Combatting Crime: AG James and Mayor Adams

AG James and Mayor Adams Take Down Massive Retail Theft and Crime Operation

NEW YORK: New York Attorney General Letitia James and New York City Mayor Eric Adams on May 26, announced the takedown of a massive retail theft operation in New York City that stole and resold millions of dollars in goods. As outlined in the indictment unsealed today, 41 people were charged for their roles in this crime ring that stole luxury clothing and goods and thousands of items from drug stores that were then resold on eBay. During the three-year joint investigation conducted by the Office of the Attorney General’s (OAG) Organized Crime Task Force (OCTF) and the NYPD’s Grand Larceny Division, law enforcement seized more than $3.8 million worth of stolen retail items from the enterprise’s alleged boss, Roni Rubinov, more than 550 stolen gift and cash cards, and more than $300,000 in cash. The defendants are being charged with various counts of enterprise corruption, money laundering, criminal possession of stolen property, scheme to defraud and conspiracy. “Today’s takedown of this massive retail theft operation is part of our continued efforts to combat crime and restore an environment where all New Yorkers feel secure,” said Attorney General James. “These individuals stole millions of dollars in luxury goods and cleared the shelves of drug stores in the communities we live and resold these goods for great profit. We will continue to work with our partners in law enforcement to crackdown on crime and protect all our communities.” “Today we are showing that New York City will not tolerate crime — street crime, retail crime, or organized crime,” said Mayor Adams. “Public safety is the prerequisite to prosperity, and so we want to be clear that we will investigate, arrest, and prosecute criminals when they break the law. This wasn’t just shoplifting, but people going into stores and clearing off shelves as part of an organized crime ring. This massive retail-theft scheme affected every level of our economy, from department stores to big chains to independent businesses — all of whom were already impacted by the COVID-19 pandemic. I want to thank Attorney General James for her partnership, the NYPD, and all our partners for working to make New York safer, stronger, and more prosperous.” “The NYPD is committed to stopping anyone — and any enterprise — that threatens the well-being of the people we serve,” said Police Commissioner Keechant L. Sewell. “We are proud of this long-term, intelligence-driven investigation and of our partnerships with the Attorney General’s Office, Homeland Security Investigations, and everyone who worked together to dismantle this criminal operation and arrest and prosecute its alleged participants to the fullest extent of the law.” “Organized retail crime goes well beyond the obvious financial loss for retailers,” said Melissa O'Connor, president and CEO, Retail Council of New York State. “This activity has become a serious community safety issue and, unfortunately, it has gotten more prevalent over time. I want to thank Attorney General Letitia James for holding these crime syndicates accountable to the full extent of the law. This sends a bold message to those who continue to engage in unlawful and dangerous acts in local stores throughout the state. Our top priority is the safety of our employees and customers.”l

New York, NY - May 26, 2022: Mayor Eric Adams speaks during joint announcement with Attorney General Letitia James at AG New York office. Editorial credit: lev radin / Shutterstock.com

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Black Agenda/ continued from page 1 bills would increase access to doulas and midwives, convene a task force to chart a path to achieve universal child care in New York City, prohibit discrimination against rent-regulated and rent-subsidized tenants, and declare June as Caribbean Heritage Month. In ‘A Black Agenda for New York City,’ Council Member Hudson outlined issue areas and policy priorities aimed at tangibly improving the socio-economic and material well being of Black New Yorkers, including six bold recommendations like a universal basic income for residents of the ZIP codes with the highest rates of gun violence and putting money directly in the hands of poor Black New Yorkers via baby bonds and a paycheck guarantee. Her agenda included a call for a citywide doula program so that all people giving birth can access a doula or midwife regardless of their ability to pay, the creation of a universal childcare system in New York City, housing support for Black residents, and support for Black artists and cultural organizations. These four bills move our City closer to realizing the just and equitable future we all deserve. “This Council is faced with the opportunity to enact meaningful policies that will deliver true, tangible change for everyday New Yorkers and improve the material conditions of the most vulnerable among us,” said Council Member Crystal Hudson. “My ‘Black Agenda for New York City’ is a roadmap for this legislative body to deliver immediate and equitable solutions to some of the most pressing issues facing our City, from housing and education to childcare and public safety. The policy recommendations put forth in the ‘Black Agenda,’ some of which we will begin to pursue with these introductions are critical to making our City a more compassionate place for all. When we are deliberate in offering care to our most marginalized–many of whom are our Black neighbors–we ensure our entire City thrives.”

Doula Access Bill This bill, co-prime sponsored by Council Member Jennifer Gutiérrez, would require the Department of Health and Mental Hygiene to conduct an education and outreach campaign about services offered by doulas and midwives to ensure all New Yorkers know of free and lowcost resources. The bill requires the agency to disseminate written materials and publish a report that outlines the methods of outreach used to comply with the law, which would take effect 120 days after becoming law. “Having recently experienced childbirth, I feel strongly about the benefits that doulas and midwives offer to improve the birthing process,” said Council Member Jennifer Gutiérrez. “Not only can they provide emotional, physical, and educational support, but they also provide another advocate in the room who can ensure a positive and safe birth. Additionally, well-trained doulas are positioned to advocate for women of color in ways that have been shown to help reduce contributing factors of maternal mortality. I’m proud to be introducing legislation with Council Member Hudson to increase awareness of doulas and midwives, promote the benefits they offer to birthing people, and create opportunities for those giving birth to make decisions about their own body and baby, which could save lives.”

Universal Child Care Task Force This bill, co-prime sponsored by Council Member Julie Menin, will create a specific task force with the sole responsibility of investigating mechanisms to make child care more affordable and accessible to all. It would also review how the City could provide additional funding and resources to providers and child care professionals to support their work. No later than 270 days after the law goes into effect, the task force would be required to submit a report, put forth recommendations for establishing universal child care for all children ages five and under, and publish it on the Department of Health and Mental Hygiene website. The law would take place immediately upon passage. "New York City is facing an affordable childcare crisis of astronomical proportions. As we envision the future of our City, we must strengthen the support systems needed to meet the demand for high quality, affordable and equitable childcare,” said Council Member Julie Menin. “Providers around the City severely lack resources and cannot adequately pay and retain qualified staff. This crisis has a ripple effect on many aspects of our daily life. Studies have shown that children who are well cared for have greater success later in life and parents who can afford childcare are more productive members of society. Affordable childcare is the foundation upon which we rebuild from the aftermath of the pandemic. One of the wealthiest cities in the world must take steps to address the need for affordable, high-quality early childhood care.”

Rent Regulation Discrimination This bill, sponsored by Council Member Kristin Richardson Jordan — and introduced last session by Council Member Helen Rosenthal — would ban landlords and building owners from discriminating against rent-regulated and rent-subsidized tenants by limiting access to elements of their building, including entrances, facilities, and amenities like gyms, game rooms, outdoor lounges, or laundry facilities. It would also ban fees levied against rent-regulated tenants that are not levied against market-rate tenants for facilities or amenities. The law would take effect 120 days after it becomes law.

Caribbean Heritage Month This resolution — co-prime sponsored by Public Advocate Jumaane Williams and nearly two dozen other Council Members — will declare June as Caribbean Heritage Month. Currently, there are more than 861,000 residents across the five boroughs who are Caribbean-born, most of whom are from the Dominican Republic, Jamaica, Haiti, and Trinidad and Tobago. New York City has some of the most diverse Caribbean communities outside of the Caribbean itself and one of the most impactful, as many New Yorkers of Caribbean heritage and Caribbean immigrants served our City as front-line workers during the pandemic. In 2006, then-President George W. Bush signed a proclamation declaring June as Caribbean Heritage Month. Now, the City Council must follow suit and honor the contributions of the Caribbean diaspora to our City. “As a proud Caribbean-American, as a first generation New Yorker, I’m honored to partner with Council Member Hudson and so many of my colleagues in this push to officially designate June as Caribbean-American heritage month in our City,” said Public Advocate Jumaane D. Williams. “The diversity of cultures that the Caribbean represents–the people, the music, the cuisine, the traditions–is as rich as it has been influential to the people who are honored with Caribbean roots, and to the City of New York. Our culture is one of vibrancy, of life, of facing hardship and persevering. These are values our City should celebrate.”l

CM Kristin Richardson Jordan partnered with CM Hudson on Rent Regulation Discrimination. Photo: NYC Council Public Advocate Jumaane WIlliams partnered with CM Hudson on Caribbean Heritage Month. Editorial credit: a katz / Shutterstock.com

Hotel Workers Exploited/ continued from page 1 places and locations. One of the critical things associated with travel is hospitality, explicitly staying in hotels and resorts.

Hospitality Business and COVID-19 Pandemic Like other businesses, the sector experienced significant changes driven by the pandemic. Before COVID-19, hotels ran various services that catered to their customers' needs. They had much staff, including housekeepers, to ensure that their customers had the best experience while on their property. These jobs served as a source of livelihood for many immigrants, especially women. However, travel restrictions and country-wide lockdowns greatly impacted the industry during the pandemic. Thus, forcing players within the sector to reinvent themselves. During the period in the United States, some hotels voluntarily became alternative facilities. They provided accommodation for hospital networks and healthcare staff, allowing them to reduce their commute times and hosting emergency staff. They focused on implementing thoughtful and strategic practices that helped protect their cash position, including staff furloughing, layoffs, and catering to the customers' changing needs, which lasted beyond the pandemic. Housekeeping policies varied across U.S. hotel companies. Many updated their cleaning guidelines to follow the Centers for Disease Control and Prevention guidance. Which stated that hotels should not clean guestrooms occupied by the same customer over multiple days unless requested. At the time, to enforce safety protocols and promote social distancing, many hotels switched to offering room cleaning only if a guest requested or after staying a certain number of days. The hotel guests could leave trash outside their door and call the front desk for clean towels. Other hotels started experimenting with less frequent cleaning to promote sustainability, which became more widespread early in the pandemic.

Post-Pandemic However, it's been two years since the pandemic, and Aon's survey reports that over 35% of hotels expect to recover in this time and beyond. Many hotels across the United States, including 4-star hotels like the Hilton Hawaiian Village, have maintained the same operation by no longer offering daily housekeeping services like trash collection, replacing the bed linen, wiping furniture, cleaning toilets, and bathtubs except requested. Even as safety restrictions fade and demand grows across the country as travel season peaks, many hotels keep their new cleaning policies.

Reasons for New Cleaning Policies Hotel management, in their defense, claims customer preferences drive the policies. At the same time, other stakeholders defer in opinion. They say that management's quest for profit is influencing the new policy. They cited that there has been no staff hired in over two years. Instead, they remain in 'on-call' status, where many await a call to confirm there's work for them. In an interview with ABCNews the UNITE HERE Hotel Workers Union President, D. Taylor said, "The policy is about more money in the owners' pocket. They put a greater workload on frontline workers and eliminate jobs." In an interview with the Associated Press, President & CEO of the American Hotel & Lodging Association, Chip Rogers, said it was the demands of guests and not hotel profits that guided decisions about pandemic housekeeper services. "Many guests, to this day, don't want people coming into their room during their stay," he said. "To force something onto a guest that they don't want is the opposite of working in the hospitality industry." Furthermore, he explained that the pandemic changed the standard of most hotel guests wanting daily cleaning. He said it's not clear if that will result in a permanent shift.

Impact on Immigrants & Exploited Workers While many housekeepers have lost their jobs due to the reduced work, others still employ them, revealing that they have fewer hours with a gruesome workload. Most of the unemployed and overworked housekeepers are mainly immigrant women. They are still confronting the aftermath of lost work caused by the pandemic's shutdowns.

continued on page 13

Hotel Workers Exploited/ continued from page 12 In another report by the Washington Post, they spoke to Luis Espejo about the effect of the policy change. "It's a big change for us," she said, "We are so busy at work now. We cannot finish cleaning our rooms." Brian Figeroux, Esq of Ask the Lawyer Radio Program (www.askthelawyer.us) spoke on the issue of exploited hotel workers: "When we come to America, we want to improve our lives. We want to earn more income to help ourselves and the families that we left behind in those different corners of the globe. We are black, and we are Latino. We have different languages, but we all came here for the same purpose. Now, the Welcome to Americait varies. What does Welcome to America mean? Who are welcome to America? What is our plight here? How are we treated? And if we look at the different types of workers that contribute to America, we need to understand those workers' experiences. One of the areas that we work in is as hotel workers, whether in the north, the south, the east, or the west. We clean hotel rooms, and cleaning hotel rooms is no easy task. They are dirty. People with more wealth stay in those rooms. The rooms that we clean may not even be able to afford to stay in those rooms, except obviously, if we are cleaning them. A couple of years ago, many Jamaicans who came to the south had a lawsuit against those hotels stealing their wages. Imagine that you are a hotel worker from another country. You're here on the H-2B visa. Imagine those who came here without inspection working, undocumented in these hotels. So, what they did was give us a number of rooms to clean within 8 hours. That wouldn't take 8 hours but will take at least 16 hours. So, half our wages will go because it's not physically possible to clean these hotel rooms in 8 hours. It requires 16 hours. And since the pandemic, many of these workers were not working because hotels were shut down. Many of these workers, Black, Latino, and Asian, have been exploited. And what does exploitation mean? Again, given a task to do in 8 hours that requires 16 hours. Sometimes the equipment used is not modern, so it takes even longer. And these workers work very hard. And the money that they get goes back to their home countries. In Jamaica, the number one foreign currency earner is remittances. In Mexico, it's over $22 billion a year. And the list goes on the countries that we come from that we send money back. In fact, we say that many of us have barrel children back home. What does that mean? Those children depend on the barrels that we stuff with food and clothing, and other things for them to survive at home. Sometimes entire villages in other countries where our children live depend on remittances for good economic activity. And the countries need that foreign currency to purchase goods and food services from other countries because that's how you pay for goods and services in our country using the U.S. dollar reserves. We need to have unions that can protect them. We need nonprofit organizations that will help them with essential services like learning how to speak English, whether they're from Haiti, which is close to us, or Latino countries. We must think about those people. Because no one is thinking about them."

Hotel Housekeeping Policies & Unions Generally, housekeeping policies vary across hotel establishments based on the type of hotel. For instance, luxury hotels provide daily housekeeping unless guests opt-out of the service. Some guests prefer not to request housekeeping during their stay, choosing to pick up after themselves. While many hotel brands outside of the luxury, five-star market are shifting toward an opt-in model for daily housekeeping. However, unionized hotel workers are trying to get the message across to guests that when they turn down daily room cleaning services, it threatens their jobs and source of livelihood. In some locations such as New Jersey, hotels are required by law to offer daily cleaning, which some guests still turn down, while New York does not have an explicit policy addressing the issue, thereby jeopardizing the housekeepers' jobs, "When I come home from work now,

continued on page 14

Hotel Workers Exploited/ continued from page 13 "says Martha Bonilla of New Jersey, "I only want to go to bed because I am physically exhausted." So, she asks guests to demand daily cleaning to make her job less tedious. The hotel housekeepers further shared that when the hotel rooms are unclean for days, it is harder for them to restore the room to the pristine state that most guests expect when they check-in. According to Elvia, another hotel housekeeper, "The work becomes harder if you don't clean a room for many days," she said. "You will have several days of scum in the bathrooms," she added. In some cases, working fewer hours means fewer benefits or not qualifying for additional benefits such as health insurance. Several workers in this category consider leaving the job but can't because they have children in school. There are fewer job options with conducive flexible hours for workers with younger-aged school children. Politicians should address this hotel policy. They should advocate for the poor working conditions and other affected workers, mostly immigrant workers. Several first and second-generation immigrants work as housekeepers and are affected by the non-daily room cleaning policy. As guests, returning to a clean hotel room is part of the paid experience and should not be a hassle while on a trip. Every guest should be aware of the consequences of taking up your hotel's 'opt-out' housekeeping policy. It means returning to a room with no clean towels, a messed-up bed, trash, and a dirty bathroom. While such minor incidents can affect a guest's broad experience, ideally, it shouldn't be a concern. You pay as a hotel guest to be pampered rather than bothered about the room's state and towels. Despite the acclaimed staffing shortages, respect for social distancing, or management's way of saving money, a hotel differs from home, and maintaining topnotch housekeeping services is critical. Therefore, next time you decide to 'opt out' and accept alternate room cleaning, remember that you are encouraging sub-standard services. You have accepted to stay in filthy rooms, facilitated painful workloads for few hired staff members, and lost income for hotel housekeepers and immigrants.l

Parole Requests in Response to the Shooting in Uvalde, Texas

Editorial credit: Jinitzail Hernandez / Shutterstock.com

If you are seeking parole into the United States for yourself or someone else to attend a funeral or provide emergency assistance to a family member affected by the shooting at Robb Elementary School in Uvalde, Texas, submit a request for urgent humanitarian or significant public benefit parole by filing Form I-131, Application for Travel Document. You should provide evidence of the relationship to the affected family member, a completed Form I-134, Declaration of Financial Support, and any other evidence required to support the parole request. Please write “Uvalde” on the top right of your Form I131 and include a cover sheet on top of the application package that indicates “Uvalde.” USCIS is exempting the Form I-131 fee for those requesting parole in response to the Uvalde shooting. To request expedited processing, please email humanitarianparole@uscis.dhs.gov after submitting the Form I-131 package. Please write “Uvalde expedite request” in the subject line.l

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Summer Glow Up: Cosmetic Surgery Dos and Don’ts

What are the best cosmetic procedures to consider doing right now? Which treatments should be avoided? “Avoid resurfacing procedures, laser treatments, body surgery and neck treatments (if you care about looking a little swollen in public),” advised top New York City plastic surgeon Dr. Richard Westreich. “Summer is the time for noninvasive face and body treatments since you can't cover up!” He added that breast augmentations can be done year-round, and laser treatments should be planned for October or November. Whatever procedure you’re considering, due diligence is still the best defense against potential post-op problems, he cautioned. “My best advice to people is to go back to the mindset before the Zoom boom,” he said, explaining that virtual consults have streamlined the process and tightened the timeline between concept and completion. “Don’t rush into something just because it’s easy or convenient.” Popular procedures include breast augmentation, liposuction, rhinoplasty, eyelid surgery and facelifts. Less invasive procedures like Botox injections are skyrocketing. If you’re considering any cosmetic procedure, these safety tips from Dr. Westreich can improve your chances of a better outcome: Tip 1: Make sure any doctor you schedule through a virtual visit allows you to cancel AFTER an in-person meeting for surgery. There is no substitute for face to face. Tip 2: Your health doesn’t belong in the bargain bin. Tip 3: Medical tourism can be dangerous. Laws may differ; regulations may differ; problems with after care may arise. Tip 4: Understand informed consent. Ask for examples of not only the good outcomes but also the potential bad ones. Ask for data specific to the procedure and the doctor performing it (complication rates, death rates). Tip 5: Surgery belongs in accredited operating rooms. Ask to see accreditation certificate (AAA, AAAA, JCAHO). Tip 6: Make sure the board certification of a doctor makes sense for the procedure they are performing. Tip 7: If significant issues arise after a procedure (surgery or office injection), seek a second opinion on management.l Dr. Richard Westreich can be seen regularly on several national news programs, including ABC, CBS, FOX and Newsmax.

Kitchen Corner

This is a quick and easy shrimp kabob recipe, perfect for beginners. Requires minimal ingredients, but is bursting with flavor. Serve over a bed of rice with fresh lemon wedges.

Darlene Gould, AllRecipes.com

Ingredients 1 pound frozen shrimp, thawed and peeled ¼ cup olive oil 1 tablespoon minced garlic 2 teaspoons lemon juice ¼ teaspoon pepper 1 pinch finely chopped parsley metal skewers cooking spray

Directions Step 1 Rinse and dry shrimp.

Step 2 Whisk olive oil, garlic, lemon juice, pepper, and parsley together in a bowl and pour into a large resealable plastic bag.

Garlic Shrimp Kabobs

Add shrimp, coat with the marinade, squeeze out excess air, and seal the bag. Marinate in the refrigerator for 2 hours. Step 3 Preheat an outdoor grill for medium heat and lightly oil the grate. Lightly coat metal skewers with cooking spray.

Step 4 Remove shrimp from the marinade and shake off excess. Discard the remaining marinade. Place about 5 shrimp on each skewer.

Step 5 Cook on the preheated grill until shrimp are bright pink on the outside and the meat is opaque, about 5 minutes; do not overcook.

Cook's Note Wooden skewers may be substituted for metal skewers, if desired. Before using, soak wooden skewers in water for15 minutes to prevent them from catching on fire on the grill.

Editor's Note Nutrition data for this recipe includes the full amount of marinade ingredients. The actual amount of marinade consumed will vary.

Nutrition Facts Per Serving: 141 calories; protein 12.4g; carbohydrates 0.7g; fat 9.7g; cholesterol 115mg; sodium 132.8mg. l Prep: 15 mins Cook: 5 mins Additional: 2 hrs Total: 2 hrs 20 mins Servings: 6

GENERATIONS

16 A Pandemic Lesson: Older Adults Need to Go Back to Their Doctor and Make Preventive Care a Top Priority

BY LAURIE ARCHBALD-PANNONE THE CONVERSATION

Older people have borne a higher burden of illness and death from COVID-19, with people 65 and older experiencing higher rates of hospitalization and death. That’s only part of the sad story, however. In many instances, older people stopped seeing their doctors, and standard clinical care for their chronic medical conditions and preventive care was postponed. When medical clinics reopened, after initial shutdowns in the spring of 2020, many patients didn’t return. National surveys and the Centers for Disease Control and Prevention have shown that nearly a third, or about 32%, of U.S. adults reported delaying routine care because of the pandemic from March to July 2020. In fact, a national survey from the Harvard School of Public Health, the Robert Wood Johnson Foundation and NPR found that one in five U.S. households had trouble getting medical care when they needed it during the coronavirus outbreak. That was most often because of challenges getting an appointment, which resulted in poor health outcomes in more than half, or 57%, of the cases. While care for medical emergencies is critical, preventive care is also important to optimize health, especially among older adults. As a geriatrician and professor of medicine, I think one of the best things the U.S. health care system could now is focus on preventive care, particularly for older adults.

Care beyond COVID-19 vaccines Because of their vulnerability to COVID-19, older Americans were first in line for COVID-19 vaccines as they became available to the public. That aligned perfectly with public health prevention strategies. Vaccination for older adults, including those for influenza, shingles and pneumonia, is a key component of preventive care. For older adults, though, there’s more to preventive care than vaccination. Preventive care is an important piece of health care, in keeping with the patient’s other medical conditions and goals of care. Preventive screening in older adults should be based on a personalized prevention plan between the patient and their doctor. Preventive screenings ideally identify issues before problems occur – talking about living alone, change in memory, any falls and who is around to help out when needed. For people over 65 years old who have Medicare Part B for 12 months, Medicare allows for an annual wellness visit once every 12 months, often at no cost. The Medicare annual wellness visit differs from a regular follow-up appointment for chronic medical conditions. This visit is fully focused on health risk and prevention. With the changes from the COVID-19 pandemic, your doctor or health care provider can even do it as a telemedicine video visit. The focus of this visit is on preventive care and health. It includes: •A review of your medical and family history •Development or updating of a list of current providers and prescriptions continued on page 18

HEALTH

17 Nasal COVID-19 Vaccines Help the Body Prepare for Infection Right Where it Starts – In Your Nose and Throat

BY MAYURESH ABHYANKAR THE CONVERSATION

Imagine inhaling just a few drops of liquid or mist to get protected from COVID-19. That is the idea behind nasal COVID-19 vaccines, and they have been getting a lot of attention recently as a spray or liquid. These nasal vaccines would be based on the same technology as normal vaccines given by injection. But as Mayuresh Abhyankar, a University of Virginia researcher who studies infectious diseases and works on nasal vaccines, explains, vaccinating someone right where the coronavirus is likely to start its attack comes with many immunological benefits.

1. What are nasal vaccines? Nasal vaccines are administered, as the name suggests, through the nose. More accurately called intranasal vaccines, these vaccines are liquids that can be given as a spray or through a dropper or syringe. The most common nasal vaccine is FluMist, a nasal spray that uses inactivated flu virus to protect against influenza. An intranasal vaccine could be a weakened live virus similar to FluMist, a nucleic acid vaccine like mRNA coronavirus vaccines or a protein vaccine like Hepatitis B vaccines or the CorbeVax coronavirus vaccine. Intranasal vaccines are best suited to protect against pathogens that enter through the nose, like the flu or the coronavirus. By mimicking the first step of natural exposure to an airborne pathogen, these vaccines help train a person’s immune system at the potential place of infection. Scientists have shown that the first immune response in the respiratory tract after a person is exposed to an airborne virus can influence how sick a person gets. So in theory, intranasal vaccines could provide better protection than vaccines given through a shot in the arm.

2. How does the coronavirus infect people? SARS-CoV-2, the virus that causes COVID-19, usually enters the body through the nose and lands on the mucus membrane at the back of the nasal passage and in the throat. The virus then enters the cells it touches, replicates and spreads. Just underneath these cells of the mucus membrane are many types of immune cells that form what is called the mucosal immune system. Cells of the mucosal immune system are the first to identify invading coronavirus particles and start mounting a protective response. In an unvaccinated individual, it takes about two weeks for these immune cells to build up a protective response after encountering the coronavirus. By that time, the virus can easily have infected other body parts, like the lungs, which can lead to severe disease. Nasal vaccines follow a lot of the same steps. When you inhale a nasal vaccine, the particles land on the mucus membrane in your nasal cavity or the back of your throat, enter the cells in those places and trigger an immune response. This process teaches the body about the coronavirus and allows it to deal with any continued on page 18

A Pandemic Lesson/ continued from page 16

•Height, weight, blood pressure and other routine measurements •Detection of any cognitive impairment •Personalized health advice •Assessment of risk factors and treatment options •Advance care planning •A schedule or checklist for appropriate preventive services, such as screenings and vaccines

There’s no need to worry if you didn’t see your doctor in the past year. I’m sure they’d be happy to hear from you and work to keep you healthy. So, call your doctor or health care provider today to schedule an appointment, and ask whether you are eligible to schedule a Medicare annual wellness visit. As the nation begins to move past the highest case numbers and mortality of the COVID-19 era, the health care system and patients need to focus on optimizing health.l Nasal COVID-19 Vaccines/ continued from page 17 future real infections.

3. How are nasal and intramuscular vaccines different? When you get a COVID-19 shot in your arm, the vaccine triggers a strong immune response in the cells near where you got the shot. It also causes your immune system to produce some coronavirus-specific antibodies and other immune cells in other locations throughout your body. When the coronavirus begins infecting cells in a person’s respiratory tract, the immune cells nearby will start mounting a defense. Your body will also send antiviral immune cells and antibodies from other locations to the site of infection. But by the time enough coronavirus-specific immune cells gather around the infection site to stop the virus from replicating, the virus has likely already begun to spread throughout the body, making it difficult for the immune system to keep up. Nasal vaccines mimic the virus in order to prepare the immune system against a virus, just like any other vaccine. But importantly, they mimic the process of infection, too, and boost protective response within the mucosal immune system of the nose and throat. In simple terms, intranasal vaccines are like knowing there is going to be a break-in and putting your guards in the right location before the trouble even starts. The science bears this idea out. In a head-to-head comparison, AstraZeneca’s COVID-19 vaccine provided greater protection in hamsters that were vaccinated intranasally compared to those vaccinated intramuscularly. Nasal vaccination could also be used in concert with intramuscular immunization. In a recent study, my colleagues and I gave some mice both a nasal and intramuscular vaccine and exposed them to a lethal dose of SARS-CoV-2 – 100% of these mixed-vaccinated mice survived, compared to only 10% of the unvaccinated mice. We are now testing if this mixed approach is superior to just intranasal or just intramuscular approaches on their own. Finally, intranasal vaccines are painless, noninvasive and do not require specialized training to use.

4. What are the risks of nasal vaccines? Getting the dosage correct can be harder with nasal vaccines than a shot, especially with young children. If someone has a stuffy nose or sneezes out a part of the vaccine before it’s completely absorbed, this can result in a lower-than-desired dose. There are some unique health risks too. All vaccines go through rigorous safety testing and clinical trials, but these processes are especially important for nasal vaccines due to the simple fact that the nose is close to the brain. In 2000,

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27.7% of people who received an inactivated intranasal influenza vaccine in Switzerland developed transient facial paralysis – also known as Bell’s palsy. Later, researchers found that a bacterial toxin added to the vaccine to enhance the immune response was the culprit. This is the only reported instance of neurological issues stemming from intranasal vaccines, but it is something to consider.

5. How long until intranasal COVID19 vaccines are ready? As of late May 2022, there are no approved COVID-19 intranasal vaccines for human use. There are currently seven in clinical trials, and three of them –manufactured by Beijing Wantai Biological Pharmacy, Bharat Biotech, and Codagenix and Serum Institute of India – are in phase-3 human trials. In the coming months, the results of these trials will not only show how safe these promising new vaccines are, but also if they perform better than the vaccines in use today. l Mayuresh Abhyankar is an Associate Professor of Infectious Diseases and International Health, University of Virginia

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