Since 2009, companies handling health records have been required to notify consumers if their data is breeched. Now, the rule has been extended to health apps that track fitness, vital statistics, sleep and more. The FTC ruled 3-2 that companies producing such apps must inform users impacted by data breaches, lest they face a financial penalty of over $43,000 per day, The Hill has reported.
"As many Americans turn to apps and other technologies to track diseases, diagnoses, treatment, medications, fitness, fertility, sleep, mental health, diet, and other vital areas, this Rule is more important than ever," the FTC wrote in the ruling. "Firms offering these services should take appropriate care to secure and protect consumer data."
A more fundamental problem is the commodification of sensitive health information, where companies can use this data to feed behavioral ads or power user analytics.
Recent high-profile breaches include UnderArmour's MyFitnessPal breach that affected 150 million users in 2018. A more recent data leak came about due to an exposed server that contained 61 million records related to fitness trackers and wearables that exposed Apple and Fitbit users' data online.
The rule passed along party lines, with the majority Democratic commissioners voting 3-2 in favor. However, the Republican commissioners dissented because the FTC was already working on revamping health breach notification rules. "The right way to go about it is to conclude the ongoing rulemaking process, especially when the statutory and regulatory interpretation on which the majority rely is far from clear," said commissioner Noah Phillips.
FTC Chair Lina Khan said the ruling is just the start of what's needed. "A more fundamental problem is the commodification of sensitive health information, where companies can use this data to feed behavioral ads or power user analytics," Khan said. "The Commission should be scrutinizing what data is being collected in the first place and whether particular types of business models create incentives that necessarily place users at risk."
During Crimean War, hospitals of the day weren't so much centers of healing or recovery as they were the places where injured combatants went to die slightly more slowly. Turkey's Scutari hospital was one such notorious example. Converted by the British Empire from army barracks, Scutari lacked every imaginable amenity, from basic sanitation to sufficient ventilation, this "hospital" served as a potent incubator for myriad infectious diseases — that is until Florence Nightingale and her team of volunteer nurses arrived in 1854.
Maladies of Empire by Jim Downs explores how many aspects of modern medicine are borne on the backs of humanity's most abhorrent impulses, though in the excerpt below, Downs illustrates how one woman's unyielding tenacity and fastidious record keeping helped launch the field of preventative medicine.
While in Scutari, Nightingale developed a system of record keeping that tracked a variety of factors at the Barrack Hospital and the nearby General Hospital. She took notes on everything from cleanliness to the quantity of supplies to diet to the placement of latrines and graveyards.
She also carefully examined the physical space. She took careful note of the size of the wards, the condition of the roof, and the quality, size, and placement of the windows. In her book on the health of the British army, like Thomas Trotter and others who wrote about the importance of fresh air, she pointed to the problem of improper ventilation, and she devoted an entire section to “bad ventilation.” She quoted the report of the sanitary commission, which remarked on the “defective state of the ventilation” in the Barrack Hospital. There were only “a few small openings here and there,” so that there was no way for the “hot and foul” air to escape. As an adherent of the miasma theory, she believed that diseases were spread through the air and advocated for ventilation to release the “foul air” from hospitals.
In addition to inadequate ventilation, Nightingale pointed to poor drainage and badly designed sewers and plumbing. In her testimony to the royal commission, Nightingale reported on the filthy conditions she found in the Barrack Hospital when she arrived. “The state of the privies... for several months, more than an inch deep in filth, is too horrible to describe.” She observed six dead dogs under one of the windows, and a dead horse lay in the aqueduct for weeks. The drinking water was dirty; once she saw used hospital uniforms in the water tank. Rats and insects abounded, and “the walls and ceilings were saturated with organic matter.”
In the conclusion to her report on the health of the British Army, she explained, “We have much more information on the sanitary history of the Crimean campaign than we have upon any other, but because it is a complete exam (history does not afford its equal) of an army, after failing to the lowest ebb of disease and disaster from neglects committed, rising again to the highest state of health and efficiency from remedies applied.
"It is the whole experiment on a colossal scale.” She pointed out that during the first seven months of the Crimean campaign, mortality exceeded that of the plague of 1665 as well as that of recent cholera epidemics. But during the last six months of the war, after sanitary reforms had been made, “we had... a mortality among our sick little more than that among our healthy Guards at home.”
Using mortality data that she had collected during the war, along with domestic mortality statistics, Nightingale showed that between 1839 and 1853, mortality among soldiers was much higher than among civilian men: “of 10,000 soldiers [at the age of 20], 7,077 live to the age of 39, out of whom 135 die in the next year of age; whereas out of 10,000 civilians at the age of 20, 8,253 attain the age of 39, and of those 106 die in the year of age following.” Nearly all mortality among soldiers was the result of disease; “actual losses in battle form a very small part of the calamities of a long war.” Nightingale classified the causes of death as “zymotic diseases” (which in the nineteenth century referred to infectious diseases such as fevers, measles, and cholera), “chest and tubercular diseases,” and “all other diseases (including violent deaths).” Nightingale was critical of the army’s classification system for diseases. At the bottom of a chart, she notes, “Bronchitis and influenza have no place in the Army nomenclature. The chronic catarrh of the Army Returns is believed to be really phthisis, in the great majority of cases; acute catarrh comprehends both epidemic catarrh, or influenza and bronchitis.”
Nightingale presented statistics using charts, tables, and diagrams, which were just beginning to appear in research reports, to make it easier for readers to visualize the comparison she was making. She developed a new kind of graphic, called a “rose chart,” also known as a coxcomb chart or polar area diagram, to present mortality data from the Crimean War. Each chart, which is laid out like a pie, shows data from one year, with the slices representing months. Each slice is divided into colored segments whose area is proportional to the number of deaths.
One segment is for deaths from wounds, a second for “preventable or mitigable zymotic diseases,” and a third for all other causes. A quick glance at the charts of deaths from April 1854 to March 1855 and April 1855 to March 1856 is enough to show that many more deaths were caused by disease than by combat, and that overall mortality decreased in the second year.
To further make visible the dangers of unsanitary hospitals, Nightingale gathered mortality data for matrons, nuns, and nurses working in fifteen London hospitals who died of the “zymotic diseases” of fever and cholera. She presented tables, which she notes William Farr compiled for her, showing that the mortality rate of the nursing staff was much higher than that of the female population in London; in addition, women working in hospitals were more likely to die of zymotic diseases than were other women. She used these figures to argue for the “very great importance” of hygiene in hospitals. “The loss of a well-trained nurse by preventible [sic] disease,” she wrote, “is a greater loss than is that of a good soldier from the same cause. Money cannot replace either, but a good nurse is more difficult to find than a good soldier.”
In her book Notes on Hospitals, she retold the story of the British prisoners of war who died in a crowded jail cell in India in 1756: “Shut up 150 people in a Black hole of Calcutta, and in twenty-four hours an infection is produced so intense that it will, in that time, have destroyed nearly the whole of the inmates.” Nightingale’s reference to the case is evidence for its status as the prototypical illustration of the need for ventilation. And the fact that it took place in India shows how British medical authorities used information from around the empire.
As a result of her work with large numbers of patients in the Crimean War, Nightingale framed her analysis like an epidemiologist, in terms of populations. She focused on how disease spread within a group. She devoted her energies not to changing bedpans or dressing wounds but to studying the structure of hospitals, analyzing statistics, and figuring out how to increase ventilation.
The war provided her the opportunity to compare mortality rates in varied settings: crowded hospitals, shabby tents, and wooden huts. It also underscored to her the importance of preventive measures, which constitutes one of the major tenets of modern epidemiology. By publishing her observations, her insights, and guidelines for hospitals to follow, she hoped to provide a set of rules and guidelines for physicians to follow to prevent the spread of disease. While efforts to ensure proper hygiene as a way to guard against illness can be traced to Mesopotamian civilization and Sanskrit writings from 2000 BCE, Nightingale’s warnings, in particular, and sanitary reform, more generally, sparked a critical turning point in the middle of the nineteenth century that gave rise to preventive medicine. This transformed military medicine from an enterprise that largely focused on treatment and surgery to one that began to engage epidemiological questions and issues.
The trickle-down of features from Fitbit’s higher-end wearables to its everyday fitness trackers continues with the Charge 5. This new edition of the device is packing both ECG and EDA sensors, both of which were first found in the higher-end Sense, to better help you monitor your heart health and stress. Charge 5 also gets a few quality-of-life improvements compared to its predecessor, including a new body that’s 10 percent thinner and a new color AMOLED display with an always-on option.
But the real point of this new tech is to integrate the Fitbit into your daily health routines as something more than just a tracker. The ECG sensor will, naturally, help you check your heart’s electrical activity and check for signs of atrial fibrillation. The EDA, or Electrodermal Activity sensor (itself a fancier term for Galvanic Skin Response) is designed to measure the perspiration of your hands, which can be a marker for stress. As with the Sense, users can then be coached through a stress-reduction session if their stats get too aggressive.
Fitbit is also looking to bolster its $10-per-month Premium offering to encourage more of its hardware users to sign up to a monthly subscription. That includes a new Daily Readiness Score, which sounds a lot like Garmin’s Body Battery calculation, which will examine how ready you are to work out. It’ll do that by looking at your heart rate variability, recent sleep schedule and activity to judge if you should hit the treadmill or the couch that day.
Premium will also get a new collection of workouts from Les Mills to help coach you through the workout du jour. In addition, Fitbit is partnering with Calm, and Premium users will get access to “30 pieces of Calm content in seven languages,” with users able to run an EDA scan at the same time as listening to a Calm-created mindfulness session. Or they will be, since the material is expected to arrive at some point in September.
The Fitbit Charge 5 is available to pre-order today, and will cost $179.95 complete with six months of Fitbit Premium thrown in.
Researchers from Italy have created a robot that could one day allow diabetes patients to get a dose of insulin without any needles. PILLSID involves two separate parts. One component is an internal insulin dispenser that a doctor would surgically implant in your abdomen. The other is a magnetic capsule loaded with the hormone.
Anytime you need to refill the dispenser, you take one of the pills, and it travels down your digestive system until it reaches the point where the device is implanted near your small intestine. Using the power of magnets, the device rotates the capsule into position and then punctures it with a retractable needle and pumps the refill of insulin into a reservoir. The cool thing here is that the dispenser charges wirelessly, limiting the number of interventions a doctor needs to maintain the device. Once the capsule is empty, it continues its trip down your digestive system until you eventually poop it out. Good times.
On the surface, the system may sound scary, but in a lot of ways, it’s preferable to many of the current tools you can use as a type 1 diabetes patient to regulate your blood sugar levels. Insulin pumps, for instance, involve a tube or needle that you need to self-administer. One jab might not be so bad, but some people need to get multiple injections per day. "Maybe it's scary to think about a docking station inside the body, but it worked," Arianna Menciassi, one of the co-authors of the study, told IEEE Spectrum. Unintuitively, this is a much less intrusive system, and it has the potential to be useful for administering other life-saving drugs.
In a test involving three diabetic pigs, the research team found the system could successfully manage their insulin levels for several hours. In some instances, they found bodily fluids from the pigs would leak into the robot. So as a next step, the team is working on sealing the device better.
While it will likely be some time before PILLSID makes its way to hospitals, devices that attend to your medical needs from inside your body are likely to become more and more common. In 2016, for instance, MIT showed off an origami robot that can pick up objects from inside your intestine.
A number of companies make "hearing enhancement" devices that look more like a set of earbuds than a piece of clinical tech. Nuheara has been a staple at CES with its IQbuds line and companies like Bose, Bragi, Olive and others have offered a mix of tech and hardware to assist with hearing loss. Even Apple plans to introduce a "Converstaion Boost" for its AirPods Pro. Since the FDA allows companies to sell directly to consumers with mild-to-moderate hearing loss without the need for a prescription, the list of options is constantly growing. Another company that's specifically equipped to blur the line between hearing aid and true wireless earbuds is Jabra, thanks to the auditory assistance expertise of its parent company GN.
With the Jabra Enhance Plus, the company offers a more approachable device for people who may not need what all-day hearing aids offer just yet. Jabra describes these earbuds as "a miniaturized true wireless form factor" that's 50 percent smaller than its stellar Elite 75t model. Those are already some of the smallest buds I've tested, so reducing the size even further makes the Enhance Plus more comfortable and more discreet. Plus, a design that resembles earbuds rather than a traditional hearing aid helps reduce the stigma around wearing something that helps your hear better.
Inside, four separate sound processing features work to improve audio quality. The Enhance Plus analyzes sound to keep things as natural as possible while also reducing noise for speech clarity. The earbuds also ensure feedback doesn't hinder amplification and they isolate sounds coming from in front of you.
Jabra
In addition to providing hearing enhancement, the Jabra Enhance Plus can work just like a set of true wireless earbuds to play music and take calls. Similar to other earbuds, the Enhance Plus comes with multiple sizes of ear tips to help you find the best fit, on-board controls and water/dust resistance (IP52). Jabra says they'll last 10 hours on a charge with 30 hours total when you factor in the charging case. An app assists with setup and offers a degree of customization.
Jabra plans to launch the Enhance Plus at "select hearing care clinics" in the US "towards the end of the year." A licensed professional will conduct a hearing test to make sure these earbuds are appropriate. There's no word on pricing just yet, but the company says it's applying for approval under the FDA's self-fitting category. If you're looking for more of a true hearing aid rather than these "enhancers," Jabra also offers the Enhance Pro. It carries the more traditional behind-the-ear hearing aid design along with a charging case. It's also pricey, starting at $1,800.
If that's what you're after, the Bose SoundControl hearing aids went on sale in May in a handful of states. That device puts the company's audio expertise to use to help you hear better, and Bose said it was the first FDA-cleared hearing aids that could be sold directly to consumers. What's more, they're more affordable at $850, but they run on the typical zinc-air batteries for hearing aids rather than being rechargeable.
In the past, we’ve seen doctors use AI software to detect brain tumors, kidney illness and various cancers. Now, researchers from IBM and Michael J. Fox Foundation (MJFF) say they’ve developed a program that can predict how the symptoms of a Parkinson’s disease patient will progress in terms of both timing and severity. In The Lancet Digital Health journal, they claim the software could transform how doctors help patients manage their symptoms by allowing them to better predict how the disease will progress.
“Our aim is to use AI to help with patient management and clinical trial design. These goals are important because, despite Parkinson’s prevalence, patients experience a unique variety of motor and non-motor symptoms,” IBM said.
The breakthrough wouldn’t have been possible without the Parkinson’s Progression Markers Initiative, a study the Michael J. Fox Foundation sponsored. IBM describes the dataset, which includes information on more than 1,400 individuals, as the “largest and most robust volume of longitudinal Parkinson’s patient data to date” and says it allowed its AI model to map out complex symptom and progression patterns.
It’s estimated Parkinson’s disease affects more than 6 million people globally, and there’s currently no known cure for it. IBM Research and MJFF plan to continue work on the AI model. In the future, they hope to make it better at providing more granular characterizations of the various stages of the disease.
A company that makes an implantable brain-computer interface (BCI) has been given the go-ahead by the Food and Drug Administration to run a clinical trial with human patients. Synchron plans to start an early feasibility study of its Stentrode implant later this year at Mount Sinai Hospital, New York with six subjects. The company said it will assess the device's "safety and efficacy in patients with severe paralysis."
Synchron received the FDA's green light ahead of competitors like Elon Musk’s Neuralink. Before such companies can sell BCIs commercially in the US, they need to prove that the devices work and are safe. The FDA will provide guidance for trials of BCI devices for patients with paralysis or amputation during a webinar on Thursday.
Another clinical trial of Stentrode is underway in Australia. Four patients have received the implant, which is being used "for data transfer from motor cortex to control digital devices," Synchron said. According to data published in the Journal of NeuroInterventional Surgery, two of the patients were able to control their computer with their thoughts. They completed work-related tasks, sent text messages and emails and did online banking and shopping.
It takes around two hours to implant a Stentrode device with a minimally invasive procedure, according to Synchron. The device is implanted through a blood vessel at the bottom of the neck and maneuvered into the brain. Synchron CEO Thomas Oxley told Bloomberg the device could be available to buy within three to five years.
We've seen helmets and AI that can spot brain tumors, but a new hard hat can actually treat them, too. As part of the latest neurological breakthrough, researchers used a helmet that generates a magnetic field to shrink a deadly tumor by a third. The 53-year-old patient who underwent the treatment ultimately passed away due to an unrelated injury. But, an autopsy of his brain showed that the procedure had removed 31 percent of the tumor mass in a short time. The test marked the first noninvasive therapy for a deadly form of brain cancer known as glioblastoma.
The helmet features three rotating magnets connected to a microprocessor-based electronic controller operated by a rechargeable battery. As part of the therapy, the patient wore the device for five weeks at a clinic and then at home with the help of his wife. The resulting magnetic field therapy created by the helmet was administered for two hours initially and then ramped up to a maximum of six hours per day. During the period, the patient's tumor mass and volume shrunk by nearly a third, with shrinkage appearing to correlate with the treatment dose.
The inventors of the device — which received FDA approval for compassionate use treatment — claim it could one day help treat brain cancer without radiation or chemotherapy. “Our results...open a new world of non-invasive and nontoxic therapy...with many exciting possibilities for the future,” said David S. Baskin, corresponding author and director of the Kenneth R. Peak Center for Brain and Pituitary Tumor Treatment in the Department of Neurosurgery at Houston Methodist Neurological Institute. Details of the procedure have been published in the peer-reviewed journal Frontiers in Oncology.
Eargo recently announced its latest smart hearing aid — the Eargo 5. We don’t do a lot of hearing aid news here at Engadget, but the California-based company makes some of the most "gadgety" we’ve tried and the latest model certainly appears to continue that trend.
Like the Neo HiFi and the Neo before it, the Eargo 5 is a tiny, "invisible" (completely in the canal, or CIC) hearing aid that comes with a charging case. With older Eargos, that case doubled as a way to connect the “buds” to your phone. Unfortunately, that meant the buds had to be in it while they were updated. What’s new this time around is that you can perform profile changes and more while actually wearing the hearing aids. What's more, there are key new features that change how the hearing aids sound. It’s an exciting update for fans of the brand as it adds to Eargo’s already slick user experience, something sorely lacking in many of the mainstream brands you find at your local audiologists.
The most interesting new feature is “Sound Match." Hearing aids have long had different profiles, and will usually be tuned for your own needs by an audiologist, but Eargo’s direct-to-consumer (and the need for the buds to be in the case) approach has made this much-needed personalization difficult. Until now?
Sound Match is effectively a hearing test built-in to the Eargo app. Once you pair the case (via Bluetooth) you can remove the Eargo 5s and the app will walk you through the test. If you’ve ever completed a hearing test, you’ll be familiar with this one. The app plays a series of sounds and you tell it if you can hear it or not; at the end, you’ll be presented with the results for each ear.
James Trew / Engadget
As simple as this is, my initial experiences with it weren’t entirely smooth. Not least because it took a few tries (and some back and forth with Eargo) to even get the case to pair with the app. After trying several restarts and installations, I was able to get connected and access the test — most likely due to me having early hardware.
From then on the test was mostly straightforward, until I spotted there was a “replay” button. I noticed that sometimes when I didn’t initially hear a sound, I definitely heard it after tapping replay. As in, it was audible enough that I wouldn’t have missed it the first time around. This meant I had to re-do the test to make sure I hadn’t incorrectly tapped “No” when really the sound just didn’t play at all.
Minor hiccups aside, once I was confident I had completed the test properly, I could further customize the experience by changing what profiles are available on the device. There are six situational ones (restaurant/meeting etc) and four presets. You can store a total of four on the hearing aids themselves.
Previous Eargo models would simply tell you the number of the audio profile that is active as you switch through the four on offer (via a double-tap on your tragus). With the Eargo 5 it now tells you the name of that profile if you chose one of the "situational" ones to eliminate any guesswork. You can also further tweak these profiles in the app, or simply change the volume and noise reduction (there’s now noise reduction here too I should mention) without having to permanently change the profile. This includes adjusting the volume and the treble/bass.
James Trew / Engadget
Although you can now adjust the sound and profiles while actually wearing the Eargo (before, you had to take them out and plop them in the case, which is less than ideal), there’s no capability for music/audio streaming from your phone. Eargo uses ultrasonic commands to communicate between the case and the hearing aids. That’s a neat way to enable small updates, but not enough for anything more heavyweight. Remember, size is key here, and streaming on devices this small, that go fully in your ear, isn’t a simple thing to do.
This new customization functionality really does improve the Eargo experience. I have tried several different devices and the ones that best serve my hearing loss are, predictably, the ones that have been tuned by an audiologist. This meant that, while older Eargos were some of the most appealing in terms of user experience and fit, they weren’t quite suitable for my personal situation and only provided users with limited tools to adjust the sound to their needs.
With the Eargo 5, I find them much more assistive in my hearing, particularly on the side I have problems with. In fact, I personally prefer just wearing only one, as my hearing loss is unilateral and having a boost on the "good" side can feel a bit much. I also find wearing both a bit less comfortable. There’s no logical reason why wearing one for extended periods should be fine, but two isn’t, but I think the combination of too much "extra" hearing (on my good side) and the physical feeling of something in both ears is just a lot of sensory stimulation, for me at least. Obviously, if you have a bilateral hearing deficiency you’ll want all the assistance you can get.
If you own a pair of older Eargos and were wondering if the hearing test feature might come to your model via an update, sadly it's not possible. There's specific hardware here to enable the ultrasonic commands, that isn't present in previous models.
James Trew / Engadget
Beyond Sound Match, Eargo claims the sound has been redesigned from the ground up for “optimal audio and speech performance.” The company doesn’t elaborate further but, with the new customization feature, it’s fair to say this is a very different experience than previous models already so any other improvements are hard to pick out, but good to know they are there.
Beyond the core updates, there are some welcome usability tweaks, too. The charging case now has lights around where the hearing aids should be placed to help you correctly seat them at night. Those lights also provide feedback by changing color when there’s a software update or the aids aren’t charging properly. You’ll also no longer need to make sure the contacts on the buds meet the ones in the case. A new magnetic inductive charging system means they will click themselves into the right position automatically.
While Eargo's app remains a slick experience, there are a few small opportunities to improve it further. The volume control is nice and simple, and you can choose to boost either side individually, or both as a pair. What’s lacking is visual feedback or even a tone in your ear, to let you know when you’ve reached the top or bottom of the range. There’s also no indication of whether any changes you make to a profile are permanently saved or an obvious way to reset them to default, but these are minor UI issues.
Battery life is claimed to be around 16 hours per charge. Add to that the battery in the case and this means you won’t need to plug them in for a couple of days, which is handy for weekends away where you don’t want to have to worry about finding an outlet. Should you need to, though, the charger is USB-C, so likely something you already have for your phone or laptop (a cable is, of course, included).
All in all, it's a substantial update for a direct-to-consumer product. Eargo has been getting a lot of things right in terms of making its products user-friendly and appealing to a mass audience. This matters when it's estimated that over 40 million Americans could benefit from an assistive hearing device. What was lacking, until now that is, was a way to tune them to your specific needs. Which in the world of hearing loss, can be the difference between understanding the television a bit better and being able to pick out quieter sounds in a noisy environment. The latter is something that makes daily life feel a lot more natural and makes social situations much more comfortable, so it's something really valuable to have on a device this small.
Remember, though, hearing aids are not a cheap product category. A good pair will often run you a couple of thousand dollars, more if you want something bespoke. The Eargo 5, then, at $2,950 might seem steep compared to a pair of wireless headphones but is relatively affordable among its hearing aid peers. If you’re already an Eargo user looking to upgrade, there’s a “repeat customer discount” that can shave off $500 from the MSRP.
You might not have to visit an optometrist just to get a basic prescription update for your glasses. Warby Parker is trotting out Virtual Vision Test, a revamp of its Prescription Check app that lets you renew your glasses or contact lens prescription using only an iPhone and your existing eyewear. Prop up your phone, stand 10 feet away and you can walk through a familiar "can you read this" test that will gauge whether or not your glasses or contacts need updating.
The update isn't automatic. An eye doctor will review the results and give you a verdict within two days. If you're seeing well enough, you'll just need to pay $15 to renew your prescription. If you're either struggling or just aren't eligible to use the app (see below), Warby Parker will recommend that you get a thorough eye exam.
The company is clear that this isn't a replacement for your eye doctor, and that you'll have to meet certain criteria beyond what we just mentioned. You have to be between 18 and 65 years old, with no existing eye health concerns and a single-vision distance prescription.
The approach relies on iOS' Vision Framework to measure your distance from your iPhone and ensure that you're far enough away from a proper test. We've asked Warby Parker about an Android version, although that might take a while given that it would need a rough equivalent to Vision Framework.
The motivations behind Virtual Vision Test are clear — on top of the renewal fee, this could lead to more people buying Warby Parker glasses and visiting the company's stores. Regardless, it could be very useful if you either can't make time to update your prescription or are still skittish about a visit while COVID-19 remains a concern.
