As More Red States Legalize Marijuana, Some Officials Try to Nip It in the Bud

With his state reeling amid one of the worst COVID-19 outbreaks in the nation, the last thing South Dakota Speaker of the House Steven Haugaard wants to be dealing with during the upcoming legislative session is marijuana. But the state’s voters haven’t left the Republican much choice.

This fall, South Dakota became the first state in the U.S. to legalize both medical marijuana and recreational marijuana in the same election. Haugaard, who long opposed any form of marijuana legalization, now must participate in the creation of a medical marijuana program.

South Dakota voters enshrined legal marijuana in the state’s constitution. So if Haugaard had any thoughts about reversing the initiative once lawmakers reconvene on Jan. 12, they’ve been dashed.

“With a constitutional amendment, there’s really not much we can do about it. It’s written in stone until it’s repealed,” Haugaard said.

South Dakota is one of a handful of states in which voters both approved marijuana ballot questions and elected Republicans to lead state governments. Montana and Arizona, two other states in which Republicans control (or will soon control) the governor’s office and legislature, also backed recreational marijuana at the ballot box. Mississippi passed a measure legalizing medical marijuana.

New Jersey, which has a Democratic governor and Democratic-majority legislature, also passed a recreational marijuana ballot question.

Many conservative lawmakers oppose the legalization of marijuana, an illegal drug under federal law. But they are discovering obstacles to simply passing bills to reverse the initiatives when state legislatures return to work in January. Some marijuana opponents, realizing the limitations to altering a constitutional amendment, are turning to the courts or local officials to undo the measures or at least blunt the effects of legal pot.

Before the November election, 11 states and Washington, D.C., had legalized recreational marijuana, most of them left-leaning states, with exceptions like Alaska. An additional 21 states allow medical marijuana. In the wake of the election, 15 states will have legalized recreational marijuana and 35 will allow medical marijuana.

In conservative states like Montana, where passage of a bill can change or negate a ballot initiative, one thing giving lawmakers pause is that many voters who elected them also approved the legalization of marijuana use for adults 21 and up.

In Montana, 57% of voters approved the recreational marijuana initiative — the same share received by President Donald Trump. In South Dakota, 54% voted for recreational marijuana and a whopping 70% approved medical marijuana. In Arizona, the recreational pot proposition also passed easily.

Those kinds of margins are what caused state Rep. Derek Skees to reconsider a bill he was drafting to repeal the Montana ballot measure in anticipation of its passage.

Skees told the Missoulian the day after the election that after it became clear voters supported it — while also supporting Republican candidates for office up and down the ballot — he decided to shelve it.

“There’s no way I’m going to try to overturn the will of Montana,” Skees told the newspaper.

Haugaard said opposition to the South Dakota measure was derailed by the pandemic and voters never got the message from opponents about the potential negative impacts of legalization.

Proponents of legalization spent nearly $800,000 on their campaign in South Dakota — most of it coming from the New Approach Political Action Committee, a pro-legalization group that works across the country — and five times what opponents of ballot measures raised.

Colorado, the first state to allow recreational use of marijuana in 2014, is often held up as the poster child for what can happen. Proponents say the state has benefited from increased tax income and economic activity. But opponents, including Haugaard, point to studies about increased traffic deaths in Colorado since legalization to explain why they think it’s a bad idea.

“That side of the story wasn’t told and had it been told I think this vote would have gone differently,” Haugaard said.

Marijuana opponents aren’t waiting to see what state lawmakers do, if anything — they’re going to court. The Pennington County, South Dakota, sheriff and the superintendent of the South Dakota Highway Patrol have filed a lawsuit challenging the constitutionality of the marijuana amendment. The Rapid City Journal reported the suit had the backing of Gov. Kristi Noem, and that the state was paying for part of the suit. Noem was a vocal opponent of legalization during the campaign.

Should the legal challenge fail, the amendment is scheduled to take effect July 1 and, according to the governor’s office, it will be up to the state health department to implement it. The legislature will have more control over how the medical marijuana program will work. Haugaard said that will be a big focus of the 37-day session.

Opponents in Montana are also asking the courts to disallow recreational marijuana. Steve Zabawa, a Billings car dealer who has campaigned against legalized marijuana for years, said in his lawsuit that what the voters passed would illegally take power from state lawmakers by designating where tax revenue will go.

Zabawa blamed its passage at the ballot box on pro-marijuana advocacy groups that so outraised and outspent opponents of the measure that he compared it to David and Goliath.

“They candy-coated this deal. They lied to the entire state of Montana by saying that this would benefit veterans and fish and wildlife,” Zabawa said. “They crossed a line and we’re calling them on it.”

Zabawa said that if the courts don’t block recreational marijuana, he’s hopeful that Montana’s Republican-controlled Statehouse will stymie its implementation.

“I just don’t think there’s a lot of love for marijuana in Montana,” Zabawa said.

In Arizona, a recreational marijuana ballot measure was rejected by voters just four years ago. This year it passed by a wide margin. The state’s voters also chose Joe Biden over President Donald Trump, the first time a Democrat won the presidential election in the state since 1996.

It’s unlikely Arizona’s Republican-led legislature can do anything to stop implementation because of a 1998 law that prohibits lawmakers from changing a voter-approved initiative without a three-quarters majority.

State lawmakers’ hands may be tied, but the initiative did give municipalities some power to restrict its use. The day after the initiative passed, Oro Valley Town Council approved an emergency declaration that would limit which type of businesses could sell marijuana and prohibited its use in public places.

The declaration was based on language written by the League of Arizona Cities and Towns and given to members prior to Election Day.

One of the major backers of the state ballot measures is the Marijuana Policy Project, a Washington, D.C.-based organization that supports sweeping marijuana policy changes across the country. Deputy Director Matthew Schweich said this election showed how the public’s opinion on marijuana is rapidly evolving.

Schweich said he believes the results of the 2020 election bode well for future legalization efforts in states and even at the federal level. Because of that growing support, he dismissed any chance Montana or South Dakota could derail recreational legalization but added that his organization will do whatever it can to fight those efforts.

“This is a bipartisan issue [and] I think we’re at a tipping point. We’ve passed it in big states and small states, liberal states and conservative states,” he said. “We’re feeling pretty good. We believe that 2021 is our year.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Opposition to Obamacare Becomes Political Liability for GOP Incumbents

In the 2014 elections, Republicans rode a wave of anti-Affordable Care Act sentiment to pick up nine Senate seats, the largest gain for either party since 1980. Newly elected Republicans such as Cory Gardner in Colorado and Steve Daines in Montana had hammered their Democratic opponents over the health care law during the campaign and promised to repeal it.

Six years later, those senators are up for reelection. Not only is the law still around, but it’s gaining in popularity. What was once a winning strategy has become a political liability.

Public sentiment about the ACA, also known as Obamacare, has shifted considerably during the Trump administration after Republicans tried but failed to repeal it. Now, in the midst of the COVID-19 pandemic and the ensuing economic crisis, which has led to the loss of jobs and health insurance for millions of people, health care again looks poised to be a key issue for voters this election.

With competitive races in Colorado, Montana, Arizona, North Carolina and Iowa pitting Republican incumbents who voted to repeal the ACA against Democratic challengers promising to protect it, attitudes surrounding the health law could help determine control of the Senate. Republicans hold a slim three-vote majority in the Senate but are defending 23 seats in the Nov. 3 election. Only one Democratic Senate seat — in Alabama, where incumbent Doug Jones is up against former Auburn University football coach Tommy Tuberville — is considered in play for Republicans.

“The fall election will significantly revolve around people’s belief about what [candidates] will do for their health coverage,” said Dr. Daniel Derksen, a professor of public health at the University of Arizona.

The Affordable Care Act has been a wedge issue since it was signed into law in 2010. Because it then took four years to enact, its opponents talked for years about how bad the not-yet-created marketplace for insurance would be, said Joe Hanel, spokesperson for the Colorado Health Institute, a nonpartisan nonprofit focused on health policy analysis. And they continued to attack the law as it took full effect in 2014.

Gardner, for example, ran numerous campaign ads that year criticizing the ACA and, in particular, President Barack Obama’s assertion that “if you like your health care plan, you’ll be able to keep your health care plan.”

But now, Hanel said, the ACA’s policies have become much more popular in Colorado as the costs of health exchange plans have dropped. Thus, political messaging has changed, too.

“This time it’s the opposite,” Hanel said. “The people bringing up the Affordable Care Act are the Democrats.”

Despite Gardner’s multiple votes to repeal the ACA, he has largely avoided talking about the measure during the 2020 campaign. He even removed his pro-repeal position from his campaign website.

Democratic attack ads in July blasted Gardner for repeatedly dodging questions in an interview with Colorado Public Radio about his stance on a lawsuit challenging the ACA.

His opponent, Democrat John Hickenlooper, fully embraced the law when he was Colorado governor, using the measure to expand Medicaid eligibility to more low-income people and to create a state health insurance exchange. Now, he’s campaigning on that record, with promises to expand health care access even further.

Polling Data

Polling conducted by KFF for the past 10 years shows a shift in public opinion has occurred nationwide. (KHN is an editorially independent program of KFF, the Kaiser Family Foundation.)

“Since Trump won the election in 2016, we now have consistently found that a larger share of the public holds favorable views” of the health law, said Ashley Kirzinger, associate director of public opinion and survey research for the foundation. “This really solidified in 2017 after the failed repeal in the Senate.”

The foundation’s polling found that, in July 2014, 55% of voters opposed the law, while 36% favored it. By July 2020, that had flipped, with 51% favoring the law and 38% opposing it. A shift was seen across all political groups, though 74% of Republicans still viewed it unfavorably in the latest poll.

Public support for individual provisions of the ACA — such as protections for people with preexisting conditions or allowing young adults to stay on their parents’ health plans until age 26 — have proved even more popular than the law as a whole. And the provision that consistently polled unfavorably — the mandate that those without insurance must pay a fine — was eliminated in 2017.

“We’re 10 years along and the sky hasn’t caved in,” said Sabrina Corlette, a health policy professor at Georgetown University.

Political Messaging

Following the passage of the ACA, Democrats didn’t reference the law in their campaigns, said Erika Franklin Fowler, a government professor at Wesleyan University and the director of the Wesleyan Media Project, which tracks political advertising.

“They ran on any other issue they could find,” Fowler said.

Republicans, she said, kept promising to “repeal and replace” but weren’t able to do so.

Then, in the 2018 election, Democrats seized on the shift in public opinion, touting the effects of the law and criticizing Republicans for their attempts to overturn it.

“In the decade I have been tracking political advertising, there wasn’t a single-issue topic that was as prominent as health care was in 2018,” she said.

As the global health crisis rages, health care concerns again dominate political ads in the 2020 races, Fowler said, although most ads haven’t explicitly focused on the ACA. Many highlight Republicans’ support for the lawsuit challenging preexisting condition protections or specific provisions of the ACA that their votes would have overturned. Republicans say they, too, will protect people with preexisting conditions but otherwise have largely avoided talking about the ACA.

“Cory Gardner has been running a lot on his environmental bills and conservation funding,” Fowler said. “It’s not difficult to figure out why he’s doing that. It’s easier for him to tout that in a state like Colorado than it is to talk about health care.”

Similar dynamics are playing out in other key Senate races. In Arizona, Republican Sen. Martha McSally was one of the more vocal advocates of repealing the ACA while she served in the House of Representatives. She publicly acknowledged those votes may have hurt her 2018 Senate bid.

“I did vote to repeal and replace Obamacare,” McSally said on conservative pundit Sean Hannity’s radio show during the 2018 campaign. “I’m getting my ass kicked for it right now.”

She indeed lost but was appointed to fill the seat of Sen. Jon Kyl after he resigned at the end of 2018. Now McSally is in a tight race with Democratic challenger Mark Kelly, an astronaut and the husband of former Rep. Gabby Giffords.

“Kelly doesn’t have a track record of voting one way or another, but certainly in his campaign this is one of his top speaking points: what he would do to expand coverage and reassure people that coverage won’t be taken away,” said Derksen, the University of Arizona professor.

The ACA has proved a stumbling block for Republican Sens. Thom Tillis of North Carolina and Joni Ernst of Iowa. In Maine, GOP Sen. Susan Collins cast a key vote that prevented the repeal of the law but cast other votes that weakened it. She now also appears vulnerable — but more for her vote to confirm Brett Kavanaugh’s nomination to the Supreme Court and for not doing more to oppose President Donald Trump.

In Montana, Daines, who voted to repeal the ACA, is trying to hold on to his seat against Democratic Gov. Steve Bullock, who used the law to expand the state’s Medicaid enrollment in 2015. At its peak, nearly 1 in 10 Montanans were covered through the expansion.

As more Montanans now face the high cost of paying for health care on their own amid pandemic-related job losses, Montana State University political science professor David Parker said he expects Democrats to talk about Daines’ votes to repeal cost-saving provisions of the ACA.

“People are losing jobs, and their jobs bring health care with them,” Parker said. “I don’t think it’s a good space for Daines to be right now.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Two Navajo Sisters Who Were Inseparable Died of COVID Just Weeks Apart

Cheryl and Corrina Thinn were almost joined at the hip. The sisters, both members of the Navajo Nation, shared an office at Arizona’s Tuba City Regional Health Care. Cheryl conducted reviews to make sure patients were receiving adequate care. Corrina was a social worker. Their desks were just inches apart.

They lived together, with their mother, Mary Thinn. They helped raise each other’s children.

And they died just weeks apart, at ages 40 and 44, after falling ill with COVID-19.

Close friend Lynette Goldtooth, a registered nurse and case manager, won’t go near the area of the hospital where they worked, knowing she’ll break down if she sees their empty seats.

“That’s where I used to go to see Corrina every morning,” Goldtooth said. “I used to sit in Cheryl’s chair. Corrina and I would just start talking, catch up on what we did during our time off, laugh and joke.”

Cheryl and Corrina are among hundreds of U.S. health care workers who died after helping patients battle the virus. The Guardian and KHN are investigating more than 1,000 of these workers’ deaths in the Lost on the Frontline project.

The Navajo Nation was ravaged by COVID-19 this spring. In May, it reported the highest per capita infection rate in the United States. As of Aug. 21, the sisters were among 489 members of the reservation who had died of the virus, according to the Navajo Department of Health.

Experts attributed the spread to the prevalence of multigenerational housing and poor sanitation infrastructure — many homes lack running water. Like medical centers across the country, local hospitals across the Navajo Nation experienced shortages of personal protective gear.

In early March, Corrina, without personal protective equipment, saw a patient who was showing symptoms of COVID-19, according to her sister Chris. Corrina made sure the patient was comfortable and asked what else she could do to help. A couple of days later, that patient died, and a test for COVID-19 came back positive.

“Within days after that, she got sick really fast,” Chris said.

The sisters’ employer declined to comment for this story.

Corrina’s first concern was for Cheryl, who started showing symptoms of the virus around the same time that she did. Cheryl’s job as a utilization review technician required face-to-face interaction with patients to verify their insurance and discuss workers’ compensation. She had underlying health conditions, including rheumatoid arthritis.

“Corrina worked with people with RA when she was on Pima reservation, so she knows the effects of having it,” Mary, her mother, said. “I think that’s what worried her the most, because she thought it might make [Cheryl’s] immune system weaker.”

Chris remembers calling Cheryl on her 40th birthday, March 19. Cheryl joked about how, as the baby of the four siblings, she was “still young and pretty.” But she also complained that it was difficult for her to breathe. She was admitted to the Tuba City hospital the next day.

Corrina’s condition worsened as well, and she checked herself into the emergency room at Tuba City on March 21. Hospital staff tried assisted-breathing treatments on her, to no avail.

Cheryl was airlifted to Flagstaff Medical Center on March 24. She never knew that Corrina was briefly in the hospital with her.

Corrina was airlifted to Banner Thunderbird Medical Center in Glendale later that night.

Chris said that the last time she spoke with Corrina, she was still in the ER. “She just messaged us saying she was going to get flown out, that she loves us and that she was going to be back,” Chris said. “That was the last time we heard from her.”

Because of shortages, the sisters weren’t tested for COVID-19 until they were transferred out of Tuba City. They both tested positive and were then intubated at their respective hospitals. Cheryl died on April 11, and no family members were allowed to be with her.

“I couldn’t even hold my baby,” her mother said. “I couldn’t even hold her hand when she passed.”

The family had a small service before burying Cheryl next to their father, Navajo Police Sgt. Jimmie Thinn Sr., and Cheryl’s ex-husband, who died in January. Even after their marriage ended, the two remained close and co-parented Cheryl’s son, Kyle.

Chris said the whole experience felt “very lonely.”

Numbed by the pain of Cheryl’s death, the family shifted their focus to Corrina.

“You tell yourself that we just need to get her healthy enough to come home,” Chris said. “And then all of the sudden, she’s gone.”

Corrina died on April 29 — 18 days after her sister’s death and two weeks after her birthday, which she spent on a ventilator. Although she was unconscious, her nurse sang “Happy Birthday.”

Corrina’s oldest son, Gary Werito Jr., had tried for weeks to take leave from his Fort Bliss Army post in El Paso, Texas. His superiors declined his requests out of concerns he might contract the virus while on leave.

Separated from his mother by hundreds of miles, Werito tried to reach her through prayer.

“I would burn cedar,” he said. “I was trying to talk to my mom. I was telling her, ‘Mom, you’re going to get through this. You’re going to come home. You’re going to meet your granddaughter.’”

Werito and his wife were expecting their second child. The baby would have been Corrina’s first granddaughter.

Werito remembers his mother as a “model Navajo.”

“She left the reservation to get an education, and then she came home,” he said. “She could have worked anywhere else as a social worker, but she chose to help her own people.”

Before becoming a social worker, Corrina worked for the Tuba City Police District for more than 10 years. She ended her law enforcement career as a senior police officer.

Goldtooth, the sisters’ friend and colleague, said Corrina was particularly effective at the hospital because she spoke English and Navajo fluently. The Native language, which helped the U.S. win World War II as a secret code for communications, is not written down.

“A lot of people aren’t fluent in Navajo anymore,” she said. “When elderly people would come [to the hospital], they don’t speak a lot of English. She was there to talk with them. It would really surprise people.”

Cheryl was more soft-spoken than her sister. Mary remembers her as empathetic and insightful. Her siblings often sought her advice.

“That’s what we miss about her,” Mary said. “She might be the quiet one, but she always has important things to say to us.”

Both sisters left behind young sons. Corrina’s son Michael is 14, and Cheryl’s son just turned 12. The cousins are keeping each other company, reminding Mary of the way her daughters behaved.

Honoring her former service with the Tuba City Police District, law enforcement escorted Corrina’s body from Flagstaff to Tuba City. Her family was humbled by the outpouring.

“We had people lined up honoring her return,” Mary said. “They paid their respects, flying their flags. Some officers were standing along the road saluting her.”

Since June, the Navajo Department of Health has enforced strict curfews during the week and lockdowns over the weekend. Those measures have been effective, as they’ve seen cases decline over the past two months. The Navajo Nation began its first reopening phase in mid-August, allowing most businesses to operate at 25% capacity.

In late July, Werito left the Army for good and came home to Tuba City. His daughter was born on Aug. 5 in the same hospital where his mother and aunt worked. Her middle name is Lois, the same as Corrina’s.

Werito said he sometimes forgets his mother is gone and expects her to come home from work.

“My grandmother told me it’s a little peace of mind that I’m home now,” he said. “It kind of fills that void that my mom and my aunt left.”

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.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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COVID Plans Put to Test as Firefighters Crowd Camps for Peak Wildfire Season

HELENA, Mont. — Jon Paul was leery entering his first wildfire camp of the year late last month to fight three lightning-caused fires scorching parts of a Northern California forest that hadn’t burned in 40 years.

The 54-year-old engine captain from southern Oregon knew from experience that these crowded, grimy camps can be breeding grounds for norovirus and a respiratory illness that firefighters call the “camp crud” in a normal year. He wondered what the coronavirus would do in the tent cities where hundreds of men and women eat, sleep, wash and spend their downtime between shifts.

Paul thought about his immunocompromised wife and his 84-year-old mother back home. Then he joined the approximately 1,300 people spread across the Modoc National Forest who would provide a major test for the COVID-prevention measures that had been developed for wildland firefighters.

“We’re still first responders and we have that responsibility to go and deal with these emergencies,” he said in a recent interview. “I don’t scare easy, but I’m very wary and concerned about my surroundings. I’m still going to work and do my job.”

Paul is one of thousands of firefighters from across the U.S. battling dozens of wildfires burning throughout the West. It’s an inherently dangerous job that now carries the additional risk of COVID-19 transmission. Any outbreak that ripples through a camp could easily sideline crews and spread the virus across multiple fires — and back to communities across the country — as personnel transfer in and out of “hot zones” and return home.

Though most firefighters are young and fit, some will inevitably fall ill in these remote makeshift communities of shared showers and portable toilets, where medical care can be limited. The pollutants in the smoke they breathe daily also make them more susceptible to COVID-19 and can worsen the effects of the disease, according to the Centers for Disease Control and Prevention.

Also, one suspected or positive case in a camp will mean many other firefighters will need to be quarantined, unable to work. The worst-case scenario is that multiple outbreaks could hamstring the nation’s ability to respond as wildfire season peaks in August, the hottest and driest month of the year in the western U.S.

The number of acres burned so far this year is below the 10-year average, but the fire outlook for August is above average in nine states, according to the National Interagency Fire Center. Twenty-two large fires ignited on Monday alone after lightning storms passed through the Northwest.

A study published this month by researchers at Colorado State University and the U.S. Forest Service’s Rocky Mountain Research Station concluded that COVID outbreaks “could be a serious threat to the firefighting mission” and urged vigilant social distancing and screening measures in the camps.

“If simultaneous fires incurred outbreaks, the entire wildland response system could be stressed substantially, with a large portion of the workforce quarantined,” the study’s authors wrote.

This spring, the National Wildfire Coordinating Group’s Fire Management Board wrote — and has since been updating — protocols to prevent the spread of COVID-19 in fire camps, based on CDC guidelines. Though they can be adapted by managers at different fires and even by individual team, they center on some key recommendations:

  • Firefighters should be screened for fever and other COVID symptoms when they arrive at camp.
  • Every crew should insulate itself as a “module of one” for the fire season and limit interactions with other crews.
  • Firefighters should maintain social distancing and wear face coverings when social distancing isn’t possible. Smaller satellite camps, known as spike camps, can be built to ensure enough space.
  • Shared areas should be regularly cleaned and disinfected, and sharing tools and radios should be minimized.

The guidelines do not include routine testing of newly arrived firefighters — a practice used for athletes at training camps and students returning to college campuses.

The Fire Management Board’s Wildland Fire Medical and Public Health Advisory Team wrote in a July 2 memo that it “does not recommend utilizing universal COVID-19 laboratory testing as a standalone risk mitigation or screening measure among wildland firefighters.” Rather, the group recommends testing an individual and directly exposed co-workers, saying that approach is in line with CDC guidance.

The lack of testing capacity and long turnaround times are factors, according to Forest Service spokesperson Dan Hottle.

The exception is Alaska, where firefighters are tested upon arrival at the airport and are quarantined in a hotel while awaiting results, which come within 24 hours, Hottle said.

Fire crews responding to early-season fires in the spring had some problems adjusting to the new protocols, according to assessments written by fire leaders and compiled by the Wildland Fire Lessons Learned Center.

Shawn Faiella, superintendent of the interagency “hotshot crew” — so named because they work the most challenging or “hottest” parts of wildfires — based at Montana’s Lolo National Forest, questioned the need to wear masks inside vehicles and the safety of bringing extra vehicles to space out firefighters traveling to a blaze. Parking extra vehicles at the scene of a fire is difficult in tight dirt roads — and would be dangerous if evacuations are necessary, he wrote.

“It’s damn tough to take these practices to the fire line,” Faiella wrote after his team responded to a 40-acre Montana fire in April.

One recommendation that fire managers say has been particularly effective is the “module of one” concept requiring crews to eat and sleep together in isolation for the entire fire season.

“Whoever came up with it, it is working,” said Mike Goicoechea, the Montana-based incident commander for the Forest Service’s Northern Region Type 1 team, which manages the nation’s largest and most complex wildfires and natural disasters. “Somebody may test positive, and you end up having to take that module out of service for 14 days. But the nice part is you’re not taking out a whole camp. … It’s just that module.”

The total number of positive COVID cases among wildland firefighters among the various federal, state, local and tribal agencies is not being tracked. Each fire agency has its own system for tracking and reporting COVID-19, said Jessica Gardetto, a spokesperson for the Bureau of Land Management and the National Interagency Fire Center in Idaho.

The largest wildland firefighting agency is the Agriculture Department’s Forest Service, with 10,000 firefighters. Another major agency is the Department of the Interior, which BLM is part of and which had more than 3,500 full-time fire employees last year. As of the first week of August, 111 Forest Service firefighters and 40 BLM firefighters (who work underneath the broader Interior Department agency) had tested positive for COVID-19, according to officials for the respective agencies.

“Considering we’ve now been experiencing fire activity for several months, this number is surprisingly low if you think about the thousands of fire personnel who’ve been suppressing wildfires this summer,” Gardetto said.

Goicoechea and his Montana team traveled north of Tucson, Arizona, on June 22 to manage a rapidly spreading fire in the Santa Catalina Mountains that required 1,200 responders at its peak. Within two days of the team’s arrival, his managers were overwhelmed by calls from firefighters worried or with questions about preventing the spread of COVID-19 or carrying the virus home to their families.

In an unusual move, Goicoechea called upon Montana physician — and former National Park Service ranger with wildfire experience — Dr. Harry Sibold to join the team. Physicians are rarely, if ever, part of a wildfire camp’s medical team, Goicoechea said.

Sibold gave regular coronavirus updates during morning briefings, consulted with local health officials, soothed firefighters worried about bringing the virus home to their families and advised fire managers on how to handle scenarios that might come up.

But Sibold said he wasn’t optimistic at the beginning about keeping the coronavirus in check in a large camp in Pima County, which has the second-highest number of confirmed cases in Arizona, at the time a national COVID-19 hot spot. “I quite firmly expected that we might have two or three outbreaks,” he said.

There were no positive cases during the team’s two-week deployment, just three or four cases where a firefighter showed symptoms but tested negative for the virus. After the Montana team returned home, nine firefighters at the Arizona fire from other units tested positive, Goicoechea said. Contact tracers notified the Montana team, some of whom were tested. All tests returned negative.

“I can’t say enough about having that doctor to help,” Goicoechea said, suggesting other teams might consider doing the same. “We’re not the experts in a pandemic. We’re the experts with fire.”

That early success will be tested as the number of fires increases across the West, along with the number of firefighters responding to them. There were more than 15,000 firefighters and support personnel assigned to fires across the nation as of mid-August, and the success of those COVID-19 prevention protocols depend largely upon them.

Paul, the Oregon firefighter, said that the guidelines were followed closely in camp, but less so out on the fire line. It also appeared to him that younger firefighters were less likely to follow the masking and social-distancing rules than the veterans like him. That worried him as he realized it wouldn’t take much to spark an outbreak that could sideline crews and cripple the ability to respond to a fire.

“We’re outside, so it definitely helps with mitigation and makes it simpler to social-distance,” Paul said. “But I think if there’s a mistake made, it could happen.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Más pruebas para COVID, pero esperas demasiado largas por los resultados

El 15 de junio, Elliot Truslow fue a una farmacia CVS en Tucson, Arizona, para hacerse el test para el coronavirus. El hisopado nasal en el sitio de pruebas al paso tardó menos de 15 minutos.

Más de 22 días después, el estudiante graduado de la Universidad de Arizona todavía estaba esperando los resultados.

Primero le dijeron que tomaría de dos a cuatro días. Después, CVS dijo cinco o seis. El sexto día, la farmacia estimó que los tendría en 10.

“Es indignante”, dijo Truslow, de 30 años, que ha estado en cuarentena en su casa desde que fue a una manifestación de apoyo a Black Lives Matter en su universidad. Truslow nunca ha tenido síntomas. En este punto, los resultados de la prueba ya casi no importan.

La experiencia de Truslow es un ejemplo extremo de las crecientes y a menudo terribles esperas de los resultados de las pruebas para COVID-19 en los Estados Unidos.

En un hospital, los pacientes pueden tenerlos en un día. Pero las personas que se hacen las pruebas en clínicas de urgencias, en centros de salud comunitarios, farmacias y sitios de pruebas al paso que maneja el gobierno suelen esperar una semana o más.

Durante la primavera, la espera era de cuatro a cinco días.

Esto significa que los pacientes, y sus médicos, no tienen la información necesaria para saber si deben modificar conductas. Expertos en salud aconsejan a las personas que, mientras esperan, actúen como si tuvieran COVID-19, lo que significa que deben ponerse en cuarentena y evitar estar cerca de otras personas.

Pero reconocen que esto no es realista si la gente tiene que esperar una semana o más.

La alcaldesa de Atlanta, Keisha Lance Bottoms, quien anunció el lunes 6 de julio que había dado positivo para el virus, se quejó de que esperó ocho días por sus resultados en una entrevista en MSNBC el miércoles 8.

Elliot Truslow fue a hacerse el test a un sitio de pruebas al paso en Tucson, Arizona, el 15 de junio. El 22 todavía estaba esperando los resultados.(Courtesy of Elliot Truslow)

Durante ese tiempo, tuvo una serie de reuniones con funcionarios y electores de la Ciudad: “cosas que yo habría hecho de otra manera si hubiera sabido que había un resultado positivo en mi casa”, dijo en el programa Morning Joe.

“Por la lentitud en tener los resultados es que estamos en esta espiral ascendente de casos”, remarcó.

Esta lentitud también podría retrasar el regreso de los estudiantes a los campus escolares este otoño. Y ya está evitando que algunos equipos profesionales de béisbol entrenen a finales de julio.

Los retrasos podrían incluso frustrar el plan de Hawaii para recibir a más turistas. El estado había estado exigiendo a los visitantes que permanecieran en cuarentena durante 14 días, pero anunció el mes pasado que a partir del 1 de agosto se levantaría el mandato para los viajeros que pudieran demostrar que habían dado negativo para COVID en los tres días anteriores a su arribo a las islas.

En California, el gobernador Gavin Newsom habló de este problema con periodistas el miércoles 8. “Realmente estábamos progresando como nación, no solo como estado, y ahora estamos empezando a ver retrasos de varios días”, dijo.

Los retrasos incluso afectan a personas en poblaciones vulnerables de alto riesgo, dijo Newsom, citando un brote masivo en la prisión estatal de San Quintín, que ha estado enviando sus pruebas al laboratorio Quest.

El estado ahora está considerando asociarse con laboratorios locales, con la esperanza de que puedan proporcionar una respuesta más rápida.

El doctor Amesh Adalja, experto en enfermedades infecciosas del Centro Johns Hopkins para la Seguridad de la Salud en Baltimore, dijo que las largas esperas complican la respuesta nacional a la pandemia.

“Neutralizan la utilidad de la prueba”, dijo. “Necesitamos encontrar una manera de hacer que las pruebas sean más rápidas para que las personas sepan si pueden reanudar sus actividades normales o volver al trabajo”.

El problema es que los laboratorios que las realizan están abrumados por la demanda, que se ha disparado en el último mes.

“Reconocemos que los resultados de estas pruebas contienen información necesaria para guiar tratamientos y los esfuerzos de salud pública”, dijo Julie Khani, presidenta de la Asociación Americana de Laboratorios Clínicos, un grupo comercial.

Azza Altiraifi de Vienna, Virginia, se hizo el test para COVID en un CVS el 1 de julio. El 7 de julio todavía estaba esperando los resultados. Todavía tiene síntomas, incluyendo fatiga.(Courtesy of Azza Altiraifi)

La doctora Temple Robinson, CEO del Bond Community Health Center en Tallahassee, Florida, dijo que los resultados de las pruebas pasaron de estar en tres días a 10 en las últimas semanas.

Muchos pacientes pobres no tienen la capacidad de aislarse fácilmente porque viven en hogares pequeños con muchas personas. “La gente está tratando de cumplir con las reglas, pero no se les está dando las herramientas para ayudarlas si no saben si dieron positivo o negativo”, dijo.

Robinson no culpa a los grandes laboratorios. “Nadie estaba preparado para este volumen de pruebas”, dijo. “Es un momento muy aterrador”.

Azza Altiraifi, de 26 años, de Vienna, Virginia, lo sabe muy bien. Comenzó a sentirse enferma y con problemas para respirar el 28 de junio. A los pocos días tuvo escalofríos y dolor en las articulaciones, y luego una sensación de punción en los pies. Fue al CVS de su vecindario para hacerse la prueba el 1 de julio. Todavía estaba esperando el resultado.

Lo más frustrante de su situación es que su esposo es paramédico y su empleador no le permite ir a trabajar porque puede haber estado expuesto al virus. Su esposo se hizo la prueba el 6 de julio y está esperando noticias. No ha presentado síntomas.

Charlie Rice-Minoso, vocero de CVS Health, dijo que los pacientes esperan en promedio de cinco a siete días por los resultados. “Hay más espera a medida que aumenta la demanda de pruebas”, dijo.

En el sur de Florida, el Distrito de Atención Médica del condado de Palm Beach, que ha examinado a decenas de miles de pacientes desde marzo, dijo que los resultados demoran entre siete y nueve días.

CityMD, una gran cadena de atención de urgencias en el área de la ciudad de Nueva York, les dice a los pacientes que probablemente tengan que esperar al menos siete días para obtener resultados debido a demoras en Quest Diagnostics.

Quest Diagnostics, uno de los laboratorios más grandes de los Estados Unidos, dijo que el tiempo promedio ha aumentado de cuatro a seis días en las últimas dos semanas. La compañía ha realizado casi 7 millones de pruebas para COVID este año.

“Quest está haciendo todo lo posible para agregar capacidad de prueba en medio de esta crisis y las demandas sin precedentes”, dijo la vocera Kimberly Gorode.

En Treasure Coast Community Health, en Vero Beach, Florida, les dicen a los pacientes que deben esperar de 10 a 12 días por los resultados.

La directora ejecutiva, Vicki Soule, dijo que Treasure Coast está inundada de llamadas diarias de pacientes que quieren conocer sus resultados.

“La ansiedad está en aumento”, expresó.

Julie Hall, de 48 años, de Chantilly, Virginia, se hizo la prueba el 27 de junio en un centro de atención de urgencias después de enterarse que su esposo había dado positivo para COVID-19 mientras se preparaba para la cirugía de reemplazo de cadera.

Estaba consternada por tener que esperar hasta el 3 de julio para obtener una respuesta. Hall dijo que ni ella ni su esposo presentaron síntomas. La mujer resultó negativa.

“Pero fue horrible por la incógnita y no saber si había expuesto a alguien más”, dijo sobre la cuarentena en casa esperando los resultados. “Cada vez que estornudabas, alguien decía ‘COVID’ a pesar de que te sentías completamente bien”.

La corresponsal Anna Maria Barry-Jester en California colaboró con esta historia.

As COVID Testing Soars, Wait Times For Results Jump To A Week — Or More

Elliot Truslow went to a CVS drugstore on June 15 in Tucson, Arizona, to get tested for the coronavirus. The drive-thru nasal swab test took less than 15 minutes.

More than 22 days later, the University of Arizona graduate student was still waiting for results.

Elliot Truslow had a drive-thru COVID test at a CVS in Tucson, Arizona, on June 15. CVS told Truslow to expect results in two to four days, but 22 days later, still nothing.(Courtesy of Elliot Truslow)

Truslow was initially told it would take two to four days. Then CVS said five or six days. On the sixth day, the pharmacy estimated it would take 10 days.

“This is outrageous,” said Truslow, 30, who has been quarantining at home since attending a large rally at the school to demonstrate support of Black Lives Matter. Truslow has never had any symptoms. At this point, the test findings hardly matter anymore.

Truslow’s experience is an extreme example of the growing and often excruciating waits for COVID-19 test results in the United States.

While hospital patients can get the findings back within a day, people getting tested at urgent care centers, community health centers, pharmacies and government-run drive-thru or walk-up sites are often waiting a week or more. In the spring, it was generally three or four days.

The problems mean patients and their physicians don’t have information necessary to know whether to change their behavior. Health experts advise people to act as if they have COVID-19 while waiting — meaning to self-quarantine and limit exposure to others. But they acknowledge that’s not realistic if people have to wait a week or more.

Atlanta Mayor Keisha Lance Bottoms, who announced Monday that she had tested positive for the virus, complained she waited eight days for her results in an interview on MSNBC Wednesday. During that time, she held a number of meetings with city officials and constituents — “things that I personally would have done differently had I known there was a positive test result in my house,” she said on “Morning Joe.”

“We’ve been testing for months now in America,” she added. “The fact that we can’t quickly get results back so that other people are not unintentionally exposed is the reason we are continuing in this spiral with COVID-19.”

The slow turnaround for results could also delay students’ return to school campuses this fall. It’s already keeping some professional baseball teams from training for a late July start of the season. The lag times could even foil Hawaii’s plan to welcome more tourists. The state had been requiring visitors to quarantine for 14 days, but it announced last month that starting Aug. 1 that mandate would be lifted for people who could show they tested negative within three days before arriving in the islands.

In California, Gov. Gavin Newsom noted the problem when addressing reporters Wednesday. “We were really making progress as a nation, not just as a state, and now you’re starting to see, because of backlogs with [the lab company] Quest and others, that we’re experiencing multiday delays,” he said.

The delays even apply to people in high-risk, vulnerable populations, he said, citing a massive outbreak at San Quentin State Prison, which has been sending its tests to Quest. The state is now looking at partnering with local labs, hoping they can provide faster turnaround.

Dr. Amesh Adalja, an infectious disease expert at the Johns Hopkins Center for Health Security in Baltimore, said the long waits spell trouble for individuals and complicate the national response to the pandemic.

“It defeats the usefulness of the test,” he said. “We need to find a way to make testing more robust so people can function and know if they can resume normal activities or go back to work.”

The problem is that labs running the tests are overwhelmed as demand has soared in the past month.

Azza Altiraifi of Vienna, Virginia, got her COVID test at CVS on July 1. She still has symptoms, including fatigue — but as of July 7, she was still awaiting the result.(Courtesy of Azza Altiraifi)

“We recognize that these test results contain actionable information necessary to guide treatment and inform public health efforts,” said Julie Khani, president of the American Clinical Laboratory Association, a trade group. “As laboratories respond to unprecedented spikes in demand for testing, we recognize our continued responsibility to deliver accurate and reliable results as quickly as possible.”

Dr. Temple Robinson, CEO of Bond Community Health Center in Tallahassee, Florida, said test results have gone from a three-day turnaround to 10 days in the past several weeks. Many poor patients don’t have the ability to easily isolate from others because they live in smaller homes with other people. “People are trying to play by the rules, but you are not giving them the tools to help them if they do not know if they tested positive or negative,” she said.

“If we are not getting people results for at least seven or eight days, it’s an exercise in futility because either people are much worse or they are better” by then, she said.

Given the lag in testing results from big lab companies, Robinson said her health center this month bought a rapid test machine. She held off buying the machine due to concerns the tests produced a high number of false-negative results but went ahead earlier this month in order to curtail the long waits, she said.

Robinson doesn’t blame the large labs and points instead to the surge in testing. “We are all drinking through a firehose, and none of the labs was prepared for this volume of testing,” she said. “It’s a very scary time.”

Azza Altiraifi, 26, of Vienna, Virginia, knows that all too well. She started feeling sick with respiratory symptoms and had trouble breathing on June 28. Within a few days she had chills, aches and joint pain and then a needling sensation in her feet. She went to her local CVS to get tested on July 1. She was still awaiting the result July 8.

What is most frustrating about her situation is that her husband is a paramedic, and his employer won’t let him work because he may have been exposed to the virus. He was tested July 6 and is still awaiting news.

“This is completely absurd,” Altiraifi said. She also worries that her husband may have unknowingly passed on the virus on one of his ambulance calls to nursing homes and other care facilities before he began isolating at home. He has not shown any symptoms.

Altiraifi, who still has symptoms including fatigue, said she was initially told she would have results in two to four days, but she was suspicious because after using a nasal swab to give herself the test, the box to put it in was so full it was hard to close.

Charlie Rice-Minoso, a spokesperson for CVS Health, said patients are waiting five to seven days on average for test results. “As demand for tests has increased, we’ve seen test result turnaround times vary due to temporary processing capacity limitations with our lab partners, which they are working to address,” he said.

In South Florida, the Health Care District of Palm Beach County, which has tested tens of thousands of patients since March, said findings are taking seven to nine days, several days longer than in the spring.

CityMD, a large urgent care chain in the New York City area, said it now tells patients they will likely wait at least seven days for results because of delays at Quest Diagnostics.

Quest Diagnostics, one of the largest lab companies in the United States, said average turnaround time has increased from three to five days to four to six days in the past two weeks. The company has performed nearly 7 million COVID tests this year.

“Quest is doing everything it can to add testing capacity to reduce turnaround times for patients and providers amid this crisis and the unprecedented demands it places on lab providers,” said spokesperson Kimberly Gorode.

At Treasure Coast Community Health in Vero Beach, Florida, officials are advising patients of a 10- to 12-day wait for results.

CEO Vicki Soule said Treasure Coast is deluged with calls every day from patients wanting to know where their test results are.

“The anxiety on the calls is way up,” she said.

Julie Hall, 48, of Chantilly, Virginia, got tested June 27 at an urgent care center after learning that her husband had tested positive for COVID-19 as he prepared for hip replacement surgery. She was dismayed to have to wait until July 3 to get an answer.

“I was thrilled to be negative, but by that point it likely did not matter,” she said, noting that neither she nor her husband, Chris, showed any symptoms.

“It was awful and terrible because of the unknowns and not knowing if you exposed someone else,” she said of being quarantined at home awaiting results. “Whenever you would sneeze, someone would say ‘COVID’ even though you feel completely fine.”

Senior correspondent Anna Maria Barry-Jester in California contributed to this article.