Lax states are attracting shoppers and students from stricter neighbors — and sending back COVID-19 cases. The imbalance underscores the lack of a national policy.
This article was published on Tuesday, December 1, 2020 in ProPublica.
For months after Washington state imposed one of the earliest and strictest COVID-19 lockdowns in March, Jim Gilliard didn't stray far from his modular home near Waitts Lake, 45 miles north of Spokane.
The retiree was at high risk from the coronavirus, both because of his age, 70, and his medical condition. Several years ago, he had a defibrillator implanted. So he mainly ventured out during the pandemic to shop for food.
There wasn't much else to do anyway. Gatherings in his county were limited to no more than 10 people, there was a mask mandate, movie theaters were closed and many nightclubs and concert venues were shuttered because of a state ban on all live entertainment, indoors and out.
An hour away in Idaho, life was more normal. The state left key COVID-19 regulations up to localities, many of which made masks optional. Even in places that required face coverings, enforcement was laxer than in Washington. High school sports, canceled for the fall in Washington, were on full display in Idaho. Most Idaho schools welcomed back students in person, in contrast to the remote learning prevailing in Washington. Businesses reopened earlier and with fewer restrictions. There were concerts and dances.
Weary of Washington's restrictions, thousands of residents made the easy drive over the border to vacation, shop and dine in Idaho. Gilliard resisted temptation until he learned that the annual Panhandle Bluesfest would go on as scheduled near Priest River, Idaho, on Sept. 12. A keyboardist who used to own a blues club just outside Coeur d'Alene, Idaho, Gilliard was buoyed after months of relative isolation by the prospect of hanging out with friends while listening to music on a remote mountainside surrounded by soaring pine trees and thick hemlocks. He decided to go.
A friend took a picture of Gilliard at the festival. Wearing a bandanna fashioned as a headband, a cut-off T-shirt and dark glasses, he was perched on a tree stump and pointing back at the camera. As was permitted by local regulations at the time, he was not wearing a mask, nor were about 10 people sitting together in the background.
As the number of COVID-19 cases skyrockets nationwide, the extent of the public health response varies from one state — and sometimes one town — to the next. The incongruous approaches and the lack of national standards have created confusion, conflict and a muddled public health message, likely hampering efforts to stop the spread of the virus. The country's top infectious disease expert, Dr. Anthony Fauci, said last month that the country needs "a uniform approach" to fighting the virus instead of a "disjointed" one.
Nowhere are these regulatory disparities more counterproductive and jarring than in the border areas between restrictive and permissive states; for example, between Washington and Idaho, Minnesota and South Dakota, and Illinois and Iowa. In each pairing, one state has imposed tough and sometimes unpopular restrictions on behavior, only to be confounded by a neighbor's leniency. Like factories whose emissions boost asthma rates for miles around, a state's lax public health policies can wreak damage beyond its borders.
"In some ways, the whole country is essentially living with the strategy of the least effective states because states interconnect and one state not doing a good job will continue to spread the virus to other states," said Dr. Ashish Jha, dean of the Brown University School of Public Health. "States can't wall themselves off."
A motorcycle rally in August in Sturgis, South Dakota, with half a million attendees from around the country spread COVID-19 to neighboring Minnesota and beyond, according to Melanie Firestone, an epidemic intelligence service officer for the Centers for Disease Control and Prevention, who co-authored a report on the event's impact.
South Dakota "didn't have policies regarding mask use or event size, and we see that there was an impact in a state that did have such policies," Firestone said. "The findings from this outbreak support having consistent approaches across states. We are all in it together when it comes to stopping the spread of COVID-19."
Viruses don't respect geographic boundaries. While some states require visitors, especially from high-risk areas, to be tested or quarantined, others like South Dakota have no such restrictions. Many people who are tired of strict COVID-19 measures in their states have escaped to areas where everyday life more closely resembles pre-pandemic times. There, with fewer protections, they're at risk of contracting the virus and bringing it back home.
After the Idaho concert, Gilliard started feeling ill and was diagnosed with the coronavirus. For about a week, he stayed in bed. As his condition worsened, he was admitted to a Spokane hospital and placed on a ventilator. He died on Oct. 15. His death certificate lists COVID-19 as the underlying cause.
Going to the Idaho festival likely killed Gilliard, his ex-wife, Robin Ball, said.
"If he had been wearing a mask, not shaking hands and keeping distance, he could probably be alive," she said. "He had been careful before that. He shouldn't have been up there."
The degree of coronavirus regulation tends to track political lines. President-elect Joe Biden carried blue Washington state with 58% of the vote, while President Donald Trump easily won red Idaho with 64%. Trump has helped to fuel the patchwork response to the pandemic, criticizing the approaches of some states, praising others and at times contradicting the advice of his own coronavirus task force and Fauci.
"What really struck me [is] how hard it is to take the pandemic strategy as laid out by the White House with every state on its own and ... implement it because every state is not on its own, they are all interconnected," Jha said.
Biden has said he wants to implement national standards, such as required mask wearing, to help blunt the spread of COVID-19 while acknowledging the federal government has little power to do so. He hopes to work with governors and local officials to establish consistent standards across the country.
A lack of such consistency is affecting eastern Washington, which appears to be absorbing some of the costs — both human and economic — of Idaho's more laissez-faire approach to the virus. The rate of new cases in and around Spokane, near the Idaho border, is far higher than in Seattle and western Washington, which experienced one of the earliest outbreaks in the country in February. Although slightly more than half of recent COVID-19 cases in Spokane spread among households or personal contacts, Spokane Regional Health District epidemiologist Mark Springer said, "people bringing back COVID-19 from larger events in Idaho" has been a problem. And with Idaho's rate of new cases now doubling Washington's, Idahoans who commute to the Spokane area pose an outsized danger. At the same time, Washington's shuttered businesses have ceded customers to their Idaho competitors.
Public schools in Washington have also suffered. After opening the school year with remote-only instruction, the Newport School District lost about one-fourth of its 1,200 students. Most of them opted either for specialized online-only programs or for nearby private and public schools across the border in Idaho, which offered in-person learning and sometimes didn't require masks or social distancing, said Newport Superintendent Dave Smith. The plunge in enrollment has led to a $1.2 million drop in funding, he said.
In early October, Newport began some in-person learning but had to return to remote instruction after a COVID-19 outbreak in the community. The source was traced to a Christian church and school only a few feet from the Washington border in Oldtown, Idaho.
"It's incredibly frustrating," Smith said. "I certainly think aligned standards across the nation would have changed our situation."
Washington Gov. Jay Inslee recently called on "Idaho leaders to show some leadership" and be more aggressive in combating COVID-19. He blamed the virus spread in Idaho for straining Washington hospitals. For their part, some in Idaho have complained that the rise of COVID-19 there has more to do with the influx of Washington residents over the summer and fall than with a lighter regulatory touch.
Many of those Washingtonians headed to Coeur d'Alene (pop. 52,400), the seat of Kootenai County and the largest city in northern Idaho. Despite some cancellations, many tourism activities went on as scheduled. The Spokesman-Review newspaper in Spokane ran a feature headlined, "A nearby escape: Coeur d'Alene Resort offers amenities for singles and families." The resort, the article noted, was offering special packages for families that include a pizza-making experience, scenic cruise tickets and discount theme park tickets. In the resort garage, most of the license plates were from Idaho or Washington.
"Yes, the coronavirus exists," the article continued. "However, the luxe Coeur d'Alene Resort is open and taking steps to make an experience as safe as possible." While employees wore masks, the article said, they were optional for guests and about two-thirds opted not to use them. The resort did not respond to requests for comment.
At a park in downtown Coeur d'Alene, a weekly concert series called Live After 5 attracted crowds all summer. Though attendance was lower than in prior years, it swelled as promoters targeted marketing to tourists, concert organizer Tyler Davis said. At one show in July, a member of the band surveyed the large gathering and said, "Look around you guys, it feels kind of normal tonight." Groups of people danced in front of the stage, food trucks lined up along one side and vendors set up tents. Masks were "encouraged but not required."
The day after that show, the Panhandle Health District encompassing five Idaho counties ordered a mask mandate in Kootenai. It required masks in indoor and outdoor public places when a social distance of 6 feet could not be maintained.
Springer, the epidemiologist, watched the flow of Spokane County residents to Idaho with concern. "The issue with Idaho is a somewhat significant one for us in that the restrictions are a pretty stark contrast between what is in Idaho and what we have in Washington," he said. "Coeur d'Alene is a sister community to us."
Jim Gilliard was a popular figure in the blues music community around Spokane and northern Idaho. In the 1990s, he operated a music club outside Coeur d'Alene called Mad Daddy's Blues. He was a talented musician himself, playing keyboards in local blues bands, even after losing a finger and badly injuring two others in a table saw accident.
Gilliard was raised in New York City and Pennsylvania. His father, E. Thomas Gilliard, was an acclaimed ornithologist who served as curator of birds at the American Museum of Natural History and was often gone for months at a time on expeditions to New Guinea. After Gilliard met Ball, the two headed to Colorado and enjoyed life as ski bums, moving from resort to resort for a couple of years before eventually settling in Coeur d'Alene, and having a son. After they divorced two decades ago, she stayed in Coeur d'Alene and he ended up in the village of Valley, Washington. (pop. 164).
Gilliard was one of nearly 300 people who paid $25 each to attend the blues festival, which was held 2 miles up a mountain road outside Priest River, Idaho, a tourist town 6 miles from the Washington border.
Bonner County, where the concert was held, is a rural pocket of defiance against government public health mandates related to the coronavirus. When the local library instituted a mask requirement for users, mask-less demonstrators, some clutching small children, protested and tried to enter the library as staff members stood their ground and explained they were only trying to prevent people from getting sick. The county sheriff wrote to the governor criticizing lockdown orders early in the pandemic, alleging that public health officials misled the public and that "COVID-19 is nothing like the plague."
Concert organizers Billy and Patty Mullaley said they waited until the end of June before deciding to go ahead with it. The only potential roadblock was getting liability insurance at an affordable price during a pandemic, which they were able to do after shopping around.
"At the time, there were not any restrictions" on events like theirs in Idaho, Patty Mullaley said. "We did not take it lightly, having the event. We really put thought into it." They bleached outhouses and the area around the concert stage offered plenty of space for social distancing, she said. Among those most grateful they went ahead, she said, were musicians who had been starved for gigs because of coronavirus-related cancellations. Featured acts included Sammy Eubanks, Coyote Kings and Tuck Foster and the Tumbling Dice.
Mullaley said the festival drew Washington residents eager for events banned in their own state. "From my experience, everyone and their dog from Washington was over here," she said. "Our COVID is probably from people coming over here from Washington."
Few of the hundreds of people at the festival wore masks and many didn't stay socially distant, according to attendees. "Part of what made it magical was people were completely free and happy and not fearful at all," said Sylvia Soucy, who had COVID-19 earlier in the summer. People danced barefoot on the soft sand and mingled with friends, she said.
Mullaley said people socially distanced "as much as possible." In the end, she said, "these were all adults" who made individual decisions. Soucy agreed. "It was completely a choice all of us made," she said. The remote setting — no cellphone service, no electricity and surrounded by hundreds of acres of undeveloped forest — added to the temporary joy of escaping from the virus, Soucy said.
Soucy said she talked to Gilliard there and he was in good spirits, "glad that people were not worried about being able to get together there on the mountain." Gilliard also chatted with other friends, including a former girlfriend, according to Soucy. Ball said the former girlfriend was diagnosed with COVID-19 shortly after the festival and notified Gilliard.
A photo posted on Facebook of Gilliard at the blues concert in Idaho shortly before he tested positive for COVID-19.
"I don't know why he let his guard down," Ball said. "I will never understand that." In the end, she thinks it had to do with "a long summer of not having a lot of stuff to do. He had been so cautious for those seven or eight months. He just didn't feel like it was going to be a problem."
The Mullaleys said they were unaware of anyone else from the concert getting COVID-19 around that time. But some Washington residents who tested positive for the coronavirus told contact tracers that they had attended the blues festival, according to Matt Schanz, the administrator of Northeast Tri County Health District, a public health agency in Washington covering counties near the Idaho border.
That doesn't definitively mean that they contracted the virus at the festival, he said. "We have 550 cases within three counties, and if you read the summary reports, a decent number of those have some affiliation with Idaho," Schanz said.
South Dakota has largely remained open for business during the pandemic. Gov. Kristi Noem, an ally of Trump's, has refused to impose a mask mandate, saying there are questions about its effectiveness. The state has not placed any restrictions on bars and restaurants and officials allowed the 10-day motorcycle rally in Sturgis. Such a rally would have been prohibited in Minnesota. Both Minnesota and South Dakota are in the top five states when it comes to rates of cases per capita over the last week.
The CDC advises that outdoor events are less risky than indoor ones. The Sturgis rally, which featured events in both settings, is now linked to at least 86 COVID-19 cases in Minnesota, including four people who were hospitalized and one death, according to a CDC report released in November. The report said the total is likely an undercount as some of those infected declined to share their close contacts with health officials.
"These findings highlight the far-reaching effects that gatherings in one area might have on another area," the researchers wrote. They added, "This rally not only had a direct impact on the health of attendees, but also led to subsequent SARS-CoV-2 transmission among household, social, and workplace contacts of rally attendees upon their return to Minnesota."
Mike Kuhle, the mayor of Worthington, Minnesota, said South Dakota's approach to the pandemic "is a source of heartburn for me and sleepless nights." His city is close to both the South Dakota and Iowa borders. In addition to worries about the virus spreading from South Dakota, Kuhle said, "during the lockdown people have gone to Sioux Falls for shopping. It's ugly for our businesses."
A similar dynamic has played out in the Quad Cities area at the border of Illinois and Iowa. There, thousands of people cross bridges over the Mississippi River every day to work, visit family and shop in each state.
Experts who study the way we think and make decisions say that it can be more than politics driving our decision-making this year. The unprecedented nature of the pandemic undermines how we process information and assess risk. Need proof? Look around.
As cases in Iowa began to surge this summer, Gov. Kim Reynolds dismissed mask mandates as "feel-good" measures that are difficult to enforce. Until recently, Iowa restaurants and gyms were allowed to operate at full capacity as long as social distancing measures were in place. There was no state-imposed limit on the size of social gatherings. Nicknamed "COVID Kim" by her critics, Reynolds changed course in mid-November in the face of surging cases and hospitalizations, requiring masks.
Illinois clamped down earlier and harder, instituting a mask mandate at the end of April. Movie theaters opened in Iowa before those in Illinois. Iowa never closed its golf courses when neighboring states like Illinois did.
For Illinois businesses, the gap between the two states' regulations has been crushing, said Paul Rumler, the president of the Quad Cities Chamber.
"A river runs through it but otherwise this is one community," he said. On the Illinois side, "we have retailers and restaurants who want to be responsible corporate citizens and follow the guidelines knowing they are at a disadvantage from a business literally 3 miles away."
Rumler said the chamber advocated for the two states to have a consistent approach to the pandemic to no avail. "If there was a federal standard, it would eliminate the confusion of our region," he said. "It would make our life a lot easier."
Debbie Freiburg, a volunteer contact tracer for the county encompassing the Illinois side of the border, said the looser restrictions in Iowa offered Illinois residents the chance to "take a break" from the virus.
"It's bad and the differences are huge, unfortunately," she said. "I can be in Iowa in 10 minutes, and there were a lot of us going shopping in Iowa."
Freiburg, who retired to the area after working as a pediatric cancer nurse in Washington, D.C., said cases in her Illinois county have been tracked to Iowa, including several from a large wedding at a hotel just over the border.
Tensions between Washington and Idaho over their divergent responses to the pandemic escalated in October. As the count of COVID-19 cases climbed, the board of the Panhandle Health District in Idaho voted 4-3 to rescind the mask order it had imposed on Kootenai County three months before. Officials in Washington were stunned. Inslee, the governor, refused to rule out restrictions on border traffic.
The move by the health board came amid growing resistance in the state to mandatory public health measures to control the virus and skepticism that COVID-19 was even real.
A group of Idaho politicians, including Lt. Gov. Janice McGeachin, appeared in a video in October urging the state to limit restrictions. Sitting in a truck with an American flag draped over the side, McGeachin placed a gun over a Bible. "We recognize that all of us by nature are free and equal and have certain inalienable rights," she said. A legislator in the video said "the pandemic may or may not be occurring."
State Rep. Tony Wisniewski, who represents Kootenai and also appeared in the video, urged the health board to make masks optional. He compared the mask mandate to what he said was a requirement in Nazi Germany to tell authorities if a neighbor was Jewish.
Health board member Allen Banks said he was "deeply suspicious" of tests for COVID-19. In an email to a senator who had criticized the board's mask mandate, he wrote, "I hope you and the legislators who support your effort will continue to stand for truth rather than the fantasy of a phony disease based on a false test."
Board member Walt Kirby, who had voted in July to approve the mask mandate initially, was the deciding vote. He opposed a mandate because people were "pretty damn nasty" to him for supporting it before, he explained. "I am not going to vote for it, I am just not because no one is wearing the damn masks anyway," Kirby said, adding that he wears a mask. As for people who ignore the advice of public health experts, he said, "I am just sitting back and watching them catch it and die and hopefully I will live through it. You know I am 90 years old already and I am not getting involved in it anymore."
Even as the requirement was rescinded, cases in Kootenai were soaring. The rate of hospitalizations in the border area in northern Idaho is nearly double the rate in the Spokane region. Overall, the number of new cases in Idaho per capita is almost twice that of Washington.
With the county mandate overturned, the city of Coeur d'Alene considered in late October whether to adopt one on its own. Mayor Steve Widmyer and the City Council were inundated with hundreds of emails and telephone calls, many from mask opponents.
"This is Idaho, not Washington or California," wrote one resident. "Let the people decide if they wish to mask up or not." Another told the city leaders, "If you want to live with a mask 'muzzle' on your face move to California or Washington."
Ball, Gilliard's ex-wife, urged Widmyer to support a mandate. "People come here so they don't have to wear a mask and fill our bars and businesses while spreading covid," she wrote.
In Coeur d'Alene, the mayor only votes to break a tie among the city councilors. Widmyer, who had complained that city officials "shouldn't have been put into this position," didn't have to vote, because the council approved the mandate 4-2 on Oct. 26. Protesters outside chanted, "No more masks, we will not comply," and the blowback has been swift. A group of residents is pushing to recall the pro-mandate councilors. The mayor did not respond to interview requests.
As states reopen, see if they meet White House guidelines for reopening and whether their COVID-19 infection rate is increasing or not.
While Coeur d'Alene adopted a mandate, nearby Post Falls and Hayden rejected similar proposals. All three cities are less than 20 miles from the Washington border. Idaho Gov. Brad Little has also remained steadfast in opposition to the idea, unlike Iowa's Reynolds. "Idaho's health officials have been mindful of the challenges of mitigating spread of COVID-19 in border communities since the onset of the pandemic," a spokeswoman for Little said in an email. The governor's "priority at this time is mitigating the spread of COVID-19 in Idaho and preserving healthcare capacity for those in need."
For the Panhandle health board, however, the situation became too dire to ignore. On Nov. 19 it reversed itself again and passed a mask mandate for all five of its counties, including Bonner, the site of the blues festival. But county sheriffs have ignored enforcing the mandate or made it a low priority, according to local media.
The move came too late to save Gilliard. "Until everyone in this country can do the same thing, all states on the same page, limit crowd size and mask mandates that are enforced, this is going to happen," said Ball, his ex-wife. "It only makes sense. Because what we have been doing hasn't been working."
David Armstrong is a senior reporter at ProPublica specializing in healthcare investigations. david.armstrong@propublica.org
When someone in the building died, a notice was often taped to a window in the lobby: "WE REGRET TO ANNOUNCE THE PASSING OF OUR FRIEND…." The signs did not say how or where the friend had died, and because they were eventually removed, they could be easy to miss. In March, as these names began to appear more frequently at Bronxwood, an assisted living facility in New York, Varahn Chamblee tried to keep track. Varahn, who had lived at Bronxwood for almost a year, was president of its resident council. Her neighbors admired her poise and quiet confidence. She spoke regularly with management, but as the coronavirus swept through the five-story building, they told her as little about its progress as they told anyone else.
Some residents estimated that 25 people had died — that was the number Varahn had heard — but others thought the toll had to be higher. There was talk that a man on the second floor had been the first to go, followed by a beloved housekeeper. An administrator known as Mr. Stern called in sick. Around the same time, Varahn noticed that the woman who fed the pigeons had also disappeared.
The New York State Department of Health advises adult care facilities to inform residents about confirmed and suspected COVID-19 cases. But inhabitants of Bronxwood said they were kept in the dark. In the absence of official communication, it was difficult to sort out hearsay from fact. "I was told that it was 42 people," said Renee Johnson, who lived on the floor above Varahn. "But honestly we don't know. They are not telling us anything." When for a couple of weeks Renee herself was bedridden — fatigued and wheezing — there were rumors that she, too, had passed away.
Because so many people were missing, and no one knew where they'd gone, life began to feel like a horror film. The dining room, once an outlet for gossip and intrigue, was shuttered and the theater room padlocked. Staff covered the lobby in tape, as if it were the scene of a crime. The library began filling up with the possessions of those who had vanished: their televisions and computers, their walkers and bags of clothes.
It seemed like a good omen when a few residents came back from the hospital grinning, having faced the ordeal and lived to tell about it. "I wouldn't even say to them, 'I thought you were dead,'" Varahn said. "I was just happy to see them." But then she spotted these survivors in the lobby or going out shopping and worried that the sickness would continue to spread.
The virus was taking the worst toll in the Bronx, and Bronxwood sat within the borough's hardest-hit ZIP code, although it would be weeks until anyone would know this. But by April, it was clear that elderly Black and brown people with preexisting health conditions, living in crowded housing in the city's poorest neighborhoods, were among those most susceptible. That many of Bronxwood's residents belonged to this demographic did not escape anyone there.
When Varahn arrived at Bronxwood in the summer of 2019, she was 65 and still worked at two salons. She hadn't been planning to move to an assisted living facility, but she was desperate to find an affordable room. She had been sharing a ground-floor apartment with her 28-year-old son in Allerton, a working-class neighborhood in the Bronx, before her landlady pushed her out to make space for her grandchildren. Friends told Varahn she should have taken the matter to court, and maybe she could have, but she believed that things happened for a reason.
In the brick vastness of the east Bronx, with its towering apartment blocks and modest duplexes, Bronxwood's cream-and-beige exterior stood out. The building was just a 20-minute walk up the street from her old apartment, so she didn't have to worry about missing her clients, her church sisters or the kids she mentored, who called her Mother V. Her benefits covered the $1,270 rent, which included three meals a day and housekeeping. The shared bedrooms — crammed with two twin beds, two stout night tables, two wardrobes and two wooden dressers — were small, but Varahn didn't think she'd spend much time in hers.
On the first floor, which housed the recreation and meeting rooms, there was always something to do. Staff threw holiday parties and monthly birthday celebrations. Visitors came by to help with knitting and coloring and computer lessons. There was Uno, Pokeno and afternoon bingo. On Wednesdays, members of the cooking club prepared Cornish hens, fish and chips, liver with onions. In the afternoon, bands would perform — classical and jazz, calypso and merengue — and some of the singers were quite talented.
Not long after Varahn moved in, she met Glenda King at a Bible study group. Glenda, who is 68 and has lived at Bronxwood for over seven years, wears square transition lenses and tucks her gray hair into a prim, low bun. Dryly self-deprecating, she considers herself an introvert who has the misfortune to live in a building with 270 other people. She makes a point of being friendly, even though she likes to say that she has no true friends.
At first, Glenda found Varahn to be reserved, but she soon realized that what she had mistaken for detachment was simply Varahn's way of taking in her new surroundings. Varahn knew how to draw people out and listen to their problems. She had worked as a beautician since high school, first at flagship boutiques in the city and later for the disco diva Carol Douglas and on the sets of Spike Lee films. Her clients felt comfortable confiding in her, and before long, so did the residents of Bronxwood. "I can go up and talk to her about anything," Glenda told me. "Her forte is humility."
All adult care facilities are legally required to maintain a forum where residents can independently discuss their living conditions, but some resident councils, like Bronxwood's, are more active than others. Although Varahn was new to the building, people encouraged her to run for president. She would bring an unusual amount of political experience to the council: She had previously served as vice chair of the Allerton Barnes Block Association and as president of both the neighborhood merchant's group and a charity society at her church. Under her bed, she stored the plaques from various luncheons that had celebrated her civic advocacy.
After Varahn's victory in the September elections, Glenda, who had worked for many years as a typist, took on the duties of council secretary, and Hurshel Godfrey, another longtime resident, assumed the vice presidency. Every month, the council gathered in the main lobby, which fit about 60 people, some of them perched on their walkers. Varahn, who has a broad, serious face and a sleek bob, dressed for the occasion in crisp two-piece suits with lapels. She worked to cultivate a shared sense of purpose. "I never said I could do something, even if that was true," she said. "I always emphasized that we could do it together."
One of the first things Varahn noticed that fall, as the weather grew colder, was how few residents had proper winter clothes. Some explained that they were stuck indoors because they lacked coats. Old men shuffled around in flip-flops in the rain. In the annual grant application for extra state funding, Varahn secured a bigger clothing allowance — $200 per resident — and a double-oven stove for the communal kitchen. She brought in educational speakers for Veterans Day and Black History Month, and planned field trips to go out dancing and to the casino. "Varahn had a lot of connections," Hurshel said. "I knew a few people, but she knew a lot."
Some of the local politicians Varahn was acquainted with started asking her if she had ever considered running for higher office: The City Council elections were coming up in 2021. In February, she started riding the subway to midtown Manhattan to take a class for first-time candidates. Former campaign managers shared tips on electoral strategy and the best kind of eye contact to make with large crowds. Maybe, she thought, electoral politics was her calling.
At this point, the virus was said to be on the other side of the world. It hadn't yet surfaced in a nursing home in Kirkland, Washington, or in New Rochelle, just a short drive up the road.
Until the 1980s, elderly Americans with medical needs had limited options: They could age at home with family or aides, or they could "park and die," as the saying went, at a nursing home. Assisted living facilities emerged as a third way, rejecting the clinical strictures of a medical institution in favor of a more informal, dormlike setting.
In the last four decades, demand for assisted living has soared. The paradigm promises residents the freedom to live autonomously — and operators freedom from regulation. Unlike nursing homes, assisted living facilities are not subject to federal oversight. The standards for care — along with the definition of "assisted living" — vary greatly from state to state (and from facility to facility).
During the pandemic, these freedoms have become liabilities. "If infection control was limited and regulation was already ineffective in nursing homes, it's almost nonexistent in assisted living," said David Grabowski, a professor of healthcare policy at Harvard Medical School who studies long-term care for older adults. "It's all the problems we are talking about with nursing homes, but even more so. There's less regulation, far less staffing and many of the residents are just as sick." The population in assisted living often closely resembles that of nursing homes, yet there are no requirements that the former provide full-time medical staff. In New York, according to government data, half of those in assisted living are over 85, two-thirds need help bathing and a third have Alzheimer's or some other form of dementia.
At Bronxwood, the state's third-largest adult care facility, residents said that employees initially lacked protective gear as they cleaned dozens of rooms. As in other homes in the city at the start of the outbreak, shared bathrooms and group meals made it difficult to isolate. And because it is not a medical institution, residents continued to enter and leave the building as they'd always done. (Neither Bronxwood nor Daniel Stern, an administrator, responded to repeated requests for comment.)
Less than 1% of Americans reside in long-term care facilities — a category that includes nursing homes and assisted living residences — but these facilities account for around 40% of the country's COVID-19 deaths. Researchers caution that this figure represents an undercount. Many states do not publish this data, or do so incompletely, and fewer than half of all states report cases in assisted living facilities, according to research by the Kaiser Family Foundation. "As a result," the analysis said, "it is difficult to know the extent to which residents and staff at assisted living facilities have been affected by COVID-19 or the extent to which interventions are urgently needed."
The way that New York counts deaths has been controversial from the start. That's because the state's Health Department will not attribute a death to a residential healthcare facility unless the death occurs on the premises. The unusual policy has baffled residents and their family members, along with lawmakers and healthcare experts. "This is a really big hole in New York state data," Grabowski said. "If someone lives for a long time in a nursing home, it makes no sense that their death is then attributed to the hospital rather than the nursing home." Without a proper count of cases and deaths, advocates argue, officials cannot direct scrutiny or resources to afflicted homes.
For more than two hours at a hearing in August, legislators repeatedly pressed the state health commissioner, Dr. Howard Zucker, for the number of deaths that could be traced back to residential healthcare facilities. His answers did not satisfy his interrogators. "It seems, sir, that in this case you are choosing to define it differently so you can look better," said Gustavo Rivera, the state Senate Health Committee chairman, whose district includes part of the Bronx. "And that's a problem."
Gov. Andrew Cuomo has boasted about the relatively low death toll in the state's nursing homes, despite the fact that no other state counts these deaths as New York does. As of mid-November, there have been more than 6,619 virus-related deaths within the state's nursing homes and 179 in its adult care facilities, according to official data. Bronxwood, however, has never appeared in that tally.
"The public list is incomplete and misleading," said Geoff Lieberman, the executive director of the Coalition of Institutionalized Aged and Disabled, an organization that advocates on behalf of adult home residents in New York City. "Either everyone at Bronxwood died at the hospital, or the information isn't being accurately reported." Before the August hearing, Lieberman and his colleagues at CIAD interviewed residents at 28 adult homes in New York City, including Bronxwood, and tallied around 250 deaths from their accounts — a stark contrast to the 53 deaths that facilities had self-reported to the state. Bronxwood employees likewise sounded the alarm: In April, six staff members told local news that by their count more than a dozen residents had died.
Residents played detective, too. In May, when the U.S. death toll hit 100,000, Renee Johnson tried to match the names she saw in the newspaper to those of her missing neighbors. "We lost a lot of friends," she said. "And you're scared — you're really scared — because you don't know if you're next."
Jonah Bruno, a spokesman for the Department of Health, defended New York's approach to counting COVID-19 deaths in residential healthcare settings. "The Department goes to great lengths to ensure the accuracy and consistency in our data reporting," he wrote in an email. Bruno did not disclose how many residents died in the hospital after falling ill at Bronxwood, but he noted that the facility passed an infection control survey in May. "Since the start of this pandemic," he added, "we have made protecting the most vulnerable New Yorkers, including those in adult care facilities, our top priority."
Slowly and then all at once, everything that had made Bronxwood bearable was taken away. Residents were discouraged from seeing one another, going outside or congregating in common areas. Visitors were banned. Whenever people lingered downstairs or smoked out on the patio, staff ushered them back to their rooms.
Varahn hung posters in the lobby to try to boost morale. The first gave the administration and staff five hand-drawn stars and thanked them "for caring during COVID-19." "WE ARE ALL IN THIS TOGETHER," read the second, on which she had colored an American flag. Some residents thought their president was doing the best she could, given the circumstances. Others were offended. They didn't want to thank anyone: They were miserable.
Deborah Berger, who lives on the fourth floor, likened the new regime to living in a giant day care center. Glenda said she felt like a puppy in a doghouse. Renee compared it to jail.
The analogies were ready at hand, but what was harder to express was how little trust they had in the institution tasked with protecting them. "Nobody is talking to us," Renee said. "The staff just say: 'Go to your room. Go to your room.' There's no feelings. There's no nothing."
Glenda washed her hands until she felt as if they were going to fall off. She wiped everything down with bleach — door handles, dresser, windowsill. She had a weak left lung, and she was terrified. "If I get one hit of that coronavirus," she liked to say, "I'm not going to make it." When her legs got stiff from sitting, she paced up and down her cappuccino-colored hallway, about the length of a city block. Other times, wearing a surgical mask, she wheeled her walker downstairs, though the state of affairs there could be disappointing. A lot of residents didn't wear masks. They huddled around the TV and crowded in the elevator. People were getting complacent. "Not me," Glenda said.
The council had suspended its meetings, but toward the end of April, several residents approached Varahn to report that Bronxwood was not giving them their stimulus checks. In fact, complaints about missing or partial stimulus checks were so widespread throughout the city's facilities that the state issued a guidance: Residents' money belonged to residents. Varahn convened an impromptu meeting with the council's leadership in the stairwell — the only somewhat quiet place in the building — to strategize about what to do.
Hurshel, the vice president, was planning to ask about his check. "Don't ask," Varahn coached him. "Say, 'I came here to get my money and I'll cash it myself.'" Glenda noted that people with dementia might not remember the existence of the checks in the first place, so she knocked on doors to remind them.
Part of Varahn's role as president was to relay these and other concerns to Mr. Stern. They had an easy, playful rapport. Sometimes, he asked what an intelligent woman like her was doing living in a place like this. The question flattered her, but it also unsettled her, as if she wasn't wanted or didn't belong.
People talked about leaving Bronxwood almost as soon as they arrived, but the truth was that they were there because they had nowhere else to go. The elderly are typically steered to places like Bronxwood after a stay in the hospital. They have taken a fall or needed a surgery, and while they're recovering, lose their apartment. Others, like Glenda, are recommended by a caseworker at a shelter. It's not uncommon for such homes to hire recruiters to help fill their beds.
While many assisted living facilities cater to a wealthy clientele, who pay out of pocket, Bronxwood primarily serves low-income seniors. (It is, technically speaking, an adult home with an assisted living program.) Most residents sign over their supplemental security income to pay for the room and board — and out of that sum the facility gives them a $207 "personal needs allowance" each month. The money runs out quickly, since it often goes toward phone bills, toiletries, transportation and more nutritious food.
Out of Bronxwood's 270 or so residents, more than half are enrolled in its assisted living program, whose costs are covered by Medicaid. In theory, the program offers an extra level of care to those who need it. In practice, it functions as a "huge financial boon" to the adult home industry, said Tanya Kessler, a senior staff attorney with Mobilization for Justice, a legal services organization. Bronxwood can charge Medicaid between $78 and $154 per enrolled resident each day, depending on his or her needs. But Kessler said there's little oversight into whether this additional funding results in additional care. Bruno, the spokesman, said that the Health Department conducts regular inspections of assisted living programs "to ensure all applicable laws, regulations and guidelines are being followed."
Healthier residents at Bronxwood told me that they seemed to be roomed with those who were more infirm, effectively placing them in the role of an extra aide. "One of the big complaints we hear is, 'I'm not well myself, but they put this person in here that they expect me to look after,'" said Sherletta McCaskill, who, as the training director of CIAD, helps adult home residents organize councils and independent living classes. "It speaks to the lack of services that these homes are providing." The most recent audit by New York's Office of the Medicaid Inspector General found that Bronxwood had overbilled Medicaid by $4.4 million in 2006 and 2007. (Bronxwood requested an administrative hearing to challenge the findings, according to an OMIG spokesperson; the date is pending.)
In the pandemic, everyone's escape plans, loudly discussed yet endlessly deferred, took on a new urgency. Residents told Varahn that they were joining the city's long wait list for subsidized senior housing, or that a son or daughter was coming to rescue them. Faye Washington, who was 68 and lived down the hall from Glenda, tried to compile a list of senior housing options in the Bronx. "You know why I want to get out?" Faye said. "Because when all those people passed away, it killed me."
Faye told Glenda, "I'm taking you with me." But Glenda was not in any hurry. It was safer, she felt, to be where an aide could hear if she called for help. She had heart problems, anxiety, memory loss and chronic fatigue. Her family had asked her to stay with them, but she did not want to babysit relatives. As she saw it, if God had wished her to have more children, he would have let her keep getting her period.
Varahn's family urged her to leave as soon as possible, even if it meant losing a month of rent. But where would she go? Varahn wondered. And then what would she do? The lady who lived across the hall had gone to see her daughter in Georgia, and now she was stuck there while all her things were here.
As the lockdown dragged on, Varahn felt herself sliding into a depression. Before March, she was always out with a client or at some community meeting. Now she was eating three meals a day on a rectangular folding table at the edge of her bed. She was gaining weight from staying inside. Her feet were swollen. Her back hurt.
She started taking walks, sometimes just a few blocks, to relieve the pain. The soccer field across the street, where kids played on Saturdays, was empty. Many of the stores on White Plains Road, Boston Road and Allerton Avenue, including the salons, were closed until further notice, and some days it felt like the entire world was at a standstill.
It wasn't just the forced isolation that discouraged her. Everything was happening on some sort of screen, and the tedious video engagements and text messages often left her frustrated. In her class for first-time campaigners, which had migrated to Zoom, the connection was always faltering, making it difficult to understand what anyone was trying to say.
At other times, she wasn't isolated enough. Her roommate rose at dawn and sold loose cigarettes throughout the day. People were always stopping by. Whenever Varahn was on a call or at a virtual meeting, the roommate muttered under her breath or cursed sarcastically. Once, the noise was so disruptive to the class that the instructor told Varahn to mute herself, which she found humiliating. What would have been merely an inconvenient pairing in normal times had under quarantine become an oppressively intimate arrangement. There was also the problem of Varahn's older sister, Childris, whose heart was starting to fail. The grief put a constant pressure on her days. All this made it hard to concentrate, and she soon fell behind on her studies. So many things about her path to the City Council were uncertain now anyway. Was a person of her age expected to knock on doors? Would she have to campaign through a computer screen?
Varahn began searching for a way to reclaim her freedom. She asked Mr. Stern for a room of her own. As far as she could tell, there was plenty of space in the building. A private accommodation could double as a little office for the council, she reasoned — somewhere that residents could feel comfortable speaking to her. But management never acted on her request. Victoria Kelley, a former jazz singer who had lived at Bronxwood for three years, suspected that Varahn's battle for the clothing allowance had turned administrators against her. Such retaliation is not unheard of, according to advocates who work with residents at adult care facilities. "If you don't have someone on the council to fight for you, nothing gets done, but Varahn did fight," Victoria told me. "Some of the naysayers got jealous."
With the arrival of spring, a different approach revealed itself to Varahn. First she rented a car, so she could get around more easily. Bright flowers fringed the patio, and slender trees cast ragged patches of shade on the sidewalk. Her errands had been piling up, too. She needed to buy cases of bottled water, pick up her son's stimulus check from her ex-landlord, haul her sheets to the laundromat after her roommate got bedbugs.
Then she started driving for the pleasure of it, humming along to power ballads on Christian radio and chatting on the phone with friends. She found herself going through the boxes in her U-Haul storage unit, making a mental inventory of all the things she didn't have space for at Bronxwood, like her slow cooker, her turkey roaster, her Ashley Stewart outfits, her dance costumes. One weekend, a few FOR SALE signs caught her attention. That was when she realized what was happening: She wanted out.
It was a complicated undertaking. Most apartments were too expensive, which is why she hadn't been able to get one in time last year. And even if she was lucky enough to find something affordable, she would have to keep working — perhaps, if salons weren't allowed to reopen, somewhere that wasn't a salon. Then again, she didn't want any of the residents to feel that she was leaving them behind.
One morning toward the end of July, Glenda's cellphone rang. The sound surprised her, because she had stopped paying the bill. When Glenda called the number back from the room's landline, it turned out to be Varahn, who announced that she was moving out the next day and promised to stop by in September "to pass the torch." Glenda told Varahn she was happy for her, and she was. But she wished her friend had let her know sooner. Hurshel, the vice president, was unable to step in, because he, too, had just left. After five years on the city waitlist for affordable housing, he'd finally landed a new spot. It was less than a block away from Bronxwood. "You have to get out of there," he warned his old friends.
That same week, Bronxwood laid off employees without warning, apparently because of the declining number of residents. There was no longer an aide for the fourth floor, according to three people who lived there, and there was no one to speak up about it. "I feel stripped naked, like we're getting ready for the slaughterhouse," Glenda said the next day. We were sitting down the street, and as staff trailed out of the building at the end of the afternoon shift — a long procession of teal and navy scrubs — some of them were wiping away tears. "Right now, the administration can say anything goes."
Glenda knew she did not want to serve as president, even in an interim capacity, and asked Renee, a former president, what to do. Renee was telling everyone who had asked her this question the same thing: She didn't have a clue. "We're so lost right now," Renee said to me in August. Her bingo crew had dwindled from more than 15 players to fewer than 10. She was pessimistic about the prospects for a socially distanced election: "We don't even know who is dead or alive."
Varahn had implied to Glenda that she was staying in the Bronx. In reality, she was moving to suburban Maryland. She had signed the lease for a one-bedroom apartment in a senior living community just a short drive away from her daughter's house. It was everything that Bronxwood was not: serene and quiet, lush with greenery.
She had told Glenda only half of the story because she couldn't quite believe her good fortune. "I feel so sorry because some of them are waiting there thinking that they will someday get an apartment," Varahn said. "If it wasn't for my associations" — the support from her family, her earnings from the salon — "I would be stuck there, too."
Her family was relieved about her departure, but Varahn remained uneasy. With a room of her own, she thought, or even a different roommate, she probably would have stayed. As it was, the likely return of the virus in the winter frightened her.
When she packed up her belongings, she felt as if she were packing up the future she had once imagined for herself. "By now, I would have been running for City Council, if this virus didn't happen," she said. "So I'm saying to myself, well, you know, that wasn't in God's plan." Though she kept her move a secret, one resident spotted her carrying boxes in the hallway and asked her, "Are you just going to leave us like that?" It was the same question she had been asking herself for months.
In a handwritten letter Varahn gave to Bronxwood's administrators before she left, she expressed her desire to remain president from afar until it was safe to hold an election. She had planned to retire there, the letter said, yet it was impossible to do so under the current circumstances. She expected Mr. Stern, or at least his secretary, to call to offer his regrets, but she never got a response. It made her feel as though nothing she had done at Bronxwood mattered — as though she had never lived there at all.
Ava Kofman reports on technology. To send Ava tips, email ava.kofman@propublica.org, or text 347-410-0113.
The Trump administration is rushing to approve dozens of eleventh-hour policy changes. Among them: The Justice Department is fast-tracking a rule that could reintroduce firing squads and electrocutions to federal executions.
This article was published on Wednesday, November 25, 2020 in ProPublica.
Six days after President Donald Trump lost his bid for reelection, the U.S. Department of Agriculture notified food safety groups that it was proposing a regulatory change to speed up chicken factory processing lines, a change that would allow companies to sell more birds. An earlier USDA effort had broken down on concerns that it could lead to more worker injuries and make it harder to stop germs like salmonella.
Ordinarily, a change like this would take about two years to go through the cumbersome legal process of making new federal regulations. But the timing has alarmed food and worker safety advocates, who suspect the Trump administration wants to rush through this rule in its waning days.
Even as Trump and his allies officially refuse to concede the Nov. 3 election, the White House and federal agencies are hurrying to finish dozens of regulatory changes before Joe Biden is inaugurated on Jan. 20. The rules range from long-simmering administration priorities to last-minute scrambles and affect everything from creature comforts like showerheads and clothes washers to life-or-death issues like federal executions and international refugees.
Every administration does some version of last-minute rule-making, known as midnight regulations, especially with a change in parties. It’s too soon to say how the Trump administration’s tally will stack up against predecessors. But these final weeks are solidifying conservative policy objectives that will make it harder for the Biden administration to advance its own agenda, according to people who track rules developed by federal agencies.
“The bottom line is the Trump administration is trying to get things published in the Federal Register, leaving the next administration to sort out the mess,” said Matthew Kent, who tracks regulatory policy for left-leaning advocacy group Public Citizen. “There are some real roadblocks to Biden being able to wave a magic wand on these.”
In some instances the Trump administration is using shortcuts to get more rules across the finish line, such as taking less time to accept and review public feedback. It’s a risky move. On the one hand, officials want to finalize rules so that the next administration won’t be able to change them without going through the process all over again. On the other, slapdash rules may contain errors, making them more vulnerable to getting struck down in court.
The Trump administration is on pace to finalize 36 major rules in its final three months, similar to the 35 to 40 notched by the previous four presidents, according to Daniel Perez, a policy analyst at the George Washington University Regulatory Studies Center. In 2017, Republican lawmakers struck down more than a dozen Obama-era rules using a fast-track mechanism called the Congressional Review Act. That weapon may be less available for Democrats to overturn Trump’s midnight regulations if Republicans keep control of the Senate, which will be determined by two Georgia runoffs. Still, a few GOP defections could be enough to kill a rule with a simple majority.
“This White House is not likely to be stopping things and saying on principle elections have consequences, let’s respect the voters’ decision and not rush things through to tie the next guys’ hands,” said Susan Dudley, who led the Office of Information and Regulatory Affairs in the Office of Management and Budget at the end of the George W. Bush administration. “One concern is the rules are rushed so they didn’t have adequate analysis or public comment, and that’s what we’re seeing.”
The Trump White House didn’t respond to requests for comment on which regulations it’s aiming to finish before Biden’s inauguration. The Biden transition team also didn’t respond to questions about which of Trump’s parting salvos the new president would prioritize undoing.
Many of the last-minute changes would add to the heap of changes throughout the Trump administration to pare back Obama-era rules and loosen environmental and consumer protections, all in the name of shrinking the government’s role in the economy. “Our proposal today greatly furthers the Trump administration’s regulatory reform efforts, which together have already amounted to the most aggressive effort to reform federal regulations of any administration,” Brian Harrison, the chief of staff for the Department of Health and Human Services, said on a conference call with reporters the day after the election. Harrison was unveiling a new proposal to automatically purge regulations that are more than 10 years old unless the agency decides to keep them.
For that proposal to become finalized before Jan. 20 would be an exceptionally fast turnaround. But Harrison left no doubt about that goal. “The reason we’re doing this now is because,” he said, “we at the department are trying to go as fast as we can in hopes of finalizing the rule before the end of the first term.”
Easier to Pollute, Harder to Immigrate
One proposal has raced through the process with little notice but unusual speed — and deadly consequences. This rule could reintroduce firing squads and electrocutions for federal executions, giving the government more options for administering capital punishment as drugs used in lethal injections become unavailable. The Justice Department surfaced the proposal in August and accepted public comments for only 30 days, instead of the usual 60. The rule cleared White House review on Nov. 6, meaning it could be finalized any day. The Justice Department didn’t respond to a request for comment.
Once finalized, this rule might never be put into practice. The Trump administration executed a federal prisoner in Indiana on Nov. 19 and plans five more executions before Jan. 20, all with lethal injections. After that, Biden has signaled he won’t allow any federal executions and will push to eliminate capital punishment for federal crimes.
Other less dramatic-sounding rules could prove harder to unravel and have broader consequences. In particular, the Environmental Protection Agency is on the cusp of finalizing several rules that would make it harder to justify pollution restrictions or lock in soot levels for at least five years. The agency wants to keep the soot standard unchanged over the objections of independent scientific advisers and despite emerging evidence that links particulate pollution to additional coronavirus deaths.
An EPA spokesman declined to comment on the timing of these rules. “EPA continues to advance this administration’s commitment to meaningful environmental progress while moving forward with our regulatory reform agenda,” the spokesman, James Hewitt, said.
While those rules have developed over years, others were launched later and officials are taking shortcuts to finish in time. Reviews by the White House’s Office of Information and Regulatory Affairs that normally take 90 days or more are now wrapping up in as few as five days.
The White House is close to completing severalrules that would extend Trump’s record of restricting immigration and make the changes harder for the Biden administration to reverse. The pending rules would make it more difficult to claim asylum by excluding people with criminal convictions (even those that have been expunged), drastically shortening the application time and giving immigration judges more latitude to pick and choose what evidence to consider. The departments of Justice and Homeland Security didn’t respond to requests for comment.
Some rules read like Trump’s stump speeches translated into policy legalese. The Department of Energy is racing to loosen efficiency standards for showerheads and laundry machines, evoking Trump’s recurringbits about bathroomwater pressure. “Do you ever get under a shower and no water comes out?” Trump said at an October rally in Nevada. “And me, I want that hair to be so beautiful.”
Notably, the trade group representing washer manufacturers actually opposes the administration’s proposal, saying it’s unnecessary because many machines already have short-cycle options. The proposed rule is supported by small-government advocates such as the Competitive Enterprise Institute. Water and electric companies warn it could lead to higher consumption and waste. The Energy Department didn’t respond to a request for comment.
The administration is also bucking business groups with proposals to restrict high-skilled immigration; in October, the departments of Homeland Security and Labor unveiled regulations to raise wage and education requirements for H-1B visas, which are often used in the information-technology industry. (The proposal drew opposition from theSmall Business Administration, saying the higher costs would stifle innovation and growth.) But while raising the wage scale for skilled immigrants, the administration is pushing a different new rule to lower wages for “low-skilled” immigrant farmworkers. A spokesperson for U.S. Citizenship and Immigration Services (part of DHS) told ProPublica that “Any delay in responding to an economic emergency and high unemployment in a way that protects American workers and ensures the H-1B program is administered consistent with statutory requirements could cause real harm to the U.S. economy.” The Department of Labor didn’t respond to requests for comment.
Other rules are more clearly accommodating powerful business interests. A rule completed on Nov. 13 would restrict pension managers from considering social and environmental impacts (known in the industry as ESG) when choosing investments. Another Labor Department rule would make it easier for companies like Uber to withhold benefits by classifying workers as independent contractors instead of full employees. Both proposals had a truncated public comment period of only 30 days. A spokesman said the agency considers all comments regardless of how long the period lasts and that the department is working to complete all regulations on its agenda.
Chicken Plants on the Fast Track
Such shortcuts still might not be enough to finish some new rules that are just starting out now. Still, these tactics have raised alarms about the USDA’s proposal to speed up chicken factories, even though a regulatory change like that would ordinarily take two years or more. The USDA has not provided a timeline, and the proposal is not yet public while the White House reviews it. An agency spokesman said the department is following the standard process.
The rules change has the support of the National Chicken Council, an industry trade group, which argues that the timing is not political. Spokesman Tom Super called the proposal “the most deliberative and studied proposed rule that has ever been issued. It spans three decades, four administrations — Republican and Democrat — countless scientific studies and various court cases.”
The USDA has been laying the groundwork for the rule change for years. Even though safety concerns scuttled the USDA’s previous attempt to raise speeds from 140 birds per minute to 175, in 2018 the agency started granting one-off waivers to individual plants that sought permission to run faster.
The performance of those plants could equip the USDA to argue that the speed limit should go up in all of them. Although the agency has not yet released its formal justification for the new proposal, officials have referenced a new study in the journal Poultry Science that concluded that inspectors in plants with faster speeds did not detect higher average levels of salmonella contamination.
The USDA funded the study through a no-bid contract worth up to $500,000 awarded in 2018 to Louis Anthony “Tony” Cox Jr., a statistician who consults for business interests such as the American Petroleum Institute and the American Chemistry Council, according to the Center for Investigative Reporting.
Cox declined to share data he secured exclusively from the USDA or to be interviewed for this article. In emailed answers to written questions, he defended his methodology but acknowledged there’s room for further study.
Other evidence, however, suggests faster speeds could make chicken less safe to eat. In a September article in the journal Frontiers in Veterinary Science, USDA researcher Jeremy Marchant-Forde and a co-author found that USDA inspectors threw out record-low amounts of chicken when the agency let more plants speed up since May. The authors called this “a major threat to public health” to the extent it suggests inspectors were failing to find contaminated carcasses (rather than the birds having suddenly become much cleaner). But the authors cautioned they’re not food safety experts and declined to comment further.
While the food safety issues are debated, there’s already clearevidence that running faster lines poses higher worker risks, both repetitive strain injuries like carpal tunnel and traumatic injuries like cuts and amputations. But the USDA maintains that it is responsible only for food safety; worker safety is the job of the Occupational Safety and Health Administration.
That’s exactly the kind of interagency dialogue that the White House is supposed to coordinate when planning new regulations — and the kind of process that could be shortchanged in the final months of an administration, according to the American Public Health Association’s Occupational Health and Safety Section. An OSHA spokeswoman declined to say whether the agency has weighed in on the USDA’s proposal. The National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention, has not yet commented on the proposal but plans to, a spokeswoman said.
“This last-minute push for an ill-advised rule change could be deadly for essential workers in slaughterhouses,” said Jessica Martinez, co-executive director of the National Council for Occupational Safety and Health, an advocacy group for safer working conditions.
Leasing Against the Clock
Since many finalized Trump rules are currently under court challenges, the Biden administration might be able to let some of them wither or die in litigation — especially where judges have blocked or struck down the regulations and the new Justice Department could decide not to appeal.
It will also have to wrestle with other changes the Trump administration is rushing to implement, using tactics other than rule-making.
The Trump administration is also pressing ahead with opening up more federal lands to oil and gas development, despite low prices, sluggish demand and complaints from environmental groups that drilling would encroach on wildlife habitats and national parks. Bids are starting at just $2 an acre for more than 445,000 acres of public land with leases for sale to energy companies through the Bureau of Land Management, according to data from EnergyNet.com.
The leases could expand dramatically as the BLM finalizes a plan to allow oil and gas drilling on an additional 6.8 million acres of the National Petroleum Reserve in Alaska, a habitat for bears, musk oxen, caribou and birds. Spokespeople for the BLM didn’t respond to a request for comment.
Separately, the Interior Department will open up drilling in the Arctic National Wildlife Refuge. The agency is spending 30 days asking companies for bids, and then sales need another 30 days to take effect — just enough time to beat the clock before the inauguration.
An Interior Department spokesman said the agency is taking “a significant step” to implement Congress’ direction in the 2017 Republican tax bill to start drilling in ANWR. “The department will continue to implement President Trump’s agenda to create more American jobs, protect the safety of American workers, support domestic energy production and conserve our environment,” the spokesman, Conner Swanson, said. He didn’t say whether the leases would be done by Jan. 20.
Leases that have not yet been issued would be easier for the Biden administration to drop, but even finalized leases could be withdrawn if officials decide they were improperly issued or too environmentally dangerous, according to Erik Grafe, an attorney with Earthjustice in Anchorage. (Leaseholders might argue they deserve to be compensated.)
In addition, even once leases are issued, companies need permits and authorizations before actually taking action on the ground, Grafe said. Those steps would take more time and face legal challenges. Earthjustice and other groups are already suing to block the Arctic drilling program as a whole.
“We have been protecting this place forever,” said Bernadette Demientieff, executive director of the Gwich’in steering committee representing indigenous hunting communities in northeast Alaska. “This fight is far from over, and we will do whatever it takes to defend our sacred homelands.”
Eleven states let school districts decide whether students and staff must wear masks. One Georgia middle school where masks were optional became the center of an outbreak.
This article was published on Monday, November 23, 2020 in ProPublica.
On a balmy August morning in Emanuel County in eastern Georgia, hundreds of children bounded off freshly cleaned school buses and out of their parents’ cars. They were greeted by the principal, teachers and staff at Swainsboro Middle School who hadn’t seen them in four months. Before allowing the children to enter, a longtime receptionist beamed a temperature gun at their foreheads and checked for violations of the public school’s strict dress code: mostly neutral colors, nothing tight and no shoulders exposed.
Masks were optional, and about half of the children wore them. So did the receptionist, but only sporadically, according to several teachers.
Within a couple of days, the receptionist was out sick. Another receptionist called in sick as well. Both had caught the coronavirus, according to social media posts. In the ensuing weeks, a wave of cases would rush through the building — an outbreak for which district leaders blamed the community rather than the lack of a mask mandate in the schools. At least nine middle school teachers would be infected, including four along a single hallway; one would spend four weeks on a ventilator, fighting for her life. More than 100 students were quarantined because of positive cases or exposure. Within the first two months of school, the county would have one of the highest proportions of school-age COVID-19 cases in the state.
“Not everything that could have been done or should have been done was being done in the school system to stop the spread,” said Dr. Cedric Porter, a local physician who pushed in vain for a mask requirement. “Everybody seemed to be intent on keeping it secret that there was a serious problem.”
When another school district in Georgia 200 miles northwest of Emanuel went back to school in early September, the rules and results were far different. The city of Marietta required masks, with even pre-kindergarteners donning them inside school buildings. It trained its own contact tracers. During its first month of classes, it reported no school-related transmissions of COVID-19.
The divide between Emanuel and Marietta reflects a national split over how far the government should go in imposing public health measures to combat the coronavirus. As COVID-19 cases skyrocket, political leaders have struggled to balance concerns about individual freedom and harm to the economy with the imperative of curbing the virus’s spread.
Nowhere does this gulf seem wider than in the debate over whether to require students and school staff to wear masks. While Dr. Anthony Fauci and other health experts have overwhelmingly promoted masks as an effective, research-backed tactic — and one that works best only if everybody participates — some policymakers have maintained that whether to wear them should remain a personal choice. President Donald Trump has opposed mask mandates, as have many Republican legislators.
The result is a patchwork of safety protocols colored by political views. Although several states in the past weeks have belatedly mandated masks, 11, including Georgia, don’t require students to cover their noses and mouths — even when gathered indoors, in small classrooms or in close contact during sporting events, ProPublica found. The states left the matter to local districts. Schools in only about a third of Georgia’s counties require masks.
No other precaution short of closing schools — a drastic measure that can set children back academically and developmentally, and deprive them of free meals and health care — is likely to be as effective as a mask mandate, experts say. Allowing staff and students to forgo them contradicts guidance from the Centers for Disease Control and Prevention on reopenings.
“Masks are the most essential of all, especially because social distancing, quite frankly, is a challenge in most schools,” said Dr. Dimitri Christakis, director of the Center for Child Health, Behavior and Development at Seattle Children’s Hospital and the editor in chief of JAMA Pediatrics.
“The bare minimum for the protection of kids and teachers needs to be universal masking and some increased ventilation,” said Dr. Joshua Barocas, an assistant professor at Boston University School of Medicine and an infectious diseases physician at Boston Medical Center. “If you can’t do that, you have no business being open.”
An emerging body of research has shown that younger children in primary schools typically experience mild or no symptoms of the virus and are less likely to transmit it. However, older children, particularly those in middle and high school, appear to have higher transmission rates, CDC researchers found in early October. The incidence among children ages 12 to 17 was about twice that of kids 5 to 11.
“Young persons might be playing an increasingly important role in community transmission,” the researchers warned.
In Georgia, the divide over masks sent school districts such as Emanuel and Marietta on two distinct trajectories this fall, data suggests. Children tended to make up a smaller proportion of total COVID-19 cases in counties with mask mandates in schools, a ProPublica examination of reopenings in Georgia revealed. Conversely, in counties that did not require masks in the classroom, children tended to make up a larger proportion of cases.
Overall, in Georgia counties where school-age children represented less than 6% of all coronavirus cases, roughly 80% of school districts required masks. In counties where children made up 10% or more of cases, 80% of districts did not mandate masks.
To be sure, in counties where they make up larger proportions of virus cases, children may be more likely to interact without masks outside school, in homes, playgrounds and other spots. But the findings suggest that a community’s attitude toward face coverings — as reflected in its school policies — plays an important role in transmission.
“If what you’re really showing is the places where they wore masks are doing better, that’s really the bottom line,” said Dr. Benjamin Linas, an associate professor of infectious diseases at Boston University School of Medicine. “Whether it’s specifically masks in schools or not is almost just like an academic question.”
As Georgia schools began reopening this past summer, they received mixed signals on whether to require masks. In phone calls with school superintendents, public health officials advocated mask wearing. But Gov. Brian Kemp refused to mandate their use in schools, or anywhere else, even suing the city of Atlanta to prevent it from requiring masks. (He later dropped the suit and has encouraged Georgians to wear masks.)
The Georgia superintendent of schools, Richard Woods, said through a spokesman that he lacks authority to mandate masks. He “has publicly encouraged mask wearing, has modeled that in school visits and public meetings, and specifically let districts know it can be addressed through updated dress codes,” the spokesman said. “He continues to encourage any mitigation efforts to decrease the spread, while allowing local districts to do what they think is best for their communities.”
Teachers’ groups favor a statewide requirement. “The more conservative counties are the counties that are [saying], ‘We’re going to be in school five days face-to-face, no masks are required,’” said Lisa Morgan, president of the Georgia Association of Educators, a professional association that sued the state in early October over COVID-19 safety (the lawsuit is pending). Political views, she said, are “making it very hard for students and educators to be safe.”
In the absence of a mask mandate, the Georgia Department of Public Health recorded 441 outbreaks of coronavirus tied to K-12 schools through Nov. 14. The department, which defines an outbreak as more than the expected number of cases in one place within a two-week period, would not say how many cases those outbreaks included or where they occurred.
Comparing school outbreaks between states is difficult because public health departments count and categorize cases differently. But in Illinois, a more populous state that does require masks in schools, the Public Health Department reported 10 outbreaks in schools during the 30 days ending Nov. 6. Illinois defines an outbreak as five or more cases where people from different households may have shared exposure on school grounds. And three weeks after the October reopening of schools in New York City, the nation’s largest district, which requires masks, only 20 staff members and eight students tested positive out of more than 16,000 tests. (New York shut down schools last week and returned to all-remote learning as the rate of positive tests in the city rose.)
There’s no available tally of school teachers or staff in Georgia who have died of COVID-19, but ProPublica was able to identify one such death.
Julie Carter was an employee of Appling County school district, which does not require masks.
An administrative assistant in the high school’s special education department, Carter also helped organize the local Special Olympics. Students “were her whole heart,” her husband Jimmy said.
Carter, an Appling County native, was eager to work at school this fall despite having respiratory problems. Classes didn’t start until Aug. 17, but staff returned several weeks earlier. Carter, who had her own office, put on a mask when people stopped by, her husband said. The mask offered her limited protection, but experts say if her visitor wasn’t wearing one, she was still at risk.
By mid-August, she was so weak that her husband took her to a local hospital. Later that month, she was airlifted to a hospital in Jacksonville, Florida. She died on Aug. 30 before her family, which was driving there, could arrive. She was 67.
The high school posthumously named her grand marshal of its homecoming celebration, giving her family a quilt with “ACHS Homecoming 2020” embossed on it during a pep rally. The school website paid tribute to her: “She will always be remembered for being a vital part of the life of ACHS and served the school with a kind and humble heart.”
Her death, though, did not spur a reversal of the county’s mask policy: Photos on the high school’s website show clusters of students posing in Halloween costumes in the hallways, without masks. School district officials did not respond to messages seeking comment.
Emanuel County, 90 miles west of Savannah, is a rural expanse dotted with pine forests and cotton fields. The county’s winding roads brim with American flags and Trump 2020 placards. It’s a Trump stronghold; the president received about 70% of the county’s votes on Nov. 3.
Many of the county’s 22,000 residents struggle to make ends meet, with households earning less than $40,000 on average. Only one in eight adults has a college degree. The school system is the region’s largest employer, followed by a local poultry plant and Walmart. More than 4,000 students attend the county’s schools, which include one primary, two elementary, one middle, a high school and a combined middle-high school. About half of the students are white, 43% are Black and 7% are Hispanic.
The school district had four months to determine how to reopen after Kemp closed schools across the state in early April and classes went remote. The board asked Superintendent Kevin Judy to develop a plan.
Judy, who has led the district since 2014, rose from a life sciences teacher to a principal to Emanuel’s superintendent, earning a doctorate in educational leadership and administration. While he opened all the district’s schools on Aug. 3 as scheduled, he empathized with families who hesitated to return to in-person schooling. Across the county, 30% of families chose virtual learning.
“My wife, she’s had breast cancer,” he said. “She’s a kindergarten teacher, and it’s something we worry about too. She teaches face-to-face every day with 20 to 22 kindergarteners in a classroom and has had a great year and wouldn’t change it for anything.”
Before reopening, Judy said, he sought guidance from the county Health Department and local physicians. He also held “informal discussions” with the school board about whether to require masks. They decided not to, without a public debate or vote. Instead, they simply encouraged the use of masks.
“The parents raised their kids, and that’s their decision to make what they feel comfortable with,” Judy said.
The county Health Department supported the school board. “You have to look at your community and see what’s best,” said Jennifer Harrison, a nurse manager at the department, who works directly with Judy to trace school cases. “They made it an optional thing and I agree with that. You’re not going to appease everybody every time no matter what you do.”
School board member Johnny Parker, who spent 40 years as a teacher and counselor, has worn a mask to the past four board meetings. Nevertheless, he said in a mid-October interview that masks should be optional. Although Trump had been hospitalized for COVID-19 two weeks earlier, Parker cited the president’s habits to defend the district’s policy. “The president, he doesn’t wear a mask.”
School reopenings, Parker said, had no effect on transmission rates. “Protests are spreading the virus more than the schools,” he said. “People who protest don’t have them on. The ones that are rioting and destroying people’s property, they don’t have them on. That might be the spread.”
On the south side of Swainsboro, the seat of Emanuel County, winds the Tiger Trail, a a pine-wooded paved stretch where all of the town’s schools are located. More than 600 students attend the one-story, sand brick middle school. COVID-19 awareness posters line its hallways, showing children how to spot symptoms and encouraging them to socially distance.
The virus penetrated the school before the students returned. During a staff planning week, two employees tested positive for the virus, a middle school teacher said. “When it starts up before the kids even get back, that should be a signal,” the teacher said. All current teachers at the middle school who were interviewed asked not to be named for fear of retaliation.
After the receptionists fell ill and a teacher went home with symptoms at the end of the first week of school, some staff members hoped that the administration would take strong action, such as closing the middle school for cleaning or widespread quarantining. (One receptionist declined to comment, and the other did not respond to interview requests.) But the school remained open and contract tracing was limited, with only a handful of children sent home to quarantine, said four staff members. “It was just business as usual,” a teacher said.
As schools reopened, however, throngs of children, parents and grandparents began pouring into Porter’s office, a one-story brick clinic in central Swainsboro, a block away from the county’s only hospital.
Porter, one of the few African American physicians in the county, had moved to Emanuel 33 years before to start a family practice. Having grown up with severe asthma in a small Georgia town, he understood the importance of high-quality health care in rural communities. When the pandemic began in March, he scoured studies in The New England Journal of Medicine, JAMA and other top-flight medical journals, preparing himself, and his county, for the virus’s arrival.
“We had lots of cases amongst the children, and then the parents were getting it, and some of the grandparents were getting it, and we were having hospitalizations among some of the adults that got sick,” Porter said.
Data from the state’s Health Department confirms Porter’s experience. The county had nearly as many coronavirus cases among school-age children in the first month of school as in the first five months of the pandemic. Harrison, from the county’s Health Department, said that the district has had between 10 and 50 outbreaks since schools opened but could not be more specific.
Yet few Emanuel County parents were aware of the surge. For the first three weeks of school, the superintendent did not report the number of cases among staff and students on the district’s website.
“We are transparent, we’re not trying to hide anything,” Judy told ProPublica. “Did I report data the first three weeks of school? No, truthfully, it never crossed my mind.”
“I just felt angry that this was handled in the way it was handled,” Porter said. “If people really knew how bad it had been, and how bad at times it gets, there would be more outcry and more of a problem keeping the schools open. People didn’t know the extent of the problem.”
Porter surveyed his pediatric patients and their families in an attempt to trace how they had acquired the disease. When children described what went on in school, he was startled. Many teachers and students were not wearing masks. Kids were crammed into classrooms with up to two dozen desks, 2 to 3 feet apart. Children often did not socially distance in hallways and cafeterias, despite a slew of signs reminding them to do so. Sports practice and games played on, with hardly any players or coaches masked. Students were sardined into buses, where they were required to wear face coverings, but often tucked them under their chins or hung them off their ears. Children sometimes ate lunch in classrooms with closed windows, allowing aerosolized particles to spread. And in some cases, an exposed student might be sent home for quarantine, but older or younger siblings might still attend class in another school.
Many of these practices disregarded recommendations from the CDC and World Health Organization, which stressed the importance of consistent masking of children and staff; small classes with desks spaced 6 feet apart; staggered bell times to minimize crowding in hallways; limited mixing of student groups throughout the day; and thorough contact tracing. Schools can be opened relatively safely, numerous studies have found, but only with proper safeguards in place.
Concerned that keeping schools open without a mask mandate would foster the spread of the virus, Porter phoned the superintendent and asked him to reconsider. “If kids are going to be in school, everybody needs to wear masks,” he told Judy.
The superintendent told ProPublica that the district took proper precautions in opening schools: Custodians mist classrooms at breaks and frequently wipe down high-touch surfaces like door handles and light switches. Students socially distance in the halls. Every hallway has at least three hand washing stations. When children or staff test positive, school nurses work with the Health Department and use surveys to track anyone that might have been exposed. And siblings of sick children, he contended, are indeed quarantined.
Porter detailed his concerns in an impassioned op-ed in the local paper. “The science is clear that the way we’re doing things will lead to a large spike in cases,” he wrote, pleading for masking in schools. “We may not fear that students will get sick, but I promise you, too many teachers, paraprofessionals, and others will.”
The superintendent did not address why Porter’s recommendations weren’t followed. “He was saying what he felt to be factual,” Judy said.
English teacher Shonray Brooks was nervous about going back to school. She had respiratory difficulties that required an inhaler, making her more vulnerable to the virus. But she had no choice. The district required teachers in core subjects to teach in person. While some states have strong unions that have helped teachers negotiate for protections during the pandemic, Georgia does not permit collective bargaining, leaving Brooks with little recourse.
Brooks grew up in Emanuel. Her mother died when she was 7, and her grandmother stepped in to raise her and her siblings. Education took center stage. Brooks became the family’s “encyclopedia-dictionary,” said her younger sister Shonte Smith, as well as a cornerstone of the high school debate team and the preferred tutor for failing football players. After graduating from Georgia Southern University, she returned to Emanuel to teach.
Brooks taught in the district for 15 years, often arriving before 7:30 a.m. to prepare lessons, staying late to grade papers and help train the step team, and on exam days, she’d whip up grits and breakfast casseroles in her crockpot for her students.
Shonte, who works as a hair stylist in Warner Robins, Georgia, two hours away, knew that nothing would keep her sister from her students, not even a pandemic. “It was a COVID cesspool,” Shonte said, but “those kids meant the world to her.”
When school started, Brooks was in quarantine, with only her gray cat, Sassy, to keep her company. A family member had tested positive for the virus, and while she hadn’t had much contact with her, she was cautious. But after testing negative, Brooks began teaching, donning both a cloth mask and a face shield.
In her first week back, Brooks and several other staff attended the school board’s monthly meeting, hoping members would discuss how to combat the pandemic. In the cavernous high school cafeteria, Judy and the board sat before the socially distanced attendees. Of the board members, only Parker wore a mask. They talked about the virus for less than five minutes, according to Deanna Ryan, a former Swainsboro middle school science teacher who attended the meeting. Ryan had recently started teaching in a nearby charter school, which had instituted a mask mandate.
“We have roughly fifteen employees and four students that are at home positive,” reported the superintendent, according to the meeting minutes. “The student transmissions did not take place at school but through family situations. With our employees, the majority happened outside of school. We have had some that did occur with employees not following guidelines during preplanning.”
By the end of that week, Brooks felt lethargic and her body ached. She stayed home from school that Friday and got tested. She stayed in bed most of the weekend, soreness spreading through her body, her lungs heavy. “All of the symptoms you hear about, she started having them,” said Shonte, who had a friend deliver Gatorade and soup to her sister’s front porch. Brooks brought the care package inside but was so exhausted that she had to rest on her couch on the way to the kitchen. Even though she was ailing, she managed to finish her final paper for an online master’s degree in education technology at Central Michigan University.
After three days, she received her results. She had the coronavirus. Less than 12 hours later, she was rushed to the emergency room of Emanuel Medical Center, struggling to breathe.
The first day of school in Marietta looked much different from Emanuel. Masks were as common as backpacks on students stepping off buses, their waves and thumbs-ups compensating for hidden smiles as grown-ups snapped photos.
The universal masks reflected a change of heart by Grant Rivera, who has been superintendent of schools in Marietta for four years and often sports a polo shirt emblazoned with his schools’ trademark oversized M. Marietta, a city of 61,000 residents north of Atlanta, has its own school district but is part of suburban Cobb County, which is trending blue; Joe Biden carried the county over Trump by more than 14 percentage points.
When Rivera put forth a plan in June to offer students both virtual and in-person options to return to school in August, he didn’t propose a mask requirement. Parents reached out to Rivera, urging him to reconsider mandating masks. “Quite candidly, with every conversation I was having I found it harder and harder to defend why we weren’t requiring masks,” Rivera said. “I felt like I was in quicksand. I couldn’t even convince myself of the argument.”
Rivera has two young children and a formidable resume — with stints as a special education teacher, a principal and a chief of staff in the Cobb County district — along with a doctorate in education with an emphasis on school law. What he is not, he readily acknowledges, is a health expert, so he turned to local health departments and the CDC. The professionals’ advice: Mask up.
As cases and deaths soared statewide in July, the school board delayed the start of in-person schooling. By early August, Rivera had a new plan: Marietta would begin in-person schooling in September for the youngest students, as long as cases continued to drop from their July peak. Everyone would wear masks — from bus drivers to teachers to students to central office staff. The only exception would be students with a doctor’s letter documenting a valid health reason. “We started with masks, and we built everything else around that,” he said.
The school board unanimously backed his position. Chairwoman Allison Gruehn said conservative parents had been “very disappointed” with the district’s decision to start school remotely, and they were willing to accept a mask mandate since it meant that their children could learn in person.
As Marietta hashed out its safety protocol, Paulding County schools a short drive west opened without a mask mandate. Photos of maskless students packing North Paulding High School’s hallways went viral on social media, drawing national attention. Paulding reported 41 positive cases of students or staff during its first week of school, including 24 at North Paulding High, which was closed temporarily.
By the following week, the Cherokee County district just to the north had asked as many as 1,200 students and staff members to quarantine because of possible exposure to the virus. That system had also declined to mandate masks. After those uproars, Rivera told parents during a virtual meeting that “I don’t want to subject our kids to what we’re seeing in other districts.”
Few parents objected to Marietta’s mask policy. Two families emailed him asking that their kids be exempted, he said, vaguely citing “medical risks associated with masks.” Rivera relayed their concerns to public health officials, who assured him that masks don’t pose such dangers for children. One of the families withdrew a first grader from the district.
Amy Barnes was among the Marietta parents who pleaded with Rivera to reverse the district’s initial decision to make masks voluntary. Barnes, who had completed a contact-tracing course, believes that masks are an essential, science-based part of COVID-19 prevention.
She was worried about sending her three children back to school and had thought about going all-remote, until Rivera imposed the mask mandate. “What sealed the deal for my husband and I was that Marietta was requiring masks,” Barnes said. “We felt that masks were the only way to mitigate the spread in schools because it’s really hard to socially distance in classrooms.”
Still, Barnes wondered how her youngest, a fifth grader, would fare. He’d worn masks in stores, but never for seven hours straight. He started in-person classes in early October during the second phase of Mariettta’s reopening. She was relieved when he came home his first day and reported that wearing a covering all day was “not that bad.” He hasn’t complained since, she said.
Marietta mom Shamika Berger was reluctant to send her first grader, Elijah Brown, back to school because of worries about the virus. She, too, had watched the news coverage of Paulding and Cherokee counties. “I was like, ‘Nobody is taking this seriously,’” she said.
But Berger works during school hours in the deli at Walmart, and Elijah — like so many young children — had struggled staying focused in virtual class in the spring. So, with Mickey Mouse and Spider-Man masks at the ready, Elijah returned to Dunleith Elementary in early September. He, too, didn’t seem bothered by wearing the mask all day, she said. “He was just so excited to be back in school,” Berger said.
Unlike Emanuel, Marietta let teachers choose whether to return to the classroom or teach from home until Oct. 5, when more students would be coming back. The mask mandate helped reassure most teachers that it was safe to go back to school.
Second grade teacher Libby Coan said the kids in her classroom at Hickory Hills Elementary have had no problem keeping their masks on. She hasn’t had any pushback from parents, either. “I think their parents just want them in school,” she said.
First grade teacher Jenny Brems said she, too, was glad that the district didn’t leave the mask decision up to parents.“I didn’t want it to be a fudgy thing,” she said. Kids need reminders sometimes, she said, but have otherwise adjusted fine. The district allows “mask breaks” outside, she said, adding, “It’s not as traumatic as some people were afraid of.”
Wearing a mask all day in the classroom, though, has required extra effort when she teaches phonics to her students at A.L. Burruss Elementary, she said. Watching a teacher’s mouth form sounds helps kids learn how to read. Brems said she is using a clear mask her district provided, and she has become accustomed to gesturing, enunciating and projecting her voice more than usual.
She was hoarse after the first few days, she said. “I’m chugging the water like I’ve never done before,” Brems said. But the measures have kept her safe, she added — and allowed the kids to continue learning.
Still, opposition to the measures Marietta took could be found close by. Parent Jolynn Dupree, who lives in Acworth about a half-hour drive from Marietta, objected when the Cobb County district mandated masks. In July, Dupree started a Facebook group called “Masses Against Masks” for Cobb County parents who “demand that their schools not require masks while exercising their right to an education.” The group has 947 members.
“I felt like you have no voice if you are against the masks — you are looked at like you don’t like people, you want their grandma to die,” said Dupree. Her husband’s 97-year-old grandfather died of the virus in a nursing home in Marietta, but she and other family members caught it and recovered, she said. With a generally high survival rate, she said, the harm of forcing children to wear masks for seven or eight hours a day outweighs the benefit. Masks make it hard for children to breathe in steamy Georgia weather and to read facial cues, and the mandate puts too much pressure on them, she said.
“I don’t want to hurt people,” she said, “but I’m not going to psychologically hurt my kids.”
Dupree and her husband withdrew their four school-age children — who range from first to sixth grades — from the Cobb system. They now go to a private school, without masks, twice a week and are home-schooled the other days.
She said she might reconsider her stance if her children were in high school, since teenagers are more likely to spread the disease. But friends of hers in Paulding and Cherokee counties — which don’t have mask mandates — are doing fine, she said.
“When I hang out with my friends, their kids are living totally normal lives and everything seems good,” Dupree said.
When Shonray Brooks arrived at the hospital, the doctors transferred her to the intensive care unit, where she received supplementary oxygen and the antiviral medication remdesivir. Doctors monitored her for several days, examining her for blood clots and heart irregularities, common secondary symptoms of the virus. Her relatives couldn’t visit her, so they tried to keep her spirits up with text messages. “I love you, Sissy,” Shonte texted her. “I’m praying for you.”
Despite the treatments, Brooks’ condition deteriorated. Doctors decided to medivac her to a hospital in Augusta, the nearest city. By the time her helicopter landed, she was unresponsive. She was immediately placed on a ventilator.
Her friends and colleagues learned of her plight from her sister’s Facebook updates. Though school nurses spoke with several of Brooks’ students, the administration did not tell staff who had the virus, four employees said. “They were tight-lipped about everybody that had it,” said a teacher. “I’m not saying they should tell us details, but they should tell us if it was someone in the building that was around a lot of people.”
Several staff members told ProPublica that they believe the school was trying to conceal the extent of the spread. “Everybody knows, but no one knows through official channels,” said another teacher. “The general sense was, we’re not going to talk about it. We’re not going to tell you and I think at that point, teachers realized no one’s going to tell us if we’ve been exposed. No one’s gonna know until it’s too late.”
At a school board meeting in September, the teacher Deanna Ryan stepped up to the lectern. After flipping through choropleth maps from the state’s Health Department, showing the board how the virus was inundating the county, she began to talk about Brooks. When Ryan first moved to Emanuel county, Brooks quickly took her under her wing. During the 11 years they taught together at the middle school, they had lunch nearly every day and worked on each other’s class projects.
“There’s a teacher that I know who’s fighting for her life,” Ryan said, her voice quivering with each word. “She was the person who would get me to calm down and breathe. And now she’s struggling to.” Her words choked by tears, she hurried out of the room.
At least four more teachers at the middle school contracted COVID-19 after Brooks, including three other educators along the seventh grade hallway. Students rotated through classrooms together. While teachers tried to assign them to the same seats in each class, students had a way of shifting seats to be closer to their friends, broadening the potential exposure.
“Five classes a day is five sets of germs coming in and out of my class,” said a teacher. “If they are a carrier, but they are not showing symptoms, you don’t even know that they are sick. They are still spreading the germs around.”
Over the first two months of school, more than 100 students were quarantined, teachers and parents said. “I was scared,” one teacher said. “We started out with 25 kids. After three weeks, it was down to five. Kids were testing positive.”
Judy said he doesn’t dispute that the number of students quarantined was in triple digits, but he doesn’t know the exact number. “I don’t even want to ballpark it,” he said. “If you’re within 6 feet of someone for more than a cumulative 15 minutes, then that’s who gets quarantined.”
By mid-September, the county had the fifth-highest per capita rate of the virus in the state over a two-week period. Yet the schools carried on almost like normal. The high school crowned its homecoming king and queen, and sports teams played and scrimmaged before cheering parents, few of whom covered their faces.
Parental opinion over a mask mandate was divided. “I believe there’s a real virus, but I don’t believe people are dying like they say,” said one opponent, Roy Beneteau, while watching his teenage son play soccer at the local rec center. Beneteau delivers hundreds of packages daily, does not wear a mask and still hasn’t contracted the disease, he said.
Nana Davis disagreed. Sitting apart from a scrum of parents, in a folding plastic chair on the edge of a field, she was watching her 12-year-old son’s football game. He suffers from asthma and was wearing a mask under his helmet.
“I don’t think [schools are] safe,” said Davis, who enrolled her son in virtual learning. “A lot of kids touch each other, some could come to school with it, and it could endanger an asthma patient.”
Before the Emanuel school board’s October meeting, a photo was taken of members and the superintendent. Superintendent Judy donned a black mask for the picture and then quickly removed it. “I wanted to make sure everybody was able to hear,” he later said. Two of the six members who attended wore masks.
Only seven people were in the audience, including three district staff members and Ryan. Wearing her KN95 mask and a Kelly green rubber wristband with the words “Miss Brooks Strong” emblazoned on the edge, Ryan again spoke.
“Why are the adults who are leaders in this community not wearing masks?” she asked the superintendent and school board. “I’m still waiting for my friend to stand up. I would ask — no, I will plead — please wear your masks more often, especially when you’re close to people. You don’t know what you’re passing on.”
Neither the superintendent nor the board members responded. While they didn’t revisit a mask mandate, the superintendent suggested investing more than $175,000 to upgrade the district’s ventilation system with “needlepoint bipolar ionization,” which could cut down on dust, bacteria and viruses such as COVID-19. The district had just installed these devices in the middle school, Judy reported.
A couple of days after the meeting, Judy spoke with ProPublica for an hour in his office, which overlooks a parking lot in central Swainsboro. Seated behind his desk, he wore a black cotton mask and the green rubber wristband supporting Brooks. Shonte made and distributed the bracelets to honor her sister’s struggle, collecting donations for her care. Judy had ordered 100 for school staff.
Judy said he was confident that the schools had nothing to do with the outbreaks. “People were not as careful as they should have been,” he said. “They rode together in vehicles, went out to eat lunch and things like that caused it. The starting of school … there was not a spike there at all.”
Still, he acknowledged that it’s difficult to know how staff and students acquire the virus. “It could be that one of those teachers had it and shared it with the others. That’s a possibility. It could be that one of them got it from their home and the other one got it from their home. It could be a coincidence. That’s the nature of this,” he said.
Many public health expertshavecompared the effort to compel Americans to wear masks during the pandemic to the decades-long struggle to persuade people to wear seatbelts. Detractors said that mandatory seat belt laws were ineffective, uncomfortable or against their individual rights. The same arguments that have frequently been invoked against masks, even though they not only protect the wearers but also the people around them.
Though he doesn’t equate them with face coverings, Judy said, he’s opposed to mandatory seat belts, too. “I am not harming anyone else,” he said.
The view of Emanuel County officials, he added, is that “the great part of living in this country is that it is left up to individual people to make what they feel is the best decision for them and their family.”
Despite the mask mandate and other precautions, Rivera still wasn’t satisfied that Marietta was doing enough to stop COVID-19. He wanted to stay on top of whether the coronavirus was being transmitted in schools. Having heard from the Public Health Department that its contact tracing and testing program was overwhelmed, he said, “we built our own internal system.”
School nurses and other staff gained certifications in contact tracing and the district hired a part-time worker to help them. The system now has tracers who speak English, Spanish and Portuguese and can make calls from 8 a.m. to midnight. The program is crucial for reassuring parents that the schools are safe, he said.
Marietta continued to phase in students’ return to the classroom; high school students were the last to go back, on Nov. 9. Rivera kept in close touch with local health officials, checking in three times a week by phone. “I sometimes feel like I talk to them more than I talk to my wife,” he said.
Like Emanuel, Marietta upgraded its air ventilation. Sports continued too, with Marietta requiring anyone visiting its stadium to wear a mask. School officials walked through the stands during games, reminding spectators to keep theirs on or risk being ejected from the facility.
Cases were rising across the country, and a few surfaced in Marietta schools. The contact tracers looked into each one. The schools didn’t appear to be the source of any clusters, although, with the virus spreading ever faster, it was getting harder to tell.
With Shonray in a medically induced coma, Shonte checked in with her sister’s nurses daily and visited twice a week, every Thursday and Sunday. During her visits, she massaged Shonray’s arms and legs and painted her nails — a clear varnish for her fingers and an electric shade of green for her toes. After more than two weeks in the ICU, Shonte prepared for the worst.
“She’s been here 16 days, and she’s had no improvement,” a doctor told her, explaining that her sister still had a fever from a possible infection. “We’re playing this day by day.”
Shonte called family members with the somber update. “We have to be strong,” she said through tears. “We have to keep praying. She shall live and not die.”
Two days later, while she was driving to Augusta to visit her sister, a nurse called. They only contacted her for urgent reasons, and so apprehensively, she picked up the phone.
“The doctor told me to call,” said the nurse. “Shonray is up.”
Shonte shrieked in her car, too elated for words. The nurse told her that Shonray was nodding to commands and breathing over the ventilator. When Shonte arrived at her sister’s room, she pulled a chair up to the bed. “You’ve been gone for a little while,” Shonte said, stroking her sister’s hand. “And I’m so happy you’re here.” Painfully, Brooks’ lips curled into a faint smile.
A couple weeks later, after being taken off the ventilator, Brooks started her rehabilitation, slowly beginning to speak, eat and write on her own again. In early November, while her sister was visiting, Brooks walked 150 feet. Brooks, who declined to be interviewed, told Shonte that she hopes to return to teaching as soon as she’s physically able. She also heard some welcome news: With the paper she had submitted at the start of her battle with COVID-19, she had earned enough credits for her online master’s degree.
On Nov. 20, she was released from the hospital and moved in with Shonte. Waiting for her at her sister’s house: her diploma and a cap and gown she had ordered during her rehab.
The promise of antigen tests emerged like a miracle this summer. With repeated use, the theory went, these rapid and cheap coronavirus tests would identify highly infectious people while giving healthy Americans a green light to return to offices, schools and restaurants. The idea of on-the-spot tests with near-instant results was an appealing alternative to the slow, lab-based testing that couldn't meet public demand.
By September, the U.S. Department of Health and Human Services had purchased more than 150 million tests for nursing homes and schools, spending more than $760 million. But it soon became clear that antigen testing — named for the viral proteins, or antigens, that the test detects — posed a new set of problems. Unlike lab-based, molecular PCR tests, which detect snippets of the virus's genetic material, antigen tests are less sensitive because they can only detect samples with a higher viral load. The tests were prone to more false negatives and false positives. As problems emerged, officials were slow to acknowledge the evidence.
With the benefit of hindsight, experts said the Trump administration should have released antigen tests primarily to communities with outbreaks instead of expecting them to work just as well in large groups of asymptomatic people. Understanding they can produce false results, the government could have ensured that clinics had enough for repeat testing to reduce false negatives and access to more precise PCR tests to weed out false positives. Government agencies, which were aware of the tests' limitations, could have built up trust by being more transparent about them and how to interpret results, scientists said.
When healthcare workers in Nevada and Vermont reported false positives, HHS defended the tests and threatened Nevada with unspecified sanctions until state officials agreed to continue using them in nursing homes. It took several more weeks for the U.S. Food and Drug Administration to issue an alert on Nov. 3 that confirmed what Nevada had experienced: Antigen tests were prone to giving false positives, the FDA warned.
"Part of the problem is this administration has continuously played catch-up," said Dr. Abraar Karan, a physician at Harvard Medical School. It was criticized for not ensuring enough PCR tests at the beginning, and when antigen tests became available, it shoved them at the states without a coordinated plan, he said.
If you tested the same group of people once a week without fail, with adequate double-checking, then a positive test could be the canary in the coal mine, said Dr. Mark Levine, commissioner of Vermont's Health Department. "Unfortunately the government didn't really advertise it that way or prescribe it" with much clarity, so some people lost faith.
HHS and the FDA did not respond to requests for comment.
Types of COVID-19 Tests
PCR: a very accurate, lab-based test that can take days to process and report results. The test detects the virus's genetic material.
Antigen: a quick, on-the-spot test that's less sensitive than PCR but good at identifying people who are most likely to infect others.
Antibody: a test that tells you if you've had the virus in the past but doesn't tell you if you're infected now.
The scientific community remains divided on the potential of antigen tests.
Epidemic control is the main argument for antigen testing. A string of studies show that antigen tests reliably detect high viral loads. Because people are most infectious when they have high viral loads, the tests will flag those most likely to infect others. Modeling also shows how frequent, repeated antigen testing may be better at preventing outbreaks than highly sensitive PCR tests, if those tests are used infrequently and require long wait times for results. So far, there are no large scale, peer-reviewed studies showing how the antigen approach has curbed outbreaks on the ground.
People need to realize that without rapid testing, we're living in a world where many people are unknowingly becoming superspreaders, Karan said. About 40% of infections are spread by asymptomatic people with high viral loads, so antigen tests, however imperfect, shouldn't be dismissed, he said.
Even those who are more skeptical said they can be helpful with a targeted approach directed at lower-risk situations like schools, or outbreaks in rural communities where PCR is impractical, rather than nursing homes where a single mistake could set off a chain of deaths.
It is "completely irresponsible" to take a less-accurate test and say it applies to all situations, said Melissa Miller, director of the clinical microbiology lab at the University of North Carolina.
There's no precedent for the government to bet this much on a product before it's been thoroughly vetted, said Matthew Pettengill, scientific director of clinical microbiology at Thomas Jefferson University. "They put the cart before the horse, and we still can't see the horse."
The Government Quickly Embraced an Unproven Test
During a public health crisis, the FDA can issue emergency use authorizations to make tests available that might otherwise have been subjected to many months of scrutiny before being approved. The three most popular antigen tests in the U.S., from Abbott Laboratories, Quidel and Becton, Dickinson, commonly known as BD, had to submit far less proof of success than is usually required.
FDA gave the first authorization to Quidel on May 8 based on data from 209 positive and negative samples. BD got its permit July 2 with a total of 226 samples and Abbott in late August with 102. Outside of a pandemic, the agency might otherwise have required hundreds more samples; in 2018, BD's antigen test for the flu provided data on 736 samples.
There's no excuse for the small pool of data, particularly for Abbott, Pettengill said. At the start of the pandemic, the FDA authorized PCR tests based on as few as 60 samples because it was difficult to find confirmed cases. By the time Abbott got its authorization in August, it was "a completely different ballgame." Abbott'svalidation document states the company collected swabs from patients at seven sites. Given the case counts over the summer, it should have only taken a few days to collect many hundreds of samples, Pettengill said.
Abbott didn't respond to requests for comment. Quidel pointed ProPublica to an article in The New England Journal of Medicine that explained how regular antigen testing can contain the pandemic by identifying those who are most infectious.
"We have full confidence in the performance" of our test, Kristen Cardillo, BD's vice president of global communication, said in an email. BD "completed one of the most geographically broad" clinical trials for any antigen test on the market, she added, by "collecting and analyzing 226 samples from 21 different clinical trial sites across 11 states."
The day after the Abbott test was authorized, HHS placed a huge bet on it, buying 150 million tests.
Healthcare workers don't need patronizing praise. They need resources, federal support, and for us to stay healthy and out of their hospitals. In many cases, none of that is happening.
Then, it gave institutions like nursing homes advice on how to use them off-label, in a way in which they were untested and unproven.
The three tests are authorized for the most straightforward cases: people with COVID-19 symptoms in the first week of symptoms. That's how they were validated. They produced virtually no false positives that way and were 84% to 97% as sensitive as lab tests, meaning they caught that range of the samples deemed positive by PCR.
Yet HHS allowed their use for large-scale asymptomatic screening without fully exploring the consequences, Pettengill said.
A recent study, not yet peer reviewed, found the Quidel test detected over 80% of cases when used on symptomatic people and those with known exposures to the virus, but only 32% among people without symptoms, The New York Times reported.
The HHS encourages nursing homes that can't get access to PCR tests to use antigen tests, even on asymptomatic people. The agency suggested repeat testing to reduce false negatives but didn't mention false positives.
An October survey found that nearly a third of nursing homes had left the federally provided antigen tests untouched, The Wall Street Journal reported. Staff cited time-consuming paperwork for federal reporting requirements and skepticism about their accuracy.
"I think a lot of the trust was lost, unfortunately," Karan said.
"Be Prepared for Some 'Pressure'"
As antigen tests began to give false positive results in nursing homes, state public health officials in Vermont and Nevada pushed back. But HHS officials overruled their concerns and pressured them to keep using the tests.
In July, an urgent care clinic in Manchester, Vermont, discovered that, of 64 patients (mostly asymptomatic) who the Quidel test said were positive, only four, all symptomatic, got a positive PCR result. As reported by the Vermont alt-weekly Seven Days, Quidel said the fault lay with the PCR tests. The FDA also pointed a finger at the PCR "without any foundation of evidence," Levine, the state health commissioner, told ProPublica.
There was a potential problem related to the PCR machine's software, but Vermont's state lab retested the samples after upgrading the system and found no change in results, Levine said. State officials also conducted pop-up testing in the Manchester region and found just a handful of positives out of 1,600 tests, he said, proving that there was no outbreak in the community.
Levine said his health agency ended up labeling the 60 samples as "discordant" instead of "false positives" and left them out of the official case count. "We didn't want hard feelings," he said. "I do think this administration wanted to show it was doing something ... and this [antigen test] is one way to demonstrate that."
The federal government defended Quidel again in early October. The Times reported that Nevada's Health Department ordered nursing homesto stop using all antigen tests after reviewing results from 3,725 tests. Nursing homes had double-checked 39 samples the BD and Quidel tests flagged as positive, but 23 of them tested negative via PCR. Nevada's letter noted that it only learned about the problem because the state chose to go above and beyond federal guidelines: The FDA had said there was no need to double-check positive results. State officials told nursing homes to continue using PCR to fulfill testing requirements.
Cardillo, the BD spokesperson, said a "very small number" of the 11,250 nursing homes using BD tests reported higher than expected false positives, and "we are conducting thorough investigations into those cases."
When an official from the Centers for Medicare & Medicaid Services asked why the state adopted a ban, a Nevada health facilities inspector said false positives could put nursing home residents at risk, according to emails obtained by ProPublica via a public records request.
If someone tests positive on an antigen test, the nursing home may sequester the patient with other residents who are truly infected, the Nevada official, Bradley Waples, wrote. If that person later has a negative PCR test, then the faulty diagnosis will have placed them "in danger of contracting the virus by introducing them to a room full of actual positive residents."
His email didn't explain whether anyone had been infected that way. A spokesperson from the Nevada Health Department declined to comment.
In one nursing home, the antigen tests found seven positives out of 35 samples, yet all seven tested negative by PCR, Waples wrote. Two other states had reported similar false positive problems, he added.
"Thanks Brad," the CMS official replied. "It'll be interesting to see what HHS does with this information. Be prepared for some 'pressure.'"
That pressure arrived two days later in a letter from HHS, where Assistant Secretary Brett Giroir ordered Nevada to rescind the ban. You "must cease immediately or appropriate action will be taken against those involved," he wrote. Nevada complied.Bottom of Form
Giroir's letter cited some of the key arguments for antigen tests, including their ability to detect those who are most infectious. Yet the agency's reasoning glosses over many unknowns. Some people can become acutely ill without ever showing high viral loads, or only doing so briefly, said Miller, the North Carolina scientist. Those with lower viral loads may still be able to infect others, and the data is murkier for asymptomatic people, she added.
"I'm not saying it's right or wrong, but we're not fully understanding how these tests perform in certain populations, and yet they're being used," Miller said.
"It's a test, yes, but there are people on the other side of that test," she added. If you have a family member in a nursing home that's getting false positives, it takes time to confirm results by PCR, Miller said. "These are days in which the residents and their families have an incredibly high level of anxiety and worry about their loved ones."
America Needs a National Antigen Testing Plan
The initial vision of giving every American at-home tests every day has been slow to materialize. Many of the available antigen tests require machines to read the results or someone who's trained to administer the test. Some states aren't even reporting their antigen results, so it's unclear when they're used or how they complement PCR.
"We need a federal plan for who gets tested, with what tests ... when, how often, and what data should be reported back, and what those data pieces mean," said Dr. Rebecca Lee Smith, an epidemiology professor at the University of Illinois.
So much remains unknown about the best way to use antigen tests, Smith added. If you have a million tests, is it better to test a million people once, or test half a million people who are at high risk twice, or test essential workers five or 10 times? "It's how you use the tests, not just how many tests you have."
The U.S. has never had a national testing strategy, said Dr. Ranu Dhillon, an expert on rapid testing and global health equity at Boston's Brigham and Women's Hospital. The administration's haphazard approach to antigen tests is an extension of that larger failure, he said.
While there have not been well-publicized examples of false negatives that have led to outbreaks, one risk that's been overlooked until recently is the probability of false positives in low-prevalence communities — places where few people have the virus, Miller said.
Even if a test is very "specific" (providing few false positives), it can flag more false positives than true positives. This happens for both PCR and antigen tests, but if antigen testing scales up to tens or hundreds of millions of tests a month, communities and institutions could get overwhelmed, Miller said.
One paperfrom August found that if a quarter of American school kids were tested three times a week with an antigen test that's 98% specific, it would produce 800,000 false positives a week that need to be double checked by PCR tests. (For reference, the U.S. is processing an average of 1.4 million tests per day, nearly all of them PCR).
Miller said she's received confused phone calls from doctors asking for advice. She helped a state task force create a flowchart that explains how to interpret antigen results and when to do repeat testing. "But why are 50 states doing this," instead of a single clear message from the administration? Miller asked.
Karan, the Harvard physician, said federal officials need to set expectations. An employer who can't afford PCR might welcome antigen testing, because catching 80% of infected workers would be better than catching none at all. Meanwhile, anyone who gets a single negative result shouldn't use it as an excuse to go to a bar, he said, and they should understand they might test positive a couple days later. This is particularly crucial for the many who plan to rely on antigen tests results to clear them for Thanksgiving gatherings.
Smith said any testing plan must be paired with a strong program of contact tracing, isolation and quarantine. The reality in this country is that "just telling someone they're positive has not been enough. There has to be a cultural shift."
As Reuters reported,Slovakia drove down its infection rate through a mass antigen testing program that imposed strict quarantine rules. The country tested 65% of its population in one weekend, then repeated the tests in hot spots a week later. Anyone who refused testing had to stay home, while those who tested negative got certificates that let them participate in public life.
That approach wouldn't be feasible in the U.S., Smith said. "We need to instead think about empowering and supporting people to abide by isolation and quarantine."
There's a joke I've seen circulating online, over and over during this pandemic, that goes along the lines of, "Months this year: January, February, March, March, March, March, March…"
My lips pull into a smile, but my heart's not in it.
I was on the phone two weeks ago with a nurse who lives in Missouri, where cases have risen from 1,100 per day in August to about3,400 daily in November. Her husband works in the ER of a rural hospital. Every time a patient suspected of having COVID-19 walks in, the sample is sent to be tested in St. Louis, an hour and a half away. Results take eight hours or more to process.
Medical workers don't get enough protective equipment. "They're given one N95 mask and have to keep it in a bag to reuse for days," the nurse said, fretting about her husband's safety. "He should at least get a new mask for every shift, right?"
I looked at the calendar: It was Oct. 30, but it might as well have been March.
I could still hear the voice of another nurse, Sarah, in Illinois, who poured out her fears to me on March 2, when the coronavirus was just starting to make its presence known in her city.
Sarah told me she had been instructed to write her name on a brown paper bag and put her mask in it to reuse for the week. "There's this feeling like, we're just going to get it," she told me, sounding more resigned than scared.
As a health reporter covering the pandemic, I've experienced too many moments of deja vu. This summer, as the virus swept through the South, news footage ofoverwhelmed hospitals in Houston turning away ambulances recalled similar scenes from March and April in New York City. Now, we're in the so-called third wave of the pandemic, with the virus slamming into Midwestern states, and this week, Dr. Gregory Schmidt, associate chief medical officer at the University of Iowa Hospitals and Clinics, said his colleagues are converting 16 hospital beds into new ICU beds in anticipation of an influx of COVID-19 patients. "People in leadership are starting to say things in meetings like, 'I have a sense of impending doom.'"
I'm exhausted and infuriated to be doing the same interviews and hearing the same stories for a third time. Why haven't we learned? What have we been doing between March and November?
Why is Dr. Peter Wentzel, in Grafton, West Virginia, only now able to order a point-of-care test system for his community clinic, just to be told that the cartridges for it will arrive in December at the earliest? Why are clinicians at Mountain Family Health Centers in Glenwood Springs, Colorado, once again facing seven- to 10-day wait times for their patients' test results?
I remind myself that many things have improved since March. An incredible amount of scientific knowledge has been amassed about the virus itself. Thanks to detailed contact tracingstudies around the world, we've learned that the virus can be spread beyond 6 feet via small particles suspended in the air, teaching us the importance of good ventilation to decrease transmission risk. Thanks to antibody studies, we're learning that reinfection, while possible, is likely rare.
We now use ventilators less aggressively and know the benefits of steroids like dexamethasone, while other treatments like hydroxychloroquine have lost favor thanks to rigorous studies that have debunked anecdotal hype. This week,an antibody therapy developed by Eli Lilly was granted emergency use authorization by the Food and Drug Administration. Trials have shown that it can help mild to moderate COVID-19 patients reduce hospitalizations. And Pfizer shared encouraging, early news from its ongoing trial, saying its vaccine was more than 90% effective in preventing people from getting sick. It is thanks to the work of so many career scientists and medical personnel that if one gets infected with the coronavirus today, the chance of survival is higher than in March.
Yet while some material supplies have increased since March (we thankfully have more COVID-19 tests, though still not enough), humans are a fixed resource, and the skilled labor of a veteran respiratory therapist or an ICU nurse is hard to come by. Before the pandemic, America already had a nursing shortage. Now, this dearth is becoming acutely felt.
A ER nurse who lives in Wisconsin told me that her hospital is starting to run out of beds, but more urgently, it is running out of staff, in part because some workers have gotten sick and others are in quarantine. "The state keeps talking about how many beds there are, but that doesn't mean there's staff for them," she said.
When no hospital beds are available, the emergency department gets full, she explained to me; she's had to board patients there for 20 hours. Meanwhile, she wields a faulty forehead thermometer at the door. Her own temperature recently read 84.9 F — hypothermic, if true. Staff members were given plastic water bottles emblazoned with the hospital's logo as a thank you.
"It's so demoralizing," she told me. "I would take getting punched on a daily basis rather than what we're going through now."
Tim Size, executive director of the Rural Wisconsin Health Cooperative, said some of his 43 member hospitals are seeing "significant staff shortages." Initially, he said, they were able to hire from staffing agencies, which recruit traveling nurses to work short-term contracts, but now that the virus is surging in multiple states, hospitals all over are competing for the same personnel. "So people are working more overtime, which is causing more fatigue, which will lead to more burnout," Size said. "If we don't stop the growth…" He shook his head.
Schmidt, at the University of Iowa, tells me he's concerned not just about overwork, but also about the psychological toll on medical staff. "You watch patients who are young and who should have had good lives die without their families by them, and their families being distraught, and then you go out through your community and you see people partying and going to bars."
He paused, then added. "We can do anything for two months," he said. "But surge after surge, it's hard for everybody."
One thing that's burned into my head is what Chrissie Juliano, executive director of the Big Cities Health Coalition, told me when I asked her whether the constant struggles to get on top of the coronavirus have simply been because this pandemic is so unprecedented that nobody could have prepared for it.
"We would be overwhelmed to some extent," she told me. "But it didn't have to be this bad."
So much has fed into our quagmire: a lack of national leadership, the perpetuation of misinformation. The nurse in Missouri told me about a man with preexisting conditions who ended up in the ICU because he believed that the virus would go away by Nov. 4 and went out to eat at restaurants. Of course, it didn't go away that day. Instead, we hit a record high of 103,067 cases, the first time we broke six digits; 1,116 people died. It didn't have to be this bad.
I don't want to hear the same stories in a fourth wave, a fifth wave, to feel like we are trapped in an endless spiral, unnecessarily repeating our own mistakes. New leadership is coming to the White House; Joe Biden's first move as president-elect was to announce a COVID-19 advisory board. I hope it will amplify the voices of our public health leaders, depoliticize the pandemic and deliver for all of the weary front-line workers.
But we don't have to wait until then. The best way to help our medical workers isn't to stand at our windows at 7 p.m. cheering or to give them thank-you water bottles. It's to stay out of their ERs and ICUs by keeping ourselves and our neighbors safe.
A review of state distribution plans reveals that officials don’t know how they'll deal with the difficult storage and transport requirements of Pfizer's vaccine, especially in the rural areas currently seeing a spike in infections.
This article was published on Tuesday, November 10, 2020 in ProPublica.
As the first coronavirus vaccine takes a major stride toward approval, state governments’ distribution plans show many are not ready to deliver the shots.
The challenge is especially steep in rural areas, many of which are contending with a surge of infections, meaning that access to the first batch of COVID-19 vaccines may be limited by geography.
Pfizer announced Monday that its vaccine demonstrated more than 90% effectiveness and no serious bad reactions in early trial results — an impressive outcome that will pave the way for the company to seek an emergency authorization once it collects more safety data for another week or two. But establishing that the vaccine is safe and effective is just the first step.
The Pfizer vaccine is unusually difficult to ship and store: It is administered in two doses given 28 days apart, has to be stored at temperatures of about minus 100 degrees Fahrenheit and will be delivered in dry ice-packed boxes holding 1,000 to 5,000 doses. These cartons can stay cold enough to keep the doses viable for up to 10 days, according to details provided by the company. The ice can be replenished up to three times. Once opened, the packages can keep the vaccine for five days but can’t be opened more than twice a day. The vaccine can also survive in a refrigerator for five days but can’t be refrozen if unused.
Health officials haven’t figured out how to get the ultracold doses to critical populations living far from cities, according to a ProPublica review of distribution plans obtained through open records laws in every state. Needing to use 1,000 doses within a few days may be fine for large hospital systems or mass vaccination centers. But it could rule out sending the vaccine to providers who don’t treat that many people, even doctors’ offices in cities. It’s especially challenging in smaller towns, rural areas and Native communities on reservations that are likely to struggle to administer that many doses quickly or to maintain them at ultracold temperatures.
The government’s vaccine program, Operation Warp Speed, has projected optimism about its readiness to distribute the vaccine. On Monday, Gen. Gustave Perna told NPR, “I think we’re in a good place,” saying that “with the right planning, we can execute it with zero loss of vaccine.” But the federal program is only going to be responsible for delivering vaccines to the states, which must then figure out on their own how to get the shots to the people who need them most. The Centers for Disease Control and Prevention asked each state to turn in distribution plans on Nov. 2, imagining a scenario in which a vaccine with Pfizer’s specifications came first.
ProPublica obtained full preliminary plans for 47 states (Hawaii, Pennsylvania and Minnesota say they’re still working on theirs). Many struggled with how to handle a Pfizer-like vaccine. Washington state’s Health Department does not have its own warehouse that can store the Pfizer vaccine at a cold enough temperature. Arizona expects the Pfizer vaccine cannot be handled by the state’s rural communities and tribal lands. North Dakota and Oregon aren’t sure how to take care of migrant workers. Kansas’ plan appears to mistakenly assume shipments will be far smaller than 1,000 doses. Georgia’s Public Health Department is relying on local districts and counties to work out their own details.
“Early, when we don’t have lots of doses, I frankly do not anticipate that vaccine will be widely available in every rural community,” Dr. Amanda Cohn, chief medical officer for the CDC’s Vaccine Task Force, said during a call on vaccine implementation planning with rural stakeholders on Nov. 3. “The first couple months will be not ideal, but we really want to listen to our rural partners and understand what we can do to make it better,” she added.
The concern is most pronounced in places like Mt. Vernon Countryside Manor, a nursing home in southern Illinois more than 100 miles from the nearest major city, where the staff is working to contain the facility’s first COVID-19 outbreak. Glenda Lee Young, a nurse at the home, said four residents and an employee tested positive for COVID-19 in recent weeks. The sick have been isolated from the other 70 elderly residents, and are recovering.
The surrounding county has a fatality rate of 4.5%, more than double that of Illinois as a whole, according to data from the Johns Hopkins University COVID-19 dashboard. The staff at Mt. Vernon is eager for a vaccine to help them and their residents. Illinois’ distribution plan includes health care workers and people 65 years and older among the first groups to be immunized.
“Our people would not travel,” Young said. “If a vaccine becomes available, it would have to come to us.”
However, Illinois’ plan does not specify how shots will be provided to rural parts of the state that may not have enough people or ultracold storage. The state’s Department of Public Health didn’t immediately respond to a request for comment.
Young said she was not surprised by the state’s silence on rural vaccine access. “We get the shaft on a lot of stuff.”
Officials Are Trying to Hit “a Moving Target”
Health officials stressed that the plans are still evolving as they receive changing information. Even though Pfizer’s vaccine has long been seen as the likely front-runner, details from the trial, including the vaccine’s efficacy in specific populations like the elderly, have yet to be published. Shipping and storage logistics are also expected to continue to be fine-tuned with each passing week.
“It’s a moving target,” Dr. Philip Huang, director of the Dallas County Health and Human Services Department, said. “There’s new info every day.”
The changing details make it harder to plan, and some officials acknowledged they haven’t gotten very far.
“There are too many variables still to be worked out at the federal level,” a spokeswoman for the Georgia Department of Public Health said by way of declining an interview request for this article. “Much of what happens going forward will depend on the vaccine itself, when we receive it and what the protocols will be for prioritizing distribution among various populations.”
The problem with waiting for details on the vaccine to be revealed is that mass immunization is a multilayered process, involving public communication campaigns, ordering of equipment, hiring of staff, training of vaccine providers and the added complexity, in this pandemic, of making sure all vaccine sites are safe and won’t contribute to the spread. Operation Warp Speed has said its goal is to begin shipping the day that a vaccine is given the green light by the FDA, so states need to be ready at any moment.
For the initial months after the Food and Drug Administration signs off on a vaccine, the CDC advised state and local health authorities to prioritize health care workers, then move on to other essential workers and at-risk populations such as nursing home residents. Access would expand to the general public as manufacturing ramps up to make more doses available.
But there are a lot of details left to determine within those broad categories. Some health care workers have more exposure than others; North Dakota wants hospitals to document how they decided whom to vaccinate first. Maryland is prioritizing people in jails and prisons (where sharing close quarters has led to severe outbreaks), but states like Idaho and Mississippi have scheduled them for later. Arkansas, which has a large chicken industry, considers meatpacking workers to be essential. Oklahoma is prioritizing its long-term care population. Some states stressed communities of color, which have been disproportionately sickened and killed by the virus. “We are currently in the midst of a social justice movement across the county,” Kentucky’s plan notes.
Rural Communities Are “the Greatest Challenge”
Across the country, authorities are grappling with how to accommodate the Pfizer vaccine’s finicky specifications. So far, state plans show few have come up with clear solutions. Oregon, for instance, said it still needs to “develop [a] plan” for how to handle 1,000-dose orders in “remote Oregon locations, while maintaining the ultracold chain and avoiding wastage.”
Perna, the general leading logistics for Operation Warp Speed, told NPR that it’s up to states to buy more freezers. That contradicts the CDC’s instruction to not invest in more equipment. But many states said they’re doing so anyway, or at least looking into it. They’re also taking stock of what facilities already exist in their states at hospitals and universities, or where they can get dry ice.
North Dakota, where the virus has killed roughly 1 out of every 1,200 people, is considering whether to break down the 1,000-dose packages and, on its own, distribute smaller quantities to individual hospitals and clinics.
“The greatest challenge will be to moving small amounts of vaccine to widely scattered locations during Phase 1 since only a small percentage of the small population will be eligible for the vaccine,” the state’s plan said. It describes one health district that has three hospitals, two of which are more than an hour’s drive away from the nearest city via a two-lane road, and eight long-term care facilities that are even more remote. “Reaching small populations without redistribution may not [be] possible.”
Even in the case where prioritized health care workers were physically capable of driving themselves to the city to get a vaccine, relying on doctors and nurses to get themselves to a vaccine “doesn’t compute,” said Tim Size, executive director of the Rural Wisconsin Health Cooperative, which represents 43 rural acute hospitals. Wisconsin is battling its worst outbreak of the pandemic, and every hospital is stretched thin on staff, he said. Requiring everyone to take time off, twice, to get the Pfizer vaccine “means two days of lost staff time at a time we’re desperately short of staff.”
Size urged Pfizer to figure out a way to package its vaccine in smaller shipments so it could be delivered directly to rural hospitals. A spokeswoman for Pfizer declined to comment on whether the company is working on that.
Later vaccines will likely have less onerous storage requirements, and at least one, made by Johnson & Johnson, only requires one dose instead of two, so many states are hoping to have multiple options to work with that may make it easier to reach remote populations.
Some states appeared to be avoiding the issue of Pfizer’s packaging for now. The Kansas Department of Health and Environment’s plan assumes any approved vaccine will be “available in minimal quantities such as 100 doses per order.” Kansas’ department did not respond to requests for comment.
“If Pfizer comes out and says they’re going to provide doses of 25 instead of 1,000, that’s a game changer,” said Imelda Garcia, associate commissioner for the Texas Department of State Health Services’ Division for Laboratory and Infectious Disease Services. “The manufacturers were imagining mass vaccination efforts and not really thinking about rural areas. We’ve been pushing pretty hard at the federal level for them to provide smaller packages. We don’t know if that will occur or not.”
As Texas and other states consider the need to break down the 1,000-dose packages into smaller shipments, that’s an additional cost that they’d have to shoulder, since the federal government will only pay to move the vaccines once. Several states identified funding as a major problem.
Virginia’s plan included a “preparedness gap analysis” that estimates that it will need $71 million to establish and operate mass vaccination clinics, which would include hiring temporary staff and covering facility rental costs, translation services, signage and other operating costs.
The plan also calls for a further $2.5 million in equipment such as refrigerators and thermometers and $3 million for public education, including TV, radio and social media ads, as well as “targeted outreach to clinicians, vulnerable populations and other key groups.”
CDC Director Robert Redfield has said Congress will need to provide up to $6 billion for vaccine distribution, but funding negotiations stalled ahead of the election. To date, the federal government has allocated 3% of that amount, $200 million, to the states to immunize the nation.
Much of the implementation will spill into the next administration. President-elect Joe Biden on Monday named a team of public health experts to advise him on the COVID-19 response. But so far the Trump administration is refusing to cooperate with the transition.
Experts who study the way we think and make decisions say that it can be more than politics driving our decision-making this year. The unprecedented nature of the pandemic undermines how we process information and assess risk. Need proof? Look around.
This article was published on Monday, November 2, 2020 in ProPublica.
It was mid-February and Maria Konnikova — a psychologist, writer and champion poker player — was on a multicity trip. From her hotel room in New Orleans, she called her sister, a doctor, to discuss the emerging COVID-19 pandemic. Konnikova saw there were early cases in Los Angeles, where she was headed for a poker tournament.
The odds of Konnikova getting infected or spreading the virus by participating in a large indoor event were unknown. But as a poker player she had a lot of experience thinking through the probable risks associated with different decisions. So she played it conservatively. She cut short her trip and went home to quarantine in New York.
Konnikova’s psychology expertise tells her that most people have a hard time thinking through the uncertainty and probabilities posed by the pandemic. People tend to learn through experience, and we’ve never lived through anything like COVID-19. Every day, people face unpleasant and uncertain risks associated with their behavior, and that ambiguity goes against how we tend to think. “The brain likes certainty,” she said. “The brain likes black and white. It wants clear answers and wants clear cause and effect. It doesn’t like living in a world of ambiguities and gray zones.”
Many months into the pandemic, even as the nation faces its highest average daily case counts to date, people still don’t agree on how to live in the era of COVID-19. We know how to protect ourselves — washing our hands, wearing masks and staying socially distant — but many people still take unnecessary risks, even at the highest levels of government.
In late September, the White House hosted an indoor party celebrating the nomination of Judge Amy Coney Barrett to the Supreme Court. It became a possible superspreader event because attendees did not wear masks and ignored social distancing recommendations. Former New Jersey Gov. Chris Christie didn’t wear a mask at the event. He also went without one when he helped President Donald Trump prepare for his first debate. Christie later spent a week in intensive care with COVID-19 and then wrote an opinion article in The Wall Street Journal titled “I Should Have Worn a Mask.” “I let my guard down,” he wrote.
The U.S. Centers for Disease Control and Prevention called on Americans to wear masks in July. So why is it so hard for people to mask up and practice other established behaviors to prevent the spread of COVID-19? The problem, experts who study the way we think say, is that the unprecedented nature of the pandemic makes us vulnerable to subtle biases that undermine how we process information and assess risk. Our brains can play tricks on us. That causes some people to underestimate their risk, the experts said.
When Las Vegas reopened, crowds showed up without masks. An estimated 365,000 people attended the annual Sturgis Motorcycle Rally in South Dakota. Many didn’t wear helmets or masks. The festivities included a non-socially distanced concert by Smashmouth. And even though masks were distributed and required at a recent Trump campaign rally in Erie, Pennsylvania, some attendees did not wear them, and the campaign packed people into crowded buses.
It may not always seem like it, but people are rational and weigh the costs and benefits when they make decisions, said Eve Wittenberg, a decision scientist at the Center for Health Decision Science at the Harvard T.H. Chan School of Public Health. “People are not stupid here,” she said. But they have no experience thinking through a pandemic and are also getting mixed and conflicted messages from leaders, she said. That creates uncertainty and can lead people to rely on patterns of risk perception that may not be accurate.
The Power of Social Norms and Personal Experience
People may be more likely to participate in riskier activities because they tend to behave according to the norms that surround them, said Lisa Robinson, a senior research scientist at the Center for Health Decision Science. If we’re surrounded by people who behave a certain way, she said, we are more likely to behave the same way.
At this point the facts about COVID-19 are well established. It’s extremely contagious and transmitted via droplets that come from an infected person’s mouth or nose. This can happen during speech, coughing, sneezing or breathing — whether a person is experiencing symptoms or not. Older and sicker people are at higher risk of serious illness or death. But young, healthy people can still become infected and sick, and they can also put others at risk by spreading the virus.
A well-known historical example of people being directed by social norms is smoking, Robinson said. For decades the societal norm said smoking was cool, even after it was known to kill people. That contributed to a lot of people smoking, willing to take the risk. Then the norm flipped and smoking became uncool, and fewer people smoked. “We take a lot of cues from our environment,” Robinson said. “If I see a lot of people wearing a mask, I wear a mask.”
Betsy Paluck, a professor of psychology and public policy at Princeton University and MacArthur “Genius” Fellow, studies how these social norms are formed and how they shift over time.
“There’s a lot of competing information out there,” Paluck said. “Your individual decisions are very real to you, of course, but they need to be validated by other people in your neighborhood, your organization.”
Paluck said everyone is influenced by social norms, including her. She has a newborn and elderly parents, so she’s been cautious during the pandemic. But it’s getting harder to be careful as people broaden their social lives.
She talked recently to a friend who is holding her kids out of school, opting for all virtual instruction. The friend’s decision felt like a huge relief because it affirmed Paluck’s own feelings. It showed her how much we all rely on our shared reality. “Holding the line on your own is just not tenable,” she said.
Personal experience also has an outsized role in decision-making. People who were in the hot zones of New York City and New Jersey during the initial spread of COVID-19 witnessed the effects of the virus. They may have become infected themselves or known others who became sick or even died. They might have known health care workers who cared for the sick, potentially exposing themselves in the process. Meanwhile, people in parts of the country that have not been hit hard by the virus might not have had that experience and therefore fail to appreciate the risk.
Poker players, along with folks like meteorologists, horse race handicappers and lawyers who work on a contingency basis are routinely rewarded or punished based on the odds. This gives them a rare visceral, experiential understanding of percentages and lets them short-circuit a cognitive effect called the “description-experience gap,” which leads people to underestimate risk based on their own personal experiences.
Even Nobel Prize-winning economists are susceptible to it. The pandemic is beyond the limits of human intuition, said the psychologist and economist Daniel Kahneman on Konnikova’s podcast.
Wittenberg pointed to the work of Kahneman and Amos Tversky, who coined the term “availability” to describe how we base our thinking on what we’ve seen or experienced. We see it show up when a person assesses his or her risk of a heart attack by recalling instances among acquaintances, the two researchers wrote in their 1974 paper, “Judgment Under Uncertainty.”
The researchers also noted how some instances might come to mind more easily than others and thus get more heavily weighted in decision-making. Other instances might be more salient or may have happened more frequently, so they come to mind faster. Relying on “availability” to make decisions introduces biases, according to Kahneman and Tversky. “It is a common experience that the subjective probability of traffic accidents rises temporarily when one sees a car overturned by the side of the road,” the researchers wrote.
The Need for Leaders and Institutions to Guide Us
The confusion surrounding COVID-19 was magnified by a lack of testing in the early days of the pandemic and then delays in test results, Wittenberg said. That meant people didn’t have clear data to anchor their risk assessment.
The confusion called for leaders to guide the public with clear public health messages, but instead they have exacerbated the problems. It was well known relatively early in the pandemic that wearing a mask could help prevent the spread of the virus, but it took until July before Trump wore one in public for the first time. Some governors have downplayed the risk posed by the virus, others have emphasized it. That’s left the public “grappling with mixed and conflicted messages,” Wittenberg said.
Baruch Fischhoff, a psychologist who studies risk and decision-making at Carnegie Mellon University, said people are good at perceiving risk if they are getting information from a trustworthy source. But the risks associated with the coronavirus, which is invisible, are not intuitive, he said. It’s hard for people to project the exponential spread of the virus, he said. Our minds don’t easily extrapolate it, so we need leaders to help protect us from ourselves, he said.
The situation could be compared to how the government protects people at train crossings, Fischhoff said. Drivers are good at estimating the speed of other cars. But research from accidents at train crossings has shown that drivers are not good at estimating the speed of oncoming trains, which are much bigger. “Our brains are calibrated to treat a train like a car,” he said, “but it’s going faster than it looks.”
To stay safe from an oncoming train, drivers either need to go against their intuition, have someone warn them in a way they will remember or have something block the crossing when a train approaches. “Somebody needs to protect you,” he said.
Good public health communication requires testing messages to make sure they are interpreted correctly by a wide range of people, Fischhoff said. “Our official communicators have dropped the ball, and they have been undermined by people who don’t have the public’s interest at heart,” he said.
Paluck, the social psychologist, said certain leaders and influencers stick out like bright colors. They’re charismatic and we look to them when we check our own behavior. “What they say and do becomes the anchor we use,” she said.
People also put faith in trustworthy institutions, she said, even when they may not agree with what the institution is saying. She and a colleague found something suprising when they studied the effect of the Supreme Court legalizing same-sex marriage. A greater number of people supported same-sex marriage because of the Supreme Court’s decision, even if they had not changed their personal views. “They thought that there was a bigger consensus in the United States that same-sex marriage was a good thing,” Paluck said. “So that’s the power of an institution.”
Optimism Bias and Why Institutions Failed to Act
Optimism bias is a pattern of thinking that causes our brains to see future outcomes as rosier than they really are. It transcends gender, culture and age. It turns out to be incredibly helpful in most situations. There’s only one subset of the population that doesn’t experience optimism bias, Konnikova said — people suffering from depression.
“This is actually something that’s very psychologically protective,” she said. “It ends up that seeing the world as it is makes you clinically depressed.”
When it comes to institutional behavior, however, optimism bias can lead to poor planning and risky decision-making.
Dr. Eric Toner is a senior scholar at the Johns Hopkins Center for Health Security and says that the pandemic has taught him about the power of denial. The global public health community learned in mid-January about the extent of community transmission of the novel coronavirus in Wuhan, China, Toner said. The most obvious sign of concern, he said, came when China took the dramatic step of locking down Wuhan, one of its largest cities. Something really bad is happening, he thought to himself.
And yet, public health officials in the United States were slow to sound an alarm. “People have trouble recognizing when they’re facing a catastrophic threat and on the other hand they exaggerate minor threats,” Toner said. “We needed messaging from the top of the government that says this is a serious threat.”
“Until you hear the message from somebody who is in a position of authority, I think there is a tendency to really want to not believe it. People don’t want to believe really bad news.”
Toner said the Center for Health Security heard over and over again that hospital CEOs would not be convinced of the dire threat posed by the pandemic until the federal government decided to say something. But by then much time had been lost.
When public health officials did sound an early alarm, their voices were squelched. Dr. Nancy Messonnier, one of the senior leaders at the CDC, warned on Feb. 25 that there would be community spread of the virus, and that protective measures might include school closures and working from home. As ProPublica previously reported, her comments caused the stock market to drop, which infuriated Trump. Vice President Mike Pence was installed as communicator-in-chief, and the CDC officials were sidelined. “When it mattered most, they shut us up,” a senior CDC official told ProPublica.
Toner’s group is in charge of designing pandemic preparedness exercises. Some of them are eerily similar to our current situation. He said he’s often asked how it’s possible that we did all these exercises and still had such a bad response to the COVID-19 pandemic. His answer: The exercises advanced the field, but they had their limits. “They didn’t inoculate us against really bad decision-making,” he said.
Dr. Mark Zucker was put on administrative leave after ProPublica showed he told staff to keep a heart transplant patient on life support because of concerns about survival stats. Now Newark Beth Israel will seek a new leader for the program.
This article was published on Friday, October 30, 2020 in ProPublica.
Dr. Mark Zucker, director of Newark Beth Israel Medical Center’s heart transplant center, is departing after a yearlong administrative leave, the New Jersey hospital said Friday.
“Dr. Zucker and the leadership of NBIMC and RWJBarnabas Health have mutually agreed that this is an appropriate time for a formal leadership transition in the Medical Center’s transplant program,” Newark Beth Israel said in a statement. RWJBarnabas Health is the parent health system of the hospital.
Zucker went on administrative leave last year following an Oct. 3, 2019, report by ProPublica that revealed he instructed his staff to keep a patient named Darryl Young on life support and not to discuss options such as hospice care with his family until the one-year anniversary of his surgery. Young suffered brain damage during heart transplant surgery in September 2018 and never woke up.
According to current and former employees, as well as audio recordings of transplant team meetings, Zucker was concerned about the program’s one-year survival rate — the proportion of people undergoing transplants who are still alive a year after their operations. Newark Beth Israel’s one-year rate for heart transplants had dipped below the national average, and Zucker was concerned that the program might attract scrutiny from federal regulators.
Spurred by ProPublica’s articles, a subsequent investigation by the Centers for Medicare and Medicaid Services in December 2019 found that the transplant program placed patients in “immediate jeopardy,” the regulator’s most serious level of violation.
CMS investigators uncovered a series of incidents in which the hospital identified areas for improvement following botched surgeries but didn’t carry out its own recommendations, allowing “subsequent adverse events to occur.” The investigators required corrective measures, which the hospital has carried out.
Newark Beth Israel also hired outside counsel to conduct its own investigation.
“Based on the available evidence, the ongoing investigation by outside counsel — with the assistance of expert transplant consultants including physicians — has determined that Dr. Zucker and the transplant team’s post-transplant care of the patient was not affected or compromised by concerns about survival rates or concerns about the interests of the program; was not unethical; and did not deviate from the standard of care expected of medical professionals,” the hospital said in its statement.
In response to a request for comment, Zucker's lawyer sent a press release, which includes the following statement from Zucker: "Newark Beth Israel Medical Center has always had a reputation for providing high quality care, state-of-the-art care and I am truly proud to have worked there for more than three decades, served the community with honor, and contributed substantially to that reputation.”
In the past year, two other cardiologists have left the hospital to work at other programs. Newark Beth Israel said it will now start a search for a new director for its heart transplant program.
Given that we are in the midst of an unprecedented pandemic and billions of dollars in federal aid are being thrown at response and recovery efforts in Illinois, we thought you should know more about how your taxpayer dollars are being spent. Plus, we figured there’d probably be a few interesting needles in the haystack.
To accomplish this, ProPublica reporter Jodi Cohen, Chicago Tribune reporter Jennifer Smith Richards and I combed through more than 20,000 expense items from the state comptroller. We found that while the vast majority of expenses were indeed obviously linked to the pandemic — items like face masks, school meals, business grants and COVID-19 testing services — some spending included unusual purchases like crowd control grenades and firearms training simulators.
Our analysis also showed a broader pattern in the state’s response to the pandemic. In the spring, the largest contracts went to vendors for ventilators and millions of pieces of protective equipment amid a severe global supply shortage. By the summer, payments had shifted toward helping schools, businesses, and child care and health care providers. Spending continues as the state faces another wave of the virus.
There were also a number of expenses that made us pause and think: “Huh! That’s interesting.” The Department of Corrections spent nearly $1 million on bread. In seeking an explanation, we learned that the inmate-staffed central bakery was shut down for safety reasons, prompting the state to purchase bread as an alternative. Then there were payments to lease out entire hotels for people who needed somewhere to temporarily quarantine. We found that some of these facilities sat empty for almost two months.
The most questionable line items we came across were a series of purchases made by the Illinois State Police. The agency had submitted tear gas grenades, flash-bangs and other crowd control weapons as COVID-19 expenses, telling us they needed to stock up in case hospitals were overrun by people seeking COVID-19 treatment.
After we asked the governor’s Office of Management and Budget about these expenses, a spokeswoman informed us that the office had rejected the state police’s purchases, concluding that the spending might not be directly related to COVID-19.
Our story also includes a look-up tool that lets readers like you put on an investigative hat and see how your money has been spent. We’ve already gotten some interesting responses: Geoff Hing, a reporter with APM Reports, noticed millions spent on postage and printing related to increased unemployment claims. Another reader pointed out that the Department of Revenue paid $6.75 per gallon for 100 gallons of distilled water, when those regularly go for $1 at a supermarket.