Tagged COVID-19

Journalists Weigh In on Biden’s HHS Pick

KHN senior correspondent Noam Levey discussed Xavier Becerra’s nomination to lead the U.S. Department of Health and Human Services with KQED’s “Forum” on Tuesday.

KHN senior correspondent JoNel Aleccia discussed the story of an organ transplant patient who died after receiving lungs infected with covid-19 on KFI’s “The Daily Dive” podcast on Wednesday.

California Healthline senior correspondent Anna Maria Barry-Jester discussed vaccine distribution in California with KALW’s “Your Call” on Thursday. She also was part of a panel discussion about inequities in the vaccine rollout with Venice Family Clinic’s “Health and Justice” series on Wednesday.

KHN “Navigating Aging” columnist Judith Graham discussed the need for vaccinating family caregivers against covid with Newsy on Thursday.

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Aging Public Health

Learning to Live Again: A Lazarus Tale From the Covid Front Lines

The twinkle in his eyes, the delight in his smile, the joyous way he moved his disease-withered frame. They all proclaimed a single, resounding message: Grateful to be alive!

“As my care team and my family tell me, ‘You were born again. You have to learn to live again,’” said Vicente Perez Castro. “I went through a very difficult time.”

Hell and back is more like it.

Perez, a 57-year-old cook from Long Beach, California, could barely breathe when he was admitted on June 5 to Los Angeles County’s Harbor-UCLA Medical Center. He tested positive for covid-19 and spent three months in the intensive care unit, almost all of it hooked up to a ventilator with a tube down his throat. A different tube conducted nutrients into his stomach.

At a certain point, the doctors told his family that he wasn’t going to make it and that they should consider disconnecting the lifesaving equipment. But his 26-year-old daughter, Janeth Honorato Perez, one of three children, said no.

And so, on a bright February morning half a year later, here he was — an outpatient, slowly making his way on a walker around the perimeter of a high-ceilinged room at Rancho Los Amigos National Rehabilitation Center in Downey, one of L.A. County’s four public hospitals and the only one whose main mission is patient rehab.

Perez walks around the room at Rancho Los Amigos National Rehabilitation Center while a physical therapist intern times him.(Heidi de Marco / KHN)

Perez, who is 5-foot-5, had lost 72 pounds since falling ill. His legs were unsteady, his breathing labored, as he plodded forward. But he kept moving for five or six minutes, “a huge improvement” from late last year, when he could walk only for 60 seconds, said Bradley Tirador, one of his physical therapists.

Rancho Los Amigos has an interdisciplinary team of physicians, therapists and speech pathologists who provide medical and mental health care, as well as physical, occupational and recreational therapy. It serves a population that has been disproportionately affected by the pandemic: 70% of its patients are Latino, as are 90% of its covid patients. Nearly everyone is either uninsured or on Medi-Cal, the government-run insurance program for people with low incomes.

Rancho is one of a growing number of medical centers across the country with a program specifically designed for patients suffering the symptoms that come in the wake of covid. Mount Sinai Health System’s Center for Post-Covid Care in New York City, which opened last May, was one of the first. Yale University, the University of Pennsylvania, UC Davis Health and, more recently, Cedars-Sinai Medical Center in Los Angeles are among the health systems with similar offerings.

Rancho Los Amigos National Rehabilitation Center in Downey is one of L.A. County’s four public hospitals and the only one dedicated to rehabilitation. The hospital serves mostly Latino, low-income patients.(Heidi de Marco / KHN)

Rancho Los Amigos treats only patients recovering from severe illness and long stays in intensive care. Many of the other post-covid centers also tend to those who had milder cases of covid, were not hospitalized and later experienced a multitude of diffuse, hard-to-diagnose but disabling symptoms — sometimes described as “long covid.”

The most common symptoms include fatigue, muscle aches, shortness of breath, insomnia, memory problems, anxiety and heart palpitations. Many health care providers say these symptoms are just as common, perhaps more so, among patients who had only moderate covid.

A survey conducted by members of the Body Politic Covid-19 Support Group showed that, among patients who’d experienced mild to moderate covid, 91% still had some of those symptoms an average of 40 days after their initial recovery.

Other studies estimate that about 10% of covid patients will develop some of these prolonged symptoms. With more than 28 million confirmed cases in the U.S. and counting, this post-covid syndrome is a rapidly escalating concern.

“What we can say is that 2 [million] to 3 million Americans at a minimum are going to require long-term rehabilitation as a result of what has happened to this day, and we are just at the beginning of that,” said David Putrino, director of rehabilitation innovation at Mount Sinai Health.

Perez was a cook at a hotel restaurant before he fell ill, so his occupational therapy involves meal preparation.(Heidi de Marco / KHN)

Health care professionals seem guardedly optimistic that most of these patients will fully recover. They note that many of the symptoms are common in those who’ve had certain other viral illnesses, including mononucleosis and cytomegalovirus disease, and that they tend to resolve over time.

“People will recover and will be able to get back to living their regular lives,” said Dr. Catherine Le, co-director of the covid recovery program at Cedars-Sinai. But for the next year or two, she said, “I think we will see people who don’t feel able to go back to the jobs they were doing before.”

Rancho Los Amigos is discussing plans to begin accepting patients who had mild illness and developed post-covid syndrome later, said Lilli Thompson, chief of its rehab therapy division. For now, its main effort is to accommodate all the severe cases being transferred directly from its three public sister hospitals, she said.

The most severely ill patients can have serious neurological, cardiopulmonary and musculoskeletal damage. Most — like Perez — have lost a significant amount of muscle mass. They typically have “post-ICU syndrome,” an assortment of physical, mental and emotional symptoms that can overlap with the symptoms of long covid, making it difficult to tease out how much of their condition is a direct impact of the coronavirus and how much is the more general impact of months in intensive care.

Speech pathologist Katherine Chan checks Vicente Perez Castro’s throat. He had a tracheotomy while in the hospital for covid. (Heidi de Marco / KHN)
Perez uses a breathing trainer during his therapy. (Heidi de Marco / KHN)

The large, rectangular rehab room where Perez met with his therapists earlier this month is half-gym, half-sitcom set. Part of the space is occupied by weights, video-linked machines that help strengthen hand control and high-tech treadmills, including one that reduces the pull of gravity, enabling patients who are unsteady on their feet to walk without falling. “We tell patients, ‘It’s like walking on the moon,’” Thompson said.

At the other end of the room sits a large-screen TV and a low couch, which helps people practice standing and sitting without undue stress. In a bedroom area, patients relearn to make and unmake their beds. A few feet away, a small office space helps them work on computer and telephone skills they may have lost.

Perez takes a break during his therapy. He could barely breathe when he was admitted to Los Angeles County’s Harbor-UCLA Medical Center in early June of last year.(Heidi de Marco / KHN)

Because Perez was a cook at a hotel restaurant before he fell ill, his occupational therapy involves meal preparation. He stood at the sink, rinsing lettuce, carrots and cucumbers for a salad, then took them over to a table, where he sat down and chopped them with a sharp knife. His knife hand trembled perilously, so occupational therapist Brenda Covarrubias wrapped a weighted band around his wrist to steady him.

“He is working on getting back the skills and endurance he needs for his work, and just for routine daily activities like walking the dogs and walking up steps,” Covarrubias said.

Perez’s hands trembled as he tried to cut vegetables, so a weighted band was wrapped around his wrist to help keep him steady.(Heidi de Marco / KHN)

Perez, who immigrated to the U.S. from Guadalajara, Mexico, nearly two decades ago, was upbeat and optimistic, even though his voice was faint and his body still a shell of its former self.

When his speech therapist, Katherine Chan, removed his face mask for some breathing exercises, he pointed to the mustache he’d sprouted recently, cheerfully exclaiming he had trimmed it himself. And, he said, “I can change my clothes now.”

Weeks earlier, Perez had mentioned how much he loved dancing before he got sick. So they made it part of his physical therapy.

“Vicente, are you ready to bailar?” Kevin Mui, a student physical therapist, asked him, as another staff member put on a tune by the Colombian cumbia band La Sonora Dinamita.

Slowly, shakily, Perez rose. He anchored himself in an upright position, then began shuffling his feet from front to back and side to side, hips swaying to the rhythm, his face aglow with the sheer joy of being alive.

Perez dances to cumbia music as part of his physical therapy.(Heidi de Marco / KHN)

As Covid Surged, Vaccines Came Too Late for at Least 400 Medical Workers

As health care workers in the U.S. began lining up for their first coronavirus vaccines on Dec. 14, Esmeralda Campos-Loredo was already fighting for oxygen.

The 49-year-old nursing assistant and mother of two started having breathing problems just days earlier. By the time the first of her co-workers were getting shots, she was shivering in a tent in the parking lot of a Los Angeles hospital because no medical beds were available. When she gasped for air, she had to wait all day for relief due to a critical shortage of oxygen tanks.

Campos-Laredo died of covid on Dec. 18, one of at least 400 health workers identified by The Guardian/KHN’s Lost on the Frontline investigation who have died since the vaccine became available in mid-December, narrowly missing the protection that might have saved their lives.

Esmeralda Campos-Loredo, a nursing assistant in Glendale, California, died of covid-19 on Dec. 18, 2020. (Joana Campos)

“I told her to hang in there, because they are releasing the vaccine,” said her daughter Joana Campos. “But it was just a little too late.”

In California, which became the epicenter of the national coronavirus surge following Thanksgiving, 40% of all health care worker deaths came after the vaccine was being distributed to medical staff members.

An analysis of The Guardian-KHN’s Lost on the Frontline database indicates that at least 1 in 8 health workers lost in the pandemic died after the vaccine became available. Unlike California, many states do not require a thorough reporting of the deaths of nurses, doctors, first responders and other medical staff members. The analysis did not include federally reported deaths in which the name was not released and may be missing numerous recent deaths that have not yet been detected by The Guardian and KHN.

The vaccine is now widely available to health care workers around the country and since mid-January, and covid-19 cases have been trending downward in the United States.

Sasha Cuttler, a nurse in San Francisco, has been gathering health care data for one of California’s nursing unions. Cuttler was alarmed and disheartened to see the number of deaths still surging weeks after the vaccination became widely available. “We can prevent this. We just need the means to do it,” said Cuttler, who noted that, nearly a year into the pandemic, some hospitals still lack adequate protective gear and proper staffing. “We don’t want to be health care heroes and martyrs. We want a safe workplace.”

Stockton nurse Barbara Clayborne became sick the same week her colleagues started receiving their first doses of the vaccine.

The 22-year staff member and union activist at St. Joseph’s Medical Center had picketed last summer to demand more help for the beleaguered nurses treating covid patients.

Though she worked on what was considered a relatively low-risk postpartum care unit, she was advocating for her colleagues in the intensive care unit, many of whom were overwhelmed by the number of patients they were responsible for.

Barbara Clayborne, a registered nurse in Stockton, California, died of covid-19 on Jan. 8, 2021.(Ariel Bryant)

“We know what it’s like to work a full 12-hour shift and not be able to drink water or sit down or go to the bathroom,” Clayborne told the Stockton Record in August. “It’s been chaos.”

In mid-December, Clayborne, who had asthma, became ill in mid-December. She had been exposed to a patient who hadn’t yet been diagnosed with covid, said her daughter Ariel Bryant. Clayborne died on Jan. 8.

“She was the best mom and grandmother — and she was a great role model for me,” said Bryant, who herself became a nurse. Bryant works in an intensive care unit in Southern California — as the same type of nurse her mother fought so hard to protect.

If the vaccine had come just a few days earlier, it might have saved Tennessee fire chief Ronald “Ronnie” Spitzer and his department’s dispatcher, Timothy Phillips.

Spitzer and his crew from the Rocky Top Fire Department were called to a medical emergency on Dec. 11 but weren’t told until later that the patient had tested positive for covid. Both Spitzer, 65, and the firefighter who accompanied him came down with the virus. A few days later, Phillips became ill as well.

Spitzer, a 47-year firefighting veteran, was already hospitalized when his co-workers got their first doses of the vaccine in January, according to Police Chief Jim Shetterly. He died on Jan. 13, and Phillips, 54, died a few days later.

The state of Tennessee does not publish statistics on health care worker deaths, but 10 of the 22 Tennessee health care worker deaths identified by the Guardian/KHN occurred since the vaccine rollout in December.

Shetterly said his town of 1,800 has been shattered by the losses. “Everyone knows everyone here. It’s tragic when it hits the nation. But, when it’s in your town, it really hits home,” he said.

Gerald Brogan, director of nursing practice for National Nurses United, said many hospitals hadn’t done adequate planning to be ready for the recent surges, which put exhausted health care workers at extra risk.

“When there are more patients in, there’s more chaos in the hospitals and it’s harder for workers to be safe,” he said. During the recent surge, “we had nurses breaking down because of the influx of patients and the emotional and physical toll that took on workers.”

Even once all health care workers are vaccinated, he said, health care administrators would need to remain vigilant on worker safety.

He said that surge preparations, extra safety equipment, contingency staffing plans and facilities like negative-pressure rooms to stop disease from spreading around hospitals should be a regular part of preparing for potential future pandemics.

KHN reporters Shoshana Dubnow and Christina Jewett contributed to this report.

This story is part of “Lost on the Frontline,” an ongoing project from The Guardian and Kaiser Health News that aims to document the lives of health care workers in the U.S. who die from COVID-19, and to investigate why so many are victims of the disease. If you have a colleague or loved one we should include, please share their story.

Why AstraZeneca and J&J’s Vaccines, In Use the World Over, Are Still on Hold in America

The World Health Organization greenlighted emergency use of AstraZeneca and Oxford’s covid-19 vaccine this month, following in the steps of the United Kingdom, the European Union and others, who are already injecting it as quickly as possible into the masses.

But the United States is still waiting.

As covid deaths mount daily, critics say the Food and Drug Administration is moving too slowly. Meanwhile, the novel coronavirus is evolving, with new variants stalking populations the world over.

“We are truly in a race and this race is real — the more we get people vaccinated, the more it will tamp down the virus that is mutating,” said Dr. Monica Gandhi, an infectious diseases specialist and professor of medicine at the University of California-San Francisco.

The world has seven vaccines with completed clinical trials, yet the U.S. has approved only two, Gandhi and others lament.

AstraZeneca — after global trials that included some mistaken dosing — has not filed an application in the U.S., saying it first needs to finish its phase 3 U.S. trial. Simply put: AstraZeneca hasn’t applied for the U.S. job.

The company knows that the FDA doesn’t merely accept results from trials in other countries. And its confusing trial results pooled from differently designed clinical trials in Brazil and the U.K. raised questions about dosing as well as how well it works for people 65 and older. Germany and France have said not to administer the vaccine to older residents, while the World Health Organization said it was fine to do so.

The FDA — one of the oldest drug approval agencies on the globe — issued emergency use authorizations late last year for two vaccines manufactured by Moderna and Pfizer-BioNTech. It is reviewing an application from Johnson & Johnson, which filed Feb. 3, and the advisory panel is scheduled to discuss it at a Feb. 26 meeting.

“The FDA is not the villain here,” said Dr. Cody Meissner, a pediatric infectious diseases specialist at Tufts University who sits on the FDA’s vaccine advisory panel.

Drug approvals usually take months once an application is filed, but the FDA’s emergency authorizations for covid vaccines have been granted within weeks. FDA spokesperson Abigail Capobianco said its staff is working nights, weekends and holidays to prepare for the meeting — moving with a sense of urgency.

“FDA staff are mothers, fathers, grandparents, daughters, sons, sisters, brothers and more,” Capobianco said. “They and their families are also directly impacted by the work that they do.”

J&J’s vaccine, which received a billion dollars in development funds through Operation Warp Speed, uses an adenovirus — a vector that produces cold-like symptoms — to deliver a piece of genetic code that triggers an immune response in the body. It would be the first single-dose vaccine authorized in the U.S. — a possible game changer in getting more Americans vaccinated.

“People have been clamoring for it to be approved and everybody wants it to go faster,” said Dr. Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security who has called for more harmonization between approvals from the U.S., U.K. and European Medicines Agency.

“The question would be from a policy standpoint,” Adalja said. “Would the FDA be willing to say that what the EMA does is equivalent to them and they would have full confidence in the EMA decision?”

Despite the need for speed, the FDA said it will not cut corners. Before last fall, vaccines typically went through a full licensing process before being distributed to the public. The use of emergency authorization to give a vaccine to millions of otherwise healthy people has “never been done” before, said Norman Baylor, a former director of the FDA’s vaccine research and review office who now consults with pharmaceutical companies.

To prepare for J&J’s advisory committee, FDA staff members as well as the independent advisory panel will have analyzed thousands of data points to consider whether the benefit of a vaccine outweighs the risk of injecting it into millions of otherwise healthy people. The FDA is not required to follow the panel’s recommendation but usually does.

Meissner, who abstained in the vote for the Pfizer-BioNTech vaccine, said, “We want every vaccine to succeed.” Everyone on the planet needs immunization — billions of people.

“The more manufacturers that can provide vaccines, the better,” Meissner said. “I don’t think anyone would be against additional manufacturers.”

This moment — as Americans question why more tested vaccines like AstraZeneca and J&J’s vaccines aren’t approved — punctuates how the FDA’s drug approval process, honed over decades, is independent of other global agencies. Dr. Henry Miller, a senior fellow at the Pacific Research Institute who was the founding director of the FDA’s office of biotechnology, said it’s difficult to compare international vaccine development.

“It’s not like a footrace where everyone begins together,” he said. “From country to country, there are a lot of variables.”

Some are trivial, such as different application processes and whether the companies completed the forms properly. Others are more substantial — while many countries depend on academics on contract, the U.S. relies on full-time staffers who spend their careers focused on drug development, Miller said.

Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said in a recent radio interview that the “FDA gets involved very early on in the process, that makes us unique among global agencies.”

FDA staff members have had discussions with some vaccine makers “about how they would do the work” even before the vaccines went to early clinical trials in humans. They are in contact through the various stages of manufacturing, Marks said.

Technically, AstraZeneca and the other vaccine makers have filed what are called “investigational new product” applications with the FDA. That means the companies early on submit the details of drug formulation, stability and laboratory work. They also provide results data at the end of each clinical trial phase.

AstraZeneca, which was awarded up to $1.2 billion through Operation Warp Speed to develop a vaccine, “remains in close, regular communication” with federal agencies, said AstraZeneca spokesperson Brendan McEvoy.

There are differences in what each country needs from the vaccines. The AstraZeneca vaccine will be “for a very different population than the Pfizer and Moderna vaccines,” former FDA staffer Miller said. The Pfizer and Moderna vaccines are more costly and demand cold-storage infrastructure that many developing countries can’t afford.

Plus, Miller said he believes the international agencies were eager to approve AstraZeneca. “Circumstances suggest they are willing to accept a somewhat lower standard — much like a drug intended to cure cancer makes you willing to accept greater side effects because the need is so great and the benefit is so great. It’s all risk, benefit and probability,” he said.

AstraZeneca’s acceptance abroad is enough for some people. “Why wait for another clinical trial to be completed?” asked Dr. Martin Makary, a professor of surgery and health policy at the Johns Hopkins University School of Medicine in Baltimore. “You have the real-world observation of the vaccine being given to millions of people.”

Gandhi, who has followed the clinical trials from across the globe, expressed more urgency. “The U.K. will get to herd immunity faster,” she said. “All of these wonderful things the FDA is doing that we are all so impressed by are taking too long.”

In October, the FDA released guidance for companies that seek approval in the U.S. It’s “pretty clear what designs were needed in the studies and what the FDA’s expectations were for the data,” said Dr. Jesse Goodman, former director of the FDA’s Center for Biologics Evaluation and Research, which regulates vaccines. He was also the FDA’s chief scientist from 2009 to 2014, leading its response to the 2009 H1N1 pandemic.

The agency asked for evidence that the vaccine’s benefits outweigh its risks based on data from at least one well-designed phase 3 clinical trial. To pass muster, it will need to prevent disease or decrease the severity of the disease in at least 50% of people vaccinated. Both Moderna and the Pfizer-BioNTech vaccines are well above that threshold, at 94.5% and 95% respectively.

Dr. Stanley Plotkin, a scientist and vaccine developer, said Pfizer and Moderna’s vaccines were greenlighted after large U.S. trials with “very clear results, high efficacy.” One challenge for AstraZeneca will be the variation in data — different trials with different dosages and population numbers. Clinical trials found the vaccine had an efficacy of 82.4% when two doses were given 12 weeks apart.

The FDA will dig into any incoming research numbers to determine how well each vaccine works with different doses and schedules. They will question whether they prevent serious or mild disease, while accounting for varying age groups of the trial populations, including subsets that may be more likely to get sick. Other aspects up for analysis will be the immunogenicity, or antibody response, and the safety data.

“Asking questions and asking for more data, that is exactly what they are supposed to do,” said Plotkin, now a professor emeritus at the University of Pennsylvania who consults for Moderna and others.

And, since multiple vaccine investigations are underway, FDA staff members will have reviewed the data from various applications — and may have questions that are not obvious to company researchers working on individual projects, said former vaccine regulator Goodman, who is now a Georgetown University professor.

FDA staffs work beyond the numbers as well and often do a “thorough investigation and validation of the plant” where vaccines will be produced, said Kevin Gilligan, a virologist and former unit chief at the federal government’s Biomedical Advanced Research and Development Authority. “You want to make sure there aren’t any remaining pathogens in there and all the equipment used is thoroughly clean and reevaluated,” Gilligan said.

Novavax, which received $1.6 billion through Operation Warp Speed in July, is developing a two-shot protein-based vaccine. After addressing FDA questions, Novavax ramped up full-scale manufacturing operations. Novavax spokesperson Silvia Taylor said the company has been in “ongoing contact” with the FDA and is “already beginning to submit” various parts of its application and data to agency officials. It expects initial results of its U.S. phase 3 trial before summer.

Taylor said Novavax has already “locked” its manufacturing process at scale and will be ready to distribute in the U.S. as soon as emergency use is approved.

KHN editor Arthur Allen contributed to this report.

Covid Vaccine Websites Violate Disability Laws, Create Inequity for the Blind

Many covid vaccination registration and information websites at the federal, state and local levels violate disability rights laws, hindering the ability of blind people to sign up for a potentially lifesaving vaccine, a KHN investigation has found.

Across the country, people who use special software to make the web accessible have been unable to sign up for the vaccines or obtain vital information about covid-19 because many government websites lack required accessibility features. At least 7.6 million people in the U.S. over age 16 have a visual disability.

WebAIM, a nonprofit web accessibility organization, checked covid vaccine websites gathered by KHN from all 50 states and the District of Columbia. On Jan. 27, it found accessibility issues on nearly all of 94 webpages, which included general vaccine information, lists of vaccine providers and registration forms.

In at least seven states, blind residents said they were unable to register for the vaccine through their state or local governments without help. Phone alternatives, when available, have been beset with their own issues, such as long hold times and not being available at all hours like websites.

Even the federal Centers for Disease Control and Prevention’s Vaccine Administration Management System, which a small number of states and counties opted to use after its rocky rollout, has been inaccessible for blind users.

Those problems violate the Rehabilitation Act of 1973, which established the right to communications in an accessible format, multiple legal experts and disability advocates said. The federal Americans with Disabilities Act, a civil rights law that prohibits governments and private businesses from discriminating based on disability, further enshrined this protection in 1990.

Doris Ray, 72, who is blind and has a significant hearing impairment, ran into such issues when she tried to sign up for a vaccine last month with the CDC’s system, used by Arlington County in Virginia. As the outreach director for the ENDependence Center of Northern Virginia, an advocacy center run by and for people with disabilities, she had qualified for the vaccine because of her in-person work with clients.

When she used screen-reading technology, which reads a website’s text aloud, the drop-down field to identify her county did not work. She was unable to register for over two weeks, until a colleague helped her.

“This is outrageous in the time of a public health emergency, that blind people aren’t able to access something to get vaccinated,” Ray said.

Mark Riccobono, president of the National Federation of the Blind, wrote to the U.S. Health and Human Services Department in early December, laying out his concerns on vaccine accessibility.

“A national emergency does not exempt federal, state, and local governments from providing equal access,” he wrote.

Dr. Robert Redfield, who was then leading the CDC, responded that the interim vaccine playbook for health departments included a reminder of the legal requirements for accessible information.

CDC spokesperson Jasmine Reed said in an email that VAMS is compliant with federal accessibility laws and that the agency requires testing of its services.

But more than two months into a national vaccine campaign, those on the ground report problems at all levels.

Some local officials who use VAMS are aware of the ongoing problems and blame the federal government. Arlington Assistant County Manager Bryna Helfer said that because VAMS is run by the federal government the county cannot access the internal workings to troubleshoot the system for blind residents.

Connecticut Department of Public Health spokesperson Maura Fitzgerald said the state was aware of “many accessibility issues” with VAMS. She said it had staffed up its call center to handle the problems and was working with the federal government “to improve VAMS and enable the functionality that was promised.”

Deanna O’Brien, president of the National Federation of the Blind of New Hampshire, said she had heard from blind people unable to use the system. New Hampshire’s health department did not answer KHN questions about the problems.

Blind people are particularly vulnerable to contracting the covid virus because they often cannot physically distance themselves from others.

“When I go to the grocery store, I do not have the option of walking around and not being near a person,” said Albert Elia, a blind attorney who works with the San Francisco-based TRE Legal Practice on accessibility cases. “I need a person at the store to assist me in shopping.”

There is no standardized way to register for a covid vaccine nationwide — or fix the online accessibility problems. Some states use VAMS; some states have centralized online vaccination registration sites; others have a mix of state-run and locally run websites, or leave it all to local health departments or hospitals. Ultimately, state and local governments are responsible for making their vaccination systems accessible, whether they use the VAMS system or not.

“Once those portals open, it’s a race to see who can click the fastest,” Riccobono said. “We don’t have time to do things like file a lawsuit, because, at the end of the day, we need to fix it today.”

Common programming failures that make sites hard to use for the visually impaired included text without enough contrast to distinguish words from the page’s background and images without alternative text explaining what they showed, the WebAIM survey showed. Even worse, portions of the forms on 19 states’ pages were built so that screen readers couldn’t decipher what information a user should enter on search bars or vaccine registration forms.

The new vaccine pages had more errors than states’ main coronavirus pages but slightly fewer than state government websites in general, said WebAIM Associate Director Jared Smith.

close up of senior man with grey hair and beardWhen Bryan Bashin of Alameda County, California, tried on Feb. 9 to sign up for his vaccine appointment, he found the website was inaccessible. Bashin is blind and the CEO of the LightHouse for the Blind and Visually Impaired in San Francisco. (Shelby Knowles for KHN)

In Alameda County, California, when Bryan Bashin, 65, who is blind and CEO of the LightHouse for the Blind and Visually Impaired in San Francisco, tried to sign up on Feb. 9 for his vaccine appointment, he encountered multiple hurdles. The appointments slipped away. That night he received an email from the city of Berkeley offering vaccinations. But after two hours struggling with its inaccessible website, all the slots were again taken, he said in an email.

He was only able to get an appointment after his sighted sister signed him up and has since received his first shot.

“It’s an awful bit of discrimination, one as stinging as anything I’ve experienced,” Bashin said.

Susan Jones, a blind 69-year-old in Indianapolis, had to rely on the Aira app, which allows a sighted person to operate her computer remotely, when she tried to register for her vaccine appointment.

“I resent that the assumption is that a sighted fairy godmother ought to be there at all times,” said Sheela Gunn-Cushman, a 49-year-old also in Alameda County, who also had to rely on Aira to complete preregistration for a vaccine.

Emily Creasy, 23, a visually impaired woman in Polk County, Oregon, said she tried unsuccessfully for a month to make the scheduling apparatus work with her screen reader. She finally received her first shot after her mother and roommate helped her.

Even Sachin Dev Pavithran, 43, who is blind and executive director of the U.S. Access Board, an independent agency of the federal government that works to increase accessibility, said he struggled to access vaccine registration information in Logan, Utah.

The Indiana Health Department, Public Health Division of Berkeley and Oregon’s Polk County Public Health did not respond to requests for comment. Utah’s Bear River Health Department did not answer questions on the issue.

After Alameda County received complaints from users that its site was not compatible with screen readers, officials decided to move away from its preregistration technology, Health Department spokesperson Neetu Balram said in mid-February. The county has since switched to a new form.

If vaccine accessibility issues are not fixed across the country, though, lawsuits could come next, Elia said. Members of the blind community recently won landmark lawsuits against Domino’s Pizza and the Winn-Dixie grocery chain after being unable to order online.

And, Elia said, “this is not ordering a pizza — this is being able to get a potentially lifesaving vaccine.”

Have a Case of a Covid Variant? No One Is Going to Tell You

Covid-19 infections from variant strains are quickly spreading across the U.S., but there’s one big problem: Lab officials say they can’t tell patients or their doctors whether someone has been infected by a variant.

Federal rules around who can be told about the variant cases are so confusing that public health officials may merely know the county where a case has emerged but can’t do the kind of investigation and deliver the notifications needed to slow the spread, according to Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists.

“It could be associated with a person in a high-risk congregate setting or it might not be, but without patient information, we don’t know what we don’t know,” Hamilton said. The group has asked federal officials to waive the rules. “Time is ticking.”

The problem is that the tests in question for detecting variants have not been approved as a diagnostic tool either by the Food and Drug Administration or under federal rules governing university labs ― meaning that the testing being used right now for genomic sequencing is being done as high-level lab research with no communication back to patients and their doctors.

Amid limited testing to identify different strains, more than 1,900 cases of three key variants have been detected in 46 states, according to the Centers for Disease Control and Prevention. That’s worrisome because of early reports that some may spread faster, prove deadlier or potentially thwart existing treatments and vaccines.

Officials representing public health labs and epidemiologists have warned the federal government that limiting information about the variants ― in accordance with arcane regulations governing clinical labs ― could hamper efforts to investigate pressing questions about the variants.

The Association of Public Health Laboratories and the Council of State and Territorial Epidemiologists earlier this month jointly pressed federal officials to “urgently” relax certain rules that apply to clinical labs.

Washington state officials detected the first case of the variant discovered in South Africa this week, but the infected person didn’t provide a good phone number and could not be contacted about the positive result. Even if health officials do track down the patient, “legally we can’t” tell him or her about the variant because the test is not yet federally approved, Teresa McCallion, a spokesperson for the state department of health, said in an email.

“However, we are actively looking into what we can do,” she said.

Lab testing experts describe the situation as a Catch-22: Scientists need enough case data to make sure their genome-sequencing tests, which are used to detect variants, are accurate. But while they wait for results to come in and undergo thorough reviews, variant cases are surging. The lag reminds some of the situation a year ago. Amid regulatory missteps, approval for a covid-19 diagnostic test was delayed while the virus spread undetected.

The limitations also put lab professionals and epidemiologists in a bind as public health officials attempt to trace contacts of those infected with more contagious strains, said Scott Becker, CEO of the Association of Public Health Laboratories. “You want to be able to tell [patients] a variant was detected,” he said.

Complying with the lab rules “is not feasible in the timeline that a rapidly evolving virus and responsive public health system requires,” the organizations wrote.

Hamilton also said telling patients they have a novel strain could be another tool to encourage cooperation ― which is waning ― with efforts to trace and sample their contacts. She said notifications might also further encourage patients to take the advice to remain isolated seriously.

“Can our investigations be better if we can disclose that information to the patient?” she said. “I think the answer is yes.”

Public health experts have predicted that the B117 variant, first found in the United Kingdom, could be the predominant variant strain of the coronavirus in the U.S. by March.

As of Tuesday, the CDC had identified nearly 1,900 cases of the B117 variant in 45 states; 46 cases of B1351, which was first identified in South Africa, in 14 states; and five cases of the P.1 variant initially detected in Brazil in four states, Dr. Rochelle Walensky, the CDC director, told reporters Wednesday.

A Feb. 12 memo from North Carolina public health officials to clinicians stated that because genome sequencing at the CDC is done for surveillance purposes and is not an approved test under the Clinical Laboratory Improvement Amendments program ― which is overseen by the U.S. Centers for Medicare & Medicaid Services ― “results from sequencing will not be communicated back to the provider.”

Earlier this week, the topic came up in Illinois as well. Notifying patients that they are positive for a covid variant is “not allowed currently” because the test is not CLIA-approved, said Judy Kauerauf, section chief of the Illinois Department of Public Health communicable disease program, according to a record obtained by the Documenting COVID-19 project of Columbia University’s Brown Institute for Media Innovation.

The CDC has scaled up its genomic sequencing in recent weeks, with Walensky saying the agency was conducting it on only 400 samples weekly when she began as director compared with more than 9,000 samples the week of Feb. 20.

The Biden administration has committed nearly $200 million to expand the federal government’s genomic sequencing capacity in hopes it will be able to test 25,000 samples per week.

“We’ll identify covid variants sooner and better target our efforts to stop the spread. We’re quickly infusing targeted resources here because the time is critical when it comes to these fast-moving variants,” Carole Johnson, testing coordinator for President Joe Biden’s covid-19 response team, said on a call with reporters this month.

Hospitals get high-level information about whether a sample submitted for sequencing tested positive for a variant, said Dr. Nick Gilpin, director of infection prevention at Beaumont Health in Michigan, where 210 cases of the B117 variant have been detected. Yet patients and their doctors will remain in the dark about who exactly was infected.

“It’s relevant from a systems-based perspective,” Gilpin said. “If we have a bunch of B117 in my backyard, that’s going to make me think a little differently about how we do business.”

It’s the same in Washington state, McCallion said. Health officials may share general numbers, such as 14 out of 16 outbreak specimens at a facility were identified as B117 ― but not who those 14 patients were.

There are arguments for and against notifying patients. On one hand, being infected with a variant won’t affect patient care, public health officials and clinicians say. And individuals who test positive would still be advised to take the same precautions of isolation, mask-wearing and hand-washing regardless of which strain they carried.

“There wouldn’t be any difference in medical treatment whether they have the variant,” said Mark Pandori, director of the Nevada State Public Health Laboratory. However, he added that “in a public health emergency it’s really important for doctors to know this information.”

Pandori estimated there may be only 10 or 20 labs in the U.S. capable of validating their laboratory-based variant tests. One of them doing so is the lab at the University of Washington in Seattle.

Dr. Alex Greninger, assistant director of the clinical virology laboratories there, who co-created one of the first tests to detect SARS-CoV-2, said his lab began work to validate the sequencing tests last fall.

Within the next few weeks, he said, he anticipates having a federally authorized test for whole-genome sequencing of covid. “So all the issues you note on notifying patients and using [the] results will not be a problem,” he said in an email.

Companies including San Diego-based Illumina have approved covid-testing machines that can also detect a variant. However, since the add-on sequencing capability wasn’t specifically approved by the FDA, the results can be shared with public health officials ― but not patients and their doctors, said Dr. Phil Febbo, Illumina’s chief medical officer.

He said they haven’t asked the FDA for further approval but could if variants start to pose greater concern, like escaping vaccine protection.

“I think right now there’s no need for individuals to know their strains,” he said.

DeSantis Advances Questionable Link Between Lockdowns and Despair

The result of lockdowns “has been the destruction of millions of lives across America as well as increased deaths from suicide, substance abuse and despair without any corresponding benefit in covid mortality.”

Florida Gov. Ron DeSantis, Feb. 2, 2020

For months, Florida Gov. Ron DeSantis has boasted about his state’s “open for business” strategy in dealing with covid-19 and how it’s working better than so-called lockdown states.

Unlike in some other states, all Florida public schools are open for in-person learning, restaurants and bars have few restrictions, and the state has barred local governments from penalizing individuals for not wearing a mask in public.

In a recent rant against social network companies such as Facebook and Twitter, DeSantis suggested that states that had instituted heavy restrictions on residents experienced severe repercussions for residents without reducing the number of covid deaths.

“Lockdowns at the time of the pandemic were favored by the, quote, ‘narrative’ and so, in the name of, quote, ‘science,’ articles and posts warning against lockdowns were taken down and censored,” said DeSantis. “The result has been the destruction of millions of lives across America, as well as increased deaths from suicide, substance abuse and despair, without any corresponding benefit in covid mortality.”

We wondered whether that was true. Have state restrictions done such significant harm without providing any boost in the fight against covid deaths? So we dug in.

Locking In on Lockdowns

To reduce the spread of the coronavirus, states have enacted — and then sometimes relaxed or lifted — various restrictions, including mask mandates, limits on restaurant capacity, stay-at-home orders and bans on large gatherings.

DeSantis, a Republican, has bristled at such statewide orders, even resisting pleas from local officials in Florida and criticizing other jurisdictions for implementing them. He has consistently questioned their effectiveness. Late last year, for instance, he claimed that states with lockdowns had covid transmission rates twice as high as Florida’s. We rated that Half True.

We asked DeSantis’ office for any evidence supporting his more recent claim. The response reveals a mixed bag of information.

Check the Data: Did Florida’s Path Lead to Less ‘Despair’?

To support the governor’s claim that other states have seen higher numbers of deaths from suicide, substance abuse and despair than Florida has during the pandemic, DeSantis’ office sent information from the Centers for Disease Control and Prevention showing “all cause” mortality rates increased slower in Florida in 2020 — coinciding with the pandemic’s first months through June 3 — over 2019 rates than in California and New York — two states that have opted for more regulations on public gatherings and mask-wearing. DeSantis’ analysis showed Florida’s rate rose 15% compared with 16% in California and 29% in New York.

But the “all causes” category goes far beyond deaths associated with suicide and drug abuse. It includes deaths from cancer, heart disease, lung disease and dementia, for example.

DeSantis’ office did not provide any data showing how rates of suicide and drug abuse in Florida compared with those in so-called lockdown states. It sent us a Miami Herald article that said in Florida, according to preliminary medical examiners’ statistics, 2,975 people died by suicide in 2020, down 13% from the previous year. But the article did not have nationwide data or figures from California or New York.

Concerning overdose deaths, DeSantis’ office did not provide specific information. However, health experts said the pandemic likely did increase opioid overdoses. But the latest, provisional CDC data on drug overdose deaths shows Florida’s numbers rising faster than the national average.

Comparing the 12-month period ending in June 2020 to the prior 12 months, the period for which data is available, Florida had a 34% increase in the rate of overdose deaths compared with a 20% national average among states. California had a 23% increase and New York had an 18% increase.

Meanwhile, federal suicide data reflecting the months in which the pandemic has transpired will not likely be available until 2022. Experts say that anecdotal evidence suggests a possible uptick in suicide rates during the pandemic. In addition, an online tool offered by the nonprofit Mental Health America to help screen for mental health issues showed a slight increase last year in people having suicidal thoughts.

Nonetheless, Paul Gionfriddo, the group’s CEO, said he knows of no studies showing that so-called lockdown states have higher rates of suicide than those with fewer restrictions.

Gionfriddo said DeSantis may think he is mitigating the harmful effects of loneliness by not limiting public gatherings. But loneliness is not the only reason people cite in considering suicide, he said. Grief, financial insecurity and other factors also play a role, he said.

John Auerbach, president and CEO of Trust for America’s Health, a nonprofit think tank, said it’s difficult to pinpoint the psychological impact of restrictions to reduce infection because rules vary by state and within states, and such regulations have been imposed and lifted at different times.

Auerbach said he knows of no evidence that links states’ covid restrictions to suicides or drug overdose deaths.

“There are many contributing factors to suicide and drug overdoses,” he said. The pandemic itself is having the biggest effect on heightening people’s risk of dying from suicide and drug abuse — not the states’ different approaches to prevent the transmission of infection, he added.

“It is the underlying pandemic that is at the root of increased risks,” Auerbach said.

Factoring In Covid Mortality Rates

DeSantis also argued that statewide restrictions did not bring any corresponding benefit in limiting covid mortality.

We asked his office for evidence. They again pointed to the CDC increase in “all cause” mortality data that showed California’s rate was slightly higher than Florida’s. But those statistics cover all causes of death, and people are still dying of diseases and conditions besides covid.

We then consulted three epidemiologists to get their take. They all said the governor was playing loose with the facts. They stressed varying factors that affect states’ mortality rates — from the weather to socioeconomic indicators to access to health services.

The epidemiologists pointed to the latest CDC data, which indicated that Florida’s covid mortality rate is higher than California’s and seemed to undercut DeSantis’ position that lockdowns have only hurt states.

As of Feb. 22, Florida ranked 28th in covid death rates while California ranked 33rd, according to the latest CDC data, as compiled by Statista.

“That would bolster the argument that restrictions are one factor involved in lowering death rates,” said Nicole Gatto, an associate professor of public health at Claremont Graduate University in California.

Numerous others also have an effect, Gatto said, so it is impossible to compare states using current data based on their strategies.

“I do think it is an oversimplification to make the assertion that the governor did without further study of the numerous variables involved, characteristics of the population, timing of interventions and the limitations of the data,” she said.

Our Ruling

DeSantis said lockdown states have seen “increased deaths from suicide, substance abuse and despair without any corresponding benefit in covid mortality.”

The pandemic certainly has caused anxiety and distress across the country, and state and local restrictions designed to tamp down on the coronavirus’s spread have also affected people’s financial and emotional well-being. But currently, no clear data supports DeSantis’ strongly worded claim. Researchers agreed that more research is necessary before such broad conclusions could be drawn. In addition, experts said that covid death rates vary by state and numerous factors beyond state strategies to combat the virus affect this metric.

We rate the statement Mostly False.


Gov. Ron DeSantis news conference, Feb. 2, 2021

Telephone interview with Paul Gionfriddo, president and CEO of Mental Health America, Feb. 12, 2021

Mental Health America, Take a Mental Health Test, Mental Health America online screening tool, accessed Feb. 12, 2021

Centers for Disease Control and Prevention, Vital Statistics Rapid Release: Provisional Drug Overdose Death Counts — CDC data on overdose deaths, Feb. 7, 2021

Email correspondence with Meredith Beatrice, DeSantis spokesperson, Feb. 10 and 11, 2021

Telephone interview with John Auerbach, president and CEO of Trust for America’s Health, Feb. 12, 2021

Email interview with Nicole Gatto, MPH, Ph.D., associate professor of public health at Claremont Graduate University, Feb. 18, 2021

Email interview with William Miller, professor of epidemiology at the Ohio State University, Feb. 18, 2021

Telephone interview with Dr. Robert Murphy, professor of medicine and biomedical engineering and executive director, Northwestern University’s Institute for Global Health, Feb. 18, 2021

Statista, Death rates from coronavirus (COVID-19) in the United States as of Feb. 17, 2021, by state, accessed Feb. 22, 2021

Miami Herald, “One Pandemic Positive: Suicides in Florida Actually Plummeted. Experts Worry It Won’t Last,” Feb. 10, 2021

PolitiFact, “Is Florida Doing Better on COVID-19 than ‘Locked Down’ States? Dec. 2, 2020

‘It Doesn’t Feel Worth It’: Covid Is Pushing New York’s EMTs to the Brink

In his 17 years as an emergency medical provider, Anthony Almojera thought he had seen it all. “Shootings, stabbings, people on fire, you name it,” he said. Then came covid-19.

Before the pandemic, Almojera said it was normal to respond to one or two cardiac arrests calls a week; now he’s grown used to several each shift. One day last spring, responders took more than 6,500 calls — more than any day in his department’s history, including 9/11.

An emergency medical services lieutenant and union leader with the New York City Fire Department, Almojera said he has seen more death in the past year than in his previous decade of work. “We can’t possibly process the traumas, because we’re still in the trauma,” he said.

EMS work has long been grueling and poorly paid. New FDNY hires make just over $35,000 a year, or $200 more than what is considered the poverty threshold for a four-person household in New York City. (That figure is on par with national averages.) Employee turnover is high: In fiscal year 2019, more than 13% of EMTs and paramedics left their jobs.

But covid-19 has added a new layer of precarity to the work. According to Oren Barzilay, the Local 2507 union president, nearly half of its 4,400 emergency medical technicians and paramedics have tested positive for the covid virus. Five have died, though that figure doesn’t account for first responders who worked for private emergency response companies. Nationwide, at least 128 medical first responders have died of covid, according to Lost on the Frontline, an investigation by KHN and The Guardian.

The problem of EMS pay was in the spotlight in December, when the New York Post outed paramedic Lauren Caitlyn Kwei for relying on an OnlyFans page to make extra money. Kwei, who works for a private ambulance company, wrote on Twitter: “My First Responder sisters and brothers are suffering … exhausted for months, reusing months old PPE, being refused hazard pay, and watching our fellow healthcare workers dying in front of our eyes.” She added: “EMS are the lowest paid first responders in NYC which leads to 50+ hour weeks and sometimes three jobs.”

Almojera earns $70,000 annually as a lieutenant, but his paramedic colleagues’ salaries in non-leadership roles are capped at around $65,000 after five years on the job. He earns extra income as a paramedic at area racetracks and conducting defibrillator inspections. He has colleagues who drive for Uber, deliver for GrubHub and stock grocery shelves on the side. “There are certain jobs that deserve all your time and effort,” Almojera said. “This should be your only job.”

For Liana Espinal, a paramedic, union delegate and 13-year veteran of the FDNY, a sense of camaraderie and the opportunity to serve her fellow Brooklynites compensated for low pay and exhausting shifts. For years she was willing to take on overtime and even a second job with a private ambulance company to make ends meet.

But covid changed that. The department switched from eight- to 12-hour shifts last summer, leaving Espinal, a single mother of three, too exhausted to pick up overtime. Like many health care workers, she isolated from her children at the outset of the pandemic to avoid potentially exposing them to the coronavirus, leaving them in the care of her own mother; she described being separated from her 1-year-old son as “devastating.” Despite working round-the-clock to get the city through the early days of the pandemic, she often had to choose between paying rent on time or paying utility bills.

“After working this year, for me personally, it doesn’t feel worth it anymore,” she said. She is two exams shy of finishing a nursing degree she started studying for before the pandemic. She said the last year has only strengthened her resolve to shift careers.

The pandemic has disproportionately claimed Black and brown lives — Black and Hispanic people were significantly more likely than white people to die of covid — and those disparities extend to health care workers. Lost on the Frontline has found that nearly two-thirds of health care workers who have died of covid were non-white.

All five of the department’s EMS employees who died of covid were non-white.

They included Idris Bey, 60, a former Marine and 9/11 first responder who was known to stay cool under pressure. He was an avid reader who bought new books each time he got a paycheck.

Richard Seaberry, 63, was looking forward to retiring to the Atlanta area to be near his young granddaughter.

Evelyn Ford, 58, left behind four children when she died in December, just as the coronavirus vaccine became available to first responders in New York City. According to the City Council’s finance division, 59% of EMS workers are minorities.

Almojera and Espinal see a racial component to pay disparities within the FDNY. Firefighters with five years on the job can make more than $100,000, including overtime and holiday pay, whereas paramedics and EMTs cap out at $65,000 and $50,000, respectively. According to the City Council finance division, 77% of New York firefighters are white.

“My counterpart fire lieutenants make almost $40,000 more than me,” Almojera said. “I’ve delivered 15 babies. I’ve been covered head to toe in blood. I mean, what do you pay for that? You can at least pay us like the other 911 agencies.”

A spokesperson for the FDNY declined to comment on pay.

The last year has also exacted an emotional toll on an already stressed workforce. Three of the FDNY’s EMS workers died by suicide in 2020. John Mondello Jr, 23, a recent EMS academy graduate, died in April. Matthew Keene, 38, a nine-year veteran, died in June. Brandon Dorsa, 36, who had struggled with injuries from a 2015 workplace accident, died in July.

Family and colleagues told local news outlets that Mondello and Keene were struggling with trauma as a result of the pandemic. Last spring, New York Mayor Bill de Blasio and first lady Chirlane McCray announced a partnership between the U.S. Department of Defense and city agencies to help front-line health workers cope with the stress of working through the pandemic. But many EMS workers have said that the program has been difficult to access.

“There aren’t a lot of resources for people, so a lot of EMS internalize what they go through,” Almojera said. “It’s not normal to see the things that we see.”

Issues regarding pay and mental health challenges predate the pandemic: A national survey conducted in 2015 found EMS providers were much more likely than the general population to struggle with stress and contemplate suicide.

Almojera knew Keene and last spoke with him a week before his death. “You can’t say enough nice things about the guy,” he said. “I wish he had mentioned even a hint of [his struggles] on the phone. And I would have shared how I was feeling through all this.”

He said he has felt a mix of pride, exhaustion and resignation over the past year. “I’ve seen the magic that you can do on the job,” Almojera said. “And I’ve seen my brothers and sisters on this job cry after calls.”

Almojera is now representing his union in talks with the city to renegotiate EMS and paramedic contracts. He said he hopes that city officials will think of the hardships he and his fellow first responders endured over the past year when they come to the negotiating table to discuss pay raises. But early talks have not been encouraging.

“After all the sacrifices made by our members,” he said. “I don’t know whether to be angry, flip the table, or just shrug my shoulders and give up.”

This story is part of “Lost on the Frontline,” an ongoing project from The Guardian and Kaiser Health News that aims to document the lives of health care workers in the U.S. who die from COVID-19, and to investigate why so many are victims of the disease. If you have a colleague or loved one we should include, please share their story.

Lessons From California Prison Where Covid ‘Spread Like Wildfire’

When news of the pandemic first reached the men incarcerated at Avenal State Prison in central California, inmate Ed Welker said the prevailing mood was panic. “We were like, ‘Yeah, it’s going to come in here and it’s going to spread like wildfire and we’re all going to get it,’” he said. “And that’s exactly what happened.”

Almost a year later, 94% of Avenal’s incarcerated men have contracted covid-19 and eight have died. With more than 3,600 confirmed cases among prisoners and staff members, the facility tops the list of the country’s largest covid clusters in prisons compiled by The New York Times and the UCLA Covid-19 Behind Bars Data Project.

Calling the prison system’s response to the pandemic “nonchalant,” “incompetent” and at times “negligent,” Welker and his fellow inmates described a crowded and dangerous living situation. Inmates interviewed by Valley Public Radio said physical distancing was nearly impossible, and constant moves in and out of quarantine were confusing and disruptive. The postponement of visits and rehabilitative programs left the men with little opportunity to vent their frustrations.

“It’s chaos over here, man,” said John Walker, 50, an inmate interviewed via the prison system’s collect-calling service during the fall surge in cases. “That’s why the mental health program’s blowing up.”

Similar grievances have been voiced by prisoners across the country, who have contracted the virus at a rate more than three times that of the general population, according to an analysis by The Associated Press and the Marshall Project, a nonprofit newsroom dedicated to the U.S. criminal justice system. Lawsuits and criminal justice advocates detail a pandemic response in prisons and jails that has ranged from careless to egregious.

California’s prison authority denies many of these men’s claims and instead points to the long list of precautions the agency has adopted since the pandemic began. Dana Simas, press secretary at the California Department of Corrections and Rehabilitation, wrote in an email that state and Avenal officials “are continuously working with public health and health care experts to address this unprecedented pandemic and protect those who live and work in our state prisons.”

The virus continues to devastate prison populations and employees. Despite a dramatic drop in new infections since the holidays, more than 15,000 inmates nationwide have contracted the virus in the past three weeks, according to the Marshall Project. California’s facilities serve as a case study in which outbreaks recur while prison advocates argue that officials failed to enact a critical precaution: relieving overcrowding.

“There has not been the political will to do what’s necessary to keep people safe, which is to dramatically reduce prison and jail populations,” said Aaron Littman, a teaching fellow at UCLA School of Law and deputy director of the COVID-19 Behind Bars Data Project.

With more than 3,600 confirmed cases among inmates and staff members, Avenal State Prison has the country’s largest covid-19 clusters of any prison. (California Department of Corrections and Rehabilitation)
Protesters gather outside Avenal State Prison on June 6, 2020. At this prison in Central California, 94% of the incarcerated men have contracted covid-19 and eight have died. (Michelle Tran)

Early in the pandemic, corrections agencies across the country put in place measures to prevent outbreaks, mandating masks and physical distancing, setting aside housing units specifically for quarantined inmates, and establishing testing protocols for staffers and the incarcerated.

“The measures are important, the measures help … but those are not sufficient,” said Littman.

Horrific errors occurred. In late May, for instance, a transfer of a handful of inmates later discovered to have been covid-positive sparked an outbreak that killed 29 people and infected 2,600 others at San Quentin State Prison in Northern California.

Decision-makers disagree about what’s safe. At Avenal, as in all of California’s prisons, labor contracts permit guards to work different shifts in different buildings, despite the fact that many academic experts and the Centers for Disease Control and Prevention discourage the practice.

The public health director of Kings County, where Avenal is located, tried to order the prison to temporarily freeze staff assignments in May, but the state prison authority politely informed him the county has no jurisdiction over a state-run facility. “The response to us was, ‘Well, because of labor agreements, we can’t do that,’” said Kings County Supervisor Craig Pedersen. “It was one of the most frustrating interactions we had, I think, in this process.”

Workplace culture may also undermine well-intentioned precautions. In a review published in October, California’s Office of the Inspector General, the state prison watchdog, reported that staff members failed to properly wear masks at two-thirds of the prisons it inspected. The report concluded lax enforcement was to blame.

landscape of prison facility situated beside a lakeThe second-largest cluster of covid-19 cases in the nation is also in Kings County, California, at the California Substance Abuse Treatment Facility and State Prison in Corcoran, California. (California Department of Corrections and Rehabilitation)(California Department of Corrections and Rehabilitation)

Still, like Littman, many advocates and academics say preventive measures can accomplish little in such tightly packed environments. “Our review of the evidence indicates that relieving population pressures in jails, prisons, and detention centers greatly facilitates adherence to CDC guidelines, controlling COVID-19 outbreaks, and reducing health risks, particularly for medically vulnerable people,” members of the National Academies of Sciences, Engineering, and Medicine wrote in an October report. “Smaller populations make it easier for correctional officials to place individuals in single cells, have sufficient resources for testing, and safely quarantine individuals after exposure to an infected person.”

When the pandemic began, 1.5 million inmates were housed in roughly 1,900 state and federal prisons, many of which were not just crowded but overcrowded. California’s prisons were stuffed with an average of 30% more inmates than they were designed to house. Avenal’s occupancy was nearly 50% beyond capacity.

Since March, the state corrections department has granted early releases to 19,000 inmates due to medical and other circumstances, but a federal judge argued it hasn’t been enough. “I have cajoled, begged and pleaded with the governor and the secretary to release a very significantly higher number of inmates beyond their current release efforts,” U.S. District Judge Jon Tigar said during a January hearing for an ongoing court case regarding medical care within the state’s prisons. “With all appreciation for the efforts they have made, those requests have fallen on deaf ears.”

It’s not just the incarcerated who are contracting covid at alarming rates. Throughout the country, nearly 103,000 prison employees have tested positive for the virus and 184 have died, a sum that doesn’t begin to account for the infections transmitted beyond prison walls to families and communities.

“It’s a huge concern,” said Jeff Garner, executive director of the nonprofit Kings Community Action Organization in rural Kings County, where three state prisons provide jobs for more than 4,300 people. “The prisons are a huge employer in our county. Whether it’s employees or clients, it’s kind of like those six degrees of separation.”

Just 40 miles from Avenal, on the other side of this agricultural county in the San Joaquin Valley, is the California Substance Abuse Treatment Facility and State Prison, Corcoran, ranked by The New York Times as the country’s second-largest cluster of covid in prison. Kings County health officials have not responded to multiple requests for comment about how these two prison outbreaks have contributed to community transmission of the virus.

a dozen or so people hold bright colored signs to protest covid cases in prisonProtesters gather outside Avenal State Prison on June 6, 2020. At this prison in Central California, 94% of the incarcerated men have contracted covid-19 and eight have died.(Colby Lenz)

Could the arrival of the vaccines finally put a stop to covid in prisons? In December, nearly 500 academics and public health experts signed a letter to the CDC calling for prisoners and correctional employees to receive priority access. At least nine states included incarcerated people in the first tier of vaccination plans, while 15 included prison staffers, according to the Prison Policy Initiative, a research organization that studies mass incarceration.

California began offering vaccines to medically vulnerable inmates at a limited number of facilities in December. By mid-February, the state had vaccinated close to 35,800 inmates and 24,900 correctional staffers.

Ed Welker, 58, hasn’t been offered a vaccine yet, but he said he’s not interested. Despite the 63 million doses that have already been shot into American arms, he’s wary of long-term side effects — and he also feels that, at Avenal, the vaccine is obsolete. “For this particular population, I think it’s a waste of time and money, because everybody here for the most part has had” covid, he said.

Although Welker said many inmates share his views, they appear to be in a minority: In a recent court filing, state officials reported that more than two-thirds of incarcerated people who’ve been offered the vaccine have accepted it.

Still, Welker argues that getting vaccinated, like masking and physical distancing, is a moral imperative for correctional staffers, who could bring the virus back to the prison. “They signed up for this,” he said. “It’s their job to protect us.”

Kerry Klein is a reporter with Valley Public Radio.

This story is from a reporting partnership that includes Valley Public RadioNPR and KHN, an editorially independent program of KFF.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Religiosos enferman de covid mientras confortan a enfermos y moribundos

El sacerdote José Luis Garayoa sobrevivió a la fiebre tifoidea, a la malaria, a un secuestro y a la crisis del ébola como misionero en Sierra Leona, pero murió a causa de covid-19 después de atender a los enfermos de su iglesia en Texas y a los afligidos familiares de los fallecidos.

Garayoa, de 68 años, servía en la iglesia católica Little Flower de El Paso, y fue uno de los tres sacerdotes que vivía en la casa local de la Orden Católica de los Agustinos Recoletos que contrajo la enfermedad. Garayoa murió dos días antes del Día de Acción de Gracias.

Era consciente de los peligros de covid, pero no podía rechazar a un feligrés que buscaba consuelo y oraciones cuando esa persona o un ser querido luchaba contra la enfermedad, según contó la peluquera jubilada María Luisa Placencia, una de sus feligresas.

“Siempre que veía a alguien sufriendo o preocupado por un hijo o un padre, rezaba con ellos y mostraba compasión”, dijo Placencia.

La muerte de Garayoa subraya los riesgos personales que corren los líderes espirituales que confortan a los enfermos y a sus familias, dan la extremaunción o dirigen los funerales de las personas que han muerto de covid. Muchos de ellos también se enfrentan al reto de liderar a congregaciones divididas sobre la gravedad de la pandemia.

Atender a los enfermos o a los moribundos es una de las principales funciones de los líderes espirituales de todas las religiones. Susan Dunlap, teóloga en la Universidad de Duke, dijo que covid crea un sentimiento de obligación aún mayor para el clero, porque muchos pacientes están aislados de los miembros de la familia.

Las personas terminales suelen querer interactuar con Dios o arreglar las cosas, señaló Dunlap, y un miembro del clero “puede ayudar a facilitar eso”.

Esta labor espiritual es la clave del trabajo de los capellanes de los hospitales, pero puede exponerlos a la propagación de virus en el aire o, a veces, a través del tacto.

Jayne Barnes, capellán de la Clínica Billings de Montana, dijo que trata de evitar el contacto físico con los pacientes de coronavirus, pero puede ser difícil resistirse a un breve contacto, que a menudo es la mejor forma de transmitir compasión.

“Es casi un momento incómodo cuando ves a un paciente angustiado, y sabes que no debes cogerle la mano o darle un abrazo”, apuntó Barnes. “Pero eso no significa que no podamos estar ahí para ellos. Son personas que no pueden recibir visitas, y tienen muchas cosas que decir. A veces están enfadados con Dios, y me lo hacen saber. Estoy allí para escuchar”.

Sin embargo, hay veces, dijo Barnes, que la desesperación es tan profunda que no puede evitar “ponerte un guante y tomar la mano de un paciente”.

A Barnes le diagnosticaron covid cerca del Día de Acción de Gracias. Se ha recuperado y tiene una “mejor comprensión” de lo que los pacientes están soportando.

Tratar con tanto sufrimiento afecta incluso a los médicos y enfermeras más curtidos, comentó. El personal de la Clínica Billings quedó devastado cuando un médico muy querido murió de covid, y se unió en apoyo a una enfermera que estuvo gravemente enferma, pero se recuperó.

“No sólo cuidamos de los pacientes, también estamos ahí para el personal, y creo que hemos sido un activo importante”, dijo refiriéndose a los capellanes del hospital.

En Abington, Pennsylvania, el pastor Marshall Mitchell, de la Iglesia Bautista de Salem, explicó que parte de su deber espiritual es persuadir a su congregación y a la comunidad afroamericana, en general, de que tomen precauciones para evitar la enfermedad.

Por eso Mitchell permitió que los fotógrafos captaran el momento en que, en diciembre, recibió su primera dosis de la vacuna.

“Como pastor de una de las mayores iglesias de la región de Philadelphia, me corresponde demostrar los poderes tanto de la ciencia como de la fe”, dijo.

Mitchell aseguró que podría utilizar su credibilidad para convencer a otros afroamericanos, que se han visto desproporcionadamente afectados por covid, de que una vacuna puede salvar vidas. Muchos son escépticos.

La politización de las precauciones para evitar contagiarse el coronavirus, como las máscaras y el distanciamiento social, ha puesto a muchos pastores en una posición difícil.

Mitchell dijo que no tiene paciencia con las personas que se niegan a usar máscaras.

“Los mantengo muy lejos de mí”, añadió.

Jayne Barnes, capellana en la Billings Clinic, en Montana, dice que es raro no poder tocar o abrazar a un paciente con covid en crisis. Dijo que algunas veces no puede contenerse y “me pongo un guante y sostengo su mano”. (Zach Benoit)

Jeff Wheeler, pastor principal de la Iglesia Central de Sioux Falls, en Dakota del Sur, dijo que su iglesia anima a llevar máscaras y que la mayoría de los feligreses lo hacen. Sin embargo, la tensión subyacente se refleja en su mensaje a los miembros en el sitio web de la iglesia:

“A medida que avanzamos, simplemente les pedimos que eviten avergonzar, juzgar o hacer comentarios críticos a quienes llevan o no llevan máscaras”.

El jeque Tarik Ata, que dirige la Fundación Islámica del Condado de Orange, en California, explica que el Corán pide a los musulmanes que tomen medidas para cuidar de su salud y que los congregantes cumplen, en gran medida, las directrices de covid.

“Por lo tanto, nuestros miembros no tienen ningún problema con el mandato de llevar máscara”, dijo.

Covid ha golpeado duramente a la población musulmana del condado de Orange, indicó Ata. La religión se ha convertido en una importante fuente de consuelo para los miembros que han perdido sus trabajos o se han enfermado.

“Nuestra fe dice que, por muy difícil que sea la situación, siempre tenemos acceso a Dios y así el futuro será mejor”, dijo Ata.

Adam Morris, rabino del Templo Micah de Denver, Colorado, contó que se reúne con enfermos de covid a través de internet. En los servicios funerarios, le preocupa que con la máscara puesta las personas no aprecien la preocupación y la compasión que siente por su situación.

Oficia los funerales junto a la tumba para un pequeño número de dolientes, pero exige que todos los participantes lleven máscara.

Musulmanes y judíos practicantes creen que es importante enterrar a las personas rápidamente después de su muerte, dijo Morris.

“Algunas tradiciones y rituales deben seguir adelante”, concluyó Morris, “con o sin covid”.

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After Billions of Dollars and Dozens of Wartime Declarations, Why Are Vaccines Still in Short Supply?

The U.S. government has invested billions of dollars in manufacturing, used a wartime act dozens of times to boost supplies and yet there’s still not enough covid vaccine on the way to meet demand — or even the government’s own goals for national immunization.

President Joe Biden, in remarks at the National Institutes of Health this month, said the nation is “now on track to have enough supply for 300 million Americans by the end of July.” But at the current rate of production, Pfizer and Moderna will miss their targets of providing at least 100 million doses each by the end of March, let alone 200 million more doses each has promised by July.

Moderna would need to more than double its vaccine production rate from January — when it made roughly 19 million doses — to meet its contractual obligations. Pfizer supplied 40 million vaccine doses by Feb. 17. It has roughly six weeks left to deliver the first 120 million doses it has promised.

Biden and officials from the two companies say they are rapidly expanding production capacity. But critics are lining up. They want to know whether the government did enough, fast enough, to guarantee that companies would meet the urgent challenges of the pandemic. As for the manufacturers bolstered by extraordinary sums of taxpayer money, why did they not share technology and know-how sooner, or move more quickly into strategic production partnerships?

Experts say it’s complicated, noting that the output of raw materials and assembly lines can’t be ratcheted up 10,000-fold at the push of a button — and that the effort thus far has been close to miraculous. They cite bottlenecks in at least three areas: the production of specialty lipids, fatty materials that are a primary component of the Moderna and Pfizer-BioNTech vaccines; the hundreds of millions of glass vials that hold the vaccine; and the sterile automated assembly lines where vaccine moves from bulk containers into vials before shipment.

U.S. officials have run headlong into the limits of the Defense Production Act, a Korean War-era law that allows the federal government to ramp up supplies of critical materials in times of national emergency. The vaccine manufacturing process relies on a complex supply chain, from sourcing raw materials and equipment to designing chemical processes, building production lines and hiring and training workers.

Also, experts note, no one knew which vaccines would prove effective.

“A year ago there was no commercial market for mRNA product. There was scientific research and pharma making small-volume clinical lots. Now we need billions of doses, in the space of a year. That’s overloading the supply infrastructure,” said Kevin Gilligan, a senior consultant with Biologics Consulting and a former official with the Biomedical Advanced Research and Development Authority, or BARDA, a federal agency created in 2006 to deal with pandemics and bioterrorism.

As of December, the Trump administration through its Operation Warp Speed initiative had obligated nearly $14 billion for vaccine development and manufacturing, including investments to expand U.S. capacity, according to a Government Accountability Office report in January. The administration invoked the Defense Production Act on at least 23 vaccine-related contracts, in part to prioritize the government’s contracts over others, according to a KHN review of the federal contracts database, contracts obtained by the nonprofit group Knowledge Ecology International, GAO and government news releases.

They include the December contract that the Department of Health and Human Services signed with Pfizer for another 100 million doses, on top of the initial 100 million it committed to last summer. That contract, worth $1.95 billion, included DPA provisions to give the company priority access to raw materials and spare parts for factories, according to a former administration official.

The DPA has also been used in vaccine contracts with Moderna, Johnson & Johnson and other drug companies for hundreds of millions of doses. On top of that, the law has been invoked for at least 10 contracts with companies making needles or syringes. It’s been used to require glass makers Corning and SiO2 Materials Science to prioritize vial production for vaccine production, and in contracts for aspects of manufacturing with companies like Emergent BioSolutions, Fujifilm Diosynth Biotechnologies and Grand River Aseptic Manufacturing.

Operation Warp Speed awarded Emergent BioSolutions $648 million last year to boost the manufacturing capacity it needed to enter agreements with Johnson & Johnson and AstraZeneca — worth at least $615 million and $261 million, respectively — to help make their vaccines. Grand River Aseptic Manufacturing won a $160 million award from BARDA and has contracted with Johnson & Johnson to fill vials and finish packaging of its single-shot covid vaccine, which is expected to get emergency authorization from the Food and Drug Administration as soon as this month but will only have a few million doses available initially.

The Biden administration has expanded its use of the wartime act to prioritize equipment like filling pumps and filtration systems for Pfizer. “We told you that when we heard of a bottleneck on needed equipment, supplies or technology related to vaccine supply, that we would step in and help,” Tim Manning, the White House official leading the administration’s covid supply efforts, said during a February press briefing.

Yet it can do only so much, according to medical supply chain experts. Prashant Yadav, a senior fellow at the Center for Global Development at Harvard University, said it could take months for the impact of that DPA action to be felt because of the time it takes to procure equipment and get it installed, with each step tightly regulated.

The U.S. is unlikely to get a meaningful bump in capacity “unless we think about co-production deals,” in which a drug company agrees to manufacture a competitor’s vaccine, said Tinglong Dai, an associate professor at Johns Hopkins University’s Carey Business School.

So far, such arrangements have proliferated in Europe — which has less capacity to produce drugs than the United States does. Deals with other major vaccine manufacturers have been less common on the U.S. side of the pond.

“Though we have not partnered with, say, another large pharma for production, we have built strategic partnerships with a number of organizations that have been instrumental to our scaling up and meeting supply and commercialization plans,” Moderna spokesperson Ray Jordan said in an email.

Moderna this month said that its manufacturing process would scale up rapidly in the coming weeks, that it would provide the U.S. between 30 million and 35 million doses in February and March and between 40 million and 50 million doses monthly from April to July. The company declined to elaborate on what made the boost possible.

Vaccine manufacturers long ago should have been sharing technology and expertise to boost production in the U.S. and Europe, and especially in developing countries, said James Love, director of Knowledge Ecology International, a nonprofit focused on patent rights.

“We’ve wasted about a year by not doing some of the obvious things,” he said. “The rhetoric is that it’s an emergency. But on the scale-up of manufacturing, you just don’t see it.”

It’s not that simple, others say. “There wasn’t any excess capacity available in the United States a year ago. Zero,” Paul Mango, a former HHS official heavily involved in Operation Warp Speed, said regarding vaccines. “It’s getting the equipment. It’s quality control. It’s getting the employees. People make it sound like this is easy. You can’t just push 400 workers and say, go at it.”

Each Pfizer-BioNTech or Moderna shot contains billions of lipid nanoparticles, each particle containing four lipids and a strand of the nucleic acid RNA, the five pieces assembled in a way that allows the RNA to enter our cells and create a particle that stimulates the immune system to defend against the covid virus.

The lipids, which are made only in a handful of factories, have been a major supply problem. “No one has ever thought of a scenario where we would use lipid nanoparticle formulation for [billions of] doses,” Yadav said. “We have not invented a process for doing lipid nanoparticles at scale.”

Two of the lipids in the vaccine, cholesterol and DSCP, have long been used in industry to shape and buffer chemical formulations. A third lipid prevents the particles from clumping together. A fourth enables the lipid shell of the vaccine to fuse with human cells and, once inside the cell, to crack open so the RNA can move to a structure called a ribosome and make proteins that stimulate immunity.

All of these raw materials are produced under regulated conditions — in Massachusetts, Missouri, Colorado and Alabama by companies under license with Moderna, Pfizer or Acuitas Therapeutics, which was co-founded by Pieter Cullis, a University of British Columbia professor who is considered the grandfather of lipid nanoparticle technology.

Before the pandemic, these companies produced meager amounts for use in small clinical trials, laboratory experiments or in one licensed drug, patisiran, which is used to treat a rare genetic disease in about a thousand people worldwide. Now they are producing thousands of kilograms of the stuff, said Stefan Randl, a vice president at Evonik, a lipid maker. Evonik recently announced it would scale up production at two German sites, possibly in the second half of the year, to be used in the Pfizer-BioNTech vaccine. The company last year bought a U.S. lipid manufacturer in Alabama.

“All of a sudden the quantities had to be ramped up a thousand-fold or more,” Randl said. “This is the biggest bottleneck.”

Several elements of the vaccine, including lipids and enzymes used in making the mRNA, until recently were produced using animal products such as sheep’s wool, said Andrew Geall, chief scientific officer at Precision NanoSystems, which designs equipment for mixing the mRNA and lipids. Animal products could cause contamination or disease, even in minute quantities, so manufacturers now use synthetic chemicals.

Luckily, the cosmetic industry — a major user of some of the same lipids used in the vaccines — has been switching from animal products in recent decades, noted Julia Born, an Evonik spokesperson.

Still, only a limited number of companies globally have expertise and facilities to make the lipids, said Thomas Madden, CEO and a co-founder of Acuitas, and they’ve all struggled to move from quantities produced in a laboratory to industrial-scale production. For instance, he said, hazardous solvents and chemicals used in laboratory procedures need to be avoided in industrial processes, where they could give rise to workplace safety issues.

“This is a hugely complex supply chain,” Madden said. “Once you address a bottleneck at one point, you identify the next bottleneck in the process. It’s a bit of a game of whack-a-mole.”

Although it’s not particularly difficult to make the lipids used in vaccines, it takes time to get FDA authorization of a facility that can make them in high quantities, said Cullis, the UBC professor. It would take two to three years to start such a factory from scratch, so instead, Moderna and Pfizer-BioNTech have been hooking up with existing manufacturers and getting them to convert to lipid production, he said.

Another bottleneck is “fill/finish” — getting the finished vaccine into vials or syringes so the shots can be shipped to customers. Vaccine filling lines require extremely high levels of efficiency and sterility, and few companies in the world have this capacity, said Mike Watson, former president of Valera, a Moderna subsidiary. Moderna has hired Catalent, a contract manufacturer that recently experienced delays that slowed the release of some doses, to fill and finish U.S. doses at its facility in Bloomington, Indiana. At least two other companies will do the same for Moderna’s vaccine supply abroad.

In January, the French multinational Sanofi — whose own covid vaccine has been delayed by poor performance in producing immunity — agreed to offer its fill/finish line in Germany for the Pfizer-BioNTech vaccine. That line isn’t expected to be running until July.

In the U.S., the number of vaccine doses shipped to states has ticked up in recent weeks, partly because Pfizer said its five-dose vials actually provide six shots. Moderna is seeking FDA permission to add up to five doses to its 10-dose vials.

Pfizer has said it is manufacturing raw materials in St. Louis, the active ingredients for the vaccine in Andover, Massachusetts, and filling vials in Kalamazoo, Michigan.

CEO Albert Bourla, with Biden at his side in Kalamazoo on Friday, said the company added lipid production capabilities at plants in Michigan and Connecticut, as well as fill/finish lines in Kansas. He said it has significantly cut the average time it takes to make doses — from 110 days to 60 days.

“Today, during this meeting, the president challenged us to identify additional ways in which his administration could help us potentially accelerate even further the delivery of the full 300 million doses earlier than July,” Bourla said. “The challenge is accepted, and we will try to do our best.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Covid Strikes Clergy as They Comfort Pandemic’s Sick and Dying

The Rev. Jose Luis Garayoa survived typhoid fever, malaria, a kidnapping and the Ebola crisis as a missionary in Sierra Leone, only to die of covid-19 after tending to the people of his Texas church who were sick from the virus and the grieving family members of those who died.

Garayoa, 68, who served at El Paso’s Little Flower Catholic Church, was one of three priests living in the local home of the Roman Catholic Order of the Augustinian Recollects who contracted the disease. Garayoa died two days before Thanksgiving.

Garayoa was aware of the dangers of covid, but he could not refuse a congregant who sought comfort and prayers when that person or a loved one fought the disease, according to retired hairstylist Maria Luisa Placencia, one of the priest’s parishioners.

“He could not see someone suffering or worried about a child or a parent and not want to pray with them and show compassion,” Placencia said.

Garayoa’s death underscores the personal risks taken by spiritual leaders who comfort the sick and their families, give last rites or conduct funerals for people who have died of covid. Many also face challenges in leading congregations that are divided over the seriousness of the pandemic.

Ministering to the ill or dying is a major role of spiritual leaders in all religions. Susan Dunlap, a divinity professor at Duke University, said covid creates an even greater feeling of obligation for clergy, because many patients are isolated from family members, she said.

People near death often want to interact with God or make things right, Dunlap said, and a clergy member “can help facilitate that.”

Such spiritual work is key to the work of hospital chaplains, but it can expose them to virus being spread in the air or sometimes through touch. Jayne Barnes, a chaplain at the Billings Clinic in Montana, said she tries to avoid physical contact with covid patients, but it can be difficult to resist a brief touch, which is often the best way to convey compassion.

“It’s almost an awkward moment when you see a patient in distress, but you know you shouldn’t hold their hand or give them a hug,” Barnes said. “But that doesn’t mean that we can’t be there for them. These are people who cannot have visitors, and they have a lot they want to say. Sometimes they are angry with God, and they let me know about that. I’m there to listen.”

Still, there are times, Barnes said, that the despair is so profound she cannot help but “put on a glove and hold a patient’s hand.”

Barnes was diagnosed with covid near Thanksgiving. She has recovered and has a “better understanding” of what patients are enduring.

Dealing with so much suffering affects even the most hardened doctors and nurses, she said. Billings Clinic staffers were devastated when a beloved physician died of covid, and rallied behind a popular nurse who was seriously ill but recovered.

“We’re not only taking care of the patients; we are also there for the staff, and I think we have been an important asset,’’ she said of the hospital’s chaplains.

In Abington, Pennsylvania, Pastor Marshall Mitchell of Salem Baptist Church said he believes part of his spiritual duty is to persuade his congregation and the broader African American community to take precautions to avoid covid. That is why Mitchell allowed photographers to capture the moment in December when he received his first dose of a vaccine.

“As pastor of one of the largest churches in the Philadelphia region, it is incumbent on me to demonstrate the powers of both science and faith,” he said.

Mitchell said he might have credibility in convincing other African Americans, who have been disproportionately affected by covid, that a vaccine can save lives. Many are skeptical.

The politicization of covid precautions such as masks and social distancing has put many pastors in a difficult position.

Mitchell said he has no patience for people who refuse to wear masks.

“I keep them the hell away from me,” he said.

Jayne Barnes, a chaplain at the Billings Clinic in Montana, says it’s awkward not to touch or hug a covid patient in distress. But sometimes she cannot help but “put on a glove and hold a patient’s hand.” (Zach Benoit)

Jeff Wheeler, lead pastor of Central Church in Sioux Falls, South Dakota, said that his church encourages mask-wearing and that most congregants comply. However, the underlying tension is reflected in his message to members on the church’s website:

“As we move forward, we simply ask you to avoid shaming, judging or making critical comments to those wearing or not wearing masks,” it reads.

Sheikh Tarik Ata, who leads the Orange County Islamic Foundation in California, said that the Quran calls for Muslims to take actions to ensure their health and that congregants largely comply with covid guidelines

“So, our members don’t have a problem with mask mandates,” he said.

Covid has hit the Orange County Muslim population hard, Ata said. Religion has become an important source of comfort for members who have lost their jobs and struggled with illness or finding child care.

“Our faith says that no matter how difficult the situation, we always have access to God and the future will be better,” Ata said.

Adam Morris, the rabbi at Temple Micah in Denver, said he has turned to online video to meet with congregants sick with the coronavirus. When meeting with his congregation members in person, such as during graveside services, he worries that with his mask on people might miss seeing the concern and compassion he feels for their plight.

He conducts in-person graveside funerals for a small number of mourners but requires all participants to wear masks.

Observant Muslims and Jews believe it is important to bury the dead quickly after death, Morris said.

“Some traditions and rituals must go forward,” Morris said, “covid or not.”

It’s Time to Get Back to Normal? Not According to Science.

The science says “open the schools, stop wearing masks outside, and everyone at low risk should start living normal lives.”

Blog post by conservative talk show host Buck Sexton posted on Facebook, Feb. 8.

A popular Facebook and blog post by conservative radio host Buck Sexton claims scientific research indicates life should return to normal now despite the persistence of the covid-19 pandemic.

“Here’s what the science tells anyone who is being honest about it: open the schools, stop wearing masks outside, and everyone at low risk should start living normal lives. Not next fall, or next year — now,” reads the blog post, posted to Facebook on Feb. 8.

The post was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about PolitiFact’s partnership with Facebook.)

KHN-PolitiFact messaged Sexton via his Facebook page to ask if he could provide evidence to back up the statement but got no response.

So we reviewed the scientific evidence and talked to public health experts about Sexton’s post. Overall, they disagreed, noting the ways in which it runs counter to current public health strategies.

Let’s take it point by point.

Opening the Schools

In March, when government and public health leaders realized the novel coronavirus was spreading throughout the U.S., many public institutions — including schools — were ordered to shut down to prevent further spread. Many students finished the 2020 spring semester remotely. Some jurisdictions did choose to reopen schools in fall 2020 and spring 2021, though others have remained remote.

Throughout the pandemic, researchers have studied whether in-person learning at schools contributes significantly to the spread of covid. The findings have shown that if K-12 schools adhere to mitigation measures — masking, physical distancing and frequent hand-washing — are adhered to, then there is a relatively low risk of transmission.

And getting kids back into the classroom is a high priority for the Biden administration.

n a Feb. 3 White House press briefing, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said data suggests “schools can safely reopen.” The CDC on Feb. 12 released guidance on how schools should approach reopening. It recommends the standard risk-mitigation measures, as well as universal masking, contact tracing, creating student learning cohorts or pods, conducting testing and monitoring community transmission of the virus.

Susan Hassig, associate professor of epidemiology at Tulane University, said science shows that schools can open safely if “mitigation measures are implemented and maintained in the school space.”

Here’s some of the latest research that tracks with these positions:

  • Only seven covid cases out of 191 were traced to in-school spread in 17 rural K-12 Wisconsin schools that had high mask-wearing compliance and were monitored over the 2020 fall semester.
  • Mississippi researchers found most covid cases in children and teenagers were associated with gatherings outside of households and a lack of consistent mask use in schools, but not associated with merely attending school or child care.
  • Thirty-two cases were associated with attending school out of 100,000 students and staff members in 11 North Carolina schools, where students were required to wear masks, practice physical distancing and wash hands frequently.

Of course, there are some limitations to these studies, which often rely on contact tracing, a process that can’t always pinpoint where cases originate. Some of the studies also rely on self-reporting of mask-wearing by individuals, which could be inaccurate.

Additionally, Hassig pointed out that not all school districts have the resources, such as physical space, personnel or high-quality masks, to open safely.

Sexton’s assertion that schools can reopen leaves out a key piece of information: that safe reopening is highly dependent upon use of mitigation measures that have been shown to tamp down on virus spread.

‘Stop Wearing Masks Outside’

Because the coronavirus that causes covid is relatively new, the research on outdoor mask use is limited. But so far science has shown that masks prevent virus transmission.

The CDC study published Feb. 10 reported that a medical procedure mask (commonly known as a surgical mask) blocked 56.1% of simulated cough particles. A cloth mask blocked 51.4% of cough particles. And the effectiveness went up to 85.4% if a cloth mask was worn over a surgical mask.

Another experiment from the study showed that a person in a mask emits fewer aerosol particles that can be passed on to an unmasked person. And if both are masked, then aerosol exposure to both is reduced by more than 95%. A multitude of reports also show more generally that mask-wearing is effective at reducing the risk of spreading or catching other respiratory diseases.

Sexton’s post, however, advised that people should stop wearing masks outside. To be sure, public health experts agree the risk of transmitting covid is lower outdoors than indoors. But the experts also said that doesn’t mean people should stop wearing masks.

“The wind might help you a bit outside, but you are still at risk of breathing in this virus from people around you,” said Dr. Rachel Vreeman, director of the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai.

Being outside is “not a guarantee of safety,” reiterated Stephen Morse, an epidemiology professor at Columbia University Medical Center. “Especially when those people without masks are close together.”

The CDC addressed the issue of whether masks are needed outside in the agency’s mask guidelines: “Masks may not be necessary when you are outside by yourself away from others, or with other people who live in your household. However, some areas may have mask mandates while out in public, so please check for the rules in your local area.”

Overall, the prevailing scientific opinion is that, while it may be OK to go maskless outside if you are physically distant from others, ask-wearing is still recommended if you are around others.

‘Everyone at Low Risk Should Start Living Normal Lives’

All the public health experts we consulted agreed this part of the claim is absolutely false. It flies in the face of what scientists recommend should be done to get through the pandemic.

While it’s unclear what exactly the post means by “low-risk” people, let’s assume it’s referring to younger people or those without health conditions that make them more vulnerable to covid. And that “living normal lives” refers to no longer wearing masks, physical distancing or washing hands with increased frequency.

News reports and scientific evidence show that bars, parties and other large gatherings can quickly become spreader events. Moreover, even young people and those without preexisting health conditions have gotten severely ill with covid or died of it.

Even if a low-risk person doesn’t get severely sick, they could still infect others in higher-risk groups.

The sentiment of this post is similar to calls early in the pandemic to let life return to normal in an attempt to achieve herd immunity. But, on the way to achieving that goal, many would die, said Josh Michaud, associate director for global health policy at KFF.

“Everyone going back to ‘normal’ right now, especially in the presence of more transmissible and more deadly variants, would be a recipe for further public health disasters on top of what we’ve already experienced,” he added.

Already almost half a million Americans have died of covid.

The push to “return to normal” is precisely what let the new variants form and multiply, said Vreeman. “If we can ramp up getting people vaccinated and keep wearing masks in the meantime, only then will we have a chance at getting back to ‘normal.’”

Indeed, because of the new variants circulating in the U.S., Walensky and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, have urged Americans not to relax their efforts to control the virus’s spread.

Our Ruling

A blog post by conservative talk show host Buck Sexton claims scientific evidence shows that right now we should “open the schools, stop wearing masks outside, and everyone at low risk should start living normal lives.”

Scientific research shows that in order for schools to reopen safely, risk mitigation measures must be put in place, such as requiring masks, rigorous hand-washing and limiting the number of students in classrooms. These changes, though, would not represent a return to normal, but a new normal for students and teachers.

The remainder of Sexton’s statement strays further from current science. Research indicates that you’re safer outdoors than indoors, but public health experts still recommend wearing masks in public, even outside. Science does not support the idea that the time is right for some people to resume life as normal. That would allow the virus to continue to spread and have a large human cost in hospitalizations and deaths, said the experts.

Sexton’s post is inaccurate. We rate it False.

Source List:

ABC News, “’Wrecked Our Lives’: Families of 3 Young Adults Who Died From COVID-19 Share Heartbreaking Stories,” Nov. 19, 2020

American Association of Pediatrics News, Study: In-School Transmission of SARS-CoV-2 Rare in Schools Implementing Safety Measures, Jan. 8, 2021

Buck Sexton website, “Get Ready to Fight ‘Forever Covid,’” Feb. 8, 2021

BMJ Global Health, Reduction of Secondary Transmission of SARS-CoV-2 in Households by Face Mask Use, Disinfection and Social Distancing: A Cohort Study in Beijing, China, 2020

Centers for Disease Control and Prevention, Operational Strategy for K-12 Schools through Phased Mitigation, Feb. 12, 2021

Centers for Disease Control and Prevention, Guidance for Wearing Masks, updated Feb. 11, 2021

Centers for Disease Control and Prevention, Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure, 2021, Feb. 10, 2021

Centers for Disease Control and Prevention, SARS-CoV-2 Transmission Associated With High School Wrestling Tournaments — Florida, December 2020-January 2021, Jan. 29, 2021

Centers for Disease Control and Prevention, COVID-19 Cases and Transmission in 17 K-12 Schools — Wood County, Wisconsin, August 31-November 29, 2020, Jan. 29, 2021

Centers for Disease Control and Prevention, Trends in Outbreak-Associated Cases of COVID-19 — Wisconsin, March-November 2020, Jan. 29, 2021

Centers for Disease Control and Prevention, Factors Associated With Positive SARS-CoV-2 Test Results in Outpatient Health Facilities and Emergency Departments Among Children and Adolescents Aged <18 Years — Mississippi, September-November 2020, Dec. 18, 2020

Centers for Disease Control and Prevention, Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2, Nov. 20, 2020

Chalkbeat, “Do Schools Spread COVID? It May Depend on How Bad Things Already Are Around Them,” Jan. 4, 2021

The Conversation, “Being Outdoors Doesn’t Mean You’re Safe From COVID-19 — A White House Event Showed What Not to Do,” Oct. 8, 2020

Email interview with Susan Hassig, associate professor of epidemiology at Tulane University, Feb. 10, 2021

Email interview with Josh Michaud, associate director for global health policy at Kaiser Family Foundation, Feb. 10, 2021

Email interview with Dr. Rachel Vreeman, director of the Arnhold Institute for Global Health, Feb. 10, 2021

Email interview with Stephen Morse, professor of epidemiology at Columbia University Medical Center, Feb. 10, 2021

Johns Hopkins University Medical Center, Coronavirus and COVID-19: Younger Adults Are at Risk, Too, updated Dec. 2, 2020

Kaiser Health News/PolitiFact, “Social Media Image About Mask Efficacy Right in Sentiment, but Percentages Are ‘Bonkers,’” July 6, 2020

medRxiv, Closed Environments Facilitate Secondary Transmission of Coronavirus Disease 2019 (COVID-19), April 16, 2020

Pediatrics, Incidence and Secondary Transmission of SARS-CoV-2 Infections in Schools, January 2021

PNAS, An Evidence Review of Face Masks Against COVID-19, Jan. 26, 2021

The New York Times, “How Safe Are Outdoor Gatherings?” July 3, 2020

The Washington Post, “CDC Finds Scant Spread of Coronavirus in Schools With Precautions in Place,” Jan. 26, 2021

The White House, Press Briefing by White House COVID-19 Response Team and Public Health Officials, Feb. 3, 2021

Calling All Vaccinators: Closing the Next Gap in Covid Supply and Demand

Beating back covid right now comes down to balancing supply and demand.

With hopes pinned to vaccines, demand has far outstripped the supply of doses.

But, as an increasing number of vaccine vials are shipped in coming weeks, the concern about shortages may well shift to human capital: the vaccinators themselves.

“We need to mobilize more medical units to get more shots in people’s arms,” Jeff Zients, coordinator of President Joe Biden’s covid-19 task force, said at a briefing earlier this month.

Already, there have been scattered reports that vaccinators are in short supply in some areas.

“Absolutely, we do need more,” said Tom Kraus, vice president of government relations for the American Society of Health-System Pharmacists, whose members work in hospitals, clinics and large physician practices.

After all, vaccinating America is a huge undertaking.

“We are planning to vaccinate a lot more people over a shorter period of time than we’ve ever done before,” said L.J Tan, chief strategy officer of the Immunization Action Coalition, which distributes educational materials for health care professionals and the public across a range of vaccination topics.

Each year the U.S. vaccinates 140 million to 150 million residents against influenza, “but what we’re talking about now is much more intensive,” he said. For covid, the goal is to get vaccines out quickly to all those eligible in a country of 330 million people.

A state-by-state survey would be required to estimate how many total vaccinators are needed nationally, Tan said.

Still, experts are cautiously optimistic that this won’t be a hard problem to fix, pointing to efforts underway to recruit current and retired medical professionals, as well as medical students and nurses in training.

“As long as we continue to see this interest in volunteering, we should have a sufficient workforce to do it,” said Deb Trautman, president and CEO of the American Association of Colleges of Nursing.

Not just anyone can be a vaccinator. One can’t merely walk into a center and offer to help give shots. The training requirements vary by state.

To boost the effort, both the Trump and Biden administrations, using an emergency preparedness law first adopted in 2005, expanded liability protections.

With the recent expansions, those qualifying include pharmacy interns and recently retired doctors and nurses, as well as physicians, nurses and pharmacists. The government estimates there are about half a million inactive physicians and 350,000 inactive registered nurses and practical nurses in the United States.

States are also greenlighting dentists, paramedics and other first responders, said Kim Martin, director of immunization policy at the Association of State and Territorial Health Officials.

Some are also turning to nursing and medical schools, where faculty and students are often eager to participate. More than 300 schools nationally have signed a pledge offering to help administer the vaccine, according to the American Association of Colleges of Nursing.

The University of Houston College of Nursing, for example, altered its curriculum specifically to prepare students for administering covid vaccines — and teams of students and faculty have helped at community vaccination sites.

Others are joining the effort.

The Medical Reserve Corps, a national network of volunteer groups, has more than 200 units in about 40 states, Puerto Rico, American Samoa and the Northern Mariana Islands assisting with various vaccination efforts, including administering the shots, according to a Health and Human Services spokesperson.

And the military is pitching in, too, with the Pentagon approving the use of more than 1,000 active-duty service members to help the Federal Emergency Management Agency with mass vaccinations sites, the first one set for California.

Although some of these groups give ballpark figures of volunteers, it’s hard to tally just how many have stepped forward in recent months to help vaccinate.

Becoming a Vaccinator

“It should not be left to just anyone that is willing, as there are clinical skills and preparedness that is required,” said Katie Boston-Leary, director of nursing programs at the American Nurses Association.

Even those skilled in giving shots may need a training booster in the war against covid.

When she volunteered, Boston-Leary said, she was required to complete four to six hours of online training across a wide range of topics, from the optimal way to administer intramuscular injections, to specific information about the two vaccines now on the market.

“Even a nurse like me has to go through that training,” said Boston-Leary.

To aid states in setting up training, the Centers for Disease Control and Prevention offered recommendations that all health care staff members receive training in covid vaccination “even if they are already administering routinely recommended vaccines.”

The CDC has different training modules, based on experience level. For instance, there’s a module for those who have given vaccinations in the previous year, but a different one for those who haven’t done so for more than a year. The time required to complete programs varies — people with the most recent experience require less total training time.

Tan said training laypeople with no medical background to give vaccines “is not the way to go.”

Instead, such volunteers can be used to help with logistics, such as directing people to the right areas, managing traffic, moving supplies around and similar duties.

Training programs exist even for people who aren’t vaccinators but assist with storing, handling or transporting the vaccines. That’s important because the two vaccines currently in use — one from Pfizer-BioNTech and one from Moderna — have different storage requirements.

They are shipped in multidose vials, which is not unusual for vaccines. The vaccinators themselves often draw up the syringes out of the vials, said Tan.

To avoid slowdowns as patients move through the lines, some vaccination centers have other trained staffers pre-fill individual syringes. Anyone doing this task should be “someone trained in administering vaccines as well,” said Tan.

At the clinic where Katie Croft-Walsh, 65, volunteered recently in San Antonio, her only job was to administer the vaccine. Other volunteers took care of registering patients, pre-filling the individual syringes and other logistical efforts.

She decided to volunteer after hearing that help was needed. The move came with a bonus: She would get the vaccine herself at the end of her first day participating, something she already qualified for based on her age but had been unable to secure.

A practicing lawyer, Croft-Walsh previously worked as a registered nurse and kept her license current by taking required courses each year since leaving her hospital job in 1998.

Training occurred on her first day at the mass vaccination site and covered details about each type of vaccine, along with the types of syringes available, the right place to inject the dose and other information. Her group, which she said included nurses, dentists, pharmacists and upper-level nursing students, were trained and overseen by health department physicians.

The patients were all thrilled to get a dose.

“Everyone was very kind and nice,” even if they had to wait a bit in line, she said.

She liked the experience so much that she has volunteered at more clinics — and plans to start volunteering with fire departments as they begin community clinics in her city.

“It made me remember why I went into nursing in the first place,” said Croft-Walsh.

Remember, No Squeezing!

To ensure safety, training is important, Martin of the state health officers group said. It’s not that hard to give an intramuscular injection, but you need to place it in the right spot. For adults, that area is in the deltoid muscle, “not too far up the shoulder, not too far down,” she said, both to avoid injury and to make sure the vaccine goes into the muscle.

Training videos show vaccinators how to find the ideal location, first locating the bony point in the shoulder, then measuring two or three finger widths down and placing the needle in the middle of the arm.

Administering an intramuscular vaccine too high on the shoulder can cause a rare and painful injury. Such injuries were more common years ago when influenza vaccines were first rolling out, said Tan of the immunization coalition. Training on proper technique helped reduce cases since then, he said, and is also part of current efforts to train vaccinators.

It’s also important not to pinch patients’ arms when administering the vaccine, said Tan, responding to a question about a hashtag making the rounds on Twitter called #DoNotSqueezeMyArm.

For intramuscular injections to be most effective, the needle needs to penetrate the muscle, not fat.

“When you squeeze the arm, it pushes up the fat layers,” said Tan.

Those getting the vaccines, he said, can play a role, too.

“I encourage patients to ask questions,” said Tan. “If they’re concerned their arm is being squeezed, speak up. Not in a hostile manner, but say something like, ‘Hey, I read this thing about not squeezing arms. Can you explain why you’re squeezing mine?’”

Paciente de transplante muere después de recibir pulmones infectados con covid

Médicos dicen que una mujer en Michigan desarrolló covid-19 y murió el otoño pasado, dos meses después de recibir un trasplante doble de pulmón de un donante que portaba el coronavirus que causa la enfermedad, a pesar de que no mostró signos de la enfermedad y que inicialmente dio negativo.

Autoridades de la Escuela de Medicina de la Universidad de Michigan sugirieron que podría ser el primer caso comprobado en el país de covid en el que el virus se transmitió a través de un trasplante de órganos. Un cirujano que manipuló los pulmones del donante también se infectó y se enfermó, pero luego se recuperó.

El incidente parece ser aislado, el único caso confirmado entre casi 40,000 trasplantes realizados en 2020. Pero ha generado el pedido de que se hagan pruebas más exhaustivas a los donantes, con muestras tomadas de las profundidades de los pulmones, así como de la nariz y la garganta, dijo el doctor Daniel Kaul, director del servicio de trasplantes de enfermedades infecciosas de Michigan Medicine.

“No hubiéramos usado los pulmones si hubiéramos tenido una prueba de covid positiva”, dijo Kaul, coautor de un informe sobre el caso en el American Journal of Transplantation.

El virus se transmitió cuando los pulmones de una mujer de la zona centrooeste del país, que murió después de sufrir una lesión cerebral grave en un accidente automovilístico, fueron implantados en una mujer con enfermedad pulmonar obstructiva crónica en el Hospital Universitario de Ann Arbor.

Las muestras de nariz y garganta recolectadas de forma rutinaria tanto de donantes como de receptores de órganos habían dado negativo para SARS-CoV-2, el virus que causa covid.

“Todos los exámenes que normalmente hacemos y podemos hacer, los hicimos”, dijo Kaul.

Sin embargo, tres días después de la operación, la receptora tuvo fiebre; su presión arterial bajó y su respiración se volvió dificultosa. Las radiografías mostraron signos de infección pulmonar.

A medida que su condición empeoraba, la paciente desarrolló un shock séptico y problemas de función cardíaca. Los médicos decidieron realizar la prueba para SARS-CoV-2, dijo Kaul. Las muestras de sus nuevos pulmones dieron positivo.

Sospechando el origen de la infección, los médicos regresaron a las muestras de la donante. Una prueba molecular de un hisopo de la nariz y la garganta de la donante, tomada 48 horas después de extraer los pulmones, resultó negativa para SARS-Cov-2. La familia de la donante les dijo a los médicos que no tenía antecedentes de viajes recientes o síntomas de covid, y que no había tenido una exposición conocida a nadie con la enfermedad.

Pero los médicos habían conservado una muestra de líquido tomada de lo más profundo de los pulmones de la donante. Cuando analizaron ese líquido, resultó positivo para el virus. Cuatro días después del trasplante, el cirujano que manipuló los pulmones y realizó la cirugía también dio positivo.

El examen genético reveló que la donante había infectado a la receptora del trasplante y al cirujano. Otros diez miembros del equipo de trasplantes dieron negativo para el virus.

La salud de la receptora del transplante se deterioró rápidamente y desarrolló una falla orgánica multisistémica. Los médicos probaron tratamientos conocidos para covid, incluido remdesivir, un medicamento recientemente aprobado, y plasma sanguíneo convaleciente de personas previamente infectadas.

Finalmente, tuvo respiración extracorpórea con la opción conocido como ECMO, un último recurso para mantener viva a una persona, sin éxito. Fue desconectada y falleció, 61 días después del trasplante.

Kaul calificó al incidente como “un caso trágico”.

Si bien el caso de Michigan marca el primer incidente confirmado en los Estados Unidos de transmisión a través de un transplante, se sospecha de otros.

Un informe reciente de los Centros para el Control y la Prevención de Enfermedades (CDC) revisó ocho posibles casos de lo que se conoce como infección derivada de donantes que ocurrieron la primavera pasada, pero concluyó que la fuente más probable de transmisión del virus en esos casos estaba en la comunidad o en el entorno de atención médica.

Antes de este incidente, no estaba claro si el coronavirus que causa covid podría transmitirse a través de trasplantes de órganos sólidos, aunque es algo que está bien documentado con otros virus respiratorios. La transmisión por donantes de la influenza pandémica H1N1 de 2009 se ha detectado casi exclusivamente en receptores de trasplantes de pulmón, apuntó Kaul.

Si bien no es sorprendente que el SARS-CoV-2 pueda transmitirse a través de los pulmones infectados, no se sabe todavía si otros órganos afectados por covid (corazones, hígados y riñones) también puedan transmitir el virus.

“Parece que para los donantes que no son de pulmón puede ser muy difícil transmitir covid, incluso si el donante tiene covid”, dijo Kaul.

Los donantes de órganos han sido analizados de forma rutinaria para SARS-CoV-2 durante la pandemia, aunque no es un requisito de la Organ Procurement and Transplantation Network (OPTN), que supervisa los trasplantes en todo el país. Pero el caso de Michigan subraya la necesidad de pruebas más extensas antes del trasplante, especialmente en áreas con altas tasas de transmisión de covid, dijo Kaul.

Cuando se trata de pulmones, eso significa asegurarse de analizar muestras del tracto respiratorio inferior del donante, así como de la nariz y la garganta. Obtener y analizar estas muestras de donantes puede ser difícil de realizar en una urgencia. También existe el riesgo de introducir una infección en los pulmones donados, explicó Kaul.

Debido a que no se utilizaron otros órganos además de los pulmones, el caso de Michigan no brinda información sobre los protocolos de prueba para otros órganos.

En general, las transmisiones virales de los donantes de órganos a los receptores siguen siendo raras y ocurren en menos del 1% de los receptores de trasplantes, según muestran investigaciones. Los riesgos médicos que enfrentan los pacientes enfermos que rechazan un órgano de un donante son generalmente mucho más altos, dijo el doctor David Klassen, director médico de United Network for Organ Sharing, el contratista federal que administra la OPTN.

“Los riesgos de frenar los trasplantes son catastróficos”, dijo. “No creo que los pacientes deban tener miedo al proceso de transplante”.

Related Topics

Noticias En Español Public Health States

Countless Homebound Patients Still Wait for Covid Vaccine Despite Seniors’ Priority

Opening another front in the nation’s response to the pandemic, medical centers and other health organizations have begun sending doctors and nurses to apartment buildings and private homes to vaccinate homebound seniors.

Boston Medical Center, which runs the oldest in-home medical service in the country, started doing this Feb. 1. Wake Forest Baptist Health, a North Carolina health system, followed a week later.

In Miami Beach, Florida, fire department paramedics are delivering vaccines to frail seniors in their own homes. In East St. Louis, Missouri, a visiting nurse service is offering at-home vaccines to low-income, sick older adults who receive food from Meals on Wheels.

In central and northern Pennsylvania, Geisinger Health, a large health system, has identified 500 older homebound adults and is bringing vaccines to them. Nationally, the Department of Veterans Affairs has provided more than 11,000 vaccines to veterans who receive primary medical care at home.

These efforts and others like them recognize a compelling need: Between 2 million and 4.4 million older adults are homebound. Most are in their 80s and have multiple medical conditions, such as heart failure, cancer, and chronic lung disease, and many are cognitively impaired. They cannot leave their homes or can do so only with considerable difficulty.

By virtue of their age and medical status, these seniors are at extremely high risk of becoming seriously ill and dying if they get covid-19. Yet, unlike similarly frail nursing home patients, they haven’t been recognized as a priority group for vaccines, and the Centers for Disease Control and Prevention only recently offered guidance on serving them.

“This is a hidden group that’s going to be overlooked if we don’t step up efforts to reach them,” said Dr. Steven Landers, president and CEO of Visiting Nurse Association Health Group, which provides home health and hospice care to over 10,000 people in New Jersey, northeastern Ohio and southeastern Florida. His organization plans to launch a pilot home vaccination program for frail patients this week.

Jane Gerechoff, 91, of Ocean Township, New Jersey, is waiting for the group to vaccinate her. She had a stroke more than a year ago and has difficulty breathing because of a serious lung disease. “I can’t walk; I’m in a wheelchair. There’s no way in the world I could get the vaccine if they didn’t come out to me,” she said in a phone interview.

Although Gerechoff doesn’t go out, she lives with an adult son who interacts with people outside the house and she receives help from physical and occupational therapists at home. Any one of them could bring in the virus.

Reaching homebound seniors presents many challenges. At the top of the list: Home care agencies and hospice organizations don’t have access to covid vaccines either for their staff or patients.

“There is no distribution of vaccines to our members, and there has been no planning surrounding meeting the needs of the people we serve,” said William Dombi, president of the National Association for Home Care & Hospice.

Organizations that administer vaccines also complain they’re not being paid enough by Medicare to cover their costs — primarily staff time and effort. (The shots are free because the federal government is paying for them.) Making a vaccine house call requires about an hour on average, including travel, time interacting with patients and post-vaccination monitoring of people for potential side effects, according to program leaders.

Medicare reimbursement for the first shot is $16.94; for a second shot, it’s $28.39, according to Shawna Ramey, a consultant who presented the data at a recent American Academy of Home Care Medicine webinar. “The actual cost of these visits is closer to $150 or $160,” Dombi said.

Then, there are issues with cold storage and transportation for the Pfizer-BioNTech and Moderna vaccines. Both vaccines are fragile after being thawed and need to be handled carefully, according to the new CDC guidance on vaccinating homebound adults.. Once vaccine vials are opened, shots need to be delivered within six hours, according to instructions from Pfizer and Moderna.

Those requirements have proved too burdensome for Prospero Health, which serves 9,000 seriously ill patients in their homes in 20 states, including nearly 2,000 homebound patients. Fewer than 10% have been vaccinated, said Dr. Dave Moen, Prospero’s medical group president.

Things will become easier if vaccines from Johnson & Johnson and AstraZeneca receive approval, as expected, he suggested. Both of those vaccine candidates are more stable than the Pfizer and Moderna vaccines and would be easier to administer in the home, Moen said.

Palmer Kloster, 84, of Bradley, Illinois, receives care from Prospero under a contract with his Medicare Advantage insurer, UnitedHealthcare. He’s a largely immobile polio survivor who has undergone open-heart surgery and receives care from paid helpers for four hours a day.

“I really need someone to come here and give me a shot,” he told me in a phone conversation. “I don’t want that disease [covid-19]. At my age, it would be very detrimental.”

In Boston, Mary Gareffa, 84, is grateful that a physician she knows and trusts, Dr. Won Lee, came to her house in early February to vaccinate her. “I haven’t been out of the house in about eight years, except by ambulance,” said Gareffa, who has stomach cancer, weighs 73 pounds and broke her hip this summer after a bad fall.

It’s essential to reach out to patients like Gareffa, said Lee, a geriatrician who works with the Boston Medical Center’s home-based program. “It’s worth providing quality of life and reducing suffering, and covid-19 causes nothing but suffering,” she said. The Boston program has vaccinated 84 people as of Feb. 12.

The vaccines come from the medical center’s supply. Before going out, staff members call patients and address any concerns they might have about getting the shots. Most are African American and many families want to know whether the vaccine will make their frail parents or grandparents sick. “They need to hear that it’s safe to get a shot from someone who knows their medical issues,” Lee said.

Wake Forest’s house call program is sending out a doctor, nurse or physician assistant paired with a pharmacy resident to deliver vaccines. About 200 people are served through the program, most of them in their late 70s or early 80s with five or more medical conditions, said Dr. Mia Yang, the program’s director.

Wake Forest’s goal is to provide vaccine house calls to up to 40 patients a week and include family caregivers if there’s adequate supply, Yang said.

Robert Pursel, 69, who has severe osteoporosis and fluid retention in his feet and legs, and his wife Gail, 72, who has serious back problems, both received Pfizer vaccines in late January from Geisinger at their home in Millville, Pennsylvania. At first, Robert said he was skeptical, but now he’s glad he said yes. If a Geisinger nurse hadn’t come to them, he wouldn’t have been able to get out on his own.

Because of his swelling, “I can’t get my shoes on,” Robert said, and “I’d have to walk barefoot through the snow and ice out there.”

Organ Transplant Patient Dies After Receiving Covid-Infected Lungs

Doctors say a woman in Michigan contracted covid-19 and died last fall two months after receiving a tainted double-lung transplant from a donor who turned out to harbor the virus that causes the disease — despite showing no signs of illness and initially testing negative.

Officials at the University of Michigan Medical School suggested it may be the first proven case of covid in the U.S. in which the virus was transmitted via an organ transplant. A surgeon who handled the donor lungs was also infected with the virus and fell ill but later recovered.

The incident appears to be isolated — the only confirmed case among nearly 40,000 transplants in 2020. But it has led to calls for more thorough testing of lung transplant donors, with samples taken from deep within the donor lungs as well as the nose and throat, said Dr. Daniel Kaul, director of Michigan Medicine’s transplant infectious disease service.

“We would absolutely not have used the lungs if we’d had a positive covid test,” said Kaul, who co-authored a report about the case in the American Journal of Transplantation.

The virus was transmitted when lungs from a woman from the Upper Midwest, who died after suffering a severe brain injury in a car accident, were transplanted into a woman with chronic obstructive lung disease at University Hospital in Ann Arbor. The nose and throat samples routinely collected from both organ donors and recipients tested negative for SARS-CoV-2, the virus that causes covid.

“All the screening that we normally do and are able to do, we did,” Kaul said.

Three days after the operation, however, the recipient spiked a fever; her blood pressure fell and her breathing became labored. Imaging showed signs of lung infection.

As her condition worsened, the patient developed septic shock and heart function problems. Doctors decided to test for SARS-CoV-2, Kaul said. Samples from her new lungs came back positive.

Suspicious about the origin of the infection, doctors returned to samples from the transplant donor. A molecular test of a swab from the donor’s nose and throat, taken 48 hours after her lungs were procured, had been negative for SARS-Cov-2. The donor’s family told doctors she had no history of recent travel or covid symptoms and no known exposure to anyone with the disease.

But doctors had kept a sample of fluid washed from deep within the donor lungs. When they tested that fluid, it was positive for the virus. Four days after the transplant, the surgeon who handled the donor lungs and performed the surgery tested positive, too. Genetic screening revealed that the transplant recipient and the surgeon had been infected by the donor. Ten other members of the transplant team tested negative for the virus.

The transplant recipient deteriorated rapidly, developing multisystem organ failure. Doctors tried known treatments for covid, including remdesivir, a newly approved drug, and convalescent blood plasma from people previously infected with the disease. Eventually, she was placed on the last-resort option of ECMO, or extracorporeal membrane oxygenation, to no avail. Life support was withdrawn, and she died 61 days after the transplant.

Kaul called the incident “a tragic case.”

While the Michigan case marks the first confirmed incident in the U.S. of transmission through a transplant, others have been suspected. A recent Centers for Disease Control and Prevention report reviewed eight possible cases of what’s known as donor-derived infection that occurred last spring, but concluded the most likely source of transmission of the covid virus in those cases was in a community or health care setting.

Before this incident, it was not clear whether the covid virus could be transmitted through solid organ transplants, though it’s well documented with other respiratory viruses. Donor transmission of H1N1 2009 pandemic influenza has been detected almost exclusively in lung transplant recipients, Kaul noted.

While it’s not surprising that SARS-CoV-2 can be transmitted through infected lungs, it remains uncertain whether other organs affected by covid — hearts, livers and kidneys, for instance — can transmit the virus, too.

“It seems for non-lung donors that it may be very difficult to transmit covid, even if the donor has covid,” Kaul said.

Organ donors have been tested routinely for SARS-CoV-2 during the pandemic, though it’s not required by the Organ Procurement and Transplantation Network, or OPTN, which oversees transplants in the U.S. But the Michigan case underscores the need for more extensive sampling before transplant, especially in areas with high rates of covid transmission, Kaul said.

When it comes to lungs, that means making sure to test samples from the donor’s lower respiratory tract, as well as from the nose and throat. Obtaining and testing such samples from donors can be difficult to carry out in a timely fashion. There’s also the risk of introducing infection into the donated lungs, Kaul said.

Because no organs other than lungs were used, the Michigan case doesn’t provide insight into testing protocols for other organs.

Overall, viral transmissions from organ donors to recipients remain rare, occurring in fewer than 1% of transplant recipients, research shows. The medical risks facing ailing patients who reject a donor organ are generally far higher, said Dr. David Klassen, chief medical officer with the United Network for Organ Sharing, the federal contractor that runs the OPTN.

“The risks of turning down transplants are catastrophic,” he said. “I don’t think patients should be afraid of the transplant process.”

The Do’s and Don’ts on Social Media for Vaccine Haves and Have-Nots

Posting about their day is a regular practice for Generations Y and Z, especially when they have something novel or exclusive to share. So, in the thick of a global pandemic, and with the shaky rollout of covid vaccines making them somewhat of a holy grail, it’s no surprise selfies featuring the coveted shot are infecting social media timelines.

It might engender envy, even outrage, especially if the person posting seems to have cut the line. But what if the intention was to encourage others to also get the shot? Does that make it OK?

Since the pandemic began, people around the world are increasingly living out significant portions of their lives online. But with 72% of the American public using some type of social media, according to the Pew Research Center, who sets the rules for proper social media etiquette?

“This is a totally new type of world to have a pandemic in,” said Catherine Newman, the etiquette columnist at Real Simple and author of the book “How to Be a Person.” One advantage of using social media, she said, is that people can create waves of public opinion from which everyone can benefit. Newman, who also volunteers at a hospice, was vaccinated and posted a selfie. She said the selfies can help address some of the public health mistrust issues that have contributed to vaccine hesitancy.

“I don’t want to see a picture of your yacht on social media,” she said. She’d rather see covid vaccine selfies but cautions users to be mindful of the caption they choose.

After all, nearly 500,000 American lives have been lost in the pandemic and stark disparities have emerged in vaccination rates — especially among communities of color and older adults who are in the highest risk categories.

It raises the question: Is posting a vaccine selfie on your social media account a faux pas or still par for the course?

Elaine Swann, a lifestyle and etiquette expert, a certified mediator in the state of California and the founder of the Swann School of Protocol in Carlsbad, California, echoed those precautions. “RNs and front-line workers have a very different story to tell than a 20-something-year-old who got vaccinated for some obscure reason,” she said.

At the same time, she said, it’s not necessarily clear how someone came to be eligible for the vaccine. A person could present young and healthy at first glance but could have a health condition or other qualifying criteria. “We don’t know,” she said. She advises that posters follow what she calls the three core values of manners: respect, honesty and consideration.

And the same goes for people reacting to the posts.

George Francois, 35, a center director at Children’s National Hospital in Washington, D.C., chronicled his covid vaccination on Facebook. Looking at the overall death and infection rates in the African American community, he considered his post a public service. “I could inspire others to get it without having to talk to them directly,” he said.

George Francois receives his first covid-19 vaccine dose at Children’s National Hospital in Washington, D.C. Given the overall death and infection rates in the African American community, he considered his social media post a public service. (George Francois)

It’s a sentiment shared by J. Shawn Durham, 44, an actor in Washington, D.C., and an unintentional “vaccine vulture.” He got a call from a friend of a friend to get vaccinated after a scheduled patient missed their appointment — leaving a critical dose that otherwise might have gone to waste. “I am healthy. I am Black. I am scholastic, so I know about our history and the Tuskegee experiments,” he said. And, given that history, Durham posted his selfies to “lead by example,” he added. “The white and the wealthy are getting vaccinated. I want Black people to want to get vaccinated too.”

Francois didn’t receive any backlash from his post and didn’t think it was a big deal. “A lot of people post their HIV and covid test results,” he said.

Bottom line: It’s common among younger adults to publicly share things some older adults may consider to be far too personal.

“It’s kind of tacky sometimes, I think, but there’s a lot of misinformation out there,” said Emilio Delgado, 31, who was born in Puerto Rico and now lives in D.C. He posted in part to foster confidence in the vaccine — to let his connections “see that someone they knew has taken it and didn’t grow a third eyeball,” he said of his hesitant followers. For that reason, he added, it was worth it.

Delgado, a local actor and patient instructor at the George Washington University School of Medicine and Health Sciences, had access to the vaccine because in this role of “standardized patient” he is often called in to role-play ultrasounds with fourth-year medical students. He makes the bulk of his income through such patient instruction and is frequently at the hospital — a place generally considered high-risk — so he’d rather be vaccinated.

For Signe Hawley, 34, a researcher and volunteer firefighter in the foothills of northwestern Boulder, Colorado, getting the vaccine — and posting about it — was an emotional experience.

Signe Hawley receives her first covid-19 vaccination shot in Boulder County, Colorado. She shared the image on Facebook in honor of her father, Joe Hawley Sr., 67, who died from complications of covid in Connecticut in April. (Signe Hawley)

Earlier in the pandemic, she made the difficult decision to pull back from her volunteer duties to protect her wife and 2-year-old daughter. But because she had been a first responder in her community, she became eligible for the vaccine sooner than expected. “I wouldn’t cut the line,” said Hawley. “But when given the opportunity, I wouldn’t pass it up either.”

For Hawley, the hardest side effect she faced after getting the vaccine was the depth of grief and sadness that surfaced surrounding the loss of her father, along with thoughts of all of the other lives lost “in the mismanagement of this,” she said.

Her father, Joe Hawley Sr., 67, died in early April from complications of covid-19 at Norwalk Hospital in southwestern Connecticut. His family was not allowed into the intensive care unit at any time during his bout with covid. And her interest in volunteerism and service is something she inherited from her father, a “humanitarian at heart,” who was involved and committed to the New England community where he lived.

“To be vaccinated for something that my father died from is so surreal,” she said, her voice breaking. Sharing her story and the vaccine photo was a way to honor her father. “This is one step to lessening the impact of death and severe health complications with covid, but it’s not the end of it,” she said.

Ultimately, she said, the more people vaccinated the better off we all are.

“We’re all posting this hoping to get buy-in,” said national etiquette expert Diane Gottsman, an author and founder of the Protocol School of Texas, a company specializing in corporate etiquette training based in San Antonio. Know your audience, she advised. And another important reminder: Follow Federal Trade Commission guidelines, which advise against posting vaccination cards containing identifying information that could expose you to identity theft.

Feds OK’d Export of Millions of N95 Masks as U.S. Workers Cried for More

In the midst of a national shortage of N95 masks, the U.S. government quietly granted an exception to its export ban on protective gear, allowing as many as 5 million of the masks per month to be shipped overseas.

The Federal Emergency Management Agency issued the waiver in the final moments of Donald Trump’s presidency last month, allowing a Texas company to export its products after it failed to secure U.S. customers, according to the FEMA letter obtained by KHN.

National Nurses United president Zenei Triunfo-Cortez called the export waiver “unconscionable” and said N95s remain under lock and key in many hospitals. She said she still has to “beg” for a new N95 if hers gets soiled during a shift caring for covid-19 patients.

Health care employers “and a federal agency that is supposed to be protecting the people of America are not doing their jobs,” she said. “They have no regard for our safety.”

The disconnect between front-line workers going without better protection and federal officials suddenly exporting masks boils down to one thing, workplace-safety experts say: The government has not pivoted quickly enough to lift supply chain crisis-mode guidelines and force employers to take costly and sometimes cumbersome steps to better protect workers with top-quality gear.

The FEMA letter references the challenge that Fort Worth-based Prestige Ameritech faced in finding customers for its government-approved, high-end respirators: Hospitals did not want to “fit test” employees to its N95s, a 15-minute process per employee to ensure that a new N95 model seals to the face, according to company president Mike Bowen.

Prestige Ameritech’s Mike Bowen testifies before the House Energy and Commerce Subcommittee on Health hearing to discuss protecting scientific integrity in response to the covid pandemic on May 14, 2020. (Shaw Thew/AFP / Getty Images)

Bowen said he ramped up N95 production during the pandemic from 75,000 to 9.6 million per month. Lately, he said, he can’t sell them to major buyers, does not have the infrastructure to sell them to small buyers and has so many in storage that he may need to lay off workers and wind down production.

The FEMA letter references those challenges and says the waiver was granted in the “national defense interest” to ensure he keeps production running at pace. The letter was transmitted to Border Patrol officials who oversee exports 103 minutes before Joe Biden was sworn into office.

Yet even with the waiver, Bowen said, he hasn’t been able to find an overseas buyer. He said he can’t understand the contradictory information he’s getting: Front-line workers say they need more N95s, but hospitals say they don’t.

“There is a disconnect someplace, and I don’t know where it is,” Bowen said. “Why aren’t my phones ringing off the hook if there’s a shortage?”

A FEMA official said by email that the waiver could be revoked at any time if U.S. demand increases and that the agency could require the company to “satisfy domestic demand” before exporting N95s.

Although prices fall considerably for those buying in bulk, prices for smaller lots of N95s have reached $4 to $7 each, according to Get Us PPE, a nonprofit meant to match front-line workers with needed gear.

The requirement for employers to perform fit tests annually was set aside amid the public health emergency, giving employers little incentive to veer from the industry-standard models like 3M that were used for years. And the Centers for Disease Control and Prevention has left guidelines in place that say a limited cadre of health care workers should get N95s, which can be reused and rationed.

That adds up to an unusual situation in which U.S. mask supplies have surged, but employers’ motivation to buy the best protective gear has not, said Peg Seminario, a former union health and safety official who recently signed a letter urging the CDC to update its guidelines to reflect the risk of inhaling the virus.

“This is crazy,” she said. “We could … crush this pandemic where the biggest risks of infection are and we’re not doing it.”

Started by a group of emergency room doctors in March, Get Us PPE said it gets 89% of requests for gear — often N95s — from health workers outside of hospitals, like community clinics, covid testing sites and psychiatric care facilities. Demand rose throughout January, with 28% of front-line workers seeking N95s reporting that their site had none.

Yet the volunteer-run group has been able to fulfill only about 15% of the requests it receives. Dr. Ali Raja, a founder of the group and executive vice chair of the emergency department at Massachusetts General Hospital, said the need is vast outside of hospitals, but small facilities scrambling for gear are not connecting to bulk sellers like Bowen’s firm.

“There was nothing out there — no centralized place for all facilities to report PPE needs,” Raja said. “We don’t want to be the website with the best data on this. We want that to be the federal government.”

On the last day of 2020, FEMA extended its rule prohibiting anyone from exporting PPE, including N95s, without first getting express approval from the agency. The rule says the fall and winter surge in covid cases meant “domestic supply of the allocated PPE has not kept pace with demand and is not anticipated to do so.”

The U.S. Strategic National Stockpile has not yet met its goal for N95 respirators, according to a U.S. Government Accountability Office report. The report said that as of Dec. 18, there were 190 million N95 respirators in storage — well short of its goal of 300 million.

“GAO remains deeply troubled that agencies have not acted on recommendations to more fully address critical gaps in the medical supply chain,” the government watchdog report says.

Another twist to the saga is that millions of counterfeit N95s stamped “3M,” an industry standard that has long been used in previously required annual fit tests, have flooded hospital shelves even as federal agents rush to seize them at U.S. ports.

A prominent group of scientists wrote to the CDC on Monday to point out guidelines that urgently need to be changed to protect workers from inhaling tiny airborne virus particles. Their letter noted that the “CDC does not recommend the use of N95 respirators” outside health care settings, even though outsize risks are documented for bus drivers, prison guards and meatpacking staffers.

CDC guidelines also allow hospitals to limit which workers get the N95s, leaving out those in community settings and lower-level workers who typically spend the most time next to patients.

In the Lost on the Frontline project, KHN and The Guardian have documented the deaths of hundreds of more than 3,440 front-line health workers, of whom 2 in 3 were workers of color and 56% worked outside of hospitals. For more than 120 who died, family members had concerns about PPE, including the extensive reuse of N95s or the use of surgical masks for direct care of covid patients.

KHN senior correspondent JoNel Aleccia contributed to this report.

Journalists Field Questions on Covid Coverage

KHN Montana correspondent Katheryn Houghton discussed Thursday on Newsy how covid’s impact on disabled group housing isn’t tracked.

California Healthline senior correspondent Anna Maria Barry-Jester shared updates on California’s vaccine rollout on KALW’s “Your Call” on Thursday.

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Public Health

To Vaccinate Veterans, Health Care Workers Must Cross Mountains, Plains and Tundra

A Learjet 31 took off before daybreak from Helena Regional Airport in Montana, carrying six Veterans Affairs medical providers and 250 doses of historic cargo cradled in a plug-in cooler designed to minimize breakage.

Even in a state where 80-mph speed limits are normal, ground transportation across long distances is risky for the Moderna mRNA-1273 vaccine, which must be used within 12 hours of thawing.

The group’s destination was Havre, Montana, 30 miles from the Canadian border. About 500 military veterans live in and around this small town of roughly 9,800, and millions more reside in similarly rural, hard-to-reach areas across the United States.

About 2.7 million veterans who use the VA health system are classified as “rural” or “highly rural” patients, residing in communities or on land with fewer services and less access to health care than those in densely populated towns and cities. An additional 2 million veterans live in remote areas who do not receive their health care from VA, according to the department. To ensure these rural vets have access to the covid vaccines, the VA is relying on a mix of tools, like charter and commercial aircraft and partnerships with civilian health organizations.

The challenges of vaccinating veterans in rural areas — which the VA considers anything outside an urban population center — and “highly rural” areas — defined as having fewer than 10% of the workforce commuting to an urban hub and with a population no greater than 2,500 — extend beyond geography, as more than 55% of them are 65 or older and at risk for serious cases of covid and just 65% are reachable via the internet.

For the Havre event, VA clinic workers called each patient served by the Merril Lundman VA Outpatient Clinic in a vast region made up of small farming and ranching communities and two Native American reservations. And for those hesitant to get the vaccine, a nurse called them back to answer questions.

“At least 10 additional veterans elected to be vaccinated once we answered their questions,” said Judy Hayman, executive director of the Montana VA Health Care System, serving all 147,000 square miles of the state.

The Havre mission was a test flight for similar efforts in other rural locations. Thirteen days later, another aircraft took off for Kalispell, Montana, carrying vaccines for 400 veterans.

In Alaska, another rural state, Anchorage Veterans Affairs Medical Center administrators finalized plans for providers to hop a commercial Alaska Airlines flight on Thursday to Kodiak Island. There, VA workers expected to administer 100 to 150 doses at a vaccine clinic conducted in partnership with the Kodiak Area Native Association.

“Our goal is to vaccinate all veterans who have not been vaccinated in and around the Kodiak community,” said Tom Steinbrunner, acting director of the Alaska VA Healthcare System.

VA began its outreach to rural veterans for the vaccine program late last year, as the Food and Drug Administration approached the dates for issuing emergency use authorizations for the Pfizer-BioNTech and Moderna vaccines, according to Dr. Richard Stone, the Veterans Health Administration’s acting undersecretary. It made sense to look to aircraft to deliver vaccines. “It just seemed logical that we would reach into rural areas that, [like] up in Montana, we had a contract with, a company that had small propeller-driven aircraft and short runway capability,” said Stone, a retired Army Reserve major general.

Veterans have responded, Stone added, with more than 50% of veterans in rural areas making appointments.

As of Wednesday, the VA had tallied 220,992 confirmed cases of covid among veterans and VA employees and 10,065 known deaths, including 128 employees. VA had administered 1,344,210 doses of either the Pfizer or Moderna vaccine, including 329,685 second vaccines, to veterans as of Wednesday. According to the VA, roughly 25% of those veterans live in rural areas, 2.81% live in highly rural areas and 1.13% live on remote islands.

For rural areas, the VA has primarily relied on the Moderna vaccine, which requires cold storage between minus 25 degrees Centigrade (minus 13 degrees Fahrenheit) and minus 15 degrees C (5 degrees F) but not the deep freeze needed to store the Pfizer vaccine (minus 70 degrees C, or minus 94 degrees F). That, according to the VA, makes it more “transportable to rural locations.”

The VA anticipates that the one-dose Johnson & Johnson vaccine, if it receives an emergency use authorization from the FDA, will make it even easier to reach remote veterans. The vaccines from Moderna and Pfizer-BioNTech both require two shots, spaced a few weeks apart. “One dose will make it easier for veterans in rural locations, who often have to travel long distances, to get their full vaccination coverage,” said VA spokesperson Gina Jackson. The FDA’s vaccine advisory committee is set to meet on Feb. 26 to review J&J’s application for authorization.

Meanwhile, in places like Alaska, where hundreds of veterans live off the grid, VA officials have had to be creative. Flying out to serve individual veterans would be too costly, so the Anchorage VA Medical Center has partnered with tribal health care organizations to ensure veterans have access to a vaccine. Under these agreements, all veterans, including non-Native veterans, can be seen at tribal facilities.

“That is our primary outreach in much of Alaska because the tribal health system is the only health system in these communities,” Steinbrunner said.

In some rural areas, however, the process has proved frustrating. Army veteran John Hoefen, 73, served in Vietnam and has a 100% disability rating from the VA for Parkinson’s disease related to Agent Orange exposure. He gets his medical care from a VA location in Canandaigua, New York, 20 miles from his home, but the facility hasn’t made clear what phase of the vaccine rollout it’s in, Hoefen said.

The hospital’s website simply says a staff member will contact veterans when they become eligible — a “don’t call us, we’ll call you,” situation, he said. “I know a lot of veterans like me, 100% disabled and no word,” Hoefen said. “I went there for audiology a few weeks ago and my tech hadn’t even gotten her vaccine yet.”

VA Canandaigua referred questions about the facility’s current phase back to its website: “If you’re eligible to get a vaccine, your VA health care team will contact you by phone, text message or Secure Message (through MyHealtheVet) to schedule an appointment,” it states. A call to the special covid-19 phone number established for the Canandaigua VA, which falls under the department’s Finger Lakes Healthcare System, puts the caller into the main menu for hospital services, with no information specifically on vaccine distribution.

For the most part, the VA is using Centers for Disease Control and Prevention guidelines to determine priority groups for vaccines. Having vaccinated the bulk of its health care workers and first responders, as well as residents of VA nursing homes, it has been vaccinating those 75 and older, as well as those with chronic conditions that place them at risk for severe cases of covid. In some locations, like Anchorage and across Montana, clinics are vaccinating those 65 and older and walk-ins when extra doses are available.

According to Lori FitzGerald, chief of pharmacy at the VA hospital in Fort Harrison, Montana, providers have ended up with extra doses that went to hospitalized patients or veterans being seen at the facility. Only one dose has gone to waste in Montana, she said.

To determine eligibility for the vaccine, facilities are using the Veterans Health Administration Support Service Center databases and algorithms to help with the decision-making process. Facilities then notify veterans by mail, email or phone or through VA portals of their eligibility and when they can expect to get a shot, according to the department.

Air Force veteran Theresa Petersen, 83, was thrilled that she and her husband, an 89-year-old U.S. Navy veteran, were able to get vaccinated at the Kalispell event. She said they were notified by their primary care provider of the opportunity and jumped at the chance.

“I would do anything to give as many kudos as I can to the Veterans Affairs medical system,” Petersen said. “I’m so enamored with the concept that ‘Yes, there are people who live in rural America and they have health issues too.’”

The VA is allowed to provide vaccines only to veterans currently enrolled in VA health care. About 9 million U.S. veterans are not enrolled at the VA, including 2 million rural veterans.

After veterans were turned away from a VA clinic in West Palm Beach, Florida, in January, Rep. Debbie Wasserman Schultz (D-Fla.) wrote to Acting VA Secretary Dat Tran, urging him to include these veterans in their covid vaccination program.

Stone said the agency does not have the authorization to provide services to these veterans. “We have been talking to Capitol Hill about how to reconcile that,” he said. “Some of these are very elderly veterans and we don’t want to turn anybody away.”

Companies Pan for Marketing Gold in Vaccines

For a decade, Jennifer Crow has taken care of her elderly parents, who have multiple sclerosis. After her father had a stroke in December, the family got serious in its conversations with a retirement community — and learned that one service it offered was covid-19 vaccination.

“They mentioned it like it was an amenity, like ‘We have a swimming pool and a vaccination program,’” said Crow, a librarian in southern Maryland. “It was definitely appealing to me.” Vaccines, she felt, would help ease her concerns about whether a congregate living situation would be safe for her parents, and for her to visit them; she has lupus, an autoimmune condition.

As the coronavirus death toll soars and demand for the covid vaccines dwarfs supply, an army of hospitals, clinics, pharmacies and long-term care facilities has been tasked with getting shots into arms. Some are also using that role to attract new business — the latest reminder that health care, even amid a global pandemic, is a commercial endeavor where some see opportunities to be seized.

“Most private sector companies distributing vaccines are motivated by the public health imperative. At some point, their DNA also kicks in,” said Roberta Clarke, associate professor emeritus of marketing at Boston University.

Among senior living facilities — which saw their largest drop in occupancy on record last year — some companies are marketing vaccinations to recruit residents. Sarah Ordover, owner of Assisted Living Locators Los Angeles, a referral agency, said many in her area are offering vaccines “as a sweetener” to prospective residents, sometimes if they agree to move in before a scheduled vaccination clinic.

Oakmont Senior Living, a high-end retirement community chain with 34 locations, primarily in California, has advertised “exclusive access” to the vaccines via social media and email. A call to action on social media reads: “Reserve your apartment home now to schedule your Vaccine Clinic appointment!”

Although the vaccine offer was a selling point for Crow, it wasn’t for her parents, who have not been concerned about contracting covid and didn’t want to forgo their independence, she said. Ultimately, they moved in with her sister, who could arrange home care services.

This marketing approach might sway others. Oakmont Senior Living, based in Irvine, reported 92 move-ins across its communities last month, a 13% increase from January 2020, noting the vaccine is “just one factor among many” in deciding to become a resident.

But some object to facilities using vaccines as a marketing tool. “I think it’s unethical,” said Dr. Michael Carome, director of health research at consumer advocacy group Public Citizen. While he believes that facilities should provide vaccines to residents, he fears attaching strings to a vaccine could coerce seniors, who are particularly vulnerable and desperate for vaccines, into signing a lease.

Tony Chicotel, staff attorney at California Advocates for Nursing Home Reform, worries that seniors and their families could make less informed decisions when incentivized to sign by a certain date. “You’re thinking, ‘I’ve got to get moved in in the next week or otherwise I don’t get this shot. I don’t have time to read everything in this 38-page contract,’” he said.

An Oakmont Senior Living advertisement touts access to covid vaccines to attract new residents.(Oakmont Management Group)

Oakmont Senior Living responded by email: “Potential residents and their families are always provided with the information they need to be confident in a decision to choose Oakmont.”

Some people say facilities are simply meeting their demand for covid vaccines. “Who is going to put an elderly person in a place without a vaccine? Congregate living has been a hotbed of the virus,” said retired philanthropy consultant Patti Patrizi. She and her son recently chose a retirement community in Los Angeles for her ex-husband for myriad reasons unrelated to the vaccines. However, they accelerated the move by two weeks to coincide with a vaccination clinic.

“It was definitely not a marketing tool to me,” said Patrizi. “It was my insistence that he needs it before he can live there.”

The concept of using vaccines to market a business isn’t new. The 2009 H1N1 pandemic ushered in drugstore flu shots, and pharmacies have since credited flu vaccines with boosting storefront sales and prescriptions. Many offer prospective vaccine recipients coupons, gift cards or rewards points.

A few pharmacies have continued these marketing activities while rolling out covid shots. On its covid vaccine information site, CVS Pharmacy encouraged visitors to sign up for its rewards program to earn credits for vaccinations. Supermarket and pharmacy chain Albertsons and its subsidiaries have a button on their covid vaccine information sites saying, “Transfer your prescription.”

But the pandemic isn’t business as usual, said Alison Taylor, a business ethics professor at New York University. “This is a public health emergency,” she said. Companies distributing covid vaccines should ask themselves “How can we get society to herd immunity faster?” rather than “How many customers can I sign up?” she said.

In an email response, CVS said it had removed the reference to its rewards program from its covid vaccination page. Patients will not earn rewards for receiving a covid shot at its pharmacies, the company said, and its focus remains on administering the vaccines.

Albertsons said via email that its covid vaccine information pages are intended to be a one-stop resource, and information about additional services is at the very bottom of these pages.

Boston University’s Clarke doesn’t see any harm in these marketing activities. “As long as the patient is free to say ‘no, thank you,’ and doesn’t think they’ll be penalized by not getting a vaccine, it’s not a problem,” she said.

At least one health care provider is offering complimentary services to people eligible for covid vaccines. Membership-based primary care provider One Medical — now inoculating people in several states, including California — offers a free 90-day membership to groups, such as people 75 and older, that a local health department has tasked the company with vaccinating, according to an email from a company spokesperson who noted that vaccine supply and eligibility requirements vary by county.

The company said it offers the membership — which entails online vaccine appointment booking, second dose reminders and on-demand telehealth visits for acute questions — because it believes it can and should do so, especially when many are struggling to access care.

While these may very well be the company’s motives, a free trial is also a marketing tactic, said Silicon Valley health technology investor Dr. Bob Kocher. Whether it’s Costco or One Medical, any company offering a free sample hopes recipients buy the product, he said.

Offering free trial memberships could pay off for providers like One Medical, he said; local health departments can refer many patients, and converting a portion of vaccine recipients into members could offer a cheaper way for providers to get new patients than finding them on their own.

“Normally, there’s no free stuff at a provider, and you have to be sick to try health care. This is a pretty unique circumstance,” said Kocher, who doesn’t see boosting public health and taking advantage of an uncommon marketing opportunity as mutually exclusive here. “Vaccination is a super valuable way to help people,” he said. “A free trial is also a great way to market your service.”

One Medical insisted the membership trial is not a marketing ploy, noting that the company is not collecting credit card information during registration or auto-enrolling trial participants into paid memberships. But patients will receive an email notifying them before their trial ends, with an invitation to sign up for membership, said the company.

Health equity advocates say more attention needs to be paid to the people who slip under the radar of marketers — yet are at the highest risk of getting and dying from covid, and the least likely to be vaccinated.

Kathryn Stebner, an elder-abuse attorney in San Francisco, noted that the high cost of many assisted living facilities is often prohibitive for the working class and people of color. “African Americans are dying [from covid] at a rate three times as much as white people,” she said. “Are they getting these vaccine offers?”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Spurred by Pandemic, Little Shell Tribe Fast-Tracks Its Health Service Debut

Linda Watson draped a sweater with the words “Little Shell Chippewa Tribe” over her as she received the newly recognized tribal nation’s first dose of covid-19 vaccine.

“I wanted to show my pride in being a Little Shell member,” Watson, 72, said. “The Little Shell are doing very good things for the people.”

Watson has diabetes and a heart condition. The shot brought some peace of mind during a time when that isn’t fully possible. One of her sons is among those who have died of covid.

The Little Shell Tribe of Chippewa Indians of Montana is building its health services largely from scratch roughly a year after becoming the United States’ 574th federally recognized Indigenous tribe. Because of the pandemic, it’s doing it on hyperdrive.

The long-sought recognition came just months before the pandemic took hold, arriving in time to guarantee the right to crucial health care and a tribal supply of protective covid vaccines. Federal pandemic relief dollars are speeding up the Little Shell Tribe’s ability to build its own clinic.

Without the CARES Act funds, Indian Health Service and Little Shell officials said it would have likely taken years using only IHS resources to establish a clinic. The IHS already has a list of new and replacement health care facility projects nationwide estimated to cost more than $14.5 billion, yet it reported in 2019 it receives roughly $240 million each year to get that work done. At that pace, it would take 60 years to get through its current needs.

Now, in Great Falls, roughly 2 miles from where Watson got her shot, a brick building under renovation bears a banner announcing the Little Shell Tribal Health Clinic: “Coming 2021.” The former animal hospital site that the tribe purchased will provide medical, dental, vision and behavioral care, alongside traditional medicine, a pharmacy and a lab. The goal is to open the clinic by late summer.

When Watson drives by the future clinic’s site on her way to work as the tribal nation’s enrollment officer, she said, she feels proud.

“To have a Little Shell name on it, to see the results of what our ancestors had worked so hard for,” Watson said. “It’s their descendants that are now experiencing it.”

The Little Shell have advocated for their place as a sovereign nation for more than 150 years. Although Montana formally recognized the tribe in 2000, not having federal recognition until December 2019 kept it from accessing many vital services and programs.

And without a recognized homeland, the tribe’s more than 5,700 members had scattered across Northern Plains states and Canada. The vast majority live in Montana.

Because of the federal recognition, Little Shell tribal enrollment has surged and its Ojibwe language course has a lengthening waitlist.

But this newfound strength is tempered by the deep challenges of the pandemic. The coronavirus has stalled in-person celebrations and planning in the tribe’s first year of federal recognition.

Worst yet, covid has disproportionately infected and killed Indigenous people nationwide, exposing long-standing health inequities caused by a history of colonization and underinvestment in Indian Country. In Montana, Native Americans make up roughly 7% of the population yet account for 11% of the state’s covid cases and 17% of related deaths.

The Little Shell tribal health care system is so new, it doesn’t have electronic health records set up and hasn’t tracked the statistics.

With a sweater bearing the words “Little Shell Chippewa Tribe,” Linda Watson receives the first dose of the tribe’s covid-19 vaccine supply. (Desarae Baker)

In October, the tribal nation hired its first health director, who had to create a covid vaccination plan while juggling other immediate needs, such as helping establish a transportation service for members to get to doctor appointments. Setting up infrastructure for a sovereign nation without a reservation presents challenges. The tribe’s service area encompasses four counties — Blaine, Cascade, Glacier and Hill — that together would span an area larger than Maryland. Only two of those counties share a border, so the distances are even greater.

Little Shell members now have access to any IHS facility nationwide, but, until their clinic is ready, some services such as dental and vision care are far-flung even for those close to the nation’s Great Falls headquarters.

“Without our clinic, members would have to drive 118 miles one way to get some basic services — and try doing that in January and February in Montana,” Tribal Chairman Gerald Gray said.

In the meantime, the tribe is partnering with the Cascade City-County Health Department to administer about 100 vaccine doses each week, according to the tribal health department. The effort has attracted tribal members from out of state.

Many questions remain as to how the new clinic will operate. Gray said the tribe has been told IHS will operate the clinic for at least three years before the tribal nation has the chance to completely run its services. Bryce Redgrave, the Billings-area IHS director, said in a statement the agency is discussing the possibilities but “no plan has been finalized at this time.”

Little Shell leaders plan to model the clinic after an Alaska Native-owned nonprofit called Southcentral Foundation that has been emulated by other tribes, including the Eastern Cherokee in North Carolina.

“The model is about treating the whole person and prioritizing Indigenous interventions,” said Little Shell tribal council member Kim McKeehan.

What that looks like for the Little Shell is still being decided, said Molly Wendland, the Little Shell tribal health director. She said one idea is to grow plants for traditional medicines behind the clinic. The tribe also plans to have a smudge room, she said, in which members can burn sage and ask for healing.

Linda Wilmore, 51, a Little Shell member who lives in Great Falls, said the new clinic would mean she wouldn’t put off care such as going to the dentist anymore. Without an option close to home, she said, she has often waited until she’s in enough pain to warrant the three-hour round trip to an IHS health care facility that offers dental care, where her insurance won’t leave her with unwieldy out-of-pocket costs.

She is also excited about having a clinic designed for, and by, the Little Shell Tribe. Growing up, Wilmore remembers her family having to ask permission to use IHS facilities in Montana before state recognition in 2000 guaranteed it.

“You felt like the redheaded stepchild asking, ‘We’re Little Shell, can we use your clinic?’” Wilmore said.

The Great Falls clinic will also fill gaps in care for other Indigenous people in nearby rural communities and the city itself.

Little Shell member Jonni Kroll lives about 50 minutes from an Indian Health Service clinic. She says the Little Shell tribe spread out largely because they weren’t federally recognized ― and now they’re playing catch-up to understand how to access the services ensured by that recognition. (Jessica Gerlett)

Little Shell members who live far from Great Falls are sorting through how to tap into newly granted services or how to access specialty treatment they can’t get at an IHS clinic.

Little Shell member Jonni Kroll, 55, lives in Deer Park, Washington, some 380 miles from the tribe’s future clinic. Her closest IHS alternative is a roughly 50-minute drive. Her first call was to book an eye appointment, only to find the clinic doesn’t have an optometrist.

“So then I go to the next clinic on my list,” Kroll said. “That’s a problem across the board with IHS nationwide, and I think that will affect Little Shell people trying to figure out: How do we utilize this when we are scattered?”

Little Shell people are spread out largely because they weren’t recognized, she noted, and now they’re having to play catch-up to understand how to access the services that recognition ensures. She said members, some of whom have never met, are connecting by phone or online to work through those questions together.

“The Little Shell are so resilient,” Kroll said. “We’ve gotten to the point of federal recognition and so now we find a way to come past that. There are lots of doors that opened, but we have a lot to learn.”

KHN’s ‘What the Health?’: Open Enrollment, One More Time

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An estimated 9 million Americans eligible for free or reduced premium health insurance under the Affordable Care Act have a second chance to sign up for 2021 coverage, since the Biden administration reopened enrollment on healthcare.gov and states that run their own marketplaces followed suit.

Meanwhile, Biden officials took the first steps to revoke the permission that states got from the Trump administration to require many adults on Medicaid to work or perform community service in exchange for their health coverage. The Supreme Court is scheduled to hear a case on the work requirements at the end of March.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Kimberly Leonard of Business Insider and Rachel Cohrs of Stat.

Among the takeaways from this week’s podcast:

  • The Biden administration said it will promote the special enrollment period, a stark change from the Trump administration, which dramatically limited funding for outreach. But navigator groups, whose workers help individuals find and sign up for coverage, say they haven’t yet heard whether the federal government will be offering to pay them to help people during this three-month sign-up period.
  • The House appears poised to pass a bill next week that would fund the covid relief measures President Joe Biden is seeking, as well as major changes to the ACA. Senate staffers are working with the House to align legislation from both chambers as much as possible. With little or no Republican support and only razor-thin majorities in both the House and Senate, Democrats will need to find common ground among their caucus to push the bill through.
  • Congress has a firm deadline on the covid relief bill since many current programs, such as the expanded unemployment funding, expire March 14.
  • CVS announced this week that its insurance subsidiary, Aetna, will be participating in the ACA marketplaces in the fall, another sign that those exchanges are growing in acceptance.
  • The Biden administration’s effort to walk back Medicaid work requirements appears to be an effort to head off the arguments at the Supreme Court. Democrats fear that even if they stop the program through administrative action now, a high-court ruling saying the effort was legal could open the door for future Republican administrations to restore work requirements.
  • The federal government is pushing hard to get more covid vaccine shots in arms around the country and last week reported that 1.7 million doses had been distributed. But it is a race against the emerging threat of covid virus variants, which are even more contagious than the original coronavirus.
  • Among hurdles in the vaccination effort is hesitancy among certain groups to get the shot. There have been reports that 30% of military personnel refused to accept the vaccine and some high-profile athletes in the NBA don’t want to be in public service announcements promoting it. Groups opposed to vaccines in general are posting misinformation online that may also be a source of concern.
  • The latest controversy over New York Gov. Andrew Cuomo’s policies on counting deaths among nursing home residents with covid-19 has consumed Albany and led to inquiries by legal authorities. It also raises questions about whether politics — Cuomo, a Democrat, and President Donald Trump regularly sparred about covid policies — influenced public health decisions.

Also this week, Rovner interviews medical student Inam Sakinah, president of the new group Future Doctors in Politics.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: Stat’s “Hospitals’ Covid-19 Heroics Have Them Poised for Power in the New Washington,” by Rachel Cohrs

Rachel Cohrs: KHN’s “As Drug Prices Keep Rising, State Lawmakers Propose Tough New Bills to Curb Them,” by Harris Meyer; and Stat’s “States Still Can’t Import Drugs From Canada. Now, Many Are Seeking to Import Canadian Prices,” by Lev Facher

Alice Miranda Ollstein: Politico’s “How Covid-19 Could Make Americans Healthier,” by Joanne Kenen

Kimberly Leonard: The New Republic’s “The Darker Story Just Outside the Lens of Framing Britney Spears,” by Sara Luterman

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

‘I Wanted to Go in There and Help’: Nursing Schools See Enrollment Bump Amid Pandemic

Last December, Mirande Gross graduated from Bellarmine University in Louisville, Kentucky, with a bachelor’s degree in communications. But Gross has changed her mind and is heading back to school in May for a one-year accelerated nursing degree program. The pandemic that has sickened more than 27 million people in the United States and killed nearly 500,000 helped convince her she wanted to become a nurse.

“I was excited about working during the pandemic,” Gross, 22, said. “It didn’t scare me away.”

Enrollment in baccalaureate nursing programs increased nearly 6% in 2020, to 250,856, according to preliminary results from an annual survey of 900 nursing schools by the American Association of Colleges of Nursing.

“In the pandemic we saw an increased visibility of nurses, and I think that’s been inspirational to many people,” said Deb Trautman, president and CEO of the association, whose members represent nursing programs at the bachelor’s, master’s and doctoral levels. “It’s a profession where you can make a difference.”

Two-year associate nursing degree programs seem to be experiencing a similar bump, though hard numbers are unavailable, said Laura Schmidt, president of the Organization for Associate Degree Nursing.

There’s no way to know exactly what is propelling the new applications. But medical schools also saw an 18% boost in applications last year, a jump partly attributed to the pandemic and high profile of key doctors, such as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, during the crisis.

It’s possible that the media stories, social media accounts and front-line medical workers’ personal accounts of battling the novel coronavirus have played a role. “Nurse” was the No. 1 term that people queried “how to become” on Google in 2020, according to Google trends data.

Mirande Gross recently graduated from Bellarmine University in Louisville, Kentucky, with a bachelor’s degree in communications, but she’s heading back to school in May for a one-year accelerated nursing degree program. “When I saw on the news nurses being so overworked, I thought, ‘Gosh, I wish I could be in there helping,’” she says.(Melissa Gross)

For Gross, it was a turn back to an initial career choice. When she started college, nursing was her chosen path. But after fainting twice while shadowing a nurse at the hospital, she switched to a major that didn’t involve needles or blood. For the past two years, she’s worked as a newborn photographer at a hospital near her Louisville home, and she no longer gets squeamish at the sight of IVs or injuries.

“When I saw on the news nurses being so overworked, I thought, ‘Gosh, I wish I could be in there helping,’” said Gross.

Demand for nurses was strong even before the pandemic hit. There are about 3 million registered nurses in the United States, but employment is expected to grow 7% between 2019 and 2029, according to the Bureau of Labor Statistics, faster than the 4% average for all occupations. Many hospital medical staffs are stretched to the breaking point as they deal with a surge of covid-19 patients and at the same time cope with staff shortages as medical personnel have become ill with covid or had to quarantine.

Meeting the demand for nurses is hampered by long-standing capacity issues at nursing schools. According to a report by the American Association of Colleges of Nursing, programs at the bachelor’s and graduate degree levels turned away more than 80,000 qualified applicants in 2019. The reasons included not having enough faculty, clinical training sites and supervisors or classroom space, as well as budget constraints, the report found.

“The people who are prepared to teach are at least master’s degree level and frequently have doctorate degrees,” said Beverly Malone, president and CEO of the National League for Nursing. “They can work at hospitals or community care centers for [significantly] more money.”

Malone and others also noted that it can be difficult to ensure access to the clinical training slots that nursing students need. This problem was exacerbated during the pandemic when many hospitals sent nursing students home to avoid their getting sick and to conserve scarce personal protective equipment for staffers treating covid patients.

David Namnath is finishing a two-year associate nursing degree at the College of Marin in Kentfield, California. When his clinical rotation at the local hospital was canceled because of covid-19 last spring, he and other students took on a telenursing project instead.(David Namnath)

For some nursing students, the pandemic has opened their eyes to new possibilities for patient care. David Namnath is finishing a two-year associate nursing degree at the College of Marin in Kentfield, California. He learned last spring that his clinical rotation at the local hospital would be canceled because of covid.

Instead, he and other students took on a telenursing project, in which he made regular wellness check-ins and provided health education related to chronic conditions such as diabetes and back pain with eight patients over video and phone.

“It was really helpful for me,” said Namnath, 29, who has a bachelor’s degree in biochemistry and worked in a lab before starting nursing school. “It’s not something you normally learn. I think we became more three-dimensional because of it.”

Some people who got nursing degrees in years past but didn’t practice also may be taking a fresh look at the profession, said David Benton, CEO of the National Council of State Boards of Nursing. More than 222,000 nurses who were educated in the U.S. took the National Council Licensure Examination last year, a figure that was 5% higher than the year before, he said.

The economic downturn that has shuttered thousands of businesses may have made nursing more attractive, he said.

“We know that, nationally, services like the restaurant industry have shut down,” Benton said. “But one thing that hasn’t shut down is demand for health care.”

Nurses who worked in hospitals made $79,400 a year on average in 2019, according to the Bureau of Labor Statistics. But as the covid crisis hit and hospitals scrambled to find staff last year, nurses who were willing to travel to covid hot spots could make many times that amount, in some cases up to $10,000 a week.

There are many paths to becoming a nurse. A growing proportion of nurses get a bachelor of science degree in nursing at four-year colleges. But many still go to community colleges for two-year associate degrees in nursing. These programs are more affordable and may appeal to older students who are parents or going back for a second degree, said Schmidt.

Both types of graduates can take the nurse licensing exam and become registered nurses. But nurses with bachelor’s degrees may be better positioned for higher-level jobs or supervisory roles. They may also earn more money. According to the association of nursing colleges’ annual survey, 41% of hospitals and other health care facilities require new nursing hires to have a bachelor’s degree in nursing.

Many nursing schools have “RN to BSN” programs that enable registered nurses with associate degrees to get the additional training they need for their bachelor of nursing degrees. And numerous accelerated programs, like the one Mirande Gross will start in May, allow people to fill in their nursing education gaps in a compressed time frame.

Not every nursing student sees the pandemic as an opportunity, however. Steven Bemben worked as a paramedic in Uvalde County, Texas, west of San Antonio, during the first frightening months of the pandemic last year. Personal protective equipment was hard to come by, and sometimes the calls to transport very sick covid patients came nonstop.

“It was extremely stressful, and people were getting fatigued and burned out,” said Bemben, 33, who had been on the job for nine years.

Last October, he quit his paramedic job, and in January he started a two-year bachelor’s nursing program at the University of Texas-San Antonio. (He already has an associate degree, although not in nursing.)

When Bemben finishes school, he hopes, the pandemic will be in our collective rearview mirror.

“By the time I graduate, I’m trying to stay optimistic that we’ll be past all this stuff,” he said.