A KHN analysis of OSHA data found more than 780 covid-related complaints covering more than 2,000 public and private K-12 schools.

This article was published on Tuesday, January 26, 2021 in Kaiser Health News.

By Laura Ungar

Computer science teacher Suzy Lebo saw covid-19 dangers frequently in her Indiana high school: classes with about 30 students sitting less than 18 inches apart. Students crowding teachers in hallways. Students and staff members taking off their masks around others.

“I'm concerned,” said Lebo, who teaches at Avon High School in the Indianapolis suburbs. “We're not controlling the virus in our county. We're not controlling it in our state. And we're not controlling it in our schools.”

President Joe Biden's covid response proposes $130 billion to improve school safety, offers federal guidance for making schools safer and improves workplace protections to safeguard teachers and other workers from covid.

This comes after many school districts and states holding in-person classes have ignored recommendations from public health officials or written their own questionable safety rules — creating a tinderbox where covid can sicken and kill.

A KHN analysis of federal and state Occupational Safety and Health Administration data found more than 780 covid-related complaints covering more than 2,000 public and private K-12 schools. But those pleas for help likely represent only a small portion of the problems, because a federal loophole prevents public school employees from lodging them in 24 states without their own OSHA agencies or federally approved programs for local and state employees. Still, the complaints filed provide a window into the safety lapses: Employees reported sick children coming to school, maskless students and teachers less than 6 feet apart, and administrators minimizing the dangers of the virus and punishing teachers who spoke out.

KHN also found that practices contradicting safety experts' advice are codified into the patchwork of covid rules put out by states and districts. For instance, about half of states don't require masks for all students — including 11 that have exempted schoolchildren of various ages from mandatory masks, with New Hampshire excluding all K-12 students. Districts can craft stricter rules than their states but often don't.

“The response to the virus has been politicized,” said Dr. Chandy John, an expert in pediatric infectious diseases at the Indiana University School of Medicine. “There's a willingness to ignore data and facts and go with whatever you're hearing from the internet or from political leaders who don't have any scientific knowledge.”

But even with Biden's rollout of new school safety steps, struggles over balancing the need for education with covid safety are sure to continue, since it will be months before the nationwide vaccine rollout reaches all school staff members, and the shots haven't yet been approved for kids.

Meanwhile, the scope of covid in schools remains unknown. Biden's order calls for tracking it on the federal level, which wasn't happening. States haven't collected uniform data either. The Covid Monitor, a project launched by volunteers and public health researchers, has counted more than 505,000 cases in K-12 schools — more than a quarter of them among staffers. Although kids are less likely than adults to become seriously ill, recent research suggests they can spread the virus even if asymptomatic. The American Federation of Teachers estimates covid-19 has killed at least 325 school employees, though it's unclear whether they caught it at school.

Among them was Susanne Michael, 47, a fourth grade teacher at Harrisburg Elementary School in northeastern Arkansas. As a cancer survivor with diabetes, she rarely went anywhere outside her home this past fall, according to her husband, Keith. She told him she worried about catching the coronavirus while teaching, but she “went and did it because she loved it.”

She tried her best to keep more than 20 students 6 feet apart, he said, but told him it was nearly impossible.

Though she always wore a mask, he doesn't know if every student did. According to the district's website, masks are required in grades 4-12 “when social distancing is not feasible,” and “physical distancing will be practiced to the extent practical.” District leaders did not respond to requests for comment.

Michael wound up hospitalized on a ventilator. Doctors let her husband visit in protective gear because he, too, had the virus. He held her hand as she slipped away Oct. 1.

The loss hits him hardest at night. “For 27 years, I always had somebody there next to me,” he said. “It's difficult and weighs on your mind and heart a lot when you're laying there in an empty bed and your best friend's gone.”

She left five children, ages 3 to 22, including a former student and her two siblings adopted in July.

A Litany of Lapses

Doctors said covid risks can be drastically reduced by following straightforward safety practices.

“First and foremost, mask mandate, mask mandate, mask mandate,” said Dr. Jason Newland, a pediatrics and infectious diseases professor at Washington University in St. Louis.

But school employees across the nation complain such measures don't exist or aren't enforced.

“School officials openly scoff at covid-19 and believe it is a hoax. This attitude trickles down to staff, so hardly anyone has been wearing their mask or wearing it correctly,” an unidentified employee of Hart Public Schools, in rural western Michigan, wrote in an OSHA complaint in September. The complaint also described large crowds of students sitting too close in cafeterias. The employee alleges being terminated for whistleblowing.

Hart Superintendent Mark Platt said in an email that he won't comment on personnel matters, but “takes seriously its health and safety protocols for students and staff.” The district's covid preparedness and response plan requires staffers and older students to wear masks in classrooms, common areas and buses, while K-5 students must wear them everywhere except in their own classrooms with their own class.

At the public Avon Community School Corp. in Indiana, Lebo said, problems festered since the beginning of the fall semester in July, when an OSHA complaint was lodged. In addition to crowding in the halls and difficulty keeping students 6 feet apart in classrooms, Lebo said, the school's many extracurricular activities — including football, wrestling and show choir — brought their own risks.

Avon schools spokesperson Kevin Carr wouldn't comment except to say students and staff members have tried their best to abide by the district's health and safety protocols.

Over the semester ending in December, Avon schools reported 346 covid cases among nearly 9,800 in-person students and staffers, a rate of 3.5% compared with 2.1% for 1,412 remote learners. The covid rate reached 5.5% at the high school, which went remote briefly in the fall after the number of people quarantining skyrocketed.

Like the vast majority of school OSHA complaints, the one about Avon was closed without an inspection. Across all industries, research shows, just a small percentage of pandemic-related complaints have led to inspections or fines.

A Biden executive order on worker safety calls for OSHA to bolster enforcement and work with states and local governments to ensure workers, including those in the public sector, are protected from covid.

Without strong laws, “workers are facing big challenges: Do I speak up? Do I show up to work?” said Rebecca Reindel, director of occupational safety and health for the AFL-CIO. “They're making a decision between needing a paycheck and risking bringing the virus home.”

Varied, Questionable Guidance

That decision gets even harder when potentially unsafe practices are written into official recommendations.

Missouri and Iowa, for example, advise that students exposed to covid don't need to be quarantined as long as infected and exposed children are both wearing masks correctly — which goes against Centers for Disease Control and Prevention advice to quarantine anyone who has had close contact with a person who has the virus.

Some districts in South Carolina, Tennessee, Florida and Nebraska — with green lights from the Trump administration and their states — classified teachers as “critical infrastructure workers,” allowing them to keep working after exposure if they don't develop symptoms.

A superintendent in Billings, Montana, told administrators in October to “disrupt the 15-minute timeline” required to be deemed a close contact “through movement, distancing or masking.” Following media reports, he issued a statement saying he hadn't intended to “game the system” and no one should move students to avoid quarantines.

In many communities, mask rules are lax.

In Missouri, where there's no statewide mask rule, Ozark School District requires them only “when social distancing is not an option,” according to its website, which describes spacing desks and using barriers to give people a “break” from masks.

Lakeland Joint School District in Idaho recommends masks when physical distancing isn't possible. Dacia Chaffee, parent of an eighth grader and a high school freshman in the district, said “it's almost like normal,” with few students wearing masks. Her kids don't either, she said; they don't want to stand out.

Public health experts said making schools safer will require clear, consistent data and guidance — and political will. They said governments also need to give public schools enough resources to keep more than 50 million students and 3.2 million teachers safe. A recent CDC report estimated that the cost of covid mitigation measures for the 2020-21 school year ranges from $55 per student for items such as masks, plexiglass barriers and face shields to $442 per student with added custodians and transportation, such as buses and drivers, to allow for better physical distancing.

And crucially, experts said, covid policies for schools must be rooted in science, not politics.

“Behaviors and attitudes flow from the top down,” said Dr. Mark Schleiss, a pediatrics professor at the University of Minnesota Medical School. “We have to hold people accountable. This is a life-and-death situation.”

Laura Ungar: lungar@kff.org, @laura_ungar

California Hospital Association President and CEO Carmela Coyle is a power player in the state Capitol.

This article was published on Tuesday, January 26, 2021 in Kaiser Health News.

By Samantha Young

SACRAMENTO — As intensive care units filled and coronavirus cases surged over the holidays, Carmela Coyle invoked a World War II-era quote attributed to British Prime Minister Winston Churchill to rally her own troops: "If you're going through hell, keep going."

Coyle is head of the California Hospital Association, and her "troops" are the highly paid hospital executives she represents. Throughout the pandemic, as in the December memo in which she quoted Churchill, she has employed battlefield rhetoric to galvanize their massive political and financial clout.

That's because Coyle believes hospitals are quite simply "in battle conditions" — a sentiment she has impressed upon the state's top healthcare officials.

While Coyle, 60, is unknown to many Californians, she is a power player in the state Capitol, one whose profile and influence have grown in the past year. She has used her position as president and CEO of the association to lobby for the multibillion-dollar hospital industry, including asking officials to temporarily relax guidelines intended to safeguard patients and workers.

Along the way, she has been granted personal access to Gov. Gavin Newsom and other top officials, helping shape the state's response to covid-19.

"Having spent many, many hours embedded with the Governor's team in the state's Office of Emergency Services, everyone is working 18-plus hours a day," she wrote to hospital executives in March, "and the dedication to supporting what hospitals need to do their jobs is impressive."

Though she hasn't won every battle, Coyle has scored some big wins for the industry.

She successfully petitioned the Newsom administration to relax nurse-to-patient ratios and allow healthcare workers exposed to the coronavirus to continue to work — critical but contentious rule changes intended to keep hospitals staffed that were approved over union objections.

When hospitals started to fill with covid patients last summer, Newsom agreed with Coyle that hospitals could care for them while also performing moneymaking elective surgeries, which hospitals had voluntarily canceled in the spring.

Newsom invited her to a July press briefing to explain that logic to the public. At the briefing, he described Coyle as an "outstanding partner" and a leader with a "seriousness of purpose."

"I just can't thank her enough, more publicly than I have in the past, but I need to repeat it yet again," Newsom said. "We're all being put to the test, particularly our hospital system at this moment."

That Coyle, a relative newcomer to Sacramento politics, is such an influential advocate in the Capitol comes partly with the job. She represents more than 400 hospitals that provide not just critical care, but also jobs to Californians in every corner of the state.

In the first three quarters of 2019, California's hospitals earned about $101.7 billion in net patient revenue, according to financial data filed with the Office of Statewide Health Planning and Development. During the same time last year, they earned about $97.6 billion — representing a 4% decline — despite the loss of elective surgeries and a drop in emergency room visits early in pandemic.

The California Hospital Association is a healthcare heavyweight in Sacramento, along with the doctors' lobby, the dialysis industry and others. It spent nearly $5.3 million on lobbying from Jan. 1, 2019, to Sept. 30, 2020, and $4.3 million to support state and local political campaigns, according to filings with the California secretary of state's office.

In 2019, the association paid Coyle $1.4 million, it said.

"The hospitals are such a big player that you have to be working with them," especially during a public health outbreak, said David Panush, a Sacramento healthcare policy consultant who worked in state government for 35 years.

Coyle also has the ear of Mark Ghaly, secretary of the state Health and Human Services Agency. Ghaly and Coyle have corresponded often since March — sometimes multiple times a day — by phone and email about the state's response to the pandemic, according to emails obtained by California Healthline.

For instance, in March, Coyle shared a letter with Ghaly that she had sent to hospital executives, in which she warned them — and by extension, him — that "we are in battle conditions, and it's all hands on deck to turn the tide."

In other letters and emails, Coyle pressed Ghaly to allow healthcare workers exposed to the virus to continue working as long as they didn't show symptoms. Newsom later issued the rule in an executive order.

"Nurses are the heartbeat of the hospital," said Stephanie Roberson, government relations director of the California Nurses Association — whose leaders, unlike Coyle, have not been invited into the governor's state operations center since it was activated in March. "Instead, we have someone who basically represents the opposite of nursing interests standing alongside the governor discussing the importance of public health."

In a recent statement, Ghaly said the pandemic has required the state to work not only with hospitals but also with doctors, nurses, public health departments, nursing homes, laboratories and emergency services agencies to save lives.

"I am grateful to Carmela and our hospital partners for their tremendous work, particularly during this current surge when hospitals are overwhelmed with patients and intensive care units are filled," Ghaly said.

It took the administration six months to direct hospitals to test healthcare workers for covid at least once a week after requiring nursing homes to do so — a testament, critics say, to the hospital industry's political and economic impact.

"The association exists to increase profits for hospitals, increase the bottom line," said Sal Rosselli, president of the National Union of Healthcare Workers. The union lobbied for the mandatory testing rule, which took effect in December. "That's why they oppose every patient care advocacy issue, every worker issue."

Coyle countered that hospitals have no choice but to make trade-offs while they provide crisis care. She emphasized that the hospitals' requests for exemptions are temporary.

"If we don't flex some of these requirements, it means that people will not get the care they need and, worse, people may die," she said at a news conference earlier this month.

Coyle, a Minnesota native, is known for her intelligence and the expertise she has honed working on healthcare policy for more than 30 years.

As head of the Maryland Hospital Association for nine years before she took the California job in 2017, Coyle built a reputation as a consensus builder even as she looked out for her constituency. For instance, she cultivated relationships with Maryland's congressional delegation and lobbied it for federal funding in 2014 to help the state's hospitals prepare for and treat Ebola patients, most of whom were American healthcare workers who had contracted the virus in Africa.

"She really understood the old maxim that there's no such thing as permanent friends or permanent enemies. There are only permanent interests," said Stan Dorn, a senior fellow at the advocacy group Families USA, who previously served on a Maryland commission on healthcare costs with Coyle. "She understood that it's good to have good relationships with everybody because you never know, day after tomorrow, who is going to be important to your cause."

Along with her credentials comes a strong streak of determination. After Coyle graduated from Minnesota's Carleton College with degrees in economics and Spanish literature, she worked at a Washington, D.C., flower shop until the Congressional Budget Office offered her a two-year internship. She had called to check on her application every Friday for three months.

Coyle "was raised to know" such perseverance as she grew up in a working-class family, the daughter of a Colombian immigrant father.

"Kids teased me and called me names when I was a kid, my father being dark-skinned and having a heavy accent," Coyle said. "I was dark-skinned as well, and they just thought we were so strange."

Laughed at for the way her father spoke, Coyle today unabashedly harnesses the power of language to sway government officials and public opinion — and to marshal her own hospital forces to lobby "with one voice."

In the waning days of last year's legislative session, Coyle warned hospital executives of the battles before them in the Capitol: bills that would come with hefty costs to hospitals should they pass.

In the end, the industry succeeded in blocking a bill that would have made it harder for hospitals to consolidate. But they didn't get legislative approval to delay seismic retrofits at hospitals, as they had wanted. Lawmakers also passed a bill opposed by hospitals that requires them to maintain a 45-day stockpile of personal protective equipment, which Coyle had argued was unreasonable given that it has been in short supply.

"They're not all-powerful, but certainly they're influential," said state Sen. Richard Pan (D-Sacramento), who chairs the Senate Health Committee. "And during covid, they're taking care of patients. They're the ones saving the lives of people who are intubated."

When Coyle readied her troops for the legislative fights, she acknowledged they weren't going to win every battle. She borrowed another World War II quote, this time from Gen. Douglas MacArthur, to explain to hospital executives that they may need to compromise.

"In war, you win or lose, live or die," she wrote. "And the difference is just an eyelash."

California Healthline correspondent Angela Hart and KHN data editor Elizabeth Lucas contributed to this report.

Diminished testing capacity could lead to longer waits for appointments, which means infected people could potentially expose others for a longer time before learning they have the virus.

This article was published on Monday, January 25, 2021 in Kaiser Health News.

By Bernard J. Wolfson

California Gov. Gavin Newsom, under growing pressure to jump-start a faltering covid-19 vaccine rollout, jetted to Los Angeles on Jan. 15 to unveil a massive new vaccination site at Dodger Stadium that is expected eventually to inoculate 12,000 people a day.

The city-run venue had been the biggest covid testing site in the U.S., administering over 1 million tests in its nearly eight months of operation — and over 10,000 a day during the recent surge. Its redeployment to the cause of vaccination, Newsom declared, provides "an extraordinary world-class site for a world-class logistics operation."

That effort came with a trade-off: When the city of Los Angeles ended covid tests at Dodger Stadium and closed another testing site to help staff the new vaccination center, it removed, at least temporarily, about one-third of all government-run testing in Los Angeles County — the nation's largest county, with a population of 10 million, and one of the biggest covid hot spots.

Sites operated by the city, county or state account for just over one-third of all covid tests in L.A. County, said Dr. Clemens Hong, who heads the county's testing operations.

Diminished testing capacity could lead to longer waits for appointments, which means infected people could potentially expose others for a longer time before learning they have the virus.

But L.A. Mayor Eric Garcetti said that has not happened so far. In what he called an instance of "perfect timing," infection rates in L.A. County have declined since Dodger Stadium switched to vaccinations, and demand for tests has dropped by half to two-thirds, the mayor said Thursday. "We are meeting the need — actually exceeding the need."

Still, he acknowledged that converting the stadium had been a risk – one the city took because "the vaccines will prevent and heal and finally resolve this."

Many health experts agree that prioritizing vaccination over testing is the right move.

"The best way out of our current crisis is masks, few contacts per day and vaccines, so it makes sense to create lots more access points for vaccinations even if it means a bit less testing," said Dr. Bob Kocher, a senior fellow at the University of Southern California's Schaeffer Center for Health Policy & Economics and a former member of the state's COVID-19 Testing Task Force.

But with covid caseloads still high despite their recent decline from peak levels, and mutant strains of the virus threatening to fuel new outbreaks, some senior public health officials say testing remains an equally vital part of the effort to contain — and ultimately suppress — the pandemic.

And it could become even more important in the coming months, as the inoculation campaign gains steam, since the tests could prove a valuable tool for assessing how well the vaccines are working.

"It's hard to say right now, given how many people are sick with covid, that vaccine is more important," said Hong. "It's hard to balance those two against each other, because we really just need a lot of both."

Balancing vaccinations with testing and other covid-related tasks is a significant challenge for public health officials across California and the nation, because those functions draw on many of the same resources — especially the staff needed for administration and record-keeping.

At vaccination sites, keeping good records is essential for planning from day to day how many doses to pull out of the freezer. "It's got to be done right, or else you screw up when the second dose is," said Dr. George Rutherford, an epidemiologist at the University of California-San Francisco.

Sara Bosse, public health director of Madera County, noted that counties across the state have asked Newsom for $400 million in the current budget year to help defray the costs of setting up vaccination sites, including facility costs, security, data entry staffers and clinicians to give the shots and watch for adverse side effects. They are also seeking $280 million for covid testing and $440 million for contact tracing and non-group housing to protect covid-vulnerable residents.

"I think that many counties are prioritizing vaccination, and based on the resources they have, they may pull from various parts of the covid response such as contact tracing or testing," Bosse said. The funding, she said, would help county health officials avoid "those difficult decisions where we have to pull from one part of the covid response to prop up the next."

There could also be federal help on the way: President Joe Biden has announced plans to establish 100 federally supported vaccination centers and allocate $50 billion to expand testing.

In Madera County, a poor rural area of 160,000 people that stretches from the Central Valley into the Sierra Nevada, the state has largely taken over covid testing, allowing the county to focus its resources on vaccinations, Bosse said.

The big challenge on that front, she said, is having enough trained health personnel to run the vaccination sites. The county recently heard from 85 trained clinicians willing to volunteer for the vaccine effort, "which is going to be a game changer for us," Bosse said.

In Los Angeles, the city has the means to add testing capacity elsewhere and beef up mobile testing, Garcetti said. It had been considering a testing site at Pierce College in the San Fernando Valley, "which it looks like we won't need to open," the mayor said.

The city, county and state are also discussing the possibility of a partnership to expand testing at Exposition Park in South L.A.

In San Diego County, health officials expect to face a challenge due to the competition for staffing between vaccination and testing, and they are hiring to meet the need, said Sarah Sweeney, a spokesperson for the county's Health and Human Services Agency. The county hasn't yet converted testing venues to vaccination sites but expects to do so after vaccine supplies increase, she said.

San Bernardino County health officials are committed to maintaining testing at current volumes even as they ramp up vaccinations, said Corwin Porter, the director of public health. But he conceded that doing both at the same time "is a struggle" because "we don't have enough vaccine and we don't have enough staff."

The county is holding hiring events every week and working with multiple partners to find additional resources, "because we are trying not to pull anything out of testing or contact tracing," Porter said.

Beyond the resource question, another big challenge confronts health officials: "There is an issue of divided attention," said L.A. County's Hong. "Now we have two big things to deal with — three if you include contact tracing. I think we will have to be thoughtful about our strategy."

Once a broad swath of the population has been vaccinated, which could take many months, testing volume will likely drop off sharply, said UCSF's Rutherford.

"I don't see hundreds of thousands of tests a day anymore once we get well up on vaccinations," he said. "You'll be testing thousands of people to find tens of cases."

In the meantime, L.A. County will likely add questions to its testing appointment website asking people about their vaccination status, Hong said. "That way we can track what's happening in people who are vaccinated."

Ongoing covid outbreaks may require increased testing, particularly in poorer communities of color, which have been hit hardest by the pandemic — and where hesitancy to be vaccinated is likely to be more widespread, said Hong. "So the bottom line is that testing is not going away."

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

Bernard J. Wolfson: bwolfson@kff.org, @bjwolfson

Anti-vaxxers are blaming patients' coincidental medical problems on covid shots, even when it's clear that age or underlying health conditions are to blame.

This article was published on Monday, January 25, 2021 in Kaiser Health News.

By Liz Szabo January 25, 2021

Anti-vaccine groups are exploiting the suffering and death of people who happen to fall ill after receiving a covid shot, threatening to undermine the largest vaccination campaign in U.S. history.

In some cases, anti-vaccine activists are fabricating stories of deaths that never occurred.

"This is exactly what anti-vaccine groups do," said Dr. Peter Hotez, an infectious diseases specialist and author of "Preventing the Next Pandemic: Vaccine Diplomacy in a Time of Anti-Science."

Anti-vaccine groups have falsely claimed for decades that childhood vaccines cause autism, weaving fantastic conspiracy theories involving government, Big Business and the media.

Now, the same groups are blaming patients' coincidental medical problems on covid shots, even when it's clear that age or underlying health conditions are to blame, Hotez said. "They will sensationalize anything that happens after someone gets a vaccine and attribute it to the vaccine," Hotez said.

As more seniors receive their first covid shots, many will inevitably suffer from unrelated heart attacks, strokes and other serious medical problems — not because of the vaccine but, rather, their age and declining health, said epidemiologist Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy.

For example, in a group of 10 million people — about the number of Americans who have been vaccinated so far — nearly 800 people ages 55 to 64 typically die of heart attacks or coronary disease in one week, Osterholm said. Public health officials "are not ready" for the onslaught of news and social media stories to come, he cautioned.

"The media will write a story that John Doe got his vaccine at 8 a.m. and at 4 p.m. he had a heart attack," Osterholm said on his weekly podcast. "They will make assumptions that it's cause and effect."

Public health officials need to do a better job communicating the risks — real and imagined — from vaccines, said Osterholm, who has been advising President Joe Biden on the pandemic since his election.

"You get one chance to make a first impression," Osterholm said. "Even if we come back later and say, "No, [the deaths] had nothing to do with vaccination, it was coronary artery disease,' the damage has already been done."

Anti-vaccine groups such as the National Vaccine Information Center and Children's Health Defense, founded by Robert F. Kennedy Jr., are already inflaming fears about a handful of deaths — mostly in Europe — that have followed the worldwide rollout of immunizations.

In a blog post, Kennedy scoffed at autopsy results that concluded a Portuguese woman's death was unrelated to a vaccine. He cast doubt on statements by medical authorities in Denmark who said the deaths of two people there after vaccination were due to old age and chronic lung disease. In an interview, Kennedy said the post-vaccination deaths of some very frail and terminally ill nursing home patients in Norway are a danger sign. Norwegian officials have said the elderly patients died of their underlying illnesses, not from the vaccine.

"Coincidence is turning out to be quite lethal to COVID vaccine recipients," Kennedy wrote. Kennedy described the deaths as suspicious, accusing medical officials of following an "all-too-familiar vaccine propaganda playbook" and "strategic chicanery."

Here in the U.S., vaccine opponents have pounced on the tragedy of Dr. Gregory Michael, a 56-year-old Florida obstetrician-gynecologist, to sow doubts about vaccine safety and government oversight. Michael died Jan. 5 after suffering a catastrophic drop in platelets — elements in the blood that control bleeding — suggesting he may have developed immune thrombocytopenia.

According to a Facebook post by his wife, Heidi Neckelmann, doctors tried a variety of treatments to save her husband, but none worked.

A spokesperson for the Centers for Disease Control and Prevention said the agency is investigating Michael's death, as it does for all suspected vaccine-related health problems. California authorities have recommended pausing vaccinations with a particular batch of covid vaccines made by Moderna because of a high rate of allergic reactions.

"We're going to see these events happen, and we have to follow up on every one of these cases," Osterholm said. "I don't want people to think that we're sweeping them under the rug."

Many Americans were already nervous about covid vaccines, with 27% saying they "probably or definitely" would not get a shot, even if the shots were free and deemed safe by scientists, according to a December survey by KFF. (KHN is an editorially independent program of KFF.)

These people may be particularly susceptible to vaccine misinformation, said Rory Smith, an investigator at First Draft News, a nonprofit that reports on misinformation online.

A Rare Condition

Seven experts in blood disorders interviewed by KHN said there's not enough information available to blame Michael's decline on a vaccine and that the demonstrated benefits of covid vaccinations vastly outweigh any potential risk of bleeding. Even if investigators conclude that Michael's vaccine caused his death, it would still be an incredibly rare event, given that more than 12 million doses have been administered.

"It shouldn't give anyone pause about whether the vaccine is safe or not," said Dr. James Zehnder, a hematologist and director of clinical pathology at Stanford Medicine.

Michael's bleeding disorder could have been developing silently for some time, said Dr. Adam Cuker, director of the Penn Blood Disorders Center at the Hospital of the University of Pennsylvania. It could be a coincidence that Michael started showing symptoms shortly after vaccination, he said. About 30 Americans are diagnosed with immune thrombocytopenia every day.

The timing of Michael's illness suggests it had another cause, doctors said. According to his wife's Facebook post, his bleeding problems began three days after his first covid shot. It takes the body 10 to 14 days after vaccination to generate antibodies, which would be needed to cause immune thrombocytopenia, said Dr. Cindy Neunert, a pediatric hematologist at the Columbia University Irving Medical Center in New York City.

In most cases, the cause of thrombocytopenia is never known, said Dr. Deepak Bhatt, executive director of interventional cardiovascular programs at Brigham and Women's Hospital in Boston.

Immune thrombocytopenia is linked, rarely, to certain vaccines, with about 26 cases for every 1 million doses of measles-mumps-rubella vaccine.

But it can also be caused by viruses themselves, including measles and the novel coronavirus, said Dr. Sven Olson, an assistant professor of hematology-medical oncology at Oregon Health & Science University's school of medicine.

Many patients with immune thrombocytopenia are now wondering if they should be vaccinated against covid, Cuker said. Cuker said he urges nervous patients to be vaccinated, noting that any problems could be managed by closely monitoring their platelet levels and adjusting medication if needed.

Even in patients with underlying bleeding conditions, "it's still safer to get vaccinated than to get covid," Zehnder said.

"If you give a vaccine to a large enough number of people, there are going to be rare adverse events but there are also going to be coincidental events unrelated to the vaccine," Cuker said. "If an anti-vaccine group uses a single case, where no link has been proven, to discourage people from vaccination, that's terrible."

Barbara Loe Fisher, president of the National Vaccine Information Center, said her site provides balanced information from reputable news sources, including CNN, CBS and the Miami Herald, as well as Pfizer and the CDC.

In an interview with KHN, Kennedy said he questions why government officials have been so quick to dismiss connections between vaccinations and deaths. "How in the world do they know if it's a vaccine injury or not?" he asked.

"We don't discourage anybody from getting vaccinated," Kennedy said. "All we're doing is conveying the data, which is what the government should be doing. … We print the truth, which is what the medical agencies ought to do."

Alternative Facts?

Opponents of vaccination have belittled concerns about the novel coronavirus for months, opposing masks and fighting stay-at-home orders and contact tracing, said Richard Carpiano, a professor of public policy and sociology at the University of California-Riverside.

"They have come out against every public health measure to control the pandemic," Carpiano said. "They have said public health is public enemy No. 1."

Recently, anti-vaccine activists have been so eager to discredit immunizations that they have blamed covid for the deaths of people who are very much alive.

Social media users selectively edited a video of a Tennessee nurse, Tiffany Dover to make it appear as if she dropped dead after being vaccinated, when in fact she simply fainted, said Dorit Reiss, a professor at the UC Hastings College of Law in San Francisco. Although Dover quickly recovered, social media users posted a fake death certificate and obituary. Anti-vaccine activists also harassed Dover and her family online, said Reiss, who chronicled Dover's ordeal in a blog post.

Anti-vaccine activists are adept at manipulating video, Smith said.

"They are notorious for using videos and images purportedly showing the adverse effects of vaccines, such as autism in children and seizures in other vaccine recipients," Smith said. "The more emotive and graphic the videos and images — irrespective of whether it's actually linked at all to vaccines or not — the better."

In December, multiple Facebook posts falsely claimed that an Alabama nurse died after receiving one of the state's first covid vaccines. One Twitter user went so far as to identify the nurse as Jennifer McClung, who worked at Helen Keller Hospital in Sheffield, Alabama. In fact, McClung died of covid. Social media posts spread so widely that Alabama health department officials contacted every hospital in the state to confirm that no vaccinated staff member had died.

Anti-vaccine groups often build fables around "a tiny, tiny grain of truth," Smith said. "This is why misinformation, specifically vaccine misinformation, can be so convincing. … But this information is almost always taken completely out of context, creating claims that are either misleading or outright false."

The Ron Paul Institute for Peace and Prosperity twisted a news story about the deaths of 24 people at an upstate New York nursing home, incorrectly blaming their deaths on covid vaccinations. The original article noted, however, that a covid outbreak at the nursing home began in late December, before residents received any vaccines. Covid vaccines, which require two doses for full protection, did not arrive in time to save the residents' lives.

Kennedy repeated the misinformation — again incorrectly blaming the residents' deaths on vaccines — in his blog, although he linked to a local news station that reported the information correctly.

Distorting facts to discourage vaccination, Cuker said, is "very irresponsible and damaging to public health."

Liz Szabo: lszabo@kff.org, @LizSzabo