Given a paragraph, generate a claim that is supported by the given paragraph. 1) The claim must contain information from within the paragraph. 2) A sentence within the paragraph can be used as a claim. 3) The claim should not have contradictions within the paragraph. 4) The claim should be at most one sentence long.

[Q]: While governments in at least 20 other states obtained more than 30 million doses of the drug through donations from the federal reserve or private companies, Oklahoma and Utah instead bought them from private pharmaceutical companies. Top officials in both states chalked up the decisions to “the fog of war.”  Oklahoma Gov. Kevin Stitt on Tuesday defended the state’s $2 million purchase, saying the drug was showing some promise. His health secretary attributed buying the 1.2 million hydroxychloroquine pills to something that happens in the “fog of war.”  Utah Gov. Gary Herbert at first defended the state’s $800,000 purchase of 20,000 packets of hydroxychloroquine compounded with zinc, but has since ordered an investigation of a no-bid contract with a local company that had been promoting the drugs. Herbert, a Republican, also canceled an additional plan to spend $8 million more to buy 200,000 additional treatments from the same company. A left-leaning nonprofit group in Utah filed a price gouging complaint Tuesday with state regulators, arguing the $40 per pack drug was grossly overpriced. Oklahoma’s attorney general requested an investigative audit on Tuesday of its Department of Health over spending and warned the agency about retaliating against employees who report wrongful government activities under the state’s Whistleblower Act. A spokesman for Attorney General Mike Hunter declined to comment on whether the request was related to the $2 million spent on the drug. Doctors can already prescribe the malaria drug to patients with COVID-19, a practice known as off-label prescribing, and many do. But the U.S. Food and Drug Administration on Friday warned doctors against prescribing hydroxychloroquine for treating the coronavirus outside of hospitals or research settings because of reports of serious side effects, including irregular heart rhythms and death among patients. Preliminary results from a recent study done on coronavirus patients at U.S. veterans hospitals showed no benefit, casting more doubt on the drug’s efficacy during the pandemic. Those were the latest admonitions against the drug that Trump has regularly promoted in public appearances, touting its potential despite his own health advisors telling him it is unproven. Oklahoma acquired 1.2 million pills, or about 100,000 doses, on April 4 from FFF Enterprises, a California-based medical supply wholesaler, according to the Oklahoma State Department of Health. Oklahoma state Rep. Melissa Provenzano, a Democrat from Tulsa, said the state’s purchase shows that Gov. Stitt’s actions don’t follow his claim that he relies on data to drive his decisions. “Two million dollars is a lot of money to waste, especially when we have unemployment claims approved yet going unpaid, health care professionals without proper protective equipment, and diagnosed cases and deaths continuing to rise,” Provenzano said. Stitt, a first-term Republican, said hydroxychloroquine was showing some promise as a treatment in early March, and he didn’t want Oklahoma to miss out on an opportunity to acquire it. “Now there’s some evidence the chloroquine may not be as effective, but I was being proactive to try and protect Oklahomans,” Stitt said Tuesday when asked about the purchase. “That’s always going to be my first instinct, to get the equipment and things we need that I’m seeing in the future would help Oklahomans.” Oklahoma’s Secretary of Health Jerome Loughridge said several physicians, including some in Oklahoma, were previously optimistic about the drug’s promise in treating COVID-19. He added that the drug is also useful for treating lupus and some other auto-immune diseases, so the state’s supply “will not have gone to waste.” “When we were battling sort of the fog of war at that point, we certainly acquired it on the potential that it would have utility,” Loughridge said. Jeff Burton, a former adjutant general of the Utah National Guard chosen to lead the state health department’s coronavirus task force, offered a similar explanation for why the state made its purchase. He said the state never received the pills and is trying to get its money back. “I chalk it up to fog of war,” Burton told the state’s pharmacy board. “There was a lot going on. It’s easy to judge it from (an) easy chair.. . . Since then we’ve decided that was not a wise purchase.”  Doctors in Oklahoma have been using the drug to treat patients with COVID-19, often in conjunction with a second drug, azithromiocin, but the results “just are not that promising,” said Dr. Douglas Drevets, chief of infectious diseases at University of Oklahoma Medicine. FFF Enterprises said it’s the company’s policy not to comment on transactions with customers. Utah gave a local company called Meds in Motion the $800,000 contract without taking bids from other companies under emergency procurement rules, said Christopher Hughes, director of Utah’s division of purchasing. State officials haven’t explained why they didn’t seek to get the drugs for free. The Federal Emergency Management Agency said Saturday it has sent out 28.6 million tablets of hydroxychloroquine sulfate free of cost to states around the country. Several states including New York, Connecticut and Texas received donations of the medication from a private company based in New Jersey called Amneal Pharmaceutical, according to information compiled by The Associated Press. Utah taxpayers deserve to know what happened to allow a purchase that seems like a company taking advantage of the early, chaotic days of the pandemic, said Chase Thomas, executive director of the group called Alliance for a Better Utah that submitted the price gouging complaint. The complaint alleges Utah paid at least double the common price for the medication. “Whether they were buying drugs we didn’t need or paying too much for it when they could have gotten them for free, there just needed to be a lot more thought going into this,” Thomas said. Meds in Motion didn’t answer an email seeking comment about the allegations. Herbert declined to provide an update Tuesday about the investigation of the purchase. He said Friday the state’s legal counsel would aim to find out what, how and why it happened. He said he believed state officials acted in good faith as they scrambled to slow the spread of coronavirus, but acknowledged a mistake may have been made. “I have some questions about how it came about,” Herbert said Friday. “Bottom line is, we’re not purchasing any more of this drug.”  ___ McCombs and Whitehurst reported from Salt Lake City.
[A]: Oklahoma, Utah face scrutiny over malaria drug purchases.


[Q]: Authorities have managed to mitigate the spread of the virus and the COVID-19 respiratory disease it causes among Singapore’s citizens by rigorous contact tracing and surveillance, earning praise from the World Health Organization. The Ministry of Health reported just 14 cases among Singaporeans and permanent residents on Saturday. But the disease is spreading rapidly within the large migrant worker community, highlighting what rights groups say is a weak link in containment efforts. Authorities have ramped up testing for the disease in the dormitories. Saturday’s new cases takes the total in the city-state, which is under a partial lockdown, to 5,992. It has reported 11 deaths from the disease.
[A]: Singapore reports 942 new COVID-19 cases in record daily jump.


[Q]: The story focused on costs, including information about the relative cost comparison between what are called “open” surgeries and those done laparoscopically (with a thin flexible tube.) The release summarized how minimally invasive techniques reduced the length of hospital stay and complication rates for patients. “Researchers also found that, on average, the minimally invasive approach reduced length of hospital stay by approximately two days, and open operations were more than $9,000 more expensive than minimally invasive procedures. The researchers also found that laparoscopic procedures were better for patients in terms of fewer complications. Laparoscopic anti-reflux operations were less likely to result in postoperative blood clots, wound complications, surgical site infection, esophageal perforation (which can be life threatening), bleeding, cardiac failure, and death.” We rate this, but just barely, for citing cost differences between the two types of surgery and the average reduction in the number of days a patient must remain hospitalized. We do wish the release had delved more into the specifics of reduced complications. How common were the surgical complications in each surgical method? The release names complications associated with both types of surgery for GERD, while stating that patients undergoing laparoscopic procedures encountered fewer of them: “postoperative blood clots, wound complications, surgical site infection, esophageal perforation (which can be life threatening), bleeding, cardiac failure, and death.” The news release gave details about how the study examined records of about 75,000 patients from 1,000 hospitals to compare outcomes in the records for open vs. the minimally invasive laparoscopic surgeries. That’s all to the good. However, the news release didn’t mention any of the study’s limitations. The key one is that this is a retrospective, observational review of records that isn’t capable of supporting cause and effect statements such as the minimally invasive approach “reduced length of hospital stay by approximately two days.” Nor should this kind of evidence be used as the basis for statements such as laparoscopic procedures “were better for patients” and “should be the standard of care.” Patients receiving open vs. laparascopic procedures could differ in unknown ways, which is why the superiority of one approach over the other should ideally be established by a prospective, randomized controlled trial. There were other limitations outlined in the journal article that were not mentioned in the release. Because the NIS database doesn’t link to hospital records, researchers weren’t able to track and measure outcomes “including complications, readmission, and mortality, occurring after the initial hospital discharge.” The researchers were also unable to determine which open surgeries were “re-dos” of previous surgeries. The potential for errors in coding which procedures were used was also cited as a possible limitation. There was no disease mongering. The release also provided useful context on the prevalence of GERD and further specified that smaller group of patients, from the many heartburn suffers, might be candidates for the surgery. Well done. The release does not list any funding source for the research and the published study notes that authors had “nothing to disclose.”  We’ll rate this not applicable since this is an examination of existing data, and there may have been no additional outside funding. The news release does a good job here. It compares different surgical methods and it also names alternatives for treating GERD such as medications and changes in the diet. It also states which group of patients the surgery is aimed at: “Anti-reflux surgery should be considered in patients who do not achieve complete control of their symptoms [regurgitation or cough] with medications; who do not want to take medications for the rest of their lives; or who experience complications of medical therapy.” It’s clear from the release that both methods of surgery have been widely available nationally and the outcomes of 75,000 surgeries were tracked by the National Inpatient Sample (NIS) database. The release also notes that “urban academic or teaching hospitals” perform laparoscopic anti-reflux surgery more often than “open” procedures, 54.4 percent versus 45.6 percent. And it recommends that anti-reflux surgery should be performed laparoscopically in specialized centers. The news release was not about a novel procedure and made no claim of novelty. However, this isn’t the first study to examine laparoscopic vs. open surgery. For example, the British Journal of Surgery published results of a randomized trial of the two methods and the Scandinavian Journal of Gastroenterology published research on long-term outcomes following laparoscopic and open procedures for GERD. We did not observe any unjustifiable language.
[A]:
Laparoscopic anti-reflux operation for GERD linked to fewer postoperative complications