Author: bkellaway

Jasmine Obra believed that if it wasn’t for her brother Joshua, she wouldn’t exist. When 7-year-old Josh realized that his parents weren’t going to live forever, he asked for a sibling so he would never be alone.

By spring 2020, at ages 29 and 21, Josh and Jasmine shared a condo in Anaheim, California, not far from Disneyland, which they both loved.

Both worked at a 147-bed locked nursing facility that specialized in caring for elderly people with cognitive issues such as Alzheimer’s, where Jasmine, a nursing student, was mentored by Josh, a registered nurse.

Both got tested for COVID-19 on the same day in June.

Both tests came back positive.

Yet only one of them survived.

While COVID-19 takes a far deadlier toll on elderly people than on young adults, an investigation of front-line health care worker deaths by the Guardian and KHN has uncovered numerous instances when staff members under age 30 were exposed on the job and also succumbed.

In our database of 167 confirmed front-line worker deaths, 21 medical staffers, or 13% of the total, were under 40, and eight (5%) fatalities were under 30. The median age of a COVID-19 death in the general population is 78, while the median age of health care worker deaths in the database is 57. This is in part because we are, by definition, including only people of working age who were treating patients during the pandemic — but it is also because, as health workers, they are far more exposed to the virus.

Young health care workers are at a “stage in their career and a stage of life at which they have so much more to offer,” said Andrew Chan, a physician at Massachusetts General Hospital and epidemiologist at Harvard Medical School. “Lives lost among any young people related to COVID really should be considered something that’s unacceptable to us as a society.”

As coronavirus cases surge — and dire shortages of lifesaving protective gear like N95 masks, gowns and gloves persist — the nation’s health care workers face disproportionate risk. Chan’s research has found that health care workers of any age are at least three times more likely to become infected than the general population, and the risk is greater if they are people of color or have to work without adequate personal protective equipment. People of color are also likelier to have inadequate access to PPE.

In interviews, relatives and friends of these younger victims described a particular and wrenching sorrow. Everything lay ahead for these front-line workers. They were just embarking on their careers. Some still lived in the family home; others were looking forward to getting married or had young children. Several parents of victims contacted by the Guardian and KHN said they were simply unable to talk about what had happened, so immense was their grief.

Valeria Viveros, a 20-year-old nursing assistant, was “barely blooming,” said her uncle, Gustavo Urrea. She made ceviche for her patients at a nursing home in Riverside, California, and Urrea could see her visibly growing in self-confidence. When she first fell sick from the virus, she went to the hospital but was sent home with Tylenol. She returned several days later in an ambulance — her final journey.

“We’re all destroyed,” Urrea said. “I can’t even believe it.”

Dulce Garcia, 29, an interpreter at a medical facility in Chapel Hill, North Carolina, died in May. “It just doesn’t feel real,” said friend Brittany Mathis. Garcia was the one who wouldn’t let friends drive if they’d had too many drinks, and she loved going out to dance to bachata, merengue and reggaeton. “There were so many things she had unfinished,” Mathis said.

While people of any age with underlying conditions such as diabetes and obesity are at higher risk of a severe COVID-19 infection, the particular impacts of the virus on young adults are only now becoming clear.

Doctors in New York noticed that more younger patients than usual were presenting with strokes, to the point that “the average age of our stroke patients with large-vessel strokes” — the most devastating kind — “has come down,” said Thomas Oxley, a Mount Sinai medical system neurosurgeon. COVID-19 infections cause inflammation, and often blood clots, in blood vessels as well as the lungs.

Angela Padula thought that she and Dennis Bradt had done everything right.

Padula, 27, and Bradt, 29, became engaged on Feb. 8. She was a special-education teacher, and he was an addiction technician at Conifer Park, a private addiction treatment facility in Glenville, New York.

The couple wanted to save up for a few years for their wedding, but by early April, they had already purchased her engagement and wedding rings. Bradt, who had the sweeter tooth, had chosen a raspberry-swirl wedding cake.

After the pandemic hit, Bradt started showering when he got home from work. He and Padula wore masks when they went out, which was usually only for groceries or gas. They stopped visiting their immunocompromised parents.

On April 5, Bradt came down with a fever, stomach-bug symptoms and achiness, and went to the hospital. His COVID-19 test came back negative. Soon he couldn’t breathe. Another test proved positive. On April 16 he was put on a ventilator. In the process, he choked on his own vomit, which caused his lung to collapse.

Padula assumes Bradt was infected at work, and is unsure whether he had sufficient PPE. Conifer Park did not respond to queries, but according to local health authorities, 12 employees and six patients at the facility tested positive for COVID-19. Padula herself had symptoms so severe that she was taken to the emergency room in an ambulance.

She was not allowed to visit Bradt, and was quarantined alone at home, where she spent her 28th birthday, taking anxiety medication prescribed by her doctor.

On May 13, as doctors tried to coax Bradt off the ventilator, he suffered a heart attack, Padula said. She and Bradt’s mother were permitted to say goodbye to him. But “he was gone by the time we got there,” Padula said in an interview. “He didn’t look like himself,” swollen and festooned with tubes.

Today Padula is still sick. Pain in her arms, legs and back wakes her at night. She feels as though the virus has taken over her life.

“I have my days where it’s just too much to think about,” she said. “I’ll see people getting engaged on Facebook — it makes me mad. I want to be happy for them, but it’s very difficult for me to be happy. We were planning on having kids in a couple years.”

Less than two months before Josh and Jasmine Obra fell ill, Josh posted two pictures to Instagram: One was a photo of a fireworks display at Disneyland; the other was a picture of himself in medical scrubs, wearing a face mask, giving the peace sign.

“Heeeeeyo! It’s been a minute,” he wrote in the caption. “It’s been a tough month for all of us.” He worked with a vulnerable population, he said, and “it’s just mentally exhausting thinking each night when I come home that I may be having symptoms the next day.”

Even so, Josh was the kind of helpful, empathetic nurse who “makes things easier for everybody,” said colleague Sarah Depayso. He knew how to talk to patients and was attuned to others’ stress levels. “We were so busy, and it was ‘I’ll buy you lunch, I’ll buy you dinner, I’ll buy you boba.’”

It had been about 35 days since Disneyland closed its gates, Josh noted in his post. Josh’s photos — of the Sleeping Beauty castle framed by tabebuia blossoms, or of himself in an attention-grabbing Little Mermaid sweater — and corny jokes endeared him to thousands of followers on Instagram. “He had a way of capturing magic,” said his friend Brandon Joseph. The pictures were joyful, like memories of childhood.

Josh’s last post was on June 10, announcing that Disneyland planned to reopen in July. At some point the virus had reached his nursing home, infecting 49 staff members and 120 residents and ultimately killing 14 people. Approximately 41% of all U.S. coronavirus deaths are linked to nursing homes, where frail people live in close quarters, according to The New York Times.

After taking the virus test on June 12, his health deteriorated. On June 15, he messaged Joseph that he couldn’t take a full breath of air without feeling like he was being knifed in the chest. On June 20, he texted that he was at the hospital and that he had a particularly bad case.

The final time Josh spoke with his family, before he was put on a ventilator, was on June 21. “On our last video call together, I was isolated in Anaheim, quarantined, and our parents were at home,” Jasmine said. It was Father’s Day, “and I remembered crying and crying because this was the reality of what our family was.”

Josh’s family was not permitted to visit him in the hospital, and he died on July 6.

By coincidence, Josh, like his grandparents, was buried in the same cemetery as Walt Disney — Forest Lawn Memorial Park in Glendale, California.

Before the funeral, Jasmine walked over to Disney’s grave, she said. “I was like, ‘Hi, Walt. I hope you and my brother found each other.’”

Every night since he died, Jasmine has watched Southern California’s spectacular sunsets, the pinks and yellows that Josh kept returning to in his pictures. “And every time I feel like he’s with me. I look at the sky and sometimes I start talking to it, and I feel like I’m talking to my brother, and that he’s painting beautiful skies.”

Melissa Bailey, Eli Cahan, Shoshana Dubnow and Anna Sirianni contributed to this report.

This story is part of “Lost on the Frontline,” an ongoing project by The Guardian and KHN (Kaiser Health News) that aims to document the lives of health care workers in the U.S. who die from COVID-19, and to investigate why so many are victims of the disease. If you have a colleague or loved one we should include, please share their story.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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It’s a familiar moment. The kids want their cereal and the coffee’s brewing, but you’re out of milk. No problem, you think — the corner store is just a couple of minutes away. But if you have COVID-19 or have been exposed to the coronavirus, you’re supposed to stay put.

Even that quick errand could make you the reason someone else gets infected. But making the choice to keep others safe can be hard to do without support.

For many — single parents or low-wage workers, for instance — staying in isolation is difficult as they struggle with how to feed the kids or pay the rent. Recognizing this problem, Massachusetts includes a specific role in its COVID-19 contact-tracing program that’s not common everywhere: a care resource coordinator.

Luisa Schaeffer spends her days coordinating resources for a densely packed, largely immigrant community in Brockton, Massachusetts.

On her first call of the day recently, a woman was poised at her apartment door, debating whether to take that quick walk to get groceries. The woman had COVID-19. Schaeffer’s job is to help clients make the best choice for the public — sometimes, the help she offers is as basic, and important, as the delivery of a jug of milk.

“That’s my priority. I have to put milk in her refrigerator immediately,” Schaeffer said.

“Most of the time it’s the simple things, the simple things can spread the virus.”

The woman who needed milk was one of eight cases referred to Schaeffer through the state government’s Community Tracing Collaborative. Contact tracers make daily calls to people in isolation because they’ve tested positive or those in quarantine because they’ve been exposed to the coronavirus and must wait 14 days to see if they develop an infection. The collaborative estimates that between 10% and 15% of cases request assistance. Those requests are referred to Schaeffer and other care resource coordinators.

“So many people are on this razor-thin edge, and it’s often a single diagnosis like COVID that can tip them over,” said John Welch, director of operations and partnerships for Partners in Health’s Massachusetts Coronavirus Response, which manages the state’s contact-tracing program.

He said a role such as resource coordinator becomes essential in getting people back to “a sense of health, a sense of wellness, a sense of security.”

With milk on its way, Schaeffer dialed a woman who needed to find a primary care doctor, make an appointment and apply for Medicaid. That call was in Spanish.

With her third client, Schaeffer switched to her native language, Cape Verdean Creole. The man on the other end of the line and his mother had both been sick and out of work. He applied for food stamps and was denied. Schaeffer texted the regional head of a state office that manages that program. A few minutes later, the director texted back that he was on the case.

Schaeffer, who has deep roots in the community, is on temporary loan to the state’s contact-tracing collaborative and will later return to her job, helping patients understand and follow their prescribed treatments at the Brockton Neighborhood Health Center.

The collaborative said most client requests are for food, medicine, masks and cleaning supplies. COVID-19 patients who are out of work for weeks or who don’t have salaried jobs may need help applying for unemployment or help with rental assistance — available to qualified Massachusetts residents.

Care resource coordinators even connect people with legal support when they need it. An older woman employed in the laundry room at a nursing home was told she wouldn’t be paid while out sick. Schaeffer got in touch with the Community Tracing Collaborative’s attorney, who reminded the company that paid sick leave is required of most employers during the pandemic.

“So, now, everything’s in place. She started getting paid,” Schaeffer said.

There are glitches as the care resource coordinators try to support people isolating at home. Some workers who are undocumented return to work because they fear losing their jobs. When the local food bank runs out, Schaeffer has had to scramble to find a local grocer to help. The free canned goods or vegetables can be like foreign cuisine for Schaeffer’s clients, some of whom are from Cape Verde and Peru. In those cases, she can reach out to a nutritionist and set up a cooking lesson via conference call.

“I love the three-way calls,” she said, beaming.

Schaeffer and other care resource coordinators have responded to more than 10,500 requests for help so far through Massachusetts’ contact-tracing program. Demand is likely greater in cities such as Brockton, with higher infection rates than most of the state and a 28.7% lower median household income.

Massachusetts has carved out care resource coordination as a separate job in this project. But the role is not new. Local health departments routinely include what might be called support or wrap-around services when tracing contacts. With cases of tuberculosis, for example, a public health worker might make sure patients have a doctor, get to frequent appointments and have their medications.

“You can’t have one without the other,” said Sigalle Reiss, president of the Massachusetts Health Officers Association.

Partners in Health’s Welch, who is advising other states on contact tracing, said the importance of having someone assist with food and rent while residents isolate isn’t getting enough attention.

“I don’t see that as a universal approach with other contact-tracing programs across the U.S.,” he said.

Some contact-tracing programs that schools, employers or states have erected during the pandemic cover only the basics.

“They’re focused on: Get your positive case, find the contacts, read the script, period, the end,” said Adriane Casalotti, chief of government and public affairs at the National Association of City and County Health Officials. “And that’s really not how people’s lives work.”

Casalotti acknowledged that the support role — and services for people isolating or in quarantine — adds to the cost of contact tracing. She urges more federal funding to help with this expense as well as a federal extension of the paid sick time requirement, and more money for food banks so that people exposed to the coronavirus can make sure they don’t give it to anyone else.

“Individuals’ lives can be messy and complicated, so helping them to be able to drop everything and keep us all safe — we can help them through the challenges they might have,” Casalotti said.

This story is part of a partnership that include WBUR, NPR and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Ever since he was a presidential candidate, President Donald Trump has been promising the American people a “terrific,” “phenomenal” and “fantastic” new health care plan to replace the Affordable Care Act.

But, in the 3½ years since he set up shop in the Oval Office, he has yet to deliver.

In his early days on the campaign trail, circa 2015, he said on CNN he would repeal Obamacare and replace it with “something terrific,” and on Sean Hannity’s radio show he said the replacement would be “something great.” Fast-forward to 2020. Trump has promised an Obamacare replacement plan five times so far this year. And the plan is always said to be just a few weeks away.

The United States is also in the grips of the COVID-19 pandemic, which has resulted in more than 163,000 U.S. deaths. KFF estimates that 27 million Americans could potentially lose their employer-sponsored insurance and become uninsured following their job loss due to the pandemic. (KHN is an editorially independent program of the Kaiser Family Foundation.) All of this makes health care a hot topic during the 2020 election.

This record is by no means a comprehensive list, but here are some of the many instances when Trump promised a new health plan was coming soon.

2016: The Campaign Trail

Trump tweeted in February that he would immediately repeal and replace Obamacare and that his plan would save money and result in better health care.

By March, a blueprint, “Healthcare Reform to Make America Great Again,” was posted on his campaign website. It echoed popular GOP talking points but was skimpy on details.

During his speech accepting the Republican nomination in July, Trump again promised to repeal Obamacare and alluded to ways his replacement would be better. And, by October, Trump promised that within his first 100 days in office he would repeal and replace Obamacare. During his final week of campaigning, he suggested asking Congress to come in for a special session to repeal the health care law quickly.

2017: The First Year in Office

January and February:

Trump told The Washington Post in a January interview that he was close to completing his health care plan and that he wanted to provide “insurance for everybody.”

He tweeted Feb. 17 that while Democrats were delaying Senate confirmation of Tom Price, his pick to lead the Department of Health and Human Services, the “repeal and replacement of ObamaCare is moving fast!”

And, on Feb. 28, in his joint address to Congress, Trump discussed his vision for replacing Obamacare. “The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we are going to do,” he said.

March: Eyes on Congress — And Twitter

House Republicans, with backing from the White House, were the ones to introduce new health legislation, the American Health Care Act (AHCA). The repeal-and-replace bill kept in place some of the more popular provisions of the ACA. Some conservative Republicans said the bill didn’t go far enough, deriding it as “Obamacare Lite” and refusing to vote on it.

On March 9, Trump tweeted, “Despite what you hear in the press, healthcare is coming along great. We are talking to many groups and it will end in a beautiful picture!”

Later that month, as efforts to pass the AHCA continued to stall, Trump updated his earlier promise.

“And I never said — I guess I’m here, what, 64 days? I never said repeal and replace Obamacare. You’ve all heard my speeches. I never said repeal it and replace it within 64 days. I have a long time,” said Trump in his remarks from the Oval Office on March 24. (Which was true; he had said within 100 days.) “But I want to have a great health care bill and plan, and we will. It will happen. And it won’t be in the very distant future.”

April and May: A Roller-Coaster Ride of Legislation and Celebration, Then …

After an intraparty dust-up, the House narrowly passed the AHCA on May 4. Despite tepid support in the Republican-controlled Senate, Trump convened a Rose Garden celebratory event to mark the House’s passage, saying he felt “so confident” about the measure. He also congratulated Republican lawmakers on what he termed “a great plan” and “incredibly well-crafted.”

Nonetheless, Senate Republicans first advanced their own replacement bill, the Better Care Reconciliation Act, but ultimately voted on a “skinny repeal” that would have eliminated the employer mandate and given broad authority to states to repeal sections of the ACA. It failed to gain passage when Sen. John McCain (R-Ariz.) gave it a historic thumbs-down in the wee hours of July 28.

September and October: Moving On … But Not

Trump began September by signaling in a series of tweets that he was moving on from health reform.

But on Oct. 12, he signed an executive order allowing for health care plans to be sold that don’t meet the regulatory standards set up in the Affordable Care Act. The next day, Trump tweeted, “ObamaCare is a broken mess. Piece by piece we will now begin the process of giving America the great HealthCare it deserves!”

Roughly two weeks later, on Oct. 29, Trump got back to the promise with this tweet: “… we will … have great Healthcare soon after Tax Cuts!”

2019: More Talk, More Tweets

March and April: A Moving Target

It seems that 2018 was a quiet time — at least for presidential promises regarding a soon-to-be-unveiled health plan. It was reported that conservative groups were working on an Obamacare replacement plan. But in 2019, Trump again took up the health plan mantle with this March 26 tweet: “The Republican Party will become ‘The Party of Healthcare!’” Two days later, in remarks to reporters before boarding Marine One, Trump said that “we’re working on a plan now,” but again updated the timeline, saying, “There’s no very great rush from the standpoint” because he was waiting on the court decision for Obamacare. This was a reference to Texas v. U.S., the lawsuit brought by a group of Republican governors to overturn the ACA. It is currently pending before the Supreme Court.

Backtracking from his earlier promises to repeal and replace Obamacare within his first 100 days in office, Trump on April 3 tweeted: “I was never planning a vote prior to the 2020 Election on the wonderful HealthCare package that some very talented people are now developing for me & the Republican Party. It will be on full display during the Election as a much better & less expensive alternative to ObamaCare…”

June 16:

In an interview with ABC News, Trump again said a health care plan would be coming shortly.

“We’re going to produce phenomenal health care. And we already have the concept of the plan. And it’ll be much better health care,” Trump told George Stephanopoulos. When Stephanopoulos asked if he was going to tell people what the plan was, Trump responded: “Yeah, we’ll be announcing that in two months, maybe less.”

June 26:

But then, timing again changed as Trump promised a sweeping health plan after the 2020 election. “If we win the House back, keep the Senate and keep the presidency, we’ll have a plan that blows away ObamaCare,” Trump said in a speech to the Faith and Freedom Coalition’s Road to the Majority conference.

Oct. 3:

He reiterated this post-2020 election pledge in a speech to Florida retirees. “If the Republicans take back the House, keep the Senate, keep the presidency — we’re gonna have a fantastic plan,” Trump said.

Oct. 25:

Trump told reporters that Republicans have a “great” health care plan. “You’ll have health care the likes of which you’ve never seen,” he said.

2020: ‘Two Weeks’

Feb. 10:

During a White House business session with governors, Trump commented on the Republican governors’ lawsuit to undo the ACA and whether protections for preexisting conditions would be lost: “If a law is overturned, that’s OK, because the new law’s going to have it in.”

May 6:

During the signing of a proclamation to honor National Nurses Day, Trump again said Obamacare would be replaced “with great healthcare at a lesser price, and preexisting conditions will be included and you won’t have the individual mandate.”

July 19:

Trump told Chris Wallace in a Fox News interview that a health care plan would be unveiled within two weeks: “We’re signing a health care plan within two weeks, a full and complete health care plan that the Supreme Court decision on DACA gave me the right to do.”

July 31:

With no sign of a plan yet, reporters asked Trump about it at a Florida event. Trump responded that a “very inclusive” health care plan was coming and “I’ll be signing it sometime very soon.”

Aug. 3:

Pushing the timeline once again, Trump said during a press briefing that the health care plan would be introduced “hopefully, prior to the end of the month.”

Aug. 7:

Citing his two-week timeline once again, Trump said during a press briefing that he would pursue a major executive order in the next two weeks “requiring health insurance companies to cover all preexisting conditions for all customers.” Trump also said that covering preexisting conditions had “never been done before,” despite the ACA provisions outlining protections for people who have preexisting conditions being among the law’s most popular components. The Trump administration has backed the effort to overturn the ACA — including these protections — now pending before the Supreme Court.

Aug. 10:

In response to a reporter’s question about why he was planning to issue an executive order when the ACA already protects those with preexisting conditions, Trump said: “Just a double safety net, and just to let people know that the Republicans are totally strongly in favor of … taking care of people with preexisting conditions. It’s a second platform. We have: Preexisting conditions will be taken care of 100% by Republicans and the Republican Party.”

Just before publication, we asked the White House for more information regarding when exactly the plan might be unveiled. The press office did not respond to our request for comment.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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This story can be republished for free (details).

Julie Rovner, KHN’s chief Washington correspondent, on Tuesday joined WDET’s “Detroit Today” host Stephen Henderson and Dr. George Kipa, the deputy chief medical officer at Blue Cross Blue Shield of Michigan, to talk about the future of telemedicine and whether Medicare and private insurers will continue to pay for those services. You can listen to the discussion here.