Analysis: ‘Don’t Be Afraid of COVID’? Not Buying It, Unless Businesses Do Job Right

As stores, restaurants, airlines and offices try to lure clients back, this is what they need to do to earn my business: Make me feel safe — no, make me be as safe as possible. As I’ve begun to explore old haunts, some are doing a fabulous job. Others are not.

So my dollars will flow to the former, and I’ll effectively boycott the latter. Think of it as ethical shopping, with a safety twist: I’ll reward businesses that are seriously implementing recommended COVID-19 precautionary guidelines. And I’ll punish, in my own tiny way, those who don’t take them to heart.

Yes, I know businesses across the country have lost huge amounts of money because of the pandemic. But many did get billions of dollars of federal aid to sustain them.

All many of us got was a $1,200 check. Some who would not normally be eligible for unemployment benefits will be able to get them, and some beneficiaries got extended benefits. Some of those have since run out.

It is not that hard to make many businesses relatively COVID-friendly and safe, though it requires making that a priority, investing a bit and thinking out of the box.

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My local Trader Joe’s in Washington, D.C., did a stellar job. While I initially limited my shopping to once a week at the crack of dawn, I quickly came to view the store as a safe zone: Shoppers received a squirt of hand sanitizer at the door and were directed to a row of sanitized carts.

Mandatory masking was (politely) enforced, the number of customers in the store was limited, and customers waiting outside were carefully spaced in line at 6-foot intervals. Checkout clerks scanned your items from behind a plexiglass partition and placed them back in your cart.

Customers could put their groceries in their carrier bags on a frequently sanitized table outside. If you lived close by, you could simply use the cart to walk the groceries home. Used carts were gathered in an area for re-sanitizing.

Contrast that with a local CVS Pharmacy. Yes, there was a sign on the door indicating masking was required, and plexiglass partitions had been placed at checkout counters. But there was no active enforcement once inside, and it was sometimes crowded. The pile of baskets was, as always, inside the front door, and used ones were placed on top by shoppers as they left.

Some customers picking up medicines had masks around their necks, and even some of the employees — including sometimes the pharmacist — had pulled down their masks so both nose and mouth were exposed. I know wearing a mask for hours can feel stifling, but if surgeons can do it in the operating room, so can we. And if the coronavirus lingers in the air in enclosed spaces, as we now know it does, not masking could be a problem.

Last week, when I went to pick up a prescription that was not quite ready, I said I wouldn’t wait in a place where so many people were not following our local masking mandate. I left.

On a recent trip to my hometown, New York City, many restaurants in my neighborhood had erected outdoor seating areas on sidewalks and into the street. (Indoor dining was still prohibited at that time.)

But my (formerly) favorite eatery had merely put out a few tables on the sidewalk, which employees wiped down with the same damp cloth. Yes, the tables were (maybe) 6 feet apart. But tables don’t get infectious diseases, people do. The chairs, where potential COVID carriers would sit (without masks when they eat), were far closer together.

In contrast, the restaurant next door, whose food I normally consider mediocre, had sanitizer at check-in and had set up a tent hung with flowers in what was formerly a parking lane, under which tables were widely spaced with plexiglass partitions separating them.

The wait staff was scrupulous about social distancing. It limited dining to 90 minutes. The food tasted great. Did the restaurant have a new chef, or was it its lovely setup — which really allowed us to relax and not consider a world gone COVID-mad as we ate — that made us enjoy its food more than we ever had?

A high-end Mexican restaurant we visited in Brooklyn went one step further: Each diner had to give a cellphone number at the door in case contact tracing was required. It had created an online menu, so diners made their selections from their phones.

And don’t get me started on airlines, and their varying policies. The risk of in-flight transmission appears to be low if everyone is masked and doesn’t knowingly fly ill. But that’s a big if. Remember, the novel coronavirus’s cousin, SARS-CoV, a far more dangerous but less contagious virus, created an infamous outbreak on a two-hour flight from Hong Kong to Beijing in 2003.

There have been cases related to in-flight exposures in Europe and Asia. Yet Airlines for America, an industry group, said this month that there have been “no confirmed cases of COVID-19 transmission on U.S. flights [italics mine].” Are the Boeings and Airbuses somehow different in Europe than in the U.S.?

And let’s remember epidemiology: There may be demonstrated cases of in-flight transmission elsewhere only because people abroad have resumed a more normal life than America has. Very few people in the U.S. are flying these days because America still has tens of thousands of new cases a day and leads the world in deaths.

Some airlines, like Delta and Southwest, are not selling middle seats or are selling only about half their seats. United and American have been flying full whenever they can. On June 30, United’s chief communications officer Josh Earnest (yes, the former Obama White House spokesperson), dismissed the blocking of middle seats as “PR.”

“When you’re on board the aircraft, if you’re sitting in the aisle, and the middle seat is empty, the person across the aisle from you is within 6 feet of you,” he said. “The person at the window is within 6 feet of you. The people in the row in front of you are within 6 feet of you. The people in the row behind you are within 6 feet of you.”

But 3 feet is better than cheek-by-jowl. In fact, the World Health Organization says that 3 feet is acceptable for social distancing.

Yet that’s not so good if you take off your mask. So why do airlines distribute those little bags of pretzels and nuts, anyway? When my daughter flew to grad school in California, I insisted she fly Delta, though other carriers fly the same route.

Instead of trying to create a bit of social distancing, some airlines offer a few concessions. Says American: “Customers on all flights receive sanitizing wipes or gel.” United offers to rebook your flight without a change fee if it’s too full for your comfort the night before. It will notify “customers when we can if their flight is fairly full and give them the option to change it” — though you pay the price difference for a new ticket.

A friend of mine flying London to New York checked a United flight seating chart beforehand and — seeing the middle seat was free — prepared for a long, but relatively safe, flight. Shortly after they took their seat, another passenger sat in the middle seat next to them. If you’re going to start college or visit a sick relative, delaying (and paying a higher price) isn’t really a viable option.

Remember, airlines received tens of billions in taxpayer-funded loans to help them survive the pandemic. And — with their crowded, uncomfortable seats and an explosion of new fees — they do not have a good record in recent years of catering to customers’ needs.

So if the government won’t act to enforce some kind of COVID-era standards for customer satisfaction, we all can use our hard-earned dollars to do so.

Yes, COVID precautions often feel like overkill. There is little chance that I will get COVID-19 from one meal, one flight or one trip to the pharmacy. But multiply those odds by over 300 million Americans visiting millions of places. Many people — maybe someone you love — will.

One School, Two Choices: Families Brave COVID’s Tough Test

Cozbi Mazariegos stays in shape these days by running room to room inside her Marin City apartment to answer questions from her kids, ages 7, 10 and 12. They’re all working at home on laptops issued by their school, Bayside Martin Luther King Jr. Academy.

Meanwhile, Shannon Bynum’s son, Kamari, 10, and daughter, Keyari, 8, who live nearby, are back on the Bayside MLK campus. Bynum had warned them, however, that if he heard they weren’t wearing masks, they’d have to learn remotely, too.

The two households, less than 3 miles apart, have found different answers to one of the most perplexing questions this fall: Should parents send their children back to school for classes during an ongoing pandemic or keep them at home?

At Bayside MLK, a K-8 school serving the ethnically and economically diverse community of Marin City, 103 children are attending class in person, including the Bynum children. The Mazariegos kids are among 12 learning remotely.

In March, the coronavirus consigned nearly all of the nation’s 55 million schoolchildren to home schooling. One by one, school districts across the country are weighing the risks of reopening. Some that have reopened have seen a spike in coronavirus cases among students who returned to class.

Bayside MLK was one of 15 Marin County schools that received waivers from the local public health department to reopen full time on Sept. 8, but officials gave parents the choice whether to send their children to campus or keep them home.

The start of classes was delayed for a week when one school employee contracted the virus, said Principal David Finnane. Once they started, the challenges mounted.

“This is the most mind-numbing time I’ve ever had as an educator,” said Finnane, who’s been a school principal for two decades.

“These are crazy days of temperature checks, telling third grade Jenny she entered the second grade gate at the wrong time, telling Xavier to use sanitizer on his elbow after he sneezes, reminding students not to touch this thing or that thing. It’s a job this school has never had to do and now we’re doing it every day, all day long.”

Health and safety protocols enacted by the school include staggered arrival times for students (via parent drop-offs), smaller classes, spaced-out desks, routine temperature and health checks, and an intensified cleaning schedule.

Mazariegos, 52, spent a difficult summer deciding whether to send Emily, 12, Ezekiel Jr., 10, and 7-year-old Evelyn back to class if and when school reopened in the fall.

But her husband, Ezekiel, a 42-year-old construction worker, had made up his mind. “He said, ‘Are you crazy? We can’t send our kids back to school without a vaccine,’” she recalled. “‘How do we know they’d be safe?’”

Mazariegos, who was a schoolteacher in her native Guatemala but now stays at home with her kids, has juggled the roles of teacher, tech consultant and even hall monitor in recent weeks.

School hadn’t been back in session for a week before her home Wi-Fi connection crashed. The two eldest kids could not connect to their Zoom instruction sessions, so Mazariegos called the school for help. To make sure they didn’t resort to computer games in the interim, she gave them textbooks to read.

“The phone was ringing, the kids were all calling my name from different rooms,” she said. “It was crazy.”

Single father Bynum, on the other hand, chose to send his two kids back to school.

“Kids learn from other kids, not just teachers,” said the 29-year-old real estate developer. “In school, they know what’s expected of them. It’s the best place for them to be.”

Finnane, the principal, had hoped all 115 students would return to classrooms. “Many kids doing distance learning just don’t have the same support network,” he said. “They might not have the resources, a quiet place to work, a supportive adult right there who can mentor and encourage them.”

And then there are the technical issues. Students who have stayed at home have experienced internet failures, Zoom glitches and computer bandwidth problems — “or when a teacher gives out the wrong Zoom link, all of which has already happened,” Finnane said.

A recent study by the Economic Policy Institute on the educational challenges posed by the pandemic found that remote-learning programs are effective only if students have consistent access to the internet and computers and if teachers receive targeted training and support for online instruction.

While researchers acknowledged the risk of virus infection is greater at school, they found that students who have not returned to the classroom are falling behind.

“Children’s academic performance is deteriorating during the pandemic, along with their progress on other developmental skills,” the study said.

When Bayside MLK resorted to remote teaching for the entire school in the spring, officials identified 41 students who were demonstrably falling behind, Finnane said. Standardized tests given to students this academic year will provide a report card on students’ success, he added.

Over the summer, Bayside MLK teachers received one day of training to perform online classes in addition to their at-school duties.

“A full day of online-learning training helps, but when it comes to the constant challenges of teaching, especially those with special needs, I’m not sure that’s sufficient,” said Emma García, who co-authored the Economic Policy Institute study.

Mazariegos knows this all too well. Her daughter Emily has comprehension issues that have kept her back a grade.

A quiet girl who loves animals and science, and who one day wants to become a veterinarian, the sixth grader relies on her mother to spend extra time reviewing lessons.

“She has to touch and feel things, to have a lesson demonstrated before she can best understand,” her mother said. “She can’t just sit in front of a computer reading some concept over and over and over.”

Mazariegos understands her daughter may fall another year behind but says she’ll take that chance. “If we lose her to COVID-19, that year is nothing,” she said. “This is a hard decision for any mother. But Emily is so afraid of the virus that sending her back to school would just be traumatizing.”

Bynum, whose fourth grade son, Kamari, suffers from attention deficit disorder, believes the classroom is the best place for the restless child. In March, when the school was closed at the start of the pandemic, Bynum got a taste of the demanding task of being a teacher.

“With two kids in two different grades asking me questions, I struggled to explain things,” he said. “It would have been easy for me to just tell them the answer, but the object of a good instructor is to teach them to find it themselves. And I had to learn that.”

Bynum has developed his own protocol. He requires his children to shower the moment they return from school, and they get regular lectures about hand-washing and common sense.

“If I even suspect they’re not wearing their masks, I’ll say, ‘OK, it’s back to the house and your laptop,’ and they’ll say, ‘Oh yeah, Dad, I’m wearing my mask.’”

Mazariegos remains comfortable with her decision, especially when she reads about all the COVID-19 outbreaks at schools and colleges.

Her kids aren’t so sure.

Second grader Evelyn, an outgoing girl, recently joined a Zoom lesson that included classmates she hadn’t seen in person for months.

“She cried,” her mother said. “She wanted to be back at school to see her friends.”

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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‘An Arm and a Leg’: TikTok Mom Takes On Medical Bills

Can’t see the audio player? Click here to listen.

Shaunna Burns went viral on TikTok, partly because of a series of videos dishing out real-talk advice on fighting outrageous medical bills. She said the way to deal with medical debt is to be vigilant about what debt you incur in the first place.

“What you can say is I don’t want you to run any tests or do any procedures or anything without running it by me,” she said.

Burns has three children of her own, and she has become the virtual mom that thousands of Gen Z followers love. She’s funny, smart and relatable — and she has stories that’ll make your hair stand on end. Oh, and she can swear like a sailor. So maybe listen to this episode when the kids aren’t around. Also, some of her stories are kind of intense.

(You can first check the transcript to see if this episode is one you want to share with your kids.)

“An Arm and a Leg” is a co-production of Kaiser Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

To hear all Kaiser Health News podcasts, click here.

And subscribe to “An Arm and a Leg” on iTunesPocket CastsGoogle Play or Spotify.

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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5 Things to Know About a COVID Vaccine: It Won’t Be a ‘Magic Wand’

President Donald Trump makes no secret he would like a COVID-19 vaccine to be available before the election. But it’s doubtful that will happen and, even after a vaccine wins FDA approval, there would be a long wait before it’s time to declare victory over the virus.

Dozens of vaccine candidates are in various testing stages around the world, with 11 in the last stage of preapproval clinical trials — including four in the U.S. One or more may prove safe and effective and enter the market in the coming months. What then?

Here are five things to consider in making vaccine dreams come true.

1. A vaccine is vital in fighting the virus, but it won’t be a quick pass back to our old lives.

Vaccines have helped rid the world of scourges like smallpox, but the process takes time and there are no guarantees. Until clinical trials have been completed on this first round of vaccine candidates, no one knows how effective they might prove to be.

The minimum requirement by the Food and Drug Administration for any COVID-19 vaccine is that it should at least prove 50% effective when compared with a placebo — that is, a neutral saline solution.

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By comparison, the annual influenza vaccine ranges between 40% and 60% effective in preventing the illness, depending on the recipient and the season examined. In contrast, a full course of the measles vaccine is about 97% effective.

“It’s very unlikely that a first-generation vaccine will be something like a measles vaccine,” notes Dr. Amesh Adalja, a physician with expertise in infectious diseases and senior scholar at the Johns Hopkins University Center for Health Security.

2. After vaccines gain approval, the real-world evaluation ensues.

Vaccines undergo a protracted testing process involving thousands of subjects. They win FDA approval only after they demonstrate safety and meet at least the minimum standard of effectiveness. Monitoring continues after they hit the market; effectiveness and any rare side effects or safety issues become more apparent after millions of doses are given.

Hypothetically, let’s say the first new COVID vaccines prove 70% effective at preventing the disease. That would mean seven of every 10 people who roll up their sleeves will be protected, but three will not.

While that’s good news for those protected, questions remain about who is covered and who is still vulnerable. It’s possible, Adalja said, that the vaccine would reduce the severity of disease in the remaining three people, thereby helping cut hospitalizations and severe side effects.

But it’s also true that regulators are focused on whether a vaccine prevents disease. Some vaccines can keep you from getting sick without preventing infection, in which case you could still spread the virus even without exhibiting symptoms.

Mysteries remain, at least for now. Scientists don’t know how long the protection will last, for instance. Will protection fade, requiring annual shots, as with influenza? Or will it last for years?

Also, the COVID vaccine candidates are being tested only in adults so far. Most vaccine makers have delayed testing among children or pregnant and breastfeeding women, for example. That could mean an initial lag in safety and efficacy data for those groups, complicating vaccination efforts for children or even front-line health care workers, many of whom are women of childbearing age.

For all those reasons — “if you are looking for a magic wand, you won’t find one in vaccines,” said Dr. William Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University Medical Center in Nashville, Tennessee. “That said, vaccines will play a substantial role in reducing the epidemic.”

3. After a vaccine is approved, you still may need to wait awhile to get your shot.

Making vaccines is complicated. And so is distributing them. Vaccine makers say they are already producing vaccine in advance of knowing whether they will win approval. But simply having ample vaccine supply doesn’t mean manufacturers will have all the needed glass bottles, syringes or injectors to ship them right away. Indeed, some experts fear that a shortage of both production-line capabilities (special facilities are needed to make vaccines under strict sterile conditions) and limited supplies could hamper distribution of an approved vaccine. Many of the vaccine candidates must be shipped and stored at super-low temperatures, adding to the complexity.

“Even if you have the vaccine, that doesn’t mean you can ship it out. There are multiple, multiple steps, and all of them have to work,” said Dr. Ezekiel Emanuel, a vice provost at the University of Pennsylvania who has warned of potential shortages.

The Centers for Disease Control and Prevention and the National Academy of Sciences have issued a framework for who should get priority for the initial vaccine. State and local health departments will also have a say in how supplies roll out.

Current recommendations say first in line will be health care workers and people with medical conditions that put them at highest risk if they get the virus. People living in nursing homes and other congregate settings will also be higher on the list. Further down are average healthy adults.

Pay attention, and go when it’s your turn, said Schaffner.

“If they say it’s time for people who are middle-aged and have chronic underlying illness such as diabetes, heart disease and lung disease, you have to know what you have and understand it’s your turn,” he said. “You also have to understand if it’s not your turn yet. Be patient.”

Finally, many of the vaccines under consideration will require two doses spaced a few weeks apart, which would add to the delay. If more than one vaccine is approved, which is likely, people will need the second dose to come from the same manufacturer as the first. That could prove a record-keeping nightmare and lead to more delays — depending on how vaccine supplies hold up.

In testimony before Congress in mid-September, CDC Director Robert Redfield said that tens of millions of doses of vaccine may start to become available by late November or December. But the logistics of vaccine distribution means the country won’t be able to return to “regular life” until “late second quarter, third quarter 2021,” Redfield predicted.

4. So don’t throw out your masks yet.

Because any vaccine is likely to fall short of 100% effectiveness and won’t be in widespread distribution for a while, the use of masks and maintaining social distance will be required well into next year, experts say.

“The vaccine will be a start, but we’ll still need to do the things we’ve been discussing throughout — hand hygiene, wearing masks and continuing to remain specifically distant,” said Dr. Krutika Kuppalli, an assistant professor of infectious disease at the Medical University of South Carolina. “Those are the arsenal of tools we will need to use.”

5. What if I don’t want to get vaccinated?

Polls show a good percentage of Americans either don’t want a vaccine or want to wait a bit before getting one. Can they be required to get a shot?

Certain employers, such as hospitals or food production plants, could require their workers to be vaccinated, but a federal mandate is highly unlikely and probably would be unconstitutional, said professor Dorit Rubinstein Reiss, an expert on employer and vaccine law at the University of California-Hastings College of Law.

The likely approach of public health authorities is to educate people about the benefits and potential side effects of a vaccine — down to whether one might experience a sore arm.

“That’s what we do for every vaccine,” said Adalja of Johns Hopkins. A requirement of vaccination for the general public would create resistance and “foster conspiracy theories,” he said.

Most regulation of public health falls to state and local governments and health agencies, Reiss said. States would be “more likely to have narrow or specific mandates that could survive judicial review,” she said.

Schools, of course, require students to be vaccinated against a wide range of illnesses. But a school-age COVID vaccine mandate is doubtful, at least in the near term, because the vaccine hasn’t been tested on school-aged children.

Generally speaking, employers, including the federal government, have the power to require vaccinations, especially if they don’t have a unionized workforce with a contract that might limit their power. All employers, however, face limits set by civil rights and disability laws and may have to provide alternatives for people who can’t or won’t get vaccinated, Reiss said.

Not Pandemic-Proof: Insulin Copay Caps Fall Short, Fueling Underground Exchanges

DENVER — D.j. Mattern had her Type 1 diabetes under control until COVID’s economic upheaval cost her husband his hotel maintenance job and their health coverage. The 42-year-old Denver woman suddenly faced insulin’s exorbitant list price — anywhere from $125 to $450 per vial — just as their household income shrank.

She scrounged extra insulin from friends, and her doctor gave her a couple of samples. But as she rationed her supplies, her blood sugar rose so high her glucose monitor couldn’t even register a number. In June, she was hospitalized.

“My blood was too acidic. My system was shutting down. My digestive tract was paralyzed,” Mattern said, after three weeks in the hospital. “I was almost near death.”

So she turned to a growing underground network of people with diabetes who share extra insulin when they have it, free of charge. It wasn’t supposed to be this way, many thought, after Colorado last year was the first of 12 states to implement a cap on the copayments that some insurers can charge consumers for insulin. But as the COVID pandemic has caused people to lose jobs and health insurance, demand for insulin sharing has skyrocketed. Many patients who once had good insurance are now realizing the $100 cap is only a partial solution, applying just to state-regulated health plans.

Colorado’s cap does nothing for the majority of people with employer-sponsored plans or those without insurance coverage. According to the state chapter of Type 1 International, an insulin access advocacy group, only 3% of patients with Type 1 diabetes under 65 could benefit from the cap.

Such laws, often backed by pharmaceutical companies, give the impression that things are improving, said Colorado chapter leader Martha Bierut. “But the reality is, we have a much longer road ahead of us.”

The struggle to afford insulin has forced many people into that underground network. Through social media and word-of-mouth, those in need of insulin connect with counterparts who have a supply to spare. Insurers typically allow patients a set amount of insulin per month, but patients use varying amounts to control their blood sugar levels depending on factors such as their diet and activity that day.

Though it’s illegal to share a prescription medication, those involved say they simply don’t care: They’re out to save lives. They bristle at the suggestion that the exchanges resemble back-alley drug deals. The supplies are given freely, and no money changes hands.

For those who can’t afford their insulin, they have little choice. It’s a your-money-or-your-life scenario for which the American free-market health care system seems to have no answer.

“I can choose not to buy the iPhone or a new car or to have avocado toast for breakfast,” said Jill Weinstein, who lives in Denver and has Type 1 diabetes. “I can’t choose not to buy the insulin, because I will die.”

Exacerbated by the Pandemic

Surveys conducted before the pandemic showed that 1 in 4 people with either Type 1 or Type 2 diabetes had rationed insulin because of the cost. For many Blacks, Hispanics and Native Americans, the pinch was especially bad. These populations are more likely to have diabetes and also more likely to face economic disparities that make insulin unaffordable.

Then COVID-19 arrived, with economic stress and the virus itself hitting people in those groups the hardest.

This year, the American Diabetes Association reported a surge in calls to its crisis hotline regarding insulin access problems. In June, the group found, 18% of people with diabetes were unemployed, compared with 12% of the general public. Many are wrestling with the tough choices of whether to pay for food, rent, utilities or insulin.

Rep. Dylan Roberts, a Democrat who sponsored Colorado’s copay cap bill, said legislators knew the measure was only the first step in addressing high insulin costs. The law also tasked the state’s attorney general to produce a report, due Nov. 1, on insulin affordability and solutions.

“We went as far as we could,” Roberts said. “While I feel Colorado has been a leader on this, we need to do a whole lot more both at the state and national level.”

According to the American Diabetes Association, 36 other states have introduced insulin copay cap legislation, but the pandemic stalled progress on most of those bills.

Insulin prices are high in the U.S. because few limits exist for what pharmaceutical manufacturers can charge. Three large drugmakers dominate the insulin market and have raised prices in near lockstep. A vial that 20 years ago cost $25 to $30 now can run 10 to 15 times that much. And people with diabetes can need as many as four or five vials per month.

“It all boils down to cost,” said Gail deVore, who lives in Denver and has Type 1 diabetes. “We’re the only developed nation that charges what we charge.”

Before the COVID crisis triggered border closures, patients often crossed into Mexico or Canada to buy insulin at a fraction of the U.S. price. President Donald Trump has taken steps to lower drug prices, including allowing for the importation of insulin in some cases from Canada, but that plan will take months to implement.

The Kindness of Strangers

DeVore posts on social media three or four times a year asking if anybody needs supplies. While she’s always encountered demand, her last tweet in August garnered 12 responses within 24 hours.

“I can feel the anxiety,” deVore said. “It’s unbelievable.”

She recalled helping one young man who had moved to Colorado for a new job but whose health insurance didn’t kick in for 90 days. She used a map to choose a random intersection halfway between them. When deVore arrived on the dusty rural road after dark, his car was already there. She handed him a vial of insulin and testing supplies. He thanked her profusely, almost in tears, she said, and they parted ways.

“The desperation was obvious on his face,” she said.

It’s unclear just how widespread such sharing of insulin has become. In 2019, Michelle Litchman, a researcher at the University of Utah’s College of Nursing, surveyed 159 patients with diabetes, finding that 56% had donated insulin.

“People with diabetes are sometimes labeled as noncompliant, but many people don’t have access to what they need,” she said. “Here are people who are genuinely trying to find a way to take care of themselves.”

If insulin affordability doesn’t improve, Litchman suggested in a journal article, health care providers may have to train patients on how to safely engage in underground exchanges.

The hashtag #Insulin4all has become a common way of amplifying calls for help. People sometimes post pictures of the supplies they have to share, while others insert numbers or asterisks within words to avoid social media companies removing their posts.

Although drug manufacturers offer limited assistance programs, they often have lengthy application processes. So they typically don’t help the person who accidentally drops her last glass vial on a tile floor and finds herself out of insulin for the rest of the month. Emergency rooms will treat patients in crisis and have been known to give them an extra vial or two to take home. But each crisis takes a toll on their long-term health.

That’s why members of the diabetes community continue to look out for one another. Laura Marston, a lawyer with Type 1 diabetes who helped to expose insulin pricing practices by Big Pharma, said two of the people she first helped secure insulin, both women in their 40s, are in failing health, the result of a lifetime of challenges controlling their disease.

“The last I heard, one is in end-stage renal failure and the other has already had a partial limb amputation,” Marston said. “The effects of this, what we see, you can’t turn your back on it.”

The underground sharing is how Mattern secured her insulin before recently qualifying for Medicaid. When someone on a neighborhood Facebook group asked if anybody needed anything in the midst of the pandemic, she replied with one word: insulin. Soon, an Uber driver arrived with a couple of insulin pens and replacement sensors for her glucose monitor.

“I knew it wasn’t altogether legal,” Mattern said. “But I knew that if I didn’t get it, I wouldn’t be alive.”


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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Easier-to-Use Coronavirus Saliva Tests Start to Catch On

As the coronavirus pandemic broke out across the country, health care providers and scientists relied on the standard method for detecting respiratory viruses: sticking a long swab deep into the nose to get a sample. The obstacles to implementing such testing on a mass scale quickly became clear.

Among them: Many people were wary of the unpleasant procedure, called a nasopharyngeal swab. It can be performed only by trained health workers, putting them at risk of infection and adding costs. And the swabs and chemicals needed to test for the virus almost immediately were in short supply.

Some places, like Los Angeles County, moved early to self-collected oral swabs of saliva and sputum, with the process supervised at drive-thru testing sites by trained personnel swathed in protective gear. Meanwhile, researchers began investigating other cheaper, simpler alternatives to the tried-and-true approach — including dribbling saliva into a test tube.

But the transition has not been immediate. Regulators and scientists are generally cautious about new, unproven technologies and have an understandable bias toward well-established protocols.

“Saliva is not a traditional diagnostic fluid,” said Yale microbiologist Anne Wyllie, part of a team whose saliva-based test, called SalivaDirect, received emergency use authorization from the Food and Drug Administration in August. “When we were hit by a virus that came out of nowhere, we had to respond with the tools that were available.”

Eight months into the pandemic, the move toward saliva screening is gaining traction, with tens of thousands of people across the country undergoing such testing daily. However, saliva tests still represented only a small percentage of the more than 900,000 tests conducted daily on average at the end of September.

Yale is providing its protocol on an open-source basis and recently designated laboratories in Minnesota, Florida and New York as capable of performing the test. Besides the Yale test, the FDA has authorized emergency use of several others, including versions developed at Rutgers University, the University of Illinois at Urbana-Champaign, the University of South Carolina and SUNY Upstate Medical University. A further advance, an at-home saliva test, could be headed for FDA authorization, too.

Since the start of the pandemic, the Trump administration’s approach to testing has been hampered by missteps and controversy. As a key health agency during an unprecedented emergency, the FDA’s effectiveness relies on public trust in how it balances the need for speed in authorizing innovative products, like saliva tests and vaccines, with ensuring safety and effectiveness, said Ann Keller, an associate professor of health policy at the University of California-Berkeley.

“You obviously want to get new tests into the mix quickly in order to address the emergency, but you still need to uphold your standards,” Keller said. The White House’s public pressure on the FDA has complicated the agency’s efforts by undermining its credibility and independence, she said.

Respiratory viruses colonize areas inside the nasal cavity and at the back of the throat. Besides the nasopharyngeal approach, nasal samples obtained with shorter and less invasive swabs have proven effective for the coronavirus and have become widely adopted, although they also generally require a health care worker’s involvement. The millions of rapid tests that will be distributed across the country, per a recent White House announcement, rely on nasal swabs.

In the early months of the pandemic, some studies reported significant levels of the virus in oral secretions. In a Hong Kong study published in February, for example, the virus was found in the saliva of 11 of 12 patients with confirmed coronavirus infection.

In Los Angeles, which began using the oral swab test in late March, more than 10,000 samples are collected per day, said Fred Turner, chief executive of Curative, the company that developed it.

Turner sees an advantage to the swabbing strategy. The self-swab procedure takes only 20 to 30 seconds, while producing enough saliva for testing can take people two to three minutes, and sometimes longer, he said. “That might not sound like much difference,” Turner said, “but it is when you’re trying to push 5,000 people through a test site.”

Curative’s three labs process tens of thousands of tests from jurisdictions across the country in addition to L.A., Turner said. A test developed at SUNY Upstate Medical University, which is expected to become available at state labs around New York, also uses an oral swab.

For the Curative test, a health care worker is supposed to oversee the sample collection —reminding people to cough to bring up fluids, for example. When investigators at the University of Illinois launched what they called a “Manhattan Project” to develop a saliva test by mid-June, they hoped to make it possible for people to visit a collection site, drool into a test tube, seal it and drop it off without the aid of a health care worker.

The university is now testing more than 10,000 people a day at its three campuses and is seeking to expand access to communities across the state and country, said chemistry professor Paul Hergenrother, who led the research team. Like the similar Yale test, it is being made freely available to other laboratories. The University of Notre Dame, in Indiana, recently adopted it.

Like tests using nasopharyngeal and other kinds of nasal swabs, these saliva tests are based on PCR technology, which amplifies small amounts of viral genetic material to facilitate detection. Both the Yale and University of Illinois tests have managed to simplify the process by eliminating a standard intermediate step: the extraction of viral RNA. Their protocols also don’t require viral transport media, or VTM — the chemicals generally used to stabilize the samples after collection.

“You don’t need swabs, you don’t need health care workers, you don’t need VTM, and you don’t need RNA isolation kits,” Hergenrother said.

In correspondence published in the New England Journal of Medicine, the Yale team reported detecting more viral RNA in saliva specimens than in nasopharyngeal ones, with a higher proportion of the saliva tests showing positive results for up to 10 days after initial diagnosis.

The National Basketball Association provided $500,000 in support for the Yale project, said David Weiss, the NBA’s senior vice president for player matters. He said the Yale team’s decision to eliminate the process of RNA extraction, which separates the genetic material from other substances that could complicate detection, involved trade-offs but did not compromise the value of the test.

“Any molecular test that has an RNA extraction step is almost by definition going to be more sensitive, but it will also be more expensive and take longer and use supplies that are in shorter supply,” he said. “If we’re trying to look at surveillance testing to open up schools and nursing homes, a test that’s still very sensitive and a lot cheaper is an important innovation.”

Prices for coronavirus tests vary widely, running upward of $100. Tests based on the Yale or University of Illinois protocols, which require only inexpensive materials, could be available for as little as $10. The Curative testing service, which includes collection and transportation of samples as well as the laboratory component, averages around $150 per test depending on volume, said Clayton Kazan, chief medical director of the L.A. County Fire Department, which uses the tests.

Despite the advances in sample collection, tests using PCR — polymerase chain reaction — technology still require laboratory processing. Researchers have been investigating other approaches, including saliva-based antigen tests, that could be self-administered at home and would provide immediate results. (While PCR can detect coronavirus genetic material, antigen tests look for viral proteins that can signify a current infection.)

At least one company has announced it is seeking emergency use authorization for a saliva antigen test, although two others have dropped plans to develop their own versions as infeasible, according to The New York Times. Meanwhile, scientists at Columbia University, the University of Wisconsin and elsewhere are investigating the use of saliva with other kinds of rapid-test technologies.

“There’s tons of interest” in an at-home saliva test, noted Yvonne Maldonado, chief of pediatric infectious diseases at Stanford University School of Medicine.

“People really do want to get that pregnancy-type kit out there,” she said. “You could basically send people a little packet with little strips, and you pull off a strip every day and put in under your tongue.”

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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White House Testing Regimen Did Not Protect the President

President Donald Trump’s COVID-19 diagnosis is raising fresh questions about the White House’s strategy for testing and containing the virus for a president whose cavalier attitude about the coronavirus has persisted since it landed on American shores.

The president has said others are tested before getting close to him, appearing to hold it as an iron shield of safety. He has largely eschewed mask-wearing and social distancing in meetings, travel and public events, while holding rallies for thousands of often maskless supporters. 

The Trump administration has increasingly pinned its coronavirus testing strategy for the nation on antigen tests, which do not need a traditional lab for processing and quickly return results to patients. But the results are less accurate than those of the slower PCR tests. 

Testing “isn’t a ‘get out of jail free’ card,” said Dr. Alan Wells, medical director of clinical labs at the University of Pittsburgh Medical Center and creator of its test for the novel coronavirus. In general, antigen tests can miss up to half the cases that are detected by polymerase chain reaction tests, depending on the population of patients tested, he said.

The White House said the president’s diagnosis was confirmed with a PCR test but declined to say which test delivered his initial result. The White House has been using a new antigen test from Abbott Laboratories to screen its staff for COVID-19, according to two administration officials. 

The test, known as BinaxNOW, received an emergency use authorization from the Food and Drug Administration in August. It produces results in 15 minutes. Yet little is independently known about how effective it is. According to the company, the test is 97% accurate in detecting positives and 98.5% accurate in identifying those without disease. Abbott’s stated performance of its antigen test was based on examining people within seven days of COVID symptoms appearing.

The president and first lady have both had symptoms, according to White House Chief of Staff Mark Meadows and the first lady’s Twitter account. The president was admitted to Walter Reed National Military Medical Center on Friday evening “out of an abundance of caution,” White House Press Secretary Kayleigh McEnany said in a statement.

Vice President Mike Pence is also tested daily for the virus and tested negative, spokesperson Devin O’Malley said Friday, but he did not respond to a follow-up question about which test was used.

Trump heavily promoted another Abbott rapid testing device, the ID NOW, earlier this year. But that test relies on different technology than the newer Abbott antigen test.  

“I have not seen any independent evaluation of the Binax assay in the literature or in the blogs,” Wells said. “It is an unknown.” 

The Department of Health and Human Services announced in August that it had signed a $760 million contract with Abbott for 150 million BinaxNOW antigen tests that are now being distributed to nursing homes and historically black colleges and universities, as well as to governors to help inform decisions about opening and closing schools. The Big Ten football conference has also pinned playing hopes on the deployment of antigen tests following Trump’s political pressure

However, even senior federal officials concede that a test alone isn’t likely to stop the spread of a virus that has sickened more than 7 million Americans.

“Testing does not substitute for avoiding crowded indoor spaces, washing hands, or wearing a mask when you can’t physically distance; further, a negative test today does not mean that you won’t be positive tomorrow,” Adm. Brett Giroir, the senior HHS official helming the administration’s testing effort, said in a statement at the time.

Trump could be part of a “super-spreading event,” said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

Given the timing of Trump’s positive test — which he announced on Twitter early Friday — his infection “likely happened five or more days ago,” Osterholm said. “If so, then he was widely infectious as early as Tuesday,” the day of the first presidential debate in Cleveland.

Other experts say it’s too soon to say whether Trump was infected in a super-spreader event. “The president and his wife have had many exposures to many people in enclosed venues without protection,” so they could have been infected at any number of places, said Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine. 

Although Democratic presidential candidate and former Vice President Joe Biden tested negative for the virus with a PCR test Friday, experts note that false negative results are common in the first few days after infection. Test results over the next several days will yield more useful information.

It can take more than a week for the virus to reproduce enough to be detected, Wells said: “You are probably not detectable for three, five, seven, even 10 days after you’re exposed.” 

In Minnesota, where Trump held an outdoor campaign rally in Duluth with hundreds of attendees Wednesday, health officials warned that a 14-day quarantine is necessary, regardless of test results.

“Anyone who was a direct contact of President Trump or known COVID-19 cases needs to quarantine and should get tested,” the Minnesota Department of Health said.

Ongoing lapses in test result reporting could hamper efforts to track and isolate sick people. As of Sept. 10, 21 states and the District of Columbia were not reporting all antigen test results, according to a KHN investigation, a lapse in reporting that officials say leaves them blind to disease spread. Since then, public health departments in Arizona, North Carolina and South Dakota all have announced plans to add antigen testing to their case reporting.

Requests for comment to the D.C. Department of Health were referred to Mayor Muriel Bowser’s office, which did not respond. District health officials told KHN in early September that the White House does not report antigen test results to them — a potential violation of federal law under the CARES Act, which says any institution performing tests to diagnose COVID-19 must report all results to local or state public health departments.

Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, said it’s not surprising that Trump tested positive, given that so many of his close associates — including his national security adviser and Secret Service officers —have also been infected by the virus.

“When you look at the number of social contacts and travel schedules, it’s not surprising,” Adalja said.


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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El sistema de pruebas para COVID de la Casa Blanca no protegió al presidente

El diagnóstico de COVID-19 del presidente Donald Trump está generando nuevas preguntas sobre la estrategia de la Casa Blanca para realizar pruebas y contener la propagación del virus, con un presidente que ha tenido una actitud arrogante desde que el coronavirus aterrizó en suelo estadounidense.

El presidente ha dicho que las personas con las que se reúne se hacen la prueba, como para generar un escudo de seguridad. Pero él mismo ha evitado casi siempre usar máscara y distanciarse socialmente en reuniones, viajes y eventos públicos, mientras organiza mitines para miles de simpatizantes, que tampoco usan tapabocas.

La estrategia de pruebas para COVID de la Administración Trump se basa en los tests de antígenos, que no necesitan un laboratorio tradicional para procesar y obtener resultados rápidamente. Pero estos resultados son menos precisos que los de las pruebas de PCR, que llevan más tiempo.

Las pruebas “no son una salvoconducto”, dijo el doctor Alan Wells, director médico de laboratorios clínicos del Centro Médico de la Universidad de Pittsburgh y creador de su propia prueba para el coronavirus. En general, las pruebas de antígenos pueden pasar por alto hasta la mitad de los casos detectados por las pruebas de reacción en cadena de la polimerasa, dependiendo de la población de pacientes examinados, agregó.

La Casa Blanca dijo que el diagnóstico del presidente se confirmó con una prueba de PCR, pero se negó a decir cuál fue la prueba que se usó para el resultado inicial. La administración ha estado utilizando una nueva prueba de antígeno del laboratorio Abbott para detectar COVID-19 en su personal, según dos funcionarios.

La prueba, conocida como BinaxNOW, recibió una autorización de uso de emergencia de la Administración de Alimentos y Medicamentos (FDA) en agosto. Produce resultados en 15 minutos. Sin embargo, se sabe poco de forma independiente sobre su eficacia.

Según la compañía, la prueba tiene una precisión del 97% en la detección de casos positivos y una precisión del 98,5% en la identificación de personas sin enfermedad. El desempeño declarado de Abbott de su prueba de antígeno se basó en examinar a las personas dentro de los siete días posteriores a la aparición de síntomas de COVID.

Tanto el presidente como la primera dama han tenido síntomas, según Mark Meadows, jefe de gabinete de la Casa Blanca, y la cuenta de Twitter de Melania Trump. El presidente fue admitido en el hospital militar Walter Reed el viernes 2 de septiembre por la noche “por precaución”, dijo la secretaria de prensa de la Casa Blanca, Kayleigh McEnany, en un comunicado.

El vicepresidente Mike Pence también se somete a pruebas diarias para detectar el virus y dio negativo, dijo el vocero Devin O’Malley, pero no respondió a una pregunta de seguimiento sobre qué prueba se utilizó.

Trump promovió en gran medida otra prueba rápida de Abbott, ID NOW, a principios de este año. Pero esa prueba se basa en una tecnología diferente a la nueva prueba de antígenos del mismo laboratorio.

“No he visto ninguna evaluación independiente del ensayo Binax en la literatura o en blogs”, dijo Wells. “Es un desconocido”.

El Departamento de Salud y Servicios Humanos (HHS) anunció en agosto que había firmado un contrato de $760 millones con Abbott por 150 millones de pruebas de antígeno BinaxNOW, que ahora se están distribuyendo a hogares de adultos mayores y universidades históricamente afroamericanas, así como a los gobernadores para ayudar a decidir sobre reaperturas, o cierres, de escuelas.

Sin embargo, incluso los altos funcionarios federales admiten que no es probable que una prueba por sí sola detenga la propagación de un virus que ha enfermado a más de 7 millones de estadounidenses.

“Las pruebas no sustituyen evitar espacios interiores abarrotados, lavarse las manos o usar una máscara; además, una prueba negativa hoy no significa que no será positiva mañana”, dijo el almirante Brett Giroir, el alto funcionario del HHS que dirigió el esfuerzo de pruebas de la administración, en un comunicado en ese momento.

Trump podría ser parte de un “evento de superdifusión”, dijo el doctor Michael Osterholm, director del Centro de Investigación y Política de Enfermedades Infecciosas de la Universidad de Minnesota.

Dado el momento de la prueba positiva de Trump, que anunció en Twitter la madrugada del viernes 2, su infección “probablemente ocurrió hace cinco o más días”, dijo Osterholm. “Si es así, entonces ya era muy contagioso el martes”, el día del primer debate presidencial en Cleveland.

Al menos siete personas que asistieron al anuncio de Trump de su nominación de la jueza Amy Coney Barrett para la Corte Suprema, el 26 de septiembre, han dado positivo desde entonces. Entre ellos: la ex asesora de Trump, Kellyanne Conway, los senadores republicanos Mike Lee y Thom Tillis, y el presidente de la Universidad de Notre Dame, el reverendo John Jenkins.

Los expertos dicen que es demasiado pronto para decir cómo se infectó Trump. “El presidente y su esposa han estado expuestos a muchas personas en lugares cerrados sin protección”, dijo el doctor William Schaffner, especialista en enfermedades infecciosas de la Escuela de Medicina de la Universidad de Vanderbilt.

Aunque el candidato presidencial demócrata Joe Biden dio negativo para el virus con una prueba de PCR el viernes 2, expertos señalan que los falsos negativos son comunes en los primeros días después de la infección. Los resultados de pruebas durante los próximos días proporcionarán información más útil.

El virus puede tardar más de una semana en reproducirse lo suficiente como para ser detectado, dijo Wells: “Probablemente no seas detectable durante tres, cinco, siete, incluso 10 días después de estar expuesto”.

En Minnesota, donde Trump realizó un mitin de campaña al aire libre en Duluth con cientos de asistentes el miércoles 30 de septiembre, funcionarios de salud advirtieron que es necesaria una cuarentena de 14 días, independientemente de los resultados de las pruebas.

Las fallas continuas en los informes de los resultados de las pruebas podrían obstaculizar los esfuerzos para rastrear y aislar a las personas enfermas. Hasta el 10 de septiembre, 21 estados y el Distrito de Columbia no informaban todos los resultados de las pruebas de antígenos, según una investigación de KHN. Un lapso en los informes que, según los funcionarios, les impide visualizar con claridad la propagación de la enfermedad. Desde entonces, los departamentos de salud pública de Arizona, Carolina del Norte y Dakota del Sur han anunciado planes para agregar pruebas de antígenos a sus informes de casos.

Las solicitudes de comentarios al Departamento de Salud de DC se remitieron a la oficina de la alcaldesa Muriel Bowser, que no respondió. Funcionarios de salud del distrito le dijeron a KHN a principios de septiembre que la Casa Blanca no les informa los resultados de las pruebas de antígenos, una posible violación de un apartado de la Ley CARES, que indica que cualquier institución que realice pruebas para diagnosticar COVID-19 debe informar todos los resultados a las oficinas locales o departamentos estatales de salud pública.

El doctor Amesh Adalja, investigador principal del Centro de Seguridad Sanitaria de la Universidad Johns Hopkins, dijo que no es sorprendente que Trump diera positivo, dado que muchos de sus cercanos, incluidos su asesor de seguridad nacional y oficiales del Servicio Secreto, también se infectaron.

“Cuando miras la cantidad de contactos sociales y los viajes, no es sorprendente”, dijo Adalja.

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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Watch: Young Man Faces Medical Bankruptcy — Even With Insurance

“CBS This Morning” tells the story of Matthew Fentress, a young man who developed serious heart disease after a bout of flu when he was just 25. Now 31, he owes more than $10,000 in hospital bills. KHN Editor-in-Chief Elisabeth Rosenthal explains that the same cardiomyopathy Fentress got can also be a complication of COVID-19.

Fentress’ story is the latest in the ongoing crowdsourced Bill of the Month investigation, a collaboration with KHN, NPR and “CBS This Morning.”

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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Wear a Mask. If Only It Were That Simple.

Nils Hase, a retiree who lives in Tarpon Springs, Florida, is wearing a mask and loading his Home Depot haul into his car on a recent weekday afternoon. In the store, because Home Depot insists customers and staff across the country wear masks, most faces were covered. But out here in the parking lot, in a state with a serious infection rate but no mask mandate, plenty of those masks hang down around people’s chins.

“It bothers me. They are being defiant,” Hase said. “And most of the people I see that walk in without a mask are just looking for a fight. They are asking you to ‘Just ask me. Just give me a reason to yell at you.’ I just stay away from them and keep on with my own life.”

Six and a half months after President Donald Trump declared the coronavirus emergency, COVID-19 has killed more than 207,000 Americans and infected 7.3 million, now including Trump himself and the first lady.

Scientists are warning of a larger wave of infection this winter. They agree the simplest, easiest way to fight that surge is to get most people to wear masks most of the time.

Yet the political fight over face coverings rages. It plays out on city streets, in suburban grocery stores, in rural sheriff’s offices and at the highest echelons of government — all the way to the presidential debate stage this week in Cleveland. There, most of Trump’s contingent refused to wear required masks, and one of them tested positive soon afterward. Only time will tell if they spread the infection, but their behavior is mirrored across the nation.

Hefty Price in Iowa

In April, Iowa health officials cut an agreement with Iowa University to do modeling on the impact of coronavirus. Among the data are estimates of future death rates and the projection that more than a thousand Iowans could be saved by adopting a universal mask policy.

Later that month, the researchers warned Republican Gov. Kim Reynolds not to ease restrictions aimed at curtailing the virus, saying a spike would result later in the year. They also recommended a strong policy on facial coverings, producing a report that said face shields would dramatically lower the virus’s toll.

Reynolds took none of that advice. She started easing restrictions in late April. She argued it was more important to reopen the state’s economy while encouraging people to be responsible and wear masks than to throw down a mandate she called unenforceable.

“I think the goal is to strongly encourage and recommend that people wear them,” she said in late August. “I believe that people are.”

Yet at that moment, Iowa was proving the university’s predictions true, suffering the highest infection rate in the nation. In late September, the state was one of only seven that remained in the “red zone,” averaging more than 890 new infections a day.

The governor’s intransigence on masks highlights a troubling problem. At a time when experts believe the nation needs to unite around a strategy to curb a potentially catastrophic winter, the cheapest, best option — masks — have become increasingly politicized. Even Republicans like Reynolds, who agree masks work, refuse to take the advice of their experts. They oppose mandates and favor an educational approach that many people actively resist.

Dissent Within the Trump Administration

The trouble starts at the top. The Trump administration’s leading medical advisers have testified repeatedly that masks were the country’s best tool to blunt a second wave that could be significantly deadlier than the initial spike.

Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, went as far to say face coverings were a more certain bet than a vaccine if everyone would wear them.

“If we did it for six, eight, 10, 12 weeks, we’d bring this pandemic under control,” Redfield said during a Sept. 16 hearing. “They are our best defense.”

Trump contradicted him before the day was done, and just a few days earlier, as the president and his coterie did in Cleveland, Trump modeled exactly the opposite behavior. At a campaign rally of thousands in Nevada, he cheered on the mostly maskless crowd. The next day, he held a massive mask-optional indoor rally at a warehouse in Henderson, Nevada, defying state restrictions. He advised the owner (who was later fined $3,000) that he’d protect the man if the state went after him.

“I’ll be with you all the way. Don’t worry about a thing,” Trump said.

But Trump’s actions and statements are worrisome for scientists and public health experts. They have watched in horror and frustration as the president’s dismissive attitude toward masks and COVID-19 itself has gone hand in hand with growing politicization of the public health response.

Meanwhile, the White House Coronavirus Task Force, led by Vice President Mike Pence, issued a “state report” on Montana on Sept. 20 that included the suggestion that the state “consider fines for violations of face mask mandates in high transmission areas.” At a press conference, Gov. Steve Bullock, a Democrat, said fining people would not be “the Montana way.” The state is, however, one of 34 with a mask mandate in place.

Indeed, the single-strongest predictor of whether or not a state will mandate strong mask policies bears little relationship to a state’s disease problem, according to a recent study by a team at the University of Washington.

After analyzing comprehensive data on mask policies, researchers led by Chris Adolph, a professor of political science and statistics, found that having a Republican governor would predict a 30-day delay in recommending mask policies. In a state that is also ideologically conservative, the delay would be closer to 40 days. A state’s death rate or infection rate had a much weaker influence.

“Because mask mandates are far less costly than business closures or stay-at-home orders, when we started to monitor these policies in April, we hoped their adoption would be universal,” Adolph said. “Instead, we found the same pattern: Republican governors resisted mandating masks even when public health conditions called for them.”

Adolph’s research suggests Trump is at least amplifying disdain for masks and, in fact, the phenomenon has been playing out across the country, most strikingly among some of Trump’s most ardent supporters — law enforcement and extremely conservative politicians.

Anti-Mask Sheriffs

In Washington state, Florida and even Democratic California, sheriffs made headlines by taking actions in opposition to local masking guidelines.

In Washington’s Snohomish County, where the first case of COVID-19 was discovered in the United States, Sheriff Adam Fortney declared in an April Facebook post: “The impacts of COVID 19 no longer warrant the suspension of our constitutional rights.”

Democratic Gov. Jay Inslee ordered people to wear masks in public in late June, just as a summer-long rise of infections began. Lewis County Sheriff Rob Snaza responded by telling a cheering crowd outside a church, “Don’t be a sheep.” Klickitat County Sheriff Bob Songer on the radio called Inslee “an idiot” over the order.

In Florida, anti-mask resistance has been especially fierce. Again, sheriffs offered the most startling opposition. One, Marion County Sheriff Billy Woods, banned masks for his deputies and visitors to the sheriff’s department offices, though he later relented on visitors.

Even in solid-blue Los Angeles County, the sheriff’s office was reprimanded by the county inspector general because deputies refused to wear masks, in violation of public health orders.

Surprisingly, officials there who support masks were disinclined to push tough enforcement.

“One of the things in all of this is we’re not going to enforce or fine our way out of this,” L.A.’s top public health official, Dr. Muntu Davis, told reporters recently.

Researchers disagree with Davis and Reynolds, not because education doesn’t work, but because it takes a long, sustained effort.

“Developing and deploying health education programs takes time, so in emergencies where rapid compliance is essential for reducing the spread of a novel pathogen, mandates are a critical element,” said Adolph.

Tickets in Tennessee

That’s the path officials took in Nashville, Tennessee, though initially officers opted for a more lenient approach than the mayor wanted. They had to be forced to write tickets with a potential fine of $50. The police still mostly have been giving warnings — thousands on any given weekend — but they’ve also written dozens of tickets and made some arrests.

City officials credit the crackdown with curbing COVID-19, even as it ran rampant in rural Tennessee counties where there are no mask mandates. In late September, Nashville’s Davidson County had 13.5 cases per 100,000 people, while more than three dozen less populous counties had “red zone” infection rates, with more than 25 cases per 100,000 people.

Amid the conflicting messages, including where enforcement has worked, not everyone is convinced that covering your nose and mouth is something that should rise to the level of police.

“I think they have better things to do than force anybody to wear a mask,” said Jennifer Johnson, an X-ray tech in downtown Nashville. “I think it should be at your own risk, but that’s just my opinion.”

Lawsuits Plus Weekly Protests in Florida

Plenty of conservative-leaning citizens and lawmakers agree with her, to the point of suing to block mandates.

In Hillsborough County, Florida, home to Tampa, county commissioners must vote each week to renew a state of emergency that requires masks to be worn in indoor public places.

Jason Kimball, a regular speaker at those meetings opposing the order, grew so angry he started a GoFundMe campaign for a lawsuit. He hit his $5,000 goal in 24 hours.

“You can only do so much as a commission legally, without violating the state constitution and the United States Constitution,” Kimball said at a recent meeting.

Rep. Anthony Sabatini, a state lawmaker who has filed 15 similar lawsuits on behalf of others all over the state, took the case. He claims mask ordinances are an overreach by government and a violation of Florida’s privacy clause.

“The government has never done this before,” Sabatini said. “It’s never told people that they have to wear masks everywhere they go all day long, and that’s basically what it’s come to.”

A judge dismissed Sabatini’s case in Hillsborough County and several of his other lawsuits have been denied.

Like Kimball and many other mask opponents, Sabatini insists masks don’t work, saying anyone can Google it to find out.

Scientists beg to differ, and are distressed political ideology has trumped real data and made it impossible for science to dictate the best responses.

“That’s certainly been a source of frustration for those of us who work in public health,” said Joe Cavanaugh, who runs the Department of Biostatistics at the University of Iowa’s College of Public Health and helped build the modeling distributed to Gov. Reynolds.

Watching Other Countries Succeed

Dr. Ali Mokdad, a former outbreak scientist at the CDC who works for the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine, finds it especially painful to watch other countries deal with the pandemic better than the United States.

He traveled the globe to stop outbreaks, and now other countries are using the methods he and his former colleagues at the CDC taught them.

“Why aren’t people wearing a mask? For the first time in our history, of humankind, we have a measure that is really very cheap,” he said. “You can make it at home yourself from something old you have. It saves lives. It saves the economy.”

It is doubly frustrating — and alarming — because while mask adoption had been rising over the summer, it’s recently begun to slip. The shift caused IHME to adjust upward its model of how many people would get infected and die by Jan. 1 in the United States.

“This change in the last week is due mainly to the decline in masks and the increase in mobility,” Mokdad said.

The death rate estimate has since moderated — projected this week at 372,000.

One place where mask use has declined is Iowa, where Mokdad said only 28% of people say in surveys they are always likely to wear a mask when they go out.

Scientists at the University of Iowa had been using data similar to what IHME uses for its coronavirus models. The state won’t let the university make its modeling public, but when some of its data was online, the projection was that Iowa would see more than 1,000 deaths by the end of August if no additional safety steps were taken. As of Tuesday, the state’s official toll was 1,328.

By IHME’s most recent similar estimates, more than 3,400 Iowans will die by Jan. 1. With a universal mask requirement, some 1,600 could be saved. Nationally, nearly 115,000 lives could be spared.

Winter Is Coming

Cavanaugh would welcome even a toothless mandate to spare some of those lives. “Just sending that message at the state level is, I think, an important step in emphasizing the importance of it,” said the University of Iowa researcher.

Sixteen states still do not have a mandate, all of them led by Republicans.

The especially frightening element to the anti-mask movement is that it can only worsen what scientists already warn is going to be a bad winter.

When it’s cold, the virus can survive longer on surfaces, and people are stuck indoors where it can become more concentrated in the aerosolized droplets people exhale.

“We’ve seen it in our data. We’ve seen it in other countries,” Mokdad said. “It’s very strong, and it’s going to happen in the U.S., unfortunately.”

Back in Florida, Nils Hase will keep wearing his mask.

“I’ve always believed in the science behind it,” Hase said. “It’s a virus and we need to be aware of what’s going on. People who don’t, they’re just idiots.”

This story is from a reporting partnership that includes Health News Florida, KPCC, Nashville Public Radio, KHN and NPR. 


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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