“States scrambling to deploy millions of coronavirus vaccines are resorting to drastic measures as they wait for federal aid to help speed mass inoculations.
With about 4.8 million of the approximately 17 million doses shipped out by the federal government administered, state leaders like New York Gov. Andrew Cuomo are threatening steep fines for health providers that don’t use up all their shots this week; others are calling on retired health care workers, dentists and even veterinarians to staff vaccination sites. And many are reworking their carefully crafted distribution plans on the fly to get older Americans the shots sooner amid spiking infection rates and news that a more transmissible strain of the virus has reached the U.S.
The patchwork of responses comes as desperate governors are facing a vacuum of federal support, along with dire funding and workforce shortages that are hampering the pace of the rollout. Though Trump administration officials predict vaccination rates will pick up this week, the White House’s coronavirus task force has not convened a call with governors since Dec. 21. States have not yet seen the nearly $9 billion Congress approved to help vaccine distribution in a late December relief package.
“What we need from the federal government is for them to have started vaccine distribution planning much earlier in the year last year,” said Casey Katims, a federal liaison for Washington state.
Trump administration officials have repeatedly said that getting shots into arms is states’ responsibility. But it’s not clear whether states’ emergency measures will be enough to get the most ambitious inoculation campaign in U.S. history back on track. And the mishmash of state approaches is creating growing disparities around the country in who can get the vaccine. Some pharmacists have started offering leftover doses of the coveted vaccine to the general public before they spoil. In other parts of the country, people at high risk — including frontline workers — are still waiting for their shots.
“The distribution is moving slower than people had hoped,” said Clay Marsh, West Virginia’s Covid-19 czar. “We are not satisfied because we want to get vaccines in every West Virginian’s arm, but this is a massively complicated process.”
Officials with Operation Warp Speed, the Trump administration’s vaccine accelerator, have said that holidays, snowstorms and a significant reporting lag contributed to the smaller-than-expected vaccination numbers in December. More than 2.6 million people were inoculated out of the 20 million the federal government had repeatedly promised.
Administration officials rejected the notion that they have not given states adequate support. Federal officials talk to states multiple times a week and monitor statewide data to “learn how we can better assist future efforts,” a Department of Health and Human Services spokesperson said. And Vice President Mike Pence’s office said that the White House coronavirus task force is planning a call with governors for later this week or early next after not convening over the holidays.”
“Despite Covid-19 surges in Europe, the United States of America’s extraordinary death toll remains among the worst in the developed world.
As of January 9, 2021, nearly 373,000 people have died of Covid-19 in the US, with a death rate of more than 1.1 per 1,000 people, according to Our World in Data.
While there are nations with higher death rates, this still puts the US in the top 20 percent for deaths among the world’s developed countries, with more than twice the death rate of the median developed country.”
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“As a result of Covid-19 surges in Europe, the US does look relatively better, compared to other developed nations, than in September. Back then, the US had seven times the death toll as the median developed country. That gap has shrunk massively — to two times.
That’s not because the US has done better but because Europe has done much worse. After managing to largely suppress the coronavirus over the spring and summer of 2020, Europe eased up over the late summer and fall, and saw huge surges as a result.”
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“there are some countries that have managed the pandemic well. That includes some European nations like Denmark, Estonia, Cyprus, Finland, Norway, and Iceland. But the biggest success stories are Australia, Japan, South Korea, New Zealand, Singapore, and Taiwan — which have broadly adopted more aggressive government measures against the coronavirus than America.”
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“So why did the US fail so badly? A lot of this comes down to President Donald Trump. He pushed the country to reopen far too early and quickly, calling on states to “LIBERATE” their economies. He abdicated federal leadership and instead forced states, cities, and private entities to pick up the slack on a host of issues, particularly testing and, recently, vaccines. He downplayed the need for masks, outright mocking people, such as President-elect Joe Biden, for wearing them. The list goes on and on.
In comparison, other leaders around the world have taken Covid-19 more seriously — embracing social distancing, testing and tracing, masking, and, when necessary, more extreme measures like lockdowns. Even with the recent surge of the coronavirus, many countries across Europe have reacted quickly and aggressively by imposing lockdowns, slowing the spread of the virus. The US, by comparison, has by and large remained open, with some states still not requiring masks.
Clearly, not everything has gone perfectly in Europe and other parts of the world. A lot of people and places have screwed up their response to the coronavirus, showing that it’s no easy challenge.
But when the numbers are added up, the US remains an extraordinary failure in its handling of Covid-19.”
“At the beginning of the pandemic, there were understandably few tests available for detecting coronavirus infections. But the federal government made the situation much worse by screwing up the development and deployment of testing. The Centers for Disease Control and Prevention botched its own COVID-19 test while the Food and Drug Administration (FDA) blocked the development of alternatives by private companies and universities. Months later, the United States still does not have enough tests.
The good news is that the FDA has since approved more than a couple hundred COVID-19 tests. But these tests are not available on the scale needed to stem the tide of infections by enabling Americans to test themselves, warn friends and family if they test positive, and then voluntarily isolate themselves to prevent the further transmission of the disease.”
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“Operation Warp Speed was successful at scaling up vaccine production in part because the federal government issued around $18 billion in contracts to their makers. Had the government similarly prioritized COVID-19 testing, the country would not now be piddling around with just 1.5 million tests per day. The Trump administration contracted in late August with Abbott Laboratories to purchase 150 million of its point-of-care BinaxNOW COVID-19 tests for $750 million. The tests, which take about 15 minutes to provide a result, began shipping to state public health agencies at the end of September.
That’s a start, but much more testing needs to be done. Instead of using tests primarily to diagnose COVID-19 cases, they should be used as part of disease surveillance approach in which every American can test themselves frequently.”
“whichever rules the Biden administration might impose, if they reduce worker density at meat plants that are already operating at capacity, then there simply won’t be room—or jobs—for all of the workers that currently staff these plants.
That’s because meatpacking plants are designed to maximize output while complying with existing rules. Changing the rules means changing the plants. That’s not easy.”
“Less than 1% of Americans reside in long-term care facilities — a category that includes nursing homes and assisted living residences — but these facilities account for around 40% of the country’s COVID-19 deaths.”
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“Gov. Andrew Cuomo has boasted about the relatively low death toll in the state’s nursing homes, despite the fact that no other state counts these deaths as New York does. As of mid-November, there have been more than 6,619 virus-related deaths within the state’s nursing homes and 179 in its adult care facilities, according to official data. Bronxwood, however, has never appeared in that tally.
“The public list is incomplete and misleading,” said Geoff Lieberman, the executive director of the Coalition of Institutionalized Aged and Disabled, an organization that advocates on behalf of adult home residents in New York City. “Either everyone at Bronxwood died at the hospital, or the information isn’t being accurately reported.” Before the August hearing, Lieberman and his colleagues at CIAD interviewed residents at 28 adult homes in New York City, including Bronxwood, and tallied around 250 deaths from their accounts — a stark contrast to the 53 deaths that facilities had self-reported to the state. Bronxwood employees likewise sounded the alarm: In April, six staff members told local news that by their count more than a dozen residents had died.”
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“People talked about leaving Bronxwood almost as soon as they arrived, but the truth was that they were there because they had nowhere else to go. The elderly are typically steered to places like Bronxwood after a stay in the hospital. They have taken a fall or needed a surgery, and while they’re recovering, lose their apartment. Others, like Glenda, are recommended by a caseworker at a shelter. It’s not uncommon for such homes to hire recruiters to help fill their beds.
While many assisted living facilities cater to a wealthy clientele, who pay out of pocket, Bronxwood primarily serves low-income seniors. (It is, technically speaking, an adult home with an assisted living program.) Most residents sign over their supplemental security income to pay for the room and board — and out of that sum the facility gives them a $207 “personal needs allowance” each month. The money runs out quickly, since it often goes toward phone bills, toiletries, transportation and more nutritious food.
Out of Bronxwood’s 270 or so residents, more than half are enrolled in its assisted living program, whose costs are covered by Medicaid. In theory, the program offers an extra level of care to those who need it. In practice, it functions as a “huge financial boon” to the adult home industry, said Tanya Kessler, a senior staff attorney with Mobilization for Justice, a legal services organization. Bronxwood can charge Medicaid between $78 and $154 per enrolled resident each day, depending on his or her needs. But Kessler said there’s little oversight into whether this additional funding results in additional care. Bruno, the spokesman, said that the Health Department conducts regular inspections of assisted living programs “to ensure all applicable laws, regulations and guidelines are being followed.”
Healthier residents at Bronxwood told me that they seemed to be roomed with those who were more infirm, effectively placing them in the role of an extra aide. “One of the big complaints we hear is, ‘I’m not well myself, but they put this person in here that they expect me to look after,’” said Sherletta McCaskill, who, as the training director of CIAD, helps adult home residents organize councils and independent living classes. “It speaks to the lack of services that these homes are providing.” The most recent audit by New York’s Office of the Medicaid Inspector General found that Bronxwood had overbilled Medicaid by $4.4 million in 2006 and 2007. (Bronxwood requested an administrative hearing to challenge the findings, according to an OMIG spokesperson; the date is pending.)”
“Section 230 essentially functions as the internet’s First Amendment by protecting private companies from being held liable for most forms of user-generated content. This is the second time in very recent history that lawmakers have sought to sneak Section 230 changes into legislation that otherwise has nothing to do with Section 230.”
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“Section 230 has attracted bipartisan enmity, although for completely different reasons: Republican critics say that online giants such as Facebook and Twitter are too heavy-handed with content moderation, at least when it comes to conservative speech, while their Democratic counterparts want platforms to scrub more hate speech and fake news. 230’s critics range from Sen. Josh Hawley (R–Mo.) to Vice President-Elect Kamala Harris, though one wonders if either would be happy with the result of the rollback once the other party was in power.
McConnell’s bill would also create a committee to investigate election fraud and the impact of COVID-19 on voting practices, as Trump keeps pushing the conspiracy theory that President-elect Joe Biden stole the 2020 election.”
“If people can get a vaccine that is quite effective in preventing Covid-19 symptoms but still carry the virus, they could still potentially spread SARS-CoV-2. This is an important issue because there will only be very limited doses of the vaccine available once it’s cleared for emergency use — and it will likely be many months after that before a sizable amount of the US population will be able to be vaccinated. That means people who have received the injections might need to maintain precautions like wearing masks and social distancing to prevent further spread of the virus before the vast majority of people have been vaccinated.”
Adding extra critical-care beds in other departments or buildings takes precious time, resources, and space. But adding trained staff is much more difficult, especially deep into a pandemic.
When trained staff are in short supply, it’s even harder for hospitals to best meet the needs of critical-care patients. These patients include people very sick with Covid-19, but also many who need to be in the ICU for other reasons, such as those who have had a heart attack or stroke, are recovering from major surgery, or are sick with the flu, among others”
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“it is not just ICU physicians and nurses who are in short supply. “Critical care is more of a team sport,” Garner said. “This means physician-delivered care and interventions, but also careful medication selection dosage with pharmacists, skilled nursing care, respiratory therapists, midlevel providers, nutritionists, early mobilization with physical therapists.” To that list, Nagle also adds all of the other hospital staff needed to perform other essential tasks in ICUs, including bathing patients, changing linens, and other functions.”
“In June, just three states reported daily new coronavirus cases higher than 12 per 100,000 people. Today, every state except Hawaii exceeds that threshold. Some of that is due to greater testing capacity, but the climbing toll of hospitalizations and deaths, which have reached record highs nationally in the last month, show this is not merely a “casedemic” of sick people who might have gone undetected earlier in the year, but a rising tide of Covid-19 across the US.
So how did America get here?
The primary answer lies in President Donald Trump and Republican leaders in Congress, who have collectively abdicated the federal government’s role in addressing the outbreak or even acknowledging its severity. From Trump’s borderline denialist messaging on Covid-19 to Congress’s inability to pass more economic relief, the country has been left in a place where states, local governments, and the public have to fend for themselves — and none of them have the resources to deal with the coronavirus on their own.
Trump and his allies have also actively worked to sideline the Centers for Disease Control and Prevention, crippling the agency’s ability to provide guidance to states and others that have now been left out on their own.
At the same time, there are serious structural issues that hindered states’ and the public’s ability to act. Experts have long argued that the US’s public health infrastructure is underresourced and ill prepared for a serious crisis, and the pandemic has exposed this many times over: Nearly a year into the pandemic, no state has capacities for testing and contact tracing that most experts would consider adequate.
And the lack of economic relief has made it much harder for people to stay home and business owners to close down, faced with the decision of mitigating the coronavirus’s spread or failing to pay their mortgage and other bills.”
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“over time, as fatigue around the pandemic set in, governors became less proactive toward the coronavirus and more reactive — and they increasingly pushed short-term economic interests over public health concerns.
That was clear as the entire country, over the summer and fall, reopened schools, indoor dining, bars, and other risky indoor spaces, even as experts warned that the consequences could be dire. Now we’re seeing the effects.
That includes states led by Democrats and ones led by Republicans”
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“The public has eased up too. The US has generally gotten better at masking, based on public opinion surveys, but has also gotten much worse at social and physical distancing than in the spring. We’ve patronized the restaurants, bars, and other risky indoor areas that have reopened. We’ve gathered with friends and family over Labor Day, Halloween, and Thanksgiving, even as public health officials and experts have pleaded that we don’t.
As a result, the US is now among the worst performers on Covid-19 in the world. Despite recent surges in Europe and elsewhere — which were largely the result of similar failures — America remains within the top 20 percent for most coronavirus deaths per person among developed nations, with more than twice the death rate as the median developed country. If the US managed the same Covid-19 death rate as Canada, nearly 190,000 Americans would likely be alive today.
While the story behind those numbers lies mostly in what Trump and much of the federal government have wrought, it’s also on the rest of the US. From the president to governors to mayors to the public, America has failed on Covid-19 — and only by learning from those mistakes can we ensure they don’t happen again.”