New pandemic vaccine plan keeps focus on critical workers

first_imgJul 23, 2008 (CIDRAP News) – Federal health officials today released their official guidance on allocating vaccine during an influenza pandemic, with few changes from a previous draft that put military personnel, critical health and emergency workers, pregnant women, and small children at the head of the line.The 25-page guidance document is intended to help state and local leaders allocate scarce vaccine supplies in a pandemic, especially the early stages. The goals are to blunt the effects of a pandemic on public health and the economy and to limit general social disruption.The new document, issued by the Department of Health and Human Services (HHS) and the Department of Homeland Security (DHS), is a revision of one that was released in October 2007. It was developed by a federal interagency working group, which gathered two rounds of input from the public and various stakeholders, including business and community organizations.In a news release, HHS Secretary Mike Leavitt called the guidance “the result of a deliberative democratic process.””This guidance was developed to ensure that our nation’s critical infrastructure remains up and running and we address the needs of all of our citizens, enabling the country to recover from a pandemic more quickly,” added Dr. Jeffrey Runge, DHS assistant for health affairs and chief medical officer.Once a pandemic emerges, “it could be on the order of 20 weeks before matched vaccine begins to flow,” and production capacity will be limited, said Dr. William Raub, Leavitt’s science advisor, at a press conference today. “So we need a plan to target the successive batches as fairly as we can. These guidelines are the instrument to do that.”Consensus on four objectivesFederal officials said all the public and stakeholder input produced a consensus on four objectives for vaccine allocation:Protect people who are critical to the pandemic response and care for those who are sick with the fluProtect providers of essential community servicesProtect those at high risk for infection because of their jobsProtect childrenThe working group settled on five tiers, or vaccination priority groups. To facilitate the assignment of people to the different tiers, the authors sorted the population into four broad categories: homeland and national security, healthcare and community support services, critical infrastructures, and the general population. They also defined several “target groups” on the basis of occupation, type of service, age-group, or risk level.In making their recommendations, federal officials looked at three levels of pandemic severity: severe, moderate, and less severe. Some occupational and risk groups move to a higher or lower tier depending on pandemic severity, but tier 1 is the same for all levels of severity. The following classifications assume a severe pandemic.In tier 1—those first in line for vaccine—are several “critical occupations”: deployed military forces, critical healthcare workers, emergency medical services workers, fire fighters, and police. Also included are pregnant women, infants, and toddlers. Those groups total an estimated 24 million people.Among the health workers assigned to tier 1 are an estimated 300,000 public health personnel, 3.2 million hospital employees, 2.5 million outpatient and home healthcare providers, and 1.6 million workers in long-term care facilities.Tier 2, totaling an estimated 15 million people, includes the following occupational groups: military support, border protection, the National Guard, intelligence services, other national security, community services, utilities (energy and water), communications, “critical government” workers, and two groups not previously included in this tier: pharmacists and mortuary workers. Also included in tier 2 are two high-risk groups: contacts of infants, and children with certain medical conditions.Tier 3 includes several more occupational groups: other active duty military; other healthcare workers; other critical infrastructure sectors, including banking and finance, chemical, food and agriculture, pharmaceutical, postal and shipping, and transportation workers; and other government workers. Also in tier 3 are healthy children ages 3 to 18 years. Tier 3 is estimated to include 64 million people.Tier 4, an estimated 74 million people, consists of two high-risk populations: adults between the ages of 19 and 64 who have chronic medical conditions that increase their risk of severe flu, and everyone age 65 or older.Tier 5 is defined as all other healthy adults between 19 and 64 years old who don’t fall into one of the other tiers, estimated at 123 million people.The guidance says that all groups within a given tier should be vaccinated at the same time, but “sub-prioritization” may be necessary if the vaccine supply is very short, which may be the case through the first wave of a pandemic. The guidance gives recommendations about how to rank groups within tier 1 in this situation, putting front-line inpatient and hospital-based healthcare workers first.Another case of sub-prioritization is in tier 4, which includes 19- to 64-year-old adults with medical conditions and adults 65 and older. If the vaccine supply is limited, the 19- to 64-year-olds should be vaccinated first, HHS advises. The reason: elderly people have a lower immune response to flu vaccines, so putting high-risk younger adults first makes better use of the available vaccine.Protecting essential workersThe main reason for vaccinating workers in critical infrastructure sectors, the report says, is not to reduce general absenteeism, but rather to protect workers whose absence would slow or stop critical functions and also to protect workers at especially high occupational risk.At the press conference, Dr. Ben Schwartz of the Centers for Disease Control and Prevention responded to a question about why transportation workers were not ranked higher than tier 3.”We certainly recognize the importance of including the transportation system,” he said. “It’s in tier 3 because it’s an infrastructure where it’s likely the overall demand won’t increase in a pandemic and may decrease. Transportation workers are not likely to be highly exposed to ill people, and thereby won’t be at high risk. A truck driver is a pretty solitary worker.”Schwartz also said demand for nonessential commodities may drop during a pandemic, which would allow workers to shift to transporting more essential goods.In other observations, the guidance says that general population groups assume greater priority, relative to occupational groups, in less severe pandemics, ie, those ranking 1 or 2 on HHS’s pandemic severity index.During the 1957 and 1968 pandemics, healthcare and essential services were effectively maintained in the United States, the document says. “Because of this, after tier 1, occupational groups in the health care and community support services and critical infrastructure categories are not specifically prioritized and workers in these groups would be vaccinated based on their age and health status as part of the general population.”Experts welcome the planMany public health experts have praised HHS’ hard work on the pandemic vaccine allocation guidance, particularly that of the interagency working group that spearheaded the project. They have also praised the agency for its leadership role.Jeffrey Levi, PhD, executive director of Trust for America’s Health (TFAH), a nonprofit health advocacy group based in Washington, DC, wrote in an e-mail to CIDRAP News today that the guidance represents a step in the right direction. “HHS is to be commended for the breadth of outreach that was part of developing this guidance,” he said.J. Eline Garrett, JD, assistant director for health policy and public health at the Minnesota Center for Health Care Ethics (MCHCE) in Minneapolis, told CIDRAP News that HHS and other agencies have shown strong leadership. “There’s a whole lot that’s good here. A range of pandemic scenarios and scalability are very important, and we value and agree with the way that multiple tracks and category tiers are used to address the practical and ethical complexities,” she said.The public health community also appreciates federal officials’ recognition that there is a need for vaccine allocation, she said.Some see serious gapsHowever, some experts said the federal guidance still contains some serious gaps and raises a host of questions.Levi said there tier 1 includes a large number of people, which demonstrates the need for more vaccine production capacity and the need to more seriously explore vaccine stockpiles.Garrett said that despite the revisions that followed extensive input from stakeholders, the MCHCE still has a number of concerns about the federal guidance. “This is to be expected. This work is difficult and important,” she said.One of the group’s concerns is that the federal guidance doesn’t explicitly and consistently address vaccine efficacy among the different population groups.In some instances, the guidance lacks rationales for the placement of groups on the priority spectrum, which makes it seem less transparent and more difficult for public health officials to grasp, Garrett said. For example, a high priority is placed on vaccinating children, but prioritization decisions might change if the pandemic virus that emerges threatens a different group.Prioritization of workers in homeland security, healthcare, and community support acknowledges exposure levels, but it doesn’t address the risk of death or serious complications, Garrett said. Allocating vaccine to critical workers who are not at risk could shortchange members of the general population who are at risk, she added.Garrett acknowledged that it’s difficult to balance flexibility with uniformity and equity.Federal officials recommend that states uniformly apply the prioritization guidance, but she said a lack of flexibility might be impractical for some areas and in some situations. For example, authorities plan to distribute vaccine in proportion to each state’s population. However, some critical jobs might not be distributed equally among states.Also, some locations might opt to keep schools open during a pandemic and will need to factor teachers into the vaccination scheme, Garrett said.”These questions haven’t been asked or answered, but they should at least be addressed,” she said.Ignoring economic realities?Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy, which publishes CIDRAP News, said the current federal guidance falls far short of what’s needed to address critical infrastructure and economic realities.During a pandemic, failure to adequately protect workers in sectors such as power, water, food, transportation, and pharmaceuticals could cause collateral damage that could rival deaths from the virus, he said.For example, Osterholm said the transportation sector is incompletely addressed in the vaccine prioritization plan and that coal workers aren’t listed as a priority, even though half of the electricity in the United States is generated by coal.Also, he pointed out that several lifesaving drugs in the United States are generics that are made offshore. Written stakeholder comments that Osterholm and some of his colleagues submitted to HHS suggested that the federal plan should prioritize some offshore workers who help produce goods, such as generic drugs, that are critical to the United States.See also: Jul 23 HHS news releasehttp://www.hhs.gov/news/press/2008pres/07/20080723a.htmlHHS guidance document on allocating vaccinehttp://www.flu.gov/individualfamily/vaccination/allocationguidance.pdfDec 12, 2207, CIDRAP News story on public response to draft HHS planOct 24, 2007, CIDRAP News story on draft HHS guidancelast_img read more

High fuel prices are not a big surprise

first_imgCategories: Letters to the Editor, OpinionWe’ve been warned about the rising price of gas on the way. Months ago, I felt we were on the verge of being independent from foreign countries due to reports of our ability to produce vast quantities of our own oil.But still, any hiccup in the Middle East causes havoc within our own country’s prices. Trump pulls out of the Iran agreement, price hikes are on the way. I can’t wait to see my fuel oil budget for the next season due to rising prices our crude oil.Supply and demand. Well, it does get cold in the Northeast. No surprise. But the price of fuel oil needs to go up. Nothing new. People drive more in the summer. Nothing new. Surprise, the price needs to spike. These things have been going on forever. But surprise, they never see it coming I guess. Be prepared ahead of time so there are no surprises.Oil companies use any excuse so they can to reap more of our money. We have oil, but where does it go?PAUL ST. ONGECharltonMore from The Daily Gazette:EDITORIAL: Find a way to get family members into nursing homesEDITORIAL: Urgent: Today is the last day to complete the censusFoss: Should main downtown branch of the Schenectady County Public Library reopen?EDITORIAL: Beware of voter intimidationEDITORIAL: Thruway tax unfair to working motoristslast_img read more

Dearth of space sends rents flying

first_imgWould you like to read more?Register for free to finish this article.Sign up now for the following benefits:Four FREE articles of your choice per monthBreaking news, comment and analysis from industry experts as it happensChoose from our portfolio of email newsletters To access this article REGISTER NOWWould you like print copies, app and digital replica access too? SUBSCRIBE for as little as £5 per week.last_img

‘Prioritized’: Indonesia to establish $5b sovereign wealth fund to support economy

first_imgThe government can inject more money into the fund should its capital decline significantly, the law states.Indonesia would follow Russia’s sovereign wealth fund model as it would raise the required funds from private investors instead of from the country’s reserve funds, Deputy SOEs Minister Kartika “Tiko” Wirjoatmodjo said earlier this year.The Russia Direct Investment Fund (RDIF) has invested and committed 1.9 trillion rubles (US$24.35 billion), of which 1.7 trillion rubles came from coinvestors, partners and banks. It has also attracted over $40 billion in foreign capital into the Russian economy through long-term strategic partnerships since its establishment in 2011.Although the fund could act as alternative financing sources to boost economic growth, the government must ensure that the fund should be transparent and independent, said Permata Bank economist Josua Pardede,“Both the supervisory council and board of directors must be independent, transparent and far from political interest to mitigate the risk of corruption,” he told The Jakarta Post. “As the fund will manage a significant amount of assets, prudent management is the key to avoid potential state losses.”Political interests should be avoided to prevent the fund from becoming like Malaysia’s 1Malaysia Development Berhad (1MDB), said Institute for Development of Economics and Finance (Indef) senior economist Aviliani.The 1MDB fund came under the spotlight following alleged money laundering and financial fraud in which Malaysian and US investigators believe about $4.5 billion was misappropriated.Aviliani said that if managed properly, the sovereign wealth fund could allow cash-strapped Indonesia to invest more in infrastructure as it would allow foreign investors to partner with or invest in the fund.“The fund may be able to increase foreign investors’ trust in Indonesia, which has been hindered by regulatory uncertainty, but it should be implemented and supervised carefully to avoid any special interests,” she told the Post in a phone interview.Topics : It remains unclear where the wealth fund will be invested, although Sri Mulyani mentioned a combination of development fund and stabilization fund. Officials have previously mentioned projects in sectors including infrastructure, health care, energy and resources, tourism and technology. Other sovereign wealth funds elsewhere invest in financial markets as well.“We are currently formulating the government regulation as the President has asked to prioritize this,” Sri Mulyani told reporters on Wednesday. “We are hoping to get strategic and reputable partners so that we can develop the fund to better attract investment.”The establishment of the sovereign wealth fund, which will be called the Indonesia Investment Authority, is included in the Job Creation Law. The law has met with widespread protests and criticism from labor unions and civil groups over the potentially negative impact it could have on labor rights and the environment, although the government’s goal is to attract investment, boost economic growth and create jobs.The fund will have a supervisory council led by the finance minister, with members including the SOEs minister and three more professionals, according to the law. The board of directors will include five professionals to oversee the fund’s operation, including to formulate the fund’s policy and work plan, among other things. The government is preparing Rp 75 trillion (US$5.1 billion) in capital for the nation’s sovereign wealth fund to attract investment and support the economy as global heavyweights from the United States to the United Arab Emirates have expressed interest to join.Finance Minister Sri Mulyani Indrawati said Rp 30 trillion of the capital would be in cash, while the remaining would be in the form of state-owned enterprises (SOEs) shares and other state assets.The fund is aimed at attracting Rp 225 trillion in investment, with foreign funds from the United Arab Emirates, Japanese conglomerate Softbank and the US International Development Finance Corporation (IFDC) already lining up to invest in the fund, officials said previously.last_img read more

BLOG: Early Spring This Year, Says Punxsutawney Phil!

first_img February 02, 2016 Holidays,  The Blog Pennsylvania’s world-famous groundhog, Punxsutawney Phil, predicted an early spring after emerging from his burrow without seeing his shadow this morning in the Pennsylvania Wilds.Thousands of fans watched as Phil made his highly anticipated weather prognostication, commemorating 130 years of Pennsylvania’s unique Groundhog Day tradition.According to holiday folklore, if the groundhog emerges in the early morning on February 2 and does not see his shadow, there will be an early spring. If he sees his shadow, six more weeks of wintry weather are expected.The annual event that started with a small group of men known as the ‘Inner Circle’ now attracts up to 30,000 visitors to Punxsutawney, Jefferson County — located about 80 miles northeast of Pittsburgh.So with the promise of warmer weather, here is a sampling of what Pennsylvania has in store for travelers this spring:Phipps Conservatory Orchid and Tropical Bonsai Show, through February 28, PittsburghThe Orchid and Tropical Bonsai Show at the Phipps Conservatory and Botanical Gardens will provide breathtaking strolls through gardens of colorful orchids and tropical bonsai. Visitors can also experience the beauty of other unique plants in the glass Victorian greenhouse. Chase away the winter blues through striking displays designed by the talented Phipps staff.Philadelphia Flower Show, March 5-13, PhiladelphiaBoasting the world’s oldest and largest indoor exhibition of its kind, the 2016 Philadelphia Flower Show, “Explore America,” will celebrate 100 years of National Park Service with themed displays, live entertainment, and special events. The annual show is an international favorite and the major fundraiser for the Pennsylvania Horticultural Society’s City Harvest program, which feeds more than 1,200 families each week during the growing season.Annual Tour de Tanks of the Mason-Dixon Wine Trail, March 5-20, Saturdays and Sundays, YorkEach Saturday and Sunday throughout the month of March, the award-winning wineries and distilleries of the Mason-Dixon Wine Trail offer exclusive tank and barrel tastings to preview the season’s wines before they are bottled. A single ticket is good for all three weekends and offers wine lovers discounts on purchases during the events.Opening Days of Trout and Salmon Fishing Season, April 2 and April 16With more than 86,000 miles of streams and rivers and a large variety of fish, Pennsylvania is every fisherman’s dream. Fishing begins for 18 south central and southeastern counties on April 2 and statewide on April 16. Like Governor Tom Wolf on Facebook: Facebook.com/GovernorWolf BLOG: Early Spring This Year, Says Punxsutawney Phil!center_img By: Carrie Lepore, Deputy Secretary of Marketing, Tourism, and Film SHARE Email Facebook Twitterlast_img read more

Inter get Sanchez boost for Europa League final

first_img The Chilean was Inter’s biggest doubt ahead of the showpiece, but Conte is optimistic regarding the centre-forward’s recovery. Loading… The former Manchester United player completed training with his teammates Thursday and the coach considers him completely recovered from the hamstring injury he suffered against Bayer Leverkusen in Duisburg. Read Also: Galatasaray ready to hold talks with French club for Eagles starThe report from Sky Sport Italia claims Sanchez will most likely start on the bench, next to Christian Eriksen, as the Nerazzurri are set to continue with Romelu Lukaku and Lautaro Martinez up front.But the 31-year-old will provide an extra option from the bench in Cologne.FacebookTwitterWhatsAppEmail分享 center_img Inter Milan coach Antonio Conte will have Alexis Sanchez back in contention for the Europa League Final spot against Sevilla tonight, , according to Sky Sport Italia report.Advertisement Promoted ContentCulkin Cracks Up The Web With His Own Version Of ‘Home Alone’The Very Last Bitcoin Will Be Mined Around 2140. Read MorePortuguese Street Artist Creates Hyper-Realistic 3D Graffiti6 Extreme Facts About Hurricanes5 Of The World’s Most Unique Theme Parks10 Hyper-Realistic 3D Street Art By Odeith9 Most Beautiful Women Of The XX CenturyA Hurricane Can Be As Powerful As 10 Atomic BombsPlaying Games For Hours Can Do This To Your Body5 Of The World’s Most Unique Theme ParksTop 10 Enemies Turned Friends in TV10 Risky Jobs Some Women Dolast_img read more

Noteboom notches Kossuth County lidlifter

first_imgALGONA, Iowa (May 4) – Jay Noteboom was the opening night IMCA Modified winner at Kossuth County Speedway.Noteboom slid past Tad Reutzel for the top spot following a restart and those two cars pulled away. Note­boom took the win with Reutzel right behind him in his yellow no. 5R rig.Tom Berry Jr. ended in third with Jeremy Mills fourth and Tim Ward rounding out the top five.  Justin Sack­ett moved up four spots as the feature’s hard charger while Shane Swanson and Noteboom won the two modified heat races.After taking the lead early, Elijah Zevenbergen never looked back in topping the IMCA Sunoco Stok Car main event.Colby Fett built up a big lead before weaving his way through lapped traffic to the Karl Chevrolet Northern SportMod checkers.Defending champion Shannon Anderson took the IMCA Sunoco Hobby Stock checkers and Nate Coop­man was fastest in a field of 18 Mach-1 Sport Compacts.Mother Nature had pushed back the opening night event for a week.last_img read more

Holt completes Wigan switch

first_img Holt, who was the Norwich club captain, scored 78 goals in 168 appearances for the Carrow Road outfit in all competitions. He joined them from Shrewsbury in 2009 and helped them achieve back-to-back promotions in his first two seasons that took them from League One to the Premier League. He will wear the number nine shirt for Wigan, who were relegated from the top flight last season, and is the seventh signing Coyle has made since he was appointed the club’s new manager last month following Roberto Martinez’s defection to Everton. Coyle added: “There is already a great buzz about the place since the new boys have started coming through the door and this is another one that will really lift the place. “He’s been a hero to the fans at every club he’s been at and I know the Norwich fans are sad to see him go, he’s been one of the icons of their success in recent years. But now it’s the Wigan fans’ turn to enjoy him and we’re all delighted he’s coming on board.” Goalkeeper Scott Carson and striker Marc-Antoine Fortune are among the other new players to have arrived at Wigan this summer. Confirmation of the Holt deal has come on the same day that frontman Arouna Kone’s transfer from the Latics to Everton was announced. Norwich boss Chris Hughton told www.canaries.co.uk: “Grant was an important part of what we managed to achieve in the Barclays Premier League last season. Of course before I came to the club (last summer) I was very aware of the magnificent job he had already done in the three years prior to that as well. “When we look back I’m sure we will all agree that to score the amount of goals he has done for the club in that time is a remarkable achievement. Myself and all of the staff certainly wish him all the best for his time at Wigan.” Press Association Striker Grant Holt has joined Wigan from Norwich on a three-year deal.center_img The news that Holt’s switch for an undisclosed fee had been completed was announced by the two clubs simultaneously on Monday evening on their respective official websites. Regarding the capture of the 32-year-old, Wigan boss Owen Coyle told www.wiganlatics.co.uk: “This is a fantastic piece of business for us at a really good price. Grant is a proven goalscorer at every level and he will definitely bring something new to the table that we were missing in the squad.” last_img read more

Piggott out of the places on debut

first_imgJamie Piggott, son of the legendary Lester, finished well beaten on his first ride in public at Killarney. The 19-year-old partnered Pivotal Rock for his boss Tommy Stack in the Killarney Grand Live Music Handicap over an extended mile at the County Kerry venue, with the six-year-old strongly backed and eventually sent off the 6-1 favourite. Allowed to claim 10lb, the inexperienced rider was never too far off the pace aboard the market leader, but after becoming short of room in the straight, Pivotal Rock gradually faded and came home in midfield. Victory went to 20-1 shot Measured Approval for trainer Pat Flynn and jockey Danny Grant. Piggott, whose mount was seventh, said: “It was a good experience, the horse is good and honest but needed that bit extra today. “I completed my A-levels in maths and three sciences before giving riding a go. I’ve only been riding properly for eight months. I’ve been riding out in Tommy Stack’s and have been there full-time since before the winter – hopefully I can make a career of being a jockey now.” Piggott’s sister and RTE sports presenter Tracy Piggott was present to see her brother, and Fozzy Stack, representing his father, said “Jamie did nothing wrong today and I was pleased with him. He happens to have an unfortunate surname as nobody will ever beat his father.” Grant said of the winner: “He ran a cracker at the Curragh but disappointed on his last two starts so we decided to change tactics with him today. We were worried about the ground but they went a good pace and he got into the race easily, everything worked out.” center_img Press Associationlast_img read more

Millen backs Palace to beat drop

first_img “What I thought was needed was someone with experience at this level because the club haven’t got a lot of that,” he said. “For me, Tony was top of the list and I’m delighted he’s on board. I’m sure he’ll be pleased to see the team here and see their commitment to the club. It gives them something to work with.” Millen resisted the temptation to bring Pulis in for a pre-match pep talk, preferring to keep his side’s sights on their established game plan. “I spoke to Tony this morning and we felt it was really important we stay focused on what we’ve worked on for the last two weeks for this game,” added Millen. “If Tony had come in, it might have distracted from me being in charge and undermined me a little bit.” Hull boss Steve Bruce, whose team have had a serene return to the top flight compared to fellow newcomers Palace, admitted the Tigers were short of their best. “The performance is the big disappointment for us,” he said. “I don’t think we deserved to lose but we didn’t do enough as the home team to win the match. “No matter what we tried to do, we didn’t have enough composure in the final third and we unfortunately ran out of ideas pretty quickly. “We didn’t deserve to lose but we certainly didn’t do enough to win the match.” As for Pulis, Bruce feels the experienced campaigner is a fine catch. “For me, it’s a great appointment,” he said. “He’s been there, done it, worn the T-shirt. I think he’ll be a very good appointment for them.” Millen, in his final outing in caretaker charge, oversaw a 1-0 win at the KC Stadium, Barry Bannan converting with nine minutes remaining to lift the Eagles off bottom spot on goal difference from Sunderland. Pulis was present to watch his new employers double their tally of league wins for the season, but a different outcome looked to be in the offing when Yannick Bolasie was harshly dismissed three minutes before the winner. To snatch victory with 10 men required guts and when Millen makes the formal handover, he plans to tell Pulis the club are capable of beating the drop. “From a personal point of view, I’m delighted to win the game and from the players’ point of view, they deserved that,” he said. “I want the lads to enjoy it. It’s nice to be off the bottom of the league but it’s more important in the bigger picture that we’re closer to the teams around us. “I said to Tony that I honestly believe these lads can stay up. “You pick up on the vibes in training and there is a belief there. They feel they have a chance. “Tony was pleased to hear that and if he can come in and add some experience to us as a group on how to win games at this level, then we have as good a chance as five or six teams in this league.” While Millen was never in the frame as a permanent solution for Palace, he was consistently clear about the kind of man he felt would be right for the job. While names such as Aitor Karanka and Dan Petrescu floated in and out of vogue, Millen argued that a man with Pulis’ Premier League grounding would be invaluable. Keith Millen gave incoming Crystal Palace manager Tony Pulis the perfect welcome present with victory at Hull, then backed the former Stoke boss to keep the side in the Barclays Premier League. Press Associationlast_img read more