Public health experts cited many reasons for the difference, including that women make up three-quarters of the workforce in healthcare and education, sectors prioritized for initial vaccines.

This article was published on Monday, April 12, 2021 in Kaiser Health News.

By Laura Ungar  

Mary Ann Steiner drove 2½ hours from her home in the St. Louis suburb of University City to the tiny Ozark town of Centerville, Missouri, to get vaccinated against COVID-19. After pulling into the drive-thru line in a church parking lot, she noticed that the others waiting for shots had something in common with her.

"Everyone in the very short line was a woman," said Steiner, 70.

Her observation reflects a national reality: More women than men are getting COVID vaccines, even as more men are dying of the disease. KHN examined vaccination dashboards for all 50 states and the District of Columbia in early April and found that each of the 38 that listed gender breakdowns showed more women had received shots than men.

Public health experts cited many reasons for the difference, including that women make up three-quarters of the workforce in healthcare and education, sectors prioritized for initial vaccines. Women's longer life spans also mean that older people in the first rounds of vaccine eligibility were more likely to be female. But as eligibility expands to all adults, the gap has continued. Experts point to women's roles as caregivers and their greater likelihood to seek out preventive healthcare in general as contributing factors.

In Steiner's case, her daughter spent hours on the phone and computer, scoping out and setting up vaccine appointments for five relatives. "In my family, the women are about a million times more proactive" about getting a COVID vaccine, Steiner said. "The females in families are often the ones who are more proactive about the health of the family."

As of early April, statistics showed the vaccine breakdown between women and men was generally close to 60% and 40% — women made up 58% of those vaccinated in Alabama and 57% in Florida, for example.

States don't measure vaccinations by gender uniformly, though. Some break down the statistics by total vaccine doses, for example, while others report people who have gotten at least one dose. Some states also have a separate category for nonbinary people or those whose gender is unknown.

A handful of states report gender vaccination statistics over time. That data shows the gap has narrowed but hasn't disappeared as vaccine eligibility has expanded beyond people in long-term care and healthcare workers.

In Kentucky, for instance, 64% of residents who had received at least one dose of vaccine by early February were women and 36% were men. As of early April, the stats had shifted to 57% women and 43% men.

In Rhode Island — one of the states furthest along in rolling out the vaccines, with nearly a quarter of the population fully vaccinated — the gap has narrowed from 30 percentage points (65% women and 35% men) the week of Dec. 13 to 18 points (59% women and 41% men) the week of March 21.

A few states break the numbers down by age as well as gender, revealing that the male-female difference persists across age groups. In South Carolina, for example, the gender breakdown of vaccine recipients as of April 4 was slightly wider for younger people: 61% of vaccinated people ages 25-34 were women compared with 57% female for age 65 and older.

Dr. Elvin Geng, a professor at the medical school at Washington University in St. Louis, said women of all age groups, races and ethnicities generally use health services more than men — which is one reason they live longer.

Arrianna Planey, an assistant professor who specializes in medical geography at the University of North Carolina-Chapel Hill, said it's often women who manage medical appointments for their households so they may be more familiar with navigating health systems.

Decades of research have documented how and why men are less likely to seek care. A 2019 study in the American Journal of Men's Health, for example, examined healthcare use in religious heterosexual men and concluded masculine norms — such as a perception that they are supposed to be tough — were the main reason many men avoided seeking care.

Attitudes about the COVID pandemic and the vaccines also affect who gets the shots.

Dr. Rebecca Wurtz, director of public health administration and policy at the University of Minnesota, said women have been more likely to lose jobs during the pandemic, and in many cases bear the brunt of teaching and caring for children at home.

"Women are ready for this to be done even more than men are," Wurtz said.

Political attitudes, too, play a part in people's views on coping with the pandemic, experts said. A Gallup poll last year found that among both Democrats and Republicans, women were more likely to say they took precautions to avoid COVID, such as always practicing physical distancing and wearing masks indoors when they couldn't stay 6 feet apart from others.

In a recent national poll by KFF, 29% of Republicans and 5% of Democrats said they definitely would not get the shot.

Paul Niehaus IV of St. Louis, who described himself as an independent libertarian with conservative leanings, said he won't get a COVID vaccine. He said the federal government, along with Big Tech and Big Pharma, are pushing an experimental medicine that is not fully approved by the Food and Drug Administration, and he doesn't trust those institutions.

"This is a freedom issue. This is a civil liberties issue," said Niehaus, a 34-year-old self-employed musician. "My motto is 'Let people choose.'"

Steiner, who plans to retire at the end of the month from editing a magazine for the Catholic Health Association, said she was eager to be vaccinated. She has an immune disorder that puts her at high risk for severe illness from COVID and hasn't seen some of her grandchildren in a year and a half.

But she said some of the men in her life were willing to wait longer for the shots, and a few nephews haven't wanted them. She said her brother, 65, received the one-shot Johnson & Johnson vaccine in early April after her daughter made it easy by arranging it for him.

Steiner, who has now received both doses of the Moderna vaccine, said she doesn't regret taking the more difficult step of traveling five hours round trip to get her first shot in February. (She was able to find a closer location for her second dose.)

"It's for my safety, for my kids' safety, for my neighbors' safety, for the people who go to my church's safety," she said. "I really don't understand the resistance."

Laura Ungar: lungar@kff.org, @laura_ungar

Shortages were compounded by the federal government's failure to maintain a national stockpile of personal protective equipment.

This article was published on Friday, April 9, 2021 in Kaiser Health News.

By Jessica Glenza, The Guardian

Dr. Anthony Fauci thanked America's healthcare workers, who "every single day put themselves at risk" during the pandemic, even as he acknowledged that PPE shortages had contributed to the deaths of more than 3,600 of them.

KHN and The Guardian are tracking healthcare workers who died from COVID-19 and writing

"We rightfully refer to these people without hyperbole — that they are true heroes and heroines," he said in an exclusive interview with The Guardian. The deaths of so many health workers from COVID-19 are "a reflection of what healthcare workers have done historically, but putting themselves in harm's way by living up to the oath they take when they become physicians and nurses," said Fauci.

KHN and The Guardian have tracked healthcare workers' deaths throughout the pandemic in the "Lost on the Frontline" database. More than 3,600 health worker deaths have been tallied in the database, considered the most authoritative accounting in the country.

Personal protective equipment — including gloves, gowns and critical masks — have been in short supply since the pandemic began and heightened the toll. The U.S. is the world's largest importer of PPE, which made it especially vulnerable to the demand shock and export restrictions that hit the global market last spring.

"During the critical times when there were shortages was when people had to use whatever was available to them," said Fauci. "I'm sure that increased the risk of getting infected among healthcare providers."

Shortages were compounded by the federal government's failure to maintain a national stockpile of personal protective equipment, and the Trump administration's refusal to order more domestic manufacturing of PPE. That left health workers to use trash bags as gowns, reuse N95s for weeks and, at times, go totally without gloves.

The shortages led to protests by health workers, who said working amid the pandemic without equipment left them like "sheep going to slaughter." Nina Forbes, a nurse at an assisted living facility, was forced to wear a trash bag at times, according to her daughter, and later die.

Nearly 560,000 Americans have died in the COVID pandemic, with many more experiencing long-term symptoms of COVID.

Health workers have been especially vulnerable through the pandemic, as they have treated patients through early waves when the lack of personal protective equipment was especially acute, through summer surges and a disastrous peak in the winter.

A study of health workers in the U.S. and the United Kingdom in The Lancet found health workers are three times more likely than the general public to become infected with the COVID virus, with disproportionate impacts on minority health workers.

"It's very clear when you just go to the media and see the images on television — the stress and the strain on the faces of healthcare providers, nurses, doctors, other people involved in the healthcare enterprise," said Fauci.

Nevertheless, the U.S. government has failed to systematically count health worker deaths. Members of Congress, the Health and Human Services Department and academic reports have cited The Guardian and KHN's reporting as the most comprehensive. A growing chorus of policy experts and unions have called for a comprehensive count of health worker deaths.

"We certainly want to find an accurate count of the people who die," said Fauci, without noting when the government should undertake such an effort. "Certainly, that's something I think would fall under the auspices of the federal government."

Even as the vaccine rollout picks up speed, health workers continue to be imperiled. More than 400 died between the time the rollout began and late February. Infections among vaccinated health workers have steeply declined, but because deaths are a lagging indicator of the spread of COVID, some health workers will have been sickened before widespread vaccination.

At the same time, immunity to coronaviruses generally wanes over time and variants may blunt the efficacy of some vaccines. A global shortage of vaccines means dozens of poor nations have not inoculated a single person. Advocates argue this has led to a global "vaccine apartheid," which will contribute to the continued emergence of variants. Both scenarios could imperil health workers anew and necessitate a new round of adult mass vaccination.

Studies into the duration of immunity for vaccines, and variants' impact on vaccines, are ongoing. "If we're going to need to do boosting with a variant-specific boost, [we] will be prepared for it because we're already doing a study," Fauci said, with such research taking place at the National Institute of Allergy and Infectious Diseases, which he leads. Even so, "it looks like our ability to protect against variants with the standard vaccine might be better than we anticipated."

Regardless of how future vaccination campaigns play out, Fauci said, U.S. policymakers should learn from what has transpired over the past year.

"We better make sure the lesson we will learn is that we will never again be in a situation where people who are putting their health and their safety on the line don't have the appropriate equipment to protect themselves safely," he said.

Jessica Glenza, The Guardian: @JessicaGlenza

In the preceding weeks, as covid made its first advance through California, Gov. Gavin Newsom had called on cities and counties to persuade hotel operators to open their doors to people living on the streets whose age and health made them vulnerable. But in Santa Rosa, a town that thrives on tourist dollars, city leaders knew they would never find enough owners to volunteer their establishments.

By Angela Hart

SANTA ROSA, Calif. — They knew the neighborhood would revolt.

It was early May, and officials in this Northern California city known for its farm-to-table dining culture and pumped-up housing prices were frantically debating how to keep covid-19 from infiltrating the homeless camps proliferating in the region’s celebrated parks and trails. For years, the number of people living homeless in Santa Rosa and the verdant hills and valleys of broader Sonoma County had crept downward — and then surged, exacerbated by three punishing wildfire seasons that destroyed thousands of homes in four years.

Seemingly overnight, the city’s homeless crisis had burst into view. And with the onset of covid, it posed a devastating health threat to the hundreds of people living in shelters, tents and makeshift shanties, as well as the service providers and emergency responders trying to help them.

In the preceding weeks, as covid made its first advance through California, Gov. Gavin Newsom had called on cities and counties to persuade hotel operators to open their doors to people living on the streets whose age and health made them vulnerable. But in Santa Rosa, a town that thrives on tourist dollars, city leaders knew they would never find enough owners to volunteer their establishments. City Council member Tom Schwedhelm, then serving as mayor, settled on an idea to pitch dozens of tents in the parking lot of a gleaming community center in an affluent neighborhood known as Finley Park, a couple of miles west of Santa Rosa’s central business district.

Neighborhood residents weren’t keen on the idea of accepting homeless people into their enclave of tree-lined streets and sleepy cul-de-sacs. Yet in short order, thousands of residents and businesses received letters notifying them of the city’s plans to erect 70 tents that could shelter as many as 140 people at the Finley Community Center, a neighborhood jewel that draws scores of families and fitness enthusiasts to its manicured picnic grounds, sparkling pool and tennis courts.

The backlash was fierce. For three hours on a Thursday evening in mid-May, Santa Rosa officials defended their plans as hundreds of residents flooded the phone lines to register their discontent.

“Will there be a list of everybody who decided to do this to us and our park, in case we want to vote them out?” one resident barked.

“This is a family neighborhood,” another fumed.

“How can we feel safe using our park?” others pleaded.

In Santa Rosa, like so many other communities, strenuous neighborhood objections typically would drive a stake through a proposal for homeless housing and services. Not this time. Elected officials were not asking; they were telling. The project would move ahead.

“Go ahead and vote me out,” said Schwedhelm, recounting his mindset at the time. “You want to shout at me and get angry? Go ahead. It’s important for government to listen, but the reality is these are our neighbors, so let’s help them.”

Within days, the spacious parking lot at the Finley Community Center was cordoned off with green mesh fencing. Inside, spaced 12 feet apart, were 68 blue tents, each equipped with sleeping bags and storage bin. A neat row of portable toilets lined one side of the encampment, and it was fitted throughout with hand-washing stations and misters for the summer heat.

The city contracted with Catholic Charities of Santa Rosa to manage the camp, and social workers fanned out to the city shelters and unsanctioned encampments, where they found dozens of takers. The first dozen residents were in their tents four days after the site was approved, and the population quickly swelled to nearly 70. In exchange for shelter, showers and three daily meals, camp residents agreed to an 8 p.m. curfew and a contract pledging to honor mask and physical-distancing requirements and act as good neighbors.

Santa Rosa’s tent city opened May 18. And, not too long after, something remarkable happened. Finley Park residents stopped protesting and started dropping off donations of goods — food, clothing, hand sanitizer. The tennis and pickleball courts, an afternoon favorite for retirees, were bustling again. Parents and kids once more crowded the nearby playground.

And inside that towering green perimeter, people started getting their lives together.

From May to late November, Santa Rosa would spend $680,000 to supply and manage the site, a six-month experiment that would chart a new course for the city’s approach to homeless services. As cities across California wrestle with a crisis of homelessness that has drawn international condemnation, the Santa Rosa experience suggests a way forward. Rather than engage in months of paralyzing discussion with neighborhood opponents before committing to a housing or shelter project, city officials decided their role was to lead and inform. They would identify project sites and drive forward, using neighborhood feedback to tailor improvements to a plan — but not to kill it.

It was a watershed moment of action that would echo across Sonoma County.

“We know we’re pissing off a lot of people — they’re rising up and saying, ‘Hell, no!’” said county Supervisor James Gore, president of the California State Association of Counties. “But we can’t just keep saying no. That’s been the failed housing policy of the last 30 to 40 years. Everybody wants a solution, but they don’t want to see that solution in their neighborhoods.”

‘Death by a Thousand Cuts’

About a quarter of the nation’s homeless reside in California, nearly 160,000 people living in cars, on borrowed couches, in temporary shelters or on the streets. The pandemic has exacerbated the crisis for a host of reasons, including covid-related job loss and prison releases and new capacity limits at homeless shelters.

From Los Angeles to Fresno to San Francisco and Sacramento, homeless encampments have multiplied. And without toilets or trash bins, unsanctioned encampments have become magnets for neighborhood complaints about seedy, unsanitary conditions. That leads to regular law enforcement sweeps that raze an encampment only to see it rise elsewhere.

California’s capital city offers a telling example of the dynamic. An estimated 6,000 people are living homeless in Sacramento, a population that has grown more visible since covid brought office life to a standstill. Tents and tarps crowd freeway underpasses throughout the downtown grid, accompanied by wafting piles of trash and clutter.

The mayor, Darrell Steinberg, is known as a champion on homelessness issues. During his years in the state legislature, he pushed through measures that exponentially increased funding to address homelessness and mental illness. But in more than four years as mayor he has struggled to muscle through a cohesive policy for moving people off the streets and into supportive housing.

“The problem with our approach,” Steinberg said earlier this year, “is that every time we seek to build a project, there is a neighborhood controversy. Our own constituents say, ‘Solve it, but please don’t solve it here,’ and we end up experiencing death by a thousand cuts.”

With community uproar building, he is leading the charge on a new initiative to build a continuum of city-sanctioned housing, including triage shelters, sanctioned campgrounds and permanent housing with social services. The city has allocated up to $1 million in an initial outlay for tiny homes and safe camping, but as of March had gotten consensus on just one site: a parking lot beneath a busy freeway where the city will install toilets and hand-washing stations and allow up to 150 people to set up camp.

Donta Williams, homeless the past five years, shakes his head at how long it’s taken the city to sanction a campsite. Priced out of the South Sacramento neighborhood he considers home, Williams has subsisted in a series of squalid lots, regularly packing up and moving from one to the next in response to law enforcement sweeps.

“We’ve got nowhere to go,” said Williams, 40, who is a plaintiff in a legal battle with the city over encampment sweeps. “We need housing. We need services like bathrooms and hand-washing stations. Or how about just some dumpsters so we can pick up the trash?”

A Real Job, a New Beginning

Like Sacramento, Sonoma County has battled unruly homeless encampments for years. Before the fires, the crisis was more hidden, with people sheltering in creek beds and wooded glens abutting hiking and biking trails. The wildfires of 2017, 2019 and 2020 brought many out of the backcountry. And the 5,300 homes decimated by flames meant even more people displaced.

Politicians in Sonoma County described their soul-searching over how to cut through the community gridlock when it comes to finding locations to provide housing and services.

“It’s fear and anger that you’re going to take something away from me if you build this housing — that’s a big part of it, and I saw that anger directed at me, too,” said Shirlee Zane, a vocal backer of homeless services who lost her reelection bid last year after 12 years on the county board of supervisors. “It’s a psychology we see here too often, a sense of entitlement from white middle-class people.”

In creating the Finley Park model, Santa Rosa leaders drew on a few basic tenets. Neighbors were worried about crime and drug use, so the city deployed police officers and security guards for 24/7 patrols. Neighbors worried about trash and disease; the city brought in hand-washing stations, showers and toilets. Catholic Charities enrolled dozens of camp residents in neighborhood beautification projects, giving them gift cards to stores like Target and Starbucks in exchange for picking up trash — usually $50 for a couple of hours of work.

A few times a week, a mobile clinic serviced the camp, dispensing basic health care and medications. Residents had access to virtual mental health treatment and were screened regularly for covid symptoms; only one person tested positive for the coronavirus during the 256 days the site was in operation.

“We were serious about providing access to care,” said Jennifer Ammons, a nurse practitioner who led the mobile clinic. “You can get them inhalers, take care of their cellulitis with antibiotics, get rid of their pneumonia or skin infections.”

Rosa Newman was among those who turned their lives around. Newman, 56, said she had sunk into homelessness and addiction after leaving an abusive partner years before. She moved into her designated tent in September and in a matter of days was enrolled in California’s version of Medicaid, connected to a doctor and receiving treatment for a painful bladder infection. After two months in the camp, she was able to get into subsidized housing and landed a job at a Catholic Charities homeless drop-in center.

“Before, I was so sick I didn’t have any hope. I didn’t have to show up for anything,” she said. “But now I have a real job, and it’s just the beginning.”

James Carver, 50, who for years slept in the doorway of a downtown Santa Rosa business with his wife, said he felt happy just to have a tent over his head. Channeling his energy into cleanup projects and odd jobs around camp, Carver said, his morale began to improve.

“It’s such a comfort; I’m looking for work again,” Carver, an unemployed construction worker, said in November while cleaning stacks of storage totes handed out to camp residents. “I don’t have to sleep with one eye open.”

Jennielynn Holmes, who runs Catholic Charities’ homeless services in Northern California, said the Finley Park experiment helped in ways she didn’t expect.

“This taught us valuable lessons on how to keep the unsheltered population safe, but also we were able to get people signed up for health care and ready for housing faster because we knew where they were,” Holmes said. Of the 208 people served at the site, she said, 12 were moved into permanent housing and nearly five dozen placed in shelters while they await openings.

When Santa Rosa officials conceived of the Finley site, they sold it to the community as temporary, believing covid would run its course by winter. And though covid still raged, they kept that promise and closed the site Nov. 30, then held a community meeting to get feedback. “Only three or four people called in, and they all had positive things to say,” said David Gouin, who has since retired as director of housing and community services.

Several area residents said they changed their mind about the project because of the way the site was managed.

“I was amazed I never saw anything negative at all,” said Boyd Edwards, who plays pickleball at the Finley Community Center a few times a week.

“I thought they were going to be noisy and have crap all over the place. Now, they can have it all year round for all I care,” said his friend Joseph Gernhardt.

Of the 108 calls for police service, almost all were in response to other homeless people wanting to sleep at the site when it was at capacity, records show. And there was no violent behavior, said Police Chief Rainer Navarro.

With the Finley encampment closed, Santa Rosa has expanded its primary shelter while drafting plans to set up year-round managed camps in several neighborhoods, this time with hardened structures. County supervisors, meanwhile, are using $16 million in state grants to purchase and convert two hotels into housing, and have stood their ground in pushing through two Finley Park-style managed encampments, one on county property, the other at a mountain retreat center.

The time has come, they said, to stop debating and embrace solutions.

“We have estates that sell for $20 million, and then you walk by people sleeping in tents with no access to hot food or running water,” said Lynda Hopkins, chair of the county board of supervisors. “These tiny villages — they’re not perfect, but we’re trying to provide some dignity.”

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

Two-thirds of deceased healthcare workers for whom the Lost on the Frontline project has data identified as people of color.

This article was published on Thursday, April 8, 2021 in Kaiser Health News.

By Jane Spencer, The Guardian and Christina Jewett

More than 3,600 U.S. healthcare workers perished in the first year of the pandemic, according to "Lost on the Frontline," a 12-month investigation by The Guardian and KHN to track such deaths.

Lost on the Frontline is the most complete accounting of U.S. healthcare worker deaths. The federal government has not comprehensively tracked this data. But calls are mounting for the Biden administration to undertake a count as the KHN/Guardian project comes to a close today.

The project, which tracked who died and why, provides a window into the workings — and failings — of the U.S. health system during the COVID-19 pandemic. One key finding: Two-thirds of deceased healthcare workers for whom the project has data identified as people of color, revealing the deep inequities tied to race, ethnicity and economic status in America's healthcare workforce. Lower-paid workers who handled everyday patient care, including nurses, support staff and nursing home employees, were far more likely to die in the pandemic than physicians were.

The yearlong series of investigative reports found that many of these deaths could have been prevented. Widespread shortages of masks and other personal protective gear, a lack of COVID testing, weak contact tracing, inconsistent mask guidance by politicians, missteps by employers and lax enforcement of workplace safety rules by government regulators all contributed to the increased risk faced by healthcare workers. Studies show that healthcare workers were more than three times as likely to contract COVID as the general public.

"We rightfully refer to these people without hyperbole — that they are true heroes and heroines," said Dr. Anthony Fauci in an exclusive interview with The Guardian and KHN. The COVID deaths of so many are "a reflection of what healthcare workers have done historically, by putting themselves in harm's way, by living up to the oath they take when they become physicians and nurses," he said.

Lost on the Frontline launched last April with the story of Frank Gabrin, the first known American emergency room doctor to die of COVID-19. In the early days of the pandemic, Gabrin, 60, was on the front lines of the surge, treating COVID patients in New York and New Jersey. Yet, like so many others, he was working without proper personal protective equipment, known as PPE. "Don't have any PPE that has not been used," he texted a friend. "No N95 masks — my own goggles — my own face shield."

Gabrin's untimely death was the first fatality entered into the Lost on the Frontline database. His story of working through a crisis to save lives shared similarities with the thousands that followed.

Maritza Beniquez, an emergency room nurse at Newark's University Hospital in New Jersey, watched 11 colleagues die in the early months of the pandemic. Like the patients they had been treating, most were Black and Latino. "It literally decimated our staff," she said.

Her hospital has placed 11 trees in the lobby, one for each employee who has died of COVID; they have been adorned with remembrances and gifts from their colleagues.

More than 100 journalists contributed to the project in an effort to record every death and memorialize those who died. The project's journalists filed public records requests, cross-connected governmental and private data sources, scoured obituaries and social media posts, and confirmed deaths through family members, workplaces and colleagues.

Among its key findings:

• More than half of those who died were younger than 60. In the general population, the median age of death from COVID is 78. Yet among healthcare workers in the database, it is only 59.
   
• More than a third of the healthcare workers who died were born outside the United States. Those from the Philippines accounted for a disproportionate number of deaths.
   
• Nurses and support staff members died in far higher numbers than physicians.
   
• Twice as many workers died in nursing homes as in hospitals. Only 30% of deaths were among hospital workers, and relatively few were employed by well-funded academic medical centers. The rest worked in less prestigious residential facilities, outpatient clinics, hospices and prisons, among other places.

The death rate among healthcare workers has slowed dramatically since COVID vaccines were made available to them in December. A study published in late March found that only four of 8,121 fully vaccinated employees at the University of Texas Southwestern Medical Center in Dallas became infected. But deaths lag behind infections, and KHN and The Guardian have tracked more than 400 healthcare worker deaths since the vaccine rollout began.

Many factors contributed to the high toll — but investigative reporting uncovered some consistent problems that heightened the risks faced by health workers.

The project found that Centers for Disease Control and Prevention guidance on masks — which encouraged hospitals to reserve high-performance N95 masks for intubation procedures and initially suggested surgical masks were adequate for everyday patient care — may have put thousands of health workers at risk.

The investigation exposed how the Labor Department, run by Donald Trump appointee Eugene Scalia in the early part of the pandemic, took a hands-off approach to workplace safety. It identified 4,100 safety complaints filed by healthcare workers to the Occupational Safety and Health Administration, the Labor Department's workplace safety agency. Most were about PPE shortages, yet even after some complaints were investigated and closed by regulators, workers continued to die at the facilities in question.

The reporting also found that healthcare employers were failing to report worker deaths to OSHA. The data analysis found that more than a third of workplace COVID deaths were not reported to regulators.

Among the most visceral findings of Lost on the Frontline was the devastating impact of PPE shortages.

Adeline Fagan, a 28-year-old OB-GYN resident in Texas, suffered from asthma and had a long history of respiratory ailments. Months into the pandemic, her family said, she was using the same N95 mask over and over, even during a high-risk rotation in the emergency room.

Her parents blame both the hospital administration and government missteps for the PPE shortages that may have contributed to Adeline's death in September. Her mother, Mary Jane Abt-Fagan, said Adeline's N95 had been reused so many times the fibers were beginning to disintegrate.

Not long before she fell ill — and after she'd been assigned to a high-risk ER rotation — Adeline talked to her parents about whether she should spend her own money on an expensive N95 with a filter that could be changed daily. The $79 mask was a significant expense on her $52,000 resident's salary.

"We said, you buy this mask, you buy the filters, your father and I will pay for it. We didn't care what it cost," said Abt-Fagan.

She never had the opportunity to use it. By the time the mask arrived, Adeline was already on a ventilator in the hospital.

Adeline's family feels let down by the U.S. government's response to the pandemic.

"Nobody chooses to go to work and die," said Abt-Fagan. "We need to be more prepared, and the government needs to be more responsible in terms of keeping healthcare workers safe."

Adeline's father, Brant Fagan, wants the government to begin tracking healthcare worker deaths and examining the data to understand what went wrong. "That's how we're going to prevent this in the future," he said. "Know the data, follow where the science leads."

Adeline's parents said her death has been particularly painful because of her youth — and all the life milestones she never had the chance to experience. "Falling in love, buying a home, sharing your family and your life with your siblings," said Mary Jane Abt-Fagan. "It's all those things she missed that break a parent's heart."

Christina Jewett: ChristinaJ@kff.org, @by_cjewett