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Super Bowl champion wide receiver asking for early release from prison, citing dementia, coronavirus
Super Bowl champion wide receiver Mark Ingram, who is serving a 21-month federal prison sentence for his bank fraud and laundering drug money, is seeking an early release because he is suffering from dementia during the coronavirus pandemic, his lawyer said Wednesday.
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foxnews.com
Day 29 without sports
This should have been the time for the Los Angeles Clippers and the Los Angeles Lakers to offer an NBA playoff preview. Instead, we're left wondering.        
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usatoday.com
A new story book aims to help children cope with coronavirus
Children are among those fighting coronavirus and those feeling the pain it causes, and a story book wants to help them navigate both.
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edition.cnn.com
California counties struggle to get ventilators from state as Newsom ships equipment around country: report
Gov. Newsom emphasized in his Monday remarks that California will be able to get its ventilators back if and when it needs them. 
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foxnews.com
Tom Brady 'Was the Most Unhappy QB in Football' Last Year, Says Sportscaster Al Michaels
The six-time Super Bowl champion reportedly told the veteran broadcaster he was unhappy in New England, despite the Patriots sitting on an 8-0 record.
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newsweek.com
Coronavirus pandemic could send half a billion people into poverty: Oxfam
About half a billion people – or 8 percent of the world’s population — could be pushed into poverty as a result of the economic fallout from the coronavirus pandemic, according to the international aid group Oxfam. The Nairobi-based charity warned Thursday that the fight against poverty could be set back by 10 years –...
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nypost.com
US citizens in Lebanon decline repatriation offer, saying it's 'safer' in Beirut
Many US citizens in Lebanon have declined a recent embassy offer for repatriation, citing skyrocketing cases in the US. "It's safer in Beirut," some said.
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edition.cnn.com
“How to Build a Life”—New column by Arthur Brooks
Today The Atlantic begins “How to Build a Life” by contributing writer and professor Arthur C. Brooks, a new regular column about the tools needed to construct a life that feels whole and meaningful. Though not created in response to the current crisis and upheaval of American life, the column speaks clearly to the needs of this moment. Time is finite. Priorities shift over the course of a life, and people don't always point themselves toward happiness.As Brooks, who is a professor at the Harvard Kennedy School and senior fellow at the Harvard Business School, outlines in the first installment today: “We’re stuck at home; our lives on COVID time have slowed to a near halt. This creates all sorts of obvious inconveniences, of course. But in the involuntary quiet, many of us also sense an opportunity to think a little more deeply about life. In our go-go-go world, we rarely get the chance to stop and consider the big drivers of our happiness and our sense of purpose.”“How to Build a Life” is a column about how to find what matters and how to hold onto it—at any age. It’s about how to balance the competing demands on our time and build a life that feels whole. What can we do each day to increase our satisfaction and enjoyment of life? It will draw on social science, philosophy, history, and the arts to devise strategies for how people can surpass "good enough" and build a life that they truly want.Brooks’s first column synthesizes research on happiness to come up with the three equations for enriching our lives: our subjective well-being (genes + circumstances + habits); habits (our human relationships, productive work, and the transcendental elements of life); and our satisfaction (the calculation of what you have, divided by what you want).“Think of these three equations as the first class in the mechanics of building a life,” he writes. “But there is much, much more where all that comes from. Hence, this new column. In the coming months, I will pull back the curtain on the art and science of happiness to show how the brightest ideas can illuminate new solutions to our ordinary challenges.”Find “How to Build a Life” every two weeks at the Family section.Arthur C. Brooks is Professor of the Practice of Public Leadership at the Harvard Kennedy School and Arthur C. Patterson Faculty Fellow at the Harvard Business School. Before joining the Harvard faculty in July of 2019, he served for ten years as president of the American Enterprise Institute (AEI). He is the author of 11 books, and hosts the podcast “The Art of Happiness with Arthur Brooks.”
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theatlantic.com
MLB Network morning show crew still giving fans their baseball fix
Even with no live games, "MLB Central" - MLB Network's signature morning show - is offering a digital version to "put a smile on" fans' faces.       
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usatoday.com
US citizens in Lebanon decline repatriation offer, saying it's 'safer' in Beirut
Carly Fuglei was with a group of Danish friends in Beirut last month when she first considered moving back to the United States. They were preparing to leave Lebanon amid fears of a major coronavirus outbreak there, and tried to convince her to do the same.
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edition.cnn.com
Combat Rewind, April 9: Top highlights include Nick Diaz vs. Paul Daley and so much more
Check out the best highlights from this day in history with MMA Junkie's "Combat Rewind."       Related StoriesUFC 249 free fight: Tony Ferguson defeats Anthony Pettis in bloody warDustin Poirier knows why he wasn't selected for UFC 249, picks Justin Gaethje to KO Tony FergusonJan Blachowicz doesn't care about Jon Jones' legal issues: 'I want to beat him in the octagon' 
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usatoday.com
Lawyers, hobbyists and even a bridal shop are making masks — and giving them away
“This is a war," said the owner of a bridal shop. "We need to come together.”
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washingtonpost.com
Bradley Blakeman: Rebuilding after coronavirus – this is how we invest in America
Before the COVID-19 outbreak, there was bipartisan support for an infrastructure bill but there was never a consensus on how robust it should be and how it should be done.
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foxnews.com
Former AL MVP Josh Hamilton indicted on felony charge of injury to a child
The 38-year-old ex-outfielder, a member of the Texas Rangers Hall of Fame whose MLB career was derailed by substance-abuse issues, was arrested in October.
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washingtonpost.com
Ask the Captain: What will it take to return parked airplanes to service after coronavirus?
What will airlines have to do to prepare planes parked during the coronavirus crisis to return to service? Capt. John Cox explains.       
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usatoday.com
Amazon needs its workers more than ever, giving them leverage to push for safer warehouses
As Americans grow dependent on Amazon deliveries of basic necessities, the e-commerce giant's warehouse employees are using their newfound leverage to demand better working conditions.
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washingtonpost.com
What We Must Do to Prevent a Global COVID-19 Depression
A few months in, it is still hard to grasp the scale and scope of COVID-19’s global impact. A third of the world population is under some sort of “lockdown.” Over 200 countries are affected, and the number of new cases and deaths in many places are still growing exponentially. All the while, a second…
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time.com
Alan Yang's 'Tigertail' Explores the Complicated Cost of the Asian American Dream
This movie is "clearly the most personal thing I have ever done," director Alan Yang tells Newsweek.
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newsweek.com
A New Approach to Fighting the Opioid Crisis
Nikki King was 17 years old when she left the mountain hollow where she was raised by her grandparents and sneaked off to the University of Kentucky under cover of darkness. It was 2009, and the advice of her late grandmother Sue King echoed in her head as she drove: Leave. Go to college. And do not let anybody from the bigger, wider world think they’re better than you.To hear more feature stories, get the Audm iPhone app. Sue died of a heart attack in 2000, when Nikki was 9. The opioid epidemic had already begun to infiltrate eastern Kentucky by then, and in Nikki’s mind the drug problem turned into a drug crisis shortly after Sue’s death, when her family went from sleeping with the screen door unlocked to buying new doors—without glass panes, which could be knocked out by burglars. Around that time, Nikki went to a birthday party where her friend’s mom stumbled and smashed the cake into the kitchen counter. Nikki later found her passed out on the toilet, surrounded by vomit and pill bottles.By high school, Nikki had just one friend who lived with both parents. She remembers a teacher asking her classmates what they wanted to be when they grew up.“A drawer,” one boy said.“You mean an artist?”“No, a draw-er”—someone who draws disability checks and doctor-shops for OxyContin prescriptions. The pills could be had for next to nothing through Medicaid and then resold on the black market for $1 a milligram. It was the only future he could imagine for himself.Nikki knew by then that both her safety and her economic fortunes lay far from Letcher County. But her widowed papaw, Curt King, wanted her to stay home. He thought that Nikki should become a nurse, and that the community college would suffice. It didn’t matter that she had a 4.0 GPA, and he had no reference point for her high ACT score. “He didn’t understand AP classes,” she told me. “He thought that meant I was slow.”The night she ran away, Nikki stopped at an Arby’s halfway to Lexington because she was shaking too hard to drive. She’d been planning the move her entire senior year, covertly applying for scholarships and saving up $800 by working at a comic-book store. But she hadn’t ever set foot on campus, and she worried about Papaw, who was 72 and had never lived alone. She’d waited for him to fall asleep before tiptoeing out the door, and when she imagined him waking to an empty house the next morning, her shaking turned to deep, heaving sobs. Ugly crying, she calls it.Nikki thought about going back. But then she remembered one of her last conversations with her grandmother. She had forbidden Nikki from going to a certain friend’s house. They’d both heard that the friend’s mom had become addicted to OxyContin prescribed for a back injury, and had started buying pills from a dealer when her prescription ran out. She was arrested for illegal possession, then released on probation without any treatment. When she relapsed, she feared she’d lose custody of her kids for failing a drug test. Her dealer told her she could erase the OxyContin from her system by drinking Clorox. So she did, and it killed her.That was a turning point for Sue. She’d always urged Nikki to go away to college so she could return and use what she’d learned to help people in Appalachia. But after this mother’s death, she changed her mind. “Just go,” she told Nikki. “And don’t come back.”Nikki King was raised by her grandparents in Letcher County, Kentucky. Her grandfather, Curt King, is shown above. (Matt Eich)In the car that night, Nikki cried so hard that she vomited. Then she wiped herself off and drove down the mountain to college.A decade later, Nikki, now 28, has become one of the leading voices on the opioid crisis in rural America—where, some 20 years into the disaster, treatment options remain scarce even as overdose deaths continue to climb. In many rural places, neighbors turn on one another rather than placing the blame higher up—on the pharmaceutical companies that created the epidemic and the impotent regulators and bought-off politicians who enabled it. (In my reporting on the crisis, I’ve seen this attitude over and over. At a recent meeting in rural North Carolina, for instance, the head of the local Kiwanis Club objected to a plan to give people rides to treatment facilities, saying: “I think when they relapse, we should let them die and take their organs.”)[Read: The opioid epidemic might be much worse than we thought]The drug-overdose epidemic has already killed over 800,000 Americans—more than have died from AIDS—but the federal government has yet to provide adequate solutions, let alone a level of funding that could stem the crisis. In the absence of help from above, Nikki has figured out a way to get treatment to people in remote, underfunded areas. The program she’s developed is still small and new, but its results are promising, and it appears to be replicable in states that have expanded Medicaid under the Affordable Care Act. Perhaps most important, it bridges the gulf between a medical culture that too often abandons people the moment they become addicted, and a legal system that incarcerates them when they can’t recover on their own. Her aim is to help people with opioid addiction, rather than just locking them up.Video: A Small-Town Plague I first met Nikki in early 2017, after hearing about her work as a National Rural Health Association fellow at Margaret Mary Health, a community hospital in Batesville, Indiana. She was the lead data cruncher on a hospital-wide task force that had achieved a 60 percent reduction in opioid prescribing. I was writing my book Dopesick: Dealers, Doctors, and the Drug Company That Addicted America in Roanoke, Virginia, my reporting base for 30 years. When I asked Nikki to help me understand the genesis of the crisis, she suggested that we meet at Papaw’s body shop, in eastern Kentucky, not far from “Wattsburg,” as I wrote in my notes. Officially known as Whitesburg.Donald Trump had just been elected president, and J. D. Vance’s Hillbilly Elegy had topped the New York Times best-seller list. When I brought up either of those things, Nikki’s demeanor hardened, her accent thickened, and she spoke at a rapid-fire pace that most non-Appalachians would find hard to process. (Tim Putnam, the CEO of the hospital where she works, admiringly refers to these semi-rants as “going all holler.”) Nikki hated Hillbilly Elegy, she said, because Vance treated Appalachian culture as if it were his cross to bear, then turned around and used stereotypes to sell his book—“blaming the region’s problems on things like lack of thrift and a crisis of masculinity” and ignoring “the role of bigger forces in creating this miry pit of social problems.”Nikki had been out of high school for only seven years, but already she could tick off the names of more than 20 former classmates who were dead from what the economists Anne Case and Angus Deaton have called “deaths of despair”: suicide, overdose, or alcohol-related illness. In the previous year alone, six friends and relatives had died of drug-related causes. “I’m having to ration my vacation time for funerals,” Nikki told me. Her long-term goal was to return home to work on the opioid crisis in Kentucky, but she was still too young and too female to get anything done in Appalachia, she said. In Indiana she had the ear of politicians, and she spoke so often at national conferences that Putnam, her boss, had gotten used to people coming up to him and saying, “You’re the guy who works with Nikki King!” But in Kentucky, no one would return her calls.Curt King had long ago forgiven Nikki for running away to college, and had even helped her pay tuition. He drove us around the county in his rusty Ford F-150 pickup while narrating a landscape that existed only in his memory. I was supposed to imagine schools that weren’t shuttered, movie theaters that weren’t caved in, and once-booming coal towns with names like Elkhorn City and Uz (pronounced “you-zee”) and Seco, short for South East Coal Company, where his own father had been a supervisor before the mine closed in the late 1950s. “We would’ve never won World War II if not for the coal that made the steel,” he said. But none of that is here anymore, Nikki kept gently pointing out. We drove through a town called Neon where all the neon signs were burned out. “It’s like growing up in a skeleton,” Nikki said. “You look around and see the bones of when Papaw was little, but I never saw any of it.”[Read: The true cause of the opioid epidemic]We went to the town of Jenkins so I could meet former Mayor G. C. Kincer, who’d lost reelection and was now living in a self-storage facility. He told me that his most memorable day as mayor was when he went to pick up his blood-pressure medication and found the town pharmacist spread-eagle on the floor, passed out from opioids he’d stolen. Nearly a third of the county reported having a disability, and the workforce-participation rate was down to 43 percent. “If you took 100 job applications right now, you might get 10 people who could pass a drug test,” Kincer said. “I don’t see any hope.”Nikki didn’t want to hear that. “I think we can beat it,” she said. “I just need somebody to start listening to me.” She’s been saying some version of that ever since.Whitesburg, Kentucky, was one of the first areas hit by the opioid crisis before it spread to the rest of the U.S. (Matt Eich)From his perch at King’s Body Shop, where locals gather most mornings to share fast-food biscuits and talk through the problems of the world, Curt King spots trends before the social scientists do. “A lot of the drug problem here in Letcher is only slowing up now because so many people have already died off,” he told me. Indeed, in recent years, the number of overdose deaths has dropped in a handful of eastern-Kentucky counties, including Letcher and neighboring Clay. Experts aren’t sure whether the deaths have reached saturation or whether fewer among the addicted are dying because they’ve switched over to methamphetamine, which is less likely than opioids to result in an overdose.[From May 2019: One West Virginia doctor’s redemption]Nikki favors the saturation theory, noting that the opioid crisis exploded in eastern Kentucky before spreading to the rest of Appalachia. The first national story about the nascent crisis appeared in The New York Times in 2001 and focused on nearby Hazard, Kentucky, the center of the largest drug bust in state history. The federal prosecutor counted 59 deaths related to OxyContin overdoses in the area in the preceding year. The drugmaker Purdue Pharma had sent an army of sales reps into eastern Kentucky and other regions with high disability rates to promote the idea that pain was vastly undertreated, and that its new drug was virtually nonaddictive. In places where people historically had legitimate workplace injuries, the desperate and jobless were soon pilfering lawn mowers and copper wiring to fund their next OxyContin fix.When stories started to come out about escalating Oxy-fueled crime, Purdue blamed the people it had helped addict. “We have to hammer on abusers in every way possible,” Richard Sackler, Purdue’s president, wrote in an internal email only recently made public. “They are the culprits and the problem.” (Purdue did not comment on its responsibility for the epidemic, but said, “The causes of opioid addiction are multifaceted and complex.”)Sackler was hardly the only one to blame users. America’s long history of treating substance abuse as a crime, rather than a disease, dates to the Harrison Narcotics Tax Act of 1914, which outlawed the use of narcotics in treatment at a time when about 250,000 people had an addiction.A century later, we remain more likely to punish a person struggling with a substance-use disorder than to provide help. Only one in five addicted people in the U.S. receives treatment. Still fewer get what doctors consider the gold standard of care: a combination of counseling and medication-assisted treatment, which uses weaker opioids (methadone or buprenorphine, often sold under the brand name Suboxone) to reduce cravings and ease withdrawal, or an opioid blocker called naltrexone. These drugs cut mortality in half compared with abstinence-based treatment programs, and the medical consensus is clear that getting off opioids without them is nearly impossible. Once the brain’s dopamine receptors have been distorted by opioids, every waking thought is overtaken by cravings and a fear of withdrawal—of becoming dopesick, with painful diarrhea, vomiting, fevers, and crushing anxiety.But the use of medication-assisted treatment, or MAT, has faced enormous resistance in the U.S., where many judges, police officers, and even people in recovery view it as a crutch—merely substituting one drug for another—or focus on its potential for misuse. In fact, the medications for opioid-use disorder are far more tightly regulated than the painkillers that have gotten people hooked in the first place. Health-care providers must receive at least eight hours of training before they can prescribe buprenorphine, and then they’re limited in the number of patients they can treat—part of the reason only about 5 percent of physicians are licensed to prescribe the drug.[Sally Satel: The truth about painkiller addiction]The result of this thinking was visible everywhere as Nikki showed me around. I asked whether it embarrassed her, letting me see where she grew up. She slammed her fist on the steering wheel and shouted, “Yes!” She wasn’t embarrassed to be Appalachian; she was embarrassed by how desperate things now felt here. “But I’ve gone through the five stages of grief. I’ve been pissed at Big Pharma, pissed at the government. I’ve been pissed at everyone.”“At 14, I could’ve pointed out everybody who would be dead of overdose today, and I would’ve been right. If I can do that at 14, how are we letting them fall through the cracks?”Judge Ryan King saw his docket overrun by drug crime and drug-related child neglect. (Matt Eich)On the wall of his body shop, Curt King displays a framed black-and-white photograph of miners from the Elkhorn Coal Corporation labeled mine #4 night shift. The men wear overalls and hard hats with headlamps. They smile, their arms crossed, with nary a thought of global warming or a future in which people would learn to pair OxyContin with Xanax for a so-called Cadillac high.A group portrait from the same era—the 1930s—hangs in the Indiana hospital where Nikki works, but in this one men and women are dressed in fur coats and three-piece suits. At least 1,000 of them pose in front of the just-opened Margaret Mary Hospital, named for the two women who donated the money to found it. The civic boosters in the photo couldn’t have envisioned a proposed baby-cuddling program in their hospital for soothing infants born opioid-dependent. Or that drug-involved child-protection cases in their county would escalate 400 percent in the course of four years. Not in a region founded by German farmers and furniture makers, in a setting so quiet and bucolic that the basketball movie Hoosiers was set there.Nikki has worked for five years to improve access to addiction treatment in Ripley County. Rampant overprescribing of OxyContin and other opioids was happening here in the late 1990s and early aughts, just as it was in Appalachia, but the crisis didn’t make itself as immediately or as loudly known. In places like Batesville, where jobs were still plentiful, the addicted weren’t accidentally burning down abandoned factories or cutting telephone poles down in broad daylight to steal copper wiring.No, the epidemic rolled into Ripley County more like fog than fire—harder to discern and easier to dismiss. It began showing up in the crime rosters in the mid-aughts, when teenagers and 20-somethings started making the 45-minute drive east to Cincinnati to buy heroin. “By 2008, we were tracking track marks, taking pictures of everybody’s arms,” Shannon Schmaltz, who oversees the county’s probation program, told me. He got to know the names of Cincinnati dealers—“Big Tom” was popular—and started calling Cincinnati police to find out which of the probationers on his caseload had been spotted buying heroin in the city, sometimes trading their shoes or their kids’ baby clothes for it, hiding syringes in the diaper bag.Circuit Court Judge Ryan King’s docket was overwhelmed not just by drug crime but also by drug-related child neglect. “I’ve seen the placement with the foster parent, and then the foster turns out to be using drugs too,” King (no relation to Nikki) told me. “After hearings like that, you just want to quit. You think, My goodness, what are we ever gonna do? What are we doing?”Nikki and Judge King both attended a countywide opioid forum in 2018, a year after a local woman overdosed in a Chuck E. Cheese bathroom in Cincinnati, as her 5- and 7-year-old children played in the restaurant. Nikki had worked her way up from graduate fellow to manager of the hospital’s mental-health and addiction services, and she was trying to ensure that patients who overdosed and ended up in Margaret Mary’s emergency department got referrals for follow-up care, including MAT. But MAT drugs are nearly impossible to get in rural America, where more than half of counties don’t have a single buprenorphine provider, and methadone is even less available. Counseling services, too, are in extremely short supply—the ratio of residents to mental-health providers in Ripley County is 2,200 to 1. More often than not, patients who overdosed and wound up in Margaret Mary’s ER were treated with Narcan, the overdose antidote, and released. If hospital staff ever saw them again, it was usually for another overdose, sometimes a fatal one.Elsewhere in the U.S., drug courts—which allow addicted offenders to enter a treatment program instead of going to jail—have been shown to reduce recidivism. But drug courts are expensive to operate and tend to be concentrated in cities and suburbs. Many leave treatment decisions to local judges, prosecutors, and probation supervisors—who may or may not understand addiction medicine. About half of drug courts prohibit the use of MAT; some funnel probationers into abstinence-only 12-step programs, despite overwhelming evidence that they’re less effective for opioid addiction.[Read: Chronic pain is an impossible problem]Ripley County has never had the resources for a drug court anyway. Two years ago, the county’s probation program for drug offenders required drug testing, but offered only two hours of group therapy a week and no MAT. At the opioid forum, when Nikki heard Judge King describe that as the county’s “drug treatment,” she challenged him. “I think we can do a lot better,” she said. The program she eventually created, with the county judges’ blessing, provides nine hours of group therapy and a variety of social supports, plus MAT. Three nights a week, probationers in the new Courts Addiction & Drug Services, or CADS, program receive cognitive behavioral therapy, job coaching, meditation training, and other services.A speaker shares his story with a group from the CADS program. (Matt Eich)Nikki talked one of the hospital’s nurse practitioners, Jeff Coy, a former detective, into becoming the group’s first MAT provider. After taking the training course to prescribe buprenorphine, Coy went from thinking of the addicted as “druggies” to seeing them as people with a legitimate disease, not unlike diabetics who struggle to keep their blood sugar under control. “He’s also a preacher, and he cusses,” Nikki said, as if that were everything I needed to know about him. Next she recruited Lindsey Gessendorf, a therapist who’d been running a program for men in jail.Nikki knew that marshaling funds for a new program would be tough; the hospital was already $3 million in the red. But her goal was for the program to be cost-neutral within six months, through Indiana’s Medicaid expansion. The federal program covers addiction treatment, but health-care providers at Margaret Mary and elsewhere had found that high no-show rates for patients with an opioid dependency meant they couldn’t bill the government enough to break even. Nikki’s program promised to solve this problem: By coordinating with the judges, she could use the threat of jail time to ensure that patients showed up. If the group could achieve a nearly perfect attendance record, the program would essentially pay for itself.Nikki and her staff of hospital employees set up a drug-treatment center in a conference room inside the courthouse. They brought in snacks and covered the walls in homemade signs with inspirational messages. More than half the participants were given some form of medication-assisted treatment.For the first time in Ripley County’s circuit court—and quite possibly for the first time in rural America—judges were turning probationers over to health-care providers just down the hall. “I’ve never heard of that,” Brock Slabach, a senior vice president of the National Rural Health Association, told me. “This is pioneering. Most people don’t see what’s possible until they’ve seen real innovations taking place somewhere else.”Nikki finds the work gratifying, messy, sleep-robbing. Most of the patients grew up in households where drugs and abuse were common. When Nikki asked them each to name a short-term goal, one participant said he wanted a second pair of pants. Another wished to taste salmon for the first time. When Nikki passed out orange-capped pens for a writing exercise, she unknowingly triggered those who had used orange-capped needles to shoot up heroin or meth, which was just about everyone in the group. Nikki tossed the pens, and Gessendorf quickly changed course to talk about “euphoric recall” instead, explaining that powerful memories of a good high would be a long-term challenge to the participants’ recovery.Lindsey Gessendorf at the Ripley County courthouse, where she runs the CADS program with Nikki King. (Matt Eich)Nikki took care of the second pair of pants and the salmon, and replaced the orange-capped pens. But a few weeks later, a patient was caught misusing buprenorphine—snorting it outside the courthouse—and trying to sell it to others in the group. Another threatened to pull Nikki’s fingernails out.When Nikki told me about these setbacks, I thought of the ex-mayor living in a storage facility in Kentucky. Perhaps he was right. What hope did we have? The epidemic has only continued to worsen, and experts don’t know when it will plateau. Barring a flat-out overhaul of the War on Drugs—wherein a significant chunk of the estimated $50 billion the country spends on enforcement and incarceration each year would be funneled into treatment instead—how could a tiny program like Nikki’s be replicated on a large-enough scale to turn back the tide?“I ask myself that all the time,” Tim Putnam, Nikki’s boss and the hospital CEO, told me.Kenny Shadday tried OxyContin for the first time in 2009, at age 15. He’d just come out as gay, and the pills numbed his anxiety, as well as the pain inflicted by bullies. By 16, he was bouncing between juvenile-detention facilities, children’s homes, and jails. When Nikki launched the CADS program, in October 2018, he had just finished yet another sentence. He joined the inaugural class, and quickly became the most conscientious participant. He was so fearful of not being able to pee when his probation officer showed up to drug-test him at work that he routinely held it for hours at a time. He was also funny, and open with his vulnerability, qualities that made him a staff favorite. Within weeks, his time in the program became his longest period of sobriety (not counting jail time) since he was a teenager.[Read: The opioid reckoning will not be just]Two months in, Shadday was working 70-hour weeks at McDonald’s when a friend showed up with some meth she was looking to off-load. It was free, he was stressed and tired, and he knew the drug would give him a boost. He regretted it even before his high wore off. Shadday assumed he’d be cut from the program and sent back to jail; that was how probation had always worked for him. But Shadday confessed the relapse to Nikki and Gessendorf the next day, and begged for another chance.Gessendorf agreed to go to bat for him with Shannon Schmaltz, the head of probation. She planned to argue that expecting Shadday to get clean on his first try wasn’t realistic. After all, addiction is a chronic, relapsing disease, and most people need multiple attempts at recovery. Gessendorf and Nikki thought that letting Shadday stay in the program might become a turning point for the others as well—a way to build trust that could buttress the entire group.Gessendorf had her work cut out for her with Schmaltz. Before the CADS program launched, he’d seen only the abuse of MAT medicines, never the successes. When Gessendorf suggested they not jail Shadday for his relapse, his first thought was Are you serious? But Schmaltz was impressed by the CADS program. For the first time in his career, he saw that people like Shadday wanted to get better. Because he knew them. Liked them, even. So he sat down with Nikki and Gessendorf, and together they worked out a three-strikes matrix—additional treatment after one relapse, a few days of jail time after a second relapse, and a court date after a third.Kenny Shadday started using opioids at age 15 and spent years in and out of jail. He’s now completed the CADS program and is training to become a regional supervisor at McDonald’s. (Matt Eich)When Shadday was permitted to rejoin the program, Nikki realized that rural America may actually have a few advantages over cities when it comes to knocking down barriers to treatment. After all, her boss knows the judges who are Schmaltz’s bosses. Nikki used to coach a girls’ running club headed by Schmaltz’s wife, and her fiancé coaches the high-school football team. And Margaret Mary Health has community cred among politicians and judges. It’s both professional and homey—the kind of place where Brahms’s “Lullaby” chimes over the loudspeakers whenever a baby is born.After four months, nearly every participant had stuck with the CADS program, and it had doubled in size from 12 to 24 participants, with more on the waiting list—a good record, given the high failure rate of opioid-addiction recovery. Nikki was in talks with the area’s three largest businesses to provide treatment to factory workers and potential hires who can’t pass a drug test. All was going reasonably well, notwithstanding the fact that every day she felt like the cartoon dog sitting at a table saying “This is fine” while everything around him burns.In late February 2019, Nikki was in a meeting with hospital administrators when one said, in an offhand way, that Medicaid wouldn’t reimburse the hospital for the CADS program, because it was housed at the courthouse and not in a medical facility. He proposed that they shelve the program, and Nikki felt her composure slipping. Maybe they could use a hospital-owned practice in Batesville, someone else suggested. But that was half an hour from the courthouse, too far for many patients. Another practice was closer, just 10 minutes away. Maybe they could co-opt the break room, move a refrigerator around.That was when Nikki lost it, right there in front of the administrators—all of whom were at least two decades her senior. Housing a medical program inside the courthouse had been the whole point, the key to finally making the medical and legal systems mesh. It was the heretofore-missing component, a way to coordinate the carrot and the stick. The fact that people like Gessendorf and Schmaltz knew each other so well now—their quirks, their backstories, the names of each other’s spouses—those relationships, Nikki argued, were what made the program work.But then she had an idea.“Why can’t I just buy part of the courthouse?” Nikki asked. They could wall off one side of the conference room they were already using and the hospital could rent it for $25 a month. The county commissioners would have to sign off, as would the judges and Schmaltz, who worried, initially, about the appearance of spending taxpayer money to convert the space. But he was supportive. For the first time in some people’s lives, the cycle of jail to probation to relapse and back was coming to a close.Top: Nikki King at the Ripley County courthouse. Bottom: Shannon Schmaltz, who oversees probation, attends a meeting for the program. (Matt Eich)Schmaltz even came in on Saturdays to oversee the construction. He directed probationers with carpentry experience to put up the walls and frame the door. He begged a local hardware store to donate supplies, and he brought in houseplants for decoration. He installed a sign outside the door that read: margaret mary health, ripley county courthouse, suite a.“He’s been on Pinterest,” Nikki deadpanned.Above the entrance, Schmaltz affixed an appliqué he’d purchased on the internet, using a ruler to ensure consistent spacing between the words. make today amazing, it said.Last fall, as Nikki and her team prepared to celebrate the program’s first anniversary with lasagna and cake, she put up a PowerPoint: 45 people had completed the eight-month program with no issues; 18 had relapsed once, eight of whom reengaged immediately in treatment. No one had overdosed. In fact, one participant had used a Narcan kit from CADS to resuscitate a relative. “So technically, we’re at plus one,” Nikki said.Shadday had been promoted at McDonald’s and was training to become a regional supervisor. Whereas he’d arrived at our first interview, back in January 2019, wearing pajama bottoms, he now took pride in special-ordering uniform shirts and a bow tie. He’d been sober for about six months, the longest he’d gone as an adult without being jailed. He was planning to start an LGBTQ recovery group and had become a leader in a post-CADS support group held on Friday nights.Nikki was about to expand the program into an adjacent county and was getting ready to launch a recovery kitchen to teach healthy eating. And she’d more than tripled her staff, thanks in part to a $300,000 grant from the very pharmaceutical company she’d been seething about for years—Purdue Pharma. (“I told Nikki, ‘If you want to treat more people, you just have to swallow your pride and take the money,’ ” Cindy Ziemke, a Republican state representative who’d lobbied Purdue for the grant, told me.)Graduates of the eight-month CADS program gather weekly to offer one another continuing support. (Matt Eich)Nikki’s still working to change the mindset in Ripley County. She’s had heated confrontations with jailers over hard-line bans on prescribed buprenorphine in jails, including once when a pregnant CADS patient relapsed and was arrested. Denying the woman buprenorphine while she detoxed was a potentially life-threatening decision for her baby. Nikki helped arrange for her to get moved to inpatient treatment three and a half hours away.Nikki and Ziemke are working on a statewide policy that would encourage Indiana jails to allow buprenorphine (currently all but two counties forbid it), and Nikki has been recruited to join the opioid advisory committee of the American Hospital Association, a position from which she plans to push for additional reforms.She was happiest about the recent recruitment of a psychiatrist—the program’s first. It had taken pure subterfuge to persuade Christopher Dull, who lives some 90 miles away, to come on board just four days a month. He already has his own practice in Zionsville, plus a part-time job in another rural county. But after hearing about his addiction-medicine bona fides, Nikki arranged for him to speak on a panel so she could court him. A dinner followed, during which she laid out her program. When he brought up typical barriers to recovery—jobs, transportation, food insecurity—Nikki explained how she had already overcome them. She begged him to work for her, repeatedly, over the next three months. He told her no; he didn’t have the time.But she kept calling, emailing, texting—once, she threatened to show up at his Zionsville practice, with lunch. Then she told him again about her sickest patient, a woman with bipolar disorder, schizophrenia, and opioid addiction, reminding him that Ripley County has no inpatient mental-health or addiction-treatment facilities and no resident psychiatrists. And she just kept talking, breathlessly, in that all-holler manner, while simultaneously tapping her foot. And somehow she landed on the magic, heart-tugging combination of words to show just how severe this patient’s case was: “She’s 50 years old, and she’s never been in treatment before.”The twice-monthly drives and overnight stays would be a drag, and his wife wouldn’t be happy. But Dull found himself powerless to say no to the force before him, or even to fully describe just how exactly the formidable Appalachian who would not stop talking and tapping her foot had snookered him. The best explanation he could come up with was this: “You have to work in mental health to fully understand that what she’s done just doesn’t exist.”This article is part of our project “The Presence of Justice,” which is supported by a grant from the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge. It appears in the May 2020 print edition with the headline “‘At 14, I Could’ve Pointed Out Everybody Who Would Be Dead.’”
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theatlantic.com
Treat It and Beat It
We are only now entering the most intense and painful phase of the COVID-19 pandemic in America. As the strain on our health system worsens, it’s essential that we not let up on the social distancing and other mitigation efforts we’re engaged in. And it’s essential, too, for our public officials to plan the gradual and regionally tailored return to normality that will need to follow this period. A hard pause and then a soft start must be our strategy.And yet at the same time, our government needs to be directing resources and coordinating efforts on the medical-research front. A vaccine is a ways off, but effective treatments need not be. Drugs that help give those with the most acute cases of COVID-19 a much better chance of recovering would be transformative in our fight against the pandemic. They could completely change our approach to living with the virus. And the difference that having a drug available this summer rather than next year could make, in the lives of patients and the health of our economy, would be beyond measure.[Read: The best hopes for a coronavirus drug]An appropriate sense of urgency in Washington could help make that difference. America’s extraordinary biomedical-research sector is unmatched in the world, which means that any treatment is most likely to come from the United States. The federal government will need to both clear the way and pave a path for that effort, but there has been is a marked lack of urgency on this front.Former FDA Commissioner Scott Gottlieb (my colleague at the American Enterprise Institute) has powerfully laid out the case for hope about effective drug treatments. As he notes, there are basically two categories of potential drugs to watch: antiviral drugs, which would attack the virus’s ability to replicate, and antibody drugs, which would reinforce the defenses of infected patients. Both involve well-trod research paths, and America’s academic and pharmaceutical research enterprises know the work required to develop them.But they need two forms of assistance that only the federal government can give them. The first would involve rapid coordination of funds and research work on a massive scale. Some pharmaceutical companies have significant experience with the kinds of drugs required to treat COVID-19 patients, and are aggressively pursuing those drugs now. Some academic and government researchers are experts in this area too. But the usual protocols of corporate, academic, and public medical research stand in the way of robust cooperation on this front.Only one entity has any chance of quickly breaking through these barriers and coordinating ongoing work while also assuring the researchers involved that the credit (and intellectual property) will end up where they belong in the end: The National Institutes of Health. In normal times, the NIH itself can be quite slow and bureaucratic. But it has the requisite standing with all involved, the capacity to facilitate investigation and optimize clinical trials, and the necessary experience coordinating public and private work to take this on.[Read: How the pandemic will end]There is even something of a model in the role the NIH played in the early 1990s in advancing work toward antiretroviral therapies for HIV. The effort required now would need to be much faster and nimbler, and government agencies aren’t generally known for either of those things. But no one has a better shot at pulling it off, and the NIH is highly motivated and well run. It needs to take the lead.The agency has the statutory authority to take on this role right now. Tucked away in the 21st Century Cures Act, a large and complex piece of legislation enacted in 2016, is a provision that gives the NIH significantly expanded flexibility with what the statute blandly calls “other transaction authority.” This lets the agency’s director and senior leaders turn the NIH into a kind of coordinating entity for research and development work at a high level under some circumstances. The NIH has a lot of freedom to recruit partners, set milestones, coordinate internal and external work, protect the intellectual-property rights of all involved, demand deliverables with relatively minimal administrative burdens (particularly during a public-health emergency), and maybe even organize cooperation around mobilizing advance manufacturing capacity to make effective treatments available quickly.The NIH could start using this authority immediately to put itself at the center of a multifront campaign to develop effective treatments for COVID-19. No one would be compelled to participate, but it could offer major benefits for academic and corporate partners—and there is reason to think both would eagerly welcome the help.What the NIH will require from Congress to do this, however, is money. Although it has a lot of flexibility to create a new framework for coordination, moving appropriated money around to enable the work to proceed isn’t quite so easy to do on the fly.[Annie Lowrey: Where is the government?]The NIH can start with the limited funding flexibility it has. But when Congress returns for further emergency legislation later this month, it needs to prioritize a meaningful infusion of cash—nothing near the scale of the economic relief it has undertaken, but in the billions, and if the effort is also to include support for vaccine work, maybe in the tens of billions—to the NIH for this purpose. And legislators should consult with the agency’s leadership to see whether any additional legal authorities are required for the work to proceed swiftly.Second, work toward effective treatments requires the active cooperation and total commitment of the Food and Drug Administration. There is no getting around the fact that the FDA slowed the process of making tests available to Americans, wasting precious time and impeding containment efforts. The agency knows this, and is eager to do better. But it still lacks the necessary urgency to avoid slowing down efforts to develop treatments.The FDA is responsible for a wide array of biomedical responses to the coronavirus—including not only potential treatments but also diagnostics, laboratory accreditation, medical- and safety-equipment certification, various importation procedures, and much else. All of these are important. But the agency needs to focus special resources and attention on potential treatment paths, separating these from its normal approval work and implementing new procedures to collaborate closely with manufacturers at every step.One model here, as Gottlieb has suggested, could be the agency’s “Real-Time Oncology Review” process, in which the FDA reviews clinical-trial data for promising drugs for particularly deadly cancers as results become available, rather than only after the entire trial has concluded. This can speed the process quite a bit, and a similar procedure with COVID-19 treatment trials is clearly in order.[Read: Why does the president keep pushing a malaria drug?]But the degree of urgency and focus must be even greater than the FDA’s most accelerated processes today. We are in the midst of a global pandemic that threatens countless lives, and our response to it threatens economic ruin. An effective drug for those who are most endangered would dramatically alter these circumstances. The FDA should treat its role in facilitating our response to this disaster as the single most important task it has confronted in its history. And enabling the rapid development of a safe and effective treatment must be at the top of its agenda.In these two ways—by coordinating the research effort and accelerating the approval process surrounding new treatments for COVID-19—the federal government can change the fundamental character of the global response to the virus. It can help make treatments possible sooner rather than later, and the procedures put in place to do that can then also help speed up efforts toward a vaccine.Our government is far from ideally suited to these roles, of course. Bureaucracy is always slow and lumbering. Expecting it to speed things up is often folly. But in this emergency, these two agencies may have what it takes to meet these two particular challenges. And if Congress and the president can help to spur them, their work could make the crucial difference.Such an emphasis on advancing treatments would let America play to its comparative advantage in this global response. We are engaged in mitigation strategies like almost every other country—succeeding in some respects and failing in others. It is important that we persist in these and correct our mistakes while the strain on our health system peaks. But on the medical-research front, America is not just another country. When it comes to finding treatments, and ultimately a vaccine, we have by far the best potential to succeed, and thus to help the world escape this nightmare.To do that, and do it quickly, our public and private sectors must cooperate. And for that to happen, our government needs to get its act together.
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theatlantic.com
Eyeing House majority, top Republican super PAC books $43 million in fall ads
The spending plan from the Congressional Leadership Fund targets about 30 Democratic incumbents.
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washingtonpost.com
RPT-WRAPUP 1-Automakers push to reopen plants with testing and lots of masks
Global automakers reeling from the COVID-19 pandemic are accelerating efforts to restart factories from Wuhan to Maranello to Michigan, using safety protocols developed for China and U.S. ventilator production operations launched in recent weeks.
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reuters.com
Boris Johnson ‘sitting up in bed’ on 4th day battling coronavirus in ICU
Coronavirus-infected British Prime Minister Boris Johnson was “improving” and sitting up in bed as he began his fourth day in intensive care Thursday — but he could still be out of action for at least a month, according to reports. “Things are getting better for him,” culture minister Oliver Dowden said. “He’s stable, improving, sat...
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nypost.com
Ex-Los Angeles Rams stars Todd Gurley, Clay Matthews accuse team of withholding paychecks
Two former Los Angeles Rams players accused the team of withholding paychecks on Wednesday.
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foxnews.com
Clapping for Carers is Not Enough. Us Doctors Urgently Need a 'Care for Carers' Campaign | Opinion
In my 5 intense years of medical school training, I doubt I had more than a day of teaching on how to deal with grief, anxiety and death—everything we encounter daily and on a massive scale in this pandemic.
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newsweek.com
Man Caught Driving 130 MPH To Avoid 'Catching Coronavirus'
Incidents of speeding have become more common as a result of the quieter roads during the lockdown.
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newsweek.com
Double amputee schools his friends at basketball
Meet Jo Jo, a teenage amputee in Champaign, Illinois, who plays basketball better than most kids his age. “He shoots that ball like he’s standing on two legs,” said his proud mom, Tamara Washington. When Joseph was just 1 year old, a severe case of meningitis cut off blood flow to his legs, leading to...
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nypost.com
Can We Engineer a Better Response to COVID-19? | Opinion
Engineers around the world have a key role to play in tackling, right alongside their biomedical colleagues—from converting manufacturing lines to produce ventilators, to building entire hospitals at astonishing speed.
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newsweek.com
Coronavirus live updates: Stimulus checks on the way; US deaths nears 15K; astronauts head to space station
Astronauts left for the ISS, rules on essential workers were loosened. Thursday's news also includes the latest on unemployment and stimulus checks.       
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usatoday.com
Up to 150 Members of the Saudi Royal Family Infected With Coronavirus: Report
There have now been 2,932 confirmed COVID-19 coronavirus cases in the kingdom, with 41 deaths and 631 recoveries.
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newsweek.com
Victim's Mother Calls For Immediate Release of 'Innocent' Pennsylvania Death Row Inmate with Coronavirus Symptoms
Walter Ogrod has spent nearly 28 years behind bars for the 1988 slaying of Barbara Jean Horn, but her mother says she believes he is innocent and should be released immediately.
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newsweek.com
Want a full-body home workout to help you exercise while social distancing? Start with boxing.
All it takes is 40 minutes for a home workout, and you'll be burning more than 400 calories, dripping sweat and channeling your inner Muhammad Ali.       
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usatoday.com
Steph Curry made a morale-boosting call to coronavirus nurses
Steph Curry raised the spirits of a group of coronavirus nurses in Oakland, California, when he surprised them with a FaceTime call Tuesday.
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edition.cnn.com
Princess Diana's Bahamas vacation home is up for sale
Here's a home we wouldn't mind isolating in: a Bahamas beach house with a pool, five bedrooms, a terrace and 180 feet of private white-sand frontage.
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edition.cnn.com
US stocks are quiet after a big Wednesday: April 9, 2020
Investors continue to worry about the coronavirus pandemic's impact on the economy. Here's what's moving markets today.
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edition.cnn.com
Charming, chaotic scenes of family life in small-town America
In Julie Blackmon's photographs, her quiet neighborhood in Springfield, Missouri, is transformed into a theatrical stage where children reign. They gather poolside in the balmy summer; direct talent shows in the garage; and prepare to take flight off of kitchen chairs, leaving toys and household ephemera strewn about. Adults, when they do appear, are often cropped out of frame, obscured like the unintelligible grownups of Charlie Brown's world.
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edition.cnn.com
Crisis Helpline Sees Surge In Messages From Healthcare Workers Worried About Safety Amid Coronavirus Outbreak
1 in 5 texters who have contacted Crisis Help Line have expressed anxiety about the COVID-19 outbreak.
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newsweek.com
'Modern Family' Streaming: When Will the Final Season and the Rest of the Show Be Available to Watch Online?
"Modern Family" has now aired its series finale on ABC, meaning Season 11 will soon be streaming ready for fans to watch it online—though it could be some time before the rest of the show streams.
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newsweek.com
PM Johnson 'getting better' in intensive care
British Prime Minister Boris Johnson was getting better on Thursday in intensive care where he is battling COVID-19 as his government extended its bank overdraft facility and reviewed the most stringent shutdown in peacetime history.
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reuters.com
Why a lockdown is a great time to embrace ‘free-range parenting’
The idea that parents have to enrich every second of their kids' lives was a crazy lie even before the coronavirus.
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washingtonpost.com
Princess Diana's Bahamas vacation home is up for sale
Princess Diana and sons William and Harry stayed at the five-bed Casuarina Beach property in the Bahamas in 1993. Now it's on the market for $12.5 million.
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edition.cnn.com
Coronavirus killed a mother and her three sons, devastating their surviving relatives
For families like the Franklins, who lost so much so quickly, social distancing restrictions did not come soon enough.
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washingtonpost.com
With tennis tournaments halted, lower ranked players plea for financial help
Suspension of schedule shows the vast gap between the sport's haves and have-nots.
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washingtonpost.com
From bats to people to tigers? Viruses that can jump species
Jonathan Epstein, an expert on animals and disease, says we have much more to learn about how animals such as bats can transmit viruses to humans and about how they can be spread from there to other animals
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edition.cnn.com
From bats to people to tigers? Viruses that can jump species
The discovery that a tiger at the Bronx Zoo tested positive for the coronavirus has raised new questions about viruses that can jump from animals to humans to animals.
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edition.cnn.com
Maundy Thursday -- explained
Today is Maundy Thursday. In the Bible, this is the day when the Last Supper takes place, and it marks the moment that Jesus established the sacrament of the Eucharist, which is now part of every mass.
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edition.cnn.com
Bill Murray says John Prine's music once pulled him from a deep depression
Bill Murray said Wednesday that late singer and songwriter John Prine’s music once helped him through a severe bout of depression after a breakup. 
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foxnews.com
The Italian Doctor Flattening the Curve by Treating COVID-19 Patients in Their Homes
Over the last month Giovanni Sartori has lost his sense of time. He doesn’t remember exactly when his younger brother, a strong and healthy 53-year-old with whom he lived, began to have a high fever and breathing problems. But he knows that after about a week in that condition, taking the paracetamol prescribed by his…
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time.com