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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Claire Perlman contributed reporting.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Leave it to anti-abortion politicians in Texas to not let a crisis go to waste. The state has been at the forefront of the abortion wars for just about as long as they have existed in the United States, from Roe v. Wade to Whole Woman’s Health v. Hellerstedt. Now, while clinicians in the state grapple with the uncertainty of providing care in the middle of a pandemic, they are also being forced to fight for the right to keep their doors open as the state tries to quite literally shut them. The state government is claiming abortion is not an “essential” service and that it saps medical resources from physicians who need them to combat the coronavirus. 

The legal ping-pong playing out over the past week has been dizzying, even by the standards of abortion litigation. It started a week ago, when Gov. Greg Abbott issued an executive order stating that abortions must be put on hold unless the pregnancy endangers the life of the pregnant person. (In some clinics, medication abortion continued, as it was not specifically banned in the order.) Abortion providers quickly sued and, a few days later, on Monday, March 30, a federal judge granted a temporary restraining order. “Regarding a woman’s right to a pre-viability abortion, the Supreme Court has spoken clearly,” the judge said in his order, pretty openly dismissing Texas’ move. “There can be no outright ban on such a procedure. The court will not speculate on whether the Supreme Court included a silent except-in-a-national-emergency-clause in its previous writings on the issue.” A hearing on a permanent injunction was scheduled for April 13. 

But the next day, Tuesday, March 31, the 5th Circuit Court of Appeals granted a stay, effectively halting abortion once more in Texas. And this time, for good measure, medication abortion is specifically mentioned as being prohibited.

Care has been thrown into chaos. Planned Parenthood of Greater Texas said it was forced to cancel 261 procedures last week; Amy Hagstrom Miller, president and CEO of Whole Woman’s Health, told Mother Jones that her three Texas clinics turned away at least 150 patients while the initial abortion order was in place. A couple of those patients are minors, who she said “went to a really troubled place.” She told me one woman was turned away because of the order after she drove 250 miles to seek abortion care. She refused to leave the clinic, instead pledging to stay in the area until she was able to get her abortion. Eventually, she traveled to a clinic in Colorado; she and a friend drove nonstop to get there, crashing in an Airbnb that they tried to disinfect as best they could before falling asleep. The next day, they drove back to Texas.

Hagstrom Miller, who has an easy laugh even under dire circumstances, sounded exhausted and frustrated when we spoke last week. It’d clearly been a rough few days. Last Monday night, her team made calls to pregnant people who had appointments scheduled in their Texas clinics to let them know their procedures were canceled, at least for the time being. “People were sobbing, people were begging for us to see them anyway,” she recounted. “‘Can’t you just figure this out?’; ‘What am I going to do?’; ‘Where am I going to go?'” Making those phone calls and hearing the desperation in the voices of would-be patients was gutting, she said. “We’re really concerned about these people’s mental health—it’s palpable,” even through the phone.

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

“Knowing that people that are trying to access the abortion care they need right now had an appointment, and the next day, they had to cancel their appointment, and then they had it again, and now they have to cancel it again is awful,” agreed Aimee Arrambide, executive director of NARAL Pro-Choice Texas. “Especially considering we’re in a time of economic uncertainty like a public health crisis.”

The pandemic means that in addition to unplanned pregnancies and the obstacles Texas already has in place that make it incredibly difficult for women to get abortions—like a 24-hour waiting period and medically inaccurate, state-mandated counseling—many people are dealing with job loss, as well as financial and social instability. “So many of [the women seeking abortions] are low-income. They are parenting, caring for their families. Many of them have lost jobs and wages because of the pandemic, working at restaurants or bars or retail businesses that are closed. Whatever the situation is, they’re now without income,” said Amanda Beatriz Williams, executive director of the Lilith Fund, the state’s oldest abortion fund, which primarily serves women in central and southeastern Texas.

Texas Attorney General Ken Paxton, meanwhile, called Tuesday’s ruling a “victory.” 

It’s frightening but not unreasonable to wonder if Texas is providing a blueprint for other states that have sought to ban abortion in the past. Indeed, a handful of other states are also fighting legal battles over whether abortion care constitutes “essential” health care in this moment. Ohio and Alabama have garnered temporary restraining orders that allow clinics in those states to remain open, but Oklahoma, Iowa, Louisiana, and Mississippi are in limbo, subject to orders made by their governors that abortion is not essential and therefore cannot continue. This could all come to a head very soon, given that Texas is likely headed to the US Supreme Court for an emergency ruling, said Mary Ziegler, author of Abortion and the Law in America: Roe v. Wade to the Present. Abortion bans in this country have never survived challenges in the lower courts, but now, “in terms of what a state without abortion looks like, we’ll know imminently,” she warned. 

In the meantime, abortion funds in Texas are scrambling to redirect their clients to clinics in other states, even as Gov. Abbott ordered Tuesday that people should “minimize” contact by staying home. “It’s kind of hard to do planning, because we don’t necessarily know what the end of the week will look like, or apparently the end of the day, the next 24 hours,” said Stephanie Gómez, a board member at Fund Texas Choice. As Gómez points out, sending pregnant people across state lines puts them at risk of infection and increases the potential spread of the coronavirus, though she noted that the fund is instructing its clients to follow CDC guidelines to the best of their ability while traveling significant distances. The majority of Texas counties are at least 200 miles away from the nearest out-of-state abortion provider, according to an analysis by the Texas Policy Evaluation Project.

“It’s a hard situation made worse,” said Williams from the Lilith Fund. Identifying and building relationships with more out-of-state clinics is a major priority for her and her colleagues this week, though she worries that a new influx of patients will overwhelm states where abortion is still accessible. 

Worse still, the state has still not fully recovered from a 2013 omnibus bill restricting abortion that ultimately led to the Whole Woman’s Health v. Hellerstedt Supreme Court case. Before that bill became law, Texas had more than 40 health care centers where abortion could be accessed. Now, there are only 22. And in this moment, those facilities face an uncertain future as the public health crisis escalates. Hagstrom Miller told me last week that she’d been forced to lay off staff since Abbott’s initial order. “It’s crazy, trying to keep our clinics open,” she said. “We have so many people calling and needing services, and services are disrupted. It’s like a 400-level Chutes and Ladders.”

As a health care provider and also a small business owner, Hagstrom Miller said she’s feeling the pressure “keenly.”

“So many of us who have small businesses all over the country are just in peril—what support is there for us to take care of our staff in a situation like this?” she said. “Then for me as a health care provider, what a horrible time to bring abortion politics into this mix when my staff are nurses and medical assistants and doctors, who are frontline essential workers right now, and they should be given respect for being willing to put their lives on the line to take care of people instead of having to wade through this political nonsense.”

In recent weeks, Los Angeles has surpassed the San Francisco Bay Area as California’s coronavirus hub. The city is also host to one of the country’s largest undocumented populations, and doctors there are already seeing families hesitant to seek medical attention because of their immigration status—putting those residents and the rest of the population further at risk. 

“The fear is palpable, and our patients are very, very afraid,” said Jim Mangia, the CEO of St. John’s Well Child & Family Center, an LA-based network of clinics that he said serves more undocumented patients than any other provider in the country. On top of responding to the public health crisis, Mangia said in a press call Tuesday, St. John’s employees are having to constantly reassure patients that they can safely see doctors. 

St. John’s clinics across Los Angeles serve more than 100,000 patients every year, but right now they barely have enough protective equipment to last through the weekend. Mangia told reporters that, by the end of the week, St. John’s will have run out of masks, and that the organization is scrambling to purchase more from factories in China. So far, almost 900 of its patients have been sent to an isolation tent set up to treat possible cases of COVID-19. The organization has been working with county and state officials, but the problem has been with the federal government, Mangia said. As for tests, St. John’s has only about 30 left, and they don’t know when more will arrive. “The president is saying there are plenty of tests out there, but of course we know that’s not true,” he said, adding that last week 39 tests were administered, and 7 came back positive.

About 30,000 of St. John’s patients are undocumented, according to Mangia, “so we are a trusted resource.” There are so many questions coming in from the community that its phone lines are inundated with calls. Even still, Mangia added, “it’s a constant battle to overcome the latest attack by the administration on the immigrant community.” 

While there hasn’t been ICE activity in the area recently, there are constant rumors, he said. A few weeks ago before the pandemic hit Los Angeles, Mangia said a patient came into the clinic and told others that ICE was around the corner—and everybody ran out of the exam room. In recent weeks, patients have asked for extra refills of their prescriptions and copies of their children’s medical records, in case they get deported. 

“The dilemma is that we’ve recently come from a very intensive period of threats against the undocumented immigrant population in this country,” Mangia said. “We’re operating in an environment where we are constantly having to reassure patients that they can access services…and in a pandemic, it’s more difficult and more dangerous.” 

The fear is such that St. John’s staff is launching an outreach effort next week to try to educate as many people as possible in South LA about how to prevent the spread of the virus and distribute hand sanitizer, but also to reassure people that they can, and should, access medical services if they feel sick. “We’ve even gone as far as training our staff to do to a human chain around our clinic sites,” Mangia said, “and to be prepared to do that should ICE show up.”

In many red states, where abortion restrictions are plentiful and doctors who are willing to perform them are not, the physicians who do ultimately provide abortions often fly into town on a regular basis, sometimes traveling hundreds if not thousands of miles to get to clinics.

This is “not simply because of the high degree of regulation,” says Carole Joffe, co-author of Obstacle Course: The Everyday Struggle to Get an Abortion in America, “but that providers just do not feel comfortable living there.” 

“They don’t want their offices picketed, they don’t want their kids screamed at at school, they don’t want wacko protesters coming to their churches and bellowing at them—or worse,” explains Joffe, who is also a professor at the Bixby Center for Global Reproductive Health in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco. “By definition, it’s the states that have the most precarious level of provision that are dependent on these out-of-state docs.”

This setup has to be carefully coordinated in the best of times. During a pandemic, it’s downright precarious. As a Guttmacher report released earlier this month predicted, “In places that already have a limited number of providers, this will put an extreme strain on the capacity to serve patients, especially for non-emergency care.”

At the National Abortion Federation, a professional association for abortion providers, staffers have been helping facilitate these moves for years, matching physicians who live in states like California and New York to clinics in states like Texas, Indiana, and Ohio, which are hostile to abortion rights. This requires them to navigate an intricate web of restrictions that varies from state to state, meaning abortion providers can’t swoop in to serve clinics at random. In some states, for instance, physicians must have specific credentials within that state to practice, and insurance coverage for each doctor must also be considered. 

But now, as the Very Reverend Katherine Hancock Ragsdale, who leads NAF, warns, “We are beginning to hear about places that are having a shortage of doctors. A lot of abortion providers are also older, so we’ve got folks who are in dangerous demographics themselves.”

She adds, “We’re finding this across the board, people who have other health conditions that compromise their immunity or have families that are just flipped out.”

These doctors may also be facing shelter-in-place orders in their home states, even while their faraway patients need critical services. Ragsdale knows of at least one clinic that relies on seven traveling physicians. The clinic has been able to recruit a provider to travel in and help out in the short term, but how the clinic remains open beyond the next couple of weeks is still in question. Another clinic, Ragsdale says, has closed altogether because the provider has a health condition and cannot risk exposure. 

“We’re trying to do everything we can to keep the clinics open and functioning,” Ragsdale says. “[The providers] are true heroes—we worry about a day when they won’t be able to provide anymore.”

Things are particularly dire in Texas, where many clinicians fly to work and where last week Gov. Greg Abbott essentially outlawed abortion in the state as a procedure that is “not medically necessary.” While the status of the ban is in flux—on Monday, a court halted it until April 13, but earlier today, Texas Attorney General Ken Paxton filed a stay to the 5th Circuit to reinstate the ban. Planned Parenthood of Greater Texas reports that they were forced to cancel 261 procedures since Abbott’s announcement last week; Amy Hagstrom Miller, president and CEO of Whole Woman’s Health, tells Mother Jones that her three Texas clinics turned away at least 150 patients during that time. Hagstrom Miller also notes that one physician who lives in California and travels to one of the Texas clinics to work has committed to staying in the state for a few weeks to eliminate the risk from going back and forth. Dr. Ghazaleh Moayedi, who lives and works locally in Texas, says she has seen some of her peers make similar decisions, deciding to remain there instead of traveling home to their families for fear of getting stuck away from their patients. Others, Moayedi says, have been driving long distances between homes and clinics to avoid airplanes and self-isolate while still continuing to work. 

Moayedi, for her part, is taking everything day by day, but she admits to feeling a certain amount of fear. “I’m concerned about physicians who travel here not being able to continue to travel, and I’m concerned about the burnout and stress being put on all of our colleagues—the physicians, the nurses, and our staff,” she says wearily.

I'm the only actively practicing #abortion provider *living in* my community that provides care to the legal limit. The only. All others fly-in. The reality of what this means in #CoronavirusPandemic is making me twitch a little….I have to keep providing & I cannot get #COVID19 pic.twitter.com/CLAD9jhXRE

— Ghazaleh Moayedi, DO, MPH (@dr_moayedi) March 12, 2020

Amid all this new uncertainty, NAF is doing its best to fill in the holes. It’s fast-tracking a partnership it was working on with Planned Parenthood before the pandemic, which will match clinics with not just doctors, but also nurses, receptionists, and counselors from around the country; it was initially conceived as a contingency should the Supreme Court rule against clinics in the upcoming June Medical Services v. Russo case, which is scheduled for a decision this summer, but the plan has been accelerated to try and meet current needs. 

Ragsdale also notes the NAF hotline is staying in near-constant communication with the clinics in its network as a stopgap, moving around patients and appointments as needed and if possible. “It’s really an all-hands-on-deck, double-time moment for us,” she says. 

The crisis has led to near-constant communication among many providers, adds Moayedi. Group texts and email threads discuss how best to screen patients for the virus before their appointments; social distancing in the waiting room; spacing out appointment times; and managing anxieties during a massive health crisis. It’s an amped-up version of a camaraderie that has long existed in reproductive care, as the field has been plagued with legal challenges and unnecessary restrictions for decades. 

“Our work is constantly in crisis,” she says. “It’s definitely extra stressful, but this is not something that abortion providers are new to—we are experts at working in crisis, being nimble, being creative, and providing care in the most extreme circumstances.”

For now, similar bans Ohio and Alabama are on hold, and providers are fighting in court to protect access in Iowa and Oklahoma, which have also issued directives that classify abortion as nonessential care. While Massachusetts, Maryland, Colorado, Washington, New York, Illinois, New Jersey, Minnesota, New York, and Hawaii have declared abortion care essential at the time of publication, it remains to be seen how many more states will follow their lead—or that of Texas. 

“Abortion is not something that can be indefinitely delayed—you need access to health care,” Ragsdale emphasizes. “You can’t put it off until the situation’s cleared itself up.”

A major coronavirus outbreak on a US aircraft carrier has deteriorated in recent days, sparking a plea for help from a senior Navy official that is all but unprecedented. 

More than 100 sailors on the USS Theodore Roosevelt have tested positive for COVID-19, the disease caused by coronavirus, as the ship is docked in Guam with no apparent solution in sight. Captain Brett Crozier, in a four-page letter obtained by the San Francisco Chronicle, said the outbreak was “ongoing and accelerating” and urged Navy leadership to allow most sailors to leave the ship so it can be properly cleansed. 

“We are not at war,” he wrote. “Sailors do not need to die. If we do not act now, we are failing to properly take care of our most trusted asset—our Sailors.”

The Navy first revealed on March 24 that three sailors on the Roosevelt had been infected after docking at Da Nang, Vietnam, earlier this month. Its more-than-4,000-person crew was tested for COVID-19 a few days later and the amount of confirmed cases shot up. By Monday, a senior officer on board the ship told the Chronicle that between 150 and 200 crew members had tested positive. Without an immediate intervention from the Navy, that number will surely increase because of the difficulty in effectively quarantining infected sailors who are already living in cramped spaces. Using the Diamond Princess cruise ship, where hundreds of passengers were infected with the virus, as an example, Crozier emphasized that the Roosevelt’s situation was worse—a reality former Navy officials have acknowledged. 

“Warships are much more compressed than all stateroom cruise ships,” said retired Admiral James Stavridis, who spent more than three decades with the Navy, including as NATO’s top commander, in a tweet. “Think of your kitchen with a dozen sailors sleeping there. We call them ‘berthing compartments,’ but in this time of corona they will be ‘birthing compartments’—for the virus.”

Crozier’s letter reflected the severity of the crisis in language even veteran defense reporters found unusually stark. Calling the removal of hundreds of sailors a “necessary risk,” Crozier added, “Keeping over 4,000 young men and women on board the TR is an unnecessary risk and breaks faith with those Sailors entrusted to our care.” 

Even if the Roosevelt is called into service as part of an ongoing conflict, Crozier’s letter leaves no doubt it would be significantly compromised. “Decisive action is required now in order to comply with CDC and (Navy) guidance and prevent tragic outcomes,” he wrote. 

The desperate situation underscores how reluctant top military officials have been to directly acknowledge the impact of America’s worsening coronavirus crisis. Last week, Admiral Mike Gilday, chief of naval operations, released a lengthy statement noting that the Navy was “taking this threat very seriously” and said this “aggressive response will keep USS Theodore Roosevelt able to respond to any crisis in the region.” On Tuesday, acting Navy Secretary Thomas Modly told CNN that Navy leaders “don’t disagree” with the captain’s assessment and have been working over  “the last several days to move those sailers off the ship,” but said “the problem is that Guam doesn’t have enough beds right now.” 

In his letter, Crozier urged the Navy to pursue “the peace time end state” given that “war is not imminent.” Modly’s comments made clear that would not be an option.

“We are not standing down the watch. We still have a responsibility to protect the seas,” Modly said. “We’ll just have to adjust on the fly.”

As the coronavirus crisis deepens in the United States, experts have pointed to a series of disastrous missteps that helped lay the groundwork for shortages in testing and medical equipment around the country. Even some Republicans have started to concede that the federal government may have been too slow in confronting the pandemic.

But that admission, if that’s what it is, has been paired with a false new accusation: that it was Donald Trump’s impeachment trial that prevented the president, along with Congress, from mounting a forceful response to the public health crisis in January and early February.

“[Coronavirus] came up while we were tied down in the impeachment trial,” Senate Majority Leader Mitch McConnell (R-Ky.) said during an appearance on Hugh Hewitt’s radio show on Tuesday. “I think it diverted the attention of the government because everything, every day was all about impeachment.” McConnell then praised Sen. Tom Cotton (R-Ark.) for being the first to raise an alarm about coronavirus—a rather generous way to portray Cotton’s role in promoting fringe conspiracy theories about the virus’ origins.

The remarks from the top Senate Republican echoed similar narratives about impeachment percolating on the right.

But the claim—which dovetails with Trump’s ongoing efforts to blame his political opponents for his much-maligned response to the crisis—ignores reality on multiple counts. First, there’s the fact that senior administration officials, according to the Washington Post, spent weeks in January warning Trump about the virus’ potential for disaster in the United States. “Donald Trump may not have been expecting this, but a lot of other people in the government were—they just couldn’t get him to do anything about it,” one official told the Post. “The system was blinking red.”

While Trump ignored those national security warnings, he played a lot of golf, hitting the links at least five times from mid-January through early March. Did impeachment cause that? The president also found time to sign a major trade deal, the USMCA, during the trial—an action that had nothing to do with the looming crisis ahead.

McConnell’s insistence that the Senate was distracted by impeachment is similarly baseless.

The trial didn’t stop the Senate’s health committee from receiving a briefing about the virus from US public health officials on January 24. That day, Sen. Kelly Loeffler (R-Ga.) and her husband began dumping between $1.28 and $3.1 million in stock. Senate Intelligence Committee chair Richard Burr (R-N.C.) didn’t miss a February 4 briefing on coronavirus, even though it, too, was in the midst of the impeachment trial. Days later, he sold up to $1.7 million in stock, ProPublica reported. The FBI is reportedly investigating the sale by Burr, who claims he did not consider the briefing when he made the sale.

If impeachment really had prevented McConnell from taking action on coronavirus, one would have expected him to deal with the issue immediately after the trial concluded on February 5. He did not.

The first thing senators did after acquitting Trump was take a five-day weekend. Upon their return, the Senate did not turn to pandemic preparation measures. Instead, they voted on a procedural motion to confirm a federal district court judge, one of five judges they confirmed over the next few days.

But timeline aside, conservatives now blaming impeachment for the current crisis may want to rethink that strategy. Trump, remember, was impeached for withholding military aid from Ukraine in an effort to force that country’s president into opening investigations that would help him politically—actions that Stanford Law professor Pamela Karlan warned might be repeated during a natural disaster if Trump was not removed from office. Now, take a look at Trump’s explanation for why he isn’t calling back Democratic governors he believes have been too critical of his coronavirus response:

“I say: ‘Mike [Pence], don’t call the governor of Washington…Don’t call the woman in Michigan…If they don’t treat you right, I don’t call.”

Given these parallels, the Senate’s problem might not be that it paid too much attention to impeachment, but too little.

As the novel coronavirus swept the nation, and the film and TV industry production ground to a standstill, Andrew Brinkhaus watched one gig after another dry up. Stuck at home with nothing to do, the Los Angeles camera operator was surfing Twitter one day when he saw someone in Sweden post instructions on how to 3D print a face shield. It piqued his interest. He had seen that doctors and nurses and other emergency responders were struggling to get proper protective gear as they managed an onslaught of coronavirus cases. And he owned a 3D printer.

Brinkhaus, 31, decided to give it a go. Using the Swedish design, he 3D printed a headband and then went out to Office Depot and bought up a bunch of transparency sheets normally used for overhead projectors to make the face shield. He completed his first one on March 24. Since then, his unemployment service project has snowballed into a mini-manufacturing collective that in its first week has printed and donated 1,000 face shields to area hospitals, urgent care clinics, and nursing homes. 

After he started making shields at home, Brinkhaus put out a social media call for others to join in the work, using the hashtag #3DAgentsofShield. (I happened to see it because Andrew is my cousin.) As it turned out, a bunch of out-of-work film industry folks also had 3D printers at home, and they came out of the woodwork to contribute. “We now have 18 in our core group, and we have over a dozen people around the country with printers who are printing this file for us,” he told me. “They’re basically printing big batches and shipping them to us. We’re putting that into our inventory, and then we’re shipping those out as fast as we can.”

The orders came by word of mouth. The first was from a local veterinarian. Brinkhaus made 20 for her. But as the medical community got wind of the project, the orders started piling up.  Inquiries are now coming from everywhere from Nicaragua to New York. The 3D Agents of Shield have a backlog of 2,000 orders they are racing to fulfill. Just between 7 am and 9 on Monday, when I interviewed Brinkhaus, he’d gotten orders for 600 more shields. This week, the group created a GoFundMe page that raised nearly $4,000 in its first day, mostly in small donations, that have helped pay for the supplies and shipping. If there’s any money left over when the crisis passes, they plan to donate it to a medical charity.

Brinkhaus has been amazed by the response. “The more this message spreads, the more people say, ‘Hey I’ve got a printer. I want to help,’” he tells me. “The donations have followed suit in the same way. There’s a lot of excitement. We had a mom yesterday reach out because her 15-year-old-son got a 3D printer for Christmas and wants to help.” He says people are motivated by fear, anger and frustration over how the medical professionals are being forced to take care of the sick without proper protective gear.

“It’s just been this unbelievable snowball,” he says. His friends in the film industry have pooled their resources to help even as they’re filing unemployment claims and hoping for a stimulus check. Over the course of just a week, a project that formed in a group text moved into a bigger WhatsApp conversation, and now needs a Discord server to manage, the chat app designed for video gaming communities. Initially, Brinkhaus had created a simple Google doc for people to submit orders. Now, he says, someone in the group has made extensive spreadsheets that are updated in real time to manage supply and demand. Someone else created a website, spending four days in coding hell so that the site can handle all the inventory and shipments. “It’s incredible how much this has grown into a legit operation in a week,” he marvels.

The project is about to scale up again thanks to one member of the group who was in touch with a guy who runs a local sign making shop in the LA area. The shop has a huge CNC machine—an automated machine tool system that can precision-cut materials—that can massively increase their output. “With his big machine, he can do one shield in a minute, whereas our printers take 28 to 30 minutes to print,” Brinkhaus says. But the sign maker needed the raw materials. That’s where the film industry came through again, with something known as “dance floor.”

“When a camera is on a dolly, we’ll put down this plastic sheeting to protect the floor and give us a smooth surface,” Brinkhaus says. “A lot of the guys in motion picture industry own this dance floor in big sheets. They’re now all willing to donate that material.” One four-by-eight piece of dance floor can make nearly 130 masks, he says.

Once the CNC machine gets up and running, Brinkhaus thinks the rest of the collective can shift production to 3D printing much needed respirator masks. He says they make N95 masks with a flexible filament and leave space inside for part of an air conditioning filter, which can keep out particles as small as .3 microns—the level at which the CDC says is useful for protection against the virus.

If fighting coronavirus with air conditioning filters and overhead transparencies sounds a little MacGyverish, that’s because it is. “People are trying to find ways to use something commonly found on the market and repurposing them to do something important and necessary,” Brinkhaus says. He hopes that they will eventually be able to ship both the face shield and the respirators as a package deal to hospitals.

I wondered whether these 3D shields would run into any regulatory problems. Would the CDC sign off on these homemade PPEs? (Or Marvel Comics, for that matter!) “There’s obviously this huge shortage of the necessary equipment,” Brinkhaus says, noting that in a normal situation hospitals probably wouldn’t take his equipment because it hadn’t gone through a rigorous screening. “But these people are in a position where it’s literally no protection or what we’re offering,” he says. “Doctors and nurses are going out of their way to get them because it’s better than nothing.”

His group has tried to standardize its materials using commercial grade plastic, so that their shields can be cleaned, sanitized and used again, unlike some of the other ones he’s seen using foam and a bungee cord, for instance. Only medical facilities are eligible to order. That means not even Brinkhaus’s mom gets one. “I want to be able to say yes to everybody but we just have such a huge queue and such a huge demand already,” he laments. But he says they have to stay committed to the medical professionals “who are face to face with these patients who are sick and who really need ‘em.”

Why has San Francisco thus far been spared the worst of COVID-19’s impact? On Monday, the city reported 374 cases, with six deaths, a fraction of the state’s 7,414 cases. Doctors have yet to see the surge in coronavirus cases that has overwhelmed hospitals in New York City, which has 38,087 confirmed cases and 914 deaths in all.

Density might explain some of the discrepancies with New York City. NYC is the densest big city in the country, at 28,000 people per square mile; San Francisco, the second-densest city, has 18,000 per square mile. But there are other factors that may have dampened the effects of the virus: early, aggressive interventions by political and public health officials to contain the spread of the coronavirus and steel the system against an outbreak. Taken as a whole, they suggest San Francisco saved a lot of lives by starting the clock on a response well before the coronavirus had officially arrived in the city. 

Here are four things San Francisco seems to have gotten right. 

Went on emergency footing early

On Feb. 25, nine days before San Francisco announced its first two coronavirus crisis, Mayor London Breed declared a state of emergency, allowing the city to fast-track hiring and loosening up funds and resources from the state and federal government. At the time there were 57 cases throughout the United States. It would be more than two weeks before New York City declared its own state of the emergency, at which point the city had 95 cases. 

As the San Francisco Chronicle‘s Heather Knight points out, Breed’s emergency declaration sped up preparations for a coronavirus response. Among other things it allowed the city to expand its emergency operations center. In two weeks, San Francisco hired 82 nurses, a process that typically takes months. In a month, Breed managed to score 30 recreational vehicles to serve as “isolation housing” for homeless people who test positive for the coronavirus but did not need hospitalization. And starting this week, the Moscone Center will turn into a homeless shelter for 600 people who need medical care while the city tries to secure 3,000 hotel rooms for homeless people and health care workers. 

Social distanced early

On March 11, six days after it announced its first two coronavirus cases, San Francisco barred gatherings of more than 1,000 people at a time and told folks not to leave their homes unless they needed to go grocery shopping and visit medical professionals. This set the stage for more dramatic measures at a time when President Trump was assuring Americans that the “risk is very, very low.”On March 16, a day after the Centers for Disease Control and Prevention advised against gatherings of at least 50 people, San Francisco along with five other Bay Area counties issued shelter-in-place orders, affecting 6.7 million people in all. On March 19, the rest of California followed suit. On March 20, 19 days after New York City reported its first case, New York Gov. Andrew Cuomo ordered a pause on non-essential businesses and a de facto quarantine order as cases began to swell. 

In San Francisco, after reports emerged of people flooding city parks and beaches, Breed vowed to crack down on the social distancing order, closing playgrounds and warning that public spaces could be next. “You are putting lives at stake. You are putting public health in jeopardy,” Breed said during a press conference on March 23. “What happens if it’s your grandmother? What happens if it’s your uncle? It’s a matter of life or death.”

Listened to public health officials early

San Francisco’s public health director, Dr. Grant Colfax, had been tracking the coronavirus’ trajectory since December. In stark contrast, as the Washington Post reported, intelligence officials gave “ominous, classified warnings” of an impending pandemic in January and February, even as Trump and others downplayed the threat to the United States. 

Colfax pushed the city to set up the emergency operations center in January. It has relocated to the larger Moscone Center. “It was so important for us in San Francisco to get ahead of this, to get ahead of the curve before there even was a curve in San Francisco,” Colfax told the Chronicle.

Prepared for the surge 

Despite their apparent success in mitigating the spread of the virus, Breed and other officials on Wednesday were still preparing for the worst as they pleaded for more resources ahead of an anticipated surge in cases. The Chronicle reported that the city still needed 1,500 more ventilators and 5,000 more hospital beds to manage the peak of the coronavirus outbreak, based on a model comparing what’s happening in San Francisco to what transpired in Wuhan, China; New York City; and Italy. Like other officials, Breed requested from the federal government more protective gear, testing, ventilators, and beds ahead of the surge.

The hope ultimately is to give hospitals more capacity to absorb the surge. As my colleague Julia Lurie pointed out two weeks ago in her look at UCSF Medical Center: 

The hospital canceled elective surgeries to free up manpower, bed space, and, supplies, and it set up “COVID wards” for patients admitted to the hospital with coronavirus. As of Monday, security guards are posted outside the hospital to screen every person as they walk in, asking questions about respiratory symptoms, fevers, and “high-risk contact” with anyone with coronavirus.

Last week, the hospital erected two military-grade tent structures in the parking lot to triage incoming patients with respiratory symptoms: one for less ill, “treat-and-release” patients, the other for more serious cases that may necessitate being admitted to the hospital.

“It is plausible that … we could have a scenario similar to the one that is playing out in New York this very day,” Colfax said on Wednesday. “I’m sorry to say the worst is yet to come. Yet we are preparing, as we have been since the very beginning of this emergency.” 

Even if you wanted to, it’d be impossible to avoid all the scary numbers floating around about the potential toll of the coronavirus. And even though I write about science for a living, I’ve been struck by the sheer range of projections—I’ve seen estimates that say anywhere between 200,000 and 2.2 million Americans could die depending on the virus’s characteristics and what actions the federal government takes—and how helpless they make me feel. I keep thinking, what the hell are we supposed to make of all these stats? What good do these projections even do?

To be clear, I recognize that projections are scientifically important. They are also powerful tools to inform public health officials and governments as they make decisions and implement policies. (Case in point: Reporting suggests that an Imperial College London study was what helped finally spur the Trump administration into a more meaningful coronavirus response.)

But as someone out in the world just trying to internalize what the hell is going on and what we should anticipate moving forward, I’ve wondered if there’s a better way to talk about the coronavirus. What kinds of communication can actually push people to take action—to, among other things, socially distance, wash their hands, and not freak out? I recently posed this question to risk communications expert Dominique Brossard, a professor and chair in the Department of Life Sciences Communication at the University of Wisconsin, Madison.

When faced with mind-boggling projections, she says, there are two types of reactions that people typically have: They either get scared and anxious, or they dismiss the information because they find it unbelievable. Neither is good, of course. While some research suggests that a certain level of fear can lead to what Brossard calls “protective behavior,” there’s a fine line to walk between being honest and transparent with people and needlessly scaring the bejeezus out of them.

Brossard has spent nearly two decades studying how people process scientific information and the best ways to communicate in times of a public health crisis. She emphasized there is no one-size-fits-all approach to risk communication, but she shared some of her tips for how to talk about—and better yet, understand—what’s going on with COVID-19:

Find ways to connect the numbers to a person’s real life.

People’s perception of risk typically comes from qualitative thinking more than quantitative. For example, Brossard says, you could tell someone that 500,000 people are going to die from COVID-19 in the United States. “That’s kind of abstract,” she notes. It’s hard to internalize. “Very often, the problem that we have with those type of statistics is that, yes, they should generate fear. But if people cannot connect it to something that they are familiar with” then it may not have an effect on them. Instead, she says it can have a bigger impact to say something like, “500,000 could die, including your grandmother,” or “people will die in every state including yours.” 

A recent public service announcement from the city of Baltimore, which encourages people to stay home to prevent the spread of COVID-19, uses this approach. On the poster, there’s a picture of three men watching something on a cellphone and cheering. On top of their images, annotations reveal that one of them “has COVID-19 and doesn’t know it yet.” Another “has an undiagnosed heart condition.” And the third is “having dinner with his grandmother later.” It’s a jarring—and memorable—image.

“What’s much more powerful than numbers is if you can put a face on something,” Brossard says. Baltimore’s poster, she says, makes you think of someone you know, perhaps a friend. “That’s that idea, making it relevant in a way that people can identify with it.”

Another effective option is putting the number into a smaller fraction—for example, “at least one out of every two people will get the coronavirus, some experts project”—or comparing the number to the population of a city—”500,000 people, which is roughly the population of Atlanta”—can help, she says, “give a sense that these are real people.” 

Statistics can cause anxiety and fear. Hope can be a more powerful tool to get people to take action.

Hope can empower people. Stories “showing how people are coming together to address the issue of social distancing, how neighbors are helping each other with food, with child care, how people are taking seriously that idea of social distancing,” Brossard says, can give people a sense of self-efficacy and inspire them to take similar action.

Take this 2019 study on climate change behavior: Researchers surveyed 1,310 people about their feelings of hope and doubt on the subject of climate change. Participants who felt “constructive hope” (for instance, feeling that “people—individually and collectively—can reduce climate change”) and recognized the reality of the threat were more likely to support climate policy and political action. In a second survey of 674 people, respondents reported that overall their feelings of hope came from “individual and collective actions, and from positive observations of behaviors rather than from negative pressures to respond (such as extreme weather events) or from developments in science and technology,” the study authors write. In other words, people’s feelings of hope grew from seeing other people’s positive actions, not from scary events.

I also spoke with associate professor of biostatistics Hakan Demirtas and Mark Dworkin, a professor and associate director of epidemiology, both at the University of Illinois at Chicago, last week; they each echoed this sentiment. While we shouldn’t ignore the big coronavirus projections, they worry that focusing on them may raise public anxiety at a time when anxiety is already high. “I think the big message here for the public, in putting this into perspective, is: Stop focusing on the numbers,” Dworkin says. “Let the experts and policy leaders focus on them. The numbers are just raising our anxiety, right?”

“It’s an echo chamber in the media right now with these numbers,” Dworkin adds. “It’s numbers about death and tragedy and it’s really hurting people while it’s informing them…How many stories have you read about the heroic efforts of nurses and doctors versus how many times have you heard about the death counts rising and the doubling of the numbers and the horror show?”

Consider the messenger; they can be even more important than the message

Another key factor in generating action is who or what is sharing the information. It’s more or less common sense, but it’s crucial: If the messenger is someone or something people already don’t trust, they’re more likely to dismiss it, Brossard says. “We tend to accept information that fits our beliefs, and we tend to reject what doesn’t fit.” This is called “motivated reasoning.”

Surveys show, for instance, that some Republicans can accept the principles of science—physics, chemistry, biology—but can also deny that climate change is happening. That is, climate change doesn’t fit their belief structure. The same is true, Brossard argues, of some liberals who may think genetically modified foods are unsafe to eat, despite what the science tells us. If two different messengers tell you the same thing and you don’t trust one of the messengers, you may discard their message while accepting the other, according to Brossard. “Very often, trusting the messenger is more important than the content of the message itself.”

For example, Brossard and other researchers published a study in 2018 that showed that when people were presented with the same data (in this case, about nuclear technology), participants who were told the data came from MIT were more likely to find the information credible than the participants who were told it was from the Department of Energy. This is likely in part because Americans tend to trust scientists (and not necessarily the government). According to a new Pew poll, 86 percent of Americans have “a great deal” or a “fair amount” of confidence in scientists to act in the public interest. (Unfortunately for all of us, as my colleague Mark Helenowski points out, Trump has regularly ignored the advice of scientific experts.)

Look to the past for ways to learn from our mistakes

In times of crisis, what didn’t work before probably won’t work now. Brossard suggests the initial communications around climate change are one powerful example. “Who was, right away, the spokesperson for climate change? Al Gore”—someone who had just come off a contentious presidential election that went all the way to the Supreme Court. “It was framed as a Democratic issue.”

But that isn’t the only lesson from past failures regarding climate change. The issue was also framed as an environmental issue that in no way connected to the individual lives of American people. Among the first images employed to communicate the risk was a polar bear on a melting ice cap. “That was kind of like the iconic image that was used to communicate with climate change. Remember that? But people go, ‘Oh, poor polar bear,’ and went on with their lives.”

(Of course, these are not the only reasons American’s can’t agree on climate change action; don’t forget the powerful industry interests that worked to silence the warnings of scientists for decades.)

In the same way, effective COVID-19 messaging will need to connect to people’s realities, be framed as a nonpartisan issue, and instill hope. We have a chance to learn from past misfires, Brossard says. “I would say climate change communication has been a fiasco. We should be doing so much more now than we’re doing—certainly, lessons have to be learned.”

Amid mounting calls to release people locked up in jails and prisons to protect them from the coronavirus, one of the largest jails in California has reduced its population by about 500 inmates in the last two weeks. As of Monday morning, Santa Rita Jail in Dublin held about 2,150 people—nearly 20 percent fewer than usual. 

The downsizing can be attributed in part to a recent agreement between Alameda County’s district attorney, public defender, and presiding judge to modify the sentences of nearly 250 inmates and release them. A local court also ordered that dozens more prisoners awaiting trial be released without bail. The population drop is also the result of changes on the front end, starting with cops booking fewer people. In mid-March, Sheriff Gregory Ahern instructed police officers to issue citations rather than arresting people for misdemeanors and only bring those accused of felonies to Santa Rita. Deputies booked about 50 people into the jail this weekend—about half the normal number, says Sgt. Ray Kelly, the sheriff’s spokesperson. 

Meanwhile, the Alameda County district attorney’s office has drastically reduced the number of people it is charging with crimes. Over the last two weeks, it filed 70 percent fewer felony charges and 63 percent fewer misdemeanor charges, District Attorney Nancy O’Malley told a federal judge on Monday. “We are being very careful in our charging,” she said. “Doing everything we can to keep people from going into the system.” 

Santa Rita has been the subject of complaints and allegations of human rights abuses, forced labor, and unsanitary conditions. Recently, as part of a class action lawsuit alleging mistreatment and neglect of inmates with psychiatric disabilities, federal Judge Nathanael Cousins ordered the sheriff’s lawyers to provide information about how Santa Rita was responding to COVID-19 crisis. “This ‘mega jail‘ is the third largest facility in California and the fifth largest in the nation,” Cousins wrote. “I am concerned by the potential impact of the global coronavirus pandemic on the health and safety of the [inmates]. A coronavirus outbreak in the jail additionally could have serious and long-term consequences to Jail staff and in the community at large.”

During a hearing on Monday morning, Gregory Thomas, the sheriff’s attorney, reported to Cousins that of 17 Santa Rita inmates tested for the coronavirus, seven have tested negative and 10 were still awaiting results. Several housing units in the facility are under quarantine, some due to possible exposure to a nurse employed by Wellpath, the jail’s medical contractor, who tested presumptive positive for COVID-19 last week. According to Thomas, both jail staff and people being booked into Santa Rita must undergo medical screening and wash their hands before entering the facility. Most visits have been cancelled and inmates are receiving about 25 minutes of free phone and video calls. Cleaning regimens have been stepped up and officers and medical personnel have been instructed to wear masks. Masks—with any metal pieces removed—have been distributed to any inmate who wants one, Thomas said.

Yet on Monday afternoon, a local anti-incarceration group posted a report from a current Santa Rita inmate who said many jail staff are not wearing masks or gloves, and that the jail has not provided cleaning supplies in more than a week. Defense lawyers attending the hearing reported that many of their clients, including those in units designated for asymptomatic inmates, had come down with coughs. Inmates told them that neither the phones nor the communal showers and bathrooms were frequently cleaned. “People within that facility have no choice but to use communal showers, communal bathrooms,” said Kara Janssen, a lawyer representing inmates in the class action suit. She called Santa Rita “an incredibly unsafe place because of continued booking.”

During the hearing, Alameda County Public Defender Brendon Woods called for more releases from Santa Rita. “We can maybe set some sort of benchmark,” Woods said, suggesting that up to 45 percent of the jail’s population could be released. The sheriff is not considering using his emergency powers to order a mass release, though he is aware of the option, according to Kelly. “When I think of that type of emergency, I think you’re talking about catastrophic failure of infrastructure,” Kelly says. “I’m thinking like, a giant 10.0 earthquake just comes in and just levels the entire region and the jail, and you just cannot do anything but let these people walk. We’re not at that point.”

Now that Alameda County is making some changes that criminal justice activists have been calling for for years, might it continue when life returns to normal? “After we get through this crisis, I think a lot of people will be asking those questions,” Kelly says. “They’ll be saying, ‘Well, you did it during the crisis. And we all, you know, survived. And there was less people in custody. Why can’t we do it now?’ As we come out of this thing, I think a lot of those questions will have more merit and validity.”

The number of people who have died of the coronavirus pandemic in the United States has now surpassed the number of people killed in the September 11, 2001 terror attacks.

The virus’s death toll in the US hit more than 3,100 on March 30, exceeding the 2,977 victims who were killed in the World Trade Center, the Pentagon, and four hijacked planes on September 11. While the virus is incomparable in many ways to the sudden deaths on American soil in a terrorist attack, its slow-moving toll on civilian lives promises to upend American society in peacetime as only terror has done. And while the death toll surpassed 3,000 today, the number of confirmed cases is still rising rapidly, meaning many more people will likely die from COVID-19 in the weeks and months ahead.

The impact of September 11 went far beyond its initial death toll: Thousands of people were injured in the attacks, and thousands more died of diseases caused by exposure to toxic substances in the aftermath of the rubble of the Twin Towers. Its economic impact was similarly grim: In the three months following the attack, New York City’s economy lost 143,000 jobs each month and $2.8 billion in wages, according to a New York Times report from 2004.

The coronavirus’s effects will be far-reaching, as well. An estimated 160,000 people have been infected with the coronavirus in the United States, resulting in more than 20,000 hospitalizations and placing an unprecedented strain on the nation’s health care system. In addition, more than 3 million people have filed for unemployment due to the shuttering of non-essential businesses across the country. As the economy stumbled, the Congress passed a $2.2 trillion stimulus package—the largest of its kind in modern history.

Washington, even when shut down by coronavirus, is still Washington. And K Street, even remotely, is open for business, selling help to firms seeking stimulus money or approval for products related to the pandemic.

Unsurprisingly, this means that some of the characters in the president’s orbit are gaining business.

Take Brian Ballard, arguably the most successful of a slew of DC lobbyists who have cashed in on connections to the mercurial president, who has allowed his time and properties to become keys to a sprawling influence industry, despite his pledge to “drain the swamp.” Ballard is a Republican National Committee fundraiser, who, prior to 2016, lobbied for the Trump Organization in Florida. Following Trump’s election, Ballard expanded his formerly Florida-based lobbying practice into a DC powerhouse, signing major companies including General Motors, American Airlines, MGM Resorts, and foreign states such as Qatar and Turkey, as well as Albania’s ruling party. I wrote last year about how Ballard lobbied one of Trump’s lawyers, Jay Sekulow, as part of an effort to get the Justice Department to hold off on prosecuting a Turkish state bank accused of violating US sanctions on Iran. Ballard’s firm employs several officials connected to Trump, including former White House deputy press secretary Raj Shah and Pam Bondi, who left the firm to assist Trump’s impeachment team before rejoining Ballard there this month.  

Ballard is now representing at least one company, Nanopure LLC, that is seeking approval for a coronavirus cleaning product. The New York Times first reported the connection on Saturday. (Ballard also registered on March 25 to lobby for Millennium Physician Group LLC, which includes 500 health care providers in Florida. The group is expanding its virtual offerings to respond to COVID-19, but the nature of Ballard’s work for the company is not clear; the group did not respond to inquiries Monday.)

Nanopure told Mother Jones on Friday that in hiring Ballard, along with his associate Sylvester Lukis, a former Health and Human Services Department lawyer, it hopes it can get quick EPA approval to sell an aerosol mist spray it says can kill the coronavirus, as well as germs, bacteria, and other viruses in hospital rooms, hotels, and other enclosed spaces. “They’re able to put out the information,” Steve Gareleck, the CEO of the South Carolina-based firm, said. “I need help politically to get this thing to the right people.”

Gareleck said that NanoPure’s “system and solution will be able to save a lot of lives,” but because it is an aerosol mist, it needs EPA approval. The EPA has established a process to expedite such requests, Gareleck said, but epxlained that the trick for his small firm, which currently has around just eight employees, is ensuring it can quickly get studies showing the product is safe in front of decision makers. 

In an email, an EPA spokeswoman told Mother Jones that said the agency “treats all submissions equally” and referenced a March 9 press release announcing an expedited process for reviewing disinfectants that want to claim on their labels that they can kill the coronavirus. Neither Ballard nor Lukis responded to inquiries from Mother Jones.

With Ballard on board, Gareleck said he hopes approval for his product will come within weeks. “We’re getting close,” he said, “and we’re talking to right people now.”

On Monday, Hungary’s parliament awarded its nationalist prime minister, Viktor Orban, the power to rule by decree until his government decides the coronavirus crisis has passed. The move effectively eliminates any democratic opposition, and critics have already assailed it as an authoritarian power grab. Orban doesn’t have many friends in Europe—he is staunchly anti–European Union and has condemned the concept of open European borders, claiming “mixing cultures will not lead to a higher quality of life, but a lower one”—but he has found one in Donald Trump. 

Trump met with Orban last spring, over the objections of his then–national security adviser, John Bolton. He praised Orban and drew comparisons between himself and the Hungarian.

“You’re respected all over Europe. Probably, like me, a little bit controversial, but that’s OK,” Trump told his guest. “You’ve done a good job and you’ve kept your country safe.”

At the time, a group of US Congress members objected to the meeting, expressing “deep concern about Orbán’s crackdown on democracy, increased Russian and Chinese influence, and use of anti-Semitic and xenophobic language.”

Orban, who has cultivated close ties with Russian President Vladimir Putin, is known as one of Europe’s fiercest critics of Ukraine, which borders Hungary to the east. According to testimony last fall during the buildup to the impeachment trial, Trump aides were concerned about Orban trying to influence the president against Ukraine’s newly elected president, Volodymyr Zelensky. Several witnesses testified that they believed Orban was responsible for Trump’s belief that Ukraine was corrupt and set against him.

The new law gives Orban wide-ranging emergency powers and the ability to prosecute people who he says are spreading misinformation about the pandemic. It also suspends elections and referendums. There is no expiration date on the emergency powers.

Kim Lane Scheppele, a Hungary expert at Princeton University, told NPR that Orban is leading the way among likeminded world leaders in using the virus to push for more power:

“Bolsanaro in Brazil, Kaczynski in Poland…Trump in the United States, all of them have thought about using emergency powers. But no one has yet gone as far as Orban to really shut down democracy as anybody knew it in Hungary before.”

Just moments before a mass shooter opened fire in a Virginia Beach building last year, killing a dozen co-workers and injuring several others, the order came in: Shelter in place. The words rang loudly in Florida as Hurricane Michael battered the state in 2018: “SHELTER IN PLACE.” Likewise in Los Angeles in 2016 when police blared “shelter in place” after a truck carrying sulfuric acid and toxic gas exploded, sending deadly fumes downtown.

No one needs to be told what “shelter in place” means in the crosshairs of carnage: Shootings, storms, and chemical fire tell you what to do. Take cover until the coast is clear on order of officials. No carve-outs for “essential” ice cream walks. But there’s growing confusion over what “shelter in place” and “stay at home” mean in the path of this pandemic. An open secret: It’s a distinction without much difference if you go by how interchangeably they’re used in the media, but “shelter in place” is the better fit, even if it rattled New York Gov. Andrew Cuomo. The governor raged against “shelter in place” in favor of “stay at home,” presumably because “shelter in place” too readily evokes Cold War flashes of bunkers, duck-and-cover, nuclear fallout. “Words matter” was Cuomo’s press-conference point, perfectly summing up the limited response available to us: We don’t control the threat. We can’t see it. So we’ll take our control and clarity where we can, even at the level of language. Words will save lives.

Cuomo wasn’t wrong about the connotations of “shelter in place.” Historian Marian Moser Jones, a public health ethicist at the University of Maryland, points me to the phrase’s first appearance in unclassified federal documents. It was in a transcript of a 1957 House subcommittee hearing about reorganizing the “civil defense functions of the federal government”—a bit of Cold War business. The words were uttered by an expert witness, one Dr. W.E. Strope, on hand to talk about what he called “my first love, which was damage analysis.”

The first newspaper mention I could find was in a 1978 Indiana Gazette article headlined “Chlorine Leak Sends 37 to Hospitals”:

Lycoming County emergency officials issued a “shelter-in-place” warning until 9:20 a.m., when the cloud had made its way eastward and dissipated.

“Shelter in such places” appeared 22 years earlier in the Oakland Tribune—an article on President Eisenhower’s pitch for “shelters in such places as schools” to mitigate looming “thermonuclear explosions”—and variations like it fill the archives. But we don’t get “shelter in place” until the ’70s, in connection with evacuation plans, like Defense Secretary Donald Rumsfeld’s use in a 1976 “defense posture” report. “Shelter in place” spiked in the ’90s and again post-9/11, when public security infrastructure was centralized under one roof—the Department of Homeland Security. As tornadoes and pandemics came into the department’s fold alongside terror threats, the rhetoric started to merge and militarize accordingly. “So it’s easy to see how a term common in response to a chemical spill such as ‘shelter in place’ has bled over to the response to a pandemic,” Jones says.

To hear Scott Reitz tell it, “shelter in place” is the perfect conjuring phrase for the virus’s deadliness. A 30-year veteran of the LAPD and a 10-year SWAT instructor and operator, Reitz tells me that “shelter in place” gets quickly to the point. “This is a biological active shooter,” he says. Treat it like one. “It’s a lot worse than” a conventional mass shooter.

“In an active-shooter scenario, we can neutralize that. We’ll go in, we search out the source, we engage and put him down and that’s it. But the coronavirus is something where if the front-line doctors don’t have enough medical equipment to ensure their safety, and they go down, it is really critical.”

Reitz stops short: “A rose by any other name would smell as sweet”—or as toxic. Overparsing language doesn’t help, but getting the urgency down does. “It doesn’t really matter the terminology applied” to staying at home or sheltering in place as long as “you stop congregating.”

In hospitals, there’s nothing about “shelter in place” or “quarantine.” The talk is of “isolation,” says Dr. William Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University and longtime consultant to the Centers for Disease Control. “We don’t ‘quarantine’ anyone in the hospital. We ‘isolate’ them. People in quarantine don’t necessarily have the illness, but they’ve been exposed, whereas people who are ‘isolated’ are suspected of having the disease or we know have the disease.”

“Quarantine” comes from the Italian quaranta giorni, for the “40 days” that ships docking in Venice in the 14th century had to anchor and wait, for fear of spreading disease, according to the CDC. Curiously, the dictionary disagrees, pointing to French, not Italian, but the meaning holds: preventive isolation.

“It gets a little blurry around the edges,” Schaffner says, “but we have to get the message exactly right: ‘Stay at home’ doesn’t have the same ominous understanding that there’s a threat outside,” like “shelter in place” does.

At least “‘shelter in place’ has the potential to galvanize community. It’s a wartime term,” says Dana March Palmer, a professor of epidemiology at Columbia University. “This is a war, against a highly transmissible and deadly pathogen.”

“Historically speaking, ‘shelter in place’ arose as an expression referring to an order to stay exactly where one is when the shelter-in-place order is received,” says Richard Janda, co-editor of The Handbook of Historical Linguistics. “Technically then, someone who hears a shelter-in-place notice while in an outhouse should stay in the outhouse. If an approaching hurricane is visible through the cracks of the outhouse, it would probably be better to stay there than run across the yard to a nearby house. But ‘shelter in place’ overlaps with ‘stay at home’ in a plurality of cases, perhaps even a majority, so it’s not hard to see how and why ‘stay at home’ has come to be the predominant current meaning of ‘shelter in place.'”

The biggest misnomer: social distancing. Physical distancing is needed, not social distancing. Video chats socially connect us, which is why Reddit wasted no time dunking and dancing on the misuse of “social distancing” in this meme:

But wishing away a misnomer is useless. Everyone knows the underlying meaning. “The explanatory language that follows the short descriptive words” is what saves lives, Schaffner says.

Ask enough experts and a troubling truth emerges: Our national vocabulary hasn’t yet adapted to the virus; we’re still looking for a shared terminology. All we have for now is the aging grammar of an earlier moment of collective anxiety, when Americans feared infiltration and invasion by an “invisible enemy” of another kind. The Cold War lives on, Cuomo be damned.

As ever, history haunts us. A postcard from the past, exactly 65 years ago Thursday, in a Pennsylvania newspaper:

March 26, 1955

LETTERS FROM THE PEOPLE

WHO’LL HOLD THE BOMB?

Editor, The Gazette and Daily:

When the air raid siren sounds, all traffic is stopped; pedestrians are forced together off the streets and seek shelter in places so designated….[Tomorrow] will see another mock air raid, but this time the school children will be…paraded through the streets to a given point where they will wait.

If it were an air raid, what would they wait for? Machine gun bullets?

Sometimes things don’t make sense. There must be a reason for the sudden change in safety rules; what is it?

Who is going to hold the atom bomb until the kids get to the “loading area”? I guess I am just plain

STUPID.

Who is going to hold the coronavirus at a crosswalk when the kids go outside? “STUPID” is what the letter writer isn’t. Who wrote that letter? Are you out there, reading this, 65 years later? If you were, say, 25 or 30 at the time, you’d be 90 or 95 now. Are you sheltered?

In 65 more years, let a reader find this, free of pandemic, and ask if we, too, sheltered in place until the coast was clear.

When some of the earliest reports about the novel coronavirus first appeared, they suggested that individuals who were older than 65 appeared to be uniquely vulnerable to the worst effects, including death, from COVID-19, the disease from the virus. Four months after the first cases were reported in China, one of the first major outbreaks of the virus in the United States occurred in the Life Care Center in Kirkland, Washington, where 81 senior citizens were infected and 35 people died over the course of about four weeks. Soon, across the country, public health officials urged strict quarantines as a way to protect the population generally and especially the most vulnerable members: those with preexisting conditions, or those who are immune-compromised, or who are over 65.

Geriatric experts are concerned, however, that staying safe from the virus could bring some serious repercussions: Social isolation and loneliness are two conditions that are also a grave threat to the health and well-being of the nation’s older people. 

“[The quarantine] affects a group that has already been suffering the risks of social isolation at an even greater extent,” says George Demiris, a professor at the University of Pennsylvania’s Perelman School of Medicine, who specializes in ways technology can enhance health care. “I do think that this has a set of unintended consequences.” If left unaddressed, those consequences could be deadly.

In February, before the coronavirus upended the lives of millions of Americans, the National Academies of Sciences, Engineering and Medicine—a collective of scholarly institutions—teamed up with AARP, a nonprofit that advocates for senior citizens, and published a report, Social Isolation and Loneliness in Older Adults. Researchers quantified the extent of a person’s social isolation by looking at the number of interactions they had with family members, friends, and caregivers. Loneliness was reported on a subjective scale, usually measured after a senior citizen responded to a questionnaire provided by one of the research institutions. They found that almost half of the 68.7 million Americans who are older than 60 reported feeling lonely, and as a result have an “increased likelihood of early death, dementia, heart disease and more.” Isolated senior citizens are also at heightened risk of suicide. According to Lisa Marsh Ryerson, president of the AARP Foundation, those factors become compounded when seniors are also members are marginalized groups, including people of color and LGBTQ communities.

For some senior citizens, the effects of COVID-19 epidemic are a new variable. “We don’t really know what the short and long term health consequences are of an immediate and drastic change in social integration of older adults,” says Dr. Cynthia Melinda Boyd, a professor of medicine at Johns Hopkins University School of Medicine.

In terms of their level of relative independence, senior citizens can be broadly divided into four general groups: those who are living on their own in homes or apartments; those who are with their families; the 1 million seniors in assisted living facilities; and another 1.3 million who live in nursing homes.

Thirty states have now imposed jurisdiction-wide emergency quarantine measures, while some counties in other states have also implemented shelter-in-place orders as the epidemic spreads to every state and infected more nearly 90,000 people, with the deaths of more than 1,300 people. Jameca Falconer, a St. Louis–based clinical psychologist and Webster University professor, says many of her patients already suffer from social deprivation. Even as the senior care facilities in which they live have cut off visitation because of the pandemic, their lives have not changed appreciably. Falconer says that for already-isolated patients, it’s business as usual. “It doesn’t make it much worse,” she says. “This is normal activity for them. Nothing is different about their lives except what they see on the news.” 

Others may feel like an essential lifeline has been cut off, and Falconer is trying to broker new forms of communication between these patients and their families. “I’ve been talking to patients about trying to start using technology that they haven’t been too open to before, like FaceTiming,” she says. “They can still communicate with their family, even though they can’t physically see or touch them.”

In the NAS report, Demiris wrote that technology could be the essential ingredient to address isolation in seniors, and this has never been more true than during a pandemic. The sudden widespread reliance on technology to bridge social connections underscores the longstanding need in the socially isolated community of older people, where those tools aren’t always readily available. “It’s not going to work for everybody,” he says. “It will be costly and have challenges, but tech in some cases could be great to bring connectedness to people who are limited to very, very few kinds of interactions.”

There are problems with relying on technology in this situation, Falconer says. “Some don’t have financial resources to have that,” she says. She estimates that roughly half of her patients aren’t able to afford a smart phone with video chat capabilities. Others, she adds, “just don’t have the incentive to learn something new.”

Dr. Dan Blazer, a retired Duke University professor who specialized in psychiatry and behavioral sciences, noted that simple proactive steps could turn the tide of isolation for some elderly people—whether or not their circumstances are tied to Covid-19. “There are ways to contact them to see if they’re okay: telephone, knock on the door, offer to do chores,” he says.”[Showing a] willingness to help them get to the doctor. Just reaching out into the community.” Other experts suggested writing letters to them or running errands for older neighbors in local communities.

The very vulnerability of senior citizens might have the troubling effect of further stigmatizing this population. Demiris worries that identifying seniors with the disease as uniquely susceptible, could stoke ageism, creating a circumstance where people would imagine that in order to “keep ourselves safe we must distance ourselves from older adults.” As he contemplates the future, with looming shortages of supplies in hospitals, he wonders “how difficult decisions may need to be made about hospital beds and how to reallocate limited resources.”

Perhaps new empathy for older people will result from this crisis. The government’s orders to quarantine are pushing millions of Americans into an unexpected state of solitude that many senior citizens live with all the time. Falconer hopes this collective experience will open up a new perspective. “I do think it will give them a glimpse of what these people feel in their lives and how isolated they are,” she says. “And they’ll begin to appreciate and want to do something about it when things get back to normal.”

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

More than 3,000 nurses from across the country gathered the afternoon of March 12 for a critical conference call.

The nurses wanted answers from their union leaders: Could people build immunity to the coronavirus? How long does the virus stick to surfaces? What’s the best way to protect themselves from contracting COVID-19?

Although nearly two weeks had passed since the United States’ first coronavirus patient died outside of Seattle, many nurses on this call still found themselves awash in conflicting information about how to stay safe. Union leaders tried to set the record straight.

As of Sunday, more than 2,400 people across the nation have died from COVID-19, and more than 135,000 have tested positive for it. Nurses and other health care workers are at high risk of contracting the disease, and they’re panicking, saying hospitals and the government aren’t doing enough to limit their exposure.

Despite such concerns, the U.S. Department of Labor has refused to issue an emergency rule requiring hospitals to create a plan to protect their employees from exposure to the coronavirus and other infectious diseases, according to records obtained by the Center for Public Integrity. 

And the federal agency’s Occupational Safety and Health Administration won’t provide direction to its safety inspectors on how to cite hospitals and nursing homes that aren’t doing enough to protect workers from the new hazard—a departure from its practice during past outbreaks.

Meanwhile, the hospital industry’s trade group, the American Hospital Association, has successfully lobbied Congress to block passage of an emergency infectious disease standard that would strengthen protections for health care workers on the front lines. Earlier this month, House lawmakers scrapped language from a relief bill that would have forced the Department of Labor to create one.

The result: Nurses and other health care workers say they’re left to fend for themselves.

“It’s frightening,” said Katie Oppenheim, a nurse in Michigan, noting that her hospital recently began giving nurses less protective masks than the N95 respirators they’ve been wearing. Others say their hospitals won’t test employees who’ve been exposed to the coronavirus. 

A recent survey of 8,200 nurses, conducted by three nursing groups, showed that less than half had been briefed about COVID-19 by their supervisors.

The resistance to employee protections comes as more and more U.S. health care workers get sick. 

It’s unclear how many medical personnel have been infected by the coronavirus—the Centers for Disease Control and Prevention did not respond to a request for the information from Public Integrity. But media reports have identified more than 100 cases, including those involving a nurse in Connecticut and two emergency physicians in New Jersey. At least one nurse, in New York City, has died from the disease. His co-workers blamed the hospital for not providing him with appropriate protective gear. Two health care workers have also died amid the shortage of protective gear in Georgia.

Hundreds of other health care workers have been quarantined from exposure to the coronavirus at work.

There are about 18 million health care workers in the United States. Women make up the vast majority.

“This is a desperate situation, and the lives of health care workers are at stake,” said David Michaels, who led OSHA until 2017 and now teaches environmental and occupational health at The George Washington University. They “have to be the first ones protected.”

The Department of Labor’s refusal to issue an emergency rule aligns with the Trump administration’s overarching deregulation efforts. Workplace safety experts warn that the threat of fines and bad publicity from an OSHA citation is exactly what’s needed to make hospitals take care of their employees during the pandemic. The lack of enforcement action by OSHA, they say, is putting the lives of health care workers at risk, increasing the chances that they’ll spread the disease to their families and communities.

OSHA Refuses to Act

It’s possible that, a decade ago, Department of Labor officials foresaw the current crisis.

In 2010, OSHA started drafting a new safety standard that would require health care employers to create infection control plans to keep doctors, nurses and other health care workers from getting exposed to deadly diseases. That could mean building isolation rooms to quarantine patients and making sure employees wear gowns, gloves and respirators around high-risk patients.

The nation had just escaped the worst of the H1N1 swine flu, which killed more than 12,000 Americans and infected 48 health care workers. At the time, OSHA had a rule to protect health care workers from bloodborne infections — such as hepatitis — but nothing for respiratory infections, which is what COVID-19 is.

The safety standard wound its way through the rulemaking process. The Department of Labor issued a draft in early 2017. A few months later, after Donald Trump took office, the Department of Labor punted it to the agency’s “long-term” regulatory agenda. Nothing has happened since.

Fast forward three years. With COVID-19 paralyzing the country, labor unions and workers’ rights advocates have been urging OSHA to issue an emergency version of the rule right away.

On March 5, Reps. Bobby Scott, D-Va., and Alma Adams, D-N.C., sent a letter to Labor Secretary Eugene Scalia demanding the same action.

“If healthcare workers are quarantined in large numbers, or get ill or die, or fear coming to work due to the risks, it’s not just a workplace problem, it’s a national public health disaster,” they wrote.

But OSHA has since made clear that it won’t comply.

Loren Sweatt, who leads OSHA, responded in a March 18 letter that the emergency rule would “distract” hospitals from fighting the coronavirus.

“OSHA believes that the healthcare industry fully understands the gravity of the situation and is taking appropriate steps to protect its workers while responding to the public health emergency,” Sweatt responded in the letter, which Public Integrity obtained.

House lawmakers had also urged OSHA to issue what is known as a “compliance directive” to tell its safety inspectors how to issue citations against health care providers that don’t do enough to protect workers from the coronavirus. The agency issued similar directives to deal with tuberculosis outbreaks and, again, with the swine flu.

The swine flu directive, 46 pages in all, was issued in November 2009. For example, it specifically directed inspectors of hospitals and nursing homes to determine if facility managers briefed their employees about the new virus and whether they trained nurses how to deal with patients who are showing symptoms.

If hospitals and nursing homes failed the test, then OSHA could cite them and fine them.

In her letter, Sweatt noted that OSHA inspectors would continue enforcing the laws that are already on the books, like making sure hospitals record every work-related illness.

“OSHA can and will use enforcement, as necessary, to ensure the protection of workers exposed to COVID,” she wrote.

But the emergency rule could have made many of the safety guidelines from the CDC legally binding.

Hospitals and clinics receiving Medicaid and Medicare funding must have an infectious disease control plan, but the rule is rarely enforced, experts say. And research suggests that many hospitals don’t always do what they should to protect their employees from infections such as COVID-19.

A 2008 study by researchers at the University of Washington and the Washington State Department of Health, for example, found “significant gaps” in compliance with the CDC guidelines at five hospitals in the Seattle area, noting that their employees failed to use appropriate protective gear and were not properly trained.

California is the only state that has a binding standard to protect health care workers from infectious diseases. Still, nurses in the state have complained that hospitals aren’t taking all the steps they’re supposed to.

Cathy Kennedy, a registered nurse at Kaiser Permanente Roseville Medical Center in California, said staff members asked hospital managers in February to share their infection control plan and train them to stay safe. The hospital did not, she said.

Then, on March 4, the hospital reported the first coronavirus death in the state: An elderly man who had recently traveled on a Princess Cruises ship.

“You would also think that, after the first patient died, they would take our request seriously. They did not,” Kennedy, who is vice president of National Nurses United, said on the March 12 conference call with other nurses. “We are still trying to figure out what are the protocols at my facility.”

The confusion created by the coronavirus is one reason why nurses have been pushing for the emergency rule. But the hospital industry has successfully blocked efforts in Congress to force OSHA to issue one.

Congress Spikes Safety Provisions

A decade ago, the American Hospital Association lobbied successfully against OSHA’s proposed infectious disease rule. The hospital industry’s trade association is one of the most heavily financed lobbying groups in the nation, spending $26.2 million in 2019 alone.

Now, it has helped keep safety standards out of several coronavirus relief bills in Congress.

On March 12, the trade group sent out an email alert warning its members that the House’s Families First Coronavirus Response Act had an unpleasant surprise: a provision called the Health Care Worker Protection Act, which would force OSHA to create an emergency safety standard to shield workers from COVID-19.

That rule would have required hospitals and nursing homes to create a plan to protect their employees from infections and to provide nurses and doctors with respirators. It would have also allowed OSHA to apply the safety standard to others at high risk of contracting the virus, such as home health aides.

The provision had broad support from workplace safety advocates and labor unions, but the hospital industry wasn’t having it.

“This provision would be impossible to implement in hospitals due to the severe lack of availability of N95 respirators,” the American Hospital Association’s alert said. “If this provision were to be enacted, hospital inpatient capacity would be dramatically reduced.”

The trade group, which represents nearly 5,000 hospitals and other health care providers across the country, did not respond to a request for comment.

An aide on the House Committee on Education and Labor said the provision wouldn’t have punished hospitals and nursing homes for equipment shortages, as long as they made an effort to find protective gear. The aide, who spoke on the condition of anonymity to speak frankly about the issue, said the provision was taken out at the last minute from the bill.

The latest stimulus bill in the Senate doesn’t include the safety standard, but a recent proposal from House Speaker Nancy Pelosi, D-Calif., does.

As the tug of war over workplace protections continues, Europe has provided a glimpse of what could come. In Spain, about 14 percent of people infected with COVID-19 are health care workers, putting a strain on staffing at hospitals. In Italy, about 8 percent of medical professionals  have tested positive for the disease.

Rebecca Reindel, director of health and safety for the AFL-CIO labor federation, said the government doesn’t seem to grasp the urgency of the moment.

“This is seriously problematic,” she said. “The administration didn’t have protections in place, was slow to act on any sort of guidance coming out, and then it took them a while to get going.”

Nurses are now lobbying for themselves.

Bonnie Castillo, executive director of National Nurses United, spoke in a somber tone on the March 12 call with thousands of nurses.

“I know that nurses and other health care workers are feeling a lot of frustration and concern right now,” Castillo said. “The response we’ve all seen right now to COVID-19 has obviously not been a success.”

She listed all the targets they’ve lobbied to pass worker protections: the CDC, the Department of Labor, the White House, every legislator in Congress.

“We are not going to stand back,” she said. “We’re not going to be silent and let our employers or our government agencies put us in harm’s way.”

So far, the pressure hasn’t worked.

In the middle of March, as millions of people across the country started to practice social distancing measures to stem the spread of the coronavirus, Florida’s Spring Breakers did the opposite. Thousands of people, seemingly unfazed by the pandemic, took to the state’s coastline after the Republican governor, Ron DeSantis, decided not to order the beaches closed.

DeSantis still hasn’t enacted statewide stay-at-home orders, garnering plenty of criticism from local leaders and public health officials. The governor’s resistance probably isn’t just about the number of cases of the virus in his state. A new white paper shows that states with Republican governors, along with states with higher number of supporters of President Donald Trump, were slower to adopt social distancing policies—and those delays “are likely to produce significant ongoing harm to public health.”

The biggest influence in how states acted was not the number of confirmed cases, but rather politics, according to new research by a group of professors at the University of Washington. They focused on five measures taken directly from state government websites: restrictions on gatherings, school closures, restaurant restrictions, non-essential business closures, and stay-at-home orders. Trump initially downplayed the threat of the virus, and “numerous surveys have found significant partisan divides in public opinion about the severity of the coronavirus threat,” the researchers point out.

Their research showed that states with Republican governors and more Trump voters introduced social distancing policies 2.7 days later than more liberal states. “Does a 2.7 day delay matter?” the researchers write, concluding: “Given the quick doubling time of COVID-19, these delays have the potential to cause a dramatic increase in the peak volume of cases.”

President Donald Trump, walking back from his earlier aspirations to ease restrictions on Americans by Easter, extended the national social distancing guidelines through April 30, adding that the deadliest spike could hit in two weeks—on Easter weekend. 

“We know much more now” than when he made the Easter claim, Trump said during a coronavirus task force briefing on Sunday. “By June 1, we’ll be well on our way to recovery,” he added.

More than 2,300 people have died in the United States and at least 135,000 have tested positive for COVID-19 as of Sunday afternoon. New York, the hardest hit state with almost 60,000 cases, saw an increase of more than 7,000 cases in just one day. New York City Bill de Blasio told CNN’s Jake Tapper Sunday that “We have enough supplies to get to a week from today with the exception of ventilators. We’re going to need at least several hundred more ventilators very quickly.”

The White House’s extension of social distancing measures is in line with what some state governments are doing as the virus continues to spread. California for example, is strengthening its shelter-in-placer order by closing beaches and hiking trails as it prepares for an anticipated spike in hospitalizations. 

Hours before the press conference Sunday, Dr. Anthony Fauci, the country’s top infectious disease expert, had said he believed the United States will see between 100,000 and 200,000 deaths from the coronavirus, and millions infected. Fauci said at the press conference that “it is entirely conceivable that if we don’t mitigate we could reach that number,” adding that extending the guidelines was the right move and the next two weeks are critical. 

Throughout the hour-long press conference, Trump mentioned multiple times that the United States was “doing more tests than any other country in the world,” which is true by raw numbers, but not per capita. Trump said the Federal Drug Administration has approved testing that will provide “lightning fast results, in as little as five minutes.” Abbott Labs will provide 50,000 of those test daily, as early as next week. 

More than 2,000 people in the United States are dead and at least 135,000 have confirmed cases of COVID-19. But President Donald Trump has decided to use his Sunday to tweet about his TV ratings. His White House press briefings are as popular as The Bachelor finale and Monday Night Football, he boasted in a series of tweets on Sunday:

Because the “Ratings” of my News Conferences etc. are so high, “Bachelor finale, Monday Night Football type numbers” according to the @nytimes, the Lamestream Media is going CRAZY. “Trump is reaching too many people, we must stop him.” said one lunatic. See you at 5:00 P.M.!

— Donald J. Trump (@realDonaldTrump) March 29, 2020

Even for Trump, Sunday’s tweets feel exponentially out of touch with reality. 

…On Monday, nearly 12.2 million people watched Mr. Trump’s briefing on CNN, Fox News and MSNBC, according to Nielsen — ‘Monday Night Football’ numbers. Millions more are watching on ABC, CBS, NBC and online streaming sites, and the audience is expanding. On Monday, Fox News…

— Donald J. Trump (@realDonaldTrump) March 29, 2020

For weeks now, Trump’s daily press briefings have attracted an average of 8.5 million viewers on cable news. He uses the briefings to go on rants attacking the media and political opponents, and to share misinformation. News organizations, including Mother Jones, have urged TV networks to stop airing his press conferences live. Seattle’s NPR station KUOW made the decision to stop airing the briefings after observing a “pattern of false information and exaggeration.”

Only a reality TV president would brag about his popularity while the country is in the middle of a public health crisis. And, as my colleague pointed out in this ingenious video, Trump’s denial of the gravity of the situation sounds like the first act of pretty much every disaster movie ever written.