Dr. Anthony Fauci thanked America's healthcare workers, who "every single day put themselves at risk" during the pandemic, even as he acknowledged that PPE shortages had contributed to the deaths of more than 3,600 of them.
KHN and The Guardian are tracking healthcare workers who died from COVID-19 and writing
"We rightfully refer to these people without hyperbole — that they are true heroes and heroines," he said in an exclusive interview with The Guardian. The deaths of so many health workers from COVID-19 are "a reflection of what healthcare workers have done historically, but putting themselves in harm's way by living up to the oath they take when they become physicians and nurses," said Fauci.
KHN and The Guardian have tracked healthcare workers' deaths throughout the pandemic in the "Lost on the Frontline" database. More than 3,600 health worker deaths have been tallied in the database, considered the most authoritative accounting in the country.
Personal protective equipment — including gloves, gowns and critical masks — have been in short supply since the pandemic began and heightened the toll. The U.S. is the world's largest importer of PPE, which made it especially vulnerable to the demand shock and export restrictions that hit the global market last spring.
"During the critical times when there were shortages was when people had to use whatever was available to them," said Fauci. "I'm sure that increased the risk of getting infected among healthcare providers."
Shortages were compounded by the federal government's failure to maintain a national stockpile of personal protective equipment, and the Trump administration's refusal to order more domestic manufacturing of PPE. That left health workers to use trash bags as gowns, reuse N95s for weeks and, at times, go totally without gloves.
The shortages led to protests by health workers, who said working amid the pandemic without equipment left them like "sheep going to slaughter." Nina Forbes, a nurse at an assisted living facility, was forced to wear a trash bag at times, according to her daughter, and later die.
Nearly 560,000 Americans have died in the COVID pandemic, with many more experiencing long-term symptoms of COVID.
Health workers have been especially vulnerable through the pandemic, as they have treated patients through early waves when the lack of personal protective equipment was especially acute, through summer surges and a disastrous peak in the winter.
A study of health workers in the U.S. and the United Kingdom in The Lancet found health workers are three times more likely than the general public to become infected with the COVID virus, with disproportionate impacts on minority health workers.
"It's very clear when you just go to the media and see the images on television — the stress and the strain on the faces of healthcare providers, nurses, doctors, other people involved in the healthcare enterprise," said Fauci.
Nevertheless, the U.S. government has failed to systematically count health worker deaths. Members of Congress, the Health and Human Services Department and academic reports have cited The Guardian and KHN's reporting as the most comprehensive. A growing chorus of policy experts and unions have called for a comprehensive count of health worker deaths.
"We certainly want to find an accurate count of the people who die," said Fauci, without noting when the government should undertake such an effort. "Certainly, that's something I think would fall under the auspices of the federal government."
Even as the vaccine rollout picks up speed, health workers continue to be imperiled. More than 400 died between the time the rollout began and late February. Infections among vaccinated health workers have steeply declined, but because deaths are a lagging indicator of the spread of COVID, some health workers will have been sickened before widespread vaccination.
At the same time, immunity to coronaviruses generally wanes over time and variants may blunt the efficacy of some vaccines. A global shortage of vaccines means dozens of poor nations have not inoculated a single person. Advocates argue this has led to a global "vaccine apartheid," which will contribute to the continued emergence of variants. Both scenarios could imperil health workers anew and necessitate a new round of adult mass vaccination.
Studies into the duration of immunity for vaccines, and variants' impact on vaccines, are ongoing. "If we're going to need to do boosting with a variant-specific boost, [we] will be prepared for it because we're already doing a study," Fauci said, with such research taking place at the National Institute of Allergy and Infectious Diseases, which he leads. Even so, "it looks like our ability to protect against variants with the standard vaccine might be better than we anticipated."
Regardless of how future vaccination campaigns play out, Fauci said, U.S. policymakers should learn from what has transpired over the past year.
"We better make sure the lesson we will learn is that we will never again be in a situation where people who are putting their health and their safety on the line don't have the appropriate equipment to protect themselves safely," he said.
People who didn't test positive for COVID — due either to a lack of access to testing or a false-negative result — face difficulty getting treatment and disability benefits.
This article was published on Friday, April 9, 2021 in Kaiser Health News.
Kristin Novotny once led an active life, with regular CrossFit workouts and football in the front yard with her children — plus a job managing the kitchen at a middle school. Now, the 33-year-old mother of two from De Pere, Wisconsin, has to rest after any activity, even showering. Conversations leave her short of breath.
Long after their initial coronavirus infections, patients with a malady known as "long COVID" continue to struggle with varied symptoms such as fatigue, shortness of breath, gastrointestinal problems, muscle and joint pain, and neurological issues. Novotny has been contending with these and more, despite testing negative for COVID-19 seven months ago.
Experts don't yet know what causes long COVID or why some people have persistent symptoms while others recover in weeks or even days. They also don't know just how long the condition — referred to formally by scientists as Post-Acute Sequelae of SARS-CoV-2 infection, or PASC — lasts.
But the people who didn't test positive for COVID — due either to a lack of access to testing or a false-negative result — face difficulty getting treatment and disability benefits. Their cases are not always included in studies of long COVID despite their lingering symptoms. And, sometimes as aggravating, many find that family, friends or even doctors have doubts they contracted COVID at all.
Novotny, who first became ill in August, initially returned to work at the beginning of the school year, but her symptoms snowballed and, one day months later, she couldn't catch her breath at work. She went home and hasn't been well enough to return.
"It is sad and frustrating being unable to work or play with my kids," Novotny said via email, adding that it's devastating to see how worried her family is about her. "My 9-year-old is afraid that if I'm left alone, I will have a medical emergency and no one will be here to help."
Data about the frequency of false-negative diagnostic COVID tests is extremely limited. A study at the Johns Hopkins School of Medicine and Bloomberg School of Public Health, which focused on the time between exposure and testing, found a median false-negative rate of 20% three days after symptoms start. A small study in China conducted early in the pandemic found a high rate of negative tests even among patients sick enough to be hospitalized. And given the dearth of long-hauler research, patients dealing with lingering COVID symptoms have organized to study themselves.
The haphazard protocols for testing people in the United States, the delays and difficulties accessing tests and the poor quality of many of the tests left many people without proof they were infected with the virus that causes COVID-19.
"It's great if someone can get a positive test, but many people who have COVID simply will never have one, for a variety of different reasons," said Natalie Lambert, an associate research professor at the Indiana University School of Medicine and director of research for the online COVID support group Survivor Corps.
Lambert's work with computational analytics has found that long haulers face such a wide variety of symptoms that no single symptom is a good screening tool for COVID. "If PCR tests are not always accurate or available at the right time and it's not always easy to diagnose based on someone's initial symptoms, we really need to have a more flexible, expansive way of diagnosing for COVID based on clinical presentations," she said.
Dr. Bobbi Pritt, chair of the division of clinical microbiology at Mayo Clinic in Minnesota, said four factors affect the accuracy of a diagnostic test: when the patient's sample is collected, what part of the body it comes from, the technique of the person collecting the sample and the test type.
"But if one of those four things isn't correct," said Pritt, "you could still have a false-negative result."
Timing is one of the most nebulous elements in accurately detecting SARS-CoV-2. The body doesn't become symptomatic immediately after exposure. It takes time for the virus to multiply and this incubation period tends to last four or five days before symptoms start for most people. "But we've known that it can be as many as 14 days," Pritt said.
Testing during that incubation period — however long it may be — means there may not be enough detectable virus yet.
"Early on after infection, you may not see it because the person doesn't have enough virus around for you to find," said Dr. Yuka Manabe, an infectious-disease expert and a professor at the Johns Hopkins University School of Medicine.
Novotny woke up with symptoms on Aug. 14 and got a COVID test later that day. Three days later — the same day her test result came back negative — she went to the hospital because of severe shortness of breath and chest pressure.
"The hospital chose not to test me due to test shortages and told me to presume positive," Novotny wrote, adding that hospital staffers told her she likely tested too early and received a false negative.
As the virus leaves the body, it becomes undetectable, but patients may still have symptoms because their immune responses kicked in. At that point, "you're seeing more of an inflammatory phase of illness," Manabe said.
An autoimmune response, in which the body's defense system attacks its own healthy tissue, may be behind persistent COVID symptoms in many patients, though small amounts of virus hiding in organs is another explanation.
Andréa Ceresa is nearing a year of long COVID and has an extensive list of symptoms, topped by gastrointestinal and neurological issues. When the 47-year-old from Branchburg, New Jersey, got sick last April, she had trouble getting a COVID test. Once she did, her result was negative.
Ceresa has seen so many doctors since then that she can't keep them straight. She considers herself lucky to have finally found some "fantastic" doctors, but she's also seen plenty who didn't believe her or tried to gaslight her — a frequent complaint of long haulers.
A couple of doctors told her they didn't think her condition had anything to do with COVID. One told her it was all in her head. And after a two-month wait to see one neurologist, he didn't order any tests and simply told her to take vitamin B, leaving her "crying and devastated."
"I think the negative test absolutely did that," Ceresa said.
Fortunately, among a growing number of physicians specifically treating patients with long COVID, positive test results aren't vital. In the patient-led research, symptoms patients reported were not significantly different between those who had positive COVID tests and those who had negative tests.
Dr. Monica Verduzco-Gutierrez, a rehabilitation and physical medicine doctor who leads University Health's Post-COVID Recovery program in San Antonio, said about 12% of the patients she's seen never had a positive COVID test.
"The initial test, to me, is not as important as the symptoms," Gutierrez said. "You have to spend a lot of time with these patients, provide education, provide encouragement and try to work on all the issues that they're having."
She said she tells people "what's done is done" and, regardless of test status, "now we need to treat the outcome."
In the preceding weeks, as covid made its first advance through California, Gov. Gavin Newsom had called on cities and counties to persuade hotel operators to open their doors to people living on the streets whose age and health made them vulnerable. But in Santa Rosa, a town that thrives on tourist dollars, city leaders knew they would never find enough owners to volunteer their establishments.
SANTA ROSA, Calif. — They knew the neighborhood would revolt.
It was early May, and officials in this Northern California city known for its farm-to-table dining culture and pumped-up housing prices were frantically debating how to keep covid-19 from infiltrating the homeless camps proliferating in the region’s celebrated parks and trails. For years, the number of people living homeless in Santa Rosa and the verdant hills and valleys of broader Sonoma County had crept downward — and then surged, exacerbated by three punishing wildfire seasons that destroyed thousands of homes in four years.
Seemingly overnight, the city’s homeless crisis had burst into view. And with the onset of covid, it posed a devastating health threat to the hundreds of people living in shelters, tents and makeshift shanties, as well as the service providers and emergency responders trying to help them.
In the preceding weeks, as covid made its first advance through California, Gov. Gavin Newsom had called on cities and counties to persuade hotel operators to open their doors to people living on the streets whose age and health made them vulnerable. But in Santa Rosa, a town that thrives on tourist dollars, city leaders knew they would never find enough owners to volunteer their establishments. City Council member Tom Schwedhelm, then serving as mayor, settled on an idea to pitch dozens of tents in the parking lot of a gleaming community center in an affluent neighborhood known as Finley Park, a couple of miles west of Santa Rosa’s central business district.
Neighborhood residents weren’t keen on the idea of accepting homeless people into their enclave of tree-lined streets and sleepy cul-de-sacs. Yet in short order, thousands of residents and businesses received letters notifying them of the city’s plans to erect 70 tents that could shelter as many as 140 people at the Finley Community Center, a neighborhood jewel that draws scores of families and fitness enthusiasts to its manicured picnic grounds, sparkling pool and tennis courts.
The backlash was fierce. For three hours on a Thursday evening in mid-May, Santa Rosa officials defended their plans as hundreds of residents flooded the phone lines to register their discontent.
“Will there be a list of everybody who decided to do this to us and our park, in case we want to vote them out?” one resident barked.
“This is a family neighborhood,” another fumed.
“How can we feel safe using our park?” others pleaded.
In Santa Rosa, like so many other communities, strenuous neighborhood objections typically would drive a stake through a proposal for homeless housing and services. Not this time. Elected officials were not asking; they were telling. The project would move ahead.
“Go ahead and vote me out,” said Schwedhelm, recounting his mindset at the time. “You want to shout at me and get angry? Go ahead. It’s important for government to listen, but the reality is these are our neighbors, so let’s help them.”
Within days, the spacious parking lot at the Finley Community Center was cordoned off with green mesh fencing. Inside, spaced 12 feet apart, were 68 blue tents, each equipped with sleeping bags and storage bin. A neat row of portable toilets lined one side of the encampment, and it was fitted throughout with hand-washing stations and misters for the summer heat.
The city contracted with Catholic Charities of Santa Rosa to manage the camp, and social workers fanned out to the city shelters and unsanctioned encampments, where they found dozens of takers. The first dozen residents were in their tents four days after the site was approved, and the population quickly swelled to nearly 70. In exchange for shelter, showers and three daily meals, camp residents agreed to an 8 p.m. curfew and a contract pledging to honor mask and physical-distancing requirements and act as good neighbors.
Santa Rosa’s tent city opened May 18. And, not too long after, something remarkable happened. Finley Park residents stopped protesting and started dropping off donations of goods — food, clothing, hand sanitizer. The tennis and pickleball courts, an afternoon favorite for retirees, were bustling again. Parents and kids once more crowded the nearby playground.
And inside that towering green perimeter, people started getting their lives together.
From May to late November, Santa Rosa would spend $680,000 to supply and manage the site, a six-month experiment that would chart a new course for the city’s approach to homeless services. As cities across California wrestle with a crisis of homelessness that has drawn international condemnation, the Santa Rosa experience suggests a way forward. Rather than engage in months of paralyzing discussion with neighborhood opponents before committing to a housing or shelter project, city officials decided their role was to lead and inform. They would identify project sites and drive forward, using neighborhood feedback to tailor improvements to a plan — but not to kill it.
It was a watershed moment of action that would echo across Sonoma County.
“We know we’re pissing off a lot of people — they’re rising up and saying, ‘Hell, no!’” said county Supervisor James Gore, president of the California State Association of Counties. “But we can’t just keep saying no. That’s been the failed housing policy of the last 30 to 40 years. Everybody wants a solution, but they don’t want to see that solution in their neighborhoods.”
‘Death by a Thousand Cuts’
About a quarter of the nation’s homeless reside in California, nearly 160,000 people living in cars, on borrowed couches, in temporary shelters or on the streets. The pandemic has exacerbated the crisis for a host of reasons, including covid-related job loss and prison releases and new capacity limits at homeless shelters.
From Los Angeles to Fresno to San Francisco and Sacramento, homeless encampments have multiplied. And without toilets or trash bins, unsanctioned encampments have become magnets for neighborhood complaints about seedy, unsanitary conditions. That leads to regular law enforcement sweeps that raze an encampment only to see it rise elsewhere.
California’s capital city offers a telling example of the dynamic. An estimated 6,000 people are living homeless in Sacramento, a population that has grown more visible since covid brought office life to a standstill. Tents and tarps crowd freeway underpasses throughout the downtown grid, accompanied by wafting piles of trash and clutter.
The mayor, Darrell Steinberg, is known as a champion on homelessness issues. During his years in the state legislature, he pushed through measures that exponentially increased funding to address homelessness and mental illness. But in more than four years as mayor he has struggled to muscle through a cohesive policy for moving people off the streets and into supportive housing.
“The problem with our approach,” Steinberg said earlier this year, “is that every time we seek to build a project, there is a neighborhood controversy. Our own constituents say, ‘Solve it, but please don’t solve it here,’ and we end up experiencing death by a thousand cuts.”
With community uproar building, he is leading the charge on a new initiative to build a continuum of city-sanctioned housing, including triage shelters, sanctioned campgrounds and permanent housing with social services. The city has allocated up to $1 million in an initial outlay for tiny homes and safe camping, but as of March had gotten consensus on just one site: a parking lot beneath a busy freeway where the city will install toilets and hand-washing stations and allow up to 150 people to set up camp.
Donta Williams, homeless the past five years, shakes his head at how long it’s taken the city to sanction a campsite. Priced out of the South Sacramento neighborhood he considers home, Williams has subsisted in a series of squalid lots, regularly packing up and moving from one to the next in response to law enforcement sweeps.
“We’ve got nowhere to go,” said Williams, 40, who is a plaintiff in a legal battle with the city over encampment sweeps. “We need housing. We need services like bathrooms and hand-washing stations. Or how about just some dumpsters so we can pick up the trash?”
A Real Job, a New Beginning
Like Sacramento, Sonoma County has battled unruly homeless encampments for years. Before the fires, the crisis was more hidden, with people sheltering in creek beds and wooded glens abutting hiking and biking trails. The wildfires of 2017, 2019 and 2020 brought many out of the backcountry. And the 5,300 homes decimated by flames meant even more people displaced.
Politicians in Sonoma County described their soul-searching over how to cut through the community gridlock when it comes to finding locations to provide housing and services.
“It’s fear and anger that you’re going to take something away from me if you build this housing — that’s a big part of it, and I saw that anger directed at me, too,” said Shirlee Zane, a vocal backer of homeless services who lost her reelection bid last year after 12 years on the county board of supervisors. “It’s a psychology we see here too often, a sense of entitlement from white middle-class people.”
In creating the Finley Park model, Santa Rosa leaders drew on a few basic tenets. Neighbors were worried about crime and drug use, so the city deployed police officers and security guards for 24/7 patrols. Neighbors worried about trash and disease; the city brought in hand-washing stations, showers and toilets. Catholic Charities enrolled dozens of camp residents in neighborhood beautification projects, giving them gift cards to stores like Target and Starbucks in exchange for picking up trash — usually $50 for a couple of hours of work.
A few times a week, a mobile clinic serviced the camp, dispensing basic health care and medications. Residents had access to virtual mental health treatment and were screened regularly for covid symptoms; only one person tested positive for the coronavirus during the 256 days the site was in operation.
“We were serious about providing access to care,” said Jennifer Ammons, a nurse practitioner who led the mobile clinic. “You can get them inhalers, take care of their cellulitis with antibiotics, get rid of their pneumonia or skin infections.”
Rosa Newman was among those who turned their lives around. Newman, 56, said she had sunk into homelessness and addiction after leaving an abusive partner years before. She moved into her designated tent in September and in a matter of days was enrolled in California’s version of Medicaid, connected to a doctor and receiving treatment for a painful bladder infection. After two months in the camp, she was able to get into subsidized housing and landed a job at a Catholic Charities homeless drop-in center.
“Before, I was so sick I didn’t have any hope. I didn’t have to show up for anything,” she said. “But now I have a real job, and it’s just the beginning.”
James Carver, 50, who for years slept in the doorway of a downtown Santa Rosa business with his wife, said he felt happy just to have a tent over his head. Channeling his energy into cleanup projects and odd jobs around camp, Carver said, his morale began to improve.
“It’s such a comfort; I’m looking for work again,” Carver, an unemployed construction worker, said in November while cleaning stacks of storage totes handed out to camp residents. “I don’t have to sleep with one eye open.”
Jennielynn Holmes, who runs Catholic Charities’ homeless services in Northern California, said the Finley Park experiment helped in ways she didn’t expect.
“This taught us valuable lessons on how to keep the unsheltered population safe, but also we were able to get people signed up for health care and ready for housing faster because we knew where they were,” Holmes said. Of the 208 people served at the site, she said, 12 were moved into permanent housing and nearly five dozen placed in shelters while they await openings.
When Santa Rosa officials conceived of the Finley site, they sold it to the community as temporary, believing covid would run its course by winter. And though covid still raged, they kept that promise and closed the site Nov. 30, then held a community meeting to get feedback. “Only three or four people called in, and they all had positive things to say,” said David Gouin, who has since retired as director of housing and community services.
Several area residents said they changed their mind about the project because of the way the site was managed.
“I was amazed I never saw anything negative at all,” said Boyd Edwards, who plays pickleball at the Finley Community Center a few times a week.
“I thought they were going to be noisy and have crap all over the place. Now, they can have it all year round for all I care,” said his friend Joseph Gernhardt.
Of the 108 calls for police service, almost all were in response to other homeless people wanting to sleep at the site when it was at capacity, records show. And there was no violent behavior, said Police Chief Rainer Navarro.
With the Finley encampment closed, Santa Rosa has expanded its primary shelter while drafting plans to set up year-round managed camps in several neighborhoods, this time with hardened structures. County supervisors, meanwhile, are using $16 million in state grants to purchase and convert two hotels into housing, and have stood their ground in pushing through two Finley Park-style managed encampments, one on county property, the other at a mountain retreat center.
The time has come, they said, to stop debating and embrace solutions.
“We have estates that sell for $20 million, and then you walk by people sleeping in tents with no access to hot food or running water,” said Lynda Hopkins, chair of the county board of supervisors. “These tiny villages — they’re not perfect, but we’re trying to provide some dignity.”
The absence of reliable federal data exacerbated critical problems such as shortages of personal protective equipment that left many workers exposed, with fatal results.
This article was published on Thursday, April 8, 2021 in Kaiser Health News.
Calls are mounting for the Biden administration to set up a national tracking system of COVID-19 deaths among front-line healthcare workers to honor the thousands of nurses, doctors and support staffers who have died and ensure that future generations are not forced to make the same ultimate — and, in many cases, needless — sacrifice.
KHN and The Guardian are tracking healthcare workers who died from COVID-19 and writing about their lives and what happened in their final days.
Health policy experts and union leaders are pressing the White House to move quickly to fill the gaping hole left by the Trump administration through its failure to create an accurate count of COVID deaths among front-line workers. The absence of reliable federal data exacerbated critical problems such as shortages of personal protective equipment that left many workers exposed, with fatal results.
In the absence of federal action, "Lost on the Frontline," a joint project between The Guardian and KHN, has compiled the most comprehensive account of healthcare worker deaths in the nation. It has recorded 3,607 lost lives in the first year of the pandemic, with nurses, healthcare support staffers and doctors, as well as workers under 60 and people of color, affected in tragically high numbers.
The Guardian/KHN investigation, which involved more than 100 reporters, is drawing to a close this week. Pressure is now growing for the federal government to step into the breach.
Harvey Fineberg, a leading health policy expert who approved a recent National Academy of Sciences report that cited the "Frontline" project and recommended the formation of a national tracking system run by the federal government, backed the calls for change. He said his ideal solution would be a nationwide record.
"There would be a combination of a selective look backward to gain more accurate tabulations of the past burden, and a system of data-gathering looking forward to ensure more complete counts in [the] future," he said.
Zenei Triunfo-Cortez, a president of National Nurses United, the largest body of registered nurses in the U.S., said it was unconscionable how many healthcare workers have died of COVID-19. The KHN/Guardian interactive found that almost a third of those who died were nurses — the largest single occupation — followed by support staff members (20%) and physicians (17%).
Triunfo-Cortez said the death toll was an unacceptable tragedy aggravated by the lack of federal data, which made identifying problem areas more difficult. "We as nurses do not deserve this — we signed up to take care of patients, we did not sign up to die," she said.
Dr. Anthony Fauci, the nation's top expert on infectious diseases, also sees a role for federal agencies in tracking mortality among front-line healthcare workers. In an interview with The Guardian, he expressed a desire for a definitive picture of the human toll.
"We certainly want to find an accurate count of the people who died," he said. "That's something that I think would fall under the auspices of the federal government, likely Health and Human Services."
The lack of federal intelligence on deaths among front-line healthcare workers was one of the running failures of the Trump administration's botched response to the crisis. The main health protection agency, the Centers for Disease Control and Prevention, does curate some information but has itself acknowledged that its own record of 1,527 health worker fatalities — more than 2,000 fewer than the joint Guardian/KHN tally — is an undercount based on limitations in its data collection.
Overall, healthcare workers were revealed to be singularly at risk from the pandemic. Some studies have shown they were more than three times as likely to contract COVID as was the general population.
To date, there is no sign of the Biden administration taking active steps to set up a comprehensive data system. An HHS spokesperson said the department has no plans to launch a comprehensive count. However, Triunfo-Cortez said there is a new willingness on the part of the White House and key federal agencies to listen and engage.
"We have been working with the Biden administration and they have been receptive to the changes we are proposing," Triunfo-Cortez said. "We are hopeful that they will start to mandate the reporting of deaths, because if we don't have that data how can we know how effective we are being in stopping the pandemic?"
The responsiveness of the new administration is likely to be heightened by the fact that Biden's chief of staff, Ron Klain, has a track record in fighting infectious disease outbreaks. In 2014, President Barack Obama appointed him "Ebola tsar."
In an article in The Guardian last August, Klain drew on the findings of "Lost on the Frontline" to decry the ultimate price paid by healthcare workers: "Although America has applauded health workers, banged pots in their honor and offered grateful video tributes, we have consistently failed them where it mattered most."
David Blumenthal, the national coordinator for health information technology under Obama, said a national tracking system is an important step in healing the wounds of the pandemic. "So many healthcare workers feel as though their devotion and sacrifice weren't valued," he said. "We must combat the widespread fatigue and disappointment."
KHN senior correspondent Christina Jewett contributed to this report.
More than 3,600 U.S. healthcare workers perished in the first year of the pandemic, according to "Lost on the Frontline," a 12-month investigation by The Guardian and KHN to track such deaths.
Lost on the Frontline is the most complete accounting of U.S. healthcare worker deaths. The federal government has not comprehensively tracked this data. But calls are mounting for the Biden administration to undertake a count as the KHN/Guardian project comes to a close today.
The project, which tracked who died and why, provides a window into the workings — and failings — of the U.S. health system during the COVID-19 pandemic. One key finding: Two-thirds of deceased healthcare workers for whom the project has data identified as people of color, revealing the deep inequities tied to race, ethnicity and economic status in America's healthcare workforce. Lower-paid workers who handled everyday patient care, including nurses, support staff and nursing home employees, were far more likely to die in the pandemic than physicians were.
The yearlong series of investigative reports found that many of these deaths could have been prevented. Widespread shortages of masks and other personal protective gear, a lack of COVID testing, weak contact tracing, inconsistent mask guidance by politicians, missteps by employers and lax enforcement of workplace safety rules by government regulators all contributed to the increased risk faced by healthcare workers. Studies show that healthcare workers were more than three times as likely to contract COVID as the general public.
"We rightfully refer to these people without hyperbole — that they are true heroes and heroines," said Dr. Anthony Fauci in an exclusive interview with The Guardian and KHN. The COVID deaths of so many are "a reflection of what healthcare workers have done historically, by putting themselves in harm's way, by living up to the oath they take when they become physicians and nurses," he said.
Lost on the Frontline launched last April with the story of Frank Gabrin, the first known American emergency room doctor to die of COVID-19. In the early days of the pandemic, Gabrin, 60, was on the front lines of the surge, treating COVID patients in New York and New Jersey. Yet, like so many others, he was working without proper personal protective equipment, known as PPE. "Don't have any PPE that has not been used," he texted a friend. "No N95 masks — my own goggles — my own face shield."
Gabrin's untimely death was the first fatality entered into the Lost on the Frontline database. His story of working through a crisis to save lives shared similarities with the thousands that followed.
Maritza Beniquez, an emergency room nurse at Newark's University Hospital in New Jersey, watched 11 colleagues die in the early months of the pandemic. Like the patients they had been treating, most were Black and Latino. "It literally decimated our staff," she said.
Her hospital has placed 11 trees in the lobby, one for each employee who has died of COVID; they have been adorned with remembrances and gifts from their colleagues.
More than 100 journalists contributed to the project in an effort to record every death and memorialize those who died. The project's journalists filed public records requests, cross-connected governmental and private data sources, scoured obituaries and social media posts, and confirmed deaths through family members, workplaces and colleagues.
Among its key findings:
More than half of those who died were younger than 60. In the general population, the median age of death from COVID is 78. Yet among healthcare workers in the database, it is only 59.
More than a third of the healthcare workers who died were born outside the United States. Those from the Philippines accounted for a disproportionate number of deaths.
Nurses and support staff members died in far higher numbers than physicians.
Twice as many workers died in nursing homes as in hospitals. Only 30% of deaths were among hospital workers, and relatively few were employed by well-funded academic medical centers. The rest worked in less prestigious residential facilities, outpatient clinics, hospices and prisons, among other places.
The death rate among healthcare workers has slowed dramatically since COVID vaccines were made available to them in December. A study published in late March found that only four of 8,121 fully vaccinated employees at the University of Texas Southwestern Medical Center in Dallas became infected. But deaths lag behind infections, and KHN and The Guardian have tracked more than 400 healthcare worker deaths since the vaccine rollout began.
Many factors contributed to the high toll — but investigative reporting uncovered some consistent problems that heightened the risks faced by health workers.
The project found that Centers for Disease Control and Prevention guidance on masks — which encouraged hospitals to reserve high-performance N95 masks for intubation procedures and initially suggested surgical masks were adequate for everyday patient care — may have put thousands of health workers at risk.
The investigation exposed how the Labor Department, run by Donald Trump appointee Eugene Scalia in the early part of the pandemic, took a hands-off approach to workplace safety. It identified 4,100 safety complaints filed by healthcare workers to the Occupational Safety and Health Administration, the Labor Department's workplace safety agency. Most were about PPE shortages, yet even after some complaints were investigated and closed by regulators, workers continued to die at the facilities in question.
The reporting also found that healthcare employers were failing to report worker deaths to OSHA. The data analysis found that more than a third of workplace COVID deaths were not reported to regulators.
Among the most visceral findings of Lost on the Frontline was the devastating impact of PPE shortages.
Adeline Fagan, a 28-year-old OB-GYN resident in Texas, suffered from asthma and had a long history of respiratory ailments. Months into the pandemic, her family said, she was using the same N95 mask over and over, even during a high-risk rotation in the emergency room.
Her parents blame both the hospital administration and government missteps for the PPE shortages that may have contributed to Adeline's death in September. Her mother, Mary Jane Abt-Fagan, said Adeline's N95 had been reused so many times the fibers were beginning to disintegrate.
Not long before she fell ill — and after she'd been assigned to a high-risk ER rotation — Adeline talked to her parents about whether she should spend her own money on an expensive N95 with a filter that could be changed daily. The $79 mask was a significant expense on her $52,000 resident's salary.
"We said, you buy this mask, you buy the filters, your father and I will pay for it. We didn't care what it cost," said Abt-Fagan.
She never had the opportunity to use it. By the time the mask arrived, Adeline was already on a ventilator in the hospital.
Adeline's family feels let down by the U.S. government's response to the pandemic.
"Nobody chooses to go to work and die," said Abt-Fagan. "We need to be more prepared, and the government needs to be more responsible in terms of keeping healthcare workers safe."
Adeline's father, Brant Fagan, wants the government to begin tracking healthcare worker deaths and examining the data to understand what went wrong. "That's how we're going to prevent this in the future," he said. "Know the data, follow where the science leads."
Adeline's parents said her death has been particularly painful because of her youth — and all the life milestones she never had the chance to experience. "Falling in love, buying a home, sharing your family and your life with your siblings," said Mary Jane Abt-Fagan. "It's all those things she missed that break a parent's heart."
For Lim, the indelible stamp of childhood anguish drove two of her life's passions: serving people as a physician and cooking lavish feasts for friends and family — both of which she did until she died of covid-19 in January.
This article was published on Wednesday, April 7, 2021 in Kaiser Health News.
She was not yet 13 when the Khmer Rouge seized power in Cambodia and ripped her family apart. The totalitarian regime sent her and four siblings to work camps, where they planted rice and dug irrigation canals from sunrise to sunset — each surviving on two ladles of rice gruel a day. One disappeared, never to be found.
Just a few months before the Khmer Rouge fell in January 1979, Lim’s father starved to death, among the nearly one-quarter of Cambodians who perished from execution, forced labor, starvation or disease in less than four years.
For Lim, the indelible stamp of childhood anguish drove two of her life’s passions: serving people as a physician and cooking lavish feasts for friends and family — both of which she did until she died of covid-19 in January.
Within the week before her death at age 58, she treated dozens of patients who flooded the hospital during the deadly winter covid surge, while bringing home-cooked meals to the hospital for her fellow health care workers to enjoy during breaks.
“These experiences during the war made her humble and empathetic toward the people around her,” said Dr. Vidushi Sharma, who worked with Lim at Community Regional Medical Center in Fresno, California. “She always wanted to help them.”
Lim’s story is one of suffering and triumph.
During the Khmer Rouge’s brutal reign and the Cambodian civil war before it, Lim and her nine siblings attended school sporadically. The ravages of war forced the family first from its small town to the capital, Phnom Penh, and then into the countryside when the Khmer Rouge took power in 1975. As part of its vision to create a classless agrarian society, the communist group split families and relocated residents to rural labor camps.
Lim survived the work camps because she was smart and resourceful, said her youngest brother, Rithy Lim, who also lives in Fresno. She dug ditches, hauled clay-like dirt on her back, built earthen dams in the middle of a river during monsoons — all with little food or rest, he said.
She also became a skillful hunter and fisher, and learned to identify plants that were safe to eat.
“You cannot imagine the horrible conditions,” he said. “Think of it as a place that you live like wild animals, and people tell you to work. There’s no paper, no pens. You sleep on the ground. We witnessed death of all sorts.”
Vietnamese troops liberated Cambodia from the Khmer Rouge in 1979. Later that year, Lim, her mother and siblings sneaked into Thailand. “The whole family walked through minefields,” Rithy Lim recalled. There, they waited and worked in refugee camps. At one camp, they met a dentist from California’s Central Valley who was on a medical mission.
When Lim and her family arrived in the U.S. in 1982, they landed in Georgia. But she and an older brother soon moved to the small town of Taft, California, about 45 minutes west of Bakersfield, at the invitation of the dentist they’d befriended at the Thai refugee camp.
When she hit the ground, the 4-foot-11 dynamo, then 19, was driven by “pure determination,” Rithy Lim said.
Within two years, Linath Lim learned English, earned her GED and graduated from Taft College — “boom, boom, boom,” her brother recalled. (She learned to make traditional, middle-America Thanksgiving dinners when she worked at the community college’s cafeteria, which she would later cook for scores of friends and family.)
She went on to attend Fresno State and then the Medical College of Pennsylvania, sleeping on friends’ couches, borrowing money from other Cambodian refugees and scraping by.
“Imagine not having any money, studying alone, sleeping in someone else’s living room,” Rithy Lim said.
Lim became an internal medicine doctor “because she always wanted to be really involved with a lot of patients,” Rithy Lim said. After her residency, she returned to the Central Valley to practice in hospitals and clinics in underserved communities, including Porterville and Stockton, where some of her patients were farmworkers and Cambodian refugees.
California has the largest Cambodian population in the country, with roughly 89,000 people of Cambodian descent in 2019, according to a Public Policy Institute of California analysis of American Community Survey data.
Twice, Lim joined the Cambodian Health Professionals Association of America on weeklong volunteer trips to Cambodia, where she and other doctors treated hundreds of patients a day, said Dr. Song Tan, a Long Beach, California, pediatrician and founder of CHPAA.
“She was a kindhearted, very gentle person,” recalled Tan, who said he was the only member of his family to survive the Khmer Rouge. “She went beyond the call of duty to do special things for patients.”
Most recently, Lim worked the swing shift, 1 p.m. to 1 a.m., at Community Regional Medical Center. She admitted patients through the emergency room, where she was exposed to countless people with covid. She worked extra shifts during the pandemic, volunteering when the hospital was short-staffed, said Dr. Nahlla Dolle, an internist who also worked with Lim.
“She told me there were so many patients every day, and that they didn’t have enough beds and the patients had to wait in the hallway,” Tan said.
Colleagues said she was aware of the risks but loved her job. Lim, who was single and didn’t have kids, drew happiness from celebrating others’ joys. After getting home from work in the small hours, she slept for a bit, then got up to cook. Her specialties were Cambodian, Thai, Vietnamese and Italian food. She sometimes ordered a whole roasted pig that she transported to the hospital. Her memorable Thanksgiving dinners served 70 or more people.
“For any occasion that comes up — if it’s a birthday, if it’s a baby shower, if it’s Thanksgiving — she would cook, she would order food and bring everybody together,” Dolle said. “She loved to feed people because she experienced famine and lack of food.”
The week before she died, Lim cooked for her colleagues almost every day, and threw a baby shower for Sharma, complete with chicken calzones and blueberry cake.
“Every day, we were having lunch together,” Sharma said. “She did the shower, and then she’s gone.”
Lim, who had health problems including diabetes, had not been vaccinated. Family and friends had urged her to take care of herself, and to check her blood sugar and take her medications. “She would care about everyone but herself,” Sharma said.
On Jan. 15, Lim told friends by phone that she was exhausted, achy and having trouble breathing. But she said that she would be fine, that she just needed to rest. Then she stopped responding to calls and texts.
When she didn’t show up for work a few days later, her brother went to check on her at home and found her on the couch, where she had died.
Now her brother and colleagues are haunted by what-ifs over the loss of a remarkable woman and doctor: What if I had checked on her sooner? What if she had been vaccinated? What if she had gotten care when she started feeling ill?
“To have someone who has been through all that in her childhood and then flourish as a physician, a human being, coming to a new country, learning English, going to school and college without having much financial support, it’s phenomenal,” Sharma said. “It’s unbelievable.”
This story is part of “Lost on the Frontline,” a project from The Guardian and Kaiser Health News that aims to document the lives of health care workers in the U.S. who die from COVID-19, and to investigate why so many are victims of the disease.
California's overall progress masks huge variations in senior vaccination rates among the state's 58 counties, which largely are running their own vaccine rollouts with different eligibility rules and outreach protocols.
This article was published on Wednesday, April 7, 2021 in Kaiser Health News.
Even as California prepares to expand vaccine eligibility on April 15 to all residents age 16 and up, the state has managed to inoculate only about half its senior population — the 65-and-older target group deemed most vulnerable to death and serious illness in the pandemic.
Overall, nearly 56% of California seniors have received the full course of a COVID vaccine, according to the latest data from the federal Centers for Disease Control and Prevention. That's about average compared with other states — not nearly as high as places like South Dakota, where almost 74% of seniors are fully vaccinated, but also not as far behind as Hawaii, which has reached 44%. The data, current as of Tuesday, does not include seniors who have received only the first dose of the Pfizer-BioNTech or Moderna vaccine.
But California's overall progress masks huge variations in senior vaccination rates among the state's 58 counties, which largely are running their own vaccine rollouts with different eligibility rules and outreach protocols. The discrepancies notably break down by geographic region, with the state's remote rural counties — generally conservative strongholds — in some cases struggling to give away available doses, while the more populous — and generally left-leaning — metropolitan areas often have far more demand than supply.
In San Francisco Bay Area counties like Marin and Contra Costa, for example, more than two-thirds of seniors are fully vaccinated. Meanwhile, in the far northern reaches of the state, encompassing some of California's most dramatic and rugged terrain, rural counties like Tehama, Shasta and Del Norte have fully vaccinated only about a third of senior residents, according to the CDC data.
"We definitely share one thing in common and that is that we have a fairly high percentage of people who are vaccine hesitant. And that even spreads into the seniors," Dr. Warren Rehwaldt, health officer for Del Norte County, said of the Northern California counties with relatively low vaccination rates. Del Norte, which is 62% white and voted solidly for Donald Trump in the 2020 election, has vaccinated 36.6% of residents age 65 and older.
The county, population 28,000, has spotty internet service, leaving the health department reliant on phone appointments for its twice-weekly clinics, which have the capacity to give out 300 doses in a day.Bottom of Form
"I don't think we have filled any of them completely, and they are tapering off," Rehwaldt said. Often, 100 or more appointment slots go unused, even after the county expanded eligibility to age 50 and up. "We expected that, but we didn't expect it this fast," he said.
Every Thursday morning, Rehwaldt joins a local public radio broadcast to encourage people to get their shots, and the department regularly airs public service announcements. "But it's a really high hurdle to overcome serious misgivings about the vaccine itself," Rehwaldt said.
Asked what resources might help bolster vaccination rates, Rehwaldt said he'd opt for a mobile van to travel to remote areas of his county. But moments later, he sighed and said he wasn't sure a van would help much after all. "What kind of resources are going to overcome hesitancy? It's not a resource problem," he said.
Shasta County, whose population is about 80% white and voted in even stronger numbers for Trump, is also struggling to reach the 65-plus group, with just 36.6% of seniors fully vaccinated. Public information officer Kerri Schuette acknowledged health workers were encountering some hesitancy among residents but said their efforts also were hampered by early supply issues.
On the other end of the spectrum are counties like Marin, a largely suburban and affluent stretch of communities just north of San Francisco where 71.4% of seniors are fully vaccinated.
"There's a thread of privilege that does lead to ease of access to vaccines that needs to be acknowledged," said county public health officer Dr. Matt Willis. Many seniors in the county have access to computers and cars, he said, and have been able to access vaccine appointments with relative ease.
Still, the county made an aggressive plan to vaccinate seniors even before the first doses arrived, he said. Rather than waiting for the federal government's program that relied on pharmacies to vaccinate residents in long-term care facilities, for example, the health department sent in workers as soon as it had vaccines.
The county also kept its eligibility rules tightly focused on seniors age 75 and older through the middle of February, while other counties were expanding to younger age groups and a broad array of occupations. At one point, the county briefly expanded eligibility to teachers, but pulled back just one week later when doses grew scarce.
"We showed that a dose offered to someone 75 and older in Marin was 320 times more likely to save a life than a dose offered to someone younger than 50," Willis said.
Contra Costa County, a more diverse area on the other side of San Francisco Bay, has done nearly as well: 70.9% of seniors are fully vaccinated. Add in those who have received at least one dose, and the numbers are far higher: 90% of people ages 65-74 and 97% of those 75 and older, according to the county's vaccine tracker.
To reach vulnerable seniors, Dr. Ori Tzvieli, Contra Costa's deputy health officer, said the county worked with nonprofit groups to make lists of residential care facilities and low-income senior housing, then sent mobile clinics to each one. "For people who were literally homebound, we send someone inside. Otherwise, we set up a station in the lobby or right outside," he said.
The county also set up mobile clinics at farms and places of worship. It gave community health workers dedicated appointments to sign up older residents directly. And rather than have residents track down their own appointment slots online, the department had people fill out forms and then scheduled appointments for them, prioritizing those who lived in low-income ZIP codes with high rates of disease.
With a population of just over 1 million, Contra Costa now is able to vaccinate 100,000 people a week, Tzvieli said, and has recently opened eligibility to everyone over 16. But even within the county, inequalities remain. In Bay Point, for example, a largely working-class Latino community, vaccination rates are still just half of those of some wealthier communities, Tzvieli said.
Farther south, in California's agricultural Central Valley, Fresno County falls somewhere in the middle on vaccination rates. About 54% of seniors 65-plus are fully vaccinated, just under the state average. Just more than half the county's residents are Latino, many of them farmworkers. And about a fifth of the population lives in poverty, which presents its own hurdles to a vaccination campaign.
"Poverty immobilizes, physically and mentally," said Joe Prado, community health division manager in Fresno County. "For a wealthier population, going 3 to 5 miles away [to a vaccine clinic] is simple; you hop in the car and go. But if you're living in poverty, that's a big barrier."
There are community pockets that have not engaged with the county health system, meaning health officials are coming up against vaccine hesitancy and distrust, Prado added. "Our health literacy is nowhere near where it should be, and now there's a digital literacy problem, too," he said. "We're trying to deal with all this in the middle of a pandemic."
At this point in the campaign, Prado said, most seniors eager for the vaccine have received at least an initial dose: "The final 25% is going to be the most resource-intensive, the most difficult to reach."
Dr. William Schaffner, an infectious-disease specialist at Vanderbilt University, calls this public health's "low-hanging fruit phenomenon." As the proportion of people who are vaccinated grows, he said, "we'll have to work proportionally harder to keep advancing these numbers, because the eager beavers go first." In rural counties from California to Tennessee, he added, supply is already outpacing demand.
So far, just more than 75% of seniors in the U.S. have received at least one dose of vaccine, according to the CDC.
"You can look at that as the glass is half-empty or half-full," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, during a recent episode of his weekly podcast. That still leaves more than 13 million seniors unprotected despite facing the highest risk of death; 8 in 10 deaths from COVID reported in the U.S. have been among adults 65 and older.
It is crucial, Osterholm said, that states continue to direct efforts toward reaching and vaccinating vulnerable seniors who are homebound or hesitant.
"When we say we're going to open up eligibility to everybody 16 or 18 years and older, that seems like a victory," he said. "In many states, that is an admission of defeat."
To many, getting involved in politics quickly became as much a professional responsibility as studying human anatomy or shadowing residents on clinical rounds.
This article was published on Wednesday, April 7, 2021 in Kaiser Health News.
Inam Sakinah and her classmates will forever be known as the students who started medical school during the 2020 COVID-19 pandemic.
All of them had prepared for this step for years, taking hours of hard science classes in college, studying for the medical school admissions test and often volunteering, working or even getting master's or other advanced degrees before starting on the long path to earning a medical degree.
But their decisions to become doctors seemed to carry even more weight when set against the backdrop of the events of 2020.
"People were needlessly dying while our leaders were failing," said Sakinah, a first-year student at Harvard Medical School. "We also saw the crushing inequities the virus laid bare. That was the context in which we were beginning our journey into medicine." COVID has killed more than 550,000 Americans and disproportionately affected people of color.
And there were other concerns, too. Issues of racial justice came to a head in the wake of George Floyd's death in May in Minneapolis, while matters of science and public health were subject to debate on the presidential campaign trail.
To many, getting involved in politics quickly became as much a professional responsibility as studying human anatomy or shadowing residents on clinical rounds. Sakinah, for instance, is part of a group of medical students who channeled these concerns into forming a nonpartisan student organization, Future Doctors in Politics.
The organization, which launched in February, aims to educate medical students on the political process and show them how they can get involved in shaping policy, and perhaps even run for public office one day. At the core of these efforts is the idea that doctors will push for policies centered on patients, not insurers or hospitals. Bottom line: It's a way to voice their frustration with healthcare in America.
While there is currently only one chapter, at Harvard University, the group is working to establish chapters at schools such as the University of Michigan and the University of Hawaii.
The Changing Political Face of Medicine
Over the years, medical students have turned to a variety of organizations as an outlet for their political and professional concerns.
The American Medical Student Association has been politically active since it separated from the American Medical Association in 1967 and took on its current name a few years later. Since its early days, the organization has focused on health equity for people of color and, more recently, the LGBTQ community and for universal healthcare. Other student groups advocate for single issues, such as Students for a National Health Program, which lobbies for a government-run single-payer system, and Medical Students for Choice, which promotes reproductive rights.
Medical students also engage in nonpolitical work that can be seen as advocacy, such as volunteering at free clinics where patients might be uninsured or have substance use disorders, said Jonathan Kusner, a fifth-year medical student at Harvard.
Kusner helped lead a new nonpartisan AMSA effort in 2020, "MedOutTheVote," which asked medical students and providers to register to vote and then volunteer to assist others in registering. The initiative involved students at more than 80 medical schools and helped facilitate more than 13,000 registrations.
The MedOutTheVote initiative illustrates the change medical school professors and experts said they've noticed among students regarding their engagement with current events and awareness of how as doctors they might shape policy by wielding their medical expertise.
Dr. Neel Shah, an assistant professor of obstetrics, gynecology and reproductive biology at Harvard, said he thinks medical students have always been interested in politics. But today's pitched political environment makes them more inclined to speak out. "There is a greater degree of willingness to be critical of existing policies and norms, coming from students at a larger volume," said Shah.
Dr. Christopher Moriates, assistant dean for healthcare value at Dell Medical School of the University of Texas-Austin, said he's noticed a similar phenomenon.
"I really think that medical students have realized increasingly if they want to create healthier patients, their responsibility reaches beyond the patient in front of them," said Moriates. "As students are recognizing the systemic nature and the social determinants of health, they realize you have to treat the system around you as well and learn how to advocate for changes."
"I think it goes back before 2020, but 2020 put it in stark relief," he added.
While Future Doctors in Politics isn't officially aligned with a political party, it promotes values and a mission that are typically associated with Democrats or progressives, such as healthcare as a human right and racial inequity as a pressing health issue.
And it flows from the formation of the medical student organization White Coats for Black Lives, which took shape in 2015 after the deaths of Michael Brown and Eric Garner. The group's goal is to dismantle racism within the medical system and help students prepare to be racial justice advocates.
The growth of these organizations may also reflect medicine's increasing leftward tilt. Recent studies and surveys indicate more doctors identify as Democrats than Republicans, possibly in part because medical schools are admitting more women and people of color. In addition, fewer physicians now own their own practices. As small-business owners, they may have tended to lean Republican.
A widely cited 2014 study found that the percentage of doctors contributing to Republican political candidates decreased from 1991 to 2012, though certain higher-earning specialties were more likely to give to Republicans than to Democrats. A 2019 study focusing on ideology rather than party affiliation found that almost half of first-year medical students identified as liberal, while 33% identified as moderate and 19% as conservative.
Medicine Is Polarized, Too
As the rest of society deals with the growing divisions between those on the ideological left and right, so does medicine — just look at the difference in attitude about COVID vaccines between Democrats and Republicans. Medical students are not immune from these pressures. And some conservative students and professors said they often don't feel comfortable expressing their views.
"Students are afraid. Campuses are more liberal — meaning they don't necessarily believe in less government," said Rebecca Kiessling, director of programs and chapter development at the Benjamin Rush Institute, which teaches medical students about free-market healthcare options and opposes government regulation. The institute has chapters at 55 out of the 192 medical and osteopathic medical schools in the U.S.
"It is often difficult at certain schools to even get the student body or administration to agree to have a Benjamin Rush chapter, because they don't believe in what we do," said Kiessling.
Others whose politics differ from the current progressive tilt echoed this experience. Dr. Brian Miller, an assistant professor of medicine at Johns Hopkins University who is a conservative health policy expert, said the key is not losing perspective.
"Politics is increasingly polarized and medicine is no exception," Miller wrote in an email. "The challenge for us is to remain focused on our primary goal of growing future clinicians and treating patients while providing a supportive environment for people of all perspectives and walks of life."
To Dr. Lawrence Deyton, senior associate dean for clinical public health and professor of medicine at George Washington University, it's all part of the changing attitudes of what medical students feel their job responsibilities should encompass. He thinks the trend toward activism will continue.
"It's not enough to be great at the bedside or at the clinic," said Deyton. "When it comes to public health issues, the COVID crisis, racial issues, there is a role of the clinician to speak up. Our society wants to hear from us. Some people call this a political role."
Some music-streaming platforms like Apple Music don't allow third-party playlist curation. So, without a direct connection to their editorial team or partners, landing a spot on these lists isn't likely.
This article was published on Tuesday, April 6, 2021 in Kaiser Health News.
When the pandemic hit, Debórah Bond, like many artists, was caught off guard. “I thought I’d be juggling gigs and touring,” said the independent R&B/soul musician.
A full-time artist, Bond, 44, made a living through a patchwork of vocal gigs — performing live at weddings, bars and theaters, recording jingles, teaching vocal lessons and hosting events.
But the coronavirus pandemic found her burning through her savings and struggling to make ends meet in a tiny rental accessory dwelling unit above the tree-lined garage of a home in Hyattsville, Maryland. According to a 2020 report from the Rand Corp., artists were more likely than others to have lost their main source of income — music-related or not — due to the pandemic.
So with few other obvious options, and the world at a standstill for the foreseeable future, she set out to write her first solo album in the small rental she fondly referred to as her “treehouse.”
But cut off from family, friends and other nearby musicians, she devised a way to bring together out-of-work musicians from around the world, people who felt just as abandoned and stuck as she did. What resulted is an extraordinary transnational album — “compass: I,” released March 5 — that connected her with a far broader musical community and buoyed their collective spirits during a year of isolation.
The new album is a pandemic-fueled collaboration of musicians such as Chelsey Green, PhD. a violinist and acting chair of the strings department at Berklee College of Music in Boston; two-time Grammy-nominated drummer Nate Smith in Nashville; and a percussionist from the British acid jazz band Incognito, who sent in his recordings from London. “Everyone jumped on board from wherever they were,” Bond said. And most, she said, “didn’t even stress me for money. We all wanted to create.” She was even able to work with Gordon Chambers, a songwriter who has written for several artists from Beyoncé to Anita Baker and likely would not have been accessible to her or available pre-pandemic.
They were up against the challenges of not just a pandemic, but also a music industry that has come to rely heavily on curated playlists like Apple Music’s “New Music” or “From Our Editors” to promote new releases. Mainstream artists who have released music during the pandemic have teams of industry professionals ensuring their tunes end up on the most highly trafficked playlists.
Some music-streaming platforms like Apple Music don’t allow third-party playlist curation. So, without a direct connection to their editorial team or partners, landing a spot on these lists isn’t likely. Without being able to perform live at clubs and events this past year, Bond says, some independent artists may feel financial pressure to focus less on the quality of their music and more on finding ways to go viral on social media to tip the scales.
How does an independent artist find new listeners at a time when performing for a crowd isn’t allowed, and they’re battling against more than 50 million and 60 million songs already on Spotify and Apple Music, respectively?
Bond was not naïve about how the music world works, having been a performer for decades. She and her band, Third Logic, had been performing together since they were in their early 20s, but as time passed and adulthood — marriage, children, increased work responsibilities — set in, finding the time to write music together became nearly impossible. They hadn’t released a new album since “Madam Palindrome” in 2011. Time and distance from her bandmates meant that gigs were few. So, in 2019, she decided to embark on a solo career. Then covid hit.
At first, she despaired about how she would be able to pay for things like rent and food without the hope of recurring live gigs. “The pandemic relief money was really helpful,” she said, because independent artists can sometimes go weeks without making any money even without a global pandemic. Between her stimulus check and unemployment, Bond budgeted $600 a week to live on. She had affordable health insurance through Kaiser Permanente, “thanks to Obamacare,” she said. She cut expenses, stuck to her budget and received modest payments from booking a few covid-friendly, livestreamed events for Washington, D.C.’s Kennedy Center and the Music Center at Strathmore in North Bethesda, Maryland.
She was able to improvise a home-recording studio with mics, speakers, her MacBook and ProTools software and the help of music engineering friends over video conferences. Bond writes song lyrics and performs but doesn’t herself compose music. So, she put out a call to the musicians in her network and found many of them were also at home tinkering with new tunes and willing to share. Bond would “wait until late at night, turn on colored bulbs, blast things through my monitors and write,” she said.
After a rough draft of the album was completed in September, she and independent producer Brandon Lane put out a broader call for help for more live instrumentation. Their pleas circulated and produced a village of talent, as musicians from all over the world sent the singer their high-quality home recordings. “It showed me how many musicians were in the same boat,” Bond said.
Lane, who lived nearby and became part of Bond’s pandemic bubble, would come to her home studio — fully masked-up — as technical support and to co-produce the album. The title “compass: I” reflects an appreciation of the importance of trusting your own internal compass, she explained. The project showed Bond “who has my back,” she said, and that in a time of global crisis musicians — many of whom Bond considers friends — would come together to co-create with her.
Bond, who describes herself as having an eclectic Bohemian style and devil-may-care attitude, said she doesn’t want to change herself to jockey for a spot on the Billboard charts or playlists — even in the post-pandemic world.
The music industry is notoriously youth-obsessed and male-dominated, she said. The third annual report on the industry, “Inclusion in the Recording Studio?” from professor Stacy Smith and the USC Annenberg Inclusion Initiative found that in evaluating gender across eight years of Grammy nominations for Record of the Year, Album of the Year, Song of the Year, Producer of the Year and Best New Artist, 21.7% — or about 1 in 5 artists — were women.
“This is who the f*** I am,” she said. “I’m not 18, but I’m not ‘old’ either.” She wants listeners to have the chance to discover diverse musical options for female entertainers, at different ages, with different sounds and styles to match. By dint of necessity, the pandemic opened new types of doors for performers like her — through which she hopes new types of music will continue to be heard.
“You have to be smart,” she said. “It’s not hard to find new music.” Manually searching streaming apps like SoundCloud and Spotify take no more effort than scrolling through Instagram, she said. Bond hopes that listeners will take a break from the algorithms that sneakily sway our musical interests toward those artists pushed to the top of the charts and follow their own compass.
CORONA, Calif. — Antonio Espinoza loved the Los Angeles Dodgers. He loved them so much that he was laid to rest in his favorite Dodgers jersey. His family and friends, including his 3-year-old son, donned a sea of blue-and-white baseball shirts and caps in his honor.
Espinoza died at age 36 of covid-19, just days after he got his first dose of a covid vaccine. He was a hospice nurse who put his life in danger to help covid patients and others have a peaceful death.
When covid hit, it was no surprise to his family that this “gentle giant,” as friends and family called him, stepped up to the plate.
“His attitude was like, ‘No, I’m not going to be scared,’” said Nancy Espinoza, his wife of 10 years. “This is our time to shine,” he told her. “I became a nurse for a reason.”
As a hospice nurse and chief nursing officer for Calstro Hospice in Montclair, California, Espinoza routinely made house calls, visited assisted living facilities and performed death visits — during which hospice nurses pronounce patients dead.
Hospice workers aren’t just doctors and nurses, but also include home health aides, social workers, chaplains and counselors. In the past year, they have frequented some of the highest-risk environments, such as nursing homes, assisted living facilities and patients’ homes.
Hospice requires intimate patient care, and the additional safety requirements and need for personal protective equipment made it challenging, said Alicia Murray, board president of the Hospice and Palliative Nurses Association. But hospice workers adapted, she said, knowing they might be the only people who could comfort dying patients when family members were not allowed to visit medical and long-term care facilities.
“They’re taking care of dying people and, in particular, people dying of covid who may be spewing out the virus,” said Dr. Karl Steinberg, a geriatrician and palliative care specialist who is the medical director of Hospice by the Sea in Solana Beach, California, and several nursing homes.
A few months into the pandemic, when Calstro Hospice began caring for covid patients, Espinoza helped develop a covid unit. Part of his job was to make sure staff members had sufficient personal protective gear, including himself.
“Some people had a hard time getting a hold of all the PPE gear, but his office had adequate equipment,” his wife said. Right before he got sick, he was excited to receive a big shipment of gowns, N95 masks, booties and face shields from San Bernardino County, she said.
Espinoza fell ill a few days after his first dose of covid vaccine on Jan. 5, but went to work thinking it was vaccine-related. “He had kind of a sore throat and felt a little bit under the weather, but nothing major,” said Nancy Espinoza. His symptoms progressed to a fever and chills and he tested positive for covid on Jan. 10.
Seven other Calstro Hospice staff members also got covid during the pandemic, said Jennifer Arrington, Calstro Hospice’s director of patient care services.
Espinoza was a victim of bad timing, according to Dr. Lucy Horton, infectious disease specialist and associate professor at the University of California-San Diego School of Medicine.
The virus’s incubation period averages five to seven days, she explained. “If you test positive a few days after the vaccine, chances are you actually got exposed before you even got your first dose,” she said.
Horton said people aren’t fully vaccinated until at least 14 days after their second dose of a two-dose vaccine, or their first dose of a one-dose version. Early after the first dose, people don’t reap the benefit of the vaccine yet, she said.
“Even after you’re fully vaccinated, there still is a remaining risk,” said Horton, co-author of a letter to the New England Journal of Medicine about post-vaccination infection rates among health care workers in California. “Even if it’s so much lower, it’s still present.”
Espinoza knew he wanted to care for others and go into health care since he was in high school, and realized the Hispanic community needed Latino nurses in hospice care, his wife said. “He made it his purpose to help the Hispanic community understand hospice care and not be afraid of it,” she said.
On Jan. 15, Nancy Espinoza and the couple’s toddler, Ezekiel, spoke to Antonio over the phone for the last time. “I love you” were the last words she heard her husband say.
She was allowed to visit him right before he died on Jan. 25. He was intubated with an oxygen level of 25%.
Nancy Espinoza stood in the room alone with her husband for the last time. “I just wanted to be able to hold his hand and pray for him,” she said. “I wanted him to know that he wasn’t alone.”