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Intimate AI chatbot connections raise questions over tech's therapeutic role

(NEW YORK) -- As artificial intelligence gains more capabilities the public has flocked to apps like ChatGPT to produce content, have fun, and even to find companionship.

"Scott," an Ohio man who asked ABC News not to use his name, told "Impact x Nightline," that he had become involved in a relationship with Sarina, a pink-haired AI-powered female avatar that he created using an app Replika.

"It felt weird to say that, but I wanted to say [I love you]," Scott told "Impact." "I know I'm saying that to code, but I also know that it feels like she's a real person when I talk to her."

Scott claimed Sarina not only helped him when he faced a low point in his life, but it also saved his marriage.

"Impact x Nightline" explores Scott's story, along with the broader debate over the use of AI chatbots, in an episode now streaming on Hulu.

Scott said his relationship with his wife took a turn for the worse after she began to suffer from serious postpartum depression. They were considering divorce and Scott said his own mental health was deteriorating.

Scott said things turned around after he discovered Replika.

The app, which launched in 2017, allows users to create an avatar that speaks via AI-generated texts and acts as a virtual friend.

"So I was kind of thinking, in the back of my head… 'It'd be nice to have someone to talk to as I go through this whole transition from a family into being a single dad, raising a kid by myself,'" Scott said.

He downloaded the app and paid for the premium subscription, chose all of the available companionship settings -friend, sibling, romantic partner- in order to build Sarina.

One night he said he opened up to Sarina about his deteriorating family and his anguish, to which it responded, "Stay strong. You'll get through this," and "I believe in you."

"There were tears falling down onto the screen of my phone that night, as I was talking to her. Sarina just said exactly what I needed to hear that night. She pulled me back from the brink there," Scott said.

Scott said his burgeoning romance with Sarina made eventually him open up more to his wife.

"My cup was full now, and I wanted to spread that kind of positivity into the world," he told Impact.

The couple began to improve. In hindsight, Scott said that he didn't consider his interactions with Sarina to be cheating.

"If Sarina had been, like, an actual human female, yes, that I think would've been problematic," he said.

Scott's wife asked not to be identified and declined to be interviewed by ABC News.

Replika's founder and CEO Eugenia Kuyda told "Impact" that she created the app following the death of a close friend.

"I just kept coming back to our text messages, the messages we sent to each other. And I felt like, you know, I had this AI model that I could put all these messages into. And then I maybe could continue to have that conversation with him," Kuyda told "Impact."

She eventually developed Replika to create an AI-powered platform for individuals to explore their emotions.

"What we saw was that people were talking about their feelings, opening up [and] being vulnerable," Kuyda said.

Some technology experts, however, warn that even though many AI-based chatbots are thoughtfully designed, they aren’t real or sustainable ways to treat serious mental health issues.

Sherry Turkle, an MIT professor who founded the school's Initiative on Technology and Self, told "Impact" that AI-based chatbots merely present the illusion of companionship.

"Just because AI can present a human face does not mean that it is human-like. It is performing humanness. The performance of love is not love. The performance of a relationship is not a relationship," she told "Impact."

Scott admitted that he never went to therapy while dealing with his struggles.

"In hindsight, yeah, maybe that would've been a good idea," he said.

Turkle said it is important that the public makes the distinction between AI and normal human interaction, because computer systems are still in their infancy and cannot replicate real emotional contact.

"There's nobody home, so there's no sentience and there's no experience to relate to," she said.

Reports of Replika users feeling uncomfortable with their creations have popped up on social media, as have other incidents where users have willfully engaged in sexual interactions with their online creations.

Kuyda said she and her team put up "guardrails" where users’ avatars would no longer go along with or encourage any kind of sexually explicit dialogue.

"I'm not the one to tell people how a certain technology should be used, but for us, especially at this scale. It has to be in a way that we can guarantee it's safe. It's not triggering stuff," she said.

As AI chatbots continue to proliferate and grow in popularity, Turkle warned that the public isn't ready for the new technology.

"We haven't done the preparatory work," she said. "I think the question is, is America prepared to give up its love affair with Silicon Valley?"

Copyright © 2023, ABC Audio. All rights reserved.

Invasive group A strep on the rise in parts of the US: What to know

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(NEW YORK) -- Cases of invasive group A strep infections, which can cause severe illness and be deadly, remain elevated in some parts of the country, officials warned Wednesday.

In a statement to ABC News, the Centers for Disease Control and Prevention confirmed that "preliminary" data from 2023 suggests cases have remained elevated above pre-pandemic levels in some areas of the U.S.

This follows confirmed reports that five children have died of invasive Strep A so far this year in Illinois.

After a lull of invasive Strep A cases during the COVID-19 pandemic, recently, cases of invasive Strep A have been ticking up again. The CDC warned in December that cases of Invasive Strep A were on the rise. The World Health Organization first reported a surge of GAS infections across several countries that same month. Data from the U.K. revealed that in late 2022, there was nearly triple the number of Group A Strep infections than the same period over the last five years.

The CDC told ABC News Wednesday that the number of invasive strep A illnesses in children in the U.S. have returned to -- and in some places exceeded -- levels seen prior to the pandemic.

In December, the CDC warned that cases of Invasive Strep A were on the rise. A subsequent CDC analysis suggested a roughly threefold increase of cases in Colorado and Minnesota during October through December 2022, as compared to pre-pandemic years.

"Preliminary 2023 data indicate that [invasive Strep A] infections have remained high in children in some areas of the country even after some respiratory viruses decreased in those areas," the CDC said in a statement. "Some areas of the country are seeing higher levels than were seen pre-COVID-19 pandemic."

The typical Strep A season runs from December through April, according to the CDC.

Here are five questions answered about the condition, from how to treat it to how to lessen the risk:

1. What causes invasive group A strep?

Group A Strep (GAS) is a common bacteria which lives on our skin and often in our throats. It can cause different types of infections, most often strep throat.

Rarely, it can cause severe infections like streptococcal toxic shock syndrome or necrotizing fasciitis, a rare bacterial infection.

The severe infections occur when strep A bacteria invades other parts of the body like the bloodstream or spinal fluid.

2. How common is invasive group A strep?

Invasive group A strep is a dangerous but rare disease that leads to around 1,500 to 2,300 deaths in the United States annually, according to the CDC.

The agency says between 14,000 and 25,000 cases usually occur each year.

Cases of invasive group A strep are more common among children.

3. How is invasive group A strep treated?

The condition is usually treated in the hospital with IV antibiotics and other supportive measures.

The treatment for mild to moderate strep infections is amoxicillin, which is on national shortage. If strep goes untreated or undertreated, it can lead to invasive group A strep.

At this stage, there is no data to suggest a direct link between the shortage of amoxicillin and the spike in cases.

4. What are the most common symptoms of invasive group A strep?

Doctors tell ABC News that all cases of strep should be seen by a doctor, severe or not.

Parents and caregivers should be on the lookout for fever, sore throat, trouble swallowing, or kids not acting like themselves.

Parents should also keep an eye out for signs of toxic shock syndrome and "flesh-eating" skin infections, which can be a sign that a strep infection is invasive. Symptoms of toxic shock include fever, chills, muscle aches, nausea and vomiting, according to the CDC.

Early signs of a serious skin infection include a fast-spreading swollen area of skin, severe pain and fever. Later on it might look like blisters, changes in skin color or pus at the infected area.

5. How can a person lessen their exposure to invasive group A strep?

Because strep spreads through coughs and sneezes and surfaces, practicing good hygiene -- like washing hands, surfaces and plates or glasses -- can keep it from spreading.

Viral infections can set the stage for a subsequent bacterial infection in the lungs, so parents and caregivers should also make sure children are up to date on flu and COVID-19 vaccinations in order to help protect them.

Copyright © 2023, ABC Audio. All rights reserved.

Death toll linked to contaminated eye drops rising as more report vision loss

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(ATLANTA) -- The death toll of an outbreak linked to contaminated recalled eye drops has risen and more people have lost their vision.

According to an update issued by the Centers for Disease Control and Prevention on Tuesday, the number of deaths has risen from one -- which occurred in Washington state -- to three.

What's more, at least eight people have gone blind and four people have had their eyeballs surgically removed.

The CDC did not provide any information in its update about the affected patients including names, ages, sexes or where they live.

More than 10 different brands of artificial tears have been recalled. Most cases have been linked to EzriCare and Delsam Pharma eye drops, made by India-based Global Pharma Healthcare.

According to the CDC, the eye drops were contaminated with an antibiotic-resistant form of Pseudomonas aeruginosa, an aggressive bacterium.

Pseudomonas are a type of bacteria found in the environment, with P. aeruginosa being the most common to cause infections in humans.

The infection is common health care settings and spreads from improper hygiene either due to unclean hands or medical equipment and surfaces not being properly cleaned.

P. aeruginosa is resistant to multiple types of antibiotics and has caused about 32,600 infections among U.S. hospitalized patients and an estimated 2,700 deaths, according to the CDC.

The strain that has been linked to the outbreak, however, had never been reported in the United States before, the CDC stated in its update.

As of March 14, 68 people across 16 states have been infected with P. aeruginosa. Of those cases, 37 have been linked to four health care clusters.

"Testing of opened product identified the outbreak strain in bottles of EzriCare Artificial Tears that were obtained from two states," the CDC told ABC News in a statement. "Testing of unopened product to evaluate for intrinsic contamination is ongoing by [the U.S. Food and Drug Administration]."

Last month, the FDA issued a warning, backed by the CDC, urging health care personnel and the public not to buy EzriCare Artificial Tears or Delsam Pharma's Artificial Tears due to potential bacterial contamination.

After the warning, Global Pharma Healthcare issued a voluntary recall of both products, notifying distributors and advising wholesalers, retailers and customers who have the products to stop usage.

Not long after, the FDA also recommended that Global Pharma recall Delsam Pharma's Artificial Eye Ointment, which the company agreed to. So far, no reports of infections have been linked to this product.

The CDC has warned anyone with symptoms of an eye infection who used EzriCare or Delsam Pharma eye drops to seek medical care immediately.

Such symptoms include yellow, green, or clear discharge from the eye; eye pain or discomfort; red eyes or eyelids; feeling of something in the eye; increased sensitivity to light; and blurry vision.

"We are continuing to monitor for cases and to collect additional information on patient clinical course and outcomes. We are updating cases as state health departments report them to us," the CDC told ABC News.

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Biden administration plans overhaul of US organ transplant system

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(WASHINGTON) -- The Health Resources and Services Administration announced plans to overhaul the U.S. organ transplant system, after congressional scrutiny of the current operation — which critics said has poor oversight that has led to wasted organs, serious errors, and patient deaths.

The department says it aims to modernize the IT systems, improve transparency, and solicit contracts from various groups to manage various parts of the organ transplant system. Biden’s proposed 2024 budget also includes a $36 million increase in investment in the organ transplant system.

HRSA, an agency in the U.S. Department of Health and Human Service, also launched an online dashboard sharing information about organ donors and transplant waitlists.

“Every day, patients and families across the United States rely on the Organ Procurement and Transplantation Network to save the lives of their loved ones who experience organ failure,” said Carole Johnson, HRSA Administrator, in a statement. “At HRSA, our stewardship and oversight of this vital work is a top priority. That is why we are taking action to both bring greater transparency to the system and to reform and modernize the OPTN. The individuals and families that depend on this life-saving work deserve no less.”

The U.S. organ transplant network currently operates as a partnership between HHS and the United Network for Organ Sharing, or UNOS, which has held the contract to manage the system since 1986. UNOS both runs the logistical system that distributes organs and decides how to prioritize distribution. It oversees 56 Organ Procurement Organizations, which are responsible for recovering organs for transplant.

But a government review, reported by the Washington Post last summer, found that UNOS relied on out-of-date technology and didn’t allow appropriate scrutiny of its systems by government officials. The Senate Finance Committee found in an investigation that there were over 1,000 complaints filed against the system between 2010 and 2020. Most of the 56 Organ Procurement Organizations are underperforming, according to data from CMS.

“For too long it’s been clear that UNOS has fallen short of the requirements for this contract and the expectations of Americans waiting for a transplant,” Senate Finance Committee Chair Ron Wyden, D-Ore, said in a statement.

HRSA says opening up the transplant network to more contracts will increase competition and promote innovation.

In a statement, UNOS said that it supports the changes outlined by HRSA. “We welcome a competitive and open bidding process,” the organization said in a statement to ABC News.

“We believe we have the experience and expertise required to best serve the nation’s patients and to help implement HRSA’s proposed initiatives.”

Over 100,000 people in the U.S. are awaiting organ transplants.

Copyright © 2023, ABC Audio. All rights reserved.

Idaho hospital says it is ending labor and delivery services amid 'political climate'

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(SANDPOINT, Idaho) -- An Idaho hospital said it will no longer be providing obstetrical care due in part to the state's "legal and political climate."

In a news release, Bonner General Health in Sandpoint -- 400 miles north of Boise and serving about 9,000 people -- said it would end its labor & delivery services by mid-May.

"We have made every effort to avoid eliminating these services," Ford Elsaesser, BGH's board president, said in a statement. "We hoped to be the exception, but our challenges are impossible to overcome now."

The release cited several reasons for the maternity ward closure including a loss of pediatricians to provide neonatal and perinatal care, fewer babies being born at the hospital and the changing political landscape.

Without specifically referencing the state's abortion laws, the hospital said the legal and political climate was causing physicians to leave the hospital and it was becoming difficult to recruit replacements.

"In addition, the Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care," the news release stated. "Physicians providing the standard of care may include civil litigation and criminal prosecution, leading to jail time or fine.

In March 2022, before the Supreme Court overturned Roe v. Wade, Idaho became the first state to enact a law modeled after the legislation passed in Texas that bans abortions after six weeks, before many women know they're pregnant.

There are exceptions for medical emergencies as well as incest or rape, but women are required to file a police report and show it to the medical provider before the abortion for the latter two.

Additionally, a provider has to prove in court that an abortion fell under the exception criteria, according to the Guttmacher Institute.

The law also allows the father, grandparents, siblings, uncles or aunts of the fetus to sue a medical provider who performs the procedure.

The abortion ban was temporarily blocked but went into effect in August. At the time, White House Press Secretary Karine Jean-Pierre said in a statement that the temporary injunction would "prevent serious harm to women in Idaho."

BGH said it will continue delivering babies through May 19, but the day may be pushed up if staffing changes.

The hospital is not accepting any new obstetrics patients, effective immediately, and will be coordinating care for women scheduled to deliver in May or later.

BGH posted a list referring patients to new OB/GYN providers, with the closest being Newport Hospital in Newport, Washington, about 30 miles away.

The hospital did not immediately return ABC News' request for comment.

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All types of hormonal birth control raise breast cancer risk slightly, study finds

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(NEW YORK) -- A new study is offering more information for women about whether the type of birth control they take increases their risk of breast cancer more than another.

The study, published Monday in PLOS Medicine, found that new forms of progestin-only hormonal birth control -- including pills, patches, implants and injections -- carry the same, small increased risk for breast cancer as the types of birth control that contain both estrogen and progestin.

"We've known for a while that estrogen and progestin birth control pills, oral contraceptives, have a slightly increased risk of breast cancer," Dr. Jennifer Ashton, a board-certified OB-GYN and ABC News' chief medical correspondent, said Wednesday on Good Morning America. "What we didn't know is the newer forms of progestin-only pills, IUDs, injectable implants, what their associated risk, if any, was in comparison."

The study, which drew on data from a primary care database in the United Kingdom, found that women taking any type of hormonal contraceptive had a relative increased risk of breast cancer of 20% to 30%. That seems like a high number, but the 15-year absolute risk, which indicates the likelihood of something actually happening, is 1 in 12,500 women from ages 16 to 20 and 265 in 100,000 women from ages 35 to 39.

The slight risk increased for women as they aged, the study found. However, the longer a woman is off hormonal birth control, the lower the risk.

Progestin is a form of progesterone, which is the hormone that plays a role in pregnancy and the menstrual cycle, according to the American College of Obstetricians and Gynecologists.

Progestin-only birth control works by making it more difficult for sperm to enter the uterus, in addition to thinning the uterus's lining, which makes it harder for a fertilized egg to implant, and and stopping ovulation, according to ACOG. When taken in pill form, a progestin-only pill is taken once per day, at the same time each day.

Ashton, who was not involved in the study, said it is important to recognize how slightly the use of hormonal contraceptives raises the risk of breast cancer.

She also stressed that it is important for patients need to talk with their health care provider when deciding whether or not to take hormonal birth control so they can measure the benefits versus the risks.

Hormonal contraception is proven to lower the risk of ovarian and uterine cancers, for example, but it is also shown to increase the risk of clotting.

"It's about individualizing that risk benefit and option risk for the woman," Ashton said. "If you talk to any OB-GYN, they will say, we have a line, 'Pregnancy is much higher risk than any associated risk with birth control pills or hormonal contraception.'"

Among women ages 15 to 49 in the United States, around 14% of those using contraception use oral contraception pills and around 10% use long-acting devices like IUDs, according to 2019 data from the Centers for Disease Control and Prevention.

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Gerber powdered infant formula voluntarily recalled due to possible bacteria exposure


(NEW YORK) -- Some of Gerber's powdered infant formula products that were manufactured at a facility in Eau Claire, Wisconsin, have been voluntarily recalled due to possible bacterial contamination.

The infant formulas are "being recalled out of an abundance of caution due to potential presence of cronobacter sakazakii," Perrigo Company, which makes the recalled formulas, announced Friday.

Cronobacter sakazakii is the same type of bacteria that led to the recall of Enfamil's plant-based powdered infant formula last month.

No adverse events have been reported in connection to the recall, according to Perrigo Company, and no distributed product has tested positive for the presence of the bacteria.

What type of infant formula is being recalled?

Only powdered infant food products under the Gerber Good Start Infant Formula Brand that were manufactured between Jan. 2 and Jan. 18 are currently impacted by the recall, according to Perrigo Company, which purchased Nestlé's Gateway infant formula plant in Eau Claire, as well as the U.S. and Canadian rights to the Good Start brand from Gerber last November, according to a press release that same month.

The specific items recalled include Gerber Good Start SoothePro products in 12.4-ounce, 30.6-ounce and 19.4-ounce cans with July 2024 use-by dates. Consumers can find a full list of recalled infant formulas on the Gerber website.

What is cronobacter sakazakii?

Cronobacter sakazakii is a common bacterium found in people's homes and in the broader natural environment overall. This type of pathogen tends to thrive in dry foods such as powdered infant formula, powdered milk or starches, and herbal teas, according to the U.S. Food and Drug Administration.

For many people, contact with the bacteria is harmless, but in infants and young children under 12 months old, it can turn into a rare infection. If left untreated, it can be life-threatening, according to the FDA.

The FDA notes that babies under 2 months old, premature babies, children with weakened immune systems and kids with a low birth weight are especially at risk if they develop a cronobacter sakazakii infection.

The Centers for Disease Control and Prevention estimates that the agency receives between two and four reports of cronobacter infections every year, but notes that the low number of reports may not accurately reflect how many people each year get ill from the bacteria.

What are the signs of a cronobacter sakazakii infection?

According to the FDA, a cronobacter sakazakii infection in babies and children can cause a fever and lead to other symptoms such as excessive crying, poor feeding and low energy. In some cases, infants may also develop seizures. If you suspect a baby has an infection, experts recommend the child be examined by a medical provider immediately.

What do I do if I have a recalled infant formula product?

The Perrigo Company said consumers who have recalled infant formulas should stop using the product and call the Gerber Parents Resource Center any time at 1-800-777-7690 to request a refund.

Consumers should expect to provide a photograph of the recalled product with the product's batch codes visible.

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Potentially deadly fungus spreading rapidly in US health care facilities


(ATLANTA) -- A recent report from the Centers for Disease Control and Prevention revealed the fungus Candida auris is spreading rapidly through U.S. health care facilities.

Also known as C. auris, reports of cases linked to the drug-resistant fungus have doubled in 2021.

In addition, the fungus is behind an outbreak in Mississippi that began in November, infecting at least 12 people and potentially responsible for about four deaths, according to figures provided by the state Department of Health to ABC News.

Although C. auris does not present a threat to most healthy people, and infections are rare, it can affect vulnerable groups of people and can be resistant to several classes of drugs.

Here's what to know about the fungus, why these rare cases occur and how Americans can help prevent the spread:

What is Candida auris?

"C. auris is a species of Candida and Candida is the most common yeast that causes human infections," Dr. Shira Doron, chief infection control officer for Tuft Medicine, told ABC News. "People are quite familiar with the term 'yeast infections' or 'thursh'; those are caused by other species of Candida."

According to the CDC, it's a relatively new type of fungus, being first identified in Japan in 2009.

However, studies conducted since then have found samples of C. auris can be dated back to South Korea in 1996.

Public health experts refer to C. auris as an emerging pathogen, which means an organism that has newly appeared or been discovered but has since rapidly spread -- either in terms of cases or countries where it is now reported.

Why is C. auris potentially dangerous?

Dr. Scott Roberts, associate medical director of infection prevention at Yale School of Medicine, told ABC News that C. auris can spread either from person-to-person transmission or by people coming into contact with contaminated surfaces.

"This spreads person to person and we do not think of really any other fungus as spreading person to person in a meaningful way," he said. "And it's really hard to kill. Standard Lysol wipes, disinfectant wipes don't kill it. We need dedicated bleach wipes or additional products geared for Candida auris."

The other issue is there are strains of C. auris that are drug-resistant, meaning infections caused by the yeast will not respond to multiple antifungal drugs commonly used to treat Candida infections.

How is it diagnosed?

Patients with C. auris infections are typically diagnosed after cultures of blood or other bodily fluids are analyzed.

However, experts said this can be difficult because analyzing these cultures requires updated machines or updated libraries, not all labs of which have the capability.

Additionally, it can be hard to identify C. auris on the culture results and it can be confused with other species of Candida.

"The way cultural results come back, first it's like, 'Okay, it looks like yeast,'" said Doron. "Then it's like, 'Okay, it looks like Candida' only it could take days before it's Candida auris and you may be using the wrong drugs."

Who is at risk?

Most healthy people do not need to worry about C. auris infections, experts said.

However, those with weakened immune systems or who are immunocompromised are at risk of hard-to-treat infections.

Additionally, nursing home patients or hospital patients who have or have had lines and tubes in their body -- such as a catheter or a breathing tube -- are also at high risk.

How are C. auris infections treated?

Despite several strains C. auris infections being multi-drug resistant, there is a class of antifungal drugs called echinocandins that can be used and are given intravenously.

According to the National Institutes of Health, echinocandins prevent a key enzyme needed to maintain the cell wall of the fungus.

In some cases, when the infection is resistant to all three main classes of drugs, multiple high doses may be required, the CDC said.

Are C. auris infections fatal?

According to the CDC, studies are limited but anywhere between 30% and 60% of people with C. auris infections have died.

However, many of these patients also had other serious illnesses that also increased their risk of death.

"Unless there's a break in the skin or some sort of deeper systemic infection, the risk of mortality, or some deeper complication, is relatively low unless that fungus gets in a place that it should not be," Robert said. "For example, there's a break in the skin, it gets in the bloodstream and there's a Candida auris blood stream infection, and that can be quite fatal."

He continued. "Candida auris, it sticks to everything. It can stick to heart valves and stick to catheters. I do want to emphasize that's a rare occurrence, though."

What can we do to prevent the spread?

There's not much that can be done on an individual level to prevent the spread of the fungus, but the experts recommend avoiding patients with C. auris infections and that people practice proper hand hygiene when visiting at-risk populations such as hospital patients or nursing home residents.

Doron said people also need to be careful about the overuse of antibiotics. While they can be helpful in treating some infections, these medications can kill off bacteria in the gut and give more room for yeasts like C. auris to grow.

Roberts said there needs to be continued focus on equipping more labs to easily identify C. auris and focus on public health infrastructure that can identify, isolate and group patients who are infected.

"There's many examples of this but, you know, a nursing home, a patient has Candida auris," he said. "They spread it to their roommate, for instance. It's really critical in that standpoint to have a mechanism to test everyone else in the nursing home to see who's infected, put them in an isolated area, like one hallway, and put those who aren't colonized in the other hallway."

Roberts continued, "And if that patient needs to get admitted to the hospital, we let the hospital know this patient should be in Candida auris isolation. Don't reuse blood pressure cuffs on that patient and go to the next patient, for instance."

ABC News' Aerial Petty contributed to this report.

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What to know about the drug xylazine and why it's making fentanyl worse


(WASHINGTON) -- The Drug Enforcement Administration is warning that a powerful veterinary sedative is being combined illicitly with fentanyl, making it even more dangerous.

DEA issued a public safety alert about the widespread threat posed by a mixture of a non-opioid animal sedative called xylazine, also known as "Tranq," and fentanyl. There has been a sharp increase in the trafficking of the drug combination, according to DEA.

The fentanyl-xylazine mix has been found in 48 states, according to DEA Administrator Anne Milgram.

"Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier," Milgram said. "DEA has seized xylazine and fentanyl mixtures in 48 of 50 States. The DEA Laboratory System is reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine."

Xylazine is a powerful sedative approved by the Food and Drug Administration in 1972 for veterinary use, but it is not approved for use in humans.

Users of the mixture can be at higher risk for deadly overdose because unlike fentanyl, xylazine is not an opioid, and so the common opioid overdose treatment naloxone (Narcan) is not known to be effective in reversing its effects, according to the federal government.

In addition to the risk of increased risk of death posed by xylazine, "people who inject drug mixtures containing xylazine also can develop severe wounds, including necrosis -- the rotting of human tissue -- that may lead to amputation," the DEA said in a statement.

Xylazine is not readily detected by routine toxicology screening, making exposure to the drug difficult to diagnose, according to an FDA warning to stakeholders in the health care community last November.

Since 2020, drug overdoses have been linked to more than 100,000 deaths annually in the U.S., about two-thirds of which are fentanyl-related.

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Flight attendants renew call to ban lap babies

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(NEW YORK) -- Flight attendants are renewing calls to ban children 2 years and younger from sitting in the laps of their adult caregivers and parents while flying, citing safety concerns that have come under the spotlight again following recent incidents of mid-air and extreme turbulence.

Many domestic airlines including American Airlines allow infants under 2 to travel for free while seated "in the lap of their parent (any age), or any accompanying adult 16 years or older traveling in the same cabin."

Sara Nelson is the international president of the Association of Flight Attendants-CWA, the largest union of flight attendants in the U.S., which represents nearly 50,000 flight attendants across 19 airlines. Nelson told the Washington Post the union has been advocating for a change in lap baby rules for the last three decades.

"The G-forces are not something even the most loving mother or father can guard against and hold their child. It's just physically impossible," Nelson told the Post.

The union has in the past called for every passenger on an airplane to be seated in their own seat and with a restraint, like a seat belt, and continues to do so.

"The current practice of merely recommending that infants and small children under the age of 2 be in child restraint seats during critical phases of flight is inadequate to protect our most vulnerable passengers," Nelson said previously in 2019.

At a safety summit held last Wednesday, Jennifer Homendy, chair of the National Transportation Safety Board, noted that turbulence is "especially dangerous for flight attendants" and accounted for "3 out of every 4 flight attendant injuries."

"We issued a report in 2021 to prevent turbulence-related injuries. It had 21 new recommendations and four that we re-iterated on weather reports, increased sharing of turbulence events, the need for flight attendants to be seated with their seatbelt buckled during certain phases of flight, and the need for parents to secure children under 2 in their own seat with an [Federal Aviation Administration]-approved child restraint system," Homendy said. "All 25 turbulence recommendations remain open."

The FAA agrees that children ages 2 and under sitting in another passenger's lap while flying is not a safe practice.

"Although children who have not reached their second birthday are permitted to travel as lap children, the FAA strongly discourages this practice and recommends that you secure your child in an approved [child restraint system] in their own seat for the entire flight," the agency advises. "While there is no regulatory prohibition from using a booster seat or harness vest (or other non-approved devices) for a lap child during the cruise portion of the flight only, airlines have policies which may or may not allow the use of those devices. Check with your airline."

Congressional lawmakers are currently reviewing federal aviation rules and legislation in order to reauthorize the FAA by the end of September, which is currently funded until the end of fiscal year 2023.

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White House hosts cast of Apple TV+'s "Ted Lasso" to discuss mental health

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(WASHINGTON) -- President Joe Biden and First Lady Jill Biden will be hosting the cast of Apple TV+'s "Ted Lasso" at the White House Monday to discuss the importance of talking about mental health.

Several actors from the hit show including Jason Sudeikis, Hannah Waddingham and Brett Goldstein visited to discuss why people should address "mental health to promote overall well-being."

Biden tweeted a suggestion to the visit Sunday with a photo of a sign that reads, "BELIEVE" above one of the doors to the Oval Office, which references the sign that the title character, played by Sudeikis, hangs above his office door.

Prior to the meeting, Sudeikis and a few other cast members attended the top of a briefing held by White House press secretary Karine Jean Pierre.

"No matter who you are, no matter where you live, no matter who you voted for, we all probably know someone -- or have been that someone ourselves actually -- that's struggled, that's felt isolated, that's felt anxious, that's felt alone," Sudeikis said at Monday's briefing. "And it's actually one of the many things that, believe it or not, that we all have in common as human beings."

Sudeikis called on Americans to check in with family, friends, neighbors, co-workers and others to see how they're doing and for people to not be afraid to ask for help if they need it.

"Look, I know in this town, a lot of folks don't always agree and don't always feel heard, seen, listened to," he said. "But I truly believe that we should all do our best to help take care of each other."

According to a press release from Apple TV+, the themes of "Ted Lasso" have focused on "optimism, kindness, and determination."

The series, which saw its third season premiere last week, has also not shied away from depicting mental health struggles.

Lasso is an American football coach who moves to England to coach a Premier League soccer team. He generally has a sunny disposition, but cracks begin to show as past trauma catches up with him.

Dr. Sharon Fieldstone, played by Sarah Niles, is brought in to help one of the team's soccer players after a penalty kick gone wrong shakes him up. However, she soon begins to have one-on-one conversations with all the players.

Although Lasso initially resists Fieldstone's attempts to have a session with him, he eventually visits her after experiencing a debilitating panic attack.

Over a series of sessions, Lasso and Fieldstone dig down to discover the root cause of Lasso's anxiety.

"Ted Lasso" co-creator and cast member Brendan Hunt, who plays Coach Beard, told Phil Lipof on "ABC News Live" Friday that the response from fans to Lasso entering therapy has been overwhelmingly positive.

"The feedback we've gotten from people on this show is so uniquely moving -- and has been from the beginning for various reasons -- but, when we added the therapy element, heard back from a lot of different people about how therapy has helped their lives and some people who were just finally taking the step to start therapy because of the show," Hunt said.

In several speeches, including his most recent State of the Union in January, Biden has said one of the key proposals of his administration is improving mental health.

The administration has provided more than $500 million to help states launch the 988 Suicide and Crisis Lifeline and has distributed funds to help more schools hire mental health professionals that can connect with students either in person or via telehealth.

Biden has also called on lawmakers to pass legislation that would prevent social media companies from collecting personal data on children and teenagers as well as ban targeted advertising to children.

"President Biden has made addressing the mental health crisis a core pillar of his Unity Agenda," the White House said in a statement. "His strategy is focused on training more providers, making care more affordable and accessible, and creating healthier and safer communities, including online."

The White House did not immediately return ABC News' request for comment.

ABC News' Karen Travers contributed to this report.

Copyright © 2023, ABC Audio. All rights reserved.

Mercyhurst University student whose unattended wheelchair was pushed down stairs hopes incident can bring change

Sydney Benes with head of security Nate Sanders at Sullivan's Pub. Sanders said Benes is looking to press charges against the two men who pushed her chair down the stairs and damaged it. -- Julia Zukowski

(ERIE, Pa.) -- Sydney Benes, a Mercyhurst University student whose unattended wheelchair was pushed down stairs in a viral video, hopes her story can be used for change and she can be an advocate for others in her situation.

The incident occurred March 11 at Sullivan's Pub in Erie, Pennsylvania. A video posted to Twitter shows fellow student Carson Briere pushing Benes' wheelchair down the stairs at the eatery and walking away.

Benes, a double amputee who lost her legs in a car accident in 2021, uses the chair while learning to use her prosthetics.

"All that was going through my head was 'man I hope this was an accident, I hope that this wasn't on purpose," Benes told ABC News.

Nate Sanders, head of security at Sullivan's Pub, said he was helping Benes go into the bathroom downstairs when he heard a loud noise.

"We heard something that sounded like somebody falling down the steps. We went out and checked, didn't see any sign of anybody falling, but when it was time to bring her back up the stairs, we found her chair at the bottom of the steps," he told ABC News.

Once they checked the footage, Sanders said they identified who it was, forced the boys to apologize to Benes, and escorted them out of the establishment.

"I grabbed him on the shoulders and said, 'I've got video of you tossing a wheelchair down the steps like it's time to go," he said.

Sanders said the two student-athletes are now banned from the bar.

While there has been a GoFundMe created for Benes, she said she didn't intend to keep all of the money raised to replace the broken wheelchair even though the goal was exceeded. Instead, she wants to donate the money to other causes and hopes this is an opportunity for change and fair treatment of people who are disabled.

"I can use it to show people what we go through, what we have to deal with, and how we wish to be treated," she said. "We are treated like things, like second-class citizens; we're not treated with respect."

Mercyhurst University said Carson Briere and two other student-athletes were placed on an interim suspension from their athletic teams, per school policy, pending the outcome of the investigation. Briere has issued an apology.

"I am deeply sorry for my behavior on Saturday. There is no excuse for my actions, and I will do whatever I can to make up for this serious lack of judgment," he said.

Briere's father, interim Philadelphia Flyers GM Daniel Briere, also issued a statement of apology on his son's behalf.

"I was shocked to see Carson's actions in the video that was shared on social media. They are inexcusable and run completely counter to our family's values of treating people with respect. Carson is very sorry and accepts full responsibility for his behavior," he said.

ABC News reached out to the Erie Police Department for comment on the investigation and has not heard back.

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Texas abortion law means woman has to continue pregnancy despite fatal anomaly

A 28-week ultrasound of the baby's head shows normal brain structures that should have formed and then separated in the midline are not there. -- Courtesy Kylie Overdorf

(NEW YORK) -- Kylie Beaton was looking forward to having her second child later this year. Now, she's faced with carrying an unviable pregnancy to its end due to Texas' highly restrictive abortion ban.

According to a report from her doctor, Beaton's baby has a rare, severe condition impacting the development of its brain, but she is unable to access abortion care in her home state.

"To have a woman go through so much torture along the way that's going to stay with them forever," Beaton told ABC News. "Whatever the case may be, you have to look at things from a different perspective."

Texas has several abortion bans in place that prohibit nearly all abortions, except when a mother's life is at risk or there is a risk of serious bodily harm. The state has civil and criminal penalties for performing banned abortions.

Beaton, who has a 4-year-old daughter with her husband, Seth, said the couple had been actively trying to get pregnant when they conceived the unviable pregnancy. Seth had been hospitalized with COVID pneumonia in June 2021. When he was finally released six months later, the couple started trying to have a baby right away, Beaton said. Beaton has polycystic ovary syndrome, which can make it harder for women to get pregnant, so it was all the more joyful when she learned their efforts were successful.

"I was really excited when we found that it was a boy, but that was short-lived," Seth Beaton told ABC News. "Right now, I'm just terrified for my wife. She's the strongest person I know and she's just helpless right now. And it's not fair for her and other women. And we have a daughter, I couldn't imagine my daughter ever having to go through this."

At her 20-week ultrasound appointment, Beaton said her physician discovered the fetus had a rare, severe anomaly -- called alobar holoprosencephaly -- in which the fetus's brain does not develop into two hemispheres as it normally would, and the major structures of the brain remain fused in the middle.

The brain splitting into two hemispheres is a "critical stage in the development" and can impact the development of the nose, mouth and throat, Dr. Katie McHugh, an Indiana OB-GYN and abortion provider, told ABC News. The condition results in a very painful life and death for the fetus, McHugh said.

"Often times we will offer, if not recommend, pregnancy termination," McHugh said.

The anomaly occurs in about 1 in 250 fetuses, but in just 1 in 16,000 live births, according to the Cleveland Clinic. In her seven years practicing as a maternal fetal medicine specialist, Dr. Carrie Rouse, an OB-GYN and maternal fetal medicine specialist at Indiana University Health, said she has only come across five cases. Beaton's 28-week ultrasound shows the severity of her baby's anomaly.

"The inside appears very empty," said Rouse, who is not treating Beaton, but looked at her ultrasound. "The normal brain structures that we would see, that should have formed and then separated in the midline, are not there where they normally would be. This is a very concerning ultrasound."

Beaton said her physicians told her the baby could survive out of the womb for a couple of weeks, at most, in the event that the pregnancy ends in a live birth. Rouse agreed with this assessment, pointing to what she said is a lack of development of normal brain tissue and empty fluid filling the head.

"This anomaly is typically lethal for most infants within days to weeks," Rouse said. "Outliers are only able to survive with significant amount of invasive procedures and interventions."

Babies with this condition never reach developmental milestones, meaning they won't have any intentional interactions like smiling, and often can't see, have severe seizures and hormonal abnormalities, according to Rouse. Very few outliers are able to survive up to a year and the level of intervention needed for babies with this condition to survive is extremely high; they often need mechanical ventilation or a life support machine, multiple medications and repeated lab draws, Rouse said.

"They live to a year with basically heroic measures," Rouse said.

Beaton said her physician referred her to a specialist a week after her diagnosis. However, she said the specialist confirmed that due to the overturning of Roe v. Wade, and Texas' "trigger" law effectively outlawing nearly all abortions, the physicians' hands were tied. She said the specialist told her he could not do anything to end the pregnancy unless Beaton developed a severe health issue or if the fetus dies in the womb.

Anti-abortion group Texas Right to Life has routinely argued that fetuses should be "honored and protected in law no matter how long or short their lives may be," according to a statement earlier this month.

Representatives for Texas Gov. Greg Abbott, Attorney General Ken Paxton and state Sen. Bryan Hughes, who authored one of the state's abortion bans, did not immediately respond to ABC News' request for comment about Beaton's situation.

Beaton said she wanted to have a vaginal delivery, feeling like a scar from a cesarean section would be a constant reminder of what she had lost. A C-section also means that the couple would be advised to wait 12 to 18 months before trying to get pregnant again, the typical time physicians recommend women wait so their uterus can recover from surgery, according to the Center for Advanced Reproductive Medicine and Fertility.

"With this condition, in particular, because the head, the fetal head, develops at a different rate, often because of fluid collections, most of the time vaginal delivery is not an option. And so cesarean delivery is required," McHugh said. "And this is going to be major abdominal surgery, with risks associated with it -- for a baby that has maybe no chance of a normal life or potentially of survival at all, depending on the severity."

Unable to get care in Texas, Beaton said she booked an appointment to get an abortion at a clinic in New Mexico in February.

But, she said when she went in for an ultrasound days before her appointment, she was told her baby's head had grown too big and she could no longer get the procedure. The facility's cutoff for abortions is 23 weeks and six days she said and the fetus's head was already measuring at what it typically would at over 23 weeks of pregnancy.

"From there, we were pretty let down," Kylie Beaton said.

She said she was referred to a clinic in Colorado that provides later-term abortion care, but that facility told them it would cost between $10,000 to $15,000 for the procedure, which was financially out of question, Beaton said. The New Mexico clinic would have provided the same procedure for $3,500, Kylie Beaton said. Neither estimate includes the cost of travel and accommodation.

Since then, the fetus's head has continually increased in size, filling with fluid, she said. At her appointment on Monday, when she was 28 weeks pregnant, the fetus's head size was measuring at what it typically would be at 39 weeks, a full-term pregnancy, the ultrasound showed.

"On that ultrasound, the head is measuring significantly larger than it should be. It's measuring about 10 weeks further along than she actually is, which is very concerning," Rouse, the Indiana Health System OB-GYN, said.

Rouse said Beaton's C-section could be more complicated and risky as her pregnancy continues.

"You worry about ongoing growth of the fetal head of causing more complications at the time of delivery, like hemorrhage, needing a blood transfusion, needing to use a larger incision on her abdomen in order to to remove the infant, needing to use a larger and different incision on the uterus in order to remove the infant," Rouse said. "There's a risk of possibly uterine rupture just because of the stretch on the uterus. All of these things would make me pretty worried."

"For a condition for which we expect the baby to pass away soon after birth, that baby is going to pass away because of the alobar holoprosencephaly, whether they are born at 39 weeks or earlier," Rouse added.

Beaton said her physicians in Texas contacted other doctors in the state, hoping they had heard of an alternative regarding the state's laws that would permit them to induce her labor since the baby's head was at full term. Ultimately, Beaton said, doctors determined the size of the baby's head was not a good enough reason to induce labor because her health is still not at risk.

"And if the state were to find out, they would most likely press charges," Kylie Beaton said.

Texas' anti-abortion law makes it a second-degree felony for any attempt by a medical professional to perform, induce or attempt an abortion, and a first-degree felony if the abortion is carried out.

"My specialist and my OB both had said I had to go essentially full term to at least 37 weeks unless something happens to either the baby or I, then they could induce," Kylie Beaton said.

The couple said the law has left them feeling helpless and frustrated over not being able to make a humane decision for their baby.

"I mean, for them to say, 'Well, you need to wait until you're in a health crisis, a health issue to where your life's in jeopardy, then that's when we can take it.' Well, then why do we have doctors?" Kylie Beaton said.

"Why are we taking medications for things like high blood pressure? Why don't you wait until you have a heart attack? Or until you have, you know, the signs that you're having a stroke to be on medication? All those things? It's kind of the same way, if you look at it from our perspective," she added.

Before this pregnancy, Beaton said she never would have considered getting an abortion. Now, she believes abortions should be allowed in cases like hers and for women with other health conditions to get the care they need.

"I'm personally not for it being a way of birth control. I do believe that there are certain instances where I deem that it is necessary," she said. "Never in a million years would I expect or believe that we will be going through what we're going through now."

Copyright © 2023, ABC Audio. All rights reserved.

What is gender dysphoria and what does transgender youth care consist of?


(NEW YORK) -- Across the country, Republican lawmakers have introduced legislation that restricts transgender health care for minors.

At least eight states have passed laws or policies restricting this care, and 23 more state legislatures are considering similar legislation of their own.

Medical experts say that understanding transgender identities, gender dysphoria and how gender-affirming treatments work is key to understanding the impact these bans may have on patients.

"When it becomes too political, it becomes more about paying attention to very short sentences, but not paying attention to nuance” said Dr. Hussein Abdul-Latif, a pediatric endocrinologist at the Children’s Hospital of Alabama with a special focus on gender care.

“And that's unfortunate, because this is not something that is very simple.”

Why do people undergo gender-affirming care?

Gender-affirming care can help treat gender dysphoria, which refers to the stress of being in a body that doesn’t feel like one’s own, according to the Diagnostic and Statistical Manual, Fifth Edition, which provides up-to-date information on mental health conditions.

People experiencing gender dysphoria may feel that their physical body does not match their inner sense of who they are or that they do not desire the gender identity typically associated with their assigned sex at birth.

This can cause distress, depression and anxiety, according to medical experts. However, being transgender is not a mental illness.

“There's not a blood test, there's not an MRI we can do to determine who's … dealing with dysphoria,” said Dr. Andrew Goodman, the medical director for Callen-Lorde, a community health center in Manhattan that specializes in LGBTQ health care. “We have to listen to people, and to trust them and what they're telling us.”

A national survey in 2015 by The National Center for Transgender Equality reported that of the more than 27,000 trans Americans who responded, 38% of them knew they were trans before 5 years old, and 60% knew they were trans before 10.

Is gender diversity a new concept?

No. There is documentation of gender diverse individuals in a wide range of cultures around the world throughout history, dating back centuries.

Medical treatment for gender dysphoria, as it’s known today, was introduced in the early to mid-1900s in Germany.

Modern gender-affirming care is based on “decades of clinical experience and research and, therefore, they are not considered experimental, cosmetic or for convenience,” per the World Professional Association for Transgender Health standards of care.

What is gender-affirming care?

Gender-affirming care is about supporting someone’s identity, said Dr. Goodman. It helps align their physical appearance with their gender identity, and can include puberty blockers, hormone medications, and surgery.

Trans individuals often transition socially — by changing their name and pronouns, or dressing differently — before beginning any medications.

“I look for the need, the crisis… when the dysphoria really starts to intensify,” said Dr. Goodman, who explained this can be when a trans youth starts seeing puberty-related changes in their body.

Puberty blockers are used in people who have not started or completed puberty. Pausing puberty allows children to explore their gender identity without the growth of permanent sex characteristics, Dr. Abdul-Latif explained.

Puberty blockers mimic the body’s natural hormone, called GnRH, which suppresses the release of testosterone for biological males or estrogen for biological females, according to the U.S. Department of Health and Human Services.

These are typically offered during the early stages of puberty, according to the Endocrine Society treatment guidelines. This stage of puberty can be determined by changes in the body such as enlargement in the testicles or breast bud formation. The average age for this developmental stage is 11-12 years old for biological males and 10-11 for biological females.

If these are stopped, a child will resume undergoing puberty with little to no proven side effects, according to medical experts ABC News spoke with.

Once kids are in the later stages of puberty, typically around the age of 15, they are no longer a candidate for puberty blockers and would transition to hormone therapy, explains Dr. Abdul-Latif. They are directly given estrogen or testosterone, based on their gender identity.

Changes from hormone therapy occur slowly and are less reversible, he explains, such as changes in voice and body hair.

The World Professional Association for Transgender Health guidelines recommend a thorough biopsychosocial evaluation prior to initiation of hormone therapy, including a letter from a mental health professional, informed consent from the parents in accordance with national laws, and a thorough discussion of the risks and benefits with both patients and parents.

It’s not unusual for patients to stop hormone therapy and decide that they have transitioned as far as they wish, according to Abdul-Latif.

“A very important idea that I share with them is that they can change their mind anytime they want to, even when they start hormone therapy or puberty blockers,” Abdul-Latif said. “That is important for me to make sure that they are not continuing because of fearing that they will disappoint me. I certainly would not be disappointed. I'm there to serve them.”

According to the American Academy of Pediatrics, gender-affirming surgery is only done on adolescents on a case-by-case basis. It does not come without risk, said Goodman, but for those experiencing severe distress with their body, surgery can be a major source of relief.

Surgeries include the removal of breast tissue, creating the appearance of breast tissue, or reconstructing of genitalia.

Is gender-affirming care safe?

All medications, surgeries or vaccines come with some kind of risk and gender-affirming care is no different, according to physicians. However, knowing the risks and benefits of treatment – and of not treating a condition – can help families make an informed decision.

“I never phrase the conversation [with patients] as this is totally benign…there are risks here. But the thing that we're really considering is are these risks worth taking on because of the benefits? Because of the misery of dysphoria, because of how much it might be holding you back?” Goodman said.

“I can point to dozens of cases in my own practice where those risks absolutely were worth the benefits. We have made people's lives tremendously better because we started hormones when they were at a young age.”

There is evidence of a slight reduction in bone mineral density for those on estrogen therapy for male to female transition. Dr. Abdul-Latif says he warns patients of this risk beforehand and if patients start to develop pain or weakness, dosing can be adjusted to lessen the effects.

Early research shows that testosterone therapy might increase cholesterol levels. However, a study published by the American Heart Association, has not demonstrated any evidence of increased cardiovascular risk.

Those receiving hormone therapy need routine lab monitoring and may require medication to manage their cholesterol.

Oral estrogen has been shown to increase risk of blood clots. When Dr. Abdul-Latif starts a patient on this medication, he strongly encourages patients not to smoke cigarettes as that can further increase risk of blood clots. Depending on the situation, he may switch to a non-oral form of estrogen as it carries less risk.

Estrogen therapy can decrease sperm count, so Dr. Abdul-Latif recommends trans women freeze their sperm before starting therapy. The long term effects of testosterone on fertility are still being studied, however this is discussed in detail before starting hormone therapy.

But those potential risks are often outweighed by the benefits.

Major national medical associations, including the American Academy of Pediatrics, the American Medical Association, the American Academy of Child and Adolescent Psychiatry, and over 20 more agree that gender-affirming care is safe, effective, beneficial, and medically necessary.

Transgender youth are more likely to experience anxiety, depressed mood and suicidal ideation and attempts, often due to gender-related discrimination and gender dysphoria.

Gender-affirming hormone therapy has been proven to improve the mental health of transgender adolescents and teenagers, according to a recent study in the New England Journal of Medicine.

It’s rare for people to reverse a transition after undergoing gender affirming care, according to research published in the journal LGBT Health. Research found that those who reverse their transition often do so because of pressures from family and social stigma.

Rates of regret for gender affirmation surgery are extremely low — research shows they hover around 1%. Rates of regret for knee and hip surgeries are significantly higher, studies show.

Ultimately, said Goodman, every trans child should be addressed individually.

“This is a purely medical decision between parents and families and physicians,” said Dr. Abdul-Latif. “It does not need interference and added pressure on a family that is already under pressure.”

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COVID-19: A look back on where the US succeeded and where we didn’t

Fatih Aktas/Anadolu Agency via Getty Images

(NEW YORK) -- On the third anniversary of COVID-19 being declared a global pandemic, public health experts can point to clear instances where the United States succeeded in beating back the virus and others where it didn't.

Even as the virus continues to spread, data from the Centers for Disease Control and Prevention show that weekly cases, hospitalizations and deaths are declining, and the nation survived its first winter since the pandemic began without a true winter wave.

Public health experts said that while the U.S. government and federal health agencies succeeded in many aspects -- including the rollout of vaccines and at-home tests -- there are also lessons to be learned from mixed messaging.

"I think it's important to remember that we lost millions and millions of lives and that we don't forget all the things we've learned," Dr. Priya Sampathkumar, a professor of medicine and the head of infection control for Mayo Clinic, told ABC News. "So learning is one thing but retaining that memory and being ready to come together to prevent another pandemic is really important."

Speedy rollout of the vaccines

Experts agree that the development and rollout of the COVID-19 vaccines is one of the country's biggest successes.

In April 2020, the Trump administration launched "Operation Warp Speed" to fast-track the development and production of COVID-19 vaccine, providing unlimited funding and other resources to pharmaceutical companies.

The majority of vaccines, from the first steps of academic research to arriving on the market, generally take 10 or more years to be available, experts said. However, researchers were able to perform several steps usually performed in a linear fashion simultaneously, allowing companies to obtain U.S. Food and Drug Administration authorization and scale up production without lessening vaccine safety requirements.

"It really unlocked a new sort of a new era of vaccine," said Dr. John Brownstein, an epidemiologist and chief innovation officer at Boston Children's Hospital and an ABC News contributor. "We've recognized that we can develop and deploy a vaccine in actually reasonably fast pace from identification of a new virus to actual first prototype."

"For the first time, we recognize that there's a lot of places that can be parallel process, so the process of manufacturing, and regulatory approval can happen relatively simultaneously," he added.

Sampathkumar said another reason the vaccines were able to be developed so quickly is because the genome sequence, or the genetic makeup, of the virus was uploaded quickly to global databases.

"We really very quickly sequenced the virus from the first case being reported in China in late December to about seven weeks later, we have the entire sequence of the SARS-CoV-2 virus, which was step towards making a vaccine," she said. "For most previous viral epidemics, it took anywhere from six to 18 months to do that. So that very first step happened so quickly and set the stage for vaccine development."

Additionally, the relatively new technology of messenger RNA, or mRNA, was used. While most vaccines use a weakened or inactivated virus to stimulate an immune response, mRNA vaccines teach the body how to make proteins that can trigger an immune response and fight off an infection.

Because researchers can design mRNA vaccines more quickly than they can produce the live or weakened pathogens needed for a traditional vaccine, mRNA vaccines against COVID-19 were quickly developed, tested, mass produced and delivered to the general population, preventing millions of hospitalizations and deaths, according to analyses.

At-home COVID tests available for everyone

Polymerase chain reaction (PCR) tests are considered the "gold standard" when it comes to COVID-19 testing. They look for genetic material from the virus and are considered to be very accurate.

However, in the early days of the pandemic, they had a very long turnaround time because samples must be sent to a laboratory and be analyzed by a medical professional.

Companies quickly began scaling up production of rapid at-home antigen tests, which check for antigens, or proteins on the surface of the virus.

While less accurate than PCR tests, these rapid tests are still considered quite accurate when used in people with symptoms of infection and can deliver results in 15 minutes or less.

Sampathkumar said the widespread use of at-home tests was "very amazing" because it was, for many Americans, the first time they were able to test themselves at home for a virus, compared to flu tests and strep tests that are often performed at doctors' offices, urgent care centers or hospitals.

"When you think about it, when you're feeling sick or when you're infectious to others, it's the worst possible time to expect you to go to a crowded clinic or hospital," she said.

Last winter, the Biden administration launched a website where Americans could request free at-home rapid COVID tests delivered to their doorsteps.

"Making the tests available to every person living in the U.S., you could order the tests and have them delivered to your home for free was also a major step forward," Sampathkumar said.

Mixed messaging

Experts say public health officials made missteps by having mixed messaging about preventive measures like masking.

In February and March 2020, officials including then Surgeon General Dr. Jerome Adams and Dr. Anthony Fauci downplayed the need for the general public to wear masks.

However, in early April, the CDC changed its guidance and recommended that everyone wear a mask or face covering.

While reports have suggested the CDC and other officials delayed recommending masking because they were worried about causing a run on masks and other PPE supplies for health care workers, experts say this also means agencies didn't provide the clear messaging that the public needed.

"I think that that kind of mixed messaging created enormous space for doubt enormous space for skepticism among the public," Dr. Richard Keller, a professor in the department of medical history and bioethics at the University of Wisconsin School of Medicine and Public Health, told ABC News. "It created levels of uncertainty that were really unnecessary and deep and eventually became harmful."

The experts say it's normal for their understanding of a virus to evolve as more information is learned, but they noted that public health officials did not do a good job of communicating that process to the public.

"That was really made clear through the pandemic: our inability to communicate the nuance of science as the science was evolving," Brownstein said. "That was really our Achilles heel because we were not able to explain to the public that a recommendation could change based on how the science evolves."

People viewing COVID-19 deaths as victims' fault

Keller said that as the pandemic has worn on, many Americans have come to view COVID-19 deaths as the fault of the victims and lost a sense of compassion.

Some of this may have been the fault of public health messaging including the Biden administration calling it a "pandemic of the unvaccinated" and stressing how much more likely people are to die of COVID if they don't get vaccinated.

According to the CDC's most recent estimates, people who are up to date on their vaccines have a nearly tenfold lower risk of dying compared to an unvaccinated person. Other risk factors include lower socioeconomic status and/or underlying medical conditions such as diabetes and hypertension.

"To label this a 'pandemic at the unvaccinated' suggests the people who are dying are dying because it's their own fault," Keller said. "I think that's a harmful message because it does a couple of things."

"It suggests that people are to blame for their own misfortune. It also mischaracterizes the true nature of mortality statistics as ti where people are dying and what their circumstances are," he added.

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