After COVID-19 hospitalizations peaked, the number of Texans dependent on home oxygen equipment was at "an all-time high" when a winter storm overwhelmed the state's power grid in February, leaving many struggling for air.
This article was published on Tuesday, March 9, 2021 in ProPublica.
HOUSTON — Mauricio Marin felt his heart tighten when the power flicked off at his Richmond, Texas, home on the evening of Feb. 14, shutting down his plug-in breathing machine. Gasping, he rushed to connect himself to one of the portable oxygen tanks his doctors had sent home with him weeks earlier to help his lungs recover after his three-week stay in a COVID-19 intensive care unit.
Between the two portable tanks, he calculated, he had six hours of air.
Marin, 44, and his wife had heard there might be brief, rolling power outages — 45 minutes or an hour, at most — as a massive winter storm swept across Texas last month, overwhelming the state’s electric grid. After more than two hours without electricity, he started to worry.
Marin tried to slow his breathing, hoping to ration his limited oxygen supply as he lay awake all night, watching the needle on each tank’s gauge slowly turn toward zero. The next morning, his wife, Daysi, made frantic calls to the power company and Marin’s doctor’s office, but nobody was answering in the midst of the storm.
For the next two days, Marin struggled for air and shivered under a pile of blankets. On the morning of Feb. 17, as they were still without power, his wife begged him to return to the hospital. But they feared driving on icy roads, and by then neither of them could get a consistent signal to call for help, as the widespread outages had knocked cellphone towers offline. And Marin didn’t want to go. He was terrified by the prospect of another hospital stay without visitors.
Marin’s skin was slowly turning purple, and he began to cry.
“Honey,” he later remembered telling his wife, straining with each word, “at least I’m going to die with you and my kids and not alone at the hospital.”
Marin said his life was spared when a neighbor showed up at the door with an oxygen tank a few hours later, sustaining him until the power returned. But he said his doctors fear that the weeklong ordeal inflicted additional damage on his lungs and jeopardized his already tenuous recovery.
Medical experts say Marin is part of a particularly vulnerable group who suffered significant hardships and potentially lasting harm as a result of the outages: those recovering at home from COVID-19.
At the peak of the outages last month, nearly 4.5 million Texas homes and businesses were without power, sparking calls for investigations of the Electric Reliability Council of Texas, the nonprofit that operates the power grid spanning most of the state, and the Texas Public Utility Commission, which oversees the state’s electric and water utilities. Two board members of the utility commission and six members of the ERCOT board resigned and the ERCOT CEO was fired after sharp criticism that they had not done enough to prepare for winter storms and had ignored warnings about the danger severe weather poses to the state’s electric grid.
Meanwhile, the human toll is still being tallied. Dozens of Texans have filed lawsuits against ERCOT and local power companies. Some of the suits allege that medically fragile children and adults suffered permanent or severe injuries because they were unable to get electricity to power life-sustaining medical equipment. Others have been filed by the surviving loved ones of older residents who died of hypothermia in their homes.
Among those demanding accountability are some Texans recovering from COVID-19 who say the prolonged outages further imperiled their already fragile health.
said she was diagnosed with a fairly minor case of COVID-19 in early February. But after more than two days in her frigid Houston home without power or heat, she said, her symptoms became severe. She had dizziness and difficulty breathing, forcing her to seek care at an emergency room, according to a lawsuit filed in Harris County that accuses ERCOT and her utility CenterPoint Energy of negligence.
Five hours southwest, in Hidalgo County, was sent home with an oxygen machine to recover from COVID-19 after a three-week hospital stay. As she struggled for days to breathe and keep warm without power, she feared she was going to die, according to a lawsuit she filed against ERCOT and her power company, AEP Texas. After her power was restored, the woman had trouble breathing even with her oxygen machine, forcing her to seek medical care, the complaint alleges.
Mauricio and Daysi Marin have in Harris County district court against ERCOT and CenterPoint Energy.
“I told Mauricio, ‘We've got to do something about this. This cannot happen again,’” Daysi Marin said. “We need to speak out and we need to say something.”
ERCOT said it had no comment regarding the Marin lawsuit, and did not respond to a subsequent email seeking comment on the two other cases. A spokesperson for AEP said the company does not comment on pending litigation. In a statement, Olivia Koch, a spokesperson for CenterPoint Energy, said that though she couldn’t comment on pending litigation, the company is fully committed to working with stakeholders to address the issues related to the storm.
“We understand the severe impact that the historic weather and generation shortfall emergency had on all Houstonians and Texans,” she wrote in an email.
“Medical Disaster”
In an effort to reduce the strain on limited hospital resources during the pandemic, it’s become standard practice for hospitals to send most COVID-19 survivors home before their lungs have fully recovered, said Dr. Jamie McCarthy, chief physician executive for the Memorial Hermann Health System in Houston. Those patients often spend several days or weeks dependent on breathing equipment, such as oxygen concentrators or BiPAP machines, that require electricity.
As a result, McCarthy said, the number of Texas residents dependent on home oxygen was “at an all-time high” as the winter storm hit last month. With statewide COVID-19 hospitalizations peaking at more than 14,200 people in mid-January, medical experts say thousands of Texans like Marin had been sent home with plug-in breathing machines and portable oxygen tanks in the days and weeks before the electric grid failure.
When the power went out for millions of households, many recent COVID-19 survivors were left straining to breathe and unsure where to turn for help, setting back their recoveries, doctors say.
Unlike other patients with chronic lung problems who’ve spent years dependent on breathing machines and who have endured severe weather events and outages in the past, McCarthy said, patients recovering from COVID-19 likely didn’t have access to backup power sources or other contingency plans.
“Most of the people that had been sent home on oxygen concentrators related to COVID, especially this time of year, we were not sending them all home saying, ‘OK, you need to be prepared to be without power for two days, what's your plan?’” McCarthy said.
Dr. Bela Patel, the chief of critical care medicine at UTHealth’s McGovern Medical School, said that during the power outages some recovering COVID-19 patients showed up at emergency rooms, filling up already crowded hospitals. Others told her they couldn’t get to a hospital and instead spent days struggling at home.
“It was really devastating for them,” said Patel, who runs a clinic for those recovering from long-term symptoms of COVID-19. “They were panicking because they weren't getting enough oxygen, their oxygen levels were dropping and they were trying to figure out what they could do.”
Patel said she was aware of about 40 calls to her clinic throughout the outages from recovering COVID-19 patients in need of oxygen, but in most cases her team couldn’t get it to them and instead directed them to go to an emergency room. While she said she is hopeful that many of those patients will recover from the damage caused by hours or days spent in frigid homes without access to supplemental oxygen, others may not be able to bounce back.
When patients with serious respiratory conditions spend several hours or days without access to supplemental oxygen, doctors say, it puts a significant strain on their heart and lungs, limiting the flow of oxygen-rich blood to vital organs and leading to potentially life-threatening complications. Frigid temperatures like those seen during the outages — the inside of many Texas homes dropped below 40 degrees — can further complicate breathing conditions, leading to lung spasms.
“We certainly hope that most of them will get to their baseline, and some of them already have,” Patel said. “But we do know of examples where patients didn’t recover and continue to deteriorate.”
Across the state, at least 40 deaths have been directly attributed to the storm and power failure, according to The Associated Press. Experts say the figure is likely much higher, but it before the total death toll is known, as officials comb through records and certify deaths across the state. It’s unclear if any of the 40 reported cases involved people who were recovering from COVID-19.
Beyond the harm that can result from a lack of oxygen and a lack of heat, the emotional stress resulting from a dayslong power outage can also affect a patient’s heart and lung function and require additional medical care, Patel said. That’s an extra challenge in a state like Texas, with the of uninsured residents in the country.
It could have all been prevented, she said.
“When you look at the long-term effects of what this had on our patient population,” Patel said, “it’s really a medical disaster.”
“It Happened Again”
Marin, a filmmaker who moved to the United States from Colombia two decades ago after meeting Daysi at a California film festival, thought he had a bad cold when he started feeling sick in early December. But then he awoke in a panic a few days later, unable to draw in a full breath.
His wife called 911 and an ambulance rushed him to Houston Methodist Sugar Land Hospital, where doctors diagnosed him with COVID-19 and admitted him to the ICU. That night, as doctors contemplated whether to connect him to a ventilator, Marin said he silently begged God to spare his life.
He called his wife from his hospital bed, barely able to speak, and told her to tell their two children, ages 18 and 20, that he loved them, and that he was proud of them.
“I truly believed I was going to die, but somehow I was given another chance,” said Marin, who slowly recovered over the next three weeks before being sent home with supplemental oxygen. “And not even two months later, it happened again.”
On the morning of Feb. 17, Daysi Marin said, after her husband had been without power for more than two days, she feared he was dying. He told her he was having severe chest pains after so many hours straining for air.
“I have never been in a situation like that, where you see somebody dying in front of your face, and you cannot do anything,” she said. “It was terrifying.”
She felt like God was answering a prayer when a neighbor, responding to a plea she’d posted on Facebook, showed up that evening with a six-hour supply of oxygen — “like a miracle from out of nowhere,” she said.
Following the ordeal, Marin said, he feels worse than when he was initially discharged from the hospital. He can’t walk around the house without becoming winded and can’t go even a moment without being connected to supplemental oxygen. After the back-to-back traumas, he said, he feels like he’s always on edge, worried about what would happen if any of his breathing equipment fails him.
Marin said his doctors prescribed additional medication to help his body recover in the wake of the outages and have asked him to return for additional tests to determine whether his heart or lungs were further damaged.
Daysi Marin isn’t sure if her husband will ever fully recover from the ordeal — or if she will.
“Last night, Mauricio was choking again and water was coming out his nose and his mouth,” she said, two weeks after the outages. “At night, I sleep a few hours and then I’m always up, checking if he’s breathing.”
She’s had to resort to anxiety medication to manage her panic attacks, she said. “I’m worried all the time.”
In Hobbs, New Mexico, the high school closed and football was cancelled, while just across the state line in Texas, students seemed to be living nearly normal lives. Here’s how pandemic school closures exact their emotional toll on young people.
This article was published on Monday, March 8, 2021 in ProPublica.
Everything looks the same on either side of the Texas-New Mexico border in the great oil patch of the Permian Basin. There are the pump jacks scattered across the plains, nodding up and down with metronomic regularity. There are the brown highway signs alerting travelers to historical markers tucked away in the nearby scrub. There are the frequent memorials of another sort, to the victims of vehicle accidents. And there are the astonishingly deluxe high school football stadiums. This is, after all, the region that produced “Friday Night Lights.”
The city of Hobbs, population just under 40,000, sits on the New Mexico side, as tight to the border as a wide receiver’s toes on a sideline catch. From the city’s eastern edge to the Texas line is barely more than two miles. From Hobbs to the Texas towns of Seminole and Denver City is a half-hour drive — next door, by the standards of the vast Southwestern plains.
In the pandemic year of 2020, though, the two sides of the state line might as well have been in different hemispheres. Texas’s response to the coronavirus was freewheeling. Most notably, it gave local school districts leeway in deciding whether to open for in-person instruction in August, and in conservative West Texas, many districts seized the opportunity to do so, for all grades, all the way up through high school. Students wore masks in the hallways and administrators did contact tracing for positive cases of coronavirus, but everything else went pretty much as usual, including sports. On Friday nights, high schools still played football, with fans in the stands.
New Mexico’s response last year was the opposite. The state, led by Democratic Gov. Michelle Lujan Grisham, took one of the most aggressive lockdown stances in the country, and issued stringent guidelines for school reopening, so stringent that Hobbs was allowed to bring back only a sliver of its students for in-person instruction.
For high school junior Kooper Davis, whose family lives 10 minutes west of the border, this meant no school and no football. This was a problem, because he loved both of them.
Kooper had always gotten straight A’s, despite a tendency to leave big assignments to the last minute. He charmed classmates and teachers alike with his playful ebullience. His natural high spirits had carried him through his life’s primary challenge to date, his parents’ breakup when he was a small child. He started playing organized football at age 5 and could not get enough of it. He played basketball, too, but football had his heart. When the youth minister at church once apologized for missing one of his high school games, Kooper reassured him that it was okay, that he did not depend on an audience: “I play for myself,” he said.
Kooper started heading off to quarterback camps and private training — in Atlanta, New Orleans and Tucson, among other cities — hoping to better his odds of getting to play in college, an aspiration that became more feasible as he sprouted to 6 feet, 4 inches tall, ideal for throwing over linemen, if only he could get his agility and coordination to catch up with his height. His parents encouraged him to aim for the Ivy League, but he knew its football was middling. Instead, he set his sights on Stanford, which excelled in sports and academics, and which he had visited for another football camp.
For student-athletes aspiring to play in college, junior year is key. It’s that year’s video that recruiters will look at, and that year’s grades that admissions officers will scrutinize. Kooper already had a highlight reel, and it included some nice-looking throws, but it was from his sophomore season on the junior varsity team. Junior year was everything: He would be vying for the starting QB slot on varsity and taking a fistful of Advanced Placement courses. He would, in general, be getting to enjoy the experience of being Kooper Davis, a well-liked kid in a small city where the admiration flowed even from the youngsters he helped out at church, one of whom, a 9-year-old boy, was overheard gleefully reporting to his father that Kooper Davis knew his name.
But the start of the school year arrived, and there was no school. Kooper and his classmates would take their courses at home using an online program, with barely any contact with teachers or each other. His teammates would be allowed to practice only in small pods, which left them mostly doing just weightlifting sessions and agility drills. There would be no actual games.
The hope was that all this would be temporary. That was what the kids heard from the adults in charge, and they tried to believe it.
The coronavirus pandemic has been not only a health catastrophe, but an epic failure of national government. The result of the abdication of federal leadership in 2020 was an atomization of decision-making that affected the lives and well-being of millions of people. States, and frequently individual school districts — sometimes even individual schools and sports leagues — have been forced to grapple with emerging and occasionally conflicting science that has sought to decode the mysteries of a newly discovered virus. Local governmental and educational officials — the vast majority of whom aren’t epidemiologists or experts on indoor airflow — have had to formulate policy under intense time pressure while being buffeted by impassioned constituencies on every side and facing the reality that any decision would impose costs on somebody.
One of the few aspects of this terrible pandemic to be grateful for is that it has taken a vastly lesser toll on children and young adults than its major precursor of last century, the flu pandemic of 1918-1920. That earlier pandemic’s victims tended to be in the prime of life, withmortality peaking around age 28.
The novel coronavirus, by contrast, has hit the elderly the hardest. Themedian age for COVID-19 fatalities in the U.S. is about 80. Of the nearly 500,000 deaths in the U.S. analyzed by the Centers for Disease Control and Prevention as of early March, — five hundredths of a percent of the total. The CDC has also recorded about 2,000 cases of aninflammatory syndrome that has afflicted some children after they contracted the virus, resulting in about 30 additional deaths. Doctors are still uncertain whether children who survived that syndrome will experience long-term heart issues or other health problems.
Plenty of parents continue to worry for their children’s health amid the pandemic. But the primary concern from a public health standpoint has been the role that children and young adults might play in transmitting the disease to others. A growing body of evidence suggests that younger children are the to transmit the virus, but that as children older, their capacity for transmission approaches that of adults.
This has posed a conundrum from early in the pandemic: How much should children be prevented from doing outside the home, to keep them from contributing to community transmission of a highly contagious virus? Or to put it more broadly: How much of normal youth should they be asked to sacrifice? It has been a difficult balance to strike, on both a societal and family level.
In many parts of the country, particularly cities and towns dominated by Democrats, concerns about virus spread by children has resulted in all sorts of measures: closures of playgrounds, requirements that kids older than 2 wear masks outdoors, at colleges that reopened. “We should be more careful with kids,” wrote Andy Slavitt, a Medicare and Medicaid administrator under President Barack Obama who was named senior advisor for President Joe Biden’s coronavirus task force, in a . “They should circulate less or will become vectors. Like mosquitos carrying a tropical disease.”
In Los Angeles, county supervisor Hilda Solis, a former Obama labor secretary, urged young people to stay home, noting the risk of them infecting older members of their households. “One of the more heartbreaking conversations that our healthcare workers share is about these last words when children apologize to their parents and grandparents for bringing COVID into their homes for getting them sick,” she . “And these apologies are just some of the last words that loved ones will ever hear as they die alone.”
As time has gone on, evidence has grown on one side of the equation: the harm being done to children by restricting their “circulation.” There is thewell-documented fall-off in student academic performance at schools that have shifted to virtual learning, which, copious evidence now shows, is exacerbating racial and class divides in achievement. This toll has led a growing number ofepidemiologists,pediatricians andother physicians to argue for reopening schools as broadly as possible, amidgrowingevidence that schools are not major venues for transmission of the virus.
As many of these experts have noted, the cost of restrictions on youth has gone beyond academics. The CDC found that the proportion of visits to the emergency room by adolescents between ages 12 and 17 that were mental-health-related during the span of March to October 2020, compared with the same months in 2019.A study in the March 2021 issue of Pediatrics, the journal of the American Academy of Pediatrics, of people aged 11 to 21 visiting emergency rooms found “significantly higher” rates of “suicidal ideation” during the first half of 2020 (compared to 2019), as well as higher rates of suicide attempts, though the actual number of suicides remained flat.
Doctors are concerned about in childhood obesity — no surprise with many kids housebound in stress-filled homes — whileaddiction experts are warning of the long-term effects of endless hours of screen time when both schoolwork and downtime stimulation are delivered digitally. (Perhaps the only indicator of youth distress that is falling — reports of child abuse and neglect, whichdropped about 40% early in the pandemic — is nonetheless worrisome because experts suspect it is the reporting that is declining, not the frequency of the abuse.)
Finally, the nationwide surge in gun violence since the start of the pandemic has included, in many cities, a sharp rise incrimes involving juveniles, including many killed or arrested during what would normally be school time. In Prince George’s County, Maryland, a Washington, D.C., suburb where school buildings have remained closed, in just the first five weeks of this year.
“An entire generation between the ages of 5 and 18 has been effectively removed from society at large,”wrote Maryland pediatrician Lavanya Sithanandam in The Washington Post. “They do not have the same ability to vote or speak out.”
It has, instead, been left largely up to parents to monitor their children for signs of declining mental health as they determine whether to allow their kids to return to college or summer camp, to have a friend over, to go to the mall.
My family was among those facing these decisions. Our sons, now 16 and 13, have had fully remote learning in their Baltimore public schools for nearly a year now. For them, the primary release from the hours staring at the laptop screen would be sports, and for us, the answer was clear: My wife and I would let them play. The boys’ respective high school and rec-league baseball seasons were canceled last spring, but their club teams were still playing through the summer and fall. This proved a godsend, a way for the boys to keep being active outdoors and around other kids, doing something they loved to do. For my older son, the baseball meant frequent traveling to tournaments out of state, in Virginia and Pennsylvania. Almost every weekend, we’d be back on near-empty highways, staying in near-empty motels, subsisting on endless takeout chicken sandwiches whenever we couldn’t find an outdoor place for a meal.
This all started before the resumption of Major League Baseball and other professional sports, and it sometimes seemed as if our tournaments were the only serious competitive sports happening in the country, a sort of speakeasy baseball. Some precautions were taken, such as umpires calling balls and strikes from behind the mound instead of behind the catcher at home plate. The boys and their parents wore their masks inside the motels; at games, the parents spread out in the bleachers or on the sidelines. The parents ran the political gamut: liberals from Baltimore, conservatives from rural towns in Pennsylvania. But there was an implicit agreement that we were fortunate that our kids could keep playing, and we wouldn’t do anything to screw it up. Those weekends remain for me some of the only redeeming moments of an awful year.
Football at the teenage level differs from baseball in a crucial respect: It is based almost entirely around high schools, without a parallel universe of clubs and tournaments. If high school teams aren’t playing football, there is no football being played.
In New Mexico, Gov. Lujan Grisham that football and soccer would be prohibited for the fall season. “No contact sports are going to be permitted this fall,” she said. “These contact sports are just too high-risk. If we do well, if we work hard, it is possible we could just be delaying them and they could be played later in the year and later into the season. Fingers crossed, and I believe in you that we can get this done.”
As the hot Southwestern summer dragged on, Kooper Davis and his teammates placed faith in that possibility. In August, they were allowed to hold practice sessions capped at nine players each — not enough for a real practice, with offense running plays against defense, but better than the July sessions, which had been capped at five players. Kooper was vying against three other players for the starting quarterback spot. His arm strength had improved in the past year, so much so that his best friend Sam Kinney, a wide receiver, jokingly complained about the passes starting to hurt. And Kooper was a great student of the quarterback position; he had “the intangibles,” his coaches said. But he knew he needed to work on his agility, which is one reason he took the practices so seriously. He was the first to come, and last to leave.
Even with fall sports canceled, the Hobbs school district, with almost 10,000 students, was still hoping to open the new school year for as much in-person instruction as possible. More than just scholastic considerations were driving this. In late April, six weeks into the spring’s pandemic lockdowns, the community had been stunned by the suicide of an 11-year-old boy, Landon Fuller, an outgoing kid who loved going to school and had, his mother said, struggled with the initial lockdowns.
New Mexico has consistently had one of the highest in the country — it’s roughly twice the national average — and preliminary state statistics would later show the 2020 rate as unchanged. Nationwide, increased by half between 2007 and 2018, a trend that has been linked to multiple factors, from the growing availability of guns to the spread of smartphones and social media. In New Mexico, mental health experts say, the factors also include high rates of depression on Native American reservations, and rural isolation in general.
Still, the news of an 11-year-old taking his life — after riding his bike to a field near his house — had the power to shock in Hobbs. “I think the big question we all have is why, and we will never know the reason why,” his mother, Katrina Fuller, told an Albuquerque TV talk show in July. “The only thing that I was able to find was in his journal, was that he had wrote that he was going mad from staying at home all the time and that he just wanted to be able to go to school and play outside with his friends. So that was the only thing that I can imagine what was going through his head at that time.”
Hobbs is heavily conservative. Lea County, of which it is part, would vote 79% for Trump in 2020. And unlike in many other, more Democratic parts of the country, the city’s school administrators had the support of many teachers when it came to reopening: A survey in late summer found more than 70% of teachers in favor of in-person instruction. But the district’s push to reopen was rebuffed by the state education department. After initially barring any schools from reopening in August, the state released “gating criteria” for districts that wanted to resume in-person instruction in the fall. They were among the strictest in the country. They allowed only for elementary-school instruction, and required a district to stay below an average of eight new cases per day per 100,000 residents over a two-week period. For Hobbs and the rest of Lea County, population 70,000, that meant no more than five new cases per day in the whole county. (By , Kentucky’s daily threshold was 25 cases per 100,000 people and Oklahoma’s was 50 cases. Hawaii, one of the states least affected by the pandemic, put its threshold at 360 cases over a 14-day period.)
Statewide in New Mexico, the restrictions resulted in zero high schools or middle schools reopening anywhere in the state. This confounded Hobbs school officials, especially because they could see open schools across the border in Texas. “We’ve got districts 30 miles away doing it safely,” associate superintendent Gene Strickland said. “I get the fear level, but we see models that show it can be done. Allow us that opportunity.”
Kooper Davis had always thrived in school. He liked his teachers, and they liked him. He had won over his ninth-grade English teacher, Jennifer Espinoza, with his willingness to engage on the works they were reading: “The Outsiders,” “Romeo and Juliet,” “To Kill a Mockingbird.”
“He was very opinionated about why a character did this, or whatever something meant,” Espinoza said. “Even if he was wrong or going in the wrong direction, he wasn’t afraid to put his thoughts out there.” It was a great class in general, she said: “Those kids fed off each other. They would come out with amazing answers.” Kooper and Sam Kinney ribbed her about her tendency to lose her phone and took daily attendance for her. When Kooper was the only boy at Hobbs to make the Junior National Honors Society alongside 20 girls, Espinoza asked him if it felt weird. He grinned. “No, I like it!”
But Kooper hated virtual school. There were no friends to cajole, no teachers to charm. Hobbs wasn’t even holding synchronous classes online for older high schoolers. They mostly watched video lessons on their own, using an online curriculum called Edgenuity. Kooper procrastinated, as usual, but now also found it harder to focus when deadlines hit. His grades started slipping from his usual all-A’s. And these were the grades that colleges were going to be looking at.
As it was sinking in with Kooper and his classmates that school would remain remote for the rest of the fall, they got word in early October of an additional setback on the sports front. Not only would New Mexico remain one of a handful of states to bar high school sports, but practices would now be limited to just four players per coach. This meant they would mostly just be lifting weights, never mind that this often meant having many players in the weight room at a time (albeit in four-player pods), seemingly a riskier proposition than a regular practice outdoors. The football coach, Ken Stevens, could sense the morale plunging. “I seen a lot of disappointment,” he said. “Lost hope.” Some players stopped showing up. Making it especially tough, he said, was the nearby contrast. “That’s the frustration,” he said. “How come 10, 15 miles away, these kids can compete, can live a somewhat normal life?”
Kooper was despondent. “Man, this ,” he told his teammates. “We need to be back on the field.” He missed football so much that, on some Friday evenings, he headed across the state line to Texas to watch a game.
The schools in Denver City, population 5,000, had shut down amid the coronavirus lockdowns in the spring of 2020, but there wasn’t really any question about whether the 1,700-student district would reopen schools in the fall. The Texas Education Agency was letting districts make the decision. The Texas Classroom Teachers Association had nowhere near the sway of unions in other states. This didn’t keep many large urban districts in the state from starting the school year with remote learning. But Denver City and nearby small cities in West Texas opened schools. Students could choose a virtual option, but only a few dozen of Denver City’s 492 high school students took it. As for teachers, there was no option: Their job was in the classroom.
Denver City is a humble-looking town, with a Family Dollar and no Walmart, but oil-and-gas revenues had allowed it to build a new high school two years ago. The building has good ventilation, and enough space that it wasn’t hard to spread desks to allow for 4 to 6 feet between them, even in a class of 20 or more. Students were attending five days a week, without the hassle of hybrid schedules used in much of the country. They were required to wear masks in the hallways or while moving around a classroom, but many teachers allowed them to take their masks off at their desks, judging the spacing sufficient, though the teachers kept their own masks on. Lunch was still served in the cafeteria, but it never got crowded because many students went into town for lunch, at the McDonald’s drive-through or elsewhere.
The school did not administer coronavirus tests on its own, but if a student or teacher tested positive locally, the school conducted contact tracing to determine if any other teacher or student had been exposed to them for 15 minutes or more, unmasked, within six feet. Anyone who fit that definition had to quarantine at home, initially for two weeks, eventually only for 10 days, in line with CDC guidelines. The district, which offered daily and weekly tallies of cases on its website, determined that the vast share of transmissions seemed to be happening outside school, as to be the case in other places, too. “The weekends is where they’re getting it,” said principal Rick Martinez. “If we could have them all week, this is the best place for them to be.”
Over the course of the fall semester, about a dozen of the 70 staff members in the Denver City school missed time for quarantine, mostly after testing positive themselves, forcing the district to find substitutes — no easy task, but not insurmountable. All of the teachers returned. There were other challenges, such as the time in August when a player on the girls volleyball team tested positive and the school made the decision to shut down the team for two weeks, just in case another player had been exposed.
Overall, though, the fall was going so relatively well that many students who had chosen the remote option at the outset decided to come back to school, to the point where only about half a dozen were still learning at home. “It’s been stressful at times,” said the district superintendent, Patrick Torres. “It’s taken a lot of time and effort, but our kids are getting instruction face to face.”
Football went forward, too. The school capped attendance at its field, and required people to register for tickets online. The team in Seminole, 20 miles south, needed to cancel some games as the result of player quarantines, but Denver City managed to get through the fall without any cancellations, though there were some weeks where the roster got thin.
Kooper Davis came across the border once with a friend to see a game in Levelland, northeast of Denver City, and another time with his father, Justin, to see a game in Seminole. Justin, who works for a company that services oil-field equipment and runs a lawn care business on the side, noticed the reaction his tall, athletic son was getting in the Seminole stands. “People looked at us, like, ‘Who is this kid and why is he not playing?’”
Kooper’s father and his stepmother Heather, who had been together since Kooper was nine, had considered transferring him to a school in Texas, as other families were doing. This would have entailed sending Kooper to live with Heather’s brother. (Kooper had limited contact with his biological mother.) They were even considering sending Kooper and Heather to Atlanta to live near one of the coaches he’d trained with. But Heather and Justin had just had newborn twins. Plus, Kooper wanted to play with team, his friends.
His parents began to notice how much the disruption and uncertainty was wearing on their normally buoyant son. On Oct. 9, Heather went on Facebook and posted a plea for reopening. “So honestly when do we stand up for our kids?? When do we all protest and say this is enough, do we wait until our kids lose life completely?” she wrote. “So many kids are turning to the wrong things to fill a void. Sad, it’s so sad. Let’s respect the ones who wanna stay home and respect the ones who are ready to go back!!”
Two days later, the town learned of another life lost: an 18-year-old who had graduated from Hobbs High that spring at a local park after receiving a medical discharge from the Navy. Kooper did not know him well, but went out to join friends who had gathered to mourn him.
The next day, a Monday evening, Kooper and his classmates held a demonstration for reopening school and school sports, one of several across the county that day. They held theirs at the high school football stadium, a hulking edifice that can seat 15,000. The students wore masks and sat spaced apart on the stands, holding signs that said “Let Us Play” and “SOS Save Our Students.” They had the tacit support of their coaches and many of their parents, some of whom had helped shoot a testimonial video that was going to be shown on the scoreboard screen. But the video wouldn’t load right, so several students went onto the field to give impromptu speeches before the 175 or so people who were gathered there.
Kooper was among the speakers, which surprised his friend Sam Kinney. “I knew he was pretty brave, but didn’t know he was that brave,” Sam said later.
At the microphone, Kooper introduced himself, then said, “I play football and basketball and those sports make up a big part of my life, and when I’m not here every day doing something with those sports, honestly, I feel really lost in life. Since I’m a junior, college is starting to cross my mind, and without this essential year of learning, I feel completely unprepared for college. I know I’ve still got another year, but time goes faster than you really think.”
He continued, “I just believe we should be here at school and we should be here playing football. It’s crazy to think that just down the road, they’re playing a football season — they’re almost with their football season. It’s honestly ridiculous. And I’m willing to keep my teammate and classmates in line, minding whatever rules, just so I can be back here doing the stuff I love.”
Mental health experts struggle to identify a precedent for the challenge this pandemic is producing for many Americans. In prior pandemics where the technology was not available for remote work or remote schooling, lockdowns and social isolation were not as extreme and did not last as long as what we’ve lived through this past year. And the psychological stress that the pandemic has produced for so many Americans of all ages is unlike so many more acute crises that we might experience in life, said Nick Allen, a professor of clinical psychology at the University of Oregon. “There’s a difference between a stressor that makes your life unpleasant and intolerable and a stressor that takes away good things,” he said. “For a lot of people, the stressor that COVID represents is one that takes away good things. You can’t go to sporting events, you can’t see your friends, you can’t go to parties. It’s not necessarily that you’re experiencing abuse, though some may be. What’s happening is that we’re taking away high points in people’s lives that give them reward and meaning. That may have an effect over time. The initial response is not as difficult as something that’s stressful, but over time, the anhedonia, the loss of pleasure, is going to drive you down a lot more.”
Even before the coronavirus arrived, teen mental health was a cause for growing concern. Researchers and mental health professionals had come to the conclusion that, as David Brent, a University of Pittsburgh psychiatry professor, put it to me, “One thing that’s protective against it is connection to school and family and peers. We know that participation in sports and a connection to school can have a profound protective effect.”
That social connection has been attenuated in the parts of the country that have largely shuttered school buildings and associated activities. The closures have also inhibited young people’s striving for independence, youth mental health experts say. “A key developmental task of adolescence is autonomy-building,” said Jessica Schleider, an assistant psychology professor at Stony Brook University. “That is what teens are driven to do: to grow self-esteem and a strong sense of who they are.” With school and so much else closed off to them, and daily life mostly limited to the home, “the little bit of self-directedness they had before is gone. A lot are stuck in environments they didn’t choose. The futures they had been working toward aren’t options anymore.”
As the pandemic carried through the summer, worrisome signals started appearing across the country. In addition to the on the rising share of visits to emergency rooms by teenagers in distress, a University of Wisconsin survey of more than 3,000 high school athletes during the summer found that more than two-thirds reported high levels of anxiety and depression, .
For Kooper, autumn brought no relief. Every weekday morning except Wednesday, he got up at 6:30 a.m., drank a protein shake, then drove to McDonald’s for more breakfast, before arriving at school at 7 a.m. for a weightlifting session. On the way back, he’d pick up some Burger King breakfast for his two younger sisters, ages 11 and 5. The younger one would ask why he couldn’t get McDonald’s, which she preferred, on the way back, and he’d explain that traffic made it easier for him to do them in this order. Kooper would chat a bit with Heather and then shower and get to work on the computer.
There were signs that mental health was on his mind. On Oct. 16, Kooper shared a grim claim from a state representative on his Facebook account, which he seldom used: “The New Mexico Athletic Association reports there have been 8 student-athlete suicides since March 20.”
Kooper looked so alone and hunched over as he worked that Heather one day posted a picture of him online to share his struggle with others. “I know my kid isn’t the only one hurting,” she wrote. “How is this life that they are living.”
The Davises were sufficiently attuned to the mental health challenges of the pandemic that they held regular family visits with a therapist, and Kooper had gotten a couple of solo sessions as well before he and the therapist decided that was no longer necessary.
For a while, Kooper went to do some of his schoolwork at the Starbucks near the local Walmart, just to get out of the house, but then it closed down again when state restrictions tightened further. On some Tuesdays and Thursdays, he’d head to school for an afternoon session with the other quarterbacks, learning how to read defensive coverage. Some afternoons, he’d head over to the church his family belongs to, Christian Center Church, which is led by Sam’s father, Jotty Kinney, who set up a small weight room for the boys to use. On Sunday mornings, Kooper would be back at the church for his youth-group service and to help lead sessions for the younger kids. And one weekend late afternoon in November, when it was below 30 degrees out, two dozen boys went to school to play touch football, the closest they had come to having a game.
On Sunday, Dec. 6, as semester finals were getting underway for school, Kooper was at church as usual, dressed as a baby for a monthly skit he and Sam did for the little kids. Later that day, he put up another Facebook post, his first since the one in October: “With these tough times going around, I know there are many of those in need, and I want to give back to my community,” he wrote. “If any of y’all know anyone unable to leave their homes, I am willing to wait in line and pick up their groceries for them, or even run simple errands. Please pm me if you or anyone you know could use a helping hand.”
The next morning, Dec. 7, Kooper went to his Monday weightlifting session. As he left, he told Sam, in typically unabashed fashion, “Love you.” “Love you, too,” Sam responded. On the way out of the athletic building, Kooper swung by to see the basketball coach, Eddy Martinez, to tell him he thought he might be able to play with that team, too, if the schedule that the state had floated the previous week actually came to pass: a truncated football season in February, followed by a truncated basketball season. Martinez said he’d be glad to have Kooper and that he was welcome to join one of their four-person practice pods that very day. Kooper said he didn’t have his basketball shoes, but he would come the next day.
Coach Stevens got the news from the school principal that afternoon. Like others in Hobbs, he was not unprepared for such calls: There had been at least six suicide attempts by Hobbs students during the pandemic, according to district officials. But when he heard the name, Stevens was stunned. He asked, “Are you sure you got the name right?” The principal said he thought he had, but that he’d double-check with the school’s designated police officer. He called back five minutes later to say that yes, he had gotten the name right.
Jennifer Espinoza got word from fellow teachers, one of whom asked her, “Hey, did you have Connor Davis?” The name meant nothing to her, but, she asked, did they mean Kooper Davis? No, they said. “Good,” she said, “because Kooper would be out of the question.”
It had happened while Heather was at the grocery store picking up baby formula and something for dinner. At about 1 p.m., Kooper had texted Sam on Snapchat: “Love you, bro.” “Love you, too,” Sam wrote back. That was the last he heard from his friend.
The next day, Coach Stevens gathered his players and assistant coaches in the team meeting room to discuss Kooper’s death. There were counselors on hand, as well as Pastor Kinney, Sam’s dad. The adults encouraged the players to speak about what they were feeling, not to hold things in. But the players ended up just wanting to go lift weights together.
The day after that, Wednesday, a fleet of empty school buses arrived at the high school from other towns, one from as far as Clovis, 130 miles away. The buses had condolence messages painted on the windows: “We are here for you,” read the writing on the bus from Portales. “Pray for Hobbs,” said the bus from Eunice. “Artesia loves you,” said the bus from Artesia.
I reached Justin Davis on the phone that Saturday, after learning of Kooper’s death from a mother in northwestern New Mexico whose daughter had also struggled with the absence of school and sports. Justin, as I would soon learn, is a large and taciturn man, but he was eager to talk, and urged me to come to New Mexico to learn more about what Kooper and his friends had been through. He was at a loss over what he and Heather might have missed. “I had an open relationship with my son,” he said. “It’s baffling to us to figure out why he didn’t come to us.”
Suicide is ultimately an unfathomable act, but Justin said he was sure of one thing. “No doubt, if my son had been in school on Monday this wouldn’t have happened,” he said. “He would’ve had an adult standing next to him, a coach saying, ‘Kooper, quit being a dummy.’” The only way he could make sense of it, Justin said, was that “for about fifteen seconds of Kooper’s life, he let his guard down and the devil came in and convinced him of something that was wrong.” His only solace was seeing the effect the loss had on Kooper’s classmates, who were, he said, turning their lives over to God, sending letters to the governor, and generally spreading word of his son’s goodness far and wide.“I believe God needed him now,” he said.
I arrived in Hobbs two days later, just in time for the memorial inside Christian Center Church. The parking lot was jammed with oversized pickups, and the sanctuary was standing room only. The stage was dominated by balloons in black and yellow, the Hobbs High colors, and large white letters and numbers, aglow with lights, that spelled KD 10, Kooper’s jersey number. His home and away jerseys, his school backpack and a school photograph were also displayed. I found an empty space to stand in the back. There were many kids in the audience, and some were wearing raspberry-colored shirts with Kooper 10 written on them. Few people were wearing face masks.
A four-person band with two backup singers played “Another in the Fire,” a stirring song by the Australian worship band Hillsong United: “There was another in the fire/ Standing next to me/ There was another in the waters/ Holding back the seas…”
Stevens was one of several coaches and trainers who spoke via a recorded feed played on the big screen over the stage. “I have no doubt that God is not done using Kooper,” he said. “He is going to continue to use him to impact those around him, and God’s glory will shine through.”
Then the screen played a long loop of photos and videos of Kooper: wearing a Halloween costume, holding his younger sister on the beach, wearing braces, buried in sand, grinning behind Justin and Heather as they kissed at their wedding, attending a Dallas Cowboys game, singing in a school musical, holding a newspaper with his name in a sports story, sitting on a hay bale, holding the newborn twins, wearing a tux for a dance.
Heather came to the stage with Kooper’s sisters. She began by reading some lines Kooper had written in his journal, including his paraphrase of a verse of Scripture, “If your enemy is hurting give him food. If he’s thirsty, give him water,” and his interpretation of it: “No matter who it is, no matter who the person is, if they’re in need, help them. Help them. I don’t know who it is, but you need to help them.” She talked about Justin’s love for his son: “That’s his boy. Kooper’s been Justin’s rock.” She recounted all their morning chats together, after his workout sessions. “I want him to come in from football practice and tell me how practice went. I want him to tickle the babies while I go eat,” she said. “But that’s me being selfish. And I want his happiness more than I want mine.”
Pastor Kinney spoke last. “When you’d see him smile, you didn't know what was going on under that mop of hair he had,” he said. “He was one of the most driven people I have known.” He described Kooper’s “protective loyalty,” how he once ran in from the outfield of a church softball game to confront someone who was having words with Heather. He joked about Kooper letting one of his sisters sleep in one of his shirts, his willingness to dress up as a baby during the church skit for the little kids, and how Kooper was the only one of the young people he knew who would actually call him on the phone sometimes, just to talk. “No other kid in this day and age called,” he said. “He didn’t text you or put it on Snap. He called you.”
When the service ended, people stayed on for a while to talk and hug each other. It was unnerving to watch: lots of people, few masks, no windows. The event was in gross violation of the state rules on indoor gatherings, which were supposed to be capped at 40 people, but no sheriff’s deputy was about to intervene on this day. (The mass exposure did not lead to any reported local outbreaks.)
The people of Hobbs had for months been barred from letting their kids go to school or letting them play football and soccer. And now, after the death of a boy that many of them saw as linked to those restrictions, they were effectively, saying, screw it.
I chatted with some of Kooper’s teammates, asking them how they were handling remote learning. “It’s trash,” said one, Kevin Melissa. “It’s crazy,” said another, Carter Johnson. “Everyone tells us to keep positive, but it’s been almost a year. It’s hard to be positive.”
Before the event broke up, someone encouraged all of Kooper’s classmates to get together on stage for a group photo. They eagerly did so, several dozen of them bunched together, beaming for the camera. The smiles were jarring in the context of a memorial service until one remembered the broader context: It was the first time they had all gotten to be together since March.
The next morning, I met Katrina Fuller, the mother of 11-year-old Landon, in the windswept parking lot of a strip mall. She had come to bring her teenage daughter to an outdoor kids’ workout session that had been arranged hastily a few days earlier, after the news of Kooper’s death. Despite the cold, two dozen kids, most in their early teens, had come out to the parking lot and were now doing various kickboxing exercises — spaced apart and with masks on — under the guidance of some martial arts instructors.
Katrina, a prenatal educator, had been trying for months to draw attention to the mental health needs of Hobbs’ young people. She had been writing and calling elected officials and state bureaucrats and finally, with the help of the local state senator, Gay Kernan, had gotten the state to provide some training for local teachers in recognizing youth mental health troubles.
More resources had belatedly started pouring into the state: a $10 million federal grant for school-based mental health services, plus $500,000 in CARES Act funds. The challenge was less the lack of money than the lack of people to administer it: the state education department has only a single behavorial health coordinator, Leslie Kelly, who was struck by the rising concern about youth suicide during the pandemic given that the problem had existed for years in New Mexico. “I’m glad we care about this now, but our state was high pre-pandemic,” Kelly said.
Even if New Mexico’s overall numbers were holding steady, to those in Hobbs, three youth suicides plus a half-dozen other attempts by students in a matter of months in a population of 39,000 felt like its own epidemic. Shivering in the parking lot, Fuller told me about Landon, who had “just wanted to be everyone’s friend.” He was the sort, she said, who always went over to any kid sitting by themselves on the playground. And Fuller told me about the difficult weeks of the initial lockdown in the spring, when both she and her husband were feeling the stress of a loss of income. They had tried to make things as nice as possible in those weeks, with an online birthday party for the two kids, and an Easter egg hunt. But it was still hard. “All of our moods changed,” she said. And it was so hard for someone of Landon’s age to grasp time; the six weeks of closure seemed like forever.
I asked if she thought school should have opened in the fall, and she hesitated. She took the coronavirus seriously, she said. Her grandfather recently died of COVID-19. She was heartened by the launch of the exercise class but knew the town needed to come up with more, “just to let them know that we love them and they’re so wanted and they’re not alone.” She started to cry.
She said she had started hearing from many other families around the country whose kids were struggling, including a mother who’d discovered her 6-year-old’s plans for how to end her own life. “These are kids without mental health issues, with good families, kids that are loved,” she said. Definitive explanations were, of course, impossible to come by. “I’ve heard it all,” Fuller said. “I’ve blamed myself.”
She had done a lot of reading on youth suicide since Landon’s death, and had learned that rates were especially high in indigenous communities, like the Aboriginal community of Australia. In reading that, she had drawn a connection to American children who were being forced into a whole different way of life during the pandemic. “The theory is they’re reacting to modern society,” she said of the Aboriginal children. “Well, we’re introducing them to a new society here, and they’re rejecting it.”
Recently, Fuller told me, she had received an envelope in the mail from the New Mexico education department. She opened it and found a letter demanding to know why Landon had been truant from his online classes during the fall semester. The bureaucratic oversight stunned her. “He would be in school if he wasn’t dead,” she said.
After my meeting with Fuller, I went back to the church. Sam was lifting weights with another friend in the small workout room that his father had set up. After I chatted with Sam, I walked with his father back to his office. He told me that he had been running through his last interactions with Kooper, over and over, searching for a warning sign, to no avail. All he knew was that Kooper had been upset about the closures. “When you put most of your things into achieving scholastic, and achieving athletic, and those things aren’t available to you, your whole life, every goal you wanted to achieve is being taken away from you,” he said.
Kinney said he and the Hobbs school superintendent had been talking a few days earlier about the need to get kids back in school. “Like Texas, we have to learn to live with it,” he said. “You know, marginalizing our teens for other people that are high-risk, what do you pick? You know? Because, I mean, we’re losing them. Not only that, we’re losing years of their educational development.”
Kinney said his brother-in-law, also a pastor, had become seriously ill with coronavirus, and he did not doubt its danger. But, he said, the current generation of kids “are the people that are going to be running our country one day. We’re losing their leadership. They’re going to be taking care of us one day, and this is how we’re treating them?” He noted that one student at the October protest had carried a sign that read, “I’m able to vote in your next election.”
“They’ll remember these times,” he said.
That night, I went to meet with Kooper’s father and stepmother at their house, which sits out on the edge of town, near a small cattle farm. Meals cooked by friends covered the island in the kitchen. Justin and Heather told me how much comfort they were taking in the outpouring over Kooper, especially among his classmates.
But they said they were thinking of all the other kids in another way, too. If normally lighthearted Kooper, despite a loving family and natural gifts, had been struggling so much, what about all the others? How much distress was invisible to parents? “He was a kid who had everything, and this is where we’re at,” said Justin. “What’s going on with those other kids?”
On my final day in Hobbs, I made the short drive across the Texas border to Denver City. It was startling to pull into the high school parking lot and see dozens of teenagers strolling out of the school building, wearing masks and carrying backpacks, on their way to lunch. Even more startling was hearing from school administrators about how well the football season had gone — the Denver City team made it to the second round of the playoffs — and about the great event of the night prior: the holiday band concert. To avoid dense crowds, the band had held three performances, with several hundred people attending each. In the large band hall, the band director showed me the dots he had taped on the floor to keep the 70-odd musicians spaced 7.5 feet apart even as they marched, and the cloth covers that one student’s grandmother had made, decorated with the school’s mustang logo, to go over the tubas, to keep them from emitting moisture. It was hard not to be impressed by the ingenuity, the determination to try to make things work, even now. “Whatever it takes,” said Rick Martinez, the principal.
After being in Denver City, things seemed emptier than ever at the Hobbs high school complex — in normal times, the center of communal life in Hobbs. I was there to meet with Coach Stevens, who had also been wracking his mind trying to think of clues he hadn’t picked up from Kooper. He could think of nothing, other than the fact that he had noticed that one of Kooper’s grades had slipped below his norm. But he also knew how adolescents had the natural tendency to magnify troubles. “I fear for all the kids,” he said. “One thing that maybe our decision makers don’t remember is that when you’re in high school or you’re a kid, thinking you’re the only one dealing with something. That’s what you think when you’re 16: Nobody is dealing with what I’m dealing with.” Not to mention, he said, that the closures have simply given kids too many empty hours. “They’ve got so much time on their hands,” he said. “I don’t care how good a kid you are, if you have so much time on your hands, you’re going to find mischief.”
He told me how dearly he hoped the state stuck to its plan for a football season, truncated though it was. “My biggest fear is, you pull the rug on these kids,” he said. “All we’ve been doing is trying to sell hope and belief to these kids that it’s going to happen, but at some point, they’re going to quit believing in you.”
My last visit in Hobbs was to the home of Jennifer Espinoza, Kooper’s favorite teacher. When I entered her bungalow, Espinoza, a friendly woman in her 40s, said that I should feel welcome to take my mask off, because she had already been through a serious case of COVID-19, several weeks earlier. This startled me, but not nearly as much as what she told me next: that soon after her own illness, her partner of 18 years, Abe, had died of what had strongly resembled COVID-19, though his initial test had come back negative. He had been away from Hobbs at the time, working an oil-field job in Odessa, Texas, and a co-worker he had shared a truck with later tested positive. Abe died on Nov. 30, at 49, before she could see him.
And then Kooper had died, a week later. It had been a terrible month, and it had left her uncertain about the best course for the Hobbs schools and sports teams. As the school year started, she had been among the majority of teachers who were willing to return to classrooms. This had only been confirmed for her as she saw how poorly the remote learning was going: not only did most students leave their cameras off, some wouldn’t even turn on their microphones. “I can’t see them, I can’t even hear them,” she said. “They didn’t want to talk.”
But then she herself had gotten the virus — she wasn’t sure where — and its severity had hit home, even before her partner’s death. She had swung the other way on reopening. Now Kooper’s death was making her reconsider again. “If it would prevent another Kooper, then definitely, yes,” she said. “We just have to weigh the good and the bad. Do we fear everyone coming back and possibly getting COVID, or do we fear losing another student more?”
In late January, Gov. Lujan Grisham would announce that schools could reopen for all ages on Feb. 8, but at maximum 50% capacity, which meant only a couple of days per week, and under the condition that they would close if cases rose again. Sports could start a few weeks after that, with masks and without fans. Nationwide, meanwhile, President Biden’s push to reopen schools was explicitly leaving out high schools, leaving millions of teenagers with the likelihood of remote learning through the end of the school year.
In the same week as Lujan Grisham announced her reopening plan, I made another check of the coronavirus toll in Hobbs’ Lea County. The county had suffered 112 deaths attributed to COVID-19, which worked out to a per capita rate slightly lower than that in the three Texas counties abutting Lea. New Mexico as a whole had lost 3,145 people, two-hundredths of a percentage point higher than Texas in per capita terms. The overall per-capita case numbers in Lea County were slightly higher than the three counties across the border, while the case numbers in Texas were slightly higher than in New Mexico.
Numerous factors had affected these outcomes, needless to say. The states had taken very different approaches with regard to their young people, but ended up in almost identical places as far as their coronavirus tolls.
Other tolls would be harder to assess, in a year of so much damage done, in so many ways. “There’s too much hurt,” Espinoza said as I headed out of her house after our conversation. “There always seems like there’s something new to cry about.”
Danette Wilder spent years building up her company. Now it has to survive a recession that could put a generation of Black entrepreneurs out of business.
This article was published on Thursday, March 4, 2021 in ProPublica.
Of all the products made at Danette Wilder’s small manufacturing plant near the University of Kentucky in Lexington, the products she depended on most for sales were the O-rings cranked out by her vintage presses.
Each month, Wilder’s crew of six people, working at long tables as they listened to a soundtrack of funk and R&B, made thousands of the rubber loops, cut from spools into precise strips and spliced into uniform perfect circles.
The work distinguished Wilder’s company, SealingLife Technology, as one of the vanishingly few rubber products suppliers owned by a female engineer — not to mention one who is also Black. It hasn’t been an easy path: Wilder has navigated state and federal set-aside programs, tight-fisted bankers and what she saw as obvious discrimination. But eventually, Wilder built SealingLife into a reliable vendor for all manner of aerospace, medical and other industrial businesses.
Now, SealingLife is struggling to survive as orders for its O-rings have dried up over the past year, plunging the company into hundreds of thousands of dollars in debt. That’s not an unusual story in the current pandemic-induced recession, which has been a gut punch for millions of small business owners. But Wilder faces obstacles that are disproportionately common among Black-owned companies, which on average had fewer resources to draw upon going into last year, were hit particularly hard by the downturn and were less well-served by the relief programs set up to help.
“We’re in a purgatory state,” Wilder said. “The long term is, if we can’t get our foot in the door with people who understand what we do and how we do it and provide us opportunities to grow, then the outcome is very bleak.’’
There are disparities between American businesses owned by white people and those owned by all minority groups, but the widest ones are typically with Black entrepreneurs, who tend to have modest family wealth and thin professional networks to help recruit talent and cut deals. Although the number of Black-owned businesses has grown in recent years, the vast majority remain sole proprietorships. As of 2012 — the most recent data the Census Bureau has collected — average annual sales for a Black-owned business came to about $58,000, compared to nearly 10 times that amount for the average white-owned enterprise.
Those years of compounding disadvantage have been exacerbated by the pandemic. For example, 18.4% fewer self-employed Black people were working in July 2020 than there had been a year previously, compared to 6.2% fewer self-employed white people (the dips for Asian and Hispanic people were even smaller). And minority-owned businesses overall have also been at the back of the line for relief programs, which were initially designed without factoring in the unique challenges of small businesses owned by people of color. As a result, federal Paycheck Protection Program loans to businesses in areas with a higher percentage of minority residents came in later and in lesser amounts per employee.
That’s not new either. Decades of public and private initiatives meant to boost minority-owned businesses have fallen short. Since the 1980s, race-based contracting preferences have been weakened by federal court rulings. Now, the pandemic’s fallout threatens to arrest the nascent progress of a generation of Black entrepreneurs. That would only widen the yawning gap between wealth held by white people and that held by African Americans, which had barely begun to narrow after the last recession in 2009.
Wilder, 50, stands an imposing 6 feet tall, and shows up for a factory tour wearing maroon slacks, loafers, and big blocky glasses. She’s lived through all of those systemic disadvantages that show up in statistics. But she doesn't want to end up like the averages. She just wants a fair shake.
“Whenever something’s been amputated, you need a recovery period,” Wilder said. “It’s sort of like, when you get behind on something, if there's nothing to help you recover, nothing really helps.”
Danette Wilder grew up in inner-city Detroit, where her father, with only a few years of formal schooling, had moved to work in a Chrysler plant. She went to Detroit’s Central High School, which at the time had one of the worst graduation rates in the nation.
But Wilder did well in school, and enrolled at Old Dominion University, in Norfolk, Virginia, where her half-sister Gwendolyn Wilder lived. When their brother was murdered in Detroit, the two sisters took over caring for his two infant children. Danette Wilder worked multiple research and development jobs while finishing her degree, then landed an engineering job at Corning Inc., the venerable materials company now famous for making glass iPhone screens. Gwendolyn Wilder, too, got a Corning job, as an executive assistant.
Corning, located in largely white upstate New York, was making a diversity push. But Danette Wilder said she soon learned that she’d been hired at a much lower salary than the other engineering recruits; when she raised the disparity with her bosses, she said, she got nowhere.
Instead, Wilder tried a workaround, getting a side job for a few hours a week at a Toys R Us in Corning, which she knew company employees and executives would frequent. The extra income helped, but she also believes her second job led higher-ups to double her pay. “It caused such an uproar, because people were like, ‘She works for Corning?’” Wilder recalled.
Wilder reasoned that working within the system might be more effective than loudly decrying injustice. “Sometimes it’s not all about starting a riot,” she said. “It’s about strategically understanding their rules, and learning how to utilize them to get what you need.” (A spokesperson for Corning declined to comment on the incident but said that the company has “consistently operated at parity for minority and majority pay equity for many years.”)
Next, Wilder joined Toyota Motor Manufacturing in Georgetown, Kentucky, which paid even better. But the work wasn’t as professionally stimulating as at Corning, so Wilder started doing some information technology consulting on the side, and in 2005 she quit Toyota to go out on her own. One consulting client was Les Burd, who in 1989 had started a rubber company called ElastoSeal. Burd hired Wilder as ElastoSeal’s chief operating officer, and credits her with improving all manner of business functions. A few years later, when Burd was looking for a succession plan, they arranged for Wilder to buy a stake in the company.
The transfer, however, hit a snag when other people involved in the transaction objected. That brought Wilder to a familiar point for many people of color: Seeing no other plausible explanation for a setback, and wondering whether discrimination could be at play. “You see I’m educated. I’ve proven I know how to make you money. And you’re still struggling?” Wilder said. “It’s hard to prove in a court of law, but it really is that legitimate.”
Burd said he understands prejudice exists, but doubts that it thwarted his deal with Wilder (who emphasized her respect for him). “It’s just different hurdles to jump through, and we didn’t make a conscientious enough effort to get it done,” he said.
While the deal languished, Wilder started SealingLife, focusing on niche, high-value, low-volume products, many of which needed to be custom-designed to fit specific machines. ElastoSeal eventually leased part of its facility to Wilder and allowed her to run most of its operations. Wilder figures the long incubation period within an established business may have helped her gain a foothold in Kentucky’s decidedly white male manufacturing industry. (According to the Census Bureau, in 2012, 6,269 out of 7,032 manufacturing firms in Kentucky were white-owned, while 122 were owned by Black people.)
“We gained a lot of business under that camouflage, because it was white-owned,” Wilder said of assuming ElastoSeal’s operations. Gwendolyn Wilder, who now helps run SealingLife, recalled both of them being blatantly slighted in meetings with other businesses and lenders. “It’s not like it’s hidden. It’s in your face,” she said.
Danette Wilder’s small staff includes her brother Delonzo Wilder, who helps with SealingLife’s trucking division, and childhood friend Jasmine Heflin, who works in the production room. As orders dropped off during the pandemic, Wilder tried to avoid layoffs by reducing hours, which was easier because some employees left of their own accord to care for children whose schools had closed.
Inside the company’s supply warehouse, a high-ceilinged room with racks that hold spools of rubber and plastics, a curtained-off section hides much of the advanced work that may be key to SealingLife’s future. Sitting atop a giant tabletop machine used to cut large sheets of material, Wilder huddled with a young process engineer named Sarah Honchul, who showed her a tiny, orange, hole-filled rubber rectangle that she had developed for an equine medical device. (Kentucky is horse country, after all.) Honchul is also working on a gasket seal for a company that manufactures laboratory experiment systems for the International Space Station.
“That has to pass tests at NASA,” Wilder said with a hint of pride.
SealingLife is AS9100- and ISO 9001-certified, which allows it to do aerospace business. The certifications are neither easy nor cheap to get, but they are supposed to pay off by getting big companies to trust a business to deliver quality on high-risk products. SealingLife will do lower-tech jobs too; one of its more consistent gigs is making football thigh pads with custom-designed decorative imprints.
Still, everything is harder for companies without strong networks and vast capital reserves. Wilder doesn’t have the cash flow to afford high salaries, so she hires workers right out of college and trains them. She can’t afford new equipment for extruding and grinding rubber, so she buys ancient machines at auctions and refurbishes them. The colorful masses of steel sit like dinosaurs around the warehouse, in various states of operability. “The newest thing in here is probably the fridge,” said Jennifer Cady, Wilder’s quality representative.
When the machines break, which they often do, Wilder repairs them herself, sapping time from hunting new business. She could seek a loan to expand more quickly, but Black-owned firms have historically had a tougher time with lenders. According to a 2016 Federal Reserve survey, the share of Black entrepreneurs applying for loans was 10 percentage points higher than that of white entrepreneurs — but were almost twice as likely to have their applications rejected.
Burd, who is white, said he never had trouble getting loans for ElastoSeal. Wilder’s experience was different: Her own bank turned her down for a loan multiple times, and she finally found a small local bank to extend credit. Of course, it’s easier to guarantee loans with high-dollar, long-term contracts in place. And those kinds of contracts are difficult to win without equipment that produces quick turnarounds.
For example, cutting rubber for O-rings takes longer than it would if SealingLife had the capital to purchase more modern equipment. The company’s hand presses are difficult for less-skilled workers to operate, making it harder to ensure high-quality product. “We would love to get automated presses, because that makes it so we can standardize the process more, we’d have more consistent pieces coming out,” Cady said.
To help her employees develop some of those skills, Wilder sent them to train with Darryl Hawkins, who runs a small rubber compounding company in Wichita Falls, Texas. Compounding involves mixing various chemicals used in rubber production, such as carbon black, which can coat clothes and skin so thoroughly that it still seeps onto sheets after workers have taken a shower. Hawkins and Wilder met at a conference; as far as they can tell, theirs are among a small handful of Black-owned rubber companies in the U.S.
Hawkins followed a path similar to Wilder’s, but two decades earlier. He served as a chemist for tire manufacturing companies before striking out on his own in 1985. Trying to get loans, he said, he was often passed over. Instead, he slowly expanded his company. He primarily served the oil industry, which was struggling with sagging prices before the pandemic, and saw them fall off a cliff when energy demand collapsed. He would sell his business, but there aren’t many interested buyers.
“Unfortunately, it’s like trying to reach up like a drowning man right now,” said Hawkins, who has a fuzzy beard and walks with a cane. “You’d grab for almost anything.”
Wilder hoped that her orders for rubber would keep his business alive, but hasn’t had enough to pass along. She still dreams of buying Hawkins out, but the pandemic put a hitch in those aspirations. Now, she worries about becoming what he is: a small business owner without a cushion that could be wiped out if conditions worsen.
“Where is his retirement?” Wilder asked, rhetorically. “I get emotional about this now. Because there are still people out here who have a sense of integrity, want to give back and do well and serve their customers the old-fashioned way. A lot of minority companies, that’s what they want to do.”
And despite all the progress America is supposed to have made on racial equity, nothing seems to be getting easier.
“I see it happening to me,” Wilder said.
Policymakers have tried for years to mitigate the structural disadvantages facing minority-owned businesses, but those efforts have been scaled back over the years, rather than strengthened.
Take contracting preferences. After passage of a 1977 law, federal, state and local governments set firm targets for the percentage of their procurement dollars that should go to minority-owned businesses. White business owners challenged them almost immediately in court. In 1989, the U.S. Supreme Court overruled a set-aside program in Richmond, Virginia, but left the door open if the public entity conducted a study and found that minority-owned firms were disadvantaged in the area. In 1997,even that bit of flexibility disappeared, when the high court found that Philadelphia’s set-aside program was unconstitutional. Over the years, cities and states weakened their minority contracting requirements to the point where they often have little effect.
In Lexington, for example, the city government aims to award 10% of its contracting dollars to disadvantaged businesses. But that category includes women- and veteran-owned businesses, which scooped up the overwhelming majority of those opportunities in 2019 and 2020,according to the Lexington Herald-Leader. Less than 1% of the dollar value of the city’s disadvantaged-business contracts went to Black-owned businesses.
Wilder’s experience with city government contracting has been difficult. In 2014, she decided to repurpose trucks that she’d purchased for rubber business and turn them instead into a waste-hauling division. As the business grew, she signed on as a minority-owned subcontractor to a white-owned company called Waste Services of the Bluegrass, which was vying for Lexington’s 5-year, $17 million trash contract. She thinks her participation in the bid helped Waste Services ultimately win. But as the number of vehicles needed to fulfill the contract grew beyond Waste Services’ plans, she contends, her equipment was damaged and the business went to another supplier. She's now suing in Fayette County Circuit Court for breach of contract, having lost thousands of dollars on the debacle. Waste Services did not respond to a request for comment.
“Welcome to Kentucky,” Wilder said wryly.
On the state level, Kentucky maintains a directory of women- and minority-owned businesses, but does not require their participation in government procurement.
Federal programs have also been under attack. For example, in 1998, U.S. Sen. Mitch McConnell tried to amend a transportation funding bill to strip out race-based preferences. “Every time the government hands out a highway contract to one person based on race or gender, it discriminates against another person based on race or gender,” McConnell saidduring floor debate. The Department of Transportation’s disadvantaged business contracting program survived, but the Clinton administration had already tightened eligibility requirements, making it harder to qualify.
What’s left is the Small Business Administration’s 8(a) program, which gives a competitive edge for federal contracts to small firms that are owned by veterans, minorities, or women. But with onerous certification requirements and no guaranteed returns, the number of enrolled businesses sank in the early 2010s. Participation rose again over the past few years as the application process was streamlined. In 2018, the agency’s inspector general criticized the changes for giving benefits to firms that weren’t truly disadvantaged. (Hawkins’ business got certified — at a cost of about $10,000 — but he said he never saw much new business as a result. Wilder is in the process of applying, saying she thinks she’s built the connections necessary to actually win contracts.)
The federal government also tries to help minority-owned businesses in other ways. The Minority Business Development Agency, established by presidential decree in 1969, has limped along with a budget of about $45 million a year, running a network of business assistance centers and commissioning occasional research reports.
President Donald Trump proposed eliminating the MBDA, but Congress did not oblige. So to run the office, Trump appointed a 2016 campaign volunteer who, before he took a job in Trump’s Department of Commerce, had no business development experience: Henry Childs II, a Texas lawyer.
Childs said he tried to get the MBDA enshrined in statute, and despite his initial allegiance to Trump, spoke up when he saw potential problems with White House initiatives like PPP that gave an edge to businesses with strong banking relationships. “I don’t know if they thought the PPP was going to be the answer, but it wasn’t,” said Childs, who went on to launch a private equity fund for minority-owned businesses. “I don’t think they understand the difference between Wall Street and Main Street.”
Efforts to help minority-owned businesses also exist in the private sector. Over the years, many large companies have developed “supplier diversity” programs to include entrepreneurs of color. But they often have little transparency and weak standards, according tosurveys.
With heightened attention to racial injustice following the George Floyd police killing, many large corporations pledged to amp up supplier diversity and lending initiatives. Coca-Cola, for example, pledged to increase its purchases from Black-owned suppliers by $500 million over the next five years, while Netflix deposited $100 million into Black-owned banks. But Adrienne Trimble, who ran the National Minority Supplier Development Council until Mar. 1, when she took a job as chief diversity officer at Sysco, worries that corporate attention could fade.
“We don’t want this to just be a moment in time,” Trimble said. “We expect this to be a movement, and holding those companies accountable to ensuring they have diversity in their supply chains.”
Accountability is an elusive thing. Outside of government contracting, no law requires private businesses to contract with minority-owned firms, or to disclose how much they do. As Wilder has experienced, a diversity initiative can peter out quickly. “Like a lot of things to help women and minorities, there’s a big push for a while, and then it wanes off,” Wilder said, remembering her time at Corning.
Parker Hannifin, the Cleveland-based conglomerate, was SealingLife’s biggest O-ring customer until it cut back its orders almost to zero in early 2020. Wilder said the company gave her no explanation.
A spokesperson for Parker Hannifin, Aidan Gormley, said that orders were dropped after it merged several business units and began to manufacture O-rings in-house. “The change was a business decision and in no way reflected the quality of products or services provided by the supplier,” Gormley said.
Parker Hannifin said it has a diverse supplier base, but it declined to disclose any numbers, which makes Wilder skeptical about how much effort they’re putting into it. The company controls so much of the market for seals that, without it, Wilder has a more limited range of potential customers. Wilder even won a regional supplier of the year award from the NMSDC, which she hoped would jump-start new business opportunities. But pitching big companies is frustrating, even when they have supplier diversity programs.
“A lot of times the wrong people are sitting at that table, and they don’t have the knowledge to know what we’re talking about, and they don’t know where to put us,” Wilder said. “So we get caught in this nested loop, which becomes very frustrating, if 99 out of 100 times that’s what happens.”
Wilder is grateful for the nearly $500,000 she got from the SBA’s Economic Injury Disaster Loan and PPP programs, which she applied for early (although her second-draw PPP loan hasn’t come through yet, leaving her more dependent on the non-forgivable EIDL). But it’s merely left her treading water, while she works to diversify into operations consulting and team up with other small companies to go after bigger contracts.
What more could public policy do? Along with strengthening government contracting requirements for small businesses, Wilder suggests, one big step would be more heavily incentivizing and monitoring private-sector supplier diversity programs. If the federal government pushed companies like Parker Hannifin to buy goods and services from small and minority-owned firms, she thinks, the resulting leg up would allow companies like hers to grow and be more competitive.
Advocates and academics have proposed plenty of other ways to bolster Black entrepreneurs. One would be for the federal government to pump tens of billions of dollars into community development financial institutions, which explicitly focus on lending in underserved communities. (Congress got a start on this in December, allocating $12 billion to CDFIs.) Another would be re-invigorating the MBDA to fund more universal, easier-to-access technical assistance programs and to make infrastructure grants that support Black communities, like renovating and redistributing vacant properties. (Connor Maxwell, the Center for American Progress analyst who co-wrote the MBDA proposal, now works at Biden’s National Economic Council, but so far the administration’s racial equity agenda has not specifically focused on minority-owned businesses.)
One side benefit of supporting minority-owned businesses is that they tend to employ more people of color, which could also help close racial gaps in unemployment. And that’s true of Wilder. She’s always seen her business as a way to lift up those around her. Long-term, she doesn’t want SealingLife to be just a family business. She wants it to be something bigger.
“This industry has been run by a lot of white companies that do this and they pass it down to their kids, and it’s like a glass ceiling, and breaking into it is impossible,” Wilder said. And then, only half-joking: “The government needs to have a stimulus package for mental health counseling for what we go through, the constant letdowns. We need some rehab.”
The head of Alaska’s leading tribal health organization has stepped down after a former assistant accused him of "forcing and requiring sex" to keep her job. He denies wrongdoing and says their relationship was consensual.
This article was published on Tuesday, March 2, 2021 in ProPublica.
A week ago, one of Alaska’s most powerful executives abruptly resigned from his job leading the largest tribal health organization in the state. Neither the outgoing president nor the group said why.
Earlier in the day, his former assistant had delivered a scathing three-page letter to the Alaska Native Tribal Health Consortium that described a pattern of abusive behavior, harassment and coerced sexual encounters by President Andy Teuber, according to the document, obtained by the Anchorage Daily News and ProPublica.
The woman, Savanah Evans, who is 27, delivered her own resignation letter on Feb. 23, describing workplace abuse, harassment and intimidation at the hands of Teuber, who is 52.
“Andy unrelentingly coerced, forced, and required sex of me,” Evans wrote in her letter. In a phone interview Monday, she told the Anchorage Daily News and ProPublica that much of the abuse took place in ANTHC offices, and that it derailed her personal and professional life.
Evans gave her permission to be named in this article, saying she wants to end a cycle of abuse.
“If I don’t speak up,” she wrote in her resignation letter, “I will be no less guilty than those who have done nothing but swept it under the rug.”
Teuber’s departure follows the recent resignations of two consecutive Alaska attorneys general, Kevin Clarkson and Ed Sniffen, and of Anchorage Mayor Ethan Berkowitz, all following allegations of inappropriate interactions with women. Clarkson apologized for sending hundreds of text messages to a junior state employee, including some inviting her to his home. Sniffen has not responded to requests for comment about allegations that three decades ago he had sex with an underage high school student when he was her mock trial coach. Berkowitz acknowledged “unacceptable personal conduct” after a TV news reporter disclosed that he had sent her nude selfies.
In an email Monday, Teuber denied the allegations, saying he had a “completely consensual personal relationship.” In a separate email, Teuber said that Evans often initiated the sexual encounters between them. Evans, in turn, says that Teuber is the one who insisted their sexual relationship continue even after she wanted it to stop.
Teuber wrote that he couldn’t respond to some specific allegations about ANTHC, its employees or its practices because of strict confidentiality provisions he agreed to as part of his former position.
“I have never, and would never, engage in a non-consensual or ‘quid pro quo’ personal relationship with anyone,” he wrote. “The allegations of wrongdoing that I have been made aware of are false, and these allegations and their timing appear designed to portray me unjustly and falsely; to damage my personal and family relationships; but especially to sabotage my recent engagement and new marriage; and to undermine my professional prospects.”
Evans and her attorney, Jana Weltzin, said they were not aware that Teuber was engaged or had gotten married.
ANTHC spokesperson Shirley Young said Monday that the tribal health organization is conducting an “independent outside” investigation, but that the organization could not comment on specific allegations, citing personnel confidentiality rules.
Alaska law does not prohibit sexual relationships between supervisors and subordinates, and ANTHC’s policies do not explicitly prohibit them either. The organization’s policy on personal relationships in the workplace requires supervisors to disclose any sexual relationship with “an individual within their chain of command or area of influence” to the human resources department. It also requires employees who are in a relationship to behave professionally “during work hours and within the working environment.”
Teuber was not Evans’ direct supervisor even though she was his direct assistant, Weltzin said. Young said she could not comment on whether Teuber disclosed any kind of relationship with Evans, as would be required by the rule, citing personnel confidentiality rules.
Rebecca G. Pontikes, a Boston attorney who specializes in representing workers in gender-based employment discrimination and sexual harassment cases, said some companies go further and ban sexual relationships between supervisors and subordinates. Such relationships, if they aren't consensual, would amount to sexual harassment, which is illegal in the workplace under federal employment law prohibiting discrimination on the basis of sex, she said.
Teuber wrote that he would participate in the investigation and planned to offer “evidence refuting the allegations of wrongdoing made against me.” Evans said she possesses a “massive” number of text messages and one or more recordings that substantiate her claims. Teuber said he would forward video files and a “volume of exchanges” to the news organizations, but he had not done so as of Tuesday afternoon. Evans and her attorney declined to provide a copy of an audio recording that had been provided to board members, and did not respond to requests to see the text messages.
For more than a decade, Teuber was the president of the Alaska Native Tribal Health Consortium and one of the most powerful executives in Alaska.
ANTHC is “the largest, most comprehensive Tribal health organization in the United States,” according to its website, and it has a far-reaching impact in Alaska: The organization co-owns and manages the Alaska Native Medical Center, a major trauma hospital in Anchorage, as well as providing health services to more than 170,000 Alaska Native people and communities across the state.
The organization has more than 3,000 employees, making it one of the largest health employers in Alaska.
Teuber was paid a salary of more than $1 million per year to oversee ANTHC, at the same time serving as chief executive of the Kodiak Area Native Association, a regional tribal health provider. He served on other powerful boards, including the Alaska Federation of Natives, and he was a member of the University of Alaska Board of Regents. He resigned both of those roles last week as well.
Alaska has the highest rate of sexual assault in the United States, particularly among Alaska Native women.
A Sexual Relationship
Soon after she started work as Teuber’s special assistant in October 2019, Evans said she received a request for an “inappropriate photo” while on a work trip to Kodiak with Teuber, which she refused to provide. Their sexual relationship began the same month, according to the resignation letter. Within a month or two, Evans said she told Teuber she did not want to continue having sex with him, she said in an interview.
Teuber denied the allegation.
“After she made her interest plainly known, we did engage in intimate relations, which were always willing, voluntary and consensual, and often initiated by Ms. Evans,” Teuber wrote in an email.
The two continued to have sex. Evans said she was required to bring paperwork to Teuber’s home office.
“[On] my first trip to deliver papers for his signature, he pushed me into the downstairs front bedroom for sex and told me that, ‘You always listen better after I fuck you,’” she wrote to the board members.
“You may wonder if this relationship was consensual,” she wrote. “It is not, if the person controls your employment.”
In one instance, Evans wrote that “[Teuber] wouldn’t get off of me to let me leave.”
“Later he texted me, simply saying ‘I’m sorry; that wasn’t cool.’”
Teuber denied that any sexual encounter between the two was not consensual.
Another time, Teuber and the woman had a sexual encounter inside the ANTHC boardroom executive suite, she wrote.
Teuber denies this happened.
“This is another degrading, dehumanizing example of the requirement to keep my job,” she wrote. “Any time I tried to ignore his calls or texts during my personal non-work private time, he would swear at me, demand responses, and threaten me by referring to my job and stating that I have it because of him.”
Teuber responded: “I did at times express myself strongly to Ms. Evans, but all such expressions were job performance related.”
Teuber said in an email that he resigned “a few minutes” after he learned of the allegations against him. He did not answer questions about why he resigned.
“I am a single mother of a 4-year-old daughter. I am an Athabascan from the Koyukon Region,” Evans wrote to the 15-member ANTHC board. She said she appreciated the opportunity to work for the organization and acknowledged that her complaint about Teuber’s behavior would normally be sent to a human resources department, not the board of directors.
In her resignation letter, Evans said that ANTHC has tolerated and enabled similar abuse in the past.
Teuber wrote that he was not aware of any prior allegations against him.
ANTHC did not respond to questions about any past reports of abuse. In a written statement Monday, incoming chairperson Bernice Kaigelak said the organization “will not tolerate harassment of any kind.”
“As the new chair, I am committed to a harassment-free workplace,” Kaigelak said. “This is particularly important given the rate of sexual harassment or abuse of Alaska Native women. All complaints of harassment will be investigated, and prompt action will be taken when issues are identified, regardless about whom they are directed.”
People eligible for the coronavirus vaccine tell us they are running up against barriers that are designed into the very systems meant to serve those most at risk of dying of the disease. We plan to continue tracking these roadblocks.
This article was published on Monday, March 1, 2021 in ProPublica.
It's a fact that simply being eligible for a vaccine in America doesn't mean that you can instantly get one. Yet the ability to get to the front of the line isn't the same for everyone. ProPublica has found that, whether intentionally or not, some vaccine programs have been designed with inherent barriers that disadvantage many people who are most at risk of dying from the disease, exacerbating inequities in access to healthcare.
In many regions of the U.S., it's much more difficult to schedule a vaccine appointment if you do not have access to the internet. In some areas, drive-through vaccinations are the only option, excluding those who do not have cars or someone who can give them a ride. In other places, people who do not speak English are having trouble getting information from government hotlines and websites. One state is even flat-out refusing to allow undocumented workers with high-risk jobs to get prioritized for vaccination.
The vaccine supply is too low to inoculate everyone who is eligible, and competition for appointments is fierce.
"My nightmare scenario is that we have this two-tiered health system where there are people who are wealthy, privileged or connected, and then there's everybody else," Dr. Jonathan Jackson, director of the Community Access, Recruitment, and Engagement Research Center at Massachusetts General Hospital and Harvard Medical School, told ProPublica. "Once we hit that saturation point where the first tier has all gotten their vaccines, the narrative will shift to blame. It'll be 'Why haven't you taken care of this yet?'"
For People With Disabilities, It Can Be a Struggle Just to Access Their Appointments
From the moment her 69-year-old father, Jose Balboa, became eligible for the vaccine in January, Kristine Mathason spent part of each day on the phone and online trying to get him a shot. She found available appointments a few times, but couldn't find a way to actually take her father to the vaccination sites. Balboa is paralyzed on his left side after a stroke and needs a wheelchair to get around. In Miami, where he lives, most vaccine sites are drive-up only.
Mathason doesn't have a van that can accommodate Balboa's wheelchair, and she isn't able to lift her father out of it. To move him between his bed and the chair, his home health aides use a patient lift. This isn't possible when trying to get him into a car, Mathason said, as the door gets in the way of either a lifting device or two people trying to support him at once. In the past when family members tried to move him, Balboa fell.
Mathason said she was "willing to jump through all the hoops" to get Balboa the vaccine. "He's super high-risk: He's diabetic, he had a stroke 17 years ago," she said. "He has high blood pressure. My half brother who lives with him works at a restaurant, so that's like a high-risk job. We do our best."
Mathason checked out every other avenue she can think of, but each was a dead end. She looked into renting a van, but she's been out of work because of the pandemic and couldn't afford it. She thought about Uber, but wheelchair access and the cost of waiting in a drive-through were prohibitive. "He's just one of those people who unfortunately is falling through the cracks," she said.
A county service offers scheduled rides for seniors, but it only provides drop-off services and wouldn't take Balboa through a drive-through. There was an additional Catch-22: The scheduled rides require 24 hours' notice for pickup, but the local hospital that offers walk-up appointments schedules them less than 24 hours in advance. The health department in Miami-Dade County directed questions to the Florida state health department, which did not respond to requests for comment.
According to data from the Centers for Disease Control and Prevention, about 14% of adults in Florida have disabilities that affect mobility, which the CDC defines as serious difficulty walking or climbing stairs. While some people with mobility limitations may be able to access a car more easily than Balboa, he and his family were left with very few options.
"I just wish they had thought about people like my dad," Mathason said. "What about the people who don't have a me who's trying to move heaven and earth to get him an appointment? What about the people who just don't have a car and can't get anywhere?"
After more than a month of searching, Balboa got a call from the medical center he goes to for doctor visits. The center had gotten a supply of doses, and they picked him up and took him to the site in one of their wheelchair-accessible vans. On February 24th, he got his first shot.
If You Can't Access or Navigate the Internet, You Might Have Fewer Options
Eneyda Morales, a 40-year-old mother of three in East Hampton, New York, was diagnosed with breast cancer two years ago and is still undergoing treatment. Four days a week, she works at a bagel shop near her home. "I'd like to get a vaccine because of the health issues I have and because I work in a place where I have to serve people," Morales said in Spanish. But she's not sure how she's actually going to get a vaccine; while many Americans are hunting for information online, Morales doesn't own a computer, nor does she know how to use one. She has a smartphone, but she primarily uses it for simple searches like looking up addresses. The only computer at her home is the one her 8-year-old daughter's school provided for classwork.
New York state has a vaccination hotline for scheduling appointments by phone, but only for vaccines administered at state-run sites. The state site closest to Morales is about 60 miles away, an hour and a half by car. If Morales wants to get an appointment closer to home, she'll need to contact local hospitals and pharmacies directly. The state hotline's automated message tells callers that the quickest way to get information about eligibility and appointment scheduling is online.
Morales plans to seek help from OLA of Eastern Long Island, a local nonprofit, to schedule an appointment closer to home on one of her days off. Without their help, she said, she wouldn't know where to begin searching.
Some states that have tried to provide offline options for booking vaccine appointments have stumbled. A phone line set up in Maryland was inundated with callers, who complained of being put on hold and then hung up on. In Tennessee, Shelby County's decision to allow internet users to sign up first meant all the slots were snapped up by those with web access before phone appointments even opened.
About 10% of U.S. adults don't use the internet, according to the Pew Research Center. Americans who are older, have less income, have less education or are nonwhite are less likely to go online, researchers found.
People Who Don't Speak English May Have Trouble Getting Information
Gladys Godinez, the daughter of retired meatpacking workers, is an organizer for Solidarity with Packing Plant Workers who lives in Lexington, Nebraska. Her parents, like many of the immigrant workers she represents, are not fluent in English. Nebraska's Spanish-language vaccine website offers a hotline to schedule appointments by phone. Godinez wanted to see what people in her parents' situation were up against if they didn't have a tech-savvy English speaker to help, so she called the number on Feb. 2. She said it took 15 minutes for someone to pick up the phone; that person answered in English.
Godinez said she was told that no one who could speak Spanish was available. She tried to insist: "I said, 'Please, I would really like to be able to register for the vaccine.' I said it in Spanish. She said, 'We don't have anybody that can talk to you in Spanish.' So I just said 'gracias' and hung up."
Nebraska's Department of Health and Human Services said that since Feb. 13, 25% of each hotline shift is staffed by fluent Spanish speakers, but each call center agent can connect with interpretation services as needed. A spokesperson for the department did not comment on Godinez's experience.
Language isn't the only potential barrier facing immigrant workers in Nebraska. In January, Gov. Pete Ricketts was asked if undocumented immigrants in meatpacking facilities would be included in the state's upcoming vaccination push. His response was discouraging: "You're supposed to be a legal resident of the country to be able to be working in those plants. So I do not expect that illegal immigrants will be part of the vaccine with that program."
Godinez said the governor's words did a lot of damage even for people who are legal residents. "That scared a lot of individuals," she said. "Just Spanish-speaking individuals living their life, they have legal status, they're already scared of being profiled. Now here is your governor saying, 'Sorry, not sorry, undocumented workers are not going to get the vaccine.'"
Later that day, the governor's communications director tweeted that "while the federal government is expected to eventually make the vaccine available for everyone in the country, Nebraska is going to prioritize citizens and legal residents ahead of illegal immigrants." Nebraska's Department of Health and Human Services told ProPublica that proof of citizenship is not a requirement to receive the vaccine.
The federal government, even under the Trump administration, has encouraged undocumented immigrants to get vaccinated. According to a report by the Kaiser Family Foundation about immigrant vaccine access, Arizona has specifically prioritized undocumented immigrants, while Virginia and New Jersey have prioritized migrant workers. Several states, including Utah, have emphasized that undocumented immigrants are eligible for the vaccine and their personal information will not be shared with authorities. Oregon and Washington have discussed doing outreach to immigrant communities to make sure they have the right information.
Healthcare workers and advocates are also trying to make access to COVID-19 vaccines more realistic for undocumented residents. In Baltimore, local nonprofit CASA de Maryland is hiring people to knock on doors to share vaccine information and pushing for its Baltimore office, located in a COVID-19 hot spot, to become a vaccination site.
Vaccine Sites That Are Drive-Through Exclude People Without Cars
Los Angeles's Chinatown is about a mile from Dodger Stadium, one of the largest vaccination sites in the country. Despite the short distance, many of the neighborhood's seniors have no way to get vaccinated at the stadium; the site is drive-up only, and many of them have no cars. Sissy Trinh, executive director of the Southeast Asian Community Alliance, which has been providing aid to families in Chinatown and nearby Lincoln Heights during the pandemic, said community members face various hurdles that local government and testing sites haven't accounted for.
Along with lacking access to cars, many of the seniors served by SEACA primarily speak Chinese dialects, Vietnamese, Khmer or Spanish and aren't internet users. Trinh and her colleagues have been scrambling to figure out how to get these seniors vaccinated. They considered hiring Ubers or Lyfts, but the cost of paying drivers to wait in line would be too high for the small nonprofit. SEACA also can't bus the seniors together to a vaccination site for fear of exposing them to potential infection.
In late February, Los Angeles Mayor Eric Garcetti announced that the city would send a mobile vaccination clinic to Chinatown and a few other neighborhoods prioritized for their medically vulnerable residents. The city reserved 800 doses for Chinatown. SEACA helped get them to residents, scheduling appointments from its waiting list of 2,500 people, translating documents for them and recruiting volunteers who are fluent in Cantonese, Taishanese, Teochew or Vietnamese.
Trinh said she's excited that some doses are finally reaching seniors in the neighborhood, but she wishes officials had started planning for this when the pandemic started. "I know a lot of people were rushing to figure out how to get PPE to people and updating stay-at-home orders," she said. "But there should have been a dedicated team to figure out the vaccine rollout." Los Angeles officials said they hope to open additional mobile clinic sites by the end of March.
In Pima County, Arizona, health officials are also using mobile clinics to bring vaccines to high-risk residents. Baltimore and Fort Worth, Texas, are among other places attempting to overcome transportation barriers by using mobile sites.
Unclear Communication Leaves People Anxious and Unable to Plan
James, 82, lives in Chesterfield County, Virginia, outside of Richmond. (He asked to be identified only by his first name for privacy reasons.) Like many Americans, he turned first to his primary care physician for information about the vaccine. "I contacted my physician's office to find out if they'd let me, as a patient, know when I'd get the vaccine, and they said, 'Oh, no, no, we're not going to do that.'" They instead directed him to the Virginia Department of Health. So James went on the state health department's website. "I filled in all their little boxes, and that was it — I never heard a word," he said. "I had no idea whether I'm registered or not." He also tried registering on his county health department's website, and had the same experience. "You don't know whether you're talking to a computer or to a garbage can," he said. "When you're filling it in, where does the form go? I'm concerned that when I finally get to go to the vaccine site, someone's going to say I'm not registered."
James contrasted the experience to online shopping: "When you go buy something off the web, you get an immediate response from the vendor saying, 'Thank you for your purchase.' Why can't they do that? Say thank you for your registration?"
Virginia's initial vaccine registration system indeed provided no email confirmation, but the new system, implemented on Feb. 16, now provides "an immediate acknowledgement on the screen" as well as an email or text message, according to health department spokesperson Melissa Gordon. She added that "it is not practical to give an exact place 'in line' or estimated appointment time frame, because clinics are put together based on capacity, eligibility and equity drivers that change over time." The only thing the email confirmation can do, she said, is to "notify the recipient that their information had been transferred to the new statewide system and no other action was needed." Residents who signed up under the old system, including James, eventually got an email to acknowledge their registration, albeit weeks after they filled in the form. Gordon added, "Unfortunately, it may be several weeks or months before everyone can get an appointment."
Confusion over "When's it going to be my turn?" has only increased as states start to expand access to people with underlying health conditions, with criteria that can be hard to interpret. Some Massachusetts residents with asthma, for example, are at a loss as to whether they qualify, WBUR recently reported. Massachusetts has "moderate to severe" asthma on its list of eligible medical conditions, but what counts as "moderate" asthma is ambiguous.
James has been waiting for the vaccine so he can safely visit his children and four grandchildren, who range in age from 11 to 28. In the absence of information from his local health department, he's been relying on the news to glean details about the rollout. He said he read about one couple who drove nearly five hours each way from the Richmond area to Abingdon to get a vaccine. James thinks it's not worth going that far, especially since that could involve an overnight stay somewhere. "I'll just sit around and wait and mind my p's and q's," he said.
The experience so far has made him "lose faith in the whole process," he said. "The president can get on TV and say he's purchased 600 million, 600 billion of these things, and I say, 'Fine, but where is this stuff? Tell me, when is it going to be on my street?'"
President Biden has promised enough doses for all American adults by this summer. There's not much even the Defense Production Act can do to deliver doses before then.
This article was published on Friday, February 19, 2021 in ProPublica.
President Joe Biden has ordered enough vaccines to immunize every American against COVID-19, and his administration says it's using the full force of the federal government to get the doses by July. There's a reason he can't promise them sooner.
Vaccine supply chains are extremely specialized and sensitive, relying on expensive machinery, highly trained staff and finicky ingredients. Manufacturers have run into intermittent shortages of key materials, according to the U.S. Government Accountability Office; the combination of surging demand and workforce disruptions from the pandemic has caused delays of four to 12 weeks for items that used to ship within a week, much like what happened when consumers were sent scrambling for household staples like flour, chicken wings and toilet paper.
People often question why the administration can't use the mighty Defense Production Act — which empowers the government to demand critical supplies before anyone else — to turbocharge production. But that law has its limits. Each time a manufacturer adds new equipment or a new raw materials supplier, they are required to run extensive tests to ensure the hardware or ingredients consistently work as intended, then submit data to the Food and Drug Administration. Adding capacity "doesn't happen in a blink of an eye," said Jennifer Pancorbo, director of industry programs and research at North Carolina State University's Biomanufacturing Training and Education Center. "It takes a good chunk of weeks."
And adding supplies at any one point only helps if production can be expanded up and down the entire chain. "Thousands of components may be needed," said Gerald W. Parker, director of the Pandemic and Biosecurity Policy Program at Texas A&M University's Scowcroft Institute for International Affairs and a former senior official in the Department of Health and Human Services office for preparedness and response. "You can't just turn on the Defense Production Act and make it happen."
The U.S. doesn't have spare facilities waiting around to manufacture vaccines, or other kinds of factories that could be converted the way General Motors began producing ventilators last year. The GAO said the Army Corps of Engineers is helping to expand existing vaccine facilities, but it can't be done overnight.
Building new capacity would take two to three months, at which point the new production lines would still face weeks of testing to ensure they were able to make the vaccine doses correctly before the companies could start delivering more shots.
"It's not like making shoes," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in an interview with ProPublica. "And the reason I use that somewhat tongue-in-cheek analogy is that people say, 'Ah, you know what we should do? We should get the DPA to build another factory in a week and start making mRNA.' Well, by the time a new factory can get geared up to make the mRNA vaccine exactly according to the very, very strict guidelines and requirements of the FDA ... we already will have in our hands the 600 million doses between Moderna and Pfizer that we contracted for. It would almost be too late."
Fauci added that the DPA works best for "facilitating something rather than building something from scratch."
The Trump administration deployed the Defense Production Act last year to give vaccine manufacturers priority in accessing crucial production supplies before anyone else could buy them. And the Biden administration used it to help Pfizer obtain specialized needles that can squeeze a sixth dose from the company's vials, as well as for two critical manufacturing components: filling pumps and tangential flow filtration units. The pumps help supply the lipid nanoparticles that hold and protect the mRNA — the vaccines' active ingredient, so to speak — and also fill vials with finished vaccine. The filtration units remove unneeded solutions and other materials used in the manufacturing process.
These highly precise pieces of equipment are not typically available on demand, said Matthew Johnson, senior director of product management at Duke University's Human Vaccine Institute, who works on developing mRNA vaccines, but not for COVID-19. "Right now, there is so much growth in biopharmaceuticals, plus the pinch of the pandemic," he said. "Many equipment suppliers are sold out of production, and even products scheduled to be made, in some cases, sold out for a year or so looking forward."
In the meantime, the shortage of vaccines is creating widespread frustration and anxiety as eligible people struggle to get appointments and millions of others wonder how long it will be before it is their turn. As of Feb. 17, the U.S. had distributed 72.4 million doses and administered 56.3 million shots, but fewer than 16 million people have received both of the two doses that the Pfizer and Moderna vaccines require for full protection.
The Biden administration has said it is increasing vaccine shipments to states by 20%, to 13.5 million doses a week, and encouraged states to give out all their shots instead of holding on to some for second doses. But now that second-dose appointments are coming due, many jurisdictions are having to focus on those and stepping back from vaccinating uninoculated people. Even as the total number of vaccinations increased last week, the number of first doses fell to 6.8 million people, down from 7.8 million three weeks ago, according to Centers for Disease Control and Prevention data.
At best, it will take until June for manufacturers to deliver enough doses for the roughly 266 million eligible Americans age 16 and over, according to public statements by the companies.
That includes expected deliveries of Johnson & Johnson's one-dose vaccine, which is widely expected to win emergency authorization from the FDA shortly after a public advisory committee meeting on Feb. 26. But Johnson & Johnson has fallen behind in manufacturing. The company told the GAO it will have only 2 million doses ready to go by the time the vaccine is authorized, whereas its $1 billion contract with HHS scheduled 12 million doses by the end of February. It's not clear what held up Johnson & Johnson's production line; the company has benefited from first-priority purchases thanks to the DPA, according to a senior executive close to the manufacturing process. A Johnson & Johnson spokesman declined to comment on the cause of the delay, but said the company still expects to ship 100 million U.S. doses by July.
Vaccine supply won't cover all Americans until late spring, at best
Public statements from vaccine developers Pfizer, Moderna and Johnson & Johnson illustrate how many people could be covered by the available U.S. supply from now until the end of the summer.
Moderna declined to comment on "operational aspects" of its manufacturing, but "does remain confident in our ability to meet contracted quantities" of its vaccine to the U.S. and other nations, a spokesperson said in a statement. Pfizer did not respond to ProPublica's written questions.
Ramping up production is especially challenging for Pfizer and Moderna, whose vaccines use an mRNA technology that's never been mass-produced before. The companies started production even before they finished trials to see if the vaccines worked, another historic first. But it wasn't as if they could instantly crank out millions of vaccines full blast, since they effectively had to invent a novel manufacturing process.
"Putting together plans 12 months ago for a Phase 1 and 2 trial, and making enough to dose a couple hundred patients, was a big deal for the raw material suppliers," said Johnson, the product manager at Duke University's vaccine institute. "It's just going from dosing hundreds of patients a year ago to a billion."
Raw materials for the Pfizer and Moderna vaccines are also in limited supply. The manufacturing process begins by using common gut bacteria cells to grow something called "plasmids" — standalone snippets of DNA — that contain instructions to make the vaccine's genetic material, said Pancorbo, the North Carolina State University biomanufacturing expert.
Next, specific enzymes cultivated from bacteria are added to cause a chemical reaction that assembles the strands of mRNA, Pancorbo said. Those strands are then packaged in lipid nanoparticles, microscopic bubbles of fat made using petroleum or plant oils. The fat bubbles protect the genetic material inside the human body and help deliver it to the cells.
Only a few firms specialize in making these ingredients, which have previously been sold by the kilogram, Pancorbo said. But they're now needed by the metric ton — a thousandfold increase. Moderna and Pfizer need bulk, but also the highest possible quality.
"There are a number of organizations that make these enzymes and these nucleotides and lipids, but they might not make it in a grade that is satisfactory for human consumption," Pancorbo said. "It might be a grade that is satisfactory for animal consumption or research. But for injection into a human? That's a different thing."
Johnson & Johnson's vaccine follows a slightly more traditional method of growing cells in large tanks called bioreactors. This takes time, and the slightest contamination can spoil a whole batch. Since the process deals with living things, it can be more like growing plants than making shoes. "Maximizing yield is as much of an art as it is a science, as the manufacturing process itself is dependent on biological processes," said Parker, the former HHS official.
The vaccine developers are continuing to find tweaks that can expedite production without cutting corners. Pfizer is now delivering six doses in each vial instead of five, and Moderna has asked for permission to fill each of its bottles with 15 doses, up from 10. If regulators approve, it would take two or three months to change over production, Moderna spokesman Ray Jordan said on Feb. 13.
"It helps speed up and lighten the logistical side of getting vaccines out," said Lawrence Ganti, president of SiO2, an Alabama company that makes glass vials for the Moderna vaccine. SiO2 expanded production with $143 million in funding from the federal government last year, and Ganti said there aren't any hiccups at his end of the line.
Despite the possibility of sporadic bottlenecks and delays in the coming months, companies appear to have lined up their supply chains to the point that they're comfortable with their ability to meet current production targets.
Massachusetts-based Snapdragon Chemistry received almost $700,000 from HHS' Biomedical Advanced Research and Development Authority to develop a new way of producing ribonucleoside triphosphates (NTPs), a key raw material for mRNA vaccines. Snapdragon's technology uses a continuous production line, rather than the traditional process of making batches in big vats, so it's easier to scale up by simply keeping production running for a longer time.
Suppliers have told Snapdragon that they have their raw materials covered for now, according to Matthew Bio, the company's president and CEO. "They're saying, 'We have established suppliers to meet the demand we have for this year,'" Bio said.
In early December, Miguel Fernandez lay unconscious in the intensive care unit at a Los Angeles area hospital. A mechanical ventilator pumped oxygen into his lungs, which had been ravaged by COVID-19. The 53-year-old was dying.
The best, and likely only, chance of Miguel surviving was a therapy called extracorporeal membrane oxygenation, better known as ECMO. It would allow his lungs to rest while a machine infused his blood with the oxygen he needed. But PIH Health Whittier Hospital, where he had been admitted, didn't have any ECMO machines or the highly trained staff needed to run them. Only a handful of hospitals in southern California did, and they were overrun with COVID-19 cases.
Since the beginning of the pandemic, public health experts had been warning about the need to "bend the curve" — to prevent the number of COVID-19 cases from spiking so hospitals wouldn't get overwhelmed.
But starting in early November, the daily number of COVID-19 hospitalizations surged in Los Angeles County, rising eightfold between then and the wave's crest, which arrived just after New Year's Day. Within weeks, overflowing hospitals faced exactly the types of care-rationing decisions experts had feared. Hospitals set up tents to increase capacity, and ambulances circled for hours as they waited for beds to open. By early January, Los Angeles County emergency medical personnel were directed to conserve supplemental oxygen by only administering it to the neediest patients, and to stop transporting to hospitals cardiac arrest patients who couldn't be revived in the field. State officials dispatched refrigerated trucks and thousands of body bags to the region.
Inside the hospitals, for patients like Miguel, a dire situation unfolded out of public view. Critically ill patients who might survive with ECMO could not get the treatment. Doctors had to choose who received the therapy based on who they thought had the best chance to survive. Some were approved, but had to be put on a waitlist. Many patients died waiting.
"I don't think we ever thought we'd get to this point, not in California," said Dr. Jack Sun, who oversees the program that includes ECMO at UCI Health in Orange County, 30 miles southeast of Los Angeles. "You know if you don't have a bed for somebody, they are going to die."
In some parts of the country, doctors can tap into centralized systems to quickly find any available bed for ECMO at any hospital in the region. That's not the case in Los Angeles. Miguel's caregivers and family would have to hack through red tape and navigate an opaque, disconnected and sometimes unfair system to try to save his life.
Miguel, the oldest of seven siblings in a family of Mexican immigrants, was always the one who fixed things. If someone needed a job, he would help them find work. If a car broke down, he would repair it. His sister, Margarita Rodriguez, described him as a "big cuddly bear" who gave her hugs and always made her smile. Just before he was hospitalized, he had stopped by to patch a leak in her roof.
Now the family had to find a way to fix Miguel.
They scoured the internet with searches like "What do you do when a ventilator fails?" One night, Margarita found a success story from San Diego about the use of ECMO. An ECMO machine takes over the work of a patient's lungs. It extracts blood from the body and circulates it through an artificial lung that removes carbon dioxide and adds oxygen before returning the blood to the body. One study of patients at 68 U.S. hospitals found that critically ill COVID-19 patients like Miguel "had a considerably lower risk of death" if they received ECMO during their first seven days in an ICU.
Miguel was relatively healthy other than having COVID-19. He didn't smoke or have any preexisting illnesses like diabetes. He was overweight, but below weight cutoffs used by ECMO centers to determine eligibility. Across the country, patients like Miguel who had been near death on a ventilator one day were alive and leaving a hospital weeks later after undergoing ECMO.
Miguel's oldest son, Miguel Jr., knew from his conversations with doctors that his dad wasn't going to get better by staying on the ventilator. "ECMO was his last hope, his best chance to survive," Miguel Jr. said. "It was ECMO or death."
A Desperate Search
Miguel and his family had tried to protect themselves from the virus. Three of his four adult children live in his home, and when they got infected in the fall, the family isolated as much as possible. Miguel stayed distanced on some nights by sleeping in an old RV he had in the backyard.
The pandemic had forced the extended Fernandez clan to cut back on family gatherings. Before COVID-19, Miguel had often organized get-togethers at his home on the southeastern side of Los Angeles, for birthdays or graduations, or to watch football or grill. After his only daughter, Jeannette, was accepted by UCLA last year, he proudly walked around her send-off bash in a "UCLA Dad" T-shirt.
But Miguel had to keep working. He and two of his brothers owned a construction business that bought and renovated homes. They had flipped hundreds of properties, starting 12 years ago with an $80,000 fixer-upper in Compton and more recently a $2.5 million project in Pasadena. Two of Miguel's three sons worked with him. Even after COVID-19 struck his family, Miguel still had to pick up supplies and go to job sites.
In early November, Miguel started to feel sick and went to a coronavirus testing site at a local recreation center. Two days later he received an email telling him what he already suspected: He had COVID-19. By Nov. 15, he had a fever and night sweats and was having trouble breathing.
Even though he was getting sicker, Miguel didn't want to go to the hospital. He knew people like him were dying. Latino Angelenos have suffered the highest COVID-19 death rate in Los Angeles County — almost twice the rate of Blacks and about three times the rate for whites.
But by Nov. 17, Miguel struggled to breathe as he walked from the bathroom to the couch. The family had purchased an oximeter, a device that measures oxygen levels in the blood when clipped onto a finger. His oxygen level had dropped to 77%, dangerously below the 95% considered at the low range of what's normal.
"We realized this was a real emergency," said Jeannette, his 21-year-old daughter. Just before midnight, two of Miguel's sons helped him into the passenger seat of the family's Ford Explorer. Jeannette took the wheel and Miguel's wife, Alejandrina, got in the back seat.
Jeannette headed to PIH Health Whittier Hospital, a 523-bed facility near their home. Outside the emergency room, the staff helped the 275-pound Miguel into a wheelchair and put an oxygen monitor on his finger. It sounded an alarm. His wife and daughter could see fear in his eyes; he didn't say a word as he was rushed into the hospital. Jeannette and Alejandrina didn't even get to say goodbye.
PIH Health declined to make caregivers available for interviews or answer questions about Miguel's care. "PIH Health will not be able to provide a statement for this story," a hospital spokesperson said in an email.
Hospital records show that Miguel was given high-flow oxygen through a face mask and put in a bed that allowed hospital staff to flip him on his belly, boosting his oxygen level to 93%. He was treated with steroids and an antiviral drug. Two days after admission, things were looking up.
Jeannette began providing updates through a group text message labeled "Familia." It included Miguel's brothers, many cousins, nieces and nephews, parents and his four children. Miguel was "doing good," she reported. Miguel spent his days reading messages on his phone, even when lying on his stomach. He sent his family photos of his food, and made special requests of the hospital staff, asking for buttered sourdough toast and prune juice with breakfast.
The family hoped Miguel would be home for Thanksgiving. But the course of COVID-19 is unpredictable.
At 11 p.m. on Nov. 22, Miguel texted his family, letting them know he expected to have a long night. He wrote in a text: "if I want to make it to thanksgiving have stay awake and restore my oxygen levels."
When Thanksgiving arrived four days later, a scan of Miguel's lungs revealed inflammation and scar tissue. Doctors started him on a 10-day course of anti-inflammation medication. "Be out by Christmas," Miguel texted.
The family responded with encouragement. "Hang in there we are all with you," wrote his sister Margarita. "Ten days go by really fast."
But eight days later, on Dec. 4, Miguel's oxygen levels plummeted. The doctors put him on a ventilator.
Miguel was now fighting for his life.
Unable to visit him, the family prayed for his recovery. Every night Miguel was in the hospital, his extended family gathered on Zoom at 7:30 p.m. Miguel's 71-year-old mother, Martha, and 73-year-old father, Salvador, would lead an hour-long prayer session while clutching rosary beads.
The separation was especially difficult for Alejandrina, who had been married to Miguel since 1991. Miguel liked to tease her when she watched her Mexican telenovelas: Why do you watch those shows when you have me? On Mother's Day earlier in the year, Miguel had surprised her by buying a pair of rings, getting down on one knee and proposing again. The couple made plans to renew their vows on their 30th wedding anniversary this summer. When he became sick with COVID-19, Miguel assured Alejandrina he would get better so they could get married again. She promised she would wait for him.
After Miguel was intubated, his family gathered in the parking lot outside the building where ICU patients are treated, to be as close to him as possible. Miguel's mother knelt on the pavement for 40 minutes, her hands clasped in prayer. She told her grandchildren that praying needed to be sacrificial. It had to hurt to be effective.
It was hard for Miguel's family to reach the doctors to discuss treatment options, in part because family members couldn't visit. It was impossible to build a relationship at the bedside or buttonhole doctors on their rounds, the way they could have in non-pandemic times. They called multiple times a day, but it was difficult to get clear information.
When a doctor did call with an update, Miguel's daughter Jeannette would patch in her brother, Miguel Jr., and Miguel's niece, Jhaimy Fernandez, a fourth-year medical student at the University of Vermont's Larner College of Medicine.
Miguel's family members said they were the ones to bring up ECMO, shortly after he was intubated. The ICU doctor treating Miguel told them ECMO was not an option, they recalled. Jhaimy requested a consultation with the palliative care team, which specializes in helping critically ill patients and their families make treatment decisions. The palliative care team, however, agreed with the ICU doctor, she said.
"They just thought it was outrageous for us to even think about ECMO," Jhaimy said of the hospital's doctors.
Miguel Jr. said it seemed as if the doctors were not familiar with his father's medical history. They asked if he had diabetes, Miguel Jr. said, which he didn't. He didn't have any preexisting conditions that typically make patients unsuitable for ECMO. Although some ECMO centers use age cutoffs, Miguel, at 53, was young enough to be considered appropriate for the therapy.
Carlos Fernandez, Miguel's younger brother and business partner, said it was frustrating that the family had to bring the ECMO option to the caregiving team.
"They just kind of wrote him off," he said, adding that it's possible the treatment team was just overwhelmed. "He's an older, Latino, overweight man. That is the demographic the coronavirus is looking for."
In a discussion with Miguel's daughter in the early afternoon of Dec. 7, a doctor called his prognosis "very poor," according to notes in his hospital record.
That update, however, was followed by more hopeful news. The family's insistence had paid off. His doctors had now decided he was, in fact, a candidate for ECMO. The family doesn't know what changed their minds, and the medical records do not describe how the doctors arrived at that decision. The medical team told the family Miguel would be transferred soon to a site where he could receive the new treatment.
A Tangled System
That afternoon, a hospital patient case manager began the effort to find Miguel an ECMO bed.
There is no central database that hospital staff can tap into to quickly figure out where in the greater Los Angeles area an empty ECMO bed might exist. Case managers typically have to call hospitals one by one, navigating each facility's particular bureaucracy and coordinating it all with Miguel's insurer.
"It is a nonsensical, haphazard collection of stakeholders, and the pandemic has found the fault lines in it," said Dr. Douglas White, a physician who directs the program on ethics and decision making in critical illness at the University of Pittsburgh School of Medicine.
A key reason ECMO is being rationed in the U.S. is a lack of regional coorination, White said. "If one hospital has no ECMO [units], but another 50 miles away has one, there needs to be a system in place to connect them," he said. "That's how you prevent the need to ration."
In Arizona, the state health department created the Arizona Surge Line early in the pandemic to coordinate care statewide for critically ill patients, said White. More than 4,000 patients, including many from hard-hit Native American reservations, have been transferred through this clearinghouse, according to White. The system is focused on capacity for all critically ill patients, so it's broader than just ECMO treatment. But it's an example of how to connect patients to the resources they need in real time, he said.
In Washington and Oregon, ECMO program directors can log in to a document that displays the availability of ECMO beds throughout the region.
In 2016, the directors of Minnesota's six ECMO centers created a consortium to help with pandemic and emergency operations, said Dr. Matthew Prekker, a pulmonologist and critical care specialist at Hennepin County Medical Center in Minneapolis. The consortium established uniform eligibility guidelines to make sure all critically sick patients get a fair chance at the therapy.
If half the state's medical centers reach capacity, it triggers an emergency conference call between the ECMO center directors, who steer patients to open beds. "We are well organized," said Prekker. "We don't work in silos."
Los Angeles has vast academic medical centers, but no real-time coordination on finding ECMO beds. Before COVID-19 there had not been a need to coordinate such a high volume of patients, said Dr. Peyman Benharash, director of the adult ECMO program at UCLA Health. He said when COVID-19 hit, ECMO doctors created an informal group chat so they could coordinate patients and resources, but it's not something case managers can access. Benharash said his center does not use a waiting list, because he wants case managers to continue searching for any hospitals that might have a bed available. If UCLA is full, it tells case managers to call back in 12 hours.
The lack of a centralized system in Los Angeles can result in a scramble for case managers and doctors as patients' lives hang in the balance.
On the afternoon of Dec. 7, Miguel's medical records show, the PIH Whittier case manager called Miguel's insurance company. There was no guarantee the insurer would agree to a therapy that can easily run into the six figures. Insurance company rejections of ECMO are not uncommon, according to ECMO directors. But in Miguel's case that didn't seem to be an obstacle. The insurer told PIH that the University of Southern California's Keck Hospital, the Ronald Reagan UCLA Medical Center and Cedars-Sinai Medical Center might be options. The case manager left a message at USC and provided UCLA with Miguel's information. Cedars-Sinai came back with a no, saying Miguel didn't meet its criteria for ECMO therapy.
The case manager, after talking to Miguel's insurer, tried two more hospitals. One, UCI Health in Orange County, didn't have any ECMO beds available. A second, Providence Saint John's Health Center in Santa Monica, said it would review Miguel's records.
During the COVID-19 surge, ECMO centers were screening the growing number of patients to prioritize those with the best chances of survival. At 5:08 p.m., after three hours of working the phones, the case manager turned over the search to a colleague. Soon after, UCLA called to say it wouldn't take Miguel because he had a hematoma and blood clotting.
A Prayer Answered
As the case managers searched for an ECMO bed, Miguel's mother was back in the hospital parking lot holding a vigil for her son. This time, she hid a prayer card and string of rosary beads underneath the green leaves of a day lily to protect Miguel when she was not there.
The search for an ECMO bed did not make progress for most of the day on Dec. 8. The longer Miguel depended on a ventilator, the greater the chance he would either die or suffer complications that could disqualify him for ECMO. Even without complications, extended ventilator time could rule out ECMO. By now, he had been intubated for four days. Some programs will not take a patient who has been intubated more than a week.
"When it comes to somebody needing ECMO, they can fail very quickly," said Sun.
The next day, on Dec. 8, the palliative care team offered a grim prognosis in a telephone call with Miguel's family: "We told them that Mr. Fernandez was not likely to recover at this point," according to hospital records. The family said it still wanted the hospital to make every effort to save Miguel if his heart stopped.
Throughout the day on Dec. 8, a staffer at the Saint John's transfer center was trying to reach someone at PIH to discuss Miguel's case. At 8:33 that evening, a case worker at PIH wrote that she had received a call from Saint John's. The transfer contact said he had "been trying to get in contact with [case manager] all day and left VMs but no one called back."
The next day, a PIH case worker noted in the records that she had missed messages from Saint John's because it was her day off.
Saint John's had been calling PIH with good news: The hospital had accepted Miguel for its ECMO program and would admit him as soon as a bed became available. Over the next few hours, paperwork was faxed back and forth between the hospitals, and the insurance company was contacted for approval.
"Great news!!!" Jeannette announced in a message to the family group chat, adding a heart emoji. "My dad got accepted to St. John's hospital in Santa Monica!!"
The plan, she informed the group, was for Miguel to be moved later that day.
A Life-Saving Therapy
At Saint John's, Dr. Terese Hammond was receiving up to three requests a day to use ECMO to treat patients like Miguel. Hammond had been instrumental in starting the hospital's ECMO program after she was recruited in 2018 to oversee critical care. She had worked with the therapy at USC, where she headed up the pulmonary critical care fellowship.
Community hospitals like Saint John's don't typically have the budget or specialized staff for an ECMO program. Even in the United States — which spends about twice as much per person on healthcare as other developed nations — more than 90% of hospitals do not offer ECMO. In Los Angeles, the established programs are located at big academic medical centers like USC, UCLA and Cedars-Sinai.
At Saint John's, private donors came up with the money to buy a dozen ECMO units, which can cost up to $85,000 each, Hammond said. The hospital can care for as many as eight ECMO patients at once, depending on staffing.
Hammond was an early believer in using ECMO to help COVID-19 patients whose lungs were failing. Nearly every one of the COVID-19 patients treated with ECMO at Saint John's transferred in, some from more than an hour away.
"We have to validate there is benefit, and we have been able to do that," she said. "I have people alive today because of ECMO."
Miguel's family didn't have to look hard for those success stories. Los Angeles Police Department detective Michael Chang was an early ECMO patient at Saint John's whose near-death experience was featured in local news reports.
Chang had been assigned to robbery and gang investigations but was shifted early in the pandemic to working in uniform at COVID-19 testing sites, food giveaways and supermarkets. On March 30, he was admitted to a small Orange County hospital near his home with COVID-19. Six days later, he was intubated and placed on a ventilator.
As soon as Chang was intubated, his wife, Dana Chang, tapped into a network of police contacts in search of more advanced care. A captain put her in touch with an LAPD reservist who is also a surgeon, she said. That doctor told her about Saint John's and its ECMO program. He called Hammond, and a transfer was arranged.
"He was going downhill fast," Dana said of her husband. "If I left him there, he would have died."
Chang arrived by ambulance at Saint John's on April 7 and was immediately hooked up to an ECMO machine. On the evening of April 12, he was removed from the machine. He left the hospital five days later.
Michael Chang sometimes still experiences shortness of breath and bouts of a dry cough, but he credits ECMO with saving his life. "Prior to me getting it, I had never heard of ECMO," he said. "I had no idea what this thing is. The world needs to know about this."
Of the 39 COVID-19 patients placed on ECMO at Saint John's since the start of the pandemic, 15 are alive today. Hammond said most of them almost certainly would have died without ECMO.
Hammond is the first to caution that ECMO is not a miracle cure. About half the COVID-19 patients undergoing ECMO die in the hospital, according to a registry of more than 3,400 COVID-19 patients worldwide, though some centers have reported survival rates of as high as two-thirds.
Miguel's family said they knew ECMO wasn't a guarantee, just a chance, something the doctors at PIH were telling them he didn't have there. If it didn't work, they said, they would take comfort in knowing everything possible had been done to help him.
The Waiting List
The news of Miguel's pending transfer to Saint John's quickly gave way to a larger reality: There were lots of patients like Miguel in Los Angeles.
COVID-19 was surging. The number of COVID-19 patients in intensive care units had doubled in the three weeks since Miguel was hospitalized. At PIH Whittier, two weeks before he was admitted, 17 patients had COVID-19. The week Miguel arrived, that number swelled to 47. By the time he was intubated, there were 76. By Dec. 7, when the ECMO search began, there were 93.
At Saint John's, the ICU was full and unable to take in any new patients. While Hammond had approved the transfer of Miguel and had an ECMO machine to treat him, there were no beds available.
The waiting list was not something the family could see or monitor. There was no way to know who was ahead of Miguel, or why, or how fast people were moving up the list. At least at the deli counter or DMV, they could see numbers on a board, monitor their progress and make sure no one jumped the line. With Miguel's life in the balance, his family was completely in the dark.
"My dad didn't have anybody that would call to make him a priority," said Miguel Jr. "There was no way for us to hold anyone accountable for what they were saying. We just had to take them at their word."
Hammond said the waiting list is not influenced by a patient's wealth or social status, only whether they are medically qualified and "likely to survive this therapy." In the case of Miguel, she had approved him for ECMO when other hospitals said either they had no room or he didn't meet their criteria.
On Dec. 10, Miguel Jr. shared the bad news on the family chat that his father's transfer had not taken place the night before as hoped. "We have been calling my dads transfer case manager at the hospital and we even called saint johns and spoke to one of their case managers to try to speed up the transfer process but there is not much we can do but wait for a bed to open," he texted to the Familia group.
The next two days brought more waiting. "Call to Providence St Johns to follow up on ECMO spoke w/ Rachel, still no bed. no movement yet, same status," Miguel's caseworker at PIH wrote in her notes for Dec. 11.
By now Miguel had not been breathing on his own for a week and was becoming "more and more difficult to ventilate," according to hospital records.
The family didn't understand what it meant when hospitals said they had "no beds" in their intensive care units. Jeannette and Miguel Jr. called Saint John's to ask if they could buy a bed for their father. They did research to find out if donations were allowed to fund additional beds at the hospital, but were told it doesn't work that way.
Jeannette imagined ways to get inside the hospital and see with her own eyes that every one of its 266 beds was occupied. She looked into becoming a volunteer at Saint John's and found an application online.
Hammond said the phrase "not having a bed" was a euphemism for lacking enough nurses, respiratory therapists, perfusionists and doctors to care for patients who need intensive care. Saint John's expanded its ICU capacity from the normal 23 beds to 40, but adding beyond that meant stretching the staff too far.
On the morning of Dec. 12, nearly five days after the search for an ECMO bed began, the case manager told Miguel's family that he was in "the top 3" of those waiting for an ICU bed at Saint John's, according to the medical records. 12, saying that Miguel was third on a list of people waiting for an ICU bed at Providence Saint John's Health Center in Santa Monica. Credit: Courtesy of the Fernandez family
Less than an hour later, a team of doctors and nurses hurried to Miguel's room at PIH. The hospital had called a Code Blue. Miguel's heart had stopped. The team started chest compressions and administered drugs to restart his heart. It worked, but Miguel had suffered damage to his kidneys and other organs.
The next day around noon, someone from the Saint John's transfer center called a nurse at PIH Whittier to say that once again no beds were available. The PIH case manager told Saint John's that Miguel was in multi-organ failure, and might not survive the ambulance ride to the other hospital. Two hours later, Saint John's informed PIH it would no longer take Miguel as a patient "due to change in condition."
At 5:23 p.m., another Code Blue alert was sounded. This time, Miguel did not survive. In his room, a hospital worker gathered items left behind after his 26-day stay: an Apple laptop, an iPhone and a pair of cracked black-rimmed glasses.
"People Are Dying Waiting"
Miguel's wife, Alejandrina, at his funeral on Dec. 30, 2020. Credit: James Carbone for ProPublica
The story of Miguel's death and his family's scramble to get him potentially life-saving care has become a familiar one for Hammond.
She said she has had as many as seven people on her waiting list at one time, all in similarly desperate situations.
"Part of the PTSD I have, the nightmares I have, are as much having to say no and having people die on a waiting list," she said. "Those are all things that represent a lot of moral injury for physicians. We know the limitations the surge placed on our ability to do the best we can. People are dying waiting."
The rationing is not limited to Los Angeles. It is playing out across the country.
In Dallas, the ECMO unit at Baylor University Medical Center receives daily requests from across Texas and neighboring states on behalf of desperately sick COVID-19 patients. Their last chance at survival could come down to whether Baylor has a bed. "A few days ago I had five patients on my waitlist," Dr. Gary Schwartz, a lung transplant surgeon who leads the ECMO program at Baylor, said in an interview. "Two passed away while waiting. It is absolutely terrible."
Schwartz said his center, one of the busiest in the country, averaged about 120 ECMO patients a year before COVID-19. In 2020, that number grew to 158, and the number would have been higher if he had had additional capacity. "Quite honestly, there was an additional 50 to 100 who were appropriate but there were no resources for them," he said.
National guidelines created by the Extracorporeal Life Support Organization, a consortium of hundreds of ECMO centers, essentially call for rationing as the demand for ECMO spikes in regions saturated with COVID-19 cases. As surge levels escalate, "we recommend that selection criteria become more stringent to use this resource for those most likely to benefit," according to the guidelines.
Some centers have moved to implement an age cutoff for ECMO, or lower the age in existing guidelines. At Baylor, the maximum age of those considered appropriate for ECMO was dropped to 60 from 75 before COVID-19, Schwartz said. He said another center in the region reduced its age range to 50 or younger because it was overwhelmed with requests. "Many of the patients in the beginning were elderly, and we were afraid that if we had lots of those people that the younger people, 30 to 40, wouldn't have that available," he said. Schwartz said he has colleagues in Europe who think an age restriction is unethical. "In a perfect world, we would be using [ECMO] for the people most likely to survive," he said.
Schwartz and the directors of other ECMO centers in Dallas created an ad hoc group chat on WhatsApp to try to keep track of where beds were available as hospitals filled to capacity. "The real question is do we learn from this and change in the future to some kind of centralized process?" Schwartz said.
Hammond said the ECMO directors in Los Angeles have a similar arrangement where they text each other to find empty beds. The surge in Los Angeles is waning, and cases throughout the country are also going down. But new variants of COVID-19 are emerging, posing a threat of fresh surges. Hammond hopes the experience with COVID-19 will prompt the creation of a formal, permanent network to coordinate the care and movement of critically ill patients in Southern California.
Miguel's niece, Jhaimy, will become a doctor in five months and has been interviewing to do her family medicine residency training in Los Angeles. She's always been aware of healthcare disparities, and went to medical school to find ways to improve the system.
"It just pains me to see how typical a case my uncle was," she said. "He was Hispanic, mid-50s, an essential worker, not trusting of the healthcare system. He fit all the checks."
On Dec. 30, Jhaimy was one of dozens of family members who gathered to bury Miguel in a sprawling cemetery near his home.
A family friend organized a fundraiser to help defray the cost of the funeral. Miguel was his family's primary source of income, and since his death, bills have mounted.
A blue and white floral arrangement spelling out "PAPA" was placed on a stand near his grave. Underneath it was a photograph of a younger Miguel, wearing a white button-down shirt and a leather jacket.
The specter of COVID-19 hung over the graveside service. Everyone wore a mask. Miguel's mother slumped over his casket, gripping it with hands covered in clear medical gloves. She wore a face shield and a cloth mask.
Miguel's sister, left, and mother, at his casket. Credit: James Carbone for ProPublica
The burial did not bring Miguel's family members much closure. Jhaimy said she has wondered what would have happened if her uncle had not been so afraid to go to the hospital. Would he have survived if he had been treated sooner?
Miguel Jr. and Jeannette are troubled that Miguel's doctors didn't present ECMO as an option, and then resisted the idea when the family suggested it.
The family still thinks about what would have happened if an ECMO bed opened up in time.
"I believe with ECMO he would still be here today," Miguel Jr. said. "He never got the chance to fight."
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Prioritizing by age might seem like an obvious choice, given the disproportionate impact of the disease on the elderly. Setting the initial threshold at 75, however, ignores the fact that a smaller share of Black people reach that age than white people.
This article was published on Friday, February 12, 2021 in ProPublica.
MEMPHIS, Tenn. — Rosalyn Campbell and her husband, Calvin, are waiting for what may be the most in-demand item on the planet: the COVID-19 vaccine. They both caught the virus in November; Calvin Campbell tested positive just days after he’d been released from the hospital following open heart surgery.
After a weeklong stint in the hospital, he returned to his job as a buildings and grounds engineer, where he’s on light duty. But Rosalyn Campbell, who also has a heart condition, remains anxious.
“I’ve got to have it. … I want this behind me,” said Campbell, who retired from FedEx in 2013.
But it may be March before the couple, who are both Black and 65, are eligible to get the vaccine, based on the state’s age-based vaccination plan. Tennessee, like most states, gave first priority to those 75 and over, following the advice of the Centers for Disease Control and Prevention. As the virus’s death toll climbs to more than 465,000 nationwide, policymakers around the country are struggling to inject equity into vaccination policies.
Prioritizing by age might seem like an obvious choice, given the disproportionate impact of the disease on the elderly. Setting the initial threshold at 75, however, ignores the fact that a smaller share of Black people reach that age than white people. It also fails to account for research, released by the nonprofit Brookings Institution in June, showing that Black people who die of COVID-19 are, on average, about 10 years younger than white victims of the disease. (Data for Shelby County, Tennessee, where Memphis is located, bears this out as well.)
“If you [allocate the vaccine] strictly by age, you’re going to vaccinate white people who have lower risks before you vaccinate Black people with higher risks,” said Sarah Reber, co-author of the Brookings research and associate public policy professor at the UCLA Luskin School of Public Affairs.
“If you’re trying to avert deaths, you would want to vaccinate Blacks who are about 10 years younger than whites.”
The pandemic is expected to lower life expectancies nationwide, which will only exacerbate the Black-white life-expectancy gap. Before the pandemic, Black residents of Shelby County, on average, were expected to live to be 73 years and four months old, compared to 78 years and one month for white residents. What that means is that while 54% of the county’s residents are Black, Black people account for only 39% of residents 75 and up.
In Shelby County, the poverty rate is 25% higher than the statewide rate, and the residents who live below the poverty line are concentrated inside Memphis city limits.
Data from around the country — and from cities such as Washington, D.C., and Chicago — reveal vast disparities between where COVID-19 is hitting hardest and where shots are making it into arms. The latest national government data shows that when the race of the person getting the vaccine is known, Black residents are underrepresented; just over 5% of vaccine recipients were Black, compared to just over 60% who were white. By contrast, about 12% of the U.S. population is Black and 60% is white.
The population of Shelby County is 54% Black and 35% white. As of Feb. 6, 22% of Shelby County vaccine recipients are Black, compared to 43% who are white. (Around 16% are categorized as “Other/Multiracial/Asian,” while the remaining 18% or so are unknown).
Experts attribute the vaccination disparity to a number of factors, including poor internet access, lack of transportation and distrust of the medical system caused by racist practices such as the federal government’s Tuskegee syphilis study. The distrust becomes visible in a recent Kaiser Family Foundation survey in which a much higher share of Black people than white say they prefer to wait and see how the vaccine works before receiving it. (An equal share of white and Black respondents — 14% — say they definitely won’t get vaccinated.)
But these disparities aside, strict age cutoffs also play a role. Calculating the impact of those cutoffs is difficult because the age criteria are shifting downward as the rollout plan advances. Last week, the Shelby County Health Department announced that people over 70 are now eligible to be vaccinated. But that is unlikely to fully address the inequity built into the age-based system.
According to the state’s health disparities dashboard, Black residents of Shelby County have higher rates of infections, hospitalizations and mortality than white residents. Among residents between 65 and 74 whose race is known, Black people are notably overrepresented in COVID-19 fatalities, according to the SCHD, making up 67% of deaths in that age range, compared to 28% for white residents, as of Jan. 31.
Even before the vaccine rollout, some experts warned about the racial implications of prioritizing by age. Before the CDC issued its recommendations, a Chicago health disparities researcher and bioethicist raised her concerns about a “one-size-fits-all” age threshold during the public comments at a December CDC committee meeting.
“The burden of COVID mortality that we’re seeing in minority communities has shifted to much younger populations than what we are seeing in the non-minority populations,” said Dr. Monica Peek, an associate professor and physician at the University of Chicago.
The Tricky Balance of Efficiency and Equity
From the start of the pandemic, it has been clear how much harder communities of color have been hit. Late last month, two senators and a congresswoman from Massachusetts, all Democrats, sent a letter to the U.S. Department of Health and Human Services. “It is critical that the federal government’s vaccine deployment campaign does not fail the communities that have been forced to shoulder the greatest burden,” it read.
But reddressing that disparity in a vaccination rollout plan proved difficult. Reporting by MLK50 and ProPublica opens a window on those debates. The Advisory Committee on Immunization Practices, a CDC group of vaccinologists and medical and public health experts, was responsible for developing a national framework for vaccine approval and distribution. An ACIP work group decided in November to ground their work in four ethical principles: Maximize benefits and minimize harms, promote justice, mitigate health inequities, and promote transparency.
Questions about how to handle race and ethnicity surfaced at the group’s June meeting. “How should racial and ethnic groups at high risk for severe COVID-19 be prioritized? Should race and ethnicity be a criterion for vaccine prioritization?” read the June meeting summary.
Four months later, ACIP answered its own questions. “It is critical for ACIP to address equity and disproportionate impact on disadvantaged populations,” reads the October meeting summary. But, the notes continue, “approaching this from a race/ethnicity standpoint is probably not the best approach.”
Prioritizing one group over another inevitably pushes others to the back of the line, experts say, and it’s not clear whether governments could legally specify different age cutoffs by race, or whether it would be feasible politically or possible logistically.
“In general our country is very reluctant to encode racial categories into law,” said Elizabeth Wrigley-Field, assistant professor of sociology at the University of Minnesota. Wrigley-Field, who is not on the ACIP committee, recently published research on racial inequality and life expectancy that suggests racism may be as deadly as the pandemic.
In some communities that have tried more race-specific solutions for vaccine distribution, the blowback has been swift. After early data showed residents in affluent and predominantly white neighborhoods were the primary vaccine recipients, the Dallas, Texas, County Commission decided in mid-January to target the most vulnerable ZIP codes. The very next day, Texas health officials announced that the state would shrink Dallas County’s vaccine allocation unless it abandoned the plan, which the county did.
Tennessee’s vaccination plan states that “equity remains a crosscutting consideration,” and sets aside 5% of its weekly vaccine allocation for counties, including Shelby, that rank high on the CDC’s social vulnerability index, which includes race as one of 15 factors.
“This allows those counties to vaccinate more people more quickly and move ahead in the phases,” said Tennessee Department of Health spokesperson Bill Christian in an email. He didn’t answer questions about how many doses Shelby County receives or if the doses are distributed based on population; to date, those numbers have not been made public.
Although ACIP and the CDC recommended the social vulnerability index as a proxy for race, that was a mistake, said Dr. Uché Blackstock, an emergency physician and CEO and founder of Advancing Health Equity, a national group that works with health care institutions to address health inequities. “That was an opportunity for the federal advisory committee to really make a statement about how racism has essentially created environments and limited opportunities,” she said. “Racism so explicitly harms Black people, but then in terms of addressing that and mitigating the impact of racism, we cannot use race explicitly.”
The Shelby County Divide
While COVID-19 is expected to lower the country’s life expectancy by more than a year, for Black residents, it will drop by more than five years, wiping away reductions in the Black-white gap made over the last 15 years, according to research from the University of Southern California and Princeton.
On a census tract level, the life expectancy disparities in Shelby County become even more stark. Even pre-COVID-19, the gap between a virtually all-white suburban census tract and a virtually all-Black one in Memphis stood at more than 19 years.
The county’s census tract with the highest life expectancy, 84.6 years, is in the suburban town of Collierville, in a neighborhood where some street names — Scarlett’s Way, Rhett’s Way and Taraview — are inspired by “Gone With The Wind.” Here the population is 96% white, the poverty rate is less than 1%, and the median household income of nearly $108,000 is twice that of the county.
More than 20 miles west is the neighborhood with the lowest life expectancy — 65.3 years. It sits in South Memphis, where a boulevard bears the name of a wealthy developer. The census tract is 96% Black, with a 42% poverty rate and a median household income of less than $20,000, less than half of the county’s.
Campbell and her husband live about 6 miles away, in a predominantly Black part of Memphis called Whitehaven. In her neighborhood, the life expectancy is 74.5 years, just shy of the 75 and older age bracket that was first to get the vaccine.
Both Campbell and her oldest sister, retired educator Linda Williams, live in almost all-Black census tracts where the poverty rate is higher than the county’s and household income is lower. The life expectancy in Williams’ neighborhood is even shorter, at 71.7 years. Williams, 69, recalls fondly her pre-pandemic life. In the before times, she kept busy with water Zumba and water aerobics. Now, she exercises on a stationary bike that sits near a window so she can look outside. “Can’t go to church, can’t go anywhere,” she said. Late last year, she lost a friend of 30 years to the virus, and she’s eager for the vaccine. “You see the numbers on the screen, but ... it hits you different when you actually know the person,” she said.
Struggling With Equitable Distribution and Access
Of course, being eligible to receive the vaccine isn’t the same as being able to access it. And the vaccination rollout in Shelby County, as in other communities, has been troubled in ways that worsen racial inequities.
As of Feb. 1, 24 states, including Tennessee, were publicly reporting COVID-19 vaccination figures by race and ethnicity, according to the Kaiser Family Foundation. As of Feb. 10, less than 7% of the state’s vaccine recipients were Black, compared to about 17% of the state's population.
As of Feb. 6, Shelby County’s vaccination rates have been highest along the Poplar Avenue corridor, a predominantly white swath of town that starts at the Mississippi River and runs southeast toward the county’s more affluent suburbs. Rates are far lower in the largely Black and less-affluent ZIP codes north and south of the Poplar corridor.
Other problems have plagued the rollout. In January, the SCHD made more than 10,000 appointments available online two and a half days before the phone lines opened. By then, all the appointments had been claimed, largely boxing out those without internet access, who tend to be disproportionately Black, elderly and low-income.
After a particularly troubled day in late January, in which people with appointments were turned away after waiting for hours, SCHD Director Alisa Haushalter apologized. “We recognize it was not what we want to deliver for the public and we’ll make adjustments to continue to improve,” she said during a press conference.
As community leaders’ demands for equity have grown louder, the SCHD opened a drive-through vaccination site in the predominantly black neighborhood of Whitehaven. The Tennessee health department also partnered with Walmart pharmacies in an effort to expand to “rural and underserved areas,” but only four of the county’s 11 Walmarts are in what can be considered underserved areas.
In an effort to address growing community complaints about equity, late last month the SCHD made the vaccine available at a Memphis commodity center in the city’s core. Through a federal program, the center distributes healthy food to elderly residents with household incomes around $22,500 for a family of two. In Memphis, that population is overwhelmingly Black. Two residents told MLK50 and ProPublica that several of their white, affluent friends got vaccinated at the center.
Campbell knows of people who have skipped the line, and other residents have told MLK50 and ProPublica that they've seen ineligible residents subvert the SCHD’s eligibility systems. Local news outlets have reported similar circumstances.
No one wants to waste doses, said Dr. Grace Lee, an ACIP member, but equity has to be as important as efficiency.
“We want to protect as much of the population as quickly as possible,” said Lee, who is also a professor of pediatrics at Stanford University School of Medicine. “But if you take a look at that alone, without also considering measures of equity, then what you focus on is potentially losing that balance.”
Without stronger federal involvement, “the problem is just going to get worse,” said Rachael DeCruz, chief of staff for Race Forward, a national organization that works to infuse equity into public policy.
Last month, a coalition of civil rights groups asked the Biden administration to create a White House office of racial equity and inclusion, which could assist with equitable vaccine distribution.
On a grassroots level, DeCruz also encourages people to organize and “not [let] up the pressure until we see some actual change.”
“If that started happening in Memphis and in places across the country in a really unified way, I think it could have a huge impact.”
The governor finally released data on nursing home cases after lawsuits and demands from lawmakers, but hundreds of presumed COVID-19 deaths have yet to be included in the state's official total.
This article was published on Friday, February 12, 2021 in ProPublica.
Hundreds of COVID-19 deaths among New York state’s nursing home residents still have not been formally acknowledged by the administration of Gov. Andrew Cuomo, according to the Empire Center, a public policy think tank in Albany.
Bill Hammond, an analyst with the Empire Center, said recent state disclosures of all deaths of nursing home residents, whether they perished in their facilities or at local hospitals, to date failed to include more than 650 deaths of people presumed to have died of COVID-19.
Hammond said the state referenced the deaths in a footnote to its public data release, saying that it is still seeking to verify the official cause of death in those cases.
In Columbia County, for instance, at a nursing home that local health officials said had seen 18 residents die of COVID-19 in local hospitals, the state’s public tally today still just lists nine such deaths.
After months of requests from state lawmakers, subpoenas from Congress and a lawsuit by the Empire Center, the Cuomo administration in recent weeks had finally begun to concede that thousands more nursing home residents had died of COVID-19 than previously made public. When the administration last month announced totals of those nursing home residents who had died in hospitals, the number of overall deaths swelled by 50%, from some 8,000 to more than 12,000.
Today, as the virus continues to ravage New York, slightly more than 15,000 residents of nursing homes and other adult care facilities have died of COVID-19, more than in any other state. Roughly 13,000 of those were nursing home residents, close to 13% of the state’s nursing home population.
A Cuomo administration spokesman declined to respond to questions about the hundreds of still uncounted nursing home residents.
The true toll of nursing home deaths has been a controversy for the administration from the outset of the pandemic. For more than six months it has been criticized for failing to publicly count the deaths that occurred in hospitals. The administration’s policy allowing patients who had tested possible to be sent from hospitals to nursing homes already struggling to prevent the spread of the disease provoked outrage. The state’s largest union for nurses sued the Health Department for policies it said endangered front-line health care workers.
On Thursday, Melissa DeRosa, Cuomo’s most senior adviser on the pandemic response, apologized to lawmakers for the delays in making basic death data available, saying the administration was worried the death tolls would arm Republicans in Washington in what it regarded as a political vendetta against the governor. The admission shocked lawmakers, who said it was no excuse for withholding information vital to the public’s understanding of the pandemic’s true toll.
Ron Kim, the Democratic chairman of the State Assembly’s Committee on Aging, said he and others almost didn’t believe what they had heard.
“They should not be apologizing to us,” Kim said, “they should be apologizing to the people of New York.”
DeRosa’s remarks, made in an online meeting with lawmakers and administration officials and reported first by the New York Post, set off calls for resignations and a criminal inquiry.
Peter Ajemian, an administration spokesman, suggested DeRosa’s remarks should not be taken out of context. He argued that the administration had made clear to lawmakers last summer that the data on hospital deaths was difficult to verify and pull together, and that releasing unconfirmed deaths in a partisan political moment was fraught. He suggested the state had intended to get the work done on hospital deaths by the fall, but the second wave of infections had made that impractical.
A wide range of lawmakers and health experts have long derided the administration’s claims that counting COVID-19 deaths at hospitals was complicated, and they note that the administration had been doing just that in the early days of the pandemic.
“They could have disclosed the raw data on hospital deaths of nursing home residents with the caution that work needed to be done to verify official totals,” Kim said.
“They could have done that at any time, at the start, in the early months, well before Republicans were calling for them to,” he added. “But they wanted to hide bad news. They wanted to control or change the narrative of the state’s performance.”
In an interview, Hammond described months of legal combat with the administration to make the hospital deaths public. In the end, a state judge ordered the administration to answer Hammond’s freedom of information requests.
“I still don’t think this is everything,” he said of the administration data releases to date.
For instance, Hammond said the state has still not released the dates and facility names of close to 1,000 COVID-19 deaths involving residents of adult care facilities other than nursing homes. The numbers of those residents known to have died of COVID-19 jumped from 219 to close to 1,800 when the state released its data on hospital deaths.
Hammond said the failure to make public the dates and locations of the deaths handicapped efforts to better understand how the pandemic’s toll unfolded over time and across the state.
For this to happen by the start of the next school year, trials need to prove the vaccine is safe and effective in children. Experts say manufacturers aren't moving quickly enough, and that this is important for achieving herd immunity and stopping the spread of variants.
This article was published on Thursday, February 11, 2021 in ProPublica.
Children as young as first graders may be able to get the coronavirus vaccine by the time school starts in September, presuming trials are successful in those age groups, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in an interview with ProPublica.
"We're in the process of starting clinical trials in what we call age de-escalation, where you do a clinical trial with people 16 to 12, then 12 to 9, then 9 to 6," Fauci said. When asked what was the youngest age group that might be authorized for the vaccine by September, he said, "I would think by the time we get to school opening, we likely will be able to get people who come into the first grade."
As optimistic as Fauci is, several pediatricians and infectious disease experts said they wish the pediatric trials would move more quickly. In addition to restoring stability to the education system and parents' work schedules and keeping kids and those around them safe, vaccinating children is essential to helping the country, as a whole, reach herd immunity and decrease the threat of new variants.
Otherwise, "we're going to have tens of millions of individuals in our communities that are able to maintain the virus. And when that happens, what that allows is for these unusual variants to emerge that may have the ability to evade our immunity," said Dr. Buddy Creech, associate professor of pediatrics and director of the Vanderbilt Vaccine Research Program.
Despite the need, Pfizer is the only manufacturer whose pediatric vaccine trials are far enough along to potentially have data on elementary-school age children by the end of the summer.
Pfizer has finished enrolling participants in its study of 12- to 15-year-olds and anticipates having data in "the early part of 2021," according to a spokeswoman. "From there, we will plan to finalize our study in 5-11 year olds," she added. As Pfizer completes its trials in adolescents, then 5- to 11-year-olds, it'll need to submit the data to the U.S. Food and Drug Administration for review and get authorization for the vaccine's use in those age groups before it's available; currently in the U.S., the vaccine is indicated only for those ages 16 and up.
Moderna is still enrolling participants in its trial for adolescents ages 12 to 18, and it is "on track to provide updated data around mid-year 2021," the company said in an emailed statement. Stéphane Bancel, Moderna's chief executive officer, has said that the company's goal is to have data from the adolescent study in advance of the 2021 school year. Moderna said it'll begin an age de-escalation study in children ages 11 years to 6 months this year, but Bancel has said that the company doesn't expect clinical data until 2022.
Johnson and Johnson hasn't started any pediatric studies yet. "We are in discussions with regulators and partners regarding the inclusion of pediatric populations in our development plan," a spokesman said. Novavax, similarly, hasn't begun any trials in children, and a company spokeswoman said it couldn't share any details at this time. The University of Oxford, which partnered with AstraZeneca in developing a vaccine, will begin tests in 12- to 18-year-olds next month, according to Bloomberg News.
The American Academy of Pediatrics has been "really advocating to try and make these trials happen with the same urgency that they happen for adults," said Dr. Sean O'Leary, who is vice chair of its committee on infectious diseases.
The manufacturers will need to prove vaccines are safe and effective in younger bodies. The adult trials paved much of the way, but researchers still need to study how kids' immune systems react and to confirm the optimal dosage. And even if the shots are authorized by September, there will need to be enough supply on hand in order to get school children immunized before school doors open.
It's essential to act expeditiously, O'Leary said. "I would love to see a vaccine available for all children in time for the next school year."
Why It's Important to Vaccinate Kids Against COVID-19
Early on in the pandemic, some thought that children might be entirely immune. That's clearly been disproven. Out of more than 20 million U.S. cases where age information is available, about 2.2 million, or 11%, have been in children under 18. Some get very ill, though this is rare. As of Feb. 8, the Centers for Disease Control and Prevention has tracked more than 2,000 cases of what's known as multisystem inflammatory syndrome in children (MIS-C), a serious condition associated with COVID-19 that can result in cardiac dysfunction and kidney injury; 37% of the cases recorded were in Latino children and 32% in Black children.
It's also become evident that children are capable of transmitting the virus to some extent. On one hand, kids aren't superspreaders: COVID-19 is clearly dissimilar to influenza or the common cold virus, Vanderbilt's Creech pointed out. "You put one of those in a classroom, then in a few days, it's overrun," he said. "That's not what we see with COVID." But exactly how infectious children are remains somewhat unclear, in part because schools have not been fully open, making it hard to gather data, said Dr. Yvonne Maldonado, a pediatrician and professor of global health and infectious diseases at Stanford University. Studies from other countries, while informative, may not always extrapolate well to the U.S., she added.
So while the "preponderance of data" points to children being less likely to infect people when compared with adults, "they certainly do," said O'Leary, who is also a professor of pediatrics at the University of Colorado School of Medicine. "So, if you've got vulnerable people in the household and your 7-year-old comes home with COVID, it's not to say they can't give it to anybody else. They absolutely can. It's just a bit less likely."
It's important to note that the vaccines have only been proven — so far — to prevent disease and not infection (data on that is harder to gather and takes longer to prove), which means it's not guaranteed yet that vaccinated individuals can't spread the coronavirus.
But there are some inklings of hope that vaccination can at least reduce onward transmission. So if this bears out, the more people who are vaccinated in a community, including children, the more likely transmission will drop overall.
"Our current chaos about children not being in schools is just terrible for children, and I think a lot of the concern would be assuaged if children were immunized," said Dr. Sarah Long, professor of pediatrics at the Drexel University College of Medicine. "That doesn't mean to me that they can't get the infection or transmit it every once in a while, but it would reduce those possibilities tremendously."
Long is also a member of the CDC's Advisory Committee on Immunization Practices, where she has been reviewing the trial data and helping to make recommendations on how the vaccines should be used. She continued: "There are real virus control reasons, there are real societal reasons and there are economic reasons, because if children can't go to school, people can't work."
O'Leary said children as young as 6 months, which is the youngest age that Moderna plans to test, can get vaccinated so long as trial data shows the vaccines to be safe and effective. Infants under 6 months are likely to be protected by antibodies transferred through the placenta if the pregnant mother is vaccinated, he added.
How the Vaccine Will Be Studied in Kids
The pediatric vaccine trials will not be as large as the final stage adult trials, which enrolled 30,000 or more participants, giving a placebo to half and the vaccine to half. Pfizer's 12- to 15-year-old study has enrolled 2,259 participants and Moderna's adolescent trial is a similar size, aiming for about 3,000 participants. In both trials, some teens will receive a placebo.
That's enough to prove safety and benefit, experts said, in part, because the adult trials have already paved the way. To show the vaccine is safe, among the many things that Pfizer is tracking includes the percentage of participants reporting "local" reactions such as pain at the injection site, redness and swelling, as well as the percentage of participants reporting systemic reactions such as fever, headache, chills, vomiting, diarrhea, muscle pain and joint pain.
After the trials are completed, tracking for any safety issues will continue in the real world as physicians and patients will be encouraged to report to the FDA and CDC any side effects they think may be due to the vaccine.
Doctors said they'd want to make sure that there are no signs that the vaccine overinflames the immune system or causes any allergic or autoimmune responses. "I think most people that are developing these vaccines feel like the vaccine is not going to trigger MIS-C, but it's something that will be monitored for very closely both in the trials and more importantly, post-licensure," added O'Leary, from the University of Colorado. Maldonado said she'll also be on the lookout for any cases of Guillain-Barré syndrome, which is often a concern when it comes to vaccines, but she noted that no significant increases in cases were seen in any of the adult trials.
When it comes to proving benefit, the pediatric trials will focus on a different metric than the adult trials. The adult trials' primary efficacy measure was to compare how many vaccinated people wound up sick with COVID-19 symptoms compared with those who received the placebo and whether the vaccine impacted the severity of illness. Since children rarely are hospitalized due to COVID-19, the vaccine's ability to reduce severe cases would be hard to measure unless the trials enrolled an enormous number of children.
Instead, Pfizer's and Moderna's adolescent trials will focus on evaluating participants' immune response by measuring antibodies, according to Pfizer's spokeswoman and Moderna's clinical trial website.
Scientists haven't yet identified an "immune correlate of protection," which is usually defined to be the level of antibodies in the blood at which they can feel confident that a person is going to be protected from infection. Some vaccines that have been approved, like the one for measles, have an immune correlate of protection identified, while others don't.
In the absence of a definitive immune correlate of protection, the trials would compare antibody levels in children with those found in adults and extrapolate that the efficacy should then be similar. The FDA and advisory groups like the CDC's Advisory Committee on Immunization Practices would then need to discuss whether the evidence is compelling. If scientists are able to identify an immune correlate of protection, however, "and you can demonstrate that kids get that with the vaccine, that's even more satisfying," O'Leary said.
One final difference in pediatric studies is the potential for lower doses. Moderna has said that it will run its studies of children under 12 testing lower doses first.
"As we go down in age, we give the smallest possible dose of vaccine that we think is reasonable, and then we steadily increase until that point when we get that magic 'Goldilocks' level at which it works great and the side effects are tolerable," Vanderbilt's Creech explained. "I don't think one dose fits all."
A Call to Speed Pediatric Trials
Some pediatricians and infectious disease experts said they were eager for pediatric studies to move faster.
"My understanding is that the entity formerly known as Operation Warp Speed had a lot of involvement with those adult trials, but with pediatric clinical trials, they're not having the same degree of involvement," O'Leary said. "So it's more up to the manufacturers, and from my perspective, these manufacturers don't have the financial incentive to conduct these trials with the same urgency that they did with the adult trials."
Stanford's Maldonado added that she's concerned that there's not as much pressure on the manufacturers to recruit children of diverse backgrounds as there was for the adult trials."I think it's important to get those kids in to understand factors around the actual vaccine and also to get buy-in of those communities where we're seeing more hesitancy. We want to make sure they are feeling comfortable about being represented," she said.
While O'Leary is not as confident as Fauci that we'll see Pfizer's data on younger kids by September, he feels very optimistic about the availability of a vaccine in the coming months for kids as young as 12, who tend to get sicker than the younger age group.
"I think that's a really big deal," he said.
Caroline Chen covers healthcare for ProPublica. She is currently reporting on the coronavirus pandemic.