npr--2020-09-22--'White House, Inc.' Author: Trump's Businesses Offer 'A Million Potential Conflicts'

Past occupants of the White House have placed their business holdings into a blind trust .
Not President Trump .
Forbes magazine investigative journalist Dan Alexander has pored over business records , mortgage documents and government reports — and even staked out some Trump properties — to assemble a detailed picture of the president 's business interests .
He says the president has broken a number of pledges he made about how he would conduct business while in office .
`` One of [ the pledges ] was that he was going to do no new foreign deals , and @ @ @ @ @ @ @ , '' Alexander says .
`` Another one [ was ] that he was going to have outside ethics advisers review all new transactions that were coming into his business .
That did not happen . ''
As for Trump 's suggestion that he would donate all profits from foreign governments to the U.S. Treasury ?
Alexander says that has n't happened either .
`` If you just do the math on the rent that flows in from the Industrial and Commercial Bank of China , which rents space on the 20th floor @ @ @ @ @ @ @ look at what the profit margins are on rent flowing into that building , you can see that just that one lease alone means that more than three times as much money from China is flowing into Trump 's coffers than his business has donated in what it says are its profits from foreign governments , '' Alexander says .
Alexander 's new book , White House , Inc. : How Donald Trump Turned the Presidency into a Business , examines Trump 's sprawling business interests — including resorts , office buildings , @ @ @ @ @ @ @ Trump owns more than 100 different business entities , which create `` a million potential conflicts '' for the president .
On whether or not Trump is a billionaire Yes , Trump is a billionaire .
...
If you go through his assets and you look at what he owns and you look at the income that they throw off and you look at the value of other similarly traded assets , it 's just a math equation .
You get to the end , and you find that he 's worth $ @ @ @ @ @ @ @ what Trump says he 's worth .
He 'd like to imagine he 's worth $ 10 billion or something like that .
But it 's also not true what his critics say , that he 's broke or that he 's never made a dollar in his life .
It 's just an example of liberals doing what they get frustrated about conservatives doing , which is not looking at the facts and adding up the numbers and just going with what the data says .
And if you look at his @ @ @ @ @ @ @ that he 's a billionaire , but not ... as rich as he claims .
On what government officials with business interests must disclose for potential conflicts So there are some disclosures that all officials have to make .
They have to list , for example , all of the companies that they own and they have to give some information about either the revenues or the profits that those companies generate .
And so we know what he owns .
We know a little bit from that about how profitable these companies @ @ @ @ @ @ @ go to a whole range of other documents to put together the full picture and understand really what his empire is , how much money it 's generating .
And then what they do n't require , of course , is to show your tax returns .
They also do n't require you to say , for instance , who 's putting money into those companies that you own .
It 's a very simple loophole that allows Donald Trump to basically follow the law without much disclosure about who 's actually paying @ @ @ @ @ @ @ flows through shell companies .
On how Trump did n't follow tradition and put his business holdings in a blind trust If he were to truly have a blind trust , you ca n't have a blind trust and have a building that says `` Trump Tower '' on the outside of [ it ] .
How blind is that ?
We can tell what you own .
...
So you would have to divest those assets handed over to a trustee and then let that trustee invest in whatever they decided made @ @ @ @ @ @ @ financial goals were .
So it could be an index fund , could be bonds , but something that was n't readily recognizable to everyone , including yourself .
...
If you just think about it , how many business owners who are in their mid-70s are really on a very active day-to-day basis managing their businesses , especially ones that have other interests ?
Not that many .
So what Trump has done , where he 's basically handed over the keys to his kids , well , that 's what anyone @ @ @ @ @ @ @ probably be doing anyway .
So there 's really not a whole lot of separation there .
And ultimately , the question is who controls the money ?
And the person who controls the money , who owns the money , is the president .
On the challenge of figuring out who the tenants are in Trump-owned office buildings The Trump Organization and the White House wo n't release a list of the president 's tenants , and by law , although the president has to disclose , for example , that X @ @ @ @ @ @ @ providing him with , say , over $ 5 million of revenue , they do n't have to get more specific than that .
They also do n't have to then say who 's putting money into those shell companies so you do n't know who the tenants are .
And then if you go to the buildings , you can see , for instance , like the retailers on the bottom floor .
And so I did .
I went to the buildings , and I walked to try to figure out @ @ @ @ @ @ @ .
I paced out with my boots — boot over boot — and measured the length of my boot to try to estimate what the square footage was .
And then you could figure out what the market rate was per square foot and estimate how much money this tenant might be paying the president .
That 's how you have to figure out how much money is flowing in from here .
But then on the upper floors , especially in office buildings , a law firm or a bank is n't @ @ @ @ @ @ @ the side of the building .
So most of the money is stuff that 's happening up above in the sky , and you ca n't see that .
...
It 's really difficult to figure out who 's in there , how much space they have and then what they might be paying .
It 's a big puzzle , but ultimately , through a lot of different methods , we 've pieced together and identified more than 150 different tenants accountable for an estimated $ 177 million of revenue per year @ @ @ @ @ @ @ between the president and his tenants If you look across the more than 150 different tenants , at least 35 of those tenants lobbied the federal government while their landlord was in office .
At least 30 of them received more than $ 8 billion in federal contracts .
You have hundreds of millions of dollars flowing into Trump 's empire and billions of dollars flowing from Trump 's administration to these companies .
At least 17 faced federal investigations while their landlord was the president , and four government entities were renting @ @ @ @ @ @ @ conflicts of interest statue not applying to the president [ There is ] the federal conflicts of interest statute , which says that you ca n't take any actions that will clearly benefit you personally or your spouse .
But there 's an exemption to that rule for both the president and the vice president .
So every other vice president or president has acted like it pertained to them anyway , just because of the optics of it .
It looks terrible .
But Trump did not choose to act like it @ @ @ @ @ @ @ no legal restriction on him benefiting from his own power , while he 's doing something to push money to his own properties .
It 's not that he is totally free of any rules .
There are some other things that he ca n't do .
...
He ca n't participate in bribes .
He ca n't violate the foreign emoluments clause .
He ca n't violate the domestic emoluments clause , but that basic conflicts of interest statute does not apply to the president .
I think of Donald Trump 's @ @ @ @ @ @ @ that you might think of other billionaires ' yacht strategy .
They like toys .
Donald Trump loves to play golf , and he loves to buy golf courses .
He loves to own golf courses .
He loves to arrive in golf courses on his helicopters and have everybody come up to him and have him be the man .
That 's something that really exhilarates him .
And so he puts a ton of money into the things .
Some of them have been decent investments .
He made a couple @ @ @ @ @ @ @ were OK .
But by and large , it looks like it 's just been a terrible investment .
Most yachts are n't good investments either .
I guess billionaires have their vices and their things that they want to pursue .
But from a business perspective , Trump 's golf portfolio does not make a whole lot of sense .
On how Trump 's Miami golf course and resort , Doral , has taken a hit since he took office It 's one of the most consumer-facing businesses that he has .
@ @ @ @ @ @ @ becomes president and alienates half the country — including a lot of people in the Northeast , where Doral had historically drawn huge numbers of customers — then the financials just plummet .
The revenue goes way down , the profits go way down .
His profits drop from about $ 13 million in 2015 to $ 4 million and some change in 2017 .
And that 's a huge , huge gap for somebody .
His own tax representative says that the reason why is because his comments offended so many people @ @ @ @ @ @ @ used to .
On how Trump is perceived as a businessman Donald Trump 's business is sort of a Rorschach test .
You can look at it and see what you want to see .
He has done terrible businesses that have lost a lot of money .
He has done great businesses that have made a lot of money .
But what my job is , Forbes , is to sit down and just look at the numbers and figure out what are the value of these assets , what is the @ @ @ @ @ @ @ ...
If you go through the properties and you look at : Here 's what he owns .
Here 's how much it brings in .
Here 's what it 's worth .
Here 's the mortgages on it and here 's the debt .
And you just add everything up .
...
It 's a real business .
I mean , this is not a made-up fantastical thing .
He did inherit a ton of money , and he would be very , very rich , even if he had just taken @ @ @ @ @ @ @ S & P 500 .
But there are a lot of rich heirs who walk away poorer than the day that they inherited the money .
And Donald Trump , to his credit , is now richer than he was when he inherited the money .
...
There 's no question that he has done business in a way that is unethical and that a lot of business people would ( and do ) shake their heads at .
Sam Briger and Seth Kelley produced and edited this interview for broadcast .
Bridget @ @ @ @ @ @ @ adapted it for the Web .

'White House, Inc.' Author: Trump's Businesses Offer 'A Million Potential Conflicts'
Enlarge this image toggle caption Scott Olson/Getty Images Scott Olson/Getty Images
Past occupants of the White House have placed their business holdings into a blind trust. Not President Trump.
Forbes magazine investigative journalist Dan Alexander has pored over business records, mortgage documents and government reports — and even staked out some Trump properties — to assemble a detailed picture of the president's business interests. He says the president has broken a number of pledges he made about how he would conduct business while in office.
"One of [the pledges] was that he was going to do no new foreign deals, and he ended up doing foreign deals anyways," Alexander says. "Another one [was] that he was going to have outside ethics advisers review all new transactions that were coming into his business. That did not happen."
As for Trump's suggestion that he would donate all profits from foreign governments to the U.S. Treasury? Alexander says that hasn't happened either.
"If you just do the math on the rent that flows in from the Industrial and Commercial Bank of China, which rents space on the 20th floor of Trump Tower, and then you look at what the profit margins are on rent flowing into that building, you can see that just that one lease alone means that more than three times as much money from China is flowing into Trump's coffers than his business has donated in what it says are its profits from foreign governments," Alexander says.
Alexander's new book, White House, Inc.: How Donald Trump Turned the Presidency into a Business, examines Trump's sprawling business interests — including resorts, office buildings, licensing ventures and more. He says Trump owns more than 100 different business entities, which create "a million potential conflicts" for the president.
Interview Highlights
toggle caption Penguin Random House
On whether or not Trump is a billionaire
Yes, Trump is a billionaire. ... If you go through his assets and you look at what he owns and you look at the income that they throw off and you look at the value of other similarly traded assets, it's just a math equation. You get to the end, and you find that he's worth $2.5 billion. It's nowhere near what Trump says he's worth. He'd like to imagine he's worth $10 billion or something like that. But it's also not true what his critics say, that he's broke or that he's never made a dollar in his life. It's just an example of liberals doing what they get frustrated about conservatives doing, which is not looking at the facts and adding up the numbers and just going with what the data says. And if you look at his business, what the data says is that he's a billionaire, but not ... as rich as he claims.
On what government officials with business interests must disclose for potential conflicts
So there are some disclosures that all officials have to make. They have to list, for example, all of the companies that they own and they have to give some information about either the revenues or the profits that those companies generate. And so we know what he owns. We know a little bit from that about how profitable these companies are. But you've got to go to a whole range of other documents to put together the full picture and understand really what his empire is, how much money it's generating. And then what they don't require, of course, is to show your tax returns. They also don't require you to say, for instance, who's putting money into those companies that you own. It's a very simple loophole that allows Donald Trump to basically follow the law without much disclosure about who's actually paying him, because all of the money flows through shell companies.
On how Trump didn't follow tradition and put his business holdings in a blind trust
If he were to truly have a blind trust, you can't have a blind trust and have a building that says "Trump Tower" on the outside of [it]. How blind is that? We can tell what you own. ... So you would have to divest those assets handed over to a trustee and then let that trustee invest in whatever they decided made the most sense based on what your financial goals were. So it could be an index fund, could be bonds, but something that wasn't readily recognizable to everyone, including yourself. ...
If you just think about it, how many business owners who are in their mid-70s are really on a very active day-to-day basis managing their businesses, especially ones that have other interests? Not that many. So what Trump has done, where he's basically handed over the keys to his kids, well, that's what anyone who is still in the business would probably be doing anyway. So there's really not a whole lot of separation there. And ultimately, the question is who controls the money? And the person who controls the money, who owns the money, is the president.
On the challenge of figuring out who the tenants are in Trump-owned office buildings
The Trump Organization and the White House won't release a list of the president's tenants, and by law, although the president has to disclose, for example, that X shell company or Y shell company is providing him with, say, over $5 million of revenue, they don't have to get more specific than that. They also don't have to then say who's putting money into those shell companies so you don't know who the tenants are. And then if you go to the buildings, you can see, for instance, like the retailers on the bottom floor. And so I did. I went to the buildings, and I walked to try to figure out how big some of these spaces were. I paced out with my boots — boot over boot — and measured the length of my boot to try to estimate what the square footage was.
And then you could figure out what the market rate was per square foot and estimate how much money this tenant might be paying the president. That's how you have to figure out how much money is flowing in from here.
But then on the upper floors, especially in office buildings, a law firm or a bank isn't going to put "Barclays" on the side of the building. So most of the money is stuff that's happening up above in the sky, and you can't see that. ... It's really difficult to figure out who's in there, how much space they have and then what they might be paying.
It's a big puzzle, but ultimately, through a lot of different methods, we've pieced together and identified more than 150 different tenants accountable for an estimated $177 million of revenue per year.
On the potential conflicts of interest between the president and his tenants
If you look across the more than 150 different tenants, at least 35 of those tenants lobbied the federal government while their landlord was in office. At least 30 of them received more than $8 billion in federal contracts. You have hundreds of millions of dollars flowing into Trump's empire and billions of dollars flowing from Trump's administration to these companies. At least 17 faced federal investigations while their landlord was the president, and four government entities were renting space in Trump buildings.
On the conflicts of interest statue not applying to the president
[There is] the federal conflicts of interest statute, which says that you can't take any actions that will clearly benefit you personally or your spouse. But there's an exemption to that rule for both the president and the vice president. So every other vice president or president has acted like it pertained to them anyway, just because of the optics of it. It looks terrible. But Trump did not choose to act like it pertained to him. And there's no legal restriction on him benefiting from his own power, while he's doing something to push money to his own properties. It's not that he is totally free of any rules. There are some other things that he can't do. ... He can't participate in bribes. He can't violate the foreign emoluments clause. He can't violate the domestic emoluments clause, but that basic conflicts of interest statute does not apply to the president.
On Trump's investment in golf courses
I think of Donald Trump's golf strategy sort of in the way that you might think of other billionaires' yacht strategy. They like toys. Donald Trump loves to play golf, and he loves to buy golf courses. He loves to own golf courses. He loves to arrive in golf courses on his helicopters and have everybody come up to him and have him be the man. That's something that really exhilarates him. And so he puts a ton of money into the things. Some of them have been decent investments. He made a couple in the middle of the recession that were OK. But by and large, it looks like it's just been a terrible investment. Most yachts aren't good investments either. I guess billionaires have their vices and their things that they want to pursue. But from a business perspective, Trump's golf portfolio does not make a whole lot of sense.
On how Trump's Miami golf course and resort, Doral, has taken a hit since he took office
It's one of the most consumer-facing businesses that he has. And as a result, after he becomes president and alienates half the country — including a lot of people in the Northeast, where Doral had historically drawn huge numbers of customers — then the financials just plummet. The revenue goes way down, the profits go way down. His profits drop from about $13 million in 2015 to $4 million and some change in 2017. And that's a huge, huge gap for somebody. His own tax representative says that the reason why is because his comments offended so many people that they're not booking like they used to.
On how Trump is perceived as a businessman
Donald Trump's business is sort of a Rorschach test. You can look at it and see what you want to see. He has done terrible businesses that have lost a lot of money. He has done great businesses that have made a lot of money. But what my job is, Forbes, is to sit down and just look at the numbers and figure out what are the value of these assets, what is the amount of debt that he has. ...
There's no question that [Trump] has done business in a way that is unethical and that a lot of business people would (and do) shake their heads at.
If you go through the properties and you look at: Here's what he owns. Here's how much it brings in. Here's what it's worth. Here's the mortgages on it and here's the debt. And you just add everything up. ... It's a real business. I mean, this is not a made-up fantastical thing. He did inherit a ton of money, and he would be very, very rich, even if he had just taken that money and just invested in the S&P 500. But there are a lot of rich heirs who walk away poorer than the day that they inherited the money. And Donald Trump, to his credit, is now richer than he was when he inherited the money. ...
There's no question that he has done business in a way that is unethical and that a lot of business people would (and do) shake their heads at.
Sam Briger and Seth Kelley produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Meghan Sullivan adapted it for the Web.


npr--2020-09-22--America's 200,000 COVID-19 Deaths: Small Cities And Towns Bear A Growing Share

When COVID-19 claimed its first 100,000 lives in the U.S. , Hidalgo County , Texas , seemed to have avoided the worst of it .
The county , which sits on the border with Mexico , had just 10 deaths when the U.S. crossed that tragic milestone on May 27 .
But the U.S. has now doubled its death count to top 200,000 victims , and Hidalgo County has become one of the deadliest hot spots for COVID-19 .
Despite the lack of dense urban areas there — its largest city , McAllen , has fewer than 150,000 residents — @ @ @ @ @ @ @ people across the county .
`` We knew we were going to see an increase , but we could not foresee the increase we got , '' says Eduardo Olivarez , the chief administrative officer of the county health department .
`` Once we started seeing a sharp increase in fatalities , and the community started reflecting that it was their parents , friends , grandparents — once that started impacting them — the community really started sensing , 'Oh , my God , this is really extremely serious .
We need to @ @ @ @ @ @ @ is one of the most extreme examples of how the coronavirus has shifted from dealing its heaviest blows to northeastern urban areas to now reaching all corners of the country .
As the death count grows , smaller towns and rural communities bear a growing share of the burden of COVID-19 .
An NPR analysis finds that the share of COVID-19 deaths outside places considered large metro areas by the Centers for Disease Control and Prevention has grown dramatically since the country passed its first 100,000 deaths .
Then , about a fifth @ @ @ @ @ @ @ metro areas .
In the second 100,000 deaths , that share jumped to nearly half .
The largest growth occurred in small towns and rural areas , where the share of deaths nearly tripled .
Ali Mokdad , an epidemiologist at the Institute for Health Metrics and Evaluation at the University of Washington , likened the disease 's progression to HIV , which he says also took hold first in large cities before spreading to smaller cities and towns .
In rural areas , he says , people did n't expect the coronavirus @ @ @ @ @ @ @ early in the pandemic .
The first months ... it gave the rural communities false sense of security that it was n't going to get to us . ''
For COVID-19 , much of that change came as the outbreak reached its crescendo and then tapered off in New York City in April .
The state of New York made up 30,000 of the first 100,000 deaths in the country .
But new hot spots have since emerged in other large states : Arizona , California , Florida and Texas .
There , @ @ @ @ @ @ @ the largest cities .
Counties outside major metros have had some of the highest death tolls over the past several months , like Broward and Palm Beach counties in Florida — both north of Miami — and San Bernardino County , Calif. , which is east of Los Angeles .
Medium-size metro areas like those in Hidalgo County and nearby Cameron County , Texas , also sit near the top of the list .
And the virus has taken nearly 100 lives in Val Verde County , Texas , and more than 75 @ @ @ @ @ @ @ both of which have populations under 50,000 .
These places have , per capita , suffered as many deaths as parts of the New York City area did .
Other areas , particularly some in the southeast , were hit harder by deaths on a per capita basis .
Mississippi and Georgia light up on a map of per capita deaths during the second half of the pandemic .
This indicates that these areas saw a higher percentage of their residents killed by the virus even if the actual number of people who @ @ @ @ @ @ @ .
All of this underlines the virus 's implacable reach , a silent threat that continues to spread .
`` None of us live in a bubble .
We 're going to interact with each other — rural , urban , whatever , '' Mokdad says .
`` People live far apart , are less likely to see each other , but we have events that bring us together .
And the cases follow that . ''

America's 200,000 COVID-19 Deaths: Small Cities And Towns Bear A Growing Share
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When COVID-19 claimed its first 100,000 lives in the U.S., Hidalgo County, Texas, seemed to have avoided the worst of it. The county, which sits on the border with Mexico, had just 10 deaths when the U.S. crossed that tragic milestone on May 27.
But the U.S. has now doubled its death count to top 200,000 victims, and Hidalgo County has become one of the deadliest hot spots for COVID-19. Despite the lack of dense urban areas there — its largest city, McAllen, has fewer than 150,000 residents — the disease has killed more than 1,500 people across the county.
"We knew we were going to see an increase, but we could not foresee the increase we got," says Eduardo Olivarez, the chief administrative officer of the county health department.
Enlarge this image toggle caption Eric Gay/AP Eric Gay/AP
"Once we started seeing a sharp increase in fatalities, and the community started reflecting that it was their parents, friends, grandparents — once that started impacting them — the community really started sensing, 'Oh, my God, this is really extremely serious. We need to take heed.' "
Hidalgo County is one of the most extreme examples of how the coronavirus has shifted from dealing its heaviest blows to northeastern urban areas to now reaching all corners of the country. As the death count grows, smaller towns and rural communities bear a growing share of the burden of COVID-19.
An NPR analysis finds that the share of COVID-19 deaths outside places considered large metro areas by the Centers for Disease Control and Prevention has grown dramatically since the country passed its first 100,000 deaths. Then, about a fifth of deaths came from places outside large metro areas. In the second 100,000 deaths, that share jumped to nearly half.
The largest growth occurred in small towns and rural areas, where the share of deaths nearly tripled.
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Ali Mokdad, an epidemiologist at the Institute for Health Metrics and Evaluation at the University of Washington, likened the disease's progression to HIV, which he says also took hold first in large cities before spreading to smaller cities and towns.
In rural areas, he says, people didn't expect the coronavirus. "They let down their guard early in the pandemic. The first months ... it gave the rural communities false sense of security that it wasn't going to get to us."
For COVID-19, much of that change came as the outbreak reached its crescendo and then tapered off in New York City in April. The state of New York made up 30,000 of the first 100,000 deaths in the country.
But new hot spots have since emerged in other large states: Arizona, California, Florida and Texas. There, the disease has not stayed contained in the largest cities.
Counties outside major metros have had some of the highest death tolls over the past several months, like Broward and Palm Beach counties in Florida — both north of Miami — and San Bernardino County, Calif., which is east of Los Angeles. Medium-size metro areas like those in Hidalgo County and nearby Cameron County, Texas, also sit near the top of the list.
And the virus has taken nearly 100 lives in Val Verde County, Texas, and more than 75 lives in Jackson County, Fla. — both of which have populations under 50,000. These places have, per capita, suffered as many deaths as parts of the New York City area did.
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Other areas, particularly some in the southeast, were hit harder by deaths on a per capita basis. Mississippi and Georgia light up on a map of per capita deaths during the second half of the pandemic. This indicates that these areas saw a higher percentage of their residents killed by the virus even if the actual number of people who died was smaller than in other places.
All of this underlines the virus's implacable reach, a silent threat that continues to spread.
"None of us live in a bubble. We're going to interact with each other — rural, urban, whatever," Mokdad says. "People live far apart, are less likely to see each other, but we have events that bring us together. And the cases follow that."


npr--2020-09-22--With Limited COVID-19 Vaccine Doses, Who Would Get Them First?

With Limited COVID-19 Vaccine Doses , Who Would Get Them First ?
It 's still unknown when a COVID-19 vaccine might be available in the United States .
But when one is first approved , there may only be 10 million to 15 million doses available , which may be enough to cover around 3 % to 5 % of the U.S. population .
That 's according to estimates from Operation Warp Speed , the government 's vaccine project , published in a draft framework from the National Academies of Sciences , Engineering and Medicine .
There are many who @ @ @ @ @ @ @ and effective vaccine would afford ; policymakers must decide who gets the vaccine first .
A vaccine advisory group to the Centers for Disease Control and Prevention is meeting Tuesday to consider how to prioritize distribution of a future COVID-19 vaccine .
But a vote on who will get a vaccine first , originally planned for Tuesday , has been delayed .
Priority groups include `` those who have the highest risk of exposure , those who are at risk for severe morbidity and mortality ... [ and also ] the workforce that @ @ @ @ @ @ @ both health and economic status , '' said Dr. Grace Lee , a pediatrics professor at Stanford Children 's Hospital and a member of the CDC 's Advisory Committee on Immunization Practices or ACIP .
Lee spoke for herself , not the committee .
When you add all the priority groups together , they account for half of all U.S. adults , according to Dr. Kathleen Dooling , a CDC co-lead on the ACIP COVID-19 Vaccines Working Group , presenting at ACIP 's August meeting .
That 's far more than can be @ @ @ @ @ @ @ bioethicists is that the first doses should go to front-line health workers .
`` Obviously they are being placed at high risk of infection , because they 're taking care of people who are infected and infectious , '' said Ruth Faden , founder of the Berman Institute of Bioethics at Johns Hopkins , and a consultant to the World Health Organization on COVID-19 vaccine guidelines .
But even within this seemingly clear category , there are questions about who a front-line health worker is .
The definition extends beyond doctors and nurses @ @ @ @ @ @ @ and clean up after COVID-19 patients , nursing home workers and possibly pharmacy staff and emergency medical responders , according to preliminary guidelines from the CDC .
Morticians and funeral home workers may also qualify , according to a draft report from the National Academies of Sciences , Engineering and Medicine , because they handle COVID-19 victims ' bodies .
`` Health care worker vaccination sounds simple , but if we do n't have enough doses , we still have to be really judicious in how we 're implementing , '' Lee said @ @ @ @ @ @ @ a health worker exceeds the initial supply , state and local authorities might have to ration distribution further — for instance , restricting the vaccine to parts of a state that are being hit the hardest .
And that 's just for the first 10 million to 15 million doses .
In the weeks after a vaccine is approved , manufacturing should kick into gear and more vaccines should be available .
So who should get it next ?
Does it go to essential workers , who keep the buses running and the @ @ @ @ @ @ @ to the elderly , or people with preexisting conditions , who are more likely to get sick ?
A lot of the decisions will depend on the characteristics of the vaccine itself .
`` These recommendations are not in a vacuum .
They are meant for the real world .
And I think that 's what makes it so complex , '' Lee said .
Factors still unknown include who a vaccine is most effective for , who can reasonably access the vaccine and whether people will line up in droves to get @ @ @ @ @ @ @ a healthy adult cloistered in your house , waiting out the pandemic , the line for a vaccine is n't expected to last forever .
`` In a reasonable amount of time , if all goes well , we will have enough vaccine for everyone in the country who wants one , '' Faden said .
The National Academies of Sciences , Engineering and Medicine suggests that a vaccine could be available to all Americans within 12 to 18 months of its approval .
Several organizations have produced reports on prioritizing vaccine distribution @ @ @ @ @ @ @ its advisory committee that have the greatest influence over how a vaccine is used and distributed in the U.S. by health departments , hospitals and doctors ' offices .
When ACIP does vote , the committee 's advice will provide critical information that state and local health agencies will use to figure out whom to give the first vaccines to and how to reach them .

With Limited COVID-19 Vaccine Doses, Who Would Get Them First?
Enlarge this image toggle caption Hans Pennink/AP Hans Pennink/AP
It's still unknown when a COVID-19 vaccine might be available in the United States. But when one is first approved, there may only be 10 million to 15 million doses available, which may be enough to cover around 3% to 5% of the U.S. population. That's according to estimates from Operation Warp Speed, the government's vaccine project, published in a draft framework from the National Academies of Sciences, Engineering and Medicine.
There are many who would benefit from the protection a safe and effective vaccine would afford; policymakers must decide who gets the vaccine first.
A vaccine advisory group to the Centers for Disease Control and Prevention is meeting Tuesday to consider how to prioritize distribution of a future COVID-19 vaccine. But a vote on who will get a vaccine first, originally planned for Tuesday, has been delayed.
Priority groups include "those who have the highest risk of exposure, those who are at risk for severe morbidity and mortality ... [and also] the workforce that's needed for us to maintain our both health and economic status," said Dr. Grace Lee, a pediatrics professor at Stanford Children's Hospital and a member of the CDC's Advisory Committee on Immunization Practices or ACIP. Lee spoke for herself, not the committee.
When you add all the priority groups together, they account for half of all U.S. adults, according to Dr. Kathleen Dooling, a CDC co-lead on the ACIP COVID-19 Vaccines Working Group, presenting at ACIP's August meeting. That's far more than can be accommodated initially.
The general consensus among bioethicists is that the first doses should go to front-line health workers. "Obviously they are being placed at high risk of infection, because they're taking care of people who are infected and infectious," said Ruth Faden, founder of the Berman Institute of Bioethics at Johns Hopkins, and a consultant to the World Health Organization on COVID-19 vaccine guidelines.
But even within this seemingly clear category, there are questions about who a front-line health worker is. The definition extends beyond doctors and nurses to encompass hospital staff who care for and clean up after COVID-19 patients, nursing home workers and possibly pharmacy staff and emergency medical responders, according to preliminary guidelines from the CDC. Morticians and funeral home workers may also qualify, according to a draft report from the National Academies of Sciences, Engineering and Medicine, because they handle COVID-19 victims' bodies.
"Health care worker vaccination sounds simple, but if we don't have enough doses, we still have to be really judicious in how we're implementing," Lee said. If everyone who might qualify as a health worker exceeds the initial supply, state and local authorities might have to ration distribution further — for instance, restricting the vaccine to parts of a state that are being hit the hardest.
And that's just for the first 10 million to 15 million doses.
In the weeks after a vaccine is approved, manufacturing should kick into gear and more vaccines should be available. So who should get it next?
Does it go to essential workers, who keep the buses running and the grocery shelves stocked? Does it go to the elderly, or people with preexisting conditions, who are more likely to get sick?
A lot of the decisions will depend on the characteristics of the vaccine itself.
"These recommendations are not in a vacuum. They are meant for the real world. And I think that's what makes it so complex," Lee said. Factors still unknown include who a vaccine is most effective for, who can reasonably access the vaccine and whether people will line up in droves to get it.
But even if you're a healthy adult cloistered in your house, waiting out the pandemic, the line for a vaccine isn't expected to last forever.
"In a reasonable amount of time, if all goes well, we will have enough vaccine for everyone in the country who wants one," Faden said. The National Academies of Sciences, Engineering and Medicine suggests that a vaccine could be available to all Americans within 12 to 18 months of its approval.
Several organizations have produced reports on prioritizing vaccine distribution, but it's the CDC and its advisory committee that have the greatest influence over how a vaccine is used and distributed in the U.S. by health departments, hospitals and doctors' offices.
When ACIP does vote, the committee's advice will provide critical information that state and local health agencies will use to figure out whom to give the first vaccines to and how to reach them.


npr--2020-09-23--'Not Our World': This Greek Island Wants An End To Greece And Turkey's Feud

'Not Our World ' : This Greek Island Wants An End To Greece And Turkey 's Feud The pastel-painted taverns , cafes and hotels that line the small port in the remote Greek island of Kastellorizo this time of year are usually bustling with tourists , including hundreds of day-trippers from Turkey — which is just a 10-minute speedboat ride away .
This year , the port is quiet , and not just because of the coronavirus pandemic .
This stunning , craggy isle surrounded by the deep-blue Aegean Sea has become a pawn in a dispute between Greece and @ @ @ @ @ @ @ — over maritime borders and offshore gas and oil exploration rights .
As tensions heightened last month , their militaries went on alert , sending warships and warplanes to the eastern Mediterranean , and raising fears of a confrontation .
`` If you type Kastellorizo on Google , you will have an idea of war , gray zone , that something terrible is happening , '' says Eleni Karavelatzi , a tourism marketer who grew up on the island .
`` This is not our world .
This is politics . ''
The @ @ @ @ @ @ @ Oruc Reis , accompanied by Turkish warships , started gliding near disputed waters to explore for offshore natural gas between Greece and Cyprus .
This angered the Greek government , which claims that , under the United Nations Convention on the Law of the Sea , Greece has exclusive drilling rights on the continental shelf of each of its islands .
Turkey , which has not signed this convention , says it unfairly defines part of the Turkish continental shelf as Greek .
`` And Turkey tries to make it look most unfair @ @ @ @ @ @ @ says Ioannis N. Grigoriadis , a political science professor at Bilkent University in Ankara and head of the Turkey program at the Hellenic Foundation of European and Foreign Policy in Athens .
`` Turkey argues , how can this tiny island so close to Turkey deny continental shelf rights to a long Turkish coast ? ''
Turkey also takes issue with the Greek military presence on Kastellorizo , which is one of the Dodecanese islands that Italy ceded to Greece after World War II , with the provision that they be demilitarized .
@ @ @ @ @ @ @ Italy , not to Turkey .
As the Oruc Reis made its way along the Aegean Sea , Greece sent its own navy ships to shadow it .
When a Turkish frigate accidentally collided with a Greek warship on Aug. 12 , both countries ' media speculated a showdown seemed imminent on Kastellorizo .
Karavelatzi could not even imagine it .
The Turks who lived across the sea in the town of Kas were friends and neighbors .
She remembers one Turkish man inviting the entire island to his wedding in Kas .
@ @ @ @ @ @ @ the border think that we are enemies , '' she says .
`` People that live near the borders do n't think that because they see how is it to drink ouzo and [ have a ] meze with Turks . ''
This , she says , is what life looks like when politics gets out of the way .
The island of the `` red castle '' The Turks call the island Meis , after its ancient Greek name , Megisti , which means `` great . ''
Though the island is @ @ @ @ @ @ @ 's the largest of at least a dozen isles ( most of them uninhabited ) in a small archipelago .
The name Kastellorizo likely has roots in Latin , says Constantina Agapitou Crowley , a former marketing executive whose roots here go back generations and who 's known as the island 's ambassador at large .
Travelers and invaders to the island always spotted an ancient castle and fortress , shaded red by the setting sun .
`` They called it Castello Rosso , Castello Rougio , the Red Castle , '' Agapitou @ @ @ @ @ @ @ became Kastellorizo . ''
The island changed hands many times — the Byzantines , the Knights of Malta , the Ottomans .
Kastellorizo flourished in the 19th century as a sea-trading power with a population of more than 14,000 .
After two world wars and occupations by the French , Italians and British , most of its residents fled to Egypt , Palestine and Australia .
Agapitou Crowley first saw the island in 1968 , 20 years after it formally joined Greece along with the rest of the Dodecanese islands .
Kastellorizo 's @ @ @ @ @ @ @ and looting .
`` The first thing you noticed was the silence , '' she says .
`` Then I noticed the breathtaking beauty and the incredible smell of figs . ''
Fig trees were everywhere .
After residents fled during the war , the trees had sprouted in the cisterns of collapsed homes .
Her family invested in the island and helped it rebuild .
By 1970 , a former palace guard who joined the priesthood became the island 's presiding cleric .
Father Giorgos Maltezos , or Papagiorgis as he 's @ @ @ @ @ @ @ life slowly returning to the island where he had grown up .
Then Turkey invaded Cyprus in 1974 .
He feared Kastellorizo would be next .
`` We heard it on the radio , '' the priest recalled , settling down after his Sunday service at a fish tavern called Billy 's .
`` We shut off all the lights on the island .
... At the time , we were vulnerable .
We did n't have soldiers here . ''
Despina Achladioti , a widow who lived with her goats and chickens @ @ @ @ @ @ @ staked her defense by raising the Greek flag every morning .
The priest calls her a hero .
Greeks have deified her as the `` lady of Ro . ''
Greece installed an army base on Kastellorizo shortly after the Cyprus conflict , `` to allay the security concerns of the islanders , '' Grigoriadis , the political scientist , says .
`` It 's still a very limited military presence . ''
The island is dotted with hidden shelters .
Kastellorizo got on the tourist map with the 1991 Oscar-winning movie Mediterraneo @ @ @ @ @ @ @ , fewer than 500 people live on the island , most of them near the port .
The number can go down to half that in the winter .
Earlier this month , a steel-gray military ship was docked at the marina , near a row of colorful fishing boats .
Fisherman Dimitris Achladiotis has gotten used to Greek soldiers in fatigues hanging around the island .
As he unloads the catches of the day — amberjack and shrimp — he explains that the military presence has not hurt his relationships with Turkish @ @ @ @ @ @ @ invisible line in the sea that divides Greece from Turkey .
`` We all know each other , '' he says .
`` They 're good guys .
...
They used to eat with us here .
Now instead of the Turkish fishermen , we pass Turkish military ships that get too close to us . ''
Another Dimitris Achladiotis — the deputy mayor of Kastellorizo , who is related to the fisherman with the same name — also laments the loss of Turkish visitors from Kas .
The deputy mayor , whom @ @ @ @ @ @ @ The Tall One , says he wants the `` big politicians '' in Athens and Ankara to work out the maritime dispute reasonably , `` without any more tension , which is hurting us all here . ''
He points out that Turks kept the restaurants and cafes busy even during the winter .
`` One of my Turkish friends even uploaded a photo of himself on Facebook dancing Greek-style , '' he says , with a sigh .
`` He said he misses us .
We miss them too . ''
Before @ @ @ @ @ @ @ Kas farmers market every Friday .
They hung out at the town 's clubs and cafes .
Kykkos Magiafis — who goes by Tsikos — met Hurigul Bakirci at one of those cafes almost 10 years ago .
`` I had been out with my Turkish friends in Kas until really late , '' says Magiafis , a Greek who was born and raised on Kastellorizo .
`` The sun was beginning to rise .
I was dying for some coffee , and when I went to the first cafe that opened , @ @ @ @ @ @ @ spoke in a mix of Turkish , Greek and English , '' says Bakirci , who is from Kas , laughing at the recollection .
`` A year later , we got married . ''
She sometimes adds her husband 's Greek last name to her Turkish one .
The couple has a 3-year-old son named Paraschos and homes in both Kas and Kastellorizo .
They run a beach and lunch bistro on a nearby islet called Agios Georgios .
The menu features homemade Turkish gozleme alongside Greek salads .
Bakirci , who @ @ @ @ @ @ @ prompted even more Turks to visit .
`` Everyone wanted to see how I had settled here , how I was doing , '' she says .
`` They would bring friends to our beach bistro , and those friends would bring more friends . ''
Actors from Turkish soap operas — which are wildly popular in Greece — visited , too .
Magiafis remembers how excited the islanders were .
`` The grandmothers were the best , '' he says .
`` They all had canes yet they still seemed to be @ @ @ @ @ @ @ It was so much fun . ''
Now business is down , and Bakirci has n't seen her parents in person in six months .
`` It feels strange because we are 10 minutes away from each other , '' she says .
`` I can see my house from the island , I can see their cars moving .
We flash our headlights to each other to say hi . ''
Political tensions between Greece and Turkey are not new .
Greece was part of the Ottoman Empire for 400 years , @ @ @ @ @ @ @ A century later , after the empire had collapsed , Turks and Greeks went to war over territory .
As recently as 1996 , Turkey and Greece were on the brink of war over uninhabited islets in the Aegean Sea .
`` The United States , through Richard Holbrooke , averted an escalation back then , '' says Grigoriadis , the political analyst , referring to the late U.S. diplomat .
`` Now the United States is withdrawing from the world .
The secretary of state made some statements [ about the current @ @ @ @ @ @ @ a leading role .
The void is in part being filled by Germany , which is trying to make sure violence is off the table , '' he says .
Earlier this month , Greek Prime Minister Kyriakos Mitsotakis said his government plans to purchase new French fighter jets , helicopters and weapons systems .
On Sept. 13 , Greek President Katerina Sakellaropoulou visited Kastellorizo and declared that Turkey is causing `` tensions aimed not only at Greece , but also the EU and NATO , threatening peace and stability in the region @ @ @ @ @ @ @ for teaming up with Egypt , Israel and Cyprus — Turkey 's regional rivals — to form a new consortium to manage Mediterranean gas prices and infrastructure costs .
In response , Ankara signed its own maritime agreement with Libya .
A series of diplomatic fails , including last year 's Turkish invasion of Kurdish-controlled northern Syria , has left Turkey isolated , says Sinem Adar , a research associate specializing in Turkey at the German Institute for International and Security Affairs in Berlin .
`` Turkey 's concerns are now nearly inaudible @ @ @ @ @ @ @ says .
`` If this conflict is worked out according to sensibility , then [ Greece and Turkey ] need to sit at the negotiating table and come up with some compromise .
And if that does n't work , they should go to the International Court of Justice . ''
The European Union , which is threatening fresh sanctions on Turkey , has largely taken Greece 's side .
Last week , Turkey 's government decided to pull back its exploration vessel for maintenance .
Turkish President Recep Tayyip Erdogan recently told @ @ @ @ @ @ @ a chance , '' but he added that Turkey wo n't stop surveying the eastern Mediterranean .
Pantazis Houlis , a Greek mathematician who recently opened a puzzle museum on Kastellorizo , has a special puzzle for Erdogan `` in case he gets any ideas that our island is his , '' he says .
`` It 's like a Rubik 's cube with the colors of Greece , blue and white , '' he says , twisting the cube .
`` And no matter how many ways you twist it , it @ @ @ @ @ @ @ Greek flag . ''
Agapitou Crowley , the former marketing executive with deep roots on Kastellorizo , got used to watching Greek and Turkish military ships from her terrace , which has a sweeping view of the Aegean .
She wonders how long the dispute will drag on .
`` The irony is that , by the time this issue is solved , maybe all the gas and whatever will be obsolete , '' she says .
`` And in the meantime , Kastellorizo and Kas will have suffered . ''

'Not Our World': This Greek Island Wants An End To Greece And Turkey's Feud
Enlarge this image toggle caption Demetrios Ioannou for NPR Demetrios Ioannou for NPR
The pastel-painted taverns, cafes and hotels that line the small port in the remote Greek island of Kastellorizo are usually bustling this time of year with tourists, including hundreds of day-trippers from Turkey — which is just a 10-minute speedboat ride away.
This year, the port is quiet, and not just because of the coronavirus pandemic.
This stunning, craggy isle surrounded by the deep-blue Aegean Sea has become a pawn in a dispute between Greece and Turkey — NATO allies and longtime frenemies — over maritime borders and offshore gas and oil exploration rights.
As tensions heightened last month, their militaries went on alert, sending warships and warplanes to the eastern Mediterranean, and raising fears of a confrontation.
"If you type Kastellorizo on Google, you will have an idea of war, gray zone, that something terrible is happening," says Eleni Karavelatzi, a tourism marketer who grew up on the island. "This is not our world. This is politics."
Enlarge this image toggle caption Demetrios Ioannou for NPR Demetrios Ioannou for NPR
The trouble began when the Turkish research vessel Oruc Reis, accompanied by Turkish warships, started gliding near disputed waters to explore for offshore natural gas between Greece and Cyprus.
This angered the Greek government, which claims that, under the United Nations Convention on the Law of the Sea, Greece has exclusive drilling rights on the continental shelf of each of its islands. Turkey, which has not signed this convention, says it unfairly defines part of the Turkish continental shelf as Greek.
"And Turkey tries to make it look most unfair in the case of Kastellorizo," says Ioannis N. Grigoriadis, a political science professor at Bilkent University in Ankara and head of the Turkey program at the Hellenic Foundation of European and Foreign Policy in Athens. "Turkey argues, how can this tiny island so close to Turkey deny continental shelf rights to a long Turkish coast?"
Turkey also takes issue with the Greek military presence on Kastellorizo, which is one of the Dodecanese islands that Italy ceded to Greece after World War II, with the provision that they be demilitarized. Greece says it made that promise to Italy, not to Turkey.
As the Oruc Reis made its way along the Aegean Sea, Greece sent its own navy ships to shadow it. When a Turkish frigate accidentally collided with a Greek warship on Aug. 12, both countries' media speculated a showdown seemed imminent on Kastellorizo.
Enlarge this image toggle caption Demetrios Ioannou for NPR Demetrios Ioannou for NPR
Karavelatzi could not even imagine it. The Turks who lived across the sea in the town of Kas were friends and neighbors. She remembers one Turkish man inviting the entire island to his wedding in Kas.
"People who are far away from the border think that we are enemies," she says. "People that live near the borders don't think that because they see how is it to drink ouzo and [have a] meze with Turks."
This, she says, is what life looks like when politics gets out of the way.
The island of the "red castle"
The Turks call the island Meis, after its ancient Greek name, Megisti, which means "great." Though the island is less than 4 square miles, it's the largest of at least a dozen isles (most of them uninhabited) in a small archipelago. The name Kastellorizo likely has roots in Latin, says Constantina Agapitou Crowley, a former marketing executive whose roots here go back generations and who's known as the island's ambassador at large.
Enlarge this image toggle caption Demetrios Ioannou for NPR Demetrios Ioannou for NPR
Travelers and invaders to the island always spotted an ancient castle and fortress, shaded red by the setting sun. "They called it Castello Rosso, Castello Rougio, the Red Castle," Agapitou Crowley says, "and it eventually became Kastellorizo."
The island changed hands many times — the Byzantines, the Knights of Malta, the Ottomans. Kastellorizo flourished in the 19th century as a sea-trading power with a population of more than 14,000. After two world wars and occupations by the French, Italians and British, most of its residents fled to Egypt, Palestine and Australia.
Agapitou Crowley first saw the island in 1968, 20 years after it formally joined Greece along with the rest of the Dodecanese islands. Kastellorizo's homes were still in ruins from wars and looting.
"The first thing you noticed was the silence," she says. "Then I noticed the breathtaking beauty and the incredible smell of figs." Fig trees were everywhere. After residents fled during the war, the trees had sprouted in the cisterns of collapsed homes. Her family invested in the island and helped it rebuild.
Enlarge this image toggle caption Demetrios Ioannou for NPR Demetrios Ioannou for NPR
By 1970, a former palace guard who joined the priesthood became the island's presiding cleric. Father Giorgos Maltezos, or Papagiorgis as he's known here, was happy to see life slowly returning to the island where he had grown up. Then Turkey invaded Cyprus in 1974. He feared Kastellorizo would be next.
"We heard it on the radio," the priest recalled, settling down after his Sunday service at a fish tavern called Billy's. "We shut off all the lights on the island. ... At the time, we were vulnerable. We didn't have soldiers here."
Despina Achladioti, a widow who lived with her goats and chickens on the nearby islet of Ro, staked her defense by raising the Greek flag every morning. The priest calls her a hero. Greeks have deified her as the "lady of Ro."
Greece installed an army base on Kastellorizo shortly after the Cyprus conflict, "to allay the security concerns of the islanders," says Grigoriadis, the political scientist. "It's still a very limited military presence." The island is dotted with hidden shelters.
Kastellorizo got on the tourist map with the 1991 Oscar-winning movie Mediterraneo, which was filmed here.
Today, fewer than 500 people live on the island, most of them near the port. The number can go down to half that in the winter.
Earlier this month, a steel-gray military ship was docked at the marina, near a row of colorful fishing boats.
Fisherman Dimitris Achladiotis has gotten used to Greek soldiers in fatigues hanging around the island. As he unloads the catches of the day — amberjack and shrimp — he explains that the military presence has not hurt his relationships with Turkish fishermen, who work along the same invisible line in the sea that divides Greece from Turkey.
Enlarge this image toggle caption Demetrios Ioannou for NPR Demetrios Ioannou for NPR
"We all know each other," he says. "They're good guys. ... They used to eat with us here. Now instead of the Turkish fishermen, we pass Turkish military ships that get too close to us."
Another Dimitris Achladiotis — the deputy mayor of Kastellorizo, who is related to the fisherman with the same name — also laments the loss of Turkish visitors from Kas. The deputy mayor, whom the islanders call O Psilos, meaning The Tall One, says he wants the "big politicians" in Athens and Ankara to work out the maritime dispute reasonably, "without any more tension, which is hurting us all here."
Enlarge this image toggle caption Demetrios Ioannou for NPR Demetrios Ioannou for NPR
He points out that Turks kept the restaurants and cafes busy even during the winter.
"One of my Turkish friends even uploaded a photo of himself on Facebook dancing Greek-style," he says, with a sigh. "He said he misses us. We miss them too."
Before the pandemic, Greeks shopped at the Kas farmers market every Friday. They hung out at the town's clubs and cafes.
A love story
Kykkos Magiafis — who goes by Tsikos — met Hurigul Bakirci at one of those cafes almost 10 years ago.
Enlarge this image toggle caption Demetrios Ioannou for NPR Demetrios Ioannou for NPR
"I had been out with my Turkish friends in Kas until really late," says Magiafis, a Greek who was born and raised on Kastellorizo. "The sun was beginning to rise. I was dying for some coffee, and when I went to the first cafe that opened, there she was."
"We spoke in a mix of Turkish, Greek and English," says Bakirci, who is from Kas, laughing at the recollection. "A year later, we got married."
She sometimes adds her husband's Greek last name to her Turkish one. The couple has a 3-year-old son named Paraschos and homes in both Kas and Kastellorizo. They run a beach and lunch bistro on a nearby islet called Agios Georgios. The menu features homemade Turkish gozleme alongside Greek salads.
Enlarge this image toggle caption Demetrios Ioannou for NPR Demetrios Ioannou for NPR
Bakirci, who has learned Greek, says their marriage prompted even more Turks to visit.
"Everyone wanted to see how I had settled here, how I was doing," she says. "They would bring friends to our beach bistro, and those friends would bring more friends."
Actors from Turkish soap operas — which are wildly popular in Greece — visited, too. Magiafis remembers how excited the islanders were. "The grandmothers were the best," he says. "They all had canes yet they still seemed to be running to get autographs and hugs. It was so much fun."
Enlarge this image toggle caption Demetrios Ioannou for NPR Demetrios Ioannou for NPR
Now business is down, and Bakirci hasn't seen her parents in person in six months. "It feels strange because we are 10 minutes away from each other," she says. "I can see my house from the island, I can see their cars moving. We flash our headlights to each other to say hi."
"Let's give diplomacy a chance"
Political tensions between Greece and Turkey are not new. Greece was part of the Ottoman Empire for 400 years, until it declared independence in 1821. A century later, after the empire had collapsed, Turks and Greeks went to war over territory.
Enlarge this image toggle caption Demetrios Ioannou for NPR Demetrios Ioannou for NPR
As recently as 1996, Turkey and Greece were on the brink of war over uninhabited islets in the Aegean Sea.
"The United States, through Richard Holbrooke, averted an escalation back then," says Grigoriadis, the political analyst, referring to the late U.S. diplomat.
"Now the United States is withdrawing from the world. The secretary of state made some statements [about the current Greek-Turkish standoff] but did not claim a leading role. The void is in part being filled by Germany, which is trying to make sure violence is off the table," he says.
Earlier this month, Greek Prime Minister Kyriakos Mitsotakis said his government plans to purchase new French fighter jets, helicopters and weapons systems. On Sept. 13, Greek President Katerina Sakellaropoulou visited Kastellorizo and declared that Turkey is causing "tensions aimed not only at Greece, but also the EU and NATO, threatening peace and stability in the region."
Enlarge this image toggle caption Demetrios Ioannou for NPR Demetrios Ioannou for NPR
The Turkish government criticized Greece for teaming up with Egypt, Israel and Cyprus — Turkey's regional rivals — to form a new consortium to manage Mediterranean gas prices and infrastructure costs. In response, Ankara signed its own maritime agreement with Libya.
A series of diplomatic fails, including last year's Turkish invasion of Kurdish-controlled northern Syria, has left Turkey isolated, says Sinem Adar, a research associate specializing in Turkey at the German Institute for International and Security Affairs in Berlin.
"Turkey's concerns are now nearly inaudible on the world stage," Adar says. "If this conflict is worked out according to sensibility, then [Greece and Turkey] need to sit at the negotiating table and come up with some compromise. And if that doesn't work, they should go to the International Court of Justice."
The European Union, which is threatening fresh sanctions on Turkey, has largely taken Greece's side. Last week, Turkey's government decided to pull back its exploration vessel for maintenance. Turkish President Recep Tayyip Erdogan recently told reporters, "Let's give diplomacy a chance," but he added that Turkey won't stop surveying the eastern Mediterranean.
Pantazis Houlis, a Greek mathematician who recently opened a puzzle museum on Kastellorizo, has a special puzzle for Erdogan "in case he gets any ideas that our island is his," he says.
"It's like a Rubik's cube with the colors of Greece, blue and white," he says, twisting the cube. "And no matter how many ways you twist it, it's always got the pattern of the Greek flag."
Enlarge this image toggle caption Demetrios Ioannou for NPR Demetrios Ioannou for NPR
Agapitou Crowley, the former marketing executive with deep roots on Kastellorizo, got used to watching Greek and Turkish military ships from her terrace, which has a sweeping view of the Aegean. She wonders how long the dispute will drag on.
"The irony is that, by the time this issue is solved, maybe all the gas and whatever will be obsolete," she says. "And in the meantime, Kastellorizo and Kas will have suffered."
Joanna Kakissis reported from Kastellorizo, Greece.


npr--2020-09-23--New Dashboard Tracks Coronavirus Cases In Schools Across 47 States

New Dashboard Tracks Coronavirus Cases In Schools Across 47 States A new national effort asks K-12 schools to voluntarily — and anonymously — report their confirmed and suspected coronavirus cases , along with the safety strategies they 're using .
Opening schools safely in person is seen as key to restarting the economy and recovering the learning loss that has fallen most heavily on marginalized groups of students .
There are also many fears associated with reopening — of severe illness among vulnerable staff and family members , and of stoking broader outbreaks , as seems to have happened where @ @ @ @ @ @ @ COVID-19 School Response Dashboard , which NPR is reporting on exclusively , was created with the help of several national education organizations .
Right now it shows an average of 230 cases per 100,000 students , and 490 per 100,000 staff members , in the first two weeks of September .
The responses come from public , private and charter schools in 47 states , serving roughly 200,000 students both in person and online , as of Tuesday , Sept. 22 .
As of right now , this sample is a tiny fraction @ @ @ @ @ @ @ students in the United States .
But the dashboard will be continuously updated , and the number of schools participating is expected to grow .
Emily Oster , an economist at Brown University , is spearheading the effort .
She is known for her popular writing on data and science literacy for parents .
She said she got involved in independent data collection on coronavirus cases in schools because `` other people were n't doing it . ''
Eventually , the School Superintendents Association , the National Association of Elementary School Principals , @ @ @ @ @ @ @ and groups representing charter and independent schools joined forces to urge school leaders to contribute .
A software company called Qualtrics did the analysis .
Oster says the key difference with this dashboard , as opposed to other data collection efforts and some media reports , is that it highlights not just raw case numbers but also infection rates — cases as a percentage of total in-person attendance for students and staff members .
Plus , it provides some of the broader context , for example : Just how are schools opening ?
@ @ @ @ @ @ @ have ?
What kinds of mitigation factors are schools undertaking ?
Oster hopes that the number of schools participating will grow significantly , from hundreds to thousands of schools , and that the data will give insights into trends over time .
Eventually , she hopes , the information will be able to `` say something like , 'Which of these mitigation factors are associated with lower infection rates in schools ? '
— which I think will help schools that are still closed try to open safely . ''
`` I think @ @ @ @ @ @ @ effort , '' said Danielle Zerr , a pediatrician at Seattle Children 's Hospital and a professor of epidemiology at the University of Washington , who is not involved in the dashboard .
But , she said , the project is useful only relatively speaking , in the context of the general lack of a robust national testing , tracing or data-collection effort for schools .
`` There 's nothing systematic , that I 'm aware of anyway , to really evaluate how we bring children back safely . ''
Here 's a @ @ @ @ @ @ @ the database : Schools that have brought students back in person reported a total of 230 cases among just under 100,000 students who attended school in person during the two-week period covered by the dashboard .
According to guidance from the Centers for Disease Control and Prevention on school reopening , 230 cases per 100,000 over two weeks falls into the red or `` highest risk '' category .
If expressed as a daily case rate , that would be 16.4 cases per 100,000 people per day , which falls in the `` @ @ @ @ @ @ @ set by the Harvard Global Health Institute and the Brown University School of Public Health .
It 's important to underline , though , that just 77 of these 230 cases were confirmed by coronavirus tests — the bulk are `` suspected '' cases , which could be run-of-the-mill colds or fevers .
The lack of readily available testing is a huge flaw in the myriad plans around the country for bringing kids back to school , says Zerr .
`` If this country was interested in putting the right kind of resource @ @ @ @ @ @ @ have testing available , we would make it very easy .
We would require testing before bringing everybody back to school , and there would be regular testing . ''
Schools in the database reported a raw total of approximately 130 cases among nearly 40,000 staff members over the two-week period covered by the dashboard .
That rate is in the orange , or `` higher-risk '' category , according to the CDC school guidelines .
As a daily case rate , that would be 49 cases per 100,000 people per day , @ @ @ @ @ @ @ '' or highest , risk level category set by the Harvard Global Health Institute and the Brown University School of Public Health .
Again , the case numbers include just 44 confirmed cases and twice as many suspected infections .
About half of schools responding to the survey were running in person at reduced capacity to allow for some social distancing .
About 1 in 4 were running in person at full capacity .
The rest were remote only .
Interestingly , schools with remote-only learning plans reported an infection rate among staff @ @ @ @ @ @ @ full capacity .
This could indicate cases brought in from the community rather than contracted at school , Zerr suggested .
On the other hand , Oster noted , in some places teachers are being asked to teach remotely from their classrooms and infections may be passed among adults in a building .
The data collection asks schools that have brought students back in person which policies they have put in place to stop the virus 's spread .
One of the most common policies , wearing masks , is considered very effective @ @ @ @ @ @ @ of schools say they 're doing social distancing , which is another key strategy touted by experts .
By tracking the reported use of these strategies along with reported infections , says Zerr , over time you could potentially learn which strategies are most effective .
However , Zerr says that self-reporting is n't the best way to find out what schools and students are actually doing .
Are masks worn by all students and staff members all day , for example , or do they droop to the chin when kids are @ @ @ @ @ @ @ to do things robustly , you 'd have boots on the ground going in there and assessing to what degree any of these mitigation strategies are actually happening . ''
And there 's an additional problem : Schools that are most zealous about mitigation might also have more resources to devote to testing , which might turn up more cases , making them look worse in the database .
Traditional public schools report less use of safety strategies No matter what mitigation strategy you look at — masking , distancing , temperature checks @ @ @ @ @ @ @ those measures at much higher levels than traditional public schools .
This may be a function of having more resources , especially when it comes to options like holding classes outdoors .
Or it may be that schools of choice have more leeway when it comes to imposing these requirements on students .

New Dashboard Tracks Coronavirus Cases In Schools Across 47 States
A new national effort asks K-12 schools to voluntarily — and anonymously — report their confirmed and suspected coronavirus cases, along with the safety strategies they're using.
Opening schools safely in person is seen as key to restarting the economy and recovering the learning loss that has fallen most heavily on marginalized groups of students. There are also many fears associated with reopening — of severe illness among vulnerable staff and family members, and of stoking broader outbreaks, as seems to have happened where colleges have reopened in person.
The COVID-19 School Response Dashboard, which NPR is reporting on exclusively, was created with the help of several national education organizations. Right now it shows an average of 230 cases per 100,000 students, and 490 per 100,000 staff members, in the first two weeks of September. The responses come from public, private and charter schools in 47 states, serving roughly 200,000 students both in person and online, as of Tuesday, Sept. 22.
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As of right now, this sample is a tiny fraction of the more than 56 million K-12 students in the United States. But the dashboard will be continuously updated, and the number of schools participating is expected to grow.
Emily Oster, an economist at Brown University, is spearheading the effort. She is known for her popular writing on data and science literacy for parents. She said she got involved in independent data collection on coronavirus cases in schools because "other people weren't doing it." Eventually, the School Superintendents Association, the National Association of Elementary School Principals, the National Association of Secondary School Principals and groups representing charter and independent schools joined forces to urge school leaders to contribute. A software company called Qualtrics did the analysis.
Oster says the key difference with this dashboard, as opposed to other data collection efforts and some media reports, is that it highlights not just raw case numbers but also infection rates — cases as a percentage of total in-person attendance for students and staff members. Plus, it provides some of the broader context, for example: Just how are schools opening? What kinds of hybrid policies do schools have? What kinds of mitigation factors are schools undertaking?
Oster hopes that the number of schools participating will grow significantly, from hundreds to thousands of schools, and that the data will give insights into trends over time. Eventually, she hopes, the information will be able to "say something like, 'Which of these mitigation factors are associated with lower infection rates in schools?' — which I think will help schools that are still closed try to open safely."
"I think it is a really worthwhile and good effort," said Danielle Zerr, a pediatrician at Seattle Children's Hospital and a professor of epidemiology at the University of Washington, who is not involved in the dashboard. But, she said, the project is useful only relatively speaking, in the context of the general lack of a robust national testing, tracing or data-collection effort for schools. "There's nothing systematic, that I'm aware of anyway, to really evaluate how we bring children back safely."
Here's a closer look at some key metrics within the database:
Infection rate among students
Schools that have brought students back in person reported a total of 230 cases among just under 100,000 students who attended school in person during the two-week period covered by the dashboard.
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According to guidance from the Centers for Disease Control and Prevention on school reopening, 230 cases per 100,000 over two weeks falls into the red or "highest risk" category.
If expressed as a daily case rate, that would be 16.4 cases per 100,000 people per day, which falls in the "orange" or next-to-highest risk level category set by the Harvard Global Health Institute and the Brown University School of Public Health.
It's important to underline, though, that just 77 of these 230 cases were confirmed by coronavirus tests — the bulk are "suspected" cases, which could be run-of-the-mill colds or fevers.
The lack of readily available testing is a huge flaw in the myriad plans around the country for bringing kids back to school, says Zerr. "If this country was interested in putting the right kind of resource behind such an effort, we would have testing available, we would make it very easy. We would require testing before bringing everybody back to school, and there would be regular testing."
Infection rate among staff
Schools in the database reported a raw total of approximately 130 cases among nearly 40,000 staff members over the two-week period covered by the dashboard.
Loading...
That rate is in the orange, or "higher-risk" category, according to the CDC school guidelines.
As a daily case rate, that would be 35 cases per 100,000 people per day, which is in the "red," or highest, risk level category set by the Harvard Global Health Institute and the Brown University School of Public Health.
Again, the case numbers include just 44 confirmed cases and twice as many suspected infections.
About half of schools responding to the survey were running in person at reduced capacity to allow for some social distancing. About 1 in 4 were running in person at full capacity. The rest were remote only.
Interestingly, schools with remote-only learning plans reported an infection rate among staff similar to that of schools running at full capacity. This could indicate cases brought in from the community rather than contracted at school, Zerr suggested. On the other hand, Oster noted, in some places teachers are being asked to teach remotely from their classrooms and infections may be passed among adults in a building.
Mitigation strategies
The data collection asks schools that have brought students back in person which policies they have put in place to stop the virus's spread. One of the most common policies, wearing masks, is considered very effective by experts. Yet fewer than half of schools say they're doing social distancing, which is another key strategy touted by experts.
Loading...
By tracking the reported use of these strategies along with reported infections, says Zerr, over time you could potentially learn which strategies are most effective.
However, Zerr says that self-reporting isn't the best way to find out what schools and students are actually doing. Are masks worn by all students and staff members all day, for example, or do they droop to the chin when kids are changing classes? "If you were to do things robustly, you'd have boots on the ground going in there and assessing to what degree any of these mitigation strategies are actually happening."
And there's an additional problem: Schools that are most zealous about mitigation might also have more resources to devote to testing, which might turn up more cases, making them look worse in the database.
Traditional public schools report less use of safety strategies
No matter what mitigation strategy you look at — masking, distancing, temperature checks — private and charter schools reported following those measures at much higher levels than traditional public schools.
This may be a function of having more resources, especially when it comes to options like holding classes outdoors. Or it may be that schools of choice have more leeway when it comes to imposing these requirements on students.


npr--2020-09-23--A Tech Powerhouse, U.S. Lags In Using Smartphones For Contact Tracing

A Tech Powerhouse , U.S. Lags In Using Smartphones For Contact Tracing The United States is home to the world 's best-known technology companies , but so far the use of smartphones to fight the coronavirus has been tepid at best .
Smartphones have the potential to be a powerful tool in tracking the spread of COVID-19 .
They can tell you exactly how close you 've been to other people , for how long and keep a detailed log of everyone you 've been around for the last 14 days .
Linked to testing systems , they can rapidly @ @ @ @ @ @ @ in contact with tests positive .
Tech giants Google and Apple have teamed up to build a system that monitors potential exposures while keeping cellphone users ' identities anonymous .
Health officials say smartphone apps could play a role in identifying coronavirus cases early and slowing the pandemic .
Many countries , such as Germany , Ireland and Singapore , have launched these apps nationwide with a lot of success .
Yet in the U.S. , such systems are available in just a handful of states and even there are only being used @ @ @ @ @ @ @ .
When Virginia launched its COVIDWISE app at the beginning of August , Huda Mohamed downloaded it immediately .
`` I figured it was a great way of keeping myself COVID-safe because I have an immunodeficiency , '' says Mohamed , who is studying microbiology and dietetics at James Madison University in Harrisonburg , Va. And for her , an app letting her know if she had been exposed to someone who 'd tested positive for the coronavirus was a no-brainer .
`` I sent out mass text messages to my friends and @ @ @ @ @ @ @ And I was like , 'Download this app .
This is important ! '
I posted it on the JMU discussion boards . ''
The COVIDWISE app works using the platform developed jointly by Google and Apple .
It swaps Bluetooth signals with other phones around it .
But it only interacts with the phones of people who 've opted in to the system and have their Bluetooth on .
It keeps track of those encounters for the last 14 days , but to protect each user 's privacy , it does n't @ @ @ @ @ @ @ phone number of the devices .
So long as Bluetooth is turned on , it runs in the background .
For weeks , Mohamed was n't even sure the app was working .
`` I would be out and about , and I would wait for the notification , '' she says .
`` But the notification never came . ''
Then the fall semester started at James Madison University .
Students flooded back to Harrisonburg .
Campus reopened .
And soon there were more than 1,000 new COVID-19 cases at the university @ @ @ @ @ @ @ classes .
That 's when a notification popped up on Mohamed 's phone saying she 'd had 12 potential exposures .
`` It was a little scary , '' she says .
She 'd been trying to limit her outings to essential activities .
She had n't been out to large gatherings , and she could n't figure out why she had so many potential exposures all at once .
`` And I started in my head retracing my steps , thinking about who I was around that day . ''
Despite that @ @ @ @ @ @ @ when she opened the app it listed zero exposures .
Mohamed was n't sure what to do .
She does n't have health insurance or a doctor to call .
She decided to self-isolate for a bit and retreat from the world .
`` I 've been avoiding people this week , '' she said in early September .
It turns out she did n't have to do so .
The push notification was from Apple about potential exposures being analyzed by the system .
It was not an official exposure notification from @ @ @ @ @ @ @ would have only been sent out if she 'd spent at least 15 minutes within 6 feet of another app user who 'd recently tested positive .
Jeff Stover , an epidemiologist at the state 's health department , says the weekly push notifications from Apple have caused some confusion .
Apple is aware of the issue .
It says the initial language on the push notifications , which is what gave Mohamed a fright , is being updated and clarified .
Virginia is by far the national leader in the use of @ @ @ @ @ @ @ than 500,000 people have downloaded the state 's app .
Stover says despite some of the initial confusion about the push notifications , the rollout is going well .
And he says the app can reach people whom traditional contract tracers would never track down .
For example , Stover says , if he had gone to the local hardware store and `` stood in line for 15 minutes because it was just taking awhile and I ended up being positive , I have no idea who that person was in front of @ @ @ @ @ @ @ an exposure notification app , that person might get an exposure notification . ''
But very few people are getting those notifications .
Since Google and Apple launched their platform in late May , the U.S. has recorded more than 4.5 million additional cases of COVID-19 .
These smartphone systems have sent out alerts on only a few hundred of them across the 11 states that are using them .
Eight of the states are using the Google/Apple Bluetooth platform .
Three others have released apps that use GPS tracking similar to the @ @ @ @ @ @ @ used cellphone tracking to lock down anyone who might have been exposed and to cut off transmission of the disease .
But there have been greater privacy concerns about the GPS-based apps and far fewer downloads .
The Google/Apple system is only available to government health departments .
Each state must choose to opt in and then build or buy its own app .
`` That really comes back to how public health operates in the U.S. , '' says Vivian Singletary , director of the Public Health Informatics Institute in Atlanta , @ @ @ @ @ @ @ health officials on this technology .
The U.S. does n't have a national health care system .
And health , like education , is dealt with primarily at the local rather than the federal level .
`` We do not have national public health law , per se , that governs everybody across every state , '' Singletary says .
So , short of the Centers for Disease Control and Prevention issuing an app , each state has had to build its own .
For many state health officials , already overwhelmed by @ @ @ @ @ @ @ a priority .
And there have been other impediments .
All the state-issued apps require relatively new smartphones .
That could make them less effective among older residents who are most at risk from the disease , Tennessee health officials say .
Other critics say the alerts provide so little information that they 're not worth the trouble .
The alerts do n't tell the user exactly when , where or to whom they were exposed .
They do n't even disclose exactly when a person tested positive .
It may have been @ @ @ @ @ @ @ have been wearing a mask at the time .
While these apps could provide more details on the exact time , location and duration of the exposure , they do n't .
`` I think I expected more [ from the app ] , honestly , '' says Mohamed , the college student who was initially excited about COVIDWISE .
She says the app only does the bare minimum .
`` I expected it to actually notify me when it happened , not a week later . ''
And the state-issued apps still @ @ @ @ @ @ @ A nationwide database is being developed to tie them together , but currently if you 're visiting a neighboring state , the system does n't function .
And even though Apple and Google have put a priority on privacy protection , many people still say they do n't trust the technology .
Consumers and even information technology professionals still have high levels of concerns about these apps collecting personally identifiable information on their users , according to a recent poll by IT security firm SecureAge .
Still , more states are planning to @ @ @ @ @ @ @ Pennsylvania is the latest to roll one out .
Maryland is expected to release one soon .
As more people start using the apps , public health officials say they 'll become more effective and eventually could become a tool to help with contact tracing but wo n't replace it .

A Tech Powerhouse, U.S. Lags In Using Smartphones For Contact Tracing
Enlarge this image toggle caption Eman Mohammed for NPR Eman Mohammed for NPR
The United States is home to the world's best-known technology companies, but so far the use of smartphones to fight the coronavirus has been tepid at best.
Smartphones have the potential to be a powerful tool in tracking the spread of COVID-19. They can tell you exactly how close you've been to other people, for how long and keep a detailed log of everyone you've been around for the last 14 days. Linked to testing systems, they can rapidly alert you if someone you've been in contact with tests positive.
Tech giants Google and Apple have teamed up to build a system that monitors potential exposures while keeping cellphone users' identities anonymous. Health officials say smartphone apps could play a role in identifying coronavirus cases early and slowing the pandemic.
Many countries, such as Germany, Ireland and Singapore, have launched these apps nationwide with a lot of success. Yet in the U.S., such systems are available in just a handful of states and even there are only being used by a tiny percentage of the population.
When Virginia launched its COVIDWISE app at the beginning of August, Huda Mohamed downloaded it immediately.
"I figured it was a great way of keeping myself COVID-safe because I have an immunodeficiency," says Mohamed, who is studying microbiology and dietetics at James Madison University in Harrisonburg, Va.
And for her, an app letting her know if she had been exposed to someone who'd tested positive for the coronavirus was a no-brainer.
"I sent out mass text messages to my friends and family," she says. "And I was like, 'Download this app. This is important!' I posted it on the JMU discussion boards."
Enlarge this image toggle caption Eman Mohammed for NPR Eman Mohammed for NPR
The COVIDWISE app works using the platform developed jointly by Google and Apple.
It swaps Bluetooth signals with other phones around it. But it only interacts with the phones of people who've opted in to the system and have their Bluetooth on. It keeps track of those encounters for the last 14 days, but to protect each user's privacy, it doesn't record the exact time, location or phone number of the devices.
So long as Bluetooth is turned on, it runs in the background. For weeks, Mohamed wasn't even sure the app was working. "I would be out and about, and I would wait for the notification," she says. "But the notification never came."
Then the fall semester started at James Madison University. Students flooded back to Harrisonburg. Campus reopened. And soon there were more than 1,000 new COVID-19 cases at the university. Officials were forced to halt in-person classes.
That's when a notification popped up on Mohamed's phone saying she'd had 12 potential exposures.
"It was a little scary," she says. She'd been trying to limit her outings to essential activities. She hadn't been out to large gatherings, and she couldn't figure out why she had so many potential exposures all at once. "And I started in my head retracing my steps, thinking about who I was around that day."
Despite that initial notification on her home screen, when she opened the app it listed zero exposures. Mohamed wasn't sure what to do. She doesn't have health insurance or a doctor to call. She decided to self-isolate for a bit and retreat from the world.
"I've been avoiding people this week," she said in early September.
Enlarge this image toggle caption Eman Mohammed for NPR Eman Mohammed for NPR
It turns out she didn't have to do so. The push notification was from Apple about potential exposures being analyzed by the system. It was not an official exposure notification from the Virginia Department of Health. That would have only been sent out if she'd spent at least 15 minutes within 6 feet of another app user who'd recently tested positive.
Jeff Stover, an epidemiologist at the state's health department, says the weekly push notifications from Apple have caused some confusion. Apple is aware of the issue. It says the initial language on the push notifications, which is what gave Mohamed a fright, is being updated and clarified.
Virginia is by far the national leader in the use of these apps. So far, more than 500,000 people have downloaded the state's app. Stover says despite some of the initial confusion about the push notifications, the rollout is going well. And he says the app can reach people whom traditional contact tracers would never track down.
For example, Stover says, if he had gone to the local hardware store and "stood in line for 15 minutes because it was just taking awhile and I ended up being positive, I have no idea who that person was in front of me in line. At least through an exposure notification app, that person might get an exposure notification."
But very few people are getting those notifications.
Since Google and Apple launched their platform in late May, the U.S. has recorded more than 4.5 million additional cases of COVID-19. These smartphone systems have sent out alerts on only a few hundred of them across the 11 states that are using them. Eight of the states are using the Google/Apple Bluetooth platform. Three others have released apps that use GPS tracking similar to the system used in China. Beijing has used cellphone tracking to lock down anyone who might have been exposed and to cut off transmission of the disease.
But there have been greater privacy concerns about the GPS-based apps and far fewer downloads. The Google/Apple system is only available to government health departments. Each state must choose to opt in and then build or buy its own app.
"That really comes back to how public health operates in the U.S.," says Vivian Singletary, director of the Public Health Informatics Institute in Atlanta, which has hosted several forums for public health officials on this technology. The U.S. doesn't have a national health care system. And health, like education, is dealt with primarily at the local rather than the federal level.
"We do not have national public health law, per se, that governs everybody across every state," Singletary says.
So, short of the Centers for Disease Control and Prevention issuing an app, each state has had to build its own. For many state health officials, already overwhelmed by the pandemic, this hasn't been a priority.
And there have been other impediments. All the state-issued apps require relatively new smartphones. That could make them less effective among older residents who are most at risk from the disease, Tennessee health officials say.
Other critics say the alerts provide so little information that they're not worth the trouble. The alerts don't tell the user exactly when, where or to whom they were exposed. They don't even disclose exactly when a person tested positive. It may have been 13 days ago, and you may have been wearing a mask at the time. While these apps could provide more details on the exact time, location and duration of the exposure, they don't.
"I think I expected more [from the app], honestly," says Mohamed, the college student who was initially excited about COVIDWISE. She says the app only does the bare minimum. "I expected it to actually notify me when it happened, not a week later."
Enlarge this image toggle caption Eman Mohammed for NPR Eman Mohammed for NPR
And the state-issued apps still don't work across state lines. A nationwide database is being developed to tie them together, but currently if you're visiting a neighboring state, the system doesn't function. And even though Apple and Google have put a priority on privacy protection, many people still say they don't trust the technology.
Consumers and even information technology professionals still have high levels of concerns about these apps collecting personally identifiable information on their users, according to a recent poll by IT security firm SecureAge.
Still, more states are planning to launch apps in the coming weeks. Pennsylvania is the latest to roll one out. Maryland is expected to release one soon. As more people start using the apps, public health officials say they'll become more effective and eventually could become a tool to help with contact tracing but won't replace it.