One day in June, medical student Jasmina Ehab carefully examined a child’s rash. For Ehab, who is in her fourth year at the University of Southern Florida’s Morsani College of Medicine, this was an easy one. “A rash is a rash, and we know what it is once we see it,” Ehab told me. And this rash was no different. It had honey-crusted lesions, indicative of impetigo—a skin infection easily treatable with a topical antibiotic. The kid would be fine. 

The interaction was typical, but the circumstances surrounding it were not. Ehab examined the rash from a clinic, but she was the only one in the room. The patient’s mother hovered her smart phone over her child’s skin—neither of them had left their house.

Ehab learned to do virtual appointments like this on the fly last spring: Before the pandemic hit, telemedicine was largely absent from her classes. This year, things will be different: Remote visits are now covered in each section of clinical education at the medical school—from pediatrics to internal medicine to psychiatry.

Across the country, medical schools have pivoted to meet the demands of a society under quarantine: virtual classes, reformatted clinical rotations, remote residency interviews. But for aspiring physicians, hands-on experience is also essential: Surgery and bedside manner can’t be perfectly simulated in a web module. “At the end of the day,” says Dr. Kevin Krane, vice dean for academic affairs at Tulane University School of Medicine, “the MD is not an online degree.”

So how can medical schools maintain student safety while offering essential in-person training? The answer, according to some experts in the field, is to embrace long-proposed changes to the way medicine is taught. For years now, the American Medical Association—which co-sponsors the Liaison Committee on Medical Education, the accrediting body for medical schools in the US—has been contemplating a shift from rigid conventional instruction to more fluid, individualized lesson plans, says Dr. Susan Skochelak, vice president for medical education at the AMA. With traditional instruction impossible in the pandemic, some schools have begun to try those approaches. “This is an area that the pandemic has accelerated and these changes will be with us into the future,” she said.

Under normal circumstances, curriculum change moves slowly: year of planning, a year of implementation, a year to see if it worked, and three or four years to see the effect on test scores, says Dr. Deborah DeWaay, associate dean for Undergraduate Medical Education at University of South Florida. But COVID-19 threw that out the window. As this academic year was swiftly planned over the summer, the “worst fear” for Dr. DeWaay is a new crop of graduating doctors in 2021 who are missing the essential time in clinical settings that they’d have had under normal circumstances.

Which is why just about every medical school in the country has spent the last several months deciding which academic experiences can be replicated online—and which ones still must happen in person.  When the pandemic first arrived in March, the Association of American Medical Colleges quickly announced recommendations that ended normal course instruction. Students were to be pulled from clinical settings, like hospitals and primary care facilities, prompting a mad dash by medical schools to find them alternative work. At USF, for example, third year students shifted to independent study, focusing on classroom theory they’d be learning in their fourth year to make effective use of time. 

Administrators have used the summer to prepare courses for the fall. The digital transition for first and second years, before students typically interact with patients in clinical settings, was relatively painless. Most often, those years are quintessentially academic: big lecture halls, presentations, exams, studying galore. Moving those elements online was straightforward. In fact, it’d been gradually happening in the years leading up to the pandemic. In recent years, more and more instructors have recorded and uploaded their lectures for absent students. Medical students found that format more convenient, Dr. Krane says. “They will learn the content whether they sit in the classroom or not, as long as they’re given good objectives and good resources.” 

Still, “you can’t teach someone to listen to a heart on a real patient virtually,” Dr. DeWaay says. And even if you could, “You go from being completely online to now you’re a third year and you have to put twelve hour days in at the hospital—that’s gonna be really challenging if you’ve been in pajamas for two years.” The University of California-San Francisco is planning a hybrid curriculum for its first and second years, to ensure essential experiences, like cadaver lab—dissection and surgical training with a frozen corpse—may still take place in person. The tentative plan is for campus to be open three days a week, with one third of a class, about 50 students, having access to campus on each day. If a lesson necessitates an in person lab—a guest lecturer, anatomy lab, physical exams, dissections—students will come in that week, and split into groups no larger than 10.

Restrictions on how to bring in students from outside the classroom is also changing what’s happening inside. Take anatomy, for example. Historically, anatomy lab has been a three-pronged affair: cadavers lab, ultrasound, and cross-sectional—which is a two-dimensional perspective viewed through CT or MRI scans. When Dr. DeWaay was a student, those labs were spread out across four years of medical school, which made tying them together conceptually difficult. “When I did anatomy, I walked in and spent four hours dissecting and hoping I was understanding what I was supposed to be,” she said. Later, in the third year, students would revisit anatomy to learn from the cross-sectional perspective. “Some people can do it intuitively—for rest of us it’s a very challenging jump,” she said. A few years ago, USF altered its curriculum to combine the three components into one lab space to tie the three perspectives on the human body together. The pandemic has brought about the next step in evolution. Students now complete the ultrasound and cross-sectional on their computers. There’s no need to stick around in the lab space to view them—so they’ve gone remote.

Other schools are considering ditching cadaver lab entirely. Citing the high cost of working with cadavers and the risks of exposure to formaldehyde, the newly-accredited Kaiser Permenante Bernard J. Tyson School of Medicine has embraced virtual alternatives, which also allow instructors to easily simulate various medical conditions. At Tulane, Dr. Krane says some of the lab is now done digitally, but that it’s still essential that students come in and see the real thing. “Interaction with a cadaver is important for the development of professional identity,” he says. The opportunity to see and relate to a body—in all of its humanity—is visceral. “Really, there’s a sense that the cadaver is your first patient.”

While schools are considering cutting some parts of the curriculum, they’re also adding new material: USF has tried to convert conversations on lingering racial disparities into its lesson plans. “If you look at the last several hundred years in the country, there’s a pandemic happening we don’t want acknowledge,” Dr. DeWaay says. The curriculum committee decided to address demographic disparities in access to healthcare “with same rigor that we’ve been treating this pandemic.” Thus, administrators are now drawing up plans for a course that confronts racism in medicine to add to an already-existing social determinant of healthcare disparities program. UCSF, meanwhile, has shifted the focus of its health and society course to analyze the disparities of COVID-19’s effect on different communities. And according to Dr. John Davis, associate dean for curriculum at UCSF, course directors are also adding seminars on how healthcare systems handle pandemics.

As students get deeper into their academic careers, curriculums offer less to compromise over. For most schools, year three marks a major pivot point from theory to practice. Students begin clinical rotations, where they shift between essential sectors of the field—OBGYN, pediatrics, internal medicine—getting a taste of each specialty for approximately ten weeks at a hospital.

At USF, the pandemic postponed rotations from June 1 to August 3. For third year students in some clinical rotations, that means cramming what would usually be 12 weeks into eight—and hopefully being back on a normal schedule in fall 2021. “Can I do more nights? Can I do more weekends?” She says those were the questions curriculum heads were asking themselves as this academic year drew closer. In San Francisco, Dr. Davis says in addition to a tight schedule, the rotations are also subject to rigorous safety standards: UCSF isn’t permitting students to directly engage with COVID-19 or COVID-suspected patients.

Under normal circumstances a clinical rotation lasts between two and three months. Instead of assessing students at the end of their rotation, “when they’ve met the objectives, they move along,” Dr. Davis said. Organizations like the AMA have long contemplated this, and UCSF is taking the opportunity to put it into practice. Other schools, like Duke University and USF, are making rotations pass-fail. Diana Dayal, a fourth-year medical student at University of North Carolina-Chapel Hill, says she welcomes the change. Rather than a highly charged environment where students are expected to answer esoteric questions with speed and accuracy, “you can get a question wrong, or ask a question that sounds stupid,” she says. “You can admit to not knowing how to do something without it being punitive.”

Dr. Skochelak at the AMA points out a common misconception surrounding medicine: Learning doesn’t end with medical school. Life as a resident or fellow is certainly higher stakes, but receiving institutions are well aware of the circumstances surrounding the class of 2021. That probably won’t change patient experiences too much: Even without a pandemic, the healthcare system is full of physicians who months before were still students. “I don’t think there’ll be people falling through cracks,” Dr. Skochelak says. “But will they be moving onto the next stage of training with some gaps? That’s certainly possible—and we need to be prepared for that.”

As the school year begins, the future of college remains uncertain.

Like the rest of the United States’ response to the coronavirus, the process has been balkanized. Some colleges are fully reopening (with plans to mitigate spread); others are trying to go totally online; some are using a hybrid model. Just a few months ago, some universities announced plans to reopen in person, but now—with cases booming again—have reversed course.

With the Trump administration pushing to reopen schools no matter the consequences, they’ve left schools with no choice: Online education is the way forward. Learning through a screen will be the new normal for the fall semester. This brings up a persistent question: What do students miss when the college experience is yanked from them?

A lot, says Dr. Matthew Mayhew, an author and Professor of Educational Administration at Ohio State University. For almost 30 years, Mayhew has studied how the “traditional” university path affects the development of young adults and their political identities. After an effective teacher, he says, “peer education” is the most important factor for success in higher-education learning and in general success after graduation. The campus, Mayhew says, is crucial—the parties, the dining halls, the sporting events.

Mayhew recently spoke to me over the phone about how college helps a functioning democratic society thrive, why young adult’s futures are at risk, and how, most importantly, college should be accessible to all.

How do you think the development of young adults will shift in light of online learning?

What we do know is that students learn primarily from their professors. But the second most important factor to student learning involves their relationship with their peers.

When they learn something in class, do they go to the dining halls and talk about what they’ve learned with their peers? Yeah, they do. They do that in the residence halls, too. Well, now they’re at home. They don’t have their peer group to bounce ideas off of.

Does that harm a specific group?

Most of the challenges are going to fall on students who are from narratives that fall outside of the majority narrative—whether that’s race, or religion, or other social-identity groups. College affords people the opportunity to explore themselves in ways that are outside of judgments. When folks go home, they have to psychologically readjust to being a child in the home.

Why is being surrounded by your peers so important to retaining and exploring knowledge?

Students who want to explore a different part of themselves feel comfortable doing that on college campuses because they provide affinity groups for that exploration. They allow students to dive into an opportunity—or dip their toe in and then dive right in. Those kinds of things are really hard to replicate online.

Even when we talk about friendship being an important part of developing students sensibility towards say, folks of other races and religions. When you go home, even though you might have people identifying in different ways online and classroom experiences, that might not be conducive to developing friendships—which we know are critically important to how students learn about themselves and other identities.

What about low-income students?

It’s absolutely endless. There are serious ramifications for bringing students home in this in the context of COVID.

What if their families were laid off? Because of what’s going on? Then there’s going to be additional burdens for the students who contribute to the family household bottom line. And will they have time to go to class and do that at the same time? Many students serve in the hospitality/service industry and that is now compromised.

This exacerbates the whole conversation about finances. It’s why people are upset with how much college costs.

So why do you think that it’s so important to understand student’s relationship to college and then to society in general?

It’s one of the most important pillars of American society, higher education. It is the great intervention, like it or not. It’s oftentimes the first time humans ever go away, and locate themselves in a context where they have to make decisions for themselves. The first time they ever have access to people who think very differently about the world than they do, it’s the first time for a lot of those things to occur. We can really create a society that we really want as a result of encouraging students to go to college.

Based on the research and based on everything that we’ve learned, we do know that college works. That’s a very, very important idea. And that’s been demonized and compromised over time by a lot of different people in the country on a lot of different levels.

So this is all just a big argument for college accessibility?

Exactly. Yes.

What are some of the repercussions a society might face when this type of development isn’t happening—that makes college accessibility generally important?

All we can do is hypothesize based on what we know college is effective at doing, which is helping students develop their democratic self, or their civic self. So a lot of times colleges often offer opportunities for service learning experiences. And without having those opportunities, maybe the student wouldn’t develop their civic sensibilities. That might translate into students graduating from college having taken courses online, but not able to or wanting to vote, or participate in democracy in the same ways as they would had they been physically present on a college campus. Again, it’s not only service learning, it is: “Are you going to talks? Are you going to protests?”

How would you advise students who are returning to an environment of crazy uncertainty?

Let’s recap: What can college-going can be, or is it supposed to be? I think that students can access a really good time even in a socially distance environment. But guess what? There are students who can’t afford college to the left and right. And they’re taking jobs and they have to get up and serve the night shift in order to take an entry level job at 17 or 18 years old. It’s like, well, that college experience has always been a luxury, privileged experience. Now you have the opportunity to grow up and realize that your peers who aren’t going to college, oftentimes they have to mature very quickly as well.

This conversation has been edited for clarity and length.

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

As the head lobbyist for the National Rural Healthcare Association, Maggie Elehwany is on the front lines of the battle over funding for rural hospitals that are struggling to survive. According to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina, Chapel Hill, at least 128 rural hospitals have closed since 2010. Rural hospitals have long struggled because they serve smaller populations in areas that generally have high poverty rates. But in recent years, those challenges have been compounded by the decision made by many states with large rural populations to not expand Medicaid, making it harder for those hospitals to be reimbursed at reasonable rates. The COVID-19 pandemic only puts in starker relief what those hospital closures have cost the communities they serve, and it has meant more pressure on regional hospitals that are still standing. In April, through the CARES Act passed by Congress the month prior, the Department of Health and Human Services allocated $11 billion to rural hospitals. I caught up with Elehwany to learn more about how the coronavirus is exacerbating the health care crisis in rural America. 

On the challenges facing rural populations: Even before COVID, we had a fragile rural health care safety net. In rural areas, it’s all about access to primary care, but if you need a specialist, that’s especially difficult. We have systemic workforce shortages—20 percent of the population lives in rural areas, but only nine percent of physicians practice there. Recruitment and retention have always been one of the biggest challenges in rural healthcare.  The shortages are significant in other types of care too; think mental health and oral health. And rural populations are needy, they’re older, they’re poorer, they’re sicker, they have higher percentages of chronic disease. Rural areas have been dealing with the opioid epidemic, often they have riskier lifestyles and occupations, and higher percentages of smoking and drinking. All of those factors made them more vulnerable to the virus.

Complicating matters further is the hospital closure crisis in rural America. We saw a record number of closures last year, and this year, we were on track to see even more. So hospitals in cities are not only serving the populations within the city limits, but they’re also responsible for people in the surrounding counties, where hospitals may have shut down. By the time COVID hit, we already had half of all rural hospitals in the country operating at a financial loss. Then in preparation for the pandemic, hospitals were told to eliminate all non-emergency and elective care, which means decimating essentially 70 percent of those hospitals’ revenue. That was devastating.

On what rural communities need to fight COVID-19: We are asking Congress to help rural America be prepared as the pandemic swells. You may have 1000 cases reported in a community, but in the entire county, there’s just one hospital, and it’s a 25-bed critical access hospital. First and foremost, we’ve got to keep those hospitals—and all providers’ doors—open. The lifeline that was the CARES Act literally kept the doors open. It was a tourniquet, maybe it will save the leg, but if you take that tourniquet away, the patient is going to die. We’re asking for sustainable relief. We want to stop the cuts that are causing the closure crisis, but it’s also time to start thinking about new payment models for rural areas.

On how some providers are coping: Restrictions have been eased in telemedicine, including several requirements we’ve wanted to see loosened for a long time. We’re worried they’re going to flip the switch and say, OK, we’re going to end that now, the emergency is over. There’s a sense of isolation in a lot of senior populations and populations struggling with mental illness, and using telehealth can make such a difference. It doesn’t solve all of the problems, but it is cost-effective and helps people access care.

On the future of the coronavirus in rural America: We’re seeing the virus grow rapidly in rural areas where the meatpacking industry has set up shop, and in some prison populations; we’re worried that a lot of field workers and food processing plant workers are going to get sick. We’re worried that if people let their guard down, it’s going to be devastating in rural areas because of the vulnerability of the population.

Even with the influx of cash that the CARES Act provided, we still lost four rural hospitals since the pandemic began. We’re so worried that when the influx of relief stops, we’ll actually be in a worse off situation. Once COVID hits these communities, the hospitals will have fewer resources to fight it because of the massive loss of revenue. There are some estimates that those hospitals will never reach the levels they were operating at before, and even the “before” isn’t great because at least half of rural hospitals were operating at a loss.

President Trump thinks he is delivering the average American a winning hand right now—despite a cratering economy, mass unemployment, and no clear plan to fight the cause of all this calamity, the coronavirus. At a Monday afternoon press conference at the White House, Trump went so far as to say that “carpenters and policemen and farmers”—millions of ordinary Americans—are “the ones that benefit by having a good stock market, probably more than anybody else.”

Probably more than anyone else? That’s absurd on its face (only 55 percent of Americans report owning stocks, a number that correlates with higher household income, among other things.) But it’s even more disconnected from reality when you collect the receipts: This pandemic period has been a bonanza for billionaires, for whom Trump’s brutalist coronavirus denial and inaction have reaped untold rewards, as our new video infographic above shows.

This cadre of 643 Forbes-certified billionaires grew their collective wealth by an estimated $685 billion, from mid-March through early-August of this year. That’s according to a fresh analysis of Forbes’ Real-Time Billionaires Data by Americans for Tax Fairness and the Institute for Policy Studies. To be clear, that’s just the increase in wealth. In total, the richest 0.00019 percent of the US population—which includes household names like Jeff Bezos, Mark Zuckerberg, and Bill Gates—hold $3.6 trillion in combined wealth, as of August 5, 2020.

In February, we visualized the eye-popping fortune of then–Democratic presidential candidate Michael Bloomberg in a viral video on the night of his first debate. We’ve supersized that animation to explore this even-larger $685 billion figure. Watch our video above to dive into the mind-bending pool of newly generated wealth, while the death toll from COVID-19 continues to soar past 160,000 Americans.

Take the United States Postal Service. As Trump attacks the beleaguered institution, its yearly revenues of $71.1 billion are just a fraction of the wealth increase of these few hundred Americans. The cost of hiring 50,000 teachers nationwide ($30 billion) pales in comparison to the new wealth sloshing around the investment accounts of the ultra-wealthy. And while not every single billionaire gained money over these months, it’s safe to say that their paper losses don’t hit home in the same way that job losses have unmoored 16.3 million Americans currently unemployed.

Countries around the world have rebounded from lockdown and brought the coronavirus under control. But not the US. While Americans wait on a stalled Congress to take action, and endure empty presidential promises of relief via highly controversial—and potentially unconstitutional—executive orders, it’s the ultra-wealthy who are feeling like a billion bucks.

In the middle of a pandemic, in an election year, President Trump is realizing that Americans highly value the health care system he’s tried so hard to dismantle.

Last week, Trump suggested that he would sign an executive order requiring insurers to cover preexisting conditions—a key provision of the Affordable Care Act, which has been the law of the land for more than 10 years. Asked at a Monday press conference why he felt the need to reinforce an existing law, Trump all but admitted to the ploy for good PR. “Just a double safety net,” he said, “and just to let people know that the Republicans are totally, strongly in favor of preexisting condition, taking care of people with preexisting conditions.”

Trump also bragged on Monday about getting rid of the individual mandate, the requirement that uninsured Americans pay a yearly penalty, which was set to $0 as part of the 2017 tax cuts. What he didn’t mention is that the lack of an individual mandate is the basis of a lawsuit, filed by Republican attorneys general and supported by the Trump administration, that threatens to undo the entire Affordable Care Act—protections for preexisting conditions and all. Republicans argue that without the mandate, the ACA is unconstitutional; in other words, Trump has given the GOP the new ammunition to go after the health care law. (The suit is currently at the Supreme Court.) Not only would it eliminate coverage for preexisting conditions, but it would leave the 23 million Americans who currently rely on Obamacare uninsured.

The promised executive order on preexisting conditions is one of Trump’s numerous recent attempts to portray himself as a health care advocate amid a pandemic that has killed more than 160,000 Americans. With even red states like Oklahoma and Missouri voting to expand Medicaid, it has become obvious that health care is a winning issue. Just don’t let Trump fool you into thinking he’s been fighting for health care all along. 

On Friday, officials across the United States reported 1,354 new deaths from the coronavirus, bringing the total number of reported deaths in the United States, according to Johns Hopkins University’s Coronavirus Resource Center, to 161,367. The actual number of deaths, due to reporting issues, is likely to be much greater.

Friday’s death toll was not a daily record. It did not show a huge increase or drop. It was roughly the same as the reported weekday death toll for the last two weeks—this is just what normal is now, and as the surge in new cases across the Sun Belt over the last two months takes its toll, it is likely to be the new normal for quite a while.

In the last week, the death toll has surpassed the populations of Jackson, Mississippi, and Alexandria, Virginia. It’s greater than the populations of Springfield, Massachusetts, and Springfield, Illinois. (It will likely surpass the population of Springfield, Missouri, next week.) It’s greater than the populations of Manchester, New Hampshire; Fargo, North Dakota; and Macon, Georgia. It’s greater than the respective populations of Columbia and Charleston, South Carolina; Hartford and Bridgeport, Connecticut; Waco and Midland and Round Rock and Killeen and Pearland and Denton, Texas. Hayward and Pasadena and Berkeley and Lancaster, California;. It could fill the largest football stadium in the country, Michigan Stadium in Ann Arbor, one and a half times—it is also greater than the population of Ann Arbor. It is bigger than the largest city in eleven states.

“It looks like we’ll be at about a 60,000 mark, which is 40,000 less than the lowest number thought of,” President Donald Trump said in April. We passed that number in May and just kept going. Now, that many people have died in just three states—New York, New Jersey, and California.

There are days when the pandemic can sort of fade into the background of the political discourse. The president would prefer to talk about his beautiful boaters, Republican senators would prefer to talk about Antifa. But take a second today, perhaps, to read about some of the victims of the pandemic—check out the Twitter account Faces of Covid, which posts obituaries of the teachers and barbers and EMTs and siblings and spouses who are dying every day. It never went away. It is just what we live with now.

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

Back in March, as epidemiologists and front-line nurses scrambled to track and treat the spread of COVID-19, health expert Timothy Caulfield was already sounding the alarm about its sinister twin: the infodemic, or the spread of misinformation about the virus. “The tsunami of misleading noise flowing from this ‘infodemic’ has resulted in deaths, financial loss, property damage, and heightened stigma and discrimination,” he later wrote. “It has also facilitated an erosion of trust in key institutions and added to the already chaotic information environment.” Caulfield is a professor of law at University of Alberta’s School of Public Health, and the research director of its Health Law Institute, where he’s launched multiple studies on the intersection of misinformation, the Internet, and public health, and he’s helped craft guides on battling the spread of bad information. He’s also the host of the show A User’s Guide to Cheating Death, in which he debunks popular health trends that are based on pseudoscience. And he’s the author of several books, including Is Gwyneth Paltrow Wrong About Everything? I asked him about what we can do to address COVID’s parallel plague.

On how misinformation is spreading during the pandemic: I’ve been following the spread of misinformation as part of my career for decades. And I haven’t seen anything like this before. It really is incredible. There’s misinformation spreading about every aspect of the pandemic, from its source: People are saying it’s a bio-weapon (not true); that it’s caused by 5G technology (not true). To crazy cures: The idea that you can cure it with cow urine, with bleach (not true). The idea that you can “boost” your immune system, which has become a huge industry. 

In the early days the problem was just misinformation. Now every topic, whether it is masks, hydroxychloroquine, or physical distancing, has become a polarized issue. That’s made it more difficult to battle the misinformation. And layer on top of that, all of the controversies that have been associated with the science being done. For example, the recently retracted hydroxychloroquine study that was in The Lancet. It was a study that got a lot of play in the media, and it had an almost immediate impact on clinical trials. And then it gets retracted. That’s problematic, both because it’s just bad for science, but it’s also really, really bad for public trust.

It’s incredible the degree to which social media has played a role here. That’s always been the case—we’ve done studies around for example, vaccination hesitancy and how vaccination misinformation is spread. But here, it really has dominated the spread of misinformation. And of course, that means that’s also where we need to battle it. We have a study that’s out for peer review right now, where we looked at over 200 websites, pretending we are someone searching, on Google or Bing or whatever, “immune boosting.” On 85 percent of those websites, immune-boosting is portrayed as if it’s an effective way to fight COVID-19. When the whole concept of immune boosting is scientifically questionable, it’s really grim when you see those kinds of numbers. And only 10 percent of the websites had any kind of critical critique of immune boosting at all. On Instagram, it’s pictures, it’s images, it’s a lot of influencers with lifestyle brands. And there’s very little room for scientifically nuanced portrayal. So things are presented in the way as if efficacy is taken for granted. I personally looked at hundreds of postings about immune boosting, and I didn’t see a single, scientifically accurate portrayal of the concept.

And so we’re looking at all those those generators of misinformation. And then we’re also working with other researchers doing empirical research on how people respond to that misinformation, and why people spread misinformation. And then, of course, what we want to do is develop some strategies. And we’ve already done some of that and provided recommendations.

On the individual power to stop bad information from spreading: It’s one of those one of those social problems that is going to require us to come at it from every angle, right? We’re going to need governments to take action. We’re going to need regulators like the FDA and the FTC to step up and do more. We’re going to need health professional organizations to make sure their members are not spreading misinformation. We’re going to need stronger truth in our advertising laws to make sure that people aren’t leveraging the fear of the pandemic to sell therapies. We’re also going to have to—and this is a big one—figure out ways to get the social media platforms to take action. 

But perhaps the most important thing, and evidence backs this up: We need individuals to take action. There’s really interesting research that suggests the spread of misinformation is largely a bottom-up phenomenon. These are people sharing this information on Facebook and Twitter. On Instagram. We have to develop strategies and encourage people not to do that. If you can just nudge people to think about accuracy, to embrace accuracy, before they share, we can have an impact on the spread of misinformation. It sounds ridiculously simple. But there are a couple of studies to back that up. And then we need to counter misinformation when we see it, with good information. So if you see misinformation, respond with trusted sources of information that use nice, authentic language (I know it’s hard not to be snarky, I’m snarky online a lot). And then use a creative communication strategy; people respond to stories, art, humor. And lastly, make sure that the general public—not the hardcore denier—is the audience. You’re never going to change the minds of those hardcore deniers. Always aim for the general public.

On how science literacy is key to preventing pandemics, and in fostering trust: I think it’s something that should be taught as early as—and I know that sounds ridiculous—but as early as kindergarten, and it should be taught throughout middle school and through high school and all the way through university regardless discipline. It allows people to be more critical consumers of the news, more critical consumers of social media. And the other important aspect is, teaching science literacy also allows people to understand the scientific process better. It allows people to understand that science is not a list of facts. You know, science is not a person. Science is not an institution. Science is not an industry. Science is a process. It evolves, and public health officials do their best with the evolving science to make a decision. And I’m hopeful that if more people understood how science operates, they might be more forgiving of how science policy is made. And more critical of what they’re seeing on social media, in the news media, and in popular culture more broadly.

Having said all that, I think it’s important to recognize that the other thing we want to do with misinformation is listen and learn, you know, why are people being attracted to misinformation? What are their concerns? It’s not just trying to get people to be more scientifically literate, it’s also about trying to understand what’s attracting people to this information. Part of that is a breakdown in trust. I get a lot of hate mail. And regardless of the topic, whether it’s homeopathy, GMOs, alternative medicine, COVID, it’s almost always the same. They start with telling me what an idiot I am, probably a few swear words in there, but the very next paragraph is about trust. “I can’t trust the science. I can’t trust the system.” So I think that understanding what it takes to be a trustworthy institution; creating trustworthy science; and communicating in a trustworthy manner, is going to be incredibly important. I hope that’s one of the lessons we get from this current crisis.

The United States is in a really tough spot, because in many countries, Canada included, the citizens do have a higher level of trust in their government, in their health care system, and in their public health authority. That does make it easier in a public health crisis. There are institutions, including the pharmaceutical industry, including the biomedical research world, that have had bad actors and that have created legitimate situations that people can point to and legitimately say, “there are reasons I shouldn’t trust you.” And so I think we need to remember that when we’re trying to fight misinformation.

And I think that we need to make sure that the scientific house is in order. We’ve seen science has been rushed. Recently we’ve seen important science retracted in prominent journals. Without good science we’re never going to win the fight against misinformation.

On the top bunk of his cell in San Quentin State Prison, Kevin Sawyer has been chronicling one of the country’s fastest-spreading coronavirus outbreaks on a Brother ML-300 typewriter.

Sawyer, 56, is serving a 48-year-to-life sentence. He’s also associate editor of the San Quentin News, one of a small number of newspapers in the country produced entirely by incarcerated people. When California prisons went on lockdown in March, San Quentin prison officials suspended the newspaper’s operations. “Luckily,” he wrote on his typewriter soon after, “San Quentin State Prison hasn’t been faced with the challenge to maneuver through the crisis on the same scale that has overwhelmed the nation, at least not yet. But if COVID-19 does strike California’s oldest prison, the inmates there are doomed, because the state, like the rest of America, does not appear to have a viable plan to handle this kind of emergency.”

Even though San Quentin had no cases of COVID-19 at that time, inmates had to spend almost all day in their housing units out of precaution. Sawyer was determined to keep reporting, even if he would have to conduct his interviews by passing notes between cells.

In April, after we’d been writing letters to each other for a few weeks, he wrote to me to explain the creative ways he produces journalism behind bars:

I collect memos and fliers that are posted around the prison or passed out to each cell. Sometimes I document what’s posted on the bulletin boards located in the West Block housing unit. I interview inmates when we are released to go to the recreation yard every few days. I record what my five senses reveal to me. I take all of the lose papers and organize them in chronological order. (Oops! I’m not on a word processor so I spelled loose incorrectly.) Then I string a storyline together, handwritten. Because I have a portable word processor (NEO, made by Alphasmart), I’m able to organize this information into what I hope is a cogent and interesting story for readers. The NEO can output information to a PC via a USB cable, but because that’s not an option inside a prison cell, I scroll through the 5” x 2” LCD screen and retype the text on my Brother ML-300 electric typewriter.

In my cell, I keep names and addresses of outside media (including yours, obviously) that I acquired over the years. In a single word, prepared is what I am. I was that way before prison so it wasn’t a major shift in consciousness for me.

In anticipation of a lockdown or some other untimely event, I keep extra typewriter ribbons in my cell, typing paper, stationary, pens, Post-It note pads, carbon paper (to maintain a record or backup copy), Penal Code, two legal dictionaries, a regular dictionary and thesaurus, California Code of Regulations, Title 15, Prisoners Self-Help Litigation Handbook, California State Prisoners Handbook (published by the Prison Law Office), California Rules of Court, a Spanish-English dictionary, a French-English dictionary, regular lined paper, 28-line legal paper, felt pens that highlight, notes from the 400-plus books that I’ve read in the last 23 years, envelopes, postage stamps, The Bedford Handbook for Writers, The Blue Book (A system of uniform legal citation—think AP style guide), and probably a few things I’ve overlooked like paper clips.

One way I do interviews on lockdown is to write notes with questions. Inmates are sometimes more willing to write about what’s happening to them instead of filing a grievance. Because of my tenure and reputation with San Quentin News, they know me and trust that I will not exploit them or place them in a negative light. Sometimes I interview using the NEO or I’ll simply use pen and paper to do a one-on-one. If I have to send a note to an inmate while I’m in my cell, I’ll ask a porter or someone who’s out on the tier to take the note to the person. If it’s in a sealed envelope I have to inform the “runner” of the “kite” (prison slang for a letter or note) that it’s not “hot.” That means there is no incriminating or illegal information in the note, that if intercepted by a correctional officer during a random search it will not subject the runner to disciplinary treatment. Believe me, it happens. Not with me, but I still follow prison etiquette and protocol when asking for a favor. It’s all about trust and one’s reputation, so it’s never cool to put someone in a situation that they are not aware of or willing to accept the consequences.

Because there are so many prisoners in one building, I have unfettered access to them. The interviewing is easy, but I like to add “different facts and data to stories. Sometimes I’m able to overcome that obstacle by watching television news or referring to information in newspapers, magazines, books, and other material I may have in my cell, such as law books.

You asked, “What’s it like to write on a typewriter, and where did (I) get it?” If you weren’t a reporter, I’d say you’re nosey (smile). Have you ever typed on a typewriter? It’s actually really easy, even fun. Once my work is organized and edited on paper, the typewriter serves as another means of outputting the information. I’m 56 years old, so I grew up using typewriters. In junior high school I learned to type on a manual typewriter. Other than correcting mistakes (like “lose” versus “loose”) with correction tape instead of a software insert, it’s no big deal. And I type from the home key position, without looking. Mr. Talerico (Hillview Jr. High) would be proud of me. My late mother purchased the typewriter for me in 2003 from the vendor Walkenhorst’s, mainly to do legal work, but it has served many other purposes. I think it cost about $150.

Sawyer was born in San Francisco. He dreamed of majoring in business in college, but he dropped out after his son was born, and started working at a telecommunications company. This, in some ways, started him down the road toward journalism. “When I went back to school in 1990, I wanted to major in telecommunication, but California State University Hayward (now East Bay) had no such major,” he wrote to me. “The closest thing to telecom was mass communication, which focused on public relations, advertising, broadcasting and print journalism.” After graduating, he landed in prison in 1998. He soon felt the urge to write:

The two years I spent in county jail fighting the numerous charges against me (Trina Thompson, the Ghost Ship trial judge, was my first private attorney), I wrote about the experience in 23 different journals on the same sized paper that you used to handwrite your last letter to me. One of those journals (#9) got me a trip to the hole for 90 days. When I arrived in state prison, I started writing personal political essays and memoirs. I had my college AP book sent to me but never found a use for it because there wasn’t a newspaper to write for and I was an unknown in the journalism world. I kept writing and reading, though.

By the time I arrived at San Quentin, I’d been incarcerated 15 years, and I’d read 296 books that I’d extracted many notes from. By then I’d also written quite a bit. Then I discovered a little prison publication called San Quentin News. I joined its journalism guild immediately, but I didn’t want to be a staff writer. A job assignment washing dirty food trays at 3:00 a.m. changed my mind. A few months after being hired I was asked to run the guild. Reluctantly, I accepted and did the job for three years. Many of the operating procedures that are in place today, I established. I moved to the associate editor position about four years ago. Technically, I am the paper’s number two man who runs the business side of the operation. That involves me overseeing that the five of us handle all letters, email, Twitter (Instagram is coming and we’re reviving Facebook), website post, circulation/distribution, newsletters, donations, monthly reports, working with our outside development manager, project director for the nonprofit Friends of San Quentin (using the fiscal sponsor Social Good Fund), and other duties as needed. 

In 2016, Hunter College in New York named him the winner of the Aronson Award for Community Journalism, after he covered a Legionnaire’s outbreak at his prison that left scores of men sick with pneumonia-like symptoms. A couple of years earlier, the San Quentin News was honored by the national Society of Professional Journalists for “accomplishing extraordinary journalism under extraordinary circumstances.” 

When I first reached out to Sawyer in March, I asked him if life had changed in the prison after mayors in surrounding towns called on residents to shelter in place. “So funny, when your letter was handed to me through the bars, I was in the process of making and taking mental and written notes about our conditions of confinement during the coronavirus quarantine. By the time you receive this letter, I should have the first draft of a story completed,” he wrote back within days. He planned to submit the piece to major newspapers. 

He wanted to explain how social distancing inside San Quentin was impossible, how the prison cells housed two men each but were built for just one. He wanted to record how they were eating cold food served on paper trays, a change for the worse since the pandemic started, and the fact that incarcerated men weren’t initially given face masks. When officers moved some of the guys from the dorm to a gym to make more space, he asked the prison’s public information officer to send him the press releases that had gone out to journalists on the outside. “But I never got a response,” he told me. He was undeterred, and he continued drafting his account. In April, he gave me an update:

What am I learning as I try to write this important story? Not much, to be honest. Nothing surprises me about prison, and the level of dysfunction in society is a mere reflection of what gets funneled into prison. My reason for writing is to document this for the future. My work will hopefully give others a better version of what takes place in prison, instead of relying on prison administrators whose first obligation is to shield the state from civil liability because of mismanagement and neglect. I’ve also had poems and short stories published. I’m really trying to establish myself as a writer and producer (I love documentary films.) It’s why I don’t want to be catalogued as an expert on prison, even if I am because of my News reporting.

I think I’ve made it through your questions, and I’m still healthy. My back hurts though from standing on a bucket to type. I’m on the top bunk which is where I place my typewriter in my “office.” 

Until next time, take good care of yourself.

Kevin Sawyer

Soon after he sent me that letter in April, Sawyer completed his roughly 8,000-word story about life at San Quentin during the first seven weeks of the pandemic. His fellow inmates watched Gov. Gavin Newsom’s press briefings daily. Some prisoners were prepared for the lockdown with mini survival kits of coffee, ramen noodles, toothpaste, soap, paper, ink pens, stamps, and envelopes, and other supplies. But they were still afraid. “Once we get it, it’s like a petri dish in here,” an incarcerated man in his 30s told Sawyer. “It’s just a matter of time [until] they take us to a makeshift morgue.” Men who had been imprisoned for years knew to take special precautions. “Most of the ‘the West Block OGs’…defer to health care professional’s recommendations and confine themselves to their cells. OGs didn’t grow old in prison being fools.”

Up until this point, San Quentin had zero cases of COVID-19. But on May 30, the California corrections department transferred 121 people to San Quentin from a virus-plagued prison in Southern California. Some of the transferred men hadn’t been tested for the coronavirus in weeks. The virus ripped through San Quentin: Within a month, about 1 in 3 prisoners there had tested positive, along with more than 100 prison staffers. At one point, San Quentin accounted for nearly half of the active coronavirus cases in the state’s prisons. By now, more than 2,000 people at the prison have tested positive, and at least 23 have died.

“There’s people just going crazy with anxiety,” Kerry Rudd, who’s incarcerated in a San Quentin dorm with about 100 people, told my colleague Madison Pauly. “It’s like a horror movie when you’re watching like a monster inch its way towards you and you haven’t no way out, you have nowhere to run. Us being locked in here, it’s like we’re watching this virus get steadily closer to us and there’s nothing we can do.” 

I worried about Sawyer’s safety and sent him another letter in June. On July 1, he wrote back to say he was still healthy. He and his cellmate were being vigilant, he said. But just a few weeks later, I received another letter, this one hand-written instead of typed on his trusty typewriter.

He’d tested positive for the virus, he explained, and was now writing from inside a tent city that prison officials had erected outside to quarantine people. There were at least nine air-conditioned tents sprawled across a baseball field on the prison grounds, with space for more than 150 people. Sawyer—who described his tent like a “military field hospital,” similar to “the 1970s television show MASH”—said he’d have to stay there for a couple of weeks, though he was thankfully asymptomatic.

Twice a day, nurses took his blood pressure, heart rate, temperature, and oxygen levels. He worried about his friends inside his housing unit, West Block. A man one cell over from him had died already. “It was terrible the week of July 4^th,” he recalled in his letter to me on July 29, about two weeks into his stay in the tent city. “Inmates were falling out all day, every day. Alarms went off in the building so much that I lost count.”

Even from his tent, without his supplies and his typewriter, writing was top of mind. He was determined to craft a second installation of his article, to update people on how the situation had deteriorated. “Everything is happening so fast I have little time to write a story, but I’m working on it,” he wrote to me. He was taking detailed notes and had gotten his hands on a copy of a lawsuit about prison medical conditions. Soon he’d be cleared to go back to his housing unit. “So I have to gather more Tent City interviews before returning to one of the cell blocks,” he wrote.

“I’ll keep you in my thoughts,” he added as he signed off his latest dispatch to me, and “thanks for thinking of me.” He promised to keep reporting. “Life at San Quentin has changed in more ways since mid-March than I care to describe in a letter. A story is the only way to do this situation justice.”

As students in some states are starting to trickle back into schools, those very institutes of learning have become the latest battleground for the Great Mask Debate. (I use the term “debate” loosely, and sarcastically.) On Thursday, the debate hit the pages of the New York Times, by way of a high school in the Atlanta suburbs. The Times recirculated several viral photos of mostly white teenagers crammed into the hallways of North Paulding High School, creating a modern Where’s Waldo, but for face coverings.

The school district’s superintendent told the Times that they encouraged students and staff to wear masks, but they wouldn’t require them.

“Wearing a mask is a personal choice, and there is no practical way to enforce a mandate to wear them,” the superintendent wrote to the Times.

Unfortunately for Paulding County School District students, there are a number of other clothing items that can be mandated. 

According to the district’s publicly available student handbook, skirts must be no more than “3 [inches] from the top of the kneecap as measured by a ruler or the length of a 3 x 5 index card” and shorts must be “5 [inches] from the top of kneecap as measured by a ruler or the width of a 3 x 5 index card.” Shirts must be free of “writing, pictures, or graphics that unreasonably attract the attention of other students or cause disruption.” And that’s just a sample of what is allowed; the list of prohibitions is even longer:

So the schools in Paulding County, Georgia, can ban hats, but not mandate masks. Iiiiiinteresting.

Some of the lower schools in the district have their own, even stricter dress codes. One of the middle schools in the district has a 28-slide powerpoint presentation about the dress code, with three full slides dedicated just to leggings. 

Another middle school in the district prohibits “pants that touch the ground… wide legged pants, skin-tight pants [and] form-fitting clothing,” as well as jewelry that is studded or pointy. 

But a mask requirement is just impractical. 

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

Asha George is a public health security expert who spent four years a congressional staff member with the House Committee on Homeland Security before working as a government contractor for the Department of Homeland Security. As the current executive director of the Bipartisan Commission on Biodefense, she helped prepare a blueprint for how the nation should plan for and respond to an infectious disease outbreak, whether from a naturally occurring pathogen or a biological weapons attacks. She shared some of those recommendations with Mother Jones. 

On the need for a stratified hospital system: You know how we have our national trauma hospital system? Every hospital has an emergency room—if you get into an accident, they’re going to take you there. But if you need higher-level treatment, they’re going to fly you to a hospital with a high-level trauma rating. They get reimbursement from Medicare and Medicaid, and then the rest of the health insurance providers follow along with that, too. So we have a system in place for that.

We need to do the same thing for biodefense. Every hospital should be able to take in patients with whatever disease we’re talking about, but if they need more advanced care, there should be other hospitals that can provide that advanced care, and they should get reimbursement for that care from Medicare, Medicaid, and all the other health insurance providers.

When COVID-19 arrived in the United States, all the hospitals wound up self-selecting and arranging themselves into a stratified biodefense hospital system. This is the backwards way to do it. First we have a disease, and then all the hospitals have to respond, and they all kind of sort themselves out. And then somewhere months later, the Centers for Medicare and Medicaid Services decides, okay, so now we’ve decided we’re reimbursing.

I would like CMS to say to hospitals, in order for you to be accredited, you have to maintain a certain level of preparedness for pandemics, for disease events, for emergencies, and so forth. You have to have a certain number of respirators and ventilators. You have to have a certain number of gowns and loves. I think that these emergency preparedness requirements need to be included in their standards. It is an expense, but look at what happened. They wound up spending way more than they ever would have if they’d have been prepared.

On private sector involvement in a biodefense strategy: There’s this whole debate about overdependence on foreign countries for stuff we need, but we have to get used to the notion that we live in a global economy. We do need to increase our capacity in terms of manufacturing here in the United States, so that we’re not entirely dependent on foreign countries for things we need. 

In this case with the ventilators, that meant getting the auto manufacturers to produce ventilators instead of cars. That obviously they could do that, and they did do that, but don’t you think it would have been better if they had been prepared in advance to do that? They should be part of that planning.

On government preparedness: The federal government needs to get back on the stick when it comes to the national defense strategy. I think the government needs to stop being in denial about the recurrence of infectious disease outbreaks and pandemics. We need a robust, supported entity inside the White House—not just one person, but a group of people whose job it is to make sure that we are preparing and we’re doing everything we can and managing the entire federal government so that when the next pandemic occurs, when the next biological attack occurs, the federal government can swing into action.

This interview has been edited for length and clarity.

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 police discovered the woman, she’d been dead at home for at least 12 hours, alone except for her 4-year-old daughter. The early reports said only that she was 42, a mammogram technician at a hospital southwest of Atlanta and almost certainly a victim of COVID-19. Had her identity been withheld to protect her family’s privacy? Her employer’s reputation? Anesthesiologist Claire Rezba, scrolling through the news on her phone, was dismayed. “I felt like her sacrifice was really great and her child’s sacrifice was really great, and she was just this anonymous woman, you know? It seemed very trivializing.” For days, Rezba would click through Google, searching for a name, until in late March, the news stories finally supplied one: Diedre Wilkes. And almost without realizing it, Rezba began to keep count.

The next name on her list was world-famous, at least in medical circles: James Goodrich, a pediatric neurosurgeon in New York City and a pioneer in the separation of twins conjoined at the head. One of his best-known successes happened in 2016, when he led a team of 40 people in a 27-hour procedure to divide the skulls and detach the brains of 13-month-old brothers. Rezba, who’d participated in two conjoined-twins cases during her residency, had been riveted by that saga. Goodrich’s death on March 30 was a gut-punch; “it just felt personal.” Clearly, the coronavirus was coming for health care professionals, from the legends like Goodrich to the ones like Wilkes who toiled out of the spotlight and, Rezba knew, would die there.

At first, seeking out their obituaries was a way to rein in her own fear. At Rezba’s hospital in Richmond, Virginia, as at health care facilities around the U.S., elective surgeries had been canceled and schedules rearranged, which meant she had long stretches of time to fret. Her husband was also a physician, an orthopedic surgeon at a different hospital. Her sister was a nurse practitioner. Bearing witness to the lives and deaths of people she didn’t know helped distract her from the dangers faced by those she loved. “It’s a way of coping with my feelings,” she acknowledged one recent afternoon. “It helps to put some of those anxieties in order.”

On April 14, the Centers for Disease Control and Prevention published its first count of health care workers lost to COVID-19: 27 deaths. By then, Rezba’s list included many times that number — nurses, drug treatment counselors, medical assistants, orderlies, ER staff, physical therapists, EMTs. “That was upsetting,” Rezba said. “I mean, I’m, like, just one person using Google and I had already counted more than 200 people and they’re saying 27? That’s a big discrepancy.”

Rezba’s exercise in psychological self-protection evolved into a bona fide mission. Soon she was spending a couple of hours a day scouring the internet for the recently dead; it saddened, then enraged her to see how difficult they were to find, how quickly people who gave their lives in service to others seemed to be forgotten. The more she searched, the more convinced she became that this invisibility was not an accident: “I felt like a lot of these hospitals and nursing homes were trying to hide what was happening.”

And instead of acting as watchdogs, public health and government officials were largely silent. As she looked for data and studies, any sign that lessons were being learned from these deaths, what Rezba found instead were men and women who worked two or three jobs but had no insurance; clusters of contagion in families; so many young parents, she wanted to scream. The majority were Black or brown. Many were immigrants. None of them had to die.

The least she could do was force the government, and the public, to see them. “I feel like if they had to look at the faces, and read the stories, if they realized how many there are; if they had to keep scrolling and reading, maybe they would understand.”

It’s been clear since the beginning of the pandemic that health care workers faced unique, sometimes extreme risks from COVID-19. Five months later, the reality is worse than most Americans know. Through the end of July, nearly 120,000 doctors, nurses and other medical personnel had contracted the virus in the U.S., the CDC reported; at least 587 had died.

Even those numbers are almost certainly “a gross underestimate,” said Kent Sepkowitz, an infectious disease specialist at Memorial Sloan Kettering Cancer Center in New York City who has studied medical worker deaths from HIV, tuberculosis, hepatitis and flu. Based on state data and past epidemics, Sepkowitz said he’d expect health care workers to make up 5% to 15% of all coronavirus infections in the U.S. That would put the number of workers who’ve contracted the virus at over 200,000, and maybe much higher. “At the front end of any epidemic or pandemic, no one knows what it is,” Sepkowitz said. “And so proper precautions aren’t taken. That’s what we’ve seen with COVID-19.”

Meanwhile, the Centers for Medicareand Medicaid Services reports at least 767 deaths among nursing home staff, making the work “the most dangerous job in America,” a Washington Post op-ed declared. National Nurses United, a union with more than 150,000 members nationwide, has counted at least 1,289 deaths among all categories of health care professionals, including 169 nurses.

The loss of so many dedicated, deeply experienced professionals in such an urgent crisis is “unfathomable,” said Christopher Friese, a professor at the University of Michigan School of Nursing whose areas of study include health care worker injuries and illnesses. “Every worker we’ve lost this year is one less person we have to take care of our loved ones. In addition to the tragic loss of that individual, we’ve depleted our workforce unnecessarily when we had tools at our disposal” to prevent wide-scale sickness and death.

One of the most potentially powerful tools for battling COVID-19 in the medical workforce has been largely missing, he said: reliable data about infections and deaths. “We don’t really have a good understanding of where health care workers are at greatest risk,” Friese said. “We’ve had to piece it together. And the fact that we’re piecing it together in 2020 is pretty disturbing.”

The CDC and the Department of Health and Human Services did not respond to ProPublica’s questions for this story.

Learning from the sick and dead ought to be a national priority, both to protect the workforce and to improve care in the pandemic and beyond, said Patricia Davidson, dean of the Johns Hopkins School of Nursing. “It’s critically important,” she said. “It should be done in real time.”

But data collection and transparency have been among the most glaring weaknesses of the U.S. pandemic response, from blind spots in the public health system’s understanding of COVID-19 in pregnancy to the sudden removal of hospital capacity data from the CDC’s website, later restored after a public outcry. The Trump administration’s sudden announcement in mid-July that it was wresting control over hospital coronavirus data from the CDC has only intensified the concerns.

“We’d be the first to agree that the CDC has been deficient” in its data gathering and deployment, said Jean Ross, a president of National Nurses United. “But it’s still the most appropriate federal agency to do this, based on clear subject-matter expertise in infectious diseases response.”

The CDC’s basic mechanism for collecting information about health care worker infections has been the standard two-page coronavirus case report form, mostly filled out by local health departments. The form doesn’t request much detail; for example, it doesn’t ask for employers’ names. Information is coming in delayed or incomplete; the agency doesn’t know the occupational status of almost 80% of people infected.

The data about infections and deaths among nursing home staff is more robust, thanks to a rule that went into effect in April that requires facilities to report directly to the CDC. The agency told Kaiser Health News that it is also “conducting a 14-state hospital study and tapping into other infection surveillance methods” to monitor health care worker deaths.

Another federal agency, the U.S. Occupational Safety and Health Administration, investigates worker infections and deaths on a complaint basis and has prioritized COVID-related cases about the health care industry. But it has suggested that most employers are unlikely to face any penalties and has issued only four citations related to the outbreak, to a Georgia nursing home that delayed reporting the hospitalization of six staffers and three Ohio care centers that violated respiratory protection standards. Of the more than 4,500 complaints OSHA has received about COVID-19-related working conditions in the medical industry, it has closed nearly 3,200, a ProPublica analysis found.

Data problems aren’t just a federal issue; many states have fallen short in collecting and reporting information about health care workers. Arizona, where cases have been surging, told ProPublica, “We do not currently report data by profession.” The same goes for New York state, though a report in early July hinted at just how devastating the numbers there might be: 37,500 nursing home employees, about a quarter of the state’s nursing home workforce, were infected with the coronavirus from March through early June. Other states, including Florida, Michigan and New Jersey, provide data about employees at long-term facilities but not about health care workers more broadly. “We are not collecting data on health care worker infections and/or health care worker deaths from COVID-19,” a spokesperson for the Michigan Health Department said in an email.

This problem is global. Amnesty International, in a July report, pointed to widespread data gaps as part of a broader suppression of information and rights that has left workers in many countries “exposed, silenced [and] attacked.” In Britain, where more than 540 medical workers have died in the pandemic, the advocacy group Doctors’ Association UK has begun legal action to force a government inquiry into shortages of personal protection equipment in the National Health Service and “social care” facilities such as nursing homes. And in May, more than three months after the first known medical worker’s death, the International Council of Nurses called for governments across the world to start keeping accurate data on such cases, and for the records to be centrally held by the World Health Organization. The WHO estimates that about 10% of COVID-19 cases worldwide are among health workers. “We are closely following up (on) these cases through our global networks,” a spokesperson said.

“Governments’ failure to collect this information in a consistent way” has been “scandalous,” said the council’s CEO, Howard Catton, and “means we do not have the data that would add to the science that could improve infection control and prevention measures and save the lives of other healthcare workers. … If they continue to turn a blind eye, it sends a message that [those] lives didn’t count.”

So regular people, like Rezba, have stepped up with their makeshift databases.

Rezba, 40, initially wanted a career in public health. While finishing her master’s degree at Emory University in Atlanta and for a few months afterward, she worked as a lab tech at the CDC, analyzing nasal swabs to track cases of MRSA, the flesh-eating bacteria. But she decided she cared more about people than bugs, so she headed to Virginia Commonwealth University medical school in Richmond, graduating in 2009 with plans to specialize in the treatment of chronic pain.

During her residency at VCU, her first rotation was in the neonatal intensive care unit. “There was a little baby I helped take care of for three weeks. And the very last day of that rotation, his parents withdrew care…He was the first little person I pronounced dead. I went and cried in the stairwell after that.” Her next rotation was in the burn unit, then the emergency department. “It seemed like death was just everywhere,” Rezba said. Witnessing it “is something very separate from the rest of your life experiences. People look different when they’re dying. It’s not like TV. They don’t look like they’re sleeping. CPR is pretty brutal. Codes are pretty brutal.”

She began keeping a list as a way to process the grief. “In residency, you record everything—your case logs, the procedures you do. It was just sort of second nature to record their names.” Whenever a patient died she would make another entry in her notebook, then “I would kind of perseverate”—ruminate—“over their names.” At the end of the year, she took the notebook to church. “I lit candles for them. I prayed. And then I let it go.”

A decade later, Rezba was working full time as an anesthesiologist and raising three small children, her list-compiling days long past her, she thought. Then COVID-19 hit. The onetime infectious disease geek became obsessed with the videos leaking out of China—the teams of health care workers in full protective gear, the makeshift wards in tents, the ERs in chaos: “I knew early on that this was going to be a big problem.” In her job, Rezba was often called upon to do intubations. “The possibility of not having enough PPE caused a lot of anxiety for her,” said her husband, Tejas Patel, whom she met in medical school. “She would be the one, if we did hit that level of New York, who could potentially be at risk and bring it home to the kids.”

As it turned out, Rezba’s hospital wasn’t inundated, nor did it experience the PPE shortages that plagued many health care facilities. But her anxiety didn’t disappear; it just took a new shape. If health care workers were front-line heroes, she decided, her role was to search the trenches for the bodies left behind.

Rezba is the first to admit she’s not great at technology; she rarely uses a computer at home. Patel discovered what she was doing because their iPhones and iCloud accounts are linked. “Whenever she saves a picture to the phone, I can see it. And I noticed a bunch of pictures of, you know, these strangers.” He remembered how, in their student days, Rezba had insisted on humanizing the cadaver in their anatomy lab: “It upset her that it was just this anonymous person. Knowing his birthday and little things like that would make her feel better.” Patel figured the photos were part of a similar coping strategy. “It wasn’t until much later that I found out she was putting them up on Twitter.”

Much of Rezba’s digging happens in the middle of the night, when she can’t sleep. She usually starts by Googling for local news stories; if she’s still not tired, she turns to the obituary site Legacy.com. The hunt for a person’s occupation and cause of death invariably takes her to Facebook, where she follows the trail to relatives and co-workers, to vacation slideshows and videos of old men serenading their grandkids on the guitar. Every few days, she checks GoFundMe, where she’s recently been struck by the number of people who linger for weeks or months before dying. She’s still discovering deaths that occurred in April and May. Anyone under 60 gets special scrutiny. “If the obit says, ‘They died surrounded by family,’ I usually don’t bother trying to find out more, because those people didn’t have COVID. The people with COVID are mostly dying alone.”

Doctors and nurses are the easiest to find. “If someone worked in the laundry service at the nursing home, the family doesn’t put that in,” Rebza said. Yet it’s the nonmedical staff that she feels a special obligation to uncover — the intake coordinators and supply techs, the food service workers and janitors. “I mean, the hospital’s not going to function if there’s nobody to take out the trash.” Every so often, a news story mentions that several staffers from a particular nursing home or rehab center have died, without mentioning their names, and Rezba feels the rage start to bubble. “What it comes down to is, these are people that are making $12 an hour. And they get treated like they’re disposable.”

If she can’t find someone’s identity right away, or if the cause of death isn’t clear, she’ll wait a couple of days or weeks and try again. Because she comes across them anyway, she’s started to keep track of other categories of COVID-19 deaths, like kids and pregnant women, as well as health care workers in their 30s and 40s who don’t appear to have the virus but suddenly perish from heart attacks or strokes or other mysterious reasons. “I have a lot of those,” she said.

Once she’s certain she’s found someone who belongs on her list, she selects a photo or two and writes a few words in their honor. Sometimes, these read like a scrap of poetry; sometimes, like a howl.

He enjoyed crazy-dancing at home to Bruno Mars, with the moves becoming wilder the more his family laughed.

As a child, she would wrap her clothes around Dove soap so they would smell like America.

This poor baby should have his mother in his arms. Instead he has her in an urn.

A preprint study out of Italy last week hinted at the kind of lessons researchers and policy makers might glean if they had more complete data about health care workers in the U.S. The study pooled data from occupational medical centers in six Italian cities, where more than 10,000 doctors, nurses and other providers were tested for coronavirus from March to early May. Along with basic demographic information, the data included job title, the facility and department where the employee worked, the type of PPE used and self-reported COVID-19 symptoms.

The most important findings: Working in a designated COVID-19 ward didn’t put workers at greater risk of infection, while wearing a mask “appeared to be the single most effective approach” to keeping them safe.

In the U.S., many medical facilities are similarly monitoring employee infections and deaths and adjusting policies accordingly. But for the most part, that information isn’t being made public, which makes it impossible to see the bigger picture, or for systems to learn from each other’s experiences, to better protect their workers.

Imagine all of the opportunities it would present if everyone could see the full landscape, said Ivan Oransky, vice president for editorial content at Medscape, where a memorial page to honor global front liners has been one of the site’s best-read features. “You could be doing some real great shoe-leather epidemiology…You could go: ‘Wait a second. That hospital has 12 fatalities among health care workers. The hospital across town has none. That can’t be pure coincidence. What did this one, frankly, do wrong, and what’s the other one doing right?’”

To Adia Harvey Wingfield, a sociologist at Washington University and author of “Flatlining: Race, Work, and Health Care in the New Economy,” some of the most pressing questions relate to disparities: “Where is this virus hitting our health care workers hardest?” Is the impact falling disproportionately on certain categories of workers—for example, doctors vs. registered nurses vs. nursing aides—on certain types of facilities, or in certain parts of the country? Are providers who serve lower-income communities of color more likely to become ill?

“If we aren’t attuned to these issues, that puts everybody at a disadvantage,” Wingfield said. “It’s hard to identify problems or identify solutions without the data.” The answers are especially important in Black and Latino communities that have suffered the highest rates of sickness and death—and where health care workers are themselves more likely to be people of color. Without good information to guide current and future policy, she said, “we could potentially be facing long-term catastrophic gaps in care and coverage.”

The near-term consequences have also been enormous. The lack of public data about health care workers and deaths may have contributed to a dangerous complacency as infections have surged in the South and West, Friese said—for example, the idea that COVID-19 is no more dangerous than other common respiratory viruses. “I’ve been at this for 23 years. I’ve never seen so many health care workers stricken in my career. This whole idea that it’s just like the flu probably set us back quite a way.”

He sees similar misconceptions about PPE: “If we had a better understanding of the number of health care workers infected, it might help our policymakers recognize the PPE remains inadequate and they need to redouble their efforts…People are still MacGyvering and wrapping themselves in trash bags. If we’re reusing N95 respirators, we haven’t solved the problem. And until we solve that, we’re going to continue to see the really tragic results that we’re seeing.”

The misconceptions appeared to stretch to the highest reaches of the federal government, even as infections and deaths started surging again. At a White Houseevent in July focused on reopening schools in the fall, HHS secretary Alex Azar told the people gathered, “health care workers…don’t get infected because they take appropriate precautions.”

Even some medical workers have continued to be in denial. A few days before Azar spoke, Twitter was abuzz over an Alabama nurse who worked the COVID-19 floor at a hospital by day and decompressed at crowded bars by night, where she often went maskless. “I work in the health care industry,” she was quoted as saying, “so I feel like I probably won’t get it if I haven’t gotten it by now.”

Piercing that sense of invulnerability—making the enormity of the COVID-19 disaster seem real—isn’t only Rezba’s mission. From The New York Times’ iconic front page marking the first 100,000 American deaths to the Guardian/Kaiser Health News project “Lost on the Frontline,” news organizations and social media activists have grappled with how to convey the scale of the tragedy when people are distracted by multiple world-shattering crises and the normal rituals for processing grief are largely unavailable.

“The point at which accountability usually happens is when our leaders have to reckon with the families of those who’ve been lost, and that has not happened,” said Alex Goldstein, a Boston-area communications strategist behind the wrenching @FacesOfCOVID Twitter account, which has posted almost 2,000 memorials since March. With COVID-19, “no one has had to look in the eye of a crying parent who wants to show you a picture of their child or listen to someone telling you about who their mom or dad was. There has been no consequence. What would our policy decisions have looked like if [the people making them] had to come face to face with that death and loss in a more visceral way?”

It’s a question that weighs especially heavily on health care professionals, who have seen, in the most visceral way possible, the worst that COVID-19 can do. Erica Bial, a pain specialist in the neurosurgery department at a Boston-area hospital, fell dangerously ill from COVID-19 in March, her respiratory symptoms lingering for more than six weeks. She lived alone and opted not to go to the hospital, in part because she worried about infecting other people. “At that point [in the outbreak], they would have intubated me, given me hydroxychloroquine and azithromycin and probably killed me.” As her recovery dragged on, she wondered how other doctors were faring: “I couldn’t believe that I was the only physician I knew who was sick.” But as she searched online, “I could not find any data. I just started getting really frustrated at the lack of information and the disinformation…And then I started thinking about, well, what happens if I die here? Will anybody know?”

Like Rezba, Bial has a background in public health; the Facebook page she created, COVID-19 Physicians Memorial, was an attempt to build “a network where there’s accountability. I wasn’t necessarily trying to create, you know, reverence or memorialization. I was trying to understand the scope of the problem.”

Rezba soon began posting memorials on the page; as it grew to include more than 4,800 members, Bial asked her to help moderate it. Among the things the two women share is a determination to stick to facts. “I didn’t want any politics and I didn’t want any garbage,” Bial said. “(Rezba) was 100% like-minded and trustable.” She was also someone Bial could talk to, doctor to doctor, as she recovered. “It wasn’t just two people obsessed with something kind of morbid,” Bial said. “She was a source of support.”

Emergency room doctor Cleavon Gilman also gained a following for his posts on Facebook, a diary about what he witnessed as an ER resident in the NewYork-Presbyterian hospital system, battling the virus as it engulfed Washington Heights. “It was just … overwhelming,” he recalled. “We were intubating 20 patients a day. We had hallways filled with COVID patients; there was nowhere to put them.” In the space of a few brutal days in late April, three of Gilman’s colleagues died, including one by suicide. “When it’s a colleague that you’re taking care of and you know them as a person you’ve been on a journey with…man, that’s hard.”

Though much of the media focus was on the risks faced by older patients, Gilman was struck by how many of the critically ill were in their 20s, 30s and 40s. In mid-April, his own 27-year-old cousin, a gym teacher at a New Jersey charter school, suddenly died; he went to the ER twice with chest pain but was diagnosed with anxiety and sent home, according to his relatives, only to collapse in his car on the side of the road.

As the crisis in New York City ebbed, Gilman could see trouble ahead in other parts of the country, including in Yuma, Arizona, where he was about to start a new job. It seemed vitally important to help younger people understand the risks they faced—and that they created for others—by not adhering to physical distancing or wearing masks, not to mention the dangers that health care workers faced from continuing shortages of PPE. So Gilman began gathering the memorials he saw on Twitter and Facebook, many of them found by Rezba or on @FacesOfCOVID, and organizing the dead on his website in the type of gallery that he knew would pack an emotional wallop. Then he went a step further, making the photos and obituaries—more than 1,000 people—sortable by age and profession.

“You begin to see a pattern here,” he said. “When someone says, ‘Oh people aren’t dying, they’re not that [young],’ you can come back with actual names, actual articles, quickly. It’s more powerful. You have your evidence there.”

One of the most overtly political projects is Marked by COVID, formed by Kristin Urquiza in honor of her father, Mark, after her “honest obituary” of him went viral in early July. To Urquiza, who earned her master’s in public affairs from the University of California, Berkeley, and works as an environmental advocate in the San Francisco area, “the parallels between the AIDS crisis and what is happening now with COVID are just mind-boggling [in terms of] the inaction by governments and the failure to prioritize public health.” She and her partner, Christine Keeves, a longtime LGBTQ activist, hope the project will be both “a platform for people to come forward and share their stories” and the COVID-19 version of the anti-AIDS group Act Up.

They’re also raising money on GoFundMe to help other families pay for obituaries; the second honest obit on their site was for a respiratory therapist in Texas named Isabelle Odette Hilton Papadimitriou: “Her undeserving death is due to the carelessness of politicians who undervalue healthcare workers through lack of leadership, refusal to acknowledge the severity of this crisis and unwillingness to give clear and decisive direction to minimize the risks of coronavirus. Isabelle’s death was preventable; her children are channeling their grief and anger into ensuring fewer families endure this nightmare.”

It’s a trend that Rezba supports wholeheartedly. By the end of July, she had posted almost 900 names and faces of U.S. health care workers who had perished from COVID-19. She fantasized about what it would be like to leave the counting behind her. “It would be great if I could stop. It would be great if there was nobody else to find.” But she had a backlog of dozens of stories to post, and the number of deaths kept climbing.

For the second time in less than a month, President Donald Trump sat down for a mildly tough interview, which aired Monday on HBO, during which he was confronted with facts and some of his most glaring falsehoods were appropriately challenged. It was a sweeping conversation with Axios’ Jonathan Swan that produced a string of jaw-dropping and maddening moments. But even in the long list of appalling remarks from the president, the worst exchanges are likely to be remembered as these.

“You can’t do that.”

In a heated back and forth, Trump and Swan sparred over the best statistics to assess the United States’ response to the coronavirus pandemic. Trump falsely asserted that US deaths from the virus are “lower” than anywhere in the world, rifling through a disorganized stack of printed charts to somehow back the absurd claim. “Lower than the world? In what?” Swan asked.

Glancing at the charts Trump was referencing, Swan said, “You’re doing death as a proportion of cases. I’m talking about death as a proportion of the population.”

“You can’t do that,” an outraged Trump replied.

After a brief explanation of the statistical importance of comparing coronavirus numbers in proportion to a country’s population, Trump then pivoted and suggested that South Korea has been falsely reporting its numbers in order to give the appearance of a more effective response. “You don’t know that,” Trump said when Swan mentioned South Korea’s low number of deaths from coronavirus. “You think they’re faking their statistics, South Korea?”

“Uh, I won’t get into that because I have a very good relationship with the country but you don’t know that.”

.@jonathanvswan: “Oh, you’re doing death as a proportion of cases. I’m talking about death as a proportion of population. That’s where the U.S. is really bad. Much worse than South Korea, Germany, etc.”@realdonaldtrump: “You can’t do that.”

Swan: “Why can’t I do that?” pic.twitter.com/MStySfkV39

— Axios (@axios) August 4, 2020

“I don’t know John Lewis.”

When asked how history would memorialize the late civil rights icon Rep. John Lewis, Trump claimed that he didn’t know Lewis. That lack of familiarity, Trump suggested, was a direct result of Lewis’ refusal to attend his inauguration ceremony. Trump immediately followed that breathtaking display of pettiness by declining to describe Lewis as impressive—twice.

“I can’t say one way or another,” Trump said. “I found a lot of people impressive, I find many people not impressive but he didn’t come to my inauguration, he didn’t come to my State of the Union speeches.” He then declared, falsely, that as president he’s done more for Black people in America than anyone else in history.

.@jonathanvswan: "How do you think history will remember John Lewis?"

President Trump to #AxiosOnHBO: "I don't know…I don't know John Lewis. He chose not to come to my inauguration." pic.twitter.com/LDv76rrIFc

— Axios (@axios) August 4, 2020

“Yeah, I wish her well.”

In an extraordinary moment last month, Trump offered warm wishes to Ghislaine Maxwell, the longtime associate of Jeffrey Epstein who was recently charged with helping Epstein’s child-trafficking operation. “I just wish her well, frankly,” he said at a July 21 news conference. 

Asked for his thoughts on Maxwell, Trump stood by his remarks and said, “Yeah, I wish her well. I’d wish you well. I wish a lot of people well.”

He also promoted the conspiracy theory that Epstein was murdered. “Her friend or boyfriend was either killed or committed suicide in jail.”

“I mean, she’s an alleged child sex trafficker,” Swan interrupted at one point. 

Trump sure got defensive when talking about his friends Ghislaine Maxwell and Jeffrey Epstein. Wonder why.

pic.twitter.com/KTruPJHEnV

— MeidasTouch.com (@MeidasTouch) August 4, 2020

For months, Senate Majority Leader Mitch McConnell has upheld an ultimatum about passing new COVID-19 relief legislation this summer: No economic stabilization package will pass the Senate unless it protects businesses from coronavirus-related lawsuits. “We need to provide protection, litigation protection, for those who have been on the front lines,” McConnell said during a Fox News interview in April. “We have a red line on liability.”

Last Monday, a bill introduced by Sen. John Cornyn (R-Texas) and coauthored by McConnell clarified exactly which front lines Senate Republicans are interested in defending. The proposal, titled the Safe to Work Act, would make it harder for workers and customers to sue companies for negligently exposing them to the coronavirus and raises the bar for patients to sue healthcare providers for coronavirus-related malpractice. It also extends “front line” protections to healthcare executives, including nursing home owners, until 2024.

As negotiations over the coronavirus relief package stall, in part due to McConnell’s red line, experts on elder law and advocates for nursing home residents are alarmed that the Republicans’ proposed immunity shield could destroy what little accountability there is for nursing homes at a time when they’ve become deadly hotspots of COVID-19. According to the Centers for Medicare and Medicaid services, more than 40,000 people living in skilled-nursing facilities have died of the coronavirus—more than one quarter of all deaths from the illness. Those deaths represent around 1 in 32 of the country’s 1.3 million nursing home residents, though that is likely an undercount due to incomplete data.

Nursing home industry representatives have argued that a liability shield is necessary to protect providers’ ability to make difficult decisions in an emergency situation. “Subjecting health care workers and facilities to onerous litigation even as they have done their level best to combat a virus about which very little was known when it arrived in the United States would divert important health care resources from hospitals and providers to courtrooms,” the bill reads.

Yet by making liability lawsuits all but impossible, experts warn that corporate owners would not only be protected from claims of mismanaging their response to COVID-19, they would be free to pursue the kinds of cost-cutting that could endanger their vulnerable residents. “This act is not about responding to COVID-19,” says Nina Kohn, an elder law expert at Syracuse University. “It’s about using COVID-19 as a screen to eviscerate a system of public accountability that average individuals in this country rely on, but which certainly can limit corporate profitability.”

The pandemic has already created an unprecedented lack of oversight for nursing homes. In March, the Centers for Medicare and Medicaid Services ordered federal and state inspectors to only enter facilities deemed in need of infection control oversight, and didn’t clarify until June that facilities with COVID-19 outbreaks required state inspections. In May, the Government Accountability Office found that even before the pandemic, most nursing homes had infection control problems but faced no fines or other consequences. (Inspectors also may enter facilities where residents are considered to be in “immediate jeopardy”—emergency situations authorities are notoriously bad at identifying.) Meanwhile, family members, who often flag problems with their loved ones’ care, were banned from visiting all facilities starting in early spring, except for end-of life visits. So were volunteers and ombudsmen who resolve complaints and fight for residents’ interests.

“Essentially, the nursing home industry was given a holiday from any type of monitoring, oversight, or accountability during the COVID-19 pandemic, and most of that is still continuing to this very day,” says Richard Mollot, executive director of the Long Term Care Community Coalition, a New York-based nonprofit. “The normal systems that are there to protect residents are gone,” says Toby Edelman, senior policy attorney at the Center for Medicare Advocacy. “The last thing that exists is litigation.”

Fewer than 50 lawsuits have been filed so far against long-term care facilities for their handling of the coronavirus or treatment of residents during the pandemic, according to a database maintained by Hunton Andrews Kurth, a corporate law firm. In April, a woman filed a wrongful death suit against the Life Care Center of Kirkland, Washington, where her mother died of COVID-19 in March. (The facility has been linked to 129 cases and 37 coronavirus deaths.) Last month, a Tennessee woman sued a nursing home, claiming it did not adequately isolate patients with respiratory symptoms; her mother, a resident there, was infected and died of COVID-19 in late March. Another lawsuit against a nursing home in Southern California alleges it ignored infection control protocols, failed to hire enough staff, and downplayed the threat of COVID-19, leading to a resident’s death. 

Senate Republicans’ relief bill would provide nursing homes sweeping protections against coronavirus related-lawsuits, moving them to federal court and imposing stringent requirements on plaintiffs. Families would only have a year to pursue cases and would be required to obtain costly affidavits and certified medical records before filing. The bill would also raise the standard of proof plaintiffs must meet while narrowing the definition of gross negligence so that, Kohn says, it is “almost impossible to satisfy.” The bill also specifies that any problems at a nursing home due to a lack of staff or resources can’t be considered gross negligence—providing a ready-made defense for most facilities, which are often understaffed and have been losing money. 

“The intention is to stop all litigation,” Edelman says. The staffing exemption, she predicts, could be a defense for any nursing homes that do get sued: “‘Yeah, we didn’t feed your mother or give her her medication, but it’s not our fault, because we didn’t have the staff.'”

Even in normal times, advocates say, lawsuits against nursing homes are uncommon, both due the difficulty of bringing cases and their emotional toll on family members. “They don’t want to dwell on on how terrible the end of their loved one’s life was,” Mollot says. “They want to move on, to think of their loved one as not being in pain any longer.” Many cases are blocked by arbitration agreements, which were permitted after the nursing-home industry fiercely fought the Obama administration’s effort to ban them. Cases that do make it in front of a judge typically involve serious allegations such as severe bed sores, falls, and malnourishment. Plaintiffs must prove that their loved one would have survived if not for neglect or serious mistakes, and that their death was foreseeable, Kohn says. And families don’t stand to win much in damages, in part due to residents’ already-short life expectancy.

But advocates say lawsuits, though rare, matter because they can deter maltreatment. While few lawsuits make it to court, the “small threat of a big loss,” as Kohn puts it, can keep nursing homes from cutting corners to increase their profit margins. About 70 percent of the country’s 15,400 nursing homes are operated for profit. Those privately owned facilities are less likely to receive four or five-star ratings on the federal nursing home quality scale than nonprofit or government-operated homes, and more likely to be flagged as persistently low-performing or cited for abuse, a New York Times investigation found in May.

The nursing home industry, which Politico calls “one of the lobbying world’s quiet powerhouses,” has been arguing since early in the pandemic that long-term care companies should be granted legal immunity for their response efforts. The push began on the state level, where nursing home interest groups pressured governors to protect them from lawsuits. In an April 2 letter, the Florida Health Care Association, a trade group, asked Florida Gov. Ron DeSantis, to “extend sovereign immunity” to healthcare workers, including nursing homes. By late July, at least 28 states had enacted executive orders or laws protecting healthcare providers, sometimes including nursing homes, from liability lawsuits, according to the National Consumer Voice for Quality Long-Term Care. New York and New Jersey went further, granting providers some protection from criminal prosecution.

But those state-level successes were not enough for the nursing home industry. The American Health Care Association, which represents long-term care facilities, has spent more than $1.7 million this year lobbying the federal government on issues including coronavirus relief, according to the Center for Responsive Politics. Last month, Mark Parkinson, the organization’s president and CEO, wrote in a message to members that a federal immunity shield was a top priority for his organization, along with obtaining additional funding. (On July 22, President Donald Trump announced an additional $5 billion in nursing home funding.) “Only a reasonable federal immunity solution that will protect our operators and staff for their good faith efforts during this challenging time is what we’re asking for,” Parkinson wrote.

“Fortunately, Senate Majority Leader McConnell is strong on this issue and has said that if liability immunity is not in the next stimulus bill, he will not allow the bill to advance,” he added. “That gives us a real shot at success.”

On Monday, President Donald Trump pulled out all the old stops to defend his inability to control the coronavirus: delegitimizing public health experts, denouncing the media, and vilifying Democrats.

After signing an executive order limiting US government agencies’ use of foreign labor, Trump began extolling the virtues of hydroxychloroquine, the antimalarial drug that has not been proven to improve outcomes in patients with COVID-19. When a reporter countered that Dr. Anthony Fauci, the administration’s foremost infectious disease specialist, has said the drug doesn’t work, Trump replied, “I don’t agree with Fauci on everything.” Earlier in the day, Trump lashed out against Dr. Deborah Birx, apparently for accurately noting that the coronavirus is “extraordinarily widespread” in the country and for warning against reopening schools in areas with high infection rates.

Dr. Anthony Fauci: Research has shown that hydroxychloroquine is not effective in the treatment of COVID-19.

Donald Trump: "I happen to take it myself…I don't agree with Fauci." pic.twitter.com/tmvSPeJaZZ

— Mother Jones (@MotherJones) August 3, 2020

Trump also criticized Fauci for allegedly arguing against a ban on travel from China in the early weeks of the pandemic, saying, “I overrode him, and I did the right thing.” As The Atlantic‘s Ed Yong explains, travel bans ironically tend to do more harm than good, promoting last-minute travel before the restrictions go into effect and ultimately failing to halt the spread of disease.

When asked why the United States has experienced so many coronavirus deaths compared to other countries around the world, Trump said, “Hold it. Fake news, CNN. Hold it.” He then falsely implied that the worldwide spread of the virus was intentional, claiming that the virus “was released by China.” And, rather than taking responsibility for the way that the virus has ravaged American cities, he blamed Democratic mayors and governors.

This. Clip. Is. Insane.

A reporter asked the president why the US has so many deaths compared to other countries (150K+), and Trump responds with a "hold it fake news CNN." He then descends into a racist rant claiming it was "released" by China (3 times over). pic.twitter.com/E4fafsTUib

— Mother Jones (@MotherJones) August 3, 2020

“What the Democrats want,” he said, “all they’re really interested in is bailout money to bail out radical left governors and radical left mayors like in Portland and places that are so badly run. Chicago, New York City. You see what’s going on over there?”

President Trump on Monday lashed out at Dr. Deborah Birx after the White House coronavirus response coordinator warned that the coronavirus is now “extraordinarily widespread” in the United States—an assessment that while backed by science, contradicts Trump’s ongoing efforts to falsely portray the crisis in more optimistic terms.

It marked the first time the president has publicly criticized Birx, who until now, had echoed the White House’s talking points on the pandemic, even when doing so drew heavy condemnation, as well as doubt over her independence as a public health official. Trump’s newfound frustration with Birx came after she told CNN Sunday that the US had entered a “new phase” of the pandemic, one different than the situation in March and April, while also suggesting that distance learning—not the in-person reopening of schools Trump has aggressively pushed for—may be more appropriate for communities struggling to contain the spread of the virus.

On Monday, without offering any evidence, Trump framed Birx’s remarks as a response to House Speaker Nancy Pelosi’s blunt comments announcing that she didn’t have confidence in Birx. “I think the president has been spreading disinformation about the virus and she is his appointee,” Pelosi told ABC on Sunday, “so I don’t have confidence there, no.” 

“It is deeply irresponsible of Speaker Pelosi to repeatedly try to undermine & create public distrust in Dr. Birx,” Alyssa Farah, the White House’s director of strategic communications, tweeted. “It’s also just wrong. Period. Hard stop.”

That call to end criticism of Birx apparently did not reach Trump, who by accusing Birx of taking “the bait” and hitting the administration,” had unwittingly taken the baton from Pelosi. “Pathetic!”

So Crazy Nancy Pelosi said horrible things about Dr. Deborah Birx, going after her because she was too positive on the very good job we are doing on combatting the China Virus, including Vaccines & Therapeutics. In order to counter Nancy, Deborah took the bait & hit us. Pathetic!

— Donald J. Trump (@realDonaldTrump) August 3, 2020

The country’s coronavirus testing czar on Sunday tried to put the endless debate over hydroxychloroquine, the president’s preferred coronavirus treatment, to bed. “We need to move on from that and talk about what is effective,” said Brett Giroir, assistant secretary at the Department of Health and Human Services, on NBC’s Meet the Press—contradicting his boss, who is still touting the drug.

WATCH: Trump's coronavirus testing czar @HHS_ASH says America needs to "move on" from debating hydroxychloroquine. #MTP

"The evidence just doesn't show hydroxychloroquine is effective, for now." pic.twitter.com/g8OpLqajDd

— Meet the Press (@MeetThePress) August 2, 2020

For months, President Trump has hyped the anti-malarial drug hydroxychloroquine as a treatment for COVID-19. At one point, Trump even claimed he was taking the drug himself. This past week, Trump’s son Donald Trump Jr. tweeted a viral video showing doctors saying masks are not necessary and that hydroxychloroquine was a proven antidote. Twitter and Facebook took the video down for spreading misinformation, and Twitter suspended Trump Jr.’s ability to tweet for 12 hours. Trump, who also tweeted the video, defended his support of hydroxychloroquine after the video was removed, and said the doctors in the viral video were “very respected.” One of the featured doctors, Stella Immanuel, holds numerous unproven beliefs, including about sex with demons.

Despite Trump’s protestations, Dr. Anthony Fauci said on Wednesday that hydroxychloroquine is not effective. “We know that every single good study—and by good study I mean randomized control study in which the data are firm and believable—has shown that hydroxychloroquine is not effective in the treatment of Covid-19,” he said.

On Sunday, Giroir piled on. “There may be circumstances, I don’t know what they are, where a physician may prescribe it for an individual, but I think most physicians and prescribers are evidence-based and they’re not influenced by whatever is on Twitter or anything else,” he said. “And the evidence just doesn’t show that hydroxychloroquine is effective right now.”

President Trump thinks that just because there are coronavirus outbreaks around the world, he’s off the hook. That, and the only reason that the pandemic is raging unchecked is because terrific testing is revealing cases. With these twin denials, Trump has drilled an escape hatch from reality through which he can slip out to the golf course, comforted by the knowledge he’s doing the best job in the world, and even if he isn’t, the rest of the world is losing anyway, so what can a president do?

Today, Trump tweeted that the “fake news” isn’t covering an outbreak in the Australian state of Victoria. It is, of course. But this is an exercise in “Who are you gonna believe? Me or your lying eyes?” to deflect blame. If only the media covered other countries, they’d see just how much to not blame him.

Big China Virus breakouts all over the World, including nations which were thought to have done a great job. The Fake News doesn’t report this. USA will be stronger than ever before, and soon! https://t.co/pZwjvgmVTO

— Donald J. Trump (@realDonaldTrump) August 2, 2020

He picked the wrong country. Australia’s response to this recent outbreak proves him dead wrong.

After clocking record numbers of community-spread coronavirus cases—671 new coronavirus cases since Saturday, after a horrific week—the state of Victoria in southeast Australia announced it was moving to the strictest lockdowns the country has seen so far, after successfully tackling its first outbreaks earlier this year. Melbourne, Australia’s second-biggest city, is enforcing an overnight curfew, backed by fines and other police powers, as a “state of disaster” was declared in the state. The latest stay-at-home order will last six weeks.

But for all the reasons to criticize Australia’s response, denial isn’t one of them. And the difference in responses between the US and Australian responses couldn’t be starker. Trump aggressively advocates against the kind of measures Victoria is embracing as it faces down a new spike, insisting instead on unfettered opening up, flouting social distancing himself by organizing rallies. Trump has pushed the nation’s response almost entirely to governors; Australia runs a nationally coordinated response, with scientists put in the driver’s seat. There’s now a mask mandate in Victoria; Trump’s relationship with masks is, well, bad. Australia outpaces the US in tests per thousand people. The list goes on.

And then you look at the actual numbers, which speak for themselves. In Australia, just 1 in 1,445 people have contracted the coronavirus, according to the New York Times. In the US, it’s 1 in 71.

Australia has kept its death toll to 1 in 124,340 people. In the US, that’s 1 in every 2,112.

Deborah Birx, the White House coronavirus task force coordinator, acknowledged on CNN Sunday that the coronavirus pandemic has spread from the first big cities it hit in March and April to rural and urban areas across the country—an acknowledgement that the White House’s minimal response to the pandemic failed to contain it.

“What we are seeing today is different from March and April,” Birx said. “It is extraordinarily widespread.” 

Birx stressed the danger to rural Americans who may think the virus cannot reach them. “To everybody who lives in a rural area, you are not immune or protected from this virus,” she said. “If you’re in multi-generational households, and there’s an outbreak in your rural area or in your city, you need to really consider wearing a mask at home, assuming that you’re positive, if you have individuals in your households with comorbidities.”

Birx also tentatively contradicted the White House’s exhortation to reopen schools in person, saying she agreed with Robert Redfield, the head of the Centers for Disease Control and Prevention, that outbreak hotspots should use distance learning in schools. 

.@DanaBashCNN presses Dr. Deborah Birx on school reopenings.

“If you have high case load and active community spread … we’re asking people to distance learn at this moment so we can get this epidemic under control,” Dr. Birx says. #CNNSOTU pic.twitter.com/EgJwa8JjhY

— State of the Union (@CNNSotu) August 2, 2020

The warning from Birx comes shortly after news reports that she helped dissuade the White House from launching a national strategy to contain the pandemic by touting optimistic numbers about the virus’ spread back in April. The White House was in the process of abandoning what little it had done to stem the outbreak and transition responsibility to the states, and Birx, according to the New York Times, provided the data that justified that catastrophic plan:

Suzanne Prevost, the dean of University of Alabama’s Capstone College of Nursing, sent out an email on Thursday that elicited shockwaves through the university’s faculty. In the email, which went out to the nursing school’s faculty, Dean Prevost explained that she is “acutely aware” of the challenges of getting back to work right now and that those challenges are “especially pertinent for those of you,” she wrote in bold, “with school aged children.” She then implored her staff to let her know in advance if they would not be able to work in the fall so that the college will “have time to hire a new faculty member to replace you.”

“We wish that we had unlimited abilities to flex schedules and ‘make it work’ for everyone,” she wrote, “but this is just not the case.”

Dean Prevost wrote that she “wish[es] this thing would ‘just go away”’ and ended on the somber acknowledgement that”our wishes are not our reality.” (The word “wish” appeared four times in the email, suggesting that the resources Dean Prevost had at her disposal were tantamount to a pile of pennies aimed into an available fountain.)

Faculty at the @uaccn received this email from their dean yesterday directing instructors with children to consider quitting their jobs so that @UofAlabama can hire replacements. pic.twitter.com/d0JZ2sp6hx

— SafeReturnUA (@SafeReturnUA) July 31, 2020

As the Twitter thread on @SafeReturnUA‘s account pointed out, every University of Alabama faculty member has a right to twelve weeks of emergency Family and Medical Leave (FMLA) per federal law, which could cover paid leave should children have to remain home because of the coronavirus (most Alabama schools are planning to reopen in the fall). Her email also omitted information about how the University of Alabama has expanded FMLA following Congress’ passage of the Families First Coronavirus Response Act (FFCRA). The expansion provides more paid family leave benefits and emergency paid sick leave benefits, which faculty with children might find especially useful.

But many faculty at the College of Nursing are on contracts without long-term job security, making them more vulnerable to losing their jobs and the benefits that come with them. Identifying themselves as less available to work in the fall could jeopardize their chances for future employment at the University of Alabama, as made clear in the email. Despite repeated assurances from the University of Alabama’s administration that budget constrictions will not affect employees, four instructors in the English Language Institute recently did not have their contracts renewed. Since they were on contract, this technically does not count as a lay off or furlough. 

Dr. Jack Carey, an instructor at the University of Alabama’s Department of American Studies, who is involved with the United Campus Workers of Alabama and the Safe Return UA initiative, said that the email is indicative of a broader issue at the University of Alabama, which is planning to reinstate in-person classes in the fall.

“It taps into this general pattern where you have a lack of transparency, no clear communication about what’s available to people, and the university putting the burden on the workers to deal with its plans to have face-to-face instruction,” he said. “I don’t feel like it’s clear to staff, even if they become aware of these opportunities for support, how to access them.”

Following the backlash to the email, which was reposted on Twitter and Facebook by United Campus Workers Alabama, Dean Prevost issued a statement on Friday clarifying that she “did not mean to suggest that any of you should resign from your faculty positions or that you will be terminated if you are unable to return to work.” The statement also linked to the paid family leave available to staff.   

Aside from the confused messaging, why were only faculty members of the nursing school recipients of such a missive? Could it have something to do with their gender? According to the last census, nursing is a profession dominated by women—90% of the faculty at the University of Alabama’s College of Nursing use she/her pronouns on their website, reflecting the national trend.   

I have to wonder whether the same email would have ever gone out to faculty at the College of Engineering.

When I contacted the University of Alabama for comment, they said that “the University has been clear about its support and understanding of the challenges facing faculty, staff and students during these difficult times” and linked me to Dean Prevost’s new statement. But that won’t erase the initial impression of the email, which was shocking even to faculty like Carey, who has worked in academia for many years and understands the how precarious the job market is. 

“I was blown away by the email,” Carey said. “I’ve never seen anything like that.” 

Schools across the country are set to open in mere weeks—some have announced exclusive virtual learning for the first months, others have promised to reopen with safety measures in place. But parents and staff continue to grapple with the confusion over what is safe and what isn’t while coronavirus cases skyrocket around the country. Are children of certain ages unlikely to catch the virus? Could they still be vectors? Are there ways for them to be together and still be safe? On Friday, the Centers for Disease Control published a case study with more bad news about kids and COVID-19, concluding that they “might play an important role in transmission.”

The study focused on an overnight camp in Georgia where, in June, 597 campers ranging in age from 6 to 19 and staff had gathered. The camp had some protocols such as requiring a test 12 days before arriving, having staff wear masks, and placing campers into smaller pods. But there were many ways the camp fell short of what public health officials have recommended: Campers were not required to wear masks, they shared cabins of up to 15 kids, and participated in a number of indoor gatherings. First, on June 23, a teenage staff member developed symptoms, and left. The next day, the camp began sending campers home and closed down on June 27. 

Researchers found that the camp became linked to at least 260 infections among campers and staff. Children of all ages were susceptible to infection: 51 percent of the positive tests were for children who were from 6 to 10 years old, and 44 percent were 11 to 17. Of 136 cases with information about symptoms, 26 percent reported they had none.

The authors write:

These findings demonstrate that SARS-CoV-2 spread efficiently in a youth-centric overnight setting, resulting in high attack rates among persons in all age groups, despite efforts by camp officials to implement most recommended strategies to prevent transmission. Asymptomatic infection was common and potentially contributed to undetected transmission, as has been previously reported. This investigation adds to the body of evidence demonstrating that children of all ages are susceptible to SARS-CoV-2 infection and, contrary to early reports, might play an important role in transmission.

There are plenty of limitations to a case study, including that it’s possible kids became infected outside of camp, and no one can know with any certainty whether kids actually physically distanced or not. But the “attack rate,” or the number of positives, are also very likely an underestimate because of missed cases outside of the 344 tested. The camp became one of the largest super-spreader events in Georgia, where there are now 182,000 confirmed cases, more than 3,670 deaths, and 4,000 new cases added in a single day this week.

There’s still much we don’t understand about the role kids play in transmission and just how big an impact opening schools this fall will have on the still growing number of cases around the country. The political response hasn’t helped either, with Republicans like Georgia Governor Republican Brian Kemp banning cities and counties from issuing mask mandates. Parents have been left to face an impossible decision over with whether they should send their kids back to schools while science-denying politicians have given up on their responsibility to contain the pandemic. This latest study suggests that the consequences of reopening schools without stricter measures this fall may seed even worse outbreaks. 

For a deeper dive into the confusing science over sending kids back to schools, read my colleague Jackie Flynn Mogensen.