"For #COVID vaccines, shingles and even more dangerous and painful skin conditions may be the new thrombocytopenia." -- Alex Berenson in a Facebook post, April 19.

This article was publish d on Friday, April 30, 2021 in Kaiser Health News.

By Julie Appleby

Posts are showing up all over social media tying COVID-19 vaccinations to shingles and other painful skin disorders.

The source of one such post was Alex Berenson, an author and vaccine critic whose posts are sometimes cited for misinformation.

Berenson posted — first on Twitter, which then found its way to Facebook — a photo of a man covered in a severe rash. The man, according to the post, blamed the skin outbreak on a COVID vaccination he had weeks earlier. The post also included unsubstantiated information purported to be from the man's doctors, indicating a likely diagnosis of a type of rash usually triggered by medications or infections, such as herpes simplex. It led Berenson to draw the conclusion that "for #COVID vaccines, shingles and even more dangerous and painful skin conditions may be the new thrombocytopenia." That is a reference to a low blood platelet condition reported among some people who experienced blood clots after getting the Johnson & Johnson vaccine.

The post was flagged as part of Facebook's efforts to combat false news and misinformation on its news feed. (Read more about PolitiFact's partnership with Facebook.)

Without more information, it's impossible to know whether the picture was as described, or what might have led to the man's condition. We reached out to Berenson by email, but he did not respond. However, in a related Twitter thread, Berenson went on to discuss a study conducted in Israel that looked at six shingles cases occurring post-vaccination in a group of about 500 people with immune disorders.

The small Israeli study drew wide attention on social media and other outlets, and currently is the most-read article in the British Medical Journal's Rheumatology. Some outlets, including the New York Post, ran stories on its findings, often with misleading headlines.

That got us wondering: How strong is the science behind this connection?

First, a Little Background

Shingles, also called herpes zoster, occurs in people who had chickenpox, a virus that causes itchy blisters. (Shingles can be prevented by the two-dose Shingrix vaccine.)

After a person recovers from chickenpox, the varicella-zoster virus that causes it can lie dormant in the body, and then reactivate years or decades later in the form of shingles. Both are part of the herpes virus family, which includes herpes simplex Types 1 and 2.

Type 1 commonly causes "cold" sores around the mouth and lips and is spread by kissing or sharing things like toothbrushes. Type 2 can cause genital herpes, which is spread via sexual contact.

Among the things that can reactivate these dormant herpes viruses are stress, drugs that suppress the immune system or simply aging.

Now, Back to Those Social Media Posts

Neither the picture of the man with a rash or the findings of the small study in Israel prove cause and effect. In other words, just because a rash follows a vaccine by days or weeks does not mean the vaccine caused the rash.

Dr. William Schaffner, a professor in the Division of Infectious Diseases at the Vanderbilt University School of Medicine, said it's natural for people to link events that occur within a short span of time, but he stressed it doesn't prove causality.

"Just because B follows A doesn't mean A causes B," he said.

In considering whether there are links between a treatment and a side effect, researchers often follow two large groups of similar people, one group getting a particular medication or vaccine, the other not. If the vaccinated or medicated individuals experience a side effect at a greater rate than those not treated, there may be a connection.

Safety is also monitored by tracking data on reported side effects.

In the United States, the Vaccine Adverse Event Reporting System includes unverified reports from patients, doctors and others about possible illnesses or symptoms that occur following immunizations. The Centers for Disease Control and Prevention watches those reports.

"So far, the data indicates that shingles and herpes are not occurring at an increased rate in the vaccinated population," said Schaffner, who encourages people who get a rash of any kind — or shingles — following vaccination to report it through that system.

But What About That Israeli Study?

Even its authors said it was not designed to find a cause and effect.

Instead, the study followed 491 people — all of whom were being treated for underlying autoimmune inflammatory conditions, such as rheumatoid arthritis, making them more susceptible to shingles in general.

Out of those, six women ages 36 to 61 developed shingles in the days and weeks after they received the Pfizer vaccination, for a prevalence rate of 1.2%.

The researchers noted in their article that vaccine-related reactivation of shingles has been seen with other vaccines, such as those for influenza, hepatitis A and rabies. But there were no reports of herpes-related rashes in the clinical trials for COVID-19 vaccines.

In the study, most of the cases were mild, five occurred after the first dose, and all five of those women went on to have their second dose with no additional adverse effects. The researchers said their observations cannot prove causality but should prompt "further vigilance and safety monitoring of COVID-19 vaccination side effects."

Some media outlets, including the New York Post, ran headlines such as "Herpes Infection Possibly Linked to COVID-19, Study Says."

That's simply "clickbait," said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

No one is getting infected with herpes from vaccinations, he said. "What the anti-vax community is doing is giving the impression that vaccinations are giving people herpes, which is simply not true."

Adalja objects to the headline and effort to scare people, but he also said it is plausible, if yet unproven, that vaccination could reactivate an existing herpes zoster virus.

Other types of rashes and injection-site redness have certainly been reported by people who have received a COVID-19 vaccine.

Researchers at Massachusetts General Hospital, for example, reported on a group of 12 patients who had rashes that appeared four to 11 days after getting their first dose of the Moderna vaccine. Ice and antihistamines were used to treat most of the patients, half of whom experienced a rash again after the second shot.

And there have been reports on social media and in the press of people reporting similar rashes following vaccination. Still, experts say those rashes may simply be a sign that the immune system is working.

Such rashes are "pretty innocuous and easily treated," said Adalja.

Our Ruling

An online post claims the COVID-19 vaccines cause shingles or other dangerous skin conditions.

Although it contains a sliver of truth, it ignores important information. For instance, the evidence to date indicates this is an area to continue monitoring, but no direct link has been established between COVID vaccination and shingles or other serious skin conditions.

The study cited was not intended to prove cause and effect, and it was looking at patients who already had suppressed immune systems that made them more likely to get shingles whether they had a vaccination or not.

We rate this statement Mostly False.

Sources:

Telephone interview with Dr. William Schaffner, professor of medicine, division of infectious diseases, Vanderbilt University School of Medicine, April 23, 2021

Telephone interview with Dr. Amesh Adalja, senior scholar at Johns Hopkins Center for Health Security, April 23, 2021

Rheumatology, "Herpes Zoster Following BNT162b2 mRNA COVID-19 Vaccination in Patients With Autoimmune Inflammatory Rheumatic Diseases: A Case Study," April 12, 2021

The New England Journal of Medicine, "Delayed Large Local Reactions to mRNA-1273 Vaccine Against SARS-CoV-2," April 1, 2021

PolitiFact, "A Claim Comparing Adverse Events for COVID-19, Flu Vaccines Exaggerates Raw Data," Jan. 15, 2021

National Organization for Rare Disorders rare-disease database, "Erythema Multiforme," accessed April 23, 2021

Mayo Clinic, "Shingles," accessed April 23, 2021

Vanity Fair, "An Ex-New York Times Reporter Has Become the Right's Go-To Coronavirus Skeptic," April 10, 2020

Julie Appleby: jappleby@kff.org, @Julie_Appleby

BNSF Railroad is going after the local health clinic that opened to deal with the health crisis in 2000 and still screens dozens of people each month as new cases emerge.

This article was published on Thursday, April 29, 2021 in Kaiser Health News.

By Sara Reardon

Patricia Denny and her husband, Jeff, had hoped to one day get an RV and travel the country. Instead, Jeff has been forced into retirement at age 54 by a lung disease caused by the asbestos that's polluted the small town of Libby, Montana, for decades.

Jeff Denny's lungs are damaged from the asbestos he breathed while participating in an Environmental Protection Agency-run cleanup of the asbestos contamination caused by the vermiculite mine that closed 30 years ago in this community in the Cabinet Mountains. Patricia Denny is afraid she will get asbestos-related disease as well, given how many residents of the town have become sick. Barbed fibers, a byproduct of vermiculite, attach to the lungs when breathed in.

At least 400 people exposed to Libby asbestos have died of asbestosis, mesothelioma or other lung diseases, and thousands more have been diagnosed with lung damage and diseases caused by asbestos, according to the Center for Asbestos Related Disease, the Libby clinic that diagnosed Jeff Denny.

"It is not the matter of if, it is when," Patricia Denny said in an online message. "Once this barbed killer gets in ya it stays … and kills the area it penetrates."

The company that operated the mine, W.R. Grace, filed for bankruptcy in 2001, as thousands of lawsuits poured in after the extent of the contamination became known. Since then, the Montana Supreme Court has held several other companies responsible as well, including the BNSF Railway, one of the nation's largest rail companies. BNSF, owned by billionaire Warren Buffett's Berkshire Hathaway, is liable for spreading asbestos amid the dust that blew off its cars while transporting vermiculite across the nation for use in insulation and other purposes, according to court rulings.

Now, the railroad is going after the local health clinic that opened to deal with the health crisis in 2000 and still screens dozens of people each month as new cases emerge. BNSF is suing the Center for Asbestos Related Disease in federal court.

The rail company alleges that the clinic is defrauding Medicare and grant agencies by overdiagnosing asbestos-related diseases and running unnecessary tests. BNSF also takes issue with CARD's reliance on X-rays or CT scans to make its diagnoses, even if independent experts disagree with the clinic's interpretations of the scans.

"CARD knowingly billed the federal government millions of taxpayer dollars for medically unnecessary radiographic studies and interpretations that they routinely disregarded," BNSF spokesperson Lena Kent said in a statement.

In the suit, which was filed in 2019 but not made public until Feb. 18, BNSF asked the U.S. government to prosecute CARD for fraud. The government declined, leaving BNSF to sue the clinic itself under a federal whistleblower statute.

Kent said that the decision "was not taken lightly" and that BNSF "recognizes the extraordinary impact that Asbestos-Related Disease has had on the [Libby] community."

CARD's team is one of the few who study the health effects of Libby amphibole asbestos — the name of the needle-like mineral found only in Libby and a few other mines around the world. The clinic is also the leading provider of asbestos diagnostics and care in the 2,700-person town, where mesothelioma and asbestosis are rampant.

CARD and its lawyers see the lawsuit as a ploy to damage the clinic's credibility and limit the railroad's financial liability by casting doubt on the legitimacy of the clinic's diagnoses. The attorney representing CARD, Tim Bechtold, said the lawsuit is taking the clinic's time and resources away from patients. "All they want to do is hassle CARD," he said. "It's completely cynical."

The EPA declared Libby a Superfund site in 2002 and spent more than $600 million on the cleanup, according to the agency. W.R. Grace agreed to pay current and future asbestos victims' medical costs and $250 million for the cleanup, and the company emerged from bankruptcy in 2014.

People in Libby are still being diagnosed with asbestos-related diseases today. Decades can pass between exposure and the development of symptoms, according to the Centers for Disease Control and Prevention. Anyone in Libby can qualify for Medicare if they develop lung disease, under a special part of the Affordable Care Act.

The crux of BNSF's accusations is that many of CARD's diagnoses of distinct lung diseases in Libby residents are fraudulent, largely due to their rarity and the difficulty that others have diagnosing them.

Researchers from CARD and Mount Sinai hospital in New York City have found that CT scans from the lungs of people exposed to amphibole showed a distinct type of scar tissue called lamellar pleural thickening (LPT). CARD's research suggests that this scar tissue thickens over time and makes it increasingly difficult for the patient to breathe.

But few, if any, cases of asbestos-associated LPT have been diagnosed outside of CARD. The clinic said that is because no one else knows to look for it. "The disease is different than typical [asbestos-related] disease so it does in fact take a trained eye to identify it," CARD said in a statement. "If the [CT] reader did not know what he/she was looking for, then it would not be identified."

Others see this as evidence that CARD is overdiagnosing patients with a condition that may not exist. "I was appalled by what goes on in Libby," said Dr. Anthony Dal Nogare, a pulmonologist at Kalispell Regional Healthcare who has testified for BNSF in prior lawsuits. "It's like the emperor's new clothes if it's something only they can see and no one else can."

Dal Nogare, who visits Libby frequently to see patients, said he never sees LPT on CT scans and rarely sees asbestos-related lung diseases in people who did not work in the mine. He pointed out that the smoking rates in Libby are high, which could account for the shortness of breath and other symptoms CARD's patients experience.

CARD said it sends each of its CT scans to independent radiologists who can confirm the diagnosis of LPT. The clinic's records indicate it finds abnormalities in 60% of scans, while the outside radiologists find them in only 35%. CARD's administrative director, Tracy McNew, said the discrepancy occurs because the independent radiologists don't receive any clinical information about patients or their symptoms, meaning they can't learn how to see LPT and associate it with the disease.

"It's just not an exact science," said Bruce Alexander, an environmental epidemiologist at Colorado State University. Although something serious like mesothelioma would be obvious in a CT scan or X-ray, he said, trained radiologists can differ on how to interpret subtle signs like pleural thickening, which may be confused with fat on the lungs.

Dr. Paul Scanlon, a pulmonologist at the Mayo Clinic in Rochester, Minnesota, said most radiologists would read what CARD calls LPT as pleural plaques, which are difficult to mistake on a CT scan. Pleural plaques are an indication that someone has been exposed to asbestos but are not very harmful by themselves.

CARD declined to make its medical experts available to respond, citing the pending case.

"There's legitimate scientific debate about what the implications of these exposures are, but it's pretty clear people in these communities were adversely affected," Alexander said. In 2012, he studied the lungs of Minneapolis residents who lived near a plant that processed Libby vermiculite. He found about 11% of the residents there had a type of pleural thickening or plaques but said the long-term health implications are unclear.

Other evidence suggests that the lungs of Libby's residents are especially damaged, both those of people who worked in the mine and those who did not. In 2017, the CDC published a study showing that residents were more than 100 times as likely to die of the lung disease asbestosis than the general population.

"Simply by living in Libby, they were exposed to asbestos at a high-enough concentration," said paper author Samantha Naik, a former CDC epidemiologist who is now a private consultant. She said Libby represents a rare case in which an environmental chemical can be scientifically proven to cause a disease.

For her part, Patricia Denny is frustrated that BNSF and other companies have yet to be held fully accountable.

"They all made a huge profit, still are, while the people are dying," she said.

After a year of much public lionizing of doctors and other health professionals on the front lines of the COVID fight, it's a lot harder to make the case hospitals are fleecing patients.

This article was published on Thursday, April 29, 2021 in Kaiser Health News.

By Markian Hawryluk

DENVER — Before the pandemic, Colorado looked set to become the second state to pass what's known as a "public option" health insurance plan, which would have forced hospitals that lawmakers said were raking in obscene profits to accept lower payments. But when COVID-19 struck, legislators hit pause.

Now, after a year of much public lionizing of doctors and other health professionals on the front lines of the COVID fight, it's a lot harder to make the case hospitals are fleecing patients.

"It is much more difficult now that we have this narrative of the healthcare heroes," said Sarah McAfee, director of communications for the Center for Health Progress, a Denver-based health advocacy organization that pushed for the public option. "Part of this is separating the two: The people who are providing the healthcare are not the same as the corporations who are focused on the bottom line."

Colorado legislators had tried to walk a tightrope, targeting their criticism toward the business side of the industry while continuing to praise front-line health workers and trying to get buy-in from all sides. But on Monday, Democratic legislators said they'd made a deal with the health industry to scrap the public option and instead mandate lower premiums for those buying coverage on the individual or small-group markets. The bill still must be approved.

Colorado's compromise highlights the political tap dance likely to play out across the country as the pandemic changes the political discussion on healthcare costs. With states including Connecticut, Nevada and Oregon also considering public option plans this year, Colorado's example may be a sign that major healthcare upheavals will be delayed for at least another year as hospitals, providers and insurers unite and push back together.

"Nationally, there's little appetite to pursue policies that would potentially cut revenues for hospitals and other providers," said Sabrina Corlette, research professor and co-director of the Center on Health Insurance Reforms at Georgetown University. "It's very hard to do when the public sees these providers as true heroes."

At the start of this year's legislative session, Colorado Democrats had proposed giving the health industry four years to reduce health insurance premiums by 20%. Failure to meet that target would have triggered a state-designed public option plan in 2025 that would likely undercut the cost of private insurance plans. Proponents argued that as a nonprofit-run plan without the need for hefty spending for administration, marketing and profit, it could pass on significant savings to consumers. To lower premiums, insurers would have to pressure providers into taking lower payments for their services.

Instead, under the deal reached with the health industry this week, insurance plans would commit to reducing premiums by 18% over three years. If they fail to do so, insurers would have to justify their premiums and state officials would get some say over provider payment rates. Those rates would not dip below 165% of Medicare rates for hospitals, or 135% for other health providers. Hospitals had been pushing for a floor of 200% of Medicare, and physician groups are still negotiating with the bill sponsors to increase their minimum rates.

The state would design a standardized benefit plan that would limit the insurance companies' ability to skimp on benefits or increase cost sharing to make up for the drop in premiums.

Democratic Rep. Dylan Roberts, the legislation's lead sponsor, said the compromise would offer significant cost reductions for Coloradans, a benefit that was ultimately more important to him than how those savings were achieved.

"Healthcare access is the No. 1 thing I hear from my constituents," Roberts said. "Do they care whether their health insurance product is coming from a public entity or a private insurance company? I don't think they care as much about that as whether it's affordable."

But some disconnect may be occurring between what people say they want and the political will at the Statehouse to take on the unified healthcare industry. According to a November poll by Healthier Colorado, 66% of Coloradans supported the public option plan, including 78% of Blacks and 76% of Hispanics. That's virtually unchanged from polling done before the pandemic and after a hefty advertising campaign against the legislation.

Kyle Piccola, spokesperson for the advocacy group, said polling in some of the more rural, conservative districts showed 57% to 66% support. About 40% of those identifying themselves as Republicans supported the bill as it was.

"This data point," he said, "is really showing that everybody, regardless of who you are, is really feeling the high cost of care."

Democrats have the votes to push just about any bill through the House and Senate on their own, and Democratic Gov. Jared Polis had supported a public option after campaigning on the issue. But Joe Hanel, spokesperson for the nonpartisan Colorado Health Institute that analyzes health policy, said the sponsors likely courted industry and Republican support to avoid having opponents undermine the effort for years to come, as happened on the federal level with the Affordable Care Act.

"It just really seems like they just want buy-in to make this be more durable, and not be a lightning rod, not have millions of dollars of ads out there against them for years, like they are right now," Hanel said.

Industry groups had opposed last year's bill and the initial proposal this session. National groups ran a campaign with TV ads and mailers warning consumers a public option would put hospitals out of business. With the compromise, Colorado hospital, insurance and other provider associations have withdrawn their opposition.

Still, the new proposal passed its first test along a strict party-line vote in a House committee on Tuesday, as the pandemic loomed heavily over the debate. Republicans argued healthcare is dramatically different now than when a 2019 actuarial analysis suggested hospitals could easily absorb lower payment rates.

"And nothing has changed in the medical world since 2019?" Republican Rep. Hugh McKean asked the sponsors, tongue in cheek. "There hasn't been any big stuff that we're still in the middle of?"

Hospitals have also taken every opportunity to remind legislators of their role in battling the challenges of the past year.

"These are the very same hospitals who supported Colorado at every turn during the COVID-19 pandemic. They were and continue to be there for their communities," said Chris Tholen, president and CEO of the Colorado Hospital Association. "It is critical that we carefully implement this legislation and monitor it to be sure that hospitals can continue to be vital resources for their communities."

An analysis done on behalf of the Colorado Business Group on Health found that Colorado hospitals averaged a 15.6% profit margin in 2018, beating out Utah and California for the highest margins in the country. While financial data for 2020 has not yet been released, Roberts said, many of the larger hospital systems did well amid the pandemic. They also benefited from millions in federal relief money. The bill would provide additional support for many of the smaller or rural hospitals that have struggled.

Those provisions were not enough to assuage Republicans.

"If we want to have good healthcare providers in Colorado, we can't cut their funds while they are recovering from COVID," said Colorado GOP chairperson Kristi Burton Brown. "This bill completely disregards our healthcare workers and our healthcare facilities. At a time when we should be ensuring they can operate in Colorado, the Democrats are working to shut them down."

Colorado has been aggressive on healthcare policy in recent years, pushing through measures aimed at reducing healthcare costs for its residents. Proponents of the public option bill have played up the example of the Peak Health Alliance, in which communities in seven counties in western Colorado negotiated price concessions from hospitals, lowering premiums by 20% to 40%.

Tamara Pogue, a Summit County commissioner and former CEO of the alliance, said she saw similarities between the bill's approach and the Peak Health model. "It's creating incentives for the industry and the communities to work together," she said.

The Peak Health example helps to fend off criticisms that cutting costs would close hospitals and reduce access.

"We don't even have to entertain hypotheticals," Roberts said. "We have a real-world example there."

Markian Hawryluk: MarkianH@kff.org, @MarkianHawryluk

Holmes County, where half the population is Amish, has the lowest vaccination rate in Ohio, with just 10% of the population fully vaccinated.

This article was published on Wednesday, April 28, 2021 in Kaiser Health News.

By Anna Huntsman, WCPN-Ideastream  

The Amish communities of northeastern Ohio engage in textbook communal living. Families eat, work and go to church together, and through the pandemic, mask-wearing and physical distancing have been spotty. That has meant that these communities bore a high rate of infection and death.

Despite this, health officials are struggling to encourage residents to get vaccinated against COVID-19. Holmes County, where half the population is Amish, has the lowest vaccination rate in Ohio, with just 10% of the population fully vaccinated.

"About less than a percent [of Amish] are coming in," said Holmes County health commissioner Michael Derr.

Marcus Yoder, who was born Amish and is now Mennonite, said the few Amish who are getting the shots are doing so privately through doctors' offices and small rural clinics — and, they generally are keeping it to themselves.

"There were Amish people getting the vaccination the same day I was … and we all kind of looked at each other and smiled underneath our masks and assumed that we wouldn't say that we saw them," Yoder said.

Many Amish do not want to get vaccinated because they've already had COVID and believe the area has reached herd immunity, he said.

"I think one of the main driving forces is the misinformation about COVID itself — that it's not more serious than the flu," said Yoder, who lives in Holmes County and still has close ties to the religion and community. "They're saying, 'Well, it didn't affect me that much. Look at all these old people who survived.'"

Anti-vaccination conspiracy theories also have spread throughout the community, and there is a lack of awareness about the more contagious variants spreading across the country, Yoder said.

"I think we're going to see some more cases in our community, unfortunately, because of this," he said. "There simply is a lot of COVID news fatigue. They simply do not want to hear about it, and that's really unfortunate."

While some sort of herd immunity could explain why Holmes currently has a low incidence of new cases, Derr at the health department is concerned that those who previously had the virus may not be protected.

"As a region, we definitely surged over the winter, and we know that that happened about 90 days ago," Derr said. "We're primed and ready for another surge because we're not vaccinating enough."

Health officials in Indiana and Pennsylvania are also ramping up outreach in heavily Amish areas. Local health departments in Lancaster County, Pennsylvania, home to the largest Amish population in the country, are connecting with Amish bishops to try to spread the word about the vaccines.

The widespread reluctance to be vaccinated in Amish communities is not surprising to West Virginia University sociologist Rachel Stein, who studies Amish populations across the country.

"We as non-Amish are more on board with preventative medicine," Stein said. "They certainly don't have that mindset that we need to do things to stop this from happening."

Instead, she said, there's an acceptance that people will get sick and get better — or not. While childhood vaccinations have increased in Ohio's Amish communities in recent years, adults are still more hesitant, she added.

"There's oftentimes frequent breakouts of whooping cough in a settlement, and it's just like … 'This is happening now. We're in whooping cough season, and so it's time to deal with this sort of thing,'" she said.

In 2014, a measles outbreak spread rapidly through Ohio's largely unvaccinated Amish communities. Even after this experience, many Amish residents chose not to vaccinate their children against other diseases.

The low vaccination interest in Holmes County also follows national trends showing residents of rural areas are less likely to consider getting vaccinated.

A recent poll from KFF found 3 in 10 rural residents will "definitely not" get a COVID vaccine or will get vaccinated only if it is mandated.

Yoder thinks the best path forward is to encourage Amish residents who did get the vaccine to talk openly about their positive experience getting the shots.

"I think that hammering people for not doing it will not get us anywhere," Yoder said. "Some of the local business leaders have done very, very well at saying, 'Look, let's get the vaccination so we don't have to wear masks in the future, so we don't have to worry about social distancing as much in the future.' And they've used that tack and that has been a healthy way to approach it."

Derr is trying to get business owners who employ Amish workers to encourage their staffers to get a shot. Health officials hope to eventually hold vaccine clinics at these businesses and take the shots to them, but not every business owner is on board with that yet, he said.

"People are going to listen to their friends and their family, people who they interact with more, and it's going to be that telephone effect," he said. "The more and more people we tell about it and the better experiences they have, word will get around."

Derr expects more Amish will get vaccinated in the fall after the shots have been around for some time but worries that the community could see a spike in cases long before then.

This story is part of a partnership that includes WCPN-Ideastream, NPR and KHN.