As the country was gripped by the coronavirus pandemic in March, President Donald Trump saw some of the best approval numbers of his presidency. Multiple polls showed that a small majority of Americans approved of his handling of the crisis, while his personal approval ratings ticked up slightly. For a polarizing leader whose personal approval has never cracked 50 percent, it looked like the national urge to trust a leader in times of crisis might just benefit the president eight months from the 2020 elections.

But as we enter April, those numbers have reversed course. Navigator Research, a progressive survey project operated by two Democratic polling firms, began a daily tracking poll two weeks ago to measure how the public viewed the crisis and Trump’s response to it. In their first tracking poll, released on March 24, 52 percent of Americans approved of the president’s handling of the pandemic. But in the two weeks since, those numbers have declined. Their polling shows that a growing number of Americans feel that Trump downplayed the crisis, was unprepared, and failed to respond quickly. In the latest poll out Saturday, 59 percent of respondents said they had “serious concerns” that Trump failed to take decisive action in the early stages of the outbreak. Even 40 percent of voters who supported Trump in 2016 now believe he failed to take the crisis seriously enough early on. The number of people saying Trump was honest about the crisis has declined, the poll showed, and 53 percent now believe he has been dishonest.

There are obvious sources for these concerns. The pandemic is growing rapidly in the United States—by Saturday there were nearly 300,000 cases—while the medical community has been left without basic medical equipment to handle the growing demands in hospitals. In New York, the epicenter of the epidemic in the US, calls for additional ventilators have been rebuffed by Trump. With nearly 8,000 deaths by Saturday, fatalities are on the rise and public health officials warn that a terrifying shortage of hospital beds and ventilators will likely mean the mortality rate will go up. Meanwhile, unemployment is soaring, with 10 million new jobless claims since mid-March.

As more reporting analyzes administration’s response, the more evidence there is that the president shirked his responsibilities while the virus spread. According to a new report by the Washington Post, it took Trump 70 days from the first time he was notified of the coronavirus and its grave implications to treat it as a public health crisis. That’s more than two months of wasted time during which the White House failed to grasp the threat and turned down requests for emergency funding from health officials.

Though it shut down travel from China at the end of January—where the virus first appeared in the city of Wuhan in November—it had allowed 300,000 people to enter the country from there during January. And the administration rebuffed calls from health care officials and White House aides to limit travel from Europe for over a month as it became another hotspot for the virus. Trump himself compared the coronavirus to the flu and a political act by the Democrats to undermine his election chances, as he predicted it would soon disappear. 

Perhaps the most consequential failure was the administration’s bungling of testing, which hobbled the country’s response and blinded it to the potential enormity of the outbreak. The Centers for Disease Control and Prevention failed to produce a good test, causing likely fatal delays in tracking the spread of the virus. As the Post reported:

[In February] federal medical and public health officials were emailing increasingly dire forecasts amongst themselves, with one Veterans Affairs medical adviser warning, ‘We are flying blind,’” according to emails obtained by the watchdog group American Oversight.

Later in February, U.S. officials discovered indications that the CDC laboratory was failing to meet basic quality-control standards. On a Feb. 27 conference call with a range of health officials, a senior FDA official lashed out at the CDC for its repeated lapses.

Jeffrey Shuren, the FDA’s director for devices and radiological health, told the CDC that if it were subjected to the same scrutiny as a privately run lab, “I would shut you down.”

The real implications of those delays and missteps were not fully apparent during early polling regarding the White House response. But now, as the death toll mounts and more state governors have stepped up their responses to the emergency, it appears the slow response is now eating away at the public’s confidence in the president. 

On February 25, Kayleigh McEnany, a spokesperson for the Trump campaign, told Fox News, “We will not see diseases like the coronavirus come here.” Meanwhile, White House economic adviser Larry Kudlow said the virus was “contained.” More than a month later, comments like these are no longer inspiring confidence. 

On the same day Larry Kudlow said coronavirus was “contained” on Feb. 25th, Trump’s campaign spox made an even more bold claim.

“We will not see diseases like the coronavirus come here..and isn't it refreshing when contrasting it with the awful presidency of President Obama." pic.twitter.com/O0DDH3Rvkw

— andrew kaczynski🤔 (@KFILE) April 4, 2020

As of today, more than 239,000 people in the United States are infected with the coronavirus, the most cases of any country in the world. More than 6,000 people have died, which is almost twice the number of people who were killed during the 9/11 terrorist attacks. 

The number of people infected is doubling every six days, a rate higher than that of Italy, Iran, and Germany. The number of deaths is doubling every four days.

From New York to Michigan to Louisiana, hospitals are overwhelmed with new cases. In some states such as New York and Connecticut, there’s already a shortage of hospital and ICU beds. As the virus continues to spread, more states are going to run out of hospital beds.

New projections from the Institute of Health Metrics and Evaluation, a research center based out of the University of Washington, have created models that predict when every state would run out of resources including hospital beds, ventilators, and ICU beds in the next four months. Its predictions assume the strict social distancing policies that are already in place will continue in most states. Researchers say they expect the worst of the epidemic to be over by June, but not before it burdens our healthcare systems. 

Using the institute’s data projections, we created maps to show which states will run out of hospital beds, by when and by how much. The darker the shade, the more acute the shortage.

Tennessee has such an acute shortage of medical supplies and protective gear that the governor asked healthcare workers to repurpose swim goggles and diapers into masks. The state is looking to convert college dormitories, convention centers, and hotels into makeshift hospitals

Many states, such as New York, New Jersey, and Louisiana, are already running out of ICU beds. Many more states will face an acute shortage of ICU beds in the coming weeks.

Researchers from the Institute of Health Metrics and Evaluation suggest that interventions such as “canceling elective procedures, setting up additional beds, constructing temporary facilities, and using mobile military resources” can ease the burden on hospitals. “Production of ventilators, masks, and other personal protective equipment may need to be scaled up to ensure these resources are available to hospitals as demand grows.”

Roughly 9 million Americans have applied for unemployment insurance in the past two weeks as the coronavirus pandemic ravages the economy. But, thanks to the Affordable Care Act, those who have lost their employer-based health coverage don’t need to go uninsured.

Loss of job-based coverage counts as a qualifying event for a so-called “special enrollment period,” allowing people to sign up for an individual Obamacare plan outside of the annual open enrollment period, which ended on December 15. People typically have 60 days from their loss of coverage to enroll. Lower-income people may also be eligible to enroll in Medicaid.

The Kaiser Family Foundation, which considers the ACA a “substantial health care safety net,” provides a handy calculator for estimating how much a marketplace plan might cost, based on an individual’s location, income, and household details.

For people who were already uninsured before the economy melted down, the picture is more complicated. Twelve states that run their own insurance marketplaces—including coronavirus hotspots like New York, California, and Washington—have opened special enrollment periods in response to the crisis, allowing anyone who lacked insurance prior to the pandemic to get covered. President Donald Trump reportedly considered opening a special enrollment period for residents of the dozens of other states that participate in the federally run insurance marketplace, but he ultimately decided against it.

Trump has been an outspoken critic of Obamacare, siding with Republican attorneys general in a lawsuit that seeks to undo the health care law entirely. The short-term health insurance plans he espouses as an alternative do not have to comply with the ACA, meaning they could deny coverage to people with pre-existing conditions or refuse to cover services like mental health care.

On Monday, Captain Brett Crozier of the USS Theodore Roosevelt dashed off a four-page letter to his superiors detailing the frightening conditions on his ship, where dozens of sailors had become ill with COVID-19. Because of the confined nature of the aircraft carrier, Crozier said in stark terms that his crew would be unable to safely quarantine infected sailors, a situation that increased the chances of the virus spreading to others. He said 90 percent of the sailors needed to disembark in Guam, where the ship was docked, or risk further infections. “The current plan in execution on TR will not achieve virus eradication on any timeline,” he wrote. 

Hours later, the San Francisco Chronicle published excerpts from Crozier’s letter. By Thursday, he had been relieved of his command. The Navy offered no detailed rebuttal of his letter. In describing his reasons for firing Crozier, acting Navy Secretary Thomas Modly sounded at times more like he was giving him a promotion than relieving him of command. “Captain Crozier is an honorable man who, despite this uncharacteristic lapse of judgment, has dedicated himself throughout a lifetime of incredible service to our nation,” Modly told reporters on Thursday. “And he should be proud of that.”

So what did Crozier do wrong? Here’s how Modly explained it:

The letter was sent over non-secure, unclassified email even though the ship possesses some of the most sophisticated communications and equipment in the fleet. And it wasn’t just sent up the chain of command. It was sent and copied to a broad array of other people. It was sent outside of the chain of command. At the same time, the rest of the Navy was fully responding. Worse, the captain’s actions made the sailors, their families, and many in the public believe that his letter was the only reason help from our larger Navy family was forthcoming, which was hardly the case.

That explanation makes it seem like the Navy’s primary problem was not with Crozier’s choice of words, but his method of delivery. Instead of contacting his superiors discreetly, he wrote a memo that—intentionally or not—could have been leaked. Or he leaked it himself. The Navy wasn’t too clear on that, either. 

Earlier in the press conference, Modly took time to note specifically that the Chronicle is Crozier’s “hometown newspaper,” but when pressed later over whether he believed that Crozier leaked the letter, Modly demurred. “I don’t know. I don’t think I’ll ever know who leaked the information,” he said, adding that Crozier “sent it out pretty broadly. And in sending it out pretty broadly, he did not take care to ensure that it couldn’t be leaked.”

The Navy is in the midst of one of the more serious peacetime crises in its history, after already enduring turmoil in its top ranks. Modly, formerly the No. 2 civilian in the department, only took over in November after the Navy’s last civilian leader, Richard Spencer, was ousted for insubordination in a convoluted chain of events surrounding President Donald Trump’s intervention in the case of disgraced Navy SEAL Eddie Gallagher. Crozier had racked up several major awards for outstanding service since graduating from the United States Naval Academy in 1992 and seemed to clearly hold the support of his crew. A video circulating online of him leaving the Roosevelt to cheers from his sailors is one piece of evidence for that. Even Modly acknowledged that Crozier was beloved. 

Wrongfully relieved of command but did right by the sailors. #navy @UncleChaps @katebarstool @ZeroBlog30 @CaptainCons pic.twitter.com/M0aZhHNMXT

— Dylan Castillo (@Sotero269) April 3, 2020

Given the tenuous time and Crozier’s obvious track record, shouldn’t there be a stronger argument for firing him beyond the fact that his letter reached too many people? 

“I have no doubt in my mind that Captain Crozier did what he thought was in the best interests of the safety and well-being of his crew. Unfortunately, it did the opposite,” Modly said. “It unnecessarily raised alarms with the families of our sailors and marines with no plan to address those concerns. It raised concerns about the operational capabilities and operational security of that ship that could have emboldened our adversaries to seek advantage. And it undermined the chain of command who had been moving and adjusting as rapidly as possible to get him the help he needed.”

Rather than raise unnecessary concerns among families, it seems that Crozier’s memo accurately reflected their fears. One mother of a sailor on board the Roosevelt who tested positive for COVID-19 told the Washington Post that the captain’s “letter touched on all the points that us, as family members, were feeling.” The parent of another sailor under Crozier’s command told the Post he “is a hero” who cares “tremendously for the well-being of my daughter and all her shipmates on board TR.”

Even if Navy officials were already responding to Crozier’s concerns in private, their urgency clearly did not match what he felt was necessary. On Tuesday, Modly outlined a possible reason for this in an interview with CNN. “We have been working actually the last seven days to move those sailors off the ship and get them into accommodations in Guam,” he said. “The problem is that Guam doesn’t have enough beds right now and we’re having to talk to the government there to see if we can get some hotel space, create tent-type facilities.” 

But in that same interview, he also said Navy leaders “don’t disagree” with Crozier’s assessment of the threat posed by COVID-19. By Thursday, when speaking with reporters to justify his decision to fire Crozier, Modly seemed to reverse that support. This time around, he said, Crozier’s letter “misrepresented the facts of what was going on on the ship.” When asked to cite a specific example, Modly said, “Well, you raise a particular level of alarm when you say 50 people on the crew are going to die. No one knows that to be true. It does not comport with the data we have.” 

Crozier’s advice to remove sailors quickly from the ship was ultimately heeded. On Wednesday, the Navy announced a plan to remove more than half of the sailors off the ship. In announcing that decision, Modly and Admiral Michael Gilday, the chief of naval operations, acknowledged a possible misunderstanding with Crozier. “The misunderstanding perhaps was the requirement of the speed to get people off the ship,” Gilday said. “In order to act on a requirement, we have to clearly understand the requirement.”

Crozier’s letter could not have made the timeline more apparent. “Decisive action is required,” he wrote. “Keeping over 4,000 young men and women on board the TR is an unnecessary risk and breaks faith with those Sailors entrusted to our care.”

The only thing decisive about the Navy’s response was the speed with which it fired Crozier. 

Guy Snodgrass, a former Pentagon official under Defense Secretary James Mattis who served with Crozier on the USS Ronald Reagan, said his firing “sets the Navy back significantly as a professional organization, losing trust with both the American public and Sailors.” High-profile Democrats have also latched on to Crozier’s ousting as an example of the Navy’s failure to properly address the accelerating coronavirus crisis among its ranks. In a statement to Reuters, Joe Biden said, “Donald Trump’s Acting Navy Secretary shot the messenger—a commanding officer who was faithful to both his national security mission and his duty to care for his sailors.” Tommy Vietor, an Obama administration national security official who co-hosts the popular liberal podcast Pod Save America, said on Twitter that it was “moving” to watch Crozier’s sailors wish him well, “but infuriating to know that he was fired for refusing to whitewash the disastrous coronavirus response.”

The Navy, in the meantime, expects there will somehow be no deleterious impact stemming from Crozier’s firing. “I trust that it won’t have a chilling effect,” Modly said. “I hope this will reinforce the fact: We have the proper way of handling this.” When time is running out in a crisis of unexpected magnitude, Captain Brett Crozier’s story raises the question of how proper that process really is.

Michelle Mazzie has been a travel agent in Park City, Utah, for 30 years, serving mostly corporate clients and some leisure travelers. She also happens to be my sister. So when the travel industry became one of the first business casualties of the novel coronavirus, I started interviewing her about what that looked like on the ground as the pandemic first took hold.

Our first interview was on March 6. That’s the day Austin canceled its annual music and ideas festival South by Southwest. That’s also the day Vice President Mike Pence announced that 21 people aboard a Princess cruise ship were infected with the virus. President Donald Trump said he wanted to prevent it from docking in California because, “I don’t need to have the numbers [of US cases] double because of one ship that wasn’t our fault.” Businesses were canceling work travel; big conferences in Las Vegas and elsewhere were halted. I’d planned to write up the interview and post it soon after. But the travel industry proved to be a moving target. Everything we thought was true on March 6 turned was totally different a few days later. 

Within a week of that first conversation, every major sporting event in the country, from professional hockey to college basketball, got canceled. Schools closed, the economy started slowing, and the airlines were panicking. I couldn’t update my story fast enough to keep up, so we just kept talking. I’ve continued to interview my sister several times over the past month about what it’s been like to be a part of an industry that is imploding, with projected losses of more than $400 billion in 2020. Here’s what she told me. (Our interviews have been edited for clarity.)

Can you describe what it’s been like to be on the frontlines of the travel industry during the pandemic?

It’s been a nightmare. People are just exhausted. We’ve been working night and day to get people home. We’re trying to balance the needs of our clients while following the guidelines that each travel vendor has in place. But the guidelines have been changing multiple times a day. I feel like I need a law degree to figure out the logistics. I really don’t want to make an error that will cost my company money in the long run. It’s not an easy job. When the airlines won’t answer their phones, we’re the ones that are fielding everything. My company did layoffs for the first time in its 35-year history, and it’s my understanding that the largest travel management company in Utah laid off 200 people a few weeks ago. It’s been hard to watch the whole world come down like that.

When I first started talking to you about the industry in early March, you said you had friends in the travel business who were traveling around a lot right now and saying how great it was because there were no crowds. Has that changed?

Yep. Now people are definitely canceling their trips. I feel like there wasn’t a clear direction when all this started happening. I have a friend who was stuck on a ship. She went to Antarctica. They were supposed to disembark on March 17, but no one would let them dock. They sent her to the Falkland Islands. She finally got home on the 27th. 

 

 

 

 

 

 

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Look at that there I am! A Signature Travel Expert. I love this conference. I have learned so much over the past year and met some awesome travel advisors along the way. #hesstravel #galavantingtattler #sigsocial #sigtn #travelmatters #lasvegas #mandalaybay #traveleducation #stn2019 @signaturetravelnetwork

A post shared by Michelle Mazzie (@galavantingtattler) on Dec 2, 2019 at 6:43pm PST

What sorts of issues have your clients run into in the past month?

I had a gal call, and she was actually in Seoul [just before all the travel bans] and was flying to Melbourne. She was worried her flight wasn’t going to go, if she was going to be stuck there. Her flight went, and I think she was wondering if they were even going to let her get off the plane connecting through Sydney. She made it. But in Seoul, she was very concerned she’d be stuck there for 28 days. That would be so interesting because do you stay in a hotel room for 28 days and who pays for that? How much does it cost to stay in a hotel room for 28 days and eat?

Are people pissed off about having to cancel or postpone trips?

Pissed off? No, they’re mostly scared. I haven’t had anybody that’s been pissed off. Leisure travelers, they’re definitely not pissed off. It’s more of a concern thing.

I have heard that getting your travel canceled or changed, especially with the airlines right now is a nightmare. The hold times to call sound really long. Are people freaking out about this?

I feel like I should really point out that this is why you should use a travel agent. We could get [a flight] canceled and get it all figured out for you a lot faster, so you don’t have to wait four hours on hold with Delta. There is actually value in a travel professional. We will sit on hold for four hours for you. People who don’t book with us have actually called and said, “Is there something you can do?” We help them the best we can, but it’s hard when we didn’t do the booking originally.

What sorts of interesting questions are you getting?

Somebody asked me, “Do you think the airports will be empty when I go?” I said, “I sure hope so!” They want to know, “Will I get a whole row to myself?”

The Trump administration has made a number of missteps during this crisis that seem to have had an adverse impact on travel, like when he announced during a March 11 prime-time TV address, with no advance warnings, that travel from Europe to the US would be banned. Lots of people paid ridiculous amounts of money to get home before the ban took effect, and then many got stuck in crowded lines at the airport when they arrived in the US. Have moments like that made things worse for travel agents?

It has gotten worse. After he gave his speech, travelers went into a panic, and they were calling wanting to know what he meant, and we didn’t know. We had no idea what he meant. Nobody knew. On the [after-hours] lifesavers line, it was just panic. When we have all these people who are already in Europe, and then he comes out and says there’s a ban, and now they can’t come home. It’s been a lot. People were upset. They really took it out on the lifesavers line.

You couldn’t pay me enough to go on a cruise, even before the coronavirus outbreak. So I’ve been shocked to see that right up until the companies were forced to shut down people were going on them. Are you seeing any sort of change of opinions about cruise ships now that so many people have gotten sick on them?

Nobody has said they won’t get on a cruise ship. They are more just like, “When do you think we’ll be able to go?” People love cruising.

Have you ever seen anything remotely like this before?

There was 9/11 when all the flights were cancelled, and then people didn’t want to travel. That was interesting. Then there was SARS in 2003 and that cost $50 billion in travel. I think it was SARS that really hit the travel industry. But they say that this is more comparable to 9/11 as far as what the travel industry is going to lose, and that’s a lot.

Are you worried about your job?

My company has a contingency plan. I feel pretty confident in their plan, and I honestly believe that travel will come back because it always does. I feel like we have to be here for our travelers and the corporations we work with. I don’t know how long it will go on. That’s the unknown of it, right?

When the outbreak first started to get really serious, people were saying there were travel deals to be had. Were there any deals? And are they now all just a fantasy?

There are a few deals now. I think if you wanted to try to fly tomorrow you could get a really good deal! But then you land in DC or somewhere, and you have to be quarantined for 14 days. I think you can fly from DC to Salt Lake now for like $200 for immediate travel or in June, to Hawaii from SLC is $400. Soooo there are a few deals. But everybody should just stay home.

Is anyone actually traveling anymore?

It’s funny because every day, I’m so busy still doing cancellations. If somebody calls to book a new trip, I’m like, “How do I do that?” We’re like, “You actually want to buy something? Are you sure?” That’s the first question. I am happy to issue a ticket because I know next week I’ll be canceling. It will give me something to do.

One of the hardest things I’ve found about the pandemic is the way it’s put life on hold. I’m a big planner, as you know, and this time of year we’re usually making all sorts of plans: summer camp, vacations, trips to see you. What do you tell people who are in this weird purgatory?

You really have to go on like everything’s fine and make your summer plans. You could interview me now about the Utah toilet paper shortage.

Sean Doyle, a 31-year-old fourth-year med student at Emory University, is a vaccine trial veteran: Two and a half years ago, he volunteered at Emory to be injected with an experimental Ebola immunization for a trial that lasted 18 months. Last Friday, he headed to the lab once again, this time to receive a shot in the first US coronavirus vaccine trial. We talked to him about what it’s like to be a two-time vaccine guinea pig. 

Read our interview with Dr. Evan Anderson, head of Emory’s coronavirus vaccine trial. 

On what made him want to enroll: As a medical student right now, it’s a limited amount that we’re able to do—since we haven’t graduated and gone for medical training yet—to help with the response. So this seemed like a really great way to contribute to the cause.

I was contacted about being a participant in this clinical trial because I had been a participant for a vaccine trial that Emory had conducted for Ebola virus. Since I had completed that—and it had been a really rigorous trial—they thought that I might be a good candidate for this trial as well. 

When Emory first reached out, I was really excited to participate, especially because I am a medical student and learned about vaccine development, and also about the potential benefit that these vaccines can have. What with everything that’s going on, it just seemed like a no brainer to get involved in this way.

On fears: No one is really sure how it’s going to behave when it’s put in your body. So some of my friends and family indicated a little bit of concern. But I’m familiar with the statistics on how rarely really severe reactions occur. So I wasn’t really that worried about being affected negatively by participating in this trial. It really does seem like the benefit would far outweigh any potential risks.

On not catching COVID-19 while he’s enrolled in the trial: I’m basically just taking the steps that everybody else is right now— socially isolating myself to the best I can. I do live alone, which makes it a little bit easier. I’m actually in a combined MD/PhD program at Emory. I’ve gone through the first half of medical training, and I’m currently PhD in cancer biology lab. So I’m working on writing. It keeps me busy at home, and I’m definitely not bored during my time here.

On getting the shot: I went through a screening process beforehand. I gave some blood samples, and they asked me a lot of questions related to my medical history that were kind of extensive. The screening process itself was not difficult or overbearing to go through.

I got the first vaccine last Friday. It was really just like getting any other vaccine, like a flu vaccine. There really wasn’t anything that was scary about it. It just felt like a very normal process to go through.

I have felt totally fine. The only thing that I noticed after getting the vaccine was that the site of injection had a little bit of tenderness for maybe like a day or two. Just like with any other vaccine that I had gotten.

On comparing this trial to the Ebola vaccine trial: To be honest, it hasn’t been quite as hard as the Ebola vaccine trial, which occurred over the span of about 18 months. This one is going to be about 12 to 14 months, I think. For the Ebola vaccine trial, they collected many more blood samples, and there were many more visits, in part because we received more vaccine doses during that trial.

The results have not been released yet because they are still doing some evaluation of the blood samples that were collected. But Dr. Anderson [the Emory physician who heads the coronavius vaccine trial] was also involved in that trial as well. And he told me that the results should be ready to be shared soon. So I’m very excited see what the results are going to be.

I haven’t experienced any side effects from the Ebola vaccines whatsoever.

On his hopes for the trial: I hope all of the folks who have enrolled will be able to complete it. I was told that the trial now is able to enroll more participants to cover folks that may represent a broader swath of the population and to further evaluate safety.

It will take a little bit to get to the point of determining its safety and efficacy. But this is a really important first step. And hopefully, it will lead to a good outcome.

This conversation has been edited for length and clarity.

This story was originally published by ProPublica, a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

Nurses at one hospital in southeastern Washington state have alleged that, amid the COVID-19 pandemic, they were ordered by supervisors to use one protective mask per shift, potentially exposing themselves to the novel coronavirus.

At another hospital, just east of Seattle, nurses had to use face shields indefinitely.

At a third hospital, on Washington’s border with Oregon, nurses reported that respirators were expired. The hospital responded, the nurses said, by ordering staff to remove stickers showing that the respirators might be as much as three years out of date.

The accounts these nurses provided are drawn from nine complaints filed by the Washington State Nurses Association with the state Department of Labor & Industries since March 11. They paint a picture of how the first state hit by COVID-19 continues to struggle to provide adequate safety measures for medical workers.

Their struggle may well preview what medical providers in other states could face amid a national shortage of personal protective equipment, or PPE. The complaints from Washington also show the increasing sense of fear, frustration and powerlessness many nurses and other medical workers feel as COVID-19 pummels the health care system.

As of this weekend, the Washington Department of Health has reported 3,700 known COVID-19 cases in the state and 175 deaths.

ProPublica contacted all nine hospitals that were the subject of a nursing association complaint. Four responded. They said they were taking measures to protect their employees, but emphasized the unprecedented crisis in which their hospital staffs are now working. In a press briefing Thursday, Washington Gov. Jay Inslee said the federal government had supplied the state with “significant shipments of personal protective equipment” but added that he had “profound long-term concerns about being able to procure these necessities.” Inslee, a vocal critic of the Trump administration, reportedly clashed with the president in a conference call with governors Thursday, according to the Washington Post, pleading with him to take more action.

Some nurses in Washington state told ProPublica that they feel caught between their responsibility to care for patients and their own safety. They believe they have no choice but to keep working, at great personal risk and with limited means to raise concerns within their chains of command. They could be disciplined for talking to the media, and some said they had been explicitly warned about that in emails sent by hospital administrators. To refuse an assignment on safety grounds, they said, could find them ostracized by colleagues or, worse, fired for insubordination.

“It’s a health care war zone,” said a critical care nurse who works at one of the nine hospitals named in the complaints and, like all nurses interviewed for this story, asked to remain anonymous.

She told ProPublica that she has had to reuse masks and other PPE, if she can obtain it at all. She uses a simple surgical mask—a paper cover with ear loops, no eye cover—even when working with patients waiting for COVID-19 tests, because that’s all that’s available. Community members have been asked to donate handmade masks. She wears one over her surgical mask; it doesn’t protect from viruses but at least is one more layer. Every night when she comes home, she strips down in the garage and throws her dirty hospital scrubs in the washer before rushing in to take a shower.

“Never in a million years did we think when we were in nursing school that our employer would not provide us with the PPE they are legally obligated to provide us with, to care for those patients,” she said.

Her supervisors acknowledge the shortage, she said, but have told staff members that unless they make do, they could run out of all protective gear, making their situation even more precarious.

“We take an oath of ‘do no harm,’” the nurse said. “Would we be willing to take care of these patients with nothing?” She has a family, some of whom would be especially susceptible to the disease.

“I don’t know what I would do,” she said. “We are continuing to reuse this equipment so hopefully we don’t have to make that choice.”

“This Is What You Signed Up For”

Nurses in Washington, where the virus first surfaced in the U.S., believe their early experience can help prepare health care workers elsewhere. The Washington State Nurses Association has even produced a list of recommendations for other states, called “Lessons learned from the front lines.” Those lessons include, “Know your employer’s plan for PPE (personal protective equipment),” and “Know the testing and treatment protocols now.”

When the novel coronavirus spread across Washington in February and March, the lack of supplies in hospitals, coupled with uncertainty over what protective measures were needed, presented many nurses with a difficult choice. Nurses given a dangerous job could accept the assignment and its attendant risks, or refuse and face possible discipline. The WSNA, a union that represents more than 17,000 nurses, advised members who refused an assignment to stay and do other jobs. For those nurses who accepted an “abnormally dangerous” assignment, the union advised filling out what is called an ADO form. ADO stands for Assignment Despite Objection.

When ProPublica mentioned ADO forms to some nurses in Washington, they did not react with enthusiasm. “It’s the stuff of fairytales,” said one nurse in the Seattle area who specializes in mental health. “Nurses, administratively, are strongly discouraged to use the forms or outright shamed for documenting what they are uncomfortable with in a caregiving situation.”

Under collective bargaining agreements, nurses disciplined for refusing an assignment can push back, arguing that the discipline lacked “just cause.” But the WSNA has warned its members that given the current national and state emergency declarations, the resolution of any such objection “would likely be delayed and the outcome may be uncertain.”

Ruth Schubert, the association’s communications director, said the WSNA has received about 70 Assignment Despite Objection forms related to the coronavirus. She declined to provide copies, citing confidentiality, but did share excerpts, including one that said: “Continue to be asked to reuse single use masks for COVID-19 modified droplet patients and wear ill-fitting gowns that fall off shoulders. Goggles not available.” Some nurses are unlikely to fill out an ADO for fear “that management will see them as complainers,” Schubert wrote in an email.

The WSNA said nurses fear being disciplined for talking with the media. A doctor from PeaceHealth St. Joseph Medical Center in Bellingham, close to the Canadian border, told the Seattle Times on Friday that he was fired after he raised multiple concerns about the hospital’s lack of protective measures against COVID-19. A spokesperson for PeaceHealth St. Joseph confirmed the doctor was fired but had no comment because the physician was employed by another company, called TeamHealth.

PeaceHealth St. Joseph is one of the nine hospitals the state nursing association has filed a complaint against, for allegedly asking nurses to reuse and share their protective equipment without proper cleaning. As of Saturday morning, PeaceHealth had not responded to ProPublica’s inquiries about this incident or the complaints. TeamHealth, the doctor’s primary employer, told ProPublica that the physician has “not been terminated,” and that TeamHealth is “committed to engaging with him to try to find a path forward. Now more than ever, we need every available doctor, and we will work with [him] to find the right location for him.”

A Seattle nurse who specializes in oncology said her hospital’s administration initially downplayed the risks: “I had a manager come in and tell me, ‘This is just like the common cold.’” The nurse added, “We’re being told, business as usual, this is what you signed up for.”

Some nurses in Washington have turned to Facebook to express their frustrations. (ProPublica isn’t identifying the nurses in these threads, but did confirm their nursing credentials through state licensing records.)

Commenting on a Facebook post that warned against using cloth masks, one registered nurse wrote, “We need to be able to wear something!!!”

A different post linked to a Bloomberg story about hospital workers making masks from supplies bought at craft stores and Home Depot, including industrial tape and foam. “No offense but I’m not wearing someone’s arts and crafts project with this thing,” wrote one registered nurse.

Facebook posts linking to a Tacoma News Tribune story about nurses reusing disposable masks generated multiple me-too threads. “We are doing this,” wrote a nurse in Everett. “Our hospital … also,” wrote a nursing assistant southeast of Seattle. “It’s everywhere,” one RN wrote, followed by a second RN, “This is everywhere,” followed by a third RN, “Yep.”

One nurse told ProPublica that she wrote on Facebook that she had decided to take a break from her job because she could no longer deal with what she considered an unsafe environment.

She was met with criticism by another nurse, who commented that they didn’t get into this field to “cut and run.” That devastated the nurse who spoke to ProPublica, who responded she didn’t “sign up to die.”

The nurse, who works in an eastern Washington hospital, started to get concerned when, on March 10, her hospital loosened some of its PPE guidelines. She is now using up all her vacation and sick leave because she’s nervous to return to work. If she isn’t approved for an extended leave of absence, she said, she is “100 percent prepared to resign.”

“These Are Not Normal Times”

The most recent complaint filed by the state nurses association was on March 23 against Overlake Medical Center. Based in Bellevue, just east of Seattle, Overlake has had dozens of patients with COVID-19 on any given day. On Friday, the number was 40, said Morgan Brice, a hospital spokeswoman. At least 11 patients have died at Overlake from COVID-19, according to Brice. A number of them arrived at the hospital under “comfort care,” meaning their death was imminent and the hospital made efforts to keep them comfortable in their final days.

The complaint filed with the Department of Labor & Industries said nurses were being required to reuse face shields “indefinitely.” “They must clean them themselves and … store in their own locker for reuse day after day, until the chinstrap is loose,” the complaint says, adding: “RNs report the chinstrap is loose after one 12-hr shift.” The complaint also said the hospital was failing to make sure that notification of exposure was reaching nurses on their days off, “thus prompting additional community and family exposure.”

Brice, in an email, told ProPublica that Overlake had yet to receive a copy of the complaint and would not respond to the specific allegations until it has. But the hospital, she wrote, is “committed to investigating the facts related to any complaint and acting appropriately.” She outlined some steps Overlake has taken during the outbreak, including having a team of nurses “committed to the health of our employees.”

“We have dedicated extensive resources to training staff on how to use and maintain their PPE,” Brice wrote. “We have posted videos, daily FAQs for staff, formed a PPE float team to help guide employees, along with our managers rounding the floors on a consistent basis. We know we have taken extraordinary and proper measures to protect the health and safety of our staff, while we respond to the medical challenges being presented on a daily basis.”

The complaints filed with Labor & Industries use a fill-in-the-blank form, with a narrative section to describe alleged hazards.

On March 11, the nurses association filed a complaint against St. Joseph Medical Center in Tacoma, saying nurses were being directed to reuse and share protective equipment. The complaint also alleged that nurses weren‘t being fit-tested for N95 masks, a protective respiratory device worn over the face. Masks that aren‘t properly fitted to a person‘s face can admit contaminated air.

CHI Franciscan, the medical system that includes Tacoma‘s St. Joseph, said it is cooperating with the investigation but was told by the Department of Labor & Industries that no action is required at this time. The system denied that nurses “have been or will be asked to use PPE in a manner not in compliance with CDC, FDA and DOH guidelines,” according to an emailed statement from Cary Evans, the company‘s vice president for communications and government affairs.

The hospital is operating with “7-12 days of PPE” and said it has not had a situation where demand for PPE exceeded supply. Administrators have expanded fit testing for N95 masks. They are also accepting donations of PPE gear from the community. Normally, a 30-day PPE supply is preferred, according to the Washington State Hospital Association.

“These are not normal times,” Evans‘ statement said, “and we are doing everything we can to keep our staff and patients safe, while also conserving masks under the latest local CDC guidelines.”

The same day it filed the St. Joseph complaint, the nurses association submitted seven others, two against hospitals within the same medical system: Multicare Tacoma General Hospital and Multicare Good Samaritan Hospital in Puyallup, a community southeast of Tacoma. A spokesperson for the system wrote that all employees “have the appropriate personal protective equipment (PPE) they need today to do their jobs safely” and noted that hospital staff are allowed “to preserve PPE resources needed to care for our most critical patients.”

“Due to supply chain disruptions, health systems worldwide are dealing with shortages of PPE,” the statement read.

Another complaint, filed against PeaceHealth Southwest Medical Center, a hospital in Vancouver, across the Columbia River from Portland, Oregon, said nurses were reporting lack of access to masks and respirators. When the nurses reported that respirators were outdated, the hospital “directed staff to remove outdated 2017 and 2019 ‘service by‘ stickers on equipment,” the complaint said.

The hospital did not respond to requests for comment from ProPublica as of Saturday morning.

Beth Zborowski, senior vice president of membership engagement and communications for the Washington State Hospital Association, said a lack of PPE is probably the medical community‘s top problem in the state, in terms of its efforts to fight COVID-19. The association advises hospitals to follow Department of Health and CDC recommendations, though many nurses say the latter keeps changing.

“Prior to the pandemic, masks were available on carts outside of rooms,” Zborowski said. “What started happening is those things started disappearing pretty quick. People had to put conservation measures in.” It‘s one reason the state canceled elective procedures in recent weeks.

It‘s unclear how many health care workers in the state may have become ill as a result of COVID-19, though a doctor at EvergreenHealth near Seattle has been infected and Schubert, of the state nursing association, said she knows of nurses who have become sick. Zborowski said the state hospital association does not have a formal record but added she has not heard about many front-line medical workers becoming ill, as they have in New York and Italy. She hopes that means the conservation and safety measures hospitals are taking are working. The goal is to preserve the PPE; otherwise, “I think we will start to see health care workers getting sick.”

Eileen Ravella, a physician assistant at an urgent care facility in Olympia, said her employer is doing well under the circumstances, trying to keep COVID-19 cases cordoned off from other patients and using a drive-through testing area they set up to meet the need. This is helping them preserve PPE, but she knows the system is breaking under the weight of the pandemic.

“I think we all have to step up and do our best despite the obstacles,” Ravella said. “Those patients need us.”

A nurse who works in a western Washington emergency room said that a few weeks into the pandemic, the crisis conditions had begun to feel normal, “which is kind of horrible, too.”

Now she‘s advising nurses in other states about what she‘s experienced. Initially, many of them refused to take her seriously.

She admits that she downplayed COVID-19 at first. Then, in mid-March, she found out about the EvergreenHealth doctor who had contracted the virus.

“It became really real then that some of us may not make it out of here alive,” she said.

A few days later, she and her colleagues received a message from their hospital administrator, advising them to complete their advanced directives—basically a living will.

“[N]ow with COVID-19 making who gets sick an unpredictable event,” the message read, “it‘s an important time to get this done.”

Earlier this week, lawyers representing the state of California notified a panel of federal judges that the state’s corrections department intends to slow the spread of the coronavirus in its facilities by freeing about 3,500 inmates convicted of nonviolent crimes who were already due to be released within 60 days. Those early releases won’t affect Stacey Dyer, who is currently serving life without parole after she was convicted of murdering a 19-year-old in a small city in California’s Central Valley. Sixteen years into her sentence at the Central California Women’s Facility in Chowchilla, the 40-year-old works as a peer drug and alcohol counselor and sees her children once a month at most. Survived and Punished, a prison abolition group that advocates for prisoners who are survivors of sexual and domestic violence to be released, has petitioned Gov. Gavin Newsom to commute her sentence.

I spoke with Dyer by phone last week. Her prison currently has zero confirmed COVID-19 cases, according to data published by the state corrections department—but just one inmate there has been tested for the virus. With the prison on a modified schedule to promote social distancing, Dyer has been spending up to 22 hours a day in a shared cell with four bunks, watching TV news to glean information about the pandemic outside. What follows is a condensed and edited transcript of her comments based on phone and email correspondence.

Stacey Dyer: In the beginning, the officers were taking our toilet paper. I don’t know if they’re still hoarding toilet paper out there or not, but this was at the time everybody had first started going to the grocery store and there was, like, no toilet paper.

We have boxes of toilet paper, gloves, and sanitary wipes, stuff like that, that the janitors use to clean up. They keep an inventory of everything, from the toilet paper to the cleaning chemicals to the pads and tampons. They check it frequently and pass it out weekly to each room. A couple of boxes came up missing, and there was no other way it could have disappeared but staff, because it’s locked up. We kind of joked about it, because our toilet paper is horrible. It’s not really even toilet paper; it’s like this one-ply sandpaper. It has, kind of, a smell to it. It’s the worst of the worst of toilet paper. So we laughed and said they must be really desperate.

The staff that was here that day agreed that the remaining toilet paper in the closet would be safer if we passed it all out and started hoarding it in our rooms. So there wasn’t any toilet paper for staff to steal unless they came in our rooms and got it, which—then we would know who they are.

Once the boxes came up missing, everybody kind of panicked and started hoarding toilet paper and pads, and sanitary napkins, and stuff like that. The same with the groceries at the canteen. The canteen supervisor said that she has a couple thousand dollars worth of canteen left, and after that, she didn’t know if the next shipment was coming in. So everybody was basically buying up everything in the canteen. We’re hoarding things like people were hoarding things out there. The big difference is we can’t go to the grocery store any time we want.

I’m a drug and alcohol counselor for the drug program here. [With programs canceled,] I’m missing my support network, and my pay. Everybody that I work with is positive. They’re all mentors, they’re all drug and alcohol counselors, and they’re my support system. And even though I live in a good room and a good unit, there are a lot of people that are on a different page—a lot more negativity. People are taking drugs and drinking to try to cope with the lockdown, which in turn usually ends in some type of conflict among roommates. It’s basically pruno, fermented juice or fruit that they let sit. It’s really unhealthy, pretty risky, but they do get drunk off of it and usually end up fighting.

You definitely have to have a good room right now. There’s four bunks, and I’m not sure the dimension of the cell, but it’s a pretty tight squeeze. It’s definitely less than six feet apart from one bunk to the next. We share the bathroom, the shower, and the sink. We’re pretty much with each other all day, except for our hour and a half out and in the dayroom.

A lot of people I see are having problems. A lot of conflict, a lot of arguing, a lot of fighting. Some people don’t handle being locked down all day well. I don’t think they handle it mentally and emotionally, so they start lashing, taking it out on each other, or they start trying to complain or control things. If somebody’s not washing their hands enough, they might start bullying them to wash their hands, calling them dirty or nasty. People are getting bullied if they sneeze, cough, or sniffle.

Officers are really grumpy and angry and taking it out on us. I got a lot of comments from some of the officers in passing, saying, “Oh, you better not have the coronavirus,” stuff like that. There’s been a lot of rumors. Like if things got really bad, the officers could abandon us. That they don’t have to, legally, help us or save us or do anything for us. They can leave us for dead. I don’t think it’s going to get that bad. But my first thought was feeling sort of a desperation. Like, oh god, how am I going to survive? If worse came to worst, and there was nobody there to feed us or to even unlock our doors? Being trapped in the cell and not having food, or what if they stopped running the water or the electricity?

Thinking about it, and just seeing the tone of the officers and their attitudes, it just really made me feel like I was basically worthless, like I’m not worthy of being saved.

Watching the news and seeing things on TV, seeing how people are reacting out there to being isolated from each other, it’s like watching the whole world get locked up in prison with us. Watching the news, I’m seeing them struggle emotionally from not having a connection with people, missing their family, and loved ones. I see it’s taking a toll on people. They’re depressed, in the free world. And it’s just interesting to me because we’ve been going through that since we’ve been in prison. Going through these emotions, feeling isolated, and trying to find creative things to do with our time. Most of us are used to entertaining ourselves and have games, puzzles, and adult coloring books to keep ourselves occupied. We are used to being locked up, while the rest of the world is getting a small bitter taste of what we go through.

The California Department of Corrections and Rehabilitation says no toilet paper has gone missing from the Central California Women’s Facility, and that allegations of increased drug use, drinking, and fighting there are unfounded. “We understand that the inmate population is watching the news and are experiencing the same kinds of uncertainty and anxiety that many might be experiencing in the public,” CDCR press secretary Dana Simas said in a statement. “We have contingency plans on top of contingency plans to address any situation where COVID-19 might significantly impact our operations, including ensuring we always have enough staff to continue operations at each institution.”

Today, as was inevitable, a map from the New York Times made its rounds on Twitter showing where Americans are not staying home (answer: the Southeast) and it was taken wildly out of context—used to more or less say, look at those ignorant Trumpers below the Mason-Dixon line!

My colleague, Kevin Drum, called the map “infuriating” and explained the concentration of continued movement in the South over the past few weeks in this way:

The map doesn’t look this way because people in the South are idiots. It’s almost certainly because they’re conservative and they watch a lot of Fox News. They also listen to President Trump. And Rush Limbaugh. And what they heard was that the coronavirus was “just a bad cold.” That “within a couple of days it’s going to be down to close to zero.” That the hysteria was nothing but a “new hoax” from Democrats who want to bring down the president.

For weeks that’s what they heard. And they believed it. And so they resisted taking it seriously. That’s starting to shift now that Trump and the conservative noise machine have changed their tune, but it’s several weeks too late. What a shameful performance.

While I agree people in the South are not idiots, and that President Trump has whiffed in showing any real leadership during this pandemic—a fact that has real consequences—I respectfully disagree with the broader point here. 

For weeks, all over the internet, the message has been “stay home,” “stay the fuck home,” “stay home or you’re a monster who will bring about the apocalypse and the ultimate collapse of human civilization.” Yes, stay home. But what if you can’t? 

We don’t often discuss that the ability to stay home is a privilege, one that is a lot more common in places like the Bay Area, where I live. My privilege in this situation is mostly a product of sheer, stupid luck, not some moral high ground, and it is also partly due to the fact that now I live in urban California, in an area where leadership has taken the threat of the virus seriously and where my job can be conducted pretty easily with a laptop and some WiFi—a luxury in and of itself.

My family and many of my friends back home in the South are generally not so fortunate. It doesn’t make them lesser people. And it doesn’t mean they settle into their living rooms at night to watch Fox News, dumbly absorbing whatever nonsense is spat out at them by blonde women with impossible hair or white men with rage etched into their faces. Sure, those people exist—but a whole shit ton of people watch Fox News, and data shows that it’s very much not just in the South. It’s simply unfair to assume that COVID-19 has gained a stronghold there because of conservative propaganda and blind loyalty to Trump. It is because of inequality, poor infrastructure, poverty, food deserts, and a whole host of other reasons, some of them political. 

Poor leadership certainly plays a significant role here, and plenty of blame rests with those in power who do take their cues from the president (who takes his cues from Fox News). My colleague Tim Murphy wrote about how the nation’s Trumpiest governors—that “cohort of mini-Trumps,” as he writes—have turned a massive health crisis into a game of politically motivated chicken. And I’ve already written about how Gov. Bill Lee in Tennessee, my home state, has taken absurdly inadequate steps to protect the state. That he only just decided today, Thursday, April 2, to issue a stay-at-home order (previously it was just a “safer-at-home” order) means that my father, who is at a higher risk for severe illness due to the virus, has not been able to “stay the fuck home” without losing his job, which, economically, is not an option for my family. I do not know if this new order even means he will finally get some reprieve. Instead, my father uses the PTO he has to take days off here and there, trying to mitigate his risk, but also lessening the chance of a real vacation after all of this is over.

There are also other reasons for not being able to stay the fuck home beyond the necessity of remaining employed. The Times map getting all the attention is pointing out where people have been driving more than two miles over the past few weeks. But in rural areas, you cannot often just walk a few blocks to a bodega or a grocery store. In my hometown, for example, your options are a Dollar General or a Food Rite—if you need anything that either place does not carry, it means traveling to another county, where groceries are generally cheaper anyway because Wal-Mart. This map from Vox shows where there are populations of people who have no car and no supermarket within a mile. The highlighted areas in this map are pretty similar to the one in the Times. What’s more, these areas are often places that don’t have reliable public transportation, if they have any public transportation at all.

Vox

One more point that is crucial to consider: As the Atlantic points out, more young (or younger) people in the South appear to be dying from the coronavirus. This isn’t so surprising when you consider the South has some of the worst health disparities in the country. Again, that cannot be attributed easily to Fox News or the Trump effect; instead, it should be attributed to policy. As Van R. Newkirk II writes:

Health disparities tend to track both race and poverty, and the states in the old domain of Jim Crow have pursued policies that ensure those disparities endure. The South is the poorest region in the country. The poor, black, Latino, or rural residents who make up large shares of southern populations tend to lack access to high-quality doctors and care. According to the State Health Access Data Assistance Center, Mississippi, North Carolina, Texas, Florida, Georgia, and Louisiana all spend less than $25 per person on public health a year, compared to $84 per person in New York. Nine of the 14 states that have refused to expand Medicaid to poor residents under the Affordable Care Act are in the South. And many of those states are led by Republican leaders who have imitated President Donald Trump’s dallying and flip-flopping, and now find themselves flat-footed.

I’m worried about how the South will fare over the next several months and do expect, as Newkirk suggests, the pandemic will take a particularly dire toll in my home region. But this crisis affects all of us, and I know plenty of Southerners (conservatives included) who are taking it seriously.

So, my plea: Beyond remembering our own privilege, something we don’t easily do even in moments like this one, don’t forget those maps you’re sharing out of context, those numbers you’re citing, have long, thick, and twisted roots—and they run much deeper than partisanship. 

If the weeks seem like decades to you right now, consider this bit of good news: The first US trial for a coronavirus vaccine is already underway, just months after the novel virus emerged. That’s a record. The new vaccine, made by the National Institute of Allergy and Infectious Disease and the pharmaceutical company Moderna, is in its first phase of testing at two sites: the Kaiser Permanente Washington Health Research Institute in Seattle and the Vaccine and Treatment Evaluation Unit at Emory University in Atlanta. Over the next several months, 45 volunteers will receive the shot, called mRNA-1273. During this phase, researchers will begin to study its safety and its ability to stimulate the immune system.

This is just the beginning, of course—if this trial is successful, it will be 18 months before the vaccine will be available to the public. And this vaccine is just one of several that scientists will test. The worldwide coordination among scientists is unprecedented, and it will be fascinating to watch over the coming months. 

We spoke to the Emory site’s principal investigator, Evan Anderson, an associate professor of internal medicine and pediatrics who specializes in infectious disease.

How did Emory get involved with the study?

Our Vaccine Treatment and Evaluation Unit, which is a network of clinical sites around the country that’s supported by National Institutes of Health, has been doing vaccine studies for 60 years now. And some of those vaccine studies are of emerging pathogens and infections. The network was very involved with the 2009 H1N1 response and has done a number of pandemic preparedness studies. We jumped at the opportunity to be involved with this very important study.

How are you recruiting volunteers?

We have a long history of having conducted a number of similar studies in the past. We have a large number of people that have been involved in prior studies. We reached out to a number of them.

What has the process been like for them?

First, we have a brief screening phone call with them that typically takes maybe 15 or 20 minutes. We give them the opportunity to ask a few questions, and they give their consent.

Then they come in for an actual screening visit, at which time we spend a while talking through the specific criteria, outlining the risks and benefits associated with the study, the fact that it’s voluntary, the fact that they can withdraw at any point in time. We discuss issues of privacy. We do an exam, and we go through a long series of questions to make sure that we think they truly are potentially eligible.

They then have blood drawn. That will give us answers about whether or not their labs show they are eligible for the study. About a quarter to a third of those that have volunteered end up not being eligible due to different reasons.

What happens with those who are selected? 

The eligible volunteers are brought back for an actual vaccine, at which time we update them about any additional risks that have been identified and make sure that they’re still eligible to receive the vaccine. Then they receive the vaccine, and afterward they have blood drawn. Then they have to wait in clinic for an hour.

They have a “memory aid” that they end up completing over the next week. On a daily basis they have to keep track of any local symptoms, meaning redness, swelling, tenderness, itching at the side of injection. They also keep track of any more systemic symptoms, things like fevers, chills.

They get a couple of phone calls in the days after they received the vaccine. Then they’re back a week later, at which time we go through any actual symptoms that they’ve had. Again they have blood drawn. Then two weeks post-vaccine, they’re back to clinic again.

We go through the records with them to make sure that they’re still eligible to receive the second dose of the vaccine. Then you repeat the whole process. After those initial few weeks out from the second dose, they’re back in the clinic at four weeks, then three months, six months, a year. In all, it’s about 13 to 14 months that they’re committing to be involved with the study. We want to make sure at the beginning that they stay with us, if at all possible.

The volunteers are not paid in the classical sense, but they are compensated for their time and involvement. These studies are very intense. They require multiple hours in the clinic. If they complete the study, they’ll be reimbursed about $700.

What happens if somebody gets COVID-19 during those 13 months that they’re part of the trial?

The individuals who are being enrolled in the trial are purposely being selected as low-risk, from the standpoint that they are able to maintain social separation and follow CDC guidance. So we’re trying to enroll people who are not out in the community due to job-related things.

That has excluded people like health care providers, who clearly have a heightened risk of acquiring infection. In general, we have more people who are primarily living alone or living with a spouse or partner, rather than people who are living in a family with children.

Especially the first two months after they get their first dose of vaccine through a month after they get their second dose of vaccine, we really need to try and have them avoid getting infected with the virus, if at all possible. In part, because that will then impact the safety assessments and the immune response assessments that are critical to making decisions about moving forward with the vaccine.

What are the risks of the vaccine?

The most common things that we expect to see are the local side effects—tenderness or soreness at the site of injection, then systemic side effects, meaning fevers, chills, achiness, in the days after they receive the vaccine. Those are things that we expect we will see from the vaccine because typically they’re seen in all vaccines.

There’s always the potential for a severe allergic reaction to the vaccine.

There’s been some concern raised about if someone was, in fact, to get the vaccine, and then were infected with the virus, whether the vaccine could result in more severe disease. That’s a theoretical concern that we’ve seen with a couple of prior vaccines. They use different technology, and we think it’s unlikely that that will be the case here. 

I think the other possibility—and this is quite possible—is that we don’t see any immune response. That’s why vaccines fail most frequently. And then there’s what we hope, that we’ll ultimately see protection by the vaccine against the disease.

How often do trials like these end in failure or non-resolution?

This is just the phase one study, so there are a lot of steps that are required after this study is completed. There still needs to be a phase two and a phase three study that will enroll larger numbers of people. In this phase one study, it is primarily the immune response that we’re looking at—particularly the antibodies but also other immune markers. The phase 3 study looks at whether it actually works in terms of prevention of COVID-19.

Which is to say, the majority of early vaccine candidates are not going to make it to market. Most of the time they are not successful. Obviously, we hope that will be different for this vaccine candidate, but we don’t know.

If this vaccine were to get through all of the phases, how long would it take for it to be widely available to the public?

The key point for this phase one study will be around the two-month mark, [which is] after the initial dose of vaccine and the last phase one study participants being enrolled. The safety of the vaccine at that point in time, and whether we’re seeing an immune response, will then determine whether or not the vaccine moves into phase two studies.

The best-case scenario for getting the vaccine to market? People have said maybe a year, which is optimistic. Eighteen months is probably more realistic for the vaccine candidate. There are there are other vaccines in the pipeline too that the National Institutes of Health will be testing. So they’re not putting all their eggs in one basket.

How is the vaccine that you’re testing different from vaccines that exist for, say, childhood illnesses?

A lot of existing vaccines use what’s called a live, attenuated approach, where a weakened virus is used for vaccination. That hopefully will generate a good immune response but will not cause the patient to become sick. There are a number of vaccines that fall into that category, like the measles, mumps, and rubella vaccine.

Another category is the vaccines that contain a protein or proteins from the disease. The idea is that those proteins will generate an immune response to that protein resulting in protection from disease. Sometimes it’s a large number of proteins, like for the influenza vaccine. You’ve got the whole virus with some of those vaccines. Other times, it’s just a protein from the bacteria or virus. That would include things like pneumococcal vaccine.

This vaccine is different in that it is what’s called mRNA vaccine. It contains part of the genetic code of what’s called the spike protein from the coronavirus. If you think of the virus, it’s kind of a little circle with little proteins sticking off of it. Those proteins give it the crown-like appearance, which is where the term coronavirus comes from.

Those proteins sticking off the circular virus are spike proteins, and this vaccine contains the genetic codes for a section of that spike protein. When it’s injected in the individual, the hope is that it will tell that person’s body to make that protein and express that protein that will generate an immune response. That protein will then provide protection against actual COVID-19.

What if the virus mutates? What are the implications for the vaccine?

That is always a risk with vaccines in general. We think the technology being used here would be much more amenable [to make] adjustments fairly quickly in that instance—you could just change the genetic code that’s in the mRNA. There would need to be additional studies if the vaccine did need to change.

How could pharmaceutical companies help this process?

The extent to which one pharmaceutical company might focus on developing a vaccine impacts their ability to continue forward with other drugs that they may be developing for other purposes—drugs that might require lifelong administration such as for high blood pressure or for other conditions. And many of those drugs can bring better financial rewards for an individual corporation than developing a vaccine.

I think that is part of the issue as to why there has been limited interest on the part of pharmaceuticals in vaccines in general. A greater commitment to vaccine development in general would certainly be of great benefit for our nation moving forward.

Researchers at the Murdoch Children’s Research Institute in Melbourne, Australia, made an exciting announcement late last week: They’re planning to test among health care professionals a century-old vaccine’s ability to fight COVID-19.

“We hope to see a reduction in the prevalence and severity of COVID-19 symptoms in healthcare workers receiving the BCG vaccination,” Professor Nigel Curtis, a clinician-scientist who leads MCRI’s Infectious Diseases Research Group, said in a press release. Similar trials are underway in the Netherlands, Bloomberg reports.

The BCG vaccine, first administered in 1921, was developed to protect against tuberculosis but has been shown to treat other conditions as well, like bladder cancer. “We wouldn’t be doing this if we didn’t think that this might work,” Curtis told Bloomberg. “We cannot guarantee that this will work. And of course, the only way to find out is with our trial.” 

Studies also suggest that receiving the BCG vaccine early in life may protect children from other, unrelated infections later on. As I reported earlier this year, the BCG vaccine is just one of several vaccines to show “off-target” effects:

In a 2015 meta-study, researchers analyzed hundreds of thousands of hospitalizations in Spain that occurred between 1992 and 2011 and found that 10- to 14-year-olds who had received the BCG vaccine at birth saw nearly 70 percent fewer hospital visits due to non-tuberculosis infections than those who had not. In 2018, a study of more than 3,000 hospitalized adults in New Zealand showed that having previously gotten the flu shot decreased the severity of illness and hospitalization time for people who ultimately contracted the flu—even for strains they hadn’t been protected against. The average vaccinated patient, the study found, spent four fewer days in the ICU for flu-related infections than their unvaccinated counterparts. (The flu vaccine also reduces your risk of hospitalization in the first place.) And in 2019, a small study led by researchers in England suggested that the typhoid vaccine, made with a weakened form of salmonella, might also help combat the flu by giving the immune system a “boost” to fight other pathogens.

Scientists aren’t exactly sure why some vaccines seem to have positive, unintended consequences (and this particular field studying “off-target” effects is controversial among experts). But in 2012, researchers published a landmark study involving the BCG vaccine that suggests a possible mechanism—here’s how Mihai Netea, a professor at Radboud University in the Netherlands and an author of the study, described it to me: When you get a live vaccine for a disease, certain cells in your body can “bookmark” instructions for how to fight the pathogen in their DNA. When a similar pathogen comes along, the cells “know exactly where to open the book.”

There is some early, population-level research to support the idea of using BCG vaccination to fight the new coronavirus: A recent study from researchers in New York shows that countries with universal BCG vaccination have seen fewer deaths from COVID-19 compared to countries without widespread BCG vaccination, like the United States and Italy. But, as the authors caution, this data is correlational; the paper is awaiting peer review.

It’ll take some time to know whether the BCG vaccine can actually help protect against the novel coronavirus, and Melbourne’s Royal Children’s Hospital has only just started recruiting volunteers from hospitals around Australia. But at this point, without a coronavirus vaccine, researchers are trying out every trick in the proverbial book. As Curtis put it,  “The clock is definitely ticking.”

Yesterday, I published a story about a major FDA roadblock to advancing new COVID-19 plasma therapies to fight the pandemic: recovered gay men like me couldn’t donate blood because, using the FDA’s regulatory parlance, I’m a man who has had sex with a man in the last 12 months. That guidance was stopping me from donating the plasma that scientists say might contain answers to beating back the disease. My immune system, having kicked COVID-19, could be used as a protective “blanket” for much sicker patients in promising new trials around the country. This predicament was in addition to widespread shortages of blood during the outbreak, in general.

Here’s the key piece of that reporting from yesterday, at which point the FDA said it wasn’t going to change the regulation, but was watching the situation closely:

The FDA blood bank guidelines are in place to reduce the risk of HIV transmissions resulting from blood transfusions, because gay and bisexual men in the US have a higher risk of getting this disease from sex. Until 2015, the FDA enforced a lifetime ban on gay men giving blood. It then decided to allow those who haven’t had sex in over a year to donate. The agency’s reasoning is that it takes time to detect recent infections of those diseases. But the yearlong window remains a sore point for gay rights. The guidance pays no heed to whether you’re in a monogamous sexual relationship, or Tinder-hopping, while screening for viruses has become much quicker and more precise. In the two years after the UK narrowed its abstinence window in 2017 to three months, there was no reported rise in contaminated blood supply. Canada moved to a three-month model in June, 2019.

Now, the FDA is pulling this restriction in line with practices elsewhere around the world—a three­-month abstinence window, instead of the full 12 months—to address the “urgent and immediate need for blood and blood components.” In a statement released on its website Thursday morning, Dr. Peter Marks, director of the agency’s Center for Biologics Evaluation and Research, stated:

People who donate blood are part of our critical infrastructure industries. More donations are needed at this time and we hope people will continue to take the time to donate blood… Based on recently completed studies and epidemiologic data, the FDA has concluded that current policies regarding certain donor eligibility criteria can be modified without compromising the safety of the blood supply.

The new guidance also affects those with recent tattoos and piercings, and others. Read the full details here. And there is some other good news buried in the press release: The changes will happen immediately and are “expected to remain in place after the COVID-19 pandemic ends.” 

“Progress!” said Peter Staley, the AIDS activist I spoke to for my original story. “But they still need to include a no-window exception for these plasma studies, using HIV viral load tests to assure safety.”

Alphonso David, president of LGBTQ rights group Human Rights Campaign told me on a video press call Thursday afternoon that while the rule is a step in the right direction, there’s still more work to do to banish stigma from the blood supply completely. “The policy should not be based on “I am a gay man,” he said. “That is what the science shows and for some reason the FDA continues to latch onto a policy that is based on identity.”

HRC instead advocates for a system based on an individualized risk assessment of personal sexual behaviors. “A person who had unprotected sex only days before can still donate blood,” he said. “But a gay man or a bisexual man who had sex with another man within three months of the date of donation—despite using condoms, despite taking HIV prevention medication—they cannot donate. This difference is unfair, and it’s based on bias.”

On COVID-19 convalescent treatments, specifically, Dr. W. David Hardy, an infectious diseases professor at Johns Hopkins University who has also pushed for FDA reform, expressed hope that this new rule might speed up the qualification process for donors like me. “It would be made much, much faster,” he said. “Because the waiting period would be very much shorter.”

For the fuller picture about how plasma therapy works, click here. Or you can listen to this week’s episode of the Mother Jones Podcast, which recounts my journey to recovery and what I’ve learned so far about the science of immunity:

This story has been updated with reactions from advocates and experts.

On Wednesday, Georgia Republican Gov. Brian Kemp issued a stay-at-home order, effective Friday, in an effort to combat the spread of COVID-19 in the state. Some parts of Georgia were already under such orders, thanks to local officials, and other parts of the country had begun taking such steps weeks earlier.

Kemp, like a number of other Trump-friendly Republican governors, had put off the inevitable for days. Why now? He’d just found out “that this virus is now transmitting before people see signs,” Kemp explained. “What we’ve been telling people from directives from the CDC for weeks now that if you start feeling bad stay home—those individuals could have been infecting people before they even felt bad. Well we didn’t know that until the last 24 hours.”

A stunning admission of deadly ignorance from Georgia Gov. Brian Kemp, who says he only just learned that asymptomatic people can transmit #Covid19. “[I]ndividuals could have been infecting people before they ever felt bad, but we didn’t know that until the last 24 hours.” pic.twitter.com/T7NZWk2GDR

— Andisheh Nouraee (@andishehnouraee) April 2, 2020

I’m sorry, what? What on Earth?

It’s true that, this week, the Centers for Disease Control and Prevention announced that as many as 25 percent of people carrying the virus might be asymptomatic. That’s a new and ominous chunk of data supporting the idea that you can still transmit the virus even if you don’t feel sick. But it’s not a new idea. People have been talking about asymptomatic people transmitting coronavirus for a long time now.

“Infected people without symptoms might be driving the spread of Coronavirus more than we realized,” blared one CNN headline on March 19th, exactly 14 days ago.

“Coronavirus spreads quickly and sometimes before people have symptoms, study finds”—that was Science Daily on March 16, reporting on a study from the University of Texas.

On March 5, a group of German doctors reported to the New England Journal of Medicine “a case of 2019-nCoV infection acquired outside Asia in which transmission appears to have occurred during the incubation period in the index patient”—an asymptomatic transmission.

I mean, we know all of this. How come Brian Kemp didn’t?

In response to the coronavirus pandemic, more than 20 states so far have shuttered nonessential businesses—and, like clockwork, an increasingly unlikely parade of corporations is claiming to be essential. The latest is Cash Store, a “payday loan alternative” chain that has classified its more than 100 locations in Illinois, Michigan, New Mexico, and Wisconsin as essential businesses. All four states have issued shelter-in-place orders—but at Cash Store, life goes on.

Some states’ essential business lists, like Illinois’, do include “banks and financial institutions.” But payday loan shops aren’t considered financial institutions—in fact, at least one circuit court has specifically held that they’re not. Still, Cash Store has declared that it’s staying open as an essential financial service, meaning all of its storefronts are staffed and open regular hours—including for borrowers who want to “invest funds for both long and short periods” or “transfer financial risks between customers.”

Payday lenders are notorious for finding customers in tough spots and leaving them in worse ones. Rollovers, deceptive ads, and unrealistic repayment schedules push desperate borrowers into debt traps, where many pay thousands of dollars in interest on a few hundred in loans—and still wind up in bankruptcy. Borrowers take out new loans so they don’t default on old ones; according to a Pew Charitable Trusts report, paying off an average payday loan “requires about one-third of an average borrower’s paycheck, not leaving enough money to cover everyday living expenses without borrowing again.” They’re likely to borrow for critical needs: California’s Medicaid expansion cut payday loans by more than 10 percent, a 2017 Health Affairs study found. And payday loan “alternatives,” like car title loans, often end in repossession.

But it’s an incredibly lucrative industry: Short-term borrowers—i.e., broke people with bad credit—paid more than $60 billion in fees and interest in 2015. Things got worse with Donald Trump’s rollback of Obama-era consumer protections, along with his gutting of the one federal agency built to fight predatory lending.

Cash Store is the retail face of Texas-based Cottonwood Financial, a major player in retail lending that spent more than $50 million on advertising in the 2000s alone. Cottonwood CEO and President Trevor Ahlberg (also an enthusiastic big-game hunter, according to a detailed investigation by the Texas Observer) has donated more than $1 million to conservative causes, and thousands to Trump-supporting PACs—and he’s far from alone in the industry. As early as 2013, Texans for Public Justice found that Ahlberg was “by far, the most politically active payday lender,” according to D Magazine.

Cottonwood’s Better Business Bureau page is a litany of complaints (and often form-letter responses) from consumers who claim they were asked to pay the same debt, or parts of it, multiple times; that Cash Store made unauthorized direct withdrawals from their checking accounts; and, from one employee identifying as a benefits specialist, that Cash Store said it wouldn’t add her young child to her employer health insurance without a court order. (Cottonwood replied, acknowledging that it had eventually added the kid.) In its own backyard of Texas, Cash Store’s practices appear to work around local laws that limit loan amounts and installments, the Observer reported. 

It’s not immediately clear why Cash Store would keep hundreds of brick-and-mortar stores open. Many payday lenders offer online cash advances, including through apps you can access by phone. Some claim to remotely deposit your funds in minutes. And if you want to give Cash Store your money from home, no problem: You can make a loan payment by phone, by mail, or electronically, per its coronavirus webpage. But need to borrow some cash? You’ll have to head in. Unlike some competitors, Cash Store will only take money remotely, not hand it out, despite the evidence that small cash loans can be approved remotely. That means thousands of workers are coming in to hundreds of stores, helping Cottonwood collect debts—at the cost of exposure to COVID-19.

Cash Store’s website claims that it has “implemented additional cleaning and disinfecting protocols” and sent its stores “extra cleaning supplies to increase health safety.” Their blog features multiple COVID-related posts: “We decided to fact-check some of the top coronavirus-related stories, to help you see past the stigma and get to the point!” one says. Another offers laid-off job seekers a list of companies now hiring, from CVS to Papa John’s—after all, you can’t get a payday loan with no payday. With 5 million or more jobs on the chopping block in March alone, Americans will need money in the months ahead. But the typical requirement for a payday loan is a regular income stream, and sweeping job losses could mean trouble for payday lenders.

If Cash Store risks losing business, why stay fully open? One clue: Americans hold about $10 billion in outstanding payday loans. Many borrowers default on high-interest loans, and shops like Cash Store work that into their model; Cottonwood Financial sells its unpaid debt to collectors for pennies on the dollar. But third-party debt collectors are about to get more business than they can handle, most of it better than payday loans—so ultra-high-interest lenders had better collect what they can, while they can. “At this point, we are a glorified collection agency,” one cash advance lender wrote on Facebook. On social media, small lenders are racing to collect from individuals and small businesses, swapping stories about funders who won’t help them lend more, but who still expect their money.

Unlike small-fry independent lenders, Cottonwood isn’t beholden to anyone. The firm bills itself as “one of the largest privately held” retail lenders in the country; it’s cash-rich, boasts zero debt, and risks much less by closing some or all of its 300-plus stores. Even if they were laid off, front-line workers at Cash Store could collect expanded unemployment benefits under the CARES Act; instead, they’re risking COVID-19 for the sake of Cottonwood’s investments. (Cottonwood didn’t respond to requests for comment.)

Other types of lenders are offering breaks on the high interest and short deadlines of most cash advances. U.S. Bank has cut rates on its short-term cash loans, which it touts as a payday loan alternative. Barclays is waiving fees on (usually expensive) credit-card cash advances. Cash Store, meanwhile, is offering borrowers hit by the tidal wave of shutdowns and layoffs a chance to…borrow again. A web FAQ for the business says you can score a “cash back refinance” on your payday loan “alternative”—but that you “still need to visit your local Cash Store in order to complete the loan agreement.” Luckily, if you’ve already paid off a Cash Store loan, you’re preapproved for another.

In fact, the nation’s five biggest banking and finance regulators have unanimously pushed banks and credit unions to offer serious payday loan alternatives during the coronavirus crisis—cheaper alternatives, not equally pricey loans in a slick wrapper. Even borrowing with your credit card, if you have one, could cost less in interest and won’t force you into a store.

Cash Store isn’t the only shop staying open in the dubious guise of an essential service. GameStop, Guitar Center, and Hobby Lobby have also informed Americans that we can’t live without them. Joann Fabrics and Crafts, borrowing from Thoreau, initially defied state orders to shut down, although it’s now giving away make-your-own-mask kits for Good Samaritan seamsters. And some have tried to make an extra buck in the crisis: The hardware chain Menards was ordered last week to quit jacking up prices on cleaning supplies and masks. States have seen a rash of price-gouging complaints, and the cost of protective gear has soared among online retailers.

Do you have other examples of companies refusing to shut down despite better judgment, cutting corners on safety, or just plain profiteering? Help Mother Jones track corporate cash grabs during the pandemic with an email to scoop@motherjones.com. If you can, include photos, links, or documentation.

This story is from Columbia Journalism Investigations and the Center for Public Integrity, a nonprofit, nonpartisan investigative media organization in Washington, D.C.

In late August 2017, Hurricane Harvey cut through Texas and other southern states, its catastrophic floods affecting millions of Americans. Within a month, Hurricane Irma swept through Florida, and then Hurricane Maria devastated Puerto Rico.

The federal Disaster Distress Helpline saw a surge in calls and texts for help that September. Nothing since has topped that—until now.

The helpline, 800-985-5990, run by the Substance Abuse and Mental Health Services Administration and the nonprofit Vibrant Emotional Health, answered roughly 7,000 calls and received 19,000 text messages in March, a more than eight-fold increase from February. That far outstrips the number of texts and calls in August and September 2017 combined, according to data obtained by the Center for Public Integrity and Columbia Journalism Investigations.

Amid the coronavirus pandemic, hotlines in the US are seeing a spike in activity that might be unprecedented. That’s because the situation is, too.

“This feels different, and it is,” said Roxane Cohen Silver, a professor of psychological science, medicine and public health at the University of California, Irvine. “This is an invisible threat: We don’t know who is infected, and anyone could infect us. This is an ambiguous threat: We don’t know how bad it will get … we don’t know how long it will last. And this is a global threat: No community is safe.”

Dozens of studies link psychological burdens with isolation and crises, including epidemics. In one study of Hong Kong’s 2003 severe acute respiratory syndrome outbreak, nearly half of surveyed residents said the experience weighed on their mental health. Sixteen percent showed signs of post-traumatic stress disorder, or PTSD, six months after the outbreak ended.

Sarah Lowe, a psychologist and assistant professor at Yale School of Public Health, calls the coronavirus a “slow-motion disaster” with potentially widespread and persistent mental-health fallout. Lowe, who studies the effects of disasters, said she worries that some people will be disproportionately affected, particularly medical workers, the sick, those with pre-existing mental illness and anyone facing economic challenges.

“We know from previous disasters that long-term financial strain tends to be associated with depression and PTSD,” she said.

Like the federal hotline, the National Alliance on Mental Illness’ HelpLine is seeing a surge in calls. Before COVID-19, the illness the novel coronavirus causes, 150 calls would be a big day, said Dawn Brown, the HelpLine director. Now it’s surpassing that number daily.

“It’s continuing to go up,” she said, adding that nearly half the callers at some point mention the virus.

Callers to NAMI’s line, 800-950-6264, are sharing feelings of anxiety and depression as well as asking for advice about how to continue mental-health treatment and get medicine refilled during stay-at-home orders.

“People with mental illness require a great support system,” Brown said. “They don’t do well with uncertainty and ambiguity, which this has certainly caused. Just when you think you’ve got a handle on it, something else happens, whether it be a shelter-in-place order or more news coverage talking about death and shortages.”

In New York City, which has the most confirmed cases in the country, NAMI’s local affiliate is seeing jumps in calls to its own helpline, 212-684-3264. Call volume in the past few weeks has gone up roughly 60 percent, said Matt Kudish, the group’s executive director.

And the number of people taking a free screening test for anxiety offered online by the advocacy organization Mental Health America is up more than 20 percent from mid-February through mid-March, compared with the early part of the year. That’s the COVID-19 effect, said Paul Gionfriddo, the group’s president and CEO.

He’s worried the country may be under-reacting to the mental-health toll. “And it’s only going to get worse as we have to bring widespread grieving into the equation as more people die,” he said. “Because people will be grieving alone.”

Some federal and state health authorities are rushing to maintain psychological support. The US Department of Health and Human Services has expanded access to teletherapy, including for Medicare, and some states are waiving telemedicine restrictions for Medicaid. The US Drug Enforcement Administration is now allowing doctors to prescribe medications virtually without having to first meet a patient face-to-face.

New York Gov. Andrew Cuomo launched a COVID-19 Emotional Support Hotline, 844-863-9314, and said 6,000 mental-health professionals have volunteered to help.

What officials say in this fraught period also can help, or harm, mental health.

“Not every message from public health leaders will be comforting,” said Brian Hepburn, who leads the National Association of State Mental Health Program Directors. But consistent messaging will build trust, he said, and as a result “you are going to see a decrease in fear, in those spikes.”

The first uptick in calls to the Disaster Distress Helpline happened on March 16, the same day President Donald Trump announced recommendations such as closing schools and avoiding gathering in groups of more than 10 people. Six days earlier, he assured Americans that the administration’s response was “really working out” and downplayed the threat by saying deaths were minuscule compared with the flu.

Lowe said she was upset to see the president’s March 20 press conference, in which he criticized a reporter who asked, “What do you say to Americans who are scared?” Trump rebuffed the question, calling the reporter “terrible.”

“I found that invalidating of people’s fears and worry,” Lowe said. “People are afraid. Denying that will only make those feelings intensify.”

Two hotlines that aren’t seeing increased calls: the National Suicide Prevention Lifeline and the National Domestic Violence Hotline. Administrators at both are keeping a close watch for changes.

“Because we expect that people are spending more time at home, possibly not leaving the home for work each day, for example, we know survivors are spending more time in closer proximity to their abusers,” said Katie Ray-Jones, CEO of the domestic violence hotline.

Helplines and crisis hotlines are only an initial support system for people in emotional distress. Gionfriddo, of Mental Health America, is urging people — and elected officials — not to assume the anxiety and other corrosive effects will disappear on their own when the pandemic is over. The amounts of mental-health funding in Congress’ coronavirus package, he said, “are rounding errors,” money that in his view will not be enough to address the surge in needs.

“If we make them an afterthought—if we don’t address them aggressively—they’ll still be there,” he said.

Dean Russell is a reporting fellow for Columbia Journalism Investigations, an investigative reporting unit at the Columbia Journalism School. Funding for CJI is provided by the school’s Investigative Reporting Resource and the Energy Foundation. Jamie Smith Hopkins is a reporter and editor at the Center for Public Integrity, a nonprofit investigative newsroom in Washington, D.C.

Despite President’s Donald Trump’s bluster, tests for the coronavirus remain in short supply. And we likely won’t contain the virus until healthcare providers can dramatically scale up testing. One major obstacle: a shortage of swabs, which clinicians need to gather samples from patients’ noses and throats to determine if they’re stricken with COVID-19.

These aren’t ordinary Q-tips. According to the Centers for Disease Control and Prevention, they have to be tipped not with cotton, which is used for over-the-counter ear swabs, but with with synthetic fiber. And they’re about six inches long. (This video shows how swabs like this are typically used.)

“There’s not nearly enough product,” said Meg Wyatt, senior director of  diagnostics supply-chain services for Premier Inc., which procures medical gear for 4,000 US hospitals and health systems. Premier’s hospital customers are scrambling to bring enough swabs to ramp up testing, and “there’s just no good news.”

Two companies supply the great bulk of medical-grade swabs to the US market, Wyatt said: Maine-based Puritan, and Copan Diagnostics Inc., located in the COVID-19 hotspot of Lombardy, Italy. Both companies say they’re ramping up production, but it hasn’t been enough. And as of now, Wyatt says, there’s no clarity on when the shortage will end. Meanwhile, COVID testing is just now ramping up across much of the globe, including India, a country with more than four times the population of the United States. 

As they scramble to ramp up production, swab makers like Copan and Puritan have been forced to ration the product, supplying hospitals based on what they use in a normal year, Wyatt said.  For example, she said, swab makers may tell a hospital buyer “you’re getting 80 percent of your historical usage—and historical usage reflects a normal flu season,” she said. “But with the COVID-19 spike, that’s not nearly enough to meet what [hospitals] need.” Hospitals “aren’t seeing relief,” even as the demand for testing “just keeps growing and growing,” Wyatt said. 

I wondered whether big companies that make cotton-tipped swabs for the household market could be enlisted to rig their factory lines to produce medical-grade COVID-19 swabs. A spokesperson for Unilever, maker of Q-Tips, said the company could not retrofit its machinery to make medical-grade swabs. 

Meanwhile, a 3D printing company called Formlabs has jumped into the breach. A spokeswoman for the company, which is working on a design from a team of physicians at the University of South Florida Health, says it will “soon” be able to pump out about about 100,000 COVID-19 testing swabs daily at its US Food and Drug Administration-registered print farm in Ohio. Hospitals equipped with Formlabs printers will be able to produce them as well, the spokeswoman said. But she declined to give a timeline on when Formlabs would begin delivering the product. When it does, she wrote in an email, “we believe that any number of swabs we produce will provide relief to healthcare providers in need.”

President Trump has shifted from glibly promising the end of social distancing by Easter to warn of a “painful two weeks ahead” as the United States now reports more cases of COVID-19 than any other country. As of March 27, most states had implemented some kind of social distancing policies, from shutting down schools and non-essential businesses to imposing stay-at-home orders to slow down the spread of the coronavirus. But did they act too late?  

There is already evidence that state-level decisions on when to require social distancing were driven by politics, not public health. By March 16, the governors of all 50 states had declared a state of emergency. Yet as the animation at the top of this article shows, Democratic governors generally declared emergencies before Republican governors. Four of the last five states to declare an emergency (West Virginia, Oklahoma, Mississippi, and Georgia) have Republican governors.

That data comes from a study released last week by political scientists at the University of Washington, who found that states with Republican governors and a higher number of Trump voters were slow to roll out policies to control the spread of the virus—potentially undermining efforts to “flatten the curve” of transmission.

The researchers looked at when governors in every state announced five important social distancing measures: closing schools and non-essential businesses, putting restrictions on restaurants and social gatherings, and issuing stay-at-home orders. States started implementing these policies on March 10, nearly two weeks after the first reported date of community transmission of coronavirus in the United States. But some states moved a lot quicker than others. 

States’ delays in taking action could produce significant, ongoing harm to public health, the researchers write. The variation in the timing of these policies echoes the 1918 influenza pandemic, when officials were faced with similar decisions whether to require social distancing. Philadelphia held a massive parade to welcome soldiers home while St. Louis cancelled a similar event; it had one eighth the number of deaths as Philadelphia. The University of Washington researchers note the recent contrast between Kentucky and Tennessee’s official responses to the coronavirus: “On 6 March 2020, after Kentucky had its first confirmed case of COVID-19, Governor Andy Beshear (D) immediately called a state of emergency, encouraged social distancing, and closed bars and restaurants ten days later. But when neighboring Tennessee uncovered its first confirmed case of COVID-19 on March 5th, Governor Bill Lee (R) waited until 12 March to declare a state of emergency and finally closed restaurants and bars on 22 March.” As of March 31, Kentucky had 480 reported cases, according to the New York Times; Tennessee had 1,642.

Overall, the researchers found that the strongest predictor of why a state responded slowly to the pandemic was political ideology. States with Republican governors and a higher percentage of Trump supporters were the slowest in implementing social distancing policies. “All else equal, states with Republican governors and Republican electorates delayed each social distancing measure by an average of 2.70 days… [A] far larger effect than any other factor, including state income per capita, the percentage of neighboring states with mandates, or even confirmed cases in each state,” they write.

The researchers hypothesize that these states waited to act partly because of President Trump’s statements downplaying the virus’s severity, which were magnified by Fox News and other conservative media in the early stages of the pandemic. They also speculate that Republican governors may have feared retaliation if they were seen to contradict the president.

The researchers also looked at various factors that may have influenced a governors’ decision to delay mandating social distancing, including the number of coronavirus cases in the state, what neighboring states were doing, and their states’ economic status. They found that the number of cases had little bearing on when policies were introduced, but neighboring states’ policies did influence each other. Poorer states were slower to adopt social distancing.

“Barring positive developments in the fight against COVID-19, the public health impact of this delay is likely to be massive,” the researchers conclude. “In a state where coronavirus infections are doubling every seven days, this would raise the peak caseload by 30.6%. In a state where infections are doubling every three days, Republican partisanship might raise the peak level of cases by 86.6%.”

Correction: An earlier version of the animated map used the wrong colors for Nebraska and Nevada. 

In less than a single month, the coronavirus pandemic has completely altered the day-to-day lives of millions of Americans. With many stores running out of essential items such as milk, eggs, and canned food almost as soon as they’re stocked, it can be difficult to find the groceries needed to stay safely inside for weeks at a time.

That’s especially true for many of the 42 million people who rely on the Supplemental Nutrition Assistance Program—commonly known as SNAP, or food stamps. SNAP recipients each receive an electronic benefits transfer card, which works like a debit card, that’s recharged with a set amount of credits each month to use on groceries. So if they run low, they may have to postpone a trip to the grocery store until their SNAP accounts are refilled.  

As a new month begins, there’s been messaging circulating online urging people who don’t rely on SNAP to refrain from grocery shopping during the first few days of April, so that people using food stamps have a better chance of stocking up on popular supplies. “If you’re not having a food emergency, please don’t go to the grocery store on April 1st and 2nd. Wait until the 3rd,” read one particularly viral tweet this week. “People who are on food stamps get their accounts recharged on the first of the month, and have likely been running on fumes.”

“Many of them haven’t been able to shop since March 1,” Hugh C. Minor IV, a spokesperson for the Rhode Island Community Food Bank, told the Providence Journal. On Monday, the food bank asked Rhode Island residents to “pause” their grocery shopping on April 1 and 2 for SNAP shoppers. 

It’s a nice sentiment. But as I found out after calling around, this advice only applies to a handful of states that issue SNAP benefits at the beginning of the month. Rhode Island, Nevada, North Dakota, Vermont, Guam, and the US Virgin Islands all disperse SNAP benefits on the first day of each month, as established by the US Department of Agriculture. Most other states—including Florida, California, and Texas—and the District of Columbia have a more staggered schedule so that recipients don’t overwhelm grocery stores on the same day.

But there are bigger challenges for people using SNAP during the coronavirus pandemic, according to Ellen Vollinger, the legal director for the Food Research and Action Center. “Part of the tough times that low-income people have is how meager their normal-sized allotment is,” she says. The average SNAP recipient gets $127 a month; while the average cost of groceries per month for one person typically ranges from $165 to $345, based on data published by the USDA. “They were not as well situated to stockpile,” Vollinger notes. And while grocery delivery is an option for people who don’t want to risk a trip to the store, that option is not available for SNAP recipients in most of states. 

The $2 trillion coronavirus relief bill that Congress passed last week includes a nearly $16 billion boost to the SNAP program for 2020, with the expectation that many more people will sign up for benefits as the economic fallout from the pandemic grows. That extra money will be sorely needed, but Vollinger is skeptical that it will be enough for people, especially during emergency situations like the one we’re currently experiencing. The increased funding will only cover the anticipated rise in SNAP enrollment; it won’t increase the benefits of current recipients.

“At the outset of this, there were recommendations that households all stockpile for 14 days worth of food,” Vollinger says. “When you’ve got a very meager SNAP allotment, that’s not easy to do. If people are concerned about the SNAP shopper, the best thing they could do is advocate to Congress and the White House to give them more benefits.”

This story was published in partnership with ProPublica, a nonprofit newsroom that investigates abuses of power. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

Five years ago, the U.S. Department of Health and Human Services tried to plug a crucial hole in its preparations for a global pandemic, signing a $13.8 million contract with a Pennsylvania manufacturer to create a low-cost, portable, easy-to-use ventilator that could be stockpiled for emergencies.

This past September, with the design of the new Trilogy Evo Universal finally cleared by the Food and Drug Administration, HHS ordered 10,000 of the ventilators for the Strategic National Stockpile at a cost of $3,280 each.

But as the pandemic continues to spread across the globe, there is still not a single Trilogy Evo Universal in the stockpile.

Instead last summer, soon after the FDA’s approval, the Pennsylvania company that designed the device—a subsidiary of the Dutch appliance and technology giant Royal Philips N.V.—began selling two higher-priced commercial versions of the same ventilator around the world.

“We sell to whoever calls,” said a saleswoman at a small medical-supply company on Staten Island that bought 50 Trilogy Evo ventilators from Philips in early March and last week hiked its online price from $12,495 to $17,154. “We have hundreds of orders to fill. I think America didn’t take this seriously at first, and now everyone’s frantic.”

Last Friday, President Donald Trump invoked the Defense Production Act to compel General Motors to begin mass-producing another company’s ventilator under a federal contract. But neither Trump nor other senior officials made any mention of the Trilogy Evo Universal. Nor did HHS officials explain why they did not force Philips to accelerate delivery of these ventilators earlier this year, when it became clear that the virus was overwhelming medical facilities around the world.

An HHS spokeswoman told ProPublica that Philips had agreed to make the Trilogy Evo Universal ventilator “as soon as possible.” However, a Philips spokesman said the company has no plan to even begin production anytime this year.

Instead, Philips is negotiating with a White House team led by Trump’s son-in-law, Jared Kushner, to build 43,000 more complex and expensive hospital ventilators for Americans stricken by the virus.

Some experts said the nature of the current crisis—in which the federal government is scrambling to set up field hospitals in New York’s Central Park and the Jacob K. Javits Convention Center—underscores the urgent need for simpler, lower-cost ventilators. The story of the Trilogy Evo Universal, described here for the first time, also raises questions about the government’s reliance on public-private partnerships that public health officials have used to piece together important parts of their disaster safety net.

“That’s the problem of leaving any kind of disaster preparedness up to the market and market forces—it will never work,” said Dr. John Hick, an emergency medicine specialist in Minnesota who has advised HHS on pandemic preparedness since 2002. “The market is not going to give priority to a relatively no-frills but dependable ventilator that’s not expensive.”

The lack of ventilators has quickly become the most critical challenge to keeping alive many of the people most seriously sickened by the virus. Ventilators not only help people breathe but also can provide pressure that holds the lungs open so the air sacs don’t collapse.

Neither HHS nor Philips would provide a copy of their contract, citing proprietary technical information that would have to be redacted under a Freedom of Information Act request. But from public documents and interviews with current and former government officials, it appears that HHS has at times been remarkably deferential to Philips—and never more so than in the current pandemic.

From the start of its long effort to produce a low-cost, portable ventilator, the small HHS office in charge of the project, the Biomedical Advanced Research and Development Authority, or BARDA, knew that it might need to move quickly to increase production in an emergency and insisted that potential partners be able to ramp up quickly in the event of a pandemic.

But the contract HHS signed in September 2019 gave Philips almost a year before it had to produce a single Trilogy Evo Universal, and two more years to fulfill the order of 10,000 ventilators.

On the same day in July that the FDA cleared the stockpile version of the ventilator, it granted the application of Philips’ U.S. subsidiary, Respironics, to sell commercial versions of the Trilogy Evo. Philips quickly began shipping the commercial models overseas from its Murrysville, Pennsylvania, factory.

Steve Klink, the company’s Amsterdam-based spokesman, said Philips was within its rights under the HHS contract to prioritize the commercial versions of the Trilogy Evo. An HHS spokeswoman—who insisted she could not be identified by name, despite speaking for the agency—did not disagree.

“Keep in mind that companies are always free to develop other products based on technology developed in collaboration with the government,” she said in a statement to ProPublica. “This approach often reduces development costs and ensures the product the government needs is available for many years.”

Just last month, HHS gave a very different impression to Congress, hailing the Trilogy Evo it funded as a breakthrough in its campaign for pandemic preparedness.

“This game-changing device, considered a pipedream just a few years ago, is now available at affordable prices to improve stockpiling and deployment” in an emergency, the agency told Congress in a budget document delivered on Feb 10.

But less than two weeks later, officials overseeing the Strategic National Stockpile approached Philips with an urgent appeal: Start making our ventilators. On March 10, Philips agreed to a modification of the HHS contract—one that called for the company to produce the Trilogy Evo Universal “as soon as possible,” a spokesperson said.

However, in a subsequent statement, the HHS spokeswoman said Philips is only required to deliver the ventilators “as they are completed.” Klink, the company spokesman, said Philips was only committed to meeting the original contract deadline of 10,000 ventilators by September 2022.

Had government officials insisted that Philips first produce the ventilators that taxpayers paid to design, the government could conceivably be distributing all 10,000 to hospitals now. Last year, Philips plants in Pennsylvania and California produced 500 ventilators of various models per week; they sped up to 1,000 per week earlier this year, Klink said. At that pace, the stockpile ventilators could have been completed even if Philips devoted only part of its lines to their production.

Klink said the reason the company is not producing the stockpile ventilator is because it has not yet been mass-produced and would require time-consuming trial runs. In the current crisis, it’s faster and more efficient to continue producing the versions it is already making, he said.

Asked if Philips could hand over its Trilogy Evo Universal design to another manufacturer, he argued that the fundamental constraint on production is not the company’s assembly lines but its dependence on more than 100 smaller companies around the world that make the 650 parts needed for a hospital ventilator.

“We cannot sell a ventilator with only 649 parts,” he said. “It needs to be the whole 650.”

It is difficult to assess how much profit motives might be driving Philips’ decisions about which ventilators to produce because the company does not disclose how much it charges different clients for commercial models.

The commercial version of the Trilogy Evo has had its own problems. Not long after it began selling the ventilators last summer, Philips sent out recall notices to customers in Europe and the U.S., alerting them to a software glitch that prompted the devices to shut down without sounding their alarm. The software has since been updated and the problem solved, the company said.

Klink said Philips hopes to be making 4,000 ventilators of all types each week in the U.S. by October, and that it would prioritize “those communities and countries that need it the most.”

But as the pandemic spreads, desperate global demand for the commercial models of the Trilogy Evo is driving up prices sharply, and evidence from the chaotic open market for the devices raises questions about Philips’ stated commitment to prioritize the neediest.

On Staten Island, a saleswoman at No Insurance Medical Supplies, who would give her name only as Jeanette, said the company was selling to “anyone who calls,” including doctors and individuals. The company’s first shipment of 50 devices sold out quickly, but an additional five ventilators arrived on Friday. The company requested 148 more, but Philips Respironics said it could only provide 11 ventilators by April 6, she said. The company’s prices are determined by what the manufacturer charges, she said.

The competition abroad is also intense. On March 12, the regional government of Madrid, one of the cities hardest hit by the virus, bought 10 Trilogy Evo ventilators from a Spanish medical supply company for about $11,000 each. In Budapest, Hungary, the Uzsoki Street Hospital announced that a local property development company had donated two “ultra-modern” Philips Trilogy Evo ventilators on March 18.

The struggle has grown so fierce that last week, a trade group representing ventilator manufacturers asked the head of the Federal Emergency Management Agency to decide for the manufacturers whom they should sell to first.

“We would appreciate the Administration’s leadership and the advice of clinical and other experts within the Administration in deciding how to allocate these products in the most effective way,” the Advanced Medical Technology Association wrote in a letter to FEMA Administrator Peter Gaynor.

Medical experts and public health officials have believed for nearly two decades that they needed a less-expensive and simpler-to-operate portable ventilator that could be made and distributed quickly in an emergency.

“This is not a new problem,” said W. Craig Vanderwagen, a former senior HHS official who oversaw studies that led to the government’s early efforts to design and build a low-cost portable ventilator for such eventualities. “We knew back in the 2000s that ventilators were going to be critical in pandemic preparedness. That was a clear gap that we identified.”

In the early 2000s, American public health experts and government officials were gripped by a sense of urgency they had not felt before. The 9/11 attacks and the anthrax scare that followed underscored the need for sweeping new actions to keep the country safe. Outbreaks of Avian influenza—first reported in Hong Kong in 1997—exposed the public health system’s vulnerability to new, highly fatal pathogens from overseas. The George W. Bush administration’s disastrously slow and inept response to Hurricane Katrina in 2005 prompted widespread calls for the government to strengthen its ability to deal with a growing array of emergencies, from new, highly contagious diseases to previously unthinkable terrorist attacks.

One obvious vulnerability was to a viral pandemic or a chemical or biological attack that would ravage the lungs of its victims, setting off a cascade of cases of what doctors call Acute Respiratory Distress Syndrome, or ARDS.

“None of us expected an event on the scale of what we’re going through now,” said Dr. Lewis Rubinson, a pulmonologist who participated in several of the early government-sponsored medical studies. “We had to guess: What would the patients look like? What we predicted correctly was that we could face massive cases of ARDS.”

By the early 2000s, officials at the Centers for Disease Control and Prevention had already begun working to stockpile a few thousand ventilators for such an eventuality, former officials said. But studies by medical experts and government scientists—including sophisticated models of what might occur in the event of various disasters, outbreaks or attacks—suggested a bigger problem. Hospitals could be crippled not only by shortages of complex and costly ventilators, but also by a lack of the trained respiratory technicians who are generally required to operate the machines.

The experts envisioned one important solution: a portable ventilator that was less complex than hospital machines and could be more quickly produced, safely stockpiled and widely distributed in emergencies. They envisioned a device that could be deployed in field hospitals like the ones that authorities are now rushing to create in Central Park and elsewhere.

The job of bringing such a device to life fell to BARDA, an innovative office of HHS that was established in 2006 to help the country prepare for pandemic influenza, new types of infectious diseases or an attack or accident involving chemical, biological or radiological weapons.

Much of BARDA’s work has been focused on developing potentially critical vaccines and other medicines that are not necessarily profitable for big pharmaceutical companies. The agency often works with medical researchers at the National Institutes of Health and elsewhere, identifying promising therapies and other innovations, and then forms partnerships with private biotechnology or other companies to create the drugs and move them through various stages of regulation.

In 2008, BARDA began trying to find a company that could make a ventilator that would be inexpensive—ideally, less than $2,000 each—and could be simple enough to use that “inexperienced health care providers with limited or no respiratory support training” could operate the devices during a pandemic, according to the agency’s solicitation for bids.

BARDA also anticipated the shortage of parts and competing priorities that the ventilator industry now faces. Companies bidding for the contract had to show they could secure the parts needed to “ramp up production to supply at least” 1,700 ventilators per month and 10,000 in six months’ time. The companies also had to pledge that government “contracts will be honored during a pandemic,” the initial solicitation said.

With only a couple of bids, BARDA settled on a small, privately held ventilator company in Costa Mesa, California, Newport Medical Instruments Inc. BARDA and Newport signed a $6.4 million contract in September 2010, specifying that the money would be doled out incrementally as the company met various milestones.

But in May 2012, Newport was purchased by a larger Irish medical device company, Covidien, for $108 million. Covidien quickly downsized and asked Rick Crawford, Newport’s former head of research and development and the lead designer of the BARDA ventilator, to finish up the project without any staff assigned to him. Crawford said he took a job with another company.

“I don’t know how you finish a project when nobody reports to you,” he recalled thinking.

A former BARDA official who worked on the project said that Covidien began raising issue after issue and demanded more money. BARDA agreed, eventually tacking on almost $2 million more to the price tag, records show. Even so, Covidien abandoned the project.

A spokesman for the still-larger firm that acquired Covidien in 2015, Medtronic, said that the prototype ventilator created by Newport Medical “would not have been able to meet the specifications required by the government, nor at the price required.” In a statement responding to a story in The New York Times, Medtronic said it left the federal government with all the designs and equipment created in the project.

Several former BARDA officials said such outcomes come with their territory. Like big pharmaceutical companies, they had to take chances, especially in the development of vaccines.

“There are going to be risks like that when you partner with businesses,” said one former senior BARDA official, who, like others, asked for anonymity because she was not authorized to speak for the agency. “It’s a problem that we at BARDA had encountered before, where a company changed hands and changed priorities.”

In March 2016, less than two years after signing its ventilator contract with BARDA, Philips Respironics agreed to pay $34.8 million to settle a Justice Department lawsuit under the False Claims Act and the Anti-Kickback Statute. Justice lawyers accused the manufacturer of effectively paying kickbacks to medical suppliers to buy its masks for sleep apnea. The company also agreed to abide by a five-year Corporate Integrity Agreement with HHS inspector general that imposed a series of oversight measures on the company’s operations.

With BARDA’s continuing support, Philips finally won FDA approval for the Trilogy Evo Universal ventilator in July 2019. Klink, the Philips spokesman, said the $13.8 million from HHS covered only a portion of the design and development costs for the ventilator and that the company invested more.

Rubinson, now the chief medical officer of Morristown Medical Center in Morristown, New Jersey, praised the BARDA effort as essential, adding that if 10,000 ventilators seems like a small number in the COVID-19 crisis, it had to be understood in the context of government officials’ typical unwillingness to buy equipment it might only need in an emergency.

“They could have bought a million ventilators,” he said. “And then you would be writing about the boondoggle of all these devices that never got used.”

Today, the government’s failure to obtain the Trilogy Evo Universal is seen by some experts as the real game changer.

“Even if a few months ago we had taken dramatic action to develop these kinds of ventilators, it would have been better,” said Hick, the emergency medicine specialist in Minnesota. “If I had a ventilator that cost $4,000 rather than $16,000, I’d be in better shape. We can buy a lot more of them.”

Claire Perlman contributed reporting.

Just three weeks ago, when Melanie and her husband welcomed their new daughter into the world, it was impossible to imagine how dramatically and quickly all they took for granted would change. At the hospital, while she recovered, her parents, who live just an hour away from her northern Virginia home, watched her 2-year-old son. All four grandparents met at the hospital to welcome their new granddaughter. Then, just one week later she had to turn her in-laws away from a second visit, and for the last two weeks, she and her young family have been isolating in their home, leaving only for walks and supplies.

“It’s completely different” from having her first child, Melanie says. “A lot of that joy has been taken away from me.” She’s had to introduce her new baby to people through FaceTime and has taken to holding her daughter up Lion King–style for neighbors to admire from a safe distance.

Melanie and her family aren’t alone. As of this week, more than a third of the world’s population is under some form of restriction, and confirmed cases of the virus and deaths continue to rise. There are more than 738,000 confirmed cases of the coronavirus, and more than 35,000 people have died globally, with the United States leading the world in confirmed cases. In Melanie’s home state of Virginia, which has seen 1,250 cases and 27 deaths so far, Gov. Ralph Northam has joined 27 states and Washington, DC, in issuing a stay-at-home order. Virginia’s will be in effect until June 10, a few weeks before Melanie expected to have ended her maternity leave and return to her job as a software engineer. 

Because her baby was due in the spring, Melanie says imagined long walks with friends. One friend, who lives around the block, also has a young son and delivered a baby girl a couple of weeks before Melanie. “We had a lot of plans to spend time together,” she says. “Get out with the other new moms and things like that. Obviously I’m not seeing her and she’s not seeing me.”

The immediate aftermath of a birth can be a joyful but often complicated time for new mothers. The demands of an infant, the physical recovery of childbirth, and a rollercoaster of hormones, even under the best of circumstances, can lead to postpartum depression, anxiety, or a sense of deep isolation. But during a global pandemic, when social distancing has become a public health requirement, new mothers are facing unexpected demands during a potentially fragile time. 

Community is incredibly important for postpartum parents, says Joia Crear-Perry, an OB/GYN, and founder and CEO of the National Birth Equity Collective, an organization dedicated to ending disparities in maternal and infant care. “One of the major risk factors for both anxiety and depression is social isolation situations,” she says. Postpartum depression affects roughly one in seven women, and for low-income women the rate can be much higher. The “baby blues,” a term describing the sadness, irritability, and mood swings within 10 days of giving birth, occurs in upwards of 80 percent of all postpartum women.

“Women, after they have a child, feel like there’s so much joy and happiness around them,” says Maureen Van Niel, a reproductive psychiatrist, and president of the American Psychiatric Association’s Women’s Caucus. “So when new moms are not feeling that way themselves, they’re hesitant to tell people. So it’s very hard sometimes for people to get diagnosed with postpartum depression even when it occurs.”

Once diagnosed, however, there are plenty of treatments available, Van Niel says. Individual therapy or cognitive behavioral therapy are both options and can be accessed online. But for people with a more serious postpartum illnesses, particularly those with a prior history of mental health disorders, medication can be a helpful, low-risk, and a necessary addition to therapy. Most of the medication available for postpartum depression is safe to use while breastfeeding, Van Niel notes. “However,” she adds, “it is important that people be followed by a psychiatrist to address and follow their individual situation.“

Screening for postpartum mood disorders can be difficult at the best of times, but today, decisions that used to be straightforward aren’t any more. Both parents and physicians must decide if it’s safer to have an in-person visit or not, and this could lead to delays in treatment. Pediatricians, OB/GYNs, and psychiatrists are trained to screen for these disorders, but during remote visits, this all becomes much more difficult.

“Visits are way down across the country at pediatric practices, and that’s actually a very big problem right now in primary care,” says Sean O’Leary, a pediatrician and member of the American Academy of Pediatrics Committee on Infectious Disease. O’Leary says providers are doing their best to separate healthy families from sick families. That’s easier if their practices have different locations, but sometimes doctors see healthy infants in the morning, perform a deep clean, and then see sick infants in the afternoon. Pediatricians are also screening parents and infants for COVID-19, the disease caused by the coronavirus. O’Leary is concerned about not being able to do in-person checkups on infants, which he once used as an opportunity to screen parents for any problems they may be experiencing. 

Although new research has emerged from China suggesting that children under the age of 1 may be more susceptible to the virus than older children, O’Leary says parents of infants don’t necessarily need to take precautions other than the recommended social distancing practices. “I don’t think things particularly change for them right now in most parts of the country where we’re recommending social distancing,” he says.  

Many new parents have simply held off on the series of new baby visits. Melanie and her husband have adopted a wait-and-see attitude about going in for future visits, especially because their pediatrician’s office is in a hospital. She says they have been skipping their follow-up appointments but are waiting to make a decision about their appointment two months from now, when their daughter is due for vaccinations. Both mother and daughter are healthy, and while Melanie says she did experience “baby blues” after her son’s birth, it hasn’t been an issue this time. But not accessing child care for her 2-year-old, or giving family and friends an opportunity to help out, has added to an already stressful and anxious situation. 

Child care for new mothers is another serious challenge. Jen Manne is a physician and infectious disease researcher in Boston who gave birth to her son 11 weeks ago. The lack of child care options has left her with a nearly impossible decision: Does she leave her newborn and his 4-year-old sister with her parents in Florida for as long as it takes for the contagion to abate, or does she take him back with her to Boston and risk not being able to access child care, or the possibility of infection? Both Manne and her husband work at a hospital, and finding someone in Boston willing to watch an infant while they work and expose themselves to two physicians at heightened risk has been an extreme challenge.

Manne says this wasn’t what she had imagined returning from maternity leave would involve. Speaking with her friends, many of whom are also doctors and in similar situations, has been helpful. “We cry a lot,” she says. She admits that her worries about not caring for her new baby herself is not completely rational, but “I don’t feel emotionally ready to be separated from him,” she says, adding, “It still feels like a very strong bond, and I’m just grappling a lot with that.”

In addition to child care concerns, experts worry about how new restrictions on giving birth may have downstream effects on the postpartum experience for parents. Many hospitals have started permitting only essential medical personnel in the room, meaning new mothers can no longer have their partner or family with them as they give birth. “There are legitimate reasons why they’re closing these opportunities,” says Van Niel. “But that doesn’t change the fact that it will be extremely stressful for most women unexpectedly now to give birth alone without their partner or family member.” In order to have their partners there, Van Niel says, some people are opting for home birth, which carries its own risks. Birth experiences, particularly if they’re complicated, can have an affect on mental health during the postpartum period, Van Niel says. And if someone lacks emotional support during labor and delivery, that can potentially make the future more difficult. 

For now, Melanie is trying to keep her spirits up by staying busy with her 2-year-old and splitting the care of her children with her husband. “This is really putting into perspective a lot of things that are just so easy to take for granted,” she says. “Just going out for breakfast on the weekend, or picking up coffee, or going to a friend’s house for playdates…Just the little things like seeing friends is going to be so much sweeter.”