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Grief counselors from Columbine, Parkland, Sandy Hook describe what happens after a school shooting

Yasin Ozturk/Anadolu Agency via Getty Images

(NEW YORK) -- Sandy Austin was in her second year working as a school counselor in Colorado in 1999 when two students opened fire at Columbine High School in Littleton, killing 12 of their fellow students and a teacher before turning their guns on themselves.

Responding to a district-wide call for counselors, Austin drove to a nearby elementary school where parents and caregivers were gathered to hear whether their children were alive. She spent the next nearly 10 months counseling students, teachers, school staff, parents and community members in the wake of the shooting.

On Tuesday, when a gunman burst into Robb Elementary School in Uvalde, Texas, and killed at least 19 children as well as two adults, Austin said she immediately thought of the mental health support that the survivors, parents, teachers and community will need in the days, weeks and years ahead.

"It takes me right back to that day at Columbine," Austin, who later worked as a crisis facilitator for the American School Counselor Association (ASCA), told ABC News' Good Morning America in a recent interview. "I think of those little ones, all their life, they're going to need that counseling. It'll always be hanging over those kids."

Among those killed were a pair of fourth-grade teachers who were longtime staff members at Robb Elementary School. The 19 slain children were students aged 10 and 11, including several who were cousins.

Tuesday's massacre was the second-deadliest school shooting in U.S. history. While public attention in the aftermath of such a tragedy may turn to the school's security plan or the local law enforcement response, mental health experts like Austin say the attention for them turns to the mental health plan that every school should have in place. This includes ensuring teachers and staff know how to talk to students about the trauma they just suffered in a developmentally appropriate way and having extra counselors ready to help, Austin said.

Austin noted at the time of the Columbine shooting, there was no real plan in place for how to help the school community cope.

In the two decades since, as the number of school shootings has risen dramatically in the United States, more schools now have plans in place. But, sadly, it's become overwhelming for schools to try to keep pace with the growing scale of crises, according to Dr. David Schonfeld, a developmental behavioral pediatrician and director of the National Center for School Crisis and Bereavement at Children’s Hospital Los Angeles.

"I'm finding that the response is getting better, but the challenge is getting harder," Schonfeld told GMA, explaining that shootings today "generally overwhelm any plan that’s in place with the resources that any school or district has."

Schonfeld was one of the first mental health professionals on site in the wake of the 2012 shooting at Sandy Hook Elementary School in Newtown, Connecticut, in which 20 children and six adults were gunned down. Less than six years later, Schonfeld helped a grieving community in Parkland, Florida, where a gunman shot and killed 17 students and staff members at Marjory Stoneman Douglas High School in 2018.

In the immediate aftermath of both the Sandy Hook and Stoneman Douglas shootings, grief counselors were made available to the school community, as they have also been in Uvalde after Tuesday's shooting, according to local ABC affiliate KSAT-TV.

The work of the grief counselors, according to Schonfeld, is to listen to kids and adults alike, to validate their feelings, make them feel as safe as possible and support the community as it moves from a state of shock to realizing the permanency of the event.

"When I arrive in communities, one of the first questions I get is: 'When we will go back to normal?' And I say: 'You will never go back to what you were. We don't go back in time. We don't forget life-changing events,'" Schonfeld told GMA. "It will change the community. That doesn't mean they're permanently damaged, it just means they're altered."

"The kids who are in the community are forever changed," he added. "They will never go back to a childhood that didn’t have a mass shooting. That will define them."

Austin said her grief counseling role in the immediate aftermath of the Columbine shooting was to bring water to parents to help them with the task of taking care of themselves.

"Everyone is just in a daze," she said. "People don’t know what to think. They’re so shocked."

As time goes on, a community like Uvalde will likely focus on bringing in mental health professionals who can offer support for the long-term, according to Schonfeld.

"Usually there is an outpouring of volunteers that want to assist and provide support, but that also has its own issues because you end up with a turnover of these volunteers so children may be talking about their distress and then going back and having to talk with someone else," he said. "When we come, we try to provide systems-level solutions."

In Parkland, grant funding allowed Broward County school officials to hire over 100 mental health professionals after the 2018 shooting, according to Rachel Kusher, a counseling specialist at Stoneman Douglas who was hired through the grant.

The newly-hired counselors were sent not just to Stoneman Douglas, where the shooting took place, but also to the five elementary schools and two middle schools that feed into the high school.

"At the high school, we had three full grade levels here that had been on campus the day of shooting. We had students who were injured in the shooting, we had siblings," Kusher told GMA. "And then at the middle and elementary schools, a lot of students were on what we call 'code red' during the event, so a lot of those students also had been traumatized or had siblings that were here on campus at [Stoneman Douglas] the day of it, or neighbors, family members."

"The difference between the shooting that occurs at a school versus a shooting that might occur elsewhere is that kids don't really have a choice whether or not to come back -- and the same thing for teachers," she added. "They have to return to the site of the trauma."

Recovery for survivors of school shootings is often even harder than for those impacted by other traumas, according to a research analysis published by the American Psychological Association (APA). Research shows students may experience survivors' guilt and post-traumatic stress disorder (PTSD), and they may also struggle with grades and school attendance.

Kusher said that after the Stoneman Douglas shooting, counselors used a tiered-approach to reach students based on their need. At the most basic level, counselors went into classrooms at all eight schools to talk about resiliency and coping strategies.

For students who were on campus the day of the shooting, counselors helped on a more one-on-one basis with reactions like anxiety, PTSD, avoidance of school and making accommodation plans for students who wanted to, for example, sit in a certain seat in a classroom based on their experience that day, according to Kusher.

Students who were directly impacted by the shooting -- whether through injury or the death of a loved one, friend or teacher -- received even more direct attention.

"A lot of what I did personally as their school-assigned counselor was just really helped them with anything they needed, sit with them, sit with their family," Kusher recalled. "They all have my personal cell phone number. They know how to reach me, and I still am in contact with a lot of them."

Mental health counselors also provided long-term support for parents of students as well as for teachers and staff members across the school district. They also had to implement new ways to do things like fire drills and shooter response drills so that students would not be re-traumatized, according to Kusher and her colleague Tonia Summers, a middle school-level guidance counselor.

"What we found is, like a year later, people were now having different types of issues with PTSD. So for some it was right away, for some it was a few months and for some it was a year," Summers told GMA. "There were all different levels of trauma that were happening and you have to be on top of all of it."

Over the past four years, part of the job of counselors across the Broward County School District has also been responding to a "huge uptick" in 504 plans -- support plans schools develop for students with disabilities -- due to a sharp rise in anxiety diagnoses, according to Christine Ross, a guidance counselor who works with the elementary schools that feed into Stoneman Douglas.

And when another school shooting happens, like the one on Tuesday, counselors nationwide brace for new mental health traumas.

"It's almost like ripping a Band-Aid off. It takes you right back to being there," Ross told GMA. "You never know what the students are going to be like when they walk through the doors."

Summers agreed, adding: "When you have dealt with some type of trauma, you’re more susceptible to other types of trauma, so something like this happens and they’re retraumatized again."

The long-term and far-reaching effects that a school shooting can have on survivors were seen tragically three years ago, when a Stoneman Douglas student, a former student and the father of a Sandy Hook victim each died by suicide within the span of a few weeks in 2019.

Even in schools across the country where shootings are not part of their past, counselors responded to support students in the wake of Tuesday's massacre, showing the even wider ripple effects a mass trauma can have.

"If there's a big traumatic national event, like a school shooting, school counselors know to make themselves available and that's what is happening," Olivia Carter, a school counselor support specialist for Cape Girardeau Public Schools in Cape Girardeau, Missouri, told GMA.

"It really digs into a deep fear for a lot of people," she added. "There’s a lot of fear and a lot of dysregulation, and there’s a need to have resources available."

For Kusher and other counselors who have lived through a school shooting or its aftermath, they said they want those in Uvalde to know that they are there for them and are supporting them.

"Those school counselors at Robb Elementary School need to help themselves too," Kusher said. "They're part of this club that nobody wants to be a part of."

Copyright © 2022, ABC Audio. All rights reserved.

The difference in treating child victims of gun violence versus adults

Portra/Getty Images

(NEW YORK) -- The mass shooting at an elementary school in Uvalde, Texas, Tuesday left 21 people dead -- including 19 students and two teachers -- and 17 additional people injured.

As of Thursday, at least six people remain hospitalized including three children and one adult at University Hospital in San Antonio and two adults at Brooke Army Medical Center in Fort Sam Houston.

And while all gunshot victims receive the same core care, there are differences when it comes to treating pediatric patients compared to adults.

Dr. Michael Rodriguez, a family physician and a professor at the David Geffen School of Medicine at the University of California, Los Angeles, said child patients may require different types of medication, or different doses depending on their weights and heights, as well as different levels of fluids.

"The fact of whether they are adults or children is a major issue," he told ABC News. "Partially because it requires a different level of expertise so, with children, you need to have some pediatric expertise."

This means a child gunshot patient will need to be treated by emergency providers who specialize in pediatrics, including pediatric surgeons, pediatric anesthesiologists, pediatric nurses and so on.

All gunshot patients are checked to make sure their airways are clear, that they are breathing on their own and have good circulation, medical experts who spoke with ABC News said.

But one unique aspect of many pediatric trauma centers is the availability of a child life specialist, according to Dr. Katherine Hoops, a pediatric intensive care physician at Johns Hopkins Children's Center.

Child life specialists are health care professionals who help children and families handle the challenges of hospitalization, illness and injury, including by psychologically preparing them for certain procedures, offering therapeutic play and coordinating support services.

"They specialize in child development and helping the child to cope with that injury from their early presentation to the hospital," she told ABC News.

Hoops, who is also core faculty at the Center for Gun Violence Solutions at the Johns Hopkins Bloomberg School of Public Health, added pediatric patients admitted with gunshot wounds are often some of the most severely ill patients.

"Many of [them] will have the highest rates of readmission to the hospital for complications for their injuries and they do unfortunately have some of the highest mortality rates of pediatric trauma patients," she said.

According to police, the gunman arrived at the school wielding a Daniel Defense AR-15-style assault rifle.

AR-15s have been used in several mass shootings including at a movie theater in Aurora, Colorado, in 2011; a music festival in Las Vegas in 2017; and at Sandy Hook Elementary School in Newtown, Connecticut, in 2012.

Doctors explained that, traditionally, injuries from handguns leave clean entry and exit wounds or just become lodged in the skin and, because they are traveling at a low velocity, do not cause life-threatening bleeding unless a major organ or artery is hit.

But bullets from AR-15s exit the barrel at three times the speed that handgun bullets exit the barrel. This means that when AR-15 bullets hit the skin, they often leave huge entry and exit wounds that are not clean.

"When a high-velocity firearm enters a body, it basically creates a wave and a blast," Dr. Lillian Liao, a pediatric trauma surgeon at University Hospital in San Antonio -- treating four patients from the Uvalde shooting -- told "Nightline." "So it looks like a body part got blown up ... A handgun may create one small hole, whereas a high-velocity firearm will create a giant hole in the body that is with missing tissue."

She added all the patients had "large destructive wounds."

"By that, I mean that there were not only a small hole in the body part, but large areas of tissue missing in various body parts that sustained injuries from the firearm," Liao said.

Rodriguez said that because assault weapons are designed to shoot more rounds of bullets than handguns, pistols or revolvers, people are more likely to have life-threatening injuries.

"As a result, people don't just get one wound, they may get numerous wounds and the more bullets that hit a person, the more likely vital organs they could hit or arteries or vessels that could lose greater amounts of blood," he said.

This can be particularly devastating when it comes to a child with a gunshot wound.

"When you're talking about a small child, that firearm that's high velocity will just destroy a significant portion of tissue and is more likely to hit major organs," Liao said. "And a child or an adult can bleed to death in as little as five minutes."

While medical and surgical advances have helped lower the number of shootings that result in fatalities, the doctors said they want efforts to focus on driving down gun violence overall.

"We need to take into account that there are things that we know that work and prevent these events … licensing minimum age requirements, large capacity magazine restrictions, safe storage and safe handling requirements," Hoops said. "We -- as clinicians, pediatricians, our surgical colleagues -- we support those initiatives that prevent patients from ever coming to our care."

ABC News' Lucien Bruggeman and Jennifer Watts contributed to this report.

Copyright © 2022, ABC Audio. All rights reserved.

How to use books to help kids cope and talk after a school shooting

Courtesy Andrea Burns

(NEW YORK) -- Nearly a decade since a mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, in 2012, cut the lives of 20 children and six adults short, American families, parents, caregivers, teachers, and school staffers are grappling with yet another mass shooting. This week, it happened at Robb Elementary School in Uvalde, Texas, and at least 19 children and two adults died in the aftermath.

It's a subject Andrea Burns has talked about with her fourth grade classes for the last eight years at an elementary school in Kansas City, Kansas.

Burns stepped aside from teaching this year, but she recalls how she and other teachers at her former school would conduct intruder drills with students regularly. She told Good Morning America that she wouldn't shy away from speaking about a topic such as a school shooting when it was appropriate and timely.

"I'm very up front with my students, even if they're in fourth grade. I'm like, 'This is real life and we have to talk about this," Burns said. "'I don't want to scare you, not saying this is going to happen but we have to be prepared in case it ever does."

"I would bring up this is what happened. This is what we would do if it were us. This is where we would hide. This is what I would do. This is what you guys would do. This is the direction we would go in. This is what you would hear," Burns said.

The educator-turned-book buyer said she used picture books to guide conversations with students on difficult topics.

"So anytime it happens, honestly, that same conversation gets brought up every single time, unfortunately. But the reason why I'm bringing out these books is because when big topics like this happen, I 100% use literacy to help kids relate to it," Burns said.

To help adults start or continue conversations with young children about the emotions surrounding a tragedy, Burns suggests using books as a key tool.

Here are her top six book picks as a starting point (especially suitable for kindergarteners through fifth graders):

On grief and sadness

"There Was a Hole" by Adam Lehrhaupt

"'There Was a Hole' is incredible because it doesn't just cover grief. It covers sadness, when you have that emptiness in your heart, whether you're upset about something, [or] you're missing someone," Burns said.

Published last month, Burns added: "It's all about how there's a hole in this girl's heart and her friend teaches her how to patch up the hole. It's very, very sweet and timely and beautiful."

On breaking news and mixed emotions

"The Breaking News" by Sarah Lynne Reul

"'The Breaking News' is probably the most popular in [this] category, because it's literally about you hear something on the news and how do you react?" Burns said.

"Catching Thoughts" by Bonnie Clark

"This one is about all your different unwelcome thoughts in your head," according to Burns. "So whether you're feeling anxious or you have just a bunch of different feelings, sadness, anxiety. It's about a girl who has thoughts and simply cannot lose these unwanted thoughts and they're all represented in these different balloons and she ends up letting go of the balloons. It's very, very special."

On worries

"Kids Can Cope: Put Your Worries Away" by Gill Hasson

"This one talks about worrying and anxiety. How do you feel when you're worried? Getting help with your worries, so it's really more of a good informational book for either teachers to share with kids or adults," Burns said.
For finding the good in times of distress

"Most People" by Michael Leannah

"It's about the people helping people. You always want to find the good people in the bad situations," Burns said of the 2017 book, published by Tilbury House.

On school shootings specifically

"I'm Not Scared…I'm Prepared!" by Julia Cook

This picture book, published by National Center for Youth Issues, focuses on what happens when a "dangerous someone" enters a school.

When it comes to difficult subjects, Burns recommends that adults talk to children honestly and give them the opportunity to discuss them.

"I think a lot of people try to hide the bad news from kids, but in reality, we have social media these days. They're going to see this on TikTok. They're gonna see it on Instagram. They're going to see it anywhere anyway, so they might as well hear it from a trusted adult first," Burns said.

"I just think being truthful is the first thing and I know we want to protect our kids, but there's a way to do it, where you could have those meaningful conversations because this is going to happen throughout life. This isn't just a one-time deal."

Copyright © 2022, ABC Audio. All rights reserved.

How to help victims' families, first-responders and Uvalde community after school shooting

Yasin Ozturk/Anadolu Agency via Getty Images

(UVALDE, Texas) -- Americans have turned their attention to Uvalde, Texas, after the devastating shooting at Robb Elementary School that left 19 children and two adults dead on Tuesday.

The mass shooting marked the second-deadliest school shooting in recent U.S. history behind the 2012 attack at Sandy Hook Elementary in Connecticut that left 26 victims dead.

As onlookers search for ways to get involved and help those affected, local and national efforts are in place to support the victims, families and others coping with the trauma of yet another mass shooting in this country.

Blood Drives

Even for people not in the immediate local area, organizations like the South Texas Blood and Tissue Center are able to connect blood donors with those in need at local Uvalde hospitals.

"Thanks to generous blood donors, we were able to send 15 units of blood to Uvalde via helicopter to be available at the site of the shooting and at the area hospitals," the organization announced Wednesday morning. "Later this afternoon, we received a request and sent an additional 10 units of blood to a hospital in Uvalde."

The critical need comes on the heels of a months-long blood supply shortage.

With the center’s supply is running low, the organization said, "This tragedy highlights the importance of always having blood available on the shelf and before it’s needed."

An emergency blood drive was scheduled for Wednesday from 9 a.m. to 2 p.m. local time at the Herby Ham Activity Center in Uvalde. As of time of publication, all appointments were booked through Saturday but the center stressed that help would still be needed and encouraged people to reserve appointments through Memorial Day.

Verified Fundraisers

Online and virtual donations are highly-visible, immediate ways to financially support victims' families, first responders and local communities impacted by mass shootings, but it's vital to ensure the source is trusted, vetted and honestly managing funds.

According to the school's website, First State Bank of Uvalde has set up a memorial fund account for the victims of Tuesday's shooting. Those looking to donate may contribute funds at any First State Bank branch or mail checks to P.O. Box 1908, Uvalde, TX, 78802, with checks payable to the Robb School Memorial Fund.

Donors may also contribute using Zelle by sending payments to robbschoolmemorialfund@gmail.com.

VictimsFirst is a nonprofit network of families of the deceased and survivors from the last two decades of mass shootings. It originated in 2012 to protect victims, educate communities and fund first responders and victims.

The VictimsFirst fund created in the wake of the Uvalde tragedy is supported by the National Compassion Fund in partnership with GoFundMe and the San Antonio Area Foundation. The National Compassion Fund is a subsidiary of the National Center for Victims of Crime, and states on its website that it collects donations and is in charge of forming a "local Steering Committee to determine eligibility and distribution of funds."

Anita Busch, president of VictimsFirst and co-founder of the National Compassion Fund, whose own family has suffered through two mass shootings -- the 2012 theater shooting in Aurora, Colorado, and the 2017 Las Vegas concert shooting -- helped create a new model for charitable giving to ensure that 100% of donations collected for victims of mass casualty crime actually go directly to the victims.

"For Uvalde, we'll continue to collect and set it up very similar to El Paso,” she told ABC News, referencing the group's work after the 2019 Walmart shooting. "The National Compassion Fund will also be administering those funds. We will make sure that it’s a separate bank account, that everything is transparent and once we’re satisfied as victims of previous mass shootings, we’ll go ahead and put the funds into the NCF."

"We're very transparent about what we collect and if there's any question [about what someone gives], we ask and get that in writing -- put that in the correct bank accounts and go from there," she said. "We are so grateful that public intent will be very transparent."

Busch added that donors could "give to the victims or you can give to the community or both, just as we did in Buffalo," referring to the May 14 mass shooting at a Tops Friendly Markets grocery store in Buffalo, New York, that left 10 people dead.

Busch also serves as a Mass Violence Relief Specialist and adviser to the National Compassion Fund, and has personally helped victims, survivors and communities behind the scenes in more than 30 mass casualty crimes.​

There are also two Uvalde area funeral homes that posted on social media about covering the cost of services for families of the shooting victims.

"For over 60 years, we have supported Uvalde and beyond," Rushing-Estes Mortuary Uvalde wrote in a Facebook post. "Today, our resolve is stronger than ever. We are here for the people of Uvalde and our professionals are currently at Robb Elementary assisting law enforcement. As the situation develops and we have the opportunity to assist our community, not one family will be charged for our services."

Hillcrest Memorial Funeral Home also said in a Facebook post that it would handle any services for victims free of charge.

"We have fought together as a community and we will pull together as one now in our time of need," the post read. "Hillcrest will be assisting families with NO COST for funerals for all involved in today’s horrific events. Prayer for our small amazing town."

Grief Counseling

There are also resources available for people not in the immediate Uvalde area who may be caring for others coping with anxiety and residual trauma, or who may be affected themselves.

The National Disaster Distress Helpline, a year-round disaster crisis counseling hotline, is available to anyone in the U.S. experiencing distress or other mental health concerns related to recent mass shootings.

The free, confidential services are available 24/7 and offered in over 100 languages, including Spanish and American Sign Language (ASL) for those who are deaf or hard of hearing.

"It is common to feel distress before, during, and after a disaster. Emotional distress is second only to death and injury in terms of the toll disasters take within impacted communities," the organization said in a press release. "Most distress symptoms are temporary, but for some individuals and families these symptoms may last for weeks or months after a natural or human-caused disaster, including incidents of mass violence."

Anyone experiencing distress or other mental health concerns related to disaster can call or text 1-800-985-5990 to connect with a trained counselor. Spanish-speakers can call or text the hotline and press "2" for 24/7 bilingual support.

Deaf or hard of hearing American Sign Language users experiencing disaster distress can contact the hotline by dialing 1-800-985-5990 through a direct videophone option via any videophone-enabled device, or by selecting the “ASL Now” option on the hotline's website at disasterdistress.samhsa.gov. Videophone calls are answered 24/7 by trained crisis workers fluent in ASL from the hotline's crisis center partner DeafLEAD.

The National Disaster Distress Helpline also has Online Peer Support Communities for survivors of mass violence in the U.S.

Victims' loved ones and emergency responders with experience from mass violence can connect with one another in a private, moderated Facebook group to offer or receive emotional support in the aftermath of a mass shooting. This can include methods to cope, memorial dates, self-care strategies and support through daily living challenges.

Copyright © 2022, ABC Audio. All rights reserved.

Comfort dogs sent to Texas to offer support following elementary school shooting

Lutheran Church Charities

(UVALDE, Texas) -- Several dogs are among the responders traveling to Texas Wednesday, one day after a gunman opened fire at an elementary school in the city of Uvalde, killing at least 19 children and two teachers.

The trained animals are all part of Lutheran Church Charities (LCC) K-9 Ministries, a K-9 unit that travels across the U.S. to provide comfort and support to people impacted by disasters such as mass shootings.

Eight of the group's canines, all golden retrievers, will be dedicated to the Uvalde community. They range in age from 3 to 9, according to Lutheran Church Charities' K-9 crisis response coordinator Bonnie Fear.

Canine responders Cubby and Devorah are traveling from Fort Collins, Colorado, while Miriam is being sent over from Kingfisher, Oklahoma. Abner, Elijah, Gabriel, Joy, and Triton are already in Texas and will head over to Uvalde from Austin, Houston, Plano and Wichita Falls.

The dogs will offer a unique form of support to anyone impacted by the Robb Elementary shooting, including children, adults, local residents and first responders.

"We are going to attend a mass vigil at the fairgrounds in Uvalde at 7 p.m. tonight," Fear told "Good Morning America." "We are also aware and have been directed to the civic center in Uvalde where school staff, teachers, families are gathering, and from there, we hope to connect with first responders, the school staff, families, any churches that request the dogs."

Some of the dogs have responded to past school shootings as well.

"Cubby has been to all the mass shootings and crises with me since 2016," Fear told GMA, including the Oxford High School shooting last November in Oxford, Michigan.

“We just see a lot of shock, crying, [people who are] distraught, especially coming in the day after a mass shooting," Fear said. "People are not ready to process or listen or answer questions. So we just show up with the dogs."

"We listen if they talk," she added. "We're silent. We let the dogs connect with people and they can express their feelings at that time and we're not counselors, so we are just present, standing with them in their sorrow."

Lutheran Church Charities' president and CEO Tim Hetzner recalled to GMA one comfort dog visit that made a particularly lasting impression on him.

"I remember one situation in Sandy Hook, four days after the shooting," Hetzner said, referring to the 2012 mass shooting at an elementary school in Newtown, Connecticut, that left 20 children and six adults dead. "We were at a community center and this couple was there with their young boy. … I had a dog named Howe at that time."

"Howe looked up at the boy, got up, walked over to the boy, rolled into his legs and the boy came down on top of him. They just laid there. After about 10 minutes, the boy lifted up Howe’s ear and told him everything that happened in that classroom. Parents started crying because it was the first time the boy had talked in four days. First time and it was a dog."

Hetzner said the charity has seen an increase in requests for comfort dogs in the last two years. The group's K-9 unit has expanded from four dogs in 2008 to over 130 dogs in 27 states.

The dogs will be deployed in Uvalde until at least Monday and will be given ample breaks to recuperate in between working shifts, the group said.

Copyright © 2022, ABC Audio. All rights reserved.

Nation's latest COVID-19 wave largely hidden from view, health experts say


(NEW YORK) -- Current COVID-19 cases are just a fraction of what they were at the peak of the omicron wave.

But many people in the country may be noticing what seems to be a flood of cases in their social circles.

Health experts say this anecdotal evidence may not be simply coincidence, as the U.S. may be in a “hidden” wave -- one much larger than reported data would suggest.

“There's a lot of COVID out there. I see it in my social circles, in my kids' schools and in the hospital employee infection numbers,” Dr. Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center in Boston, told ABC News. “We are clearly in a wave.”

Although it is clear that infection rates have been steadily rising in recent weeks to their highest reported level since mid-February, scientists acknowledge that it is difficult to know how high COVID-19 case and even hospitalization numbers truly are, given the likely “substantially” undercounting of infections.

This is due in part to changes in data collection and reporting and the proliferation of at-home tests. Some state officials report that health departments and healthcare facilities have also ended traditional tracking of COVID-19 patients, which epidemiologists say make it more difficult to know how many patients are coming into hospitals in need of care.

Last month, former Food and Drug Administration Commissioner Dr. Scott Gottlieb estimated that officials were likely only picking up “one in seven or one in eight” infections.

And President Joe Biden’s new coronavirus response coordinator, Dr. Ashish Jha, acknowledged that there are "a lot of infections" last week, likely the result of highly infectious omicron subvariants spreading across the country.

“We know that the number of infections is actually substantially higher than that. It's hard to know exactly how many but we know that a lot of people are getting diagnosed using home tests,” Jha explained.

More than 100,000 Americans officially testing positive every day

The nation's reported daily case average, which officials say consists largely of PCR tests, now stands at more than 100,000 new cases reported a day, according to data from the Centers for Disease Control and Prevention (CDC).

In recent weeks, nearly every state in the country has reported an increase in COVID-19 infections and the number of virus-positive people who are admitted to the hospital.

The Northeast remains the nation’s most notable known COVID-19 hotspot, though surges in some cities, like Boston, appear to be showing initial signs of slowing.

Nationally, according to the CDC’s community levels, more than 45% of Americans live in an area with a medium or high COVID-19 risk.

The high community level suggests there is a "high potential for healthcare system strain" and a "high level of severe disease," and thus, the CDC recommends that people wear a mask in public indoor settings, including schools.

Hospitalization numbers have been increasing in recent weeks, but not at a rate as significant as infections.

However, over the course of the spring and winter, hospitalization data, too, has become less accessible, leading some experts to suggest patient totals could also be undercounted.

Earlier this year, the Department of Health and Human Services ended the requirement for hospitals to report several key COVID-19 metrics, including a daily total of the number of COVID-19 deaths, the number of emergency department overflow and ventilated patients and information on critical staffing shortages.

Further, certain states have stopped outright reporting of statistics including hospital bed usage and availability, COVID-19 specific hospital metrics and ventilator use.

However, Doron said a possible significant surge in infections, without an overwhelming number of hospitalized COVID-19 patients, could be a promising sign.

“If cases are really a lot higher than what we are seeing, it means the ratio of hospitalizations to cases and deaths to cases is even lower than what we are seeing, and we are already seeing a ‘decoupling’ between cases and hospitalizations and deaths,” Doron said, which could indicate the virus is moving closer to a form that Americans can live with.

Even so, Doron added, “at a population level, however, COVID poses more risk because there are so many cases, and hospitals are already so full with both COVID and non-COVID patients.”

A shift away from traditional testing

In recent months, states from coast to coast, have moved to shutter public testing sites, with an abundance of rapid COVID-19 tests now available in pharmacies and through the federal government.

“While home testing has created broader population access to infection status and hopefully better access to treatment, it has also created a major blind spot in our public health surveillance efforts,” John Brownstein, Ph.D., an epidemiologist at Boston Children's Hospital and an ABC News contributor, said. “The latest BA.2 surge was masked by the shift in testing behavior and likely delayed decisions on public health interventions.”

The shift away from traditional COVID-19 testing has left some health experts worried about continued issues of access to adequate healthcare and preventative health tools, such as testing and antiviral treatments, to protect vulnerable communities.

According to ABC News' analysis last summer of pharmacy locations across the country, there are 150 counties where there is no pharmacy, and nearly 4.8 million people live in a county where there's only one pharmacy for every 10,000 residents or more.

“What concerns me even more is what might be happening in communities and among families with fewer resources. Public testing sites have closed, home tests are expensive at the drugstore, and navigating the system to order free tests or get tests reimbursed by insurance requires literacy and technology,” Doron said.

Broader insights on infection through home testing and wastewater sampling will be critical in the future to fully understand the scope of surges and protect all Americans, Brownstein said.

Virus not disappearing in low-transmission counties

This winter, following the omicron surge, the CDC released a new risk level map, which shifted away from focusing on the level of transmission within a community, and rather shifted the attention to hospital capacity and admission levels.

The rollout of the new map, which aims to help people and local officials assess when to implement potential mitigation measures, caused controversy among some Americans, explained Doron. While some people argued the shift in metrics was long overdue and a sign of the times, others said the move was premature.

“Some people were happy because they felt that we were beyond the time period in which we needed to reimpose restrictions and mandates every time cases increased, given widespread population immunity from vaccination and infection,” Doron said. “It made other people angry because a transition to a medium or high-risk status now requires increases in hospitalizations, which are lagging indicators, in other words there can be a lot of cases before hospitals get full, and some people might choose to take extra precautions sooner.”

Brownstein noted that given the shift away from transmission rates, some Americans may not be fully aware of the continued dangers of the virus, as a green county is not necessarily indicative of the virus simply disappearing.

“While the CDC map reflects decreased risk of severe complications from COVID infection, it unfortunately hides places with high community transmission,” Brownstein said. “This masking of risk may provide a false sense of security especially to those at high risk of hospitalization and death.”

Copyright © 2022, ABC Audio. All rights reserved.

How to talk to kids after 19 children, two adults killed in Texas school shooting


(NEW YORK) -- At least 19 children and two adults are dead after a shooting at Robb Elementary School in Uvalde, Texas, according to the Texas Department of Public Safety.

The 18-year-old suspect, who is also dead, was a student at Uvalde High School, according to Texas Gov. Greg Abbott.

The governor said the suspect also allegedly shot his grandmother before entering school premises, but did not give any details about her condition.

In the wake of the deadly mass shooting, many parents are left grappling with how to explain the horrific act of gun violence -- at a setting where most kids spend a majority of their days -- to their children and teens.

"For the majority of students, school is a safe and supporting environment," Dr. Robin Gurwitch, a licensed clinical psychologist and professor at Duke University Medical Center, told ABC News in 2018, after 17 people, including students, were killed at Marjory Stoneman Douglas High School in Parkland, Florida.

"So when a shooting happens at a school, it undermines our sort of worldview about where I can be that is a safe place," she added.

Gurwitch, a member of the National Child Traumatic Stress Network, broke down how parents can discuss the news with their children, and how to help them to feel safe in the aftermath of the harrowing headlines.

Parents should initiate a conversation

Gurwitch stressed that in situations like a mass tragedy, it is "extremely important" for parents and caregivers -- especially those with children in high school -- to "be willing to bring this topic up."

"We really want to want to wrap our arms around them and make them feel safe," she added. "But part of being a parent is willingness to discuss difficult topics."

"To believe that our children don’t know that these events occur is wishful thinking," Gurwitch said. "We live in an age where we can go online and see live feed of people leaving the school, of responders, it's updated every few moments."

Gurwitch suggests that if you are watching the news with your children, turn it off and talk about the events calmly in order to get an idea of what they know, where they are coming from, and what misconceptions they may have already heard.

It is also critical to reassure children that parents and adults at their school "are going to do everything we can to make you safe," Gurwitch added.

"Let them know that their school has plans in place to do everything to the best of their ability to make them safe," she said.

Adapt the conversation based on your child's age

Gurwitch emphasized that the conversation about the news should vary based on the age of your child.

"I use the analogy 'it is the same as having a conversation about where do babies come from' -- it is a very different conversation if I'm talking to a preschool or elementary school student than if I'm talking to a high school student," Gurwitch said.

When it comes to children preschool age and below, she added that parents should limit their media exposure.

"Preschoolers may not understand instant replays," she said. "So that loop of children running out of the school, if they don't know that that's a replay, they think that school has thousands and thousands of students."

For high school and older middle school age students, Gurwitch recommends addressing the incident directly, saying that you want to talk to them about the school shooting that happened and asking them what they know about it.

For children younger than that, Gurwitch recommended initiating the conversation by saying, "There was a very sad thing that happened at a school ... today. It is very sad because people were hurt and people were killed, and I just want you to know about it if you hear kids talking about it at your school, and if you have any questions, you can talk to me."

Regardless of your child's age, Gurwitch stressed that parents should "most importantly show a willingness to answer questions," and listen to their children's concerns.

"Younger children may ask the same question over and over again," she added. "That is how they process information."

How to respond if your child says they don't feel safe going back to school

If your child or teen says they do not feel safe going back to school, Gurwitch emphasized that it is important not to invalidate their feelings, but to talk about them.

"Say, 'Tell me what it is that you're worried about? What it is that you don’t feel safe about?'" she said. "Validate why your child may not feel safe. If we just discount it with a throwaway, 'You are going to be fine,' we shut down the conversation."

Gurwitch added that you can reassure your child that "nowadays schools do have safety plans, and schools do practice shooting drills."

"Some people are concerned about practicing these drills, but it's like fire drills, it doesn't make kids more scared that fires are going to break out, it makes students feel more secure that they have a plan in place," she said.

"Be patient and supportive as children are trying to make sense of how something so horrific can happen at a setting where I go to be with friends, to learn," she added.

Check back in

"I think that is really important to check back in tomorrow, to check back in the next day, to find out what are your friends talking about related to this school shooting," Gurwitch said. "It is very important to get an understanding of how children are coping."

"When there is a tragedy ... a one-and-done conversation is not sufficient," she added. "Let your child or teenager know that 'I really do care about you and I am open to having this discussion.'"

If you notice your child or teen is distressed for a longer period of time, and Gurwitch added this may show up in "problems with sleep, problems with attention and focus, and increased irritability," she recommends that parents reach out to their school guidance counselor, a local psychological association or even their pediatrician for further help.

The National Child Traumatic Stress Network offers comprehensive resource guides for parents, caregivers and educators to support students. Click HERE for resources related to school shootings.

Copyright © 2022, ABC Audio. All rights reserved.

FDA warns against storing avocados in water as seen in viral social media hack

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(NEW YORK) -- A recent viral TikTok food hack has been dubbed unsafe by the U.S. Food and Drug Administration.

Videos of halved avocados submerged in bowls or containers of water have bubbled up on TikTok and other social media platforms over the past few months. Creators and commenters alike were stunned to see the vibrant green flesh of the popular fruit still seemingly perfect after removing it from the water to use it without scraping off its usual oxidized brown layer.

But an FDA official told ABC News' Good Morning America the agency "does not recommend this practice."

"The main concern is with the possibility that any residual human pathogens (i.e. Listeria monocytogenes, Salmonella spp., etc.) that may be residing on the avocado surface may potentially multiply during the storage when submerged in water," the official said in a statement to GMA.

"In addition, research performed by FDA scientists has shown that Listeria monocytogenes has the potential to infiltrate and internalize into the pulp of avocados when submerged in refrigerated dump tanks within 15 days during refrigerated storage," they added. "In this case, even surface disinfecting the avocado skin prior to slicing would not be able to remove the contamination."

Copyright © 2022, ABC Audio. All rights reserved.

Billie Eilish opens up about having Tourette's syndrome: 'I have made friends with it'

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(NEW YORK) -- Billie Eilish is opening up about living with Tourette's syndrome.

In a new episode of David Letterman's series My Next Guest Needs No Introduction, the singer, who was diagnosed at the age of 11, spoke about her tics and living with the disorder.

During the interview, Eilish appeared to start "ticcing." When Letterman asked about it, she said, "It's really weird; I haven't talked about it at all."

She added, "I'm very happy to talk about it. I actually really like answering questions about it because it's really interesting, and I am incredibly confused by it. I don't get it."

The "Happier Than Ever" singer then detailed her various tics, including wiggling her ear, raising her eyebrow, clicking her jaw, moving her head, opening her mouth and flexing various muscles in her arms.

"These are things you would never notice if you're having a conversation with me, but for me, they're very exhausting," she said.

Eilish said she had been unhappy with her tics, but now, she told Letterman, they're a "part" of her. "I have made friends with it, so now I'm pretty confident in it," she said.

"So many people have it and you'd never know. A couple [other] artists have come forward and said, 'I've always had Tourette's,'" Eilish revealed. "And I'm not going to out them because they don't want to talk about it. But that was really interesting to me because I was like, 'You do? What?'"

Copyright © 2022, ABC Audio. All rights reserved.

Pediatrician answers parents' questions about COVID-19 vaccine for kids under 5

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(NEW YORK) -- Pfizer's release of data showing its three-shot COVID-19 vaccine is 80% effective among children under the age of 5 is welcome news for parents anxious to get their young children vaccinated more than two years into the COVID-19 pandemic.

With the Food and Drug Administration (FDA) set to meet in June to review data from both Pfizer and Moderna, a COVID-19 vaccine could be widely available to everyone in the United States ages 6 months and older by July.

The news comes as the U.S. is experiencing another COVID-19 wave, with cases rising in nearly every state and official infection numbers up to more than 100,000 per day, according to the Centers for Disease Control and Prevention (CDC).

In the U.S., 28% of 5- to 11-year-olds and 58% of 12- to 17-year-olds are fully vaccinated against COVID-19, according to the American Academy of Pediatrics' analysis of CDC data.

"I think we all want to be done with this pandemic but unfortunately, it's not quite done with us," said Dr. Sean O'Leary, vice-chair of the AAP's committee on infectious diseases. "We are in a much different place than we were two years ago in terms of both the therapeutics that are available to treat the disease and the vaccines, showing a decreased spread of the disease and a decrease in hospitalizations."

O'Leary, also a pediatrician and professor of pediatrics at the University of Colorado and Children's Hospital Colorado, spoke to ABC News' Good Morning America to answer parents' top trending questions about the COVID-19 vaccine and kids.

1. What does the Pfizer vaccine efficacy news mean?

Earlier this year, Pfizer moved forward with studying three doses of its COVID-19 vaccine for kids 6 months to under 5 years old after disappointing data on a two-dose vaccine.

The new data released by the company Monday shows the three-dose vaccine is effective in kids, which means the vaccine is one step closer to being authorized by the FDA, according to O'Leary.

"This was really the news we've been waiting for from Pfizer on whether or not this third dose was going to meet the requirements required from the FDA," he said. "The immune response that the vaccine provided for the children in the trial was similar to the immune response that we saw in older adolescents and adults in who we know the vaccine is effective in preventing infection, hospitalization and death."

In addition to being effective, the new data also shows the three-dose vaccine "appears to be safe," O'Leary said.

2. What happens next for the Pfizer and Moderna vaccines for young kids?

Next month, FDA advisers will meet to discuss the COVID-19 vaccine applications for kids from both Pfizer and Moderna, which submitted its request to the FDA in April.

The FDA has tentatively scheduled the meetings for June 14 and 15, during which advisers will review applications for Moderna's COVID-19 vaccine for kids ages 5 to 17 and ages 6 months to under 6 years, as well as Pfizer's vaccine for kids ages 6 months to under 5 years.

Within one or two days of the FDA meetings, the applications go to a CDC advisory committee. From there, the director of the CDC, Dr. Rochelle Walensky, decides on whether or not to grant emergency use authorization for the vaccines.

With that timing, we could see a vaccine for kids under age 5 approved by the beginning of July, according to O'Leary.

Pfizer's vaccine is currently available for people ages 5 and older, while Moderna's vaccine is authorized for people ages 18 and older.

3. Do kids under 5 get the same vaccine as adults?

The dosage of the vaccine is different for children than it is for adults, but the vaccine itself is the same for everyone, according to O'Leary.

If authorized, Pfizer's vaccine dosage for kids ages 6 months to under 5 years would be three shots of 3 micrograms each. Each dose is one-tenth the adult dose.

Moderna's vaccine for kids under age 6, if authorized, would be a two-dose, 25-microgram shot, about one-quarter of the dose used for adults, given 28 days apart.

4. How do I know the COVID-19 vaccine is safe for my child?

Pfizer's newly-released data on its three-dose vaccine for kids under age 5 showed "no significant safety" concerns, according to O'Leary.

The fact that a vaccine for the youngest children is coming after the vaccine has already been delivered to hundreds of millions of people around the world should bring comfort to parents, O'Leary said.

"There is no reason to expect in this age group that we're going to have some kind of different safety profile than what we saw in children, for example, 5 and older, in whom millions and millions of doses have been given," he said. "So we have a pretty good understanding of the safety profile."

The CDC has also released multiple studies over the past year showing COVID-19 vaccines are safe and effective for older children.

Overall, O'Leary said parents should remember that, based on data, the benefits of the COVID-19 vaccine in protecting kids outweigh any potential risks.

"I think we all know that the disease is most severe in the elderly and people who have problems with their immune system, but that's not to say that COVID-19 is a benign illness in children," he said. "We've seen tens of thousands of hospitalizations in children, and the risk to children under 5, actually, for hospitalization is higher than it is for older children, so absolutely there is a need to protect those children with the vaccine."

For parents of children of all ages who may be on the fence about getting their child vaccinated, O'Leary said to speak with your child's pediatrician.

"The best thing you could do is make an appointment with your pediatrician and talk with them about about the vaccine," he said. "I think it is important to get those kids vaccinated but, on the other hand, I do understand why parents have some questions, and your best source of information is going to be your child's pediatrician."

5. How long after having COVID-19 can my child get a vaccine?

If a child has not been vaccinated against COVID-19 and contracts the virus, they can get vaccinated "as soon as they're out of their isolation period, based on when they were infected and had symptoms," according to O'Leary.

"It doesn't need to necessarily be the next day but, in general, as soon as as they can to provide that protection," he said.

For people who are not vaccinated, CDC guidelines are to quarantine at home for five full days.

6. How do I know if my child needs a booster vaccine?

A booster dose of Pfizer's vaccine was authorized earlier this month for children ages 5 to 11 years old.

A child in that age range must wait at least five months after completion of a primary series to receive the booster, according to the FDA.

"I do think it's important," O'Leary said of fully vaccinated people ages 5 and older receiving a booster dose. "The data have been fairly clear over the last several months, and particularly during this omicron wave, that this booster really matters in terms of prevention of the severe outcomes."

7. What precautions should my family take until a vaccine for young kids is authorized?

O'Leary said families should continue to practice safety protocols including mask wearing for children ages 2 and older, hand-washing and social distancing.

"We know that crowded, indoor settings where people are not masked is one of the higher-risk places, so try to avoid those types of environments," he said.

O'Leary also said parents should make sure their kids of all ages are up to date on all their vaccinations.

"Honestly, for children, a lot of the diseases, although we don't see them anymore, are actually more severe in kids than COVID-19, things like measles," he said. "Going into the summer is a perfect time to make an appointment with your pediatrician for a checkup and make sure your kids are up to date on their vaccines."

Copyright © 2022, ABC Audio. All rights reserved.

First increase in births reported in seven years, CDC finds

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(NEW YORK) -- The number of births increased in the United States for the first time in seven years, according to a new federal report.

Provisional data published Tuesday from the Centers for Disease Control and Prevention's National Center for Health Statistics found there were 3,659,289 babies born in 2021, a 1% increase from 2020.

It also marks the first rise in births since 2014. Prior to this report, the number of births had been decreasing by an average of 2% per year.

The report did not explain why the number of births increased, but Pew Research Center polls have suggested Americans delayed having babies during the first year of the pandemic due to public health and economic uncertainty, so the rising number could be the result of a rebound.

"​​When it comes to changes in fertility behavior, we're limited," Dr. Brady Hamilton, from the NCHS Division of Vital Statistics and lead author of the report, told ABC News. "That's where you need a survey about what's behind the decision-making process."

The report also showed the fertility rate -- the number of live births per 1,000 women between the ages 15 and 44 -- was 56.6. This is up from 56 in 2020 and the first increase since 2014, according to the CDC.

However, the total fertility rate -- the number of births a hypothetical group of 1,000 people would have over their lifetimes -- was 1,663.5 births per 1,000 women.

This is still below what experts refer to as replacement level, the level a population needs to replace itself, which is 2,100 births per 1,000 women.

The team found birth rates among women aged 25 and older increased while decreasing for those aged 24 and younger.

"That sort of suggests [that] when we saw the decline in births from 2019 to 2020, probably a lot of births were postponed," Hamilton said. "People were waiting to see what happened [with the pandemic] and rates rose in older women as they may have proceeded to have that child."

Among teenagers aged 15 to 19, the rate of birth declined 6% from 15.4 per 1,000 to 14.4 per 1,000 -- a record low for this age group.

Teenage births have been continuously falling since 2007 by an average of about 7% through last year.

"When you look at it across time, that's a 77% decline since 1991 and 65% decline since 2017. That's astonishing," Hamilton said. "That's certainly good news. And it will be interesting to see when we go into next year if it continues on."

Meanwhile, for tweens and teens aged 10 to 14, the rate of birth was 0.2 per 1,000, which is unchanged since 2015, the report found.

Additionally, researchers also looked at births by race and found that white and Hispanic women each saw the number of births increase by about 2% from 2020 to 2021.

Meanwhile, Black and Asian women saw the number of births decline by 2.4% and 2.5%, respectively, over the same period, while American Indian/Alaskan Native women saw their numbers fall by 3.2%.

The report also examined the type of delivery and how early the babies were born.

Data showed that 32.1% of babies were born via cesarean delivery in 2021, up from 31.8% in 2020 and the second increase in a row after the rates had declined from 2009 to 2019.

The percentage of C-sections increased among all racial and ethnic groups, with the highest seen among Black women, from 36.3% to 36.8%.

While C-sections can lower the risk of death in women with high-risk pregnancies, they are associated with complications such as infection or blood clots, according to the Cleveland Clinic.

The preterm birth rate also rose by 4% in 2021 from 10.09% to 10.48%, which is the highest reported rate since 2007. Increases were seen in babies born early preterm, which is before 34 weeks gestation, and later preterm, which is 34 to 37 weeks gestation.

Premature babies are at a greater risk for problems with feeding, breathing, vision and hearing, as well as behavioral issues.

"Whenever you see an increase in preterm births, that's concerning," Joyce Martin, from the Division of Vital Statistics and co-author of the report, told ABC News. "And we saw an increase in early-term babies, and they're at greater risk than later-term babies of not surviving the first year of life."

Martin said it's not clear what's behind the rise in preterm birth rates but said mothers younger than 18 and older than 35 are more likely to have premature babies.

"And we did see an increase in older moms' birth rates. It's not clear if it influences this change yet," she said.

Copyright © 2022, ABC Audio. All rights reserved.

Moms search for solutions after daughters die by suicide

Caroline Long

(NEW YORK) -- Eva Long was a funny, bright and goofy child who became a talented singer, piano player and songwriter in her teen years, according to her mom, Caroline Long.

She was also someone who battled depression, an increasingly common mental health struggle among teenagers, but one that Long said Eva worked hard to keep a secret.

"She was so worried about people finding out," said Long, adding that the shame kept Eva from wanting to see a therapist. "She didn’t want anyone to know. She wanted to keep it so secretive."

The changes in Eva's mental health started in eighth grade, according to Long, who said she thought at the time that Eva was experiencing typical teenage angst.

"In eighth grade she had a phone and the social media thing was starting ... all the posing that the girls do, and the pictures. All that stuff, that was the beginning of it," said Long, who lives in Colorado. "Going into her freshman and sophomore years, she was just kind of struggling to figure out who her friends were."

"She would come home, exhausted, and she would say, 'You know, it's so hard for me, because I feel like I have to pretend,'" Long said.

For years, the rates of mental health struggles among teens have been on the rise in the United States. By 2019, the number of children between the ages of 3 to 17 with a diagnosed mental or behavioral health condition rose to over eight million, according to Department of Health and Human Services (HHS) data.

Long said she took advice from other mothers whose daughters were also struggling with mental health and sought professional help for Eva, who refused.

Then, in the spring of 2020, at the end of Eva's senior year of high school, the coronavirus pandemic struck, and Long said she watched her daughter revert even further.

"They stopped having school in person, so they all had to do online classes," said. "It was very isolating for all the kids, and for Eva, it was really, really devastating because she scrolled through social media that much more. There was just a huge disconnect from actually engaging with people."

Eva did not have a senior prom or a high school graduation, but earned her high school diploma and went on to study at a state university in Southern California, according to Long.

Though she faced difficulties -- including what Long says Eva described to her as two instances of sexually violent behavior from male peers -- by the end of last summer and the start of her sophomore year of college, Long said she saw Eva in a good place mentally and physically.

It made it all the more devastating to Long when, on Sept. 17, 2021, she received a phone call that Eva had died by suicide while away at college.

"I was just in shock. I said, ‘This can’t be real. This can’t be true," said Long, who was traveling overseas at the time. "That cry of a mother when they’ve lost their child is a pretty wicked one, and I couldn’t stop it."

It was the same grief-stricken cry Honey Beuf said she experienced two years earlier when she received a phone call on Jan. 8, 2019, that her then-19-year-old daughter, Liv, had been taken to the hospital while away at college in Colorado.

Liv later died, a death that was caused by suicide, according to Beuf.

"What you go through as a parent is you feel everything so viscerally and on a cellular level, it’s so incredibly awful. I sometimes have such a hard time putting it into words," said Beuf. "You can’t even process it, let alone the fact that she’s gone because she ended her own life."

Liv was diagnosed as a child with a nonverbal learning disorder that doctors said made her prone to depression and anxiety. Beuf said Liv started seeing a therapist early on.

In middle school, after episodes of bullying that Beuf said worsened her mental health, Liv went on medication, according to her mom.

Though her mental health was always at the forefront, Liv did well in high school, becoming a cheerleader and vocalist, and the "funniest person you've ever met," according to Beuf. She went on to college and told her family the day before she died that she wanted to become a mental health therapist.

Liv was also member of the LGBTQ+ community, according to Beuf, one of the populations of young people identified as most at-risk for suicide, according to the Centers for Disease Control and Prevention (CDC).

Though Liv was open with her parents and siblings about her mental health struggles, she hid it from her peers at college, which Beuf said she believes was a "huge contributing factor" to her death.

And it was only after Liv died that Beuf said she and other family members learned the extent of her struggles, which she said also included binge drinking.

"After she passed away we found all her journals and we saw the journaling of like eating, weight loss logs, different groups on Facebook for people to get information on how to continue their eating disorders," said Beuf, who said she knew Liv has struggled with an eating disorder but thought she was in recovery. "When we got hold of her phone, looking at her social media posts, the number of photographs she would put up and then take down."

"For one post, there would be like 50 photographs in her camera roll," continued Beuf. "I had no idea that she was that intensely into trying to perfect the image that she was putting out there."

A growing mental health crisis

In the years since their daughters' deaths, both Beuf and Long said they have watched as the mental health crisis among teens, particularly teen girls, has only grown.

"You think they’re doing fine because they’re very quiet about it and they don’t share," Long said.

"I think maybe they don’t even know what they’re going through," she said of teens who struggle. "And parents have so much shame. What I hear is, ‘I knew my son or daughter so well, how could I have not seen this?’ It's the worst grief."

Beuf described herself as "stunned on a daily basis" by the growing mental health crisis she sees across the country and through families that reach out to her after the loss of a child to suicide.

"One mom just reached out to me who lost her 11-year-old," she said. "The statistics are horrifying."

Among girls ages 12 to 17, there was a 51% rise in suspected suicide attempts from Feb. 21 to March 20, 2021, compared to the same time period in 2019, according to data released last year by the CDC.

Last year, amid the pandemic, youth mental health was declared a "national emergency" by a coalition representing over 77,000 physicians and over 200 children's hospitals.

U.S. surgeon general Dr. Vivek H. Murthy issued a 53-page advisory warning of a growing mental health crisis among young people, writing, "The challenges today’s generation of young people face are unprecedented and uniquely hard to navigate."

While the pandemic put a spotlight on kids' mental health, experts say, it has been a long-boiling crisis. Between 2009 and 2019, for example, the number of high school students in the U.S. who reported feeling sad or hopeless increased by 10 percentage points, to nearly 37%. The number of students having seriously considered attempting suicide increased in that same time period from nearly 14% to 19%, according to CDC data.

"We were already kind of in a place of a very serious and significant mental health and suicide crisis, even before the pandemic began," said Dr. Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention (AFSP). "And during the pandemic, there have been some further data points that relate to girls in particular."

According to Moutier, suicide rates for youth have been on the rise in the U.S. for the past 15 years. As of today, suicide is the third leading cause of death for kids ages 10 to 19, and the second for young adults ages 20 to 34, the AFSP said, noting that suicide disproportionately impacts Black children and kids who identify as LGBTQ+.

Suicide deaths are much more prevalent among men, while suicide attempts are much higher among women.

Long said she believes her daughter Eva's death was done on impulse, saying, "I think she didn’t want to die but she just wanted the pain to end."

Moutier said that while girls still remain less at risk for death by suicide, the past two years of the pandemic have seemed to impact girls in different, worrisome ways when it comes to their mental health.

In April, a CDC survey found that nearly half of high school girls in the U.S. said their mental health was not good most of the time or always during the pandemic, almost double the percentage of boys who reported the same.

"The pandemic meant less in-person time with their peer group and in healthy activities with their peers, such as academics, athletics, other kinds of positive social engagement, and more might have shifted towards screen time and social media time," said Moutier. "We wonder if that's one of the reasons that girls' distress level was kind of pressed upon, perhaps even more so than boys as a group."

Dr. Nicole Cammack, a licensed clinical psychologist and president of Black Mental Wellness, a Washington, D.C.-based practice, said she believes girls suffered more of a loss of coping tools during the pandemic. She said girls, particularly Black girls who face greater mental health stigmas, often have a harder time asking for help.

"I have a lot of young girls who come to therapy, and it's a struggle to even get to the place of feeling empowered to say, 'These are the emotions or the feelings or the struggles or challenges that I'm having,'" she said. "Even being able to put that into words could feel very different."

A difficult search to find help

Hannah, a 14-year-old from San Diego, California, was finishing sixth grade in 2020 when the pandemic began and her classes shifted online.

Hannah, who asked that her last name not be used to protect her privacy, said she became a "hermit" in her room, turning to her phone as a social outlet.

"I think that definitely was negative," she said. "I had my phone and we did a lot of FaceTiming and texts, so I wasn’t completely cut off from my friends, but it was definitely different from face-to-face contact and seeing each other and socializing every day."

Hannah's mom, Brooke, who also asked that her last name not be used, described her daughter's phone habits during the pandemic as "endless scrolling" on social media. In time, she said she noticed personality changes in her daughter, including after Hannah returned to school in-person.

"Any social interactions seemed to be really taxing, and I was watching her not just get shy and show signs of anxiety or stress, but extreme fatigue, especially when she went back to school," said Brooke. "She would just come home from school and hit the bed and fall asleep for hours and hours and hours."

Fatigue is an early sign of depression and anxiety, along with other changes in behavior like withdrawing from activities and friends, eating more or less, sadness or irritability, avoidance and performing worse in school, according to the Child Mind Institute, a nonprofit organization focused on kids' mental health.

Brooke said she decided to have a direct conversation with Hannah about her mental health after she said three friends who are moms had teenage daughters who attempted suicide within the span of a few months.

At the advice of those friends, Brooke asked Hannah directly if she had thought about killing herself, to which Hannah replied she had multiple times.

Long said it is a question she wishes she had asked Eva.

"If I could go back, that's what I would do over," said Long. "I think all parents should ask their children, 'Have you ever contemplated suicide? Have you ever attempted suicide?' You have to keep at it with your children, keep asking those questions, keep that conversation open."

For Brooke, while she said the conversation with Hannah was difficult, what surprised her more was how difficult it became trying to find help for Hannah. After taking her to a behavioral health urgent care center in San Diego, Brooke said she spent three weeks and countless hours on the phone trying to get Hannah in to see a mental health expert.

"I started calling and emailing dozens of different clinics and providers and didn’t get any responses or got responses saying they were completely full or had a seven month wait-list," she recalled. "Nothing was improving and I felt extremely frustrated and helpless and then you start to worry if I really can’t find help, how do I make sure things aren’t getting to an acute state?"

The lack of mental health providers to treat young people is a nationwide issue due to the unfortunately high demand, according to Dr. Hina Taib, a pediatrician and adolescent specialist at the Atria Institute in New York City.

"There truly is a bottleneck with not enough services to meet the demand," she said. "Some of the most common questions I get are how do I find a therapist, or I can’t find a therapist and how do I convince my teen to see a therapist."

Long said she experienced the shortage firsthand when her daughter Eva came to her the summer before her death, asking to see a therapist.

"It was the first time she said she wanted to see a therapist but I called probably 60 therapists and all of them were full," Long recalled. "There are not enough therapists out there to deal with the amount of depression going on today."

Moiya Toliver, now 20, said she had no mental health resources available to her when she began to withdraw from life as the pandemic hit in her senior year of high school.

Switching to online school, she said, left her with no way to socialize with her peers, and without the ability to go to school ever day, she was stuck in what she called a "toxic" situation at home with her family.

"I sunk into a more depressive state," she said. "And I really didn’t have time to ground myself and try to figure out how to regain myself mentally. I just had to basically push through."

Toliver said no one she knew in her small hometown in Texas, including at her school, talked about mental health.

It was only when she began attending Howard University in Washington, D.C., that Toliver said she heard people openly discussing mental health, which allowed her to take steps to heal, including seeing a therapist.

Experts say that due to the high demand for mental health services among teens, there have been new efforts to respond.

"Pediatricians like myself and adolescent medicine specialists have been up-training themselves in therapeutic skills to be able to provide families with first steps into getting better mental health spaces," said Taib, adding for parents, "Mental health is health and your pediatrician is an appropriate point of contact, even a first point of contact, for a concern that you may have with your child."

The pandemic also spurred the use of telehealth, which has made it easier to access mental health help, especially for young people, both Taib and Moutier said.

Brooke said she was finally able to find a therapist for her daughter through Brightline, a virtual behavioral health company that, among other things, offers interactive mental health content and care tools for teenagers.

Hannah is now preparing to enter high school in the fall, she says feeling much stronger mentally thanks to the coping skills she learned and the freedom she feels to share her mental health struggles.

"I think that because the pandemic brought a mental health crisis, schools and the world began to recognize it more," she said. " That is when we began to talk about it more and more at school, and that’s when my friends, we started to talk about it more."

Mom and daughter work to end a mental health crisis

For Honey Beuf and her daughter Tess Kunik, one of her two surviving children, their grief over the loss of Liv was compounded by the growing mental health crisis among teens they saw playing out across the country.

"It makes me angry that we are not doing enough to support young people," said Tess, who was eight years older than Liv and considered her sister her best friend. "It makes me angry and then I kind of float in and out of re-traumatization and in my own grief."

After Liv's death, Beuf moved to Pennsylvania to be closer to Kunik. Together, the mother and daughter started a nonprofit organization, The Liv Project, which is focused on creating tools and resources to help kids and families talk about mental health and end the stigma.

In addition to presenting workshops on mental health in schools across the country, Kunik and Beuf worked with mental health professionals to develop a game, called The Game That Goes There, which provides prompts for people to have what Kunik describes as "fearless conversations about mental health."

"One of the responses that always stands out is one of the kids said, 'I like this game because it gives kids a chance to talk without adults thinking they have to fix this,'" said Kunik. "A lot of the people I talk with say, 'Adults want to jump in and fix us. We just want them to listen to us.'"

Added Beuf, "We've heard over and over again, 'The grownups come into school and they put up this big PowerPoint presentation and then they're done.' We need to be having these open dialogues [on mental health] all the time, every day."

Beuf said she believes it will take everyone -- parents, teens, schools, government, medical professionals, nonprofits and more -- fully listening to kids to turn the tide of the youth mental health crisis.

She said she wants to encourage parents especially to have "difficult" but open conversations with their teenage kids about their mental health.

"One of the biggest lessons that I've learned through this whole process that I wish I had known is that when your child is struggling, it's really important to just sit down with them, and say, 'I am here for you. I love you, and no matter what you say, nothing can scare me,'" said Beuf. "Just sit with your child and let them talk. They just want to be heard."

If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting HOME to 741741. You can reach Trans Lifeline at 877-565-8860 (U.S.) or 877-330-6366 (Canada) and The Trevor Project at 866-488-7386.

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One confirmed, six presumptive monkeypox cases in US; government releasing vaccines for exposed

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(NEW YORK) -- With seven people in the U.S. now confirmed or presumed to have monkeypox, officials from the Centers for Disease Control and Prevention say the risk remains low and there's no evidence the virus has evolved to be more transmissible.

"This is not COVID," Jennifer McQuiston, deputy director of the Division of High-Consequence Pathogens and Pathology at the CDC, said during a media briefing Monday.

There is one confirmed positive case in Massachusetts. There is one presumptive positive case in New York, one in Washington state, two in Utah and two in Florida.

The CDC said Monday that the government is in the process of releasing some vaccines from its national stockpile. There is no need to vaccinate the general public against monkeypox, officials said. Rather, those vaccines will be used among a small number people who have been exposed.

Still, CDC officials cautioned that more cases are likely, and the agency is now raising awareness among men who identify as gay or bisexual.

"I think that we need to pay close attention to the communities in which this might be circulating, so that we can communicate effectively with them and help bring this outbreak under control," McQuiston said.

Monkeypox is not a sexually transmitted infection, and anyone can become infected regardless of sexual orientation.

The virus, a less-transmissible cousin of smallpox, is passed through close contact with another person, including hugging, touching or prolonged face-to-face contact.

An early cluster of monkeypox cases in London was among a nuclear family who lived in the same household.

But health officials say many early clusters in Europe and Canada happened among groups of men who have sex with men, with some ongoing transmission reported in this community.

"Anyone -- anyone can develop and spread monkeypox infection," Dr. John Brooks, medical epidemiologist, Division of HIV/AIDS Prevention at the CDC, said. "But, many of those affected in the current global outbreak identify as gay and bisexual men. We want to help people make the best-informed decisions to protect their health."

Specifically, the CDC is now warning people to watch out for a distinctive rash in the genital region, which could be confused with an STI.

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FDA advisers to meet to discuss COVID-19 shots for kids, vaccines for fall

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(NEW YORK) -- In the wake of Pfizer's new pediatric COVID-19 vaccine data for children under the age of 5, which was released on Monday, the Food and Drug Administration has set new, tentative dates for when its advisers will meet to discuss the COVID-19 vaccine applications for children.

The FDA said it expects its independent Vaccines and Related Biological Products Advisory Committee to convene in mid-June to discuss both Pfizer and Moderna's pediatric COVID-19 vaccines.

"As we continue to address the ongoing COVID-19 pandemic, there are a number of anticipated submissions and scientific questions that will benefit from discussion with our advisory committee members," Dr. Peter Marks, director of the Center for Biologics Evaluation and Research, said in a statement on Monday.

Although children 5 years and older already have access to a COVID-19 vaccine -- and now a booster shot -- through Pfizer's two-dose vaccine, on June 14, the committee will meet to discuss Moderna's emergency use authorization request for children ages 6 to 17 years of age.

The next day, on June 15, the committee will meet to discuss both Moderna's emergency authorization request for children ages 6 months to under 6 years of age and Pfizer and BioNTech's authorization request for children ages 6 months to under 5 years of age.

The new dates confirm the FDA anticipates that its advisers will review both Moderna and Pfizer's applications for young children at the same time, which would indicate that both vaccines could be authorized by the end of June.

The FDA emphasized the dates are tentative, but officials noted that should any of the submissions be completed in a "timely manner and the data support a clear path forward following our evaluation," the agency will move forward and convene the committee at an earlier or later date.

On June 8, 21 and 22, the FDA has held dates for its advisers to meet to discuss updates to the Moderna and Pfizer-BioNTech emergency use authorization requests. As more data and information is submitted by the companies, additional scheduling details will be released, officials wrote.

"The agency is committed to a thorough and transparent process that considers the input of our independent advisers and provides insight into our review of the COVID-19 vaccines. We intend to move quickly with any authorizations that are appropriate once our work is completed," Marks said.

Ahead of an anticipated fall and winter surge, the FDA also announced new dates for the committee to discuss a possible new generation of COVID-19 vaccines, which could address already circulating variants.

The FDA also plans to convene its advisers on June 28 to discuss whether the COVID-19 strain composition of the vaccines should be modified for the fall.

Federal regulators are expected to decide on a new COVID-19 vaccine design in early July, which would allow vaccine companies to begin production for rollout this fall and winter.

"We'll have to make some decision by early July to make sure that the manufacturers know what we're looking to do, so that they know what they have to start producing in large quantities," Marks told ABC News in an interview, last week.

Additionally, the FDA's advisers are expected to meet on June 7 to discuss an EUA request for a COVID-19 vaccine manufactured by Novavax to protect against COVID-19 in individuals 18 years of age and older.

Novavax asked for emergency authorization of its protein-based vaccine earlier this year in January.

Novavax was part of the Trump administration's Operation Warp Speed -- the multibillion-dollar program that was created at the onset of the pandemic to quickly bring safe and effective vaccines to market.

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Pfizer three-dose COVID vaccine 80% effective against symptomatic omicron infection for youngest children

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(NEW YORK) -- In long-awaited data, Pfizer said its three-dose vaccine was 80% effective against symptomatic omicron COVID-19 infection among children 6 months to under 5 years old.

The company cautioned that estimate was preliminary and could be adjusted as more data is collected. The trial wasn't big enough to estimate protection against severe disease, which experts expect to be higher.

For all age groups, vaccine efficacy against more mild breakthrough infections waned in the face of the highly transmissible omicron variant, but efficacy against severe disease and death remained high for most age groups.

Pfizer announced in December that it would not move forward with a two-dose vaccine after disappointing data, instead opting to study three doses for this age group. The company will submit the new data as part of its ongoing “rolling” submission to the FDA.

For anxious parents, the Pfizer news offers reassurance that the vaccine help protect young children currently not eligible for vaccination.

In the wake of Pfizer's new pediatric COVID-19 vaccine data, the Food and Drug Administration (FDA) has set a new, tentative date of June 15 for its advisers to discuss the COVID-19 vaccine applications for young children, meaning both vaccines could potentially be authorized by the end of June.

Pfizer also said its vaccine was safe, with a similar safely profile as placebo shots. If authorized, this vaccine would be three shots of 3 micrograms each. Each dose is one-tenth the adult dose.

Moderna's shot, if authorized, would be two doses, with each dose a quarter of the adult dose. Moderna is also studying a third shot for young children.

“We are pleased that our formulation for the youngest children, which we carefully selected to be one-tenth of the dose strength for adults, was well tolerated and produced a strong immune response,” said Albert Bourla, Pfizer's chairman and chief executive officer, in prepared remarks.

Moderna, meanwhile, asked the FDA for authorization on April 28 for a two-dose vaccine for this age range. Moderna’s preliminary analysis found its two-dose pediatric vaccine was 51% effective against symptomatic COVID-19 among children 6 months to under 2 years old, and 27% among children 2 to 5 years old -- roughly the same efficacy seen in adults during the omicron surge. Protection against serious disease and death was higher.

"I anticipate a lot of parents will be asking whether they should choose a two-dose Moderna vaccine or the three-dose Pfizer vaccine," said Dr. Alok Patel, pediatric hospitalist at Stanford Children's health and an ABC News contributor. "I would recommend that parents pay attention to the FDA and CDC’s guidance and what final analysis reveals for both vaccines."

Experts caution that vaccine efficacy against symptomatic infection is a high bar, and experts expect these vaccines will offer excellent protection against severe illness, just as they do for adults.

Though children under five is the last remaining age group that’s yet to be vaccinated, polls indicate there could be sluggish uptake.

A recent survey from KFF found that just under 1 in 5 parents are eager to get their children under five vaccinated right away.

However, the KFF poll more than half of parents said that they feel they do not have enough information about the vaccines’ safety and efficacy for children under age 5 — which could change after the public FDA advisory meetings to discuss the pediatric data.

"Parents should also be aware that this preliminary data will be supplemented by additional data in June, which will then be thoroughly reviewed by both the FDA and the CDC," Patel said.

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