The data on COVID-19 hospitalizations and new cases looks better, for a change. After hitting a peak on January 8, the 7-day average case count is down 40 percent, according to the New York Times. Hospitalizations are improving, too, down 24 percent. This isn’t just in a few highly populated states. We’re seeing steep cliffs in new case counts all across the country—half of states have experienced at least a 50 percent drop. 

Our daily update is published. States reported 2M tests, 147k cases, 97,561 people currently hospitalized with COVID-19, and 2,972 deaths. pic.twitter.com/O1eif97YOT

— The COVID Tracking Project (@COVID19Tracking) January 31, 2021

All of this is promising news. Vaccine distribution, bumbling as the rollout has been, seems to be finally doing some good.

But there are two big caveats.

Yes, for the first time since December 1 2020, hospitalizations are below the 100,000 mark, according to the COVID-19 Tracking Project. But that doesn’t mean ICU beds still aren’t nearly full (or, in the case of the hospital closest to me in the Bay Area, entirely full of 81 COVID-19 patients). There is still the possibility of a healthcare system remaining overly taxed. The peak was so high that any declines need to be taken into context of the horrific rise we saw during the first winter months.

And then there are these new strains. As COVID-19 mutates, scientists have scrambled to track new strains of the disease—potentially more infectious—that could harm the case decline researchers predicted following a projected peak in January. “We’re very worried,” Francis Collins, director of the National Institutes of Health, told the Washington Post. There are variants of the coronavirus from California, from England, and from South Africa (a strain just detected in Baltimore). Research suggests the various vaccines will work on the new strains, but the level of effectiveness for each strain, and for each vaccine, remains unclear.

For now, at least, we have some hope: The trend lines are headed in the right direction.

Today marks the one-year anniversary of the World Health Organization declaring “a public health emergency of international concern over the outbreak of novel coronavirus.” Since then the virus has killed more than 2.2 million people worldwide. 

At the time WHO Director General Dr. Tedros Adhanom Ghebreyesus made the declaration, there were fewer than 100 cases in the world, and this week we passed 102 million reported cases. More positive cases have been reported in the past two weeks than during the first six months of the pandemic, Tedros said at a press conference Friday.

“A year ago, I said the world had a window of opportunity to prevent widespread transmission of this new virus,” Tedros said. “Some countries heeded that call; some did not.”

The United States is one of the countries that squandered that opportunity under the leadership of a president who denied the severity of the virus, refused to wear a masks or to advise the public to do so, put the economy ahead of public safety, and kept key information from the American public about how the disease spreads.

For much of the last year, the United States has had some of the worst rates of infection in the world. As of Saturday, there have been 25.9 million COVID-19 cases confirmed in the United States, and more than 436,000 people have died, according to data from John Hopkins University.  

President Joe Biden has made the pandemic a top priority for his administration since taking office Jan. 20, signing executive orders that mandate mask-wearing for travel, streamline vaccine distribution, and prioritize those hardest hit by the virus. These are all crucial mitigation measures, but for millions of families—Black and Brown people disproportionately among them—it’s already too late. 

“The pandemic has exposed and exploited the inequalities of our world,” Tedros said. “There is now the real danger that the very tools that could help to end the pandemic—vaccines—may exacerbate those same inequalities.”

Vaccines are giving us another window of opportunity to bring the pandemic under control, so “we must not squander it,” he said. “The world has come to a critical turning point in the pandemic and also a critical turning point in history.” 

A parent without child care, Ashley Bartholomew was preparing to resign from her role in El-Paso as a nurse when cases of COVID-19 spiked. Seeing the influx of patients—in 2020, the urban counties west of the Mississippi River with the highest per-capita COVID-19 death rate were the Texas border counties of Hidalgo and El Paso—she delayed. In the final moments, she met a patient who believed COVID-19 is no worse than the flu.

I didn’t know that the thread would go as viral as it was going to. I had been planning to resign—we’re a military family and with child care and stuff, it wasn’t going to be sustainable for me to continue to work with three little kids we’re moving soon too. So, I needed to resign.

I’m an RN in El Paso and was recently transferred from the OR to COVID ICU.

I resigned from my job last week and I’ve been asked several times, “What was the breaking point?” I don’t know a specific one, but I’ll share this: a thread 🧵1/

— Ashley B., BSN, RN (@TheBlondeRN) November 16, 2020

The day prior, I went into work and the administration came to us at the front desk and said, “We’re closing down the OR. We’re only going to run two rooms for emergencies and everyone else needs to be redeployed to the COVID-19 units.” That’s the day that I went to COVID-19 ICU. And I saw first-hand just how busy and how crazy it was over there. They had a huge influx of patients with a lag of waiting for the travel FEMA nurses to get on board and get running. I was like “Wow, they need all the help they can get.” I actually told my boss and was like, “Hey, I can take three more weeks…just put me in the main COVID-19 ICU for my shifts and I’ll pick up some extra shifts and I’ll stay until November 13.”

It was my last shift, and I went into this patient’s room to check his glucose. He was awake and alert. He was being transferred to a lower level of care; he was doing well enough to where he didn’t need to be in ICU anymore. He was definitely—definitely—the exception to all the other patients I had seen that day. It was lunchtime and the news was on. And he kind of referenced towards the TV like, “Oh, fake news.” I was shocked. I thought to myself wow, we’ve really dropped the ball, or we’ve missed something—a key ingredient here—if this patient is thinking this isn’t any more than a flu and he should’ve just taken his vitamins.

I started to wonder…is this person thinking clearly? Just the power of denial, even as a coping mechanism, was surprising to me. He was thinking clearly, I realized, after a little bit more conversation. That’s when I was just kind of honest with him and said, “This is my last shift and I’ve never seen so much death and so much sickness my entire 10 years of being in healthcare combined.” He was just like “Woah, really?” And I’m like “Yeah, this has been unlike anything I’ve ever seen.”

That’s when he asked how other people were doing and if a lot of people had died, and I said “yeah.” And he said, “Well, that must be really hard.”

When he changed from the pure denial to validating “wow, that must be hard” it made me cry. I think that was kind of the only response that I could have because it was so overwhelming to me in the moment. And then I apologized, I said, “sorry I don’t mean to tear up in front of you.”

In most places in the United States, teachers don’t yet qualify for COVID-19 vaccines. But one county in rural Georgia decided several weeks ago that its educators deserved early protection from the coronavirus—and now will face stiff consequences as a result. 

Bucking designated priority group orders from the Georgia Department of Public Health, officials in Elbert County allowed teachers to be vaccinated at the same time as senior citizens over the age of 65. The county, which is in the northeast corner of Georgia, opened schools for in-person learning in the fall. Elbert County officials explained to the Atlanta Journal Constitution that many local students lack internet required for remote learning, and some rely on schools for food. The teachers are “seeing it, they’re facing it every day, a lot of times with 20 kids in their classroom,” Elbert County School District superintendent Jon Jarvis told the Atlanta Journal Constitution earlier this week.  

But yesterday, Elbert County got word from the Georgia Department of Public Health that it would be punished for flouting the guidelines. The state plans to suspend all vaccine shipments to Elbert County for six months. According to Georgia DPH spokesperson Nancy Nydam, the state will not resume shipments to Elbert County until late July. “It is critical that DPH maintains the highest standards for vaccine accountability to ensure all federal and state requirements are adhered to by all parties, and vaccine is administered efficiently and equitably,” Nydam wrote to me in an email.

That decision doesn’t sit right with Peter Hotez, a vaccinologist, pediatrician, and dean of the National School of Tropical Medicine at Baylor College of Medicine. “I think it’s really important that we stop punishing groups or individuals for vaccinating those outside state or [national] COVID-19 vaccination guidelines,” he wrote to me in an email. He wrote that the guidelines aren’t laws, and that they were proposed “without a full understanding of our depleted health system for administering adult vaccinations.” He added that the guidelines “mostly serve as a barrier or hindrance to vaccinations rather than their intended purpose.”

Those sentiments were echoed by Jen Kates, senior vice president and director of global health & HIV policy at the Kaiser Family Foundation, who is tracking vaccine rollout efforts across the nation. “These are really impossible choices for any jurisdiction to make, and it raises tough questions about how states can best manage this process, ensure some uniformity across the state, and get shots in arms,” she wrote in an email. “Still, at the end of the day, it is not clear that this ‘stick’ approach, which cuts off the county from more doses, helps to reach the goal of vaccinating people—even those in the state’s priority groups—more quickly.”

When I tried to reach Elbert County’s Jarvis, his team emailed back a press release, which didn’t indicate whether the county planned to back off of vaccinating teachers. “Our goal during the COVID-19 pandemic has been to provide the best possible education for our students through both in-person and distance learning options, which we have done all but six days since the school year began in August,” the press release said. “The Elbert County School District will continue in its commitment to work in partnership with our local health officials, teachers, staff, and families to mitigate the spread of COVID-19 in our school district and community.”

This story was originally published by Undark and is reproduced here as part of the Climate Desk collaboration.

One afternoon this past December, a package arrived at Mora Valley Community Health Services in northern New Mexico. The rural clinic, which serves a county of 4,521 people, is nestled beside a pasture with a flock of chickens and a few goats. A mile up the road sits the town of Mora — a regional hub just big enough for a trio of restaurants, two gas stations, and a single-building satellite office for a nearby community college.

Shortly after the package arrived, clinic staff received an email explaining that this “ancillary convenience kit” was a test of the system designed to transport SARS-CoV-2 vaccines from the state’s warehouse to Mora and other rural communities across the state. While this package contained supplies for administering the vaccine — syringes, needles, alcohol swabs, and more — the real challenge would occur the following week. That’s when 100 doses were scheduled to be delivered, and the clinic’s staff would have 30 days at most to administer the doses before they spoiled.

As promised, the vaccine arrived on Dec. 21. Staff worked in phases, stationing patients in exam rooms in numbers to match the doses coming from each vial. Each patient completed a health questionnaire, received a shot, and then was monitored for 15 minutes to be sure the vaccine did not trigger an adverse reaction. Within a few weeks, all 100 shots were in arms.

As the United States begins its massive vaccine rollout, health departments across the country are scrambling to plan and adjust, often while simultaneously managing a surge in new Covid-19 cases. “Just trying to keep up and stay alert of what new things are coming down the line is pretty critical,” said Jessica Martinez, a Mora Valley nurse. Rural clinics face unique challenges in getting highly perishable vaccines to residents who often live many miles away. “We’re kind of out here on our own,” she said.

Additionally, data show that rural residents are less likely to receive a flu shot than residents of metropolitan areas. This trend, combined with the reluctance of rural communities to embrace coronavirus mitigation measures, has some experts worried: “Think about a person who needs to drive one hour for a shot, then do the same 20 days later for a second shot,” said Diego Cuadros, a professor of health geography and disease modeling at the University of Cincinnati. “If it’s a person who maybe doesn’t think this is too important, or has some misperception or misinformation about vaccines, this is going to be extremely challenging.”

Ultimately, Cuadros and others worry that the virus might linger in pockets of rural America, from which it could reemerge into the broader population, compromising efforts to get the virus under control. To prevent this, health care workers are starting with a public information campaign, while state health departments are encouraging pharmacies to run outreach clinics and set up new sites for vaccinations. Currently, the most pressing issue facing less populated areas is how to store and administer vaccines before they lose their effectiveness.

The messenger RNA technology used to develop the two vaccines that have received approval in the U.S. so far — one developed by the pharmaceutical giant Pfizer and German drugmaker BioNTech and one by the biotechnology startup Moderna — requires that they both be kept cold. The Pfizer-BioNTech vaccine needs to be kept at a temperature between –112 and –76 degrees Fahrenheit, while Moderna’s lasts longest if kept between -13 F and 5 F.

Because of its large and far-flung rural population, New Mexico was selected by Pfizer as one of four states of varying demographics and geographies to participate in a pilot program for refining the deployment of its vaccine, both in the U.S. and around the world. The company designed a temperature-controlled shipment container the size of a carry-on suitcase that weighs about 70 pounds when filled with dry ice and up to 975 vials of the vaccine and can keep the vaccine viable for up to 10 days, or up to 30 days if the dry ice is refilled. As the first round of 17,550 doses of Pfizer vaccine was being moved around New Mexico in mid-December, 75 had to be discarded after a gauge indicated they’d become too warm, either a failure in the cold-storage system or in the data-logging device. After the losses, a state official said the devices’ temperature settings were recalibrated and an alarm set to go off if they began to warm.

Purchasing super-cold storage equipment is costly and demands a higher-voltage outlet, said Eric Tichy, vice chair of supply chain management for the Mayo Clinic. Stock of that equipment—particularly of the size that would be appropriate for smaller pharmacies and clinics—is also simply sold out. That may leave many of them leaning on Pfizer’s container and dry ice refills.

With 237 vaccines in development on the World Health Organization’s list of candidates, the future will likely include vaccines that tolerate warmer temperatures. Johnson & Johnson is expected to release information later this month on a candidate that needs only refrigerator storage and a single dose. “A lot of people are focused on that one,” Tichy said. “Especially for worldwide distribution, that’s a big deal.”

It’s also possible ongoing testing will show the two vaccines already in circulation remain stable at less cold temperatures, Tichy said. Initially, Moderna’s vaccine seemed to require super-cold storage, but it’s been shown to remain effective for up to 30 days in a refrigerator at up to 46 F.

The bigger challenge Tichy sees is that once a vaccine vial is opened, staff have just six hours to use all five or 10 doses it contains. “It’s a precious resource,” he said, “You don’t want to just give it to two people and have to throw out the rest of the contents. You want to get five people vaccinated.”

The first wave of inoculations targets health care workers and residents in long-term care facilities, so there’s a central location at which vaccines can reach them. For vaccinating the public at large, the U.S. Department of Health and Human Services has partnered with large national pharmacy chains, as well as networks of small regional chains and independent pharmacies. The incoming Biden administration has signaled it will continue with this strategy, noting in the outline of its vaccination plan that nearly 90 percent of Americans live within five miles of a pharmacy, while also acknowledging that more will be needed to reach those who live in more isolated areas.

The Rural Policy Research Institute at the University of Iowa found 750 counties nationwide with no partnership pharmacies, and another 334 with just one such pharmacy. The majority of states have at least one county without a partnership pharmacy, and large swaths of Kansas, Montana, Nebraska, North Dakota, South Dakota, and Texas, and smaller chunks of Colorado, Nevada, New Mexico, and Utah, reported no partnered pharmacies.

“We need to be alert to the fact that it’s not as simple as thinking you’ve got a contract with 19 franchises and that’s going to cover the nation because Walgreens and CVS are everywhere — well, no they’re not,” said Keith Mueller, director of the Rural Policy Research Institute. “It doesn’t mean you can’t figure out a way. It just means you have to get to the next level of planning.”

In some states, that hasn’t presented much of a hurdle. Independent pharmacies have procured doses of the vaccines and done well administering them, but rates vary widely from state to state.

Rural communities often run short on resources, whether it’s cold storage facilities or a population of retired nurses and doctors to tap to help administer vaccines, he added. The geography can also compound the disparities in access that affect racial minorities.

Kim Atwater, who owns two pharmacies in rural New Mexico towns, decided that for now, it doesn’t make sense to order doses of the vaccines. “We don’t have refrigeration facilities to keep it,” she said. “We’re just a very, very small community.”

In rural areas, the lack of pharmacies and major medical centers means that much of the vaccination effort is falling to local health clinics like the one in Mora. “We know it’s a cardinal sin to waste a dose, and we are not trying to be wasteful,” Martinez said.

Unwillingness to get vaccinated may also present a hurdle. While some national surveys report growing numbers saying they will take a Covid-19 vaccine when it becomes available to them, Cuadros said he hasn’t seen that data broken down between rural and urban respondents. Data that tracked vaccination rates for influenza shows them much lower in rural areas.

Atwater’s conversations with locals suggest that pattern may carry over to the new vaccines. “There’s a lot of people who are just saying, ‘Oh, I’m not getting that,’” she said. “We hear a lot of, ‘That? No, no, not until there’s more testing done on it.’”

Mora bucked trends this fall by making flu vaccination more convenient, Martinez said. Her clinic offered drive-through clinics, welcomed walk-ins, sent staff to patients’ homes, and even invited a UPS driver to receive a shot after dropping off packages at the clinic. As a result, they administered 400 flu vaccines compared to roughly 250 last year.

But when it comes to the new Moderna vaccine they were set to receive, Martinez said, she still heard reluctance. A poll showed only 29 of about 86 clinic staff were immediately interested in taking the vaccine. In addition to providing those staff more information to ease any concerns, she reached out to the local ambulance service, the school nurse’s office, and even a long-term residential facility to add names to the list, rather than see doses go to waste. After ramped-up education efforts and a new mandate for employees, 80 staff members were vaccinated, according to Martinez.

The plan New Mexico submitted to the Centers for Disease Control and Prevention forecasts this need for flexibility, pointing out that if more doses arrive in a community than there are health care workers interested in taking it, the rules around who is first in line may need to relax.

The clinic has already worked to make it easier for residents to get a SARS-CoV-2 test. On a recent weekday afternoon, staff put out flags where the dead-end gravel road named for the clinic meets the highway that announced “Covid testing” and “flu shots.” By the time blue-gowned, masked, and face-shielded staff stepped outside, a line of vehicles threaded through the parking lot. Staff reached in the window of the first pickup truck in line, took a swab, and the driver pulled away and back onto the highway. Staff have bundled up to administer these tests even on days with below-freezing temperatures and frigid winds, and when snow has shut down other testing sites.

But with the CDC recommendation to watch people for 15 minutes after they receive a vaccine for adverse responses to it, Martinez said, a drive-through approach would be risky. Staff would have to try to keep an eye on patients through windshields, then rush into the gravel parking lot with a crash cart and epinephrine if someone had an allergic reaction. They’d considered erecting an insulated tent, but given the prioritization of elderly, potentially frail or vulnerable patients who wouldn’t do well in the winter weather, the private medical information elicited by the questions preceding a vaccine, and the need to have emergency equipment on hand, they decided to book people for 20-minute appointments inside the clinic. Now, they’re on standby for the second doses, getting “slammed with calls” from people wanting to get in line, and helping people who rushed to pop-up clinics in one town sort out how to get their second dose on time.

“It’s just going to take a lot of planning, and of course, trial and error,” Martinez said. “It is a little bit draining sometimes to try and make everything — the community — a better place and healthy and be committed to the organization and to our patients first and foremost, so we just try and tell people, ‘Wear your mask, wash your hands.’”

One year ago, on the same day that the CDC announced a test for COVID-19 and a day after Wuhan had gone into lockdown, Donald Trump tweeted the following:

China has been working very hard to contain the Coronavirus. The United States greatly appreciates their efforts and transparency. It will all work out well. In particular, on behalf of the American People, I want to thank President Xi!

The relevant context for this tweet isn’t just the disease that would soon become a pandemic. Trump had struck a trade deal with China just days before, and this tweet was part of the political effort to maintain an air of sunny relations with a country that only four months earlier he’d called “threat to the world,” a country he would be demonizing again by spring. 

It will all work out well. The English language is not yet evolved enough to accurately describe what Trump managed to do on Twitter during his presidency. He loved walking the line between lying and misleading, between sincerity and insincerity, the bullshitter-in-chief who sometimes seemed to bullshit himself most of all. This case was no different. His optimism was unfounded, unrealistic, and ultimately self-serving, and that was clear even then, when we had no idea how the coronavirus would unfold. Can optimism be a lie? Trump had derailed at least one early call on the topic by asking about vapes, making it wholly obvious that he had not dedicated enough thought to the issue of COVID-19 to even guess about the ultimate state of things. A year and more than 420,000 U.S. deaths later, it is clear that he was blind, confident, and remorseless about leading America straight to hell.

See also: The ultimate timeline of Trump’s deadly coronavirus denial

As the pandemic worsened last year, President Donald Trump appeared to be relying on his own stream of unofficial coronavirus data, according to Dr. Deborah Birx, the former White House coronavirus response coordinator. “There was parallel data streams coming into the White House that were not transparently utilized,” Birx said Sunday in an interview with CBS’s “Face the Nation. “I saw the president presenting graphs that I never made. So, I know that someone out there or someone inside was creating a parallel set of data and graphics that were shown to the president.” 

Birx, who has announced her imminent retirement from the federal government, said she did not know who was organizing Trump’s data side channel, “but I know what I sent up, and I know that what was in his hands was different than that.” She also mentioned that Trump’s controversial COVID adviser Dr. Scott Atlas “brought in parallel data streams.”

Dr. Deborah Birx on #Covid19 #disinformation inside the #Trump White House: “I saw the president presenting graphs that I never made” she tells @margbrennan

“Someone inside was creating a parallel set of data and graphics that were shown to the president"

More on @FaceTheNation pic.twitter.com/1TMlIdvnWR

— Face The Nation (@FaceTheNation) January 24, 2021

Birx’s revelation is further confirmation from the inside of what was long obvious from the outside: Trump’s coronavirus strategy—which included downplaying risk, pushing unproven treatments, and making false promises—was not based on science or the advice of his own team of the public health experts.

To date, more than 24 million people have contracted coronavirus in the United States and more than 400,000 have died from COVID-19. Experts recently told Mother Jones that if Trump had listened to public health officials and taken steps like enacting mask mandates and boosting the production of personal protective equipment, as President Biden has pledged to do, “we could have dramatically reduced the loss of life.”

Birx was frequently criticized for not publicly challenging Trump’s unscientific rhetoric (like the time he suggested injecting disinfectant), and after she warned of a dangerous “new phase” of the pandemic last August, he tweeted that her comments were “pathetic.” Yet Birx told CBS’s Margaret Brennan that she had worked behind the scenes to make the situation the “least terrible it could be” and to minimize the damage being done by the president. She said her colleagues were part of the effort: “There was a coalition of four of us at the beginning, from [FDA head] Steve Hahn to [CDC head] Bob Redfield to myself to Tony Fauci, making it clear that we would make sure that we could get the information out to the public in one way or the other.”

Birx said that Vice President Mike Pence, who headed the White House’s coronavirus task force, was aware of that she was contradicting Trump’s public statements when she communicated with directly with state governors. Brennan clarified, “[Pence] knew that you were telling the governors privately to do things that the president publicly was making light of. When he was saying, ‘You don’t really need to wear a mask,’ or pushing to reopen the economy faster than your guidelines would allow? Mike Pence knew that?”

“He knew what I was doing,” Birx said.

Birx on messaging #maskup in the face of a defiant president with the private support of @Mike_Pence @margbrennan: Why is that a covert operation?

Birx: "Because if this isn't working and you're not going to get that to work, you have to find another solution" pic.twitter.com/hCOEuUyUHL

— Face The Nation (@FaceTheNation) January 24, 2021

When asked what her biggest mistake was in helping leading Trump administration’s coronavirus response, Birx said she could have been “more outspoken,” especially on the issue of coronavirus testing. “I didn’t know all the consequences of all these issues,” she said.

Birx's biggest mistake leading the Trump #coronavirus task force?

"I always feel like I could have done more, been more outspoken, maybe been more outspoken publicly. I didn't know all the consequences of all of these issues."

More of her interview on today's @FaceTheNation pic.twitter.com/egZeFZCQ0W

— Face The Nation (@FaceTheNation) January 24, 2021

On Biden’s second day in office, he issued a slew of executive actions aimed at curbing the coronavirus pandemic, and they came at a particularly desperate moment. By most counts, more than 400,000 Americans have died of COVID-19. The vaccination rollout program has been plagued by logistical problems and poor messaging. Meanwhile, the country is bracing for the onslaught of more contagious new variants. The new president’s executive actions are wide ranging: Biden called for widespread mask mandates, and he intends to invoke the Defense Production Act to supercharge the manufacturing of lifesaving protective gear. He also aims to streamline vaccine distribution and prioritize those hardest hit by the virus, particularly Black and Latinx communities.

It’s about time. Earlier this week, New York Times columnist Ezra Klein called Biden’s plan “maddeningly obvious.” Indeed, the measures that he suggests reflect the basic tenets of good public health policy. It is tempting to wonder what would have happened if the Trump administration had followed these well established guidelines. How would the last year have been different? Where would we be now? We decided to put the question to a few experts from our Pandemic-Proofing America series. Here are their answers.

Perry Halkitis, epidemiologist and dean of the Rutgers University School of Public Health:  The lack of respect for science and the complete disregard of the mitigation strategies to control COVID resulted in unnecessary deaths. It was estimated that if 95 percent of people consistently wore masks, 130,000 lives could be saved between November 2020 and March 2021. Instead, we will be at 500,000 deaths by March. If we had sound political leadership and truth last year, we could have cut total deaths in half. If the Trump administration had a sound national vaccination program, we would have utilized most, not a third, of our doses. Instead, lack of coordination left the states with the burden that they do not have the resources to implement. We also would have enough uptake [of vaccines] to achieve herd immunity by June.

Gregg Gonsalves, assistant professor at Yale School of Public Health and an associate professor at Yale Law School: President Biden’s executive orders on the federal COVID response are exactly what we should have expected a year ago from President Trump. These initial actions are driven by solid, mainstream public health thinking, which Democratic and Republican Administrations in the past would have enacted if faced with the crisis that befell us in 2020. That is the tragedy of this moment: If President Trump had just followed this path last January we would have had fewer cases, fewer deaths. President Trump would have had bipartisan support, scientists and public health experts would have been rushing in to help, had he simply done the right thing. Instead, he fully, deliberately tossed aside much of this pandemic playbook, for reasons I’ll never quite understand, bringing death and devastation to our country month after month.

Peter Hotez, vaccinologist, pediatrician, and dean of the National School of Tropical Medicine at Baylor College of Medicine: We could have dramatically reduced the loss of life in our nation from COVID-19 if we had brought in the full force of the federal government. Aside from the horrible and deliberate disinformation campaign, there was a refusal to launch a national or federal response, instead leaving this to the states. But the states never had the intellectual horsepower and knowledge to fight COVID. As a result: 1) we missed the virus entry from Southern Europe into NYC in March April last year; 2)  we never entirely fixed diagnostic testing; 3) we never created a system of syndromic surveillance or contact tracing; 4) [there was] no epidemic modelling to have a roadmap; 5) we never scaled virus genome sequencing to anything close to what is needed to detect emerging variants; 6) we failed to halt the surge in the summer or 7) the fall surge, and now 8) our national vaccine plan. Ultimately it was disinformation and this bizarre insistence on having the states in the lead which led to our national failure and 400,000 Americans who lost their lives. The disinformation was straight out of the White House, but the insistence on the states was both White House and likely internal failings within Health and Human Services agencies.

He’s finally free.

Dr. Anthony Fauci, the leading infectious disease expert whom Trump once threatened to fire, said at Thursday’s White House press briefing that he felt “liberated” to work for an administration committed to combating the pandemic.

“You’ve joked a couple times today already about the difference that you feel in being the spokesperson for this issue in this administration versus the previous one,” a reporter said. “Do you feel less constrained?”

“You said I was joking about it,” Fauci replied. “I was very serious about it. I wasn’t joking.”

Fauci said that Trump’s espousal of hydroxychloroquine was “uncomfortable” because it was “not based on scientific fact.” But, based on conversations he’s already had with the president, he thinks the Biden administration will be different.

“The idea that you can get up here and talk about what you know, what the science is, and know that’s it, let the science speak, it is somewhat of a liberating feeling,” he said.

Watch the video below:

"Let the science speak. It is somewhat of a liberating feeling."

New administration, new Fauci. 👏 pic.twitter.com/NMDIPhE2EE

— Mother Jones (@MotherJones) January 21, 2021

The morning of January 8, employees gathered in the lobby at LiveWell, a nonprofit long-term care facility in central Connecticut, to receive their first dose of the COVID-19 vaccine. Armed with fresh N95 masks and face shields, they trooped upstairs in 15-minute increments to get their shots, then returned to cheers and applause from their colleagues. Some took photos in front of a poster emblazoned “I got my #ShotOfHope.” Others put a sticker on their face shields to indicate they’d gotten vaccinated.

Meanwhile, CVS pharmacists and pharmacy technicians went from room to room vaccinating LiveWell’s residents, all of whom have dementia. By the end of the day, 99 percent of the facility’s 111 residents had received their first dose, while about 70 percent of the facility’s 207-person staff had been vaccinated, according to LiveWell chief operating officer Maley Hunt.

The high vaccination rate among LiveWell’s staff appears to be unusual for Connecticut, where, like elsewhere across the country, it’s been difficult to convince nursing home employees to get the coronavirus vaccine. As the first of three rounds of vaccination wrapped up in Connecticut nursing homes earlier this month, only about 40 percent of the staff at the state’s facilities had agreed to be vaccinated so far, according to Dr. Vivian Leung, a member of the state’s public health department who has been helping nursing homes detect and respond to the coronavirus.

Since the earliest days of the pandemic in the United States, nursing homes have been the site of the country’s most lethal outbreaks—including in Connecticut, where residents and staff account for 65 percent of all COVID-19 deaths. Across the country, nursing home residents and staff have been uniformly prioritized for early vaccination. In late December, under the federal Pharmacy Partnership for Long-Term Care Program, Walgreens, CVS, and other drug stores began holding vaccination clinics at nursing homes. But now, as the initial round of clinics approaches completion, not only has the rollout been slower than expected, but early estimates reveal that in some places, more than half of nursing home staff are still waiting to be vaccinated or refusing the shot altogether.

In some Virginia nursing homes, for example, as few as 10 to 20 percent of staff have agreed to receive the vaccine, estimates Dr. Christian Bergman, a geriatrician and member of the state’s COVID-19 long-term care task force; the more successful facilities in the state have vaccinated around 40 percent of their employees. North Carolina’s secretary of health and human services said in early January that more than half of nursing home workers in the state might refuse the vaccine. In Ohio, just 40 percent of staff statewide who had been offered the first dose of the vaccine in late December accepted it, Gov. Mike DeWine said at a press conference. A spokesperson for CVS Health, which is administering nursing home vaccinations in 49 states, Washington DC, and Puerto Rico, says that initial vaccine uptake among staff remained low as of mid-January. 

Now, states, employers, and associations for nursing home professionals are mounting efforts to convince more workers to get the vaccine, offering Zoom chats with experts, town hall meetings, and online education about the vaccine’s safety and effectiveness. The goal is to prevent future outbreaks at nursing homes, Bergman explains. “The more staff that get vaccinated, the less likely that you would have a new outbreak in the future,” he says. “The size of the outbreak would likely be smaller if you had more staff that were vaccinated.” Even though vaccination rates are high among long-term residents, most nursing homes will continue to care for short-stay patients who may be unvaccinated and vulnerable.

Bergman isn’t surprised by the low vaccination rates among some nursing homes. According to the CDC, only about 69 percent of long-term care facility staff get flu vaccinations. “If I have 40 percent of staff getting this brand new vaccine after just one clinic with CVS, that’s very good turnout,” he says. In a January 6 progress report, CVS Health noted that the low rate of staff vaccinations so far may be partly due to staggered vaccination dates. And in some facilities, the vast majority of staff have opted to get the vaccine as soon as it was offered, including at the Life Care Center of Kirkland, the center of the first known US outbreak. 

But Bergman has noticed a stratification among long-term care workers who have so far decided to get vaccinated: Managers are more likely to want the vaccine, while lower-paid workers like sanitation staff and certified nursing assistants are more hesitant. That’s no surprise to Lori Porter, cofounder and CEO of the National Association of Health Care Assistants, a professional group for certified nursing assistants. In an informal Facebook poll of 3,119 CNAs conducted by Porter’s group in mid-December, 72 percent of respondents were a “hard no” for the vaccine. Just six percent were undecided.

Some believe the vaccine is a hoax, Porter says; some think they are being used as guinea pigs. CNAs, she explains, “don’t trust the government, and they don’t trust their leaders, their managers”—a result, she argues, of CNAs being “battered” by workplace conditions, where they are under high pressure to care for too many residents with little professional support. “Oftentimes, they’re not communicated with,” she says, “which also leads to the trust factor.” That mistrust, Porter adds, has only grown as companies began offering incentives to be vaccinated. One nursing home chain, PruittHealth, said it would distribute Waffle House gift cards to vaccinated employees. At least two chains, Juniper Communities and Atria Senior Living, have made vaccines mandatory for almost all workers.

Porter is worried about the second round of clinics. She’s begun to hear from CNAs who say they will refuse the second dose of the vaccine. “Not because they’re afraid of it,” she explains. “They can’t afford to miss three days work with the side effects.” 

At LiveWell, a standalone nonprofit facility in Plantsville, Connecticut, the groundwork for its successful vaccination rollout was laid in early in the pandemic, when managers at the nursing home tried to send a message that all employees were all responsible for keeping LiveWell’s dementia patients safe. “We have a population of people that can’t tolerate wearing a mask,” Hunt says. “They don’t understand social distancing. They kind of sometimes go in other people’s rooms, or use different bathrooms. The idea of stopping the spread, once it got in the building, was basically designated as almost impossible.”

To safeguard residents, LiveWell required employees to wear masks and prohibited visitors before the state required such measures. It also decided not to allow staff to work multiple jobs, which is common among nursing home employees. (A recent study analyzing smartphone location data found that nursing homes that had more staff or contractors moving among multiple facilities tended to have a higher number of COVID-19 cases.) According to Hunt, employees who gave up other jobs to stay at LiveWell were offered more hours, while those who declined to give up other gigs may return to their LiveWell jobs after they get the vaccine or once community transmissions decreases.

The company also paid attention to who was inside the nursing home’s “bubble.” “The team wasn’t just the team that worked here,” Hunt says. “We made sure that we were keeping people’s family safe as well.” The company offered masks for employees’ kids, hand sanitizer for households, and back-to-school packs to families. Under the Families First Coronavirus Response Act, the company offered paid leave not only to workers with symptoms, but also to those whose family members had been exposed to the virus. It also gave rapid antigen tests to family members who were showing symptoms of COVID-19. “Creating that bubble with both our staff and our families, and letting the families know how important they are in rooting us on, and making sure that they’re feeling connected with what’s happening, even when they’re not here, made them tremendous advocates and supporters of the team,” Hunt says. By the time the vaccine became available, she says, “Our staff were so excited. They see this as hope, and they see this as a return to normalcy.”

LiveWell almost escaped the pandemic unscathed. The combination nursing home and assisted living facility went more than 270 days without any coronavirus cases among its residents. Then, shortly after Thanksgiving, an employee tested positive one day after working in one of the skilled nursing units. Over the following weeks, 29 out of 30 residents in that unit tested positive for the virus. Nine people died. Hunt remembers standing in the affected unit in the midst of the outbreak as another staff member told her they didn’t want to get the vaccine. “It evoked an emotional response in me,” she says. “I had this feeling of, ‘Why? How could you not want to get this? This is going to save lives.'” 

As LiveWell prepared for vaccinations, the company called every employee on staff individually to have a conversation about the vaccine, Hunt says. Those who weren’t sure about it were required to attend a half-hour Zoom meeting with a doctor of geriatric medicine, who answered their questions and tried to address their worries. Some employees brought up their concern that the vaccine had been developed too quickly; some had questions about potential long-term side effects or implications for pregnant women; others cited disinformation about microchips or fetal tissue being in the vaccine. The doctor, Hunt said, tried to listen without judgement, understand the roots of people’s fears, and address their questions fully. “They might be saying, ‘What about the long term side effects?'” Hunt says. “But what they’re thinking is something else, or there’s something underneath there, some other medical experience that they’ve had.”

Leung, at the Connecticut Department of Public Health, believes that more nursing home staff members in the state may get the vaccine when it is offered a second time. “There seems to be an increased confidence and decreased concern as medical staff are seeing more and more of their colleagues get vaccinated,” she says. Bergman, in Virginia, harbors the same hope. At his nursing home’s first vaccination clinic, 24 out of 85 staff agreed to be vaccinated. “If they can provide firsthand experience,” he says, “we may be able to convince a few other people who were just kind of anxious about, potentially, the side effects.” 

According to Hunt, 25 more LiveWell employees have pledged to get their first dose of the vaccine at the facility’s second clinic date on January 29. Ultimately, the company is aiming for 90 percent of its employees to be vaccinated. For now, Hunt says, it’s focusing on one-on-one outreach to people still hesitant to get the shot.  “We’re not giving up on them yet,” she says.

This article has been updated.

On the final full day of Donald Trump’s presidency, the United States reached another grim milestone during four years marked by plenty of grim milestones. By most measures, 400,000 people in the US now have died from the coronavirus. It’s the highest death toll in the world—but tragically unsurprising given the trajectory of the past year. 

The staggering toll was both preventable and entirely predictable. Even aside from his vast personal incompetence—we’ll get to that later—President Trump blithely put into practice cherished conservative principles that are incompatible with a decent pandemic response. Castigating and delegitimizing government institutions, demonizing minority communities, and playing into white grievances may help Republicans win elections, but when it comes to beating back a massive public health catastrophe, what’s paramount is robust public agencies, a strong health care system, and special attention to the vulnerable. In many ways, we were doomed from the start.

But then there is the unique, Trumpian imprint of mendacity and cruelty. In March 2020, when the virus was seriously spreading and the country was hobbled by a lack of tests and testing strategy, Trump responded to a question from a reporter with a single line that would go on to define his administration’s coronavirus approach and inexorably lead to the number of deaths on his last full day in office 10 months later. “No,” he said emphatically, “I don’t take responsibility at all.” As the death toll first climbed, then soared, Trump and his enablers continued to act as if the president was the real victim. “I am incredibly disappointed in the politicization of this COVID-19 response,” Rep. Mark Green (R-Tenn.) said last March at a Congressional hearing. “The 24/7 criticism that the president is undergoing is unwarranted at a minimum.”

Trump never found a grudge he wouldn’t hold and a grievance he wouldn’t amplify. So it didn’t help that the virus’s first assault was concentrated in the Democratic stronghold of New York City, his hometown, the scene of many of his commercial and social triumphs that today has become hostile foreign territory to him and his merry band of family members and other sycophants. Plus, throughout the country, the virus was disproportionately killing people of color. For our white supremacist president, this deserved not even glancing recognition.

As the East Coast attempted to cope with the onslaught of the virus, the Trump administration maintained the illusion that people who lived in red states were immune. Even when he belatedly declared a state of emergency in mid-March and many states instituted lockdowns to varying degrees, the administration didn’t ramp up testing or begin contact tracing in any systematic way that might have at least managed to bring the virus under some control. To make matters worse, when the Centers for Disease Control and Prevention recommended wearing masks, Trump rejected and ridiculed them and his supporters dutifully followed suit, pretending that this most basic effort to contain the spread of the disease was in fact some kind of intolerable infringement on their rights. Anti-maskers frequently made public spectacles of themselves as they were denied entry into grocery stores and even appropriated the “I Can’t Breathe” mantra from racial justice protesters. As I wrote last July:

Officials have reassured anyone who would listen that even though wearing a mask can be a little uncomfortable, it doesn’t inhibit breathing. Nonetheless, almost immediately, the mask mandates turned into a new front in the culture war. Only liberal sheep wore masks to protect the public from coronavirus; real conservatives and libertarians would never stoop to something so feminine and weak! Just look at the president! Meanwhile, as the coronavirus has surged in the South and West, so too has the intensity of the mask war. The anti-mask cohort has adopted a slogan they saw was very effective, insisting that when wearing a mask, they can’t breathe.  

When his supporters sometimes violently protested public health restrictions, especially in areas where Black people were dying disproportionately, he encouraged them, tweeting “LIBERATE” Virginia and Michigan. 

By late May, the death toll had reached 100,000—a dark day for a nation that was once told 60,000 deaths would be the high-end. And still the Trump administration didn’t act, except to suggest that coronavirus patients inject bleach (just kidding, he later insisted) or to hawk hydroxychloroquine, an unproven medical treatment. Contrary to the president’s cherished convictions, the virus didn’t leave Trump-supporting regions alone, and the death toll accelerated in the midwest and in Southern states. Instead of, at least, caring about his own supporters, the president became preoccupied with his reelection and with demonizing Black Lives Matter protests. Plus, ever determined, against the advice of public health professionals, he held campaign rally in Tulsa, Oklahoma, where failed presidential candidate and co-chair of the Black Voices for Trump Herman Cain was photographed maskless. Cain died from coronavirus the following month.

Thus we witnessed our president’s modus operandi during a crisis: teetering between ignoring the virus and denying its severity by continually insisting the country was “rounding the corner.” Besides, he had more important things to do, like pack the Supreme Court after the death of Justice Ruth Bader Ginsburg. Even then, his generally unmasked September White House party for Amy Coney Barrett, whose nomination to the Supreme Court was rushed through in the days leading up to the election, turned into a superspreader event. Then, in October, Trump tested positive for the virus and was hospitalized for three days. Maybe this would bring him and his administration to their collective senses. 

Of course not.

After recovering, Trump became the Superman his doctors always pretended he was, assuring the country that the deadly virus was actually not a big deal. “Don’t be afraid” of the virus, he crowed as the death toll surpassed 200,000. His supporters were in such deep denial, that Trump added to his repertoire of lies that recovery from the virus was a breeze. One only needed to be pumped up on steroids and receive the best medical care on the planet at Walter Reed Medical Center.  

All this denial didn’t help him in the end, since he was defeated and will now, fortunately, not serve a second term—partially because of his disastrous handling of the coronavirus. When the country entered the worst phase of the pandemic thus far, Trump was more preoccupied with perpetuating the Big Lie that the election had been stolen from him through massive fraud. As my colleague Dave Gilson wrote in December, in the month after the election, Trump launched 729 tweets, but not a single one was about the death toll:

Reading Trump’s recent tweets, you would never know the United States is in the midst of a surging pandemic that is killing more than 2,000 people a day. Of his 729 tweets between November 3 and December 16, more than two-thirds were about his attempts to reverse his election loss through baseless claims of voter fraud and far-fetched lawsuits. The pandemic was just a blip: Four percent of his tweets were about vaccines and just two percent mentioned the coronavirus at all—without ever acknowledging its human cost or encouraging Americans to take precautions to protect themselves or others from getting sick. 

A kind of psychic numbing had gripped so many of us by the end of December, when 300,000 people had died from the coronavirus; it would take only a few weeks for the next 100,000 to follow them. The Washington Post reported in December that according to a wealth of psychological research, the higher the death toll climbs, the less we care. Or rather, the less we are emotionally capable of caring. In mass disasters like the pandemic, say, or a tsunami, the more death surrounds us, the more remote it feels. Not that the Trump administration even thought to commemorate the lives lost with any public mourning, much less mention the staggering death toll in any public statement. Even then, the sheer scale was difficult to fathom, unless one is mourning a lost parent, child, sibling, relative, neighbor, friend, or co-worker. 

The Trump administration has finally reached its conclusion with a predictably dark legacy: the only president to be impeached twice—once for inciting an insurrection— the only lame duck president to carry out federal executions—since the federal death penalty was reinstated, only three executions had been carried out by a president until Trump executed 13 people—and a president who exacerbated the toll from the deadliest months in US history. 

Yes, millions of people are breathing a sigh of relief that the Trump presidency is over. But the aftermath is just beginning. The coronavirus death toll will continue to climb, the vaccine rollout will continue to lag, and the economic recovery will continue to drag on. The United States will be grappling with the damage from a one-term president for years to come.

Trump’s 2017 inaugural address was laden with ominous references. Nonetheless, he still promised to “fight” for the country. “I will fight for you with every breath in my body,” Trump said. “I will never, ever let you down.” But all the clues that Trump would make for a horrific pandemic president were there from the beginning. He began his campaign by demonizing the people who would be most impacted by the coronavirus and, as president, continued the Republican tradition of dismantling public institutions. In the end, the words from his inaugural address that most reflected his presidency were not his vow to fight for his country, but his description of “American carnage.” Four years later, he shunned the typical farewell address, choosing to release a 20-minute video highlighting his accomplishments. “We did what we came here to do,” he said. “And so much more.”

Since the start of the pandemic, deep racial inequities in US society have led to people of color being infected and dying of the coronavirus at higher rates than white people. The disproportionate pain and death suffered by non-white communities is the result of stark racial divides: who works “essential” jobs in grocery stores and public transit, who has access to health care, and who lives near sources of environmental pollution that contribute to underlying health conditions, like asthma and heart disease, that can worsen COVID-19. Black, Hispanic, and Native people are dying from COVID-19 at nearly three times the rate of white people, according to CDC data. 

Now, with potentially lifesaving vaccines being rolled out nationwide, early data show that fewer initial doses of the vaccine are going to the communities of color most affected by the coronavirus. According to a Kaiser Health News analysis, Black people are being vaccinated at lower rates than white people in 16 states that provided racial data on vaccination distribution.

In most states nationwide, the first doses of the vaccine were allocated to health care workers, a racially diverse workforce that includes a range of workers on the front lines of the pandemic, from doctors to nursing home assistants to janitorial staff. Even still, a disproportionate share of the vaccines are going to white people. In Mississippi, which is 38 percent Black and where 37 percent of health care workers are Black, Black people account for just 15 percent of vaccinated residents so far. Thirty percent of Maryland residents are Black, and 42 percent of health care workers in the state are Black, but Black people make up only 16 percent of those who have received their first vaccine dose there. Of the states that provided data, Pennsylvania had the highest disparity: 1.2 percent of the white population had been vaccinated, but just 0.3 percent of Black residents had gotten the vaccine. 

The disparities in vaccination appear to be the result from both access issues and distrust of the vaccine, experts told Kaiser Health News. For example, Dr. Taison Bell, a member of the University of Virginia Health System’s vaccination distribution committee and a Black physician, said that janitorial staff at his hospital did not have access to the hospital email, meaning they did not receive the same information about registering for the vaccine as the rest of the staff.

Meanwhile, Dr. Mysheika Roberts, public health commissioner of Columbus, Ohio, pointed out that in Black communities, public health officials must overcome distrust built by decades of mistreatment—both individual experiences of denigration by doctors and famous examples of exploitation like the Tuskegee syphilis study and the experience of Henrietta Lacks. “We have to dig deep, go the old-fashioned way with flyers, with neighbors talking to neighbors, with pastors talking to their church members,” Roberts said.

This article has been updated.

COVID-19 reduced life expectancy in the general United States population by more than a year, a new study from the Proceedings of the National Academy of Sciences found. It also showed massively disproportionate impacts for Black and Latino populations driven by the pandemic. 

The coronavirus has caused more than 380,000 deaths in the United States. It is a staggering total. And an indictment: The death rate in the US outpaces other countries with populations over 5 million. In 2020, this mass death caused one of the worst years for life expectancy in nearly 20 years. Researchers estimate the pandemic dropped average life expectancy in the country down to 77.48 years—the lowest it’s been since 2003.

The effect has been disproportionate. Black and Latino population life expectancies are estimated to have dropped by 2.10 years and 3.05 years, respectively, compared to just a 0.68-year reduction for whites. This staggering gap in COVID-19 outcomes, as Mother Jones reporter Edwin Rios has noted for us in the past, has to be understood in context. “This disproportionate effect [of COVID-19] is a social issue in the guise of an epidemiological one,” Rios wrote in April. It’s not “because of biology,” but because:

Black Americans, particularly in the Southern states that have not expanded Medicaid under the Affordable Care Act, are more likely to be uninsured. They’re more likely to work a low-paying job. They’re more likely to suffer from heart disease, asthma, cancer, and other conditions. …

It’s because of straightforward social choices such as where toxic dumps get sited, where new highways get built, and where Black people have historically been permitted to live.

Unaffected by the population’s existing age distributions, life expectancy is a particularly useful metric for examining the impact of COVID-19 beyond infection rates, the authors argue. Black and Latino populations in the US tend to be younger than white populations. The coronavirus kills older people at alarmingly higher rates. Raw mortality rates don’t account for this fact.

The lower life expectancy represents a unique failure. “The US reduction in 2020 life expectancy is projected to exceed that of most other high-income countries,” the study authors note, “indicating that the United States—which already had a life expectancy below that of all other high-income developed nations prior to the pandemic—will see its life expectancy fall even farther behind its peers.”

Last year, after the state of Texas temporarily banned abortions in a purported effort to slow the spread of the coronavirus, nearly 1,000 Texans crossed the border to access abortion services in other states. According to a new study published in the Journal of the American Medical Association, there were 1,752 fewer abortions performed in Texas last April (compared to the number performed in April of 2019). But 947 patients traveled to clinics in Arkansas, Colorado, Kansas, Louisiana, New Mexico, and Oklahoma to receive care. A representative of Planned Parenthood of the Rocky Mountains told Mother Jones that during the ban, they experienced a sevenfold increase in Texas patients in their New Mexico, Colorado, and Nevada clinics alone. 

The ban stemmed from Texas Gov. Greg Abbott’s March executive order that required all procedures that were not “immediately, medically necessary” be postponed, theoretically to preserve PPE for frontline workers and save hospital beds for coronavirus patients. The state’s attorney general interpreted the order to include most abortion services, despite the fact that abortion providers require minimal PPE and, as Kari White, lead author of the study and an investigator for the Texas Policy Evaluation Project (TxPEP) said, “complications from abortion are incredibly rare, particularly those that require hospitalization.”

Abortion advocates said at the time that the ban was more political opportunism than genuine concern for public health. Texas lawmakers have attempted to rollback reproductive rights for nearly half a century—the pandemic was just their latest justification. “The stated reasons for prohibiting abortion during that time period were just not grounded in scientific evidence or typical medical practice,” she said. (Abortions were allowed to resume in Texas on April 22.)

But as per usual, the attempt to stop abortions from happening merely meant that they were happening elsewhere and in less safe conditions. In addition to finding that women were forced to cross state lines to get care, the study also found that second-trimester abortions—which are less safe than first trimester procedures—jumped nearly 61 percent after the ban was lifted because many women had to put off getting care.

Even though it only lasted for a month, the ban had a profound affect on many women. Dr. Bhavik Kumar, a physician at Planned Parenthood Center for Choice in Houston, said during the ban, his patients were desperately seeking help, calling clinics all over town. They were “calling the clinic every day, even driving up to the clinic, just to see if we were open,” he said. 

“It was chaotic, it was confusing,” said Kumar, who also serves as the national medical spokesperson for the Planned Parenthood Federation of America. “There was an executive order, but because that went through the courts, there were a total of eight times that we either opened or closed, sometimes in the middle of the day.” When the ban was lifted in late April, Kumar’s clinic had a backlog hundreds of names long.

Back in March, Amy Hagstrom Miller, president and CEO of Whole Woman’s Health, similarly told my colleague Becca Andrews that the ban—as well as it’s near-constant legal back-and-forth—was wearing on would-be patients: 

Last Monday night, her team made calls to pregnant people who had appointments scheduled in their Texas clinics to let them know their procedures were canceled, at least for the time being. “People were sobbing, people were begging for us to see them anyway,” she recounted. “‘Can’t you just figure this out?’; ‘What am I going to do?’; ‘Where am I going to go?’” Making those phone calls and hearing the desperation in the voices of would-be patients was gutting, she said. “We’re really concerned about these people’s mental health—it’s palpable,” even through the phone.

Now, her staffers have to make the calls all over again. “It’s absolutely cruel to say to somebody, ‘You have to continue your pregnancy against your will when there’s a pandemic,’” Hagstrom Miller said. “Those patients are just heartbroken.”

The pandemic also compounded the obstacles to abortion already in place in Texas. One woman told TxPEP researchers that she was unemployed during the pandemic when she learned she was pregnant. She had a mandatory ultrasound done, but had to postpone the abortion procedure because she couldn’t afford the cost out-of-pocket and Texas doesn’t allow patients to pay for abortion care using state insurance or Medicaid. But because the same medical provider has to perform both the ultrasound and the abortion, she couldn’t reschedule.

“They said, ‘No, you have to come in the next week and redo the whole process and get another ultrasound and do everything all over again.’ And I’m like, I don’t want to pay an extra hundred dollars,” she said. The woman, who was kept anonymous, decided to carry her pregnancy to term because she was overwhelmed by the logistics and increasing costs of her delayed abortion.

TxPEP researchers talked to her and nine other women who sought abortion care in late March and early April, who detailed the stress and risk they faced while trying to end their pregnancies. Another woman, pseudonymously named Maria Isabel, successfully had an abortion in south Texas, but only after nine weeks of rescheduling at multiple clinics in her city. By the time she was able to get an appointment she was past the gestational age limit for medication abortion, and had to pay $1,200 for a procedural abortion instead. Yet another woman was able to travel 700 miles to New Mexico for an abortion, but worried that she’d contracted coronavirus because she was feeling feverish on the drive home. 

“It was stressful time for everybody, everybody was dealing with economic uncertainty,” White said. But to make matters worse, these women either had to wait a month for abortions to resume in Texas or risk contracting coronavirus while traveling across state lines. All of them reported stress, anxiety, or depression. 

“I don’t think that I’ve ever been more depressed in my life, to the point where I didn’t see a future for myself,” one woman told White and her colleagues. “I said, ‘Well, I just have to deal with this. This is just going to have to be what it is. I’m either going to have to parent this baby or adoption.’ I think every day I sat there, it just got worse and worse and worse and worse, and I felt like I didn’t have any options.”

Better science communication can help combat the coronavirus pandemic. But as Mother Jones has reported since the beginning of the outbreak, scientists are frustrated by the lack of coordination and coherence in the Trump Administration’s public health messaging. “The government is missing a huge opportunity in not using social media as a means to get people aligned on COVID messaging,” a microbiologist Jessica Malaty Rivera told us in November. “Science communication just can’t be an afterthought,” said Yale epidemiologist and science messaging expert Saad Omer.

The Trump administration could learn a thing or two from Rob Swanda, a 26-year-old PhD student at Cornell, whose social media talents have earned him overnight science communication stardom.

When Swanda first created his viral video explaining the mRNA technology used in two coronavirus vaccines, he had a smaller audience in mind: his parents. “My mom is a hairstylist,” he told me on a recent Zoom call. Her clients were asking how the vaccine worked.  He knew he could help them understand things clearly. “So you can imagine my shock that it has been seen by over 3 million people,” he said. 

The video is an energetic and simple explainer of how mRNA, a new genetic technology, is being used in both the Pfizer and Moderna vaccines. Using a whiteboard, Swanda explains complex science in a way that has connected with over 4 million people so far. 

Explaining jargon like “mRNA,” “spike protein,” and “lipid nanoparticle”, Swanda breaks down fears about the vaccine. “Being cautious of how the thing how the mRNA vaccine works is very reasonable, it’s a new innovation,” he says. “But if we just only relied on the old technology, like the attenuated or weakened version of the virus, we’re still waiting on those clinical trials to end, so how many more months are we going to be waiting?” While mRNA isn’t new in the newest sense (mRNA vaccines have been development for the last decade or so), it’s never been utilized on such a massive scale. And because the mRNA process eliminates the need for labs to grow a protein and then inject it—the mRNA teaches your body to make the protein itself—it cuts out a time-consuming production step in traditional vaccine manufacturing.

Here I describe a brief overview of how the Pfizer/BioNTech or Moderna mRNA vaccines work. Taking a vaccine is one’s personal choice, and I hope this video can help someone make that decision rooted in science. pic.twitter.com/ZjFH0DH5ca

— Rob Swanda (@ScientistSwanda) December 7, 2020

So far, feedback has been good. “I was pleasantly surprised that like 99.9 percent of everything has been super positive,” he says. But there’s still that .01 percent. Some commenters accused him of “listening to music” in his AirPods, or claimed that he “was being paid by these companies.” (A few even insinuated that Rob was a pawn of Bill Gates.)

But that hasn’t dissuaded Swanda from the task at hand. Between the pandemic and an encroaching climate crisis, science is increasingly part of our everyday lives, and Swanda believes that he and his peers can use viral social media communication to help. “The connectedness of this new generation coming into science is going to be super critical for pushing out new research that’s going to span multiple disciplines,” he says. “We can use that.”

Check out more of Swanda’s science explainers on YouTube.

After months of mishandling its COVID-19 response, Arizona has reached a new low: The state now has the highest infection rate of anywhere in the world, according to new data released this week. Over the past seven days, the state has seen a daily average of 118.3 new cases per 100,000 residents, well above countries like the Czech Republic (99.4) and the United Kingdom (86). 

NEW: Arizona has highest rate of #COVID19 in the world, latest data shows: https://t.co/wpkplqHU0Q #abc15 pic.twitter.com/gMK4bYGFrn

— ABC15 Arizona (@abc15) January 4, 2021

But if you drive around many parts of the state, you wouldn’t know that it leads the world in infections. That’s because Gov. Doug Ducey and municipal leaders think it’s perfectly fine to just keep doing what Arizonans have been doing for months, which perhaps is best described as “whatever the hell they want”—including eating and drinking inside at bars and restaurants so long as you wear a mask when you first walk through the door. 

Ducey refuses to enact a statewide mask mandate or make changes to his unusually relaxed restrictions on large events, indoor gatherings, and non-essential business openings. Driving around Tucson, I see packed parking lots at outlet malls, lines out the door at brunch places with indoor seating only, and sports bars with dozens of people hanging out inside without masks. Bowling alleys, arcades, and movie theaters are also open at half capacity, and indoor gyms at 25 percent occupancy.  

Compare that with California, which has the second-highest infection rate in the United States right now, with an average of 95.8 daily cases per 100,000 people. California is currently in crisis mode, with strict restrictions on indoor activities, and Gov. Gavin Newsom issued a stay-at-home order last month that shut down indoor and outdoor dining, among other things, until the numbers go down. 

In Arizona, it apparently doesn’t matter that the state is breaking nationwide records for infections: Life has gone on basically the same since the state opened up in May, after briefly enacting tighter restrictions in the spring. The summer months saw huge spikes in infection rates and hospitalizations when extreme heat made it more difficult to be outdoors. Now, even though Arizona has some of the most beautiful weather in the country—it was 70 and sunny Tuesday afternoon in Phoenix and Tucson—the infection rates and hospitalizations are higher than during the summer spike. The kind of social interaction currently taking place inside could easily be forced outdoors, but apparently that’s just not the kind of thing people here (elected officials and regular folks) want to deal with right now.

In early December, as the number of cases, deaths, and hospitalizations continued to rise, health care leaders in Arizona wrote a letter urging the state health department to immediately issue a statewide shelter-in-place order, end all indoor dining, and close athletic activities for at least a month to avoid a disaster. Ducey held a press conference days later thanking Arizonans for being “so responsible” over Thanksgiving (even though his own health department reported a spike after the holiday weekend), ignoring the recommendations of the health care leaders. He made no changes to slow down the spread of the coronavirus. Days later, nurses at the Tucson Medical Center wrote a public letter to the city’s residents practically begging them to stay home ahead of Christmas. 

In Tucson, city leaders enacted a three-week-long 10 p.m. curfew after Thanksgiving but made no other mitigating changes. As public health experts I talked to about the efficacy of curfews pointed out, it does does little good to stop serving people drinks indoors at a bar at 10 p.m. when you’ve had hundreds of maskless patrons there throughout the day. 

Of course, there are thousands upon thousands of Arizonans taking this pandemic seriously and living in a new normal that follows all the guidelines we now know work to slow the spread of this deadly virus. So many of us have changed the way we live and are sticking to it because the pandemic is far from over. But as this Instagram account seems to show, Ducey’s twentysomething son, Jack, is not one of those people.  

We received this video from a follower which was posted to Jack Ducey’s public Instagram story earlier this week.

If @dougducey’s own adult son isn’t following Ducey’s soft advice how can Ducey expect Arizonans to? We need mitigation measures with enforcement now.#DeadOnDucey pic.twitter.com/COpmWXZYRV

— #DeadOnDucey (@AccountableInAZ) January 3, 2021

New York became the fourth state to reach 1 million coronavirus cases after Gov. Andrew Cuomo’s office released data reporting 15,074 new cases on Friday alone. Over 30,000 people in the state and 350,000 people nationwide have died from COVID.

New York joined  California, Texas, and Florida, as the only other states to surpass 1 million cases, as the nationwide total of coronavirus cases hit 20 million on New Year’s Day. Experts are anticipating those numbers to spike after travel and gatherings over the Christmas and New Year’s holidays.

It’s likely, however, that the total number of cases and deaths is even higher given the scarcity of testing in the spring when available tests were sparse and the spread of the pandemic in the US was just beginning. 

On ABC’s This Week, leading infectious disease expert Dr. Anthony Fauci told moderator Martha Raddatz that he did not expect coronavirus deaths to reach such heights. “But, you know, that’s what happens when you’re in a situation where you have surges related to so many factors,” he said, “inconsistent adhering to the public health measures, the winter months coming in right now with the cold allowing people or essentially forcing people to do most of their things indoors as opposed to outdoors.”

President Donald Trump had claimed that the numbers from the Centers for Disease Control of those who had been infected by COVID were “exaggerated.” But on CNN’s State of the Union, US Surgeon General Dr. Jerome Adams said, “From a public health perspective, I have no reason to doubt those numbers.” 

Even with the initial rollout of a vaccine, it’s unclear when the spread of cases will slow. The Trump administration has been criticized for bungling vaccine distribution. The Centers for Disease Control and Prevention (CDC) said on Saturday morning that it administered 4,225,756 first doses and has distributed 13,071,925 doses throughout the country, which is a far cry from Trump’s September promise of 100 million doses created and 20 million doses administered by the end of 2020.

Many doses are set to expire by the end of January, without a clear plan of accelerating vaccinations to avoid this. Regardless, the numbers are an improvement from the only 2.1 million doses that had been administered as of Dec. 30. 

Trump claimed on Sunday, without citing evidence, that vaccines “are being delivered to the states by the Federal Government far faster than they can be administered!” 

Cuomo didn’t address New York’s surpassing one million cases directly in a statement on Saturday but encouraged New Yorkers to remain steadfast in taking precautions to slow the spread of the disease.

“As daunting as it may seem after all this time, it’s critical that the rest of us remain tough and keep up our efforts to slow the spread,” Cuomo said. “We’ve already come so far and we will finally reach that light at the end of the tunnel if we all just do our part.”

This story was originally published by High Country News and is reproduced here as part of the Climate Desk collaboration.

In November, the state of Wyoming announced that it had ceased calling the contacts of people who test positive for COVID-19 to let them know they may have been exposed to the virus. Instead, it asked Wyomingites to do it themselves. Health officials from some counties and tribes have continued their own contact-tracing programs, however—and, with the state’s resources stretched thin, that patchwork of local coverage remains key to supporting Wyoming communities.

About six weeks before the announcement, the number of COVID-19 cases in Wyoming began to spike. The state saw just a few dozen new cases a day throughout the spring and summer, but by late November, there were multiple days with more than 1,000 new cases. Surges in hospitalizations and deaths soon followed. With only around 130 public health workers available to make calls statewide, the state had to triage its efforts. It chose to focus on calling people who test positive, but it no longer attempted to notify their close contacts.

As a result, groups like Teton County’s contact tracing team—comprising two dozen County Health Department employees and volunteers—are the state’s remaining contact tracers. When the group started contact tracing, in March, the caseload felt manageable. By late November, it had become overwhelming. “There is no break,” said Andi Gordon, Teton County’s COVID-19 lead case coordinator. But the team remains dedicated to trying to curb the virus’ spread—and keep the community united. “We’re trying to hold on so strongly to that personal touch. I want to keep calling people, because I think people really value that.”

On the ground, contact tracers are making vital connections between local residents and community resources. Erin Engavo-Munnell, the COVID coordinator at Eastern Shoshone Tribal Health on the Wind River Reservation, said that she and her team are able to connect with their neighbors in a way people outside the area may not be able to. (The state has contracted with a company called Waller Hall to help with case investigations, but its employees largely call from outside Wyoming.) “All three of us who do contact tracing are enrolled members, and members of the local community —people are more likely to talk to us and give us information, and be more open,” said Engavo-Munnell. She also tells people about services that can deliver food and cleaning supplies to them while they’re in quarantine, whether they live on the reservation or not.

In Teton County, Gordon’s team is so well-connected that they frequently end up calling people they know. “It’s a small community,” she said. “We say to the team, ‘If you think it’s going to facilitate the work, go for it, but if you think it’s going to complicate it, recuse yourself.’ It happens a lot.” The team has also facilitated some on-the-fly problem solving. For instance, they realized that COVID-positive people often weren’t able to get home from the hospital. “There wasn’t anyone to drive them. Who’s going to drive a COVID-positive person?” said Gordon.

Ultimately, local firefighters and EMTs pitched in, as did the police department, which used sheriff’s vans with enclosed cabs to transport people. The team also enlisted the local sheriff’s office to help pick up and deliver prescriptions to quarantining residents.

The borders between reservations and counties are permeable, however, and that can complicate the tasks these small teams are doing to try to control the spread of COVID-19 in their communities. Sometimes, said Gordon, they’ll call someone only to discover they’ve already traveled somewhere, if only as far as the next county. That means more potential exposures, and more calls for the team. The Wind River Reservation is surrounded by Fremont and Hot Springs counties, so people often end up traveling through it. In the initial weeks of the pandemic, while Fremont County clinics limited testing amid staffing and supply shortages, the Wind River Reservation offered testing to any local residents, enrolled tribal members or not. 

Meanwhile, other areas, inundated by new cases, have handed off all calls to the state—which means only COVID-positive people are being contacted. Fremont County’s nurse manager, Becky Parkins, confirmed in mid-December that the county is no longer contact tracing. (She declined to answer further questions, noting that she was focused on facilitating the county’s imminent rollout of the COVID-19 vaccine.) Without tracing, there are fewer opportunities to stop the chain of viral transmission; even though Wyomingites are asked to call their contacts, illness or stigma may prevent them from doing so. It also masks the extent of community spread—and that can make people less concerned about the virus and less willing to take precautions.  

New cases started to decline in December, and Clay Van Houten, the Wyoming Department of Health’s infectious disease epidemiology unit manager, said that the state will monitor COVID-19 numbers to determine whether it can resume contact tracing. “It will depend on what we see over the next few weeks,” Van Houten said in mid-December. One option is to contact trace on a case-by-case basis to maximize resources. “If we can identify clear exposure for folks, or clear exposures for others to the case, then it makes sense to do more intense contact tracing,” he said.

Meanwhile, local contact tracers continue calling, and calling, and calling. “While sometimes it feels like we’re just drowning, at the same time, I always want to keep in mind that every person we do get ahold of is one person we have been able to make a difference with,” said Janet Garland, Teton County Health Department’s nurse manager. “If we don’t get to everybody on the list today, they’ll be there tomorrow—and we’ve made a difference for those folks we got to today.”

In early December, a local news station first reported that Emma Walker, and others, quit the TLC Adult Care Center, an assisted-living facility and nursing home in West Newton, Pennsylvania, because of what employees said was inadequate pandemic response. “It’s not being handled properly at all,” Walker told the station. She, and other workers, alleged that the owners failed to even provide proper protective equipment. According to data reported to the Pennsylvania Department of Health, there was an outbreak at the facility: 27 residents and 11 staff members had tested positive for COVID-19. (Less than five deaths have been reported, the state says.) Contacted multiple times for comment, The TLC Adult Care Center’s owners did not address the specific incidents and alleged failures to meet pandemic safety requirements outlined in this article.

I first started after I left my kids’ father and I was looking for work. I didn’t know what the heck I wanted to do with my life back then.

My stepmom’s friend told me about this job. She had issues there with the owners, but she said that it was a good place to work. I ended up applying and getting the job without having no experience or background.

I found out after working there that I love doing it. I loved that one-on-one with the people. I looked at it like they were my grandparents. I took care of them and gave them everything they needed. And I could feel the love they gave me.

Because I worked overnight, we cleaned the whole building and then we got the residents up. We washed them and got them dressed and ready for the day. We had 17 people we had to do. There were people who requested me to do it because I knew their routine, I knew everything they liked.  Say someone wanted lotion on their feet, I knew that’s what they wanted. And I wouldn’t skip over that because I wanted to get my job done. I did it because that’s what they wanted. I tried to keep everything normal, how they would have done things day to day at home.

Whenever I first started, it was fine, everything was fine.

And then this coronavirus situation hit.

On November 25, 2020 is whenever the owner Stephanie Short called and told us about a positive resident in our building. We’re thinking she’s the one that brought it in. A couple of days prior to that, on a Monday, she changed the schedule. Her son got it at school and then she was taking care of him, we found that she was asymptomatic, and she continued to come into work until she found out she was positive.

Then a resident got positive.

It started to get real shady after that. We moved the one resident that was positive into a private room that had somebody else in it and that person got moved to her bed, instead of quarantining the positive and the roommate. They switched it up and cross contaminated, which we all questioned and we were told that it was fine. The first initial resident would come out of her room all the time. They were just letting her.

Even before the positive, whenever they first started getting sick, we could tell because of the coughing, and the body aches, and a lot of them would get confused. When a lot of them started having breathing problems, we knew right away that’s what it was. We were saying that they were probably positive. We got told that it was probably a cold. If we were getting tested regularly, we would have caught it faster.

The only thing that they did provide us was one N95 mask. We had to provide our own mask before the N95s were given to us. That was in the beginning of November, whenever we got fitted for them. That was the only really thing that they did for us and got for us. They told us to use hospital gowns to protect us, instead of giving us proper PPE, which is the gowns that have full length sleeves that go all the way into your gloves and that way you’re not exposed.

I feel it in my heart that it’s negligence.

Then Thanksgiving, on the 26^th, is whenever we all started having symptoms. I got called to come in. I didn’t have a babysitter until my scheduled time to be there at seven o’clock pm. The owner told me to bring my kids in there. I kind of fought with her about it. I told her that it wasn’t right to bring my own children who were five and three at the time. That made me think: “Does she really care about what’s going on to risk my kids going in?” But me being me, I let that go. I had to wait until I had a babysitter, and I did go in.

On Friday, I started getting more symptoms of COVID. I expressed to her that I was starting to feel sick, but I was still going to come in because I knew she needed me because we were understaffed. I was already on my seventh day of working without having a day off. On my eight day, I went to the hospital because I was having like an asthma attack type symptoms. That’s when they confirmed that I had COVID.

I had a paper saying that I had to quarantine and she told me that it was impossible for me to quarantine because she didn’t have enough staff members and she couldn’t come in until that following Wednesday when she was done quarantining. Well, I made the decision not to go in at all. I was so sick; I could barely move. My body hurt so bad. My oxygen levels dropped. My mom came and she started taking care of me. I’m actually pretty healthy, I was so shocked of how sick I got. I was quarantining away from my kids for a total of 12 days.

I didn’t want to go in until we had the proper equipment to take care of the positive people. As I got sicker and sicker throughout, I didn’t want to risk my life. With my kids I was just scared that I would give it to them, and they would have it worse than me.

The owners kept texting and calling me. My mom actually answered the phone one time and my mom was like, she has literally been in bed for four days and she physically can’t. When I called back, she said: “Is there any chance that you’ll go work tonight?” My voice is still raspy from it, I couldn’t finish sentences. I could barely breathe and then doing a 12-hour day with a mask on already not being able to breathe… I couldn’t do it.

There have been four people who died. They were completely fine before all this happened. She didn’t tell any of the family members until I think the third one died. They still haven’t even confirmed that it was COVID-related.

Four days into quarantining I decided to quit. I texted saying I wasn’t coming back.

I was looking out for the well-being of myself and my kids. That does kind of sound selfish, but I put my kids before anybody else anyway. Part of me didn’t want to quit. I didn’t want to leave because of the residents. I cared so much for them and I didn’t want their needs to be ignored because I wasn’t there to fulfill my job. I’m not getting no rise or no gains from this. I did it because I care for the people who live there. I obviously felt kind of sad because I do have a big heart. I feel like I abandoned them. I know that they miss me and that breaks my heart because I left so suddenly. I kind of gave no warning. I know they’re not going to get the exact care that I gave them. I just don’t want them to have anger towards me. I know most of them will understand because they knew I had to care for my babies.

They started pointing fingers at us like it was our fault. Supposedly, I’m being blamed for bringing it in on Thanksgiving. She’s—Stephanie, the owner—telling family members that an employee brought it in because her mother had it. She’s also telling the family members that they are fine and that they’re handling everything properly. They weren’t whenever I was there. But I can’t say now because I’m not there anymore.

Now, my other concern is not having a job. I have my own house. I have bills to pay. But it’s a risk I had to take. I can find another job. Next thing is for me to get better. I still have to test negative to even move on.  

I would like to still be in this field. I do want to get certified. It’s a lot harder being a single mom going to school and needing a job to keep a roof over our heads. But I’ve gotten through with their abusive dad, I can go through this. I know I can make it work for us. If I were to stay in this field, I would want to make sure that the owners are taking every precaution because it’s still going to be around. It’s not just in that building.

I know people quit right after me. I think me doing it kind of gave them the courage to. They were all having the same exact experiences as I was.

As the world grapples with the devastation of the coronavirus, one thing is clear: The United States simply wasn’t prepared. Despite repeated warnings from infectious disease experts over the years, we lacked essential beds, equipment, and medication; public health advice was confusing; and our leadership offered no clear direction while sidelining credible health professionals and institutions. Infectious disease experts agree that it’s only a matter of time before the next pandemic hits, and that one could be even more deadly. So how do we fix what COVID-19 has shown was broken? In this Mother Jones series, we’re asking experts from a wide range of disciplines one question: What are the most important steps we can take to make sure we’re better prepared next time around?

In 2013, Julia Devanthéry joined Harvard Law School’s Legal Services Center and specialized in teaching students how to represent tenants in housing disputes. In 2017, after witnessing how many clients were facing housing instability due to domestic violence, sexual assault, and stalking, she realized that students needed a more focused approach to representing them. So, she founded the Housing Justice for Survivors Project within the Center in order to train law students in what is known as a trauma-informed practice, one that focuses on domestic violence-oriented defense strategies against eviction, while also helping clients break leases without financial repercussions and find transitional housing.

In 2019, Devanthéry and her students won an important case in the Massachusetts Supreme Judicial Court after appealing an eviction order on behalf of a client who had fallen behind on payment of rent because her abusive partner was stealing her income. The court’s ruling in Boston Housing Authority v. Y.A. affirmed the right of domestic violence survivors in public housing to raise the Violence Against Women Act as a defense against an eviction procedure. 

Now, with the coronavirus pandemic and stay-at-home orders often leaving victims of domestic violence trapped with abusive partners, the team’s eviction defense work has become even more urgent. Like several other states, Massachusetts enacted a comprehensive temporary moratorium in April prohibiting most residential evictions, but Republican Gov. Charlie Baker let it expire in mid-October. The same day the state’s eviction moratorium ended, Devanthéry warned that “without a moratorium in place, we will still see an explosion of homelessness now that evictions are allowed to go forward next week.” She forecasted “a humanitarian crisis” and a “completely preventable tsunami of homelessness.” She spoke to Mother Jones about the importance of states keeping bans on evictions in place, and why we need to be thinking past January 31, when the federal moratorium extended as part of the stimulus package Trump signed on Sunday is set to expire. 

On the heightened vulnerability of survivors: A lot of our cases involve instances where victims are being brought to court—or their tenancies and housing benefits are being terminated—for reasons that are directly related to their experiencing abuse. Our clients get blamed, even though they are unable to exercise control over the person who was physically and emotionally hurting and systematically terrorizing them in their own homes. Because of the power dynamics in an abusive relationship, if the abusive partner refuses to put their name on the lease or to contribute income towards rent, that’s a violation of the housing program that could cause the victim to lose a voucher—which otherwise they would have had for the rest of their lives. We see that situation a lot where people are being held accountable for the actions of their abusers. But in reality, within the context of that relationship, they don’t have the power to compel the abuser to do anything, because the power is so skewed in the other direction.

On the importance of housing protections contained in the Violence Against Women Act (VAWA): A survivor reached out to us and shared that she was experiencing very significant physical and emotional abuse. Her partner was threatening to dismember her, and kill her and her daughter. The housing provider was going to terminate the Section 8 voucher, but we put together a letter where she asked for the protection of VAWA, which prevents people from losing housing subsidies and their homes as a result of domestic violence. We sent it over to the Housing Authority, and within a week-and-a-half they reversed their decision and allowed her to keep her housing subsidy—which she needed in order to be able to afford rent. It also spared her the re-traumatization of becoming homeless as a result of being in an abusive relationship. The abusive partner is incarcerated, and she and her daughter are safe and able to stay home for Christmas. 

VAWA has not yet been reauthorized, and that’s an unspeakable shame on this Congress and the Republicans who obstructed it. There are many programs that serve domestic violence survivors but many funding sources are not available, and that hurts clients every single day. But the housing provisions built into VAWA do not expire, they still are the law of the land. I’m hopeful that, looking ahead to a new Congress, we might have some cause to be optimistic about the strengthening of the protections—especially when you have the author of VAWA in the White House!

On the trauma of eviction: Anyone who’s facing housing instability is panicked. It’s such a scary and overwhelming experience. Especially if you have a family and kids, thinking about where they’re going to go, how it’s going to impact school, how you’re going to explain to them that you have to pack up and leave without a place to go. What they’re facing is a sheriff or constable coming to their home—basically bursting through the door even if it’s locked—with movers, who are just strangers, who come into the home and start packing and removing belongings. Then they physically remove the tenant and their family from the property and put those belongings in storage. People lose property, essential documents, medication and eyeglasses, and all the things that people need for survival. It’s just a very violent experience in and of itself. 

On how the pandemic has made everything worse: It’s been a really difficult time for our clients. While we were all ordered to stay home to keep ourselves and our community safe from the spread of the coronavirus, our clients basically have been required to stay in spaces that are the opposite of safe for them. They have to stay confined in spaces where their physical health and emotional and sexual autonomy are jeopardized. People have been dealing with a lot of extreme violence and having a very hard time accessing safe shelter alternatives, because the predominant model for emergency domestic violence shelters relies on congregate living spaces. Because there are fewer shelter spaces, what folks end up doing is going to live with family and friends in a way that also puts family units at risk of contracting the coronavirus. Or, they decide to stay in a very unsafe, violent situation because there are no alternatives. I have a number of clients who have coronavirus and are very sick. They are trying to deal with their safety concerns, take care of their kids, figure out what to do about housing, while also dealing with this deadly virus. There’s also limited access to courts, so it’s very hard to get access to restraining orders. When eviction cases are going forward virtually that’s a huge barrier for clients who maybe don’t have stable wifi or smartphones. 

For people who are in abusive relationships to find a safe space to even just talk to a lawyer or a service provider is a real challenge. We’re having to be very creative about when and where we make appointments. That’s been incredibly stressful and scary. Then you layer on top of that the economic devastation of the virus, the suffering is just really unprecedented. Even though we’re not physically in our offices, and we’re not able to build rapport and trust with people in ways that we used to do—and that we hope we will do again in the future—the need for connection is as high as it’s ever been.

On the benefits and shortcomings of an eviction moratorium: People are facing loss of housing in such astronomical rates right now because the Massachusetts moratorium has been lifted. Some people are protected by the federal moratorium, but not everyone. While we had it, it was incredibly powerful and the result was that people were able to stay in their homes during one of the most difficult periods in our state’s and in our country’s history. They didn’t have to deal with the trauma and rupture of housing loss in the midst of the pandemic.

What we’ve been seeing since October has been a real surge in people reaching out to us for help. All of the advocates I’m connected with on the housing and the domestic and sexual violence side, everyone was just in disbelief that the state moratorium would be lifted. They just couldn’t imagine it. I think there were political factors that pressured the governor not to extend the moratorium again, and he just let it expire. Now, it’s a disaster. It’s complete chaos in the housing courts, and people are losing their homes and being evicted. We have a huge snowstorm right now—like a foot of snow. There’s a coronavirus surge and no place for people to go, and no financial resources to help them transition to appropriate alternative housing. It’s really just shocking and disappointing and outrageous. I don’t know how else to describe what I’m seeing.

On attempts to mitigate the harm: There’s a new study about the correlation between COVID-19 deaths and the lifting of state moratoriums. Keeping people housed and also allowing them to get access to dispute resolution and rental assistance would have saved lives. What eviction diversion initiatives aim to do is really positive; to reduce the total number of evictions that go through court by doing a variety of early interventions, to provide rental assistance to address non-payment, to do out-of-court mediation, and increase the number of free lawyers for folks who do end up in court. Unfortunately, what we have is a highly adversarial, punitive system of evictions alongside a diversion program that is not completely staffed up and not operating at full capacity. There’s not nearly enough money in rental assistance allocated to address the total amount of money owed by tenants across the state, and there aren’t lawyers yet for everybody who needs them. These are all great ideas but meanwhile the eviction machine is ramping up. People should not be evicted during this time, period. 

On rental assistance and eviction records: There’s just going to be a huge amount of rental debt following people around after this crisis. We need a shift in how we’re conceiving of rental assistance. We should move away from a sort of welfare benefit model, where tenants have to go through cumbersome bureaucratic procedures to get access to money as a bargaining chip to use through the eviction process to keep them housed. Instead we should impose a moratorium that prevents evictions, but allows landlords to get access to 100 percent compensation for the rent that is owed while taking that off of the tenants’ ledger. That would be a much better way to run these programs and ensure that the financial strain caused by COVID-19 is not going to follow people around for months, or years, after the pandemic is over.

We’re also going to see a massive increase in the number of cases coming through the courts, and people who never had any contact with courts, as well as very low-income people dealing with poverty, are going to have eviction records. We’re going to see people who are just locked out of the rental market at a huge rate as a result of being brought through the court system because of the economic devastation of COVID-19. Legislation to allow people to seal their eviction records, forgiving the debt, and then making sure that eviction actions are not like zombie marks on everyone’s records are all really important.

On the need for long-term solutions: The lack of enough safe affordable housing for all creates a perpetual scarcity of resources for people dealing with poverty and impacts survivors in particular. We need a guarantee of safe, affordable housing for all. That means an expansion of affordable housing programs sufficient to meet the need, and increased protections against the loss of housing. Societally, we should approach housing as a basic need that everyone should have access to no matter their income—like healthcare or public education. In a world in which there’s a right to housing, everybody has an opportunity to have a place to live, no matter how poor they are, no matter how disabled they are, no matter what their needs are. That’s the world I’m working towards.

This interview has been edited for length and clarity.