Monthly Archives: April 2020

Neal Browning receives a shot in the first-stage safety study clinical trial of a potential vaccine for COVID-19, the disease caused by the new coronavirus, Monday, March 16, 2020, at the Kaiser Permanente Washington Health Research Institute in Seattle. Browning is the second patient to receive the shot in the study. (AP Photo/Ted S. Warren)
Clinical trial led by Roswell Park, University at Buffalo will test effectiveness of anti-inflammatory drug

BUFFALO, N.Y. — Roswell Park Comprehensive Cancer Center and the University at Buffalo (UB) have launched a collaborative clinical trial that will make a new investigational treatment option available to local patients who are hospitalized and diagnosed with critical or severe COVID-19, the disease caused by the new Coronavirus, which has already sickened more than 163,000 patients in the United States. The study, led by Igor Puzanov, MD, MSci, FACP, of Roswell Park, will allow eligible patients at four local medical facilities to participate in a large international study of the anti-inflammatory agent sarilumab.

“Some of the ways that COVID-19 affects the body are similar to how cancer and auto-immune conditions affect the body, so we can draw on what we know from those fields to address the pressing challenge of how best to treat the novel coronavirus. We are applying the extensive expertise in immunotherapies and the immune response that we have here at Roswell Park and UB, hoping that we can improve outcomes for individual patients and dampen the pandemic’s impact on Buffalo and Western New York,” says Dr. Puzanov, Director of the Early Phase Clinical Trials Program and Chief of Melanoma at Roswell Park and overall Principal Investigator on the trial, who has done extensive work with a similar drug, tocilizumab.

“In March, the U.S. Department of Health and Human Services announced a partnership with Regeneron to support a U.S. clinical trial of sarilumab in certain COVID-19 patients,” says Congressman Brian Higgins, who has been speaking with researchers at Regeneron in recent weeks. “The selection of Roswell Park, and other local partners, as collaborators on this study brings promising potential COVID-19 treatment to local patients enrolled in this trial and continues the longstanding tradition of Roswell researchers being at the forefront of breakthrough science.”

Co-Principal Investigator Gene Morse, PharmD, of the UB School of Pharmacy and Pharmaceutical Sciences will oversee protocol activities for the three additional local sites invited to participate in this study: Erie County Medical Center, in collaboration with John Crane, MD, PhD, Professor of Medicine in UB’s Jacobs School of Medicine and Biomedical Sciences; and Buffalo General Medical Center and Millard Fillmore Suburban Hospital, in collaboration with Jamie Nadler, MD, also Professor of Medicine in the Jacobs School.

“As a career-long investigator in viral diseases, I am excited by the advances possible for treating COVID-19 and HIV by applying new knowledge learned about the immune system by cancer researchers. And how fortunate we are that world-renowned Roswell Park scientists like Dr. Puzanov are right here in Buffalo,” says Dr. Morse, SUNY Distinguished Professor in the UB School of Pharmacy and Pharmaceutical Sciences and Director of UB’s Global Virus Network Center of Excellence.

“This clinical trial, which came together in a matter of days, is a great example of how collaborative research moves farther and faster than work any one of our centers could achieve alone,” notes James Mohler, MD, a urologist who is Associate Director and Senior Vice President, Translational Research and Chief of Inter-Institutional Academics at Roswell Park. “We hope to announce soon clinical trials of other new or repurposed drugs to help patients suffering from COVID-19 in Western New York and elsewhere.”

The local trial will be part of a large international clinical trial sponsored by Regeneron and Sanofi, the companies that make sarilumab. The drug, also known as Kevzara, is a monoclonal antibody that inhibits the interleukin-6 (IL-6) pathway by binding and blocking the IL-6 receptor. While it has been approved by the U.S. Food and Drug Administration as a treatment for moderate to severe rheumatoid arthritis, experts believe IL-6 inhibitors may help to prevent or control the overactive inflammatory response in the lungs of patients who are severely or critically ill with COVID-19 — a hypothesis based in part on preliminary data from a study in China using the similar agent, tocilizumab.

“This strategy does not treat COVID-19,” notes Dr. Puzanov. “It’s designed to address some of its most damaging effects, caused by inflammation and cytokine storm. If it is proven effective in reducing or preventing severe lung injury in these patients, it could significantly reduce the need for ventilators. And that would truly be a big relief right now.”

The study is expected to enroll quickly and may only be open to new patients for a brief period.

Additional collaborative studies for COVID-19 and other diseases are anticipated through this network of clinical researchers led by Roswell Park and in collaboration with UB.

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Roswell Park Comprehensive Cancer Center is a community united by the drive to eliminate cancer’s grip on humanity by unlocking its secrets through personalized approaches and unleashing the healing power of hope. Founded by Dr. Roswell Park in 1898, it is the only National Cancer Institute-designated comprehensive cancer center in Upstate New York. Learn more at www.roswellpark.org, or contact us at 1-800-ROSWELL (1-800-767-9355) or ASKRoswell@RoswellPark.org.

 

The City of Buffalo is thinking ahead to the end of New York State’s PAUSE order by previewing proposals for its new normal.

Mayor Byron Brown announced a proposal to continue using a work from home and flexible scheduling model even after the order is lifted.

“It could create a dynamic where fewer people would be coming to City Hall every week,” he said “There’d be less cars on the road, there’d be less energy usage for heat, for electric, there’d be less waste being created, less paper that would have to be recycled and for those that have been concerned about parking in downtown — more parking availability.” “More importantly, it would keep our employees and citizens safer.”

It is part of the City’s proposal to reduce its carbon footprint by 40% in 2020.

We reached out to other large employers in the area to see whether similar discussions are being had.

A spokesperson for Erie County said it’s very early still, but when the PAUSE order is lifted “there will be a process to determine what the new normal will look like as it relates to the Erie County government workforce, but right now it’s all hands on deck to respond to the pandemic.”

And the University at Buffalo, another large employer in the region, said it is having discussions both at a local level and within the SUNY schools system about following suit. 

All discussions are preliminary and as far as the City’s plans it would have to be ironed out with the common council, workers’ unions, and the comptroller.

Monroe County’s death toll from the coronavirus surpassed 100 over the weekend with the announcement Sunday by county health officials that seven more people had died of the disease.

The total number of dead in the county stands at 106.

Officials on Sunday also confirmed 20 news cases of COVID-19, the disease caused by the virus, bringing the case count to 1,277 since the outbreak began. Of those patients, 594 have recovered and 577 of them are actively fighting the disease.

The number of daily active cases fell Sunday for the first time since April 13, when the case count dropped by 10 to 390 to 400. But it steadily escalated from there.

Officials will be watching to determine whether Sunday’s drop was a one-time blip or the start of a positive trend here.

The figures were revealed a few hours after Governor Andrew Cuomo spoke of re-opening New York.Workers in the construction and manufacturing industries will likely head back to work in the state’s first phase of reopening, which could come in less than three weeks, the governor said.

The second phase of the state’s reopening, to come later, is expected to drag out over a period of several weeks, with the state approving businesses to reopen on a case-by-case basis.

Cuomo said the first stage of reopening the economic could begin May 16 if the state’s COVID-19 numbers continue to trend in a positive direction. Those decisions will also be made on a regional basis, Cuomo said.

Even if statewide hospitalizations continue to decrease, a region with less favorable numbers may have to wait for their economy to reopen, Cuomo said.

“We’re assuming we’ll have seen a decline in the state for 14 days,” Cuomo said. “But, what regions of the state have seen a decline for 14 days — that’s where you will start the conversation to get to phase one within that region.”

Guidance from the U.S. Centers for Disease Control requires that states observe a 14-day decline in the prevalence of COVID-19 before they begin to reopen their economy.

The number of new hospitalizations in New York has declined for the last nine days.

Assuming that trend continues, New York will begin its first phase of reopening, on a regional business, by allowing construction to resume, and permitting manufacturers to continue operations.

Those businesses will be required to take precautions to prevent infection.

The second phase will be broken out into several different stages.

Businesses deemed by the state to be more essential than others, but also at a lower risk of spreading COVID-19, will be allowed to open first. The state will require, during the second phase, that businesses submit plans for reopening that explain how they’ll prevent further infections.

Regions will also be barred from allowing events or attractions that would draw a large number of visitors from another area, Cuomo said. That’s to prevent people from flocking to that area from another region, where the disease may be more prevalent.

From a statewide perspective, the disease continued to trend downward Sunday.

Aside from a decrease in hospitalizations from COVID-19, the net number of intubations also declined by 115 to 3,577. An additional 1,423 were discharged Saturday.

The total number of identified cases in New York reached 288,045, as of Saturday, according to the state. An additional 367 people died from the disease Saturday, bringing the statewide recorded number of fatalities to 16,966.

 

 

    The president of Erie Community College is leaving for a new position. ECC’s Board of Trustees has announced Dan Hocoy will remain through his contract, ending June 30, then move to Missouri.

    Hocoy has led ECC for only three years, after serving in various administrative roles in higher education over the last 20 years. He took over for former congressman Jack Quinn, who served as president from 2008 to 2017.

    Dan Hocoy is leaving Erie Community College to take a position in Missouri.
    CREDIT ERIE COMMUNITY COLLEGE

    Hocoy will assume the position of Vice Chancellor for Strategic Initiatives for Metropolitan Community College and President of MCC-Longview campus in July.  ECC said MCC serves 30,000 students across five campuses in the greater Kansas City area, while MCC-Longview is the only community college ever selected as TIME magazine’s College of the Year.

    “It has been a blessing to be back in the region of my childhood, which also allowed me to take care of my parents in their last days,” Hocoy said about his presidency. “And it has been my greatest honor to serve the College and work with our Board of Trustees, the County Executive and the Erie County Legislature. I have also enjoyed being part of the SUNY family, working closely with Senior Vice Chancellor of Community Colleges, Johanna Duncan-Poitier, as well as serving Chancellor Kristina Johnson and the great state of New York.”

    ECC Trustees Chair Len Lenihan said the Board is immediately undertaking plans for interim leadership, while beginning the process to form a search committee for the next president.

    “We are grateful to Dr. Hocoy for his valuable contributions to advance SUNY Erie over the past three years,” said Lenihan. “Dan has been able to bring financial stability to the College with balanced budgets and creating efficiencies that contributed to the highest reserves the College has ever seen. He was also able to move the College from “warning” into “good standing” with the Middle States Commission on Higher Education. His work to bring innovation and change to the College has been instrumental in helping us identify areas for growth and improvement that will benefit the College for a long time to come.”

     

    Congressman Brian Higgins (NY-26) announced residents can now check the status of direct payments provided through the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Today the U.S. Treasury announced the launch of the “Get My Payment” App, which allows Americans to track the status of their emergency relief funding and add bank direct deposit information if the Internal Revenue Service (IRS) doesn’t already have it on file.

    Higgins said, “With people out of work, household budgets are stretched thin.  Direct payments help support the most urgent needs of Western New Yorkers during this public health emergency.”

    Congress approved direct economic relief to Americans through the CARES Act on March 27.  The IRS will disburse a $1,200 payment to every eligible adult ($2,400 for joint filers), plus an additional $500 per dependent child up to age 17. Payments gradually phasedown for individual incomes exceeding $75,000, $112,500 for head of households, or $150,000 for joint filers. Once income surpasses these thresholds, the check amount is reduced incrementally.

    Higgins warned residents to beware of potential scams.The Treasury began distribution of this funding, delivering relief to approximately 80 million Americans this week.  For additional information visit the IRS direct payment webpage at:https://www.irs.gov/coronavirus/economic-impact-payments.

     

    G-Health Enterprises has always strived to transform healthcare by removing barriers created by social determinants of health in underserved communities. With all the news of COVID-19 case and death disparities in minority communities, this mission has become more important than ever. To that end, Dr. Raul Vazquez and his Value Based Payment team are leading the charge with The Community Response Plan.

    The Community Action Response Plan is GBUACO’s initiative to unite churches, community based organizations, and medical partners in Western New York for a comprehensive approach to combat the coronavirus and mitigate its effects on the community. To achieve these goals, they will be conducting outreach efforts to provide education and connections with primary care providers, social support, and community resources, launching accessible, multi-site testing centers to test high risk, symptomatic patients, utilizing tele-health and tele-monitoring systems to address the virus and maintain patient health, and creating a voluntary isolation unit within hotels to reduce the burden on hospitals and families for those with mild-to-moderate coronavirus symptoms.

    “Coronavirus shed light on social determinants of health which is what we have in many minority communities,” says Dr. Raul Vazquez, President and CEO of G-Health Enterprises. “I have been in practice for the last 30 years and some of this has changed and some of it hasn’t changed, which is sad. If you don’t have food, transportation, an apartment or stability in your life, then you aren’t going to check up on your health.”

    Testing is available for high risk patients of Urban Family Practice, all primary care providers in the GBUACO Network, and now to members of the community whose providers are outside of our network, in which case we will send the results your primary provider. If an individual has no primary provider, Urban Family Practice will make the appointment through them to ensure everyone has the option to get tested. Insurance covers COVID-19 tests and for those who do not have insurance and qualify for Medicaid, we can connect you with a GBUAHN outreach enroller who will help with insurance enrollment.

    Before visiting our COVID-19 testing locations, please complete a screening by our nurses to determine if you are eligible. You can begin this process by downloading the UFP, GBUAHN or GBUACO apps and filling out the COVID19 surveys or by calling our Nurse Advice Line 716- 604-0504.

    Anyone who is interested in becoming a part of the GBUAHN Health Home can inquire about eligibility by calling 716-247-5282 ext. 2128 or completing a referral on the GBAUHN website, gbuahn.org.

    Rochester Superintendent Terry Dade said Wednesday that he has inquired with a lawyer about breaking his contract with the Rochester City School District at the end of the academic year in June.

    He described his relationship with the Board of Education as strained and said its lack of support for him fueled his decision to leave.

    “The way a good district operates is we unify as leaders to identify what the problem is and then to collaboratively come up with solutions, and unfortunately that has not occurred,” Dade said.

    Dade became the troubled district’s sixth leader in 10 years in July, having arrived with high expectations from Fairfax County Public Schools in Virginia, where he was an assistant superintendent and led a turnaround effort for some of that system’s worst-performing schoolsHe expressed support for several initiatives in place in Rochester, including a common curriculum, relying more heavily on data to influence decisions, and restorative justice practices, which promote inclusiveness and relationship-building to solve problems. 

    But he has spent most of his roughly 10 months on the job attempting to plug budget deficits that stemmed from the district overspending in excess of $27 million last year prior to his arrival.  Consequently, he has laid off scores of teachers, and recently proposed $87 million in budget cuts that include more layoffs and reductions in cherished programs that have met with resistance from the board and the community at large. 

    Dade said he has had to shoulder the burden of balancing the budget without the backing of the board.

    “The way a good district operates is we unify as leaders to identify what the problem is and then to collaboratively come up with solutions, and unfortunately that has not occurred,” Dade said.

    Dade, whose annual salary is $250,000, signed a three-year contract with the board, a body with a reputation for running superintendents out of town. The board was harshly criticized in a 2018 report by a state-appointed education watchdog for micromanaging the district.School Board President Van White did not return a message seeking comment.

    Mayor Lovely Warren issued a statement decrying the board, and renewed her call for the state chancellor to step in and take over the district.

    “Today, yet again our school board and its enablers are putting their wants, and their salaries, before needs of the children they purport to serve,” Warren said.

    “It is a travesty that we would lose another superintendent, especially during the most severe fiscal crisis RCSD has faced,” her statement went on. “Again, rather than deal with a catastrophe of their own creation, the school board has attempted to disgrace and destroy another leader that dare speak the truth.”

    News of Dade’s departure followed a severe state comptroller’s audit of the district’s dire fiscal picture released this week that suggested district officials set the stage for financial ruin when they ran roughshod over their own cost projections in preparing the 2018-19 budget.

     

    Rochester, NY – Administrators at two Rochester health providers said Tuesday they are opening clinics in areas of the city where many people of color live.

    Jordan Health and Trillium Health officials said the clinics aim to give people of color easier access to testing and treatment for COVID-19.

    In the latest data from the county public health department, black people were more than half of those being treated for the disease in an intensive care unit despite being less than a quarter of the county’s population.“We need more testing focused on communities of color, so that we can identify and treat those that are sick earlier,” Mayor Lovely Warren said. “The testing being located within the community where people reside is very important.”

    The Jordan Health clinic opened Tuesday at Hudson Avenue and Holland Street, north of the Inner Loop. Trillium’s clinic will open next week at Monroe Avenue and South Union Street. Both clinics will be physically separated from the health centers they neighbor, and both will see patients only by appointment.

    Jordan and Trillium officials said the clinics offer care on a sliding cost scale.

    “No one should avoid care because they’re afraid of getting a bill,” said Dr. Laurie Donohue, Jordan Health’s chief medical officer. “The impact of poverty on health is huge,” Donohue said.

    County Public Health Commissioner Dr. Michael Mendoza said earlier this month that early data indicated people of color waited longer to seek treatment for respiratory symptoms than white residents in the county.

    On Tuesday, Mendoza said that better access to testing for communities with high proportions of racial and ethnic minorities would identify infections earlier. That would allow patients to be in touch with a doctor sooner and underscore the importance of staying isolated from other people, he said.

    Identifying the virus earlier is especially important for people with chronic illnesses, Donohue said.

    “We can catch the effects of this virus before they lead to emergent care, ICU care, intubation and ventilator need,” she said.

    High blood pressure and diabetes are the two most common underlying conditions in New York state COVID-19 deaths. Black people in Monroe County are four times as likely to be hospitalized for diabetes as white people.

    “Communities of color being the most ill patients when it comes to COVID-19 really reflects on the fact that we all need to do more,” said Dr. Robert Biernbaum, Trillium Health’s chief medical officer. “We need to ensure that their needs are going to be met.”

     

    ‘We are very worried about a surge. If we were to reopen like that, just snap the fingers and reopen, we would have a surge. I guarantee it,’ Mark Poloncarz said

    Now that Governor Andrew Cuomo has officially announced reopening will be done on a regional basis, many questions remain, such as: When will it happen, and how?

    Erie County Executive Mark Poloncarz said he’s already in conversation with Lt. Governor Kathy Hochul, who’s leading the effort for Western New York.

    “As she noted, we will not keep Erie County and Western New York closed any one day more than we need to, but we also won’t open it up any day earlier until it’s right,” Poloncarz said.

    Poloncarz explained reopening Western New York likely won’t happen at all once.

    “We all wanna get back to business as usual but we have to do it in such a safe manner which will probably mean a rolling opening of the community,” Poloncarz said.

    Dr. Thomas Russo, the chief of infectious disease at the University at Buffalo, said the regional approach makes sense.

    “We should only reopen when we get our cases down to zero, or as close to zero as possible,” Dr. Russo said, “and have the necessary amount of testing to be able to identify new cases if they arise and public health support to do contact tracing to really minimize a resurgence of new cases.”

    Poloncarz stressed, “We are very worried about a surge. If we were to reopen like that, just snap the fingers and reopen, we would have a surge, I guarantee it.”

    Even when state government and public health officials deem it appropriate to reopen, preventing further spread of the coronavirus will likely remain a top priority.

    Dr. Russo told 2 on Your Side, “I see that when we’re ready to reopen, I see a world with many, many people, and hopefully everyone wearing masks.

    “I think that’s gonna be one of the critical public health measures that’s gonna enable us to expand the types of things we’re doing, increasing interactions and minimizing the risks of the resurgence of new cases with the coronavirus.”

    When asked what it would take to reopen Western New York, Hochul added, “We need to keep an eye on the numbers, the test-positive cases, the number of hospitalizations or hospital capacity.”Right now in Erie County, we’re still seeing a gradual increase in the number of positive cases, we’ve expanded testing, which is also important. So, I want to see a flattening and a downward trajectory, first of all, so this will be driven by the data, because public health is our number one priority.”

     

      WASHINGTON (AP) — More than 4.4 million laid-off workers applied for U.S. unemployment benefits last week as job cuts escalated across an economy that remains all but shut down, the government said Thursday.

      Roughly 26 million people have now filed for jobless aid in the five weeks since the coronavirus outbreak began forcing millions of employers to close their doors. About one in six American workers have lost their jobs in the past five weeks, by far the worst string of layoffs on record. That’s more than the number of people who live in the 10 largest U.S. cities combined.

      Economists have forecast that the unemployment rate for April could go as high as 20%.

      The enormous magnitude of job cuts has plunged the U.S. economy into the worst economic crisis since the Great Depression of the 1930s. Some economists say the nation’s output could shrink by twice the amount that it did during the Great Recession, which ended in 2009

      26 million lost jobs in last five weeks

      Claims are for temporary financial assistance from state government by individuals who have been laid off

      An urgent question for the unemployed is how quickly the economy may rebound. Most economists expect some employers to start rehiring within a few months, though significant job gains aren’t considered likely until later in the year.

      Few experts foresee a downturn anywhere near as long as the Great Depression. During the Depression, unemployment stayed high for nearly a decade, with the rate remaining in double-digits all the way from 1931 until 1940.

      The painful economic consequences of the virus-related shutdowns have sparked angry protests in several state capitals from crowds insisting that businesses be allowed to reopen. Thursday’s report, showing that the pace of layoffs remains immense, could heighten demands for re-openings.

      Some governors have begun easing restrictions despite warnings from health authorities that it may be too soon to do so without causing new infections. In Georgia, gyms, hair salons and bowling alleys can reopen Friday. Texas has reopened its state parks.

      Yet those scattered re-openings won’t lead to much rehiring, especially if Americans are too wary to leave their homes. Most people say they favor stay-at-home orders, according to a survey by The Associated Press-NORC Center for Public Affairs and believe it won’t be safe to lift social distancing guidelines anytime soon. And there are likely more layoffs to come from many small businesses that have tried but failed to receive loans from a federal aid program.

      The number of people who are receiving unemployment benefits has reached a record 16 million, surpassing a previous high of 12 million set in 2010, just after the 2008-2009 recession ended. This figure reflects people who have managed to navigate the online or telephone application systems in their states, have been approved for benefits and are actually receiving checks.

      Just about every major industry has absorbed sudden and severe layoffs. Economists at the Federal Reserve estimate that hotels and restaurants have shed the most jobs — 4 million since Feb. 15. That is nearly one-third of all the employees in that industry. The layoffs, striking hard at front-line service occupations, have disproportionately hit minority and lower-income workers, who typically have little or no financial cushions.

      Construction has shed more than 9% of its jobs. So has a category that includes retail, shipping and utilities, the Fed estimated. A category that is made up of data processing and online publishing has cut 4.7%.

      Europe’s economies, too, are headed for severe recessions, with surveys of economic activity released Thursday plunging to all-time lows. The downturn is putting up to 59 million jobs at risk, or 26% of all employment in the European Union, according to McKinsey, the consulting firm. That figure includes people who could be laid off outright as well as those who are still on payrolls but might be put on shorter work hours or furloughs. The crisis could double the level of unemployment, which is 6.5% in the 27-country EU.

      Unemployment is also likely to rise in the United Kingdom. Analysts at Capital Economics say the U.K. economy is headed for its biggest quarterly economic contraction in more than a century.

      In some states, many laid-off workers have run into obstacles in trying to file applications for benefits. Among them are millions of freelancers, contractors, gig workers and self-employed people — a category of workers who are now eligible for unemployment benefits for the first time.

      “This has been a really devastating shock for a lot of families and small businesses,” said Aaron Sojourner, a labor economist at the University of Minnesota. “It is beyond their control and no fault of their own.”

      In Florida, applications for unemployment benefits nearly tripled last week to 505,000, the second-highest total behind much-larger California’s 534,000. Florida has had trouble processing many of its applications. Its figure suggests that the state is finally clearing a backlog of filings from jobless workers.

      In Michigan, 17% of the state’s workforce is now receiving unemployment aid, the largest proportion in the country. It is followed by Rhode Island at 15%, Nevada at 13.7% and Georgia at 13.6%.

      When the government issues the April jobs report on May 8, economists expect it to show breathtaking losses. Economists at JPMorgan are predicting a loss of 25 million jobs. That would be nearly triple the total lost during the entire Great Recession period.

      A $2 trillion-plus federal relief package that was signed into law last month made millions of gig workers, contractors and self-employed people newly eligible for unemployment aid. But most states have yet to approve unemployment applications from those workers because they’re still trying to reprogram their systems to do so. As a result, many people who have lost jobs or income aren’t being counted as laid-off because their applications for unemployment aid haven’t been processed.

      Among them is Sasha McVeigh, a musician in Nashville. Having grown up in England with a love of country music, she spent years flying to Nashville to play gigs until she managed to secure a green card and move permanently two years ago. McVeigh had been working steadily until the city shut down music clubs in mid-March.

      Since then, she’s applied for unemployment benefits but so far has received nothing. To make ends meet, she’s applied for some grants available to out-of-work musicians, held some live streaming concerts and pushed her merchandise sales.

      By cutting expenses to a bare minimum, McVeigh said, “I’ve managed to just about keep myself afloat.” But she worries about what will happen over the next few months.

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      AP Writers Travis Loller in Nashville and Pan Pylas in London contributed to this report.

       

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