• A Stable One-Shot COVID Vaccine Is Deemed Safe and Effective

    Paul Christian Gordon/Zuma

    Johnson & Johnson’s one-shot coronavirus vaccine is highly effective at preventing severe disease and death from COVID-19, the Food and Drug Administration found in analyses published today.

    An international study found the vaccine’s efficacy rate to be 72 percent in the United States and 64 percent in South Africa, where a more contagious variant is spreading. While these figures are lower than Pfizer’s and Moderna’s efficacy rates, the vaccine greatly reduces the risk of hospitalization and death from COVID-19 and could play a key role in keeping the pandemic at bay. In a clinical trial of 40,000 people, no one who took the vaccine was hospitalized or died of COVID-19 after the vaccine took effect.

    Plus, the vaccine requires only one shot and does not need special refrigeration—good news at a time when demand for vaccines greatly outstrips supply.

    The FDA could authorize the vaccine for emergency use as early as Saturday, with 20 million doses available by the end of March and a total of 100 million doses delivered by the end of June.

  • The United States Marks Half a Million COVID-19 Deaths

    Artist Suzanne Brennan Firstenberg walks among thousands of white flags planted in remembrance of Americans who have died of COVID-19 in October 2020.Patrick Semansky/AP

    The United States’ COVID-19 death toll has surpassed 500,000, a staggering milestone.

    “People decades from now are gonna be talking about this as a terribly historic milestone in the history of this country, to have these many people to have died from a respiratory-borne infection,” Dr. Anthony Fauci said in a CNN interview Monday morning. “It really is a terrible situation that we’ve been through, and that we’re still going through.”

    It’s nearly impossible to conceive of the loss of half a million Americans. The virus has killed one in 670 people across the country. In places like New York City, the number is closer to one in 295. President Biden will hold a memorial ceremony this evening and will order flags on federal property to fly at half staff for five days.

    COVID-19 infection rates in the US have fallen dramatically since their January peak, and more than 13 percent of the country’s population has received at least one vaccine dose. Still, public health officials are urging the public not to let their guard down. At a White House COVID-19 response team press briefing this afternoon, Fauci reiterated that people should continue wearing masks because of the possibility that people who have been vaccinated could still be infected and spread the disease asymptomatically.

    “There will be things that you will not be able to do because the burden of virus in society will be very high,” he said. “We are still at an unacceptably high baseline level with the seven-day average being quite high.”

    It was a little less than a year ago that then-President Trump declared that the coronavirus was “going to disappear.” Lockdowns in New York City, one of the initial epicenters, began in mid-March 2020. Since then, the world as we knew it has disappeared.

  • A Small Georgia Town Was Trying to Play by the Rules. The State Seized Its Vaccines Anyway.

    Dr. Jonathan Poon (right) next to his father, Dr. Glenn Poon (left), outside the Medical Center of Elberton in Elberton, GeorgiaMother Jones illustration

    Update, February 19, 2021: After this piece was published, Dr. Poon reported that the Georgia Department of Health restored vaccines access to the Medical Center of Elberton. The clinic will be able to order shots starting March 8 and resume vaccinations March 15. 

    It was a gloriously sunny Wednesday in early February, but Dennis Fowler was worried. The 77-year-old retired transit worker sat in the waiting room at his doctor’s office at the Medical Center of Elberton, a bustling clinic in rural Elbert County, Georgia. He was there for a routine appointment, but he had also come to ask his doctor about his COVID-19 vaccine. Weeks earlier, as soon as they’d heard they were eligible, Fowler and his wife called to make appointments to get their shots. The prospect of an immunization was a big relief: Dennis’ wife had kidney failure, and the two had spent the last 11 months under strict quarantine to protect her. But a few days earlier, the Fowlers’ doctor had called to tell them the bad news. They may not get a vaccine after all and would likely have to start the process all over again. “We’re concerned that we’ll get the virus before we get our shot,” Fowler said. 

    The Fowlers are not the only ones in this Georgia community whose vaccinations were canceled. In late December, the county had finished vaccinating health care professionals and first responders, so the Elberton Medical Center opened up appointments to what they’d thought was the next tier: people over age 65 along with essential workers, including teachers. Most people in town cheered this development. The schools had been open since August, since remote learning was impossible for the community’s many children who lacked internet access. But the doctors at the medical center didn’t realize that the Georgia Department of Health had changed the guidelines in January, and teachers were not eligible after all. When the Georgia DPH found out that the Medical Center of Elberton had vaccinated 177 school workers with Pfizer and Moderna vaccines, state health officials meted out a harsh punishment. They suspended all vaccine shipments until July and seized most of the remaining doses in the clinic’s freezer, leaving only enough for those who had already gotten their first dose to receive a second.

    The state’s seizure of the clinic’s vaccine supply comes at a critical time. At the urging of the Centers for Disease Control and Prevention, many states have opened vaccine appointments to broader swaths of the community to speed the process and prevent wasted doses. Yet some local leaders are cracking down hard on anyone who doesn’t rigidly adhere to guidelines. The New York Times recently reported that a physician in Houston was fired this month for giving away vaccine doses that otherwise would have gone to waste. Many public health experts question the logic of disciplining providers. “I think it’s really important that we stop punishing groups or individuals for vaccinating those outside state or [national] COVID-19 vaccination guidelines,” Peter Hotez, a vaccinologist and dean of the National School of Tropical Medicine at Baylor College of Medicine, told me for a previous story. The guidelines, he said, “mostly serve as a barrier or hindrance to vaccinations rather than their intended purpose.”

    I visited the Medical Center of Elberton last week and chatted with Dr. Jonathan Poon, a physician who practices at the clinic, which is the largest in town and the main supplier of COVID-19 vaccines. He planned to distribute vaccines to the more than 3,000 patients the clinic sees every month. Now, like the Fowlers, most will struggle to get immunized elsewhere. About 70 percent lack private insurance, and many don’t have internet access they’d need to book appointments at other locations. “We’re in a very precarious situation,” he said. 

    Kiera Butler/Mother Jones

    Elbert County is in the far northeastern corner of Georgia, close to the South Carolina border. Many of its 20,000 residents are employed making tombstones and memorial statues out of stone—a mural downtown in Elberton, the county seat, boasts the town is “the monument capital of the world.” Trucks bearing slabs of granite rumble through the modest downtown, a square of municipal buildings and a few storefronts still open for business: Stan’s Music World, say, and Tena’s Fine Jewelry & Gifts. On Friday nights, people go to see the the Blue Devils football team from the high school play at the Granite Bowl stadium, which is carved out of 100,000 tons of blue granite. The people here live modestly: In 2018, the median household income was about $44,000, and nearly 20 percent lived below the poverty line.

    On the day that I visited, I watched as residents stopped to greet each other around town. The older ladies had names like Sarabelle and Shelly Anne. “How’s your mama?” They asked neighbors at the pharmacy. “She managing okay?” 

    Almost everyone in this county knows Dr. Poon because he’s lived here almost his whole life. His family, originally from Hong Kong, moved to Elberton when Poon was 3 months old so his father could practice family medicine. Poon decided to follow in his father’s footsteps, and after medical school and residency, he moved back home to practice family medicine. Today, he sees patients down the hall from his father.

    Poon, who has an unflappable air about him and speaks in a slow Southern drawl, isn’t used to being in the spotlight. He spends his days at the clinic, seeing local patients at all phases of life: children with sore throats, pregnant women, elderly people who need medication for diabetes. But in the last few weeks, Poon has appeared on TV news shows, talking about how much the people of Elbert County need the vaccines that the state took away. As he and I walked from the parking lot of the medical center to the pharmacy, neighbors greeted him like a conquering hero. “Thank you so much for what you’re doing for our town,” a man in a pickup truck said through his window. “I really mean it.”

    When Poon and his colleagues heard in November that vaccines would be available by the end of the year, their planning went into overdrive. The clinic purchased a special freezer for $7,000, and a trailer to use as a vaccination clinic for $90,000. They wanted to make it as easy as possible for their patients to get vaccines, and they aimed to get the process started quickly. They saw how their community was suffering.

    COVID-19 ripped through Elbert County this winter. So intense was the spread of disease that the small local hospital had to send patients to ICUs as far away as Jacksonville, Florida. The county EMS team has been stretched thin, transferring patients while also trying to provide regular emergency services to the county. In the three local nursing homes, the COVID-19 mortality rate was 30 percent. Poon estimates that 30 or 40 people died of the virus. 

    The county’s plight did not move the state public health department to reverse its decision despite Poon’s efforts. When I contacted the Georgia DPH for a previous story, spokesperson Nancy Nydam responded, “It is critical that DPH maintains the highest standards for vaccine accountability to ensure all federal and state requirements are adhered to by all parties, and vaccine is administered efficiently and equitably.” In other words, there was little hope for recourse. 

    When the state seized the medical center’s vaccines, the pharmacy next door, Madden’s, attempted to pick up some of the slack, applying to receive more vaccine doses from the state, a process that took several weeks. The gregarious head pharmacist, Don Piela, has been working hard to book appointments every day. As he stood behind the prescriptions counter, he told me he had to bring in help to cope with the demand for vaccine. His wife, who usually works as a pharmacist in another town, came into assist with booking appointments and performing vaccinations. The pharmacists also had to contend with unscrupulous line jumpers. An Atlanta couple in their 50s, for instance, drove two hours from the suburbs for a vaccine, claiming they were caregivers for the woman’s elderly mother, who lived in Tennessee. The pharmacists had to turn them away.

    Piela told me he’s grateful that his pharmacy was able to help with vaccines, but he’s worried that the state’s decision to punish the medical center could have consequences beyond the pandemic. “If the state is coming in and suspending vaccines to a medical facility, there’s part of your population says, ‘Well, they must have been doing something wrong,’” he says. “If you damage the reputation of anybody, that’s damaging. But especially somebody that’s in health care, that’s really even more damaging.”

    Dennis Fowler, 77, at the Medical Center of Elberton;

     Kiera Butler/Mother Jones

    Poon and his colleagues are working hard to try to convince state officials to restore their vaccine supply. They’ve been meeting regularly with county leaders, who have appealed the state’s decision twice, with no luck. State public health representatives responded with a letter stating that the decision to withhold vaccines will stand. Poon is worried that all the delays are wasting valuable time. Every day that Elbert County residents don’t get vaccinated is another day they could contract the virus. Meanwhile, more contagious variants are spreading quickly; the one that originated in Africa already has been identified in neighboring South Carolina.  

    Fowler, the 77-year-old whose vaccine appointment was canceled, is frustrated about being stuck in the house indefinitely, always worried about the fragility of his wife—and himself. If the state doesn’t restore vaccine shipments, he’ll make an appointment at Madden’s, but he doesn’t know how long he’ll have to wait—it could be weeks. He misses seeing his neighbors and going for a date with his wife to the Outback Steakhouse. He’s eager to get back to church. “I’m hoping something will come through,” he said, “and we will be able to get our shots.”

    Standing in front of the clinic, Poon looked at the vaccine trailer his practice had purchased and shook his head. He intends to keep trying to impress upon the state that his patients deserve vaccines, and that he and his colleagues never meant to flout any rules. “There’s nothing we’re doing for personal gain,” he said. “We’re just trying to do the right thing.”

    This piece has been updated. 

  • The Pandemic Has Unmasked America’s Deepest Inequities

    Louise Pomeroy

    COVID-19 doesn’t discriminate, but the havoc wrought by the virus—the deaths, economic devastation, and intergenerational trauma—has disproportionately affected Black, Latino, and Native American communities. The Trump administration’s feckless response didn’t help, yet even proactive steps have reinforced preexisting inequities: Stay-at-home orders protected people with the privilege to work remotely while frontline workers, disproportionately Black and Latino, took on greater risk of exposure. People of color have also experienced more unemployment and financial insecurity. As Mary Bassett, director of Harvard’s François-Xavier Bagnoud Center for Health and Human Rights, explains, none of this is caused by the virus itself: “It’s because of the social consequences of race in our society, which has been reinforced by decades, centuries of bad practices and policies.”

    Illustrations by Louise Pomeroy

    The COVID death rate for Black Americans ages 30 to 49 is four times that of white Americans.
    Black Americans make up 12% of all 50- to 64-year-olds yet 22% of all COVID deaths in this age group.

    The COVID death rate for Native Americans ages 18 to 29 is 12 times that of white Americans.

    White Americans make up 68% of all 50- to 64-year-olds yet only 39% of all COVID deaths in this age group.

    Latinos make up 20% of all 30- to 49-year-olds yet 45% of all COVID deaths in this age group.
    After California reopened last summer, the rate of excess deaths among Latinos in the state tripled.

    Asian Americans make up 6% of the population and 4% of all COVID deaths.

    The jobless rate for Latinas in December was nearly three times higher than it was a year earlier.
    Due to COVID, Americans’ life expectancy has dropped 1.2 years. For Black Americans, it’s down 2.1 years; for Latinos, 3 years.

    More than 40% of the 12 million jobs lost by women last spring have not come back.

    Black men had the nation’s highest unemployment rate in December—10.4%—their highest level since 2015.
    As of mid-January, the vaccination rate for Black Americans in 11 states was less than half that for white Americans.

    Sources: Death rates: Calculations based on data from the Centers for Disease Control and Prevention (data as of February 3, 2021) and Census Bureau; household surveys: Census Bureau (data as of January 6, 2021); California excess deaths: JAMA Internal Medicine; Latina unemployment rates: Bureau of Labor Statistics; life expectancy drops: Proceedings of the National Academy of Sciences; women’s job losses: National Women’s Law Center; vaccination rates: Kaiser Health News (data as of January 14, 2021); Black men’s unemployment rates: Bureau of Labor Statistics, St. Louis Fed; concern about local outbreak: Civiqs

  • New Research Confirms the British COVID-19 Variant Is Running Rampant Across the US

    Andreas Arnold/AP Images

    In mid-January, the Centers for Disease Control and Prevention warned that a coronavirus variant first identified in the United Kingdom was likely going to, as the New York Times put it at the time, “lead to a wrenching surge in cases and deaths that would further burden overwhelmed hospitals.”

    A new study, published on Sunday by a team of scientists from labs across the country, including the Scripps Research Institute, ahead of full peer review, confirms that dire prediction. The variant, known as B.1.1.7, is “spreading rapidly in the United States, doubling roughly every 10 days,” the Times reported Sunday, with a transmission rate 30-to-40 percent higher than more common strains. In a matter of weeks, this variant could be the predominant domestic variant, the research suggests.

    “There could indeed be a very serious situation developing in a matter of months or weeks,” Nicholas Davies, an epidemiologist at the London School of Hygiene and Tropical Medicine, who was not part of the research team, told the newspaper.

    The news comes as communities across the country—and around the world—continue to grapple with spotty vaccine availability and distribution. President Joe Biden has increased his goal for daily vaccinations to 1.5 million (up from 1 million) and overall dosing numbers are increasing. Still, the current pace means that it won’t be until late summer before a sufficient majority of Americans will have been vaccinated, leaving a troubling window for the B.1.1.7 variant, and others, to circulate widely.

    “If these data are representative,” Davies told the Times, “there may be a limited time to act.”

  • I Moderated a Facebook Live Event With Two Nursing Home Residents. It Was Shocking.

    Andres "Jay" Molina, Molly Schwartz, and Vincent Pierce talk during a Facebook Live event.

    Andres "Jay" Molina, Molly Schwartz, and Vincent Pierce talk during a Facebook Live event.Mother Jones Illustration

    It’s impossible to consider the full impact of the pandemic without looking at nursing homes. According to data from the COVID tracking project, an astonishing 35 percent of all COVID deaths in the United States have been nursing home deaths. And that’s likely far from the real number. A recent report from the New York Attorney General’s office found that nursing home deaths in the state have been undercounted by up to 50 percent.

    This week, I published a story about how the pandemic has prompted residents at Coler Rehabilitation and Nursing Care Center to speak out about what they’ve gone through during the various surges of the contagion. Many Coler residents have been infected by the coronavirus. Many have died. They’ve been on lockdown for months on end, sometimes unable to leave their rooms. They’ve had to fight for protective measures against the virus, like proper PPE, frequent testing, and isolation of COVID patients.

    Last night, I got the chance to interview Vincent Pierce and Andrew “Jay” Molina—two residents whose voices have been the strongest in asserting the rights of Coler residents—for a Facebook Live event. Neither of them fit the image of what one would think of as a traditional, elderly, nursing home dweller. Pierce is 34-years-old and paralyzed from the neck down. Molina is 43 and restricted to a wheelchair because of a lung disease. But they share a commitment to spread awareness about disability rights, the impact of the pandemic on nursing home residents’ physical and mental health, and what nursing home administrators could do better. 

    Over the summer, during the racial justice protests, Pierce founded the Nursing Home Lives Matter movement as a way to advocate for rights of nursing home residents he believed had been ignored during the spread of the coronavirus. He wanted them to play more of a role in the decision-making that affects their health and well-being. “I was hesitant at first, because I would be afraid of any type of retribution from the administrators,” said Pierce. “But then I realized somebody has to really speak up from inside, and who else but me? No one else is gonna do it, and I felt like it was time.”

    Molina is the co-director of an upcoming documentary, Fire Through Dry Grass, about the spread of COVID inside Coler when the New York City was overwhelmed by the pandemic last March and April. He was prompted to start filming after an infected patient was moved into his room at Coler. Despite Molina’s rare lung condition, Coler administrators refused to move the patient out. A COVID patient was also moved into the room of Ray Watson, a fellow resident and Molina’s friend. Watson caught the virus and died.

    When that happened, I said enough is enough,” Molina told me during the event last night. “We have to say something. I am a filmmaker, so that is the way I know how to express myself.”

    Pierce and Molina were broadcasting from inside the nursing home where they’ve been on lockdown for the past 10 months. In the background you’ll hear some bleeps from medical machinery and nursing staff talking in the background. (It was my first time doing one of these, so please excuse my inability to speak to the camera. Zoom can be tricky like that.) “I would hope everyone that’s watching that has anyone living inside a nursing home, join the movement and let this be heard across the country,” said Pierce at the end of our conversation. “Nursing home lives matter.”

  • Letting People Out of Prison to Avoid COVID Isn’t That Controversial

    A woman wearing a mask takes part in a vigil outside Queensboro Correctional Facility on April 23, 2020Johannes Eisele/Getty

    A new poll indicates widespread public support for releasing some prisoners early to slow the spread of COVID-19, which has rapidly spread through prisons and jails, killing incarcerated people at twice the rate of people outside.  

    The poll, conducted by Data For Progress, a progressive think tank, and The Appeal, a policy research outlet, and published today, was based on an online survey of more than 1,110 likely voters. Most said they supported releasing elderly people, people charged with low-level offenses or with less than six months remaining on their sentences, and people with medical conditions that put them at higher risk of complications from COVID. Nearly two-thirds of respondents, including more than half of Republicans, believe the police should be booking fewer people into jails.

    The results line up with those of similar polls from last spring that found widespread support for early releases as a way of controlling the spread of the coronavirus and limiting its impact on people in federal and state custody.

    Republicans were far more likely than Democrats to oppose early release for people in prisons and jails. Just 37 percent of Republicans supported releasing prisoners who do not pose a threat to public safety and have medical conditions like cancer or lung disease. 

    The poll results point to strong public support for releasing elderly prisoners, who have extremely low recidivism rates. Sixty-three percent of respondents approved of releasing them if they did not pose a serious risk to public safety—including half of Republicans. Governors in several states, including Michigan and Maryland, have taken executive actions to prioritize older prisoners for release.

    White people were significantly more likely to oppose releasing people from prison as a public health measure compared to Black and Latino respondents. Nearly 70 percent of Black and Latino voters supported releasing people with low-level offenses, versus 56 percent of white respondents. While 61 percent of Black and Latino voters said people within six months of completing their sentences should be released, 54 percent of white voters answered the same way.

    The onset of the pandemic did more to quickly reduce the US prison and jail population than any other development in recent history. Nationally, the prison and jail population fell 14 percent between 2019 and mid-2020—from 2.1 million to 1.8 million incarcerated people, according to a recent report from the Vera Institute of Justice. The decline in prison population appears to be mainly the result of fewer people being sent to prison, rather than early releases, according to an analysis by the Prison Policy Initiative. The dramatic drop in jail populations in the first half of 2020 was the result of releasing pretrial detainees and booking far fewer people in the first place.

    According to the poll, measures like issuing tickets and summons rather than arresting and booking people into jail are supported by nearly two-thirds of voters, including a majority of Republicans. 

    Since the middle of 2020, jail populations have been rising again—the result of a complicated mix of factors including court delays, a pause on transfers of sentenced people from jails to prisons, and a backlog of people facing felony charges who were not deemed eligible for pretrial release. Some police departments have already abandoned the alternatives to jailing people that they adopted at the beginning of the pandemic. As early as last May, Philadelphia police resumed arresting people for nonviolent property crimes, rolling back a policy of briefly detaining and fingerprinting suspects before releasing them until charges could be filed later.

    More than 1.8 million people remain locked up in the United States. More than 570,000 incarcerated people and prison and jail staff have tested positive for COVID-19, by the New York Times’ count. At least 2,500 have been killed by the virus.

  • Let’s Stop Naming COVID Variants After Countries

    Jesús Hellín/AP

    Earlier this week, CNN’s Alisyn Camerota asked epidemiologist Dr. Salim Abdool Karim, the co-chair of the South African Ministerial Advisory Committee on COVID-19, about the “South African variant” of the coronavirus and whether it was any deadlier. He took a deep breath and explained that early evidence doesn’t suggest that the variant causes more serious instances of the disease, but only that this mutation spreads faster than others. He also pointed out that calling the strain the “South African variant” was not appropriate. Even though it was first identified in the country, it might not even have originated there. “It’s better just to call it by its name: 501Y.V2,” Karim said, adding that 501Y.V2 now is present in as many as 31 countries, including the United States. 

    Camerota acknowledged that talking about the South African variant—or the Brazilian or the UK variant, for that matter—to refer to the still little-understood but worrying mutations of the virus may be more convenient for the media and the public. “I don’t mean to disparage South Africa, but it’s just a handy shorthand,” she said. But health experts and genetic sequencing researchers have a number of concerns about how geographical associations are not only inaccurate but can potentially stigmatize certain countries and populations. Donald Trump appeared to do so deliberately by constantly referring to the coronavirus as the “Chinese virus,” a description that incited some racist demonstrations.

    One researcher recently described the current naming system as a “bloody mess.” 

    “It’s too confusing with these variant names,” said Dr. Maria Van Kerkhove, the World Health Organization’s COVID-19 technical lead, according to Politico. “I am on record multiple times to say we need to fix this because it’s too hard to communicate all these numbers.” 

    The WHO’s official guidelines for naming new infectious diseases, which don’t cover variants, discourage the mentions of geographic locations, people’s names, and cultural references. 

    Epidemiologists have started adopting unusual “nicknames” for certain mutations. The UK seems to be the place where the “Pooh” mutation was identified but it shares “Nelly” with Brazil and South Africa. 

    Critics of the location-informed nomenclature also argue it could potentially discourage countries conducting genetic sequencing from notifying the broader international public health community of the discovery of a new variant. “The last thing we want to do is dissuade any particular place from reporting they’ve got a new concerning variant—in fact, we want to do the opposite,” Oliver Pybus, an evolutionary biologist at the University of Oxford, told Nature. As a leader in viral sequencing, the UK is naturally more likely to find new variants than other countries, experts say

    In recent weeks, the detection of variants in Brazil, South Africa, and the UK has led to the imposition of travel bans. Dr. Tulio de Oliveira, the bioinformatician who spearheaded the discovery of the variant in South Africa, said countries are “being sanctioned because they were transparent about the results of their genomic surveillance.” 

    So what are the options to reverse this trend? The WHO is reportedly conferring with other agencies such as the Centers for Disease Control and Prevention and the National Institutes of Health on how to implement a common nomenclature for the variants. The goal is to avoid “geopolitical issues” while also finding a way to simplify the otherwise technical terminology based on genetic sequence.

    As a Brazilian, I may be taking this a bit personally. I’m the first to admit that my country, which has struggled to contain soaring infection rates from the start, is in trouble. And there are plenty of candidates who can share the blame. But language matters. In looking at all the alarming headlines about a “Brazilian variant” arriving in Minnesota or the Bay Area, like some sort of terrifying alien invader, I can’t help but think that we Brazilians don’t pose a danger to others any more than we do to ourselves. And let’s face it, we didn’t ask for some new variant either.

  • COVID-19 Has Killed 1 in 475 Native Americans

    Tribal members at the burial of a husband and wife on the Standing Rock Indian Reservation, December 2020. Richard Tsong-Taatarii/Getty

    This story was originally published by The Guardian and is reproduced here as part of the Climate Desk collaboration.

    Covid is killing Native Americans at a faster rate than any other community in the United States, shocking new figures reveal.

    American Indians and Alaskan Natives are dying at almost twice the rate of white Americans, according to analysis by APM Research Lab shared exclusively with the Guardian.

    Nationwide one in every 475 Native Americans has died from Covid since the start of the pandemic, compared with one in every 825 white Americans and one in every 645 Black Americans. Native Americans have suffered 211 deaths per 100,000 people, compared with 121 white Americans per 100,000.

    The true death toll is undoubtedly significantly higher as multiple states and cities provide patchy or no data on Native Americans lost to Covid. Of those that do, communities in Mississippi, New Mexico, Arizona, Montana, Wyoming and the Dakotas have been the hardest hit.

    The findings are part of the Lab’s Color of Coronavirus project, and provide the clearest evidence to date that Indian Country has suffered terribly and disproportionately during the first year of the deadly coronavirus pandemic.

    The losses are mounting, and the grief is accumulating.

    “Everyone has been impacted. Some families have been decimated. How can we go back to normal when we’ve lost so many after so many layers of trauma? It’s unbearable,” said Amber Kanazbah Crotty, a tribal council delegate in the Navajo Nation.

    On Tuesday, the former Navajo president and Arizona state representative Albert Hale died from Covid, bringing the tribe’s death toll to 1,038, the equivalent of losing one in every 160 people on the reservation.

    The figures show that even though multiple more infectious variants are yet to take hold in the United States, the situation has already wrought a devastating toll on Native communities and may get worse.

    Last month was the deadliest so far in the US, with 958 recorded Native deaths – a 35% increase since December, a bigger rise than for any other group. For white Americans, deaths rose by 10% over the same period.

    “Not only do Native people have the highest rate of Covid deaths, the rate is accelerating and the disparities with other groups are widening. This latest data is terrible in every way for indigenous Americans,” said Andi Egbert, senior analyst at APM Research Lab.

    There are 574 federally recognized American Indian tribes and Alaska Native Villages in the United States. The Navajo Nation, the second largest by population, has suffered the greatest number of deaths, but smaller tribes are facing insurmountable losses.

    In Montana, the Northern Cheyenne tribe has lost about 50 people to Covid so far – which is 1% of the reservation population of 5,000 people.

    “Our collective grief is unimaginable. Losing 1% of our people is the equivalent of losing 3 million Americans. Native Americans are used to dying at disproportionate rates and we’re used to scarcity but Covid is different, there’s a growing sense of hopelessness,” said Desi Rodriguez-Lonebear, an assistant professor of sociology and American Indian studies at the University of California.

    Rodriguez-Lonebear added: “I fear the long-term impacts on mental health, our children, community resilience and cohesiveness. We’re in the middle of a massive storm and we’re not prepared for the aftermath.”

    About a quarter of those who have died were native Cheyenne speakers. The tribal clinic is currently receiving 100 vaccine doses a week, at which rate it will take almost a year to vaccinate everyone.

    “Our language, culture and traditions is what makes us Cheyenne, but we’re losing our teachers. How am I going to teach my son when I still have so much to learn? Indigenous communities are facing a cultural crisis that other communities are not.”

    n Oklahoma, the Cherokee Nation, the country’s biggest tribe, has suffered a relatively low death count thanks to a well-functioning tribe-led health service and a public health system that has pushed testing, contact tracing and consistent science-led messaging from day one, according to Chief Chuck Hoskin.

    “We have one of the best public health systems in the country, which allowed us to be nimble when the worst crisis in modern memory struck … We’re a society, unlike the wider US, which believes in our citizens having access to healthcare at no costs,” said Hoskin.

    Still, there have been significant losses. At least 35 of the remaining 2,000 fluent Cherokee speakers have died from Covid, undermining an ambitious program launched in 2019 to stop the language dying out.

    As a result, tribal leaders decided to prioritize fluent speakers, alongside frontline workers and elders, and about half have now been vaccinated. Overall, almost one in 10 citizens on the reservation have been vaccinated.

    “So far we’ve led this country in getting the vaccine out in an efficient and effective way. The only question now is whether the US can keep up with the Cherokee Nation,” Hoskin added.

    Anecdotal evidence from across the country suggests that tribal vaccination programs, which can include mobile clinics, home visits and drive-throughs, appear to be running more efficiently and effectively than in many states, though shortages are widespread.

    Amid growing debate and concern about vaccine hesitancy in communities of color, the Urban Indian Health Institute (UIHI) conducted the first ever national survey to better understand Native Americans’ knowledge, attitudes, and beliefs.

    About 75% of participants said they would be willing to receive a Covid vaccine – compared with just 56% of the general US population according to one large survey in December 2020. The vast majority view getting the vaccine as a community responsibility, even though three-quarters have safety concerns. The survey included American Indians and Alaska Natives across 46 states – representing 318 different tribal affiliations.

    “The results show the danger in grouping all people of color together when deciding on public health messaging to overcome Covid vaccine hesitancy,” said Abigail Echo-Hawk, director of the national tribal epidemiology centre based in Seattle.

    The findings, published last week, have since been incorporated into a public health campaign called “Be a Good Ancestor”, focusing on community responsibility over individualism.

    Joe Biden’s national Covid strategy lays out plans to bolster federal resources to speed up the vaccine rollout in Indian Country, as part of the administration’s efforts to improve equity.

    Overall, there is no race data for about 42,000 of America’s Covid deaths, which means we do not know the ethnic background of one in 10 people killed by the virus so far, according to the researchers. Perhaps 700 or more Native Americans are likely to be missing from the data.

    “The structural racism in the data collection systems makes us invisible by hiding deaths, which perpetuates inequalities and leads to further deaths in our communities, as this information is used to allocate resources,” said Echo-Hawk. “The maze of missing data is part of the genocide that continues to be perpetrated against our people. Their final stories are being lost.”

    The data issues have not been fixed over the past year. Instead, the same gaps are now hampering our understanding about the vaccine rollout: almost half the race and ethnicity data is missing from the vaccine recipients, according to the CDC, thwarting efforts to ensure equitable access and accountability.

    In states with patchy or no data, it is extremely hard to know whether states and counties allocated vaccine doses for indigenous residents are using them appropriately.

    Tribal leaders and health experts agree that while the excessive death toll is shocking, it’s hardly surprising given the chronic structural, economic and health inequalities – such as overcrowded housing, understaffed hospitals, lack of running water and limited access to healthy affordable food – resulting from the US government’s failure to comply with treaty obligations promising adequate funding for basic services in exchange for vast amounts of tribal land.

    After centuries of broken promises, expectations are high given that Native American voters helped Joe Biden win crucial swing states including Arizona, Wisconsin and Nevada to take the White House.

    On Wednesday, Biden approved the Navajo Nation’s disaster declaration, which will result in additional federal resources for the tribe as Covid rates again climb.

    But longstanding inequalities require transformational changes, and experts are calling on Biden to fully fund the Indian Health Service, for the first time in history, which would enable the yet-to-be-nominated new director to reduce chronic health disparities that have contributed to the high death toll.

    “Native people showed up for Biden-Harris. Now it’s time to show up for them,” said Echo-Hawk.

  • New COVID-19 Cases Are Plummeting—but Don’t Celebrate Just Yet

    Experts worry new strains could make vaccines less effective.Michael Ciaglo/Getty

    The data on COVID-19 hospitalizations and new cases looks better, for a change. After hitting a peak on January 8, the 7-day average case count is down 40 percent, according to the New York Times. Hospitalizations are improving, too, down 24 percent. This isn’t just in a few highly populated states. We’re seeing steep cliffs in new case counts all across the country—half of states have experienced at least a 50 percent drop. 

    All of this is promising news. Vaccine distribution, bumbling as the rollout has been, seems to be finally doing some good.

    But there are two big caveats.

    Yes, for the first time since December 1 2020, hospitalizations are below the 100,000 mark, according to the COVID-19 Tracking Project. But that doesn’t mean ICU beds still aren’t nearly full (or, in the case of the hospital closest to me in the Bay Area, entirely full of 81 COVID-19 patients). There is still the possibility of a healthcare system remaining overly taxed. The peak was so high that any declines need to be taken into context of the horrific rise we saw during the first winter months.

    And then there are these new strains. As COVID-19 mutates, scientists have scrambled to track new strains of the disease—potentially more infectious—that could harm the case decline researchers predicted following a projected peak in January. “We’re very worried,” Francis Collins, director of the National Institutes of Health, told the Washington Post. There are variants of the coronavirus from California, from England, and from South Africa (a strain just detected in Baltimore). Research suggests the various vaccines will work on the new strains, but the level of effectiveness for each strain, and for each vaccine, remains unclear.

    For now, at least, we have some hope: The trend lines are headed in the right direction.

  • A Year Ago Today, the WHO Called COVID a “Public Health Emergency of International Concern”

    Health care workers operate in an ICU in the "COVID Area" of the Beverly Hospital in Montebello, California.Xinhua/Zeng Hui via Getty Images

    Today marks the one-year anniversary of the World Health Organization declaring “a public health emergency of international concern over the outbreak of novel coronavirus.” Since then the virus has killed more than 2.2 million people worldwide. 

    At the time WHO Director General Dr. Tedros Adhanom Ghebreyesus made the declaration, there were fewer than 100 cases in the world, and this week we passed 102 million reported cases. More positive cases have been reported in the past two weeks than during the first six months of the pandemic, Tedros said at a press conference Friday.

    “A year ago, I said the world had a window of opportunity to prevent widespread transmission of this new virus,” Tedros said. “Some countries heeded that call; some did not.”

    The United States is one of the countries that squandered that opportunity under the leadership of a president who denied the severity of the virus, refused to wear a masks or to advise the public to do so, put the economy ahead of public safety, and kept key information from the American public about how the disease spreads.

    For much of the last year, the United States has had some of the worst rates of infection in the world. As of Saturday, there have been 25.9 million COVID-19 cases confirmed in the United States, and more than 436,000 people have died, according to data from John Hopkins University.  

    President Joe Biden has made the pandemic a top priority for his administration since taking office Jan. 20, signing executive orders that mandate mask-wearing for travel, streamline vaccine distribution, and prioritize those hardest hit by the virus. These are all crucial mitigation measures, but for millions of families—Black and Brown people disproportionately among them—it’s already too late. 

    “The pandemic has exposed and exploited the inequalities of our world,” Tedros said. “There is now the real danger that the very tools that could help to end the pandemic—vaccines—may exacerbate those same inequalities.”

    Vaccines are giving us another window of opportunity to bring the pandemic under control, so “we must not squander it,” he said. “The world has come to a critical turning point in the pandemic and also a critical turning point in history.” 

  • The Nurse Who Changed the Mind of a Patient Downplaying the Pandemic

    Mother Jones illustration; Courtesy of Ashley Bartholomew

    A parent without child care, Ashley Bartholomew was preparing to resign from her role in El-Paso as a nurse when cases of COVID-19 spiked. Seeing the influx of patients—in 2020, the urban counties west of the Mississippi River with the highest per-capita COVID-19 death rate were the Texas border counties of Hidalgo and El Paso—she delayed. In the final moments, she met a patient who believed COVID-19 is no worse than the flu.

    I didn’t know that the thread would go as viral as it was going to. I had been planning to resign—we’re a military family and with child care and stuff, it wasn’t going to be sustainable for me to continue to work with three little kids we’re moving soon too. So, I needed to resign.

    The day prior, I went into work and the administration came to us at the front desk and said, “We’re closing down the OR. We’re only going to run two rooms for emergencies and everyone else needs to be redeployed to the COVID-19 units.” That’s the day that I went to COVID-19 ICU. And I saw first-hand just how busy and how crazy it was over there. They had a huge influx of patients with a lag of waiting for the travel FEMA nurses to get on board and get running. I was like “Wow, they need all the help they can get.” I actually told my boss and was like, “Hey, I can take three more weeks…just put me in the main COVID-19 ICU for my shifts and I’ll pick up some extra shifts and I’ll stay until November 13.”

    It was my last shift, and I went into this patient’s room to check his glucose. He was awake and alert. He was being transferred to a lower level of care; he was doing well enough to where he didn’t need to be in ICU anymore. He was definitely—definitely—the exception to all the other patients I had seen that day. It was lunchtime and the news was on. And he kind of referenced towards the TV like, “Oh, fake news.” I was shocked. I thought to myself wow, we’ve really dropped the ball, or we’ve missed something—a key ingredient here—if this patient is thinking this isn’t any more than a flu and he should’ve just taken his vitamins.

    I started to wonder…is this person thinking clearly? Just the power of denial, even as a coping mechanism, was surprising to me. He was thinking clearly, I realized, after a little bit more conversation. That’s when I was just kind of honest with him and said, “This is my last shift and I’ve never seen so much death and so much sickness my entire 10 years of being in healthcare combined.” He was just like “Woah, really?” And I’m like “Yeah, this has been unlike anything I’ve ever seen.”

    That’s when he asked how other people were doing and if a lot of people had died, and I said “yeah.” And he said, “Well, that must be really hard.”

    When he changed from the pure denial to validating “wow, that must be hard” it made me cry. I think that was kind of the only response that I could have because it was so overwhelming to me in the moment. And then I apologized, I said, “sorry I don’t mean to tear up in front of you.”

  • A Rural County in Georgia Vaccinated Teachers. The State Suspended Vaccine Shipments to Punish Them.

    In most places in the United States, teachers don’t yet qualify for COVID-19 vaccines. But one county in rural Georgia decided several weeks ago that its educators deserved early protection from the coronavirus—and now will face stiff consequences as a result. 

    Bucking designated priority group orders from the Georgia Department of Public Health, officials in Elbert County allowed teachers to be vaccinated at the same time as senior citizens over the age of 65. The county, which is in the northeast corner of Georgia, opened schools for in-person learning in the fall. Elbert County officials explained to the Atlanta Journal Constitution that many local students lack internet required for remote learning, and some rely on schools for food. The teachers are “seeing it, they’re facing it every day, a lot of times with 20 kids in their classroom,” Elbert County School District superintendent Jon Jarvis told the Atlanta Journal Constitution earlier this week.  

    But yesterday, Elbert County got word from the Georgia Department of Public Health that it would be punished for flouting the guidelines. The state plans to suspend all vaccine shipments to Elbert County for six months. According to Georgia DPH spokesperson Nancy Nydam, the state will not resume shipments to Elbert County until late July. “It is critical that DPH maintains the highest standards for vaccine accountability to ensure all federal and state requirements are adhered to by all parties, and vaccine is administered efficiently and equitably,” Nydam wrote to me in an email.

    That decision doesn’t sit right with Peter Hotez, a vaccinologist, pediatrician, and dean of the National School of Tropical Medicine at Baylor College of Medicine. “I think it’s really important that we stop punishing groups or individuals for vaccinating those outside state or [national] COVID-19 vaccination guidelines,” he wrote to me in an email. He wrote that the guidelines aren’t laws, and that they were proposed “without a full understanding of our depleted health system for administering adult vaccinations.” He added that the guidelines “mostly serve as a barrier or hindrance to vaccinations rather than their intended purpose.”

    Those sentiments were echoed by Jen Kates, senior vice president and director of global health & HIV policy at the Kaiser Family Foundation, who is tracking vaccine rollout efforts across the nation. “These are really impossible choices for any jurisdiction to make, and it raises tough questions about how states can best manage this process, ensure some uniformity across the state, and get shots in arms,” she wrote in an email. “Still, at the end of the day, it is not clear that this ‘stick’ approach, which cuts off the county from more doses, helps to reach the goal of vaccinating people—even those in the state’s priority groups—more quickly.”

    When I tried to reach Elbert County’s Jarvis, his team emailed back a press release, which didn’t indicate whether the county planned to back off of vaccinating teachers. “Our goal during the COVID-19 pandemic has been to provide the best possible education for our students through both in-person and distance learning options, which we have done all but six days since the school year began in August,” the press release said. “The Elbert County School District will continue in its commitment to work in partnership with our local health officials, teachers, staff, and families to mitigate the spread of COVID-19 in our school district and community.”

  • Small-Town America Grapples With Vaccine Logistics

    Public health officials test for COVID-19 in Livingston, Montana, in December 2020.William Campbell/ Getty

    This story was originally published by Undark and is reproduced here as part of the Climate Desk collaboration.

    One afternoon this past December, a package arrived at Mora Valley Community Health Services in northern New Mexico. The rural clinic, which serves a county of 4,521 people, is nestled beside a pasture with a flock of chickens and a few goats. A mile up the road sits the town of Mora — a regional hub just big enough for a trio of restaurants, two gas stations, and a single-building satellite office for a nearby community college.

    Shortly after the package arrived, clinic staff received an email explaining that this “ancillary convenience kit” was a test of the system designed to transport SARS-CoV-2 vaccines from the state’s warehouse to Mora and other rural communities across the state. While this package contained supplies for administering the vaccine — syringes, needles, alcohol swabs, and more — the real challenge would occur the following week. That’s when 100 doses were scheduled to be delivered, and the clinic’s staff would have 30 days at most to administer the doses before they spoiled.

    As promised, the vaccine arrived on Dec. 21. Staff worked in phases, stationing patients in exam rooms in numbers to match the doses coming from each vial. Each patient completed a health questionnaire, received a shot, and then was monitored for 15 minutes to be sure the vaccine did not trigger an adverse reaction. Within a few weeks, all 100 shots were in arms.

    As the United States begins its massive vaccine rollout, health departments across the country are scrambling to plan and adjust, often while simultaneously managing a surge in new Covid-19 cases. “Just trying to keep up and stay alert of what new things are coming down the line is pretty critical,” said Jessica Martinez, a Mora Valley nurse. Rural clinics face unique challenges in getting highly perishable vaccines to residents who often live many miles away. “We’re kind of out here on our own,” she said.

    Additionally, data show that rural residents are less likely to receive a flu shot than residents of metropolitan areas. This trend, combined with the reluctance of rural communities to embrace coronavirus mitigation measures, has some experts worried: “Think about a person who needs to drive one hour for a shot, then do the same 20 days later for a second shot,” said Diego Cuadros, a professor of health geography and disease modeling at the University of Cincinnati. “If it’s a person who maybe doesn’t think this is too important, or has some misperception or misinformation about vaccines, this is going to be extremely challenging.”

    Ultimately, Cuadros and others worry that the virus might linger in pockets of rural America, from which it could reemerge into the broader population, compromising efforts to get the virus under control. To prevent this, health care workers are starting with a public information campaign, while state health departments are encouraging pharmacies to run outreach clinics and set up new sites for vaccinations. Currently, the most pressing issue facing less populated areas is how to store and administer vaccines before they lose their effectiveness.

    The messenger RNA technology used to develop the two vaccines that have received approval in the U.S. so far — one developed by the pharmaceutical giant Pfizer and German drugmaker BioNTech and one by the biotechnology startup Moderna — requires that they both be kept cold. The Pfizer-BioNTech vaccine needs to be kept at a temperature between –112 and –76 degrees Fahrenheit, while Moderna’s lasts longest if kept between -13 F and 5 F.

    Because of its large and far-flung rural population, New Mexico was selected by Pfizer as one of four states of varying demographics and geographies to participate in a pilot program for refining the deployment of its vaccine, both in the U.S. and around the world. The company designed a temperature-controlled shipment container the size of a carry-on suitcase that weighs about 70 pounds when filled with dry ice and up to 975 vials of the vaccine and can keep the vaccine viable for up to 10 days, or up to 30 days if the dry ice is refilled. As the first round of 17,550 doses of Pfizer vaccine was being moved around New Mexico in mid-December, 75 had to be discarded after a gauge indicated they’d become too warm, either a failure in the cold-storage system or in the data-logging device. After the losses, a state official said the devices’ temperature settings were recalibrated and an alarm set to go off if they began to warm.

    Purchasing super-cold storage equipment is costly and demands a higher-voltage outlet, said Eric Tichy, vice chair of supply chain management for the Mayo Clinic. Stock of that equipment—particularly of the size that would be appropriate for smaller pharmacies and clinics—is also simply sold out. That may leave many of them leaning on Pfizer’s container and dry ice refills.

    With 237 vaccines in development on the World Health Organization’s list of candidates, the future will likely include vaccines that tolerate warmer temperatures. Johnson & Johnson is expected to release information later this month on a candidate that needs only refrigerator storage and a single dose. “A lot of people are focused on that one,” Tichy said. “Especially for worldwide distribution, that’s a big deal.”

    It’s also possible ongoing testing will show the two vaccines already in circulation remain stable at less cold temperatures, Tichy said. Initially, Moderna’s vaccine seemed to require super-cold storage, but it’s been shown to remain effective for up to 30 days in a refrigerator at up to 46 F.

    The bigger challenge Tichy sees is that once a vaccine vial is opened, staff have just six hours to use all five or 10 doses it contains. “It’s a precious resource,” he said, “You don’t want to just give it to two people and have to throw out the rest of the contents. You want to get five people vaccinated.”

    The first wave of inoculations targets health care workers and residents in long-term care facilities, so there’s a central location at which vaccines can reach them. For vaccinating the public at large, the U.S. Department of Health and Human Services has partnered with large national pharmacy chains, as well as networks of small regional chains and independent pharmacies. The incoming Biden administration has signaled it will continue with this strategy, noting in the outline of its vaccination plan that nearly 90 percent of Americans live within five miles of a pharmacy, while also acknowledging that more will be needed to reach those who live in more isolated areas.

    The Rural Policy Research Institute at the University of Iowa found 750 counties nationwide with no partnership pharmacies, and another 334 with just one such pharmacy. The majority of states have at least one county without a partnership pharmacy, and large swaths of Kansas, Montana, Nebraska, North Dakota, South Dakota, and Texas, and smaller chunks of Colorado, Nevada, New Mexico, and Utah, reported no partnered pharmacies.

    “We need to be alert to the fact that it’s not as simple as thinking you’ve got a contract with 19 franchises and that’s going to cover the nation because Walgreens and CVS are everywhere — well, no they’re not,” said Keith Mueller, director of the Rural Policy Research Institute. “It doesn’t mean you can’t figure out a way. It just means you have to get to the next level of planning.”

     

    In some states, that hasn’t presented much of a hurdle. Independent pharmacies have procured doses of the vaccines and done well administering them, but rates vary widely from state to state.

    Rural communities often run short on resources, whether it’s cold storage facilities or a population of retired nurses and doctors to tap to help administer vaccines, he added. The geography can also compound the disparities in access that affect racial minorities.

    Kim Atwater, who owns two pharmacies in rural New Mexico towns, decided that for now, it doesn’t make sense to order doses of the vaccines. “We don’t have refrigeration facilities to keep it,” she said. “We’re just a very, very small community.”

    In rural areas, the lack of pharmacies and major medical centers means that much of the vaccination effort is falling to local health clinics like the one in Mora. “We know it’s a cardinal sin to waste a dose, and we are not trying to be wasteful,” Martinez said.

    Unwillingness to get vaccinated may also present a hurdle. While some national surveys report growing numbers saying they will take a Covid-19 vaccine when it becomes available to them, Cuadros said he hasn’t seen that data broken down between rural and urban respondents. Data that tracked vaccination rates for influenza shows them much lower in rural areas.

    Atwater’s conversations with locals suggest that pattern may carry over to the new vaccines. “There’s a lot of people who are just saying, ‘Oh, I’m not getting that,’” she said. “We hear a lot of, ‘That? No, no, not until there’s more testing done on it.’”

    Mora bucked trends this fall by making flu vaccination more convenient, Martinez said. Her clinic offered drive-through clinics, welcomed walk-ins, sent staff to patients’ homes, and even invited a UPS driver to receive a shot after dropping off packages at the clinic. As a result, they administered 400 flu vaccines compared to roughly 250 last year.

    But when it comes to the new Moderna vaccine they were set to receive, Martinez said, she still heard reluctance. A poll showed only 29 of about 86 clinic staff were immediately interested in taking the vaccine. In addition to providing those staff more information to ease any concerns, she reached out to the local ambulance service, the school nurse’s office, and even a long-term residential facility to add names to the list, rather than see doses go to waste. After ramped-up education efforts and a new mandate for employees, 80 staff members were vaccinated, according to Martinez.

    The plan New Mexico submitted to the Centers for Disease Control and Prevention forecasts this need for flexibility, pointing out that if more doses arrive in a community than there are health care workers interested in taking it, the rules around who is first in line may need to relax.

    The clinic has already worked to make it easier for residents to get a SARS-CoV-2 test. On a recent weekday afternoon, staff put out flags where the dead-end gravel road named for the clinic meets the highway that announced “Covid testing” and “flu shots.” By the time blue-gowned, masked, and face-shielded staff stepped outside, a line of vehicles threaded through the parking lot. Staff reached in the window of the first pickup truck in line, took a swab, and the driver pulled away and back onto the highway. Staff have bundled up to administer these tests even on days with below-freezing temperatures and frigid winds, and when snow has shut down other testing sites.

    But with the CDC recommendation to watch people for 15 minutes after they receive a vaccine for adverse responses to it, Martinez said, a drive-through approach would be risky. Staff would have to try to keep an eye on patients through windshields, then rush into the gravel parking lot with a crash cart and epinephrine if someone had an allergic reaction. They’d considered erecting an insulated tent, but given the prioritization of elderly, potentially frail or vulnerable patients who wouldn’t do well in the winter weather, the private medical information elicited by the questions preceding a vaccine, and the need to have emergency equipment on hand, they decided to book people for 20-minute appointments inside the clinic. Now, they’re on standby for the second doses, getting “slammed with calls” from people wanting to get in line, and helping people who rushed to pop-up clinics in one town sort out how to get their second dose on time.

    “It’s just going to take a lot of planning, and of course, trial and error,” Martinez said. “It is a little bit draining sometimes to try and make everything — the community — a better place and healthy and be committed to the organization and to our patients first and foremost, so we just try and tell people, ‘Wear your mask, wash your hands.’”

  • A Year Ago Today, Trump Said COVID Would “All Work Out Well”

    Donald Trump makes a toast during a state dinner hosted by his Chinese counterpart Xi Jinping in November 2017. REUTERS/Thomas Peter

    One year ago, on the same day that the CDC announced a test for COVID-19 and a day after Wuhan had gone into lockdown, Donald Trump tweeted the following:

    China has been working very hard to contain the Coronavirus. The United States greatly appreciates their efforts and transparency. It will all work out well. In particular, on behalf of the American People, I want to thank President Xi!

    The relevant context for this tweet isn’t just the disease that would soon become a pandemic. Trump had struck a trade deal with China just days before, and this tweet was part of the political effort to maintain an air of sunny relations with a country that only four months earlier he’d called “threat to the world,” a country he would be demonizing again by spring. 

    It will all work out well. The English language is not yet evolved enough to accurately describe what Trump managed to do on Twitter during his presidency. He loved walking the line between lying and misleading, between sincerity and insincerity, the bullshitter-in-chief who sometimes seemed to bullshit himself most of all. This case was no different. His optimism was unfounded, unrealistic, and ultimately self-serving, and that was clear even then, when we had no idea how the coronavirus would unfold. Can optimism be a lie? Trump had derailed at least one early call on the topic by asking about vapes, making it wholly obvious that he had not dedicated enough thought to the issue of COVID-19 to even guess about the ultimate state of things. A year and more than 420,000 U.S. deaths later, it is clear that he was blind, confident, and remorseless about leading America straight to hell.

    See also: The ultimate timeline of Trump’s deadly coronavirus denial

  • Dr. Deborah Birx Says Someone Was Feeding Trump “Parallel” Coronavirus Data

    Drew Angerer/Getty

    As the pandemic worsened last year, President Donald Trump appeared to be relying on his own stream of unofficial coronavirus data, according to Dr. Deborah Birx, the former White House coronavirus response coordinator. “There was parallel data streams coming into the White House that were not transparently utilized,” Birx said Sunday in an interview with CBS’s “Face the Nation. “I saw the president presenting graphs that I never made. So, I know that someone out there or someone inside was creating a parallel set of data and graphics that were shown to the president.” 

    Birx, who has announced her imminent retirement from the federal government, said she did not know who was organizing Trump’s data side channel, “but I know what I sent up, and I know that what was in his hands was different than that.” She also mentioned that Trump’s controversial COVID adviser Dr. Scott Atlas “brought in parallel data streams.”

    Birx’s revelation is further confirmation from the inside of what was long obvious from the outside: Trump’s coronavirus strategy—which included downplaying risk, pushing unproven treatments, and making false promises—was not based on science or the advice of his own team of the public health experts.

    To date, more than 24 million people have contracted coronavirus in the United States and more than 400,000 have died from COVID-19. Experts recently told Mother Jones that if Trump had listened to public health officials and taken steps like enacting mask mandates and boosting the production of personal protective equipment, as President Biden has pledged to do, “we could have dramatically reduced the loss of life.”

    Birx was frequently criticized for not publicly challenging Trump’s unscientific rhetoric (like the time he suggested injecting disinfectant), and after she warned of a dangerous “new phase” of the pandemic last August, he tweeted that her comments were “pathetic.” Yet Birx told CBS’s Margaret Brennan that she had worked behind the scenes to make the situation the “least terrible it could be” and to minimize the damage being done by the president. She said her colleagues were part of the effort: “There was a coalition of four of us at the beginning, from [FDA head] Steve Hahn to [CDC head] Bob Redfield to myself to Tony Fauci, making it clear that we would make sure that we could get the information out to the public in one way or the other.”

    Birx said that Vice President Mike Pence, who headed the White House’s coronavirus task force, was aware of that she was contradicting Trump’s public statements when she communicated with directly with state governors. Brennan clarified, “[Pence] knew that you were telling the governors privately to do things that the president publicly was making light of. When he was saying, ‘You don’t really need to wear a mask,’ or pushing to reopen the economy faster than your guidelines would allow? Mike Pence knew that?”

    “He knew what I was doing,” Birx said.

    When asked what her biggest mistake was in helping leading Trump administration’s coronavirus response, Birx said she could have been “more outspoken,” especially on the issue of coronavirus testing. “I didn’t know all the consequences of all these issues,” she said.

  • Biden’s COVID Plan Is Simple. Trump Could Have Done It and Saved More Than 130,000 Lives.

    Al Drago/ZUMA

    On Biden’s second day in office, he issued a slew of executive actions aimed at curbing the coronavirus pandemic, and they came at a particularly desperate moment. By most counts, more than 400,000 Americans have died of COVID-19. The vaccination rollout program has been plagued by logistical problems and poor messaging. Meanwhile, the country is bracing for the onslaught of more contagious new variants. The new president’s executive actions are wide ranging: Biden called for widespread mask mandates, and he intends to invoke the Defense Production Act to supercharge the manufacturing of lifesaving protective gear. He also aims to streamline vaccine distribution and prioritize those hardest hit by the virus, particularly Black and Latinx communities.

    It’s about time. Earlier this week, New York Times columnist Ezra Klein called Biden’s plan “maddeningly obvious.” Indeed, the measures that he suggests reflect the basic tenets of good public health policy. It is tempting to wonder what would have happened if the Trump administration had followed these well established guidelines. How would the last year have been different? Where would we be now? We decided to put the question to a few experts from our Pandemic-Proofing America series. Here are their answers.

    Perry Halkitis, epidemiologist and dean of the Rutgers University School of Public Health:  The lack of respect for science and the complete disregard of the mitigation strategies to control COVID resulted in unnecessary deaths. It was estimated that if 95 percent of people consistently wore masks, 130,000 lives could be saved between November 2020 and March 2021. Instead, we will be at 500,000 deaths by March. If we had sound political leadership and truth last year, we could have cut total deaths in half. If the Trump administration had a sound national vaccination program, we would have utilized most, not a third, of our doses. Instead, lack of coordination left the states with the burden that they do not have the resources to implement. We also would have enough uptake [of vaccines] to achieve herd immunity by June.

    Gregg Gonsalves, assistant professor at Yale School of Public Health and an associate professor at Yale Law School: President Biden’s executive orders on the federal COVID response are exactly what we should have expected a year ago from President Trump. These initial actions are driven by solid, mainstream public health thinking, which Democratic and Republican Administrations in the past would have enacted if faced with the crisis that befell us in 2020. That is the tragedy of this moment: If President Trump had just followed this path last January we would have had fewer cases, fewer deaths. President Trump would have had bipartisan support, scientists and public health experts would have been rushing in to help, had he simply done the right thing. Instead, he fully, deliberately tossed aside much of this pandemic playbook, for reasons I’ll never quite understand, bringing death and devastation to our country month after month.

    Peter Hotez, vaccinologist, pediatrician, and dean of the National School of Tropical Medicine at Baylor College of Medicine: We could have dramatically reduced the loss of life in our nation from COVID-19 if we had brought in the full force of the federal government. Aside from the horrible and deliberate disinformation campaign, there was a refusal to launch a national or federal response, instead leaving this to the states. But the states never had the intellectual horsepower and knowledge to fight COVID. As a result: 1) we missed the virus entry from Southern Europe into NYC in March April last year; 2)  we never entirely fixed diagnostic testing; 3) we never created a system of syndromic surveillance or contact tracing; 4) [there was] no epidemic modelling to have a roadmap; 5) we never scaled virus genome sequencing to anything close to what is needed to detect emerging variants; 6) we failed to halt the surge in the summer or 7) the fall surge, and now 8) our national vaccine plan. Ultimately it was disinformation and this bizarre insistence on having the states in the lead which led to our national failure and 400,000 Americans who lost their lives. The disinformation was straight out of the White House, but the insistence on the states was both White House and likely internal failings within Health and Human Services agencies.

  • Dr. Fauci Calls Start of Biden Administration “Liberating”

    Alex Brandon/AP

    He’s finally free.

    Dr. Anthony Fauci, the leading infectious disease expert whom Trump once threatened to fire, said at Thursday’s White House press briefing that he felt “liberated” to work for an administration committed to combating the pandemic.

    “You’ve joked a couple times today already about the difference that you feel in being the spokesperson for this issue in this administration versus the previous one,” a reporter said. “Do you feel less constrained?”

    “You said I was joking about it,” Fauci replied. “I was very serious about it. I wasn’t joking.”

    Fauci said that Trump’s espousal of hydroxychloroquine was “uncomfortable” because it was “not based on scientific fact.” But, based on conversations he’s already had with the president, he thinks the Biden administration will be different.

    “The idea that you can get up here and talk about what you know, what the science is, and know that’s it, let the science speak, it is somewhat of a liberating feeling,” he said.

    Watch the video below:

  • How One Long-Term Care Facility Convinced Most of Its Staff to Get the COVID Vaccine

    A nurse in a long-term care facility in Massachusetts receives the coronavirus vaccine.Suzanne Kreiter/Boston Globe/Getty

    The morning of January 8, employees gathered in the lobby at LiveWell, a nonprofit long-term care facility in central Connecticut, to receive their first dose of the COVID-19 vaccine. Armed with fresh N95 masks and face shields, they trooped upstairs in 15-minute increments to get their shots, then returned to cheers and applause from their colleagues. Some took photos in front of a poster emblazoned “I got my #ShotOfHope.” Others put a sticker on their face shields to indicate they’d gotten vaccinated.

    Meanwhile, CVS pharmacists and pharmacy technicians went from room to room vaccinating LiveWell’s residents, all of whom have dementia. By the end of the day, 99 percent of the facility’s 111 residents had received their first dose, while about 70 percent of the facility’s 207-person staff had been vaccinated, according to LiveWell chief operating officer Maley Hunt.

    The high vaccination rate among LiveWell’s staff appears to be unusual for Connecticut, where, like elsewhere across the country, it’s been difficult to convince nursing home employees to get the coronavirus vaccine. As the first of three rounds of vaccination wrapped up in Connecticut nursing homes earlier this month, only about 40 percent of the staff at the state’s facilities had agreed to be vaccinated so far, according to Dr. Vivian Leung, a member of the state’s public health department who has been helping nursing homes detect and respond to the coronavirus.

    Since the earliest days of the pandemic in the United States, nursing homes have been the site of the country’s most lethal outbreaks—including in Connecticut, where residents and staff account for 65 percent of all COVID-19 deaths. Across the country, nursing home residents and staff have been uniformly prioritized for early vaccination. In late December, under the federal Pharmacy Partnership for Long-Term Care Program, Walgreens, CVS, and other drug stores began holding vaccination clinics at nursing homes. But now, as the initial round of clinics approaches completion, not only has the rollout been slower than expected, but early estimates reveal that in some places, more than half of nursing home staff are still waiting to be vaccinated or refusing the shot altogether.

    In some Virginia nursing homes, for example, as few as 10 to 20 percent of staff have agreed to receive the vaccine, estimates Dr. Christian Bergman, a geriatrician and member of the state’s COVID-19 long-term care task force; the more successful facilities in the state have vaccinated around 40 percent of their employees. North Carolina’s secretary of health and human services said in early January that more than half of nursing home workers in the state might refuse the vaccine. In Ohio, just 40 percent of staff statewide who had been offered the first dose of the vaccine in late December accepted it, Gov. Mike DeWine said at a press conference. A spokesperson for CVS Health, which is administering nursing home vaccinations in 49 states, Washington DC, and Puerto Rico, says that initial vaccine uptake among staff remained low as of mid-January. 

    Now, states, employers, and associations for nursing home professionals are mounting efforts to convince more workers to get the vaccine, offering Zoom chats with experts, town hall meetings, and online education about the vaccine’s safety and effectiveness. The goal is to prevent future outbreaks at nursing homes, Bergman explains. “The more staff that get vaccinated, the less likely that you would have a new outbreak in the future,” he says. “The size of the outbreak would likely be smaller if you had more staff that were vaccinated.” Even though vaccination rates are high among long-term residents, most nursing homes will continue to care for short-stay patients who may be unvaccinated and vulnerable.

    Bergman isn’t surprised by the low vaccination rates among some nursing homes. According to the CDC, only about 69 percent of long-term care facility staff get flu vaccinations. “If I have 40 percent of staff getting this brand new vaccine after just one clinic with CVS, that’s very good turnout,” he says. In a January 6 progress report, CVS Health noted that the low rate of staff vaccinations so far may be partly due to staggered vaccination dates. And in some facilities, the vast majority of staff have opted to get the vaccine as soon as it was offered, including at the Life Care Center of Kirkland, the center of the first known US outbreak. 

    But Bergman has noticed a stratification among long-term care workers who have so far decided to get vaccinated: Managers are more likely to want the vaccine, while lower-paid workers like sanitation staff and certified nursing assistants are more hesitant. That’s no surprise to Lori Porter, cofounder and CEO of the National Association of Health Care Assistants, a professional group for certified nursing assistants. In an informal Facebook poll of 3,119 CNAs conducted by Porter’s group in mid-December, 72 percent of respondents were a “hard no” for the vaccine. Just six percent were undecided.

    Some believe the vaccine is a hoax, Porter says; some think they are being used as guinea pigs. CNAs, she explains, “don’t trust the government, and they don’t trust their leaders, their managers”—a result, she argues, of CNAs being “battered” by workplace conditions, where they are under high pressure to care for too many residents with little professional support. “Oftentimes, they’re not communicated with,” she says, “which also leads to the trust factor.” That mistrust, Porter adds, has only grown as companies began offering incentives to be vaccinated. One nursing home chain, PruittHealth, said it would distribute Waffle House gift cards to vaccinated employees. At least two chains, Juniper Communities and Atria Senior Living, have made vaccines mandatory for almost all workers.

    Porter is worried about the second round of clinics. She’s begun to hear from CNAs who say they will refuse the second dose of the vaccine. “Not because they’re afraid of it,” she explains. “They can’t afford to miss three days work with the side effects.” 

    At LiveWell, a standalone nonprofit facility in Plantsville, Connecticut, the groundwork for its successful vaccination rollout was laid in early in the pandemic, when managers at the nursing home tried to send a message that all employees were all responsible for keeping LiveWell’s dementia patients safe. “We have a population of people that can’t tolerate wearing a mask,” Hunt says. “They don’t understand social distancing. They kind of sometimes go in other people’s rooms, or use different bathrooms. The idea of stopping the spread, once it got in the building, was basically designated as almost impossible.”

    To safeguard residents, LiveWell required employees to wear masks and prohibited visitors before the state required such measures. It also decided not to allow staff to work multiple jobs, which is common among nursing home employees. (A recent study analyzing smartphone location data found that nursing homes that had more staff or contractors moving among multiple facilities tended to have a higher number of COVID-19 cases.) According to Hunt, employees who gave up other jobs to stay at LiveWell were offered more hours, while those who declined to give up other gigs may return to their LiveWell jobs after they get the vaccine or once community transmissions decreases.

    The company also paid attention to who was inside the nursing home’s “bubble.” “The team wasn’t just the team that worked here,” Hunt says. “We made sure that we were keeping people’s family safe as well.” The company offered masks for employees’ kids, hand sanitizer for households, and back-to-school packs to families. Under the Families First Coronavirus Response Act, the company offered paid leave not only to workers with symptoms, but also to those whose family members had been exposed to the virus. It also gave rapid antigen tests to family members who were showing symptoms of COVID-19. “Creating that bubble with both our staff and our families, and letting the families know how important they are in rooting us on, and making sure that they’re feeling connected with what’s happening, even when they’re not here, made them tremendous advocates and supporters of the team,” Hunt says. By the time the vaccine became available, she says, “Our staff were so excited. They see this as hope, and they see this as a return to normalcy.”

    LiveWell almost escaped the pandemic unscathed. The combination nursing home and assisted living facility went more than 270 days without any coronavirus cases among its residents. Then, shortly after Thanksgiving, an employee tested positive one day after working in one of the skilled nursing units. Over the following weeks, 29 out of 30 residents in that unit tested positive for the virus. Nine people died. Hunt remembers standing in the affected unit in the midst of the outbreak as another staff member told her they didn’t want to get the vaccine. “It evoked an emotional response in me,” she says. “I had this feeling of, ‘Why? How could you not want to get this? This is going to save lives.'” 

    As LiveWell prepared for vaccinations, the company called every employee on staff individually to have a conversation about the vaccine, Hunt says. Those who weren’t sure about it were required to attend a half-hour Zoom meeting with a doctor of geriatric medicine, who answered their questions and tried to address their worries. Some employees brought up their concern that the vaccine had been developed too quickly; some had questions about potential long-term side effects or implications for pregnant women; others cited disinformation about microchips or fetal tissue being in the vaccine. The doctor, Hunt said, tried to listen without judgement, understand the roots of people’s fears, and address their questions fully. “They might be saying, ‘What about the long term side effects?'” Hunt says. “But what they’re thinking is something else, or there’s something underneath there, some other medical experience that they’ve had.”

    Leung, at the Connecticut Department of Public Health, believes that more nursing home staff members in the state may get the vaccine when it is offered a second time. “There seems to be an increased confidence and decreased concern as medical staff are seeing more and more of their colleagues get vaccinated,” she says. Bergman, in Virginia, harbors the same hope. At his nursing home’s first vaccination clinic, 24 out of 85 staff agreed to be vaccinated. “If they can provide firsthand experience,” he says, “we may be able to convince a few other people who were just kind of anxious about, potentially, the side effects.” 

    According to Hunt, 25 more LiveWell employees have pledged to get their first dose of the vaccine at the facility’s second clinic date on January 29. Ultimately, the company is aiming for 90 percent of its employees to be vaccinated. For now, Hunt says, it’s focusing on one-on-one outreach to people still hesitant to get the shot.  “We’re not giving up on them yet,” she says.

    This article has been updated.

  • The Trump Presidency Ends With 400,000 COVID Deaths

    Andrew Lichtenstein/Getty

    On the final full day of Donald Trump’s presidency, the United States reached another grim milestone during four years marked by plenty of grim milestones. By most measures, 400,000 people in the US now have died from the coronavirus. It’s the highest death toll in the world—but tragically unsurprising given the trajectory of the past year

    The staggering toll was both preventable and entirely predictable. Even aside from his vast personal incompetence—we’ll get to that later—President Trump blithely put into practice cherished conservative principles that are incompatible with a decent pandemic response. Castigating and delegitimizing government institutions, demonizing minority communities, and playing into white grievances may help Republicans win elections, but when it comes to beating back a massive public health catastrophe, what’s paramount is robust public agencies, a strong health care system, and special attention to the vulnerable. In many ways, we were doomed from the start.

    But then there is the unique, Trumpian imprint of mendacity and cruelty. In March 2020, when the virus was seriously spreading and the country was hobbled by a lack of tests and testing strategy, Trump responded to a question from a reporter with a single line that would go on to define his administration’s coronavirus approach and inexorably lead to the number of deaths on his last full day in office 10 months later. “No,” he said emphatically, “I don’t take responsibility at all.” As the death toll first climbed, then soared, Trump and his enablers continued to act as if the president was the real victim. “I am incredibly disappointed in the politicization of this COVID-19 response,” Rep. Mark Green (R-Tenn.) said last March at a Congressional hearing. “The 24/7 criticism that the president is undergoing is unwarranted at a minimum.”

    Trump never found a grudge he wouldn’t hold and a grievance he wouldn’t amplify. So it didn’t help that the virus’s first assault was concentrated in the Democratic stronghold of New York City, his hometown, the scene of many of his commercial and social triumphs that today has become hostile foreign territory to him and his merry band of family members and other sycophants. Plus, throughout the country, the virus was disproportionately killing people of color. For our white supremacist president, this deserved not even glancing recognition.

    As the East Coast attempted to cope with the onslaught of the virus, the Trump administration maintained the illusion that people who lived in red states were immune. Even when he belatedly declared a state of emergency in mid-March and many states instituted lockdowns to varying degrees, the administration didn’t ramp up testing or begin contact tracing in any systematic way that might have at least managed to bring the virus under some control. To make matters worse, when the Centers for Disease Control and Prevention recommended wearing masks, Trump rejected and ridiculed them and his supporters dutifully followed suit, pretending that this most basic effort to contain the spread of the disease was in fact some kind of intolerable infringement on their rights. Anti-maskers frequently made public spectacles of themselves as they were denied entry into grocery stores and even appropriated the “I Can’t Breathe” mantra from racial justice protesters. As I wrote last July:

    Officials have reassured anyone who would listen that even though wearing a mask can be a little uncomfortable, it doesn’t inhibit breathing. Nonetheless, almost immediately, the mask mandates turned into a new front in the culture war. Only liberal sheep wore masks to protect the public from coronavirus; real conservatives and libertarians would never stoop to something so feminine and weak! Just look at the president! Meanwhile, as the coronavirus has surged in the South and West, so too has the intensity of the mask war. The anti-mask cohort has adopted a slogan they saw was very effective, insisting that when wearing a mask, they can’t breathe.  

    When his supporters sometimes violently protested public health restrictions, especially in areas where Black people were dying disproportionately, he encouraged them, tweeting “LIBERATE” Virginia and Michigan. 

    By late May, the death toll had reached 100,000—a dark day for a nation that was once told 60,000 deaths would be the high-end. And still the Trump administration didn’t act, except to suggest that coronavirus patients inject bleach (just kidding, he later insisted) or to hawk hydroxychloroquine, an unproven medical treatment. Contrary to the president’s cherished convictions, the virus didn’t leave Trump-supporting regions alone, and the death toll accelerated in the midwest and in Southern states. Instead of, at least, caring about his own supporters, the president became preoccupied with his reelection and with demonizing Black Lives Matter protests. Plus, ever determined, against the advice of public health professionals, he held campaign rally in Tulsa, Oklahoma, where failed presidential candidate and co-chair of the Black Voices for Trump Herman Cain was photographed maskless. Cain died from coronavirus the following month.

    Thus we witnessed our president’s modus operandi during a crisis: teetering between ignoring the virus and denying its severity by continually insisting the country was “rounding the corner.” Besides, he had more important things to do, like pack the Supreme Court after the death of Justice Ruth Bader Ginsburg. Even then, his generally unmasked September White House party for Amy Coney Barrett, whose nomination to the Supreme Court was rushed through in the days leading up to the election, turned into a superspreader event. Then, in October, Trump tested positive for the virus and was hospitalized for three days. Maybe this would bring him and his administration to their collective senses. 

    Of course not.

    After recovering, Trump became the Superman his doctors always pretended he was, assuring the country that the deadly virus was actually not a big deal. “Don’t be afraid” of the virus, he crowed as the death toll surpassed 200,000. His supporters were in such deep denial, that Trump added to his repertoire of lies that recovery from the virus was a breeze. One only needed to be pumped up on steroids and receive the best medical care on the planet at Walter Reed Medical Center.  

    All this denial didn’t help him in the end, since he was defeated and will now, fortunately, not serve a second term—partially because of his disastrous handling of the coronavirus. When the country entered the worst phase of the pandemic thus far, Trump was more preoccupied with perpetuating the Big Lie that the election had been stolen from him through massive fraud. As my colleague Dave Gilson wrote in December, in the month after the election, Trump launched 729 tweets, but not a single one was about the death toll:

    Reading Trump’s recent tweets, you would never know the United States is in the midst of a surging pandemic that is killing more than 2,000 people a day. Of his 729 tweets between November 3 and December 16, more than two-thirds were about his attempts to reverse his election loss through baseless claims of voter fraud and far-fetched lawsuits. The pandemic was just a blip: Four percent of his tweets were about vaccines and just two percent mentioned the coronavirus at all—without ever acknowledging its human cost or encouraging Americans to take precautions to protect themselves or others from getting sick. 

    A kind of psychic numbing had gripped so many of us by the end of December, when 300,000 people had died from the coronavirus; it would take only a few weeks for the next 100,000 to follow them. The Washington Post reported in December that according to a wealth of psychological research, the higher the death toll climbs, the less we care. Or rather, the less we are emotionally capable of caring. In mass disasters like the pandemic, say, or a tsunami, the more death surrounds us, the more remote it feels. Not that the Trump administration even thought to commemorate the lives lost with any public mourning, much less mention the staggering death toll in any public statement. Even then, the sheer scale was difficult to fathom, unless one is mourning a lost parent, child, sibling, relative, neighbor, friend, or co-worker. 

    The Trump administration has finally reached its conclusion with a predictably dark legacy: the only president to be impeached twice—once for inciting an insurrection— the only lame duck president to carry out federal executions—since the federal death penalty was reinstated, only three executions had been carried out by a president until Trump executed 13 people—and a president who exacerbated the toll from the deadliest months in US history. 

    Yes, millions of people are breathing a sigh of relief that the Trump presidency is over. But the aftermath is just beginning. The coronavirus death toll will continue to climb, the vaccine rollout will continue to lag, and the economic recovery will continue to drag on. The United States will be grappling with the damage from a one-term president for years to come.

    Trump’s 2017 inaugural address was laden with ominous references. Nonetheless, he still promised to “fight” for the country. “I will fight for you with every breath in my body,” Trump said. “I will never, ever let you down.” But all the clues that Trump would make for a horrific pandemic president were there from the beginning. He began his campaign by demonizing the people who would be most impacted by the coronavirus and, as president, continued the Republican tradition of dismantling public institutions. In the end, the words from his inaugural address that most reflected his presidency were not his vow to fight for his country, but his description of “American carnage.” Four years later, he shunned the typical farewell address, choosing to release a 20-minute video highlighting his accomplishments. “We did what we came here to do,” he said. “And so much more.”