Notes from the TN Dept of Health: Hepatitis C

The following information is written by and provided in partnership with the Tennessee Department of Health:

2020 has been a difficult year for all of us. This Spring and Summer have made us all think more about our health, and how important it is that we take care of ourselves today to prepare for the problem that could be just over the horizon. 

This year has also put into sharp focus all the reasons we have for not being proactive about our health. Health care is expensive and, for many of us, challenging to access. Health information is hard to understand and is changing every day. The evolution around HIV is a perfect example of this. HIV treatment gets easier to access for Tennesseans every year, and in the last decade has gone from a process which a person might delay to one where getting into treatment as soon as possible changes how a person lives with the disease. On top of that, HIV prevention tools now include PrEP, a daily pill.

The realities around prevention and treatment for hepatitis C have gone through a similar evolution. The term hepatitis refers to inflammation of the liver, and can be caused by many different things. These causes include fatty liver disease, over-consumption of alcohol, exposure to toxins and chemicals, some drugs and medications, and infections. In Tennessee, one of the main causes of hepatitis is the hepatitis C virus. 

Hepatitis C virus is ten times more infectious than HIV, and one in four people with HIV will experience hepatitis C co-infection.  As the use of injection drugs continues to rise statewide, so too does hepatitis C; approximately 53% of people who inject drugs have hepatitis C (source). 

LGBTQ people are more likely to misuse substances, including both drugs and alcohol, than others. Discrimination and stigma can contribute to over-dependence on alcohol and drugs for LGBTQ people (source). LGB youth are 25% more likely to drink alcohol, twice as likely to use ecstasy and cocaine, and four times as likely to use heroin and meth (source).  LGBTQ people are also less likely to have health insurance than others, particularly youth, seniors, and transgender persons, putting significant barriers between them and routine medical care (source, source, source). These realities mean that LGBTQ people are more likely than others to come into contact with HIV and hepatitis C, while also having unique barriers to health care.

In Tennessee, access to hepatitis C screening and treatment has increased dramatically in the last few years. This is huge for LGBTQ people who are at elevated risk for hepatitis C, because it can now be cured in most people while the consequences of lack of treatment compound significantly over time. Over 90% of people with hepatitis C can be cured with 8-12 weeks of oral medication (source). If left untreated, complications include chronic hepatitis C infection (75-85 out of every 100 people), chronic liver disease (60-70 out of a 100), cirrhosis (5-20 out of a 100), and death (1-5 out of 100) (source). Cirrhosis and liver cancer cause about 1 in 5 percent of hepatitis C-related deaths, as treatment options are limited for these conditions (source).

Hepatitis C is a health concern where knowledge about screening and treatment is critical, and can mean the difference between three months of treatment and years of chronic health issues. Hepatitis C screening is a two-step process that starts with an antibody test (which will always be positive for anyone who has ever been exposed to hepatitis C) and an RNA confirmatory test (which can tell you if you currently have hepatitis C). Antibodies to hepatitis C are not protective, and you can be re-infected even if you have successfully completed past hepatitis C treatment.

If you think you might have hepatitis C, your local health department can provide you with testing and treatment options. Here is a list of health departments in Tennessee that you can use to find the location most convenient for you. 

If you have a positive hepatitis C test, or if you have had a positive test in the past but need support finding free or low cost treatment, Tennessee has Viral Hepatitis Case Navigators who provide resources to patients seeking hepatitis C treatment. To get started, contact your local health department and ask to be connected to a Viral Hepatitis Case Navigator. 

If you want to get involved in the statewide effort to better coordinate work around HIV, sexually transmitted infections, hepatitis C, and substance misuse, click here to learn more about the End the Syndemic Tennessee initiative.


Tennessee County Mask Mandates: Status

On July 3 Tennessee Governor Bill Lee granted county mayors the authority to issue mask/face covering mandates. Here is the status of mask mandates in Tennessee counties.

You can buy a rainbow mask at this link.

Bradley CountyNo mask mandate for now.

Cheatham County:  "Hard no," according to a July 6 WSMV report.

Davidson/Nashville:  Mask mandate is in place.

Dickson County:  "Hard no," according to a July 6 WSMV report.

Franklin CountyThe Mayor says NO in this video.

Greene CountyMask mandate announced on July 13 to begin on July 15.

Hamblen County: Mask mandate issued on August 1.

Hamilton CountyHamilton County had issued a mask mandate on July 6 to take effect on Friday.

Henry CountyMask mandate in place.

Jefferson CountyMayor announced no mask mandate on July 8.

Knox County:  Mask mandate in place, but the County Mayor voted against it and the Sheriff has not indicated he will enforce itThis Facebook group discusses which Knoxville-area businesses are following the mask mandate.

Loudon County:  County Mayor says no mask mandate at this time, according to WATE.

Madison County:  Mask mandate is in place, but there has been a protest.

Maury CountyCounty Mayor said on July 6 that there would be no mask mandate.

Montgomery County: Mask mandate announced on July 14.

Putnam CountyNo mask mandate announced on July 7.

Robertson CountyMask mandate announced on July 7.

Rutherford County: Mask mandate announced on July 20.

Sevier County: Mask mandate announced on July 7.

Shelby County:  Mask mandate in place.

Sumner County: Sumner County's mandate was issued on July 6. Read the statement from Mayor Holt here. Thanks to everyone who contacted the County Mayor.

Sullivan CountyMask mandate announced on July 10.

Washington County: Mask mandate announced on July 13 to begin July 14.

Williamson CountyMask mandate in place as of July 6. Thanks to everyone who contacted the County Mayor.

Wilson County: Mask mandate announced on July 17.

*Send any updates to [email protected] .

 


Notes from the TN Dept. of Health: Long Term Survivors of HIV

The following information is provided through a partnership with the Tennessee Department of Health:

June is a month of great importance for people living with HIV. June 5th was HIV Long Term Survivors’ Day, a celebration of and a day of awareness for people who have been living with HIV for 20 or more years. In Tennessee, 4,126 people have been living with HIV for at least 20 years, and 252 people have lived with HIV for 30 years or more. 

The theme of HIV Long Term Survivors’ Day this year was “Not Our First Pandemic,” connecting the early years of the HIV epidemic to our current fight with COVID-19. Tennesseans in this group struggle with challenges managing their HIV including isolation, poverty, increased stigma amongst their age peers, and AIDS Survivor Syndrome. 

People who have lived with HIV for multiple decades have watched the world go from ignorance to knowledge about how a virus works, spreads, and is successfully treated. The present progression of COVID-19 in the United States and globally mirrors some of those same community and public health steps. 2020 will be the first year in more than a decade when National HIV Testing Day (June 27) does not result in large, in-person community gatherings and testing events. In many states, in-person Pride celebrations and parades have been cancelled or brought online. 

For those who have lived with HIV for decades, COVID-19 might have interrupted their medical appointments, mental health care, and health-promoting social interaction. Additionally, fear that their long-term immunocompromising condition might make them more susceptible to COVID-19 means there is a new cause for anxiety and distress. Currently, the U.S. Department of Health and Human Services maintains that HIV alone is not one of the chronic conditions that puts people at increased risk for a life-threatening COVID-19 infection.

According to the CDC, people living with HIV trying to protect themselves from COVID-19 should be doing the same things recommended for all other Americans: maintaining daily healthy practices (including rigorous hand-washing and wearing a face mask when interacting outside the home) and reducing in-person social contact as much as possible. Maintaining their HIV treatment regimen during this time and continuing activities that reduce stress are vitally important. While many medical services are unavailable during COVID-19 community mitigation, HIV treatment and mental health care are essential services. Click here for a list of HIV medical providers in Tennessee that are designated as Ryan White Part B Centers of Excellence. Click here for more information about maintaining mental, social, and behavioral health during COVID-19 community mitigation. 

Day-to-day, we all have people and habits we turn to for emotional support and to curb rising stress. COVID-19 makes it harder to find opportunities to socialize, communicate with family, and keep up with healthy habits. For those struggling with substance abuse, this stress could contribute to desires to turn to unhealthy coping behaviors. Click here for a list of harm reduction programs providing services related to substance use and abuse near you. COVID-19 has interrupted our regular plans with friends and social interaction in public settings. There are supportive social groups all over Tennessee that are meeting or hosting activities online during the pandemic. Don’t let fear or discomfort with video conferencing get in the way of your ability to enjoy these new opportunities to connect with your peers. Click the links for more information about how to navigate Zoom, Go-To Meeting, Webex, and Google Hangouts/Google Meet

For people living with HIV who are at home, the activities we have grown accustomed to seeing in June are still happening, just in different forms. Globally, Pride organizations are coming together to create an online, international Pride event on June 27. For those who would normally refer their friends and family members not living with HIV to free testing at this time of year, many of the organizations on this list are now offering no-contact telehealth HIV testing.

This summer is both radically different from what we all expected, and eerily familiar for our HIV Long Term Survivors. No matter how different (or familiar) things look, we do have the tools we need to take care of ourselves and each other. 


Attack on transgender youth health care moving to the House floor!

Rep. Ragan's HB2576, which says that it is child abuse to offer gender-affirming health care to transgender youth, could be coming to the House floor soon. On June 11, it was deferred to the final calendar of the House Calendar & Rules Committee. It got slowed down a bit, but could pick up speed next week. Take action today!

*Use this EASY campaign to send a message to your own member of the Tennessee House of Representatives.

*Send the campaign link to friends via email or post it on social media. Share in supportive Facebook groups.

*If you would like to support our work with a contribution, you can do so at this link.

We are grateful for all your support!


Make calls to oppose attacks on transgender youth health care

Leave Messages on HB2576

HB2576, the bill would label gender-affirming care for transgender youth as child abuse, is up for a vote on Tuesday afternoon.  Call the legislators in the region/counties closest to you and leave messages. Phone numbers and scripts are below. Call by Noon on Tuesday, June 9. Thank you!

EAST TENNESSEE

Blount County/Maryville/Alcoa area

*Rep. Bob Ramsey at 615-741-3560

“Rep. Ramsey, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”

Chattanooga/Hamilton and Bradley Counties

*Rep. Esther Helton at 615-741-1934

“Rep. Helton, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”

*Rep. Mark Hall at 615-741-1350

“Rep. Hall, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”

*Rep. Robin Smith at 615-741-2548

“Rep. Smith, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”


Lakeway Area

*Rep. Jerry Sexton at 615-741-2534

“Rep. Sexton, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”


Washington County

*Rep. Matthew Hill at 615-741-2251

“Rep. Hill, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”

*Rep. Micah Van Huss at 615-741-1717

“Rep. Van Huss, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”


MIDDLE TENNESSEE

Nashville/Davidson County

*Rep. John Ray Clemmons at 615-741-4410

“Rep. Clemmons, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”

*Rep. Vincent Dixie at 615-741-1997

“Rep. Dixie, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”

*Rep. Bob Freeman at 615-741-0709

“Rep. Freeman, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”

*Rep. Darren Jernigan at 615-741-6959

“Rep. Jernigan, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”


Robertson County

*Rep. Sabi Kumar at 615-741-2860

“Rep. Kumar, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”


Rutherford County

*Rep. Bryan Terry at 615-741-2180

“Rep. Terry, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”


Southern Middle TN (also includes part of West TN)

*Rep. David Byrd at 615-741-2190

“Rep. Byrd, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”


Upper Cumberland Area/Putnam/Warren/White Counties

*Rep. Ryan Williams at 615-741-1875

“Rep. Williams, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”

*Rep. Paul Sherrell at 615-741-1963

“Rep. Sherrell, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”


Williamson County

*Sam Whitson at 615-741-1864

“Rep. Whitson, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”


WEST TENNESSEE

Fayette, McNairy, and Hardeman Counties

*Rep. Ron Gant at 615-741-6890

“Rep. Gant, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”

Hardin County (district also linked to Southern Middle TN counties)

*Rep. David Byrd at 615-741-2190

“Rep. Byrd, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”

Memphis/Shelby County

*Rep. Barbara Cooper at 615-741-4295

“Rep. Cooper, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”

*Rep. Tom Leatherwood at 615-741-7084

“Rep. Leatherwood, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”

*Rep. Larry Miller at 615-741-4453

“Rep. Miller, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”

*Rep. Kevin Vaughan at 615-741-1866

“Rep. Vaughan, my name is ________________ and I live in _____________. Please, vote NO on House Bill 2576 on Tuesday in the Health Committee. The state should not interfere with the health care of transgender youth.”


Slate of Hate pushing ahead into week of June 8

Utterly oblivious to calls for racial justice, concerns about COVID-19, and thousands of unemployed, the leadership of the Tennessee House of Representatives is pressing forward with the Slate of Hate.

June 9

*HB2576, the bill that labels gender-affirming health care for transgender youth as child abuse, is up for a vote in the House Health Committee. TAKE ACTION and use the campaign at this link to contact the committee.

How to Help:

*Click on the campaign listed above and SHARE with your friends on social media and email it to them and urge them to participate.

*If you would like to support our work with a contribution, you can do so at this link. We are grateful!


Slate of Hate moves into week of June 1

Despite a rising number of COVID-19 cases, calls for racial justice, and substantial unemployment, the Tennessee House of Representatives is forging ahead with the #SlateofHate for a second week. Here is the calendar of bills for the week of June 1 with email action campaigns for each bill.

June 2

*HB1689, one of the anti-transgender student athlete bills, is up for a vote in full House of Representatives. ***Update: The Senate companion bill has been deferred until December 1, which stops the bill for now. We will continue to track it, but this is good news! The bad news later on June 3 is that the House bill was passed on the floor.

*HB2576, the bill that labels best-practice gender-affirming care for transgender youth as child abuse, is up for a vote in the House Judiciary Committee. ***Update: The bill passed the House Judiciary Committee and heads to the Health Committee.

June 3

*HB1572, one of the anti-transgender student athlete bills, is up for a vote in the House Education Committee. ***Update: The bill was taken off notice in the House Education Committee on June 3.

 

How to Help:

1. Use each of the action campaigns listed above and share them on social media and email them to friends.

2. Be a district captain during our virtual Advancing Equality Days on the Hill on June 2 and 3. Email us at [email protected] to sign up or to get more information.

3. Make a contribution at this link.

 


TN House picks up Slate of Hate week of May 25

The COVID-19 global pandemic and the Memorial Day holiday haven't stopped the Tennessee House of Representatives from scheduling hearings on some of the anti-LGBTQ bills in the #SlateofHate .

Action Calendar:

May 26

*HB1572, one of the bills that prevents transgender youth from participating in school sports. Take action and use this campaign to oppose HB1572 on May 26 and HB1689 that will be considered on May 28.  ***Update: On May 26, HB1572 passed the House K-12 Subcommittee and will advance to the full House Education Committee.

May 27

*HB2827, the bill that freezes in place current health care protocols for transgender youth. Take action and use this campaign to oppose HB2827. ***Update: As of May 27, the bill is off notice. GOOD NEWS!

*HB2576, the bill that criminalizes providing gender confirmation health care to transgender youth. Take action using this campaign to oppose the bill. ***Update: On May 27, the bill passed the House Criminal Justice Subcommittee.

*HB2410 and HB2310, anti-marriage equality bills. Take action on both bills with this campaign. ***Update: As of May 27, both bills have been taken off notice so there is no need to do the campaign at this link. GOOD NEWS!

May 28

*HB1689, one of the bills that prevents transgender youth from participating in school sports. If you took action using the campaign for the bill on May 26, then you do not need to take additional action.

TEP is scheduling virtual Advancing Equality Days on the Hill for June 2 and 3. If you would like to participate, go to this Facebook event page.  If you would like to support our work, you can do so at this link.


Study questions for the COVID-19 diagram of concerns

Venn diagrams have made the leap out of math and logic classes and into the world of memes. Venn diagrams often include a series of circles to show where elements overlap or don't.  If you want an easy explanation of Venn diagrams and sets, take a look at this page.

The popular Venn diagram on concerns about COVID-19:  Lately a Venn diagram has been making the rounds that shows three equally sized circles that intersect. One circle is about taking COVID-19 seriously, one about economic devastation, and the third about expansion of "authoritarian" government policies.  Here's a look at it:

TheDiagram.jpg

Feelings:  First, all feelings about a situation are valid. People feel a wide range of emotions in a pandemic and their concerns land in different places.  The diagram is a clear and compelling appeal to feelings and is not an assessment of the scale of the issues or even a diagram that shows the cause-and-effect relationship among the three circles. 

How do we know the diagram is about feelings and not an analysis? It's all in the language. With a header that affirms "It's OK," we are tipped off that it is we who are being validated, which can give the illusion that the merits of our beliefs are also being validated.  In addition, each circle uses feeling language such as "taking seriously," "very concerned," and "worried about."

There's nothing wrong with that per se. In fact, it's always important to attend to people's feelings, especially during a pandemic. It's important for mental health reasons and it's important for policymakers and advocates to understand people's feelings in order to persuade the public.  But we should ask critical questions so that we don't allow others to manipulate our feelings to the point of distorting the reality of the situation and the need for specific policy interventions.

Study Questions:  Here are a few study questions to consider that might help you explore whether this diagram is a manipulation or whether it is accurate in important ways.

1. What is implied when the circles are equal in size?  Does it mean all three concerns are equal in their harm?  Does it mean all three threats are equally likely to take place?  Based on your information, is there one circle or are there two circles that are more of a real threat?  If so, which one or ones?  How big would you make the different circles if you drew your own diagram?

2. Who or what sectors of our society benefit if we treat the three circles as equal?  Who benefits if you resized the circles based on what you think the greatest threat is?

3. If the circles are all the same size, what effect does it have on people who wish to take action? Does it stall or spur action?  If the circles are resized with the greatest concern represented in the largest circle, what effect would that have as a call to action? 

4. By showing how the three concerns overlap, does the diagram hide ways that one circle causes another?  In other words, is COVID-19 a concern in its own right AND a cause of the other two circles?  Or are the three circles simply three different sets of concerns?

5. Who is the target of the lower right circle discussing "authoritarian" policies? This is an important point. In public debates, some are calling governors and mayors who issue safer-at-home orders authoritarian, while others view the President's seizure of PPE as authoritarian. Many view the extension of the Patriot Act during the pandemic as authoritarian. In Tennessee, questions have arisen about sharing health information with law enforcement.  So it's important to be clear when talking about authoritarian policies whose policies you mean. 

Memes are here to stay. So are our feelings. They will be part of our public debates and the way we come to terms with all the challenges we face. But it is wise to raise questions about both when we're making decisions.  What questions would you add to improve your understanding of the diagram and where it leads people?


From TN Department of Health: National Transgender HIV Testing Day

We are pleased to bring you this information through a partnership with the Tennessee Department of Health:

April 18th is National Transgender HIV Testing Day, and all across the state there are opportunities for transgender people to learn their HIV status, get connected to care, and work with their peers to prevent HIV in their communities. 

Transgender people face significant barriers to health care, especially in the South. According to the National Center for Transgender Equality, these barriers include lack of health insurance, lack of access to providers knowledgeable about transgender health, and discrimination. One in three transgender people have avoided or delayed accessing sexual health care out of fear of discrimination. These fears are not ungrounded. Over half of transgender people engaged in healthcare have had to teach a medical provider about providing appropriate care, and approximately 20% of transgender people have been refused medical care by a provider because they were transgender. 

Nearly one million Americans identify as transgender.  Transgender women are at particularly high risk for contracting HIV. According to the Centers for Disease Control, 14% of American transgender women have HIV. That percentage is greater for African American transgender women (44%) and Latinx transgender women (26%). While similar data for transgender men does not exist, transgender men who are gay, bisexual, and same-gender loving are at risk for HIV just as cisgender gay, bisexual, and same-gender loving men are---but they are much less likely to be properly screened for HIV by health care providers. Transgender non-binary people who have sex without a prevention method and/or share needles are also at risk for HIV. Nearly half of all transgender Americans who are living with HIV live in a Southern state. 

Tennessee Department of Health understands that these healthcare barriers will persist unless addressed. Work with health departments, health care providers, and non-profit partners to improve HIV prevention services for transgender people is ongoing. The Tennessee Transgender Task Force, a body comprised of transgender advocates knowledgeable about the HIV prevention and care network, helps shape and inform statewide HIV initiatives. The Cultural Awareness Survey Program assesses health department sexual health services, providing feedback to key public health leadership about how healthcare for transgender patients can be improved. 

Through the Tennessee Department of Health, HIV testing, PrEP, condoms, and HIV treatment are available to all residents, and in celebration of National Transgender HIV Testing Day we raise awareness of these resources. 

Rapid HIV testing is available all over Tennessee, where a simple finger prick can yield an accurate, same-day result. Many places in Tennessee use a double-rapid testing process, which means that a person can test positive for HIV and start on the path to getting into care on the same day. Click here for a statewide list of rapid HIV testing locations. 

Transgender people, regardless of how they identify, can use both PrEP and condoms to safely protect themselves from contracting HIV. Tennessee has a robust condom distribution network, searchable online through Free Condoms TN. Getting PrEP in Tennessee can start online as well, through Get PrEP TN. Anyone can use Get PrEP TN to learn more about PrEP, contact a PrEP navigator, and find a medical provider to help them start the process. For transgender people wary of discrimination in health care settings, the PrEP navigator can attend the first PrEP doctor’s appointment with a client and help leverage resources through patient assistance programs to pay for PrEP. 

Transgender people in Tennessee who want more access to sexual health care still face significant barriers, but also have access to more resources than ever before. Here is a list of regional resources that transgender people can use to improve their sexual health:

Update: April 18th is an opportunity to highlight how HIV affects transgender communities, but this April there is a health concern overshadowing all others. Due to state and local restrictions related to COVID-19, not all of the services detailed above are currently available. If you are worried about COVID-19 and looking for accurate sources of up-to-date information, here is a list of national and regional resources:



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