It also left a litany of unanswered questions: who came up with the narrow criteria, how many hospitals would qualify and whether the funding will be enough to prevent hospital closures in the near term.

Assembly Bill 108, signed into law last week, will provide grants to public and nonprofit hospitals that meet several criteria, including having less than 10 days of cash on hand and having more than half of their patients on government-funded insurance programs or uninsured. The goal is to tide eligible hospitals over until July 1, when the new fiscal year begins, said Sen. John Laird, a Santa Cruz Democrat who chairs the Senate Budget Committee and championed the funding bill.

The measure, put in print on May 4, flew through both legislative chambers in just three days before Gov. Gavin Newsom signed it within hours. By Monday, the program was up and running and hospitals had just a week to apply. The Department of Health Care Access and Information will announce recipients May 26.

“It is a rare occurrence for bills to go from the starting block to the finish line in just a few days,” said veteran lobbyist and Capitol watcher Chris Micheli, who said the speed reflects the urgent need of hospitals and a consensus among leaders.

Hospital leaders interested in applying said they were pleased the Legislature acted so quickly, though some are scrambling to meet the application deadline after learning about it just a week ago.

Laird told CalMatters that he knows of two to three hospitals that will likely qualify but declined to name them, arguing that doing so could scare off vendors and hospital staff.

When pressed, he acknowledged that potential recipients include Watsonville Community Hospital in his own district.

“This bill comes at a completely inopportune time in the budget process, and the time was not dictated by us,” Laird said during a budget hearing last Tuesday. “It was dictated by a few hospitals going under.”

The criteria are so narrow and the bill moved in such an “expedited fashion” that it seems tailored to the needs of a specific hospital, said Assembly Budget Committee Vice Chair David Tangipa, a Fresno Republican, who voted for the bill nonetheless.

“It says 10 days. Why not put it at 30 days?” he said. “They needed to make sure that even though it appears to be a general fund that all of these other hospitals could apply for, that probably only one hospital met all of those qualifications.”

Neither Laird nor the finance department staff was able to explain how they came up with the criteria, including why they picked 10 days — instead of any other number — of cash on hand to indicate a dire enough financial situation. Hospital administrators said the typical goal is at least 90 days of cash on hand.

The ambiguity frustrated some state lawmakers, who repeatedly pressed for clarity during the budget hearing. Sen. Chris Cabaldon, a Napa Democrat, called the lack of answers “profoundly disturbing.”

“It’s been one long ‘I said what I said’ hearing,” he said. Still, he voted for it.

Others lamented that the criteria, especially the 10-day threshold, should have been expanded to allow more hospitals to compete for the funding.

“Right now, it’s far too narrow, and really by this time the hospital has gone over the cliff,” Sen. Lola Smallwood-Cuevas, a Los Angeles Democrat, told CalMatters in an interview. She, too, voted for it. “We want to figure out who’s standing on the cliff, who’s a few feet from the cliffs, who’s a mile from the cliff.”

The $25 million grant comes as hospitals across California, particularly in rural areas, say they are at risk of dropping services or shutting their doors due to rising labor costs and federal Medi-Cal funding cuts.

The funding woes sparked calls for renewed funding for the state’s Distressed Hospital Loan Program, which in 2023 gave 16 financially distressed hospitals nearly $300 million. Of those, 15 have asked for more time to repay the debt, and nine of them have also applied for loan forgiveness, according to the California Health Facilities Financing Authority.

The California Hospital Association, which represents nearly 400 hospitals, is sponsoring a bill to put another $300 million into the loan program. Senate Democrats proposed $200 million in funding in mid-April but have not specified if the dollars would be a loan or a grant.

Newsom proposed up to $50 million toward hospitals in “immediate and significant financial distress” in 2026-27 in his budget revision Thursday.

A few hospitals plan to apply

Watsonville Community Hospital, which has publicly shared its financial struggles, reported having 8 days of cash on hand in the last quarter of 2025, according to the most recent financial records collected by the state. The hospital received an $8.3 million state loan in 2023 as part of the distressed hospital program lawmakers passed that year. When asked about the hospital, Laird said the hospital is “quite likely” to be eligible.

“This is critically important for the hospital as we navigate fiscal challenges brought on by funding delays and cutbacks at the federal level,” hospital spokesperson Jennifer Murray said in an email.

Hospitals in the Central Valley and rural Southern California also could benefit from the grant, according to Laird.

Madera Community Hospital told CalMatters it intends to apply for a slice of the grant money. The hospital reopened its doors in March 2025 after closing at the start of 2023. American Advanced Management, the company that took over the hospital, received $57 million from the state to reopen it. State data show the hospital ended 2025 with two days of cash on hand.

Delays in reimbursements and low patient volume in its outpatient clinics are contributing to Madera Community’s slower-than-expected recovery, said Matthew Beehler, a spokesperson for the hospital. He said Madera Community is still working on contracting with some insurers and is not yet receiving funds from the Hospital Quality Assurance Fee, a state-federal supplemental payment program for hospitals that serve a high number of Medi-Cal and uninsured patients. State data show that in 2022, before the hospital closed, it relied on more than $16 million in supplemental payments.

The $57 million from the state, Beehler said, helped cover the hospital’s first six months of operations. Beyond that, American Advanced Management has covered the shortfalls.

“I think that we are headed towards the path of real sustainability for the hospital,” Beehler said. “It just takes time to have all that sort of reach its state of equilibrium.”

In the Eastern Sierra, Dr. Kevin Flanigan, CEO of the Southern Inyo Healthcare District, said he, too, plans to apply for the state’s emergency grant. He said his hospital needs about $1 million to get through 2026. However, he does not know if his hospital will qualify given the 10 days of cash on hand criteria. He said Southern Inyo’s cash balance fluctuates anywhere between 18 to 20 days of cash to 8 to 10 days — grim in either case.

If his hospital doesn’t qualify for a grant? “Then God willing, we find money elsewhere. If not, we begin the process of closing certain things,” Flanigan said. Southern Inyo is a small hospital, with only four acute care beds, 30 skilled nursing beds and an outpatient clinic; there isn’t much to cut from, he said.

“We are clearly one of the most precarious hospitals in the state.”

Unanswered questions

Laird told CalMatters he is confident the $25 million will be enough to save hospitals facing the most imminent threat of closure.

But it’s unclear how he and the finance department arrived at the dollar amount. Department of Finance spokesperson H.D. Palmer said the figure represents the administration’s “best assessment of potential funding needs” and is partly based on the Distressed Hospital Loan Program, which gave 16 hospitals an average of $19 million each to keep them afloat for several years.

Laird said the amount was based on the number of hospitals legislators “informally” think would be eligible. Whatever is left untapped by June 30 would revert back to the state, he said, and legislators could add more funding if it runs out.

“It is what we think is necessary now,” Laird said.

The Department of Health Care Access and Information collects and publishes financial data from hospitals quarterly, but that data lags. Which hospitals qualify for the grant will depend largely on their self-reported finances as of April 15, the department said.

Many state lawmakers want more answers, too. Sen. Shannon Grove, a Bakersfield Republican, grilled finance department staff over the bill details.

“How long is this lifeline going to last? Is it even going to save the people who are in the 10-day timeframe?” she asked.

“That is the intent,” said Lupe Manriquez of the Department of Finance.

“I know it’s the intent. Is it going to save them?” Grove pressed.

“That’s the goal,” Manriquez answered.

Cabaldon told the staff he wouldn’t even bother asking about the criteria because “I already know what the answer is going to be.”

“It is incumbent on this committee to be able to have real answers to the questions that are posed about the why and the evidence,” Cabaldon said. “We are not having a conversation. We are asking questions of fulfilling our constitutional role in this process and getting zero answers.”

Palmer called the heat on his staff “undignified sniping and sarcasm,” noting that the bill originated from the same legislative chamber that’s now questioning it.

“They asked for our assistance in the expedited consideration of the bill outside of the regular budget process — and we complied and cooperated,” Palmer said in an email. “If members were either unable or unwilling to do some basic homework on their own bill that they wanted to be put on a fast track, then that’s a question that’s better posed to them — not us.”

How long a lifeline?

But throwing money at hospitals to keep them afloat is not the answer, some lawmakers argued.

“We can’t just keep giving $25 million handouts over 10 days where a hospital is looking to close,” Smallwood-Cuevas said, noting that President Donald Trump’s H.R. 1, which sharply reduces federal spending on Medicaid, could devastate hospitals.

“What is the state doing to identify and support vulnerable safety net hospitals before they reach the point of fiscal crisis? That is an answer I want to hear.”

Some hospital administrators also called for longer-term solutions. Katherine Burnworth, board president of the Imperial Valley Healthcare District, which oversees Imperial County’s two hospitals, told CalMatters that while she appreciates state action, $25 million statewide “is a drop in the bucket compared to the scale of the problem.”

“That may help a small number of hospitals avoid a near-term emergency, but it does not address the ongoing instability that communities like ours live with year after year,” Burnworth said.

While acknowledging the importance of emergency grants, Republicans on the committee argued that California has shortchanged hospitals’ Medi-Cal reimbursements. The California Hospital Association estimates that hospitals are reimbursed 74 cents for each dollar they spend on Medi-Cal patients. Hospitals that see a high share of Medi-Cal patients do get supplemental payments to help offset some of the gaps in reimbursement.

The GOP lawmakers also said that some state regulations, such as a minimum wage hike for health care workers and the requirement that all hospitals comply with new seismic safety requirements by 2030, will burden hospitals with high costs.

“We are throwing Band-Aids on everything, when really we need to just get together and fix the issues of what are the unfunded state mandates that are on our hospitals right now,” Tangipa said.

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NEW YORK (AP) — More U.S. hospitals are requiring masks and limiting visitors as health officials face an expected but still nasty post-holiday spike in flu, COVID-19 and other illnesses.

While many experts say this season likely won’t prove to be as deadly as some other recent winters, it still could mean hundreds of thousands of hospitalizations and many thousands of deaths across the country.

New York City last week instituted a mask mandate for the city’s 11 public hospitals. Similar measures were ordered last week at some hospitals in Los Angeles and Massachusetts. Some hospitals reinstated masking rules for employees months ago, in anticipation of a seasonal rush of sick people.

Flu and COVID-19 infections have been increasing for weeks, with high levels of flu-like illness reported in 31 states just before Christmas. Updated national numbers are to be released Friday, but health officials predict infections will grow in many states well into January.

“What we’re seeing right now, in the first week of January, is really an acceleration — of flu cases, in particular,” said Dr. Mandy Cohen, director of the Centers for Disease Control and Prevention.

There is some good news. Flu and COVID-19 cases may peak by the end of the month and then drop, Cohen said. Though the flu has been skyrocketing, this year’s cases are being caused by a strain that usually doesn’t cause as many deaths and hospitalizations as some other versions. What’s more, signs suggest current flu vaccines are well-matched to the strain.

“I don’t think it’s going to be overwhelming,” said Dr. William Schaffner, Vanderbilt University infectious diseases expert. He deemed the current season “moderately severe.”

The CDC is pointing the public to an agency website where people can look up their county, which can help them make decisions about whether to wear masks or take other precautions. Cohen urged people to get vaccinated and to seek treatment for flu and COVID-19.

Vaccinations are down this year, officials say. About 44% of U.S. adults had gotten flu shots by Dec. 23, according to the most recently available CDC vaccination survey data. Only about 19% of U.S. adults were reported to have received an updated COVID-19 shot as of early December.

COVID-19 cases are causing more severe disease than the flu but have been rising less dramatically. Health officials are keeping an eye on JN.1, a new version of the ever-evolving coronavirus. The omicron variant was first detected in the U.S. in September and just before Christmas accounted for an estimated 44% of COVID-19 cases.

The JN.1 variant may spread easier or be better at evading our immune systems, but there is no evidence that it causes more severe disease than other recent variants, health officials say. Current evidence indicates vaccines and antiviral medications work against it.

The CDC also has reported disappointing vaccination rates against another seasonal bug, respiratory syncytial virus, or RSV. That is a common cause of mild cold-like symptoms, but it can be dangerous for infants and older people. RSV cases rose in the fall but appear to have plateaued and are even going down in some places, according to the latest data.

At Hillsdale Hospital in southern Michigan, a 65% increase in respiratory illness activity in late December triggered a limitation to visitors in the birthing center. Only a spouse, a support person and grandparents can visit. They all must wear a mask and not show symptoms of sickness.

The restriction is common for the hospital around this time of year, said Dr. Nichole Ellis, a pediatrician who is the hospital’s medical chief of staff. But it’s more difficult this season, she added.

“In the past, we would have one … disease that we were tracking or monitoring at one time,” Ellis said. “But now, babies and children will have multiple diseases at the same time. It’s not that they just have RSV … but they’re getting RSV and COVID at the same time, or influenza and RSV at the same time because all of the diseases are prevalent in our community.”

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From 1993 to 2003, there was a 44% increase in emergency department visits nationally, according to a 2016 study. The COVID pandemic only intensified the problem. 

In 2020, the overall rate of ED trips increased to 40 visits per 100 people, with the rate of ED visits for Black people was 70 visits per 100 people, the highest of any racial/ethnic group, according to the Centers for Disease Control and Prevention. 

In Los Angeles, the nation’s second-largest city, patients can wait for hours to be seen in the emergency department, while some lie in hallways for days at a time, according to a recent Los Angeles Times report. Even when there is a legitimate need to divert ambulances to contend with overcrowding, such diversions can exacerbate health disparities, including maternal mortality, especially in low-income communities. 

People in low-income communities face longer wait times, travel times and even death in pursuit of care for time-sensitive conditions, like heart attack and stroke. Studies connect ambulance diversion to delayed cardiac care and higher mortality rates for Black Americans. Moreover, when safety net hospitals — hospitals primarily serving low-income communities and communities of color — close or turn away ambulances, nearby wealthier hospitals shutter, exacerbating delays in care.

These problems only deepened when hospitals became overextended and overcrowded during the COVID-19 pandemic, according to reporting published nationwide over the last year, California EMTs I’ve spoken with, and leading experts on the topic. 

Renee Monge, an EMT who works with L.A. County, describes overcrowding and severely understaffed hospitals as a strong predictor of delays in care. He also says there are differences in care delays between public ambulance services and private ambulance services.  

Delays in care due to hospital overcrowding are not unique to Los Angeles. Dave Carillo, a retired EMT who worked out of Sacramento during the COVID-19 pandemic, said diversions were mainly due to overcrowding, and with each diversion, patients in transit were deprived of hospital care. Patients with complex care needs would need to travel farther, he said. If a patient was burned, the only hospital equipped with a burn unit was UC Davis, sometimes hours away from patients’ homes. If heart attack patients were in critical condition, there was effort to take them to a suitable center near home, but hospitals properly equipped were not always nearby. 

When Carillo was working, it was common for ambulances to go on diversion, especially due to hospital overcrowding. When transporting a patient, ambulances would often need to wait until they could pass off a patient to a nurse or trauma unit before being free to pick up other patients. In times of severe overcrowding, that meant longer times waiting in ER parking lots caring for patients until Carillo and his team were assigned a new diversion location.

“When I was transporting [a patient] sometimes we would have long wait times, sometimes it was 20 minutes, sometimes it was six hours,” he said. 

Overcrowding, in Carillo and Monge’s experience, delayed hospitals’ ability to adequately care for patients. Overcrowding impacts people with more severe medical histories, regardless of race. In other words, anyone could be impacted. 

Although maintained by hospitals, data on ambulance diversion is tightly guarded. With the support of the Center for Health Journalism’s 2023 Data Fellowship, I will examine the local effects of hospital overcrowding in Los Angeles and explore why research lags behind on-the-ground experiences of overcrowding. I will strive to tell data-rich narratives that combine the stories of people impacted by overcrowded hospitals with data on how and where these problems are occurring.

David Tan, president of the National Board of EMS Physicians, said that research often lags because researchers do not feel the need to update findings when the original problem remains. Tan explained that outsiders and researchers have misconceptions about the type and extent of overcrowding. 

“It is not emergency department overcrowding but, more honestly, hospital overcrowding. ERs cannot get patients out the back and upstairs to the inpatient services, which makes getting patients through the front door of the ER next to impossible,” said Tan.

Many ERs are on “disaster” status as a matter of routine, said Tan, underscoring the need for more research on the subject.  

“Hospitals have no incentive to rapidly discharge patients who are ready to go, clean rooms, and get patients up from the ER ASAP,” said Tan.

Through interviews with researchers and experts on overcrowding and its effects, and conversations with families, patients and EMTs who have been impacted by ambulance diversions, I will delve deeper into why the gaps in research on hospital overcrowding in California exist, and how those gaps contribute to overcrowding at state and local levels.

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Hospitals should be places you can trust to provide comfort and healing when you’re most vulnerable. But that trust may have been shattered by brutal Covid protocols that critics claim turned many hospitals into hellscapes of systematic medical murder.

The victims’ stories have been muffled by the mainstream media, but they’re starting to break through. For one thing, lawsuits against three hospitals have been filed in California by 14 bereaved families who claim their loved ones were killed by a deadly protocol. Meanwhile, activist organizations like Protocol Kills, the FormerFedsGroup Freedom Foundation, and American Frontline Nurses are collecting and documenting stories from bereaved families about what happened to their loved ones when they entered a hospital hoping for healing and, instead, were led to bizarre and tortured deaths.

I find it heartbreaking to read their stories, which share a haunting similarity, a feeling of being trapped in a highly organized nightmare. The ritual progresses in predictable stages: first, the patient is isolated from family, who are unable to advocate for their loved one or monitor what’s happening. Next, the patient is diagnosed with Covid-19 or Covid pneumonia, even if they came to the hospital because of a broken arm. Then, they’re bullied into getting remdesivir, a highly toxic drug which killed 53 percent of Ebola patients who had the misfortune to take it. Next, according to the California lawsuit, “They are placed on a BiPap machine at a high rate, making it difficult for them to breathe.

Their hands are often tied down so they can’t take the BiPap machine off their face.” I know this is getting unbearably painful to read, but stay with me to the bitter end to memorialize the victims’ suffering. As the patients writhe in agony, psychiatrists are brought in to diagnose them with agitation and sedate them. Now, shot up with remdesivir, sedated with drugs that make it tough to breathe against the BiPap ventilator, and strapped down in restraints, the victims are denied food and sometimes even water. Should they try to summon help, they may find the hospital played a vicious trick on them, placing their phone and call button for the nurse out of reach.

In the final stages, they are intubated and slowly die alone, left to rot into a skeletal corpse with bed sores. Is this America? It’s almost impossible to comprehend the magnitude of this moral collapse. How did doctors and nurses who spent years studying so they could help people all of a sudden turn into ruthless sadists, presiding over enforced deaths? How did hospitals metastasize from places of healing into chambers of horror? According to the Association of American Physicians and Surgeons (AAPS), the answer is quite simple: money.

The federal government incentivized this protocol with massive payouts to the hospitals. AAPS writes, “Our formerly trusted medical community of hospitals and hospital-employed medical staff have effectively become “bounty hunters” for your life.” AAPS explains that two Covid emergency acts from the government created this catastrophic loss of life. The CARES Act, a $2 trillion stimulus package, was passed in 2020, purportedly to ease the financial impact of Covid on American families. It provided gigantic bonuses to hospitals to institute federal protocols on Covid, ensuring that Covid would be massively diagnosed and treated with deadly combinations of remdesivir, ventilators, and other lethal methods. Now that this top-down death protocol was bought and paid for, the government made sure that patients and their families were helpless to fight against it.

The Centers for Medicare and Medicaid Services (CMS) granted waivers to hospitals allowing them to remove critical patient rights. Your ability to give informed consent, receive visitors, and be free from solitary confinement – gone! Vanished, obliterated with a single magical government “waiver.” These actions destroyed the ability of doctors to make independent judgements based on their patients’ needs and turned highly trained medical staff into killer robots obeying the federal government’s commands. If you want to understand the enormity of the government money gusher, here’s AAPS on what the hospital payments included:

• A “free” required PCR test in the Emergency Room or upon admission for every patient, with government-paid fee to hospital.

• Added bonus payment for each positive COVID-19 diagnosis.

• Another bonus for a COVID-19 admission to the hospital.

• A 20 percent “boost” bonus payment from Medicare on the entire hospital bill for use of remdesivir instead of medicines such as Ivermectin.

• Another and larger bonus payment to the hospital if a COVID-19 patient is mechanically ventilated.

• More money to the hospital if cause of death is listed as COVID-19, even if patient did not die directly of COVID-19.

• A COVID-19 diagnosis also provides extra payments to coroners.

Hundreds of thousands of Americans may have died due to these protocols, and we urgently need an investigation into this butchery. Who designed this protocol, which forbade safe drugs like ivermectin and hydroxychloroquine, and incentivized known toxins like remdesivir? Who enforced it? Were hospital administrators personally rewarded for their participation in this scheme? Were patients illegally deprived of their constitutional rights and defrauded with phony medical information? Why were patients denied nutrition and water? How was hospital staff forced to comply? Where’s the money trail? Who signed off on it?

Understanding what happened in the hospitals is a crucial piece of solving the Covid puzzle. A vast ecosystem of confusion, manipulation, and artificially induced panic was created by the government and their media lackeys to stampede the public into welcoming soul-crushing lockdowns and dangerous experimental injections. Hospitals were shut down for elective surgeries, depriving them of their usual income and making them more desperate for government payouts. Covid patients were forced into nursing homes, immediately killing thousands of frail victims and terrifying the public with the skyrocketing death count. Safe, widely used drugs like hydroxychloroquine and ivermectin were demonized, and studies were fabricated to lie about their effectiveness. Doctors and scientists who tried to speak the truth were fired, investigated, and censored. Why?

We’re living through a time of historic crimes against humanity, rife with atrocities that once would have been unimaginable in America. We don’t yet know how many innocent people were killed in the hospitals during Covid, but whatever that number is — some experts estimate hundreds of thousands — it’s too many. Every one of those innocent dead was someone’s son, daughter, mother, father, husband, wife, friend.

For all the faceless dead, let’s pause for a moment to pay tribute to Grace Schara, a sweet 19-year-old girl with Down Syndrome who died on October 13, 2021, at St. Elizabeth Hospital in Appleton, Wisconsin. Grace was injected with a lethal mix of sedatives and as she sank into death, her sister was prevented from seeing her by an armed guard. Her parents begged over Facetime for the nurse to save her, but they were told that Grace was coded DNR (Do Not Resuscitate), although they had ordered the hospital to take all life-saving measures. Alone, uncomprehending, and in pain, Grace slowly died as her parents watched on Facetime. Her father, Scott Schara, is now suing the hospital to “pave the way for thousands of other victims’ families to file similar claims.” Grace was loved. May her memory be a blessing and an inspiration.

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Children’s hospitals in parts of the U.S. are seeing a surge in a common respiratory illness that can cause severe breathing problems for babies.

RSV cases fell dramatically two years ago as the pandemic shut down schools, day cares and businesses. With restrictions easing in the summer of 2021, doctors saw an alarming increase in what is normally a fall and winter virus.

Now, it’s back again. And doctors are bracing for the possibility that RSV, flu and COVID-19 could combine to stress hospitals.

“I’m calling it an emergency,” said Dr. Juan Salazar of Connecticut Children’s Hospital, where RSV has caused a shuffling of patients into playrooms and other spaces not normally used for beds. The institution explored using a National Guard field hospital, but has set aside that option for now.

A look at RSV and what the recent surge may mean:

WHAT IS RSV?

It stands for respiratory syncytial virus, a common cause of mild cold-like symptoms such as runny nose, cough and fever. Nearly all U.S. children normally catch an RSV infection by age 2.

People infected are usually contagious for three to eight days. Babies and people with weakened immune systems can spread RSV for up to four weeks. There is no vaccine for it, though several candidates are in testing.

WHO DOES IT AFFECT?

Everyone can get RSV. But it causes the most threat to infants, older adults and other vulnerable people, who can get serious airway and lung infections.

Among U.S. kids under age 5, RSV typically leads to 58,000 hospitalizations and up to 500 deaths in a year.

For adults 65 and older, RSV causes 177,000 hospitalizations and 14,000 deaths yearly.

For babies, the struggle to breathe can interfere with eating. “And that’s really when we start to worry,” said Dr. Melanie Kitagawa of Texas Children’s Hospital in Houston, where more than 40 children have RSV.

“They’re breathing fast, breathing deep. We see them using muscles in their chest to help them breathe,” Kitagawa said. “These are kids who are having difficulty taking a bottle because their breathing is being impacted and they can’t coordinate both at once.”

WHY IS THERE AN INCREASE NOW?

The virus is encountering a highly vulnerable population of babies and children who were sheltered from common bugs during the pandemic lockdowns.

Immune systems might not be as prepared to fight the virus after more than two years of masking, which offered protection, according to Dr. Elizabeth Mack of Medical University of South Carolina.

“South Carolina is drowning in RSV,” Mack said in a news release. The surge arrived earlier this year than normal, she said.

For babies, their mothers may not have been infected with RSV during pregnancy, which could have given the children some immunity.

U.S. health officials have noted a rise this month in national reports of respiratory illnesses, which they say is at least partly due to the early spread of flu in much of the South.

Last week, more than 7,000 tests came back positive for RSV, according to CDC figures. That’s more than in previous surges.

IS THERE A TREATMENT?

There’s no specific treatment, so it’s a matter of managing symptoms and letting the virus run its course. Doctors may prescribe oral steroids or an inhaler to make breathing easier.

In serious cases, patients in the hospital may get oxygen, a breathing tube or a ventilator.

WHAT DO DOCTORS RECOMMEND?

Prevent the spread of viruses by washing hands thoroughly and staying home when you’re sick.

During RSV season, an injection of an antibody-based medicine is sometimes prescribed to protect premature infants and other very vulnerable babies.

If you’re worried your child is having a severe breathing problem, “do not hesitate” to go to an emergency department or call 911, said Dr. Russell Migita of Seattle Children’s Hospital, where RSV is on the rise.

For less severe medical problems, Migita said, call your regular health care provider for advice, use telehealth or go to urgent care.

In Chicago on Saturday, Dr. Juanita Mora saw a family of five kids all with RSV, ranging from a 3-year-old to a teenager. Fearing what’s ahead this winter, she’s telling everyone to get a flu shot and a COVID-19 booster.

“We don’t want a triple whammy, a triple pandemic,” Mora said.

___

Associated Press/Report for America reporter James Pollard contributed from Columbia, South Carolina. AP Medical Writer Mike Stobbe contributed.

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By Amber Dance

Loss of pandemic funding endangers care for poor, uninsured

Safety-net hospitals, which provide care regardless of patient’s ability to pay, received a sorely needed financial boost during the pandemic thanks to billions in emergency federal funds. As that funding comes to an end, hospitals are struggling to provide care for people who’ve come flooding in with health problems after delaying treatment during the pandemic, writes Noah Weiland at The New York Times.

Even before COVID, such hospitals operated on slim margins, said Beth Feldpush of the trade group America’s Essential Hospitals.

As a result of 2020’s CARES Act, the government distributed $178 billion to hospitals and other health care providers to cover expenses and lost revenue.

The federal COVID-19 Uninsured Program handed out more than $20 billion to cover testing, vaccination and treatments for people without health insurance, but the program is now out of funds.

And the federal public health emergency declaration boosted coverage for Medicare and Medicaid patients, but that’s currently set to expire in July.

These temporary measures helped safety-net hospitals, but only to a certain extent. Michele Johnson, director of the aid group the Tennessee Justice Center, likened the pandemic aid to “some rouge on the corpse.”

More CARES Act money flowed to rich hospitals and large academic centers than to small clinics in rural areas, according to research by the nonprofit RAND Corporation.

Still, for hospitals that barely scrape by, every bit of aid is a boost. Now, while COVID hospitalizations remain low, people who put off care are returning to a severely strained system. Weiland describes everything from advanced cancers because people skipped screening, to broken bones left to fester for months, to an excess of bunions. At the same time, costs for medicines and staff have skyrocketed, creating a situation that’s overwhelming safety-net hospitals.

There’s no additional help in sight: The latest $10 million pandemic aid bill, which would cover more free treatments and vaccines for all Americans, remains stalled in Congress.

New variants keep coming

The coronavirus continues to develop new mutations and combinations of mutations at a rate too fast for scientists to keep up. The latest variants to watch — but not panic over — are new flavors of omicron known as BA.4, BA.5, and BA2.12.1.

Currently, the BA.2 variant, which is about 30% more transmissible than BA.1 that came before it, makes up more than half of U.S. cases.

And the virus is still spreading effectively. For example, despite stringent requirements for vaccination and day-of COVID testing, several attendees of the April 30 White House Correspondents Dinner have since tested positive for the virus.

BA.2.12.1 is now coming on strong, at just over one-third of U.S. cases and rising. This one is 25% more transmissible than BA.2

Scientists are also watching the BA.4 and BA.5 variants, now surging in South Africa.

“It just seems like the latest chapter of a never-ending saga,” Dr. Peter Chin-Hong of UC San Francisco told the Los Angeles Times.

All three variants seem to be better at evading the immune response than what’s come before. They each have mutations that likely help them bind more tightly to target cells and avoid antibodies that try to get in the way, reports Brenda Goodman at CNN.

It’s not yet known if these variants cause milder or more severe disease.

“The data all point to the possibility of more reinfections from newer omicron subvariants,” writes Beth Mole at Ars Technica. “This could drive yet more waves of infection in the U.S. and around the world — though experts don’t expect another towering wave like the BA.1 surge in January.”

The continued evolution of the omicron variant could undermine the efficacy of vaccines based on the BA.1 version that are now under development, Mole writes.

It could also be a sign that the coronavirus is moving towards more flu-like behavior, writes Megan Molteni at STAT. With influenza, variants tend to drift from one similar version to another, in contrast to the arrival of markedly different variants as happened with the coronaviruses beta, delta, omicron and the like.

“This could be good news, because more stable, predictable evolution would make it easier to develop meaningful COVID-19 vaccines and boosters,” writes Molteni.

That said, there’s no guarantee there aren’t more wild-card, Greek-letter variants in the future. Scripps Research physician Dr. Eric Topol writes on his blog that preparing for novel variants will require vaccines that create broad protection and more antiviral medications.

Delta is also still lurking in the wings, meaning it could re-emerge with new variants, writes Judy Siegel-Itzkovich at The Jerusalem Post.

Topol notes that there’s no reason to believe the next variant will cause milder disease than the ones that came before. Future variant severity is unpredictable, as is the ceiling on coronavirus transmissibility, so things could get worse before they get better.

Paxlovid fails to prevent infection

Recent data dashed hopes that the antiviral Paxlovid could be used as a post-exposure prophylactic to prevent infection in people who share a home with COVID patients.

While disappointing, these results are not wholly unanticipated, reports Matthew Herper at STAT. Dr. Daniel Barouch of the Beth Israel Deaconess Medical Center told him, “The biology of treating infection is different from the biology of preventing infection.”

It’s not clear exactly why the treatment didn’t help; it could be that the drug needed to be provided sooner after exposure to stop the virus in its tracks.

Reports have also surfaced recently that some people who take Paxlovid, after they’re infected, become sick again after they’ve finished treatment.

“Little is yet known about the rebound cases, such as whether the highly transmissible omicron variant plays a role,” reports Bloomberg. “While there’s no proof it’s caused by the drug, doctors say they need more information about what action to take when the virus surges in someone who’s just been treated.”

Pfizer says that in its studies, people who took placebo pills had the same rate of rebound as those on the real drug, suggesting the treatment isn’t causing the renewed symptoms.

Both the NIH and the FDA are looking into the problem, as are other research groups. There are a number of questions to answer, notes Dr. Paul E. Sax at the New England Journal of Medicine’s Journal Watch blog. For example, should the standard treatment course be longer, or should people who relapse take a second course of the drug?

Despite these issues, relapses seem to be rare, and experts told STAT’s Herper they remain confident in Paxlovid’s ability to thwart the virus.

Barouch said, “These new data would not make me less enthusiastic in prescribing Paxlovid for therapeutic purposes.”

FDA imposes limits on J&J vaccine

Johnson & Johnson’s coronavirus vaccine will now be accessible only for people who can’t take one of the other vaccines — due to allergy to an ingredient, for example, or because the others are unavailable — as well as those who flat-out refuse vaccines made with the messenger RNA technology used by Pfizer and Moderna.

The Johnson & Johnson shot uses a different formula: a virus that delivers the coronavirus spike DNA.

The FDA made this announcement last Thursday, citing 60 cases of blood clotting problems linked to the vaccine.

There have been nine deaths from the condition.

The agency and the CDC had temporarily paused the vaccine’s use back in April of 2021 when it had knowledge of just six cases of the clotting disorder.

The Johnson & Johnson vaccine initially showed promise because it was meant to be a one-shot, easily transported and stored inoculation, compared to the mRNA vaccines that each started with a two-dose series and required very cold storage.

But it never took off; 18.7 million J&J shots have been administered, compared to more than 558 million of the two mRNA vaccines combined.

Pfizer hopes for little-kid booster data within weeks

Pfizer, which is testing a three-dose regimen of its COVID-19 vaccine in children younger than five, now says it should have the results ready for regulators by late May or early June, AP News reports.

That would put it in line behind Moderna, which has already filed for authorization of its two-dose protocol for the youngest children, but still in time for anticipated meetings of the FDA’s outside advisory committee on vaccines.

While the vaccine can’t come soon enough for some parents, others aren’t in a rush. The latest poll from the Kaiser Family Foundation finds that 18% of parents with kids in this age group will hurry to the pharmacy, while 38% plan on a wait-and-see approach.

More than half of the parents surveyed said they didn’t have enough information to evaluate the vaccines’ safety and efficacy for their young children — a fair point, as the full data have not yet been made publicly available.

The poll also found that 27% of parents “definitely” would not vaccinate their kids under 5, and a further 11% would do so only if it were required.

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In a 5-0 vote without comment, the board formally adopted an amendment to the original Salt Creek Trail Project budget, raising it by $157,000, all of which will be reimbursed to the county as part of an agreement with the Regional Park & Open Space District, one of several entities spearheading the development.

The total project budget is now $8,141,868, though it’s uncertain whether all of the funds will need to be expended.

Work on the east-west Salt Creek Trail got underway in the first half of 2020, and since that time a four-mile segment between Goetz Road and Interstate 215 in Menifee has been finished, as well as a one-mile segment on the north side of Diamond Valley Lake in Hemet. Pedestrians and bicyclists are able to use the completed pathways.

According to the Regional Park & Open Space District, costs have been driven up unexpectedly by accommodations for nesting migratory birds, relocation of utility lines and habitat restoration. Curb and gutter improvements, rock slope reinforcement, concrete ramps, cable fencing, pipe gates, pedestrian crossing enhancements and flood control channel upgrades are part of the project, which former Supervisor Marion Ashley championed before retiring over three years ago. He lauded it as a future attraction sure to encourage more residents to enjoy the outdoors.

“The regional trail will provide the opportunity for expansion of local and regional trail systems, sidewalk and bike path connections from the trail to surrounding communities, schools, commercial areas and ultimately two key regional recreational facilities at Lake Skinner and Diamond Valley Lake,” according to a statement posted to the board’s agenda. “The trail will … significantly improve quality of life for residents.”

Salt Creek is tying into an existing network of walking paths, offering a five-foot wide space for pedestrians, as well as a 14-foot wide space for bicyclists and other approved devices.

Most of the project budget is composed of federal grants and local development impact fee revenue.

Along with the Regional Park & Open Space District, the county Transportation & Land Management Agency is involved with the trail, along with the Riverside County Transportation Commission.

The project is part of the Southern California Association of Governments’ “2035 Bikeway Network” regional plan unveiled in 2012.

All trail segments are expected to be finished over the next few years.

City News Services | Contributed

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Impatient with years of inaction in Washington on prescription drug costs, U.S. hospital groups, startups and nonprofits have started making their own medicines in a bid to combat stubbornly high prices and persistent shortages of drugs with little competition.

The efforts are at varying stages, but some have already made and shipped millions of doses. Nearly half of U.S. hospitals have gotten some drugs from the projects and more medicines should be in retail pharmacies within the next year as the work accelerates.

Most groups are working on generics, while at least one is trying to develop brand-name drugs. All aim to sell their drugs at prices well below what competitors charge.

“These companies are addressing different parts of the problem and trying to come up with novel solutions” to produce cheaper medicines, said Stacie Dusetzina, a Vanderbilt University health policy professor. “People should be able to access the drugs that work for them without going broke.”

While some of the projects are solving supply problems and reducing medication costs for hospitals, drug price experts are split on how much consumers will benefit.

Dusetzina said the efforts could bring needed price competition, at least for some drugs.

Dr. Aaron Kesselheim, a Harvard Medical School researcher and price expert at Brigham & Women’s Hospital in Boston, thinks for some drugs these projects “can lower patients’ out-of-pocket costs … absolutely.”

But David Mitchell, founder of the independent consumer group Patients for Affordable Drugs, said the projects are workarounds that help in niches, but are “not enough to fix a broken system.”

Civica Rx was started three years ago by a hospital consortium. It now provides over 50 generic injectable medicines in chronic shortage to more than 1,400 hospital members and the Veterans Affairs and Defense departments. It already has sold enough medication to treat 17 million people, including many hospitalized with COVID-19.

Now it’s expanding to help patients directly, said chief executive Martin VanTrieste. Its new partnership with Anthem and Blue Cross health plans, CivicaScript, is picking six or seven expensive generic drugs to start. It will have contract manufacturer Catalent start producing those drugs to sell at 50,000 retail pharmacies starting in 2023.

Other “alternative drugmakers” include:

—Two enterprises, from Premier Inc. and Phlow Corp., focused on providing their hospital members with affordably priced generics that are chronically scarce.

— NP2, which is about to start producing cheaper generic IV cancer medicines.

— EQRx, which is creating brand-name drugs for cancer and inflammatory disorders to sell at “radically lower prices” than rival brands.

Walmart recently added insulin to its in-house brand of products for people with diabetes. It’s selling its own version of the mealtime insulin NovoLog, in partnership with manufacturer Novo Nordisk, for less than half NovoLog’s price.

Even entrepreneur Mark Cuban has jumped in, giving his name and money to a public-benefit company aiming to provide cheap alternatives to high-cost generic drugs at 15% above manufacturing costs, no insurance needed.

In January, Mark Cuban Cost Plus Drug Co. launched its first medication, a pill for parasitic worm infections that it sells through independent pharmacies for about $40 per two-dose treatment, said founder and CEO Dr. Alex Oshmyansky. The company is building a factory in Dallas but paying other manufacturers for now and aims to launch up to 100 more drugs by year’s end.

Vanderbilt’s Dusetzina sees Cuban’s company as best positioned to cut out-of-pocket costs.

“It’s a really nice project to go after products where there’s little competition — and price gouging,” she said.

Brand-name drugs get monopolies lasting up to two decades under U.S. patent law, so most of the alternative drugmakers are targeting certain off-patent medicines whose prices have risen dramatically in recent years.

Generics are usually cheap. But as buyers pushed for barely break-even prices on these drugs over the last couple decades, generic manufacturers consolidated. With fewer factories making certain generics, even temporary plant closures triggered lasting shortages. And the reduced competition led to big price hikes, often forcing doctors to try costlier, less-effective alternatives and hospital pharmacists to spend long hours seeking alternatives for drugs in shortage.

Those years-long shortages spurred Civica’s formation. It also led a top hospital group purchasing organization, Premier Inc., to launch a program that has contractors making more than 60 products for about 850 member hospitals, said its chief pharmacy officer, Jessica Daley. The two groups say they’ve gotten numerous drugs off national shortage lists.

Phlow Corp., a public benefit drug manufacturer largely funded by government grants, partnered in March with 11 top children’s hospitals to address shortages by making generic medicines in child-size doses for cancer and other life-threatening conditions. Phlow and Civica are building neighboring factories in Petersburg, Virginia.

Such efforts have been helping hospitals stock crucial drugs — sedatives, painkillers, antibiotics and respiratory medicines — needed for COVID-19 patients.

The alternative drugmakers are hiring U.S. contract manufacturers whenever possible and getting drug ingredients here or in Europe, to diversify supply chains heavily reliant on China and India, which limited exports of drugs and ingredients early in the pandemic. The Biden administration also is working to increase domestic production of essential generic drugs.

Harvard’s Kesselheim foresees the new generic manufacturers helping to boost supply and lower prices, but he thinks developing new brand-name drugs — as EQRx is trying to do — is tougher.

EQRx is currently testing 10 novel drugs that it licensed the rights to, for cancers and immunologic disorders like rheumatoid arthritis. One already in final-stage testing could launch within three years.

The company expects to start work on another 10 patented drugs in ultra-expensive categories in the next year and is collaborating with Exscientia, a firm that uses artificial intelligence to design drugs and speed up testing.

Insurers are among EQRx’s early investors, said the company’s president, Melanie Nallicheri. They expect the company to turn a profit, but they also support plans to price medicines at up to two-thirds off rival brand-name drugs, she said.

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The rapidly escalating surge in COVID-19 infections across the U.S. has caused a shortage of nurses and other front-line staff in virus hot spots that can no longer keep up with the flood of unvaccinated patients and are losing workers to burnout and lucrative out-of-state temporary gigs.

Florida, Arkansas and Louisiana all have more people hospitalized with COVID-19 than at any other point in the pandemic, and nursing staff is being stretched thin.

In Florida, virus cases have filled so many hospital beds that ambulance services and fire departments are straining to respond to emergencies. Some patients wait inside ambulances for up to an hour before hospitals in St. Petersburg, Florida, can admit them — a process that usually takes about 15 minutes, Pinellas County Administrator Barry Burton said.

One person who suffered a heart attack was bounced from six hospitals before finding an emergency room in New Orleans that could take him in, said Joe Kanter, Louisiana’s chief public health officer.

“It’s a real dire situation,” Kanter said. “There’s just not enough qualified staff in the state right now to care for all these patients.”

Michelle Thomas resigned as a manager of the emergency department of a Tucson, Arizona, hospital three weeks ago after hitting a wall.

“There was never a time that we could just kind of take a breath,” Thomas said Tuesday. “I hit that point … I can’t do this anymore. I’m so just tapped out.”

She helped other nurses cope with being alone in rooms with dying patients and holding mobile phones so family members could say their final goodbyes.

“It’s like incredibly taxing and traumatizing,” said Thomas, who is unsure if she will ever return to nursing.

Miami’s Jackson Memorial Health System, Florida’s largest medical provider, has been losing nurses to staffing agencies, other hospitals and pandemic burnout, Executive Vice President Julie Staub said. The hospital’s CEO says nurses are being lured away to jobs in other states at double and triple the salary.

Staub said system hospitals have started paying retention bonuses to nurses who agree to stay for a set period. To cover shortages, nurses who agree to work extra are getting the typical time-and-a-half for overtime plus $500 per additional 12-hour shift. Even with that, the hospital sometimes still has to turn to agencies to fill openings.

“You are seeing folks chase the dollars,” Staub said. “If they have the flexibility to pick up and go somewhere else and live for a week, months, whatever and make more money, it is a very enticing thing to do. I think every health care system is facing that.”

Texas Gov. Greg Abbott on Monday directed state officials to use staffing agencies to find additional medical staff from beyond the state’s borders as the delta variant overwhelms its present staffing resources. He also has sent a letter to the Texas Hospital Association to request that hospitals postpone all elective medical procedures voluntarily.

Parts of Europe have so far avoided a similar hospital crisis, despite wide circulation of the delta variant, with help from vaccines.

The United Kingdom on Monday had more than 5,900 COVID-19 patients in hospitals, but the latest surge has not overwhelmed medical centers. As of Tuesday, the government said 75 percent of adults have been fully vaccinated.

The same was true in Italy, where the summer infections have not resulted in any spike in hospital admissions, intensive care admissions or deaths. About 3,200 people in the nation of 60 million were hospitalized Tuesday in regular wards or ICUs, according to Health Ministry figures.

Italian health authorities advising the government on the pandemic attribute the relatively contained hospital numbers to the nation’s inoculation campaign, which has fully vaccinated 64.5% of Italians 12 years of age or older.

The U.S. is averaging more than 116,000 new coronavirus infections a day along with about 50,000 hospitalizations, levels not experienced since the winter surge. Unlike other points in the pandemic, hospitals now have more non-COVID patients for everything from car accidents to surgeries that were postponed during the outbreak.

That has put even more burden on nurses who were already fatigued after dealing with constant death among patients and illnesses in their ranks.

“Anecdotally, I’m seeing more and more nurses say, ‘I’m leaving, I’ve had enough,’” said Gerard Brogan, director of nursing practice with National Nurses United, an umbrella organization of nurses unions across the U.S. “’The risk to me and my family is just too much.’”

COVID-19 hospitalizations have now surpassed the pandemic’s worst previous surge in Florida, with no signs of letting up, setting a record of 13,600 on Monday, according to the Department of Health and Human Services. More than 2,800 required intensive care. At the height of last year’s summer surge, there were more than 10,170 COVID-19 hospitalizations.

At Westside Regional Medical Center in Plantation, Florida, the number of COVID-19 patients has been doubling each week for the past month, wearing down the already short staff, said Penny Ceasar, who handles admissions there.

The hospital has converted overflow areas to accommodate the rise in admissions. Some staffers have fallen ill with COVID-19.

“It’s just hard. We’re just tired. I just want this thing over,” Ceasar said.

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At the appointment, I said a traditional Jewish blessing; my nurse said, “Thank you, Jesus,” and injected me in the arm. I wept. It was the week of my birthday.

I was preparing for a heavy week of work over Christmas and New Year’s when I received the vaccine. Supplies were limited, so only the very front-line workers were eligible and we had to be discreet, because so many deserving folks had to wait. Yet the medical system was continuing to notice who our “front lines” really were — not just doctors and nurses, but also the housekeeping staff who scrubbed COVID rooms in the ICU, and the food service workers who kept all of us nourished, and many, many others.

A week or so later, more of the hospital staff was eligible. A few weeks after that, a vaccine was available to essentially any hospital worker who would take it. Soon, vaccine appointments were going begging: availability had outpaced demand.

Some of this was because our hospitals were getting better at vaccine administration: at staffing our sites and lining up eligible recipients, and at matching our supplies to our appointments. But it turns out that we were also zipping through the hospital because a lot of people were saying no.

You have to remember that this was back in January and early February, before the vaccine was available to the general population. The only people being offered the vaccines were workers at hospitals, mostly health care workers, whose livelihood depends on science. And perhaps even more shocking to me, the people declining the vaccine had been on the front line in the health care system most directly impacted by COVID-19 deaths. Reports last summer showed that the overwhelming majority of COVID-related deaths among health care workers happened in New York: 368 fatalities as of mid-September.

The people being offered the vaccine had been watching people in COVID units get sick and die, day after day, for just as long as I had. And they still said “No.” I couldn’t believe it.

To be honest, I still can’t.

Some who declined had already gotten COVID-19 and had laboratory evidence of antibodies. They didn’t feel there was evidence showing that the vaccine had any advantage over their native immune response. This made some sense to me, though the idea is strongly contradicted by CDC guidance, which is very clear that getting a vaccine is advantageous to people who have recovered from the disease.

But many people who never contracted the virus and had no immunity also turned down the vaccine, and I wanted to understand. I’m a chatty person — I make small talk with people pretty much everywhere. So I started to ask. When I bought lunch at the cafeteria, I slid my credit card into the slot with a “Thank you so much! Hey, did you get your vaccine?”

“No,” said the cashier worker. She looked at me, surprised. “You did?”

“Yep, I did. I’m one of the doctors here and I feel so much better since I got it.”

“Hmm,” she said. “No side effects? Huh. I just felt really pushed into it. I wanted to think about it.”

“I actually didn’t have any side effects, though you know, you can, though generally not serious. And I understand,” I said. “But you know this disease is just waiting to get us, especially where we work. Every day wait feels like a scary day, at least to me.”

“Yeah, maybe,” she said. “I’m thinking about it. “ I talked to the guy who works in house cleaning on Labor and Delivery. I have a nice conversation with him most Thursdays when I’m on call. Usually we talk about how his kid is doing in school or where he’s planning to go on vacation. I know he also works next door, at the converted COVID ICU, which has seen many deaths.

The first time, I asked him if he got his vaccine, and his answer was minimalist: “Yeah, I know. I gotta look into that.” I just said, “Yeah, I know. I just feel so much less guilty about bringing this virus home since I got vaccinated, you know? It’s not just us living under this cloud — it’s our families too.”

The second time, he started the conversation. He had done some research and found out that Dr. Fauci had gotten the Moderna vaccine. Our institution was offering the Pfizer version. “I’m going to wait for the Moderna,” he said “That Fauci guy knows what’s what.” I told him that Fauci would tell him to grab a vaccine, any vaccine, as soon as he could, but he shook his head at me.

The most recent time, he just waved at me, and I didn’t feel I should mention the vaccine at all. In the end, I’m a doctor at this institution, and he’s a member of the housekeeping staff. That is a power differential that no amount of small talk can eliminate. And if he didn’t want to talk about the vaccine, pushing him on that felt like using that power, even if I meant to protect him. So I waved back as I left, and I haven’t mentioned it with him since.

There are many opinions about vaccine hesitancy. A lot has been written about people of color, and the legitimate mistrust that medical trials have earned since the notorious Tuskegee experiments on Black people with untreated syphilis, in the 1930s. But talking about an almost century-old unethical experiment assumes that COVID-19 vaccine distrust is rooted in inequitable treatment of the past, and that’s not true. Unfortunately, that inequitable treatment is very much present. COVID-19 pandemic data about complications and deaths continues to demonstrate how much worse the pandemic has been for communities of color: not long ago but today. That well-deserved mistrust of medical treatments is real, and needs to be explored and addressed at length.

But the vaccine hesitancy I see isn’t unique to people of color. It spans ethnic, racial, and socioeconomic backgrounds. Some people come from a place of long-standing vaccine mistrust. Some are in the midst of a general crisis of faith about elections and media. Many others are likely responding to the steady erosion of trust in the government over decades, and then I would argue, an abrupt fall in the last year of a mishandled pandemic.

And I can see how it is hard to trust a government that responded to COVID-19 so badly it led to over 500,000 deaths, many of them preventable, and then offers you a new shot of miracle protection. I can see how that might seem too good to be true. I just am not entirely sure what to do about that.

But the diversity of vaccine hesitancy means that there’s no one story here. Everybody has their own reasons for saying no — legitimate or not, or a bit of each — and their own velocity of change toward vaccine acceptance. Some holdouts will be persuaded soon; some will not. Some will get their shot after more effective public health messaging, or when they see how the vaccine has real, immediate benefits — being able to hug their grandchildren again or travel without quarantine. And some will get their shots when work requires it, or when there are things they aren’t allowed to do if they aren’t vaccinated.

And some people won’t budge. We as society will have to decide how much to make that cost.

I started out as a proselytizer of vaccines. But I saw how my conversations hinged on my power as a white woman, as a doctor, as an employer. I saw how careful I had to be about that if I wanted to make ethical change on this issue; if I wanted people to have an unforced choice.

I still talk about vaccines, but more gently, more carefully. That doesn’t seem right, either; this feels urgent and lifesaving. But it’s so easy to cross the line into an overbearing bully, and I am trying to stay on the right side of that line.

And it turns out, change does happen.

A few weeks ago, I was in the COVID ICU, rounding on a pregnant patient with pneumonia who was finally recovering. I heard my name called by a woman around my height. I couldn’t place her identity under the scrub cap and mask, so it took me a good two minutes to realize that she was one of the clerks from our labor and delivery unit, finishing nursing school, and doing rotations in the ICU.

“I had no idea you were in school!” I said. “Good for you!” And maybe because I had just come from the bedside of a sick COVID patient, and because she and I had worked together for a while, I impulsively said, “You got your vaccine, though, right? Before starting this rotation?”

She shook his head and looked down. “Come on,” I said, a panicky note entering my voice. “No, really. COME ON. I’m worried about you. You are a Black woman, you CANNOT get sick. Look where you work. Look how many we’ve lost.”

She sighed: “I know you’re right, Dr. K. I’ll get there. I’m just not there yet. I need some time.”

I wanted to push it; I wanted to convince her. Instead, I bumped elbows, wished her luck, and told her we missed her upstairs.

I recently saw her again in the ICU, across the room. She waved, flashed me her ID, and pointed to the bright, fresh “I got the shot” sticker on the front. I have no idea what got her there, or when or why. But I smiled so big she could see it behind my mask. And she smiled right back.

Chavi Karkowsky • Contributor

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