A Recipe for Trouble? Reversal of California Outdoor Dining Ban Has Heads Spinning

KFF Health News, February 4, 2021

Some scientists think the policy whiplash erodes trust in health messaging.

This article was published on Thursday, February 4, 2021 in Kaiser Health News.

By Anna Almedrala

Outdoor dining is resuming in California under state and local orders issued last week — but with covid cases, hospitalizations and deaths still far higher than they were when the bans took effect, restaurant owners and workers are wary of reopening their patios and parking lots.

Los Angeles County’s outdoor dining ban began Nov. 25, and a statewide ban, part of a broader stay-at-home order, took effect Dec. 5. No clear data from contact tracing could justify outdoor dining bans, public health officials acknowledged.

New cases in California are down nearly 65% from last year’s peak on Dec. 15, but still high enough to prompt confusion about why Gov. Gavin Newsom allowed outdoor dining and other activities to resume.

As has frequently been the case during the pandemic, messaging is mixed regarding the safe way to return to outdoor dining. When California Health and Human Services Secretary Mark Ghaly appeared in a video to explain the lifting of the ban, a slide alongside him said, “If you miss a friend, you can go out to eat outside at a restaurant together.”

But L.A. County’s new rules for outdoor dining restrict tables to people within a single household.

Some scientists think the policy whiplash erodes trust in health messaging.

“The original decision to close was not data-driven, and therefore the decision to reopen wasn’t data-driven,” said Dr. Monica Gandhi, a professor of medicine and an infectious diseases doctor at the University of California-San Francisco. “It looks like you’re not cleanly following numbers and making recommendations appropriately, and that can really confuse people.”

Measuring the impact of outdoor dining on covid transmission is difficult because the activity changes with the seasons, and it coincides with other activities that move from indoors to outdoors in nicer weather, said Aaron Yelowitz, a professor of economics at the University of Kentucky, who co-authored a nationwide analysis that measured the effects of the earliest shutdown orders on covid transmission.

Covid transmission in L.A. decreased within two weeks of the outdoor dining ban, a data point suggesting that the stop played a role in curbing the spread of the coronavirus.

With conditions no better, or even worse, than they were in November, the new order “doesn’t make sense,” said Billy Silverman, owner of Salazar, a Mexican barbecue restaurant in Los Angeles.

The county department of health seemed to affirm Silverman’s observation on Friday, the first day L.A. restaurants could reopen for outdoor dining.

“Although some restrictions were just lifted, we’re still in a very dangerous period in terms of cases, hospitalizations and deaths,” said county health officer Dr. Muntu Davis. He noted on Friday that L.A. County had 7,112 new cases and 228 deaths, and that 5,855 people were hospitalized with the disease.

While much lower than in mid-January, the covid burden is far higher than it was on Nov. 22, the day the county announced the outdoor dining ban, when it reported a daily tally of 2,718 cases, nine deaths and 1,401 hospitalizations.

If the covid numbers don’t improve in coming weeks, Silverman said, he can’t justify reopening his 120-seat, mostly outdoor restaurant. Though completely closed for more than half a year and then operating at 50% capacity in the fall, the business has managed to stay afloat with the help of a federal Paycheck Protection Program loan.

Silverman tried to operate with only takeout and delivery when L.A. County instituted its outdoor dining ban, but he couldn’t break even on sales to cover the labor costs. Having laid off around 65 people in March, he furloughed his workers — a much smaller kitchen crew by then — a second time in early December.

“I’ve talked to a lot of staff members, and they don’t feel comfortable rushing back to a potentially hazardous situation,” Silverman said. “I’m not going to do that to them.”

Christian Albertson, co-owner of the Monk’s Kettle tavern in San Francisco, was also stunned by the reversal.

“I can’t wrap my head around it, especially when the vaccine is so close,” Albertson said. “It just feels crazy. It is absolutely insane that we’re opening right now.”

The slow, uneven vaccine distribution makes this a precarious moment, said Jennifer D. Roberts, an assistant professor at the University of Maryland school of public health. As the shots trickle out through the community, starting with the eldest and most vulnerable residents, younger service workers — many of whom live in multigenerational homes — could be put at risk if customers relax habits like mask-wearing and physical distancing, she said.

Still, Albertson plans to resume outdoor dining in mid-February, to coincide with California Craft Beer Week. He’s confident in the protocols his restaurant developed last year to keep staffers and customers safe in a 30-seat patio area. Revenue in 2020 was down 55% compared with 2019 at Monk’s Kettle; the business is being kept afloat with governmental loan programs.

“I’d much rather wait a month or more and then have everyone come back permanently,” he said. “Right now, it’s ‘Come back, and let’s see if we can get past the first couple of weeks before cases start going up again.’”

At the heart of the issue is the lack of data showing that outdoor restaurant dining has had a role in the spread of covid. The strongest research to date includes a Centers for Disease Control and Prevention study that found covid-positive people were more than twice as likely to report eating at a restaurant two weeks before getting sick. A Stanford-led study found that restaurants operating at full capacity spread four times as many additional covid cases as the next-worst venue, indoor gyms. Neither of these studies differentiated between indoor and outdoor seating.

In the final few months of 2020, cases were rising rapidly in Los Angeles and throughout the state, however, and officials targeted outdoor dining in the absence of anything else they could regulate. With the state’s spotty contact-tracing efforts insufficient to connect outdoor dining to disease transmission, officials gave different explanations for the ban.

L.A. County’s department of public health director, Barbara Ferrer, said it was needed because outdoor dining required customers to take off their masks, raising the risk of transmission. Ghaly, the state official, said the ban had a broader aim. Transitioning to takeout and delivery “really has to do with the goal of trying to keep people at home, [and is] not a comment on the relative safety of outdoor dining,” he said Dec. 8.

“That was the frustrating part for us — that it was like a hunch,” said Jot Condie, president and CEO of the California Restaurant Association, which represents about 22,000 restaurants in the state. “They had a hunch that this was probably not safe, and let’s just shut it down.”

Condie’s association won a lawsuit against the county to overturn the ban, but by then the state’s regional orders were in place. Since the orders restricted individuals from everything except work, essential errands and exercise, the group didn’t escalate its suit to the state level, as restaurants weren’t being singled out.

Restaurants, perhaps more than any other industry, have borne the brunt of back-and-forth pandemic restrictions. Up to 1 million Californian restaurant workers have been laid off or furloughed since the pandemic began, according to the California Restaurant Association, and 30% of the 396 restaurant owners the association surveyed said they were at risk of closing or downsizing.

In December, California’s leisure and hospitality sector lost 117,000 jobs, the largest sector lost in the state, and most of these positions were in food services.

The loss of so many restaurant positions has made the job market extremely competitive for laid-off workers, adding pressure to job searches.

Vincent Campillo, a 38-year-old bartender in Los Angeles, lost both his jobs at the beginning of the pandemic and has been living on unemployment benefits since. He began to pick up occasional fill-in shifts toward the end of 2020.

“It’s ridiculous that L.A. is opening right now,” Campillo said. “It blows my mind and I can’t understand it.”

Newsom’s announcement seemed to divide the city into haves and have-nots, he said. Customers are cheering a return to outdoor restaurant dining, but Campillo is filled with dread. While young and healthy, he joked that he didn’t know if he and covid would “get along,” and didn’t want to find out.

Yet Campillo said he would return to work if asked, to maintain the relationships and networks he needs to remain employed long term. He hopes to get a vaccine as soon as they are offered to food service workers.

“I don’t know why I should be put in that place just so that someone can have a glass of natural wine and a charcuterie plate,” Campillo said. “People who are desperately in need of an income have to be the ones to serve them and put themselves in harm’s way.”

Covid-Certified Businesses Try to Woo Leery Patrons

KFF Health News, February 4, 2021

At a time when officials in parts of the nation are facing backlash from business owners who have been hurt by covid restrictions, Mesa County's 5-star program encourages them to partner with the local health department to promote the directives.

This article was published on Thursday, February 4, 2021 in Kaiser Health News.

By Christie Aschwanden

GRAND JUNCTION, Colo. — On a sunny Saturday this month, Ruth Hatfield was sitting with a friend’s dog on a sidewalk bench in downtown Grand Junction. Back home in Snowmass Village, 120 miles away through winding Rocky Mountain roadways, local officials had just shut down indoor restaurant dining as covid cases reached some of the highest levels in Colorado.

Here in Grand Junction, though, restaurants were open, and Hatfield had sought out those with the local health department’s “5-star certifications,” a designation meant to reassure people it is safe to patronize businesses during the pandemic. Those 5-star restaurants are part of an innovative program that allows businesses that agree to follow certain public health protocols to be open with less stringent rules than would ordinarily apply.

At a time when officials in parts of the nation are facing backlash from business owners who have been hurt by covid restrictions, Mesa County’s 5-star program encourages them to partner with the local health department to promote the directives.

Whether the approach boosts compliance with health directives remains to be seen. This largely rural county of 154,000 people on the Utah border is divided about covid protocols, with many still skeptical of wearing face coverings.

For example, Hatfield recalled a recent visit to a 5-star certified restaurant in Grand Junction where a party of four ignored a host’s request that they wear masks while waiting to be seated.

“I’m impressed with the 5-star program, but I’m not impressed with the level of mask-wearing here,” she said.

Mesa County public health director Jeff Kuhr and Diane Schwenke, president of the Grand Junction Area Chamber of Commerce, came up with the idea for the 5-star program in June.

“It is a way of encouraging [businesses] to do the right thing, that they could then use as a marketing tool,” Schwenke said.

Businesses interested in the program fill out a form and the health department sends them a list of program requirements, which include mask enforcement for employees and customers, regular cleaning schedules, hand-sanitizing stations and spacing of furniture, Kuhr said.

The program launched in July with about 100 businesses, including restaurants, gyms and bars, and has since grown to around 600.

The Colorado Department of Public Health and Environment was so pleased with the Mesa County program that it unveiled a statewide version in December, with Douglas County becoming the first in the Denver metro area to be approved. Officials in Utah, Michigan and Canada also have expressed interest.

“This whole event is about juggling viral suppression” while preventing economic devastation and the upheaval it brings to families and communities, said Jill Hunsaker Ryan, executive director of the state health department.

The 5-star program has helped keep restaurants open despite rising covid numbers, but state officials are still analyzing data to see if it helps reduce spread of the virus, Hunsaker Ryan added.

In practice, public health isn’t just about medicine. It’s about politics too, said Kirsten Bibbins-Domingo, professor and chair of the Department of Epidemiology and Biostatistics at the University of California-San Francisco. Though covid health directives have sometimes pitted business owners against public health officials, the 5-star program aims to unite the two.

“Ultimately, you have to deal with compliance not just with the hard hand of enforcement, but also with strategies that engage people in the goals of public health,” Bibbins-Domingo said.

Because participation in the program provides the opportunity to operate with looser restrictions on capacity and hours, businesses have incentive to comply, “even if they don’t think that the coronavirus exists — and we still have people here who believe that,” said Bill Hilty, medical director of the emergency department at St. Mary’s Hospital in Grand Junction.

“The program doesn’t impugn people who didn’t believe in covid or in masks,” Hilty said. “Their freedom was not infringed.”

Any business is eligible for the program, but it is especially appealing to gyms, restaurants and bars, which face restrictions on capacity and, in some cases, hours. For instance, Mesa County’s restaurant capacity limit under current covid rules is 25%, but eating establishments in the 5-star program are allowed to seat up to 50% capacity. Schwenke estimated that at least half the county’s restaurants have signed on.

The 5-star program has “absolutely saved us,” said Josh Niernberg, executive chef and owner of restaurants Bin 707 Foodbar, Taco Party and Bin Burger in Grand Junction.

Even so, he said, he has mixed feelings. The program allowed his businesses to remain open, but support in enforcing the rules has been minimal, he said.

Niernberg worries about the risk to his employees, who face “a daily struggle with anti-maskers” who visit his restaurants and demand to know why they’re being asked to wear a mask there, when other establishments not in the program don’t require them.

Even with the 5-star program, Bin 707 is operating at about a 20% loss each week, he said. Mesa County’s 5-star restaurants may be allowed 50% occupancy, but they’re also required to have 6 feet between tables. That spacing allows just 22% occupancy at Bin 707, Niernberg said.

In Mesa County, compliance is enforced by the honor system, reports from the public and occasional compliance checks by health department employees. About 10 establishments have been booted from the program for noncompliance.

Kuhr said his department does not release the names of businesses that have left the program.

On the face of it, loosening rules imposed to slow covid might seem like a bad idea, but if the 5-star program can produce better compliance with public health rules, it might be a good strategy for slowing the coronavirus, said Bibbins-Domingo of UCSF.

“I don’t want to dismiss the strategy, because buy-in is the holy grail in public health communication,” she said.

At the same time, when cases and community spread reach critical levels, as they did recently in Colorado and across the U.S., then at some point there’s a faulty logic to keeping businesses open, even with restricted hours, which may not do much to slow transmission. Density, on the other hand, “is very clearly related to transmission, so it’s the one thing I’d be very loath to ease up on,” Bibbins-Domingo said.

Whether the 5-star program would nudge businesses to accept public health directives or would simply be used as license to open was something considered as the program was coming together.

“We discussed this early on — who’s going to use this as a loophole and then not require masks,” Schwenke said. “We were worried about that initially, but the interesting thing is that this has seemed rare.”

Hard Bargain: Biden and Congress Agree on Basic Relief, but Chasms Remain on Covid Plan

KFF Health News, February 4, 2021

Biden's wide-ranging, high-dollar proposal has ignited new tensions.

This article was published on Thursday, February 4, 2021 in Kaiser Health News.

By Emmarie Huetteman

President Joe Biden and a group of Republicans agreed this week on how much Congress should spend on vaccine distribution, covid-19 testing and other health investments that public health officials say are desperately needed to fight the pandemic.

But agreement on those popular programs, which make up only 9% of Biden's $1.9 trillion relief proposal, is not enough to dispense that money quickly.

It will likely have to wait as the president and lawmakers hash out a bigger deal to also address the pandemic's economic toll, or as Democrats pursue the lengthy process that would allow them to pass their relief plan without Republicans. The latter would require the support of nearly every Democrat in Congress.

The disagreements that nearly torpedoed December's relief package remain, underscoring how differently lawmakers view the pandemic and their responsibility to support the millions of Americans suffering from it. And Biden's wide-ranging, high-dollar proposal, which also includes provisions increasing child care tax credits and raising the minimum wage to $15 that Republicans said would be deal breakers, has ignited new tensions.

This week 10 Senate Republicans offered a $618 billion counterproposal, matching Biden's requests for $160 billion for vaccinations, testing, treatment and other measures to contain the coronavirus; $4 billion for mental health and substance use disorder services; and $12 billion for nutrition assistance. They also provided lower counteroffers on spending to reopen schools, sending direct payments to some lower-income consumers and enhancing unemployment benefits, and on a handful of other programs. Those are cuts that some progressive Democrats said they could not support.

Biden has called for both parties to work together to right the economy and stop the virus. But it is unclear whether either party is willing to compromise at a time when emotions are still raw over the insurrection at the Capitol and the looming impeachment trial. However this is resolved could potentially set the tone for his presidency.

While some have suggested a "shots and checks" strategy to initially just deliver aid in the form of vaccinations and stimulus checks, many Democrats worry that would leave other urgent problems unaddressed, like the enhanced jobless benefits for millions of Americans that expire next month.

After Biden met with the Senate Republican group earlier this week to discuss their proposal, White House press secretary Jen Psaki said Biden "will not settle for a package that fails to meet the moment."

That leaves lawmakers trading proposals and jumping through procedural hoops to pass a big package, while public health officials — from the government's top infectious disease expert, Dr. Anthony Fauci, to the state officials who testified before the House this week — pleading for critical funding that already has the approval of members of both parties.

"Getting vaccines out quickly has become more important than ever," Dr. Joneigh S. Khaldun, Michigan's chief medical executive, told lawmakers.

Here are a few of the key disagreements — among the many — that could hold up public health funding.

Stimulus Checks

The Senate Republicans' counterproposal suggested the strictest limits yet on which Americans would be eligible for the next round of relief checks, arguing Congress should not spend extra money to help higher-income Americans.

Individuals making up to $50,000 — or couples making up to $100,000 — would receive up to $1,000 per person under the Republican proposal.

Last year's relief packages also imposed income limits on recipients. The most inclusive proposal, passed last March, sent up to $1,200 to individuals making as much as $99,000 a year (or as much as $198,000 for couples).

Biden's proposal would send $1,400 per person. Democrats are discussing making those payments more targeted. They argue the checks could help support those who get infected and must stay home from work to recover and protect others.

Democrats are describing the $1,400 checks as rounding out the $600 checks many Americans recently received from the December relief package.

That legislation was delayed when former President Donald Trump and Democratic leaders pushed to more than triple the payments to $2,000 per person — a proposal that Minority Leader Mitch McConnell, then the majority leader, said could not pass the Senate.

Progressive Democrats have argued for monthly payments, a suggestion that party leaders have not embraced.

State and Local Funding

The Republican proposal did not include additional emergency funding for state and local governments, an exclusion some Democrats say makes the package a non-starter.

Both proposals would give states money specifically for reopening schools, distributing vaccines and more. But Biden also proposed $350 billion for states and localities that generally could be used at their discretion to cover budget shortfalls and unexpected expenses directly related to the pandemic.

"The financial burden being placed on states is tremendous," Dr. Courtney N. Phillips, secretary of Louisiana's Department of Health, told lawmakers Tuesday.

"The resources provided to states, communities and families will allow us to come out the other side of this pandemic successfully and not looking at a new financial problem facing our country," she said.

In the first, $2.2 trillion relief package last year, Congress established a $150 billion fund to help state, local and tribal governments coping with the pandemic. The money was distributed based on population, with broad guidelines: State and local governments generally may use the money for "necessary expenditures" that arose from the pandemic.

States have put those dollars toward a variety of needs, from hazard pay for health workers to improved internet access. Some, like Oregon, Mississippi and North Dakota, sent additional relief checks to residents. Others, like Colorado, helped renters and homeowners facing eviction or foreclosure.

States have until the end of this year to spend the money, at which point the federal government will reclaim any unspent funds.

Republicans have argued that states do not need more money, because some of the original funding remains unspent. In December, for instance, some sounded the alarm that Texas had about $2 billion left of its disbursement — even as state officials pleaded for more help for rural hospitals, renters and food banks.

Experts note the pandemic has not taken as heavy an economic toll on state and local governments as once feared. But a recent analysis from the Brookings Institution estimated state and local governments, which already have cut about 1.3 million jobs in less than a year, stand to lose roughly $350 billion over the next three years.

Jobless Benefits

In the month after Trump declared a national emergency, more than 22 million Americans filed for unemployment benefits. By December, 10.7 million people remained out of work.

Those who filed for unemployment assistance in the early months of the pandemic received an additional $600 a week, among other benefits expanded under the first relief package — until the end of July, when the extra cash expired. In December, Congress gave the jobless an extra $300 a week.

Republicans have proposed another short-term extension of the additional $300-per-week benefit, expiring at the end of June. Biden proposed raising it to $400 and extending the benefit through September.

The current benefits are set to expire March 14, the date Democrats are now calling the unemployment benefits "cliff" — and citing as the deadline for the next relief package.

Sen. Ron Wyden (D-Ore.), the incoming chairman of the Senate Finance Committee, called an extension of at least six months "essential."

"We can't keep jumping from cliff to cliff every few months," Wyden said in a statement. "Workers who have lost their jobs through no fault of their own shouldn't be constantly worrying that they are going to lose their income overnight."

Emmarie Huetteman: ehuetteman@kff.org, @emmarieDC  

'Cruel' Digital Race For Vaccines Leaves Many Seniors Behind

KFF Health News, February 4, 2021

The efforts to vaccinate people 65 and older have strained under the enormous demand that has overwhelmed cumbersome, inconsistent scheduling systems.

This article was published on Thursday, February 4, 2021 in Kaiser Health News.

By Will Stone

With millions of older Americans eligible for covid-19 vaccines and limited supplies, many continue to describe a frantic and frustrating search to secure a shot, beset by uncertainty and difficulty. 

The efforts to vaccinate people 65 and older have strained under the enormous demand that has overwhelmed cumbersome, inconsistent scheduling systems.

The struggle represents a shift from the first wave of vaccinations — healthcare workers in healthcare settings — which went comparatively smoothly. Now, in most places, elderly people are pitted against one another, competing on an unstable technological playing field for limited shots.

"You can't have the vaccine distribution be a race between elderly people typing and younger people typing," said Jeremy Novich, a clinical psychologist in New York City who has begun a group to help people navigate the technology to get appointments. "That's not a race. That's just cruel."

While the demand is an encouraging sign of public trust in the vaccines, the challenges facing seniors also speak to the country's fragmented approach, which has left many confused and enlisting family members to hunt down appointments.

"It's just maddening," said Bill Walsh, with AARP. "It should be a smooth pathway from signing up to getting the vaccine, and that's just not what we're seeing so far." 

Glitchy websites, jammed phone lines and long lines outside clinics have become commonplace as states expand who's eligible — sometimes triggering a mad dash for shots that can sound more like trying to score a ticket for a music festival than obtaining a lifesaving vaccine. 

After being inundated, some public health departments are trying to hire more staff members to handle their vaccination hotlines and specifically target seniors who may not be able to navigate a complicated online sign-up process.  

"Just posting a website and urging people to go there is not a recipe for success," said Walsh. 

'Terribly Competitive'

Like many other seniors, Colleen Brooks, 85, had trouble sorting through the myriad online resources about how to find the vaccine where she lives, on Vashon Island in the Puget Sound near Seattle.

"It was an overwhelming amount of information," she said. "I knew it was here someplace, but it wasn't easy to find out how to get it."

After making calls, Brooks eventually got a tip from a friend who had spotted the vaccines being unloaded at their town pharmacy. When she dropped by her health clinic to inquire about how to sign up, it happened they were giving out shots that same day.  

"That was totally serendipitous for me, but I actually personally know several seniors who just kind of gave up," said Brooks. 

Finding out how to get a vaccine appointment was more straightforward for Gerald Kahn, 76, who lives in Madison, Connecticut. 

Kahn got an email notice from the state's vaccine registration system telling him to make an appointment, but he ran into problems at the very end of the sign-up process. 

"As much as I would pound my finger on the face of my iPad, it didn't do me any good," he said.

So Kahn did what many have and called a younger family member, who was able to help him finish signing up. 

"I think there are a lot of people my age, maybe the preponderance, who can only go so far into the internet, and then we're not only stymied but also frustrated," he said. 

When Helen Francke, 92, logged on for a vaccine at the designated time, she discovered the spots available in Washington, D.C., filled up almost instantaneously. 

"It was evident that I was much too slow," she said. "It's terribly competitive and clearly favors those with advanced computer skills." 

The next week, Francke tried calling and going online — this time with the help of her neighbors — without success.

"If I had had to depend on the D.C. vaccination website and telephone, I'd still be anxious and unsuccessful," said Francke, who got a shot only after finding information on a neighborhood discussion group that directed her to a hospital. 

In Arizona, Karen Davis, 80, ended up on a roundabout quest through state and hospital websites with no clear sense of how to actually book an appointment. 

"I kept trying to do it and kind of banged my head against the wall too many times," she said.

Davis, a retired nurse, called her doctor and the pharmacy and then eventually turned to a younger relative, who managed to book a 5 a.m. appointment at a mass vaccination site. 

"I'm sure they did not expect older people to be able to do this," she said. 

Miguel Lerma, who lives in Phoenix, said his 69-year-old mother has been unsuccessful in finding a shot. 

"She's not an English speaker and doesn't know technology well, and that's how everything is being done," said Lerma, 31. 

Lerma said it's especially painful to watch his mother struggle to get the vaccine — because he lost his father to covid last year. 

"She's mourning not only for my dad, but she's also suffering as an adult now because she depended on him for certain tasks," Lerma said. "He would've handled all this." 

'Desperate' Seniors Look for Help

Philip Bretsky, a primary care doctor in Southern California, said his older patients would typically call him or visit a pharmacy for vaccines like the annual flu shot, rather than rely on novel online scheduling systems. 

"That's not how 85-year-olds have interacted with the healthcare system, so it's a complete disconnect," he said. "These folks are basically just investing a lot of time and not getting anything out of it." 

California's recent decision to change its vaccination plan and open it up to those over 65 only adds to the confusion. 

Bretsky said his patients are being told to call their doctor for information, but he isn't even sure when his office, which is authorized to give the vaccines, will receive any. 

"Patients in this age group want to know that they're at least being heard or somebody is thinking about the challenges they have," he said. 

There are some local efforts to make that happen.  

In the village of Los Lunas, New Mexico, public health workers held an in-person sign-up event for seniors who needed assistance or simply a device connected to the internet. 

A Florida senior center recently held a vaccination registration event and a clinic specifically for people over 80 who might not have a computer. 

Novich, the clinical psychologist in New York, teamed up with a few other people to create an informal help service for older adults. It began as a small endeavor, advertised through a few synagogues and his Facebook page. They've now helped more than 100 people get shots.  

"We have a huge number of requests that are just piling up," said Novich. 

"People are really desperate and they're also confused because nobody has actually explained to them when they are expected to get vaccinated. … It's a big mess." 

The ongoing shortage of vaccines has led Novich to halt the service for now. 

This story is part of a partnership that includes NPR and KHN.

100M Covid Shots in 100 Days Doesn't Get Us Back to Normal

KFF Health News, February 3, 2021

Does 100 million doses translate to 100 million people being vaccinated by April 30? The short answer: no.

This article was published on Wednesday, February 3, 2021 in Kaiser Health News.

By Victoria Knight

April 30 will mark the end of the first 100 days of President Joe Biden's tenure. That's a benchmark presidents often set for making good on high-priority campaign promises.

In early December, Biden announced that one promise would be to get 100 million covid-19 vaccines into the arms of Americans in the first 100 days, averaging about 1 million daily doses. The U.S. reached that pace around Inauguration Day but will have to maintain it for the next three months for Biden to reach his goal.

If realized, how will everyday life change? We asked the experts.

Could 100 Million Doses Achieve Herd Immunity?

First, does 100 million doses translate to 100 million people being vaccinated by April 30?

The short answer: no.

Biden has emphasized that his goal doesn't mean 100 million people will be fully vaccinated, but rather that 100 million shots will be administered. After all, both the Moderna and Pfizer-BioNTech vaccines require two doses.

When we first reached out to Biden team members in early December to ask about this target number, they said they were aiming for 50 million people to receive both doses and become fully inoculated. Then, in early January, they said the president-elect instead favored releasing most of the vaccine supply as it's produced, rather than holding back doses for people's second shots, on the assumption that new vaccine being produced would cover those booster shots on schedule. The Trump administration, still in office, announced a similar plan. Even now, though, about two weeks into Biden's term, confusion continues to surround the implementation of that policy, which could influence the number of people who receive both vaccine doses within the first 100 days.

At a Jan. 26 press briefing, Biden said his goal of 100 million shots "means somewhere between 60 — maybe less, maybe more — million people" will receive at least one dose of vaccine.

Some critics have said the target number should be higher. A day earlier, Biden suggested he would like to eventually increase the rate of vaccinations to 1.5 million a day.

Whether it's 50 million or 60 million people who are fully inoculated by the end of April, that number is still well below the prevailing herd immunity threshold recommended by public health experts.

Remember, herd immunity is achieved when enough people in a population become resistant to a disease so that it has difficulty spreading. Epidemiologists estimate at least 70% of a population must be protected to reach herd immunity. Because it's unknown how long natural immunity lasts after being infected with the coronavirus, it's recommended that even those who have had covid be vaccinated to reach herd immunity. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has suggested the herd immunity benchmark could be higher, up to 90%, especially since it seems some new covid variants are more transmissible than the dominant U.S. strain.

For now, let's leave the herd immunity estimate at 70% and figure out how long it would take to reach that level.

Dr. Bruce Y. Lee, a professor of health policy and management at the City University of New York, walked KHN through the math. About 330 million people live in the U.S. Seventy percent of that figure equals about 231 million.

Currently, the U.S. has access only to the two-dose Moderna and Pfizer vaccines, meaning the nation would need 462 million doses to fully vaccinate enough people to reach that 70% mark.

At a rate of 1 million doses administered per day, it would take more than 460 days. "Which we would reach sometime in early 2022," said Lee.

An additional challenge: Of the estimated 330 million people in the U.S., about 70 million are children and not yet eligible to receive a vaccine, so the vast majority of adults would have to be vaccinated to achieve this level of herd immunity.

Others have sketched out how the timeline accelerates if vaccination numbers improve. For instance, KFF chief executive Drew Altman wrote in a column that if the U.S. increased vaccine administration to 1.9 million shots a day, 70% of the population could have vaccine coverage by Labor Day. If vaccinations were increased to 2.4 million a day, that threshold could be reached by July 4. (KHN is an editorially independent program of KFF.)

In addition, other vaccines are in the pipeline that require only one dose, such as the Johnson & Johnson vaccine, and could change these projections.

At the White House's second covid response team briefing on Jan. 29, Andy Slavitt, senior adviser to the team, said about 1.2 million vaccine doses per day had been administered in the past week. Vaccine trackers from Bloomberg News and The Washington Post also report about 1 million people in the U.S. receiving their first dose of vaccine every day in the past week. And the Biden administration expects this number to increase significantly in the coming weeks and months.

But roadblocks loom, including a short supply of vaccine.

Between the Trump and Biden administrations, the U.S. has agreed to purchase 600 million doses, in all, of the covid vaccines from Moderna and Pfizer. One-third, or 200 million, of that amount was supposed to be delivered by the end of March. The remaining doses aren't slated to arrive until late spring and summer.

"The brutal truth is it's going to take months before the majority of Americans are vaccinated," Biden acknowledged during his Jan. 26 news conference announcing the United States' latest vaccine acquisition.

The difficulty of reaching people who may have trouble accessing the vaccine, such as rural residents or communities of color, could also hamper vaccination efforts. And certain individuals are likely to be hesitant or refuse to get vaccinated.

When Will Life Return to Normal?

What if you become one of the lucky ones to get vaccinated during Biden's first 100 days of the vaccine rollout?

People will still not be able to return to their pre-pandemic activities, said public health experts. A sense of normalcy won't return until we approach 70% or more of Americans vaccinated.

"As hard as it is to hear, if you get your second dose of the vaccine before we have vaccinated the majority of the population, we all still need you to take the same protective measures you were taking before you were vaccinated," said Dr. Rachel Vreeman, director of the Arnhold Institute for Global Health at Mount Sinai's medical school in New York City.

That means, even if you're vaccinated, you should continue to wear a mask, practice physical distancing with those outside your household, stay home and regularly wash your hands. The same precautions are recommended for those who won't be inoculated by April 30.

Vreeman added that a week or two after you receive your second dose of the vaccine, you are less likely to get seriously ill from covid. But you could still get sick. And it's possible you could pass on the virus to others not yet vaccinated. Clinical trials for the covid vaccines didn't evaluate whether it stopped asymptomatic transmission, only if symptoms were reduced.

"Immediately at the end of April, for the average American, there won't be a dramatic change in what they're seeing in regards to social distancing and masking," said L.J Tan, chief strategy officer for the Immunization Action Coalition, a nonprofit that works with the Centers for Disease Control and Prevention to distribute vaccine information.

Jeffrey Shaman, an environmental health professor at Columbia University, said states should maintain covid restrictions, such as those related to face coverings, remote work and limited travel, during the vaccine distribution process. In a recent modeling study, Shaman and his colleagues found that if such restrictions were lifted this month, 29 million additional covid infections could emerge by summer. He recommends keeping them in place through July.

"The bottom line is, if we lift our restrictions and we go back to what it was like before the pandemic, the virus is going to take off again," said Shaman. "Then the race to get vaccines in arms will be complicated because more people will get sick."

Experts also said that with multiple covid variants circulating in the U.S., some of which appear to be highly transmissible, taking precautions seriously is critical — especially if vaccines aren't as protective against them. Plus, the fewer people who get sick, the less likely it is the virus can replicate, mutate again and create more variants.

As for when things will return to normal? That depends on the rate of vaccinations and how many Americans are willing to roll up their sleeves.

"I think we will be back to life in the fall, hopefully before Thanksgiving," said Tan.

Other experts we asked said it's possible there could be some semblance of a return to normalcy in the summer.

But, they all agreed, it certainly won't happen by April 30.

Victoria Knight: vknight@kff.org, @victoriaregisk

In Austin, Some Try to Address Vaccine Inequity, but a Broad Plan Is Elusive

KFF Health News, February 3, 2021

When Texas first released its distribution plan, advocates and local officials raised concerns.

This article was published on Wednesday, February 3, 2021 in Kaiser Health News.

By Ashley Lopez, KUT

Communities of color have been among the hardest hit during the pandemic. But advocates in Texas say those communities are likely to have a harder time getting the vaccine in the coming months, so they are urging local leaders to step in.

Travis County Judge Andy Brown, the county executive in the Austin area, put together a vaccination event recently. Brown said he'd been hearing concerns that there weren't enough places to get a covid-19 shot on the east side of Austin, which has more Black and Latino residents and more poverty than other parts of the city.

So, Brown asked a hospital for extra doses. And with 600 in hand, he worked with other local officials to set up a temporary drive-thru vaccination site in a southeast Austin parking lot. 

"They all realized that we need to get the vaccines in the arms of people who are in the hardest-hit ZIP codes," Brown said. "People who are Latinx, who are African American — and especially who are over 65, because those are the people who get sickest."

When Texas first released its distribution plan, advocates and local officials raised concerns. Twenty-three states, including Texas, are tracking vaccination rates by race, and Texas, like all the others, is vaccinating Black residents at a slower rate.  

Texas House Member Sheryl Cole, a Democrat who represents Black and Latino communities in East Austin, said she pointed out that the initial plan had 65 vaccine sites for Austin, but only nine on the east side.  

"Without a doubt, we are seeing disparate treatment of distribution and providers," she said.

Part of the reason is that the plan relied heavily on chain stores, such as H-E-B, Kroger, Randalls, Walgreens and CVS. Brown said those big grocery and drugstores just aren't as prevalent in East Austin.

"The fact is, this part of town, frankly, does not have as many H-E-Bs, pharmacies, [and] has a higher uninsured rate," he said.

Mayor Steve Adler said his office has been lobbying state health officials to turn over the bulk of the vaccines to local governments, which know best how to get them to the hardest-hit communities.

"I believe that it goes out much more quickly and goes out to the people who most need it," he said.

And this lobbying has worked. Recently, Texas health officials have started giving vaccines to local health departments, which are set up to vaccinate thousands of people. 

But there have been hiccups.

State officials pushed back against city leaders in Dallas who planned to use their hub vaccine distribution solely for Black and brown communities. The city has since decided to abandon that plan, according to The Texas Tribune.

Then there is the issue of scarcity. For example, the week of Jan. 18, Austin officials got about 12,000 doses for a city of about 1 million people. 

Jeremy Lopez, who lives in East Austin, signed up to get a vaccine from the city as soon as he could. Lopez had a kidney transplant in 2006 and is in a high-risk group. But he still has no idea when he'll get vaccinated.

"There's no definite time frame of like 'Oh, in a week. Oh, in two weeks,'" he said. "It's like 'Don't call us; we will call you.'"

Local officials are urging people to be patient.

Austin City Council Member Natasha Harper-Madison said she thinks everyone, including state and local government, should have done more planning.

"I am a member of Austin's governing body, and I've got to tell you that I don't think we have done everything we could have to make certain that we were prepared for what we knew was coming," she said.

That includes having plans to prioritize the hardest-hit communities, Harper-Madison said.

Cole said Black and Latino Texans have already been through enough.

"The underserved community already has to deal with economic disparity and loss of jobs with covid — and then to add this additional burden is not good. It's not fathomable," she said.

This story is part of a reporting partnership that includes NPR, KUT and KHN.

Ashley Lopez, KUT: alopez@kut.org, @‪AshLopezRa‪dio

Dispelling Vaccine Misinformation and Myths in California's Breadbasket

KFF Health News, February 3, 2021

Advocates and public health officials are trying to dispel myths about the covid vaccines and urge the farmworkers to get vaccinated.

This article was published on Wednesday, February 3, 2021 in Kaiser Health News.

By Heidi de Marco

MECCA, Calif. — Dust swirled in the air as Luz Gallegos parked her SUV on the side of a dirt road. She had just learned that her aunt died of covid-19 — the third family member to succumb to the disease in only two weeks.

She stepped out of her car at about 11:30 a.m. onto a bell pepper farm in this agricultural community in the Coachella Valley, a little northwest of the Salton Sea.

Gallegos, a daughter of farmworkers who had worked in the fields herself, had only 15 minutes to make what she considered a life-or-death pitch to roughly 20 workers who had just finished a break.

The farm had already seen two workers fall ill to covid.

"We're losing people in our community each day," she said.

Gallegos, now executive director of the immigrant advocacy group TODEC Legal Center, came to dispel myths about the covid vaccines and urge the farmworkers to get vaccinated. Farmworkers, who are among the most vulnerable to covid, are also among the most hesitant to get the shots.

Some worry about the vaccines' safety and potential side effects, or how they could affect people with underlying health conditions, like diabetes. Others express the unfounded rumor that the government will use the vaccines to implant chips into their arms, leading to their being tracked and deported.

"This community lives in fear," Gallegos said. "They don't have any confidence in the government."

A study out in late January from the University of California-San Francisco found that farmworkers and other agricultural workers had the third-highest risk of death during the pandemic in California, after cooks and packaging machine operators.

"That's higher than doctors or nurses," said Alicia Riley, an epidemiology and biostatistics postdoctoral scholar at UCSF who worked on the study. "With vaccination, we now have a new tool available to protect these workers who have endured the highest rate of excess mortality during the pandemic."

Since October, Gallegos has been visiting farms throughout Riverside County.

She just got the first dose of vaccine herself, a detail she shared with the farmworkers gathered around her. "I didn't get any side effects, but some say it feels like a bruise on your arm," she told them in Spanish.

Gallegos had started off the talk by claiming a victory: "We won. They're going to prioritize farmworkers in the first phases of the vaccine."

Gov. Gavin Newsom confirmed last week that farmworkers will be prioritized for the shots, along with healthcare workers, people age 65 and up, and workers in education, child care, emergency services, and the food and agricultural industries.

Diana Tellefson Torres, executive director of the UFW Foundation, said agricultural workers check all the boxes when it comes to vulnerability: They often work in close proximity, travel from farm to farm across county borders, live in crowded housing and in multigenerational households, and lack healthcare. "We know that this is a large task," Tellefson Torres said. "But there are different levels of vulnerability in our society right now, and I can't emphasize enough that we need to take care of those who are nurturing us right now."

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

Heidi de Marco: heidid@kff.org, @Heidi_deMarco

When Your Chance for a Covid Shot Comes, Don't Worry About the Numbers

KFF Health News, February 2, 2021

There are five reasons experts say you should take the J&J shot — assuming the FDA authorizes it — if it's the one that's offered to you first.

This article was published on Monday, February 1, 2021 in Kaiser Health News.

By Arthur Allen and Liz Szabo

When getting vaccinated against covid-19, there’s no sense being picky. You should take the first authorized vaccine that’s offered, experts say.

The newest covid vaccine on the horizon, from Johnson & Johnson, is probably a little less effective at preventing sickness than the two shots already being administered around the United States, from Pfizer-BioNTech and Moderna. On Friday, Johnson & Johnson announced that, in a 45,000-person trial, its vaccine was about 66% effective at preventing moderate to severe covid illness. No one who received the vaccine was hospitalized with or died of the disease, according to the company, which said it expected to seek Food and Drug Administration authorization as early as this week. If the agency authorizes use of the vaccine, millions of doses could be shipped out of J&J’s warehouses beginning in late February.

The J&J vaccine is similar to the shots from Moderna and Pfizer-BioNTech but uses a different strategy for transporting genetic code into human cells to stimulate immunity to the disease. The Moderna and Pfizer-BioNTech vaccines were found in trials last fall to be 94% effective against confirmed covid. They also prevented nearly all severe cases.

But the difference in those efficacy numbers may be deceptive. The vaccines were tested in different locations and at different phases of the pandemic. And J&J gave subjects in its trial only one dose of the vaccine, while Moderna and Pfizer have two-dose schedules, separated by 28 and 21 days, respectively. The bottom line, however, is that all three do a good job at preventing serious covid.

“It’s a bit like, do you want a Lamborghini or a Chevy to get to work?” said Dr. Gregory Poland, director of the Mayo Clinic’s Vaccine Research Group. “Ultimately, I just need to get to work. If a Chevy is available, sign me up.”

So while expert panels may debate in the future about which vaccine is best for whom, “from a personal and public health perspective, the best advice for now is to get whatever you can as soon as you can get it, because the sooner we all get vaccinated the better off we all are,” said Dr. Norman Hearst, a family doctor and epidemiologist at the University of California-San Francisco.

Here are five reasons experts say you should take the J&J shot — assuming the FDA authorizes it — if it’s the one that’s offered to you first:

1. All three vaccines protect against hospitalization and death.

Of the 10 cases of severe disease in the Pfizer trial, nine received a placebo, or fake vaccine, and none of the 30 severe cases in the Moderna trial occurred in people who got the true vaccine. Johnson & Johnson did not release specific numbers but said none of the vaccinated patients were hospitalized or died. “The real goal is to keep people out of the hospital and the ICU and the morgue,” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “This vaccine will do that well.”

2. The efficacy levels could be a case of apples and oranges.

The data that Moderna and Pfizer-BioNTech presented to the FDA for their vaccines came from large clinical trials that took place over the summer and early fall in the United States. At the time, none of the new variants of covid — some of which may be better at evading the immune responses produced by vaccines — were circulating here. In contrast, the J&J trial began in September and was put into the arms of people in South America, South Africa and the United States.

Newly widespread variants in Brazil and South Africa appear somewhat better at evading the vaccine’s defenses, and it’s possible a new variant in California — where many J&J volunteers were enrolled — may also have that trait. The J&J vaccine was 72% effective against moderate to severe covid in the U.S. part of the trial, compared with 57% in South Africa, where a more contagious mutant virus is the dominant strain. Another vaccine, made by the Maryland company Novavax, had 90% efficacy in a large British trial, but only about 50% in South Africa. The Moderna and Pfizer-BioNTech vaccines might not have gotten the same sparkling results had they been tested more recently — or in South Africa.

“This vaccine was tested in the pandemic here and now,” said Dr. Dan Barouch, a Harvard Medical School professor whose lab at the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston developed the J&J vaccine. “The pandemic is a much more complex pandemic than it was several months ago.”

Some of that difference in performance also could be attributable to different patient populations or disease conditions, and not just the mutant virus. A large percentage of South Africans carry the human immunodeficiency virus, or HIV. Chinese vaccines have performed wildly differently in countries where they were tested in recent months.

“We don’t know which vaccines are the Lamborghinis,” Poland said, “because these aren’t true head-to-head comparisons.”

3. Speed is of the essence.

To stop the spread of covid, the mutation of the virus that causes it and the continued pummeling of the economy, we all need to be vaccinated as quickly as possible. The inadequate supply of vaccines has been felt acutely.

Dr. Virginia Banks’ 103-year-old mother is one of the few living Americans who were around for the country’s last great pandemic — the 1918 influenza — yet she’s been unable to get a covid vaccination, said Banks, a physician with Northeast Ohio Infectious Disease Associates in Youngstown.

Patients can’t be picky about which vaccine they accept, Banks said. People “need to get vaccinated with the vaccines out today so we can get closer to herd immunity” to slow the spread of the virus.

Banks has worked hard to promote covid vaccines to skeptical minority communities, frequently appearing on local TV news and making at least two presentations by Zoom each week. Blacks to date have been vaccinated against covid at much lower rates than whites.

“There’s a downside to waiting,” said Dr. William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University Medical Center. Delaying vaccination carries serious risks, given that more than 3,800 Americans have been dying every day of covid.

4. The J&J vaccine appears to have some real advantages.

First, it seems to cause fewer serious side effects like the fever and malaise suffered by some Pfizer-BioNTech and Moderna vaccine recipients. High fever and dehydration are particular concerns in fragile elderly people who “have one foot on the banana peel,” said Dr. Kathryn Edwards, scientific director of the Vanderbilt Vaccine Research Program. The J&J vaccine “may be a better vaccine for the infirm.”

Many people may also prefer the J&J shot because “it’s one and done,” Schaffner said. Easier for administrators too: just one appointment to schedule.

5. The J&J vaccine is much easier to ship, store and administer.

While the Johnson & Johnson vaccine can be stored in regular refrigerators, the Pfizer-BioNTech vaccine must be kept long-term in “ultra-cold” freezers at temperatures between minus 112 degrees and minus 76 degrees Fahrenheit, according to the Centers for Disease Control and Prevention.

Both the Moderna and Pfizer-BioNTech vaccines must be used or discarded within six hours after the vial is opened. Vials of the J&J vaccine can be stored in a refrigerator and restored for later use if doses remain. “Right now we have mass immunization clinics that are open but have no vaccine,” said Offit. “Here you have a single-dose regime with easy storage and handling.”

A person’s address — not their personal preference — may determine which vaccine they receive, said E. John Wherry, director of the Institute for Immunology at the University of Pennsylvania’s Perelman School of Medicine. He pointed out that the Johnson & Johnson vaccine is a simpler choice for rural areas.

“A vaccine doesn’t have to be 95% effective to be an incredible leap forward,” said Wherry. “When we get to the point where we have choices about which vaccine to give, it will be a luxury to have to struggle with that question.”

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

In Philadelphia, a Scandal Erupts Over Vaccination Startup Led by 22-Year-Old

KFF Health News, February 2, 2021

The marketing plan hinged on inoculating local celebrities like rapper Meek Mill, a Philadelphia native, to attract his fan base.

This story was published on Tuesday, February 2, 2021 in Kaiser Health News.

By Nina Feldman, WHYY and Max Marin, WHYY and Alan Yu, WHYY

It started as a group of college friends who wanted to help during the pandemic. They had tech skills, so they used 3D printers to make face shields. Then they organized as a nonprofit, Philly Fighting Covid, and opened a testing site in a Philadelphia neighborhood that didn't have one yet.

The organization's leader, Andrei Doroshin, had bigger ambitions. Even before the first coronavirus vaccine was authorized, the 22-year-old graduate student at Drexel University planned to get involved, although he has no background in healthcare.

On the evening of Oct. 7, Doroshin gathered 15 of the nonprofit's staff members and volunteers for a meeting on a Philadelphia rooftop to show them a fancy PowerPoint. More people joined via livestream to watch him unveil his plan to vaccinate the city of Philadelphia.

In slide after slide, he laid out his vision with colorful graphics and maps, covering all aspects of a vaccination system, from scheduling to staffing to safety protocols.

The marketing plan hinged on inoculating local celebrities like rapper Meek Mill, a Philadelphia native, to attract his fan base.

“This is a wholly Elon Musk, shooting-for-the-heavens type of thing,” Doroshin said. “We're gonna have a preemptive strike on vaccines and basically beat everybody in Philadelphia to it.”

Doroshin described scaling up until they were managing five mass vaccination sites and 20 smaller sites scattered throughout the city. He claimed they could vaccinate between 500,000 and 1.5 million people. And they would make a lot of money doing it.

“This is the juicy slide,” said Doroshin, clicking over to the financing plan. “How are we gonna get paid?” He explained that the vaccine doses were free, provided by the federal government. But Philly Fighting Covid could bill insurance companies $24 a dose for administering it.

“I just told you how many vaccines we want to do — you can do the math in your head,” he said.

A month later, Doroshin made a similar presentation, complete with colorful maps and a $2.7 million projected budget, to the Philadelphia City Council. He said his team at Philly Fighting Covid had begun submitting plans for building out five high-capacity sites that could each take up to 10,000 patients a day.

Philly Fighting Covid's promise of efficiently vaccinating the population was an alluring one as city leaders were desperate to pull out of the pandemic. Doroshin told NBC's “Today” show that his company didn't think like a traditional medical institution. “We're engineers, we're scientists, computer scientists, we're cybersecurity nerds. We think a little differently than people in healthcare do.”

“We took the entire model and just threw it out the window,” Doroshin added. “We said to hell with all of that. We're going to completely build on a new model that is based on a factory.”

By Jan. 9, Doroshin had a deal with the Philadelphia Department of Public Health and Mayor Jim Kenney's administration. The city never signed a formal contract with Philly Fighting Covid or gave the organization any money, but it did provide its unofficial sanction and publicity.

Most important, the city turned over part of its vaccine allotment to the group and helped it find recipients by sharing lists of residents who were newly eligible for the vaccine, based on the city's own prioritization scheme. The city relied on Philly Fighting Covid's registration as a vaccine provider with the Centers for Disease Control and Prevention.

On Jan. 8, Doroshin and Kenney stood side by side at a press conference to kick off the first mass vaccination clinic at the Pennsylvania Convention Center. It was targeted at healthcare workers not affiliated with major hospitals, such as home health aides or doctors, nurses or therapists in private practice.

“What you see here is the problem that we've been solving for six months,” Doroshin told reporters. “This is the problem of vaccinating an entire population of people on a scale that has never been seen before in the history of our species.”

Kenney was also hopeful that the arrangement would help diversify the racial breakdown of vaccine recipients. At that point, only 12% of vaccinated Philadelphians were Black — in a city where 44% of residents are Black.

“Equitable distribution of this vaccine is extremely important to our entire administration,” said Kenney at the Jan. 8 kickoff event.

But in an early sign of trouble, Philly Fighting Covid failed to verify its progress on the equity goal. After that first vaccine event, at which 2,500 doses were administered, City Council President Darrell Clarke requested the demographic breakdown of the recipients.

The health department told him that Philly Fighting Covid had somehow lost all the racial and ethnic data for the patients. The group was blaming “a glitch” in the Amazon cloud. Still, the city continued to turn over thousands of vaccine doses to Philly Fighting Covid.

As the startup continued to hold clinics, WHYY began investigating the organization and its founder.

Reporters uncovered other serious problems, and it soon became clear that the group's logistical strengths and self-promotional flair, which had once made the startup seem so compelling, weren't working. The investigation revealed that in December, just before Philly Fighting Covid began its vaccination work, it reorganized and became a for-profit company called Vax Populi.

Philly Fighting Covid had spent months organizing city-funded testing events — at which residents reported good experiences. But in January, it abruptly shuttered those operations, leaving partner organizations in the lurch. The group posted this decision on social media, just a few days after the convention center kickoff, at which Doroshin had promised to open two new testing sites and to start offering free rapid testing.

Several groups that had been partnering with Philly Fighting Covid on testing events claim they received little or no notice, jeopardizing plans for testing in communities of color.

“They completely ghosted us,” said Cean James, pastor of Salt & Light church in Southwest Philadelphia, which had been planning a series of pop-up testing events with Philly Fighting Covid.

Michael Brown had been working with the group to organize a testing event on Martin Luther King Jr. Day. He said Doroshin told his group that testing wasn't important anymore.

“The statement he made was very clear: 'I don't believe that testing is relevant anymore. People don't follow the instructions, people don't do what they're supposed to do, and all it does is … cause panic,'” Brown said later.

There were signs that Doroshin wasn't that concerned about standard clinical protocols. Employees with more clinical experience than he had said he brushed off technical questions as bothersome and approached the vaccination effort as if he were a tech mogul focused on disrupting norms.

“Stop using best practices,” Doroshin said during a recent interview with HealthDay. “I think the old best practices in healthcare, in terms of intramuscular injections, were written for a hospital visit that would take 30 minutes, that you needed to do a bill for as a provider visit. Those best practices can mostly go out the window.”

The city soon began to back away from the group. At the initial launch, the city promoted Philly Fighting Covid's pre-registration website and encouraged everyone to sign up. Just a week later, officials changed course and claimed the city had nothing to do with the website. The conflicting messages caused confusion among the 60,000 Philadelphians who had signed up thinking it was an official city site. Many were left worried about what would happen to their personal information. The city then launched its own pre-registration site.

The process Philly Fighting Covid used to schedule appointments was also flawed. Anyone who received a hyperlink could sign up for a time slot, which prompted many who received it to assume they were automatically eligible, even though at that time the clinic was technically only for healthcare workers and the elderly.

Some who received the link in error went through with their appointments. Others backed out when they learned it wasn't their turn. Still more had their doses canceled by Philly Fighting Covid upon arrival.

When Jillian Horn came to get a shot, she said she saw seniors waiting in line get turned away because of booking errors.

“There was literally 85-year-olds, 95-year-old people standing there, with printed appointment confirmations saying, 'I don't understand why I can't get vaccinated,' ” Horn recalled.

On Jan. 23, volunteer nurse Katrina Lipinsky was helping at one of Philly Fighting Covid's vaccination events. She said that about half an hour before the event's scheduled end, staffers started telling volunteers and other workers to call anyone they knew to come in for a shot because there were going to be extras.

Then she saw Doroshin grab a handful of vaccines and stuff them in his bag, along with the corresponding CDC vaccination record cards.

“The idea of somebody who's not a licensed healthcare professional vaccinating their own friend, with or without observation, period, that certainly was not the right thing to do,” Lipinsky told WHYY.

Doroshin initially denied Lipinsky's account but eventually admitted he took doses home during a Jan. 28 interview on NBC's “Today” show. The following day at a press conference, he said he had vaccinated his girlfriend, but no one else. He did not explain how Philly Fighting Covid ended up with extra doses after it turned away people, including seniors, who were in line waiting for the vaccine that same day.

The city cut ties with Philly Fighting Covid on Jan. 25, citing the company's abandonment of its testing work and the company's new privacy policy, which would have allowed it to sell patient data.

Health commissioner Dr. Tom Farley has been asked to explain what happened. Doroshin approached with a vaccine plan, he said, that met the city's health standards.

“I hope people can understand why on the surface this looked like a good thing,” Farley said. “In retrospect, we should have been more careful with this organization.”

The city had other options for a mass vaccination partner. Philadelphia is home to four major health systems, including the University of Pennsylvania medical system, which said it was prepared to ramp up community vaccination efforts as far back as November, well before the city started working with Philly Fighting Covid.

Kenney called for an investigation Friday, and several state lawmakers called for Farley's resignation.

In a press conference at his apartment building Friday, Doroshin called the city's decision to dissolve the partnership “dirty power politics” and alleged it was part of a political conspiracy. He said that if given the chance, he wouldn't have done anything differently.

This story is part of a partnership that includes WHYY, NPR and KHN.

Long-Haul Covid Cases Cast New Light on Chronic Fatigue Sufferers

KFF Health News, February 2, 2021

The percentage of covid patients who become long haulers is hard to pin down — in part because many early covid patients were not tested in time to detect the virus.

This article was published on Tuesday, February 2, 2021 in Kaiser Health News.

By Kevin Cool

Four weeks after San Diego pediatric nurse Jennifer Minhas fell ill with covid-19 last March, her cough and fever had resolved, but new symptoms had emerged: chest pain, an elevated heart rate and crushing fatigue. Her primary care physician told her she was just anxious, and that none of her other covid patients had those issues. "That wasn't what I needed to hear," Minhas said.

At times, she's been too exhausted to hold up her head. "I was kind of a zombie for months, shuffling around unable to do much of anything."

The clinical term for the flattening fatigue Minhas describes is "post-exertional malaise." It is a common symptom among patients who have not recovered from covid. It is also consistent with a standard feature of another chronic illness: myalgic encephalomyelitis, also known as chronic fatigue syndrome, or ME/CFS.

ME/CFS patients also report cognitive impairment — "brain fog" — and orthostatic intolerance, in which standing upright produces a racing heart rate and lightheadedness. Minhas has experienced these symptoms, as have many other "long haulers," the tens of thousands of post-covid patients who haven't recovered.

The percentage of covid patients who become long haulers is hard to pin down — in part because many early covid patients were not tested in time to detect the virus. But "long covid" is potentially an enormous problem. A recent study of 1,733 covid patients in Wuhan, China, found three-quarters of them still had symptoms six months after being released from the hospital.

As of January, doctors had documented more than 21 million cases of covid in the United States. "If just 5 percent develop lingering symptoms,'' — about 1 million cases — "and if most of those with symptoms have ME/CFS, we would double the number of Americans suffering from ME/CFS in the next two years," Harvard Medical School professor Dr. Anthony Komaroff wrote recently in the Harvard Health Letter.

The cause of ME/CFS is unknown, but multiple studies have found it follows acute infections with viruses — everything from the 1918 "Spanish" flu to Ebola. "A certain percentage of people don't recover," said Leonard Jason, a researcher at DePaul University.

Scientists are trying to figure out the mechanisms of the disease and why it develops in certain people and not others. According to the Centers for Disease Control and Prevention, ME/CFS shares certain characteristics with autoimmune diseases, in which the immune system attacks healthy tissue in the body. Multiple studies are underway to explore this and other potential causes.

Doctors who specialize in treating ME/CFS are beginning to pivot to long-covid patients. Dr. Peter Rowe, whose clinic at Johns Hopkins is one of the country's leading centers for ME, has so far seen four long haulers at his practice. "All of them meet the criteria for ME/CFS," he said.

Despite years of research, there is no biomarker for ME/CFS, so blood tests are ineffective as a diagnostic tool. Rowe's approach is to tease apart which symptoms may have identifiable causes and treatments, and address those. One example: A 15-year-old boy Rowe was treating for ME/CFS was so sick that even sitting upright a few hours a day exhausted him and made schoolwork virtually impossible. The boy's heart rate while lying down was 63; when he stood up it skyrocketed to 113. This effect is known as postural orthostatic tachycardia syndrome, or POTS.

Rowe knew from interviews with the boy's mother that he had an extraordinary appetite for salt. So much so that he kept a shaker at his bedside and would regularly sprinkle salt on his hand and lick it off.

Rowe hypothesized that he was dealing with a sodium retention problem. To counter it, he prescribed the steroid fludrocortisone, which promotes sodium resorption in the kidneys. Three weeks later, the boy had recovered so dramatically he was helping a neighbor with a landscaping project, pushing rocks around in a wheelbarrow. "He was a different kid," Rowe said.

Such a course of treatment would not be applicable in a typical case, Rowe said, "but it does emphasize the potential for patients to get a substantial improvement in their CFS symptoms if we address the orthostatic intolerance."

Beginning in the 1980s, many doctors treating ME/CFS prescribed a combination of cognitive behavioral therapy and an exercise regimen based on a now discredited assertion that the illness had no biomedical origin. That approach proved ineffective — patients often got demonstrably worse after pushing beyond their physical limits. It also contributed to a belief within the medical establishment that ME/CFS was all in your head, a narrative that has largely been refuted.

"ME/CFS was never a mostly behavioral problem, although it has been cast as that," Rowe said.

Answers have been slow to arrive, but attitudes about the illness are beginning to change. Advocates of patients point to a 2015 report by the Institute of Medicine that called ME/CFS "a serious, chronic, complex, systemic disease" and acknowledged that many doctors are poorly trained to identify and treat it. The CDC says as many as 90% of the estimated 1 million U.S. patients with ME/CFS may be undiagnosed or misdiagnosed.

The problem is exacerbated by a reluctance to provide health care coverage to patients whose illnesses aren't easily diagnosed, said Joe Dumit, a medical anthropologist at the University of California-Davis. "Making patients prove they are not just suffering, but suffering from a documented illness, saves money. So, I worry about the way in which covid long haulers will be treated as the numbers rise." The best treatment in many cases may be rest or reduced workload, "which translates into some form of disability coverage," he said.

But since long haulers typically sicken immediately after having had a testable viral infection, perhaps they won't be disbelieved, Rowe said — after all, their illness "starts as a 'real' illness.''

Long haulers may also help researchers better understand the onset of the illness because they are being studied as their symptoms emerge, while ME/CFS patients often aren't seen until they've been ill for two or more years, he said.

"There's no question that this legitimizes in many ways the experience of people with ME/CFS who have felt they weren't believed," DePaul's Jason said.

In July, the nonprofit Solve ME/CFS launched an initiative aimed at understanding similarities between long haulers and patients with ME/CFS. Dubbed You+ME and underwritten by the National Institutes of Health, it includes an app that enables registrants to record their symptoms and their effects over time.

Such efforts may further diminish the tendency of doctors to ignore patients' complaints of symptoms that seem to have no evident cause, said Lauren Nichols, 32, a long hauler with a long list of miseries — everything from severe gastrointestinal problems to shingles in her left eye.

"I was one of those people who falsely believed that if you can't see the illness it's psychosomatic," said Nichols, who helps administer Body Politic, a support group for long-covid patients that has found common cause with the ME/CFS community.

"Now I'm living it," she said. "If I have one message for doctors, it's 'Believe your patients.'

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