The school's experience provides a window into the hardships millions of families across the country have endured since last March, and exemplifies why education isn't the only reason many Americans want schools to fully reopen.

This article was published on Tuesday, March 23, 2021 in Kaiser Health News.

By Giles Bruce

After covid-19 forced Olivia Goulding’s Indiana middle school to switch back to remote learning late last year, the math teacher lost contact with many of her students. So she and some colleagues came up with a plan: visiting them under the guise of dropping off Christmas gifts.

This story also ran on USA Today. It can be republished for free.

One day in December, they set out with cards and candy canes and dropped by the homes of every eighth grader at Sarah Scott Middle School in Terre Haute, a city of more than 60,000 near the Illinois border where both Indiana State University and the federal death row are located. They saw firsthand how these kids, many living in poverty and dysfunctional families, were coping with the pandemic’s disruptions to their academic and social routines.

“You just have a better concept of where they’re coming from and the challenges they really do have,” Goulding said. “When you’re looking at that electronic grade book and Sally Lou hasn’t turned in something, you remember back in your mind: ‘Oh, yeah, Sally Lou was home by herself, taking care of three younger siblings when I stopped by, and I spotted her helping Johnny with his math and she was helping this one with something else.’”

The school’s experience provides a window into the hardships millions of families across the country have endured since last March, and exemplifies why education isn’t the only reason many Americans want schools to fully reopen. Schools like Sarah Scott help hold their communities together by providing households with wide-ranging support, which has become much tougher during the pandemic.

“A lot of our students are struggling emotionally,” said Sarah Scott’s principal, Scotia Brown. “They’re stressed because they’re falling behind in their work. Or they’re stressed because of the conditions they’re living with at home.”

Even before the coronavirus struck, kids at Sarah Scott faced significant obstacles that compounded the normal social challenges and surging hormones of middle school. They live in Vigo County, which has the state’s highest rate of child poverty and high rates of child neglect. Nearly 90% of students qualified for free or reduced-fee lunches. Some showed up needing to shower and change at the school, which has a food pantry that also offers clothes and hygiene products.

Things got more difficult for students when covid threw Sarah Scott’s normal schedule into disarray. Initially, the school went totally remote, then moved to partially in-person for the start of the 2020-21 school year. When covid spiked in October, Sarah Scott went remote again because not enough substitute teachers could fill in for quarantining staff. Since January, students have been spending part of each week in the school building, with no plans as of early March to open fully.

Kids were given laptops to use at home. But internet access can be problematic.

“Internet has been the worst,” said Samantha Riley, mother of seventh grader Mariah Pointer. “So many people are on it, it shuts down all the time.”

When that happens, she uses the Wi-Fi emitting from the school bus that sits in front of her apartment complex, one of several parked around the community to fill the gaps.

Even when the internet works, though, keeping kids on task at home isn’t easy. Heather Raley said she often cries from the stress of trying to make her eighth grade daughter engage online. “It just seems like we’re always butting heads over this,” Raley said. “It’s just a bigger battle getting the work done.”

As in many other communities, students are falling behind academically. Some don’t do any of their e-learning activities. Sarah Scott’s reports to child protective services for educational neglect — when caregivers aren’t getting their children to either in-person or remote classes — have more than tripled this school year.

Brown said she also worries about physical neglect and abuse, which is harder to detect when interacting with students remotely. “If you’re in an abusive home and you have to be there five days out of the week because you’re doing remote learning, you’re in that environment even more,” she said.

More time at home can also mean doing without necessities, including food.

The school helps by offering free breakfasts and lunches for in-person students and to-go lunches on remote days. Sometimes, the principal delivers boxes of groceries to students’ homes. The school recently secured a microwave for one family and an inflatable mattress for a student who’d been sharing a bed with his grandmother.

For some kids, the stress of the pandemic has worsened emotional problems and mental illness. Recently, a former Sarah Scott student who had moved out of state logged into her former teacher’s virtual class to say she planned to kill herself. The school contacted police, who checked on her. Referrals for suicidal students are up fourfold, Brown said.

School social worker Nichelle Campbell-Miller said it’s been tough counseling kids online or through text messages.

“I am all about building relationships and being in person and being able to dap you up or give you a hug and be like, ‘Hey, what’s up?’” she said, using a term for various greetings like fist bumps or elaborate handshakes. “So being online is extremely difficult for me, because you can’t really tell the tone of your student. When I’m talking to you in person, I can read your body language and I can gauge where you’re at.”

Right now, she said, the psychological well-being of her middle schoolers is even more important than education.

Many students, such as eighth grader Trea Johnson, come up against challenges on both fronts. Trea transferred to Sarah Scott two days before covid ended in-person learning.

“We struggle with school anyway,” said his mom, Kathy Poff. “Then when this pandemic came along, it just knocked our feet out from under us.”

His grades plunged. He began to hate school, Poff said. He didn’t attend his daily video meetings with his teachers. His mother fought with him to complete his online assignments.

“I usually get pretty bored,” said Trea, whose long, straight hair sometimes falls over his eyes.

Poff found him a therapist he meets with once a week. She said his mood and academic productivity have improved. He wants to be a computer programmer and has been coding in his spare time lately. She also moved his computer into her bedroom so she could better monitor him and has started paying him to do his schoolwork.

“I can’t even imagine what it would be like to be a 13-year-old going through this pandemic,” said Poff, 51, a single mother. “They’re going through changes anyway, adjusting to adolescence and figuring out who they are, and they don’t even have a social group to figure that out.”

Goulding, the math teacher, said she’s glad she and her co-workers can help provide stability and continuity during this trying period. One recent night, for example, she got a call from a truant boy’s grandmother, who said she was in poor health and raising him alone. The next day, the principal and social worker picked him up and drove him to school.

Still, Goulding lamented not seeing her most vulnerable students on the days when they are remote.

“How do I check on my kids? How do I make sure they’re eating? How do I make sure,” she paused to compose herself, her voice quavering, “they’re safe?

“You’re no longer thinking about, ‘How are they doing on their polynomials?’ You’re thinking about, you know, the reality of life.”

Immigrant populations are eager to be vaccinated but the barriers are steep, including lower rates of technology literacy and how well they speak English.

This article was published on Tuesday, March 23, 2021 in Kaiser Health News.

By Rachana Pradhan

In late February, a week after Virginia launched a centralized website and call center for COVID-19 vaccine preregistration, Zowee Aquino alerted the state to a glitch that could prove fatal for non-English speakers trying to secure a shot.

Callers who requested an interpreter on its new 1-877-VAX-IN-VA hotline would be put on hold briefly and then patched through. Then the line would automatically hang up on them.

It was a startling discovery for Aquino, a community health manager, and her colleagues at NAKASEC Virginia, a nonprofit that works with Asian Americans across the state. The glitch was a "direct barrier to access," she wrote to senior state officials, "and must be addressed immediately."

But that wasn't the only problem. Only two languages were offered when callers dialed in — "press 1 for English" or "press 2 for Spanish." But Virginia is home to speakers of many other languages — Chinese, Korean, Vietnamese, Arabic, Mongolian, Amharic and dozens more — who would need the help of translators to get their place in line for a vaccine.

"There's so much attention to, let's translate flyers, right? We're like, what's the point of translating a flyer that says you can call 'VAX in VA' and we have all these languages, when the phone line doesn't work consistently, or it's not even set up well for non-English, non-Spanish-speaking populations?" said Sookyung Oh, the group's Virginia director.

Concerns about equity have loomed large in the nation's mass COVID vaccination effort. Distribution of doses has been spotty among underserved populations, many of whom have been hit disproportionately by COVID hospitalizations and deaths. As Aquino found, barriers to vaccinating those groups begin with providing basic information about the shots and getting people registered.

Several individuals in interviews said the immigrant populations they work with, including Asians and Latinos, are eager to be vaccinated. But the barriers are steep, including lower rates of technology literacy and how well they speak English, if at all.

"Especially in stressful situations, they are not trying to struggle through English," said Oh, who described trying to secure a vaccine appointment for her mother — a Korean woman who lives in Philadelphia — as a "complete clusterf***" because the city's registration portal isn't available in that language.

President Joe Biden announced this month that by May 1 the federal government would launch a website and new call center to help people find vaccine appointments, but officials have declined to elaborate on whether the website will be translated into non-English languages and which languages will be available through the call center. A spokesperson for the Department of Health and Human Services did not respond to questions about language access.

Approximately 5.3 million U.S. households have limited English proficiency, according to the U.S. Census 2019 American Community Survey. And, it found, nearly 68 million people speak a language other than English at home.

The CDC's website for COVID-19 vaccine information is comprehensively translated into four languages: Chinese, Korean, Spanish and Vietnamese. The federal agency has drafted other flyers about vaccines, but which languages the materials are available in varies considerably. A "Facts about COVID-19 Vaccines" flyer is translated into nearly two dozen languages, including Arabic, French, Tagalog, Russian, Somali and Urdu. Other documents are not translated at all; if they are, Spanish is the most common translation.

"It's really concerning that the information is not available in different languages," said Bert Bayou, director of the Washington, D.C., chapter of African Communities Together, which works with immigrants across the metropolitan area.

Virginia in mid-February released a centralized online preregistration system and a new hotline for vaccinations, a full month after residents 65 and older and those with certain medical conditions could register for appointments. As of mid-March, the state health department's portal could be translated only into Spanish, spoken by nearly 8% of the state's population. Similarly, the District of Columbia's vaccine preregistration website that launched this month was initially available only in English, although officials were working to have it translated into additional languages before the month is out.

Any agency that fails to inform limited-English speakers of how to access their services — in this case, vaccinations — could be found to have violated federal laws that prohibit discrimination in healthcare on the basis of race, color, national origin and other factors, said Mara Youdelman, a managing attorney at the National Health Law Program, a civil rights advocacy organization.

"If they launch a website and they choose not to have it translated into multiple languages, I would say at a minimum that they should have some taglines on the webpage about where to get more information," Youdelman said. Even beyond the law, making the vaccination process as accessible as possible to non-English speakers is "the necessary thing to do and the right thing to do."

Otherwise, she said, "we're not going to reach the herd immunity we all want and need to get life back to normal."

Fairfax County, the most populous county in Virginia, maintained its own registration portal, but officials only on March 15 launched a Spanish registration website, two months after the state significantly broadened vaccine eligibility. In the interim, Spanish speakers had been directed to download a PDF questionnaire, and then call a phone line to relay their information for an eventual appointment. Roughly 14% of the county's population identifies as Spanish-speaking, according to the 2019 American Community Survey.

In Virginia, many immigrants are left with the heavily promoted VAX-IN-VA hotline, where access to interpretation services was uneven. The state eventually added a "press 3" menu option for help in a different language — although the "press 2" and "press 3" prompts are spoken in English — that allowed non-English and non-Spanish speakers to more easily connect with interpreters in more than 100 languages.

Yet their needs often fall to the back of the line because the languages are so discrete and, after Spanish, there's no "obvious" third language that's prioritized, Oh said. Census data shows that more than 1.3 million Virginians speak a language other than English at home, including about 310,000 who speak Asian and Pacific Island languages and 295,000 who speak Indo-European languages.

A state spokesperson said that, upon reviewing call logs, in some situations the callers were the ones who may have hung up while on hold, and other times call center agents may have accidentally hung up. Records showed that this occurred fewer than 10 times, mostly all during the first week.

"We had a small handful of issues but looking forward we have not uncovered any ongoing issues," Vaccinate Virginia spokesperson Dena Potter wrote in an email. She did not respond to questions about whether state officials planned to translate Virginia's preregistration portal into other languages and whether the system might violate federal civil rights laws.

Nationally, Asian Americans have had lower COVID mortality rates than other minorities, including Black and Latino Americans. However, there are troubling signs that underscore the urgency to boost vaccination rates. According to data compiled by the American Public Media Research Lab, the four-week period between early February and early March was the deadliest stretch of the pandemic for Asian, Latino, white and Indigenous Americans. Roughly 3,730 new deaths were reported among Asian Americans. Among Hispanics, 16,780 new deaths were reported.

To figure out whether they're eligible and to get vaccine appointments, non-English speakers rely on the clinics that treat them, English-speaking friends and family, and other nonprofits that serve immigrant communities. Without reliable information across languages, health centers and other nonprofits worry about what fills the void: Rumors and false information proliferate not only on U.S. social media platforms but apps like WhatsApp and WeChat used around the world.

"They're not your Facebook and your Instagram chats," said Andrea Caracostis, CEO of the HOPE Clinic in Houston, a federally qualified health center that treats patients from at least 60 countries. "I think language issues and misinformation from abroad is going to erode a lot of the work that we do."

The Houston area is home to one of the largest Vietnamese populations in the country. In late January, the clinic prioritized Vietnamese seniors for shots after receiving about 500 doses from the city. To make it happen, Caracostis said, they partnered with local Vietnamese doctors, nurses and even medical students to help. Clinic staff members translated immunization release forms before patients showed up.

"It's going to take a village," she said.

Groups are assembling teams of volunteers to make preregistration calls and appointments, and setting up pop-up registration sites in church parking lots in poorer neighborhoods.

"You can answer questions right on the spot," said Wanda Pierce, co-chair of Arlington County's Complete Vaccination Committee, a 40-plus-person group formed to ensure equitable distribution of vaccines in that Virginia suburb of Washington. County officials have organized preregistration pop-ups, typically done alongside other services for low-income residents, such as clothing and food distribution. A recent pop-up held at Macedonia Baptist Church, a Black church in a lower-income area of the county, saw a handful of limited-English speakers preregister for vaccines, according to organizers.

Recent polling has found that vaccine hesitancy is dipping among minority groups; however, they are still more likely to take a "wait and see" approach than white Americans. And many are struggling to secure appointments.

A March poll from KFF found that among adults who have gotten at least one dose of vaccine, 39% said someone else had helped them find or schedule an appointment. Hispanic adults were more likely than white adults to say they did not have enough information about where or when they could get vaccinated.

Spanish-language needs and outreach to Latinos haven't been adequately prioritized, said Luis Angel Aguilar, the Virginia state director of CASA. In addition to language access, "there's not enough communication and information now on where and who to call," he said.

"It's so easy for people to give up and say, 'You know, I tried,'" added Nancy White, president of the Arlington Free Clinic, which treats low-income minorities and counts Spanish, Mongolian and Amharic speakers among its patients.

The clinic, instead of signing up patients through Virginia's preregistration portal, is using its own system to get its patients vaccinated since the clinic receives an allocation of doses directly from the county. After an early pilot program to vaccinate seniors 75 and older, Arlington Free Clinic this month began vaccinating people 65 and up and those with chronic medical conditions. It relies on over 100 volunteer interpreters to help patients navigate the healthcare system.

"You can do it," White said of getting around language issues, "but it takes a lot of time and a lot of manpower."

Rachana Pradhan: rpradhan@kff.org, @rachanadixit

CMS says the change was designed to give patients and doctors more options and help lower costs.

This article was published on Tuesday, March 23, 2021 in Kaiser Health News.

By Susan Jaffe

A cost-saving change in Medicare launched in the final days of the Trump administration will cut payments to hospitals for some surgical procedures while potentially raising costs and confusion for patients.

For years, the Centers for Medicare & Medicaid Services classified 1,740 surgeries and other services so risky for older adults that Medicare would pay for them only when they were admitted to the hospital as inpatients. Under the new rule, the agency is beginning to phase out that requirement and, on Jan. 1, 266 shoulder, spine and other musculoskeletal surgeries were crossed off what's called the "inpatient-only list." By the end of 2023, the list — which includes a variety of complicated procedures including brain and heart operations — is scheduled to be gone.

CMS officials said the change was designed to give patients and doctors more options and help lower costs by promoting more competition among hospitals and independent ambulatory surgical centers. But they forgot one thing.

While removing the surgeries from the inpatient-only list, the government did not approve them to be performed anywhere else. So patients will still have to get the care at hospitals. But because the procedures have been reclassified, patients who have them in the hospital don't have to be considered admitted patients. Instead, they can receive services on an outpatient basis.

CMS pays hospitals less for care provided to beneficiaries who are outpatients, so the new policy means the agency can pay less than it did last year for the same surgery at the same hospital and Medicare outpatients will usually pick up a bigger part of the tab.

"The impetus for this is for Medicare to save money," said Dr. James Huddleston, a professor of orthopedic surgery at the Stanford University Medical Center and the chair of the American Association of Hip and Knee Surgeons' Health Policy Council. "The oldest trick in the book is to say the patients don't need to be cared for in an expensive hospital setting."

But since seniors will still have to go to the hospital, "it's sort of a distinction without a difference," he added.

"This is not about a different care setting, or giving more choice to providers," said Judith Stein, executive director of the Center for Medicare Advocacy. "It's about Medicare billing practices that will further confuse hospital patients."

When unveiling the final rule in December, then-CMS Administrator Seema Verma said the change would give seniors and their physicians more options for care "without micromanagement from Washington." She promised the new policy would also let seniors avoid hospitals, especially during the COVID-19 pandemic, and free up needed beds.

CMS did add services that it will cover when provided by ambulatory surgery centers this year, a spokesperson said last month, but those don't include procedures that were on the inpatient-only list.

Dr. Catherine MacLean, chief value medical officer at New York City's Hospital for Special Surgery, said CMS should have tested the change as a pilot project to be sure it's safe for patients. "These are big procedures," she said, with a lot of "cutting, sewing and bleeding" that require post-surgery monitoring due to a significant risk of complications, especially for patients with multiple health problems.

The change applies to adults who have government-run Medicare insurance, but some Medicare Advantage plans sold by private companies have similar policies.

CMS officials said the change was a response to numerous requests seeking assurance that payment requirements do not override physicians' judgment and assessment of their patients' conditions. But health care groups representing millions of providers opposed it.

Even though seniors getting this care will be considered outpatients, they may still stay in the hospital overnight or longer, often on the same floor as those who are admitted, getting the same nursing care, lab tests and drugs with one big difference: their bill.

Patients admitted to the hospital typically receive an all-inclusive package of services and pay only this year's Medicare hospital deductible of $1,484 for a stay of up to 60 days. They also pay 20% of doctors' charges. Medicare picks up the rest of the bill.

Outpatient services are charged differently, with the patient typically paying 20% of the Medicare-approved amount for each service. That's one payment for the outpatient surgery plus, for example, a second payment for blood transfusions, and more payments depending on what may be included in the surgery charge and how many other separately billed items the patient needs. (And, like admitted patients, outpatients also pay 20% of doctors' charges.)

As with other outpatient services, in most cases each charge cannot exceed $1,484. "However, your total copayment for all outpatient services may be more than the inpatient hospital deductible," according to the federal government's annual guide sent to all Medicare beneficiaries.

Patients will also be hit with a "facility fee" up to several thousand dollars to cover the hospital's overhead costs, said Richard Gundling, senior vice president at the Healthcare Financial Management Association. After Medicare pays its portion, outpatients owe 20% of the facility fee. And because Medicare prescription drug plans don't cover medication ordered for hospital patients, they're treated as if they have no drug insurance and can be charged exorbitant amounts for drugs they routinely take at home.

Another item that can be tacked onto the bill for outpatients — but not admitted patients — is called "excess charges." Providers who do not accept the Medicare-approved amount as full payment can charge up to an extra 15% of that amount. Medicare pays none of these extra charges.

These surprise expenses can add up even for people who buy supplementary or Medigap health insurance to cushion the sticker shock. These private policies cover some portion of the patient's payments for Medicare-approved charges. Only the most expensive policies cover "excess charges." Otherwise, when Medicare doesn't cover something, Medigap doesn't chip in, so the patient is on the hook for the total charge.

In addition, Stein warned that the new rule will "sometimes limit their Medicare coverage when they need care after leaving the hospital." Medicare patients don't qualify for nursing home coverage even if they stay in the hospital for the required three days. That time doesn't count because they were not admitted to the hospital — something Medicare patients who are in the hospital for observation care have complained about for years, forcing some to sue the government for a change.

Outpatients may also find it more difficult to get home health care. Medicare pays home care agencies more for people after a hospital inpatient stay, but those who are not admitted may have trouble finding agencies willing to serve them at Medicare's lower reimbursement, said Stein.

A procedure that was on the inpatient-only list can still be provided to an admitted hospital patient, if health care providers can justify the need based on their clinical judgment. But there's no guarantee that CMS will agree the admission was necessary and cover it.

Since the Biden administration inherited the new policy, critics are hoping CMS will rescind it.

"The decision ought to be made by the surgeons in consultation with their patients," said Dr. Joseph Bosco, a vice chair of NYU Langone Health's department of orthopedic surgery and president of the American Academy of Orthopaedic Surgeons. "We don't need the federal government or health insurance companies interfering in the doctor-patient relationship."

Susan Jaffe: Jaffe.KHN@gmail.com, @SusanJaffe

Rumors on campus abound about students who are exploiting loopholes and getting vaccinated against COVID in order to party and go on spring break.

This article was published on Monday, March 22, 2021 in Kaiser Health News.

By Fred Mogul

Hawaii, Florida, Seattle and the South of France are on the minds of New York City college students. Those are some of the destinations that undergrads mentioned when asked where they'd go for spring break, if they weren't grounded by COVID-19.

"I'd be getting a house with 10 people, with a pool, and we'd be going crazy in Miami," said Sile Ogundeyin, 22, a senior economics major at Columbia University, who was sitting on the steps of the library with his friends.

"I was supposed to be in London for study abroad this semester, so I probably would've gone someplace close to there for spring break — maybe in southern Europe," said New York University sophomore Aliyah Verdiner, 20, a business major from Brooklyn. "That would've been a lot of fun, but I guess not this year."

Some students, however, are being more adventurous. Rumors on campus abound about students who are exploiting loopholes and getting vaccinated against COVID in order to party and go on spring break.

"She's going skiing in Vermont with a bunch of friends," Aliza Abusch-Magder said of her roommate, whom she declined to name. "She's very excited to be going to parties and — how do I say this? — making up for lost time in quarantine."

Abusch-Magder said her roommate was "calling on something in her medical history that doesn't actually affect her day-to-day, to qualify for the vaccine." Other young people shared similar reports, such as of peers getting vaccinated who had asthma in their past but not their present.

"I just don't think it's ethical," said Abusch-Magder, a first-year English major from Atlanta. But she also expressed doubt that such behavior is widespread at Columbia.

"I think here it's an outlier, and I think at some schools it's standard," she said, echoing what she'd heard from high school friends on other campuses. "There's a very high standard of ethics here, and there's a lot of discourse on it."

It's impossible to know how often college students are getting vaccinated. Rumors about it happening illegitimately are widespread, but most of the stories appear to be secondhand. And many aren't so nefarious on closer examination, because some vaccinated students are actually eligible; they work in labs or healthcare settings, or they have underlying health issues that put them at high risk for severe COVID.

"I put in my height. I put in my weight. And it said I was obese," said Shira Michaeli, who was sitting on the Columbia library steps, "attending" an online lecture on human rights on her laptop. Obesity qualifies you for early vaccination in at least 29 states.

Michaeli is a bit ambivalent, because she feels healthy, and she's comfortable with her body weight, which she believes is not really a "comorbidity." But she said she has had breathing problems ever since suffering a bad case of COVID last year. And she also plans to be a camp counselor this summer. So she feels she qualifies for the vaccine on a few counts, even if her body mass index is what officially qualifies her.

"I think, for a while, I was really insecure about it, and then I thought, 'Listen, for most of my life [my weight] has been bad for me. Clothing hasn't been my size. People haven't been … " Michaeli's voice trailed off. "But for once in my life, it'll benefit me, instead of hurting me."

The 19-year-old Bronx native was scheduled to receive her first shot the next day, so she was several weeks away from being fully vaccinated. She said it wouldn't have mattered for spring break, anyway, because she had planned to stay close to her dorm, working on papers, perhaps sleeping in a little more than usual, and getting coffee with friends.

"I'm excited to get vaccinated, but I don't think it's going to give me any freedom other people don't have," Michaeli said. "I think I'll be a little less anxious, but I don't think it's going to change any of my behavior. I think there are plenty of people being unsafe, so I don't have any wiggle room to be unsafe."

Down in Greenwich Village, at NYU, there's very little tension among the vaccine haves and have-nots when it comes to spring break — because there isn't much of a spring break. It's a single day, added to create a long weekend in March.

But that doesn't keep Simran Hajarnavis from dreaming.

"If there wasn't COVID, and there was a real spring break, I'd probably try to plan something with my friends," she said, turning to one of them and asking: "Want to go to Hawaii?"

Sitting in Washington Square Park, Hajarnavis and her girlfriends said they're not too worried about being vaccinated right away, as long as they get their shots in time to study abroad in their upcoming junior year.

A few yards away, Aishani Ramireddy said she has already gotten her vaccine, but she's not doing anything differently from any other student.

"It's definitely weird," she said. Ramireddy's mother is a physician in Los Angeles. She said that, when she was home, she got the vaccine at the end of the day, at her mother's office, because there were unused doses that would have been thrown out. Still, she feels conflicted about it.

"It just felt like such a privilege to even have that as an option," Ramireddy said.

Another NYU student, Anna Domahidi, from Chicago, also had an option to get a vaccine, but declined. She doesn't hold it against her friend Ramireddy, but she does question another friend, who she said talked up his childhood asthma to qualify for a shot. Domahidi still thinks he crossed an ethical line, even though he lives with a parent who's immunocompromised: "That's, like, a little better in my mind, but I don't know."

This story comes from KHN's health reporting partnership with NPR.