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<br /> As the mercury plummets and the latest weather forecast predicts fresh rounds of <keyword id="10265" type="UNKNOWN" weightage="100" keywordseo="Snow">snow</keyword> across the Indian mountains, a gleeful crowd from home and abroad goes traipsing upon the ethereal <keyword id="918784" type="UNKNOWN" weightage="100" keywordseo="ski-slopes">ski slopes</keyword>. Heading off to the <keyword id="23693" type="ORGANIZATION" weightage="100" keywordseo="Swiss-Alps">Swiss Alps</keyword> or <keyword id="2005582" type="UNKNOWN" weightage="100" keywordseo="Val-dIsre">Val d’Isère</keyword> in <keyword id="6354785" type="COUNTRY" weightage="60" keywordseo="France">France</keyword> might be the classic choice of many, but <keyword id="2005583" type="UNKNOWN" weightage="100" keywordseo="Powder-skiing">powder skiing</keyword> in the <keyword id="52569" type="CITY" weightage="100" keywordseo="himalayas">Himalayas</keyword> is getting increasingly popular among local and <keyword id="1704954" type="UNKNOWN" weightage="100" keywordseo="global-tourists">global tourists</keyword> in love with <keyword id="1614562" type="UNKNOWN" weightage="100" keywordseo="winter-sports">winter sports</keyword>. India is now home to a dozen or so <keyword id="2005584" type="UNKNOWN" weightage="100" keywordseo="Ski-areas">ski areas</keyword> and plans are afoot to build several international standard <keyword id="78303" type="UNKNOWN" weightage="100" keywordseo="Ski-resorts">ski resorts</keyword>.<br />
<br /> <keyword id="90842" type="SPORT" weightage="100" keywordseo="skiing">Skiing</keyword> took off in the country during the days of the <keyword id="81273" type="ORGANIZATION" weightage="100" keywordseo="British-Raj">British Raj</keyword> when two army officers first started the <keyword id="2005578" type="UNKNOWN" weightage="100" keywordseo="Ski-Club-of-India">Ski Club of India</keyword> in <keyword id="108228" type="CITY" weightage="100" keywordseo="Gulmarg">Gulmarg</keyword> back in 1927. Fast-forward to 2014 and you will find improved facilities, along with the eternally breathtaking <keyword id="6439698" type="ENTERTAINMENT" weightage="100" keywordseo="mountain">mountain</keyword> views, the best <keyword id="2005590" type="UNKNOWN" weightage="100" keywordseo="Powder-snow">powder snow</keyword> and the vast, undulating <keyword id="2005591" type="UNKNOWN" weightage="100" keywordseo="Snowy-tracks">snowy tracks</keyword> – from <keyword id="2005592" type="UNKNOWN" weightage="100" keywordseo="Gentle-slopes">gentle slopes</keyword> and <keyword id="2005593" type="UNKNOWN" weightage="100" keywordseo="Groomed-trails">groomed trails</keyword> to <keyword id="2005595" type="UNKNOWN" weightage="100" keywordseo="Steep-bowls">steep bowls</keyword>, <keyword id="2005596" type="UNKNOWN" weightage="100" keywordseo="Chutes">chutes</keyword> and <keyword id="2005598" type="UNKNOWN" weightage="100" keywordseo="Tree-runs">tree runs</keyword> spilling off the magnificent ridges. Gulmarg in <keyword id="23412" type="CITY" weightage="100" keywordseo="Jammu-Kashmir">Jammu &amp; Kashmir</keyword> and <keyword id="484044" type="CITY" weightage="100" keywordseo="Auli">Auli</keyword> in <keyword id="44522" type="CITY" weightage="100" keywordseo="Uttarakhand">Uttarakhand</keyword> are the showpiece destinations, especially Auli, which features the <keyword id="2005599" type="UNKNOWN" weightage="100" keywordseo="Second-largest-slopes-in-Asia">second largest slopes in Asia</keyword>. A research survey by the <keyword id="2005579" type="UNKNOWN" weightage="100" keywordseo="Alpine-Tourism-Promotion-Council">Alpine Tourism Promotion Council</keyword> (ATPC) considers Auli’s slopes to be the best in the world.<br />
<br /> <keyword id="2005600" type="UNKNOWN" weightage="100" keywordseo="Heli-skiing">Heli-skiing</keyword> in the Himalays is another fabulous experience as the chopper flies one to spectacular heights and the <keyword id="105846" type="POSITION" weightage="100" keywordseo="Skier">skier</keyword> rides down the unexplored slopes – the perfect setting for this great <keyword id="6739232" type="UNKNOWN" weightage="100" keywordseo="Adventure-sport">adventure sport</keyword>. The thrill-hunters can also go <keyword id="2005604" type="UNKNOWN" weightage="100" keywordseo="Yak-skiing">yak skiing</keyword> in <keyword id="6363190" type="COMPANY" weightage="100" keywordseo="Manali">Manali</keyword> – an <keyword id="2005608" type="UNKNOWN" weightage="100" keywordseo="Extreme-snow-sport">extreme snow sport</keyword> only meant for the brave hearts. Those looking for <keyword id="2005609" type="UNKNOWN" weightage="100" keywordseo="Off-season-skiing">off-season skiing</keyword> would not be disappointed either. There is <keyword id="2005611" type="UNKNOWN" weightage="100" keywordseo="Grass-skiing-in-summer">grass skiing in summer</keyword>, held on a 120 meter-long grassy slope in <keyword id="569617" type="UNKNOWN" weightage="100" keywordseo="Solang-Valley">Solang Valley</keyword> where one can use special <keyword id="2005612" type="UNKNOWN" weightage="100" keywordseo="Skis-fitted-with-wheels">skis fitted with wheels</keyword>. If you are already feeling excited and want to chill out among the snow, slopes and the wild <keyword id="383218" type="PERSON" weightage="100" keywordseo="slides">slides</keyword> and <keyword id="95340" type="UNKNOWN" weightage="100" keywordseo="Tumbles">tumbles</keyword>, here is a look at India’s 7 <keyword id="2005614" type="UNKNOWN" weightage="100" keywordseo="Best-skiing-destinations">best skiing destinations</keyword>.<br />
<br />
<strong>Image:</strong> Wikipedia

Time To Celebrate The Snow: Check Out These 7 Ski Destinations
In India

<p class="source"><span>Justin Sullivan/Getty Images</span></p><p class="caption">A view of UC Davis Medical Center on February 27, 2020 in Sacramento, California.</p><ul class="summary-list"><li>A confirmed <a href="https://www.businessinsider.com/china-virus-everything-we-know-deadly-2019-ncov-wuhan-spread-2020-1">coronavirus</a> patient in California had no travel history in China and no known exposure to anyone infected.</li><li>It's the first potential case of "community spread" in the US.</li><li>One health official said this requires a transition "from trying to contain the disease to more of a mitigation approach."</li><li><a href="https://www.businessinsider.com/?hprecirc-bullet">Visit Business Insider's homepage for more stories</a>.</li></ul><p>A patient in Solano County, California, has gotten the COVID-19 coronavirus without traveling to China or having any known contact with someone sick, the Centers for Disease Control and Prevention confirmed on Wednesday.</p><p>"This person appears to be a community-acquired case of coronavirus, which would be the first here in the United States," Bela Matyas, the Solano County health officer, said in a press conference on Thursday. He added, however, that he doesn't think this is the only such case. </p><p>"There are probably cases of coronavirus from community acquisition in multiple parts of the country right now," Matyas said.</p><p>That means the virus is likely spreading undetected in the US, according to Amesh Adalja, an infectious-disease expert at the Johns Hopkins Center for Health Security.</p><p>Adalja offered a simple definition of community spread:</p><p>"'Community spread' reflects the fact that the virus is out there in the community spreading from person to person, meaning that it's not just spreading from people who had contact with someone from China or a travel history, but that it's something established in the community," he said.</p><p>That reality, Matyas said, means health officials have to transition "from trying to contain the disease to more of a mitigation approach."</p><h2>A delay in detection </h2><p>The California patient is now in serious condition, <a href="https://edition.cnn.com/asia/live-news/coronavirus-outbreak-02-27-20-intl-hnk/index.html">according to CNN</a>.</p><p>She initially went to the NorthBay VacaValley Hospital on February 15. The 50-bed hospital is in Solano County, which is also home to the Travis Air Force Base, where some Americans evacuated from China and from the quarantined Diamond Princess cruise ship <a href="https://www.businessinsider.com/coronavirus-americans-quarantined-air-force-base-what-are-they-doing-2020-2">have been quarantined</a>.</p><p>A surgeon at the base, who requested that he be kept anonymous, told Business Insider that it's likely the new case has some connection to the the base, given the proximity.</p><p>But Matyas said no such link has been found and added that workers on the base were "scary meticulous" about safety.</p><p>"This individual has no connection whatsoever to that federal mission and to any of the personnel that have been involved in that evacuation process," he said. </p><p class="source"><span>Hector Amezcua/AP Photo</span></p><p class="caption">Ambulances outside the Travis Air Force Base in California.</p><p>The patient was not tested for COVID-19 at VacaValley during her four days there. After her symptoms worsened, she was transferred to the University of California, Davis Medical Center in Sacramento on February 19. But she wasn't tested there either until four days later.</p><p>"Since the patient did not fit the existing CDC criteria for COVID-19, a test was not immediately administered. UC Davis Health does not control the testing process," the center said in a statement.</p><p>Until now, the CDC has made decisions about whether to test people for the coronavirus based on whether they have recently traveled to places with outbreaks. </p><p>But this case, Adalja said, shows that "when we have protocols set up to really identify patients only based on travel history, those are going to fall short of identifying all cases."</p><p>Matyas said testing criteria are indeed changing now, and the CDC praised the doctors who diagnosed the woman in a statement on Thursday.</p><p>"This case was detected through the US public health system - picked up by astute clinicians," the CDC said.</p><h2>Dozens of healthcare workers were exposed</h2><p class="source"><span>AP Photo/Damian Dovarganes</span></p><p class="caption"> Tien Nguyen wears a mask as she shops at the 168 Market in Alhambra, California, on January 31, 2020. </p><p>Health officials are working to trace and isolate anyone the patient had contact with - her family has been quarantined, and hospital staff are being evaluated and tested.</p><p>Aimee Brewer, president of NorthBay Healthcare, said any medical workers who had direct contact with the patient at VacaValley have been tested for the virus and are now on paid leave at home. So far, there have been no more positive tests, she said.</p><p>"As far as the headcount is concerned, at this time I can say it's a moving target," Steve Huddleston, vice president of public affairs at NorthBay Healthcare, said in a press conference Thursday. "We have identified dozens of employees on our health team, but it still remains less than 100."</p><p>According to <a href="https://edition.cnn.com/asia/live-news/coronavirus-outbreak-02-27-20-intl-hnk/index.html">CNN</a>, a University of California, Davis student is also under investigation, and the student's two roommates are being isolated at their home off campus as well.</p><p>The CDC said in a statement on Thursday that "unprecedented, aggressive efforts have been taken to contain the spread and mitigate the impact of this virus."</p><h2>A question of when, not if</h2><p>A day before this case of community spread was reported, CDC officials suggested it was imminent.</p><p>"It's not so much a question of if this will happen anymore, but rather more a question of exactly when this will happen and how many people in this country will have severe illness," Dr. Nancy Messonnier, the head of the National Center for Immunization and Respiratory Diseases at the CDC, said during a media briefing.</p><p>But thus far, the <a href="https://www.businessinsider.com/us-preparations-coronavirus-outbreak-slowing-testing-mask-shortages-2020-2">US lags behind other countries in testing</a> - as of Wednesday, only 445 Americans had been tested for the virus.</p><p class="source"><span>Reuters</span></p><p class="caption">An illustration, created by the CDC depicts the novel coronavirus</p><p>"At first, CDC was the only place where testing could be performed," Richard Martinello, an associate professor of infectious disease at the Yale School of Medicine, <a href="https://www.businessinsider.com/us-preparations-coronavirus-outbreak-slowing-testing-mask-shortages-2020-2">previously told Business Insider</a>. "For a country of our size, when you only have a single site doing that, it limits the resources available for testing."</p><p>The CDC sent test kits nationwide earlier this month, but those were also found to be flawed, so only about a dozen labs can currently run the tests, <a href="https://www.washingtonpost.com/health/2020/02/25/cdc-coronavirus-test/">according to The Washington Post</a>.</p><h2>'The cat's out of the bag in terms of it having spread'</h2><p>Solano County and the nearby San Francisco and Santa Clara counties have all declared emergencies.</p><p>Matyas said the declaration frees up resources to "allow us to investigate this incident more effectively and more efficiently."</p><p>But he added that containment is "only possible when you're dealing with a disease condition where you know everyone who's sick, and they get sick before they spread, and you can contain them - and that's a rare reality."</p><p class="source"><span>Manuel Silvestri/Reuters</span></p><p>Now, he said, efforts must focus on mitigation because "we know the cat's out of the bag in terms of it having spread, and what we're trying to do is slow the spread as much as possible."</p><p>California Gov. Gavin Newsom <a href="https://www.cnbc.com/2020/02/27/california-is-monitoring-8400-people-for-the-coronavirus.html">announced</a> Thursday that 33 people in the state have tested positive for the virus - including citizens repatriated to military bases - and 8,400 people are being monitored. He stressed that the risk to the public is still low, but added that the state needs access to more resources. </p><p>"We have just a few hundred testing kit,s and that's surveillance testing as well as diagnostic testing. That's simply inadequate to do justice to the kind of testing that is required to address this issue head on," Newsom said.</p>            <h3>NOW WATCH: <a href="https://www.businessinsider.com/coronavirus-myths-debunked-wuhan-china-2020-2">Pathologists debunk 13 coronavirus myths</a></h3>

The US' newest coronavirus patient had no known exposure to anyone sick and hadn't gone to China, which suggests containment might be impossible

<p><strong><div class="KonaFilter image-container display-table"><div><div class="image on-image"></div><p></p></div></div></strong></p><ul><li><strong>A new vaccine for heroin is getting closer to human trials.</strong></li><li><strong>But it's still 10 to 15 years from reaching the market.</strong></li><li><strong>Addiction experts and treatment professionals are wary of how much it will help the current opioid crisis.</strong></li></ul><p>Two scientists are locked in a race to develop a groundbreaking vaccine for heroin. But many addiction experts and health officials warn that the medicine is unlikely to be the end game for the current opioid crisis and is a decade from reaching the market, at the earliest.</p><p>Dr. Kim Janda, a chemist at the Scripps Research Institute in La Jolla, California, has been developing vaccines targeting addictive substances for nearly 30 years and has pioneered much of the research in the field. He began developing the heroin vaccine about a decade ago and in recent years has begun work on a vaccine for fentanyl, <a href="http://www.businessinsider.com/fentanyl-drug-prince-overdose-deaths-2016-8">a painkiller 50 times more powerful than heroin</a> and <a href="http://www.businessinsider.com/fentanyl-legal-drug-stronger-heroin-contaminating-street-drugs-vancouver-canada-2017-5">the cause of an increasing number of overdose deaths</a>.</p><p>His competitor, Dr. Gary Matyas, has been developing his vaccine since 2011 at the Walter Reed Army Institute of Research in Maryland, a facility run by the Department of Defense. Matyas' work largely builds on Janda's and grew out of a research push to develop a vaccine for HIV - his vaccine has since become a combination heroin and HIV vaccine. So far, both Janda's and Matyas' vaccines have been tested only in animals.</p><p>While work on opioid vaccines stretches back decades, the research has gained added urgency in light of the opioid crisis. Last year, <a href="http://www.businessinsider.com/opioid-overdose-death-statistics-2016">more than 30,000 Americans died from overdoses</a> related to opioids, with that number rising nearly every year since 1999. President Donald Trump announced <a href="http://www.businessinsider.com/trump-opioid-crisis-national-emergency-2017-8">that he was declaring the crisis "a national emergency</a>" last month, but his administration has yet to officially do so.</p><p>Still, the prospect of a heroin vaccine has stoked a lot of interest and enthusiasm in the research. But as more is learned about the vaccine, its limitations as a moonshot cure have become clearer.</p><p>"Vaccines are an innovative approach that may be promising, but it won't be the panacea," Dr. Ivan Montoya, a <a href="https://www.drugabuse.gov/about-nida/organization/divisions/division-pharmacotherapies-medical-consequences-drug-abuse-dpmcda/office-director-od">director at the National Institute on Drug Abuse</a>, who has approved grants for both projects, told Business Insider.</p><h2><strong>Keeping heroin from entering the brain</strong></h2><p>Vaccines help the body create antibodies. For example, a measles vaccine works by helping the body's immune system make antibodies that can confront the virus should you come across it. That way, you won't get sick.</p><p>That's how a heroin vaccine would work, in theory, helping the body's immune system recognize the heroin molecule and knock it out of the body before it can get to the brain receptors that give you a high. If you aren't able to get high - ideally for a long period after the vaccine's given - it could make it easier to quit, or at least protect you from overdose.</p><p>"These drugs have to get in the brain to have their function," Matyas said.</p><p>While the details are still being worked out, each vaccine works in different ways. Janda's vaccine is designed to specifically eliminate heroin, while Matyas is working to make his vaccine bind to the substances that heroin breaks down to. If successful, that would mean Matyas' vaccine could block the effects of a wider variety of opioids.</p><p>That's important because one of the main concerns is that many addicts switch between substances to get their fix. A persistent opioid addiction leaves the brain perpetually lacking endorphins for long periods after use stops. Because neither vaccine fixes that, it could leave addicts trying to alleviate cravings by opioids not covered by the vaccine.</p><p>"If you create a vaccine for morphine, people could switch to fentanyl. We already have people using fentanyl rather than heroin to avoid triggering drug tests because fentanyl is so difficult to detect," Mark Willenbring, a leading addiction psychiatrist who runs Alltyr, a treatment clinic in Minneapolis, told Business Insider.</p><p>On the other hand, creating a vaccine that targets a broad spectrum of opioids has its own problems. One of the most effective treatments for opioid use disorder are maintenance drugs like buprenorphine (commonly known as Suboxone) and methadone, which are chemically similar to opioids and work by attaching to the same brain receptors, preventing users from using other opioids to get high while reducing cravings and withdrawal symptoms.</p><p>Matyas acknowledged that creating a vaccine that stops problematic opioids while avoiding treatment drugs is the goal.</p><h2>What it will take to get a heroin vaccine approved</h2><h2><div class="KonaFilter image-container display-table"><div><div class="image on-image"></div><p></p></div></div></h2><p>For now, the vaccine has been tested only in animals. Montoya at NIDA called current studies of the vaccines' use in animals "encouraging" but said it remains to be seen whether they will work in humans.</p><p>The hope is to get a human clinical trial started within a couple of years, but that could take <a href="http://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/how-clinical-trials-are-planned-and-organised/how-long-it-takes-for-a-new-drug-to-go-through-clinical-trials">up to 15 years</a> from the earliest of human trials to approval. First, <a href="http://www.businessinsider.com/how-fda-drug-approval-works-2017-2">researchers will have to show that the vaccine is safe to administer</a>, then you have to show it's effective at what it sets out to do. A heroin vaccine will likely take just as long, by Matyas' estimate.</p><p>That process won't be cheap and will need the backing of a drug company.</p><p>While Matyas has licensed his vaccine to biotech company Opiant, which <a href="http://www.businessinsider.com/price-of-naloxone-narcan-skyrocketing-2016-7">developed the NARCAN anti-overdose spray</a>, CEO Dr. Roger Crystal told Business Insider it is waiting for more pre-clinical data before deciding whether to proceed. The data should be available by the end of the year.</p><p>In the event Matyas' vaccine doesn't pan out, Crystal said Opiant would look to license other potential vaccines until the company found a success. "We're here for the long run," Crystal said.</p><p>Despite being the trailblazer in the field, Janda has had more difficulties attracting significant interest for his vaccine, at least until recently. He said that just a few years ago he nearly gave away the vaccine free. As the opioid crisis has intensified, so has interest. He is now working on a deal with a small biotech company - he declined to name which since the deal isn't done - to bring his vaccine through clinical trials, which he says will cost between $30 million and $40 million.</p><p>Janda says his focus is on getting the vaccine to the public as soon as possible.</p><p>"I'm not looking to make money off this," he said. "The people out there that have these problems don't have deep pockets."</p><h2><strong>Making 'a good decision once'</strong></h2><p></p><div class="KonaFilter image-container display-table float_right"><div><div class="image on-image"></div><p></p></div></div>The heroin vaccine appears to be part of a trend in addiction research focusing on long-acting treatments that rely less on patients' decision-making.<p>Opioids hijack the brain's rewards system, resulting in fundamental changes to addicts' brain wiring. The longer one uses, the <a href="http://www.businessinsider.com/maia-szalavitz-unbroken-brain-treating-addiction-as-a-learning-disorder-2016-4">more profound changes are to an addict's ability to make choices</a>. One recovering addict, Andi Peterson, told Business Insider that even while enrolled in a treatment program, getting high "<a href="http://www.businessinsider.com/heroin-addict-explains-why-hard-stay-sober-drug-rehab-center-2017-4">required no thought" and was "like breathing</a>."</p><p>Most addicts go through years and several stints of treatment to achieve abstinence. Relapse is a common and expected part of the process.</p><p>Addiction experts and treatment professionals have long worked toward solutions that acknowledge this aspect of brain <keyword id="41551" type="UNKNOWN" weightage="100" keywordseo="science">science</keyword>. The "gold standard" of opioid-use-disorder treatment, according to them, are psychological therapies in conjunction with maintenance medication like buprenorphine or methadone, which prevent users from getting high while reducing cravings.</p><p>But such treatments must be taken daily, and while buprenorphine can be taken anywhere, methadone must be taken at a clinic often far from the patient's home. If a patient forgets or misses a dose, the cravings return and can trigger a relapse.</p><p>Researchers such as Matyas and Janda are looking to work around that daily-choice issue. The first medication to achieve that is Vivitrol, <a href="https://www.vivitrol.com/opioid-dependence/what-is-vivitrol">a monthly injection</a> approved by the FDA in 2010 that blocks opioid receptors in the brain. But the drug has been criticized for its side effects - including a painful withdrawal process - and questionable success.</p><p>Many patients that do end up trying Vivitrol, according to treatment professionals that spoke to Business Insider, tend to stop after the first monthly shot, largely because the drug, like the vaccine, has no effect on cravings.</p><p>"Some places have good luck with patients returning for their monthly shot, but we haven't had much success," Sandi Kuehn, the CEO of the Center for Addiction Treatment in Cincinnati, told Business Insider. Most patients aren't interested in the treatment, she said.</p><p>&#xa0;</p><p>Crystal, Opiant's CEO, thinks the vaccine will be more effective than Vivitrol precisely because it works for longer than Vivitrol's one-month timeline, and requires patients to only "make a good decision once."</p><p>While it is unclear how long a vaccine will remain effective, Janda said it would likely require three injections over three months, with the possibility of a booster shot at a later date. A study <a href="http://pubs.acs.org/doi/ipdf/10.1021/jacs.7b03334">presented in August at an industry conference</a> found that the vaccine lasted as long as eight months in monkeys.</p><p>NIDA is also funding research into long-acting versions of buprenorphine, particularly Probuphine, an <a href="https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm503719.htm">implant that doles out the medicine</a> for six months. Approved last year, Probuphine <a href="https://www.drugabuse.gov/about-nida/noras-blog/2016/05/probuphine-game-changer-in-fighting-opioid-dependence">has been called a "game changer</a>" by Dr. Nora Volkow, the director of NIDA, largely because it solves the daily-decision issue while alleviating cravings, unlike the vaccine or Vivitrol.</p><p>"The more often you have to administer the medication, you lower the adherence to treatment," said Montoya of NIDA, adding that the agency thinks long-acting treatments will improve adherence.</p><h2><strong>Another Vivitrol</strong></h2><p></p><div class="KonaFilter image-container display-table float_right"><div><div class="image on-image"></div><p></p></div></div><p>Vivitrol has drawn headlines over the past year after investigations by <a href="https://www.propublica.org/article/vivitrol-opiate-crisis-and-criminal-justice">ProPublica,</a> <a href="https://www.nytimes.com/2017/06/11/health/vivitrol-drug-opioid-addiction.html?mcubz=1&amp;_r=0">The New York Times</a>, and the <a href="https://www.statnews.com/2016/11/14/opioids-prisons-vivitrol/">Associated Press</a> reported how Alkermes, which developed the drug, grew its business from $30 million in 2015 to $209 million a year later, primarily by <a href="https://www.propublica.org/article/vivitrol-opiate-crisis-and-criminal-justice">marketing its product directly to drug courts, prisons,</a> and other parts of the criminal-justice system.</p><p>In many cases, the company targeted judges in areas hard hit by the opioid crisis wary of maintenance treatment and with a bias toward viewing addiction as a moral weakness. Vivitrol was pitched as a way to avoid treatment that "substitutes one opioid for another," a still common misconception of buprenorphine <a href="http://www.businessinsider.com/hhs-secretary-tom-price-medication-assisted-treatment-suboxone-news-opioid-crisis-2017-5">repeated in May by Health and Human Services Secretary Tom Price</a>.</p><p>Daniel Wolfe, a director at progressive organization Open Society Foundations, slammed Vivitrol in STAT News as a treatment that "<a href="https://www.statnews.com/2017/06/29/vivitrol-methadone-opioids/">prioritizes the fantasy of being drug-free</a> over the real interests of people in need of help."</p><p>Addiction experts and treatment professionals worry that the heroin vaccine, if marketed improperly, could go down the same path - providing governments another reason to avoid maintenance therapies, which they see as more effective.</p><p></p><div class="KonaFilter image-container display-table"><div><div class="image on-image"></div><p></p></div></div><p>"When the courts start practicing medicine from the bench, there is a real fear that they may latch onto vaccines and mandate them without involving clinicians," Dr. Devang Gandhi, the head of the University of Maryland's addiction residency program, told Business Insider. "That is often the case now, where decisions are made by judges who don't really understand what these medications are."</p><p>That fear may not be entirely unfounded. When asked what Opiant saw as a potential market for the vaccine, Crystal said it would be "ideal" to administer to those with a history of abuse, "particularly in the prison setting."</p><h2><strong>'You can't find a magic bullet for this'</strong></h2><p></p><div class="KonaFilter image-container display-table float_right"><div><div class="image on-image"></div><p></p></div></div><p>While addiction experts and treatment professionals expressed excitement at the prospect of Janda's and Matyas' research, many wondered how "practically useful" such a vaccine would be for those on the front lines of the crisis.</p><p>Willenbring, the addiction psychiatrist, said that solving the opioid crisis is not a matter of developing new treatments but expanding access of current treatments to those that need it.</p><p>"The problem right now is not that we don't have effective treatments, it's that we don't have enough of it," said Willenbring, who was the director of treatment research at the National Institute of Alcohol Abuse and Alcoholism from 2004 to 2009.</p><p>The treatment paradigm - psychological therapies in conjunction with buprenorphine or methadone - represents&#xa0;"some of the most effective treatments not just in addiction but all of medicine," Gandhi said.</p><p>While the Obama administration <a href="http://www.businessinsider.com/obama-buprenorphine-suboxone-policy-2016-7">made administrative changes to increase the number of prescribers </a>administering buprenorphine last year, a study <a href="http://www.healthline.com/health-news/anti-opioid-drug-is-underused#2">conducted by the Johns Hopkins School of Medicine earlier this year</a> found that only 44% of physicians who had obtained a waiver to prescribe buprenorphine were doing so at full capacity. The White House opioid commission <a href="http://www.businessinsider.com/trump-opioid-commission-republican-healthcare-obamacare-repeal-2017-8">recommended expanding access to buprenorphine and other</a> medication-assisted treatments in its July report.</p><p></p><div class="KonaFilter image-container display-table"><div><div class="image on-image"></div><p></p></div></div><p>Willenbring put it bluntly: "It's hard for me to talk about highly theoretical treatments that may not work when we already have highly effective treatments that people can't access," he said. "If we're serious about ending this crisis, we'd make sure anybody who wants medicated-assisted treatment can have immediate access at an affordable price, if not free."</p><p>Kuehn, the CEO of the Ohio treatment center, said that the complicated nature of addiction makes it unlikely that any one treatment will work for all patients, but that any additional treatments could be effective tools.</p><p>"You can't find a magic bullet for this. It would be misleading for the public to think that it can be easily cured," she said.</p><p>While Janda acknowledged the limitations of the vaccine, he said it's not designed to be a cure-all, but something that could be used in conjunction with current treatments to help addicts.</p><p>"If we think that the treatments we have right now are going to solve our problems, I don't think that's going to be the case," he said. "We've got to start looking outside the box to try to find some alternative or other therapies."</p><div><div style="position:relative;width:auto;padding:0 0 39.58%;height:0;top:0;left:0;bottom:0;right:0;margin:0;border:0 none" data-break-on="414" data-lg-id="experience-59b313f0dfd7a" data-lg-src="//view.ceros.com/business-insider/desktop-heroin-vaccine-compare-chart-1-1" data-lg-padding="39.58%" data-sm-id="experience-59b31a36105d4" data-sm-src="//view.ceros.com/business-insider/desktop-heroin-vaccine-compare-chart-1-1-1?heightOverride=570" data-sm-padding="47.5%">    </div></div><div><div style="position:relative;width:auto;padding:0 0 56.25%;height:0;top:0;left:0;bottom:0;right:0;margin:0;border:0 none" data-break-on="414" data-lg-id="experience-59b3011f0a5c8" data-lg-src="//view.ceros.com/business-insider/desktop-heroin-vaccine-compare-chart" data-lg-padding="56.25%" data-sm-id="experience-59b313e186356" data-sm-src="//view.ceros.com/business-insider/desktop-heroin-vaccine-compare-chart-1" data-sm-padding="83.33%">    </div></div>    <div class="margin-top">        <h3>NOW WATCH: <a href="http://www.businessinsider.com/nasa-footage-hurricane-harvey-threat-texas-2017-8">Terrifying NASA footage from space shows the giant Hurricane Harvey about to slam the Texas coast</a></h3>        <div>                    </div>    </div>

2 scientists are locked in a race to develop a groundbreaking vaccine for heroin, but it might not be a 'magic bullet'

<p><div class="KonaFilter image-container display-table float_right"><div><div class="image on-image"><p class="source"><span><a href="http://www.wzzm13.com/news/local/kalamazoo/police-at-least-8-victims-multiple-dead-after-car-hits-bicyclists/235907309">Phil Dawson/WZZM</a></span></p><p class="caption">A view of police and fire officials responding to a collision that killed several bicyclists near Kalamazoo, Michigan.</p></div><p></p></div></div>At least <a href="http://www.wzzm13.com/news/local/kalamazoo/police-at-least-8-victims-multiple-dead-after-car-hits-bicyclists/235907309">five bicyclists were killed</a> Tuesday evening after being struck by a pickup truck north of Kalamazoo, Michigan, several local media outlets reported.</p><p>Kalamazoo County Undersheriff Paul Matyas told WOOD-TV that <a href="http://woodtv.com/2016/06/07/bicyclists-dead-after-crash-north-of-kalamazoo/">at least nine victims</a> were involved, some of whom may be children. It's not clear whether any of those killed were children.</p><p>Matyas said the driver fled on foot after the collision, but has since been arrested.</p><p>Witnesses said the bikes and the truck had been moving in opposite directions at the time of the collision.</p><p>"I saw a bunch of bikes hit the front of his truck and a couple of them flew," one witness, Markus Eberhard, told WOOD-TV.</p><p>According to the National Highway Safety Traffic Administration, <a href="http://www-fars.nhtsa.dot.gov/Main/index.aspx">726 cyclists were killed</a> in the US in 2014.</p>    <div class="margin-top">        <h3>NOW WATCH: <a href="http://www.businessinsider.com/mythbusters-adam-savage-wont-work-with-jamie-hyneman-anymore-2016-5">Adam Savage reveals why he and 'MythBusters' cohost Jamie Hyneman won't be working together anymore</a></h3>        <div>            <div>        <div class="ooyala-video-player" data-video-autoplay="false" data-video-id="8yMjBqMTE64Z8GLc4yQx9nPkambvO6n4" data-player-variable="ooyalapopvideo" id="ooyalaplayer_popvideo" style="width:1280px;height:720px"></div>        </div>        </div>            </div>

At least 5 bicyclists killed in a hit-and-run crash in Michigan

<ul class="summary-list"><li>A resident of Brooklyn, New York went to the emergency room with a fever and cough on Thursday. He'd just returned from <a href="https://www.businessinsider.com/japan-close-every-school-to-fight-the-spread-of-coronavirus-2020-2">Japan</a>, where over 200 people have the new coronavirus.</li><li>His case was not "of concern" based on CDC criteria, so he did not receive a coronavirus test. CDC guidelines allow him to resume his normal life, including taking the subway.</li><li>The man still doesn't know whether he has the coronavirus, so he's quarantining himself in his apartment just in case.</li><li>The case points to the CDC's limited capacity for testing, which could leave cases undetected.</li><li>For the latest case total, death toll, and travel information, see <a href="https://www.businessinsider.com/china-virus-everything-we-know-deadly-2019-ncov-wuhan-spread-2020-1">Business Insider's live updates here</a>.</li><li><a href="https://www.businessinsider.com/?hprecirc-bullet">Visit Business Insider's homepage for more stories</a>.</li></ul><p>When a 35-year-old man went to a New York City hospital with a fever, cough, and aches, emergency-room staffers put him in isolation and suited up in gowns, gloves, and goggles. He'd recently returned from a business trip to Japan, where at least <a href="https://www.mhlw.go.jp/stf/newpage_09860.html">230</a> people have tested positive for <a href="https://www.businessinsider.com/china-virus-everything-we-know-deadly-2019-ncov-wuhan-spread-2020-1">the new coronavirus</a>.</p><p>Doctors at the NYU Langone Hospital in Brooklyn suspected he might have COVID-19. Tests for 20 other viruses came back negative, including five strains of flu. But the CDC denied the hospital's request to test for the coronavirus, the man told Business Insider, because his condition wasn't severe enough to hospitalize him.</p><p>Officials even told the hospital that the patient could resume life as normal, including taking the subway to his workplace in midtown Manhattan, he said.</p><p>"They kind of left me in this state which was kind of a choose-your-own-adventure," the man said. Business Insider confirmed his identity and reviewed paperwork from his hospital visit, but is keeping the man anonymous for security reasons.</p><p>"If this turns into a pandemic or whatever this is, it shouldn't come down to individual decisions," he added.</p><p>The man said his doctor did not agree with the CDC's verdict and recommended ways the patient could quarantine himself at home. He's taking the advice, though he still doesn't know for sure whether or not he has COVID-19. </p><p>The case highlights a major hurdle for containing the new coronavirus in the US: Testing capacities are still limited.</p><p>"Other countries are testing much more broadly than we are," William Schaffner, an infectious-disease specialist at the Vanderbilt University School of Medicine, <a href="https://www.businessinsider.com/us-preparations-coronavirus-outbreak-slowing-testing-mask-shortages-2020-2">previously told Business Insider</a>. "We are trotting along while they're racing along."</p><h2>Limited testing capacities mean cases like this can go undiagnosed</h2><p>In the hospital, the man said, health workers scanned his chest to check for pneumonia and ordered testing for 20 basic viruses. He tested negative for all of them. The man's chest scan came back clear, and his symptoms weren't severe enough to keep him in the hospital.</p><p>His doctor told him she had requested a COVID-19 test from the state's health department, but was told he didn't need one.</p><p>"She said, basically, if we didn't hospitalize you… then you don't meet the criteria that's set by the CDC, which means we can't perform testing through the CDC," he said.</p><p>According to CDC <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fclinical-criteria.html">guidelines</a>, a person who has recently traveled to Japan is only considered a potential COVID-19 patient if they have symptoms severe enough for hospitalization. The same standards apply to people who have traveled to China, Iran, Italy, and South Korea. </p><p>A signed letter from the man's ER doctor, reviewed by Business Insider, said the Department of Health had advised the man that his case was not "of concern to have COVID-19." The doctor did, however, recommend "that he stay home until fever resolves."</p><p>The New York State Department of Health declined to comment for this story, and the CDC did not respond to a request for comment in time for publication.</p><p>The CDC had only tested about 470 people in the US for coronavirus as of Sunday, according to the agency's official count. Overnight, the CDC appears to have <a href="https://twitter.com/JuddLegum/status/1234536619270688768">removed</a> those testing numbers from its <a href="https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html">website</a>. Alex Azar, secretary of Department of Health and Human Services, <a href="https://abcnews.go.com/Politics/secretary-alex-azar-hhs-ramping-testing-coronavirus/story?id=69308111">told ABC on Sunday</a> that 3,600 Americans had been tested. </p><p>"We're still dealing with a test that is limited in its availability, so we still have to prioritize by risk," Bela Matyas, the health officer in Solano County, California, said in a <a href="https://www.facebook.com/ABCNews/videos/officials-give-news-update-on-coronavirus-case-in-solano-county-california/1584310271725799/">Thursday press conference</a>.</p><p>Matyas said that was one of the reasons why a California patient spent multiple days in two different hospitals without getting tested.</p><p>In New York city, 10 people have been <a href="https://www.health.ny.gov/diseases/communicable/coronavirus/">tested</a> for COVID-19 and another 22 have been tested elsewhere in the state. On Sunday, the New York State Department of Health <a href="https://twitter.com/nycHealthy/status/1234163700245901314?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1234163700245901314&amp;ref_url=https%3A%2F%2Fabc7ny.com%2F5977498">confirmed its first case</a> - a woman in her late 30s who had recently traveled to Iran. </p><p>"In New York state, the person who tested positive was only the 32nd test we've done in this state. That is a national scandal," Matthew McCarthy, a Manhattan physician and an assistant professor of medicine at Cornell, <a href="https://twitter.com/BGrueskin/status/1234497232302415880">told CNBC on Monday</a>.</p><p>South Korea, by contrast, has implemented free coronavirus-testing drive-thrus and tested more than <a href="https://www.cdc.go.kr/board/board.es?mid=a30402000000&amp;bid=0030&amp;act=view&amp;list_no=366419&amp;tag=&amp;nPage=1">109,000 people</a>.</p><p>What's more, many CDC tests distributed to state labs have been <a href="https://www.businessinsider.com/us-preparations-coronavirus-outbreak-slowing-testing-mask-shortages-2020-2">faulty</a>, causing more than half the labs to receive inconclusive results.</p><p>"It is easy to do for some countries, but what happened in the US is the CDC created a test, sent it out to all 50 states and then said, 'Wait hold up don't use it,'" McCarthy said.</p><p>He added: "I still have to call the Department of Health. I still have to make my case, plead to test people."</p><h2>Uber trips and a vague 'viral illness' diagnosis</h2><p>While in Japan, the man said, he wore a mask most of the time but couldn't avoid crowded train stations. Halfway through the trip, he developed a mild cough. He returned to New York on Tuesday, landing at Newark Liberty International Airport.</p><p>Over the next couple of days, he started to feel achy and feverish, describing a feeling of "pure burning, like my whole body burning."</p><p>He called NYU Langone Hospital on Thursday.</p><p>"I felt like things were just compounding," he said. "It felt like symptoms were adding up and things were on an upward trajectory. So that made me nervous."</p><p>A hospital staffer told him to come into the emergency department, the man said, so he called an Uber. When he arrived, a nurse gave him a surgical mask and escorted him to a private room.</p><p>"The next time someone came into that room, they were in a quarantine outfit essentially," he said. "Full face covers, full apron, shoes wrapped up, and gloves, plastic glasses. Literally no part of their body exposed."</p><p>But after his examination, the man was cleared to leave the hospital with a vague diagnosis of "viral illness."</p><p>He called another Uber to take him home.</p><h2>'The ultimate test of my own personal morality'</h2><p>The patient said the ordeal has proven expensive. He only went to the ER because he feared he'd been exposed to the new coronavirus, he said - normally, he wouldn't spend money on an emergency room visit for a fever and a cough.</p><p>What's more, the man shares a one-bedroom apartment with his girlfriend, so he said she's staying in a hotel to avoid contact with him. She has dropped groceries off in his building's lobby, he added, and also left him the medications that doctors prescribed: prednisone, a steroid that suppresses inflammation, and benzonatate to treat his cough.</p><p>"It's like the ultimate test of my own personal morality," he said between audible bouts of coughing. "Are you willing to spend thousands of dollars going to the ER, paying for hotels, and isolating yourself so you don't get people you don't know sick?"</p><p>The man added that although he knows the recommended quarantine period is 14 days, he's not sure whether that time period should start when his cough began, when his fever began, or when he visited the hospital. He said he's been trying to work from home and is sleeping a lot, watching TV, playing video games, and checking his temperature several times a day.</p><p>He is starting to feel better: He said his fever, which reached 102 degrees Fahrenheit on Tuesday, is gone now, though his cough has not improved. </p><p>He's worried he might have passed the virus to his girlfriend.</p><h2>'I can't imagine I'm the only one'</h2><p>The man said he's been repeatedly calling the New York State Department of Health to ask if they've changed the criteria or decided to test him, but he has heard nothing from them. </p><p>He said he understands that the CDC is prioritizing tests for people who develop severe symptoms. But he worries that coronavirus patients could be slipping through the cracks.</p><p>"I can't imagine I'm the only one coming back from one of those countries with minor flu-like symptoms," the man said, adding that he thinks New York health officials should have tested far more than eight people by Saturday.</p><p>"It doesn't make any sense to me that we've only tested eight people. It doesn't make any sense. It's not possible unless there's other people like me who tried to get testing and have been denied testing, and just haven't spoken up about it."</p><p><em>Aria Bendix contributed reporting.</em></p><ul class="read-more-links"><li>Read more:</li><li><a href="https://www.businessinsider.com/us-government-travel-warnings-for-coronavirus-outbreak-2020-2">The CDC is warning travelers about visiting 5 countries because of the coronavirus. Here's the US government's guidance.</a></li><li><a href="https://www.businessinsider.com/diamond-princess-cruise-passengers-details-photos-from-quarantine-evacuation-2020-2">2 US grad students who were on the Diamond Princess cruise share harrowing details and photos from their quarantine and 'zombie movie' evacuation</a></li><li><a href="https://www.businessinsider.com/coronavirus-covid-19-cases-united-states-to-increase-shouldnt-panic-2020-3">'There is absolutely going to be an explosion in the number of identified cases' of coronavirus in the US. A Yale healthcare expert explains why you shouldn't panic.</a></li><li><a href="https://www.businessinsider.com/coronavirus-treatments-and-vaccines-gileads-remdesivir-moderna-2020-3">We don't have any good treatments for the novel coronavirus right now, but scientists are racing to change that</a></li></ul>

A New York City man wasn't tested for coronavirus even though he had symptoms and had gone to Japan. It highlights the troublingly limited scope of US testing.

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The US' newest coronavirus patient had no known exposure to anyone sick and hadn't gone to China, which suggests containment might be impossible

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2 scientists are locked in a race to develop a groundbreaking vaccine for heroin, but it might not be a 'magic bullet'

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At least 5 bicyclists killed in a hit-and-run crash in Michigan

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A New York City man wasn't tested for coronavirus even though he had symptoms and had gone to Japan. It highlights the troublingly limited scope of US testing.

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