Category: From California Healthline.org

More than 300,000 people have died from COVID-19 in the United States.

It is the latest sign of a generational tragedy — one still unfolding in every corner of the country — that leaves in its wake an expanse of grief that cannot be captured in a string of statistics.

“The numbers do not reflect that these were people,” said Brian Walter, of New York City, whose 80-year-old father, John, died from COVID-19. “Everyone lost was a father or a mother, they had kids, they had family, they left people behind.”

There is no analogue in recent U.S history to the scale of death brought on by the coronavirus, which now runs unchecked in countless towns, cities and states.

“We’re seeing some of the most deadly days in American history,” said Dr. Craig Spencer, director of Global Health in Emergency Medicine at NewYork-Presbyterian/Columbia University Medical Center.

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During the past two weeks, COVID-19 was the leading cause of death in the U.S., outpacing even heart disease and cancer.

“That should be absolutely stunning,” Spencer said. And yet the most deadly days of the pandemic may be to come, epidemiologists predict.

Even with a rapid rollout of vaccines, the U.S. may reach a total of more than half a million deaths by spring, said Ali Mokdad of the Institute for Health Metrics and Evaluation at the University of Washington.

Some of those deaths could still be averted. If everyone simply began wearing face masks, more than 50,000 lives could be saved, IHME’s model shows. And physical distancing could make a difference too.

No other country has come close to the calamitous death toll in the U.S. And the disease has amplified entrenched inequalities. Blacks and Hispanics/Latinos are nearly three times more likely to die from COVID-19 than whites.

“I’m really amazed at how we have this sense of apathy,” said Dr. Gbenga Ogedegbe, a professor of medicine and population health at New York University Grossman School of Medicine. He said there’s evidence that socioeconomic factors, not underlying health problems, explain the disproportionate share of deaths.

The disease, he said, reveals “the chronic neglect of Black and brown communities” in this country.

Though the numbers are numbing, for bereaved families and for front-line workers who care for people in their dying moments, every life is precious.

Here are reflections from people who’ve witnessed this loss — how they are processing the grief and what they wish the rest of America understood.

‘There Are Things We Can Do to Still Make a Difference’

Darrell Owens, a doctor of nursing practice in Seattle, was startled to learn recently that he had signed more death certificates for COVID-19 than anyone else in Washington.

Owens runs the palliative care program at the University of Washington Medical Center-Northwest, where he has treated COVID patients since the early spring.

“I’m feeling much more anger and frustration than I did before because much of what we’re dealing with now was preventable,” Owens said.

“We’re all in this great big storm, but some people are in a yacht and some people are on a cruise ship and some people are on a raft,” he added. “We’re not all in this together.”

Owens still finds moments of grace and meaning as he cares for the dying.

“The other day, there was a lady I was taking care of who’d come from a local nursing home and it was very clear that she was nearing the end,” Owens said. “I just picked up her hand. I sat there. I held her hand for about 25 minutes until she took her last breath.”

He stepped out of the room and called the patient’s daughter.

“It made such a difference for her that her mom was not alone,” he said. “What an incredible gift that she gave me and that I was able to give her daughter. So there are things that we can do to still make a difference.”

‘It’s Not a Joke. It’s Not a Hoax.’

Since his father died of COVID-19 in the spring, Brian Walter of Queens, New York, has helped run a support group on Facebook for people who’ve lost family and friends to COVID-19.

It’s helped him grieve his father John, whom he describes as a very loving man dedicated to his autistic grandson and to running a youth program for teenagers.

“It’s been lifesaving in a lot of ways,” Walter said. “Together, we face a lot of issues since we are grieving in isolation. But at the same time, we’re also dealing with people that openly tell us that this is not a real condition, that this is not a real issue.”

Some in their group admit they denied the severity of the virus and shunned precautions until it was too late.

“It’s not a joke. It’s not a hoax, and you will not understand how horrible this is until it enters your family and takes away someone,” he said.

All of this complicates the grief, but it has also led Walter and others in his group to speak out and share their stories, so that numbers don’t obscure the actual people who were leading full lives before dying from COVID-19.

“I know what it’s like to have to say goodbye to somebody over a Zoom call and to not have a funeral,” Walter said.

‘300,000 Stories That Got Shut Down Too Quickly’

Martha Phillips, an ER nurse who took assignments in New York and Texas in the spring and summer, said there is one patient who has become almost a stand-in for the grief of the many whose deaths she witnessed.

It was the very last COVID patient she cared for in Houston.

“I reached down to just adjust her oxygen tubing just a little bit,” Phillips recalled. “And she looks up at me and she sees me through my goggles and my mask and my shield and meets my eyes and she goes, ‘Do you think I’m going to get better?’”

“What do you say to someone who’s not ready to die? Who has so much to live for, but got this and now they’re trapped?”

Two months later, Phillips discovered the woman’s obituary online.

“That one was the hardest,” she said. “But there’s 300,000 people who had time left that was stolen from them; 300,000 stories that got shut down too quickly.”

‘This Is Worse Than Being in War’

ER physician Dr. Cleavon Gilman, a veteran of the Iraq War, said it’s still hard to communicate the brutality of a disease that kills people in the privacy of a hospital wing.

When Gilman was in New York City during the spring surge, he never imagined the U.S. would be losing thousands of people each day to COVID-19 so many months later.

“That 300,000 Americans would be dead and life would go on and people would not have empathy for their fellow Americans,” he said. “I can tell you this is worse than being in war.”

The enemy is invisible, he said, the war zone is everywhere, and many refuse to take the most simple actions to combat the virus, even as morgues fill up in their own community.

Throughout the pandemic, Gilman, who is now working in Yuma, Arizona, has shared photos and stories of people who’ve died from COVID-19 each day on social media.  “It’s really important to honor them,” he said.

This story is from a reporting partnership with NPR and KHN. 

This story also ran on The Associated Press. It can be republished for free.

Tisha Coleman has lived in close-knit Linn County, Kansas, for 42 years and never felt so alone.

As the public health administrator, she’s struggled every day of the coronavirus pandemic to keep her rural county along the Missouri border safe. In this community with no hospital, she’s failed to persuade her neighbors to wear masks and take precautions against COVID-19, even as cases rise. In return, she’s been harassed, sued, vilified — and called a Democrat, an insult in her circles.

Even her husband hasn’t listened to her, refusing to require customers to wear masks at the family’s hardware store in Mound City.

“People have shown their true colors,” Coleman said. “I’m sure that I’ve lost some friends over this situation.”

By November, the months of fighting over masks and quarantines were already wearing her down. Then she got COVID-19, likely from her husband, who she thinks picked it up at the hardware store. Her mother got it, too, and died on Sunday, 11 days after she was put on a ventilator.

Across the U.S., state and local public health officials such as Coleman have found themselves at the center of a political storm as they combat the worst pandemic in a century. Amid a fractured federal response, the usually invisible army of workers charged with preventing the spread of infectious diseases has become a public punching bag. Their expertise on how to fight the coronavirus is often disregarded.

Some have become the target of far-right activists, conservative groups and anti-vaccination extremists, who have coalesced around common goals — fighting mask orders, quarantines and contact tracing with protests, threats and personal attacks.

The backlash has moved beyond the angry fringe. In the courts, public health powers are being undermined. Lawmakers in at least 24 states have crafted legislation to weaken public health powers, which could make it more difficult for communities to respond to other health emergencies in the future.

“What we’ve taken for granted for 100 years in public health is now very much in doubt,” said Lawrence Gostin, an expert in public health law at Georgetown University in Washington, D.C.

It is a further erosion of the nation’s already fragile public health infrastructure. At least 181 state and local public health leaders in 38 states have resigned, retired or been fired since April 1, according to an ongoing investigation by The Associated Press and KHN. According to experts, this is the largest exodus of public health leaders in American history. An untold number of lower-level staffers has also left.

“I’ve never seen or studied a pandemic that has been as politicized, as vitriolic and as challenged as this one, and I’ve studied a lot of epidemics,” said Dr. Howard Markel, a medical historian at the University of Michigan. “All of that has been very demoralizing for the men and women who don’t make a great deal of money, don’t get a lot of fame, but work 24/7.”

One in 8 Americans — 40 million people — lives in a community that has lost its local public health department leader during the pandemic. Top public health officials in 20 states have left state-level departments, including in North Dakota, which has lost three state health officers since May, one after another.

Many of the state and local officials left due to political blowback or pandemic pressure. Some departed to take higher-profile positions or due to health concerns. Others were fired for poor performance. Dozens retired.

KHN and AP reached out to public health workers and experts in every state and the National Association of County and City Health Officials; examined public records and news reports; and interviewed hundreds to gather the list.

Collectively, the loss of expertise and experience has created a leadership vacuum in the profession, public health experts say. Many health departments are in flux as the nation rolls out the largest vaccination campaign in its history and faces what are expected to be the worst months of the pandemic.

“We don’t have a long line of people outside of the door who want those jobs,” said Dr. Gianfranco Pezzino, health officer in Shawnee County, Kansas, who is retiring from his job earlier than planned because, he said, he’s burned out. “It’s a huge loss that will be felt probably for generations to come.”

Existing Problems

The departures accelerate problems that had already weakened the nation’s public health system. AP and KHN reported that per capita spending for state public health departments had dropped by 16%, and for local health departments by 18%, since 2010. At least 38,000 state and local public health jobs have disappeared since the 2008 recession.

Those diminishing resources were already prompting high turnover. Before the pandemic, nearly half of public health workers said in a survey they planned to retire or leave in the next five years. The top reason given was low pay.

Such reduced staffing in departments that have the power and responsibility to manage everything from water inspections to childhood immunizations left public health workforces ill-equipped when COVID-19 arrived. Then, when pandemic shutdowns cut tax revenues, some state and local governments cut their public health workforces further.

“Now we’re at this moment where we need this knowledge and leadership the most, everything has come together to cause that brain drain,” said Chrissie Juliano, executive director of the Big Cities Health Coalition, which represents leaders of more than two dozen public health departments.

Politics as Public Health Poison

Public health experts broadly agree that masks are a simple and cost-effective way to reduce the spread of COVID-19 and save lives and livelihoods. Scientists say that physical distancing and curtailing indoor activities can also help.

But with the pandemic coinciding with a divisive presidential election, simple acts such as wearing a mask morphed into political statements, with right-wing conservatives saying such requirements stomped on individual freedom.

On the campaign trail, President Donald Trump ridiculed President-elect Joe Biden for wearing a mask and egged on armed people who stormed Michigan’s Capitol to protest coronavirus restrictions by tweeting “LIBERATE MICHIGAN!”

Coleman, a Christian and a Republican, said that’s just what happened in Linn County. “A lot of people are shamed into not wearing a mask … because you’re considered a Democrat,” she said. “I’ve been called a ‘sheep.’”

The politicization has put some local governments at odds with their own health officials. In California, near Lake Tahoe, the Placer County Board of Supervisors voted to end a local health emergency and declared support for a widely discredited “herd immunity” strategy, which would let the virus spread. The idea is endorsed by many conservatives, including former Trump adviser Dr. Scott Atlas, as a way to keep the economy running, but it has been denounced by public health experts who say millions more people will unnecessarily suffer and die. The supervisors also endorsed a false conspiracy theory claiming many COVID-19 deaths are not actually from COVID-19.

The meeting occurred just days after county Public Health Officer Dr. Aimee Sisson explained to the board the rigorous standards used for counting COVID-19 deaths. Sisson quit the next day.

In Idaho, protests against public health measures are intensifying. Hundreds of protesters, some armed, swarmed health district offices and health board members’ homes in Boise on Dec. 8, screaming and blaring air horns. They included members of the anti-vaccination group Health Freedom Idaho.

Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, has tracked the anti-vaccine movement and said it has linked up with political extremists on the right, and taken on a larger anti-science role, pushing back against other public health measures such as contact tracing and physical distancing.

Members of a group called the Freedom Angels in California, which sprung up in 2019 around a state law to tighten vaccine requirements, have been organizing protests at health departments, posing with guns and calling themselves a militia on the group’s Facebook page.

The latest Idaho protests came after a July skirmish in which Ammon Bundy shoved a public health employee who tried to stop him and his maskless supporters from entering a health meeting.

Bundy, whose family led armed standoffs against federal agents in 2014 and 2016, has become an icon for paramilitary groups and right-wing extremists, most recently forming a multistate network called People’s Rights that has organized protests against public health measures.

“We don’t believe they have a right to tell us that we have to put a manmade filter over our face to go outside,” Bundy said. “It’s not about, you know, the mandates or the mask. It’s about them not having that right to do it.”

Kelly Aberasturi, vice chair for the Southwest District Health, which covers six counties, said the worker Bundy shoved was “just trying to do his job.”

Aberasturi, a self-described “extremist” right-wing Republican, said he, too, has been subjected to the backlash. Aberasturi doesn’t support mask mandates, but he did back the board’s recommendation that people in the community wear masks. He said people who believe even a recommendation goes too far have threatened to protest at his house.

The Mask Fight in Kansas

The public health workforce in Kansas has been hit hard — 17 of the state’s 100 health departments have lost their leaders since the end of March. 

Democratic Gov. Laura Kelly issued a mask mandate in July, but the state legislature allowed counties to opt out. A recent Centers for Disease Control and Prevention report showed the 24 Kansas counties that had upheld the mandate saw a 6% decrease in COVID-19, while the 81 counties that opted out entirely saw a 100% increase.

Coleman, who pushed unsuccessfully for Linn County to uphold the rule, was sued for putting a community member into quarantine, a lawsuit she won. In late November, she spoke at a county commissioner’s meeting to discuss a new mask mandate — it was her first day back in the office after her own bout with COVID-19.

She pleaded for a plan to help stem the surge in cases. One resident referenced Thomas Jefferson, saying, “I prefer a dangerous freedom over a peaceful slavery.” Another falsely argued that masks caused elevated carbon dioxide. Few, besides Coleman, wore a mask at the meeting.

Commissioner Mike Page supported the mask order, noting that a close friend was fighting COVID-19 in the hospital and saying he was “ashamed” that members of the community had sued their public health workers while other communities supported theirs.

In the end, the commissioners encouraged community members to wear masks but opted out of a county-wide rule, writing they had determined that they are “not necessary to protect the public health and safety of the county.”

Coleman was disappointed but not surprised. “At least I know I’ve done everything I can to attempt to protect the people,” she said.

The next day, Coleman discussed Christmas decorations with her mother as she drove her to the hospital.

Stripping of Powers

The state bill that let Linn County opt out of the governor’s mask mandate is one of dozens of efforts to erode public health powers in state legislatures across the country.

For decades, government authorities have had the legal power to stop foodborne illnesses and infectious diseases by closing businesses and quarantining individuals, among other measures.

When people contract tuberculosis, for example, the local health department might isolate them, require them to wear a mask when they leave their homes, require family members to get tested, relocate them so they can isolate and make sure they take their medicine. Such measures are meant to protect everyone and avoid the shutdown of businesses and schools.

Now, opponents of those measures are turning to state legislatures and even the Supreme Court to strip public officials of those powers, defund local health departments or even dissolve them. The American Legislative Exchange Council, a corporate-backed group of conservative lawmakers, has published model legislation for states to follow.

Lawmakers in Missouri, Louisiana, Ohio, Virginia and at least 20 other states have crafted bills to limit public health powers. In some states, the efforts have failed; in others, legislative leaders have embraced them enthusiastically.

Tennessee’s Republican House leadership is backing a bill to constrain the state’s six local health departments, granting their powers to mayors instead. The bill stems from clashes between the mayor of Knox County and the local health board over mask mandates and business closures.

In Idaho, lawmakers resolved to review the authority of local health districts in the next session. The move doesn’t sit right with Aberasturi, who said it’s hypocritical coming from state lawmakers who profess to believe in local control.

Meanwhile, governors in Wisconsin, Kansas and Michigan, among others, have been sued by their own legislators, state think tanks or others for using their executive powers to restrict business operations and require masks. In Ohio, a group of lawmakers is seeking to impeach Republican Gov. Mike DeWine over his pandemic rules.

The U.S. Supreme Court in 1905 found it was constitutional for officials to issue orders to protect the public health, in a case upholding a Cambridge, Massachusetts, requirement to get a smallpox vaccine. But a 5-4 ruling last month indicated the majority of justices are willing to put new constraints on those powers.

“It is time — past time — to make plain that, while the pandemic poses many grave challenges, there is no world in which the Constitution tolerates color-coded executive edicts that reopen liquor stores and bike shops but shutter churches, synagogues, and mosques,” Justice Neil Gorsuch wrote.

Gostin, the health law professor, said the decision could embolden state legislators and governors to weaken public health authority, creating “a snowballing effect on the erosion of public health powers and, ultimately, public’s trust in public health and science.”

Who’s Left?

Many health officials who have stayed in their jobs have faced not only political backlash but also threats of personal violence. Armed paramilitary groups have put public health in their sights.

In California, a man with ties to the right-wing, anti-government Boogaloo movement was accused of stalking and threatening Santa Clara’s health officer. The suspect was arrested and has pleaded not guilty. The Boogaloo movement is associated with multiple murders, including of a Bay Area sheriff deputy and federal security officer.

Linda Vail, health officer for Michigan’s Ingham County, has received emails and letters at her home saying she’d be “taken down like the governor,” which Vail took to be a reference to the thwarted attempt to kidnap Democratic Gov. Gretchen Whitmer. Even as other health officials are leaving, Vail is choosing to stay despite the threats.

“I can completely understand why some people, they’re just done,” she said. “There are other places to go work.”

In mid-November, Danielle Swanson, public health administrator in Republic County, Kansas, said she was planning to resign as soon as she and enough of her COVID-19-positive staff emerged from isolation. Someone threatened to go to her department with a gun because of a quarantine, and she’s received hand-delivered hate mail and calls from screaming residents.

“It’s very stressful. It’s hard on me; it’s hard on my family that I do not see,” she said. “For the longest time, I held through it thinking there’s got to be an end in sight.”

Swanson said some of her employees have told her once she goes, they probably will not stay.

As public health officials depart across the country, the question of who takes their places has plagued Dr. Oxiris Barbot, who left her job as commissioner of New York City’s health department in August amid a clash with Democratic Mayor Bill de Blasio. During the height of the pandemic, the mayor empowered the city’s hospital system to lead the fight against COVID-19, passing over her highly regarded department.

“I’m concerned about the degree to which they will have the fortitude to tell elected officials what they need to hear instead of what they want to hear,” Barbot said.

In Kentucky, 189 employees, about 1 in 10, left local health departments from March through Nov. 21, according to Sara Jo Best, public health director of the Lincoln Trail District Health Department. That comes after a decade of decline: Staff numbers fell 49% from 2009 to 2019. She said workers are exhausted and can’t catch up on the overwhelming number of contact tracing investigations, much less run COVID-19 testing, combat flu season and prepare for COVID-19 vaccinations.

And the remaining workforce is aging. According to the de Beaumont Foundation, which advocates for local public health, 42% of governmental public health workers are over age 50.

Back in Linn County, cases are rising. As of Dec. 14, 1 out of every 24 residents has tested positive.

The day after her mother was put on a ventilator, Coleman fought to hold back tears as she described the 71-year-old former health care worker with a strong work ethic.

“Of course, I could give up and throw in the towel, but I’m not there yet,” she said, adding that she will “continue to fight to prevent this happening to someone else.”

Coleman, whose mother died Sunday, has noticed more people are wearing masks these days.

But at the family hardware store, they are still not required.

This story is a collaboration between The Associated Press and KHN.

Methodology

KHN and AP counted how many state and local public health leaders have left their jobs since April 1, or who plan to leave by Dec. 31.

The analysis includes the exits of top department officials regardless of the reason. Some departments have more than one top position and some had multiple top officials leave from the same position over the course of the pandemic.

To compile the list, reporters reached out to public health associations and experts in every state and interviewed hundreds of public health employees. They also received information from the National Association of County and City Health Officials, and combed news reports and public records, such as meeting minutes and news releases.

The population served by each local health department is calculated using the Census Bureau 2019 Population Estimates based on each department’s jurisdiction.

The count of legislation came from reviewing bills in every state, prefiled bills for 2021 sessions, where available, and news reports. The bills include limits on quarantines, contact tracing, vaccine requirements and emergency executive powers.

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

BEVERLY HILLS — As the pandemic took hold and well-grooved music festivals canceled their mainstream events, Krista Selico saw an opening. She had been organizing the Helix Festival as an opportunity to give artists in the urban music community a chance to redefine the genre for themselves, as well as choose more racially diverse headliners.

The industry’s destination festivals had excluded many diverse performers and types of music, she said, adding: “Urban music is so much more than what we hear on the radio.”

Although the COVID crisis dealt a blow to entertainment events worldwide, it also gave birth to new channels of entertainment. Netflix, Fever and Secret Cinema joined forces to create the Stranger Things “drive-into experience,” an immersive drive-thru concept that leads patrons through the world of the Netflix series “Stranger Things” from the safety — and distance — of their cars. A R I Z O N A, a band signed by Atlantic Records, performed an immersive livestream concert from Nashville on Oct. 29 through mySongbird, a new live-performance streaming app. Comedian Dave Chappelle has been hosting physically distanced comedy shows and music events at Wirrig Pavilion in Yellow Springs, Ohio, since May.

And Selico’s Helix Festival seemed primed for the COVID era.

Her goal was to feature less-mainstream offerings in a protected Caribbean environment — reportedly more affordable this year because COVID-19 has greatly eaten into conventional tourism. The lineup included Noise Cans, a Bermuda-born DJ based in the U.S. known as Collas who fuses Caribbean carnival music with electronic dance, Nigerian-American Afrobeats star Davido, and contemporary R&B/hip-hop artist Ty Dolla $ign.

“It’s called Helix Festival because we’re talking about our DNA,” said Selico, a University of Southern California graduate and health care administrator in Los Angeles. The festival was scheduled for October and sales were hot, with tickets in the $1,800-$3,000 price range.

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Of course, with the pandemic spreading, Selico realized that festival patrons would see more health and safety precautions implemented. That could mean limited-capacity tickets with potentially higher price tags, suggesting that, in turn, artists and promoters would have to offer more of an experience in exchange for those sales.

At USC, Selico majored in cultural arts, with an emphasis in classical voice. She loved singing opera but felt shut out of the operatic world due to race. As a Black woman, she said, she felt pressured to fit into the limited mainstream molds Black artists are often pressed into: mainly hip-hop and R&B. She created Helix Festival to elevate and broaden the urban music menu.

Selico had been planning the luxury, urban music festival for two years before the pandemic hit. Because the festival was designed to be high-end, boasting private accommodations for attendees, she and her crew pushed forward with planning and promoting through the summer months, even as established festivals were canceling (many not offering refunds). “We’ll be on lockdown for two weeks, then two weeks turns into two months … but the ticket sales continued and no one’s asking for refunds,” she said.

Some large festivals such as Tomorrowland — a two-week-long Belgian electronic dance music festival — went fully virtual using streaming services, but Selico’s was planned for overseas, on an island — Jamaica — with a low COVID case count. And at an expansive resort — the Bahia Principe Grand in Runaway Bay — where safe outdoor enjoyment and social distancing seemed plausible.

The festival’s COVID-19 precautions were developed using the same protocols established by Jamaica’s Ministry of Tourism, Ministry of Health & Wellness (MoHW), the Jamaica Tourist Board and the Tourism Product Development Co. From intake to departure, Selico said, coronavirus precautions would be in place.

She knew she would have to orchestrate her first festival with more precautions than any prior such event and less of a fun-filled, devil-may-care attitude: “If someone gets dehydrated and passes out, we’ve got to test them for everything now,” she said.

Because of the setting, Selico reasoned that COVID-era safety adjustments wouldn’t seem onerous. Even before the pandemic, a luxury component of Helix was private beach “pods” for patrons spaced at least 6 feet apart for lounging on the beach. And “everything is digital,” she said. There would be no exchange of physical money or tickets at Helix Festival, similar to procedures restaurants across America are adopting, along with doing away with physical menus.

She put extra safeguards in place:

• Attendees would be required to submit negative COVID test results 48 hours before arrival and, in lieu of rum punch, would be greeted with temperature checks at the airport, at other transit points and before entering the festival grounds. Face masks would be required on all trips to and from the airport and resort.
• If an attendee exhibited COVID-19 symptoms, the Helix Festival site stated, they would be moved into a designated isolation room at the venue for screening by a COVID-19 Safety Point Person — an employee designated to conduct spot checks, which the Jamaican government now requires of both the hotel and festival organizers. The MoHW would be contacted and, if necessary, the attendee would be put into mandatory quarantine.
• During concerts, guests would be seated in every other seat in all open seating areas, while groups who arrive together could sit next to one another. A minimum distance of 6 feet would be maintained between patrons and performers on designated stage areas, an easy feat considering the Helix Festival’s main stage was to be set on the ocean in the middle of a small bay on the resort.
• For an even more enhanced luxury experience, and elevated social distancing, guests could purchase such upgrades as a VIP cabana for up to six people, or for $6,000 guests could rent a private catamaran — the festival’s version of box seats — for up to 10 people, docked around the floating stage.

When patrons weren’t getting their urban music palates expanded by acts on the main stage, themed events would feature visual artists, fire dancers and even a hologram light show presented by Chad Knight, a 3D designer with Nike. These activities — including any water sports — would be limited to follow social distancing requirements, the festival’s site stated.

According to the festival site, no food or beverages would be sold on festival grounds — another break from pre-COVID music festivals. Prepaid top-shelf liquor and snack boxes would be prepackaged and individually sealed before distribution at check-in. Hand-sanitizer stations would be strategically placed throughout the festival grounds, as well as touchless waste bins.

As of Dec. 10, Jamaica — the fourth-most-populous country in the Caribbean — had seen over 11,509 COVID-19 cases and 270 deaths, according to the government’s ministry of health and wellness website. Currently, travelers to Jamaica must apply for travel authorization through the Jamaica Tourist Board, including an upload of the results from a valid PCR test performed no more than seven days from their arrival date.

With the average ticket pricing starting at around $2,000 and no sure way to guarantee attendees would be permitted across the Jamaican border or quarantined, in late August Selico decided to postpone the festival until fall 2021. Tickets to the nearly sold-out event were refunded at 100%. “We’re going to add more artists. We’re going to be able to expand on this health care aspect,” Selico said.

And, since COVID-19 is likely to be around for a while, vaccine or not, she is confident she has developed the expertise to be a pandemic-friendly festival promoter. “I think this is the model for festivals going forward,” Selico said.

If clinical trials for COVID-19 vaccines aren’t expanded soon to include children, it’s unlikely that even kids in their teens will be vaccinated in time for the next school year.

The hurdle is that COVID vaccine makers are only in the early stages of testing their products on children. The Pfizer vaccine authorized for use by the Food and Drug Administration on Friday was greenlighted only for people ages 16 and up. Moderna just started trials for 12- to 17-year-olds for its vaccine, likely to be authorized later this month.

It will take months to approve use of the vaccines for middle- and high school-aged kids, and months more to test them in younger children. But some pediatricians say that concerns about the safety of the front-runner vaccines make the wait worthwhile.

Although most pediatricians believe the eventual vaccination of children will be crucial to subduing the COVID virus, they’re split on how fast to move toward that, says Dr. James Campbell, professor of pediatrics at the University of Maryland School of Medicine’s Center for Vaccine Development and Global Health. Campbell and colleagues say it’s a matter of urgency to get the vaccines tested in kids, while others want to hold off on those trials until millions of adults have been safely vaccinated.

Much of the debate centers on two issues: the degree of harm COVID-19 causes children, and the extent to which children are spreading the virus to their friends, teachers, parents and grandparents.

COVID-19’s impact on children represents a tiny fraction of the suffering and death experienced by vulnerable adults. Yet it would qualify as a pretty serious childhood disease, having caused 154 deaths and more than 7,500 hospitalizations as of Dec. 3 among people 19 and younger in the United States. Those numbers rank it as worse than a typical year of influenza, and worse than diseases like mumps or hepatitis B in children before the vaccination era.

Studies thus far show that 1%-2% of children infected with the virus end up requiring intensive care, Dr. Stanley Plotkin, professor emeritus of pediatrics at the University of Pennsylvania, told a federal panel. That’s in line with the percentage who become gravely ill as result of infections like Haemophilus influenza type B, or Hib, for which doctors have vaccinated children since the 1980s, he pointed out.

Campbell, who with colleagues has developed a plan for how to run pediatric COVID vaccine trials, points out that “in a universe where COVID mainly affected children the way it’s affecting them now, and we had potential vaccines, people would be clamoring for them.”

The evidence that teens can transmit the disease is pretty clear, and transmission has been documented in children as young as 8. Fear of spread by children has been enough to close schools, and led the American Academy of Pediatrics to demand that children be quickly included in vaccine testing.

“The longer we take to start kids in trials, the longer it will take them to get vaccinated and to break the chains of transmission,” said Dr. Yvonne Maldonado, a professor of pediatrics at Stanford University who chairs the AAP’s infectious disease committee. “If you want kids to go back to school and not have the teachers union terrified, you have to make sure they aren’t a risk.”

Other pediatricians worry that early pediatric trials could backfire. Dr. Cody Meissner, chief of pediatric infectious diseases at Tufts Medical Center and a member of the FDA’s advisory committee on vaccines, is worried that whatever causes Multisystem Inflammatory Syndrome in Children, a rare but frightening COVID-related disorder, might also be triggered, however rarely, by vaccination.

Meissner abstained from the committee’s vote Thursday that supported, by a 17-4 vote, an emergency authorization of the Pfizer vaccine for people 16 and older.

“I have trouble justifying it for children so unlikely to get the disease,” he said during debate on the measure.

But panel member Dr. Ofer Levy, director of the Precision Vaccines Program at Boston Children’s Hospital, said the 16-and-up authorization would speed the vaccine’s testing in and approval for younger children. That is vital for the world’s protection from COVID-19, he said, since in the United States and most places “most vaccines are delivered early in life.”

While vaccines given to tens of thousands of people so far appear to be safe, the lack of understanding of the inflammatory syndrome means that children in any trials should be followed closely, said Dr. Emily Erbelding, director of the Division of Microbiology and Infectious Diseases at the National Institute of Allergy and Infectious Diseases.

Under a 2003 law, vaccine companies are required eventually to test all their products on children. By late last month, Pfizer had vaccinated approximately 100 children 12-15 years of age, said spokesperson Jerica Pitts.

Moderna has started enrolling 3,000 children 12 and over in another clinical trial, and other companies have similar plans. Assuming the trials show the vaccines are safe and provide a good immune response, future tests could include progressively younger children, moving to, say, 6- to 12-year-olds next, then 2- to 6-year-olds. Eventually, trials could include younger toddlers and infants.

Similar stepdown approaches were taken to test vaccines against human papillomavirus (HPV), influenza and other diseases in the past, Erbelding noted. Such trials are easiest to conduct when researchers know that a measurable immune response, like antibody levels in the blood, translates to effective protection against disease. Armed with such knowledge, they can see whether children were protected without them having to be exposed to the virus. Federal scientists hope to get that data from the Moderna and Pfizer adult vaccine trials, she said.

Vaccine trials geared to tweens or younger children may involve testing half-doses, which, if protective, would require less vaccine and might cause fewer incidents of sore arms and fevers that afflicted many who’ve received the Pfizer and Moderna vaccines, Campbell said.

But unless additional studies begin quickly, the window for having an FDA-authorized vaccine available before the next school year “will be closed even for our oldest children,” said Dr. Evan Anderson, a pediatrics professor at Emory University. “Our younger children are almost certainly going into next school year without a vaccine option available for them.”

In the meantime, teachers are likely to be high on the priority list for vaccination. Protecting school staff could allow more schools to reopen even if most children can’t be vaccinated, Erbelding said.

Eventually, if the SARS-CoV-2 virus remains in circulation, governments may want to mandate childhood vaccination against the virus to protect them as they grow up and protect society as a whole, Plotkin said.

In the 1960s, Plotkin invented the rubella vaccine that has been given to hundreds of millions of children since. Like COVID-19, rubella, or German measles, is not usually a serious illness for children. But congenital rubella syndrome afflicted babies in the womb with blindness, deafness, developmental delays and autism. Immunizing toddlers, which, in turn, protects their pregnant mothers, has indirectly prevented hundreds of thousands of such cases.

“We don’t want to use children to protect everyone in the community,” said Campbell. “But when you can protect both children and their community, that’s important.”

And while a coronavirus infection may not be bad for most children, missed school, absent friends and distanced families have caused them immense suffering, he said.

“It’s a huge burden on a child to have their entire world flipped around,” Campbell said. “If vaccinating could help to flip it back, we should begin testing to see if that’s possible.”

Tisha Coleman ha vivido en el muy unido condado de Linn, Kansas, por 42 años. Y nunca se ha sentido tan sola.

Como administradora de salud pública, ha luchado cada día de la pandemia para mantener a salvo a su condado rural, ubicado a lo largo de la frontera con Missouri. A cambio, ha sido acosada, demandada, vilipendiada y le han gritado “cumple-órdenes”.

Los meses de peleas por máscaras y cuarentenas ya la estaban desgastando. Luego contrajo COVID-19, probablemente de su esposo, quien se ha negado a exigir el uso de máscaras en la ferretería familiar. Su madre también lo contrajo y murió el domingo 13 de diciembre.

En todo Estados Unidos, funcionarios de salud pública estatales y locales se han encontrado en el centro de una tormenta política.

Algunos han sido el blanco de activistas de extrema derecha, grupos conservadores y extremistas antivacunas, que se han unido en torno a objetivos comunes: luchar contra los mandatos de uso de máscaras, las cuarentenas y el rastreo de contactos, con protestas, amenazas y ataques personales.

El poder de la salud pública también se está socavando en los tribunales. Legisladores, en al menos 24 estados, han diseñado leyes para debilitar poderes que la salud pública ha mantenido por mucho tiempo.

En medio de este retroceso, desde el 1 de abril, al menos 181 líderes de salud pública estatales y locales, en 38 estados, han renunciado, se han jubilado o han sido despedidos, según una investigación en curso de The Associated Press y KHN. Expertos dicen que se trata del éxodo más grande de líderes de salud pública en la historia de los Estados Unidos.

Uno de cada 8 estadounidenses, 40 millones de personas, vive en una comunidad que perdió a su líder de salud pública local durante la pandemia. En 20 estados, los principales funcionarios de salud pública han dejado sus puestos, y también se ha ido un número incalculable de empleados de niveles inferiores.

Muchos de los líderes se retiraron debido al retroceso político o la presión de la pandemia. Algunos se fueron para ocupar puestos de más alto perfil o por problemas de salud. Otros fueron despedidos por mal desempeño. Docenas se jubilaron.

“No tenemos gente haciendo fila afuera para cubrir estos puestos”, dijo el doctor Gianfranco Pezzino, oficial de salud en el condado de Shawnee, Kansas, quien había decidido jubilarse a fines de año, porque, dijo, ha llegado a su límite. “Es una gran pérdida que es probable que impacte en las  generaciones futuras”.

Pero Pezzino no llegó al 31 de diciembre. El lunes 14, luego que los comisionados del condado aliviaran las restricciones, renunció inmediatamente.

Estas partidas son una erosión adicional a la ya frágil infraestructura de salud pública del país, antes de la campaña de vacunación más grande en la historia de los Estados Unidos.

AP y KHN informaron anteriormente que, desde 2010, el gasto per cápita de los departamentos de salud pública estatales se había reducido en un 16%, y en los departamentos de salud locales, un 18%. Al menos 38,000 empleos de salud pública estatales y locales han desaparecido desde la recesión de 2008.

Desde que comenzó la pandemia, la fuerza laboral de salud pública en Kansas se ha visto muy afectada: 17 de los 100 departamentos de salud del estado han estado perdiendo a sus líderes desde finales de marzo.

La gobernadora demócrata Laura Kelly emitió un mandato de uso de máscaras en julio, pero la legislatura estatal permitió que los condados optaran por no participar. Un informe reciente de los Centros para el Control y Prevención de Enfermedades (CDC) mostró que los 24 condados de Kansas que habían cumplido con este mandato registraron una disminución del 6% en los casos de COVID-19, mientras que los 81 condados que optaron por no participar por completo vieron un aumento del 100%.

Coleman presionó para que el condado de Linn mantuviera la regla, pero los comisionados escribieron que las máscaras “no son necesarias para proteger la salud pública y la seguridad del condado”.

Coleman se sintió decepcionada, pero no sorprendida. “Al menos sé que he hecho todo lo posible para intentar proteger a la gente”, dijo.

En Boise, Idaho, el 8 de diciembre, cientos de manifestantes, algunos armados, invadieron las oficinas de salud del distrito y las casas de los miembros de la junta de salud, gritando y haciendo sonar las bocinas. Entre ellos había miembros del grupo anti-vacunas Health Freedom Idaho.

Según expertos, el movimiento contra las vacunas se ha vinculado con extremistas políticos de derecha, y ha asumido un papel más amplio en contra de la ciencia, rechazando otras medidas de salud pública.

Ahora, los opositores están recurriendo a las legislaturas estatales, e incluso a la Corte Suprema, para despojar a los funcionarios públicos del poder legal que han tenido durante décadas para detener las enfermedades transmitidas por alimentos y las enfermedades infecciosas mediante el cierre de negocios y las cuarentenas, entre otras medidas.

Legisladores de Missouri, Louisiana, Ohio, Virginia y al menos otros 20 estados han elaborado proyectos de ley para limitar los poderes de la salud pública. En algunos estados, estos esfuerzos han fracasado; en otros, los han acogido con entusiasmo.

Mientras tanto, los gobernadores de varios estados, incluidos Wisconsin, Kansas y Michigan, han sido demandados por sus propios legisladores, u otros, por utilizar sus poderes ejecutivos para restringir las operaciones comerciales y exigir máscaras.

En Ohio, un grupo de legisladores busca procesar al gobernador republicano Mike DeWine por sus reglas sobre la pandemia.

Un fallo de 5-4 el mes pasado indicó que la Corte Suprema también está dispuesta a imponer nuevas restricciones a los poderes de la salud pública. Lawrence Gostin, experto en derecho de salud pública de la Universidad Georgetown, en Washington, DC, dijo que la decisión podría animar a legisladores estatales y a gobernadores a buscar limitaciones adicionales.

Junto con la reacción política, muchos funcionarios de salud se han enfrentado a amenazas violentas. En California, un hombre con vínculos con el movimiento de derecha Boogaloo, que está asociado con múltiples asesinatos, fue acusado de acechar y amenazar al funcionario de salud de Santa Clara. Fue arrestado y se declaró inocente.

Linda Vail, funcionaria de salud del condado de Ingham, en Michigan, recibió correos electrónicos y cartas en su casa diciendo que sería “derrocada como la gobernadora”, lo que interpretó como una referencia al intento frustrado de secuestrar a la gobernadora demócrata Gretchen Whitmer.

“Puedo entender completamente por qué algunas personas simplemente se fueron”, dijo. “Hay otros lugares para ir a trabajar”.

A medida que los funcionarios de salud pública a lo largo del país parten, la cuestión de quién ocupa sus lugares preocupa a la doctora Oxiris Barbot, quien dejó su trabajo como comisionada del departamento de salud de la ciudad de Nueva York en agosto en medio de un enfrentamiento con el alcalde demócrata Bill de Blasio.

“Me preocupa si tendrán la fortaleza necesaria para decirles a los funcionarios electos lo que necesitan escuchar en lugar de lo que quieren escuchar”, dijo Barbot.

En el condado de Linn, los casos están aumentando. Hasta el 14 de diciembre, 1 de cada 24 residentes había dado positivo para COVID.

“Por supuesto, podría rendirme y colgar la toalla, pero todavía no he llegado a ese punto”, dijo Coleman.

Ha notado que más personas usan máscaras en estos días.

Pero en la ferretería familiar, todavía no son mandatorias.

Michelle R. Smith es reportera de AP, y Anna Maria Barry-Jester, Hannah Recht y Lauren Weber son reporteras de KHN.

Esta historia es una colaboración entre The Associated Press y KHN (Kaiser Health News), un servicio de noticias sin fines de lucro que cubre temas de salud. Es un programa editorialmente independiente de KFF (Kaiser Family Foundation) que no tiene relación con Kaiser Permanente.

Esta historia fue producida por Kaiser Health News, un programa editorial independiente de la 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).

This story also ran on The Guardian. It can be republished for free.

As a boy, Robert Weber chased the blazing lights and roaring sirens of fire engines down the streets of Brooklyn, New York.

He hung out at the Engine 247 firehouse, eating ham heroes with extra mayonnaise, and “learning everything about everything to be the best firefighter in the world,” said his wife, Daniellle Weber, who grew up next door.

They married in their 20s and settled in Port Monmouth, New Jersey, where Weber joined the ranks of the more than 1 million firefighters America calls upon when stovetops, factory floors and forest canopies burst into flames.

Weber was ready for any emergency, his wife said. Then COVID-19 swept through.

Firefighters like Weber are often the first on the scene following a 911 call. Many are trained as emergency medical technicians and paramedics, responsible for stabilizing and transporting those in distress to the hospital. But with the pandemic, even those not medically trained are suddenly at high risk of coronavirus infection.

Firefighters have not been commonly counted among the ranks of front-line health care workers getting infected on the job. KHN and The Guardian are investigating 1,500 such deaths in the pandemic, including nearly 100 firefighters.

In normal times, firefighters respond to 36 million medical calls a year nationally, according to Gary Ludwig, president of the International Association of Fire Chiefs. That role has only grown in 2020. “These days, we pump more oxygen than water,” Ludwig said.

In mid-March, Weber told his wife he noticed a new pattern in the emergency calls: people with sky-high temperatures, burning lungs and searing leg pain.

Within a week, Weber’s fever ignited, too.

‘This Job Isn’t Just Meatball Subs and Football Anymore’

Snohomish County, Washington — just north of Seattle — reported the first confirmed U.S. COVID case on Jan. 20. Within days, area fire departments “went straight into high gear,” Lt. Brian Wallace said.

Within weeks, the Seattle paramedic said, his crew had responded to scores of COVID emergencies. In the ensuing months, the crew stood up the city’s testing sites “out of thin air,” Wallace said. Since June, teams of firefighters have performed over 125,000 tests, a critical service in a city where over 25,000 residents had tested positive as of late October.

Wallace calls his team a “public health workforce that’s stepped up.”

Firefighters elsewhere did, too. In Phoenix’s Maricopa County, which is still notching new peaks in COVID cases, firefighters each shift receive dozens of emergency calls for symptoms related to the virus. Since March, firefighters have registered over 3,000 known exposures — but “that’s just the tip of the iceberg,” said Capt. Scott Douglas, the Phoenix Fire Department’s public information officer, “this job isn’t just meatball subs and football anymore.”

In Washington, D.C. — with over 24,000 COVID cases tallied since March — firefighters have been exposed in at least 3,000 incidents, said Dr. Robert Holman, medical director of the city’s fire department.

They’ve helped in other ways, too: Firefighters like Oluwafunmike Omasere, who serves in the city’s poverty-stricken Anacostia neighborhood, have bridged “all the other social gaps that are killing people.” They’ve fed people, distributed clothes and offered public health education about the virus.

“If it weren’t for us,” Omasere said, “I’m not sure who’d be there for these communities.”

‘We’re Going In Completely Unarmed’

For the more than 200 million Americans living in rural areas, one fire engine might cover miles and miles of land.

Case in point: the miles surrounding Dakota City, Nebraska. That’s steak country, home to one of the country’s largest meat processing plants, owned by Tyson Foods. And it’s on Patrick Moore, the town’s first assistant fire chief, to ensure the plant’s 4,300 employees and their neighbors stay safe. The firehouse has a proud history, including in 1929 buying the town’s first motorcar: a flame-red Model A.

“We made a promise to this community that we’d take care of them,” Moore said. COVID-19 has tested that promise. By the time 669 employees tested positive at Tyson’s plant on April 30, calls to the firehouse had quadrupled, coming from all corners of its 70-square-mile jurisdiction. “It all snowballed, so bad, so fast,” Moore said.

Resources of all kinds — linens, masks, sanitizer — evaporated in Dakota City. “We’ve been on our own,” Moore said.

Ludwig, of IAFC, said firefighters have ranked low on the priority list for emergency equipment shipped from the Strategic National Stockpile. As stand-ins for “the real stuff,” firehouses have cobbled together ponchos, raincoats and bandannas. “But we all know these don’t do a damn thing,” he said.

In May, Ludwig sent a letter to Congress requesting additional emergency funding, resources and testing to support the efforts of firehouses. He’s been lobbying in D.C. ever since. Months later, the efforts haven’t amounted to much.

“We’re at the tip of the spear, yet we’re going in completely unarmed,” Ludwig said. It’s been “disastrous.”

As of Dec. 9, more than 29,000 of the International Association of Fire Fighters’ 320,000 members had been exposed to the COVID virus on the job. Many were unable to get tested, said Tim Burn, the union’s press secretary. Of those who did, 3,812 tested positive; 21 have died.

Moore, in Dakota City, got it from a man found unconscious in his bathtub. The patient’s son told the crew he was “clean.” Yet three days later, Moore got a call: The man had tested positive.

Within days, Moore’s energy level sunk “somewhere between nothing and zero.” He was hospitalized in early June, recovered and was back on emergency calls by Independence Day. He couldn’t stand for long, so he took on the role of driver. Moore said he’s still not at full strength.

As the virus has pummeled the Great Plains, calls to Moore’s department are up nearly 70% since September. Only a handful of his guys are still making ambulance runs, and most have gotten sick themselves. “We’re holding down the fort,” he said, “but it ain’t easy.”

For the first time in my life, I questioned my career choice.

Chief Peter DiMaria

It’s the same story inside firehouses across the nation. In Idaho’s Sun Valley, Chief Taan Robrahn — and one-fifth of his company — contracted COVID after a ski convention. In New Orleans, Aaron Mischler, associate president of the city’s firefighter union, got it during Mardi Gras — as did 10% of the force. In Naples, Florida, almost 25% of Chief Peter DiMaria’s members got it. And in D.C., Houston and Phoenix collectively, over 500 firefighters tested positive — while an additional 3,500 were forced into quarantine.

Quarantining, of course, can put loved ones at risk too: Robrahn’s wife and their three-year-old twins got it. “Mercifully,” Robrahn said, the family recovered.

DiMaria, whose 18-year-old has a heart defect, has been spared so far. But after Big Tony, a close colleague under his command, died of COVID-19 — and after spending months resuscitating people with heart attacks and respiratory distress induced by the virus — he’s as concerned as ever.

“For the first time in my life,” DiMaria said, “I questioned my career choice.”

‘It Weighs Heavy’

The distress of these emergency calls resounds in gasps, wailing, tears.

Some departments — including Houston and Dakota City — have taken on another burden: removing the bodies of those killed by the virus. “You can’t unsee this stuff,” said Samuel Peña, chief of Houston’s department, “the emotional toll, it weighs heavy on all of us.”

Into winter, firefighters have endured a second surge. “We’re battle-weary,” Peña said, “but there’s no end in sight.”

Meanwhile, Mischler said, tax revenue is plummeting, forcing budget cuts, layoffs and hiring freezes, “at the very moment we need the reinforcements more than ever.” And in the volunteer departments, which constitute 67% of the national fire workforce, recruitment pipelines are running dry.

So people like Robert Weber filled the gaps on nights and weekends, which for the New Jersey firefighter proved disastrous.

On March 26, the day after his fever rose, Weber was hospitalized. His was an up-and-down course. On April 15, his wife got a call: Come immediately, the doctor said.

Weber died before she pulled into the hospital parking lot.

This story is part of “Lost on the Frontline,” an ongoing project from The Guardian and Kaiser Health News that aims to document the lives of health care workers in the U.S. who die from COVID-19, and to investigate why so many are victims of the disease. 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.

In the final weeks before the Nov. 3 election, supporters of a down-in-the-weeds effort to overturn a tax law in Colorado received a cascade of big checks, for a grand total of more than $2 million.

All came from Kent Thiry, the former CEO of DaVita, one of the largest kidney care companies in the country. This was not the first time he donated big to a ballot initiative aimed at tweaking the nitty-gritty details of how Colorado functions. Nor will it be the last.

Thiry has given at least $5.9 million to Colorado ballot measures since 2011 — and all of them won, according to a KHN review of Colorado campaign finance data. According to data from the National Institute on Money in Politics, Thiry’s donations to ballot measures in that state are second only to those of billionaire Pat Stryker. Campaign finance records show that before that, he gave to ballot issue committees in California, where he used to live, dating to at least 2007.

[khn_slabs slabs=”241887″ view=”inline” /]

It’s the same playbook his former company has successfully used in California. As KHN has reported, in 2018 DaVita was among several companies to break an industry record in campaign spending for a ballot measure by any one side in California. This year, the industry came close to breaking that record to defeat a measure that would have further regulated dialysis clinics and that DaVita said would have limited access to care.

Ballot initiatives, which are allowed in about half the states, enable individuals and groups to circumvent legislatures and ask voters to decide on a law. And in many states, the campaigns for and against them are bankrolled by the rich: either corporations fighting to preserve their profits or multimillionaires with a political shopping list.

“I prefer things that have systemic impact,” says Thiry. Measures that he has bankrolled have eliminated the caucus system for presidential primaries, brought unaffiliated voters into the primaries and created a new system intended to eliminate gerrymandering. “Democracy is not a spectator sport.” (Rachel Woolf for KHN)

“Wealthy individuals have been pouring money into ballot measures, even seemingly unrelated to their industry, for over a century,” Daniel Smith, a political scientist studying direct democracy at the University of Florida, wrote in an email to KHN.

Given that health care is a $3.6 trillion industry, its top executives are among the ranks of those who can have an enormous impact in ballot measure politics. This year, Kent Thiry and Mike Fernandez, chairman and CEO of private equity firm MBF Healthcare Partners, were among the 19 individuals or couples who spent $1 million or more on ballot issue campaigns this year, according to Bloomberg. In previous elections, medical equipment company owner Loren Parks has also given big money to ballot initiatives.

Overall, those in the health industry have spent more on ballot measures in Colorado than in any other state except Missouri and California, according to data from the National Institute on Money in Politics, and that’s largely due to Thiry.

“He really has become the 800-pound gorilla of the ballot initiative process in Colorado,” said Josh Penry, a Republican campaign strategist in Denver who has worked with Thiry, including on a ballot measure campaign Thiry helped fund. “He wields more power in an informal way than virtually all the elected officials, if you look at the impact he’s had.”

Even though Thiry and his wife, Denise O’Leary, a former venture capitalist on the board of directors of medical device company Medtronic, have made hefty earnings from health care, Thiry’s ballot initiative donations as an individual have nothing to do with the industry.

“I prefer things that have systemic impact,” said Thiry. Measures he has bankrolled have eliminated the caucus system for presidential primaries, brought unaffiliated voters into the primaries and created a system intended to eliminate gerrymandering.

“Democracy is not a spectator sport,” he said.

Thiry previously donated to ballot measure committees in California, to prevent changes to term limits and to create a system for redistricting led jointly by Democrats, Republicans and citizens unaffiliated with a political party.

After moving his company’s headquarters from Los Angeles to Denver in 2010, he began backing ballot measures in his new state, too, with equal success and bigger sums, jumping from the tens of thousands to the millions. He spent more than $2 million backing a pair of measures to allow unaffiliated voters to participate in primaries.

In 2018, while his company was helping break an election spending record to defeat a California measure that would have capped the industry’s profits, Thiry was putting more than $1.2 million toward redistricting efforts in Colorado very similar to the one he backed in his previous home state to help reduce gerrymandering.

His latest donations went to a measure that successfully overturned a tax law from the 1980s that may have helped Colorado homeowners, but which critics said left public services like education and fire districts underfunded in some rural areas.

Thiry doesn’t just shell out cash. As the online newspaper The Colorado Independent has pointed out, Thiry’s offices played a large role in bringing two warring groups with different ideas about redistricting to the same table. His efforts tend to revolve around raising the power of unaffiliated voters, who make up about 40% of Colorado’s active voters, according to state data.

Fernandez, the private equity billionaire, said he has similar motivations. He donated $7.3 million to a Florida initiative to change how primaries work in that state and bring unaffiliated voters like himself into the fold.

“I’ve never spent so much money [on] something that I have no business reason to be in at all,” he said.

The effort was, he said, nearly “a one-man show” in terms of financing. But it still failed, garnering 57% of votes when it needed 60% to pass. Fernandez said he’ll try again in 2022.

“I come from a country where you can see that control of a government by a single party is deadly,” said Fernandez, who was born in Cuba. “Florida has been controlled by the Republican Party for the last three decades. And when I was a Republican, that was great.”

But, he said, it quickly became clear that bringing the issue to legislators was a dead end. That’s expected, according to John Matsusaka, executive director of the Initiative and Referendum Institute at the University of Southern California. Ballot initiatives are a natural route to tweak electoral machinery, he said, because legislators have a conflict of interest on issues like gerrymandering and term limits.

In fact, Matsusaka thinks the U.S. could use national ballot initiatives, which other democracies have, as a route to restoring confidence in the federal government.

“I don’t look at ballot propositions as a way to drive a progressive agenda or conservative agenda or any sort of agenda,” he said. “I view it as a way to put the people in control. And they can go where they want to go.”

Even if that means eroding their own power a little. One of the first initiatives Thiry donated to in Colorado is something Matsusaka considers “anti-democracy” — an effort called Raise the Bar, a ballot initiative about ballot initiatives. It required petitioners to get signatures from every corner of the state to put an initiative on the ballot. Some view this as problematic.

Thiry says he’s getting more involved in Unite America, an effort to break what’s been called the “doom loop” of partisanship. (Rachel Woolf for KHN)

“You have to now collect signatures in every senate district of Colorado,” said Corrine Rivera Fowler, director of policy and legal advocacy with the Ballot Initiative Strategy Center, a national organization that supports progressive ballot initiatives. “That’s a tremendous undertaking for grassroots communities.”

Thiry, meanwhile, intends to take what he’s learned in Colorado and apply it elsewhere. He said he’s getting more involved in several national democracy reform groups, including Unite America, an effort to break what’s been called the “doom loop” of partisanship. Thiry said he hopes to help create “a tidal tsunami of political momentum.”

“One of my goals is to have this democracy reform energy in places like Colorado — or elsewhere — move from being an ad hoc collection of activist projects to a true movement,” he said. “Kind of like the civil rights movement, kind of like the gay marriage movement, and like the #MeToo movement or Black Lives Matter.”

He no longer works for DaVita, after stepping down as executive chairman earlier this year.

“I have no title anymore. Just ‘citizen.’ It’s a title I wear with great pride and energy,” he said.

As for the next measure Thiry will back, he’s open to recommendations.

This story also ran on NBC News. It can be republished for free.

If there’s such a thing as a date with destiny, it’s marked on Dr. Taison Bell’s calendar.

At noon Tuesday, Bell, a critical care physician, is scheduled to be one of the first health care workers at the University of Virginia Health System to roll up his sleeve for a shot to ward off the coronavirus.

“This is a long time coming,” said Bell, 37, who signed up via hospital email last week. “The story of this crisis is that each week feels like a year. This is really the first time that there’s genuine hope that we can turn the corner on this.”

For now, that hope is limited to a chosen few. Bell provides direct care to some of the sickest COVID-19 patients at the UVA Health hospital in Charlottesville, Virginia. But he is among some 12,000 “patient-facing” workers at his hospital who could be eligible for about 3,000 early doses of vaccine, said Dr. Costi Sifri, director of hospital epidemiology.

“We’re trying to come up with the highest-risk categories, those who really spend a significant amount of time taking care of patients,” Sifri said. “It doesn’t account for everybody.”

Even as the federal Food and Drug Administration engaged in intense deliberations ahead of Friday’s authorization of the Pfizer and BioNTech COVID vaccine, and days before the initial 6.4 million doses were to be released, hospitals across the country have been grappling with how to distribute the first scarce shots.

An advisory committee of the Centers for Disease Control and Prevention has recommended that top priority go to long-term care facilities and front-line health care workers, but the early allocation was always expected to fall far short of the need and require selective screening even among critical hospital workers.

Hospitals in general are advised to target the members of their workforce at highest risk, but the institutions are left on their own to decide exactly who that will be, Colin Milligan, a spokesperson for the American Hospital Association, said in an email.

“It is clear that the hospitals will not receive enough in the first weeks to vaccinate everyone on their staff, so decisions had to be made,” Milligan wrote.

At Intermountain Healthcare in Salt Lake City, the first shots will go to staff members “with the highest risk of contact with COVID-positive patients or their waste,” said Dr. Kristin Dascomb, medical director of infection prevention and employee health. Within that group, managers will determine which caregivers are first in line.

At UW Medicine in Seattle, which includes Harborview Medical Center, one early plan called for high-risk staff to be selected randomly to receive first doses, said Dr. Shireesha Dhanireddy, medical director of the infectious disease clinic. But the University of Washington hospital system expects to receive enough doses to vaccinate everyone in that high-risk tier within two weeks, so randomization isn’t necessary — for now.

“We are allowing people to schedule themselves,” Dhanireddy said, and encouraging staffers to be vaccinated near the end of their workweeks in case they have reactions to the new vaccine.

Trial results have shown the shots frequently produce side effects that, while not debilitating, could cause symptoms such as fever, muscle aches or fatigue that might keep someone home for a day or two.

“We want to make sure that not everybody has the vaccine on the same day so that if there are some side effects, we don’t end up being short-staffed,” said Sifri, of UVA Health, noting that guidelines call for no more than 25% of any unit to be vaccinated at once.

At UVA Health, once the initial 3,000 doses are distributed, the hospital plans to rely on what Sifri described as “a very strong honor code” to allow staff members to decide where they should be in line. They’ve been asked to consider professional factors, like the type of work they do, as well as personal risks, such as age or underlying conditions like diabetes.

“We’re going to ask team members, using the honor code, to determine what their risk is for COVID and to determine whether they need to have an early vaccine sign-up time or a later vaccine sign-up time,” he said.

That plan was chosen after health care staff members soundly rejected other options. For instance, few favored a proposal to allocate dosages via a lottery, like the chaotic birthday-based system depicted in the 2011 pandemic horror film “Contagion.” “That was the biggest loser,” he said.

Hospital officials also stressed they are trying to devise distribution plans that ensure vaccines are allocated equitably among health care workers, including the social, racial and ethnic groups that have been disproportionately harmed by COVID-19 infections. That requires thinking beyond front-line doctors and nurses.

At UVA Health, for example, one of the first groups invited to get shots will be 17 workers whose job is to clean rooms in the special pathogens unit where severe COVID cases are treated.

“We acknowledge that everybody is at risk for COVID, everybody is deserving of a vaccine,” Sifri said.

In many cases, it will be clear who should go first. For instance, although Dhanireddy is an infectious disease doctor who consults on COVID cases, she is happy to wait to be vaccinated. “I wouldn’t put myself in the first group at all,” she said. “I think that we need to protect our staff that are really right there with them most of the day — and that’s not me.”

But hospitals must remain vigilant about relying on workers to prioritize their own access, Dhanireddy cautioned. “Sometimes, self-selection works more for self-advocacy,” she said. “It’s great that some individuals say they would defer to others, but sometimes that’s not actually the case.”

For some health care workers, not being first in line for vaccination is fine. Because the vaccine initially has been authorized only for emergency use, hospitals won’t require employees to be inoculated as part of this first round. Between 70% and 75% of health care staff at UVA Health and Intermountain Health would accept a COVID vaccine, internal surveys showed. The rest are unsure — or unwilling.

“There are some that will be immediate acceptors and some who will want to watch and wait,” Dascomb said.

Still, hospital officials say they’re confident that those who want the vaccine won’t have to wait long. Enough doses for roughly 21 million health care personnel should be available by early January, according to CDC officials.

Bell, the critical care doctor, said he’s grateful to be among the first to receive the vaccine, especially after his parents, who live in Boston, both contracted COVID-19. He has posted about his upcoming appointment on Twitter and said he and other health care workers who are among the first in line should be public about the process.

“We’ll serve as an example that this is a safe and effective vaccine,” he said. “We’re letting it go into our bodies. You should let it go into yours, too.”

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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Si existe una cita con el destino, está escrita en el calendario del doctor Taison Bell.

Al mediodía del martes 15 de diciembre, Bell, especialista en cuidados intensivos del Sistema de Salud de la Universidad de Virginia será uno de los primeros en arremangarse para recibir la vacuna que lo protegerá del coronavirus.

Bell, de 37 años, se inscribió la semana pasada a través del correo electrónico del hospital para recibir la vacuna. “La historia de esta crisis es que cada semana se siente como un año. Esta es realmente la primera vez que hay una esperanza genuina de que podemos revertir esta situación”.

Por ahora, esa esperanza se limita a unos pocos elegidos. Bell atiende a algunos de los pacientes con COVID-19 más enfermos en el hospital UVA Health en Charlottesville, Virginia.

Bell es uno de los 12,000 trabajadores del hospital “que trabajan directo con estos pacientes”, que podrían ser elegibles para unas 3,000 primeras dosis de vacunas, dijo el doctor Costi Sifri, director de epidemiología del hospital.

“Estamos tratando de encontrar las categorías de mayor riesgo, aquellas que realmente pasan una cantidad significativa de tiempo cuidando a los pacientes”, dijo Sifri. “No se tiene en cuenta a todo el mundo”.

Incluso cuando la Administración de Alimentos y Medicamentos (FDA) participaba en intensas deliberaciones antes de la autorización del viernes de la vacuna contra COVID de Pfizer y BioNTech, y días antes de que se liberaran las 6.4 millones de dosis iniciales, los hospitales de todo el país ya estaban planeando cómo distribuir la primeras, y escasas, dosis.

Un comité asesor de los Centros para el Control y Prevención de Enfermedades (CDC) recomendó que la máxima prioridad sea para los hogares de adultos mayores de atención a largo plazo y para los trabajadores de atención médica de primera línea.

Pero se sabía que la primera tanda de vacunas no iba a cubrir toda la necesidad y que se iba a tener que hacer un proceso más selectivo, incluso entre los trabajadores críticos del hospital.

En general, se aconseja a los hospitales que cubran a los miembros de su fuerza laboral con mayor riesgo, pero las instituciones deben decidir exactamente quiénes serán, dijo Colin Milligan, vocero de la Asociación Estadounidense de Hospitales, en un correo electrónico.

“Está claro que los hospitales no recibirán lo suficiente en las primeras semanas para vacunar a todos los miembros de su personal, por lo que hubo que tomar decisiones”, escribió Milligan.

En Intermountain Healthcare, en Salt Lake City, Utah, las primeras inyecciones serán para los miembros del personal “con el mayor riesgo de contacto con pacientes COVID positivos o sus desechos”, dijo la doctora Kristin Dascomb, directora médica de prevención de infecciones y salud del personal. Dentro de ese grupo, los gerentes determinarán qué cuidadores son los primeros en la fila.

En la UW Medicine, en Seattle, Washington, que incluye el Harborview Medical Center, un plan temprano requería que el personal de alto riesgo fuera seleccionado al azar para recibir las primeras dosis, dijo la doctora Shireesha Dhanireddy, directora médica de la clínica de enfermedades infecciosas.

Pero el sistema hospitalario de la Universidad de Washington espera recibir dosis suficientes para vacunar a todas las personas en ese nivel de alto riesgo dentro de dos semanas, por lo que la selección aleatoria no ha sido necesaria por ahora.

“Permitimos que las mismas personas programen la cita”, dijo Dhanireddy, y alentamos al personal a vacunarse cerca del final de sus semanas laborales en caso de que tengan reacciones a la nueva vacuna.

Los resultados de los ensayos han demostrado que las inyecciones con frecuencia producen efectos secundarios que, aunque no debilitantes, podrían causar síntomas como fiebre, dolores musculares o fatiga que podrían mantener a alguien en casa por uno o dos días.

“Queremos asegurarnos de que no todo el mundo reciba la vacuna el mismo día para que, si hay algunos efectos secundarios, no acabemos quedando cortos de personal”, dijo Sifri, de UVA Health, y señaló que las directrices exigen que no más del 25% de cualquier unidad se vacune a la vez.

En UVA Health, una vez que se distribuyan las 3,000 dosis iniciales, el hospital planea confiar en lo que Sifri describió como “un código de honor muy estricto” para permitir que los miembros del personal decidan qué lugar ocupar en la fila. Se les ha pedido que consideren factores profesionales, como el tipo de trabajo que realizan, así como riesgos personales: la edad o afecciones subyacentes como la diabetes.

“Vamos a pedirles a los miembros del equipo, utilizando el código de honor, que determinen cuál es su riesgo de COVID y si necesitan tener una cita temprana para la vacuna o una fecha posterior”, explicó.

Se elaboró este plan después que el personal de atención médica rechazara rotundamente otras opciones. Por ejemplo, pocos favorecieron una propuesta para asignar dosis a través de una lotería, como el caótico sistema basado en la fecha de cumpleaños de la película “Contagion”, sobre una horrible pandemia.

Funcionarios del hospital también enfatizaron que están tratando de diseñar planes de distribución que garanticen que las vacunas se asignen de manera equitativa entre los trabajadores de salud, incluidos los grupos sociales, raciales y étnicos que han sido perjudicados de manera desproporcionada por COVID-19. Eso requiere pensar más allá de los médicos y enfermeras de primera línea.

Por ejemplo, en UVA Health, uno de los primeros grupos invitados a vacunarse será el de 17 trabajadores cuya tarea es limpiar cuartos en la unidad de patógenos especiales donde se tratan los casos graves de COVID.

“Reconocemos que todo el mundo está en riesgo de contraer COVID, todo el mundo merece una vacuna”, dijo Sifri.

En muchos casos, quedará claro quién debe ir primero. Por ejemplo, aunque Dhanireddy es doctora especialista en enfermedades infecciosas que consulta sobre casos de COVID, está feliz de esperar. “No me pondría en el primer grupo en absoluto”, dijo. “Creo que tenemos que proteger a nuestro personal que realmente está ahí con ellos la mayor parte del día, y esa no soy yo”.

Para algunos trabajadores de salud, no ser el primero en la fila para la vacunación está bien. Debido a que la vacuna inicialmente fue autorizada solo para uso de emergencia, los hospitales no requerirán que los empleados sean vacunados como parte de esta primera ronda. Entre el 70% y el 75% del personal de atención médica de UVA Health e Intermountain Health aceptaría una vacuna COVID, mostraron encuestas internas. El resto no está seguro o no está dispuesto.

“Hay algunos que aceptarán de inmediato y otros querrán observar y esperar”, dijo Dascomb.

Aún así, autoridades del hospital dicen que confían en que aquellos que quieran la vacuna no tengan que esperar mucho. Dosis suficientes para aproximadamente 21 millones del personal de atención médica deberían estar disponibles a principios de enero, según funcionarios de los CDC.

Bell, el médico de cuidados intensivos, dijo que está agradecido de estar entre los primeros en recibir la vacuna, especialmente después que sus padres, que viven en Boston, contrajeran COVID-19. Publicó sobre su próxima cita en Twitter y dijo que otros trabajadores de salud que se encuentran entre los primeros en la fila deberían hacer público el proceso.

“Serviremos como ejemplo de que esta es una vacuna segura y eficaz”, dijo. “La estamos dejando entrar en nuestros cuerpos. Deberías dejar que entre en el tuyo también”.

Esta historia fue producida por Kaiser Health News, un programa editorial independiente de la 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).

Back in early January, before COVID-19 was as familiar as the furniture, I went in for my annual physical. My doctor looked at my test results and shook his head. Virtually everything was perfect. My cholesterol was down. So was my weight. My blood pressure was that of a swimmer. A barrage of blood tests turned up zero red flags.

“What are you doing differently?” he asked, almost dumbfounded.

After all, I’m a 67-year-old balding guy who had spent much of his life as a desk-bound journalist dealing with nasty ailments like hernias (in my 30s), kidney stones (40s) and shingles (50s).

I ruminated over what had changed since my last physical. Sure, I exercise more than 90 minutes daily, but I’ve been doing that for five years. And yes, I watch what I eat, but that’s not new. Like most families with college-age kids, mine has its share of emotional and financial stresses — and there’d been no let-up there.

Only one thing in my life had registered any real change. “I’m volunteering more,” I told him.

I’d been spending less time in my basement office and more time out doing some good with like-minded people. Was this the magic elixir that seemed to steadily improve my health?

All signs pointed to “yes.” And I was feeling great about it.

Then just as I realized how important volunteering is to my health and well-being, the novel coronavirus appeared. As cases climbed, society shut down. One by one, my beloved volunteer gigs in Virginia disappeared. No more Mondays at Riverbend Park in Great Falls helping folks decide which trails to walk. Or Wednesdays serving lunch to the homeless at a community shelter in Falls Church. Or Fridays at the Arlington Food Assistance Center, which I gave up out of an abundance of caution. My modest asthma is just the sort of underlying condition that seems to make COVID-19 all the more brutal.

It used to be that missing even one day of volunteering made me feel like a sourpuss. After almost eight months without it, I’m downright dour.

Science helps explain why.

“The health benefits for older volunteers are mind-blowing,” said Paul Irving, chairman of the Center for the Future of Aging at the Milken Institute, and distinguished scholar in residence at the USC Leonard Davis School of Gerontology, whose lectures, books and podcasts on aging are turning heads.

When older folks go in for physicals, he said, “in addition to taking blood and doing all the other things that the doctor does when he or she pushes and prods and pokes, the doctor should say to you, ‘So, tell me about your volunteering.’”

A 2016 study in Psychosomatic Medicine: Journal of Behavioral Medicine that pooled data from 10 studies found that people with a higher sense of purpose in their lives — such as that received from volunteering — were less likely to die in the near term. Another study, published in Daedalus, an academic journal by MIT Press for the American Academy of Arts & Sciences, concluded that older volunteers had reduced risk of hypertension, delayed physical disability, enhanced cognition and lower mortality.

“People who are happy and engaged show better physiological functioning,” said Dr. Alan Rozanski, a cardiologist at Mount Sinai St. Luke’s Hospital, a senior author of the Psychosomatic Medicine study. People who engage in social activities such as volunteering, he said, often showed better blood pressure results and better heart rates.

That makes sense, of course, because volunteers are typically more active than, say, someone home on the couch streaming “Gilligan’s Island.”

Volunteers share a dirty little secret. We may start it to help others, but we stick with it for our own good, emotionally and physically.

At the homeless shelter, I could hit my target heart rate packing 50 sack lunches in an hour to the beat of Motown music. And at the food bank, I could feel the physical and emotional uplift of human contact while distributing hundreds of gallons of milk and dozens of cartons of eggs during my three-hour shifts. When I’m volunteering, I dare say I feel more like 37 than 67.

None of this surprises Rozanski, who looked at 10 studies over the past 15 years that included more than 130,000 participants. All of them, he said, showed that partaking in activities with purpose — such as volunteering — reduced the risk of cardiovascular events and often resulted in a longer life for older people.

Dr. David DeHart knows something about this, too. He’s a doctor of family medicine at the Mayo Clinic in Prairie du Chien, Wisconsin. He figures he has worked with thousands of patients — many of them elderly — over his career. Instead of just writing prescriptions, he recommends volunteering to his older patients primarily as a stress reducer.

“Compassionate actions that relieve someone else’s pain can help to reduce your own pain and discomfort,” he said.

At age 50, he listens to his own advice. DeHart volunteers with international medical teams in Vietnam, typically two trips a year. He often brings his wife and children to help, too. “When I come back, I feel recharged and ready to jump back into my work here,” he said. “The energy it gives me reminds me why I wanted to be a doctor in the first place.”

I think of my personal rewards from volunteering as cosmic electricity — with no “off” button. The good feeling sticks with me throughout the week — if not the month.

When will it be safe to resume my volunteering activities?

I’m considering my options. The park is offering some outdoor opportunities involving cleanup, but that lacks the interaction that lifts me. I’m tempted to go back to the food bank because even Charles Dinkens, an 85-year-old who has volunteered next to me for years, has returned after eight months away. “What else am I supposed to do?” he posed. The homeless shelter isn’t allowing volunteers in just yet. Instead, it’s asking folks to bag lunches at home and drop them off. Oh, they’re also looking for people to “call” virtual games of bingo for residents.

Virtual bingo just doesn’t float my boat.

Truth be told, there is no one-size-fits-all way to safely volunteer during the pandemic, said Dr. Kristin Englund, staff physician and infectious disease expert at the Cleveland Clinic. She suggests that volunteers — particularly those over 65 — stick with outdoor options. It’s better in a protected space where the general public isn’t moving through, she said, because “every time you interact with a person, it increases your risk of contracting the disease.”

Englund said she’d consider walking dogs outside for a local animal shelter as one safe option with some companionship. “While we do know that people can give COVID to animals,” she said, “it’s unlikely they can give it back to you.”

Meanwhile, my next annual physical is coming right up in January. It’s got me to wondering if my labs will be quite as pristine as they were the last go-round. I’ve got my doubts. Unless, of course, I’ve resumed some sort of in-person volunteering by then.

Last year, an elderly woman staying at the homeless shelter pulled me aside to thank me after I handed her lunch of tomato soup and a turkey sandwich. She set down her tray, took my hand, looked me smack in the eye and asked, “Why do you do this?”

She was probably expecting me to say I do it to help others because I care about those less fortunate than me. But that’s not what came out.

“I do it for myself,” I said. “Being here makes me whole.”

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.

USE OUR CONTENT

This story can be republished for free (details).