TASK DEFINITION: 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.
PROBLEM: The health director for Ridgefield, Connecticut, says there is no way that he and his staff of two can identify and isolate all the people who have interacted with an infected patient, not at the rate cases are multiplying across the town. "Tracing exposures of exposures of exposures. It's just impossible," Briggs said. "The cases are to the point where we can't possibly trace everybody back now." Known as contact tracing, this vital but labor-intensive process is becoming increasingly difficult for stretched health departments in towns and cities across the United States, which has more than 160,000 cases, more than any country in the world. A massive testing campaign, coupled with intensive contact tracing, is credited with helping South Korea slow the spread of coronavirus, whereas the United States has been criticized for a slow response. Epidemiologists say such investigations can mean the difference between nipping an outbreak early and effectively losing control, as has happened in hot spots where contact tracing has given way to lockdowns as the primary tool to prevent spread. Some states outside of the major population centers have taken that advice to heart, as the virus continues its march across the United States. Health officials in those areas acknowledge, however, that it is a race against the clock and that they, too, will be unable to carry out such widespread tracing if the case numbers climb beyond a certain point. Wyoming, for one, has five staff in its state's infectious diseases unit working to identify all contacts with a person who has tested positive, and then asking or ordering them to self-quarantine, and monitoring their health. "Our numbers are small enough," said Kim Deti, a spokeswoman for Wyoming's health department, which has reported 109 cases so far and no deaths. "We'll maintain it as long as we can." West Virginia is tapping its national guard to assist in a similar effort at expansive contact tracing, and coupling that with a stay-at-home order and other distancing steps. On Sunday, the state reported 145 cases and its first coronavirus death. "It's incredibly important that at the same time as you are doing that rapid contact investigation and tracing and outbreak management, that we do the preventive measures in partnership with that everywhere," state health officer Cathy Slemp said at a news conference last week. Alabama, which has confirmed nearly 1,000 cases, is attempting to investigate contacts for all of them, a spokeswoman for its health department said, noting that contact tracing has been an "effective tool in reducing the spread" for tuberculosis and other communicable diseases in the state. New York City, which accounts for a quarter of all cases nationwide, is an example of how the lack of testing in January and February handicapped so-called "disease detectives" from identifying initial infections and containing the spread. The city is now limiting its detectives to contact tracing for outbreaks involving health care workers and clusters in assisted living facilities and nursing homes, its health commissioner, Oxiris Barbot, said during a news conference earlier this month. Louisiana, an emerging hot spot with 5,237 cases and 239 deaths, has similarly narrowed its contact tracing in the New Orleans area, the epicenter of the state's outbreak, to focus on vulnerable populations and high-risk groups. Theresa Sokol, an assistant state epidemiologist in Louisiana, said that by the time the initial patients in the New Orleans area were identified the virus had already taken hold in the community. As cases mounted, she said, social distancing became a more effective tool than contact tracing. But outside New Orleans there is reason to believe that digging deeply into all cases can yield results, especially when combined with the governor's statewide stay-at-home order, Sokol said: "I believe that there is still time." Like other municipalities in the New York area, Ridgefield closed its schools and non-essential businesses. But the virus has continued to spread broadly beyond the cluster at the Benchmark Senior Living at Ridgefield Crossings facility, which has been linked to six of the town's seven deaths. The town hired an additional employee to process the deluge of coronavirus-related data, but keeping up is a challenge. "It's overwhelming for a small health department," First Selectman Rudy Marconi said. Looking ahead, experts see aggressive testing and contact tracing as key to handling subsequent waves of the virus. Kenneth Castro, a professor of global health, epidemiology, and infectious diseases at Emory University, said local, state and federal governments should start recruiting an "army" of people to handle contact investigations. "Identify and contain is better than having society shutdown. It's a balancing act," said Castro, who oversaw the Centers for Disease Control and Prevention's tuberculosis effort for two decades through 2013. "We won't be able to maintain physical distancing forever." (This story has been refiled to correct spelling of "stretched" in paragraph four.)

SOLUTION: 'It's just impossible': tracing contacts takes backseat as virus spreads.

PROBLEM: Since 2000, 34 of Iowa's 118 community hospitals have closed their birthing units, according to the Iowa Department of Public Health. There have been two so far this year, down from eight closures last year the most in a single year. Most of those closures have happened at smaller facilities than the 49-bed Marshalltown hospital. Iowa's aging population is a key reason for these closures, Dr. Stephen Hunter, vice chairman of obstetrics at the University of Iowa Hospital & Clinics in Iowa City, told Iowa Public Radio . "Some rural counties have lost as many as 40 percent of their population in the last three decades," Hunter said. "That's a lot of people gone, unfortunately. That leaves a system that's not adequate for those that remain in those counties." Hunter said the state is also facing a severe shortage of OB/GYNs and family practice doctors who practice obstetrics. And, he said, Medicaid reimbursements are so low for obstetrics that hospitals can't support the service. According to figures from the University of Iowa Hospitals & Clinics, Medicaid reimbursed it about one-third of what commercial insurance plans did for services such as ultrasounds and deliveries last year. Competition from bigger hospitals in bigger cities presents a business challenge, too. "There simply aren't enough women choosing to deliver locally," UnityPoint Health President Jenni Friedly said. "This is a problem that has been going on for a long time. . There are enough women becoming pregnant, but they are going elsewhere to deliver. It's clear OB/GYN patients are already selecting Ames and Des Moines for their care." Stephanie Trusty, a nurse who tracks birthing trends for the state, told the Marshalltown Times-Republican that "some of these birthing units are beautiful. They're like a four-star hotel." But does the loss of birthing units at the smaller hospitals and consolidation of birthing services affect health outcomes? A 2017 University of Minnesota study said the loss of labor and delivery units in smaller, more remote counties is linked with a decrease in prenatal care and increase in out-of-hospital and preterm births. The Iowa Public Health Department and the University of Iowa are keeping watch for any such problems, but so far have not seen any sizable incidence, Trusty said. Hansen Family Hospital CEO Doug Morse in Iowa Falls told Iowa Public Radio that hospital officials decided labor and delivery care were too expensive to continue in the aging, rural community with a declining birth rate. After three months of public meetings, Morse said, hospital officials opted to use half the money they would save to turn the unit into a mental health program for seniors. "It really did become fairly clear that people recognize that this wasn't necessarily ... delivering babies isn't necessarily a service that matches an elderly population," he said. The closing of the birth unit at the Iowa Falls hospital forced Jessica Sheridan to change her plans to have her baby born there, just five minutes from her home. She established relationships with doctors in Ames, an hour away, where her daughter was delivered in mid-December. "We were lucky. It was nice weather," Sheridan said.

SOLUTION: Costs forcing some hospitals to stop delivering babies.

PROBLEM: The vaccine, Ervebo, is approved for individuals aged 18 years and older and has already been used under emergency guidelines to try to protect against the spread of a deadly Ebola outbreak in Democratic Republic of Congo. The shot is also being reviewed by U.S. health regulators and a decision is expected in the first quarter of next year. The Ebola virus causes hemorrhagic fever and spreads from person to person through direct contact with body fluids. It kills around half of those it infects. Since the middle of last year, the Congo Ebola outbreak has killed more than 2,100 people, making it the second-largest Ebola outbreak in history, after the 2013-16 epidemic in West Africa that killed more than 11,300. "The EU is supporting international efforts to combat Ebola on all fronts, from vaccine development to delivering humanitarian aid on the ground," EU Ebola Coordinator Christos Stylianides said in a statement dated Nov. 10. Merck has said its priority was to get regulatory approval of its Ervebo manufacturing site in Germany so that licensed supply of the vaccine "can be used to support global public health preparedness".

SOLUTION:
Merck wins European approval for first-ever Ebola vaccine.