Category: From California Healthline.org

El 30 de abril se cumplirán los primeros 100 días de mandato del presidente Joe Biden. Este es un punto de referencia que los presidentes suelen establecer para cumplir con las promesas de campaña de alta prioridad.

A principios de diciembre, Biden anunció que una de sus promesas sería administrar 100 millones de vacunas a los estadounidenses. Eso se traduce en aproximadamente un millón de dosis al día.

Estados Unidos alcanzó ese ritmo alrededor del día de la toma de posesión, pero ahora tendrá que mantenerlo durante los próximos tres meses para que Biden alcance su objetivo.

Y si lo consigue, ¿qué significará para nuestra vida cotidiana? Esto dicen expertos.

¿Qué relación hay entre las 100 millones de dosis y conseguir la inmunidad colectiva? 

En primer lugar, ¿se traducen 100 millones de dosis en 100 millones de personas vacunadas para el 30 de abril?

La respuesta es no.

Biden ha hecho hincapié en que su objetivo no implica que 100 millones de personas vayan a estar totalmente vacunadas, sino que se aplicarán 100 millones de vacunas. Después de todo, tanto la vacuna de Moderna como la de Pfizer requieren dos dosis.

A principios de diciembre, el equipo de Biden dijo que su objetivo era que 50 millones de personas recibieran las dos dosis. Luego, a principios de enero, el gobierno de Biden cambió su política y dijo que liberaría la mayoría de las vacunas a medida que fueran llegando, en lugar de retener las dosis para la segunda inyección.

Esto podría cambiar el número de personas que reciben las dos dosis de la vacuna en los primeros 100 días.

En una rueda de prensa el 26 de enero, Biden dijo que sus 100 millones de vacunas “significa que unas 60 —tal vez menos, tal vez más— millones de personas” recibirán la vacuna contra covid-19.

Algunos críticos han dicho que el número a alcanzar debería ser mayor. Y, la última semana de enero Biden sugirió que le gustaría, eventualmente, acelerar el ritmo a 1,5 millones al día.

Pero, ya sean 50 o 60 millones de personas las que reciban las dos dosis a finales de abril, esa cifra sigue estando muy por debajo del umbral de inmunidad colectiva recomendado por los expertos en salud pública.

Recordemos que la inmunidad colectiva se produce cuando un número suficiente de personas de una población es inmune a una enfermedad, de modo que resulta difícil que ésta siga propagándose.

Los epidemiólogos estiman que es necesario inocular al menos al 70% de la población para que se alcance esta inmunidad. El doctor Anthony Fauci, director del Instituto Nacional de Alergias y Enfermedades Infecciosas, ha sugerido que la cifra podría ser mayor, incluso hasta el 90%, especialmente porque parece que algunas de las nuevas variantes del coronavirus pueden ser más transmisibles que la variante estándar de Estados Unidos.

Por ahora, dejemos la estimación de la inmunidad de rebaño en el 70% y calculemos cuánto tiempo se tardaría en llegar a este punto.

El doctor Bruce Y. Lee, profesor de política y gestión sanitaria de la City University of New York, le explicó a KHN los cálculos. En Estados Unidos viven unos 330 millones de personas y el 70% de esa cifra son 210 millones.

En la actualidad, el país sólo tiene acceso a las vacunas de dos dosis de Moderna y Pfizer. Mientras sólo estén disponibles las vacunas de dos dosis, el país necesitaría 420 millones de dosis para que los 210 millones de personas completaran su vacunación.

“A un ritmo de 1 millón administrado por día, eso llevaría más de 420 días”, dijo Lee. “Lo que alcanzaríamos en algún momento a principios de 2022”.

La Kaiser Family Foundation (KFF) calcula que Estados Unidos tendría que aumentar la administración de vacunas a 1,9 millones al día para alcanzar el 70% de inmunidad para el Día del Trabajo. Si se aumentaran las vacunas a 2,4 millones al día, se podría alcanzar el 70% de inmunidad para el 4 de julio. (KHN es la agencia de noticias de KFF, que elabora periodismo en profundidad sobre temas de salud).

Además, hay otras vacunas en preparación que, al requerir sólo una dosis, cambiarían estas proyecciones, como la de Johnson & Johnson.

En la segunda sesión informativa del equipo de respuesta a covid-19 de la Casa Blanca, el 29 de enero, Andy Slavitt, asesor principal del equipo, dijo que en la última semana se habían administrado alrededor de 1,2 millones de dosis de vacunas al día.

Los rastreadores de vacunas de Bloomberg News y el The Washington Post también informan de que alrededor de 1 millón de personas al día recibieron su primera dosis de la vacuna en la última semana. Y el gobierno de Biden espera que esta cifra aumente significativamente en las próximas semanas y meses.

Pero, podría haber obstáculos por delante, incluyendo el suministro de la vacuna.

Entre las administraciones de Trump y Biden, en total, Estados Unidos ha acordado comprar 600 millones de dosis a Moderna y Pfizer. Se supone que un tercio, o 200 millones, de esa cantidad llegará a finales de marzo. Las dosis restantes no llegarán hasta finales de la primavera y el verano.

“La verdad más brutal es que van a pasar meses antes de que la mayoría de los estadounidenses estén vacunados”, reconoció Biden durante una conferencia de prensa el 26 de enero en la que anunció la última adquisición de vacunas por parte de Estados Unidos.

Los esfuerzos de vacunación también podrían retrasarse si resulta difícil llegar a los grupos que pueden tener problemas para acceder a la vacuna, como los residentes rurales o las comunidades de color. También es probable que haya personas que duden o se nieguen a vacunarse.

¿Cuándo volverá la vida a la normalidad? 

¿Qué pasa si eres uno de los afortunados que se vacuna durante los primeros 100 días del despliegue de la vacuna de Biden?

No mucho, dicen expertos en salud pública. Nadie podrá volver a las actividades normales que hacía antes de la pandemia. Eso no podrá ocurrir hasta que consigamos vacunar a cerca del 70% o más de los estadounidenses.

“Aunque resulte duro aceptarlo, si recibes tu segunda dosis de la vacuna antes de que hayamos vacunado a la mayoría de la población, vas a tener que seguir tomando las mismas medidas de protección que tomabas antes de vacunarte”, escribió en un correo electrónico la doctora Rachel Vreeman, directora del Instituto Arnhold de Salud Global de la Escuela de Medicina Icahn de Mount Sinai.

Eso significa que, aunque estés vacunado, debes seguir usando mascarilla, practicar el distanciamiento físico con las personas ajenas a tu hogar, quedarte en casa y lavarte las manos. Y esas mismas precauciones se recomiendan también para quienes no se vacunen antes del 30 de abril.

Vreeman añadió que una o dos semanas después de recibir la segunda dosis de la vacuna, es menos probable que uno se enferme gravemente de COVID-19. Pero todavía puedes enfermar. Y también es posible que transmitas el virus a otras personas que aún no estén vacunadas. En los ensayos clínicos de la vacuna COVID-19 no se evaluó si se detenía la transmisión asintomática, sólo si se reducían los síntomas.

“A finales de abril, para el estadounidense medio no habrá un cambio dramático en lo que se refiere al distanciamiento social y al enmascaramiento”, dijo L.J. Tan, jefe de estrategia de la Immunization Action Coalition.

Jeffrey Shaman, profesor de salud ambiental de la Universidad de Columbia, señaló que los estados deberían mantener las restricciones, como las relacionadas con cubrirse la cara, el trabajo a distancia y la limitación de los viajes, durante el despliegue de la vacuna.

En un reciente estudio, Shaman estimó que si esas restricciones se levantaran en febrero podría haber 29 millones de infecciones adicionales por covid para el verano. Recomienda mantenerlas hasta julio.

“La conclusión es que si levantamos las restricciones y volvemos a lo que era antes de la pandemia, el virus va a despegar de nuevo”, advirtió Shaman. “Entonces la carrera por conseguir vacunas se complicará porque habrá más gente enferma”.

Los expertos también dijeron que con las múltiples variantes de covid-19 que circulan ahora en los Estados Unidos, algunas de las cuales parecen ser altamente transmisibles, tomar estas precauciones en serio es aún más importante. Sobre todo, porque la vacuna puede no ser tan protectora contra algunas de ellas. Además, cuantas menos personas enfermen, menos probable será que el virus pueda replicarse, mutar de nuevo y crear más variantes.

¿Y cuándo se volverá a la normalidad? ¿Ocurrirá? Eso dependerá del ritmo de vacunación y de cuántos estadounidenses estén dispuestos a ponerse manos a la obra.

“Creo que volveremos a la vida en otoño, con suerte antes de Acción de Gracias”, dijo Tan.

Otros expertos a los que preguntamos dijeron que es posible que haya alguna apariencia de vuelta a la normalidad en el verano.

Pero todos coincidieron en que no será para el 30 de abril.

Esta historia fue producida por KHN, que publica California Healthline, un servicio editorialmente independiente de la California Health Care 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 also ran on The New York Times. It can be republished for free.

The Biden administration’s much-needed national strategy to end the covid-19 pandemic includes plans to remedy the chaotic vaccination effort with “more people, more places, more supply.” The Federal Emergency Management Agency will open more vaccination sites, the government will buy more doses, and more people will be immunized. Still, by all estimates, the demand for vaccines will far exceed the supply for months to come.

For weeks, Americans have watched those who are well connected, wealthy or crafty “jump the line” to get a vaccine, while others are stuck, endlessly waiting on hold to get an appointment, watching sign-up websites crash or loitering outside clinics in the often-futile hope of getting a shot.

To eliminate this knock-out-your-neighbor race to score a vaccine, the administration needs to find ways to build trust in the system. It will take more than “more people, more places, more supply” to end the Darwinian competition and restore confidence and order.

That’s in part because, desperate to end their own pandemic nightmare, many of our most respected institutions and politicians have behaved badly. Of course, hospitals have performed heroics during the pandemic — turning orthopedic wards into covid intensive care units, canceling elective surgeries, bringing retired health care workers back to help, all the while losing thousands of staff members to the virus. But some also have behaved selfishly during the vaccine rollout.

When the vaccine was released in December, the Centers for Disease Control and Prevention recommended that health care personnel and nursing home residents receive the first doses. It was pretty clear whom the agency had in mind for “health care personnel”: those who deal directly with patients, including doctors, nurses, technicians, janitors and the people who deliver meals, along with those who might come into contact with the virus, like security guards and laundry staff, as part of their jobs.

But many hospitals interpreted the recommendation broadly, inoculating their entire staff — public relations departments, administrators, programmers, laboratory scientists and, sometimes, their boards. They offered vaccines to psychiatrists who were seeing their patients on Zoom. They vaccinated radiologists who were reading films at home. Some of those immunized were at the upper end of the medical income totem pole, people who had sat out the pandemic at country homes.

Many hospitals pay no taxes because the care they provide benefits their communities. In their vaccine rollout, many of those were not thinking about their communities, only about themselves.

That behavior set a precedent for the national chaos that followed. “From soup to nuts, the whole thing has fallen apart,” said Arthur Caplan, one of the country’s leading medical ethicists. What Caplan called “unfair priority” left him “incredibly irritated”; ethics were often absent from the algorithm. “Once you’ve lost public confidence in the fairness of the process, it undermines willingness to follow the rules,” he said.

Once random people working remotely got shots, those outside medical centers played whatever cards they had, too. Therapists who were teleworking claimed eligibility. Politicians and their spouses — sometimes former spouses — got vaccines.

People offered donations in exchange for vaccinations. Health officials and private doctors tipped off friends about when new vaccine doses would be released. On screening forms, people checked the boxes needed to get a vaccination appointment and in some places were immunized even after their duplicity was discovered.

Pity the rule-followers: Many older Americans who are not tech-savvy or lack internet access have been unable to get slots. It might be theoretically possible to sign up by phone, but by the time you get through, the newly released appointments may be gone. Those without a child or grandchild to help secure an appointment could be out of luck.

Hospitals, clinics and vaccination sites have explained away bad behavior by saying they didn’t want to waste unused vaccines. Many have experienced higher-than-expected refusal rates from those expected to get a shot.

I don’t blame the lucky recipients; after all, hospitals would just offer the unused vaccine to the next person on the list. But I do blame whoever it was in the hospital hierarchy or the health clinic who decided to distribute and redeploy vaccines this way.

If there were unexpected extras, couldn’t hospitals have instead walked those doses to patients in the geriatric, hypertension or diabetes clinics? Or offered them to one of the many nursing homes and assisted living facilities whose workers and residents have still not been vaccinated, though they, like health care personnel, were the Centers for Disease Control and Prevention’s top priority?

Gregg Gonsalves, who is 57, HIV-positive and an epidemiologist at the Yale School of Public Health, said he faced an ethical quandary when he was notified of his eligibility for the vaccine; he was unsure whether to sign up. His 86-year-old mother has not gotten one yet.

“Ethicists are saying, ‘if offered, take it,’ but stepping in line in front of my own mother? I know speed is of the essence in getting shots into arms, but this is entrenching gross inequities,” Gonsalves said. (He declined to say what his decision was.)

The problem is that, often, people are not really being “offered” the vaccine; in some cases, they are grabbing it through position, influence or deceit. They are, in the abstract, taking it from someone perhaps more in need — a subway worker, a high-risk patient, maybe even their own mother.

Now, the new administration is coordinating with states to set up more mass vaccination sites. That’s great. But the United States has allowed its public health system to become a hollowed-out underfunded mess, and many vaccination clinics are being run and staffed by contracted private companies. And the private sector has so far proved too vulnerable to private favoritism.

Until the supply is sufficient, the government needs to give the shots to the people and places that need it most, and find ways to ensure that the plan is followed; the system could prioritize ZIP codes that have high covid-19 infection rates or target low-income populations who might otherwise have a difficult time securing an appointment.

In Britain, citizens are notified, according to risk group, when it is their turn to book an appointment. They don’t have to play knock-out-your-neighbor to score one. We shouldn’t either.

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 started as a group of college friends who wanted to help during the pandemic. They had tech skills, so they used 3D printers to make face shields. Then they organized as a nonprofit, Philly Fighting Covid, and opened a testing site in a Philadelphia neighborhood that didn’t have one yet.

This story is part of a reporting partnership that includes NPR, WHYY and KHN. It can be republished for free.

The organization’s leader, Andrei Doroshin, had bigger ambitions. Even before the first coronavirus vaccine was authorized, the 22-year-old graduate student at Drexel University planned to get involved, even though he has no background in health care.

On the evening of Oct. 7, Doroshin gathered 15 of the nonprofit’s staff members and volunteers for a meeting on a Philadelphia rooftop to show them a fancy PowerPoint. More people joined via livestream to watch him unveil his plan to vaccinate the city of Philadelphia.

In slide after slide, he laid out his vision with colorful graphics and maps, covering all aspects of a vaccination system, from scheduling to staffing to safety protocols.

The marketing plan hinged on inoculating local celebrities like rapper Meek Mill, a Philadelphia native, to attract his fan base.

“This is a wholly Elon Musk, shooting-for-the-heavens type of thing,” Doroshin said. “We’re gonna have a preemptive strike on vaccines and basically beat everybody in Philadelphia to it.”

Doroshin described scaling up until they were managing five mass vaccination sites and 20 smaller sites scattered throughout the city. He claimed they could vaccinate between 500,000 and 1.5 million people. And they would make a lot of money doing it.

“This is the juicy slide,” said Doroshin, clicking over to the financing plan. “How are we gonna get paid?” He explained that the vaccine doses were free, provided by the federal government. But Philly Fighting Covid could bill insurance companies $24 a dose for administering it.

“I just told you how many vaccines we want to do — you can do the math in your head,” he said.

A month later, Doroshin made a similar presentation, complete with colorful maps and a $2.7 million projected budget, to the Philadelphia City Council. He said his team at Philly Fighting Covid had begun submitting plans for building out five high-capacity sites that could each take up to 10,000 patients a day.

Philly Fighting Covid’s promise of efficiently vaccinating the population was an alluring one as city leaders were desperate to pull out of the pandemic. Doroshin told NBC’s “Today” show that his company didn’t think like a traditional medical institution. “We’re engineers, we’re scientists, computer scientists, we’re cybersecurity nerds. We think a little differently than people in health care do.”

“We took the entire model and just threw it out the window,” Doroshin added. “We said to hell with all of that. We’re going to completely build on a new model that is based on a factory.”

By Jan. 9, Doroshin had a deal with the Philadelphia Department of Public Health and Mayor Jim Kenney’s administration. The city never signed a formal contract with Philly Fighting Covid or gave the organization any money, but it did provide its unofficial sanction and publicity.

Most important, the city turned over part of its vaccine allotment to the group and helped it find recipients by sharing lists of residents who were newly eligible for the vaccine, based on the city’s own prioritization scheme. The city relied on Philly Fighting Covid’s registration as a vaccine provider with the Centers for Disease Control and Prevention.

On Jan. 8, Doroshin and Kenney stood side by side at a press conference to kick off the first mass vaccination clinic at the Pennsylvania Convention Center. It was targeted at health care workers not affiliated with major hospitals, such as home health aides or doctors, nurses or therapists in private practice.

“What you see here is the problem that we’ve been solving for six months,” Doroshin told reporters. “This is the problem of vaccinating an entire population of people on a scale that has never been seen before in the history of our species.”

Kenney was also hopeful that the arrangement would help diversify the racial breakdown of vaccine recipients. At that point, only 12% of vaccinated Philadelphians were Black — in a city where 44% of residents are Black.

“Equitable distribution of this vaccine is extremely important to our entire administration,” said Kenney at the Jan. 8 kickoff event.

But in an early sign of trouble, Philly Fighting Covid failed to verify its progress on the equity goal. After that first vaccine event, at which 2,500 doses were administered, City Council President Darrell Clarke requested the demographic breakdown of the recipients.

The health department told him that Philly Fighting Covid had somehow lost all the racial and ethnic data for the patients. The group was blaming “a glitch” in the Amazon cloud. Still, the city continued to turn over thousands of vaccine doses to Philly Fighting Covid.

As the startup continued to hold clinics, WHYY began investigating the organization and its founder.

Reporters uncovered other serious problems, and it soon became clear that the group’s logistical strengths and self-promotional flair, which had once made the startup seem so compelling, weren’t working. The investigation revealed that in December, just before Philly Fighting Covid began its vaccination work, it reorganized and became a for-profit company called Vax Populi.

Philly Fighting Covid had spent months organizing city-funded testing events — at which residents reported good experiences. But in January, it abruptly shuttered those operations, leaving partner organizations in the lurch. The group posted this decision on social media, just a few days after the convention center kickoff, at which Doroshin had promised to open two new testing sites and to start offering free rapid testing.

Several groups that had been partnering with Philly Fighting Covid on testing events claim they received little or no notice, jeopardizing plans for testing in communities of color.

“They completely ghosted us,” said Cean James, pastor of Salt & Light church in Southwest Philadelphia, which had been planning a series of pop-up testing events with Philly Fighting Covid.

Michael Brown had been working with the group to organize a testing event on Martin Luther King Jr. Day. He said Doroshin told his group that testing wasn’t important anymore.

“The statement he made was very clear: ‘I don’t believe that testing is relevant anymore. People don’t follow the instructions, people don’t do what they’re supposed to do, and all it does is … cause panic,’” Brown said later.

There were signs that Doroshin wasn’t that concerned about standard clinical protocols. Employees with more clinical experience than he had said he brushed off technical questions as bothersome and approached the vaccination effort as if he were a tech mogul focused on disrupting norms.

“Stop using best practices,” Doroshin said during a recent interview with HealthDay. “I think the old best practices in health care, in terms of intramuscular injections, were written for a hospital visit that would take 30 minutes, that you needed to do a bill for as a provider visit. Those best practices can mostly go out the window.”

The city soon began to back away from the group. At the initial launch, the city promoted Philly Fighting Covid’s pre-registration website and encouraged everyone to sign up. Just a week later, officials changed course and claimed the city had nothing to do with the website. The conflicting messages caused confusion among the 60,000 Philadelphians who had signed up thinking it was an official city site. Many were left worried about what would happen to their personal information. The city then launched its own pre-registration site.

The process Philly Fighting Covid used to schedule appointments was also flawed. Anyone who received a hyperlink could sign up for a time slot, which prompted many who received it to assume they were automatically eligible, even though at that time the clinic was technically only for health care workers and the elderly.

Some who received the link in error went through with their appointments. Others backed out when they learned it wasn’t their turn. Still more had their doses canceled by Philly Fighting Covid upon arrival.

When Jillian Horn came to get a shot, she said she saw seniors waiting in line get turned away because of booking errors.

“There was literally 85-year-olds, 95-year-old people standing there, with printed appointment confirmations saying, ‘I don’t understand why I can’t get vaccinated,’ ” Horn recalled.

On Jan. 23, volunteer nurse Katrina Lipinsky was helping at one of Philly Fighting Covid’s vaccination events. She said that about half an hour before the event’s scheduled end, staffers started telling volunteers and other workers to call anyone they knew to come in for a shot because there were going to be extras.

Then she saw Doroshin grab a handful of vaccines and stuff them in his bag, along with the corresponding CDC vaccination record cards.

“The idea of somebody who’s not a licensed health care professional vaccinating their own friend, with or without observation, period, that certainly was not the right thing to do,” Lipinsky told WHYY.

Doroshin initially denied Lipinsky’s account but eventually admitted he took doses home during a Jan. 28 interview on NBC’s “Today” show. The following day at a press conference, he said he had vaccinated his girlfriend, but no one else. He did not explain how Philly Fighting Covid ended up with extra doses after it turned away people, including seniors, who were in line waiting for the vaccine that same day.

The city cut ties with Philly Fighting Covid on Jan. 25, citing the company’s abandonment of its testing work and the company’s new privacy policy, which would have allowed it to sell patient data.

Health commissioner Dr. Tom Farley has been asked to explain what happened. Doroshin approached with a vaccine plan, he said, that met the city’s health standards.

“I hope people can understand why on the surface this looked like a good thing,” Farley said. “In retrospect, we should have been more careful with this organization.”

The city had other options for a mass vaccination partner. Philadelphia is home to four major health systems, including the University of Pennsylvania medical system, which said it was prepared to ramp up community vaccination efforts as far back as November, well before the city started working with Philly Fighting Covid.

Kenney called for an investigation Friday, and several state lawmakers called for Farley’s resignation.

In a press conference at his apartment building Friday, Doroshin called the city’s decision to dissolve the partnership “dirty power politics” and alleged it was part of a political conspiracy. He said that if given the chance, he wouldn’t have done anything differently.

This story is part of a partnership that includes WHYY, NPR and KHN, 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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Este artículo también fue publicado por Radio Bilingüe. It can be republished for free.

MECCA, Calif. — El polvo hace remolinos en el aire mientras Luz Gallegos estaciona su SUV a un lado de la calle de tierra. Acaba de enterarse que su tía murió a causa de covid-19, el tercer familiar en sucumbir al virus en solo dos semanas.

Gallegos bajó de su auto a las 11:30 am, en una granja de pimientos en esta comunidad agrícola en el Valle de Coachella, apenas al noroeste de Salton Sea.

La mujer, que trabajó ella misma en los campos junto a sus padres, tuvo solo 15 minutos para hablar de un tema relacionado con la vida y la muerte ante unos 20 trabajadores que acababan de terminar su descanso.

La granja ya ha visto a dos trabajadores enfermarse con covid.

“Perdemos personas en nuestra comunidad a diario”, dijo.

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“Estoy muy agradecido de que este grupo viniera aquí para darnos información sobre el virus y la vacuna”, dijo Juan Castillo (no está en la foto), gerente de la granja. “Como trabajadores agrícolas, a veces vamos de casa al trabajo y regresamos y no tenemos tiempo para escuchar las noticias”.

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).

This story also ran on Radio Bilingue. It can be republished for free.

MECCA, Calif. — Dust swirled in the air as Luz Gallegos parked her SUV on the side of a dirt road. She had just learned that her aunt died of covid-19 — the third family member to succumb to the disease in only two weeks.

She stepped out of her car at about 11:30 a.m. onto a bell pepper farm in this agricultural community in the Coachella Valley, a little northwest of the Salton Sea.

Gallegos, a daughter of farmworkers who had worked in the fields herself, had only 15 minutes to make what she considered a life-or-death pitch to roughly 20 workers who had just finished a break.

The farm had already seen two workers fall ill to covid.

“We’re losing people in our community each day,” she said.

https://californiahealthline.org/wp-content/uploads/sites/3/2021/02/Reporte-campania-pionera-d-vacuna-campesina-version-completa-.mp3

“I’m very grateful that this group came out here to give us information about the virus and vaccine,” says farm manager Juan Castillo (not shown). “As farmworkers we sometimes go from home to work and back and don’t have time to listen to the news.”

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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California Gov. Gavin Newsom, struggling to salvage a once-bright political future dimmed by his mishandling of the covid crisis, tapped nonprofit health insurer Blue Shield of California last week to allocate the state’s covid vaccine.

The company has thus far said little about how it plans to reorganize a gargantuan and complicated vaccination campaign that has befuddled and frustrated public health officials and vaccine seekers alike.

The agreement with Blue Shield was made under an emergency authorization, circumventing the customary bidding process. Kaiser Permanente, California’s largest health plan, will sign an agreement with the state to manage vaccinations for its 9 million members and provide additional assistance to the broader effort. (KHN is not affiliated with Kaiser Permanente.)

Blue Shield’s job will be to assemble a statewide vaccination network and “allocate vaccines directly to providers to maximize distribution efficiency,” according to a statement from the California Health and Human Services agency.

Newsom hopes that replacing the patchwork of county-by-county efforts with a centralized system will accelerate the pace of vaccinations.

The vaccine rollout has been plagued by early stumbles, including confusing appointment systems; shifting rules on vaccine eligibility; long lines that have kept older people waiting for hours, leading some to abandon their quest and go home unvaccinated; and faulty data collection that left state officials unable to say whether Newsom had met his goal of administering 1 million doses in 10 days.

Some health care experts cautiously welcomed the new plan, saying Blue Shield could help bring more structure and efficiency to the enterprise of vaccinating California’s nearly 40 million residents.

Blue Shield is the third-largest health insurer in California, after Kaiser Permanente and Anthem Blue Cross. It contracts with a large number of hospitals, medical groups, pharmacies and other providers across the state. Newsom is counting on the insurer’s extensive web of relationships to help get vaccines out more quickly and effectively.

Since Blue Shield “has got an organization with a statewide footprint and knowledge of the geography and the population, it seems they could think through all the scheduling and logistics,” said Glenn Melnick, a professor of health economics at the University of Southern California’s Sol Price School of Public Policy.

Critics said Blue Shield may not be up to the task, and some suspected the decision was not entirely unrelated to the fact that the insurer has been a major Newsom donor.

Here are answers to five key questions about Blue Shield’s participation in the covid vaccination program:

1. Is Blue Shield up to the task?

Time will tell. Despite its experience and clout in the health care industry, Blue Shield has never attempted anything of such magnitude — with so much riding on it and so many eyes watching.

Skeptics note that Blue Shield’s track record in delivering health care to its enrollees has not always been stellar. Its rollout of Affordable Care Act health plans in 2014 was beset by errors, and it has been fined by regulators for improper coverage cancellations and consumer grievance violations, among other things. In 2015, it lost its state tax-exempt status following a controversy over large premium hikes and its hefty financial reserves.

In 2019, the most recent year for which data is available, Blue Shield had the second-highest rate of consumer complaints — after UnitedHealthcare — among the nine largest California health plans regulated by the state’s Department of Managed Health Care. And it got the lowest possible score on access to care in the 2019-20 health plan ratings by the National Committee for Quality Assurance.

2. Was Newsom’s decision politically motivated?

It’s hard to say definitively without having been a fly on the wall, but Blue Shield is on very good terms with the governor.

It gave about $1 million to support Newsom’s 2018 gubernatorial bid, according to filings with the California Secretary of State Office. Last year, the company contributed an additional $31,000 to Newsom’s 2022 campaign for governor, as well as $269,000 to his ballot measure committee.

“The reality, I think, is that it reflects the tight relationship Blue Shield has built with Newsom, not its capabilities,” said Michael Johnson, a former Blue Shield executive who resigned from the company in 2015 and is now one of its fiercest critics.

In addition, Blue Shield’s CEO, Paul Markovich, was co-chair of Newsom’s covid testing task force from March to June last year – experience that some health care experts cited as an asset in the insurer’s new role.

Another possible factor in the governor’s decision to shake things up is his political need to turn things around quickly, with an effort to recall him gaining momentum from the vaccination chaos.

3. Is Blue Shield well placed to accomplish the equitable distribution of vaccines to underserved communities that Newsom called “the North Star” of the new centralized system?

These communities are not among Blue Shield’s core constituency. It has a small presence in Medi-Cal, the state-funded insurance program for people with low incomes — and only in Los Angeles and San Diego counties. But it does have relationships with numerous hospitals and other providers that serve Medi-Cal patients. It will also need to collaborate with the state’s counties.

“It’s critical that Blue Shield be required to work hand in hand with local public health jurisdictions to reach vulnerable populations that do not have the same level of access to traditional health care,” said Sara Bosse, director of Madera County’s Department of Public Health.

4. What could have motivated Blue Shield to tackle such an onerous assignment?

Its payment from the state will be at cost, so there’s no apparent profit motive. Though Blue Shield could theoretically leverage its vaccine decision-making power to the advantage of its own business, health care experts doubt it would behave in such a cynical manner.

“Our goal is to do all we can to help overcome this pandemic, and it is our commitment to do that work at cost without making a profit from the state,” Blue Shield said in a news release Friday.

Melnick said he knew of no other health plan in the country that has jumped in to help public officials with testing or vaccinations. If Blue Shield succeeds, “it could be an answer for a lot of states and could put pressure on other plans to step up,” he said. By the same token, Blue Shield will probably catch the blame if vaccine supply shortages continue.

Johnson, the former Blue Shield executive, suggested a motive other than pure selflessness. “I think the biggest value to Blue Shield is the prestige of it,” he said. “It implies Blue Shield has the skill and integrity to be entrusted with something this vital to tens of millions of people.”

5. How will Blue Shield’s results be measured?

It shouldn’t be too difficult to determine whether the insurer is meeting two key goals the state set for it: to speed up the pace of vaccinations and to focus in particular on underserved communities. Both can be measured.

The bar for success is pretty low, Johnson said. “The whole thing has been managed so disastrously,” he said, “that it wouldn’t be difficult for Blue Shield to improve on the state’s performance thus far and come out of this looking like it did a good job.”

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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When getting vaccinated against covid-19, there’s no sense being picky. You should take the first authorized vaccine that’s offered, experts say.

The newest covid vaccine on the horizon, from Johnson & Johnson, is probably a little less effective at preventing sickness than the two shots already being administered around the United States, from Pfizer-BioNTech and Moderna. On Friday, Johnson & Johnson announced that, in a 45,000-person trial, its vaccine was about 66% effective at preventing moderate to severe covid illness. No one who received the vaccine was hospitalized with or died of the disease, according to the company, which said it expected to seek Food and Drug Administration authorization as early as this week. If the agency authorizes use of the vaccine, millions of doses could be shipped out of J&J’s warehouses beginning in late February.

The J&J vaccine is similar to the shots from Moderna and Pfizer-BioNTech but uses a different strategy for transporting genetic code into human cells to stimulate immunity to the disease. The Moderna and Pfizer-BioNTech vaccines were found in trials last fall to be 94% effective against confirmed covid. They also prevented nearly all severe cases.

But the difference in those efficacy numbers may be deceptive. The vaccines were tested in different locations and at different phases of the pandemic. And J&J gave subjects in its trial only one dose of the vaccine, while Moderna and Pfizer have two-dose schedules, separated by 28 and 21 days, respectively. The bottom line, however, is that all three do a good job at preventing serious covid.

“It’s a bit like, do you want a Lamborghini or a Chevy to get to work?” said Dr. Gregory Poland, director of the Mayo Clinic’s Vaccine Research Group. “Ultimately, I just need to get to work. If a Chevy is available, sign me up.”

So while expert panels may debate in the future about which vaccine is best for whom, “from a personal and public health perspective, the best advice for now is to get whatever you can as soon as you can get it, because the sooner we all get vaccinated the better off we all are,” said Dr. Norman Hearst, a family doctor and epidemiologist at the University of California-San Francisco.

Here are five reasons you should take the J&J shot — assuming the FDA authorizes it — if it’s the one that’s offered to you first:

1. All three vaccines protect against hospitalization and death.

Of the 10 cases of severe disease in the Pfizer trial, nine received a placebo, or fake vaccine, and none of the 30 severe cases in the Moderna trial occurred in people who got the true vaccine. Johnson & Johnson did not release specific numbers but said none of the vaccinated patients were hospitalized or died. “The real goal is to keep people out of the hospital and the ICU and the morgue,” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “This vaccine will do that well.”

2. The efficacy levels could be a case of apples and oranges.

The data that Moderna and Pfizer-BioNTech presented to the FDA for their vaccines came from large clinical trials that took place over the summer and early fall in the United States. At the time, none of the new variants of covid — some of which may be better at evading the immune responses produced by vaccines — were circulating here. In contrast, the J&J trial began in September and was put into the arms of people in South America, South Africa and the United States.

Newly widespread variants in Brazil and South Africa appear somewhat better at evading the vaccine’s defenses, and it’s possible a new variant in California — where many J&J volunteers were enrolled — may also have that trait. The J&J vaccine was 72% effective against moderate to severe covid in the U.S. part of the trial, compared with 57% in South Africa, where a more contagious mutant virus is the dominant strain. Another vaccine, made by the Maryland company Novavax, had 90% efficacy in a large British trial, but only about 50% in South Africa. The Moderna and Pfizer-BioNTech vaccines might not have gotten the same sparkling results had they been tested more recently — or in South Africa.

“This vaccine was tested in the pandemic here and now,” said Dr. Dan Barouch, a Harvard Medical School professor whose lab at the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston developed the J&J vaccine. “The pandemic is a much more complex pandemic than it was several months ago.”

Some of that difference in performance also could be attributable to different patient populations or disease conditions, and not just the mutant virus. A large percentage of South Africans carry the human immunodeficiency virus, or HIV. Chinese vaccines have performed wildly differently in countries where they were tested in recent months.

“We don’t know which vaccines are the Lamborghinis,” Poland said, “because these aren’t true head-to-head comparisons.”

3. Speed is of the essence.

To stop the spread of covid, the mutation of the virus that causes it and the continued pummeling of the economy, we all need to be vaccinated as quickly as possible. The inadequate supply of vaccines has been felt acutely.

Dr. Virginia Banks’ 103-year-old mother is one of the few living Americans who were around for the country’s last great pandemic — the 1918 influenza — yet she’s been unable to get a covid vaccination, said Banks, a physician with Northeast Ohio Infectious Disease Associates in Youngstown.

Patients can’t be picky about which vaccine they accept, Banks said. People “need to get vaccinated with the vaccines out today so we can get closer to herd immunity” to slow the spread of the virus.

Banks has worked hard to promote covid vaccines to skeptical minority communities, frequently appearing on local TV news and making at least two presentations by Zoom each week. Blacks to date have been vaccinated against covid at much lower rates than whites.

“There’s a downside to waiting,” said Dr. William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University Medical Center. Delaying vaccination carries serious risks, given that more than 3,800 Americans have been dying every day of covid.

4. The J&J vaccine appears to have some real advantages.

First, it seems to cause fewer serious side effects like the fever and malaise suffered by some Pfizer-BioNTech and Moderna vaccine recipients. High fever and dehydration are particular concerns in fragile elderly people who “have one foot on the banana peel,” said Dr. Kathryn Edwards, scientific director of the Vanderbilt Vaccine Research Program. The J&J vaccine “may be a better vaccine for the infirm.”

Many people may also prefer the J&J shot because “it’s one and done,” Schaffner said. Easier for administrators too: just one appointment to schedule.

5. The J&J vaccine is much easier to ship, store and administer.

While the Johnson & Johnson vaccine can be stored in regular refrigerators, the Pfizer-BioNTech vaccine must be kept long-term in “ultra-cold” freezers at temperatures between minus 112 degrees and minus 76 degrees Fahrenheit, according to the Centers for Disease Control and Prevention.

Both the Moderna and Pfizer-BioNTech vaccines must be used or discarded within six hours after the vial is opened. Vials of the J&J vaccine can be stored in a refrigerator and restored for later use if doses remain. “Right now we have mass immunization clinics that are open but have no vaccine,” said Offit. “Here you have a single-dose regime with easy storage and handling.”

A person’s address — not their personal preference — may determine which vaccine they receive, said E. John Wherry, director of the Institute for Immunology at the University of Pennsylvania’s Perelman School of Medicine. He pointed out that the Johnson & Johnson vaccine is a simpler choice for rural areas.

“A vaccine doesn’t have to be 95% effective to be an incredible leap forward,” said Wherry. “When we get to the point where we have choices about which vaccine to give, it will be a luxury to have to struggle with that question.”

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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A la hora de vacunarse contra covid-19 no hay que ser quisquilloso. Los expertos afirman que debes ponerte la primera vacuna autorizada que te ofrezcan.

La vacuna anti covid más reciente, de Johnson & Johnson, es probablemente un poco menos eficaz para prevenir la enfermedad que las dos vacunas que ya se administran en los Estados Unidos, de Pfizer-BioNTech y Moderna.

El 29 de enero, Johnson & Johnson (J&J) anunció que, en un ensayo con 45,000 personas, su vacuna tuvo una eficacia de un 66% en la prevención de casos moderados a graves de la enfermedad.

Según la empresa, ninguno de los vacunados fue hospitalizado o murió a causa de covid. J&J comunicó que solicitaría la autorización de la Administración de Alimentos y Medicamentos (FDA) de inmediato. Si la agencia autoriza su uso, millones de dosis podrían ser distribuidas a partir de finales de febrero.

La vacuna de J&J es similar a las de Moderna y Pfizer-BioNTech, pero utiliza una estrategia diferente para transportar el código genético a las células humanas con el fin de estimular la inmunidad a la enfermedad.

En los ensayos clínicos de otoño, las vacunas de Moderna y Pfizer-BioNTech resultaron eficaces en un 94% contra covid. También evitaron casi todos los casos graves.

Pero la diferencia en esos niveles de eficacia puede ser engañosa. Las vacunas se probaron en distintos lugares y en diferentes fases de la pandemia. Además, J&J administró a los sujetos de su ensayo una sola dosis, mientras que Moderna y Pfizer administran dos dosis, separadas por 28 y 21 días, respectivamente.

Sin embargo, el resultado final es que las tres hacen un buen trabajo en la prevención de los casos graves de covid.

“Es como si quisieras un Lamborghini o un Chevy para ir al trabajo”, dijo el doctor Gregory Poland, director del Grupo de Investigación de Vacunas de la Clínica Mayo. “Al final, sólo necesito llegar al trabajo. Si hay un Chevy disponible, apúntame”.

Así que, aunque los paneles de expertos puedan debatir en el futuro sobre qué vacuna es mejor para quién, “desde una perspectiva personal y de salud pública, el mejor consejo por ahora es vacunarse lo antes posible, porque cuanto antes nos vacunemos todos, mejor estaremos”, señaló el doctor Norman Hearst, médico de familia y epidemiólogo de la Universidad de California-San Francisco.

Las siguientes son cinco razones por las que deberías ponerte la vacuna de J&J —suponiendo que la FDA la autorice— si es la que te ofrecen primero:

1. Las tres vacunas protegen contra la hospitalización y la muerte.

De los 10 casos graves en el ensayo clínico de Pfizer, nueve recibieron un placebo, o vacuna falsa, y ninguno de los 30 casos graves en el ensayo de Moderna lo sufrieron personas que habían recibido la vacuna verdadera

Johnson & Johnson no dio a conocer cifras concretas, pero comunicó que ninguno de los pacientes vacunados tuvo que ser hospitalizado y ninguno murió. “El verdadero objetivo es mantener a la gente fuera del hospital, de la terapia intensiva y de la morgue”, apuntó el doctor Paul Offit, director del Centro de Educación sobre Vacunas del Hospital Infantil de Philadelphia. “Esta vacuna lo logra bien”.

1. Valorar los niveles de eficacia sería como comparar peras con manzanas.

Los datos que Moderna y Pfizer-BioNTech presentaron a la FDA procedían de grandes ensayos clínicos que tuvieron lugar durante el verano y principios del otoño en los Estados Unidos.

En ese momento, no había surgido ninguna de las nuevas variantes de covid, algunas de las cuales podrían evadir mejor las respuestas inmunitarias producidas por las vacunas. En cambio, el ensayo de J&J comenzó en septiembre y se administró a personas de Sudamérica, Sudáfrica y los Estados Unidos.

Las nuevas variantes de Brasil y Sudáfrica parecen ser algo mejores a la hora de evadir las defensas de la vacuna, y es posible que una nueva variante en California —donde se inscribieron muchos voluntarios de J&J— también tenga esa característica.

La vacuna de J&J tuvo una eficacia del 72% contra covid de moderado a grave en la parte estadounidense del ensayo, en comparación con el 57% en Sudáfrica, donde la cepa dominante es un virus mutante más contagioso.

Otra vacuna, fabricada por la empresa de Maryland Novavax, tuvo una eficacia del 90% en un amplio ensayo clínico británico, pero sólo del 50% en Sudáfrica. Las vacunas de Moderna y Pfizer-BioNTech podrían no haber obtenido los mismos resultados espectaculares si se hubiesen probado más recientemente, o en Sudáfrica.

“Esta vacuna se probó en la pandemia aquí y ahora”, señaló el doctor Dan Barouch, profesor de la Escuela de Medicina de Harvard cuyo laboratorio, en el Centro de Investigación de Virología y Vacunas del Centro Médico Beth Israel Deaconess de Boston, desarrolló la vacuna de J&J. “La pandemia es hoy mucho más compleja ahora que hace unos meses”.

Parte de la diferencia de resultados también podría atribuirse a las diferentes poblaciones de pacientes o condiciones de la enfermedad, y no sólo al virus mutante. Un gran porcentaje de sudafricanos es portador del virus de la inmunodeficiencia humana, o VIH. Las vacunas chinas han tenido un rendimiento muy diferente en los países donde se han probado en los últimos meses.

“No sabemos qué vacunas son los Lamborghinis”, dijo Poland, “porque no se pueden establecer verdaderas comparaciones”.

1. La rapidez es esencial.

 Para frenar la propagación de covid, la mutación del virus que lo provoca y los continuos golpes a la economía, es necesario que todos nos vacunemos lo antes posible. Pero la falta de vacunas se ha dejado sentir de manera dramática.

La madre de la doctora Virginia Banks, de 103 años, es una de las pocas estadounidenses vivas que estuvieron presentes en la última gran pandemia del país, la de la gripe de 1918, y sin embargo no ha podido vacunarse contra covid, según contó Banks, médico de Northeast Ohio Infectious Disease Associates, en Youngstown.

Los pacientes no pueden exigir el tipo de vacuna que quieren ponerse, dijo Banks. La gente “tiene que vacunarse con cualquiera de las vacunas que hay disponibles para que podamos acercarnos a la inmunidad de grupo” y frenar así la propagación del virus.

Banks se ha esforzado por promover las vacunas contra covid entre las comunidades minoritarias más escépticas, apareciendo con frecuencia en las noticias de la televisión local y haciendo al menos dos presentaciones por Zoom cada semana. Hasta la fecha, las personas de raza negra se han vacunado contra el covid en porcentajes mucho más bajos que los blancos no hispanos.

“Esperar tiene su lado negativo”, advirtió el doctor William Schaffner, profesor de medicina preventiva y política sanitaria en el Centro Médico de la Universidad de Vanderbilt. Retrasar la vacunación conlleva graves riesgos, dado que más de 3,800 estadounidenses se mueren cada día a causa de covid.

1. La vacuna de J&J parece tener algunas ventajas reales.

En primer lugar, parece causar menos efectos secundarios graves, como la fiebre y el malestar que sufrieron algunos receptores de la vacuna de Pfizer-BioNTech y Moderna.

La fiebre alta y la deshidratación son especialmente preocupantes en personas mayores frágiles que “están al borde del abismo”, explicó la doctora Kathryn Edwards, directora científica del Programa de Investigación de Vacunas de Vanderbilt. La vacuna de J&J “puede ser la mejor para estos pacientes”.

Muchas personas también pueden preferir la vacuna J&J porque “se administra una sola vez”, señaló Schaffner. También es más fácil para los que la aplican: sólo hay que programar una cita.

1. La vacuna de J&J es mucho más fácil de enviar, almacenar y administrar.

Mientras que la vacuna de Johnson & Johnson puede almacenarse en frigoríficos normales, la de Pfizer-BioNTech debe conservarse a largo plazo en congeladores “ultrafríos” a temperaturas de entre -112 y -76 grados Fahrenheit, según los Centros para el Control y la Prevención de Enfermedades (CDC).

Tanto la vacuna de Moderna como la de Pfizer-BioNTech deben utilizarse o desecharse en las seis horas siguientes a la apertura del vial. Los viales de la vacuna de J&J pueden guardarse en un frigorífico y volver a utilizarlos si quedan dosis.

“En estos momentos tenemos clínicas de inmunización masiva que están abiertas, pero no tienen vacunas”, dijo Offit. “Pero ésta es de dosis única y de fácil almacenamiento y manipulación”.

Dónde vives —y no tu preferencia personal— puede determinar qué vacuna recibas, indicó E. John Wherry, director del Instituto de Inmunología de la Escuela de Medicina Perelman de la Universidad de Pennsylvania. Señaló que la vacuna de Johnson & Johnson es una opción más sencilla para las zonas rurales.

“Una vacuna no tiene que ser efectiva en un 95% para convertirse en un increíble salto adelante”, aseguró Wherry. “Cuando lleguemos al punto en que tengamos opciones sobre qué vacuna administrar, será un lujo tener que debatir esa cuestión”.

Esta historia fue producida por KHN, que publica California Healthline, un servicio editorialmente independiente de la California Health Care 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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The U.S. Department of Agriculture and the Department of Health and Human Services have once again developed new food guidelines for Americans that urge people to customize a diet of nutrient-dense food. For the first time, they make recommendations for infant nutrition and for different stages of life.

But, as in past iterations, they lack seasoning. They do not acknowledge the nuances of culture and ethnicity at the heart of how Americans feed themselves.

Congress requires a revision of these guidelines every five years to ensure they reflect the best available science and respond to the general population’s health needs.

Ethnic variations have been suggested for years, but there is still little guidance given to Americans of different backgrounds on how to eat more healthfully.

“There’s different ways you can be racist,” said Esosa Edosomwan, a certified nutrition specialist and behavioral coach in Washington, D.C. “You can be racist by omitting people, by making guidelines that only cater to a specific group.” Edosomwan — a Nigerian American also known as the Raw Girl — began her nutrition journey while trying to find a diet that would help alleviate persistent acne. She found a raw food class and began writing about her food-as-medicine reeducation on her blog, Raw Girl Toxic World.

“I was trying to figure out what I could become that would allow me to treat people with nutrition,” she said. “I saw mostly white women in this field that were celebrity nutritionists.”

“A white dietitian, she’s probably going to tell you to have some Greek yogurt with a handful of almonds and a serving of protein the size of your fist, when what you really want is egusi soup,” Edosomwan said, referring to the West African dish made from the ground, nutrient-dense egusi seed, vegetables and meat or fish. Food is a big part of culture, and you can’t dismiss where a client comes from, she said. Her clients are encouraged to cook within their culture, but to make changes to ingredients when needed to improve nutritional quality.

“These guidelines are completely incompatible with us achieving our best health,” Edosomwan said of the government guidelines. Statistics bear this out. According to a 2017 JAMA study, nearly half of all U.S. deaths from heart disease, stroke and Type 2 diabetes may be attributed in part to poor diet. These health conditions disproportionately affect people of color. For instance, 11.7% of Black people, 12.5% of Hispanics and 9.2% of non-Hispanic Asians have been diagnosed with diabetes, versus 7.5% of non-Hispanic whites, according to the 2020 National Diabetes Statistics Report.

The USDA boasts a long history of providing “science-based dietary guidance to the American public” and frequently revising it. It goes back to before World War II. An attempt to correct overeating came with the “Food Pyramid” — first published in 1992. The recommendations have more recently been branded simply as “My Plate,” with an app that can be downloaded to any mobile device. But simplifying the recommendations may make them less relevant.

“Culture is everything,” said Inez Sobczak, certified nutritionist and owner of Fit-Nez in Arlington, Virginia. Sobczak was born in Miami to Cuban refugees and has been a nutritionist for 15 years, specializing in weight loss, hormone management and emotional and crisis eating.

While USDA guidelines can’t account for every food culture, Sobczak said, they could be more inclusive. And while she can’t create a new food pyramid overnight — it’s a more complicated process than one would think — she tries to teach people of color how to eat better.

Oldways, a Boston-based organization, has been trying for decades. It first developed a Mediterranean food pyramid in 1993 and has since created charts for African, Latin American and Asian diets, as well as ones for vegetarians and vegans. It also offers classes, such as their six-week Taste of African heritage program. Kelly Toups, director of nutrition at Oldways, said the organization also participates in sessions with the USDA. But not much has changed.

“It would be great to see more cultural representations more explicitly shown in the guidelines,” she said.

Why has it never happened? Partly because the process is elaborate: A government committee of about 20 scientists and health experts study the National Health and Nutrition Examination Survey. The survey attempts to discover what people are eating and how healthy they are. The interviews, conducted in either English or Spanish, leave out Americans who speak other languages.

Next, the committee conducts “food pattern modeling” by looking at different food groups, the nutrients they provide and how much of each group is needed at each stage of life to establish recommendations.

These recommendations are set by age and gender but do not consider variables such as ethnicity, geographic location or access to healthy foods. “If I had to guess, you’re mostly looking at things that are available in typical grocery stores in the U.S.,” said Sarah Reinhardt, the lead food systems and health analyst in the food and environment program at the Union of Concerned Scientists.

In July the USDA released a whopping 835-page scientific report that formed the basis for the 2020-2025 Dietary Guidelines, released at the end of December.

Wait, there’s more. The federal committee also examines piles of food research. But it cannot evaluate research that isn’t available. Vegetarian and Mediterranean diets have been rigorously examined, but not many studies are looking at West African or Native American diets, for example.

The USDA acknowledges this gap. In the 2020 report, the members highlighted the issue. “Nutrition science would benefit from scientists in the field conducting primary research in more diverse populations with varying age groups and different racial, ethnic and socioeconomic backgrounds,” a USDA spokesperson said.

Still, the food industry dominates and guides the discussion. Due to a lack of public funding, Reinhardt said, a lot of nutrition research is funded by industry. “Science isn’t unbiased. It really depends on who is setting the agenda,” she said.

One issue is that the African American diet isn’t a monolith. “There are many immigrants in this country who are Black but hail from different cultural backgrounds,” Edosomwam said.

For instance, the African diet involves lots of tubers — things like yams and cassava, she said. But some African American diets, especially those traced back to slavery, are based on the “soul food” concept, which comes from the practice of making meals from leftover scraps that slave owners would allow them to eat — foods such as pig intestines, called chitterlings.

“Cultural foods and traditions matter,” she said. But part of the challenge is helping people “reimagine these dishes to make them healthier by changing the ingredients and creating new traditions.” Unfortunately, she added, “there’s no plant-based substitute for chitterlings.”

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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A divide between “haves” and “have-nots” is emerging as older adults across the country struggle to get covid-19 vaccines.

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Seniors with family members or friends to help them are getting vaccine appointments, even if it takes days to secure them. Those without reliable social supports are missing out.

Elders who can drive — or who can get other people to drive them — are traveling to locations where vaccines are available, crossing city or county borders to do so. Those without private transportation, are stuck with whatever is available nearby.

Older adults who are comfortable with computers and have internet service are getting notices of vaccine availability and can register online for appointments. Those who can’t afford broadband services or don’t use computers or smartphone apps are likely missing out on information about vaccines and appointments.

The extent of this phenomenon has not been documented yet. But experts are discussing it on various forums, as are older adults and family members.

“I’m very concerned that barriers to getting vaccines are having unequal impact on our older population,” said Dr. XinQi Dong, director of the Institute for Health, Health Policy and Aging Research at Rutgers University.

Disproportionately, these barriers appear to be affecting Blacks and Hispanic elders as well as people who are not native English speakers; older adults living in low-income neighborhoods; seniors who are frail, seriously ill or homebound; and those with vision and hearing impairments.

“The question is ‘Who’s going to actually get vaccines?’ — older adults who are tech-savvy, with financial resources and family members to help them, or harder-to-reach populations?” said Abraham “Ab” Brody, an associate professor of nursing and medicine at New York University.

“If seniors of color and people living in poor neighborhoods can’t find a way to get vaccines, you’re going to see disparities that have surfaced during the pandemic widening,” he said.

Preliminary evidence from an analysis by KHN indicates this appears to be happening. In 23 states reporting vaccine data by race, Blacks are being vaccinated at a far lower rate than whites, based on their share of the population. The data on Hispanics suggests similar disparities but is incomplete. 

Although the data is not age-adjusted, Blacks and Hispanic seniors have been far more likely to become seriously ill and die from covid than white seniors during the pandemic, other evidence shows.

Myrna Hart, 79, who has diabetes and high blood pressure and lives in Cottage Grove, Minnesota, a southern suburb of St. Paul, is afraid she’ll be left behind during the vaccine rollout. Hart, who is Black, is eager to get a shot, but she can’t travel to two large vaccination sites for seniors in Minneapolis’ northern suburbs, more than 30 miles away.

“That’s too far for me to drive; I don’t know my way, and I could get lost,” she said. “If they have a handful of people who look like me in those places, I would be surprised. I wouldn’t feel safe going there by myself.”

Family members can’t give her a ride. Hart’s husband is in a skilled nursing facility, receiving rehabilitation after having a leg amputated due to diabetes. Her son is in the hospital, with complications from kidney disease. A daughter lives in Westchester County, New York.

So far, Hart has had no success getting an appointment online at smaller, closer vaccine locations.

“I don’t know how much I can endure this,” she said, her voice breaking, as she described her fear of catching covid and her frustration. “I’m afraid they’re going to run out [of vaccine] before they get to people my age, now that they’ve changed the plan to include 65-year-olds who are jumping ahead of us.”(Like many states, Minnesota widened eligibility to people 65 and older in mid-January, following recommendations from the federal government.)

Although Hart, a former accountant and bookstore owner, knows her way around computers, many older adults don’t.

According to a new survey by University of Michigan researchers, nearly 50% of Black seniors and 53% of Hispanic older adults did not have online “patient portal” accounts with their health care providers as of June 2020, compared with 39% of white elders.

What’s more, a significant portion of Black and Hispanic older adults lack internet access — 25% and 21%, respectively, according to the Census Bureau.

“It’s not enough to offer technological solutions to these seniors: They need someone — an adult child, a grandchild, an advocate — who can help them engage with the health care system and get these vaccines,” said Dr. Preeti Malani, director of the University of Michigan’s National Poll on Healthy Aging.

In Birmingham, Alabama, Dr. Anand Iyer, a pulmonologist who specializes in caring for older adults, runs a clinic for more than 200 indigent patients with various types of chronic lung disease — conditions that put them at risk of becoming seriously ill if they’re infected with coronavirus. Seventy percent of his patients are Black, and many are elderly.

“I would estimate 10% to 20% are at risk of missing out on vaccines because they’re homebound, live alone, don’t have transportation or lack reliable social connections,” he said. “Unfortunately, those are the same factors that put them at risk of poor outcomes from covid.”

Every week, he gets a call from a 90-year-old Black patient who lives alone in Tuskegee with chronic obstructive pulmonary disease, heart failure, cancer and severe arthritis. “She’s old, but she’s resilient and she keeps me posted on what’s going on,” Iyer said.

To the doctor’s knowledge, this patient doesn’t have children, other family members or friends to help her; instead, she relies on a handyman who comes around every so often. “How in the world is she supposed to get the vaccine?” he wondered.

Kei Hoshino Quigley, 42, of New York City, knows that her parents — Japanese American immigrants, who have lived with her since last March — couldn’t have managed without her help.

Although Quigley’s 70-year-old father and 80-year-old mother speak English, they have heavy accents and “it can be very hard for people to understand them,” she said.

In addition, Quigley’s father doesn’t know how to use computers, and her mother’s eyesight isn’t good. “For older people who don’t speak English as their native language and who are intimidated by the computer, the systems that have been set up are just nuts,” Quigley said.

Knowing they couldn’t navigate vaccine registration systems on their own, Quigley spent hours online trying to secure appointments for her parents.

After encountering a host of problems — frequent error messages, information she inputted suddenly getting wiped out on vaccine registration sites, calendars with disappearing-by-the-second appointments, incorrect notices that her parents didn’t quality — Quigley arranged for her mother to be vaccinated in mid-January and for her father to get his first shot a few weeks later.

Language issues are also a significant hurdle for older Hispanics, who “are not being offered information on vaccines in a way they understand or in Spanish,” said Yanira Cruz, president and chief executive officer of the National Hispanic Council on Aging.

“I’m very concerned that older adults who are not fluent in English, who don’t have a family member to help them navigate online, and who don’t have access to private transportation are going to be left out” during this rollout, she said.

None of the older adults living in two low-income housing complexes run by her organization in Washington, D.C., and Garden City, Kansas, have received vaccines, Cruz said. “We should be bringing the vaccines to where seniors live, not asking them to take a bus, expose themselves to other people, and try to find their way to a clinic,” she said.

Nothing can substitute for a friend or family member determined to make sure an older loved one is protected against covid. Joanna Stolove has played that role for her father, 82, who is blind and has congestive heart failure, and her mother, 74, who has Lewy body dementia.

The couple lives in Nassau County on New York’s Long Island and receives 40 hours of care at home each week.

Stolove, a geriatric social worker, took time during work to try to get her father an appointment, but many people don’t have that luxury. She works at a naturally occurring retirement community in Morningside Heights, a diverse neighborhood on the Upper West Side of Manhattan.

With substantial effort, Stolove secured an appointment for her father at a large drive-in vaccine site on Jones Beach on Jan. 26; her sister found an appointment for her mother there in late February. At work, where many of her clients live alone and don’t have family members or friends whom they can rely on for help, she counsels them about vaccines and tries to find appointments on their behalf.

“I have so many advantages in assisting my parents,” Stolove said. “Without help from someone like me, how can people find their way through this?”

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