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As a pandemic presses on, waves of grief follow its path

In a strong voice tinged with her Irish homeland, Fiona Prine talks hauntingly about loss. From her COVID-19 infection and isolation — self-imposed in hopes of sparing her husband, folk-country legend John Prine — to his own devastating illness and death, she’s had more than her share in this year like no other.

Illness and death are the pandemic’s most feared consequences, but a collective sense of loss is perhaps its most pervasive. Around the world, the pandemic has spread grief by degrees.

While less than 1% of the global population is known to have been infected, few on Earth have been spared some form of loss since the coronavirus took hold. With nearly 1 million deaths worldwide, full-blown bereavement is the most recognizable.

But even smaller losses can leave people feeling empty and unsettled.


Layoffs. Canceled visits with Grandpa. Shuttered restaurants. Closed gyms. These are losses that don’t fit neatly into a “Hallmark category.’’ But they are not insignificant — especially when anxiety is already heightened, says psychologist and grief specialist Robert Neimeyer of the Portland Institute for Loss and Transition.

Activities that are part of usual routines, that bring pleasure or purpose, give people a sense of control over their lives. Losing them can result in psychological distress and unease, he says.

In normal times, people look to families, friends, communities for support in coping with loss. But in the pandemic, “We don’t have as much capacity as a human community to meet the needs. Nearly everyone has been affected,’’ he says.

“If you were to approach anyone on the street and ask them 10 times, `What have you lost?’, you would hear some remarkable stories.’’

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By the time John and Fiona Prine returned home from a trip to Ireland in late February, the pandemic was spreading. Soon after, Prine had hip replacement surgery, and they hunkered down in their Nashville home for his recovery.

They’d been careful overseas and came home feeling healthy but cautious. Coronavirus tests were almost an afterthought.

“We were doing fine. Happy to be home. John was already up on his feet with a cane,’’ Fiona Prine says.

Prine was 73, a cancer survivor with chronic lung disease, but still performing regularly. His wife and manager, 15 years younger, was protective. She often watched from backstage.

“I knew this would not be a safe virus for John,’’ she says.

When the call came with results showing she’d tested positive, “You might as well have told me I was pregnant,” Fiona Prine says. Hoping to keep her husband healthy, “I literally bolted for the bedroom and locked myself in practically.”

His test results were “indeterminate.” But he seemed OK.

Her quarantine was tough on both of them. They missed each other, and FaceTimed every evening. “He didn’t like to be away from me,’’ she says. Both news junkies, they followed pandemic developments.

“God, there are so many things I wish were different,” she said in a selfie video while confined to that bedroom

‘Abuse Deterrent’ ADHD Tx May Face Uphill Approval Path

An abuse-deterrent stimulant product for attention deficit-hyperactivity disorder (ADHD) got a skeptical review from FDA technical staff ahead of an advisory committee meeting later this week.

AR19 is an oral amphetamine sulfate immediate-release capsule formulated to reduce non-oral abuse. The drug, developed by Arbor Pharmaceuticals, will go before the Psychopharmacologic Drugs Advisory Committee (PDAC) and the Drug Safety and Risk Management (DSaRM) Advisory Committee on Thursday.

The main question looming over AR19 is whether it will indeed deter intranasal and IV abuse through its novel formulation. In briefing documents prepared for panel members, FDA staff suggested they weren’t persuaded by the company’s studies.

Non-medical use of prescription stimulants has remained relatively stable since 2010 and, in 2018, 2% of the U.S. population was misusing stimulants, according to the briefing documents. Young adults are more likely than adults of other ages to misuse stimulants, and the vast majority of misuse occurs orally.

However, based on the immediate-release properties of AR19 capsules, the drug was not intended to and “will not deter abuse by the oral route,” the agency staff stated.

Intranasally, AR19 “did not provide convincing evidence” of abuse-deterred effects compared to 10-mg amphetamine sulfate in a human abuse potential (HAP) study, wrote Tiffany R. Farchione, MD, acting deputy director of the psychiatry division of the FDA Office of Neuroscience, in the briefing documents.

The drug failed to demonstrate a 10% reduction in the reinforcing properties outlined in the HAP study. However, that study was later invalidated because the drugmaker did not prespecify a protocol that removed outlier subjects, the agency staff stated.

Regardless, in a post-hoc analysis conducted by the FDA that excluded outliers, “drug liking” — a measure of abuse liability — was not significantly different between groups either.

In syringeability studies submitted in the application, it was feasible to extract at least 10 mg of amphetamine sulfate per liter when using the higher doses of AR19 (20 mg and 40 mg), which constitutes the minimum reinforcing dose, according to the briefing documents.

Although there were no safety concerns identified with the administration of AR19 when taken orally, the formulation of the drug has been linked with toxicities, such as hemolysis and thrombotic microangiopathy, when manipulated for unintended routes of administration, the agency stated.

Arbor Pharmaceuticals seeks approval and labeling of AR19 as an Abuse-Deterrent Opioid because there is no established pathway for developing abuse-deterrent stimulants.

“The patterns of misuse and abuse, morbidity, and mortality associated with prescription stimulants are different from those associated with prescription opioids, and the [FDA] has not determined that prescription stimulant products warrant the same regulatory approach as opioid analgesics with regard to [abuse-deterrent formulations],” Farchione wrote.

She noted that the FDA has also “expressed concerns” that the term “abuse deterrent” is often misinterpreted to mean a drug carries a lower risk of addiction.

AR19 contains the same active ingredient as Evekeo (amphetamine sulfate), Arbor Pharmaceuticals’ FDA-approved ADHD treatment. AR19 has been shown to reduce symptoms in adults with ADHD. The proposed dosing ranges

Trump says he feels better, but his chief of staff says he is ‘still not on a clear path to a full recovery.’

Mr. Meadows called into Fox News on Saturday night, knowing the president was most likely watching, and praised his “unbelievable courage” and “unbelievable improvement.” But he also confirmed that Mr. Trump’s condition on Friday was worse than originally described. “Yesterday morning we were real concerned with that,” Mr. Meadows said. “He had a fever and his blood oxygen level had dropped rapidly.”

The mixed messages only exacerbated the confusion and uncertainties surrounding the president’s situation. During their briefing on Saturday, the doctors refused to provide important details and gave timelines that conflicted with earlier White House accounts and left the impression that the president was sick and began treatment earlier than officially reported.

Two people close to the White House said in separate interviews with The New York Times that the president had trouble breathing on Friday and that his oxygen level dropped, prompting his doctors to give him supplemental oxygen while at the White House and transfer him to Walter Reed where he could be monitored with better equipment and treated more rapidly in case of trouble.

During the televised briefing, Dr. Conley said the president was not currently receiving supplemental oxygen on Saturday but repeatedly declined to say definitively whether he had ever been on oxygen. “None at this moment and yesterday with the team, while we were all here, he was not on oxygen,” he said, seeming to suggest that there was a period on Friday at the White House when he was.

Dr. Conley likewise appeared to indicate that the president was first diagnosed with the virus on Wednesday rather than Thursday night, before Mr. Trump disclosed the test on Twitter early Friday morning. While describing what he said was the president’s progress, he said Mr. Trump was “just 72 hours into the diagnosis now,” which would mean midday on Wednesday.

Just two hours later, the White House issued a statement it said was written by Dr. Conley trying to clarify. “This morning while summarizing the president’s health, I incorrectly used the term ‘72 hours’ instead of ‘Day 3,’” it said.

Dr. Conley also said that on Thursday afternoon “we repeated testing and, given clinical indications, had a little bit more concern.” Late that night, he said, “we got the P.C.R. confirmation that he was” positive. Mr. Trump attended campaign events on both Wednesday night and Thursday without wearing a mask and gathering hundreds of supporters who likewise were not taking precautions against the virus.

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An ‘exhausted’ Trump’s long path to coronavirus

When President Donald Trump stepped into the dining room of his golf club in New Jersey on Thursday, high-dollar attendees gathered for a fundraiser there thought he seemed a little off.



a man wearing a suit and tie: US President Donald Trump and First Lady Melania Trump step off Air Force One upon arrival at Cleveland Hopkins International Airport in Cleveland, Ohio on September 29, 2020. - President Trump is in Cleveland, Ohio for the first of three presidential debates.


© Mandel Ngan/AFP/Getty Images
US President Donald Trump and First Lady Melania Trump step off Air Force One upon arrival at Cleveland Hopkins International Airport in Cleveland, Ohio on September 29, 2020. – President Trump is in Cleveland, Ohio for the first of three presidential debates.

Subdued from a week of campaigning, maybe. Hoarse from a string of large rallies. Perhaps a little pale underneath the crystal chandeliers.

“Exhausted,” described one person who saw him.

Little could those guests know that the tired-sounding man sitting across the white brocade tablecloth would test positive, hours later, for coronavirus.

Nor were they aware that before he arrived, both Trump and his senior aides received information suggesting he could have been exposed — and therefore could be contagious. Like usual, the President wasn’t wearing a mask.

Trump’s positive diagnosis, announced in a tweet during the small hours on Friday morning only after word leaked his top aide Hope Hicks had become infected, has thrown the nation’s leadership into tumult and sent the capital scrambling to determine who else might be infected.

Questions of government continuity arose in ways they haven’t in years; Trump’s diagnosis amounted to the most serious health threat to an American president since the non-fatal shooting of President Ronald Reagan in 1981.

Suffering only “mild” symptoms, according to the White House — which include a fever, a person familiar with the matter said — Trump alternated Friday between upbeat entreaties to aides to go about business as usual and more worried-sounding brooding about his health, according to a person familiar with the matter. He canceled all of his upcoming campaign travel and failed to appear for a scheduled phone call midday with state and local officials to discuss the impact of the pandemic on vulnerable senior citizens.

“I know many of you were expecting to hear from President Trump today, but as I’m sure you are all aware, President Trump and the first lady tested positive for Covid-19,” Vice President Mike Pence, acting in his stead, told the officials.

In a memo Friday afternoon, Trump’s physician wrote that he “remains fatigued but in good spirits.” He said Trump had been administered a Regeneron polyclonal antibody cocktail and has been taking zinc, vitamin D, famotidine, melatonin and a daily aspirin. The decision to give Trump an experimental monoclonal antibody cocktail is a sign of how concerned the White House may be by the diagnosis, Dr. Jonathan Reiner, a CNN medical analyst and professor at George Washington University, said.

The story of how Trump contracted coronavirus was still being learned on Friday as aides hurriedly tried to trace who he’d been in contact with and whether they themselves might be contagious. At 74-years-old, clinically obese and with known heart ailments, Trump himself fits within a high-risk category.

Yet taken in