Trump CDC chief joins 'Big Ass Fans' -- which promotes controversial Covid-killing technology

Dr. Robert Redfield, former director of the Centers for Disease Control and Prevention, has joined Big Ass Fans, lending his scientific credibility to a company division that says its ion-generating technology kills the coronavirus. The company charges $9,450 for a fan with technology that academic air quality experts question.

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As strategic health and safety adviser, he follows Dr. Deborah Birx, former White House coronavirus response coordinator, into the booming air purifying industry. Last month, she signed on with ActivePure, a company that also makes a pitch about virus-destroying technology, but markets some devices that run afoul of California indoor air quality rules, according to a KHN investigation.

The two bring name recognition to companies selling products that are advertised to make it safer for people to gather maskless inside schools, offices, gyms and stores. The companies market 99.9% coronavirus kill rates.

Academic indoor air quality experts who criticize certain claims about covid-killing technology say the industry-funded studies often focus on results of tests run in a space ranging in size from a shoebox to a cabinet that do not reflect the conditions in a large room. Studies backed by the industry rarely make it clear whether the touted “virus-killing" ions or molecules are doing the work, experts say, or if improvements come from a fan or filter on a device.

“There's no other way to say it — it's completely unproven whether these devices would work in a real-world setting," Timothy Bertram said of devices that claim to attack molecules in midair. He is a chemistry professor who studies aerosol particles at the University of Wisconsin-Madison.

Redfield, who led the CDC during the Trump administration's pandemic response, did not respond to requests for comment before publication. “Proper ventilation has a major role to play in mitigating transmission of COVID-19 and other respiratory pathogens," Redfield said in a Big Ass Fans news release. “Big Ass Fans is a leader in designing airflow systems and making places where we live, work, and play, safer."

Academic air quality experts, though, say high-profile physician sign-ons amount to celebrity endorsements.

“I'd much rather see good data transparently released than listen to Deborah Birx talk about how good this technology is when I know she isn't an expert on air disinfection," said William Bahnfleth, an architectural engineering professor at Penn State who studies indoor air quality and leads the American Society of Heating, Refrigerating and Air-Conditioning Engineers Epidemic Task Force.

Bertram said he studied the performance of various ion- and hydroxyl-releasing devices in classrooms and found that some emitted ozone, a gas associated with the onset or worsening of asthma. Others created other new small particles. When it came to improving ventilation, none performed as well as a HEPA filter, he said, which together with a MERV-13 filter in a heating system and increased outside ventilation is the standard recommendation. Bertram did not say which specific devices he reviewed, but said that will be detailed in a forthcoming study.

Big Ass Fans is entering the coronavirus air purifying market with brand recognition based on its uncontroversial air-moving mega-fans. Its Clean Air System fans are already used in schools and by companies such as Toyota, Tiffany & Co. and Orangetheory Fitness.

Some Clean Air System fans use UVC light, widely considered an effective air cleaning technology. Other fans use bipolar ionization, a technique that the Environmental Protection Agency warns is “an emerging technology, and little research is available that evaluates it outside of lab conditions," adding that evidence of its effectiveness is less documented than the evidence for far more established choices like air filtration.

Big Ass Fans spokesperson Alex Risen stressed in an interview that its technology is just one layer of protection against the coronavirus. The company, headquartered in Lexington, Kentucky, says its technology “pairs scientifically proven air purifying technologies with powerful airflow solutions. This results in a system that kills 99.99% of pathogens to keep your people protected and your business booming."

The company charges about $500 to $1,500 more for fans with Clean Air System technology.

In the pandemic, federal funding to buy such devices for schools has exploded, with roughly $193 billion available so far. Congressional Democrats are pushing for $100 billion more. With community pressure to reopen classrooms, school officials have begun to invest heavily in air cleaning technology, though some experts worry risks are not being considered.

The EPA has warned about bipolar ionization's ability to generate ozone and other potentially harmful byproducts indoors. A study by top indoor air quality experts in the Building and Environment journal found that another company's bipolar ionization technology created other byproducts, including toluene, which can have developmental effects after long-term inhalation exposure.

Risen, the Big Ass Fans spokesperson, stressed that its ionization technology does not emit ozone or other byproducts and is not “putting bad things into your lungs." He said the products do not emit hydrogen peroxide. ActivePure, the air cleaning company Birx has signed on with, makes air cleaners that emit gaseous hydrogen peroxide, which it claims can seek out and destroy viruses, mold and bacteria, according to the KHN investigation.

“We know that we're not producing any negative products," Risen said. “We know that at the concentrations that you're at, you're not getting negative effects."

Joe Urso, ActivePure Technologies CEO, said the “FDA has cleared a number of devices that emit hydrogen peroxide into the ambient air at a safe level for people to breathe, including our ActivePure Medical Guardian."

Bahnfleth said Big Ass Fans had made more of a good faith effort with its studies than others in the market. But he added that, without measuring potential gaseous byproducts, the research was not complete.

“They still do nothing to address potential adverse impacts of chemical byproduct exposure," said Brent Stephens, an indoor air quality expert who reviewed Big Ass Fans Clean Air System's reports and leads the civil, architectural and environmental engineering department at the Illinois Institute of Technology.

Stephens added that the controlled testing spaces — without people or furniture or other products that would be in a classroom or office — did not reflect real-world circumstances. And he worried about the “really high" ion counts, saying he would not recommend them for occupied spaces.

Bahnfleth echoed Stephens' concerns, pointing to a study that showed adverse health effects such as increased oxidative stress levels — which are linked to cancer and other neurological diseases — for those exposed to a high number of negative ions. Experts said more research is needed, as bipolar ionization, like that used by Big Ass Fans, produces both positive and negative ions.

Risen defended the safety of ions in an interview, noting they occur naturally.

It's hard to tell if the fan moving the air or the bipolar ionization is having an impact on the virus in the studies provided by Big Ass Fans, said Delphine Farmer, a Colorado State University associate professor who specializes in atmospheric and indoor chemistry. Also, she said, without real-world testing, it's unclear what sort of reaction this product could have when exposed to classroom fumes from paint, glue or markers.

“Anything that actually destroys a virus is potentially doing other chemistry as well," she said.

Another Clean Air System study claimed a 99.999% reduction of the virus that causes covid from the air.

“When they give you 99.999%, that's a red flag to any scientist. We don't know anything to that degree," Bertram said. “That's just nuts."

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


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This doctor survived Cambodia’s Killing Fields -- but not Covid

Linath Lim's life was shaped by starvation.

She was not yet 13 when the Khmer Rouge seized power in Cambodia and ripped her family apart. The totalitarian regime sent her and four siblings to work camps, where they planted rice and dug irrigation canals from sunrise to sunset — each surviving on two ladles of rice gruel a day. One disappeared, never to be found.

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Just a few months before the Khmer Rouge fell in January 1979, Lim's father starved to death, among the nearly one-quarter of Cambodians who perished from execution, forced labor, starvation or disease in less than four years.

For Lim, the indelible stamp of childhood anguish drove two of her life's passions: serving people as a physician and cooking lavish feasts for friends and family — both of which she did until she died of covid-19 in January.

Within the week before her death at age 58, she treated dozens of patients who flooded the hospital during the deadly winter covid surge, while bringing home-cooked meals to the hospital for her fellow health care workers to enjoy during breaks.

“These experiences during the war made her humble and empathetic toward the people around her," said Dr. Vidushi Sharma, who worked with Lim at Community Regional Medical Center in Fresno, California. “She always wanted to help them."

Lim's story is one of suffering and triumph.

During the Khmer Rouge's brutal reign and the Cambodian civil war before it, Lim and her nine siblings attended school sporadically. The ravages of war forced the family first from its small town to the capital, Phnom Penh, and then into the countryside when the Khmer Rouge took power in 1975. As part of its vision to create a classless agrarian society, the communist group split families and relocated residents to rural labor camps.

Lim survived the work camps because she was smart and resourceful, said her youngest brother, Rithy Lim, who also lives in Fresno. She dug ditches, hauled clay-like dirt on her back, built earthen dams in the middle of a river during monsoons — all with little food or rest, he said.

She also became a skillful hunter and fisher, and learned to identify plants that were safe to eat.

“You cannot imagine the horrible conditions," he said. “Think of it as a place that you live like wild animals, and people tell you to work. There's no paper, no pens. You sleep on the ground. We witnessed death of all sorts."

Vietnamese troops liberated Cambodia from the Khmer Rouge in 1979. Later that year, Lim, her mother and siblings sneaked into Thailand. “The whole family walked through minefields," Rithy Lim recalled. There, they waited and worked in refugee camps. At one camp, they met a dentist from California's Central Valley who was on a medical mission.

When Lim and her family arrived in the U.S. in 1982, they landed in Georgia. But she and an older brother soon moved to the small town of Taft, California, about 45 minutes west of Bakersfield, at the invitation of the dentist they'd befriended at the Thai refugee camp.

When she hit the ground, the 4-foot-11 dynamo, then 19, was driven by “pure determination," Rithy Lim said.

Within two years, Linath Lim learned English, earned her GED and graduated from Taft College — “boom, boom, boom," her brother recalled. (She learned to make traditional, middle-America Thanksgiving dinners when she worked at the community college's cafeteria, which she would later cook for scores of friends and family.)

She went on to attend Fresno State and then the Medical College of Pennsylvania, sleeping on friends' couches, borrowing money from other Cambodian refugees and scraping by.

“Imagine not having any money, studying alone, sleeping in someone else's living room," Rithy Lim said.

Lim became an internal medicine doctor “because she always wanted to be really involved with a lot of patients," Rithy Lim said. After her residency, she returned to the Central Valley to practice in hospitals and clinics in underserved communities, including Porterville and Stockton, where some of her patients were farmworkers and Cambodian refugees.

California has the largest Cambodian population in the country, with roughly 89,000 people of Cambodian descent in 2019, according to a Public Policy Institute of California analysis of American Community Survey data.

Twice, Lim joined the Cambodian Health Professionals Association of America on weeklong volunteer trips to Cambodia, where she and other doctors treated hundreds of patients a day, said Dr. Song Tan, a Long Beach, California, pediatrician and founder of CHPAA.

“She was a kindhearted, very gentle person," recalled Tan, who said he was the only member of his family to survive the Khmer Rouge. “She went beyond the call of duty to do special things for patients."

Most recently, Lim worked the swing shift, 1 p.m. to 1 a.m., at Community Regional Medical Center. She admitted patients through the emergency room, where she was exposed to countless people with covid. She worked extra shifts during the pandemic, volunteering when the hospital was short-staffed, said Dr. Nahlla Dolle, an internist who also worked with Lim.

“She told me there were so many patients every day, and that they didn't have enough beds and the patients had to wait in the hallway," Tan said.

Colleagues said she was aware of the risks but loved her job. Lim, who was single and didn't have kids, drew happiness from celebrating others' joys. After getting home from work in the small hours, she slept for a bit, then got up to cook. Her specialties were Cambodian, Thai, Vietnamese and Italian food. She sometimes ordered a whole roasted pig that she transported to the hospital. Her memorable Thanksgiving dinners served 70 or more people.

“For any occasion that comes up — if it's a birthday, if it's a baby shower, if it's Thanksgiving — she would cook, she would order food and bring everybody together," Dolle said. “She loved to feed people because she experienced famine and lack of food."

The week before she died, Lim cooked for her colleagues almost every day, and threw a baby shower for Sharma, complete with chicken calzones and blueberry cake.

“Every day, we were having lunch together," Sharma said. “She did the shower, and then she's gone."

Lim, who had health problems including diabetes, had not been vaccinated. Family and friends had urged her to take care of herself, and to check her blood sugar and take her medications. “She would care about everyone but herself," Sharma said.

On Jan. 15, Lim told friends by phone that she was exhausted, achy and having trouble breathing. But she said that she would be fine, that she just needed to rest. Then she stopped responding to calls and texts.

When she didn't show up for work a few days later, her brother went to check on her at home and found her on the couch, where she had died.

Now her brother and colleagues are haunted by what-ifs over the loss of a remarkable woman and doctor: What if I had checked on her sooner? What if she had been vaccinated? What if she had gotten care when she started feeling ill?

“To have someone who has been through all that in her childhood and then flourish as a physician, a human being, coming to a new country, learning English, going to school and college without having much financial support, it's phenomenal," Sharma said. “It's unbelievable."

This story is part of “Lost on the Frontline," a 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.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


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Rand Paul gets schooled by scientists -- including one he cited -- after lashing out at Anthony Fauci again

“Sorry Dr Fauci and other fearmongers, new study shows vaccines and naturally acquired immunity DO effectively neutralize COVID variants. Good news for everyone but bureaucrats and petty tyrants!"

— Sen. Rand Paul in a tweet, March 21, 2021

That Sen. Rand Paul of Kentucky often disagrees with infectious-disease expert Dr. Anthony Fauci is well known.

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Recently, the pair clashed at a Senate hearing when Paul, a Republican, argued against mask recommendations for people who have had covid-19 or have been vaccinated against it.

At the hearing, Fauci, President Joe Biden's chief medical adviser, pushed back against Paul's characterization of wearing masks as “theater." Continued caution is advised, Fauci said, as scientists study the new variants now circulating in the U.S. and other countries.

Paul, an eye doctor by training, continued the squabble a few days later, calling out Fauci in a tweet, pointing to a study that he said “shows vaccines and naturally acquired immunity DO effectively neutralize COVID variants."

The tweet linked to a study published online at the JAMA Network, a family of specialty medical journals.

We reached out to Paul's office for additional sources for his tweet but did not receive a reply.

So, we asked the experts: Are covid variants effectively neutralized by vaccines or natural immunity conferred on people who recover from the illness?

In short, the research cited by Paul does show good blood levels of neutralizing antibodies against at least some of the current variants following infection or vaccination. But they're not the whole story.

Mehul S. Suthar, an author of the study Paul cited, said the results are encouraging but should not be seen as all-encompassing: “Our interpretation is that our study looks at one aspect of immune response, antibodies."

Small Samples. Big Questions.

Neutralizing antibodies are important because they can block the ability of a virus like the one that causes covid to infect cells. But the body also has other defenses. T cells, for example, can be spurred by infection or vaccination, Suthar said, although the study was not designed to look at those.

For the study, researchers gathered blood samples from 40 people who were in the hospital with covid or had recovered from it. From the National Institutes of Health, they also received blood samples drawn from 14 people who had gotten both doses of the Moderna vaccine, said Suthar, an assistant professor at Emory University's vaccine center.

Then they ran tests on those samples against the original SARS-CoV-2 virus and three variants, including the one dubbed B.1.1.7, which first appeared in the United Kingdom and is now circulating widely in the U.S.

They wanted to know: Did antibodies produced by being infected or vaccinated neutralize B.1.1.7?

“We are lucky with B.1.1.7 that our antibodies appear to work well against this virus," Suthar said.

However, as with any study, there are caveats. For one thing, the results were based on a small number of samples. And the analysis did not include other variants of concern, such as the ones that emerged in South Africa and Brazil, which limits the ability to draw broad conclusions.

Finally, antibodies are just one measure of potential protection against disease. Laboratory research measuring antibodies indicates that some immunity is created by both illness and vaccination, but the strength and longevity of that protection — the effectiveness in the real world — is a separate question. That's partly because the ideal level of neutralizing antibodies needed for protection is not known and other immune protections, such as T cells, aren't measured.

Also, in the real world, other factors — such as the variant a person is exposed to, and the presence of other mitigating factors, including masks and good ventilation — can make a difference.

“Part of the reason that real-world data are so important is looking at the whole picture of immunity," said Gigi Gronvall, a senior scholar at Johns Hopkins Bloomberg School of Public Health. “Also, with the level of community transmissions of disease, I would be concerned that there will be more variants that emerge."

Nuance Matters

Paul's tweet — taking aim at what he sees as an overcautious approach by public health experts — doesn't capture that type of nuance, nor does it reference studies on the other emerging variants.

“Blanket assertions made by non-scientific experts are not going to help," said Gronvall.

Dr. Jesse Goodman, professor of medicine and a specialist in infectious diseases at Georgetown University, agreed.

“It's wrong to declare victory and say there's no problem with variants and that everyone previously infected will be fine," said Goodman, who served as chief scientist of the Food and Drug Administration under the Obama administration.

Viruses naturally mutate as they replicate. So it's not surprising that the coronavirus has done so. Several variants have emerged, including home-grown ones from California and New York.

Lab tests on blood samples from vaccine trial participants in South Africa showed lower levels of neutralizing antibody production, possibly related to the variant circulating there.

How big a difference the lower levels measured in those samples make isn't yet known.

Levels are still high and could “effectively neutralize the virus," Fauci wrote in an editorial published Feb. 11 in JAMA.

Even so, clinical trials used to test covid vaccines before they were approved for emergency use showed lower efficacy when tested in areas where the South African variant was circulating.

“We expect vaccines and prior infection to offer significant protection against variants that are closely related," said Goodman. “But as they become more genetically different — like the South African one — that protection could go down."

The main goal of the vaccines is to prevent hospitalization and death, and all the vaccines in use in the U.S. appear to substantially reduce the risk of hospitalization and death from covid, according to research.

“Even if the current vaccines may not be perfect, they do appear to prevent more severe outcomes," Goodman said.

Don't assume, as Paul's tweet implies, that recovering from covid or getting vaccinated means zero risk of infection.

For one thing, reinfection is rare but can occur.

Goodman pointed to a recent study conducted in Denmark showing that a small percentage (0.65%) of people who tested positive for covid in the spring fell ill again.

“People should not presume that even if they had the vaccine or were previously infected that there's no future risk," Goodman said.

Even though no vaccine is 100% effective, Gronvall at Hopkins said not to use that as an excuse to avoid inoculation.

“The vaccines appear to be great," she said. “Get one when you can."

Our Ruling

Paul is correct that the JAMA study showed vaccination or previous infection appeared, based on a small sample of people, to help neutralize the virus. However, he left out important details that make his position an oversimplification of a complicated issue.

The study considered only one variant — the one that emerged in the U.K. — and did not include an analysis of other types now circulating, or the potential for additional variants that could emerge. Also, the type of antibody studied is just one factor in protecting against disease, and just what those levels of neutralizing antibodies measured in a laboratory experiment may mean in the real world is not known.

So, for those reasons, we rate the senator's statement Half True.

Source List:

Telephone interview with Mehul S. Suthar, assistant professor at the Emory Vaccine Center, March 22, 2021

Telephone interview with Gigi Gronvall, senior scholar at Johns Hopkins Center for Health Security and associate professor in the environmental health and engineering department at Johns Hopkins Bloomberg School of Public Health, March 23, 2021

Telephone interview with Jesse Goodman, professor of medicine at Georgetown University and former chief scientist of the Food and Drug Administration, March 24, 2021

JAMA Network, “Neutralizing Antibodies Against SARS-CoV-2 Variants After Infection and Vaccination," March 19, 2021

CNN Politics, “Masks Are Not Theater, Fauci Tells Sen. Rand Paul in Hearing Exchange," March 18, 2021

The New England Journal of Medicine, “Neutralizing Activity of BNT162b2-Elicited Serum," March 8, 2021

The New England Journal of Medicine, “Serum Neutralizing Activity Elicited by mRNA-1273 Vaccine," March 17, 2021

Yale Medicine, “Comparing the COVID-19 Vaccines: How Are They Different?," updated March 25, 2021

Fast Company, “Can I Get Covid-19 Twice? New 'Lancet' Study Offers Insight on Reinfection Rates," March 22, 2021

JAMA Network, “SARS-CoV-2 Viral Variants — Tackling a Moving Target," editorial, Feb. 11, 2021

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By Julie Appleby, Kaiser Health News

CVS vaccine appointments are going unfilled deep in Trump country

Last week, as covid vaccine appointment slots were snapped up within an hour at CVS stores in 20 states, slots remained open all day at CVS pharmacies in Alabama, South Carolina and Louisiana.

The dozens of open appointment slots in the three Southern states stood in sharp contrast to the availability in states such as Delaware, Connecticut and Pennsylvania, where appointments generally were gone by midmorning or earlier. CVS and other retailers typically post appointment slots around 7 a.m. for the next day.

In many counties across the three states — particularly in rural areas — retailers and outpatient clinics are among the few places offering covid-19 shots. CVS and other large pharmacies, including Walgreens and Walmart, are among the biggest providers of the vaccinations.

South Carolina health officials said they noticed demand was waning at some vaccine sites — and, as a result, lowered the age eligibility for the shots from 65 to 55 starting Monday.

“Reports here and there from around the state, not everywhere, indicate vaccine appointments have not been filling, so this was the time to do this," said Nick Davidson, senior deputy for public health at the South Carolina Department of Health and Environmental Control.

Marvella Ford, a professor in the department of public health sciences at the Medical University of South Carolina in Charleston, wasn't surprised by the vacant appointments.

“We know we have work to do to engage with the community to get the word out about the safety and effectiveness of the vaccine," she said. Many in the state's large Black community are skeptical about the vaccine, she said, and many poor residents in rural areas face hurdles, including lack of transportation to vaccine sites and lack of internet access to book appointments.

“There are a lot of barriers," Ford added, “and we want to shine a light on them so we can figure out a way to overcome them."

Ford is a leader of a Black faculty group that, along with a Hispanic faculty group at the medical school, has been meeting with community organizations across the state to urge Black and Hispanic residents to get vaccinated.

Dr. Scott Harris, Alabama's state health officer, attributed the openings at CVS to the pharmacy chain having recently added several stores offering the vaccine. “I do not believe there is an issue with uptake, but we will continue to monitor this," he said.

As of 4 p.m. Friday, all 33 Louisiana CVS stores that are offering vaccines had dozens of open Saturday appointments for covid vaccines.

Two-thirds of the 80 participating CVS stores in South Carolina had openings. About half of the 56 CVS stores in Alabama administering vaccines still had availability.

CVS spokesperson Mike DeAngelis could not explain why the three states had more supply than demand. “We are aware that demand for vaccine appointments at our pharmacies is stronger in some states than it is in others," he said. “We are working across multiple fronts to increase awareness of vaccine availability, safety and effectiveness."

CVS is one of several large, national pharmacies offering covid shots. But it's the only retailer that makes it easy for people to go online and search by state for open appointments over several days. At Walgreens and Walmart, users can search for the shots only by ZIP code.

As a result, consumers in states where vaccines remain extremely limited can easily see where CVS appointments remain aplenty. While some states have enacted residency requirements to block out-of-state visitors from getting vaccines, other states such as South Carolina have not.

Lior Rennert, a biostatistician at the Clemson University School of Public Health who has worked on South Carolina's vaccine rollout, said he was surprised to hear of the open slots since the state ranks in the top 10 nationally in the number of vaccines given out, measured as a percent of population. Yet, he said, politically conservative states like those in the Deep South face more challenges overcoming vaccine hesitancy than more liberal states.

He expects open slots to get filled up as the state expands eligibility.

“If there continue to be a lot of openings in the next week or two, that may indicate either a lack of communication about availability at CVS locations or that there is simply not as great of a demand due to vaccine hesitancy," Rennert said.

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When your chance for a Covid shot comes, don't worry about the numbers

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

The newest covid vaccine on the horizon, from Johnson & Johnson, is probably a little less effective at preventing sickness than the two shots already being administered around the U.S., from Pfizer-BioNTech and Moderna. On Saturday, the Food and Drug Administration authorized the Johnson & Johnson vaccine after reporting it showed about 66% effectiveness at preventing covid illness in a 45,000-person trial. No one who received the vaccine was hospitalized with or died of the disease, according to the data released by the company and FDA. As many as 4 million doses could be shipped out of J&J's warehouses beginning this week.

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

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

“It's a bit like, do you want a Lamborghini or a Chevy to get to work?" said Dr. Gregory Poland, director of the Mayo Clinic's Vaccine Research Group, who was a paid consultant in the J&J study. “Ultimately, I just need to get to work. If a Chevy is available, sign me up."

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

Here are five reasons you should take the J&J shot if it's the one that's offered to you first:

1. All three vaccines protect against hospitalization and death.

Of the 10 people who got severe disease in the Pfizer trial, nine had received a placebo, or fake vaccine; none of the 30 severe cases in the Moderna trial occurred in people who got the true vaccine. A month after receiving the Johnson & Johnson shot there were no deaths or hospitalizations in those who had been vaccinated. “The real goal is to keep people out of the hospital and the ICU and the morgue," said Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia. “This vaccine will do that well."

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

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

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

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

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

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

3. Speed is of the essence.

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

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

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

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

“There's a downside to waiting," said Dr. William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University Medical Center. Delaying vaccination carries serious risks, given that, as of Saturday, some 2,000 Americans were still dying each day of covid.

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

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

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

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

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

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

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

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

[Editor's note: This is an updated version of a story that was originally published Feb. 1.]

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States aim to chip away at abortion rights with Supreme Court in mind

When Rep. Lola Sheldon-Galloway introduced a bill in the Montana House two years ago that would have prohibited abortions after 20 weeks of pregnancy, the Republican legislator knew it was unlikely to survive the veto pen of the Democratic governor.

Sure enough, then-Gov. Steve Bullock vetoed that bill and two other anti-abortion measures passed by the Republican-led state legislature. In his veto message, Bullock wrote that “for over 40 years, the U.S. Supreme Court has recognized that the U.S. Constitution prohibits a state from banning abortion."

But now Bullock's gone, replaced by Republican Greg Gianforte, who has promised to sign two proposed measures that would put new limits on abortion. And abortion-rights advocates worry the court ruling that Bullock based his vetoes on — the landmark 1973 Roe v. Wade decision — is on shaky ground.

The Supreme Court tilted further right with last year's confirmation of Justice Amy Coney Barrett, giving the high court a makeup of six justices appointed by Republican presidents and three appointed by Democrats.

That has emboldened lawmakers in Montana and other right-leaning states to introduce dozens of anti-abortion bills this year in the hope that the high court will hear lawsuits against new state laws and side with the states. The goal is to chip away at Roe v. Wade.

According to Kristin Ford, national communications director for NARAL Pro-Choice America, more than 60 bills have been introduced or passed in state legislatures so far this year to restrict abortion. Most are in conservative-leaning states like Montana, Kansas and Wyoming.

“These legislators are willing to do whatever it takes to advance their extreme agenda of gutting Roe v. Wade and pushing abortion care as far out of reach as possible," Ford said. “With Roe in the crosshairs, the stakes for women, people who are pregnant and families are higher than ever."

Ford and other abortion-rights advocates said any one of those bills could be challenged and make its way to the Supreme Court.

That's the apparent aim of the conservative state lawmakers pushing bills. In Montana, legislators have introduced six anti-abortion measures so far this year, including Sheldon-Galloway's proposed ban on abortions after 20 weeks.

“If this legislation made it all the way to the Supreme Court, that would be a good thing, because we need to revisit Roe v. Wade," Sheldon-Galloway said.

Eric Scheidler, executive director of the Pro-Life Action League, based in Chicago, said the rash of bills exemplifies the changing methods of the anti-abortion movement. When his father founded the Pro-Life Action League in the 1970s, the organization's goal was simply to get the Roe v. Wade decision overturned, either in the courts or in the statehouses. But now anti-abortion groups are taking a piecemeal approach.

He said it's more likely that the current Supreme Court will overturn Roe v. Wade incrementally rather than all at once.

“Will this court overturn Roe v. Wade? It's possible," Scheidler said. “But I think we're more likely to see this court put more restrictions on abortion. I think five years from now we'll realize that Roe v. Wade was slowly overturned without it ever making a big headline."

For anti-abortion groups, pushing legislation through at the state level may be their only option since Democrats control Congress and the White House. President Joe Biden has said he wants to “codify" Roe v. Wade and appoint federal judges who will respect the precedent.

Sheldon-Galloway said her bill, dubbed the Pain-Capable Unborn Child Protection Act, would protect unborn children who might feel pain during an abortion.

Abortion advocates said that the bill is based on dubious science and that abortions at that point in pregnancy are rare and usually happen only for medical reasons. Similar bills are being introduced in Florida, Hawaii, New Jersey and Oregon.

“There are very few abortions that happen after 20 weeks, and when they do they usually occur because of a significant medical issue," said Alison James, chairperson of Montanans for Choice, an abortion-rights group. “These are usually wanted pregnancies, and so these unnecessary laws put women and families through the wringer. It will treat them like criminals."

Groups like Montanans for Choice have stepped up their efforts this year because they know that any abortion bill that passes the Montana legislature will be signed into law. Other bills working their way through the legislature would prohibit people from accessing abortion medication through the mail and require doctors to offer an ultrasound before terminating a pregnancy. Another would create a ballot initiative asking Montanans to decide whether fetuses that live through an abortion are people with legal rights.

Similar legislation has been introduced in a dozen other states, according to the National Right to Life Committee.

Nicole Smith, a fellow of the Society of Family Planning and a board member for Montanans for Choice, said it is highly likely that any abortion bills that become law would be challenged in court, making the states the first battleground in the new laws' journey to the Supreme Court.

“We're seeing an onslaught of bills," Smith said. “And it will result in a legal battle."

[Correction: This article was updated at 2 p.m. ET on March 2, 2021, to correct that Gov. Greg Gianforte promised to sign two anti-abortion measures into law.]

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Becerra has long backed single-payer -- that doesn’t mean it will happen if he’s HHS Secretary

“Becerra supports Bernie’s government takeover of your health care, eliminating your employer-provided coverage.” — TV ad funded by Cotton for Senate, Feb. 22 This story was produced in partnership with PolitiFact. It can be republished for free. A digital ad running in Georgia and New Hampshire says Xavier Becerra, President Joe Biden’s nominee for Health and Human Services secretary, supports “Medicare for All.” “Becerra supports Bernie’s government takeover of your health care, eliminating your employer-provided coverage,” the narrator says. The ad, funded by the campaign PAC of Sen. Tom Co...

Connecticut is doling out vaccines based strictly on age. It’s simpler, but is it fair?

With covid vaccines expected to remain scarce into early spring, Connecticut has scrapped its complicated plans to prioritize immunizations for people under 65 with certain chronic conditions and front-line workers. Instead, the state will primarily base eligibility on age. Gov. Ned Lamont pointed to statistics showing the risk of death and hospitalization from covid-19 rises significantly by age. Yet, shifting to an age-based priority system — after health workers, nursing home patients and people 65 and up have been offered vaccines — has frustrated people with health conditions such as canc...

Trump administration approved export of millions of N95 masks as American workers cried for more

In the midst of a national shortage of N95 masks, the U.S. government quietly granted an exception to its export ban on protective gear, allowing as many as 5 million of the masks per month to be shipped overseas.

The Federal Emergency Management Agency issued the waiver in the final moments of Donald Trump's presidency last month, allowing a Texas company to export its products after it failed to secure U.S. customers, according to the FEMA letter obtained by KHN.

National Nurses United president Zenei Triunfo-Cortez called the export waiver “unconscionable" and said N95s remain under lock and key in many hospitals. She said she still has to “beg" for a new N95 if hers gets soiled during a shift caring for covid-19 patients.

Health care employers “and a federal agency that is supposed to be protecting the people of America are not doing their jobs," she said. “They have no regard for our safety."

The disconnect between front-line workers going without better protection and federal officials suddenly exporting masks boils down to one thing, workplace-safety experts say: The government has not pivoted quickly enough to lift supply chain crisis-mode guidelines and force employers to take costly and sometimes cumbersome steps to better protect workers with top-quality gear.

The FEMA letter references the challenge that Fort Worth-based Prestige Ameritech faced in finding customers for its government-approved, high-end respirators: Hospitals did not want to “fit test" employees to its N95s, a 15-minute process per employee to ensure that a new N95 model seals to the face, according to company president Mike Bowen.

Bowen said he ramped up N95 production during the pandemic from 75,000 to 9.6 million per month. Lately, he said, he can't sell them to major buyers, does not have the infrastructure to sell them to small buyers and has so many in storage that he may need to lay off workers and wind down production.

The FEMA letter references those challenges and says the waiver was granted in the “national defense interest" to ensure he keeps production running at pace. The letter was transmitted to Border Patrol officials who oversee exports 103 minutes before Joe Biden was sworn into office.

Yet even with the waiver, Bowen said, he hasn't been able to find an overseas buyer. He said he can't understand the contradictory information he's getting: Front-line workers say they need more N95s, but hospitals say they don't.

“There is a disconnect someplace, and I don't know where it is," Bowen said. “Why aren't my phones ringing off the hook if there's a shortage?"

A FEMA official said by email that the waiver could be revoked at any time if U.S. demand increases and that the agency could require the company to “satisfy domestic demand" before exporting N95s.

Although prices fall considerably for those buying in bulk, prices for smaller lots of N95s have reached $4 to $7 each, according to Get Us PPE, a nonprofit meant to match front-line workers with needed gear.

The requirement for employers to perform fit tests annually was set aside amid the public health emergency, giving employers little incentive to veer from the industry-standard models like 3M that were used for years. And the Centers for Disease Control and Prevention has left guidelines in place that say a limited cadre of health care workers should get N95s, which can be reused and rationed.

That adds up to an unusual situation in which U.S. mask supplies have surged, but employers' motivation to buy the best protective gear has not, said Peg Seminario, a former union health and safety official who recently signed a letter urging the CDC to update its guidelines to reflect the risk of inhaling the virus.

“This is crazy," she said. “We could … crush this pandemic where the biggest risks of infection are and we're not doing it."

Started by a group of emergency room doctors in March, Get Us PPE said it gets 89% of requests for gear — often N95s — from health workers outside of hospitals, like community clinics, covid testing sites and psychiatric care facilities. Demand rose throughout January, with 28% of front-line workers seeking N95s reporting that their site had none.

Yet the volunteer-run group has been able to fulfill only about 15% of the requests it receives. Dr. Ali Raja, a founder of the group and executive vice chair of the emergency department at Massachusetts General Hospital, said the need is vast outside of hospitals, but small facilities scrambling for gear are not connecting to bulk sellers like Bowen's firm.

“There was nothing out there — no centralized place for all facilities to report PPE needs," Raja said. “We don't want to be the website with the best data on this. We want that to be the federal government."

On the last day of 2020, FEMA extended its rule prohibiting anyone from exporting PPE, including N95s, without first getting express approval from the agency. The rule says the fall and winter surge in covid cases meant “domestic supply of the allocated PPE has not kept pace with demand and is not anticipated to do so."

The U.S. Strategic National Stockpile has not yet met its goal for N95 respirators, according to a U.S. Government Accountability Office report. The report said that as of Dec. 18, there were 190 million N95 respirators in storage — well short of its goal of 300 million.

“GAO remains deeply troubled that agencies have not acted on recommendations to more fully address critical gaps in the medical supply chain," the government watchdog report says.

Another twist to the saga is that millions of counterfeit N95s stamped “3M," an industry standard that has long been used in previously required annual fit tests, have flooded hospital shelves even as federal agents rush to seize them at U.S. ports.

A prominent group of scientists wrote to the CDC on Monday to point out guidelines that urgently need to be changed to protect workers from inhaling tiny airborne virus particles. Their letter noted that the “CDC does not recommend the use of N95 respirators" outside health care settings, even though outsize risks are documented for bus drivers, prison guards and meatpacking staffers.

CDC guidelines also allow hospitals to limit which workers get the N95s, leaving out those in community settings and lower-level workers who typically spend the most time next to patients.

In the Lost on the Frontline project, KHN and The Guardian have documented the deaths of hundreds of more than 3,440 front-line health workers, of whom 2 in 3 were workers of color and 56% worked outside of hospitals. For more than 120 who died, family members had concerns about PPE, including the extensive reuse of N95s or the use of surgical masks for direct care of covid patients.

KHN senior correspondent JoNel Aleccia contributed to this report.

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Prominent scientists call on CDC to better protect workers From Covid

A prominent group of academics is pressing the Biden administration to move faster and take stronger action to protect high-risk workers from airborne exposure to the coronavirus, urging enforceable standards to help safeguard risky workplaces including health care, food processing and prisons. The researchers say that even though the Centers for Disease Control and Prevention has acknowledged the virus can spread through tiny airborne particles, it needs to take “strong immediate” action to update its guidance to reduce the risk. “This is the opportunity now,” said David Michaels, a professor...

Why Joe Biden has a chance to cut deals with red state holdouts on Medicaid

President Joe Biden has an unexpected opening to cut deals with red states to expand Medicaid, raising the prospect that the new administration could extend health protections to millions of uninsured Americans and reach a goal that has eluded Democrats for a decade. The opportunity emerges as the covid-19 pandemic saps state budgets and strains safety nets. That may help break the Medicaid deadlock in some of the 12 states that have rejected federal funding made available by the Affordable Care Act, health officials, patient advocates and political observers say. Any breakthrough will require...

Bay Area cities go to war over gas stoves in homes and restaurants

San Francisco restaurant owners, already simmering over covid-19 restrictions, are ready to boil over because of a city ban on natural gas stoves in new buildings that takes effect in June. The ban, which also affects other gas appliances, is part of a statewide campaign aimed at reducing climate change-feeding carbon emissions as well as health hazards from indoor gas exposure. A similar ban went into effect in Berkeley in 2020; Oakland and San Jose recently passed similar measures, and other California cities ar...

Rural hospital remains entrenched in Covid ‘war’ even amid vaccine rollout

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Nearly half of American adults now want the Covid vaccine — ASAP

Americans' reluctance to get vaccinated for covid-19 is waning, according to a poll released Wednesday.

Nearly half of adults surveyed in January said they have either already been vaccinated or want the vaccine as soon as they can, up from about a third of adults polled in December, according to the latest KFF survey. (KHN is an editorially independent program of KFF.)

About 20 million Americans have been vaccinated for covid since distribution of the first vaccines began in mid-December. The pace has also picked up in recent weeks, with more than a million Americans on average getting vaccinated every day. The survey found that when people know someone close to them who has been vaccinated, they are more likely to want the shots.

About half of those who said they want the shot as soon as possible know someone who has already gotten a dose, a much larger share than among those who said they'll get it only if required (29%) or will refuse to get it (36%).

Nearly half (47%) of adults said they have personally received at least one vaccine dose or know someone who has. People posting their vaccination status on social networks such as Facebook and Twitter has helped spread the word.

Racial, ethnic and economic disparities continue, however. White adults (51%) are more likely than Black (38%) or Hispanic (37%) respondents to have either been vaccinated or know someone who has, and those with annual household incomes of at least $90,000 are almost twice as likely as those with incomes under $40,000 to say so (64% vs. 34%). (Hispanics can represent any race or combination of races.)

About 3 in 10 adults said they want to wait until the vaccine “has been available for a while to see how it is working for others" before getting it themselves. About 7% of adults said they will get the vaccine only “if required to do so for work, school or other activities," and just 13% said they will “definitely not get" the vaccine, not a significant change.

The poll also found about 1 in 3 health care workers planned to wait to see how the vaccine is working or would get it only if required to.

The percentage of people who said they want the vaccine immediately is up among the racial and ethnic groups surveyed, although white (53%) adults remained more likely to say so than Black (35%) and Hispanic (42%) adults. Black (43%) and Hispanic (37%) adults were more likely than white adults (26%) to say they want to “wait and see" before getting vaccinated, according to the poll.

Democrats and independents also showed increased enthusiasm, though Republicans' views were little changed since December.

Republicans remained the least enthusiastic political group, with 32% saying they have already been vaccinated or want the vaccine as soon as they can, 33% saying they want to wait and see how it works for others, and 25% saying they will definitely not get the vaccine.

The KFF survey of 1,563 adults was conducted Jan. 11-18 and had a margin of error of +/-3 percentage points.

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.


This story can be republished for free (details).

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On Trump’s last full day, nation records 400,000 COVID-19 deaths

While millions wait for a lifesaving shot, the U.S. death count from covid-19 continues to soar upward with horrifying speed. On Tuesday, the last full day of Donald Trump's presidency, the death toll reached 400,000 — a once-unthinkable number. More than 100,000 Americans have perished in the pandemic in just the past five weeks.

In the U.S., someone now dies of covid every 26 seconds. And the disease is claiming more American lives each week than any other condition, ahead of heart disease and cancer, according to the Institute for Health Metrics and Evaluation at the University of Washington.

"It didn't have to be like this, and it shouldn't still be like this," said Kristin Urquiza, whose father, Mark, died of covid in June, as the virus was sweeping through Phoenix.

Urquiza described it as "watching a slow-moving hurricane" tear apart her childhood neighborhood, where many people have no choice but to keep going to work and risking their health.

"I talk to dozens of strangers a day who are going through what I did in June, but the magnitude and the haunting similarities between our stories six months later is really hard," said Urquiza, who addressed the Democratic National Convention in August. She co-founded Marked By COVID, to organize grieving families and supporters. The group calls for a faster government response and a national memorial for pandemic victims.

Given its large population, the U.S. death rate from covid remains lower than the rate in many other countries. But the death toll of 400,000 now exceeds any other country's count — close to double what Brazil has recorded, and four times the toll in the United Kingdom.

"It's very hard to wrap your mind around a number that is so large, particularly when we've had 10 months of large numbers assaulting our senses and really, really horrific images coming out of our hospitals and our morgues," said Dr. Kirsten Bibbins-Domingo, chair of epidemiology at the University of California-San Francisco.

Scientists had long expected that wintertime could plunge the country into the deadliest months yet, but even Bibbins-Domingo wasn't ready for the sheer pace of deaths, or the scale of the accumulated losses. The mortality burden has fallen heavily on her own state of California, which was averaging fewer than 100 deaths a day for long stretches of the pandemic, but has ranged up to more than 500 in recent days.

She said California followed the science with its handling of the pandemic, yet the devastation unfolding in places like Los Angeles reveals just how fragile any community can be.

"It's important to understand virology. It's important to understand epidemiology. But ultimately, what we've learned is that human behavior and psychology is a major force in this pandemic," she said.

The U.S. in mid-January has averaged more than 3,300 deaths a day — well above the most devastating days of the early spring surge, when daily average deaths hovered around 2,000.

"At this point, looking at the numbers, for me the question is: Is there any way we can avoid half a million deaths before the end of February?" said Dr. Ashish Jha, dean of the Brown University School of Public Health.

"I think of how much suffering as a nation we seem to be willing to accept that we have this number of people getting infected and dying every day."

How Did U.S. Go From 300,000 Deaths to 400,000?

The path to 400,000 deaths was painfully familiar, with patterns of sickness and death repeating themselves from earlier in the pandemic.

A shocking number of people in nursing homes and assisted living facilities continue to die each week — more than 6,000 in the first week of January.

Deaths linked to long-term care account for more than a third of all covid deaths in the U.S. since the beginning of the pandemic. In a handful of states, long-term care contributed to half the total deaths.

Certain parts of the country have a disproportionately high death rate. Alabama and Arizona, in particular, have experienced high rates, given their populations. The virus continues to kill Black and Indigenous Americans at much higher rates than whites.

The chance of dying of covid remains much higher in rural America than in the urban centers.

People over 65 make up the overwhelming majority of deaths, but Jha said more young people are dying than earlier in the pandemic, simply because the virus is so widespread.

In this newest and grimmest chapter of the pandemic, the virus has preyed upon a public weary of restrictions and rules, and eager to mix with family and friends over the holiday season.

Like many other health workers, Dr. Panagis Galiatsatos at Johns Hopkins Hospital is now witnessing the tragic consequences in his daily rounds.

"My heart breaks, because we could have prevented this," said Galiatsatos, an assistant professor of medicine who cares for covid patients in the intensive care unit.

"A lot of what we saw during the holiday travel was the inability to reach our loved ones or family members — not like a public service announcement, but one on one, talking to them [about the exposure risks]. … I really felt like we failed."

Galiatsatos still recalls a grandmother who was transported six hours from her home to his hospital — because there were no beds anywhere closer. On the phone, he heard her family's shock at her sudden passing.

"They said, 'But she was so healthy. She cooked us all Thanksgiving dinner and we had all the family over,'" he said. "They were saying it with sincerity, but that's probably where she got it."

Light at the End of a Very Long Tunnel

The enormous loss of life this winter has happened, paradoxically, at a time that many hope marks the start of the final chapter of the pandemic.

A quarter of all covid deaths have happened during the five weeks since the Food and Drug Administration authorized the first vaccine.

"The trickle of vaccine is so tragically scant. What we need is more of a river of it," said Dr. Howard Markel, who directs the University of Michigan's Center for the History of Medicine.

Markel, who has written about the 1918-19 flu pandemic, said it's estimated it killed upward of 700,000 Americans.

Of the covid pandemic, he said, "I hope we're not talking … 600,000 or more."

At this point, about 3 in 100 people have been vaccinated, placing America ahead of many other countries but behind the optimistic promises made in the early days of the rollout. Given the current pace of vaccination, experts warn, Americans cannot depend solely on the vaccine to prevent a crushing number of additional deaths in the coming months.

UCSF's Bibbins-Domingo worries that the relief of knowing a vaccine will eventually be widely available — the light at the end of the tunnel — may actually lull millions more Americans into a false sense of safety.

"This tunnel is actually a very long tunnel, and the next few months, as the last few months have been, are going to be very dark times," she said.

The emergence of more contagious variants of SARS-CoV-2, the covid virus, complicates the picture and makes it all the more imperative that Americans spend the coming months doubling down on the very same tactics — masks and physical distancing — that have kept many people safe so far.

But Jha, of Brown University, says the country now faces a different task from that of the fall, when "big behavioral changes and large economic costs" were required to prevent deaths.

"Right now what is required is getting people vaccinated with vaccines we already have," he said. "The fact that's going super slow still is incredibly frustrating."

It is this dichotomy — the advent of lifesaving vaccines as hospitals are filled with more dying patients than ever before — that makes this moment in the pandemic so confounding.

"I can't help but feel this immense somberness," said Kristin Urquiza. "I know that a vaccine isn't going to make a difference for the people that are in the hospital right now or who will be in the hospital next week or even next month."

This story is from a reporting partnership with NPR.

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