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“We’ve Let the Worst Happen”: Reflecting on 400,000 Dead

ProPublica is a nonprofit newsroom that investigates abuses of power. This piece was originally published in The Weekly Dispatch, a newsletter that spotlights wrongdoing around the country. Sign up for it here. In May of last year, ProPublica health care reporter Caroline Chen reflected on the first 100,000 lives lost to COVID-19 and posed an important question: “How do we stop the next 100,000?” Eight months later, with 300,000 additional American lives lost and the chaotic distribution of the vaccine underway, Chen shares her thoughts on where we are and what happens next. In your 100,000 lives lost piece, you wrote about questions we needed to ask at that moment: “How do we prevent the next 100,000 deaths from happening? How do we better protect our most vulnerable in the coming months? Even while we mourn, how can we take action, so we do not repeat this horror all over again?” It’s been almost eight months since then. What are the biggest questions we need to be asking now? I’m afraid that we did end up repeating this horror all over again — and again — and again. There’s no way of dancing around this: We’ve failed to protect our most vulnerable. We’ve let the virus spread out of control across America. We’ve let the worst happen. So here’s the question on my mind now: How are we going to end the pandemic? We have a vaccine in hand, and I’m so grateful for it. It is, truly, a game changer. But there are different ways that this story can go from this moment in January. We can end the pandemic as quickly as possible, with rapid distribution and uptake of the vaccine, with everyone doing their best to maintain best practices (social distancing, etc.) while they wait their turn, prioritizing those who need the vaccine most, doing whatever we can to alleviate the pressure on exhausted health care workers and public health officials. Get Our Top Investigations Subscribe to the Big Story newsletter. Or we can drag it out, with a chaotic and sputtering vaccine rollout, exacerbating inequities in society by letting those who have connections, or money, or power get the vaccine first, and continue to ignore what science tells us, so we have so many more COVID-19 cases that we give the virus evermore chances to mutate away from our currently effective vaccine. We are the authors of the final chapters of this story. How are we going to determine its ending? In November, parishioners of a church in Minneapolis, Minnesota, light candles in remembrance of members who have died of COVID-19. (Renee Jones Schneider/Star Tribune via Getty Images) You also wrote about choices our nation’s leaders have had to make. What choices are the most pressing right now for the Biden administration? Biden’s administration does not have the luxury of doing one thing at a time. I’ve watched America lurch from one pandemic theme du jour to another. For a while contact tracing was really hot. Then we all got into antibody testing. Now the hype is about vaccines. This virus is incredibly wily, it’s spreading out of control and front-line workers are exhausted. The administration really needs to be able to work on multiple fronts, bringing in funding, staffing and supplies to sustain public health officials who are trying to do testing while conducting contact tracing interviews while also setting up vaccine clinics. We can’t rush to vaccinate then drop the testing ball. We still do not have a clear strategy for testing asymptomatic people. I’d love to see a nationwide sharing of sequencing data so we can track and evaluate variants more robustly. Every single health care staff — and hey, what about meatpacking workers and other front-line laborers — should have access to N95s. It’s insane to me that I am still told by some nurses that they have to reuse their masks for two weeks. Last but not least: Clear, consistent and transparent communication from the White House, the Department of Health and Human Services, the Centers for Disease Control and Prevention, the Food and Drug Administration and all branches of government would be desperately welcome. We’re hearing a lot about mutations and new variants of the virus that spread more quickly. Should we be changing our behavior? Viruses are constantly mutating; it’s just what viruses do. A lot of these mutations aren’t actually meaningful, and it’s only when they have some sort of functional difference that we consider them a new variant, like the B.1.1.7 variant (also known as the U.K. variant). When a new variant is detected, the question is always, what’s the significance? In the case of the B.1.1.7 variant, it’s pretty clear now that it’s more transmissible, but there isn’t enough data so far to say whether it causes more severe disease. Read More 100,000 Lives Lost to COVID-19. What Did They Teach Us? Each person who has died of COVID-19 was somebody’s everything. Even as we mourn for those we knew, cry for those we loved and consider those who have died uncounted, the full tragedy of the pandemic hinges on one question: How do we stop the next 100,000? Still, a more transmissible variant will result in the virus spreading faster, meaning more cases, more overloaded hospitals, diminished therapeutic resources and thus probably a worse outcome if you do get sick — not because you got more severely ill in the first place, but because you didn’t get as good care as you would have otherwise if hospitals weren’t stretched so thin. So far, some B.1.1.7 cases have been found in the U.S., but it doesn’t appear to be dominant. And we need to make sure that doesn’t happen. Epidemiology Professor Andrew Lover at the University of Massachusetts Amherst told me he thinks we’re in a critical period right now — with hospitals still recovering from post-holiday surges, vaccine protection yet to kick in and pandemic fatigue at an all time high. “The vaccine is on the horizon, but it’s really challenging to message that it won’t have a major impact for months,” he said. Epidemiologist Marc Lipsitch at the Harvard T.H. Chan School of Public Health has argued that contact tracers should prioritize any case that involves a B.1.1.7 variant, because those cases will spread faster. To be able to do that, testing resources — specifically the type of tests that can identify B.1.1.7 — need to be ramped up and widely distributed. As for individuals, however, there’s nothing you need to change about your behavior if you’re worried about variants. You already know what to do, you just have to fight the fatigue and do it. Wash your hands. Wear a mask. Social distance. Seek the outdoors. Get your vaccine when it’s your turn. Do whatever you can to not be a case. Of all of the great reporting you and other science reporters have done on the pandemic, most people experience only a swath of what the big picture of the pandemic is — the bigger picture that you as a reporter have. You’ve reported on some of these smaller swaths, individual stories and experiences, but also the larger systemic failures. What do we lose sight of with the big picture, and what do we lose sight of with the small picture? Sometimes when I’m looking at the charts, I have to remind myself what the numbers mean. It’s become so easy after months and months of this to become numb. For example, even though the case count is finally starting to go down in Los Angeles County, and that is good news, it’s not just a trend line. Those are people. And even if I can be happy on one level that the tide seems to be turning in LA County, I should also keep in mind that that’s still 7,900 individuals who were diagnosed with COVID-19 yesterday, and close to 200 people who died. Each person — as my May essay said — was somebody’s everything. I have to remember that, so I don’t ever treat the numbers like just numbers in my reporting. Maricela Arreguin Mejia and her brother Nestor Arreguin mourn the death of their father Gilberto Arreguin Camacho on Dec. 31, 2020 in Whittier, California. Camacho died from COVID-19. (Patrick T. Fallon/AFP via Getty Images) On the flip side, when I’m listening to people’s stories, I always keep in mind that one person’s experience may not speak for the whole. There are a lot of vaccine snafus happening across the country right now. Some of them are dysfunctions unique to that particular vaccine site, and as a national reporter, they’re not my story to tell. So I talk to a lot of people and gather as many stories as I can. And when I start to hear the same themes repeat over and over, that’s when I start to think, Hmmm, there’s something going on here. It’s not a good sign when clinics across the country are all canceling appointments on the same day. That’s when I swing into action to try and find out the Why. That’s a ProPublica story. You wrote eight months ago: “I refuse to succumb to fatalism, to just accepting the ever higher death toll as inevitable. I want us to make it harder for this virus to take each precious life from us. And I believe we can.” What were you feeling then that fueled you to write about refusing to succumb to fatalism, and what are you feeling now? What was I feeling? Oh, boy. I was leaking tears and writing at the same time because our brilliant visuals editor Andrea Wise was sending me her selections for that essay and I was looking at the images just thinking how awful it was for people to have to be going through this: not just to be sick and die, but in so many cases to have to die alone — or to have a loved one in the hospital and not be able to be by their side. There’s one image in there of a funeral home in New Jersey with the spaced out chairs that seemed so bleak to me. Even after your loved one’s death, you couldn’t lean close to a friend or relative for comfort. I didn’t want people to just roll over and accept that more people would die. It angered me that some people were ignoring the guidance of public health officials and what science told us could help reduce cases. I wanted people to realize that there’s accountability at all levels: from federal policies all the way down to your own actions, every day. And now? I’m tired. I miss my family so much (they’re mostly overseas). But I still haven’t given up. I remind myself that I can’t solve the world’s problems, but I can do my little bit as a health reporter and hope it helps, somehow. And now there’s a new administration. I don’t think it’ll be perfect by any means, but I am hopeful to see that President Biden takes the pandemic seriously and I look forward to seeing what actions his administration takes in the coming weeks. We know the vaccine distribution isn’t going well. But what reasons do we have to be hopeful? Well for starters, we have a vaccine that works! Two, in fact, and potentially another on the way (Johnson & Johnson’s). As a former biotech reporter, I know that drug development is a slog, so the fact that we have two very efficacious vaccines that made it to market in under a year is truly amazing. A healthcare worker and patient at a free COVID-19 test center in Los Angeles. (Ringo Chiu/AFP via Getty Images) But of course, shots in the vial are pointless if they don’t get to people’s arms. So where am I seeing hope? So far, production appears to be going OK. There obviously isn’t as much available vaccine as the demand, but there haven’t been any major manufacturing snafus, so I expect Pfizer and Moderna to continue to ramp up as planned. I am also hoping that as more vaccines become available, this should (fingers crossed) coincide with federal, state and local entities sorting out the logistical issues that have plagued the rollout so far. Ideally, things will go more smoothly when the bulk of the supply becomes available. I’ll stay optimistic, while looking out for everything that may be going wrong, of course. That’s my job. Help Us Report on COVID-19 Vaccines The development and deployment of a vaccine will affect everybody on the planet. Help us identify and tell important stories.

How Many Vaccine Shots Go to Waste? Several States Aren’t Counting.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published. As reports emerge across the country of health facilities throwing out unused and spoiled COVID-19 vaccines, some state governments are failing to track the wastage as required by the Centers for Disease Control and Prevention, leaving officials coordinating immunization efforts blind to exactly how many of the precious, limited doses are going into the trash and why. In Washington, a health facility allegedly threw out some COVID-19 vaccine doses at the end of workers’ shifts because staff believed state guidelines blocked them from giving unused shots to people below the top priority tier. In Maryland, workers appear to have tossed thawed doses when they ran out of time to administer them safely. How many doses, exactly, have been wasted in those states is unknown because neither state is tracking unused or wasted vaccines. In Indiana, where hospitals have told the media about discarding some shots, the state Health Department said it requires wastage to be reported but wasn’t able to tell ProPublica how many doses have been tossed statewide. Nonetheless, it asserted that “wastage has been minimal.” Experts say that waste reporting is essential during a vaccination campaign to encourage careful handling and the use of every viable dose and, more importantly, to identify potential problems in the shipping and cold storage operations. With inconsistent reporting requirements and no enforcement of a federal mandate to report wastage, vaccine providers have little incentive to acknowledge wasting vaccines, said Dr. Ashish Jha, dean of the School of Public Health at Brown University. Get Our Top Investigations Subscribe to the Big Story newsletter. Jha said he thinks that the true number of wasted doses across the country is far higher than a handful. After he detailed one anecdote he heard about an ER physician forced to waste vaccine doses in a thread on Twitter, his phone quickly filled with more than a dozen messages from other medical workers, confirming what he suspected: At a time when the U.S. is desperately short on vaccines, a significant number of doses are ending up in the trash. Clinics and hospitals have “gotten slammed” when the media has learned of them wasting even a few doses, he said. “And the signal to everybody else is, if you have waste, don't report it. Because if you do, you're gonna get into a lot of trouble. That combination means, at least in my assessment, there's a lot of waste and a lot of underreporting of that waste." The CDC requires all organizations that administer the vaccine to report the number of vaccine doses “that were unused, spoiled, expired, or wasted as required by the relevant jurisdiction.” The CDC also asked states to describe their wastage monitoring method during the distribution planning process. Vaccine providers, such as pharmacies and hospitals, are supposed to provide data on wasted doses to their state health agencies, which then send the information to the CDC. Like many parts of the vaccine rollout, that has not gone according to plan. State by state, ProPublica found, reporting requirements vary and are not reliably communicated to vaccine providers. Even when the rules are clear, they are not regularly enforced, nor are numbers reported to the public. Maryland’s Hospital Association said wastage data “is not systematically collected,” while the state’s Health Department said that “unless they are reported to us, MDH does not track specific instances of accidental vaccine wastage at the local level.”A Washington State Health Department spokesperson said that the state “does not systematically capture wasted dose information.” The spokesperson added that providers are encouraged to use up all of the shots they receive and that “if a provider doesn’t have enough qualifying employees under” the top priority group, “they can help vaccinate workers who aren’t receiving vaccine directly from their employers.” Michigan’s Department of Health and Human Services said, “We have not asked that vaccine providers report this data,” though it said that 10 wasted doses had been reported to it as of Jan. 13.In some cases, states said they were aware of specific instances of wastage. New Jersey said that it was “aware of 16 vials that had to be discarded because they arrived broken when the boxes were open.” While a spokesperson noted that providers are instructed to give vaccines to people on waitlists to minimize the chances of vaccine being discarded, the spokesperson didn’t respond to questions about whether providers were mandated to report wasted doses. Other states do have wastage reporting mandates. Pennsylvania, for example, said it requires providers to report any doses that are received and are not able to be used and was able to give a percentage — 0.1% of doses received for injections as of Jan. 11 — that had to be disposed of. “The majority of discarded vaccine is related to vials broken in handling and syringe issues, such as bent or broken needles or clients refusing after the vaccine dose was drawn,” said Department of Health spokesman Barry Ciccocioppo. Read More How Operation Warp Speed Created Vaccination Chaos States are struggling to plan their vaccination programs with just one week’s notice for how many doses they’ll receive from the federal government. The incoming Biden administration is deciding what to do with this dysfunctional system. Colorado also said that waste is being tracked. “The state is aware that Pueblo Local Public Health rendered 300 doses of the Pfizer vaccine unusable after a portable vaccine storage unit malfunction,” a spokesperson from the state’s Joint Information Center said. “The state’s goal is to use every single available vaccine, acknowledging that emergencies may occur infrequently in the distribution process.” In every mass vaccination effort, some share of doses unavoidably goes into the trash rather than arms. However, data on wasted shots — especially in large quantities — is an essential tool for federal and state health agencies trying to spot problems in how the vaccine is being shipped, stored and given to the public. State vaccine officials monitor wastage numbers to determine if providers are mishandling shipments or improperly maintaining the temperature of their vials, said Dr. Kelly Moore, deputy director of the Immunization Action Coalition and former head of Tennessee’s immunization program. "Are they tracking things and responding appropriately, if you're seeing extremely low wastage rates and everything is always perfect?" Moore said. "When things look too good to be true, they usually are." The two vaccines currently authorized, made by Moderna and Pfizer-BioNTech, both must be used within six hours of leaving cold storage, reaching room temperature and being opened. If there are no-shows for vaccination appointments, pharmacists have to quickly find replacements before the thawed vaccines expire. Complicating the count is the fact that the number of doses available in a vial sometimes exceeds the amount prescribed on the label — pharmacists have commonly found that they can squeeze a sixth dose out of Pfizer’s vials, even though they are labeled as containing five. That means that a vaccine site could be allocated a certain number of doses on paper, have a few extra ones left that need to be tossed and still come out net positive. In that situation, it is unclear if the discarded doses should count as waste. Data on wasted doses is routinely monitored in childhood immunizations in large part because it is required by the federal Vaccines For Children program, which provides innoculations to millions of children not covered by private health insurance, said Dr. Sean O'Leary, a professor of pediatric infectious diseases at University of Colorado Medicine. “Practices that are participating in that program, which are the vast majority of pediatric practices and a lot of family medicine practices, are used to keeping track very carefully of their vaccine inventory.” There isn't a federal program overseeing most adult vaccinations, so any wastage reporting for adult shots, like the flu shot, would be managed state by state. While collecting wastage data is a good business practice, O’Leary said it is most useful as a deterrent against vaccine providers mishandling or discarding doses irresponsibly. "It's being tracked as a disincentive to letting [wastage] happen,” he said, “for accountability for people who are delivering the vaccines that they are doing their best to give the vaccines and store them properly." However, there is also a danger in stigmatizing the waste of vaccine doses, said Moore, the immunization coalition deputy director. Accidents and normal human error are going to make some vials unfit to use on patients. Doses compromised by unsafe temperatures or contamination need to be thrown out, not injected into people. “You never, ever want to have clinics feel pressured not to waste vaccine that needs to be wasted,” Moore said. “If you say, ‘No one should ever damage vaccine,' you're really going to be in trouble.” The CDC says vaccine providers should avoid wastage and disclose when it happens. “If there is excess vaccine, clinic staff should do everything possible to avoid wasting the dose. If vaccine wastage occurs, it should be reported into CDC’s Vaccine Tracking System (VTrckS),” said CDC spokeswoman Kristen Nordlund. “We are working to figure out how to provide this data online in the future when the data is more complete." In the meantime, federal officials have begun to urge that priority guidelines not get in the way of using vaccines. “It’s more important to get people vaccinated than to perfectly march through each prioritized group,” Alex Azar, secretary of health and human services under President Donald Trump, said at a briefing on Jan. 6. This means that a pharmacist should use a dose that’s about to expire on any available person — even someone who isn’t in a priority group — rather than letting it go in the trash. “There’s always someone in line. The whole nation is in line,” said Lori Freeman, chief executive officer of the National Association of County and City Health Officials. “There’s no reason for any vaccine to go to waste.” Dr. Mysheika Roberts, health commissioner of Columbus, Ohio, said in an interview last week that her local vaccination site hasn’t had to waste a single dose of vaccine so far. Initially, if there were extra doses at the end of the day, they used them on their own staff, she said. After that, the mayor allowed them to put police officers on the waitlist — even though only health care providers were technically eligible at the time — so the vaccinators could call the station if they had extra doses. Managing a waitlist is complicated, Roberts said, because you need to have people who want the vaccine and have both the transportation and flexibility to get to the vaccine clinic within about 30 minutes, but so far it has worked out. The vaccine clinic has also managed to further reduce potential waste by getting appointment confirmations and defrosting vaccine vials close to appointment times, she said. An Ohio Department of Health spokesperson said the state requires providers to report waste, and that 165 doses of the vaccine had been recorded as wastage as of Jan. 15. “I hope to never be in a position where I have to waste a dose,” Roberts added. “I’d go on a street corner and find someone to give the vaccine to before I have to throw it away.”