Health Workers Unions See Surge in Interest Amid Covid

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The nurses at Mission Hospital in Asheville, North Carolina, declared on March 6 — by filing the official paperwork — that they were ready to vote on the prospect of joining a national union. At the time, they were motivated by the desire for more nurses and support staff, and to have a voice in hospital decisions.

A week later, as the covid-19 pandemic bore down on the state, the effort was put on hold, and everyone scrambled to respond to the coronavirus. But the nurses’ long-standing concerns only became heightened during the crisis, and new issues they’d never considered suddenly became urgent problems.

Staffers struggled to find masks and other protective equipment, said nurses interviewed for this story. The hospital discouraged them from wearing masks one day and required masks 10 days later. The staff wasn’t consistently tested for covid and often not even notified when exposed to covid-positive patients. According to the nurses and a review of safety complaints made to federal regulators, the concerns persisted for months. And some nurses said the situation fueled doubts about whether hospital executives were prioritizing staff and patients, or the bottom line.

By the time the nurses held their election in September — six months after they had filed paperwork to do so — 70% voted to unionize. In a historically anti-union state with right-to-work laws and the second-least unionized workforce in the country, that margin of victory is a significant feat, said academic experts who study labor movements.

That it occurred during the pandemic is no coincidence.

For months now, front-line health workers across the country have faced a perpetual lack of personal protective equipment, or PPE, and inconsistent safety measures. Studies show they’re more likely to be infected by the coronavirus than the general population, and hundreds have died, according to reporting by KHN and The Guardian.

Many workers say employers and government systems that are meant to protect them have failed.

Research shows that health facilities with unions have better patient outcomes and are more likely to have inspections that can find and correct workplace hazards. One study found New York nursing homes with unionized workers had lower covid mortality rates, as well as better access to PPE and stronger infection control measures, than nonunion facilities.

Recognizing that, some workers — like the nurses at Mission Hospital — are forming new unions or thinking about organizing for the first time. Others, who already belong to a union, are taking more active leadership roles, voting to strike, launching public information campaigns and filing lawsuits against employers.

“The urgency and desperation we’ve heard from workers is at a pitch I haven’t experienced before in 20 years of this work,” said Cass Gualvez, organizing director for Service Employees International Union-United Healthcare Workers West in California. “We’ve talked to workers who said, ‘I was dead set against a union five years ago, but covid has changed that.’”

In response to union actions, many hospitals across the country have said worker safety is already their top priority, and unions are taking advantage of a difficult situation to divide staff and management, rather than working together.

Labor experts say it’s too soon to know if the outrage over working conditions will translate into an increase in union membership, but early indications suggest a small uptick. Of the approximately 1,500 petitions for union representation posted on the National Labor Relations Board website in 2020, 16% appear related to the health care field, up from 14% the previous year.

In Colorado, SEIU Local 105 health care organizing director Stephanie Felix-Sowy said her team is fielding dozens of calls a month from nonunion workers interested in joining. Not only are nurses and respiratory therapists reaching out, but dietary workers and cleaning staff are as well, including several from rural parts of the state where union representation has traditionally been low.

“The pandemic didn’t create most of the root problems they’re concerned about,” she said. “But it amplified them and the need to address them.”

A nurse for 30 years, Amy Waters had always been aware of a mostly unspoken but widespread sentiment that talking about unions could endanger her job. But after HCA Healthcare took over Mission Health in 2019, she saw nurses and support staff members being cut and she worried about the effect on patient care. Joining National Nurses United could help, she thought. During the pandemic, her fears only worsened. At times, nurses cared for seven patients at once, despite research indicating four is a reasonable number.

In a statement, Mission Health said it has adequate staffing and is aggressively recruiting nurses. “We have the beds, staffing, PPE supplies and equipment we need at this time and we are well-equipped to handle any potential surge,” spokesperson Nancy Lindell wrote. The hospital has required universal masking since March and requires staff members who test positive to stay home, she added.

Although the nurses didn’t vote to unionize until September, Waters said, they began acting collectively from the early days of the pandemic. They drafted a petition and sent a letter to administrators together. When the hospital agreed to provide advanced training on how to use PPE to protect against covid transmission, it was a small but significant victory, Waters said.

“Seeing that change brought a fair number of nurses who had still been undecided about the union to feel like, ‘Yeah, if we work together, we can make change,’” she said.

Old Concerns Heightened, New Issues Arise

Even as union membership in most industries has declined in recent years, health workers unions have remained relatively stable. Experts say it’s partly because of the focus on patient care issues, like safe staffing ratios, which resonate widely and have only grown during the pandemic.

At St. Mary Medical Center outside Philadelphia, short staffing led nurses to strike in November. Donna Halpern, a nurse on the cardiovascular and critical care unit, said staffing had been a point of negotiation with the hospital since the nurses joined the Pennsylvania Association of Staff Nurses and Allied Professionals in 2019. But with another surge of covid cases approaching, the nurses decided not to wait any longer to take action, she said.

A month later, officials with Trinity Health Mid-Atlantic, which owns the hospital, announced a tentative labor agreement with the union. The contract “gives nurses a voice in discussions on staffing while preserving the hospital’s right and authority to make all staffing decisions,” the hospital said in a statement.

In Colorado, where state inspection reports show understaffing led to a patient death at a suburban Denver hospital, SEIU Local 105 has launched a media campaign about unsafe practices by the hospital’s parent company, HealthOne. The union doesn’t represent HealthOne employees, but union leaders said they felt compelled to act after repeatedly hearing concerns.

In a statement, HealthOne said staffing levels are appropriate across its hospitals and it is continuing to recruit and hire staff members.

Covid is also raising entirely new issues for workers to organize around. At the forefront is the lack of PPE, which was noted in one-third of the health worker deaths catalogued by KHN and The Guardian.

Nurses at Albany Medical Center in New York picketed on Dec. 1 with signs demanding PPE and spoke about having to reuse N95 masks up to 20 times.

The hospital told KHN it follows federal guidelines for reprocessing masks, but intensive care nurse Jennifer Bejo said it feels unsafe.

At MultiCare Indigo Urgent Care clinics in Washington state, staff members were provided only surgical masks and face shields for months, even when performing covid tests and seeing covid patients, said Dr. Brian Fox, who works at the clinics and is a member of the Union of American Physicians and Dentists. The company agreed to provide N95 masks after staffers went on a two-day strike in November.

MultiCare said it found another vendor for N95s in early December and is in the process of distributing them.

PPE has also become a rallying point for nonunion workers. At a November event handing out PPE in El Paso, Texas, more than 60 workers showed up in the first hour, said SEIU Texas President Elsa Caballero. Many were not union members, she said, but by the end of the day, dozens had signed membership cards to join.

Small Successes, Gradual Movement

Organized labor is not a panacea, union officials admit. Their members have faced PPE shortages and high infection rates throughout the pandemic, too. But collective action can help workers push for and achieve change, they said.

National Nurses United and the National Union of Healthcare Workers said they’ve each seen an influx in calls from nonmembers, but whether that results in more union elections is yet to be seen.

David Zonderman, an expert in labor history at North Carolina State University, said safety concerns like factory fires and mine collapses have often galvanized collective action in the past, as workers felt their lives were endangered. But labor laws can make it difficult to organize, he said, and many efforts to unionize are unsuccessful.

Health care employers, in particular, are known to launch aggressive and well-funded anti-union campaigns, said Rebecca Givan, a labor studies expert at Rutgers university. Still, workers might be more motivated by what they witnessed during the pandemic, she said.

“An experience like treating patients in this pandemic will change a health care worker forever,” Givan said, “and will have an impact on their willingness to speak out, to go on strike and to unionize if needed.”

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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Illinois, primer estado en ofrecer cobertura médica a adultos mayores indocumentados

Como jefa de enfermería en uno de los hospitales más concurridos de la red de seguridad de atención médica de Chicago, Raquel Prendkowski ha sido testigo del devastador número de víctimas que COVID-19 ha causado entre los residentes más vulnerables de la ciudad, incluyendo a personas que no tienen seguro médico por su estatus migratorio.

Algunos llegan tan enfermos que van directo a cuidados intensivos. Muchos no sobreviven.

“Vivimos una pesadilla constante”, dijo Prendkowski mientras trataba a pacientes con coronavirus en el Hospital Mount Sinai, fundado a principios del siglo XX para atender a los inmigrantes más pobres. “Ojalá salgamos pronto de esto”.

La enfermera cree que algunas muertes, y mucho sufrimiento, podrían haberse evitado si estas personas hubieran tenido un tratamiento regular para todo tipo de condiciones crónicas —asma, diabetes, enfermedades del corazón— que pueden empeorar COVID-19.

Y ahora se siente esperanzada.

En medio del brote del mortal virus que ha afectado de manera desproporcionada a las comunidades hispanas, Illinois se convirtió recientemente en el primer estado de la nación en extender el seguro médico público a todos los adultos mayores no ciudadanos de bajos ingresos, incluso si son indocumentados.

Defensores de los inmigrantes esperan que inspire a otros estados a hacer lo mismo. De hecho, legisladores demócratas de California están presionando para expandir su Medicaid a todos los inmigrantes indocumentados del estado.

“Hacer esto durante la pandemia muestra nuestro compromiso con la expansión y ampliación del acceso a la atención de salud. Es un gran primer paso”, señaló Graciela Guzmán, directora de campaña de Healthy Illinois, que promueve la cobertura universal en el estado.

Muchos inmigrantes indocumentados sin cobertura de salud no van al médico. Ese fue el caso de Victoria Hernández, una limpiadora de casas de 68 años que vive en West Chicago, Illinois. La mujer, nativa de la Ciudad de México dijo que, cuando no tenía seguro, simplemente no iba al médico.

Soportaba cualquier dolencia hasta que encontró un programa de caridad que la ayudó a  tratar su prediabetes. Dijo que tiene la intención de inscribirse en el nuevo plan estatal una vez que tenga más información.

“Estoy muy agradecida por el nuevo programa”, explicó a través de un traductor que trabaja para DuPage Health Coalition, una organización sin fines de lucro que coordina la atención de caridad para personas sin seguro médico como Hernández en el condado de DuPage, el segundo más poblado del estado. “Sé que ayudará a mucha gente como yo. Sé que tendrá buenos resultados, muy, muy buenos resultados”.

Primero, Healthy Illinois intentó ampliar los beneficios de Medicaid a todos los inmigrantes de bajos ingresos, pero los legisladores decidieron empezar con un programa más pequeño, que cubre a adultos mayores de 65 años o más que son indocumentados, o que han sido residentes permanentes, tienen tarjeta verde, por menos de cinco años (este grupo no califica para seguro de salud auspiciado por el gobierno).

Los participantes deben tener ingresos que estén en o por debajo del nivel de pobreza federal, que es de $12,670 para un individuo o $17,240 para una pareja. Cubre servicios como visitas al hospital y al médico, medicamentos recetados, y atención dental y oftalmológica (aunque no estancias en centros de enfermería), sin costo para el paciente.

La nueva norma continúa la tendencia de expandir la cobertura de salud del gobierno a los inmigrantes sin papeles.

Illinois fue el primer estado que cubrió la salud de niños indocumentados y también los transplantes de órganos. Otros estados y el Distrito de Columbia lo hicieron después.

El año pasado, California fue el primero en ofrecer cobertura pública a los adultos indocumentados, cuando amplió la elegibilidad para su programa Medi-Cal a todos los residentes de bajos ingresos menores de 26 años.

Según la ley federal, las personas indocumentadas generalmente no son elegibles para Medicare, Medicaid que no es de emergencia y el mercado de seguros de salud de la Ley de Cuidado de Salud a Bajo Precio (ACA). Los estados que ofrecen cobertura a esta población lo hacen usando sólo fondos estatales.

Se estima que en Illinois viven 3,986 adultos mayores indocumentados, según un estudio del Centro Médico de la Universidad de Rush y el grupo de demógrafos de Chicago Rob Paral & Associates; y se espera que el número aumente a 55,144 para 2030. El informe también encontró que el 16% de los inmigrantes de Illinois de 55 años o más viven en la situación de pobreza, en comparación con el 11% de la población nacida en el país.

Dado que la administración saliente de Trump ha promovido duras medidas migratorias, sectores del activismo pro inmigrante temen que haya miedo a inscribirse en el nuevo programa porque podría afectar la capacidad de obtener la residencia o la ciudadanía en el fututo, y trabajan para asegurarles que no lo hará.

“Illinois cuenta con un legado de ser un estado que acepta al recién llegado y de proteger la privacidad de los inmigrantes”, señaló Andrea Kovach, abogada que trabaja en equidad en la salud en el Shriver Center for Poverty Law en Chicago.

Se espera que la normativa cubra inicialmente de 4,200 a 4,600 inmigrantes mayores, a un costo aproximado de entre $46 millones a $50 millones al año, según John Hoffman, vocero del Departamento de Salud y Servicios Familiares de Illinois.

Algunos representantes estatales republicanos criticaron la expansión de la cobertura, diciendo que era imprudente hacerlo en un momento en que las finanzas de Illinois sufren por la pandemia. En una declaración condenando el presupuesto estatal de este año, el Partido Republicano de Illinois lo denominó “atención de la salud gratuito para los inmigrantes ilegales”.

Pero los defensores de la nueva política sostienen que muchos inmigrantes sin papeles pagan impuestos sin ser elegibles para programas como Medicare y Medicaid, y que gastar por adelantado en cuidados preventivos ahorra dinero, a largo plazo, al reducir el número de personas que esperan para buscar tratamiento hasta que es una emergencia.

Para Delia Ramírez, representante estatal de Illinois, ampliar la cobertura de salud a todos los adultos mayores de bajos ingresos es personal. A la demócrata de Chicago la inspira su tío, un inmigrante de 64 años que no tiene seguro.

Dijo que intentó que la legislación cubriera a las personas de 55 años o más, ya que la gran mayoría de los indocumentados no son personas mayores (señaló que muchos de los inmigrantes mayores —2,7 millones, según estimaciones del gobierno— obtuvieron el estatus legal con la ley de amnistía federal de 1986).

Un mayor número de inmigrantes más jóvenes también pueden estar sin seguro. En los Centros de Salud Esperanza, uno de los mayores proveedores de atención médica para inmigrantes de Chicago, el 31% de los pacientes de 65 años o más carece de cobertura, en comparación con el 47% de los de 60 a 64 años, según Jeffey McInnes, que supervisa el acceso de los pacientes a las clínicas.

Ramírez dijo que su tío la llamó después de ver las noticias sobre la nueva legislación en la televisión en español. Contó que su tío ha vivido en el país por cuatro décadas y ha trabajado para que sus cuatro hijos fueran a la universidad. También padece asma, diabetes e hipertensión, lo que lo hace de alto riesgo para COVID-19.

“Yo le dije: ‘Tío, todavía no. Pero cuando cumplas 65 años, finalmente tendrás atención médica, si es que aún no hemos conseguido legalizarte”, recordó Ramírez, emocionada, durante una reciente entrevista telefónica.

“Así que es un recordatorio para mí de que, en primer lugar, fue una gran victoria para nosotros y ha significado la vida o una segunda oportunidad de vida para muchas personas”, dijo. “Pero también significa que todavía tenemos un largo camino por recorrer para hacer de la atención de salud un verdadero derecho humano en el estado, y en la nación”.

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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Illinois Is First in the Nation to Extend Health Coverage to Undocumented Seniors

As a nurse manager for one of Chicago’s busiest safety-net hospitals, Raquel Prendkowski has witnessed covid-19’s devastating toll on many of the city’s most vulnerable residents — including people who lack health insurance because of their immigration status. Some come in so sick they go right to intensive care. Some don’t survive.

“We’re in a bad dream all the time,” she said during a recent day treating coronavirus patients at Mount Sinai Hospital, which was founded in the early 20th century to care for the city’s poorest immigrants. “I can’t wait to wake up from this.”

Prendkowski believes some of the death and suffering could have been avoided if more of these people had regular treatment for the types of chronic conditions — asthma, diabetes, heart disease — that can worsen covid. She now sees a new reason for hope.

Amid a deadly virus outbreak that has disproportionately stricken Latino communities, Illinois recently became the first state to provide public health insurance to all low-income noncitizen seniors, even if they’re in the country illegally. Advocates for immigrants expect it will inspire other states to do the same, building on efforts to cover undocumented children and young adults. Currently, Democratic legislators in California are pushing to expand coverage to all low-income undocumented immigrants there.

“The fact that we’re going to do this during the pandemic really shows our commitment to expansion and broadening health care access. It’s an amazing first step in the door,” said Graciela Guzmán, campaign director for Healthy Illinois, a group that advocates for universal coverage.

Undocumented immigrants without health insurance often skip care. That was the case for Victoria Hernandez, 68, a house cleaner who lives in West Chicago, a suburb. The Mexico City native said she had avoided going to the doctor because she didn’t have coverage. Eventually, she found a charity program to help her get treatment, including for her prediabetes. She said she intends to enroll in the new state plan.

“I’m very thankful for the new program,” she said through a translator who works for the DuPage Health Coalition, a nonprofit that coordinates charity care for the uninsured in DuPage County, the state’s second-most populous. “I know it will help a lot of people like me.”

Healthy Illinois pushed state lawmakers to offer health benefits to all low-income immigrants. But the legislature opted instead for a smaller program that covers people 65 and older who are undocumented or have been legal permanent residents, also known as green card holders, for less than five years. (These groups don’t typically qualify for government health insurance.) Participants must have an income at or below the federal poverty level, which is $12,670 for an individual or $17,240 for a couple. It covers services like hospital and doctor visits, prescription drugs, and dental and vision care (though not stays in nursing facilities), at no cost to the patient.

The new policy continues a trend of expanding government health coverage to undocumented immigrants.

Illinois was the first state to cover children’s care — a handful of states and the District of Columbia have since followed suit — and organ transplants for unauthorized immigrants. In 2019, California became the first to offer public coverage to adults in the country illegally when it opened eligibility for its Medi-Cal program to all low-income residents under age 26.

Under federal law, undocumented people are generally not eligible for Medicare, nonemergency Medicaid and the Affordable Care Act’s health insurance marketplace. The states that do cover this population get around that by using only state funds.

An estimated 3,986 undocumented seniors live in Illinois, according to a study by Rush University Medical Center and the Chicago demographer group Rob Paral & Associates — but that number is expected to grow to 55,144 by 2030. The report also found that 16% of Illinois immigrants 55 or older live in poverty, compared with 11% of the native-born population.

Given the outgoing Trump administration’s crackdown on immigration, some advocates worry that people will be afraid to enroll in the insurance because it could affect their ability to obtain residency or citizenship. Andrea Kovach, senior attorney for health care justice at the Shriver Center on Poverty Law in Chicago, said she and others are working to assure immigrants they don’t need to worry. Because the new program is state-funded, federal guidance suggests it is not subject to the “public charge” rule designed to keep out immigrants who might end up on public assistance.

“Illinois has a legacy of being a very welcoming state and protecting immigrants’ privacy,” Kovach said.

The Illinois policy is initially expected to cover 4,200 to 4,600 immigrant seniors, at an approximate cost of $46 million to $50 million a year, according to John Hoffman, a spokesperson for the Illinois Department of Healthcare and Family Services. Most of them would likely be undocumented.

Some Republicans criticized the coverage expansion, saying it was reckless at a time when Illinois’ finances are being shredded by the pandemic. The Illinois Republican Party deemed it “free healthcare for illegal immigrants.”

But proponents contend that many unauthorized immigrants pay taxes without being eligible for programs like Medicare and Medicaid, and that spending on preventive care saves money in the long run by cutting down on more expensive treatment for emergencies.

State Rep. Delia Ramirez, a Chicago Democrat who helped shepherd the legislation, advocated for a more expansive plan. She was inspired by her uncle, a 64-year-old immigrant who has asthma, diabetes and high blood pressure but no insurance. He has been working in the country for four decades.

She wanted the policy to apply to people 55 and older, since the vast majority of those who are undocumented are not seniors (she noted that a lot of older immigrants — 2.7 million, according to government estimates — obtained legal status under the 1986 federal amnesty law).

The real impact of this plan will likely be felt in years to come. At Esperanza Health Centers, one of Chicago’s largest providers of health care to immigrants, 31% of patients 65 and older lack coverage, compared with 47% of those 60 to 64, according to Jeffrey McInnes, who oversees patient access there.

Ramirez said her uncle called her after seeing news of the legislation on Spanish-language TV.

“And I said to him, ‘Tío, not yet. But when you turn 65, you’ll finally have health care, if we still can’t help you legalize,’” Ramirez recalled, choking up during a recent phone interview.

“So it is a reminder to me that, one, it was a major victory for us and it has meant life or a second chance at life for many people,” she said. “But it is also a reminder to me that we still have a long way to go in making health care truly a human right in the state and, furthermore, the nation.”

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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Eureka! Two Vaccines Work — But What About the Also-Rans in the Pharma Arms Race?

This story also ran on Daily Beast. It can be republished for free.

As I prepared to get my shot in mid-December as part of a covid vaccine trial run by Janssen Pharmaceuticals, I considered the escape routes. Bailing out of the trial was a very real consideration since two other vaccines, made by Moderna and Pfizer-BioNTech, had been deemed safe and effective for emergency approval.

Leaving the trial would be a perfectly sane decision for me or anyone who had volunteered for an ongoing covid experiment. Why risk getting covid-19 if I was given a placebo, a shot with no vaccine in it? The way tests are designed, I might not be told whether I received the vaccine until the clinical trial is over, months from now.

Dropping the placebo arm could also be ethically sound from the company’s point of view. Researchers frequently halt trials when they have a product that works — or manifestly doesn’t. And the two approved vaccines are 95% effective.

That very real choice for thousands of people offering to join or remain in the ongoing vaccine tests creates a conundrum for science and for society. If trials can’t go forward, that could very well have an impact on the world’s supply of covid vaccines and eventually on vaccine prices, especially if booster shots are needed in years to come. In markets where there are only two competing drugs, prices can shoot sky-high. If there are four or five on the market, competition usually kicks in to control costs.

In short, the welcome arrival of two covid vaccines deemed safe has uncovered a series of ethical and logistical challenges. And it has governments, companies and scientists scrambling for solutions.

“The world’s vaccine experts are saying the longer we can carry out a placebo-controlled trial the better,” Matthew Hepburn, who runs the vaccine development arm of Operation Warp Speed, the multibillion-dollar federal program to fight covid-19, told me. “But as a volunteer in the Janssen trial, you can always drop out.”

As for the best way to resolve broader problems, “it’s a debate in real time,” he said.

Generally, there are two aspects to the debate. First, what should be done with placebo recipients of the Moderna and Pfizer trials now that it’s clear both shots prevent the disease and appear safe? Second, how can the scores of companies in the United States and overseas that are still testing covid vaccines adapt when there are apparently reliable products already on the market?

The FDA’s advisory committee debated the first question during two meetings in December. They heard Stanford University statistician Steven Goodman argue in favor of a “double-blind crossover” modification of the Pfizer and Moderna trials. Everyone who got placebo shots in the trials would now get two doses of the real vaccine, and vice versa. That way everyone would be protected but still “blind” as to when they were properly vaccinated.

Such a rejigger of the current trial would provide more data on the vaccine’s safety and durability of protection, although the longer-term comparison of vaccine versus placebo would be lost. It’s a marvelous idea in principle, the panelists agreed, but pretty hard to carry out. Neither Moderna nor Pfizer has agreed to it.

Pfizer wants to “unblind” placebo recipients of its vaccine — to reveal they got the saline solution and give them the real thing — once their risk group gets its turn in line for the vaccine. It has already started vaccinating health care workers who got the placebo.

Moderna, which has thousands of soon-to-expire leftover doses from its trial, said it intends to unblind its trial and vaccinate all the placebo recipients. In doing so, it would be recognizing the altruistic service the test subjects made to science and society by joining the trial.

Another proposal would split the placebo recipients in the trial into two groups. In one group, everyone would get a single dose of the vaccine. In the other, each would get two doses. This would be a way of testing evidence that emerged during the Pfizer and Moderna trials that a single dose might provide sufficient protection. If that were true, vaccination of the country could happen nearly twice as fast, because there would be twice as many doses of vaccine to go around.

No one knows to what extent the Food and Drug Administration could force the hands of the two companies, which still expect to get full licensure for their vaccines this year. Moderna is considered more amenable to the suggestion since, unlike Pfizer, it got nearly $1 billion in federal funding to develop its vaccine.

Other vaccine developers — including Operation Warp Speed participants Janssen (owned by Johnson & Johnson), AstraZeneca, Novavax, Sanofi and Merck & Co. — are closely watching to see which path is taken.

They are in a race against time — a race that may not end well for those running late in getting their vaccine out. And halting those efforts could hurt billions of people elsewhere in the world whose lives and livelihoods will depend on the arrival of plentiful, cheap vaccines.

One problem is finding willing test subjects. As increasing numbers of Americans are vaccinated, and the virus recedes from our shores, “the fewer the number of people eligible to participate in trials,” said Susan Ellenberg, professor of biostatistics at the University of Pennsylvania.

For now, AstraZeneca and Janssen appear well situated. Both have closed enrollment in their U.S. trials and are likely to file within a few months for emergency use authorizations, like those that have allowed Moderna and Pfizer to start vaccinating the public.

Novavax officials last week started their late-stage trial in the U.S. and predict they can get full enrollment before the majority of the U.S. population is vaccinated.

Sanofi and Merck, whose timetables are more drawn out, are more likely to conduct most of their trials overseas.

In theory, drug companies could overcome these hurdles by testing multiple vaccines against one another and against approved vaccines. Dr. Steven Joffe, a University of Pennsylvania bioethicist, proposed in a recent JAMA article that Operation Warp Speed pay for such a trial.

Scientists and policymakers batted around the idea of a single U.S. trial, with multiple vaccine candidates competing against one another and a single placebo arm, during initial discussions last spring about the creation of Operation Warp Speed.

The idea went nowhere in the United States. It was taken up by World Health Organization officials and major biomedical research groups, which have tried to create such a vaccine trial in the rest of the world — with little success thus far.

So, for now, future vaccine trials are somewhat up in the air.

“There’s this tension created by getting the first vaccines out there so quickly,” said David Wendler, a senior researcher in bioethics at the National Institutes of Health’s Clinical Center. “For public health it’s good, but it has the potential to undermine our ability to keep going on the research side and really knock out the virus.”

Companies, governments and outside funders need to quickly develop consensus on appropriate trial designs and regulatory processes for additional covid vaccines, added Mark Feinberg, president and CEO of the International AIDS Vaccine Initiative.

As for me, I decided I would stay in the Janssen trial. However, the day before I was scheduled to get my injection — real or fake — the research organization running the inoculations called to say I failed to make the cut: J&J had stopped its trial enrollment.

So, I’ll buy some new masks and get in line for my vaccine with everyone else.

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

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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Heading Off the Next Pandemic

As the covid-19 pandemic heads for a showdown with vaccines it’s expected to lose, many experts in the field of emerging infectious diseases are already focused on preventing the next one.

They fear another virus will leap from wildlife into humans, one that is far more lethal but spreads as easily as SARS-CoV-2, the strain of coronavirus that causes covid-19. A virus like that could change the trajectory of life on the planet, experts say.

“What keeps me up at night is that another coronavirus like MERS, which has a much, much higher mortality rate, becomes as transmissible as covid,” said Christian Walzer, executive director of health at the Wildlife Conservation Society. “The logistics and the psychological trauma of that would be unbearable.”

SARS-CoV-2 has an average mortality rate of less than 1%, while the mortality rate for Middle East respiratory syndrome, or MERS — which spread from camels into humans — is 35%. Other viruses that have leapt the species barrier to humans, such as bat-borne Nipah, have a mortality rate as high as 75%.

“There is a huge diversity of viruses in nature, and there is the possibility that one has the Goldilocks characteristics of pre-symptomatic transmission with a high fatality rate,” said Raina Plowright, a virus researcher at the Bozeman Disease Ecology Lab in Montana. (Covid-19 is highly transmissible before the onset of symptoms but fortunately is far less lethal than several other known viruses.) “It would change civilization.”

That’s why in November the German Federal Foreign Office and the Wildlife Conservation Society held a virtual conference called One Planet, One Health, One Future, aimed at heading off the next pandemic by helping world leaders understand that killer viruses like SARS-CoV-2 — and many other less deadly pathogens — are unleashed on the world by the destruction of nature.

With the world’s attention gripped by the spread of the coronavirus, infectious disease experts are redoubling their efforts to show the robust connection between the health of nature, wildlife and humans. It is a concept known as One Health.

While the idea is widely accepted by health officials, many governments have not factored it into policies. So the conference was timed to coincide with the meeting of the world’s economic superpowers, the G20, to urge them to recognize the threat that wildlife-borne pandemics pose, not only to people but also to the global economy.

The Wildlife Conservation Society — America’s oldest conservation organization, founded in 1895 — has joined with 20 other leading conservation groups to ask government leaders “to prioritize protection of highly intact forests and other ecosystems, and work in particular to end commercial wildlife trade and markets for human consumption as well as all illegal and unsustainable wildlife trade,” they said in a recent press release.

Experts predict it would cost about $700 billion to institute these and other measures, according to the Wildlife Conservation Society. On the other hand, it’s estimated that covid-19 has cost $26 trillion in economic damage. Moreover, the solution offered by those campaigning for One Health goals would also mitigate the effects of climate change and the loss of biodiversity.

The growing invasion of natural environments as the global population soars makes another deadly pandemic a matter of when, not if, experts say — and it could be far worse than covid. The spillover of animal, or zoonotic, viruses into humans causes some 75% of emerging infectious diseases.

But multitudes of unknown viruses, some possibly highly pathogenic, dwell in wildlife around the world. Infectious disease experts estimate there are 1.67 million viruses in nature; only about 4,000 have been identified.

SARS-CoV-2 likely originated in horseshoe bats in China and then passed to humans, perhaps through an intermediary host, such as the pangolin — a scaly animal that is widely hunted and eaten.

While the source of SARS-CoV-2 is uncertain, the animal-to-human pathway for other viral epidemics, including Ebola, Nipah and MERS, is known. Viruses that have been circulating among and mutating in wildlife, especially bats, which are numerous around the world and highly mobile, jump into humans, where they find a receptive immune system and spark a deadly infectious disease outbreak.

“We’ve penetrated deeper into eco-zones we’ve not occupied before,” said Dennis Carroll, a veteran emerging infectious disease expert with the U.S. Agency for International Development. He is setting up the Global Virome Project to catalog viruses in wildlife in order to predict which ones might ignite the next pandemic. “The poster child for that is the extractive industry — oil and gas and minerals, and the expansion of agriculture, especially cattle. That’s the biggest predictor of where you’ll see spillover.”

When these things happened a century ago, he said, the person who contracted the disease likely died there. “Now an infected person can be on a plane to Paris or New York before they know they have it,” he said.

Meat consumption is also growing, and that has meant either more domestic livestock raised in cleared forest or “bush meat” — wild animals. Both can lead to spillover. The AIDS virus, it’s believed, came from wild chimpanzees in central Africa that were hunted for food.

One case study for how viruses emerge from nature to become an epidemic is the Nipah virus.

Nipah is named after the village in Malaysia where it was first identified in the late 1990s. The symptoms are brain swelling, headaches, a stiff neck, vomiting, dizziness and coma. It is extremely deadly, with as much as a 75% mortality rate in humans, compared with less than 1% for SARS-CoV-2. Because the virus never became highly transmissible among humans, it has killed just 300 people in some 60 outbreaks.

One critical characteristic kept Nipah from becoming widespread. “The viral load of Nipah, the amount of virus someone has in their body, increases over time” and is most infectious at the time of death, said the Bozeman lab’s Plowright, who has studied Nipah and Hendra. (They are not coronaviruses, but henipaviruses.) “With SARS-CoV-2, your viral load peaks before you develop symptoms, so you are going to work and interacting with your family before you know you are sick.”

If an unknown virus as deadly as Nipah but as transmissible as SARS-CoV-2 before an infection was known were to leap from an animal into humans, the results would be devastating.

Plowright has also studied the physiology and immunology of viruses in bats and the causes of spillover. “We see spillover events because of stresses placed on the bats from loss of habitat and climatic change,” she said. “That’s when they get drawn into human areas.” In the case of Nipah, fruit bats drawn to orchards near pig farms passed the virus on to the pigs and then humans.

“It’s associated with a lack of food,” she said. “If bats were feeding in native forests and able to nomadically move across the landscape to source the foods they need, away from humans, we wouldn’t see spillover.”

A growing understanding of ecological changes as the source of many illnesses is behind the campaign to raise awareness of One Health.

One Health policies are expanding in places where there are likely human pathogens in wildlife or domestic animals. Doctors, veterinarians, anthropologists, wildlife biologists and others are being trained and training others to provide sentinel capabilities to recognize these diseases if they emerge.

The scale of preventive efforts is far smaller than the threat posed by these pathogens, though, experts say. They need buy-in from governments to recognize the problem and to factor the cost of possible epidemics or pandemics into development.

“A road will facilitate a transport of goods and people and create economic incentive,” said Walzer, of the Wildlife Conservation Society. “But it will also provide an interface where people interact and there’s a higher chance of spillover. These kinds of costs have never been considered in the past. And that needs to change.”

The One Health approach also advocates for the large-scale protection of nature in areas of high biodiversity where spillover is a risk.

Joshua Rosenthal, an expert in global health with the Fogarty International Center at the National Institutes of Health, said that while these ideas are conceptually sound, it is an extremely difficult task. “These things are all managed by different agencies and ministries in different countries with different interests, and getting them on the same page is challenging,” he said.

Researchers say the clock is ticking. “We have high human population densities, high livestock densities, high rates of deforestation — and these things are bringing bats and people into closer contact,” Plowright said. “We are rolling the dice faster and faster and more and more often. It’s really quite simple.”

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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In Fast-Moving Pandemic, Health Officials Try to Change Minds at Warp Speed

Nine months into the pandemic that has killed more than 320,000 people in the U.S., Kim Larson is still trying to convince others in her northern Montana county that COVID-19 is dangerous.

As Hill County Health Department director and county health officer, Larson continues to hear people say the coronavirus is just like a bad case of the flu. Around the time Montana’s governor mandated face coverings in July, her staffers saw notices taped in several businesses’ windows spurning the state’s right to issue such emergency orders.

For a while, the county with a population of 16,000 along the Canadian border didn’t see much evidence of the pandemic. It had only one known COVID case until July. But that changed as the nation moved into its third surge of the virus this fall. By mid-December, Hill County had recorded more than 1,500 cases — the vast majority since Oct. 1 — and 33 people there had died.

When Larson hears people say pandemic safety rules should end, she talks about how contagious the COVID virus is, how some people experience lasting effects and how hospitals are so full that care for any ailment could face delays.

“In public health, we’ve seen the battle before, but you typically have the time to build your evidence, research showing that this really does save lives,” Larson said. “In the middle of a pandemic, you have no time.”

Public health laws typically come long after social norms shift, affirming a widespread acceptance that a change in habits is worth the public good and that it’s time for stragglers to fall in line. But even when decades of evidence show a rule can save lives — such as wearing seat belts or not smoking indoors — the debate continues in some places with the familiar argument that public restraints violate personal freedoms. This fast-moving pandemic, however, doesn’t afford society the luxury of time. State mandates have put local officials in charge of changing behavior while general understanding catches up.

Earlier this month, U.S. Surgeon General Jerome Adams stood next to Montana’s governor in Helena and said he hopes people wear masks because it’s the right thing to do — especially as COVID hospitalizations rise.

“You don’t want to be the reason that a woman in labor can’t get a hospital bed,” Adams said, adding a vaccine is on the way. “It’s just for a little bit longer.”

He spoke days after state lawmakers clashed over masks as a majority of Republican lawmakers arrived for a committee meeting barefaced and at least one touted false information on the dangers of masks. As of Dec. 15, the Republican majority hadn’t required masks for the upcoming legislative session, set to begin Jan. 4.

And now a group opposed to masks from Gallatin and Flathead counties has filed a lawsuit asking a Montana judge to block the state’s pandemic-related safety rules.

Public health laws typically spark political battles. Changing people’s habits is hard, said Lindsay Wiley, director of the health law and policy program at American University in Washington, D.C. Despite the misconception that there was universal buy-in for masks during the 1918 pandemic, Wiley said, some protesters intentionally built rap sheets of arrests for going maskless in the name of liberty.

She said health officials realize any health restrictions amid a pandemic require the public’s trust and cooperation for success.

“We don’t have enough police to walk around and force everyone to wear a mask,” she said. “And I’m not sure we want them to do it.”

Local officials have the best chance to win over that support, Wiley said. And seeing elected leaders such as President Donald Trump rebuff his own federal health guidelines makes that harder. Meanwhile, public shaming like calling unmasked people selfish or stupid can backfire, Wiley said, because if they were to give in to mask-wearing, they would essentially be accepting those labels.

In the history of public health laws, even rules that have had time to build widely accepted evidence weren’t guaranteed support.

It’s illegal in Montana to go without a seat belt in a moving car. But, as in 13 other states, authorities aren’t allowed to pull people over for being unbuckled. Every few years, a Montana lawmaker, backed by a collection of public health and law enforcement organizations, proposes a law to allow seat belt traffic stops, arguing it would save lives. In 2019, that request didn’t even make it out of committee, squelched by the arguments of personal choice and not giving too much power to the government.

Main opposition points against public health laws — whether it’s masks, seat belts, motorcycle helmets or smoking — can sound alike.

When Missoula County became the first place in Montana to ban indoor smoking in public spaces in 1999, opponents said the change would destroy businesses, be impossible to enforce and violate people’s freedom of choice.

“They are the same arguments in a lot of ways,” said Ellen Leahy, director of the Missoula City-County Health Department. “Public health was right at that intersection between what’s good for the whole community and the rights and responsibilities of the individual.”

Montana adopted an indoor smoking ban in 2005, but many bars and taverns were given until 2009 to fall in line. And, in some places, debate and court battles continued for a decade more on how the ban could be enforced.

Amid the COVID pandemic, Missoula County was again ahead of much of the state when it passed its own mask ordinance. The county has two hospitals and a university that swells its population with students and commuters.

“If you have to see it to believe it, you’re going to see the impact of a pandemic first in a city, most likely,” Leahy said.

Compliance hasn’t been perfect and she said the need for strict enforcement has been limited. As of early December, out of the more than 1,500 complaints the Missoula health department followed up on since July, it sent closure notices to four businesses that flouted the rules.

In Hill County, when the health department gets complaints that a business is violating pandemic mandates, two part-time health sanitarians, who perform health inspections of businesses, talk with the owners about why the rules exist and how to live by them. Often it works. Other times the complaints keep coming.

County attorney Karen Alley said the local health officials have reached out to her office with complaints of noncompliance on COVID safety measures, but she has not seen enough evidence to bring a civil case against a business. Unlike other health laws, she said, mask rules have no case studies yet to offer a framework for enforcing them through the Montana courts. (A handful of cases against businesses skirting COVID rules were still playing out as of mid-December.)

“Somebody has to be the test case, but you never want to be the test case,” said Alley, who is part of a team of three. “It’s a lot of resources, a lot of time.”

Larson, with the Hill County Health Department, said her focus is still on winning over the community. And she’s excited about some progress. The town’s annual live Nativity scene, which typically draws crowds with hot cocoa, turned into a drive-by event this year.

She doesn’t expect everyone to follow the rules — that’s never the case in public health. But Larson hopes enough people will to slow down the virus. That could be happening. By mid-December, the county’s tally of daily active cases was declining for the first time since its spike began in October.

“You just try to figure out the best way for your community and to get their input,” Larson said. “Because we need the community’s help to stop it.”

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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Analysis: Some Said the Vaccine Rollout Would Be a ‘Nightmare.’ They Were Right.

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WASHINGTON — Even before there was a vaccine, some seasoned doctors and public health experts warned, Cassandra-like, that its distribution would be “a logistical nightmare.

After Week 1 of the rollout, “nightmare” sounds like an apt description.

Dozens of states say they didn’t receive nearly the number of promised doses. Pfizer says millions of doses sat in its storerooms, because no one from President Donald Trump’s Operation Warp Speed task force told them where to ship them. A number of states have few sites that can handle the ultra-cold storage required for the Pfizer product, so, for example, front-line workers in Georgia have had to travel 40 minutes to get a shot. At some hospitals, residents treating COVID patients protested that they had not received the vaccine while administrators did, even though they work from home and don’t treat patients.

The potential for more chaos is high. Dr. Vivek Murthy, named as the next surgeon general under President-elect Joe Biden, said this week that the Trump administration’s prediction — that the general population would get the vaccine in April — was realistic only if everything went smoothly. He instead predicted wide distribution by summer or fall.

The Trump administration had expressed confidence that the rollout would be smooth, because it was being overseen by a four-star general, Gustave Perna, an expert in logistics. But it turns out that getting fuel, tanks and tents into war-torn mountainous Afghanistan is in many ways simpler than passing out a vaccine in our privatized, profit-focused and highly fragmented medical system. Gen. Perna apologized this week, saying he wanted to “take personal responsibility.” It’s really mostly not his fault.

Throughout the COVID pandemic, the U.S. health care system has shown that it is not built for a coordinated pandemic response (among many other things). States took wildly different COVID prevention measures; individual hospitals varied in their ability to face this kind of national disaster; and there were huge regional disparities in test availability — with a slow ramp-up in availability due, at least in some part, because no payment or billing mechanism was established.

Why should vaccine distribution be any different?

In World War II, toymakers were conscripted to make needed military hardware airplane parts, and commercial shipyards to make military transport vessels. The Trump administration has been averse to invoking the Defense Production Act, which could help speed and coordinate the process of vaccine manufacture and distribution. On Tuesday, it indicated it might do so, but only to help Pfizer obtain raw materials that are in short supply, so that the drugmaker could produce — and sell — more vaccines in the United States.

Instead of a central health-directed strategy, we have multiple companies competing to capture their financial piece of the pandemic health care pie, each with its patent-protected product as well as its own supply chain and shipping methods.

Add to this bedlam the current decision-tree governing distribution: The Centers for Disease Control and Prevention has made official recommendations about who should get the vaccine first — but throughout the pandemic, many states have felt free to ignore the agency’s suggestions.

Instead, Operation Warp Speed allocated initial doses to the states, depending on population. From there, an inscrutable mix of state officials, public health agencies and lobbyists seem to be determining where the vaccine should go. In some states, counties requested an allotment from the state, and then they tried to accommodate requests from hospitals, which made their individual algorithms for how to dole out the precious cargo. Once it became clear there wasn’t enough vaccine to go around, each entity made its own adjustments.

Some doses are being shipped by FedEx or UPS. But Pfizer — which did not fully participate in Operation Warp Speed — is shipping much of the vaccine itself. In nursing homes, some vaccines will be delivered and administered by employees of CVS and Walgreens, though issues of staffing and consent remain there.

The Moderna vaccine, rolling out this week, will be packaged by the “pharmaceutical services provider” Catalent in Bloomington, Indiana, and then sent to McKesson, a large pharmaceutical logistics and distribution outfit. It has offices in places like Memphis, Tennessee, and Louisville, which are near air hubs for FedEx and UPS, which will ship them out.

Is your head spinning yet?

Looking forward, basic questions remain for 2021: How will essential workers at some risk (transit workers, teachers, grocery store employees) know when it’s their turn? (And it will matter which city you work in.) What about people with chronic illness — and then everyone else? And who administers the vaccine — doctors or the local drugstore?

In Belgium, where many hospitals and doctors are private but work within a significant central organization, residents will get an invitation letter “when it’s their turn.” In Britain, the National Joint Committee on Vaccination has settled on a priority list for vaccinations — those over 80, those who live or work in nursing homes, and health care workers at high risk. The National Health Service will let everyone else “know when it’s your turn to get the vaccine ” from the government-run health system.

In the United States, I dread a mad scramble — as in, “Did you hear the CVS on P Street got a shipment?” But this time, it’s not toilet paper.

Combine this vision of disorder with the nation’s high death toll, and it’s not surprising that there is intense jockeying and lobbying — by schools, unions, even people with different types of preexisting diseases — over who should get the vaccine first, second and third. It’s hard to “wait your turn” in a country where there are 200,000 new cases and as many as 2,000 new daily COVID deaths — a tragic per capita order of magnitude higher than in many other developed countries.

So kudos and thanks to the science and the scientists who made the vaccine in record time. I’ll eagerly hold out my arm — so I can see the family and friends and colleagues I’ve missed all these months. If only I can figure out when I’m eligible, and where to go to get it.

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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Health Officials Fear Pandemic-Related Suicide Spike Among Native Youth

WOLF POINT, Mont. — Fallen pine cones covered 16-year-old Leslie Keiser’s fresh grave at the edge of Wolf Point, a small community on the Fort Peck Indian Reservation on the eastern Montana plains.

Leslie, whose father is a member of the Fort Peck Assiniboine and Sioux Tribes, is one of at least two teenagers on the reservation who died by suicide this summer. A third teen’s death is under investigation, authorities said.

Leslie’s mother, Natalie Keiser, was standing beside the grave recently when she received a text with a photo of the headstone she had ordered.

She looked at her phone and then back at the grave of the girl who took her own life in September.

“I wish she would have reached out and let us know what was wrong,” she said.

In a typical year, Native American youth die by suicide at nearly twice the rate of their white peers in the U.S. Mental health experts worry that the isolation and shutdowns caused by the COVID-19 pandemic could make things worse.

“It has put a really heavy spirit on them, being isolated and depressed and at home with nothing to do,” said Carrie Manning, a project coordinator at the Fort Peck Tribes’ Spotted Bull Recovery Resource Center.

It’s not clear what connection the pandemic has to the youth suicides on the Fort Peck reservation. Leslie had attempted suicide once before several years ago, but she had been in counseling and seemed to be feeling better, her mother said.

Keiser noted that Leslie’s therapist canceled her counseling sessions before the pandemic hit.

“Probably with the virus it would have been discontinued anyway,” Keiser said. “It seems like things that were important were kind of set to the wayside.”

Tribal members typically lean on one another in times of crisis, but this time is different. The reservation is a COVID hot spot. In remote Roosevelt County, which encompasses most of the reservation, more than 10% of the population has been infected with the coronavirus. The resulting social distancing has led tribal officials to worry the community will fail to see warning signs among at-risk youth.

So tribal officials are focusing their suicide prevention efforts on finding ways to help those kids remotely.

“Our people have been through hardships and they’re still here, and they’ll still be here after this one as well,” said Don Wetzel, tribal liaison for the Montana Office of Public Instruction and a member of the Blackfeet Nation. “I think if you want to look at resiliency in this country, you look at our Native Americans.”

Poverty, high rates of substance abuse, limited health care and crowded households elevate both physical and mental health risks for residents of reservations.

“It’s those conditions where things like suicide and pandemics like COVID are able to just decimate tribal people,” said Teresa Brockie, a public health researcher at Johns Hopkins University and a member of the White Clay Nation from Fort Belknap, Montana.

Montana has seen 231 suicides this year, with the highest rates occurring in rural counties. Those numbers aren’t much different from a typical year, said Karl Rosston, suicide prevention coordinator for the state’s Department of Public Health and Human Services. The state has had one of the highest suicide rates in the country each year for decades.

As physical distancing drags on, fatality numbers climb and the economic impacts of the pandemic start to take hold of families, Rosston said, and he expected to see more suicide attempts in December and January.

“We’re hoping we’re wrong in this, of course,” he said.

For rural teenagers, in particular, the isolation caused by school closures and curtailed or canceled sports seasons can tax their mental health.

“Peers are a huge factor for kids. If they’re cut off, they’re more at risk,” Rosston said.

Furthermore, teen suicides tend to cluster, especially in rural areas. Every suicide triples the risk that a surviving loved one will follow suit, Rosston said.

On average, every person who dies by suicide has six survivors. “When talking about small tribal communities, that jumps to 25 to 30,” he said.

Maria Vega, a 22-year-old member of the Fort Peck Tribes, knows this kind of contagious grief. In 2015, after finding the body of a close friend who had died by suicide, Vega attempted suicide as well. She is now a youth representative for a state-run suicide prevention committee that organizes conferences and other events for young people.

Vega is a nursing student who lives six hours away from her family, making it difficult to travel home. She contracted COVID-19 in October and was forced to isolate, increasing her sense of removal from family. While isolated, Vega was able to attend therapy sessions through a telehealth system set up by her university.

“I really do think therapy is something that would help people while they’re alone,” she said.

But Vega points out that this is not an option for many people on rural reservations who don’t have computers or reliable internet access. The therapists who offer telehealth services have long waitlists.

Other prevention programs are having difficulties operating during the pandemic. Brockie, who studies health delivery in disadvantaged populations, has twice had to delay the launch of an experimental training program for Native parents of young children. She hopes the program will lower the risk of substance abuse and suicide by teaching resiliency and parenting skills.

At Fort Peck, the reservation’s mental health center has had to scale down its youth events that teach leadership skills and traditional practices like horseback riding and archery, as well as workshops on topics like coping with grief. The events, which Manning said usually draw 200 people or more, are intended to take teenagers’ minds away from depression and allow them to have conversations about suicide, a taboo topic in many Native cultures. The few events that can go forward are limited now to a handful of people at a time.

Tribes, rural states and other organizations running youth suicide intervention and prevention initiatives are struggling to sustain the same level of services. Using money from the federal CARES Act and other sources, Montana’s Office of Public Instruction ramped up online prevention training for teachers, while Rosston’s office has beefed up counseling resources people can access by phone.

On the national level, the Center for Native American Youth in Washington, D.C., hosts biweekly webinars for young people to talk about their hopes and concerns. Executive Director Nikki Pitre said that on average around 10,000 young people log in each week. In the CARES Act, the federal government allocated $425 million for mental health programs, $15 million of which was set aside for Native health organizations.

Pitre hopes the pandemic will bring attention to the historical inequities that led to lack of health care and resources on reservations, and how they enable the twin epidemics of COVID-19 and suicide.

“This pandemic has really opened up those wounds,” she said. “We’re clinging even more to the resiliency of culture.”

In Wolf Point, Natalie Keiser experienced that resiliency and support firsthand. The Fort Peck community has come together to pay for Leslie’s funeral.

“That’s a miracle in itself,” she said.

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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Many US Health Experts Underestimated the Coronavirus … Until It Was Too Late

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A year ago, while many Americans were finishing their holiday shopping and finalizing travel plans, doctors in Wuhan, China, were battling a mysterious outbreak of pneumonia with no known cause.

Chinese doctors began to fear they were witnessing the return of severe acute respiratory syndrome, or SARS, a coronavirus that emerged in China in late 2002 and spread to 8,000 people worldwide, killing almost 800.

The disease never gained a foothold in the U.S. and disappeared by 2004.

Although the disease hasn’t been seen in 16 years, SARS cast a long shadow that colored how many nations — and U.S. scientists — reacted to its far more dangerous cousin, the novel coronavirus that causes COVID-19.

When Chinese officials revealed that their pneumonia outbreak was caused by another new coronavirus, Asian countries hit hard by SARS knew what they had to do, said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. Taiwan and South Korea had already learned the importance of a rapid response that included widespread testing, contact tracing and isolating infected people.

The U.S., by contrast, learned all the wrong lessons.

This country’s 20-year run of good luck with emerging pathogens —including not just SARS, but also the relatively mild H1N1 pandemic, Middle East respiratory syndrome, Ebola, Zika virus and two strains of bird flu — gave us a “false sense of security,” Adalja said.

KHN’s in-depth examination of the year-long pandemic shows that many leading infectious disease specialists underestimated the fast-moving outbreak in its first weeks and months, assuming that the United States would again emerge largely unscathed. American hubris prevented the country from reacting as quickly and effectively as Asian nations, Adalja said.

During the first two decades of this century, “there were a lot of fire alarms with no fire, so people tended to ignore this one,” said Lawrence Gostin, director of Georgetown’s O’Neill Institute for National and Global Health Law, who acknowledges he underestimated the virus in its first few weeks.

In a Jan. 24 story, Dr. William Schaffner told KHN the real danger to Americans was the common flu, which can kill up to 61,000 Americans a year.

“Coronavirus will be a blip on the horizon in comparison,” said Schaffner, a professor of preventive medicine and health policy at Vanderbilt University Medical Center. “The risk is trivial.”

The same day, The Washington Post published a column by Dr. Howard Markel, who questioned China’s lockdown of millions of people. “It’s possible that this coronavirus may not be highly contagious, and it may not be all that deadly,” wrote Markel, director of the Center for the History of Medicine at the University of Michigan.

JAMA, one of the most prestigious medical journals in the world, published a podcast Feb. 18 titled, “The 2020 Influenza Epidemic — More Serious Than Coronavirus in the US.” A week later, JAMA published a large infographic illustrating the dangers of flu and minimizing the risks from the novel virus.

Dr. Paul Offit, who led development of a rotavirus vaccine, predicted that the coronavirus, like most respiratory bugs, would fade in the summer.

“I can’t imagine, frankly, that it would cause even one-tenth of the damage that influenza causes every year in the United States,” Offit told Christiane Amanpour in a March 2 appearance on PBS.

President Donald Trump picked up on many of these remarks, predicting that the coronavirus would disappear by April and that it was no worse than the flu. Trump later said the country was “rounding the turn” on the pandemic, even as the number of deaths exploded to record levels.

Caitlin Rivers, an epidemiologist and assistant professor at the Johns Hopkins Bloomberg School of Public Health, worried — and tweeted — about the novel coronavirus from the beginning. But she said public health officials try to balance those fears with the reality that most small outbreaks in other countries typically don’t become global threats.

New sitrep out from Wuhan pneumonia outbreak. 59 cases between 12/12 and 12/29. SARS ruled out, but no other etiology identified. Still no evidence of H2H.

— Caitlin Rivers, PhD (@cmyeaton) January 5, 2020

“If you cry wolf too often, people will never pay attention,” said epidemiologist Mark Wilson, an emeritus professor at the University of Michigan School of Public Health.

Experts were hesitant to predict the novel coronavirus was the big pandemic they had long anticipated “for fear of seeming alarmist,” said Dr. Céline Gounder, an infectious disease specialist advising President-elect Joe Biden.

Many experts fell victim to wishful thinking or denial, said Dr. Nicole Lurie, who served as assistant secretary for preparedness and response during the Obama administration.

“It’s hard to think about the unthinkable,” Lurie said. “For people whose focus and fear was bioterrorism, they had a world view that Mother Nature could never be such a bad actor. If it wasn’t bioterrorism, then it couldn’t be so bad.”

Had more experts realized what was coming, the nation could have been far better prepared. The U.S. could have gotten a head start on manufacturing personal protective equipment, ventilators and other supplies, said Dr. Nicholas Christakis, author of “Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live.”

“Why did we waste two months that the Chinese essentially bought for us?” Christakis asked. “We could have gotten billions of dollars into testing. We could have had better public messaging that we were about to be invaded. … But we were not prepared.”

Dr. Fauci Doesn’t Cast Blame

Dr. Anthony Fauci, the nation’s top infectious disease official, isn’t so critical. In an interview, he said there was no way for scientists to predict how dangerous the coronavirus would become, given the limited information available in January.

“I wouldn’t criticize people who said there’s a pretty good chance that it’s going to turn out to be like SARS or MERS,” said Fauci, director of the National Institute of Allergy and Infectious Diseases, noting this was “a reasonable assumption.”

It’s so easy to go back with the retrospect-o-scope and say ‘You coulda, shoulda, woulda.’

— Dr. Anthony Fauci

Fauci noted that solutions are always clearer in hindsight, adding that public health authorities lose credibility if they respond to every new germ as if it’s a national disaster. He has repeatedly said scientists need to be humble enough to recognize how little we still don’t know about this new threat.

“It’s so easy to go back with the retrospect-o-scope and say ‘You coulda, shoulda, woulda,’” Fauci said. “You can say we should have shut things down much earlier because of silent spread in the community. But what would the average man or woman on the street have done if we said, ‘You’ve got to close down the country because of three or four cases?’”

Scientists largely have been willing to admit their errors and update their assessments when new data becomes available.

“If you’re going to be wrong, be wrong in front of millions of people,” Offit joked about his PBS interview. “Make a complete ass of yourself.”

Scientists say their response to the novel coronavirus would have been more aggressive if people had realized how easily it spreads, even before infected people develop symptoms — and that many people remain asymptomatic. “For a virus to have pandemic potential, that is one of the greatest assets it can have,” Adalja said.

Although COVID-19 has a lower death rate than SARS and MERS, its ability to spread silently throughout a community makes it more dangerous, said Dr. Kathleen Neuzil, director of the Center for Vaccine Development at the University of Maryland School of Medicine.

People infected with SARS and MERS are contagious only after they begin coughing and experiencing other symptoms; patients without symptoms don’t spread either disease.

With SARS and MERS, “when people got sick, they got sick pretty badly and went right to the hospital and weren’t walking around transmitting it,” Christakis said.

Because it’s possible to quarantine people with SARS and MERS before they begin spreading the virus, “it was easier to put a moat around them,” said Offit.

Based on their knowledge of SARS and MERS, doctors believed they could contain the novel coronavirus by telling sick people to stay home. In the first few months of the pandemic, there appeared to be no need for healthy people to wear masks. That led health officials, including U.S. Surgeon General Jerome Adams, to admonish Americans not to buy up limited supplies of face masks, which were desperately needed by hospitals.

Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!

— U.S. Surgeon General (@Surgeon_General) February 29, 2020

“We are always fighting the last epidemic,” Markel said. “Our experiences with coronaviruses was that they kind of burn themselves out in warm weather and they didn’t have the capacity to spread as viciously as this one has.”

Many scientists were skeptical of early anecdotes of pre-symptomatic spread.

“It takes a lot to overturn established dogma,” Wilson said. “Jumping on an initial finding, without corroborating it, can be just as bad as missing a new finding.”

As evidence of pre-symptomatic spread accumulated, the Centers for Disease Control and Prevention in April changed its advice and urged Americans to mask up in public.

I continue to be baffled that we keep making the same mistakes. It’s almost like we’re doomed to repeat this cycle endlessly.

— Dr. Amesh Adalja

Adalja notes that the CDC’s earlier advice against wearing masks was based on research that found them to be ineffective against spreading influenza. New research, however, has shown masks reduce the transmission of the novel coronavirus, which spreads mainly through respiratory droplets but can travel in the air as tiny particles.

Adalja said the U.S. should have learned from its early stumbles. Yet in spite of abundant evidence, many communities still resist mandating masks or physical distancing.

“I continue to be baffled that we keep making the same mistakes,” Adalja said. “It’s almost like we’re doomed to repeat this cycle endlessly.”

Some Saw It Coming

There were scientists and journalists who immediately recognized the threat from the novel coronavirus.

“We had to immediately react as if this were going to hit every corner of the Earth,” said Adalja, who began blogging about the novel virus Jan. 20. It was clear “this was not a containable virus.”

Adalja led a 2018 project identifying the features that allow emerging viruses to become pandemic. In that prescient report, Adalja and his co-authors highlighted the threat of certain respiratory viruses that use RNA as their genetic material.

The more Adalja learned about the novel coronavirus, the more it seemed to embody the very type of threat he had warned about: one with “efficient human-to-human transmissibility, an appreciable case fatality rate, the absence of an effective or widely available medical countermeasure, an immunologically naïve population, virulence factors enabling immune system evasion, and respiratory mode of spread.”

Although the CDC set the wheels of its response in motion early, establishing an incident management structure on Jan. 7, the agency’s early missteps with testing are well known. The outbreak escalated rapidly, leading the World Health Organization to declare a health emergency on Jan. 30 and the U.S. to announce a public health emergency the next day.

Adalja and other experts dismissed some of the Trump administration’s early responses, such as quarantines and a travel ban on China, as “window dressing” that “squandered resources” and did little to contain the virus.

“There was political inertia about the public health actions that could have avoided lockdowns,” Adalja said. “We let this spill into hospitals … [and] if you give a virus a three-month head start, what do you expect?”

In a Jan. 7 post on a website of the Infectious Diseases Society of America, Dr. Daniel Lucey labeled the pneumonia “Disease X,” using the WHO’s term for an emerging pathogen capable of causing a devastating epidemic, for which there are no tests, treatments or vaccines.

Lucey, adjunct professor of infectious diseases at Georgetown University Medical Center, notes that the international response was hampered by misinformation from Chinese officials. “The Chinese government said there was no person-to-person spread,” said Lucey, who traveled to China hoping to visit Wuhan. “That was a lie.”

When China revealed on Jan. 20 that 14 health workers had been infected, Lucey knew the virus would spread much farther. “To me, that was like Pandora’s box,” Lucey said. “I knew there would be more.”

When the number of infected health workers grew to 1,716 on Feb. 14, Lucey said, “I almost threw up.”

Although his blog is read by thousands of infectious disease specialists, Lucey emailed a special warning to journalists and a dozen doctors and public health officials, hoping to alert influential leaders.

“I put this heartfelt commentary in my email and just got silence,” Lucey said.

Succeeding With Vaccines

At the National Institute of Allergy and Infectious Diseases, scientists had studied the protein structure of coronaviruses for years.

Researchers had developed a vaccine against SARS, Fauci said, although the epidemic ended before researchers could widely test it in humans.

“We showed it was safe and induced an immune response,” Fauci said. “The cases of SARS disappeared, so we couldn’t test it. … We put the vaccine in cold storage. If SARS comes back, we will do a phase 3 [clinical] trial.”

Dr. Barney Graham, deputy director of the Vaccine Research Center, asked Chinese scientists to share the coronavirus’s genetic information. After the genome was published, Graham went immediately to work.

“We jumped all over it,” Fauci said. “We had a meeting on Jan. 10 and five days later they started [working on] a vaccine.”

Although scientists knew the COVID outbreak might end before a vaccine was needed, “we couldn’t take the chance,” Fauci said.

“We said, ‘We have no idea what is going to happen, so why don’t we just go ahead and proceed with a vaccine anyway?’”

Although his team worried about finding the money to pay for it all, Fauci told them, “‘Don’t worry about the money. I’ll find it, you do it, if we really need it, I’m sure we’ll get it.’”

Health experts hope the U.S. will learn from its mistakes and be better prepared for the next threat.

Given how many novel viruses have emerged in the past two decades, it’s likely that “pandemics are going to become more frequent,” Gounder said, making it critical to be ready for the next one.

Of all the lessons learned during the pandemic, the most important is that “we can’t be this unprepared again,” said Dr. Tom Frieden, who directed the CDC during the Obama administration.

“To me, this should be the most teachable moment of our lifetime, in terms of the need to strengthen public health in the United States and globally,” Frieden said.

But Gounder notes that U.S. public health funding tends to follow a cycle of crisis and neglect. The U.S. increased spending on public health and emergency preparedness after the 9/11 and anthrax attacks in 2001, but that funding has declined sharply over the years.

“We tend to invest a lot in that moment of crisis,” Gounder said. “When the crisis fades, we cut the budget. That leads us to be really vulnerable.”

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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How to Pull Off a COVID-Era Music Festival

BEVERLY HILLS, Calif. — As the pandemic took hold and well-grooved music festivals canceled their mainstream events, Krista Selico saw an opening. She had been organizing the Helix Festival as an opportunity to give artists in the urban music community a chance to redefine the genre for themselves, as well as choose more racially diverse headliners.

The industry’s destination festivals had excluded many diverse performers and types of music, she said, adding: “Urban music is so much more than what we hear on the radio.”

Although the COVID crisis dealt a blow to entertainment events worldwide, it also gave birth to new channels of entertainment. Netflix, Fever and Secret Cinema joined forces to create the Stranger Things “drive-into experience,” an immersive drive-thru concept that leads patrons through the world of the Netflix series “Stranger Things” from the safety — and distance — of their cars. A R I Z O N A, a band signed by Atlantic Records, performed an immersive livestream concert from Nashville on Oct. 29 through mySongbird, a new live-performance streaming app. Comedian Dave Chappelle has been hosting physically distanced comedy shows and music events at Wirrig Pavilion in Yellow Springs, Ohio, since May.

And Selico’s Helix Festival seemed primed for the COVID era.

Her goal was to feature less-mainstream offerings in a protected Caribbean environment — reportedly more affordable this year because COVID-19 has greatly eaten into conventional tourism. The lineup included Noise Cans, a Bermuda-born DJ based in the U.S. known as Collas who fuses Caribbean carnival music with electronic dance, Nigerian-American Afrobeats star Davido, and contemporary R&B/hip-hop artist Ty Dolla $ign.

“It’s called Helix Festival because we’re talking about our DNA,” said Selico, a University of Southern California graduate and health care administrator in Los Angeles. The festival was scheduled for October and sales were hot, with tickets in the $1,800-$3,000 price range.

Of course, with the pandemic spreading, Selico realized that festival patrons would see more health and safety precautions implemented. That could mean limited-capacity tickets with potentially higher price tags, suggesting that, in turn, artists and promoters would have to offer more of an experience in exchange for those sales.

At USC, Selico majored in cultural arts, with an emphasis in classical voice. She loved singing opera but felt shut out of the operatic world due to race. As a Black woman, she said, she felt pressured to fit into the limited mainstream molds Black artists are often pressed into: mainly hip-hop and R&B. She created Helix Festival to elevate and broaden the urban music menu.

Selico had been planning the luxury, urban music festival for two years before the pandemic hit. Because the festival was designed to be high-end, boasting private accommodations for attendees, she and her crew pushed forward with planning and promoting through the summer months, even as established festivals were canceling (many not offering refunds). “We’ll be on lockdown for two weeks, then two weeks turns into two months … but the ticket sales continued and no one’s asking for refunds,” she said.

Some large festivals such as Tomorrowland — a two-week-long Belgian electronic dance music festival — went fully virtual using streaming services, but Selico’s was planned for overseas, on an island — Jamaica — with a low COVID case count. And at an expansive resort — the Bahia Principe Grand in Runaway Bay — where safe outdoor enjoyment and social distancing seemed plausible.

The festival’s COVID-19 precautions were developed using the same protocols established by Jamaica’s Ministry of Tourism, Ministry of Health & Wellness (MoHW), the Jamaica Tourist Board and the Tourism Product Development Co. From intake to departure, Selico said, coronavirus precautions would be in place.

She knew she would have to orchestrate her first festival with more precautions than any prior such event and less of a fun-filled, devil-may-care attitude: “If someone gets dehydrated and passes out, we’ve got to test them for everything now,” she said.

Because of the setting, Selico reasoned that COVID-era safety adjustments wouldn’t seem onerous. Even before the pandemic, a luxury component of Helix was private beach “pods” for patrons spaced at least 6 feet apart for lounging on the beach. And “everything is digital,” she said. There would be no exchange of physical money or tickets at Helix Festival, similar to procedures restaurants across America are adopting, along with doing away with physical menus.

She put extra safeguards in place:

  • Attendees would be required to submit negative COVID test results 48 hours before arrival and, in lieu of rum punch, would be greeted with temperature checks at the airport, at other transit points and before entering the festival grounds. Face masks would be required on all trips to and from the airport and resort.
  • If an attendee exhibited COVID-19 symptoms, the Helix Festival site stated, they would be moved into a designated isolation room at the venue for screening by a COVID-19 Safety Point Person — an employee designated to conduct spot checks, which the Jamaican government now requires of both the hotel and festival organizers. The MoHW would be contacted and, if necessary, the attendee would be put into mandatory quarantine.
  • During concerts, guests would be seated in every other seat in all open seating areas, while groups who arrive together could sit next to one another. A minimum distance of 6 feet would be maintained between patrons and performers on designated stage areas, an easy feat considering the Helix Festival’s main stage was to be set on the ocean in the middle of a small bay on the resort.
  • For an even more enhanced luxury experience, and elevated social distancing, guests could purchase such upgrades as a VIP cabana for up to six people, or for $6,000 guests could rent a private catamaran — the festival’s version of box seats — for up to 10 people, docked around the floating stage.

When patrons weren’t getting their urban music palates expanded by acts on the main stage, themed events would feature visual artists, fire dancers and even a hologram light show presented by Chad Knight, a 3D designer with Nike. These activities — including any water sports — would be limited to follow social distancing requirements, the festival’s site stated.

According to the festival site, no food or beverages would be sold on festival grounds — another break from pre-COVID music festivals. Prepaid top-shelf liquor and snack boxes would be prepackaged and individually sealed before distribution at check-in. Hand-sanitizer stations would be strategically placed throughout the festival grounds, as well as touchless waste bins.

As of Dec. 10, Jamaica — the fourth-most-populous country in the Caribbean — had seen over 11,509 COVID-19 cases and 270 deaths, according to the government’s ministry of health and wellness website. Currently, travelers to Jamaica must apply for travel authorization through the Jamaica Tourist Board, including an upload of the results from a valid PCR test performed no more than seven days from their arrival date.

With the average ticket pricing starting at around $2,000 and no sure way to guarantee attendees would be permitted across the Jamaican border or quarantined, in late August Selico decided to postpone the festival until fall 2021. Tickets to the nearly sold-out event were refunded at 100%. “We’re going to add more artists. We’re going to be able to expand on this health care aspect,” Selico said.

And, since COVID-19 is likely to be around for a while, vaccine or not, she is confident she has developed the expertise to be a pandemic-friendly festival promoter. “I think this is the model for festivals going forward,” Selico said.

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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Come for Your Eye Exam, Leave With a Band-Aid on Your Arm

With multiple COVID-19 vaccines rapidly heading toward approval, optometrists and dentists are pushing for the authority to immunize patients during routine eye exams and dental cleanings.

Across the country, these medical professionals say their help will be needed to distribute the vaccines to millions of Americans — and they already have the know-how.

“When you look at what dentists do, and how many injections they give day in and day out, I think they’re more than qualified,” said Jim Wood, a California state assembly member and dentist. “It’s kind of a no-brainer.”

In California, the professional organizations representing dentists and optometrists are in talks with state officials to expand their job descriptions to include administering vaccines. Oregon has already begun training and certifying dentists to give vaccines. And at least half the states have considered allowing dentists to administer COVID vaccines once they’re available, according to the American Association of Dental Boards.

That list is likely to grow, because the U.S. Centers for Medicare & Medicaid Services recommended in October that states consider expanding their list of vaccine providers.

The dentists and optometrists seeking permission to vaccinate patients against COVID-19 and other diseases argue that their help will take some of the pressure off hospitals and doctors’ offices. It could also bring some extra money into their practices.

“Everyone in our specialized health care system should also play a preventive role,” said Dr. William Sage, a professor of law and medicine at the University of Texas-Austin. “Pandemic or not, being alert to preventive health in any setting is a good thing.”

In November, Pfizer, Moderna and AstraZeneca announced that their COVID vaccine candidates delivered promising results in clinical trials, and that millions of doses could be ready before the end of the year. Pfizer’s has to be stored at ultracold temperatures, while Moderna’s and AstraZeneca’s can be kept at standard refrigerator temperatures.

This wouldn’t be the first time health professionals other than doctors administered vaccines during a pandemic. Nursing students, EMTs and midwives in a handful of states were granted temporary and limited authority to administer flu vaccines during the H1N1 swine flu pandemic of 2009-10. Dentists in Massachusetts, Illinois, New York and Minnesota also were temporarily deputized as vaccinators.

Since then, Minnesota and Illinois have adopted laws to allow dentists to give flu shots to adults. And last year, Oregon became the first state to allow dentists to give any vaccine to any patient, whether a child or an adult.

So far, more than 200 dentists and dental students in Oregon have completed the training course offered by the Oregon Health & Science University’s School of Dentistry, with 60 others expected to finish by the end of December, said Mary Pat Califano, an instructor who helped develop the hands-on part of the training.

Students spend around 10 hours in online classes. They then undergo hands-on training during which they practice injections on a shoulder pad before practicing injecting a partner with saline. They’re taught how to counsel patients about vaccines and avoid injuring patients’ shoulders when giving the shots.

Once dentists pass an exam, they can register with the Oregon Health Authority and begin getting their staff trained to handle vaccines and procuring a fridge to store them.

The goal, Califano said, is not to replace family doctors or primary care physicians, but to supplement them. The federal Agency for Health Research and Quality found that, in 2017, 31.1 million Americans saw a dentist but not a physician.

“We just need as many people as possible to give flu shots and COVID-19 vaccines when they’re available,” Califano said. “If it happens that they’re in a dental office, and that provider is educated and capable of giving a vaccine, why not?”

In California, the state dental association is exploring options for gaining vaccine authority, which would likely require the legislature to step in. This year, California passed a law allowing pharmacists to administer COVID vaccines approved by the U.S. Food and Drug Administration.

Wood, who carried that measure, hasn’t yet committed to sponsoring a bill that would let dentists give vaccines, but says he supports the idea.

“We give injections in the mouth all day long, and these are very precise kinds of injections,” Wood said. “I think the learning curve for a dentist would be small.”

Dr. Bill Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University, said these proposals for expanding the vaccine workforce are promising. Flu vaccines, which are relatively low-risk and simple to administer, would be the perfect candidate to stock in dental and optometric fridges to start.

But Schaffner doesn’t believe dentists and optometrists will play a major role in the COVID immunization effort. It would take too long to pass legislation to expand the scope of practice for every professional who wants it in every state, he said. And since some COVID vaccines have specific shipping and subzero storing requirements, they will probably be distributed only to specially trained personnel at a small number of locations, he said.

There’s also the question of payment. It’s hard — but not impossible — to make a profit administering vaccines, Schaffner said.

Providers have to decide each season how many doses to buy, and any that go bad or remain in the fridge at the end of their shelf life equal monetary losses.

“Unless you’re very assiduous about moving the vaccine from the fridge into arms, you’re not going to make money,” Schaffner said. “People who do that can augment their income, but nobody is going to drive a Porsche because of vaccines.”

Jeff McCombs, an associate professor of health economics at the University of Southern California School of Pharmacy, agreed it might not make business sense for most dentists to start vaccinating. He said it would be hard to keep a well-stocked vaccine fridge with enough variety to meet patients’ needs without wasting doses. Generally, adults who choose not to get vaccinated do so because they’re uneducated about vaccines or afraid, he said, not because they can’t access them.

“I don’t think it’s going to harm people,” McCombs said. “I just don’t think they’ll make any money at it.”

While the California Department of Public Health said the state’s current vaccine infrastructure is sufficient for flu shots and routine immunizations, it is “carefully considering the need to include additional types of immunizers” to get Californians vaccinated against COVID-19, according to a statement from the department.

The California Optometric Association said it is in talks with Gov. Gavin Newsom’s vaccine task force about how to get optometrists into the mix, and is exploring legislative options as well.

“We can serve the dual role of assisting with vision needs and protecting from COVID,” said David Ardaya, an optometrist in Whittier who chairs an association committee that is looking into the issue. “Our whole hope is to assist our nation in regaining its health and in returning to a sense of normal.”

But three years after AB-443 was signed, the regulations implementing it have yet to be finalized.

That didn’t stop Frank Giardina, an optometrist in Nipomo, from going through a certification program anyway.

The 20-hour course, which includes online lectures, hands-on lessons and an exam, is the same course pharmacists take when learning how to give all vaccines to people of all ages.

Giardina pointed to the shingles, or herpes zoster, virus as an example of why optometrists are well suited to give vaccines. The virus can infect the eyes, and even though he’s allowed to treat shingles, he can’t give a vaccine to prevent it.

For now, he’s holding out hope he will get permission to administer vaccines, including for COVID-19. He envisions a world in which a patient comes in for contact lenses and he can offer them a flu or COVID vaccine while they’re there.

“We’re another member of the health care team. It’s a waste of manpower not to,” Giardina said. “If you’re trying to vaccinate all these people, especially in rural areas, you need whoever you can find.”

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.


This story can be republished for free (details).

Trump’s Lame-Duck Status Leaves Governors to Wing It on COVID

Not long after the world learned that President Donald Trump had lost his reelection bid, states began issuing a new round of crackdowns and emergency declarations against the surging coronavirus.

Taking action this time were Republican governors who had resisted doing so during the spring and summer. Now they face an increasingly out-of-control virus and fading hope that help will come from a lame-duck president who seems consumed with challenging the election results.

President-elect Joe Biden has promised a more unified national effort once he takes office on Jan. 20, and pressure is building on Congress to pass a new financial relief package. But with record hospitalizations and new cases, many governors have decided they can’t afford to wait.

“I don’t know any governor who’s sitting there waiting for the knight to come in on the horse,” said Lanhee Chen, a fellow at the Hoover Institution and a former senior health official in President George W. Bush’s administration. “There’s no way for these guys to just sit and wait. The virus and the crisis is getting worse hour by hour, day by day.”

As new measures trickle out across states, public health policy experts worry many don’t go far enough. For those states attempting to impose meaningful restrictions, their success depends on cooperation from a population with pandemic fatigue. And people may be reluctant to curtail their holiday gatherings.

Residents of many conservative states don’t acknowledge the depth of the health problem, especially given Trump and some of his allies have stressed the crisis is being overplayed and will end quickly.

The bottom line is that many people just aren’t sufficiently scared of the virus to do what must be done to stop the spread, said Rodney Whitlock, a health policy consultant and former adviser to Sen. Chuck Grassley (R-Iowa).

“You’re dealing with folks there who definitely put liberty over everything else because they’re not afraid enough,” Whitlock said. “Even in the face of cases, even in the face of people around them getting it. They’re just not afraid.”

Among the first governors to act was outgoing Utah Gov. Gary Herbert. The day after The Associated Press called the presidential election for Biden on Nov. 7, the Republican announced Utah’s first-ever statewide mask mandate and clamped down on social gatherings and other activities until Nov. 23.

“All of us need to work together and see if there’s a better way,” Herbert said in a news conference.

Republican and Democratic governors alike followed with measures of their own in Colorado, Iowa, Michigan, Nebraska, New York, Ohio, Oregon, Pennsylvania, Washington and other states. Strategies included partial lockdowns, limits on crowds, canceling in-person classes for schools and reducing hours and capacity for bars and restaurants.

Health policy experts largely agree that the virus’s spread, not the end of the election, is what’s driving these changes — though the end of the campaign season does take political pressure off governors inclined to issue COVID-preventive policies.

“It’s much easier to act when you don’t have attention on you than when you do, but I would hope that the action is taking place regardless of what the political circumstances are,” Chen said.

No state has yet resorted to the sort of full lockdowns enacted in the spring, which resulted in mass business closures and layoffs and sent the economy crashing.

Christopher Adolph, an associate professor at the University of Washington, and his team with the university’s COVID-19 State Policy Project have been studying states’ responses to the pandemic. Some states have made a show of taking action, without much substance behind it, he said. For example, Alaska Gov. Mike Dunleavy, a Republican, declared an emergency on Nov. 12 — but only recommended, not ordered, that people wear masks and maintain social distance.

Other governors first took small steps only to follow up with tighter restrictions. In Iowa, for example, Republican Gov. Kim Reynolds, who opposed mask mandates during the presidential campaign, initially announced that all people over age 2 would be required to wear masks at gatherings of certain sizes. On Nov. 16, she issued a simpler but stricter three-week statewide mask mandate.

North Dakota Gov. Doug Burgum, a Republican, also ordered mandatory face coverings for the first time. Hospitals there have been reporting they have more patients than capacity, and the state has been leading the country in new per capita COVID cases.

At the very least, each state should make it clear that people must not gather indoors, Adolph said. Restaurants, bars, gymnasiums and large indoor events should be closed, he said, and gatherings inside people’s homes should not happen.

“We’re not seeing enough clear, broadly communicated, well-stated, unambiguous policies,” Adolph said.

An exception is Herbert, one of two governors who will leave office in January. The two-term Utah governor will turn over the reins to his current lieutenant governor, Spencer Cox, who has been a part of the state’s response to the pandemic since the beginning. Both Republicans have promised a smooth, seamless transition between administrations.

The nation’s other lame-duck governor is Montana’s Steve Bullock, a Democrat. But unlike Herbert, the term-limited Bullock will be replaced by a governor from a different party. Republican U.S. Rep. Greg Gianforte defeated Bullock’s lieutenant governor, Mike Cooney, in the Nov. 3 election. And Bullock lost his bid for the U.S. Senate.

Bullock said in a Nov. 12 news conference that he would not take additional COVID-intervention measures without a federal aid package to blunt the economic fallout. Five days later, he reversed himself to expand a previous mask requirement and limit capacity and hours in bars, restaurants and other entertainment venues.

Gianforte has not directly answered whether he would continue Bullock’s restrictions. When asked, the governor-elect has spoken instead of personal responsibility and reopening the economy while protecting the most vulnerable people. In July, he referenced the unfounded hope that the virus would be slowed by the U.S. reaching “herd immunity” by the end of the year.

Another obstacle is that a district judge essentially ruled Bullock’s mask mandate unenforceable. State health department lawyers had asked District Judge Dan Wilson to enforce the mandate against five businesses accused of flouting the measure.

“The businesses and the owners have been put on the front line of implementing a state policy that has more exceptions than directives and would be about as effective in bailing water from the leaky boat of our present health circumstances as would a colander,” the judge said in denying the request.

That leaves Bullock with the task of managing a crisis in his final weeks of office with local officials already looking past him to a new administration.

In Flathead County, where the five businesses were sued for violating the mask mandate, local leaders were already chafing from what they saw as Bullock’s heavy hand.

“He has angered a lot of people in Flathead County,” County Commissioner Randy Brodehl, a Republican, said of Bullock. “He didn’t come here, he didn’t talk to us.”

Bullock’s troubles show that even if governors take measures to stem the spread of COVID-19, they may still have a difficult time persuading people to go along with them. That’s particularly an issue in the Upper Midwest and the Rocky Mountains, libertarian-leaning COVID hot spots where the medical infrastructure is already strained.

Some Trump supporters have followed the president’s lead in downplaying the virus and others are fatigued after months of isolation and precautions, said Whitlock.

In rural and conservative areas, people protest that COVID measures come at the expense of their personal freedom and their ability to earn a living, and some feel as though they’re being talked down to by mask advocates and public health officials, Whitlock said.

It’s going to take smart and consistent messaging to change attitudes — but that means more than Biden telling people to wear masks once he takes office, Whitlock added.

“Everybody has to own it,” he said. “You have to scream at the top of your lungs at the protests, at the celebrations, at the football games, at the concerts. It has to be, ‘Stop it!’”

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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Trump’s Anti-Abortion Zeal Shook Fragile Health Systems Around the World

In Ethiopia, health clinics for teenagers once supported by U.S. foreign aid closed down. In Kenya, a decades-long effort to integrate HIV testing and family planning unraveled. And in Nepal, intrepid government workers who once traversed the Himalayas to spread information about reproductive health were halted.

Around the world, countries that depend on U.S. foreign aid have scrapped or scaled back ambitious public health projects, refashioning their health systems over the past four years to comport with President Donald Trump’s sweeping anti-abortion restrictions that went further than any Republican president before him.

The effects have been profound: As groups scrambled to meet the administration’s strict ideologically driven rules, they severed ties with health care providers that discuss abortion in any way, deleted references to abortion on websites and in sexual education curricula, and stopped discussing modern contraception for fear of forfeiting vital American aid.

President-elect Joe Biden has pledged to reverse the policy when he takes office, and he campaigned on a promise to enshrine abortion rights in federal law. But for many foreign aid groups, the changes may be permanent.

“The U.S. has lost its position as a leader and lost its credibility,” said Terry McGovern, of Columbia University’s Mailman School of Public Health who has overseen research of the Trump policy in multiple countries.

Since Ronald Reagan, Republican presidents have barred foreign aid organizations from using U.S. global health funds to counsel women about abortion or refer them to a safe abortion provider. But the Trump administration vastly expanded those anti-abortion restrictions, known as “the global gag rule” by opponents. Under Trump, the rule applies to some $9 billion of aid touching nearly every facet of global health funding, including groups working on HIV, malaria, tuberculosis and water sanitation. Under President George W. Bush, the policy applied to a fraction of that, $600 million in foreign aid.

The Trump administration proudly touted these efforts to protect “the unborn abroad,” but the rules have left international aid groups deeply skeptical of U.S. promises and deepened the nation’s rift with European countries that have long viewed abortion access as vital to women’s health and safety.

Some major organizations opted out of any U.S. funding rather than comply with the new strictures, including Marie Stopes International and International Planned Parenthood Federation, among the largest providers of reproductive health care in the developing world. Untold numbers of front-line health care workers — in large cities and remote villages alike — have been confused by what seem like sudden swings in American policy.

And that trepidation may not be quick to dissipate even with a Democrat in the White House.

“Biden and Trump may seem radically different to Americans,” said Jennifer Sherwood, a policy manager at Amfar, the Foundation for AIDS Research. “But if you’re a small organization in sub-Saharan Africa, you may not understand what this new [Biden] administration means and if you can trust the United States.”

The restrictions intentionally constrict the activities of foreign aid groups, many of which have worked in close coordination with American counterparts for decades. The rules also have a ripple effect on their funding: U.S. funding to foreign groups is contingent on their not accepting money from other countries, or even private foundations, to underwrite abortion-related services. They are not allowed to subcontract with other organizations that run separate abortion-related projects.

Trump telegraphed the worldwide anti-abortion gains in appeals to evangelical Christians. In early October, Secretary of State Mike Pompeo touted the policy during a speech to the Florida Family Policy Council, a conservative anti-abortion group, calling it an “unprecedented defense of the unborn abroad.”

“Our administration has drawn on our first principles to defend life in our foreign policy like no administration in all of history,” said Pompeo, who is an evangelical Christian.

The hard-right policies of the Trump administration stand in stark contrast to the steady liberalization of abortion laws in countries around the world over the past two decades. Since 2000, more than two dozen countries have eased abortion laws, including Ireland, South Korea, the Democratic Republic of Congo and Ethiopia.

Even in countries where abortion is forbidden, the rules are having an impact on reproductive health care. In Madagascar, where abortion is illegal with no exceptions, the largest provider of contraception, Marie Stopes, turned down U.S. money, endangering its ability to offer unfettered medical care to women, ending support for nearly 200 public and private facilities.

Mamy Jean Jacques Razafimahatratra, a researcher at the Institut National de Santé Publique et Communautaire in Antananarivo, found that led to shortages of contraception, in a poor country where travel to nearby towns is difficult.

“The women asked us, ‘What is the cause of this rupture?’” said Razafimahatratra. “We tried to explain to them the reason, and [they say], ‘But that regulation is for abortion, so we don’t understand why we are also penalized?’”

Researchers at Amfar and Johns Hopkins, in a study published in Health Affairs, found the anti-abortion policies could have deadly consequences, specifically in preventing the spread of HIV/AIDS. Sherwood said young African women face the highest risk of HIV and many clinics had combined HIV testing and treatment with family planning services.

But, fearing they would run afoul of the Trump policy and thus forfeit funding, clinics have curtailed family planning for patients, reducing the number of women seeking care in African countries.

“A lot of the times, they want contraception,” said Sherwood. “That is what’s on their mind, and HIV is the secondary thing, something we can tack on to meet their needs all at once.”

Jennifer Kates, director of global health and HIV policy at KFF said, “I have no doubt some groups are going to say, ‘We are not going to play there anymore.’” (KHN is an editorially independent program of KFF.)

The practical challenges of restarting these programs are steep: rehiring staff, reopening clinics, retraining employees, rewriting curricula.

“You can imagine being a health care worker that was under threat of losing their funding for counseling a patient on abortion,” Sherwood said. “To us, it’s like a light switch that can turn off and on, but to them, this is a very opaque and confusing process. It’s not how health systems work. You can’t just change the way they work overnight.”

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.


This story can be republished for free (details).

Trump Says He Saved 2 Million Lives From COVID. Really?

President Donald Trump has repeatedly claimed to have saved 2 million lives from COVID-19 through his actions to combat the disease.

Recently, he made the assertion during the NBC News town hall on Oct. 15 that replaced the second presidential debate.

“But we were expected to lose, if you look at the original charts from original doctors who are respected by everybody, 2,200,000 people,” Trump said. “We saved 2 million people,” he added.

He mentioned the same ballpark figure during a Sept. 15 ABC News town hall and posted a tweet about it on Oct. 13.

Others in the Trump administration have also pointed to the 2.2 million figure. Vice President Mike Pence referenced it during the vice presidential debate on Oct. 7. So did Health and Human Services Secretary Alex Azar during a Sept. 20 “Meet the Press” television interview.

Where did this number come from? And is there any truth to the idea that Trump is responsible for saving 2 million lives from COVID-19? Since Trump continues to use it to claim success, we decided to look into it.

What We Know About the ‘2 Million’

The White House and the Trump presidential campaign did not respond to our request for evidence supporting the idea that roughly 2 million lives were spared.

It appears to have first been mentioned by the president during a March 29 White House coronavirus task force press briefing, when Trump and Dr. Deborah Birx, task force coordinator, explained they were asking Americans to stay home from mid-March through the end of April, because mathematical models showed 1.6 million to 2.2 million people could die from COVID-19.

The warning stemmed from a paper authored by Neil Ferguson, an epidemiology professor at Imperial College London. He modeled how COVID-19 can spread through a population in different scenarios, including what would happen if no interventions were put in place and people continued to live their daily lives as normal.

In the paper, Ferguson wrote, “In total, in an unmitigated epidemic, we would predict approximately 510,000 deaths in [Great Britain] and 2.2 million in the US.”

Ferguson did not respond to our request to talk through the study with him. But in a July email interview with HuffPost, he said Trump’s boasting of saving 2.2 million lives isn’t true, because the pandemic isn’t over.

Andrea Bertozzi, a mathematics professor at UCLA, said it was important to remember the 2.2 million figure was derived from a modeling scenario that would almost certainly never happen — which is that neither the government nor individuals would change their behavior at all in light of COVID-19.

The study didn’t mean to say 2.2 million people were absolutely going to die, but rather to say, “Hold on, if we let this thing run its course, bad things could happen,” said Bertozzi. Indeed, the results from the study did cause government leaders in both the U.S. and the United Kingdom to implement social distancing measures.

Experts also pointed out that the U.S. has the highest COVID-19 death toll of any country in the world — more than 220,000 people — and among the highest death rates, according to the Johns Hopkins Coronavirus Resource Center.

“I don’t think we can say we’ve prevented 2 million deaths, because people are still dying,” said Justin Lessler, an associate professor of epidemiology at Johns Hopkins Bloomberg School of Public Health.

In some instances when using the 2 million estimate, Trump and others in his administration cited the China travel restrictions for saving lives, while other times they’ve credited locking down the economy. We’ll explore whether either statement holds water.

Did Travel Restrictions Do Anything?

Trump implemented travel restrictions for some people traveling from China beginning Feb. 2 and for Europe on March 11. But experts say and reports show the restrictions don’t appear to have had much effect because they were put in place too late and had too many holes.

The Centers for Disease Control and Prevention reported the first cases of coronavirus in the U.S. arrived in mid-January. So, since the travel bans were put in place after COVID-19 was already spreading in the U.S., they weren’t effective, said Josh Michaud, associate director for global health policy at the KFF. (KHN is an editorially independent program of KFF.)

A May study supports that assessment. The researchers found the risk of transmission from domestic air travel exceeded that of international travel in mid-March.

Many individuals also still traveled into the U.S. after the bans, according to separate investigations by The New York Times and the Associated Press.

Based on all this, experts said there isn’t evidence to support the idea that the travel restrictions were the principal intervention to reduce the transmission of COVID-19.

What About Lockdowns?

On the other hand, the public health experts we talked to said multiple global and U.S.-focused studies show that lockdowns and implementing social distancing measures helped to contain the spread of the coronavirus and thus can be said to have prevented deaths.

However, Trump can’t take full credit for these so-called lockdown measures, which ranged from closing down all but essential businesses to implementing citywide curfews and statewide stay-at-home orders. On March 16, after being presented with the possibility of the national death tally rising to 2.2. million, the White House issued federal recommendations to limit activities that could transmit the COVID-19 virus. But these were just guidelines and were recommended to be in effect only through April 30.

Most credit for putting in place robust social distancing measures belongs to state and local government and public health officials, many of whom enacted stronger policies than those recommended by the White House, our experts said.

“I don’t think you can directly credit the federal government or the Trump administration with the shutdown orders,” said Lessler. “The way our system works is that the power for public health policy lies with the state. And each state was making its own individual decision.”

Some studies also explore the potential human costs of missed opportunities. If lockdowns had been implemented one or two weeks earlier than mid-March, for instance, which is when most of the U.S. started shutting down, researchers estimated that tens of thousands of American lives could have been saved. A model also shows that if almost everyone wore a mask in the U.S., tens of thousands of deaths from COVID-19 could have been prevented.

Despite these scientific findings, Trump started encouraging states — even those with high transmission rates — to open back up in May, after the White House’s recommendations to slow the spread of COVID-19 expired. He has also questioned the efficacy of masks, said he wouldn’t issue a national mask mandate and instead left mask mandate decisions up to states and local jurisdictions.

Our Ruling

President Trump is claiming that without his efforts, there would have been 2 million deaths in the U.S. from COVID-19.

But that 2 million number is taken from a model that shows what would happen without any mitigation measures — that is, if citizens had continued their daily lives as usual, and governments did nothing. Experts said that wouldn’t have happened in real life.

And while lockdowns and social distancing have indeed been proven to prevent COVID-19 illness and deaths, credit for that doesn’t go solely to Trump. The White House issued federal recommendations asking Americans to stay home, but much stronger social distancing measures were enforced by states.

Travel restrictions implemented by Trump perhaps helped hold down transmission in the context of broader efforts, but on their own, they don’t seem to have significantly reduced the transmission rate of the coronavirus.

We rate this claim Mostly False.

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.


This story can be republished for free (details).

No, the WHO Didn’t Change Its Lockdown Stance or ‘Admit’ Trump Was Right

On Monday, President Donald Trump claimed that the World Health Organization (WHO) “admitted” he was correct that using lockdowns to control the spread of COVID-19 was more damaging than the illness.

In a post on Twitter, Trump wrote: “The World Health Organization just admitted that I was right. Lockdowns are killing countries all over the world. The cure cannot be worse than the problem itself. Open up your states, Democrat governors. Open up New York. A long battle, but they finally did the right thing!”

He reiterated his statement later that night during a campaign rally, saying, “But the World Health Organization, did you see what happened? They just came out a little while ago, and they admitted that Donald Trump was right. The lockdowns are doing tremendous damage to these Democrat-run states, where they’re locked out, sealed up. Suicide rates, drug rates, alcoholism, deaths by so many different forms. You can’t do that.”

Together, the tweet and these comments got considerable attention on social media.

But did the WHO change its stance on lockdowns or concede anything to Trump, as he said it did? Briefly, no.

Since May, Trump has been vocal about asking states to reopen businesses, schools, religious services and other social activities. He also took credit for locking down the U.S. in the early stages of the pandemic, however. And his administration largely delegated lockdown decisions to governors and local governments.

Yet those lockdowns — marked by stay-at-home orders and other restrictions — have been less stringent than those implemented in other countries, said Brooke Nichols, an assistant professor of global health at Boston University.

The “definition has differed country by country and state by state. I would argue that the U.S. has never had an actual enforced lockdown like there have been in some Asian countries and in Italy last spring,” Nichols wrote in an email.

We reached out to the Trump campaign and the White House to ask for more information about Trump’s assertion but didn’t receive a response.

A Clip Doesn’t Tell the Full Story

Although the Trump team didn’t get back to us, we noticed that the Trump War Room Twitter account responded to Trump’s tweet with a link to a video, appearing to back up the president’s claim.

The video is a clip from an Oct. 8 interview with Dr. David Nabarro, a special envoy on COVID-19 for the WHO, by Scottish journalist Andrew Neil. The segment was televised by the British news outlet Spectator TV.

In response to a question about the economic consequences of lockdowns, Nabarro said: “We in the World Health Organization do not advocate lockdowns as the primary means of control of this virus. The only time we believe a lockdown is justified is to buy you time to reorganize, regroup, rebalance your resources; protect your health workers who are exhausted. But by and large, we’d rather not do it.” Nabarro then went on to describe potential economic consequences, including effects on the tourism industry and farmers or the worsening of world poverty.

We checked with Nabarro to find out if the clip accurately reflected the points he raised during a nearly 20-minute interview. He responded, by email: “My comments were taken totally out of context. The WHO position is consistent.”

That context Nabarro mentioned covered a range of topics, such as the estimate that about 90% of the world’s population is still vulnerable to COVID-19, that lockdowns are only an effective pandemic response in extreme circumstances and what Nabarro means when he talks about finding the “middle path.”

“We’re saying we really do have to learn how to coexist with this virus in a way that doesn’t require constant closing down of economies, but at the same time in a way that is not associated with high levels of suffering and death,” Nabarro said in the interview.

To achieve that via the middle-path approach, robust defenses against the virus must be put in place, said Nabarro, including having well-organized public health services, such as testing, contact tracing and isolation. It also involves communities adhering to public health guidelines such as wearing masks, physical distancing and practicing good hygiene.

So, it’s really not accurate for the president to imply that the WHO has or has not supported lockdowns, said Lawrence Gostin, a global health law professor at Georgetown University. It’s not as simple as an either-or choice.

“No one is saying that lockdowns should never be used, just that they shouldn’t be used as a primary or only method,” Gostin wrote in an email.

And Josh Michaud, associate director of global health policy at KFF, said both the WHO and public health experts have acknowledged there are economic consequences to lockdowns. (KHN is an editorially independent program of KFF.)

“Strict lockdowns are best used sparingly and in a time-limited fashion because they can cause negative health and economic consequences,” said Michaud. “That is why Nabarro said lockdowns are not recommended as the ‘primary’ control measure. Critics like to frame lockdowns as being recommended as the only measure, when in reality that is not the case.”

Has the WHO Flipped on Its Stance on Lockdowns?

And what about Trump’s assertion that the WHO had changed its position and admitted he was right?

A member of the WHO media office told us in a statement, “Our position on lockdowns and other severe movement restrictions has been consistent since the beginning. We recognize that they are costly to societies, economies and individuals, but may need to be used if COVID-19 transmission is out of control.”

“WHO has never advocated for national lockdowns as a primary means for controlling the virus. Dr. Nabarro was repeating our advice to governments to ‘do it all,’” the spokesperson said.

To test this premise, we looked at statements by WHO leaders over the course of the pandemic. In the multiple media briefings we reviewed from February onward, the WHO appeared consistent in its messaging about what lockdowns should be deployed for: to give governments time to respond to a high number of COVID-19 cases and get a reprieve for health care workers. Although WHO leaders in February supported the shutting down of the city of Wuhan, China, the presumed source of the COVID-19 outbreak, they have also acknowledged that lockdowns can have serious economic effects, and that robust testing, contact tracing and physical distancing are usually preferable to completely locking down.

There is also no evidence the WHO “admitted” Trump was right about lockdowns.

Our Ruling

Trump tweeted on Monday and then said later that night at a campaign rally that the WHO admitted he was right about lockdowns.

We found no evidence the WHO made this admission. And, based on a review of WHO communications, we found its messaging on the topic has been consistent since the pandemic’s early days.

Trump also appears to have relied on a brief video clip of a wide-ranging interview with WHO special envoy Dr. David Nabarro that didn’t give an accurate portrayal of how Nabarro characterized the use of this intervention.

We rate this statement False.

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.


This story can be republished for free (details).

Must-Reads of the Week

Hi, I’m back with a revamped Friday Breeze, tackling a few hot health care topics of the week and some news you may have missed. Here’s what the Breeze blew in this week, in these dog days of our COVID-constrained, socially distant summer:

Schools Reopen: No Easy Answers for Keeping Kids Healthy

It’s back-to-school time, which means pencils, books, hand sanitizers and, for some, a visit from Vice President Mike Pence. The vice president visited a campus of Thales Academy in Apex, North Carolina, saying, “We’ve got to open up America’s schools, and Thales Academy is literally in the forefront.” Unfortunately, a few days later, Thales suffered a setback when a fourth grader at its Wake Forest campus tested positive for COVID-19.

Things weren’t much better in other states, either. Groups of students and teachers in Indiana, Georgia, Mississippi, Louisiana and Tennessee have been forced into quarantine after being exposed to the virus. When a photo of a packed hallway at North Paulding High School north of Atlanta went viral this week, Superintendent Brian Otott acknowledged that the photo “does not look good ” but said the school was following state health recommendations. (On Thursday, two teens who posted the photo were suspended from school.) And this just in: New York Gov. Andrew Cuomo announced schools can reopen for in-person classes this fall across a state that was once the epicenter of the global pandemic.

Day cares and preschools might offer a glimpse into how to keep children safe. As KHN’s Anna Almendrala wrote this week, the facilities are “part of an unplanned national experiment” for parents weighing the pros and cons of in-person school. So far, the number of outbreaks at child care centers has remained low.

Other nations are trying different methods, with varied success. Denmark puts students in “micro-groups” of 12. Kids in New South Wales, Australia, go to school just one day a week. In Dandwal, India, students listen to a recorded voice from a loudspeaker. Israel, convinced it had beaten the virus, opened every school in May. By the first week of June, more than 2,000 students, teachers and staff had tested positive. (“[Other nations] definitely should not do what we have done,” said the chairman of the team advising Israel’s National Security Council. “It was a major failure.”)

Ohio Gov. Mike DeWine Tests Positive, Then Negative: Can We Fix Our Testing System?

I live in Ohio, and the whole state practically gasped Thursday when Republican Gov. Mike DeWine tested positive for COVID-19. Everyone asked, “How could this happen to someone who steadfastly supports wearing a mask?” Then, on Friday, another gasp when he tested negative on a second, more sensitive test — followed by a collective, “Well, of course that happened.”

It’s an understatement to say we have had major problems with our COVID testing system. Some places are flush with them; others aren’t. Celebrities, the NBA, NFL and MLB have easy access, but many regular folks have been turned away multiple times, waited more than a week for results or were told their results were lost. Frustrated with delays, six states (Louisiana, Maryland, Massachusetts, Michigan, Ohio and Virginia) announced this week a deal to buy 3 million rapid tests in an effort to reduce turnaround time.

Meanwhile, some people are pushing for universal testing with fast, less-accurate tests, the idea being that you could identify outbreaks, trace them, quarantine people and move on with life. But scientists say this wouldn’t work for two reasons. One: Most tests take samples from behind the nose or the back of the mouth and will come out positive only if that area contained the virus. In some people, however, the virus has been shown in large quantities only deep in their lungs. And two: A false-positive result sidelines a healthy person, leading to unnecessary quarantining that can affect their mental health, job, school, etc. Kelly Stafford, wife of Detroit Lions quarterback Matthew Stafford, wrote on Instagram this week that her family was harassed and put through “a nightmare” after Matthew tested false-positive for COVID.

Hurricane Isaias: How Do You Evacuate But Stay Socially Distant?

For just about everyone on the East Coast, the big talker of the week was Hurricane Isaias. (That’s pronounced “ees-ah-EE-ahs.”) Isaias skimmed Florida’s Atlantic coast as a Category 1 hurricane and banged its way up the East Coast before making landfall Monday near Ocean Isle Beach, North Carolina. All told, Isaias killed nine people, spawned more than 30 tornadoes (here’s one caught on video in Marmora, New Jersey), knocked out power to millions and forced thousands to evacuate. One major health concern was whether people in the path of the storm — including residents of nursing homes — could safely evacuate but still follow COVID safety guidelines. “We were prepared with non-congregate sheltering,” said Mike Sprayberry, director of North Carolina Emergency Management, “but many people heeded the advice to stay with family or friends or at a hotel. It wasn’t needed.” Hurricane season is in full swing (it doesn’t end until Nov. 30), so here’s some advice on how to prepare for an emergency during a pandemic — and more from the Red Cross.

Beirut Blast: The Lasting Health Effects of a Massive Explosion

About 150 people were killed and 5,000 hurt when a warehouse full of ammonium nitrate exploded Tuesday in Beirut. Ammonium nitrate, an odorless, crystal salt, is a common but highly explosive chemical that was used in several other devastating blasts, including Tianjin, China, in 2015 (165 killed); West, Texas, in 2013 (15 killed); and Oklahoma City in 1995 (168 killed). Tuesday’s blast, involving about 2,750 tons of ammonium nitrate, was roughly equal to the power of 1,155 tons of TNT, according to one weapons investigator, making it “many times larger than the most powerful conventional airdropped bomb in the U.S. arsenal [the GBU-43 Massive Ordnance Air Blast],” The New York Times reported.

The blast released nitrogen oxides, ammonia and carbon dioxide into the air. According to Newsweek and the American Lung Association, some of their health effects include lung damage, asthma attacks, lower birth weight in newborns, blindness, convulsions, suffocation and death. In the years after the Oklahoma City bombing, doctors tracked survivors’ physical and emotional health. A 1999 report from the National Institutes of Health said that up to a third of survivors reported having anxiety, depression, PTSD, asthma, bronchitis and problems with their hearing. As Tommy Muska, the mayor of West, Texas, put it this week: “We don’t seem to learn that chemical is deadly.”

Other Stories You May Enjoy:

Happy reading! Have a great weekend.

— Lauren

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.


This story can be republished for free (details).

Don’t Fall for This Video: Hydroxychloroquine Is Not a COVID-19 Cure

Millions of people, including the president of the United States, have seen or shared a video in which a doctor falsely claims there is a cure for the coronavirus, and it’s a medley starring hydroxychloroquine.

The video shows several doctors in white coats giving a press conference outside the Supreme Court in Washington, D.C. It persists on social media despite bans from Facebook, Twitter and YouTube, and it was published by Breitbart, a conservative news site.

The July 27 event was organized by Tea Party Patriots, a conservative group backed by Republican donors, and attended by U.S. Rep. Ralph Norman, R-S.C.

In the video, members of a new group called America’s Frontline Doctors touch on several unproven conspiracy theories about the coronavirus pandemic. One of the most inaccurate claims comes from Dr. Stella Immanuel, a Houston primary care physician and minister with a track record of making bizarre medical claims, such as that DNA from space aliens is being used in medical treatments.

“This virus has a cure. It is called hydroxychloroquine, zinc, and Zithromax,” Immanuel said. “I know you people want to talk about a mask. Hello? You don’t need [a] mask. There is a cure.”

As of July 27, nearly 150,000 Americans had died because of the coronavirus. Could those deaths have been prevented by a drug that’s used to treat lupus and arthritis?

No. Immanuel’s statement is wrong on several points.

‘This Virus Has a Cure’

There is no known cure for COVID-19.

According to the Centers for Disease Control and Prevention, there is no specific antiviral treatment for the virus. Supportive care, such as rest, fluids and fever relievers, can assuage symptoms.

“There is currently no licensed medication to cure COVID-19,” according to the World Health Organization.

The Cure Is ‘Hydroxychloroquine, Zinc and Zithromax’

In spite of Immanuel’s anecdotal evidence, hydroxychloroquine alone or in combination with other drugs is not a proven treatment (or cure) for COVID-19.

The Food and Drug Administration has not approved hydroxychloroquine for the prevention or treatment of COVID-19. In mid-June, the FDA revoked its emergency authorization for the use of hydroxychloroquine and the related drug chloroquine in treating hospitalized COVID-19 patients.

“It is no longer reasonable to believe that oral formulations of HCQ and CQ may be effective in treating COVID-19, nor is it reasonable to believe that the known and potential benefits of these products outweigh their known and potential risks,” FDA Chief Scientist Denise M. Hinton wrote.

The WHO and the National Institutes of Health have also stopped their hydroxychloroquine studies. Among the safety issues associated with treating COVID-19 patients with hydroxychloroquine include heart rhythm problems, kidney injuries and liver problems.

While some studies have found that the drug could help alleviate symptoms associated with COVID-19, the research is not conclusiveFew studies have been accepted into peer-reviewed journals. And large, randomized trials — the gold standard for clinical trials — are still needed to confirm the findings of studies conducted since the pandemic began.

In the video, Immanuel cited a 2005 study that found chloroquine — not hydroxychloroquine — was “effective in inhibiting the infection and spread of SARS CoV,” the official name for severe acute respiratory syndrome. But the drug was not tested on humans, the authors wrote that more research was needed to make any conclusions, and SARS is different from COVID-19.

‘You Don’t Need a Mask’

Health officials advise everyone to wear a mask in public.

The reason has to do with how the coronavirus spreads. When an infected person coughs or sneezes, they expel respiratory droplets containing the virus. Those droplets can then land in the mouths or noses of people nearby.

Since some people infected with the coronavirus may exhibit no symptoms, public health officials say everyone should cover their face in public — even if they don’t feel sick.

“The spread of COVID-19 can be reduced when cloth face coverings are used along with other preventive measures, including social distancing, frequent handwashing, and cleaning and disinfecting frequently touched surfaces,” according to the CDC.

Our Ruling

In a viral video, Immanuel said there is a cure for COVID-19, hydroxychloroquine can treat it, and people don’t need to wear masks to prevent the spread of the virus.

All of those claims are inaccurate. There is no known cure for COVID-19, hydroxychloroquine is not a proven treatment, and public health officials advise everyone to wear a face mask in public.

Immanuel’s statement is False.

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.

Must-Reads of the Week From Lauren Olsen

Hiya! I’m Lauren Olsen, your new Newsletter Editor. That’s right — the totally official, no more fill-ins, always-here-for-you Newsletter Editor. As the replacement for editor extraordinaire Brianna Labuskes, I’m here to tackle all your health news needs.

Why yes, you’re right — a pandemic is a heck of a time to take over this job. I’d argue, however, that it’s the best time, because who doesn’t need a hand sorting out all this craziness? So far, 2020 has been like trying to paint the “Mona Lisa” while riding a unicycle in a rainstorm — in other words, a sloppy mess teetering on disaster — but, with any luck, when it’s done we might all manage to smile.

In the meantime, I won’t Louvre you in the lurch. (Sorry, I couldn’t resist.) Be sure to read each day’s top health news headlines in KHN’s Morning Briefing, compiled by yours truly. Please subscribe, if you haven’t already — and tell your colleagues and friends, too. Have a comment about the Briefing or the Breeze? Send me an email at [email protected]. I look forward to hearing from you.

A Gift for You, My New Friend

Because we’ve just met, I’d like to offer you a token of friendship: Today’s Breeze will do its best to have a positive spin. Things are dreary enough in the world right now — you don’t need me to blow more gray clouds your way. In the words of Helen Keller, “Although the world is full of suffering, it is also full of the overcoming of it.”

What’s Donald Up To?

Today, let’s play a game called “What’s Donald Up To?” You won’t win any points or money. What you will win is the knowledge that there are 180 days until Inauguration Day! (I suppose your real prize will be if “your guy” wins, whether it’s President Donald Trump, Joe Biden or Kanye West.)

So what is Donald up to? He began his busy week of tweeting, mask-wearing and name-calling with a feisty interview with Fox News’ Chris Wallace on Sunday. In it, he lamented increased COVID testing (“I’m glad we do it, but it really skews the numbers”), called Dr. Anthony Fauci, America’s infectious diseases superstar, an “alarmist,” boasted about the sagging U.S. economy (“I built the greatest economy in history, I’m now doing it again”), reasserted his opinion that the virus will “disappear” and downplayed the potentially devastating physical effects of COVID-19 by saying some people just have the “sniffles.” When asked about the nearly 1,000 deaths a day in the U.S., Trump said it “is what it is.” On the positive side? Well, the interview was only about an hour.

The critiques rolled in, and for most of the week we saw a kinder, gentler version of Trump. Maybe it was because he was happy he supposedly aced the Montreal Cognitive Assessment, a test that detects early signs of dementia. Or maybe it was because he’d passed “multiple” COVID tests a day, according to his press secretary, Kayleigh McEnany. (“I don’t know of any time I’ve taken two in one day,” he clarified a few hours later.) Or perhaps he was simply feeling generous, providing $5 billion for struggling nursing homes, resuming COVID task force briefings, renewing the national public health emergency and even (gasp!) tweeting a pic of himself wearing a mask. But I think the real reason may have been because two White House cafeterias closed this week after a staffer tested positive for the coronavirus — providing another excuse for him to keep eating McDonald’s. (Just a theory.)

Even so, Trump’s good mood subsided by the end of the week, probably because he had to cancel the GOP convention in Jacksonville, Florida, amid the state’s rising COVID cases. (Not to mention that the Duval County sheriff did warn him about not being able to provide security.)

Wondering what Biden, Trump’s probable Democratic rival in November, was up to? Well, this week he released his massive “caregiving plan” for Americans — $775 billion over 10 years. (That certainly would buy a lot of Care Bears.)

California and the Terrible, Horrible, No Good, Very Bad Day

California, the most populous state, on Wednesday surpassed New York as the worst-hit state for cases (tallying 413,576 as of that day). The increase of 12,112 was the biggest single-day increase since the pandemic started. At the national level, there have been 4 million cases — it took only 15 days to jump from 3 million to 4 million — and the death toll stands at 144,000. Unfortunately, the rise in cases is outpacing the rise in testing, with The New York Times explaining: “About 21,000 cases were reported per day in early June, when the positive test rate was 4.8 percent. As testing expanded, the positive test rate should have fallen. … Instead, the positive test rate has nearly doubled.”

The number of COVID cases is likely 10 times higher than what we thought, experts now say. On Saturday, the FDA approved the use of pooled testing, essentially allowing the testing of many more people using fewer tests. But the White House, not to be outdone, announced it would push to phase out funding for testing from the COVID-relief bill in Congress. (More on that in a minute.)

In the “oops” category, 113 people in Rhode Island, about 90 in Connecticut, 26 in Kentucky and dozens in New York were told they had COVID-19 when in fact they had tested negative. (Does that qualify as positive news? I’m not sure, but I’m happy those folks are fine.) Conversely, in The Villages, Florida, one of America’s biggest retirement communities known for its golf and rockin’ house parties, is seeing a spike in positive cases, jumping from the single digits last month to at least 29 last week.

Scientists delved into the big question this week: Can you get reinfected with COVID? And the absolute, no-doubt-about-it answer was: Um, not sure. But it’s unlikely, they say. Scientists did determine that mosquitoes most likely don’t spread COVID, and they’re testing whether UV light, which can kill many nasty germs, can kill this virus, too. As a bonus, the CDC now says that if you do get sick, you should isolate for 10 days, not 14. (But severely ill patients should isolate for 20 days.)

So Much for Vacation

Congress returned from a two-week summer recess Monday to begin work on the fifth COVID-relief bill of the year, and it played out like a real-life version of Chevy Chase’s “National Lampoon’s Vacation,” starring Senate Majority Leader Mitch McConnell as Clark Griswold, House Speaker Nancy Pelosi as the Ferrari-driving Christie Brinkley and Trump as the security guard at Walley World who basically ends their fun. (My goodness, can’t you just envision it?)

Republicans had a $1 trillion agenda that included funds for schools and COVID testing, a payroll tax cut, direct checks for individuals and $600-a-week stipends for laid-off workers. Senate Republicans seemed near a deal with the White House on Wednesday as the Griswold family station wagon chugged along. But the car crashed Thursday when the two groups failed to reach an agreement on the unemployment issue. (Mind you, the Democrats haven’t even gotten involved yet.) Republicans vowed to have a new deal next week. As all this was going on, smooth-driving Pelosi left tire tracks all over Trump while speaking on CNN’s “The Situation Room” on Tuesday, calling the coronavirus the “Trump virus.”

Let’s Make a Deal: Which Vaccine Is Behind Door No. 1?

Am I the only person who can’t keep track of all the vaccines and treatments in play? Chinese group Sinopharm said it will have a vaccine ready for the public before the end of the year. (Woohoo!) British pharmaceutical firm Synairgen announced a breakthrough nebulizer treatment that reduces the severity of COVID-19, and Oxford-AstraZeneca’s vaccine AZD1222 showed promising results in human trials, too. Meanwhile, behind Door No. 2, the Russians are insisting they didn’t try to steal British coronavirus vaccine research.

Back in the good ol’ U.S. of A., five pharmaceutical giants testified to Congress on Tuesday that they wouldn’t cut corners when developing a vaccine. And Wednesday, as if on cue, Pfizer and German firm BioNTech made an unusual $1.95 billion deal to supply 100 million doses of a not-yet-finished vaccine to the federal government, which plans on giving it to Americans at no cost. (Not to nitpick, but there are 330 million people in America. I’m not great a math, but still …)

Meanwhile, behind Door No. 3, the Department of Justice indicted two Chinese nationals this week on charges that they hacked and stole research from companies working on COVID vaccines in the U.S., the U.K., Sweden, Spain, Australia and other nations.

The REALLY Important Questions

Sure, all of that stuff has big implications. But here in the real world, we’re worried about simpler stuff. For example, when can I watch NFL football? (Not for a while.) Has baseball started? (Yes!) Can I travel to the Bahamas (no), Niagara Falls (yes) or New York (maybe)? If I live in California and need a haircut, where can I get one? (Outdoors.) Should I buy my teen some condoms? (It’s up to you, but more adolescents are improvising with plastic wrapshudder.) Does it hurt to get shot with a less-lethal projectile? (Um, HECK YES.) Should I wear a mask in Atlanta, at a Marriott hotel or when buying jeans at the Gap? (Yes.) How about at the bank? (Yes, as long as you promise not to rob the joint.)

That about wraps it up for me. Hope you enjoyed my inaugural Breeze. Keep smiling! Until next week,

— Lauren

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.

Must-Reads Of The Week

Another week has gone by, and the biggest news remains that COVID numbers aren’t looking much better as the disease spreads quickly through Florida, Arizona, Texas and California.

Three million cases and 133,000 deaths in the United States. Testing still takes too long, KHN reported — the Atlanta mayor had to wait eight days for results! — and, no, more testing isn’t skewing the numbers.

With nearly 60,000 new cases in one day, the United States set another COVID record. The United States leads the world, but not in a good way, as a headline in a KHN morning newsletter put it this week. Indeed, it is quite possible that President Donald Trump’s recent rally in Tulsa, Oklahoma, contributed to the spike, Reuters reported.

COVID News, Lots of It

The focus of the arguing this week was on back-to-school plans. School districts are trying to make that hard decision in order to protect children, staff members and parents. (Well, and the economy, for that matter.) The Atlantic published some suggestions. The Centers for Disease Control and Prevention is under pressure from Trump to water down its reopening safety recommendations so, as Trump put it in a tweet Monday, “SCHOOLS MUST OPEN IN THE FALL!!!” Colleges are coming up with various plans to allow some students back on campus but offer few in-person classes.

Meanwhile, even more Americans have lost faith in Trump’s handling of the epidemic, according to a new poll released by ABC News/Ipsos: 33% approve, down from 41% three weeks ago.

The beleaguered World Health Organization, to which Trump says he will cut U.S. funding, got embroiled in a controversy over whether airborne particles transmit the coronavirus. Scientific American attempted to sort out a confusing story, while WHO acknowledges the evidence.

KHN published, with the Los Angeles Times, a very good story about how COVID-19 is starting to kill inmates on California’s death row at San Quentin. A prosecutor of one of the murderers who died wasn’t sympathetic. The Texas Tribune reports how the disease is ravaging Texas prisons and killing people who had very short sentences.

A few other stories from the week that shouldn’t be missed because they give you a good look at how government officials still struggle to get a handle on this crisis: Stat reports that the Food and Drug Administration “again risks being pulled into an ugly political fracas” over hydroxychloroquine. Jim Fallows at the Atlantic did a masterful job of telling the story of the inept coronavirus response, in the style of an aviation accident report. It’s well worth reading. This article in BMJ, the medical journal, is a little harder to read, but worth the effort for the provocative and contrary point it makes: The U.S. purchase of much of the world’s supply of the drug remdesivir, a possible COVID treatment, may be a boon to the rest of the world.

Put these two on your list for weekend reading, perhaps: The Washington Post’s horrific look inside a nursing home wracked with COVID infections and a New York Times story on the racial inequity of the coronavirus in a series of maps and graphics.

The Toolkit

Every week there are new online graphics and other visual displays of COVID data that make it easier to understand what is going on in the epidemic. A few that I and the KHN staff found:

A COVID vaccine progress tracker from The New York Times.

Another smart vaccine tracker, this one from the Milken Institute.

County-level data on COVID infections and risk calculations from the Harvard Global Health Institute. (Their server can be a bit slow. Be patient.)

Follow who is getting federal bailout money with this tool from ProPublica.

But wait: If you are assembling a toolkit, the great health reporter Charlie Ornstein of ProPublica has already done much of the work for you. Open up this Google Doc to find his very good collection.

Oddly Important News, More Odd Than Important

Well, for all the attention it was getting, some people seemed to think Kanye West running for president was big news. Forbes interviewed him, and here is one thing he said that was health care-related:

“It’s so many of our children that are being vaccinated and paralyzed. … So when they say the way we’re going to fix Covid is with a vaccine, I’m extremely cautious. That’s the mark of the beast. They want to put chips inside of us, they want to do all kinds of things, to make it where we can’t cross the gates of heaven.”

The Italian Mafia has innovated in the health care industry. The Financial Times reports: “By corrupting local officials, organised criminals have been able to make vast profits from contracts given to their own front companies, establishing monopolies on services ranging from delivering patients in faulty ambulances to transporting blood to taking away the dead.”

Here’s a well-told story of a socialite spreading COVID at a party of fellow swells.

To end on an uplifting note, because that’s important in these times, a video of a light display over Seoul with 300 drones telling Koreans to wear masks and wash their hands. (And they do. Korea has one of the lowest infection rates in the world.)