closed for in-person activities.
But New York City’s mayor, Bill de Blasio, announced elementary schools would open, reversing an earlier decision. Officials have been criticized throughout the U.S. for allowing indoor dining and for bars to remain open while schools are closed. Medical experts have noted that young children don’t spread the virus like adults do.
[[FOR RADIO ONLY: Dr. Fauci ]]
((Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases)) ((mandatory cg ABC “This Week”))
((7:28))
“Let's try to get the kids back, but let's try to mitigate the things that maintain and just push the kind of community spread that we're trying to avoid. And those are the things that you know well -- the bars, the restaurants where you have capacity seating indoors without masks; those are the things that drive the community spread, not the schools.”
((NARRATOR)) ((BROLL:))
With hope of a vaccination on the horizon, Fauci and other public health officials are urging the public to continue with safety procedures: wearing masks, avoiding crowds, keeping a physical distance from others. U.S. advisers chosen by the Centers for Disease Control and Prevention are meeting this week to decide how to distribute initial supplies of a vaccine, once one receives government approval.
((Michelle Quinn, VOA NEWS))
##
[[GRETA]]
The United States ...
has invested …
billions of dollars ...
through “Operation Warp Speed” …
a Trump Administration initiative ...
to quickly develop a COVID vaccine.
The National Institutes of Health ...
is working closely with ...
pharmaceutical companies …
during vaccine development …
and testing ...
establishing the COVID-19 ...
Prevention Network ...
to recruit volunteers …
for clinical trials.
since August 2009,
Dr. Francis Collins …
has directed …
the National Institutes of Health …
He is known …
for his extensive work ...
in the field of genetics.
I spoke to him …
about the vaccines …
up for approval …
who will get them ...
when will we get the vaccine …
and in the meantime:
what can we do?
[[COLLINS INTERVIEW]]
Greta Van Susteren: Nice to talk to you sir.
Dr. Francis Collins: Nice to talk to you Geta.
Greta Van Susteren: Well we Americans know what NIH is and we're very proud of it but what is NIH?
Dr. Francis Collins: The National Institutes of Health, it's the largest supporter of biomedical research in the world. Basically everything that the US is doing in terms of research and academic institutions, Institute's and our own intramural program is funded by the taxpayers through this budget, and I'm the director that's supposed to make sure it gets spent wisely everything from basic science to clinical trials. Diabetes rare diseases, cancer, and of course right now, COVID-19, and that's what we are all about $42 billion a year.
Greta Van Susteren: And I suspect that NIH is also working on treatments, new therapies to to fight this to the for the person who does get covid.
Dr. Francis Collins: We are indeed and that's an intense part of how I'm spending my time and we've made some real progress there. We have the drug Remdesivir, which is an antiviral that helps people who are quite sick in the hospital. We have Dexamethasone a steroid that also helps people who are the sickest of the sick in the ICU. And we have monoclonal antibodies developed from people who've survived COVID-19, basically purifying their antibodies that help them recover and giving them to other people, showing real promises, especially if you give those early to high risk individuals.
And we have other trials that are going on right now that may very well yield up other immunosuppressives or antivirals that can add to this-- compared to where we were back in February and March where we didn't have much of anything, we've now got quite a menu of therapeutics and survival has certainly improved for people who get very sick with this.
But it's still a very serious disease we've lost 275,000 people. And this is a scary few months that we're looking at with winter time, and with the vaccine not yet as widely available as it will be by the summer.
Greta Van Susteren: What does the FDA do the Food & Drug Administration we hear so much about in terms of the vaccine?
Dr. Francis Collins: So FDA is a sister agency we're both in the Department of Health and Human Services. FDA's job is to be the regulator and it's to look at some proposed new approach maybe it's a diagnostic test. Maybe it's a therapeutic maybe it's a vaccine and to get all the data together and look at it and decide if it's going to be safe and effective so we generally do the research trying to stimulate this kind of progress to happen and FDA decides whether it's safe for the public to start to use it in general way.
Greta Van Susteren: All right, so we're waiting breathlessly for these vaccines and some are farther along like Moderna and Pfizer than others but once it gets the green light from the FDA, who decides who will get it first?
Dr. Francis Collins: Well this is a big day for that, basically the CDC has an Advisory Committee on Immunization Practices – ACIP- and it's their job to look at a circumstance where you have a vaccine that FDA has decided is safe and effective at least for emergency use, but there aren't enough doses for everybody to receive them on day one. So who gets first in line? That's a big decision, it will include health care providers because we want them to be safe in their frontline experience and it will include people at high risk, particularly the elderly people with chronic illnesses.
Greta Van Susteren: Well the vaccines, as I understand, talking to experts is coming, very quickly. What has been the role of the US government to sort of fast track this have gotten rid of some of the red tape or is it provided more funds or what's the role of the US government?
Dr. Francis Collins: It is astounding what's been done here Greta, because traditionally it takes eight to 10 years to develop a vaccine against a new pathogen, this has been done in less than a year. The US government pulled all of the resources together to make sure that coordination was happening. Operation Warp Speed made it possible also to get rid of some of those long delays that oftentimes vex the process where you go to phase one and then you have to wait many months before you go to phase two, all of those things were synchronized in an unprecedented way, but not by doing any compromising at all on safety these will probably be amongst the most highly tested vaccines ever in terms of their safety and efficacy and the good news is, the first two that are going to get looked at by FDA in the coming weeks, look extremely good with efficacy over 90% which is better than most of us had dared to hope and safety record that also looks extremely good.
Greta Van Susteren: Alright, Moderna, and Pfizer as I understand it, both have something called the sort of a science behind is something called messenger RNA, are they very different vaccines or very similar?
Dr. Francis Collins: They're quite similar. Basically messenger RNA is the part of a nucleic acid that codes for protein. And this is a very clever way to make a vaccine where you basically synthesize that messenger RNA that has the right information in it, inject that into Muscle, Muscle goes, Oh I know what to do with messenger RNA I'll make a protein. And so it does and it makes the spike protein, which is the stuff that decorates the coronavirus and those spike proteins, the immune system says oh no you don't and makes an antibody to them. And it's very quick. That's why Pfizer and Moderna are the first two out of the gate because the messenger RNA approach can be started almost immediately upon the time the viruses isolated. So it is a new approach, it looks extremely promising, it is going to be transformational I think for vaccines for all kinds of things because it looks like it's really worked and this is the first time it's been taken all the way through to these phase three trials and FDA approval.
Greta Van Susteren: When I get a tetanus, when I've got a tetanus vaccine I've since then over the years had to get boosters Do you anticipate that with or can't you tell now whether if you get this vaccine that at some period, sometime in the future you need a booster.
Dr. Francis Collins: I wish we knew more about that, because this is a new virus we really don't know how durable your immunity is going to be, we don't know for people who got the COVID-19 infection naturally, could they get it again? if we knew more about that we have some sense about whether the vaccine would last for years and years. In the best of all worlds, this will last a very long time, I'm guessing boosters are probably going to be needed. I just hope they aren't too frequent tetanus we could live with a 10 year timeline if that's what it takes, but we just don't know.
Greta Van Susteren: One of the issues obviously is gonna be distribution and the Pfizer requires that the vaccine be kept so called which refrigeration incredible refrigeration. What, why is it if they're so similar the Moderna and the Pfizer one needs to be kept so much colder which is going to inhibit some of its distribution?
Dr. Francis Collins: Yeah, it's a great question and all our people puzzled if it's so similar. Moderna can just be kept in a regular freezer and can even be in a refrigerator for a week and it'll be fine there too. But the Pfizer one, it's wrapped in a different kind of envelope, it's not just the messenger RNA by itself it's sort of put into an envelope of lipids and the Pfizer liquid envelope is very tense sensitive to warming up, which is why it has to be kept at this minus 94 degrees freezer which isn't available a lot of places. Moderna's envelope is less concerned about temperature issues and so it can be stable in a more forgiving way. Coming along I should say the next set of viruses next set of vaccines bay by Johnson and Johnson, and by AstraZeneca. Those are going to be also much more forgiving as far as the temperature requirements. The so called cold chain will not be nearly as demanding for those which will be great, especially for places that don't have a lot of freezer capacity like some of the low and middle income countries that are also going to need these vaccines.
Greta Van Susteren: Doctor thank you very much and thanks to NIH and you know for, you know, I think the world's very grateful for all the work that all of you do.
Dr. Francis Collins: Well, it's a privilege to be able to be the guy trying to manage this effort with such an amazing team of dedicated scientists and we are going to get through this and science is going to be a big reason why.
[[GRETA]]
The two vaccines …
being considered …
for emergency use …
in the U.S. ...
have some significant differences.
[[FS- GRAPHIC]]
Both manufacturers say their vaccines …
which require two doses …
are about 95-percent effective.
But there are differences.
Pfizer-BioNTech …
requires ultra-cold freezers …
to transport its vaccine …
which can last in a refrigerator …
for five days.
Moderna’s vaccine …
needs to ship frozen …
and can stay up to a month …
in a refrigerator.
Pfizer-BioNTech says …
it can produce 50-million doses …
for worldwide distribution …
by the end of the year …
and 1.3 billion doses …
in 2021.
Moderna promises …
20-million doses in the U.S. …
by the end of 2020 …
and at least 500-million …
next year.
###
[[GRETA ]]
Another pharmaceutical firm …
AstraZeneca …
working with …
Britain’s University of Oxford ...
say in early trials
they have shown …
successful results.
And this vaccine …
appears more suitable ...
for fast rollout …
around the world.
Henry Ridgwell reports from London.
[[ RIDGWELL PKG ]]
###
(NARRATOR)
Early analysis of trials involving 20-thousand volunteers in Britain and Brazil show the Oxford University-AstraZeneca coronavirus vaccine is at least 70 per cent effective after two doses. In volunteers given a different dosing regime – a half dose, followed by a full dose – that figure rose to 90 per cent. None of those given the vaccine developed severe COVID-19.
((Andrew Pollard, Director, Oxford Vaccine Group))
“It really feels like a great moment that we've got now multiple vaccines. If we can get them rolled out as soon as possible, we're going to have a big impact.”
AstraZeneca plans to begin supplying hundreds of millions of doses by the end of the year, subject to regulatory approval. Doctors say several properties of the vaccine make it suitable for global rollout.
((Doctor Peter Drobac, Global Health Expert at University of Oxford))
((cg. mandatory Skype logo))
“The first is cost. So this vaccine has been priced at about one-fifth to one-tenth of the cost reportedly being sought by Pfizer and Moderna, some of the other leading vaccine candidates.”
AstraZeneca has pledged it won’t make a profit on the vaccine during the pandemic.
((Doctor Peter Drobac, Global Health Expert, University of Oxford))
((cg. mandatory Skype logo))
“In ten countries it’s already being manufactured, including a very large manufacturing partner in India. So we hope to see very large numbers of doses become available very quickly. And then thirdly, this vaccine only required kind of fridge-temperature storage.”
By contrast, the Pfizer vaccine requires storage at minus 70 degrees Celsius.
Many health systems in developing nations lack refrigeration facilities to store medicines at ultra-cold temperatures.
So far 188 countries have signed up to an initiative called COVAX – where richer countries invest in the development of several vaccines and the infrastructure required for rolling them out across the globe.
((Doctor Peter Drobac, Global Health Expert at University of Oxford))
((cg. mandatory Skype logo))
“And the goal in a perfect world would be that each of the countries that sign up for COVAX would receive enough vaccine for 20 per cent of their populations by the end of 2021. Now that’s an aspiration of course, not a guarantee. But that would allow every country to at least begin to cover the most vulnerable, front line workers etcetera.”
It’s possible the leading vaccine candidates will be given emergency approval by regulators in the coming weeks – raising hopes that the world is on the brink of a major breakthrough in the fight against the pandemic.
In the meantime, doctors say it’s vital that people follow measures to suppress the transmission of the virus.
((Henry Ridgwell, for VOA News, London.))
[GRETA]
The promising news ...
about coronavirus vaccines ...
comes as the number ...
of reported cases …
and deaths ...
reaches new highs ...
in the United States.
Dr. Mizuho (PRONO: Miz-OOH-ho) Morrison ...
is an emergency room doctor …
in Southern California.
In March…
she became infected …
with COVID-19 ...
while treating a patient.
Dr. Morrison has since recovered ...
and we spoke about the ...
public health outlook ...
for both patients and ...
healthcare providers ...
in the months ahead.
[[MORRISON INTERVIEW]]
Mizuho Morrison: The triage system is has changed a lot and this is true across the country, depending on again how cold it is outside, but as patients walk up to the emergency room you no longer get to come to the front desk and check in and give your name. You're sort of stopped outside the front door and asked, you know, some list of questions and if you're potentially COVID we’ll take your vital signs and if you're well appearing and again walking well which most COVID patients are thankfully they get triaged to the COVID tent until they're evaluated by a physician. If they're not, if they're just other other non-COVID medical patients, then if depending on how sick they are they're either roomed right away, or they're put in their cars in the parking lot and waiting until their number is called if you will to be seen. So, the difference I think in the emergency room now Greta compared to spring and summer is that back in spring and summer, the rest of the non-COVID medical patients stayed away. Meaning, if you had some chest pain, you had a cough--well that's a bad example maybe you had like leg pain or whatnot, you're gonna wait, they waited they didn't they were scared to come to the emergency room. Now we are six months, eight months, nine months into this right? Patients have not had good access to their primary care doctors, certainly haven't had access to their oncologist as they should. Patients can't wait anymore, so our volume is not just COVID although yes the COVID is back, but it is these patients who have really lacked access to any medical care and now they're coming in, super sick. So we're not just talking a little bit of injury to their kidney we're talking fulminant kidney failure, full heart failure, right. So, all of these are long term complications of neglect from these months of these patients not having access to care: this is now what we're seeing, and that on top of COVID, it's it's it's a it's a double whammy.
GVS: Not, not so much for the doctors but other health care workers is, or are just about the same as it was last spring, they must be pretty weary there.
MM: we're all tired, everyone is weary and to your point, it's not just the doctors it's for sure the nurses it's our technicians it's the it's the triage administrators you know it's everyone from the even the lab there, they must be tired of running these pcrs and rapid tests, and being exposed I was working, a Sunday night and I went out to the tent and I live in Southern California, Greta, where it's, you know, we complain about it being cold and it might be 60 degrees, it's nothing like the Midwest or the East Coast. It was chilly that night and and for the nurses who are working 12 hour shifts out in the tents with, you know, no heaters, it's cold. So I think those are new challenges. Everyone is tired. And we're just now sort of having this resurgence and so I think it is, it's, it's fatigue at every level: emotionally certainly physically for sure. And just like there seems to be no end to this. And, and yet what can you do? We show up because we have to.
GVS: Has the fatality rate come down? and I guess it's not because the virus has changed but because first of all the, we've learned so much more about but also it seems like younger people are getting a lot now and they seem to be stronger.
MM: Yeah that's such an interesting question I was having this conversation I'm on a text thread with about eight of my, you know, I would say forerunners in emergency medicine, and we were talking about why do we think the virus seems to be less severe is it less virulent I think that's one certainly possibility. Viruses are very smart they can mutate very quickly. This is an RNA virus, we know that coronaviruses do this and so for its own self sustainability if you kill off all your hosts, right, it's going to kill itself off. So they're smart so they, they can downregulate and make themselves less virulent. That's one possibility. The other possibility is, you know, the highest risk patients we have we have over 200,000 deaths. So those patients is that potentially that the highest risk patients have already sort of succumbed to this illness and now we're left with the remaining healthier patients - that's possible. I think for sure like you mentioned our treatment, knowledge, and actions, we've learned so much more I think we know how to manage this a lot better. Certainly multifactorial. What's interesting to me though Greta is that why on, like why are there pockets and regions that are being hit hard? and then I think we have to think about what is it about Detroit and Chicago, versus certain parts of the West Coast and East Coast is it the weather. Is it the fact that people are you know indoors more, what are those other variables that we maybe aren't quite put putting our finger on. I think it has to be weather and being in those tighter spaces, also higher risk patient populations. I work in East LA downtown LA very, you know impoverished area versus here in the suburbs, south of LA and you know the patient profile is different, my patients who don't have access to health care year round, who don't have primary care doctors who are you know indigent patient populations, they are certainly higher risk because they also have comorbidities right that that place them at higher risk.
GVS: I mean it's been extraordinary that we've gotten these vaccines out so fast I mean they haven't gotten the green light but they're so close, and every day I read about a new vaccine.
MM: It is so hopeful it definitely gives us a glimmer of hope and it's great that they're there all these different pharmaceutical companies are jockeying for getting this out first. To be clear, the efficacy that they're publishing and we can't wait to see the data in the medical world, but to say that anything is over 90% effective is really a remarkable statement. Most vaccines I think we're happy with anything over 60% so over 90 is an astounding finding. And if, if that proves to be true i mean i think that that gives us all significant hope, moving forward.
GVS: Doctor thank you very much. And, you know, please do me a favor and thank your colleagues and the people at the hospital. I mean we don't get to thank the you know the hospital workers we never get to see, you know that all over this country who are doing everything I can to try to help all of us.
MM
15:56 Thank you, and likewise Greta thank you so much for all that you do.
[GRETA]
This surge in COVID cases …
is taking a grueling toll …
on the physical …
and mental well-being...
of healthcare workers worldwide.
In Kenya, the stress and trauma ...
of treating COVID-19 patients ...
has prompted many on the frontlines ...
to lean on each other for support.
VOA’s Mohammed Yusuf (YOU-suff) ...
tells us more from Nairobi.
[[YOSUF PKG]]
((NARRATOR))
John Muichuhio is one of the thousands of Kenyan medical workers treating COVID-19 patients.
With the stress of the pandemic already on him, in late July he also tested positive for the virus.
((John Muichuhio, Psychologist, Mater Hospital (English, 20 sec))
“As a human being I am also thinking around that am positive for COVID, what will happen next? What if death comes? It's not easy. It’s a very traumatizing state, especially being alone there. You cannot tell people because you don’t know how people will take it.”
((NARRATOR))
Muichuhio is one or more than 700 Kenyan medical workers to test positive for COVID-19.
A trained psychologist, he was so upset by the diagnosis, he had to seek counseling himself.
He wasn’t alone.
At Nairobi’s Tigoni Hospital treatment center on an August weekend, 50 medical workers attended mental wellness counseling sessions.
((Simon Njuguna, Public Health Officer (English,13 secs))
“We have been going through a lot. The schedules have changed. We have been very busy, and so having a day off where you are having fun forgetting there is COVID. It’s very rejuvenating.”
((Njeri Njuguna, Clinician, Tigoni COVID Center, (English, 10 secs))
“I feel a bit lighter. I feel like I am very relieved. I feel like I have gained the strength to continue with my daily duties.”
((NARRATOR))
Like their colleagues worldwide, Kenyan medical workers have been working long hours to attend to patients infected with the virus.
((Iregi Mwenja, CEO, Psychiatric Disability Organization (English, 23 secs))
“A lot of those small traumas end up pilling up, and it can be really psychologically distressing. So, we decided that we would come here and have a day of expressive therapy, debriefing art therapy, bonding and having fun and games. It was a day to make the health workers feel like they are loved and appreciated.”
((NARRATOR))
With the pandemic ongoing, it’s a day that these medical workers certainly needed.
((Mohammed Yusuf, for VOA News, Nairobi.))
##
[GRETA]
For some COVID-19 patients ...
the road to recovery is long ...
with lingering symptoms.
It can include muscle pain and fatigue ...
that can last weeks or months ...
after a positive diagnosis.
VOA’s Mariama Diallo (PRONO: Dee-AH-low)
has more on COVID’s …
long-term impact on survivors.
[[DIALLO PKG]]
((NARRATOR))
Many people who had serious cases of COVID-19 are dealing with its long-term effects months after leaving the hospital.
In Barcelona, 56-year-old Pablo Aguilar is one of them. He spent three months at the hospital, one month in the ICU. It’s been five months since he left the hospital.
((Pablo Aguilar, COVID-19 survivor and rehabilitation patient))
"The truth is I am surprised because I thought that at this point I would be walking better. The long-term effects that have remained … they are tremendous. I get tired, I have become afraid of going out in the street alone. I have a small dog, taking the dog out I considered it a big responsibility. I don't dare."
((NARRATOR))
Aguilar is part of a group of COVID-19 survivors participating in a rehabilitation program in a Barcelona public hospital. Activities include exercises to strengthen muscles, and improve balance and aerobic capacity.
((NAT POP))
Another participant, Eulalia Canela, a mother of two and a 49-year-old nurse, got infected while taking care of virus patients. She was never hospitalized but suffered from pneumonia and was bedridden at home for a month.
In the summer, she thought she was getting better but noticed new symptoms popping up -- hair loss, numbness in the hands and muscle pain. Not a day goes by without a headache, she says. Recently doctors discovered her lungs weren't working properly, hence affecting her kidneys.
((Eulalia Canela, Nurse))
"Your active time reduces itself to three or four hours (a day). The rest of the time you must be on the sofa, stretched out or resting.// Dinner time comes and you must tell your kids: make yourself whatever you can because mother cannot get up from the sofa."
((NARRATOR))
Doctor Ester Marco oversees the rehabilitation program Canela is a part of. She also had COVID-19 in the spring but, unlike her patients, recovered quickly and is now back at work.
((Dr Ester Marco, Rehabilitation coordinator at Parc de Salut del Mar hospitals))
"We have two big groups of patients -- patients who are untrained (from being in ICU for example) who get tired and have muscular pain and can feel like they are running out of breath even when they are resting. And then you have another profile of patients who have difficulty swallowing or difficulty speaking.”
((NARRATOR))
Marco estimates some 15-20% of COVID-19 patients who were hospitalized will end up needing serious rehabilitation.
Spain has the sixth-highest number of coronavirus cases in the world, with more than 1.5 million people infected since the beginning of the pandemic.
((MARIAMA DIALLO VOA NEWS))
[[GRETA]]
That's all the time we have.
Thank you to my guests:
NIH Director Dr. Francis Collins …
and Dr. Mizuho (PRONO: Miz-OOH-ho) Morrison …
from the USC Medical Center.
Stay up to date ...
on the coronavirus pandemic …
With our special section …
at VOAnews.com slash COVID.
And follow me on Twitter @greta.
Thank you for being Plugged In
###
On Plugged In....
Surges and Vaccines.
U.S. infectious disease experts ...
warn of a possible spike …
in coronavirus infections ...
following a long holiday weekend …
with the most travel...
since the beginning of the pandemic.
[[SOT DR. MORRISON]] “We’re just sort of holding our breath to see what’s going to happen in the coming weeks”
Several vaccines …
are being considered …
for emergency …
use government approval …
after trials show …
better than 90 percent effectiveness.
[[SOT DR. COLLINS ]] "These will probably be amongst the most highly tested vaccines ever in terms of their safety and efficacy"
Important questions…
about the vaccines …
Who gets them?
and when?
And what happens …
until then?
On Plugged In ...
Surges and Vaccines.
###
[[GRETA]]
Hello and welcome …
to Plugged In.
I’m Greta Van Susteren …
reporting from Washington.
“A surge upon a surge.”
That is the way …
the top U.S. …
infectious disease expert...
Dr. Anthony Fauci …
suggested the next few weeks …
could play out.
This after the Thanksgiving holiday …
saw more Americans traveling …
since the start …
of the coronavirus pandemic.
The warning comes …
as the number of infections …
worldwide is spiking.
The United States …
is headed toward 14-million cases …
four million more …
than any other nation.
But there is good news:
a vaccination is coming.
The U.S. government’s …
Food and Drug Administration ...
is considering COVID-19 vaccines …
from two companies …
for emergency use.
Pfizer and Moderna …
both say their vaccine …
is more than 90 percent effective.
We begin our look …
at the prospect of COVID vaccines …
amid the biggest surge of cases …
with VOA’s Michelle Quinn.
[[QUINN PKG]]
((NARRATOR)) ((BROLL:))
Many Americans return to work this week after taking time off for Thursday’s Thanksgiving holiday. While many people chose to stay home for the holiday, others traveled and gathered with loved ones. Health officials and elected leaders are worried that may prompt greater spread of the coronavirus. With more than 4 million cases reported in the United States in November, double October’s count, there could be a surge on top of the current surge, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
((Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases))
((mandatory cg ABC “This Week”))
(( 3:30))
“We don't want to frighten people, but that's just the reality. We said that these things would happen as we got into the cold weather and as we began traveling. And they've happened. It's going to happen again.”
((NARRATOR)) ((BROLL: ))
Facing an increase in cases, Los Angeles County, the nation’s most populated, ordered new shutdown measures including a three-week stay-at-home order beginning this week. In its final stretch of the regular season, the National Football League has ordered team facilities closed for in-person activities.
But New York City’s mayor, Bill de Blasio, announced elementary schools would open, reversing an earlier decision. Officials have been criticized throughout the U.S. for allowing indoor dining and for bars to remain open while schools are closed. Medical experts have noted that young children don’t spread the virus like adults do.
[[FOR RADIO ONLY: Dr. Fauci ]]
((Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases)) ((mandatory cg ABC “This Week”))
((7:28))
“Let's try to get the kids back, but let's try to mitigate the things that maintain and just push the kind of community spread that we're trying to avoid. And those are the things that you know well -- the bars, the restaurants where you have capacity seating indoors without masks; those are the things that drive the community spread, not the schools.”
((NARRATOR)) ((BROLL:))
With hope of a vaccination on the horizon, Fauci and other public health officials are urging the public to continue with safety procedures: wearing masks, avoiding crowds, keeping a physical distance from others. U.S. advisers chosen by the Centers for Disease Control and Prevention are meeting this week to decide how to distribute initial supplies of a vaccine, once one receives government approval.
((Michelle Quinn, VOA NEWS))
##
[[GRETA]]
The United States ...
has invested …
billions of dollars ...
through “Operation Warp Speed” …
a Trump Administration initiative ...
to quickly develop a COVID vaccine.
The National Institutes of Health ...
is working closely with ...
pharmaceutical companies …
during vaccine development …
and testing ...
establishing the COVID-19 ...
Prevention Network ...
to recruit volunteers …
for clinical trials.
since August 2009,
Dr. Francis Collins …
has directed …
the National Institutes of Health …
He is known …
for his extensive work ...
in the field of genetics.
I spoke to him …
about the vaccines …
up for approval …
who will get them ...
when will we get the vaccine …
and in the meantime:
what can we do?
[[COLLINS INTERVIEW]]
Greta Van Susteren: Nice to talk to you sir.
Dr. Francis Collins: Nice to talk to you Geta.
Greta Van Susteren: Well we Americans know what NIH is and we're very proud of it but what is NIH?
Dr. Francis Collins: The National Institutes of Health, it's the largest supporter of biomedical research in the world. Basically everything that the US is doing in terms of research and academic institutions, Institute's and our own intramural program is funded by the taxpayers through this budget, and I'm the director that's supposed to make sure it gets spent wisely everything from basic science to clinical trials. Diabetes rare diseases, cancer, and of course right now, COVID-19, and that's what we are all about $42 billion a year.
Greta Van Susteren: And I suspect that NIH is also working on treatments, new therapies to to fight this to the for the person who does get covid.
Dr. Francis Collins: We are indeed and that's an intense part of how I'm spending my time and we've made some real progress there. We have the drug Remdesivir, which is an antiviral that helps people who are quite sick in the hospital. We have Dexamethasone a steroid that also helps people who are the sickest of the sick in the ICU. And we have monoclonal antibodies developed from people who've survived COVID-19, basically purifying their antibodies that help them recover and giving them to other people, showing real promises, especially if you give those early to high risk individuals.
And we have other trials that are going on right now that may very well yield up other immunosuppressives or antivirals that can add to this-- compared to where we were back in February and March where we didn't have much of anything, we've now got quite a menu of therapeutics and survival has certainly improved for people who get very sick with this.
But it's still a very serious disease we've lost 275,000 people. And this is a scary few months that we're looking at with winter time, and with the vaccine not yet as widely available as it will be by the summer.
Greta Van Susteren: What does the FDA do the Food & Drug Administration we hear so much about in terms of the vaccine?
Dr. Francis Collins: So FDA is a sister agency we're both in the Department of Health and Human Services. FDA's job is to be the regulator and it's to look at some proposed new approach maybe it's a diagnostic test. Maybe it's a therapeutic maybe it's a vaccine and to get all the data together and look at it and decide if it's going to be safe and effective so we generally do the research trying to stimulate this kind of progress to happen and FDA decides whether it's safe for the public to start to use it in general way.
Greta Van Susteren: All right, so we're waiting breathlessly for these vaccines and some are farther along like Moderna and Pfizer than others but once it gets the green light from the FDA, who decides who will get it first?
Dr. Francis Collins: Well this is a big day for that, basically the CDC has an Advisory Committee on Immunization Practices – ACIP- and it's their job to look at a circumstance where you have a vaccine that FDA has decided is safe and effective at least for emergency use, but there aren't enough doses for everybody to receive them on day one. So who gets first in line? That's a big decision, it will include health care providers because we want them to be safe in their frontline experience and it will include people at high risk, particularly the elderly people with chronic illnesses.
Greta Van Susteren: Well the vaccines, as I understand, talking to experts is coming, very quickly. What has been the role of the US government to sort of fast track this have gotten rid of some of the red tape or is it provided more funds or what's the role of the US government?
Dr. Francis Collins: It is astounding what's been done here Greta, because traditionally it takes eight to 10 years to develop a vaccine against a new pathogen, this has been done in less than a year. The US government pulled all of the resources together to make sure that coordination was happening. Operation Warp Speed made it possible also to get rid of some of those long delays that oftentimes vex the process where you go to phase one and then you have to wait many months before you go to phase two, all of those things were synchronized in an unprecedented way, but not by doing any compromising at all on safety these will probably be amongst the most highly tested vaccines ever in terms of their safety and efficacy and the good news is, the first two that are going to get looked at by FDA in the coming weeks, look extremely good with efficacy over 90% which is better than most of us had dared to hope and safety record that also looks extremely good.
Greta Van Susteren: Alright, Moderna, and Pfizer as I understand it, both have something called the sort of a science behind is something called messenger RNA, are they very different vaccines or very similar?
Dr. Francis Collins: They're quite similar. Basically messenger RNA is the part of a nucleic acid that codes for protein. And this is a very clever way to make a vaccine where you basically synthesize that messenger RNA that has the right information in it, inject that into Muscle, Muscle goes, Oh I know what to do with messenger RNA I'll make a protein. And so it does and it makes the spike protein, which is the stuff that decorates the coronavirus and those spike proteins, the immune system says oh no you don't and makes an antibody to them. And it's very quick. That's why Pfizer and Moderna are the first two out of the gate because the messenger RNA approach can be started almost immediately upon the time the viruses isolated. So it is a new approach, it looks extremely promising, it is going to be transformational I think for vaccines for all kinds of things because it looks like it's really worked and this is the first time it's been taken all the way through to these phase three trials and FDA approval.
Greta Van Susteren: When I get a tetanus, when I've got a tetanus vaccine I've since then over the years had to get boosters Do you anticipate that with or can't you tell now whether if you get this vaccine that at some period, sometime in the future you need a booster.
Dr. Francis Collins: I wish we knew more about that, because this is a new virus we really don't know how durable your immunity is going to be, we don't know for people who got the COVID-19 infection naturally, could they get it again? if we knew more about that we have some sense about whether the vaccine would last for years and years. In the best of all worlds, this will last a very long time, I'm guessing boosters are probably going to be needed. I just hope they aren't too frequent tetanus we could live with a 10 year timeline if that's what it takes, but we just don't know.
Greta Van Susteren: One of the issues obviously is gonna be distribution and the Pfizer requires that the vaccine be kept so called which refrigeration incredible refrigeration. What, why is it if they're so similar the Moderna and the Pfizer one needs to be kept so much colder which is going to inhibit some of its distribution?
Dr. Francis Collins: Yeah, it's a great question and all our people puzzled if it's so similar. Moderna can just be kept in a regular freezer and can even be in a refrigerator for a week and it'll be fine there too. But the Pfizer one, it's wrapped in a different kind of envelope, it's not just the messenger RNA by itself it's sort of put into an envelope of lipids and the Pfizer liquid envelope is very tense sensitive to warming up, which is why it has to be kept at this minus 94 degrees freezer which isn't available a lot of places. Moderna's envelope is less concerned about temperature issues and so it can be stable in a more forgiving way. Coming along I should say the next set of viruses next set of vaccines bay by Johnson and Johnson, and by AstraZeneca. Those are going to be also much more forgiving as far as the temperature requirements. The so called cold chain will not be nearly as demanding for those which will be great, especially for places that don't have a lot of freezer capacity like some of the low and middle income countries that are also going to need these vaccines.
Greta Van Susteren: Doctor thank you very much and thanks to NIH and you know for, you know, I think the world's very grateful for all the work that all of you do.
Dr. Francis Collins: Well, it's a privilege to be able to be the guy trying to manage this effort with such an amazing team of dedicated scientists and we are going to get through this and science is going to be a big reason why.
[[GRETA]]
The two vaccines …
being considered …
for emergency use …
in the U.S. ...
have some significant differences.
[[FS- GRAPHIC]]
Both manufacturers say their vaccines …
which require two doses …
are about 95-percent effective.
But there are differences.
Pfizer-BioNTech …
requires ultra-cold freezers …
to transport its vaccine …
which can last in a refrigerator …
for five days.
Moderna’s vaccine …
needs to ship frozen …
and can stay up to a month …
in a refrigerator.
Pfizer-BioNTech says …
it can produce 50-million doses …
for worldwide distribution …
by the end of the year …
and 1.3 billion doses …
in 2021.
Moderna promises …
20-million doses in the U.S. …
by the end of 2020 …
and at least 500-million …
next year.
###
[[GRETA ]]
Another pharmaceutical firm …
AstraZeneca …
working with …
Britain’s University of Oxford ...
say in early trials
they have shown …
successful results.
And this vaccine …
appears more suitable ...
for fast rollout …
around the world.
Henry Ridgwell reports from London.
[[ RIDGWELL PKG ]]
###
(NARRATOR)
Early analysis of trials involving 20-thousand volunteers in Britain and Brazil show the Oxford University-AstraZeneca coronavirus vaccine is at least 70 per cent effective after two doses. In volunteers given a different dosing regime – a half dose, followed by a full dose – that figure rose to 90 per cent. None of those given the vaccine developed severe COVID-19.
((Andrew Pollard, Director, Oxford Vaccine Group))
“It really feels like a great moment that we've got now multiple vaccines. If we can get them rolled out as soon as possible, we're going to have a big impact.”
AstraZeneca plans to begin supplying hundreds of millions of doses by the end of the year, subject to regulatory approval. Doctors say several properties of the vaccine make it suitable for global rollout.
((Doctor Peter Drobac, Global Health Expert at University of Oxford))
((cg. mandatory Skype logo))
“The first is cost. So this vaccine has been priced at about one-fifth to one-tenth of the cost reportedly being sought by Pfizer and Moderna, some of the other leading vaccine candidates.”
AstraZeneca has pledged it won’t make a profit on the vaccine during the pandemic.
((Doctor Peter Drobac, Global Health Expert, University of Oxford))
((cg. mandatory Skype logo))
“In ten countries it’s already being manufactured, including a very large manufacturing partner in India. So we hope to see very large numbers of doses become available very quickly. And then thirdly, this vaccine only required kind of fridge-temperature storage.”
By contrast, the Pfizer vaccine requires storage at minus 70 degrees Celsius.
Many health systems in developing nations lack refrigeration facilities to store medicines at ultra-cold temperatures.
So far 188 countries have signed up to an initiative called COVAX – where richer countries invest in the development of several vaccines and the infrastructure required for rolling them out across the globe.
((Doctor Peter Drobac, Global Health Expert at University of Oxford))
((cg. mandatory Skype logo))
“And the goal in a perfect world would be that each of the countries that sign up for COVAX would receive enough vaccine for 20 per cent of their populations by the end of 2021. Now that’s an aspiration of course, not a guarantee. But that would allow every country to at least begin to cover the most vulnerable, front line workers etcetera.”
It’s possible the leading vaccine candidates will be given emergency approval by regulators in the coming weeks – raising hopes that the world is on the brink of a major breakthrough in the fight against the pandemic.
In the meantime, doctors say it’s vital that people follow measures to suppress the transmission of the virus.
((Henry Ridgwell, for VOA News, London.))
[GRETA]
The promising news ...
about coronavirus vaccines ...
comes as the number ...
of reported cases …
and deaths ...
reaches new highs ...
in the United States.
Dr. Mizuho (PRONO: Miz-OOH-ho) Morrison ...
is an emergency room doctor …
in Southern California.
In March…
she became infected …
with COVID-19 ...
while treating a patient.
Dr. Morrison has since recovered ...
and we spoke about the ...
public health outlook ...
for both patients and ...
healthcare providers ...
in the months ahead.
[[MORRISON INTERVIEW]]
Mizuho Morrison: The triage system is has changed a lot and this is true across the country, depending on again how cold it is outside, but as patients walk up to the emergency room you no longer get to come to the front desk and check in and give your name. You're sort of stopped outside the front door and asked, you know, some list of questions and if you're potentially COVID we’ll take your vital signs and if you're well appearing and again walking well which most COVID patients are thankfully they get triaged to the COVID tent until they're evaluated by a physician. If they're not, if they're just other other non-COVID medical patients, then if depending on how sick they are they're either roomed right away, or they're put in their cars in the parking lot and waiting until their number is called if you will to be seen. So, the difference I think in the emergency room now Greta compared to spring and summer is that back in spring and summer, the rest of the non-COVID medical patients stayed away. Meaning, if you had some chest pain, you had a cough--well that's a bad example maybe you had like leg pain or whatnot, you're gonna wait, they waited they didn't they were scared to come to the emergency room. Now we are six months, eight months, nine months into this right? Patients have not had good access to their primary care doctors, certainly haven't had access to their oncologist as they should. Patients can't wait anymore, so our volume is not just COVID although yes the COVID is back, but it is these patients who have really lacked access to any medical care and now they're coming in, super sick. So we're not just talking a little bit of injury to their kidney we're talking fulminant kidney failure, full heart failure, right. So, all of these are long term complications of neglect from these months of these patients not having access to care: this is now what we're seeing, and that on top of COVID, it's it's it's a it's a double whammy.
GVS: Not, not so much for the doctors but other health care workers is, or are just about the same as it was last spring, they must be pretty weary there.
MM: we're all tired, everyone is weary and to your point, it's not just the doctors it's for sure the nurses it's our technicians it's the it's the triage administrators you know it's everyone from the even the lab there, they must be tired of running these pcrs and rapid tests, and being exposed I was working, a Sunday night and I went out to the tent and I live in Southern California, Greta, where it's, you know, we complain about it being cold and it might be 60 degrees, it's nothing like the Midwest or the East Coast. It was chilly that night and and for the nurses who are working 12 hour shifts out in the tents with, you know, no heaters, it's cold. So I think those are new challenges. Everyone is tired. And we're just now sort of having this resurgence and so I think it is, it's, it's fatigue at every level: emotionally certainly physically for sure. And just like there seems to be no end to this. And, and yet what can you do? We show up because we have to.
GVS: Has the fatality rate come down? and I guess it's not because the virus has changed but because first of all the, we've learned so much more about but also it seems like younger people are getting a lot now and they seem to be stronger.
MM: Yeah that's such an interesting question I was having this conversation I'm on a text thread with about eight of my, you know, I would say forerunners in emergency medicine, and we were talking about why do we think the virus seems to be less severe is it less virulent I think that's one certainly possibility. Viruses are very smart they can mutate very quickly. This is an RNA virus, we know that coronaviruses do this and so for its own self sustainability if you kill off all your hosts, right, it's going to kill itself off. So they're smart so they, they can downregulate and make themselves less virulent. That's one possibility. The other possibility is, you know, the highest risk patients we have we have over 200,000 deaths. So those patients is that potentially that the highest risk patients have already sort of succumbed to this illness and now we're left with the remaining healthier patients - that's possible. I think for sure like you mentioned our treatment, knowledge, and actions, we've learned so much more I think we know how to manage this a lot better. Certainly multifactorial. What's interesting to me though Greta is that why on, like why are there pockets and regions that are being hit hard? and then I think we have to think about what is it about Detroit and Chicago, versus certain parts of the West Coast and East Coast is it the weather. Is it the fact that people are you know indoors more, what are those other variables that we maybe aren't quite put putting our finger on. I think it has to be weather and being in those tighter spaces, also higher risk patient populations. I work in East LA downtown LA very, you know impoverished area versus here in the suburbs, south of LA and you know the patient profile is different, my patients who don't have access to health care year round, who don't have primary care doctors who are you know indigent patient populations, they are certainly higher risk because they also have comorbidities right that that place them at higher risk.
GVS: I mean it's been extraordinary that we've gotten these vaccines out so fast I mean they haven't gotten the green light but they're so close, and every day I read about a new vaccine.
MM: It is so hopeful it definitely gives us a glimmer of hope and it's great that they're there all these different pharmaceutical companies are jockeying for getting this out first. To be clear, the efficacy that they're publishing and we can't wait to see the data in the medical world, but to say that anything is over 90% effective is really a remarkable statement. Most vaccines I think we're happy with anything over 60% so over 90 is an astounding finding. And if, if that proves to be true i mean i think that that gives us all significant hope, moving forward.
GVS: Doctor thank you very much. And, you know, please do me a favor and thank your colleagues and the people at the hospital. I mean we don't get to thank the you know the hospital workers we never get to see, you know that all over this country who are doing everything I can to try to help all of us.
MM
15:56 Thank you, and likewise Greta thank you so much for all that you do.
[GRETA]
This surge in COVID cases …
is taking a grueling toll …
on the physical …
and mental well-being...
of healthcare workers worldwide.
In Kenya, the stress and trauma ...
of treating COVID-19 patients ...
has prompted many on the frontlines ...
to lean on each other for support.
VOA’s Mohammed Yusuf (YOU-suff) ...
tells us more from Nairobi.
[[YOSUF PKG]]
((NARRATOR))
John Muichuhio is one of the thousands of Kenyan medical workers treating COVID-19 patients.
With the stress of the pandemic already on him, in late July he also tested positive for the virus.
((John Muichuhio, Psychologist, Mater Hospital (English, 20 sec))
“As a human being I am also thinking around that am positive for COVID, what will happen next? What if death comes? It's not easy. It’s a very traumatizing state, especially being alone there. You cannot tell people because you don’t know how people will take it.”
((NARRATOR))
Muichuhio is one or more than 700 Kenyan medical workers to test positive for COVID-19.
A trained psychologist, he was so upset by the diagnosis, he had to seek counseling himself.
He wasn’t alone.
At Nairobi’s Tigoni Hospital treatment center on an August weekend, 50 medical workers attended mental wellness counseling sessions.
((Simon Njuguna, Public Health Officer (English,13 secs))
“We have been going through a lot. The schedules have changed. We have been very busy, and so having a day off where you are having fun forgetting there is COVID. It’s very rejuvenating.”
((Njeri Njuguna, Clinician, Tigoni COVID Center, (English, 10 secs))
“I feel a bit lighter. I feel like I am very relieved. I feel like I have gained the strength to continue with my daily duties.”
((NARRATOR))
Like their colleagues worldwide, Kenyan medical workers have been working long hours to attend to patients infected with the virus.
((Iregi Mwenja, CEO, Psychiatric Disability Organization (English, 23 secs))
“A lot of those small traumas end up pilling up, and it can be really psychologically distressing. So, we decided that we would come here and have a day of expressive therapy, debriefing art therapy, bonding and having fun and games. It was a day to make the health workers feel like they are loved and appreciated.”
((NARRATOR))
With the pandemic ongoing, it’s a day that these medical workers certainly needed.
((Mohammed Yusuf, for VOA News, Nairobi.))
##
[GRETA]
For some COVID-19 patients ...
the road to recovery is long ...
with lingering symptoms.
It can include muscle pain and fatigue ...
that can last weeks or months ...
after a positive diagnosis.
VOA’s Mariama Diallo (PRONO: Dee-AH-low)
has more on COVID’s …
long-term impact on survivors.
[[DIALLO PKG]]
((NARRATOR))
Many people who had serious cases of COVID-19 are dealing with its long-term effects months after leaving the hospital.
In Barcelona, 56-year-old Pablo Aguilar is one of them. He spent three months at the hospital, one month in the ICU. It’s been five months since he left the hospital.
((Pablo Aguilar, COVID-19 survivor and rehabilitation patient))
"The truth is I am surprised because I thought that at this point I would be walking better. The long-term effects that have remained … they are tremendous. I get tired, I have become afraid of going out in the street alone. I have a small dog, taking the dog out I considered it a big responsibility. I don't dare."
((NARRATOR))
Aguilar is part of a group of COVID-19 survivors participating in a rehabilitation program in a Barcelona public hospital. Activities include exercises to strengthen muscles, and improve balance and aerobic capacity.
((NAT POP))
Another participant, Eulalia Canela, a mother of two and a 49-year-old nurse, got infected while taking care of virus patients. She was never hospitalized but suffered from pneumonia and was bedridden at home for a month.
In the summer, she thought she was getting better but noticed new symptoms popping up -- hair loss, numbness in the hands and muscle pain. Not a day goes by without a headache, she says. Recently doctors discovered her lungs weren't working properly, hence affecting her kidneys.
((Eulalia Canela, Nurse))
"Your active time reduces itself to three or four hours (a day). The rest of the time you must be on the sofa, stretched out or resting.// Dinner time comes and you must tell your kids: make yourself whatever you can because mother cannot get up from the sofa."
((NARRATOR))
Doctor Ester Marco oversees the rehabilitation program Canela is a part of. She also had COVID-19 in the spring but, unlike her patients, recovered quickly and is now back at work.
((Dr Ester Marco, Rehabilitation coordinator at Parc de Salut del Mar hospitals))
"We have two big groups of patients -- patients who are untrained (from being in ICU for example) who get tired and have muscular pain and can feel like they are running out of breath even when they are resting. And then you have another profile of patients who have difficulty swallowing or difficulty speaking.”
((NARRATOR))
Marco estimates some 15-20% of COVID-19 patients who were hospitalized will end up needing serious rehabilitation.
Spain has the sixth-highest number of coronavirus cases in the world, with more than 1.5 million people infected since the beginning of the pandemic.
((MARIAMA DIALLO VOA NEWS))
[[GRETA]]
That's all the time we have.
Thank you to my guests:
NIH Director Dr. Francis Collins …
and Dr. Mizuho (PRONO: Miz-OOH-ho) Morrison …
from the USC Medical Center.
Stay up to date ...
on the coronavirus pandemic …
With our special section …
at VOAnews.com slash COVID.
And follow me on Twitter @greta.
Thank you for being Plugged In
###
