It was still dark outside when Veronica Perez arrived at Primex Farms, a nut packing facility in Kern County, California. Crickets murmured from the almond and pistachio groves stretching for miles in either direction. Inside the double doors, Perez, 42, usually stands next to other nut sorters alongside a conveyor belt and picks out the unseemly pistachios. But on June 25, at 4:30 a.m., Perez didn’t go in. Instead, for the next five hours, she and her colleagues formed a picket line. Some 30 employees joined on foot, with more circling and honking in their cars. They held homemade signs with the names of their infected coworkers. One sign in Spanish read, “The wise see danger and leave, but the foolish go on and suffer the consequences.” The employees chanted, “Somos esenciales!” We are essential.

In more than a decade of packing food in California, Perez had never joined a protest. But in recent months, things at Primex had become unbearable. In March, when employees concerned about the coronavirus requested to wear masks, Primex allegedly prohibited them from doing so, citing food safety concerns. When the company later allowed masks, instead of distributing them, it sold them for $8 apiece, according to several workers. (Primex denies ever selling masks.)

By early June, employees were falling ill. Those who stayed home sick reported not getting paid while they were out. Others kept coming to work, coughing and coughing. Meanwhile, Primex executives reportedly remained tight-lipped on any illness at their facility. “They said that they were going to let us know if anyone came down with it,” said maintenance worker Remigio Ramirez, “but they didn’t.”

When Ramirez told his boss in mid-June that he wasn’t feeling good, the supervisor “said we were short-staffed and needed more hands,” recalled Ramirez. It was probably just the flu, said the supervisor, urging Ramirez to take some medicine and come in.

A few days later, Ramirez, 54, was diagnosed with COVID-19. He stayed home, quarantining himself in his bedroom. “When I got up the next day, I didn’t see anyone—not my wife, not my daughters,” he said. “And I thought to myself, what’s happening? Did they leave me alone? But no, each one was in their room, sick.”

For many employees, the last straw came on June 23, when a local news channel reported that, according to Primex, 31 workers had tested positive for COVID-19. Employees watched the news in shock. Company leadership hadn’t told them about the cases, the first of which had been confirmed more than two weeks before. (Primex didn’t comment specifically on the lack of communication to employees, but said, “We began implementing [anti]-virus spreading steps long before the CDC guidelines were published. We are proud to say that we are one of the cleanest and most sanitized plants in the industry.”) 

Primex was far from the only food production facility in the area where the coronavirus was spreading. Over the summer, the disease tore through the Central Valley, the vast, dry interior of California that produces a quarter of the nation’s food, including 40 percent of the country’s fruits and nuts. By mid-August, the Kern County fairgrounds had been transformed into a federal surge testing site, and more than 1 in 5 coronavirus tests were coming out positive. “The problem we’re seeing is not whether you’re going to get infected,” said Armando Elenes, secretary treasurer of the United Farm Workers (UFW) union. “It’s no longer a matter of if—it’s a matter of when.”

Primex is relatively small by California agribusiness standards. Roughly 400 employees work in its Kern County packing facility, processing about 6 percent of California’s pistachios each year. But despite the company’s size, its workers made a rare, risky decision with sweeping implications: While the pandemic has driven many vulnerable populations further into the shadows, Primex employees, many of whom are undocumented, took to the streets.

Perez knows this is not how the playbook is supposed to go. “Most workers prefer to keep quiet for fear of losing their jobs or for fear of retaliation,” she said. “I was amazed myself at the quick response we got from our coworkers. It may be that everyone is tired of always staying silent.”

Last month, I drove to the Central Valley to talk to agricultural workers about the effect of the rapidly proliferating virus on their lives. Nearly everyone I interviewed suspected that others they worked with had had the virus at one point. But no one wanted to bring it up with their coworkers or bosses: Just as pervasive as the virus is the secrecy around it.

The mentality is, “if I feel good, even though I have the virus, I’m not going to tell you,” said one farmworker in Lost Hills. “The farm supervisors aren’t interested in if you have it or not. You might feel sick, but it’s fine—as long as you don’t die.”

[Related: “In California’s Salad Bowl, “farmworkers are working within various disasters, one on top of another.”]

An estimated half of the nation’s farmworkers are undocumented immigrants, according to the US Department of Agriculture. (Some estimate the rate to be significantly higher.) This open secret has long left farmworkers suspended in a contradiction: critical to feeding the country, yet deportable at the drop of a hat. With the pandemic, the dichotomy has only become more clear. Essential workers, including farmworkers, “have a special responsibility” to maintain normal work hours, according to President Trump’s guidance in March, yet undocumented workers don’t benefit from the federal coronavirus relief measures granted to citizens. (Those who are in the US on temporary work visas aren’t in a much better position: Some have been fired and lost their visas after getting the virus.)

Many agricultural workers now carry letters from their farms and packing plants identifying them as critical employees in case law enforcement picks them up. “I am a farm worker helping to protect our food supply during the Coronavirus pandemic,” read one such letter that a berry picker shared with me. “My job is considered essential so that we can produce food.”

Under federal coronavirus legislation and subsequent additions by California Gov. Gavin Newsom, many undocumented workers are eligible for two weeks of paid sick leave, deemed “COVID pay.” But in practice, enforcement is spotty. “If an employer is not paying them COVID pay, that sends a message to everybody else to not say anything,” said the UFW’s Elenes. And if an undocumented worker loses their job, they don’t get the unemployment stipend that the federal relief promises to other residents. “Most employees accept that they don’t have health insurance,” Elenes added. “But not having any income? That’s not something they can resolve.”

So begins a lethal feedback loop: The fear of lost wages and of immigration enforcement breeds silence, which in turn breeds transmission. “People are scared to say anything—or they take it like it’s a common cold, and they continue going to work,” said a 45-year-old who we’ll call Esperanza. Esperanza described a scene at her workplace, a plant nursery in Oxnard, similar to that at Primex: Over the summer, her coworkers started coming in sick, knowing they wouldn’t get paid if they stayed home. The nursery didn’t give out masks. But the worker response at the nursery was far less dramatic than that at Primex, and far more typical. Instead of protesting to demand better conditions or higher pay, workers simply went on working. Esperanza spoke to me over the phone in a quiet, cracking voice; just a couple weeks before, she had come down with the coronavirus.

The fear also complicates COVID-19 testing efforts. Since mid-July, Kelly Gladden, a volunteer who spearheads a mobile coronavirus testing unit, has criss-crossed Kern County to test farmworkers. Since most other testing sites are far away from farms, and some workers don’t have transportation, the idea is to meet workers literally where they’re at. The operation was initially run out of a van, but the associations of a van with US Immigration and Customs Enforcement made Gladden change tacks. Now her team, a group from the Bakersfield-based Good Samaritan Hospital, sets up the testing tent in a field, between rows of grapes, or under the awning of a food processing or packing plant. Even still, the team encounters skeptics. Some growers don’t love the idea of using up work hours for testing, and some workers are afraid that their information will be shared, or that they won’t get paid if they test positive.

Fernando Perez, who works at a dairy outside of Bakersfield, explained that he purposely didn’t get a COVID-19 test when his coworkers, including his brother, came down with the virus. Perez, who is undocumented, didn’t want to risk the financial toll of testing positive—his brother wasn’t paid for his time at home. Plus, someone needed to operate the complex machinery to feed the cows. “If no one comes in, the animals don’t eat. If they don’t eat, they don’t produce,” he explained. “If we don’t go to work, 10,000 cows will die. Our work is very, very important.”

The shroud of silence adds to a host of environmental and situational factors that had already made agricultural workers perfect targets for the virus. Few farmworkers have regular access to health care. Many live with extended family members, with several generations under one roof, or in dormitories for temporary workers, where the virus proliferates. It’s common to carpool to job sites, some of which are greenhouses or packing houses with limited air circulation. Between the pollution from the pesticides, the oil fields, and the freeways, the Central Valley has atrocious air quality: Its largest cities, Bakersfield and Fresno, have the worst air particle pollution in the country, according to the American Lung Association. Rates of asthma, the fungal lung disease Valley Fever, and other respiratory ailments soar. It’s perhaps no surprise that, according to a recent Politico analysis, the nation’s key agricultural counties have disproportionately high coronavirus infection rates.

Making matters even worse, workers have had to contend with another hazard this month: A ring of fires around the Central Valley has turned the fields into a hot, soupy smog. “People look at us and don’t pay us much attention. We’re out in the rain, the heat, every other condition,” one worker told me. “They’re not taking into account that we need help.”

On Tuesday June 23, Perez, the Primex employee, sent a message to Elenes over Facebook. He was a near stranger, but she was desperate, reeling from the news of the COVID-19 cases at the company. At Elenes’ urging, Perez reached out to other concerned coworkers asking them to join a WhatsApp group, called Justicia en Primex Farms, and to invite their other colleagues. (Primex isn’t unionized, but the UFW organizes and advocates for agricultural workers in general, regardless of union status, said Elenes.) Within 24 hours, 100 people had joined. They gathered over Zoom the following evening, many using the video chatting platform for the first time, to plan a demonstration.

When her coworkers showed up for the strike early Thursday morning, Perez was a jumble of emotions: thrilled that so many people had joined, terrified that they would face consequences. She carried a sign with a list of three demands: sick pay, job protection, and “respect.” Ramirez, the maintenance worker who’d tested positive the week before, showed support from the confines of his truck.

The effects of the demonstration appeared to be immediate. Later that day—more than two weeks after the first reported infection at Primex—the company closed for cleaning and announced it would contract with a mobile testing unit and implement other safety precautions, like installing plexiglass dividers at the sorting tables and more outdoor seating areas so employees on breaks could spread out.

When the company opened after a few days, workers gathered once again to protest. They alleged that Primex still wasn’t cleaning adequately or providing sick pay. This time, their numbers had grown to more than 60. But the demonstration lasted only a day. “We went back because we needed the work,” Perez said.

It was around that point that Elenes suggested employees start a coronavirus census, suspecting far more people than just the 31 that the company had reported were infected. Workers started coming forward in the chat, admitting they had tested positive. Since Primex is a 24-hour operation, the messages came in day and night. Elenes recalled waking up and finding message after message about positive tests among employees and their family members. One woman reported that not only was she infected, but 16 other family members were as well. The youngest was nine months old.

In the weeks after the protests, OSHA opened an investigation into the company; it remains open. But by that point, the virus was everywhere. Within three weeks, the employee census found that 97 of 400 employees were positive, along with more than 60 family members. The separate mobile testing unit provided by Primex would later find that 150 employees—more than a third of the plant’s workforce—had the virus. 

In mid-July, a 57-year-old employee named Maria Hortencia Lopez was taken off life support and died of the coronavirus. Perez had known Lopez as a lively coworker on the assembly line who often brought in fruit to share and asked after Perez’s family. “I couldn’t believe that a person so full of life, such a happy and a good person, suddenly isn’t with you anymore,” she said.

Perez’s grief was undergirded by a quiet rage. She couldn’t shake the feeling that all of this could have been prevented. “That’s what hurts the most,” she said.

Just 25 minutes away from Primex sits Delano, where, in 1966, striking grape workers famously began the 340-mile march to protest the work conditions of farm laborers. The following decade marked a brief golden era for the UFW, with Cesar Chavez at the helm. At its peak, the union was 50,000 members strong, having secured in 1975 the California Agricultural Labor Relations Act, the nation’s only legislation allowing collective bargaining among farmworkers.

In the 1970s, the conditions at Primex “would have been an invitation to organize,” said Marshall Ganz, who directed organizing in the early years of the UFW and now lectures at the Harvard Kennedy School. “There’d be a grievance, and people would call out the union to come and help.”

Those days were short lived. Internal squabbling, fueled by Chavez’s increasing paranoia and refusal to decentralize power, seeded mistrust, and the union quickly found itself in a downward spiral. Fewer contracts were renegotiated, leaving those left behind to shoulder the costs. The successive Republican governor chipped away at state labor laws. Today, with just 7,500 members, the UFW is a shell of what it once was; it now represents less than one percent of farmworkers in California.

Recent months have brought blips of COVID-related organizing up and down the West Coast. Just a month before the Primex strike, hundreds of apple packers in Washington’s Yakima Valley walked off production lines to protest a lack of safety precautions and hazard pay. One worker inquired to Oregon Public Broadcasting, “Are their apples worth more than our lives?” The UFW is pushing for $2 per hour of hazard pay at poultry giant Foster Farms, which temporarily closed one of its California facilities this month after eight workers died of complications related to the coronavirus. 

I asked Ganz: Could the pandemic lead to more organizing among farmworkers? “The whole question of where you find courage to take risks is always a question in organizing,” he said. “Where do you find courage to take risk? Grievances don’t generate courage. They generate anger or rage. They generate despair. So unless there’s some hope source, people don’t really engage. So then the question is, under these conditions, are there unusual or new sources of possibility? Hope isn’t about certainty at all—it’s just about possibility.”

But the reality is that hope is in short supply. In many ways, the pickers and packers of food in America find themselves facing the same challenges as the grape strikers of the 1960s: stagnant pay, perilous conditions, and backbreaking labor. The rate of farmworkers who are undocumented has shot up, from an estimated one in seven three decades ago to one in two today. Agribusiness companies increasingly rely on third party, hard-to-regulate staffing agencies to hire, transport, and house employees, notes University of California-Davis agricultural economist Philip Martin in his upcoming book, The Prosperity Paradox. This, combined with the eroded power of unions, makes agricultural workers today especially vulnerable. As Martin concludes, “Government enforcement of labor laws depends on complaints, and vulnerable workers rarely complain.”

At Primex, employees report that they are finally getting paid sick leave. Yet they told me that despite this small victory, the atmosphere at the plant has become increasingly oppressive.

On July 22, about a month after the first protest, dozens of workers lost their jobs when Primex canceled its contract with a temporary staffing agency. The company attributed the reduction to typical changes in seasonal production, but according to the UFW and Primex employees, the cuts included many of the most vocal workers. Primex promptly hired new workers to take the place of those who were terminated, prompting the UFW to file a complaint with the National Labor Relations Board. (The case is open; Primex declined to comment on the case but said of the UFW, “all they do is just play the blame game without any accountability.”)

In late July, a colleague of Perez’s tried to record a video inside the plant showing that that social distancing and mask wearing weren’t happening consistently, despite the company’s statements to the contrary. Primex disciplined the employee, according to another NLRB complaint, and the company required workers to sign a policy prohibiting video recording. Perez refused to sign. “That’s when [the production manager] pulled me into the office. He likes to scream a lot,” recalled Perez.

Later, Perez and Ramirez, the maintenance worker, were separately called into meetings with Primex’s manager of human resources and instructed to retract statements they made to the media over the course of the protests. Business was declining because of all the bad press, Perez and Ramirez were told—if the company went down, it would be because of employees like them. “They said, ‘This company should mean something to you,’” recalled Ramirez, who has worked at Primex for 13 years. As they spoke, he seethed, thinking about his sick wife and daughters.

Perez recalled the human resources manager “said her head was hurting from hearing me talk so much, and she didn’t want to hear from me anymore.” Despite the warnings, a lingering thought keeps Perez talking to reporters: “If it’s happening to this company, it could happen to a lot of other companies where there’s no one to talk.”

Some of the fallout from the demonstrations has been more subtle. Ramirez said that most of his remaining coworkers didn’t agree with his decision to strike, and they now say very little to him. Instead of regularly fielding requests for help, like usual, he now spends his work hours walking around, looking for broken things to fix. Another organizer was moved from operating a forklift inside to sweeping and painting outside in the sweltering heat. He’s considered quitting. “It’s hard to keep working there when the people who manage the plant don’t want you there,” he said.

At the end of July, Perez participated in a Facebook Live panel put together by Líderes Campesinas, an advocacy group for female farmworkers that she belongs to. She admitted to the group that things had been very difficult lately. Just that day, she’d been yelled at by the production manager for refusing to sign the policy against taking videos.

“I’m really short, and he’s tall,” explained Perez in Spanish. And then she began to weep. “It makes me want to cry because my coworkers—I’ve tried to be really strong in front of them, but I can’t anymore.” It seemed that when they spoke up, things got worse.

“We’re only asking for a safe place to work,” she exclaimed. “What do we have to do?”

This article has been updated. Camille Squires contributed to reporting this story.

The United States is approaching yet another grim milestone during this coronavirus pandemic: 200,000 lives lost.

It feels like so much has changed since late March, when President Donald Trump declared this unfathomable number as the high end of what he would consider an acceptable—even successful—loss of life. But in reality, not much has. We continue to fumble about, without anything resembling a coherent national response. We’re still short on materials needed for protective gear. More people are wearing masks, but many still aren’t and some outright refuse. What should be undisputed science is still being questioned by an inept administration. As a result, so many people are still getting sick. Trump will move the goal posts again.

The biggest change since his 200,000-dead prediction is unfortunately just how much and how many we’ve lost.

That is why we want to hear from you. The numbers on their own can feel both overwhelming and inadequate. So we want to understand what you, our own reader community, may have lost and what that experience has been like. Please send us some thoughts, some memories, and some insights about how you are mourning and coping with your losses.

Unless you were living under a rock, you saw photos last week of the skies over the San Francisco Bay Area that looked ripped from an apocalyptic fantasy: they were a deep, irradiated orange that didn’t look like any specific time of day.

San Jose at noon today. Red dot is the (blocked out) sun. I think all of California is resembling hell at this point 🙁 pic.twitter.com/c33q2hTp1x

— Charlotte Pullman (Manton) (@CharManton_dtLA) September 9, 2020

For the previous month, massive wildfires—including six of the top 20 burns in California’s history—have been blazing across thousands of acres all over the West, with so much smoke at times the sun was blocked. The eerie look has been disturbing enough, but health officials have been particularly concerned by the potential impact of all that smoke on residents’ health—especially those who are at high risk of contracting, or who are already suffering, from the coronavirus. Almost 70,000 people have evacuated their homes in California, another 40,000 in Oregon, and 33 people have died from the fires. And with almost 30 more major wildfires burning, the skies of much of the West, up to Seattle, are shrouded by smoke.

Health experts are especially worried about the dangerous, pervasive, and invisible particles that the smoke has produced. Smaller than 2.5 millionths of a meter in diameter, and consisting of the material burned by the flames, they are known as particulate matter 2.5, or PM2.5. They are so infinitesimal that PM2.5 are able to bypass the biological defenses humans have to filter out many other pollutants and penetrate the lungs. When wildfires burn, the air becomes filled with them.

As Undark reported:

The 2018 “State of Global Air” report—a collaboration between the research nonprofit Health Effects Institute in Boston and the Institute for Health Metrics and Evaluation at the University of Washington in Seattle—makes clear the impacts of fine particulate pollution. “PM2.5 was responsible for a substantially larger number of attributable deaths than other more well-known risk factors (such as alcohol use … or high sodium intake),” the report noted, “and for an equivalent number of attributable deaths as high cholesterol and high body mass index.”

These particles can weaken lungs and cause inflammation of preexisting respiratory conditions, like asthma or chronic obstructive pulmonary disease (COPD). This has happened in pre-pandemic years. The smaller 2018 wildfire season, for example, is thought to have caused 1,400 premature deaths in the state. But the risk is even greater this year, as the latest fire season is unprecedented in size and is taking place during a pandemic caused by a disease that specifically targets the lungs. The combination, health experts say, poses a double threat. 

“The worry this year is that the smoke from wildfires could increase the severity of COVID-19 symptoms,” Nina Bai wrote in an article from University of California San Francisco that focused on patient care. “Though there have yet to be studies looking specifically at the effect of wildfire smoke on COVID-19, there is preliminary research linking air pollution to increased COVID-19 susceptibility, severity and death.” That preliminary research, an April study from Harvard T.H. Chan School of Public Health, didn’t mince words. “A small increase in long-term exposure to PM2.5 leads to a large increase in the COVID-19 death rate,” the study concluded. According to US EPA standards, exposure to less than 12 micrograms of PM2.5 daily is a relatively safe amount. But that makes the Harvard study’s determination all the more concerning: “[A]n increase of only 1 𝜇g/m3 in PM2.5 is associated with an 8% increase in the COVID-19 death rate.” Just a marginal bump increase in PM2.5 inhalation is enough to tip death rate in a meaningful way.

This fear has been echoed by others in the health care community. As Dr. Michael Schivo, an associate professor at UC Davis who specializes COPD, tells me, there are two main potential health consequences at the intersection of COVID-19 and smoke inhalation: increased risk of contracting the coronavirus, and more severe disease symptoms. According to Schivo, when someone inhales ash and PM2.5, their lungs become inflamed and preexisting conditions can potentially flare up. Cells along the airway get irritated by PM2.5, which then can weaken the cell’s ability to protect the lining of the lungs. “Their ability to act as a natural barrier against respiratory viruses is compromised,” he says.

COVID-19 hasn’t existed long enough for there to be any rigorous studies of the effects of extreme exposure to wildfire smoke, but the case is clear with other respiratory illnesses. When respiratory viral symptoms begin to appear for someone who suffers from asthma, COPD, or the flu they could become more serious when exposed to PM2.5. That this exposure can lead to higher rates of hospitalization and death from viral infections is well-documented. In May, a study from Rovira i Virgili University, a Spanish medical school, found, “[A]ir pollutants such as PM2.5…can affect airways through inhalation, exacerbating the susceptibility to respiratory virus infections, as well as the severity of these infections.” After someone has inhaled smoke, their “immune system is already activated, and its ability to respond to a respiratory viral infection is worse,” says Schivo. “That means they’re more likely to have a severe illness from respiratory virus infection.” 

One of the consequences for those exposed to wildfire smoke, the Centers for Disease Control and Prevention noted last month, is being “more prone to lung infections, including SARS-CoV-2, the virus that cause COVID-19.” In other words, if someone was exposed to COVID-19, breathing in smoke beforehand could increase their chances of becoming infected.

Another problem, Schivo says he’s seeing now, is that patients who are already suffering from smoke-related illnesses will postpone essential hospital trips because they fear exposure to COVID-19. “I’ve had patients who are at home and need to come to the hospital because of a COPD exacerbation, but they refuse for fear of [COVID-19],” he told me. When they’re finally sick enough to “come in, they have to, because they’re critically ill.” In the meantime, Schivo says he’s treating patients remotely, hoping that steroids might be enough to address their respiratory flare ups. 

With so many people getting evacuated throughout the region, finding hospital care could add to the problems. “I could imagine that there’s a medical need that goes beyond wildfire, like being exposed to COVID-19, and then getting them health care is a real issue,” says Schivo. “It’s a perfect storm.”

There is an amazingly simple and clever step that the US federal government could take to counter a possible COVID-19 surge this fall and winter: a national crash program for flu shots. So far, the Trump administration has not embarked on such a program.

Since the start of the pandemic, public health experts have voiced the fear that the coming weeks and months could yield a “twindemic,” as the coronavirus crisis overlaps with the spread of seasonal influenza. A June editorial in Science raised the prospect of a “convergence” that could become a  “perfect storm.” Scientific American reports that epidemiologists worry the United States could “soon face two epidemics at the same time…and this combination could precipitate a crisis unlike any other.” 

The problems are obvious. COVID-19 and the flu share symptoms (fever, muscle aches, respiratory problems) and can be hard to tell apart. People who contract the flu might believe they have the more deadly COVID-19. Those who become sick with COVID-19 might assume they have the flu. Without clear and quick test results, doctors might not know what advice and treatment to provide. “Family doctors and even fancy infectious diseases experts will have trouble differentiating between patients who you treat for the flu and those who you hospitalize for COVID,” says Dr. William Schaffner, a professor of medicine in the Division of Infectious Diseases at Vanderbilt University School of Medicine.

Most important, a rise in the number of flu patients will place additional pressure on hospitals and medical facilities dealing with COVID-19. “People get sick and end up in the hospital and compete for the same beds,” notes Dr. Nahid Bhadelia, associate professor of medicine at Boston University School of Medicine and an infectious diseases physician at Boston Medical Center. “Extra tests and extra PPE will be needed.” Health care professionals dread the possible return of the COVID-caused crush on the medical system that occurred this spring. (During the 2019-2020 flu season, there were between 410,000 and 740,000 hospitalizations for flu and between 24,000 and 62,000 flu deaths, according to the Centers for Disease Control.)

Bhadelia also points out that there’s no telling yet how the flu and COVID might interact for patients who are exposed to both: “We don’t have a good sense of what co-infection looks like. Does it make either of the illnesses more severe? And some people who survive COVID have a long recovery. If they get the flu, is their flu worse because architecturally their lungs are different?”

Doing everything possible to reduce the flu this winter would certainly assist the fight against COVID-19. But that has yet to become a priority for President Donald Trump, who continues to host campaign events with super-spreading potential and who mocks mask-wearing social distancing.

There is yet no vaccine for COVID-19, but one does exist for the flu—and it’s a powerful tool: One CDC study found that increasing flu vaccination coverage by five percentage points could prevent between 4000 and 11,000 hospitalizations. And the CDC has long taken the flu season seriously. Each year, it purchases flu shots and disseminates them to state and local immunization programs, many of which also buy doses on their own.

This year the CDC has procured 9.3 million “supplemental” adult flu vaccines for distribution—far more than the 500,000 the agency typically obtains and hands out—and it has requested that state and local health entities focus on delivering these shots to underserved communities, including Black and Latino populations, according to a CDC spokesperson. The CDC also is sending $140 million in funding to state and local health departments to plan and implement vaccinations and to target minority communities, adults with underlying conditions, and essential workers. This money supports mass vaccination events, vaccine strike teams, and curbside vaccination clinics. (The effectiveness of the flu shot varies form year to year, depending on that year’s influenza strain, but the more people who are vaccinated, the greater the collective protection.)

The CDC effort is only a slice of the overall flu immunization effort. Flu shots are manufactured by private companies. (According to the CDC, these firms expect to produce about 194 to 198 million doses of influenza vaccine this season; as of early September, 47.6 million shots were distributed.) And the shots are provided to Americans by a hodgepodge of medical facilities, drug store chains, doctors’ offices, local health agencies, employers (for their workforces), and federal agencies, with different sources, including private insurers, Medicare, Medicaid, and customers, covering the tab. “It’s a bit of a quilt work,” says Schaffner. “There may well be a lot of people who need it and who don’t get it.”

There is no national immunization system to swing into action. Yet a national initiative is needed. Though the supply of flu shots is usually not a problem—and the costs are not too high—many Americans still do not obtain the vaccination. “Kroger grocery stores give free flu vaccines, and there are various means to get it,” says Schaffner. “But you have to be motivated to get it.”

A CDC study of the flu season of 2018 to 2019 noted that 62.6 percent of children in the United States (6-months to 17-years old) had received a shot. Coverage among adults was less than half: 45.3 percent. And the numbers varied widely between states (between 46 and 81 percent among children; from 34 to 56 percent among adults). Which means there is plenty of room for widely promoting and distributing flu shots. Schaffner points out that there is a need to push out the vaccine into various communities, but state and local health departments “tend not to have the budgets for something like this. We need to expand current programs and communications methods to reach out to people.”

Infectious disease experts in the United States recently spotted encouraging news in the Southern Hemisphere, where the flu season this summer (when it was winter down below) was mild. That could be because anti-COVID measures—wearing masks, socially distancing—also work to slow the spread of influenza. But in Australia, for example, these steps were more widely embraced than they have been in parts of the United States. 

“Offering a free flu shot to everyone is a no-brainer,” Bhadelia says. Yet she notes that “a lot of national health care is not national,” so there are plenty of cracks in the system. Low-income people without insurance, she adds, are often not aware of immunization programs that will provide a flu vaccination with no charge. And there are people in all income brackets who don’t see the need to get a shot. 

As the nation heads into flu season with the deadly coronavirus pandemic still untamed, a comprehensive flu shot campaign that makes the vaccination available to all and that mounts wide-ranging and creative efforts to promote and distribute flu shots (door-to-door flu shot teams?) would be a straightforward way to address this double-threat and bolster a health care system still coping with COVID-19. It also could be something of a test run for what happens should a coronavirus vaccination be developed.

“We are all anticipating a stressful winter coming up,” Shaffner says. An extensive flu shot blitz could mitigate that: “It couldn’t be simpler. Just roll up your sleeves.” Funding for such a program would certainly be crucial. But this is largely a question of national leadership, Schaffner contends. Imagine if Trump said everyone should get a flu shot. “That would be very important,” Schaffner remarks. “That could have a huge effect. It’s the best thing that we can do.” 

But as Trump has refused to embraced the basic steps necessary to contain the pandemic, he has also not yet demonstrated an interest in such an elementary and effective public health project. Could that be because of his anti-vax past? Whatever the cause, he is letting an opportunity slip by. As the COVID-19 death count approaches 200,000, Trump—and the nation—is running out of time to implement a damn easy way to assist an embattled health care system and to reduce suffering and death. 

I chose to be in occupational therapy because I wanted to do something that helped people. I didn’t think I could stomach doing injections and the medical side, because I didn’t want to hurt people. I was more interested in the greater context of people’s lives than physical therapy, where they just work on the muscles. I really found a calling. It seemed like the most practical type of therapy you do. You’re addressing exactly what the person needs to be able to do in their life. Most of the time, I felt like I was making a difference.

When the coronavirus first arrived in America, and there were cases in my state, the management where I worked continued to act like it was overblown. Any kind of mitigating PPE was just going to scare everybody. They weren’t taking enough action to limit exposure and to protect people because it would cost them money.

One of my co-workers was wearing a mask, and nobody else was really wearing masks. It was sort of an optional thing. If you wanted to, you could, but they weren’t really distributing them. Some people started wearing them and literally one of the guys whose family owned the company was in the hallway in front of everybody else saying: “Why are you even wearing that? It’s not going to help anyway.”

Everybody’s scared. They’re talking of shutting down the state, and then to just have that kind of attitude so openly, and to just call her out in the middle of the hallway where everybody else could hear—that was the first time that I thought this is not going right.

We tried to voice concerns: “Why aren’t we tracking who’s going in and out of rooms? Why aren’t we limiting XYZ?” They were starting to talk about having us start going to some of the houses where some of our clients lived—and that would have exposed more people instead of less people.

It’s not like they were considering precautions beyond the economic price of taking those precautions. That just did not sit right with me from the beginning: They were going to expose us and expose the clients to continue to make money.

Everybody was very, very concerned. We were immediately considered essential workers. We were given a letter to carry with us in the car in case we were pulled over so that we could show that we were essential workers.

Anytime we voiced concerns about how things were being handled, we were told: “Just be happy you have a job. Everybody else is losing their job, just be happy you have a job.” But in our minds, we didn’t feel protected.

It was like it was a constant state of processing. You couldn’t catch up. You couldn’t catch your breath. You couldn’t feel like you had something under control, that you felt like you were facing the day prepared.

Instead, it always felt like, “What’s this new fresh hell I’m going to experience today? What am I not going to feel like I’m safe doing? What am I going to feel like I’m not safe for other people?”

I felt like I was potentially exposing other people. The clients essentially lived in this nursing home where they’re not going in and out of the building. But we were, and then anyone I had contact with outside of work.

My family—that was where I felt scared. Very scared.

I didn’t want to go to work. Every day felt like I was preparing for combat. Soon they started to institute the PPE. We started with a mask and an N95, and then we had to put a surgical mask over the N95 because the N95 is not supposed to be used repeatedly. So in order to keep it fresh and clean, we had to put the surgical mask over, and then we had a face shield over that, and then we had a gown added on top of that. It was so hot.

Every day you’re physically uncomfortable You’re doing a physical job rehabilitating people. I’m moving people, showering people, dressing people, changing people, transferring people, doing therapy.

But in addition, you’re doing other people’s jobs because other people started phoning it in or quitting, so then we all had to pick up the slack. So I was physically exhausted, mentally exhausted, and terrified all the time.

I felt like every day, I was failing someone, like I wasn’t meeting expectations. I wasn’t able to do my job. I was trying to do so many other people’s jobs just to care for these people who were trapped.

I felt like I was losing sight of what my job actually was. Eventually, once people started quitting, they needed us to pick up the slack and do extra work. But it was so mismanaged that the people who cared did the lion’s share of the work and just got so drained and exhausted, on top of already feeling disillusioned. Every day felt surreal, like you were in some kind of nightmare that was never going to end. And then they would have a meeting to discuss new cases and new protocols, and if people were going to and from the hospital, how they were going to deal with that. I just felt like I was in a nightmare.

Once things were starting to shut down, I started to be afraid. We pulled our kids from daycare, and the schools shut down. That was like: “Okay, the schools are shutting down, that’s a big sign that this is not going away anytime soon. And this is not good. This is a real serious problem.”

The tipping point for me was in the very beginning, before they instituted the PPE. I worked with a client without a mask in his room. This person had not been out of his room for months, because he’d been on bed rest. I ended up learning that within that week he died of COVID. This was in March, when people weren’t aware of how it spread so easily and that you could be a silent carrier. I was so terrified. And my employer told me, “You can just come back to work as long as you don’t have symptoms.”

I was appalled that they wouldn’t take it more seriously: quarantine the people who have been exposed to him without PPE; don’t bring those people back in to potentially expose it to other clients, very vulnerable people with tracheotomies, people on ventilators, and people whose health and immune systems were compromised. The bottom line wasn’t taking it more seriously and protecting people. The bottom line was, “How do we stay a viable business?”

After he died, I started calling everybody I could. I called the state health department, the county health department, I called my doctor. They all basically said the same thing: “Well, CDC guidelines say because you’re an essential worker, you can go back to work as long as you don’t have any symptoms.”

But that didn’t feel right to me. So I took the week off. Within the next day or two my youngest son, who’s 2, came down with a high fever and a headache and not feeling well. That’s when I started to really panic. I called his doctor and the health department again.

Nobody would test at that time. There was no testing available, so I just had to wait it out. Which was the scariest first 24 hours, and I wondered, “How is this going to go?”

They said it goes easily for children, and they get over it quickly. I started to backtrack in my mind: “Who did I have contact with? Who did I potentially have exposure to? Did I give this to my mother through some groceries I left on her porch? Did I give this to my aunt who is immunocompromised?”

I felt like I was the carrier because the kids hadn’t been out of the house for over two, three weeks at that point. So there was nobody going in and out of the house but me who had direct exposure to someone who died of COVID. I felt sheer panic. There were no answers.

Luckily the kids were OK, but both children ended up getting it. I don’t know if it was COVID because there were no tests available. But calling all these places they said to treat it as if it is, to quarantine them.

My employer was like, “Eh, come on back to work.”

That was when I realized it wasn’t about people, and they didn’t really care about their employees enough to handle this seriously. So that was the tipping point. And there was no recovery of trust after that.

I felt obligated to the people I worked with and the clients I served, to be there for them, and I felt obligated to my family to continue to provide an income. I was not given any option to get laid off, so if I was going to leave my job it was going to be that I quit. I started to feel like it was going to come to a boiling point. I was either going to have a breakdown at work and then not be able to recover from that and damage having a reference in the future. Or I was not going to be able to function anymore at home. I was going to continue to break down.

Everybody I was working with felt trapped and felt like they couldn’t leave their jobs. I was fortunate enough to go to my family and say: “I can’t handle this anymore. I don’t know what my options are. What if I quit? How will I be able to provide for my family? How will I be able to make the bills. If it comes to that point, will you help me?”

That was the first time I ever had to ask my family for money. I pride myself on being independent and being able to take care of myself and my family. So that was a really hard thing to do just for my own pride. But I had to. I had to know what my options were.

I never thought I would be in that position, especially because going into health care, everybody tells you: “Oh, that’s great. You know, you’ll get a job in no time—a secure job and you’ll never have to worry about being employed.”

I’ve been employed basically since I was 17. Being unemployed is new to me. And I wouldn’t have been able to take that leap without support from my family. That saddens me, too, because I know there are people trapped in really bad circumstances that they can’t leave because they don’t have the family support. I don’t regret leaving. I wish I would have been able to wait till I had another job lined up, but I wasn’t going to be able to function anymore.

It’s been my identity for the past 13 years. I’ve been an employee to this family-owned company, and they always talked about how it was one big family. They did do kind of special things for us. I felt for a long time that I was in this exceptional place that really cared about people. In the end, when push came to shove, it became not about that anymore. It just became about the money and the business, and that’s not why I went into health care.

I still am an occupational therapist, and I still have a license, and I’m going to go and continue to practice. But I do feel like a big part of my life is over. It’s sort of an identity crisis. Who am I now? I was grieving leaving the people I cared about, leaving clients I was dedicated to. I really cared about their progress and their rehabilitation, and that was just being pushed aside for the wrong reasons. In the end, I’m not going to die over my job. I’m not going to continue to risk my family for a job. You know, I had options, and other people don’t. And that’s very sad.

I worked as a circulation clerk at the front desk of a library, issuing library cards, checking items out for people. You see everybody who comes in the front door. It’s a very clean environment, bright, generally quiet—although, through the 18 years I worked there, it’s evolved more into a community center and less of a “shh, people are studying” kind of place.

It’s important to me to know the rules. I was always wanting to know what was expected of me, doing the best that I could, and wanting to act appropriately.

They shut down during the pandemic relatively quickly, around when everybody else did. As soon as it happened, and I was home, I started thinking, “What is it going to take for me to feel comfortable about going back?” Being over 60 years old and having high blood pressure, although I consider myself in relatively good health, I already had two risk factors. I was hoping that the library would just stay closed, for quite a while.

As it turns out, I believe we were the one of the first libraries in Suffolk County, New York, to decide to bring employees back—though at first we weren’t opening the library to outsiders, just employees.

When we reopened, we set up curbside. We had fewer employees, less supervision. We had sanitizer, gloves. Generally, people were keeping their distance. But there were some employees who were not wearing their masks properly. I was vocal about that, saying, “Hey, you don’t have your mask on.” I’m not shy. I never cared about not speaking up to protect myself.

Before going back, we had a departmental video chat with our supervisor and the two people in administration who run the library. I probably was the only one asking questions about air circulation. I had spent time preparing for this phone call. I had reviewed CDC guidelines. I guess I did feel a little bit like Erin Brockovich, fighting for some of our rights. I got the feeling that they pretty much tolerated my behavior rather than being thrilled about it.

In that meeting, the director of the library said a number of times, “We know a number of you are not going to be comfortable coming back and we expect that.” It seemed odd to hear that over and over—almost made me feel like she was looking for some people to not come back. There was not a lot of, “We’re going to make sure that you are safe.” She actually said specifically, “You signed up for this.” That made the hair on the back of my neck go up, because anybody who works with the public did not sign up for being exposed to pandemic germs. Was the potential always there? Yes. But when was the last pandemic? Nobody ever had that in their psyche, that that was possible.

Then they made the decision that they were going to allow the public indoors. We got a very short memo that said: “This is how it’s gonna be. We’re gonna put up signs that say people need to wear masks. If someone doesn’t come in with a mask, do not be confrontational. If people decide to invade each other’s space or get too close to each other, that’s something that they’ll work out among themselves. We’re not going to get involved.”

A lot of that made me very uncomfortable. I know from the public that I work with, some are rule followers and some are not. I was concerned about who was going to be dealing with the people who were not following the rules. I had a bunch of questions, but I had no supervisor who was physically there to ask. And then I saw that on the second day of opening to the public, I was the only one who was going to be in the department. I made a call to my supervisor—didn’t get an answer. I went into the director’s office and I said, “It looks like I was scheduled alone on Tuesday morning.”

She pretty much blew me off. She said, “You need to speak with your supervisor.” I said, “I don’t see her anymore.” She put her hand up into the air to the side, and she goes, “It’s only a soft opening.”

I felt completely disrespected. To be honest, once the director of the library dismissed my concerns and didn’t seem open to wanting to discuss any other issues, I shut down. That night I cleaned out my locker of 18 years.

I wasn’t looking to say “fuck you” to them, but I wasn’t going to let them dismiss my concerns. I was privileged enough to be able to leave. I know a lot of people are not able to do that. A lot of people have to show up at jobs, because if they don’t show up at those jobs, they’re not going to be able to pay their rent. And yet they’re living in states where the governors are not mandating masks. And we have a president who doesn’t have a plan. It makes me sad, because I know a lot of people died because they’ve had to work. I have no complaints about what I went through. I know that I was very lucky to have this choice to work or not.

A lifetime ago (April), Mother Jones marked the first 100 days of America’s coronavirus crisis with a detailed timeline of the presidential chaos and incompetence that led to it. There were striking policy failures, moments of bizarre self-congratulation and deflection, and, of course, golf days. Deaths, then, numbered around 57,000.

What we didn’t have then, but do now, is insight into Trump’s motivations. In making the video that accompanied the investigation, I picked apart hours of Trumpian word salad, navigated through his mind-puddles, and uncovered hyperbole, fake science, disinformation, and denial. But was this all to save his skin? To sow chaos and avert blame? Maybe the know-nothing president really did know nothing? I figured “all of the above.”

Rewatching this video now (above), 160 days and more than 130,000 deaths later, is chilling for new reasons. Now we know Trump knew and understood the severity of the disease (“this is deadly stuff”), and its basic mechanism for transmission, before repeatedly assuring the public “it will disappear”. We know this because on February 7, Trump told journalist Bob Woodward that the coronavirus was “more deadly than even your strenuous flus.” Just three days later, the president told a rally in Manchester, New Hampshire, that “by April, you know, in theory, when it gets a little warmer, it miraculously goes away.” At a White House press briefing at the end of that month, Trump lied: “It’s a little like the regular flu.”

Trump’s fan club will find ways to help him wiggle out of his responsibility: It’s just how he talks… He didn’t want people to panic. But watching this video again, it’s hard to ignore the evidence that Trump’s denials were deliberate, and deadly.

Rewatch the video above, or check out our detailed timeline.

As President Trump downplayed the threat of the coronavirus in public earlier this year and offered a string of false and misleading claims, privately, he was telling a very different story. The virus, he acknowledged in a February phone call with journalist Bob Woodward, was actually “more deadly than your strenuous flus” and was “deadly stuff.”

That didn’t stop Trump from suggesting on Twitter that COVID-19 was less dangerous than the flu:

So last year 37,000 Americans died from the common Flu. It averages between 27,000 and 70,000 per year. Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!

— Donald J. Trump (@realDonaldTrump) March 9, 2020

In another phone conversation, Trump admitted to deliberately misleading the public about the virus. “I wanted to always play it down,” Trump told Woodward on March 19. “I still like playing it down because I don’t want to create a panic.”

Those are the newest revelations from Woodward’s forthcoming book, Rage, which, according to reports, also alleges that former Defense Secretary James Mattis warned that it might be necessary for senior administration officials to take “collective action” against Trump. That nugget is likely to enrage Trump, particularly amid the backlash prompted by an Atlantic report that he called American soldiers killed in combat “losers.”

But while Trump might work to push back against the comments attributed to Mattis, he’ll have a more difficult time denying his own remarks about the pandemic. After all, during a March 31 press briefing, he all but admitted to lying about the threat of the coronavirus:

“I want to give people a feeling of hope. I could be very negative. I could say ‘wait a minute, those numbers are terrible. This is going to be horrible,'” he said. “Well, this is really easy to be negative about, but I want to give people hope, too. You know, I’m a cheerleader for the country.”

Acosta pressed him: “So you knew it was going to be this severe when you were saying this was under control?”

Basically, yes, Trump responded: “I thought it could be. I knew everything. I knew it could be horrible, and I knew it could be maybe good. Don’t forget, at that time, people didn’t know that much about it, even the experts. We were talking about it. We didn’t know where it was going. We saw China but that was it. Maybe it would have stopped at China.”

This is President Trump on tape, on February 7, saying that the coronavirus is "more deadly than your – you know, your, even your strenuous flus." But he minimized the threat in public. On February 26, he told the public "I think that’s a problem that’s going to go away." pic.twitter.com/TOHTpqYtvZ

— Brian Stelter (@brianstelter) September 9, 2020

Trump tells Woodward he played down the threat of the coronavirus.
"I wanted to always play it down. I still like playing it down because I don't want to create a panic."

He also tells Woodward that "plenty of young people" are vulnerable — different from his public message pic.twitter.com/fJZUZtJTIv

— Manu Raju (@mkraju) September 9, 2020

 

This story was published originally by ProPublica, a nonprofit newsroom that investigates abuses of power. Sign up for ProPublica’s Big Story newsletter to receive stories like this one in your inbox as soon as they are published.

When Dr. Zachary Sussman went to Physicians Premier ER in Austin for a COVID-19 antibody test, he assumed he would get a freebie because he was a doctor for the chain. Instead, the free-standing emergency room charged his insurance company an astonishing $10,984 for the visit—and got paid every penny, with no pushback.

The bill left him so dismayed he quit his job. And now, after ProPublica’s questions, the parent company of his insurer said the case is being investigated and could lead to repayment or a referral to law enforcement.

The case is the latest to show how providers have sometimes charged exorbitant prices for visits for simple and inexpensive COVID-19 tests. ProPublica recently reported how a $175 COVID-19 test resulted in charges of $2,479 at a different free-standing ER in Texas. In that situation, the health plan said the payment for the visit would be reduced and the facility said the family would not receive a bill. In Sussman’s case, the insurer paid it all. But those dollars come from people who pay insurance premiums, and health experts say high prices are a major reason why Americans pay so much for health care.

Sussman, a 44-year-old pathologist, was working under contract as a part-time medical director at four of Physicians Premier’s other locations. He said he made $4,000 a month to oversee the antibody tests, which can detect signs of a previous COVID-19 infection. It was a temporary position holding him over between hospital gigs in Austin and New Mexico, where he now lives and works.

In May, before visiting his family in Scottsdale, Arizona, Sussman wanted the test because he had recently had a headache, which can be a symptom of COVID-19. He decided to go to one of his own company’s locations because he was curious to see how the process played out from a patient’s point of view. He knew the materials for each antibody test only amounted to about $8, and it gets read on the spot—similar to an at-home pregnancy test.

He could even do the reading himself. So he assumed Physicians Premier would comp him and administer it on the house. But the staff went ahead and took down his insurance details, while promising him he would not be responsible for any portion of the bill. He had a short-term plan through Golden Rule Insurance Company, which is owned by UnitedHealthcare, the largest insurer in the country. (The insurance was not provided through his work.)

During the brief visit, Sussman said he chatted with the emergency room doctor, whom he didn’t know. He said there was no physical examination. “Never laid a hand on me,” he said. His vitals were checked and his blood was drawn. He tested negative. He said the whole encounter took about 30 minutes.

About a month later, Golden Rule sent Sussman his explanation of benefits for the physician portion of the bill. The charges came to $2,100. Sussman was surprised by the expense but he said he was familiar with the Physicians Premier high-dollar business model, in which the convenience of a free-standing ER with no wait comes at a cost.

“It may as well say Gucci on the outside,” he said of the facility. Physicians Premier says on its website that it bills private insurance plans, but that it is out-of-network with them, meaning it does not have agreed-upon prices. That often leads to higher charges, which then get negotiated down by the insurers, or result in medical bills getting passed on to patients.

Sussman felt more puzzled to see the insurance document say, “Payable at: 100%.” So apparently Golden Rule hadn’t fought for a better deal and had paid more than two grand for a quick, walk-in visit for a test. He was happy not to get hit with a bill, but it also didn’t feel right.

He said he let the issue slide until a few weeks later when a second explanation of benefits arrived from Golden Rule, for the Physicians Premier facility charges. This time, an entity listed as USA Emergency sought $8,884.16. Again, the insurer said, “Payable at: 100%.”

USA Emergency Centers says on its website that it licenses the Physicians Premier ER name for some of its locations.

Now Sussman said he felt spooked. He knew Physicians Premier provided top-notch care and testing on the medical side of things. But somehow his employer had charged his health plan $10,984.16 for a quick visit for a COVID-19 test. And even more troubling to Sussman: Golden Rule paid the whole thing.

Sussman was so shaken he resigned. “I have decided I can no longer ethically provide Medical directorship services to the company,” he wrote in his July 13 resignation email. “If not outright fraudulent, these charges are at least exorbitant and seek to take advantage of payers in the midst of the COVID19 pandemic.”

Sussman agreed to waive his patient privacy so officials from the company could speak to ProPublica. USA Emergency Centers declined interview requests and provided a statement, saying “the allegations are false,” though it did not say which ones.

The statement also said the company “takes all complaints seriously and will continue to work directly with patients to resolve issues pertaining to their emergency room care or bill. …The allegations received pertain to a former contracted employee, and we cannot provide details or further comment at this time.”

Physicians Premier advertises itself as a COVID-19 testing facility on its website, with “results in an hour.” According to the claims submitted by Physicians Premier to Golden Rule, obtained by Sussman, the physician fee and facility fees were coded as emergency room visits of moderate complexity. That would mean his visit included an expanded, problem-focused history and examination. But Sussman said the staff only took down a cursory medical history that took a few minutes related to his possible exposure to COVID-19. And he said no one examined him.

The claims also included codes for a nasal swab coronavirus test. But that test was not performed, Sussman said. The physician’s orders documented in the facility’s medical record also do not mention the nasal swab test. Those charges came to $4,989.

The claims show two charges totaling $1,600 for the antibody test Sussman received. In a spreadsheet available on its website on Friday, Physicians Premier lists a price of $75 for the antibody test.

For comparison, Medicare lists its payment at $42.13 for COVID-19 antibody tests. That’s because Medicare, the government’s insurance plan for the disabled and people over 65, sets prices.

Complicating matters, Texas is the nation’s epicenter for free-standing emergency rooms that are not connected to hospitals. Vivian Ho, an economist at Rice University who studies the facilities, said their business model is based on “trying to mislead the consumer.” They set up in locations where a high proportion of people have health insurance, but they don’t have contracted rates with the insurers, Ho said. They are designed to look like lower-priced urgent care centers or walk-in clinics, Ho said, but charge much higher emergency room rates. (The centers have defended their practices, saying that they clearly identify as emergency rooms and are equipped to handle serious emergencies, and that patients value the convenience.)

The day after he resigned, Sussman texted an acquaintance who works as a doctor at Physicians Premier. The acquaintance said the facility typically only collects a small percentage of what gets billed. “I just don’t want to be part of the game,” Sussman texted to him.

Shelley Safian, a Florida health care coding expert who has written four books on medical coding, reviewed Sussman’s medical records and claims at ProPublica’s request. The records do not document a case of a complex patient that would justify the bills used to code the patient visit, she said. For example, the chief complaint is listed as: “A generic problem (COVID TESTING).” Under “final acuity,” the medical record says, “less urgent.” Under the medical history it says, “NO SYMPTOMS.”

Safian described the charges as “obscene” and said she was shocked the insurer paid them in full. “This is the exact opposite of an employee discount,” she said. “Obviously nobody is minding the store.”

Congress opened the door to profiteering during the pandemic when it passed the CARES Act. The legislation, signed into law in March, says health insurers must pay for out-of-network testing at the cash price a facility posts on its website, or less. But there may be other charges associated with the tests, and insurers generally have tried to avoid making patients pay any portion of costs related to COVID-19 testing or treatment.

The charges for Sussman’s COVID-19 test visit are “ridiculous,” said Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit organization that studies health care prices. Brennan wondered whether the CARES Act has made insurers feel legally obligated to cover COVID-19 costs. He called it “well intentioned” public policy that allows for “unscrupulous behavior” by some providers. “Insurance companies and patients are reliant on the good will and honesty of providers,” Brennan said. “But this whole pandemic, combined with the CARES Act provision, seems designed for unscrupulous medical providers to exploit.”

It’s illegal for medical providers to charge for services they did not provide. But ProPublica has previously reported how little insurers, including UnitedHealthcare, do to prevent fraud in their commercial health plans, even though experts estimate it consumes about 10% of all health care costs. For-profit insurance companies don’t want to spend the time and money it takes to hold fraudulent medical providers accountable, former fraud investigators have told ProPublica. Also, the insurance companies want to keep providers in their networks, so they easily cave.

In mid-July, Sussman used the messenger system on Golden Rule’s website to report his concerns about the case. Short-term health plans are typically less expensive because they offer less comprehensive coverage. Sussman said he appreciated that his plan covered the charges, and felt compelled to tell the company what had happened.

That led to a phone conversation with a fraud investigator. They went line by line through the charges and Sussman told him many of the services had not been provided. “His attitude was kind of passive,” Sussman said of the fraud investigator. “There was no indignation. He took in stride, like, ‘Yep, that’s what happens.’” The investigator said he would escalate the case and see if the facility had submitted any other suspect claims. But Sussman never heard back.

Maria Gordon-Shydlo, a spokeswoman for UnitedHealthcare, which owns Golden Rule, would not provide anyone to be interviewed. She said in an emailed statement that the company’s first priority during the pandemic “has been to ensure our members get the care they need and are not billed for COVID testing and treatment. Unfortunately, there are some providers who are trying to take advantage of this and are inappropriately or even fraudulently billing.”

“Golden Rule has put processes in place to address excessive COVID-related billing,” the statement said. “We are currently investigating this matter and, if appropriate, will seek to recoup any overpayment and potentially refer this case to law enforcement.”

Golden Rule’s 100% payment of the charges may simply come down to “incompetence,” said Dr. Eric Bricker, a Texas internist who spent years running a company that advised employers who self-fund their insurance. Insurance companies auto-adjudicate millions of claims on software that may be decades old, said Bricker, who produces videos to help consumers and employers understand health care. If bills are under a certain threshold, like $15,000, they may sail through and get paid without a second look, he said.

UnitedHealth Group reported net earnings of $6.6 billion in the second quarter of 2020. Bricker said the company may be paying bills without questioning them because it doesn’t “want to create any noise” by saying no at a time its own earnings are so high, Bricker said.

Texas has a consumer protection law that’s designed to prevent businesses from exploiting the public during a disaster. The attorney general’s office has received and processed 52 complaints about health care businesses and billing or price gouging related to the pandemic, a spokeswoman from the office said in an email. The agency does not comment on the existence of any investigations, but has not filed any cases related to overpriced COVID-19 tests.

Sussman said he got one voicemail from a billing person at Physicians Premier, saying she wanted to explain the charges, but he did not call back. He said he spoke out about it to ProPublica because he opposes Medicare-for-all health care reform proposals. Bad actors in the profession could cause doctors to lose their privilege to bill and be reimbursed independently, he said. Most physicians are fair with their billing, or even conservative, he said. “If instances like these go unchecked it will provide more ammo for advocates of a single-payer system.”

The inevitable fallout from last month’s Sturgis Motorcycle Rally, an annual event that packed nearly 500,000 people into a small town in South Dakota, is becoming clear, and the emerging picture is grim. 

According to a new study, which tracked anonymized cellphone data from the rally, over 250,000 coronavirus cases have now been tied to the 10-day event, one of the largest to be held since the start of the pandemic. It drew motorcycle enthusiasts from around the country, many of whom were seen without face coverings inside crowded bars, restaurants, and other indoor establishments. 

The explosion in cases, the study from the Germany-based IZA Institute of Labor Economics finds, is expected to reach $12 billion in public health costs.

“The Sturgis Motorcycle Rally represents a situation where many of the ‘worst-case scenarios’ for super-spreading occurred simultaneously,” the researchers wrote, “the event was prolonged, included individuals packed closely together, involved a large out-of-town population, and had low compliance with recommended infection countermeasures such as the use of masks.” 

The conclusion, while staggering, is unlikely to surprise public health officials who warned that proceeding with the rally could be disastrous, particularly given the region’s relaxed attitude towards social distancing guidelines and some of the attendees’ mockery of the pandemic. “Screw COVID. I went to Sturgis,” read one t-shirt from the rally, where overwhelming support for President Trump was the norm. 

The study comes on the heels of the first reported death from the event, a Minnesota man in his 60’s who attended the rally who died last week. South Dakota now has one of the country’s highest rates of coronavirus cases. 

The decision to re-open college campuses has been among the most contested battles in how to properly manage the coronavirus pandemic. Weeks into the fall semester, it’s becoming clearer by the day that schools are not equipped to properly manage the pandemic. Hundreds of students have tested positive since returning to campus, and now many schools are backtracking by sending students home to continue classes virtually.

At the University of Alabama, 1,200 of the school’s 38,500 undergraduates have tested positive. The University of South Carolina’s positive test rate is more than 27 percent, according to Bloomberg. Temple University, Colorado College, the University of North Carolina, and the State University of Oneonta in upstate New York have all already sent students back home.

It’s not hard to explain why containing outbreaks on college campuses is so difficult. While most schools have prohibited large parties, it’s college, and communal experiences like college football games and dorm living are still underway. Unfortunately, despite all the good intentions for social distancing, the responsibility has been put on students, instead of the institutions, and that means students are essentially being set up to fail. “The irresponsible and downright dangerous actions of a small number of our students have created the very real possibility of ending an in-person semester,” Chancellor Robert Jones from the University of Illinois in Urbana-Champaign, said in a statement. More than 100 students and organizations at the school have been disciplined for ignoring quarantine guidance. Now, according to the News Gazette “campustown becomes a ghost town as UI student lockdown begins.” 

Of course, all of this was predictable from the outset. My colleague Molly Schwartz spoke to one college administrator back and July, who said this:

We know our students want to come back to campus. This is not the college experience that they signed up for. But we have to be concerned with health and safety. When you think about reopening an overwhelmingly residential campus, and look at the social distancing requirements that are in place, and the recommendations for testing—it’s complicated. Many of our residence halls are over 50 years old, and they were built at a time when there was an emphasis on communal living. You had a roommate, you shared a bathroom, you share a living space, and all of that flies in the face of what’s appropriate in a COVID-19 environment.

That school reopened for the semester, and spikes in positive coronavirus tests have already been reported. “We must not relax the universal precautions that we know keep our community safe,” one dean wrote to UCONN students before long Labor Day weekend. “Wear a mask, stay with your family unit, maintain physical distance, and remain on campus this weekend.”

An occasional series about stuff that’s getting us through a pandemic. More here.

I have a theory that all female group chats end up in the same conversation: planning a commune.

I’ve seen it start a number of ways. A photo of the extravagant meal one of us cooked leads to a spoken desire to host a dinner party with everyone. On a Zoom hangout, someone expresses a wish to do an activity (tie-dyeing, for example) as a group. The need to share frustration—after putting up a heavy shelf or unpacking from a move, or getting comfortable riding a bike in a city again—becomes a call for help, and one of us wonders if we can just go through it all together.

From there it morphs into plans for vacation, and someone searches for a house to rent. Then we wonder how long we can take off from work (from our partners, our pets). We wonder if we can extend our time together by working remotely. It devolves into a realization: We can just bring our entire lives.

By the time you’re on the Instagram account Cheap Old Houses—and telling everyone that buying a place in Dixfield, Maine, and jointly living there for 10 years would probably be the most logical way to handle taking off work—you know you’re in full-blown commune planning.

This group-living idea occurred to me before the pandemic, but as I’ve talked to far-flung friends in recent months, it’s become an obsession. It’s rare for our group to go more than a few days without poring over another abandoned beauty, another commune contender. We swoon over the Tudors, the midcenturies, the Victorians, commenting on which have south-facing windows or “good bones.” (We recently expanded to the Nordic version of Cheap Old Houses, and our dreams have gone abroad.)

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This wonderful cottage is the perfect 19th century haven for modern adventurers! This wooden holiday home was built on the shore of the Hitra island not far from wonderful Trondheim. The house sits on a 0.7 acre plot where you’ll also find an old barn-turned-guesthouse as well as a boathouse. The area has everything a family could be looking for and then some, from bathing places to amazing hiking trails and great fishing areas nearby! #explorehitra

A post shared by Cheap Nordic Houses (@cheapnordichouses) on Jun 2, 2020 at 9:54am PDT

We scheme in earnest. We discuss who gets which room, where to put the library, how to assign cooking responsibilities, what we’d name the chickens, whether to have goats or llamas (or both!). We workshop the best use for the property. A bed and breakfast? Animal sanctuary? Organic farm? Goat yoga and writer’s retreat?! We’ve even named the future utopia: “the cry-mmune.”

For the seven of us—millennials who graduated into a housing crisis, recession, and devastating job market—these ramshackle gems often feel like the only homeownership within our reach. If it’s all impossible, why fantasize about a garden in the nation’s most expensive cities (where we live) when you can imagine a whole botanical estate somewhere else?

And yet I can’t help but laugh that this deep desire as an adult echoes a life I have, in many ways, already lived. It’s an appeal to my childhood.

In his late 30s my father wanted a more pastoral life for us. My parents traded in our stylish suburban home for a 150-year-old farm and moved my siblings, on Christmas Eve, to 10 acres in the middle of nowhere Wisconsin. We spent countless hours and trips to Menards over the next few years fixing up the property. The list of projects seemed endless. The setbacks—a crumbling foundation, a basement teeming with water damage, the occasional bat that escaped the attic—were daunting. But when everything was said and done, we had a home. There was a plentiful summer garden, a small apple orchard, and over a dozen llamas. We were #cottagecore before hashtags were a thing.

When I reached my teens, I wanted nothing more than to escape that life. The idea of moving to a big city is what sustained me through the hard high school years. It took me a long time to realize that my motivation was to exit not the lifestyle, but the loneliness. There wasn’t much for community nearby, and our closest neighbors lived more than a mile away. We had a home, sure, but no one else to share it with.

When a Reddit post made its way around the Twittersphere recently—wherein a single woman in her 40s had bought a home next to her two best single friends—I saw kinship and a new kind of future. The group knocked down the fences between their homes and turned it into a shared courtyard with a communal garden. Her married friends chastised her for putting those friendships above others; the author explained she considered those single friends her family, her life partners. As a single 30-something with no end in sight, nothing in the past few months of lockdown has felt more relatable.

It’s never been more apparent that the people I care most about are the ones I live furthest from. Pandemics have a way of exposing the need for precisely what we’re missing: competent leadership, reliable health care, job security, and justice—but also community. What I wouldn’t give for a chance to be neighbors, to be in quarantine pods, to be building a community, with my best friends right now; to knock down the fences between our restored cottages and share a meal in our joint garden. My lack of home-repair knowledge, let alone access to power tools, does nothing to dissuade the ever-present yearning to spend my days steaming off tacky wallpaper or ripping up shag carpet to reveal the hardwood underneath. If we ever bought a house for such a project, I know that making it a home wouldn’t stop when the restoration was over.

Until then, I’ll make do with imagining our #cottagecore life in every decaying, distant home the algorithms continue to feed me. 

Images from left: Birmingham Museums Trust/Unsplash, Leslie Cross/Unsplash, Marina Reich/Unsplash, Dilyar, Garifullina/Unsplash, Rumman Amin/Unsplash, Heather Ford/Unsplash, Dusan Smetana/Unsplash

It’s hard to get through a day without hearing the word “pod.” We have work pods. Friend pods. School pods. Storage pods. Tripods. Espresso pods. Ear pods. Air pods. Podcasts.  

“Pod” is the word of the moment. It’s short, snappy, and packs a lot of meaning in a few letters: from the organic, adorable image of two peas in a pod to a frisky pod of dolphins. It also flicks at the space-age futurism of the pods in 2001: A Space Odyssey and Star Trek. “Podding” is the name of the game during the pandemic. We want to cluster and contain. Stay separate, but be together. Resist infection, but transcend inconveniences. 

But the “pod” phenomenon predates COVID-19. In many ways, pod is the defining word of the millennial era and the millennials who came of age during it. The iPod came out in 2000, disaggregating songs from their albums. In 2004, podcasts quickly followed suit, breaking down the publishing barriers of the radio spectrum. The detergent industry embraced all sorts of pods with Procter & Gamble introducing the Tide pod in 2012. Elon Musk is supposedly designing pods that will liberate people from airplane cabins, shooting us around the world at lightning speed. The word “pod” signals progress, innovation, choice…and the atomization of everything. 

Star Trek-style pod gliding at 700 miles/hr? count me in @elonmusk – https://t.co/DyKEvKjB44 via @business @danahull pic.twitter.com/eLvwzYEbQD

— Marie Mawad (@Marie_a_Paris) January 29, 2016

At the risk of sounding like a “Houllebecquian” critic of modernity, I can’t help but wonder if in the quest for ever more individualized options, we aren’t calculating the human cost. As Douglas Rushkoff explained in an article earlier this week, pods offer those with economic means a cocooned insularity. In today’s virus-riddled world, pods equal freedom, choice, and mobility. A pod is an escape hatch from society. But what if in a rush to avoid one kind of disaster, those who are podding off are courting a different kind of dystopian future—one that looks less like Pandemic and more like The Machine Stops. Don’t we really lose something when we don’t listen to a song in the context of its album? 

Life in 2020 is beginning to resemble one big choose-your-own-adventure game. The very millennial fast-casual restaurant where you can “build-your-own-bowl,” à la Chipotle or Sweetgreen, is extending into all aspects of our strange new existence. There’s a line of ingredients in front of us that can be combined in endless permutations and combinations—PPE, face masks, face shields, COVID tests, contact-tracing, social distancing, virtual learning, microschools, Zoom happy hours, Hinge dates in the park. The parameters are stark and the stakes are high. With the lack of coherent guidance and surrounded by failing systems, we’re splintering off to make our own pods of clarity. Schools are remote? Fine, we’ll pod up and make our own. Offices are closed? Fine, we’ll set up our own work-from-home spaces and carry on. Friends are potential disease vectors? Fine, we’ll elbow bump and dine in clusters with our closest ones, six feet apart from those other breathing petri dishes.

The allure of self-contained, autonomous clusters—a.k.a. “pods”—is powerful. They mirror the promise of decentralized techno-solutionism that many a Silicon Valley type has tried to foist upon us at every possible turn. Their COVID-era education efforts are no exception. Spearheaded initially by Silicon Valley investors and entrepreneurs, the “microschool” train took off with seed funding, parent-teacher matchmaking startups, and cringe-worthy ads for private nannies and tutors that have gone viral.

Top Silicon Valley investor Jason Calacanis epitomized this idea of the pod parent when he sent a tweet in early August saying that he was “looking for the best 4-6th grade teacher in the Bay Area, “to teach “2-7 students in my back yard,” offering to pay that teacher more than their current salary, sweetening the deal with a $2,000 Uber Eats gift card referral fee. His tweet made news because it seemed to embody the caricature of a pod parent: the entitlement that his kids shouldn’t have to suffer through virtual school along with the plebs, the fact that he had the means to pay a teacher more than a school would, and the audacity to poach a great teacher from a school system where they would likely be changing more lives than those of the 2 to 7 students who could fit in Calacanis’ backyard “microschool.” 

Looking for the best 4-6th grade teacher in Bay Area who wants a 1-year contract, that will beat whatever they are getting paid, to teach 2-7 students in my back yard#microschool

If you know this teacher, refer them & we hire them, I will give you a $2k UberEats gift card

— jason@calacanis.com (@Jason) August 2, 2020

Well, I have news for you. There is a name for these school “pods.” It’s called homeschooling. I grew up with three siblings who were homeschooled and parents who were judged as being backward weirdos for making that decision: the language here matters. I can understand why certain parents might prefer to use the word “pod.” It doesn’t carry the same stigma of overprotective, anti-social, anti-science, religious zealots that I suspect one or two eager new pod parents might have projected onto homeschoolers in the past.

But from what I’ve read about pods, they operate almost exactly the same way that homeschooling has for a long time. “Pod” parents can make up their own curriculum. They can team up with other parents to participate in activities and classes together. They can hire private educators and tutors for certain specialized subjects. They can preserve the in-person, physical, experiential side of education that students are losing in virtual school. They can personalize school to the interests and learning styles of their children. This is homeschooling. Past studies have shown that homeschooling cuts across socio-economic divides. It remains to be seen whether school pods will do the same. 

Based on the exploding interest in homeschooling in recent weeks, the Executive Director of the National Home School Association, J. Allen Weston, estimates that the four million homeschooled K-12 students will increase to 10 million by the end of the 2020-2021 school year. Facebook groups for parents interested in podding up and homeschooling together have expanded rapidly. Alternative schools, like private schools with a focus on outdoor education, have also been seeing record enrollment numbers.

Search interest in Homeschooling is surging this summer in the US. #homeschooling https://t.co/HpW2e7JfCF pic.twitter.com/zyGKmfB5PW

— GoogleTrends (@GoogleTrends) July 23, 2020

The social dynamics in these somewhat anarchic pods are bound to get interesting. In the age of the coronavirus, asking someone to “join your pod,” be they friends, lovers, family, or neighbors, feels like a vulnerable and intimate question. It connotes that you value their friendship enough to risk disease, and trust them enough not to be promiscuous in their podventures. Extending that trust to fellow parents and running a school together? Should be next-level. Or perhaps it’s where it all begins. Meanwhile, I have single friends who are furiously trying to date (safely) and find a special someone to pod up with before the winter weather descends and we’re all stuck indoors with no more dining al fresco.

I was listening to a podcast the other day (I know). It was an interview with a woman who seemed to embody the entire paradox for me. She was in her mid-30s. She spent most of the podcast talking about her career trajectory, which involved jumping from job to job. She was pursuing her career dreams. The way she told the story, her agility and willingness to take risks led directly to the success and career fulfillment that she has achieved. But then, in the very same conversation, she talked about loneliness. How she feels lonely, how other people feel lonely, about how she’s setting up discussion groups to combat loneliness, and doing research into the severe mental health impacts of loneliness. 

The inherent contradiction slapped me across the earpods. The very mobility that made it possible for this woman to jump between careers is probably the same thing that’s making her feel lonely. It seemed so obvious to me because I can relate. I too have jumped around. In the ten years since graduating college, I’ve lived in eight cities across four countries, held at least eleven different jobs, and generally indulged my desire to forge my own path. At almost every juncture in my life, I’ve chosen change over stability. I’m not saying that this woman’s tradeoff wasn’t worth it—merely that the tradeoff exists. Mobility and rootedness sit at opposite sides of the spectrum. Like a see-saw, when one side goes up, the other must come down.

But anyway, this isn’t about my existential crises, though they are many and occasionally entertaining. We can add “pod” to the growing list of words that mean something a little different today than they did six months ago. And even with all the ways the word has become so ubiquitous as to lose some of its meaning, as an avowed podcast fanatic and the associate producer on the Mother Jones Podcast, I can attest that the age of the pod isn’t all bad. I will hop on a Zoom call with my edit pod on Thursday. I’ll keep calling our podcast team the “pod squad.” I even invited another friend to join my social pod this week (she said yes!). The word “pods” still has utility, even though, at this point, it seems as if it can be applied to absolutely anything. 

Kelsey Schwartz was a hyperactive kid, always running around and climbing on things. With strong internal cues telling her to move her body, there were times when, if she didn’t get enough exercise during the day, she would get a maddening urge to fidget her legs—a disorder known as “restless leg syndrome”—when trying to fall asleep at night. As a kid, the treatment she devised was to go outside and ride her Razor scooter in circles around the cul-de-sac out front, trying to tire her legs out so that she could fall asleep.

I remember looking out the window of my childhood bedroom and seeing Kelsey scootering in the dark, around and around and around. Because, you see, Kelsey is my little sister. I am four years older than she and wasn’t surprised when hyperactive little Kelsey grew into hyperactive big Kelsey and decided to pursue a career in occupational therapy. For the past five of her 27 years, Kelsey has been working with children with disabilities at clinics and camps. Now, she’s beginning her second and final year of her master’s degree in occupational therapy. 

The field Kelsey has chosen emerged from two 19th century movements: the Moral Treatment Movement, which pushed for more compassionate treatments for people with disabilities, and the Arts and Crafts Movement, which opposed industrialization and promoted the importance of people doing things with their hands. Occupational therapy methods became systematized and were first implemented on a broad scale after World War I when wounded and paralyzed veterans returned to the United States. The government funded holistic therapeutic exercises—like painting and woodworking—to help them rehabilitate at the Walter Reed National Military Medical Center in Washington, DC. Since then, occupational therapy (OT) has expanded to include treatments for just about anyone who requires some assistance with their activities of daily living, from kids with disabilities, to people rehabilitating from injuries, to elderly folks coping with dementia and hip replacements. “Doing stuff yourself is really important for our health,” Kelsey told me. “What we do is who we are.”

For the past two summers, Kelsey has been working as an aid at an adaptive camp in Maryland, a specialized program for kids with disabilities, operating within a standard-issue summer camp for “neurotypical” kids. Kids with disabilities and neurotypical kids are in the same groups and do the same activities, with the only difference that the kids with disabilities have aides, like Kelsey, to accompany them throughout the day.

But camp is just a brief respite from the challenges of the pandemic, which has disrupted therapy sessions for developmentally disabled kids. Occupational therapy involves lots of supervised movement, physical activity, and social interaction, so the transition to a socially-distant virtual environment during the pandemic has been tough. My sister and I sat down to talk about how her work at the adaptive camp, the ways the profession is changing, and what she thinks the long-term impact of the coronavirus crisis on children’s development could be.

What would you consider some of the foundational things that you’re working on with kids? What are some of the core skills you focus on?

For kids, the main occupations are school, social participation, and play. Those are the three biggies. A lot of the kids are coming to occupational therapy for either fine motor issues, like handwriting, or for that social piece. A lot of my work at the camp is that social part of being a kid with disabilities and being integrated into a group of neurotypical kids. For many kids, just being a part of group and thinking about dynamics is a really challenging thing. 

Tell me a little bit more about the adaptive camp you work at? 

A lot of research has shown how beneficial outdoor activities are for kids–in motor development, social development, all those kinds of things. A big struggle that parents of kids with disabilities have had is with that [social] integration portion. A lot of how we learn is through observation. It’s important is to see other kids interact with each other, not just interacting with adults who are acting like they’re kids. Because kids, you know, they’re not perfect. They’re not going to say, “Oh, I lost, it’s okay.” That’s adults modeling how you should act. Most kids don’t really act that way. 

So we set up this new model where the kids who wanted to be part of the adaptive camp would sign up, and we try to find a place for everyone. That first year was a lot of trial and error. It’s hot. There’s a lot of exercise. Then you also have to be social with the rest of the group. There’s a lot of transition times in camps, in just getting a big group to do something. That would be difficult for a lot of the adaptive campers. Standing and mingling was really hard. We tried to find the best times to take breaks and figure out what activities worked best for certain adaptive campers.

About how many kids did you have signing up for the adaptive camp throughout the course of the summer?

There was a lot of interest, because it’s the only camp in this area where you can be included in a neurotypical group, but also have support and someone who’s there just for the kid. My technical role is as an adaptive aid, and I’d have either one kid or two kids per week. The first summer was maybe eight or ten kids. Last year was the second year we did it, and we hired three more aids for at least twice as many the kids. The first summer was pretty much all kids with autism. This year we’ve been getting some more kids with physical disabilities or intellectual disabilities. They’ve ranged in age from seven years old to 21. We do canoeing, paddle boarding, ropes course, hiking. They had a primitive skills day, like fire-building or shelter building. A water day was always good. Paddle boarding was always a big win. 

What has camp looked like this year?  

This summer camp isn’t running as usual because of COVID. You can sign up for either a morning or an afternoon and book a camp activity you want. It’s a maximum of six people per group and you have to bring your own group of people. People are coming within their own groups, so it’s not like people signing up and we assign them. For the adaptive kids we’ve had them bring their siblings, which is really cool. A lot of them are really excited to show off what they’ve been doing to their siblings.

What kind of feedback have you gotten from parents about what this camp does for their kids?

We’ve gotten a lot of positive feedback. We’ve had kids with a lot of aggression issues who’ve been kicked out of camp after camp. I think for those parents it’s really hard because their kids are just excluded a lot. Finding a place where their kids are welcome, and where they’re successful has been a big difference for parents who get nonstop negative feedback that their kid is disruptive or their kid is fighting. We’re not going to kick kids out for punching people. Sometimes that happens. I’ve been punched a couple times. We’re working through these issues instead of just sending the kids away. We’re working around what their strengths are and what their needs are.

A lot of schools are going to be virtual next year. What do you think that’s going to be like for parents of kids with disabilities? 

A lot of kids receive services through the school, like OT and speech [therapy]. That kind of stuff is in their IEPs [individualized education plan]. I’m not sure what’s going to happen with that. It’s obviously different school by school. I know in the spring, kids kind of stopped receiving those services. Telehealth is now a new thing that they’re trying to do.

How does OT telehealth compare to in-person OT?

I haven’t done it, but OT professionals have found it both challenging and exciting. When you provide therapy there’s a certain level of helping someone physically and emotionally, which is harder to do through telehealth. It’s harder to have that human connection. But they’re also able to treat more people through telehealth because you can meet with anyone, anywhere. They’ve been having issues making sure people have access to fast internet and computers. They use protected software that’s HIPPA compliant—you wouldn’t just meet via Zoom. For kids, sometimes the therapist will send them supplies, like putty, and the parents need to be more involved in sessions, which has been a positive and a negative. Parents are learning more about their kids’ OT, but it’s a bigger burden on them. There is also a lack of control with kids. When you’re on telehealth, you’re a little bit at the mercy of the kid. I’ve heard stories of people being mooned.

What do you think about kids being on screens all day?

I think we’re gonna find a lot more issues from sitting on the screen all day than people are ready for. I’ve heard kids saying, “My parents got me blue light glasses.” Or, “Now I sit on the physio ball instead of sitting in a chair.” They’re getting neck pain and back pain.  

Kids really aren’t made to be sedentary. Kids love to spin. They love the tire swings. It’s really good for development to get these experiences in when you’re a kid. And kids just aren’t getting as much of those experiences. In the most basic form, movement is good for kids. And when kids are on screens, they don’t really move. That’s just a fact.

You were telling me the other day something about couches …

It’s really common for people in their TV rooms to have those big sectional couches. Everyone has a spot on the sofa. In the ’60s and ’70s, people didn’t have big couches like that. Kids would either sit crisscross on the floor—and that’s your core strength is holding you up—or they’d be on their stomach with their arms down holding themselves up. They’re using their back muscles, they’re using their core muscles. So even kids getting seats on a couch is a big difference just in terms of what they have to do while they’re watching these screens.

You are also a student. How has the Coronavirus interrupted your school life? I know you mentioned that you were supposed to have a cadaver lab that was canceled.

In the spring everything went a little wild. We moved totally online, and quickly moved to telehealth for field work. I had “Neuromuscular Mechanisms,” which involves a cadaver lab, and the cadaver lab got moved online, which was really confusing. There’s a lot of websites you can use. They show you a 3D model of a limb and you can click on the nerves, the muscles, the blood vessels, the bones, and you can dissect it. You can click on the bicep muscle and then press hide, and the bicep disappears so you can see like the stuff underneath it. It’s different using a cadaver because in every person’s body there are abnormal things. In the simulation labs, the people are kind of perfect. It wasn’t the best replacement, but it got us through.

This fall is my “physical dysfunctions” semester where we learn about adult neurological and musculoskeletal conditions that result from things like strokes and brain injuries. We learn how to transfer people from a bed to a wheel chair and make plastic splints. A lot of things we’re doing have to be in-person. There’s going to be a couple days where we’ll have to be on campus. Before school starts, we have to get a coronavirus test. We’re going to have to record our temperature and our human contact every day. You have to fill out this whole thing. And then it’ll either approve you to be on campus or not approve you. They’re going to supply us with full PPE. We’re getting two sets of gowns. We’re getting face shields. They’re transforming buildings into study pods. I’m appreciative of the faculty in my program. It’s not ideal for anyone, but they’ve really been putting in a lot of effort. Pretty much all of them have taken courses over the summer on how to teach an online class.

Do you like your work and why?

I love it! You have to have a sense of humor if you’re going to work with kids with disabilities because otherwise you’re just gonna go crazy. But it’s so fun. Their point of view on life is so interesting. It’s interesting to think about the world in different ways and hear different perspectives. It’s also really rewarding. I found that most of the time, when I estimate what the kids will be able to do, they always end up being able to do more than I think they will. The limits that have been put on them are from the adults around them. For example, this one kid really wanted to do the zip line, but every time he was up there, he was freaking out. We were up there one time for an hour with him, and when he finally went it was a big moment. It’s just really rewarding watching kids take these huge steps and do something new. They usually end up being so proud of themselves. But it can be exhausting. There’s a lot of stuff that happens that you’re just like, oh my god, I need to go home and sleep.

This interview has been edited for clarity and length. 

An occasional series about stuff that’s getting us through a pandemic. More here.

On Friday evenings, after 9 p.m., I’m referred to strictly as Vernal Pool, the druid water genasi, by some old high school friends, and—for a few hours—everything makes sense. Challenges are straightforward and accomplished in tidy, three-hour blocks. Enemies are dealt damage and, eventually, perish. Surprises are choreographed. Randomness is present but bounded—nothing more than the probabilities suggested by a virtual 20-sided die.

In Dungeons & Dragons, everything pretty much goes as planned. 

In the real world, the pressing themes—pandemic, climate change, state-sanctioned brutality, the government’s emphatic disinterest in functioning properly—lend themselves to a darker, more surreal plot. It is serious. We’re holed up in our homes. The absence of bars, physical workspaces, and cheap baseball tickets from our lives creates a sense of confused inertia. Are we a tenth of the way through the pandemic or halfway? Are we actually getting anywhere, or are we stuck in the last season of Lost? There is endless horizon in every direction—we’re measuring our time in hair growth, if at all.

D&D, on the other hand, is full of clear lines and brighter absurdities. I’m on my 18th session; I live in a tower on the outskirts of a village called Goosetown. Like real life, much of what goes on isn’t scripted. But, unlike reality, it’s safely self-contained. In a session of D&D, the cocktail of youth nostalgia and fantasy otherworldliness could give rise to almost anything—as long as it abides by the game’s few rules. It isn’t the leap into unbounded fantasy that appeals; it’s the lines, the structure, the finitude (with a sort of community working within them).

I’m not the only one investing in imaginary feudal real estate. Twitter is awash with memes about the game. The /r/DnD subreddit has added half a million subscribers this year. It’s impossible to know the motivations of those people, but surely at least a few killed their plants and realized baking is hard. Before the pandemic, D&D might seem an escapist anachronism to outsiders: the cartoon fantasy box art, the 1970s nerd zeitgeist, the plot milestones important to no one but your group of dorks. You are in your friend’s basement—carpet shagged and air conditioned—collectively imagining a confrontation with a band of goblins or kobolds (goblins, but reptilian!).

But, in playing, I’ve found another side of D&D. Traditionally, we think of such games as a way to escape society into another universe. I was finding that it, actually, became a conduit back to a semi-normal life. The game provided the comfortingly rigid rules of a society, and the room to experiment, cooperate, and play with friends. It was drawing me into the “real world”—at least what it should be.

That was the intention. In 1974, when Gary Gygax and David Arneson created the first edition of Dungeons & Dragons it was part of a broader game revolution.

In the 1950s, wargames (which are what they sound like, strategy games that simulate warfare, putting players in control of armies destined to destroy each other, with an emphasis on realism) had dominated the board game industry. Companies had capitalized on the post–Word War II glamorization of the battlefield. The company Avalon Hill released the popular Gettysburg, which allows players to recreate the 1863 battle that was the turning point of the American Civil War. America—high on the sweet fumes of victory—enjoyed playing out its selective past to confirm a trajectory bending it toward a future that World War II had validated: status as the greatest country ever. 

Then, in the mid-1960s, two things happened. Gamers began to experiment with new structural elements (like narrative and playable nonmilitary characters) and add objectives beyond sheer brutal domination. And a counterculture obsessed with the future as a utopia emerged. The “opposition to the Vietnam War and militarism,” writes Texas State University professor Joseph Laycock in his 2015 book, Dangerous Games: What the Moral Panic Over Role-Playing Games Says About Play, Religion, and Imagined Worlds, “inspired interest in noncompetitive games.” The New Games Movement surfaced too. It brought outdoor games that “emphasized play for the sake of play” instead of winning. (One example: a tug-of-war-like game where players would switch teams when one side looked close to capitulating, to ensure the game could continue.) The same people questioning the government as war machine wondered why every fun activity had to be about violently opposition with your friends too.

In this milieu, war games evolved into “role-playing games.” Players would control single avatars rather than armies, work collaboratively rather than competitively, and put emphasis on storytelling rather than tactics.

Enthusiasts like to point out that titles within the new genre, including D&D, might not actually be games—but rituals. This distinction in the RPG world has been written about ad nauseam. But, with good reason. In the shift from wargames to RPGs, players began working together toward a common goal: kill the dragon, trick the wizard, complete the quest. According to French structural anthropologist Claude Lévi-Strauss, whose work is the basis for this argument, having a common goal is the threshold that moves an activity from game to ritual. He writes in his 1962 book, The Savage Mind:

Games thus appear to have a disjunctive effect: they end in the establishment of a difference between individual players or teams where originally there was no indication of inequality. And at the end of the game they are distinguished into winners and losers. Ritual, on the other hand, is the exact inverse; it conjoins, for it brings about a union (one might even say communion in this context) or in any case an organic relation between two initially separate groups.

Off this, writer Paul La Farge makes an interesting proposition in his excellent 2006 Believer essay, “Destroy All Monsters,” that D&D fulfilled its fundamentally hippie countercultural project: “Show people how to have a good time, a mind-blowing, life-changing, all-night-long good time, by cooperating with each other!” 

If the 1960s were spent fawning over a utopia peaking on the horizon, the 1970s were a painful reckoning with the fact that it was always just a fata morgana. In quick succession, the decade piled on assassinations, Nixon, the failed Vietnam misadventure, recession, and the inklings of a coming neoliberalism. For millions of people, the American superstructure long deemed reliable was swiftly proven to be vulnerable, even impotent. It’s difficult to say whether the greasy teens and college students playing D&D were acutely disillusioned with those things. Either way, in the shadow of the decade, their ranks grew. According to Laycock’s book, by 1979 there were an estimated 300,000 players.

That makes me wonder if, despite the clear and present threats, the appeal of D&D for my group isn’t far off from the appeal it had 40 years ago. It wasn’t just an escape from the rules of reality, but it offers a sense of security there are rules at all.

In D&D, the rulebook is present and accessible, and not waylaid by random forces beyond the circle of players poring over it. “The rules are guaranteed,” LaFarge writes, “unlike the implicit, arbitrary, and often malign rules that people live by in the actual world.”

When our band of “good guys who always win” was assembled in mid-March with a public Facebook post, I had no guardrails. Weekends had become a cavernous, daunting social void. Most of my roommates were waiting out the quarantine with their families.

Now, I know what to expect. It’s dumb. But also clear. Zooming people I haven’t spoken to in years, I know our attempt to heist a band of dwarves who run a criminal syndicate in the eclectic trade city of Keaton (a “patchwork quilt knitted by a dozen different people with very conflicting ideas about how the quilt ought to look” that the dungeon master imagined into existence like an hour before our meeting) has understandable steps. To infiltrate the criminal hideout, we’ll need shapeshifting and charm spells. Still, there’s mystery. Somehow, we created an intra-organization uprising along the way, before escaping with a pirate guide named Cid Citrus aboard our giant flying manta ray. It is as radically dorky as it sounds.

There are seven of us, a group of childhood friends I’d spent countless hours playing video games with, fueled by soda and sleepover energy. Before, we’d lost touch. Correspondence relaxed to belated birthday wishes or nostalgia-fueled (but fruitless) suggestions that we catch up. Nothing stuck. But for the last four months, we’ve been gathering with purpose: to accept quests and kill the undead and explore a world that Greg, our dungeon master, has created for us. It’s all familiar enough to bring childhood close, and new enough not to feel regressive. As we navigate this unambiguous world, our sessions don’t just advance the plot of D&D. Our conversations drift to how we’re managing the circumstances of the world, or little anecdotes on how we’ve spent the years apart. Better than hair growth, better than Twitter, that has become how I measure the passage of time.

For the first time in more than 30 years, Kellie Ray, who’s driven school buses in Kentucky, Tennessee, and now Alabama, is feeling the back-to-school blues. Usually, that’s not the case. “I love the kids,” she says with a laugh, “but not the pay.” She calls the middle school children on her route in Shelby County, Alabama, her “babies.”

When Alabama schools reopened last week, Ray saw how everything had changed. Her usual bus route once required picking up about 70 kids, but on her first day back at work, she only drove five. The district, which comprises 21,000 students, divided students into two groups. Those with last names beginning with A through J were going to have in-person instruction on Mondays and Tuesdays, and those whose last names began with K through Z were in classrooms Thursdays and Fridays. According to Ray, until nine days before school started, the plan was to send the entire student body back on the same days. Many families have simply decided to keep students home for completely remote learning.

Ray could see how months of quarantine and anxiety about the coronavirus had affected the children she transported. “They were scared. They didn’t know what to do,” Ray says. “You know how rambunctious they can be. They were all quiet.”

As the pandemic enters its sixth month in the United States, schools have had to grapple with the decision of whether to reopen physically. Many teachers have been outspoken about their concerns. “We don’t believe it is possible for schools to open on September 10,” said Michael Mulgrew, president of New York City’s 200,000-member United Federation of Teachers, in a press conference on Wednesday. “It might be one of the biggest debacles in the history of the city.” But teachers aren’t the only ones who are worried. Schools are complex systems and involve lots of support staff including sanitation workers, cooks, dishwashers, school nurses, and bus drivers. And according to Mark F. Cannizzaro, president of the city’s Council of School Supervisors and Administrators, “vital questions” remain unanswered as districts attempt to sketch out what schools will look like this fall.

One of those basic questions involves the logistics of safely transporting students from home to classroom and back. There are no universal or straightforward answers and lots of conflicting priorities: educating children, supporting school districts’ thousands of staff members, keeping everyone safe, and doing so in a way that doesn’t break budgets. “Even through a lot of adversity, we’re willing and able to go when the time comes,” says Amalgamated Transit Union Local 1181-1061 president Michael Cordiello, who represents about 8,000 school bus workers from various bus companies across New York City’s five boroughs. “After working out safety protocols, I have no doubt that we will rise to the occasion. But I do think time is wasting.”

Driving school buses may not seem like full-time employment; the weekly hours can range from 6 and 10 a.m. to drive children to school, then from 2 to 4:30 p.m. to get them home. Drivers are responsible not just for ferrying children from home to school, but also monitoring them on their trip. Of the 370,000 people employed as school bus drivers, according to AARP, more than 70 percent are older than 55. They’re essential parts of the educational infrastructure, but a disproportionate number of them are of an age that makes them more vulnerable to COVID-19. Through rain or snow or a pandemic, school bus drivers famously rise to the occasion. “Look, our drivers and attendants are professionals,” Cordiello says.

In red states like Georgia, schools have already reopened, with some districts making masks optional. At North Paulding High School, in the northwest corner of the state, where the policy on mask-wearing was a “personal choice,” an image for a hallway of crowded students—few masks in sight—went viral. According to BuzzFeed News, some students and faculty had tested positive before that picture was taken. In one suburban school district, just east of North Paulding, Vox reported that 80 reported cases within the first two weeks of school forced more than 1,100 students, faculty, and workers go to into quarantine.

With potential exposure from numerous children every day, time spent in constrained space, and the reluctance of some school administrations to enforce their own rules, bus drivers are in the intersection of many of the forces at play during the reopening debates. Administrators in Gwinnett County, northeast of Atlanta, announced its bus drivers would begin driving routes last Wednesday. Earlier in the week, a whistleblower email was set up by a state house representative, which revealed that the same administrators were pushing drivers to accept children whether or not they were wearing masks. According to Patch, a Gwinnett County bus driver wrote:

The GCPS Administration has informed us that at the end of August, it’s mandatory for all school bus drivers to transport students whether they have masks or not. We have families, small children, and underlying conditions as well. In addition, a large population of GCPS school bus drivers are over the age of 60, and are highly at risk. This is unacceptable for the GCPS Administration to treat school bus drivers as if we are expendable.

New York City schools are scheduled to reopen for partial in-person learning after Labor Day, with plans to send half the students to school on a given day, with every student coming into class three days a week. That’s a stark contrast from early April, when the pandemic was killing nearly 600 people on a daily basis. And though in many ways the city is a model for recovery, there are serious concerns over the consequences of bringing more than 1 million children back to class. Under normal circumstances, more than 150,000 of those kids rely on school buses.

Bus drivers, along with many other support staff and teachers, complain there is no clear and comprehensive plan. “Quite to the contrary,” says Cordiello, who represents about 8,000 school bus workers across the five boroughs. Negotiations between the city’s department of education and bus contractors whose workers Cordiello represents only began in the last week, and he says, “There has been no conversation up to this point with our union… They haven’t discussed anything with us.” Cordiello is concerned about starting a school year without having considerable safety protocols in place. After COVID-19 first appeared in the city in early March, public schools closed down for the year on 16th of the month. “In that short period of time, we lost 20 members [to COVID-19],” he said. “We’re going to proceed very cautiously.” According to an ATU spokesperson, the city Department of Education is negotiating with bus contractors, but there is no direct line of communication between the department and Local 1181. Instead, the spokesperson said, the Local is dealing directly with the contractors.

“We are in conversations with our labor partners to make sure that proper measures are in place to ensure safety for our drivers, attendants, and our students,” said Danielle Filson, deputy press secretary for the NYC Department of Education.

Come September, New York City buses will require masks, temperature checks, and windows opened for airflow. Students will be seated in every other row to ensure space between each other. Since, in Cordiello’s words, “School buses tend to feel like a test tube for germs,” transportation vehicles will be sanitized daily.

But suppose a child is running a temperature? “If that child is there, without a parent, what do we do?” asks John Costa, president of ATU International, which has more than 200,000 members across bus driving, train operating, baggage handling, and maintenance, including those at Local 1181-1061. “Do we stay there? Do we call another bus to come and take the rest of the children? Is the operator or company going to send somebody to stay with the child until a parent comes?”

The current plan is for buses to run their regular routes, but transport less than 25 percent of their maximum capacity. “A bus of 60 would have 13 to 15 children on it,”  Cordiello explains. “That’s as far as that goes.” Initially, bus service would only be offered to children with disabilities before expanding to general population. Theoretically, two buses would be required to cover a route that previously would have been served by only one, potentially adding many hundreds of school buses to the city’s streets.

The CARES Act, passed in late March, contained provisions to keep transportation infrastructure intact even as ridership plummeted, but school buses were not part of the program. Cordiello says that the CARES Act explicitly stated that “transportation for school busing should be continued to the ‘greatest extent practicable’—but those words don’t bind anybody to anything. What’s the greatest extent practicable?”

Though the act made funds available to pay contract workers, Cordiello says the city has turned that option down, while union members faced massive layoffs in the spring. Since May 1, when the city halted payments to school bus contractors, Cordiello describes vehicles sitting in depots, “where they haven’t been maintained, probably not even started,” while “drivers and attendants who’ve been sitting home for five months on unemployment with no medical benefits.” Meanwhile, the Coronavirus Economic Relief for Transportation Services (CERTS) Act, a bipartisan bill introduced in July that intended to pump $10 billion to transportation companies, including bus drivers, has stalled in Congress.

In contrast, Fontana Unified School District in San Bernardino, California, kept district staff members, including drivers, on the payroll through the end of the school year on May 28, even after the district shut down on March 13. That includes the 1,800 members of United Steelworks 8599. Some bus drivers in the district spent the summer delivering meals for a community lunch program—with a five percent pay bump through CARES funding. And thanks to a robust relationship with the school district, Dawn Dooley, president of USW-8599 says unions and schools have worked together since July to devise reopening plans culminating in a district-wide approach called “Navigating the New Normal.”

The result, Dooley says, is that “Fontana has taken the bull by the horns.” Protocols have been established for bus drivers to check temperatures before students climb on. If a student has a temperature above 100.4, a dispatcher brings them home. Like Shelby County, the district has set its sights on a hybrid system, bringing in half the students at time. Once at school, students walk through infrared sensors to check their temperatures again. School isn’t slated to begin until August 24, and students won’t be in classrooms until Fontana is off California’s pandemic watchlist—which gauges regions’ infection rates—for two weeks. Still, “it is very troubling” she says. “You just don’t know, but if you follow the rules, if you wear mask, wash hands, and be conscious of your surroundings, I think you’ll be okay through this.” After all, as Dooley observes, “This is the new normal.”

Back in Alabama, Ray, who knows people who have died from COVID-19, is having a hard time adjusting to the difference in her daily transactions with the kids. Instead of her usual morning smile—impossible behind a mask—she tries to compliment them and “put a smile in their face, something in their head.” But between her mask and face shield, the exchange doesn’t quite work. Plus, she says driving is uncomfortable in Alabama’s late summer heat, which may raise questions about the effectiveness of air circulation inside the bus. Despite it all, Ray tries to stay positive and upbeat for the children she ferries from home to school and back. But it’s hard to shake one uncomfortable feeling. “You know,” she said, “we’re dealing with the End Times.”

In many ways, Josie Martin-Knowles has had it good during the pandemic. She lives on a farm in rural Maryland. She has lots of room to run around outside. Plus, there are chickens and goats that she has to feed on the weekends. She has a little sister to play with. Her mom runs an outdoor adventure camp, that reopened this summer under the motto “sunshine and sanitize.” It had some restrictions, with smaller group sizes, regular COVD-19 screenings, no overnights or shared equipment. Still, Josie was able to spend a lot of her hot summer days out on the Potomac River, kayaking, or tubing, or paddling around on a standup paddle board with other kids. She just finished fourth grade at a small private school that is planning to have in-person instruction in the fall. On most mornings, she gets to eat her all-time favorite breakfast: waffles with “loads and loads of Nutella.”

But Josie, age 9, is also coping with the stressors of daily life during a pandemic. The coronavirus experience and the months-long quarantine has been difficult for everyone, but tough for kids in unique ways. There’s the boredom of being stuck inside the house with your family members day after day. There’s the frustration of being filled with energy but only having limited ways to expend it. There’s the way you process time slowly, making the future feel so far away. (After all, as a proportion of a 9 year-old’s life, six months is a lot.) There’s the fact that your sphere of influence, small to begin with, just got even smaller.

“It’s hard,” she told me one morning, as we stood on the bank of the Potomac River. The katydids were buzzing and a gaggle of geese were squawking. The humid air sat heavy around us. Josie was wearing a bright blue rash guard and board shorts, ready for another day out on the water. Since we were outside and socially distant, we had our masks pulled down. I was able to admire her braces, which were her favorite color of pink, though she also likes blue. Her hair was cropped at her shoulders and streaked with blond summer highlights. Josie is talkative and astute. I was curious if she had any advice for how kids can cope with life on lockdown. Here’s a little slice of life during the coronavirus, from the perspective of one girl on the cusp of her 10th birthday.

You can listen to an edited version of our conversation here:

On getting along with siblings: I have one sister. Her name is Katie, and she’s seven years old. We really like making forts with the couch. We play dress up in the basement, which is really fun. Katie has a very big Barbie house, and she really likes playing with the Barbies.

Since we’ve been together for so long, we’ve been getting in a lot of arguments. And it’s kind of hard now because you get into so many arguments. We fight about sharing a lot. If I touch her bed she gets mad, which is kind of hard because our beds are very close together. We share a room.

If you have any siblings, when you start having an argument I think you should just be like, “Okay, I’m gonna take a break because I don’t want to argue right now. And when I’ve calmed down, I’ll come back and talk to you about it. So we can resolve the problem and make it better.” Go and do something by yourself that calms you down.

That’s what I do with my sister. Like when I get mad at my sister, I make pom-poms. I have a lot of pom-poms around the place. When I’m feeling upset, it’ll make the argument bigger because I’m not calm. I need to have some “alone time” so that I can get my feelings together so that I can talk to calmly about it. 

I would recommend trying not to make your parents mad. When I did that, my parents got very mad because they were stressed about corona.

On the coronavirus: It can be very serious to some people who are over 70. We have to keep distance or wear masks when we’re nearer to people because we don’t want other people to get it, and we don’t want to spread it. We want to have it controllable so that we can keep going out again and have it not as a risk anymore. And make people feel better about it.

My grandpa’s turning 80 in two weeks and my grandma’s turning 70. They both live in England. I’m kind of sad because normally, we get to go over for their birthday and spend their birthdays there. My grandma and my grandpa and my dad’s birthday are all in the same week. So normally we would go over for their birthdays, and stay at my grandma’s house. But we can’t this summer because we’d have to quarantine for two weeks, and we’d miss their birthdays. 

I’m not really scared for them. My grandpa and my grandma are divorced. My grandpa lives by himself, and he has two cats. My aunt has a dog, and grandpa really likes the dog. So he’s been keeping the dog over the whole quarantine. Then he has an excuse to go and walk on the beach because he can go and walk the dog. 

On online school: I don’t really like doing the online school. Sometimes it was hard because we had to be on the screens a lot. Our school didn’t do any [online school] on Tuesday because we had “tech-free Tuesdays.” So it was fun. My mom did a little homeschooling with me. She did a lot of PDFs, and our teacher did too. It was kinda hard. And my family didn’t have very many computers because my mom had just broken hers. So my dad had to get his work computer. We used that. But luckily, we have computers in school, and our teacher sent home all of her computers so that we could use them at home. 

On a normal day-in-the-life during online school: If I had online school that day, our first meeting would be at eight o’clock. I would have to brush my teeth, eat breakfast, brush my hair, and get dressed. Normally I stay in my pajamas and just put a normal shirt on. Then I’d do some schoolwork, and then have lunch. (I like having lunch really early. At maybe like 10:30.) Then have another meeting after lunch, then do some more schoolwork. Sometimes we would do lunch meetings, and our teacher would read to us because we really like it when our teacher reads to us. Then I’d do more schoolwork. Normally we’d stop doing schoolwork at about 4:00. And then me and Katie would probably like play together or maybe watch the iPad for a little bit. Then have dinner and then get ready to go to bed.

On what online school is like for parents: I think it’s gonna be really hard because also if they’re working, they’re gonna need somebody to look after their kids, even though they’re gonna be having Zoom meetings and stuff. It will be a lot harder because they’ll have to get childcare. You still need someone to look after [the kids]. A girl in my class—her parents were still going to work—so she was staying at home by herself with her older brother and doing Zoom meetings all day. [The kids] at home will probably want things that they wouldn’t normally get on a school day.

On why it’s important for kids to go to school: You need education for a normal basis in life. If you want to get a good job, or a certain job, you need education. I think school is really important. I’m really happy that they’re letting [some] schools open up again.

On good books to read: I like Harry Potter and the Percy Jackson series. I like fantasy stories and mystery and sci-fi.

On whether she has any ideas about what her life will look like when she’s grown up: Nope. Not really. I don’t know. Just expect the best.

Researchers in Hong Kong say they’ve documented the “first case of reinfection of COVID-19,” according to a Monday press release. They report a 33-year-old man, who was first hospitalized in March, picked up the coronavirus a second time four-and-a-half months later.

But, experts say, the report is no reason to panic. At least not yet. It isn’t necessarily bad news! 

As scientists have pointed out, a possible reinfection isn’t that surprising. And, crucially, the second infection was reportedly less severe than the first in this case. This indicates that the patient was able to mount an immune response that protected him from getting seriously ill—a point that Yale University immunologist Akiko Iwasaki said on Twitter was “encouraging.”

“The second infection was completely asymptomatic—his immune response prevented the disease from getting worse,” Iwasaki, who was not involved with the research, told the New York Times. “It’s kind of a textbook example of how immunity should work.” She added on Twitter, “This is no cause for alarm.”

A first case of #COVID19 reinfection from HKU, with distinct virus genome sequences in 1st and 2nd infection (142 days apart). Kudos to the scientists for this study.

This is no cause for alarm – this is a textbook example of how immunity should work.

(1/n) https://t.co/oekESn0Uhq

— Prof. Akiko Iwasaki (@VirusesImmunity) August 24, 2020

This all more or less fits with what Stanley Perlman, a professor of microbiology and immunology, as well as pediatrics, at the University of Iowa Carver College of Medicine, told me last month—waning immunity, he said, falls in line with what we know about other coronaviruses:

While we don’t truly know what “normal” is with this particular coronavirus, Perlman says, “I think our experience with many, many respiratory viral infections shows that immunity doesn’t last that long. That’s why people get colds over and over again.”

For instance, with MERS, which is caused by another coronavirus, research done by Perlman and others shows that some people who had very mild cases never developed an antibody response. Other people’s antibodies faded after a few months. And some people with severe cases saw antibodies stick around for more than a year. …

“There are different amounts of waning and it’s probably what respiratory viruses always do,” he says. “So what this virus is doing doesn’t appear to me any different than what I would have expected based on what I know about MERS and what I know about the common cold coronaviruses.”

It’s important to note that while this singular case indicates a second COVID-19 infection is possible, it’s still unclear how common reinfection is among recovered patients.

What’s more, it’s also still unknown how long immunity achieved through vaccination would last—or how possible reinfection may impact vaccine effectiveness. As I wrote last month:

Some researchers have speculated that if antibodies diminish, protection from a vaccine may do the same. …

While it’s true that waning immunity—naturally or from a vaccine—isn’t ideal, Perlman says, remember that we don’t yet have a clear picture of how much antibodies fade. Just because immunity drops doesn’t mean it will go away entirely. Plus, our immune systems may respond differently to a vaccine versus a natural infection: “We’re pretty sure, at least based on other coronavirus infections, if a person has a severe infection, then their immunity won’t wane so much. If they have a mild infection, it might wane. We don’t know what a vaccine will do: Will it be more like a mild infection or a severe infection? And that’s really the critical question.”

And, of course, as researchers have noted, Monday’s report is a preliminary finding and it was published in a press release, prior to publication in the journal Clinical Infectious Diseases. As is often true in science, more research is necessary before we can make any solid conclusions about getting reinfected with COVID-19. As Iwasaki writes, “more studies are needed to understand the range of outcomes from reinfection.”

Read more from my conversation with Perlman here.

Two years ago, Catherine Poole and her family were living in the Atlanta-adjacent city of Decatur, Georgia. They had great friends and neighbors, but when they had a second child, their two-bedroom house began to feel small, so they put it on the market and began looking for a roomier place in the close-in suburbs. But after repeatedly getting outbid, they quickly discovered that the market was hotter than they had thought. They didn’t find anything in the nearest exurbs, either. “We got pushed out,” Poole remembers. “Every offer we made was outbid by a ton. It was insane.”

Finally, the realtor showed them a handsome house in Paulding County, an exurb community about 30 miles northwest of Atlanta. It was big enough, and the school system was well-rated. Poole had some misgivings: She didn’t love the suburban vibe, and the schools weren’t very diverse. Still, the space for the price was great, so they made an offer and moved in a few weeks later.

Things haven’t exactly gone as planned: As soon as she moved, Poole could tell her family didn’t fit in. The neighbors seemed horrified that she had lived in Atlanta—they thought her beloved city was dangerous and crowded. When the coronavirus pandemic arrived, things got worse. Poole was disturbed by Gov. Brian Kemp’s refusal to enact the most basic social-distancing ordinances, but her community seemed to cheer his decisions.

In early August, no sooner had schools reopened with in-person instruction when a back-to-school photo of a crowded hallway at North Paulding County high school went viral. The student who took the photo was suspended, then un-suspended a few days later. In the wake of the ordeal, at least 12 students tested positive for COVID-19 and the school had to close for a week.

But that wasn’t the end of the national attention focused on Poole’s new home. A widely circulated Facebook post showed Paulding County parents discouraging other parents from having their children tested for COVID-19:

A video of a school board meeting showed a school board member suggesting that schools have children change seats to skirt the CDC rule that people who have spent 15 minutes or more within 6 feet of someone with COVID-19 are considered close contacts:

Per the Georgia Department of Health, schools are required to classify anyone who has been within 6 feet of a covid victim for 15 mins or more as a close contact. Theresa Lyons, who sits on the Paulding County BOE, suggested students change seats every 14 mins to get around this. pic.twitter.com/TLRlTr8ua1

— 🇯🇲Black🇭🇹Aziz🇳🇬aNANsi🇹🇹 (@Freeyourmindkid) August 8, 2020

Meanwhile, parents in the county protested virtual learning, some of them espousing the QAnon conspiracy theory:

At least one Q-anon supporter showed up at the Paulding County Board of Education meeting to demand that schools remain open. pic.twitter.com/irP0plaBMf

— 🇯🇲Black🇭🇹Aziz🇳🇬aNANsi🇹🇹 (@Freeyourmindkid) August 11, 2020

For Poole, sentiments like these are chilling but unsurprising. Poole, whose name has been changed to protect her privacy, is relatively new to Paulding; she takes the pandemic seriously; and each new incident underscored the vast rift between her and her neighbors. Now, she and her husband are house-hunting again. I was curious about what it was like to live with two children in a place where the dominant values are so at odds with her own. In a phone call last weekend, Poole told me about her increasingly alienating experience of living in Paulding County.

On her neighbors’ perception of Atlanta: It’s been two years and this county still baffles me. When we first moved in, I met some neighbors. When we told them we moved from Atlanta, they said, “Oh, God, why would you live there? Thank God, you moved out here and got out of that mess, huh?” They see Atlanta as the big, scary city, with traffic, crime, and violence. Some other parents have said, thank God you got them out of that school system. We were in one of the best school systems in the state, but they have a stereotype of the inner city: that there’s a lack of education, that everyone’s just some vagrant. Honestly, I hate to say it because you know, we’re neighbors, but now I kind of try to avoid them. There are a couple of people who live in our neighborhood who I do get along with and are super nice and very friendly. But I still drive down to Atlanta to hang out with my real true friends.

On life in the pandemic: Starting in March, we were very secluded. My husband immediately started working from home. I was working at a restaurant, and I quit. The kids were home. We played in the front yard and the backyard, and that was it. Going off mostly Facebook posts of people I know, I could immediately tell their viewpoint on it. “Masks are for sheep and you’re gonna lose oxygen,” all that.

On social media in Paulding County: I’m on a bunch of Paulding County Facebook pages. There’s the official Paulding County Schools page, and then my daughter’s middle school page. And then there’s three or four other pages that I follow. One page is usually about local politics—people running for office. But when school was coming up, every day it was, “You can’t keep my kids home. This is all a hoax, and we’re going to keep kids home for nothing. It’s the flu!” And then there’s the “don’t worry, in November this will all disappear” posts. And “this is a liberal agenda to keep the kids out of school.” Some of these are crazy conspiracy theorists, so far out that they just don’t even make sense.

Also, I’m on the unofficial Paulding County schools page, which is mostly parents. I’d say about 98 percent of the posts are about how we have to return to school face to face. “Don’t you dare try and force my child to wear a mask. That’s my civil liberties. It’s infringing on my rights.” There was even one woman who said something like, “Masks terrify my child. If I send my child to school and his teacher is wearing a mask, he’s going to have PTSD for the rest of his life.” And people are agreeing. They’re going, “You’re absolutely right.” Every now and then there’s a single post like, “Hey, guys, really, what’s the big deal if we mandated masks, like what’s the biggest problem that would come from that?” And they get ripped apart. The tone has changed slightly since those photos came out of the school. “Let’s pray for our staff and students that they remain safe.” But that’s just some people. The overall consensus is still, “I’m not gonna wear a mask, and you’re an idiot for wearing a mask.”

On one of the pages, someone was making masks and said, “I can put anything you want on this mask.” His example was, “Stay six feet back.” And then another one had a smiley face. And people were laughing at it and going, “good job selling something that doesn’t work.” And then someone says, “Hey, would you print ‘this mask does absolutely nothing’ on a mask?” Then someone else said, “Will you make one that says ‘this is a hoax’”?

On parents discouraging other parents from having their kids tested for COVID-19: I saw that post. Basically, I think the woman was saying that her son’s bus buddy tested positive, and they said that either her son needed to quarantine or get a test. And it was just this rant of, “All we’re doing is increasing numbers and making our county look bad. The more cases that we have, the more that show up. They’re going to shut us down.” I think all they care about is that they don’t want these kids virtual.

On school before COVID-19: I really liked the middle school. I liked the teachers—they were very responsive. I would get an email that said my daughter failed a test. And then a couple of days later, I would get a phone call from the teacher just to check in and let us know why she failed. It wasn’t just one teacher, it was all them. Even when they had to go virtual starting in March, I was getting phone calls and emails every day. “How can I help you today to talk you through this virtual stuff?” I was really impressed.

In June or July, they sent out a survey for input on the 2021 school year. I would have wanted a hybrid option, maybe two days in, two days off. But there wasn’t an option for hybrid. It was, “How do you feel about sending your kids back to school?” And then, “If we offered a virtual option, would you take it? Yes or no?” Nothing about masks, nothing about social distancing, nothing about class sizes. That was all from the school board. I’m personally impressed with the middle school teachers, but I think the problem is the school board.

On her daughter’s impressions of what’s going on: I don’t think she really understands. She has asked, “Why is it so hard for people to wear masks?” I try not to be negative around my kids. I just say, “You know, because it’s a personal choice right now and some people choose to wear them and some people choose to not wear them.”

We went to go visit my parents, and we all got tested just to make sure that we were negative before we went up there. My daughter said, “Well, what if it was wrong? What if we’re sick and we don’t know it, and we get someone sick?” She’s very concerned about the health aspect of it, but she doesn’t know how it’s become politicized. She doesn’t really understand that.

On life going forward: I went from the shock and awe of moving here and thinking “Wow, these people are crazy” to “I can’t change these people.” I’ve become numb to it all. There’s really nothing personally I can do to change people’s minds. If we do interact with neighbors, it’s when they’re out cutting their grass or something and we’ll say, “Hey, how you doing?” and that’s pretty much it. We’re not going to restaurants. We just stay home. We’re doing what we have to do as a family to keep ourselves safe.

President Trump announced Sunday that the Food and Drug Administration has issued an emergency authorization for the use of convalescent plasma to treat COVID-19.

The emergency order, Trump said, will “dramatically increase access to this treatment.” While public health experts have said this treatment is a step in the right direction, clinical trials have not proved whether plasma treatments work.  

In early August, the Food and Drug Administration was about to issue an emergency authorization for the use of blood plasma for COVID-19, but as the New York Times reported, that was put on hold after a group of top federal health officials argued that the data on plasma treatments was too weak. Use of plasma to treat COVID is controversial in part because no randomized clinical trials, the gold standard in scientific evidence, have been completed assessing the treatment.

Meanwhile, nearly 100,000 Americans with coronavirus have undergone plasma therapy. “In my mind, treating 98,000 people with plasma and not having conclusive data if it worked is problematic,” John Beigel, the lead author on the study that resulted in remdesivir being approved for COVID treatment, told Wired. “We should have a more robust data set before we give 98,000 people a product.”

Yet Trump has questioned the motives of the FDA, politicizing the move to pause the emergency authorization of plasma therapy. Saturday morning, Trump tweeted that “the deep state, or whoever, over at the FDA is making it very difficult for drug companies to get people in order to test the vaccines and therapeutics,” he said. “Obviously, they are hoping to delay the answer until after November 3rd.”

The deep state, or whoever, over at the FDA is making it very difficult for drug companies to get people in order to test the vaccines and therapeutics. Obviously, they are hoping to delay the answer until after November 3rd. Must focus on speed, and saving lives! @SteveFDA

— Donald J. Trump (@realDonaldTrump) August 22, 2020

On Sunday, Trump called the FDA authorization a “historic breakthrough on the fight against the China virus,” adding that the treatment has shown to reduce mortality by 35 percent. Trump said the FDA made the independent determination that plasma therapy is “safe and very effective.”

Food and Drugs commissioner Stephen Hahn called it “promising” and clarified that while the FDA has not approved plasma therapy per se, the authorization allows the agency to expand use of the treatment. 

The antibody-rich plasma needs to come from people who tested positive for the coronavirus and haven’t exhibited symptoms for weeks. They also must meet the common criteria for blood donation.

My colleague Julia Lurie wrote about plasma therapy in May: 

Plasma therapy is a century-old medical practice that involves transferring the antibody-rich part of the blood, a yellowish liquid called plasma, from people who have recovered from a disease into those struggling to fight it off. It was used in the early 1900s to treat measles and mumps, and, more recently, to treat other coronaviruses, like MERS and SARS. Early outcomes from patients in China suggest that it could serve as a treatment for COVID-19, though, as Dr. Arturo Casadevall, an infectious diseases expert at Johns Hopkins University, explained, the “coronavirus is a new virus, and whenever you’re dealing with a new entity, you need testing.” In early April, the Food and Drug Administration unveiled a national study to test those interested in receiving the experimental treatment. Under the best-case scenario, plasma could treat sick patients while a longer-term therapy, like a vaccine, is developed.

Of the treatment options floating around in the news, plasma is the only therapy that has been used for decades and is known to be relatively safe, says Casadevall. Plus, it can be implemented quickly because it doesn’t require any drug development: Theoretically, the beneficial, virus-fighting antibodies exist in the blood of most people who have recovered from the coronavirus.

This isn’t the first emergency authorization by the FDA since the pandemic began. The agency issued an emergency authorization for the malaria drugs hydroxychloroquine and chloroquine in late March. Trump himself touted the benefits of the drugs and said “A lot of good things have come out about the hydroxy. I happen to be taking it.” But on June 15, the agency revoked the order after it found the drugs “may not be effective to treat COVID-19” and their “potential benefits for such use do not outweigh its known and potential risks.” 

More than 176,000 people in the United States have died and 5.6 million have tested positive for COVID-19, according to the latest numbers from John Hopkins University. 

This post has been updated.