npr--2020-10-06--Pompeo Rails Against China At 'Quad' Meeting With Foreign Ministers In Tokyo

Pompeo Rails Against China At 'Quad ' Meeting With Foreign Ministers In Tokyo In a meeting with foreign ministers from Japan , India and Australia in Tokyo , Secretary of State Mike Pompeo urged on Tuesday that they strengthen their quartet of democracies to resist an increasingly assertive China .
It was the second ministerial meeting of an informal grouping known as the Quadrilateral Security Dialogue , better known as the `` Quad . ''
Pompeo 's Tokyo visit — which took place as Washington still reeled from news of President Trump 's coronavirus infection — also marked his first @ @ @ @ @ @ @ , Yoshihide Suga , who took over from Shinzo Abe last month .
The two men greeted each other with bows and a fist bump .
If , as it appeared , Pompeo was pushing other members of the Quad to take the U.S. side in a confrontation with China , he did not score any ringing public endorsements , and his remarks clashed with those of his host .
Pompeo aimed straight at the Chinese Communist Party in remarks before the four nations ' top diplomats sat down to talk .
`` @ @ @ @ @ @ @ is more critical now than ever that we collaborate to protect our people and partners from the CCP 's exploitation , corruption and coercion , '' he said .
But Japan 's chief government spokesman , Katsunobu Kato , insisted at a press briefing Tuesday : `` This Quad meeting is not being held with any particular country in mind . ''
A State Department readout said that Pompeo discussed concerns over China 's `` malign activity '' in the region with Australian Foreign Minister Marise Payne , but Payne made no public @ @ @ @ @ @ @ a country like Australia , which has had a pretty rocky time with Beijing over the last few months in particular , is reluctant to even seriously acknowledge what the true purpose of the Quad is , '' said Hugh White , an emeritus professor of strategic studies at the Australian National University in Canberra .
`` And that makes you doubtful about whether that true purpose can actually be very significantly achieved , '' he added , referring to the U.S. intention to confront China .
Beijing panned the meeting even before @ @ @ @ @ @ @ exclusive cliques , multilateral and plurilateral cooperation should be open , inclusive and transparent , '' Chinese Foreign Ministry spokesman Wang Wenbin told reporters last month .
On the surface , it might appear that China 's assertive actions in recent months are compelling Japan , India and Australia to close ranks with the United States .
Chinese ships and planes have made frequent incursions into waters near the Japanese-controlled but disputed East China Sea islands known as Senkaku in Japan and Diaoyu in China .
Chinese troops recently fought lethal melees with @ @ @ @ @ @ @ And Beijing has slapped punitive trade measures on Australia after Canberra called for an independent investigation into the origins of the COVID-19 pandemic .
But Payne has distanced Australia from Pompeo 's tirades against China 's Communist Party , saying in July , `` Let me reiterate that we make our own decisions . ''
Japanese politicians and other officials echo Washington 's rhetoric about shared values and the U.S.-Japan alliance as the cornerstone of regional peace and stability .
`` We 'd like to protect the Indo-Pacific from totalitarian , hegemonic powers @ @ @ @ @ @ @ means of economic and technological strength , and sometimes , even by force , '' Norihiro Nakayama , a lawmaker with the ruling Liberal Democratic Party , told NPR .
He and other lawmakers have argued for restricting the use of Chinese smartphone apps on national security grounds , and for subsidizing Japanese companies to move production out of China and back to Japan .
`` As for economic activity which relates to national security , '' Nakayama said , `` under the Japan-U.S. alliance , our basic stance is that we 'd @ @ @ @ @ @ @ State Pompeo 's suggestions to work together . ''
But Tokyo has also worked to stabilize its economic relations with China .
Before resigning last month , Abe , Japan 's former prime minister , engineered a rapprochement with Beijing after years of frosty ties , with support from businessmen and China-friendly Liberal Democratic Party politicians .
The Quad meeting ended , and Pompeo left Japan late Tuesday without announcing any major initiatives .
Ultimately , White argued , the Quad reflects the lack of a coherent U.S. plan to deal with China @ @ @ @ @ @ @ a fair element of theater to it , '' he said .
`` And the appearance of meeting and cooperating is , I think , in some ways a substitute for what you might call more concrete and effective action . ''
The grouping may yet be useful to Japan , India and Australia , he muses , if they can turn the tables on Washington and cooperate in talking it out of dragging them into a new cold war with China — although he sees that as a long shot , too @ @ @ @ @ @ @ from Tokyo .

Pompeo Rails Against China At 'Quad' Meeting With Foreign Ministers In Tokyo
Enlarge this image toggle caption Charly Triballeau/Pool via AP Charly Triballeau/Pool via AP
In a meeting with foreign ministers from Japan, India and Australia in Tokyo, Secretary of State Mike Pompeo urged on Tuesday that they strengthen their quartet of democracies to resist an increasingly assertive China.
It was the second ministerial meeting of an informal grouping known as the Quadrilateral Security Dialogue, better known as the "Quad." Pompeo's Tokyo visit — which took place as Washington still reeled from news of President Trump's coronavirus infection — also marked his first meeting with Japan's new prime minister, Yoshihide Suga, who took over from Shinzo Abe last month. The two men greeted each other with bows and a fist bump.
If, as it appeared, Pompeo was pushing other members of the Quad to take the U.S. side in a confrontation with China, he did not score any ringing public endorsements, and his remarks clashed with those of his host.
Enlarge this image toggle caption Charly Triballeau/Pool via AP Charly Triballeau/Pool via AP
Pompeo aimed straight at the Chinese Communist Party in remarks before the four nations' top diplomats sat down to talk.
"As partners in this Quad, it is more critical now than ever that we collaborate to protect our people and partners from the CCP's exploitation, corruption and coercion," he said.
But Japan's chief government spokesman, Katsunobu Kato, insisted at a press briefing Tuesday: "This Quad meeting is not being held with any particular country in mind."
A State Department readout said that Pompeo discussed concerns over China's "malign activity" in the region with Australian Foreign Minister Marise Payne, but Payne made no public mention of such concerns.
"Even a country like Australia, which has had a pretty rocky time with Beijing over the last few months in particular, is reluctant to even seriously acknowledge what the true purpose of the Quad is," said Hugh White, an emeritus professor of strategic studies at the Australian National University in Canberra.
"And that makes you doubtful about whether that true purpose can actually be very significantly achieved," he added, referring to the U.S. intention to confront China.
Beijing panned the meeting even before it began.
"Instead of forming exclusive cliques, multilateral and plurilateral cooperation should be open, inclusive and transparent," Chinese Foreign Ministry spokesman Wang Wenbin told reporters last month.
On the surface, it might appear that China's assertive actions in recent months are compelling Japan, India and Australia to close ranks with the United States.
Chinese ships and planes have made frequent incursions into waters near the Japanese-controlled but disputed East China Sea islands known as Senkaku in Japan and Diaoyu in China. Chinese troops recently fought lethal melees with Indian soldiers high in the Himalayas. And Beijing has slapped punitive trade measures on Australia after Canberra called for an independent investigation into the origins of the COVID-19 pandemic.
But Payne has distanced Australia from Pompeo's tirades against China's Communist Party, saying in July, "Let me reiterate that we make our own decisions."
Japanese politicians and other officials echo Washington's rhetoric about shared values and the U.S.-Japan alliance as the cornerstone of regional peace and stability.
"We'd like to protect the Indo-Pacific from totalitarian, hegemonic powers which try to enhance their hegemony by means of economic and technological strength, and sometimes, even by force," Norihiro Nakayama, a lawmaker with the ruling Liberal Democratic Party, told NPR.
He and other lawmakers have argued for restricting the use of Chinese smartphone apps on national security grounds, and for subsidizing Japanese companies to move production out of China and back to Japan.
"As for economic activity which relates to national security," Nakayama said, "under the Japan-U.S. alliance, our basic stance is that we'd like to respond positively to Secretary of State Pompeo's suggestions to work together."
But Tokyo has also worked to stabilize its economic relations with China. Before resigning last month, Abe, Japan's former prime minister, engineered a rapprochement with Beijing after years of frosty ties, with support from businessmen and China-friendly Liberal Democratic Party politicians.
The Quad meeting ended, and Pompeo left Japan late Tuesday without announcing any major initiatives.
Ultimately, White argued, the Quad reflects the lack of a coherent U.S. plan to deal with China's rise.
"The Quad has a fair element of theater to it," he said. "And the appearance of meeting and cooperating is, I think, in some ways a substitute for what you might call more concrete and effective action."
The grouping may yet be useful to Japan, India and Australia, he muses, if they can turn the tables on Washington and cooperate in talking it out of dragging them into a new cold war with China — although he sees that as a long shot, too.
Chie Kobayashi contributed to this report from Tokyo.


npr--2020-10-07--Tracker: Key Trump Contacts Who Have Tested Positive For The Coronavirus

Tracker : Key Trump Contacts Who Have Tested Positive For The Coronavirus President Trump and close to a dozen key members of his circle , including senior White House and campaign staff and Republican senators , have announced positive coronavirus test results in the days before and after Trump tested positive .
These announcements came after a busy two weeks for Trump , who took part in the first presidential debate Sept. 29 and officially introduced Judge Amy Coney Barrett as his Supreme Court nominee on the prior weekend .
The president also held multiple events in states around the @ @ @ @ @ @ @ , Florida , Georgia and Pennsylvania .
Many of those who tested positive were present with Trump at these events over the past two weeks .
White House aide Hope Hicks was the first senior official to announce her positive test results in this latest wave , with news of her diagnosis breaking Thursday evening .
Hours later , Trump announced that he and first lady Melania Trump had had tested positive as well .
The results have upended business at the White House , on the campaign trail and caused the Senate @ @ @ @ @ @ @ White House staffers are known to have the virus .
The White House has declined to give a total , citing privacy concerns , but is under pressure to describe the extent of the outbreak and explain how it happened .

Tracker: Key Trump Contacts Who Have Tested Positive For The Coronavirus
Enlarge this image toggle caption Drew Angerer/Getty Images Drew Angerer/Getty Images
President Trump and close to a dozen key members of his circle, including senior White House and campaign staff and Republican senators, have announced positive coronavirus test results in the days before and after Trump tested positive.
These announcements came after a busy two weeks for Trump, who took part in the first presidential debate Sept. 29 and officially introduced Judge Amy Coney Barrett as his Supreme Court nominee on the prior weekend. The president also held multiple events in states around the country, including New Jersey, Minnesota, Florida, Georgia and Pennsylvania.
Many of those who tested positive were present with Trump at these events over the past two weeks.
White House aide Hope Hicks was the first senior official to announce her positive test results in this latest wave, with news of her diagnosis breaking Thursday evening. Hours later, Trump announced that he and first lady Melania Trump had had tested positive as well.
The results have upended business at the White House, on the campaign trail and caused the Senate to delay its return.
Several other White House staffers are known to have the virus. The White House has declined to give a total, citing privacy concerns, but is under pressure to describe the extent of the outbreak and explain how it happened.


npr--2020-10-07--2 Scientists Awarded Nobel Prize In Chemistry For Genome Editing Research

The Nobel Prize in chemistry was awarded this year to Emmanuelle Charpentier and Jennifer Doudna for their work on `` genetic scissors '' that can cut DNA at a precise location , allowing scientists to make specific changes to specific genes .
`` This technology has had a revolutionary impact on the life sciences , is contributing to new cancer therapies and may make the dream of curing inherited diseases come true , '' the Nobel Committee said in announcing the prize .
Already , doctors have used the technology to experimentally treat sickle cell disease , with promising results @ @ @ @ @ @ @ for people to fully appreciate how transformative they are , that was n't the case for this new tool , known as CRISPR-Cas9 .
`` Once in a long time , an advance comes along that utterly transforms an entire field and does so very rapidly , '' says Francis Collins , director of the National Institutes of Health , which has long supported Doudna 's research .
`` You can not walk into a molecular biology laboratory today , working on virtually any organism , where CRISPR-Cas9 is not playing a role @ @ @ @ @ @ @ works and how disease happens .
It 's just that powerful . ''
Since scientific papers were published in 2011 and 2012 describing the work , Charpentier says people had repeatedly suggested to her that it was worthy of a Nobel Prize .
`` It was indeed mentioned to me a number of times , maybe more than what I would have liked , that one day this so-called discovery may be awarded the Nobel Prize , '' Charpentier said in a press briefing .
Still , even after winning other big awards @ @ @ @ @ @ @ n't completely hit her until Goran K. Hansson , the secretary-general of the Royal Swedish Academy of Sciences , called to tell her the news .
`` I was very emotional , I have to say , '' says Charpentier , who added that she had been told that winning a Nobel is always a big surprise and feels unreal .
`` Obviously , it 's real , so I have to get used to it now . ''
There 's been an ongoing feud , including a fight over lucrative patents , @ @ @ @ @ @ @ the development of CRISPR-Cas9 .
`` It 's a big field and there 's a lot of good science being done in this field .
But we have decided this year to award the prize to Charpentier and Doudna , and I can only say that , '' said Claes Gustafsson , chair of the Nobel Committee for Chemistry , when asked if the committee had considered including anyone else in the prize .
`` I guess whenever there 's a Nobel Prize selection , there 's always some second guessing about who @ @ @ @ @ @ @ , who says that George Church and Feng Zhang `` and a long list of others '' made it clear that this kind of approach could work in virtually any kind of cell .
Such a powerful new tool invariably raises questions how it should be used ethically , especially considering that one researcher in China controversially used this technique to genetically alter babies .
When that scientist described his work in modifying human embryos , Doudna said that she was `` horrified and stunned . ''
She 's called for regulation of @ @ @ @ @ @ @ responsible use of genome editing will enable CRISPR technology to improve the well-being of millions of people and fulfill its revolutionary potential . ''
Doudna is a Howard Hughes Investigator at the University of California , Berkeley .
Charpentier is with the Max Planck Unit for the Science of Pathogens in Berlin , Germany .
For two women to share the Nobel Prize in Chemistry is unusual .
Between 1901 and 2020 , it has been awarded to 185 individuals , and only 7 of them have been women .
In recent years @ @ @ @ @ @ @ to increase the diversity of researchers nominated for the science Nobel Prizes , which have been criticized for historically overlooking the achievements of both women and people of color .

2 Scientists Awarded Nobel Prize In Chemistry For Genome Editing Research
Enlarge this image toggle caption Peter Barreras/Invision/AP Peter Barreras/Invision/AP
The Nobel Prize in chemistry was awarded this year to Emmanuelle Charpentier and Jennifer Doudna for their work on "genetic scissors" that can cut DNA at a precise location, allowing scientists to make specific changes to specific genes.
"This technology has had a revolutionary impact on the life sciences, is contributing to new cancer therapies and may make the dream of curing inherited diseases come true," the Nobel Committee said in announcing the prize.
Already, doctors have used the technology to experimentally treat sickle cell disease, with promising results.
While some research advances take decades for people to fully appreciate how transformative they are, that wasn't the case for this new tool, known as CRISPR-Cas9.
"Once in a long time, an advance comes along that utterly transforms an entire field and does so very rapidly," says Francis Collins, director of the National Institutes of Health, which has long supported Doudna's research. "You cannot walk into a molecular biology laboratory today, working on virtually any organism, where CRISPR-Cas9 is not playing a role in the ability to understand how life works and how disease happens. It's just that powerful."
Since scientific papers were published in 2011 and 2012 describing the work, Charpentier says people had repeatedly suggested to her that it was worthy of a Nobel Prize.
"It was indeed mentioned to me a number of times, maybe more than what I would have liked, that one day this so-called discovery may be awarded the Nobel Prize," Charpentier said in a press briefing.
Still, even after winning other big awards, she says, that possibility didn't completely hit her until Goran K. Hansson, the secretary-general of the Royal Swedish Academy of Sciences, called to tell her the news.
"I was very emotional, I have to say," says Charpentier, who added that she had been told that winning a Nobel is always a big surprise and feels unreal. "Obviously, it's real, so I have to get used to it now."
There's been an ongoing feud, including a fight over lucrative patents, over who deserves the most credit for the development of CRISPR-Cas9.
"It's a big field and there's a lot of good science being done in this field. But we have decided this year to award the prize to Charpentier and Doudna, and I can only say that," said Claes Gustafsson, chair of the Nobel Committee for Chemistry, when asked if the committee had considered including anyone else in the prize.
"I guess whenever there's a Nobel Prize selection, there's always some second-guessing about who got left out," notes Collins, who says that George Church and Feng Zhang "and a long list of others" made it clear that this kind of approach could work in virtually any kind of cell.
Such a powerful new tool invariably raises questions about how it should be used ethically, especially considering that one researcher in China controversially used this technique to genetically alter babies.
When that scientist described his work in modifying human embryos, Doudna said that she was "horrified and stunned." She's called for regulation of the technology, writing that "ensuring responsible use of genome editing will enable CRISPR technology to improve the well-being of millions of people and fulfill its revolutionary potential."
Doudna is a Howard Hughes Investigator at the University of California, Berkeley. Charpentier is with the Max Planck Unit for the Science of Pathogens in Berlin.
For two women to share the Nobel Prize in chemistry is unusual. Between 1901 and 2020, it has been awarded to 185 individuals, and only seven of them have been women. In recent years, the Nobel committees have been trying to increase the diversity of researchers nominated for the science Nobel Prizes, which have been criticized for historically overlooking the achievements of both women and people of color.


npr--2020-10-07--Hospitals Failing To Meet New COVID-19 Data Reporting Mandate To Get Warning Letters

Hospitals Failing To Meet New COVID-19 Data Reporting Mandate To Get Warning Letters The federal government is starting to crack down on the nation 's hospitals for not reporting complete COVID-19 data into a federal data collection system .
The enforcement timeline starts Wednesday , said Seema Verma , administrator for the Centers for Medicare and Medicaid Services , in a call with reporters Tuesday .
CMS issued a rule in early September requiring hospitals to report full , daily COVID-19 data to the federal government , including such information as the number of patients and ventilators they have .
@ @ @ @ @ @ @ to hospitals across America alerting many that they have not been in compliance .
Later this month , the department of Health and Human Services will also start posting a list of hospitals noting whether they are out of compliance .
The consequences are potentially severe .
After multiple notifications , hospitals are subject to `` termination from both Medicare and Medicaid , meaning the hospital would not receive reimbursement from these programs , '' Verma says .
This would be a major loss of funding and could go into effect as early @ @ @ @ @ @ @ the latest in a string of actions , over several months , designed to get hospitals to provide more daily COVID-19 data to the federal government .
Getting more complete COVID-19 data has been a mission of Dr. Deborah Birx , a lead on the White House Coronavirus Task Force .
Daily hospital admission data is being used `` to understand where this epidemic is , how it 's moving through different populations and ensuring that we 're meeting the needs of specific hospitals and communities , '' Dr. Birx said on the @ @ @ @ @ @ @ that data useful , it also has to be timely , complete and valid . ''
Hospitals have struggled with the reporting requests , which increased in July and became mandatory in September , and have added to their administrative burdens in the midst of a pandemic .
Hospitals have been asked , cajoled and are now being forced to provide that data on a daily basis .
The industry is very concerned .
`` Tying data reporting to participation in the Medicare program remains an overly heavy-handed approach that could jeopardize access @ @ @ @ @ @ @ '' said Rick Pollack , head of the American Hospital Association , in a statement .
The hospital data reporting system drew controversy in mid-July , when the Department of Health and Human Services instructed hospitals to stop reporting data to the CDC , which had been collecting the data — reported voluntarily by hospitals — through a system many had used for decades .
Instead , hospitals were told to report to a newer system directly managed by HHS , which oversees the CDC , raising concerns among politicians and public health @ @ @ @ @ @ @ surveillance .
Hospitals were initially incentivized to report into the newer system by a threat that if they did n't report they might not receive remdesivir , one of the few drugs known to work against COVID-19 , then in short supply .
Now that remdesivir is more widely available , the government will no longer oversee its distribution .
In new CMS guidance issued Tuesday , to accompany the letters , the reporting requirement for remdesivir will be dropped in early November .
The new guidance also says hospitals can now report @ @ @ @ @ @ @ gowns once a week , instead of daily as previously required .
But it has added six daily questions about influenza , such as the number of patients who are hospitalized with flu and whether they also have COVID-19 , despite the fact that a CDC surveillance system to track flu in hospitals has been up and running for years .
Hospitals have struggled to adapt to the shifting requirements .
`` The constantly changing goal posts are going to be a real challenge for hospitals , '' says Carrie Williams , vice @ @ @ @ @ @ @ Association .
`` We want to be in compliance , we want to make sure that we 're providing the federal government with whatever they need for planning and resources .
It 's just — another change is a challenge in the middle of a pandemic . ''
Most U.S. hospitals have been participating in the reporting to some extent .
86 % are now reporting at least one element daily , says Dr. Deborah Birx .
But full compliance has been low .
An internal CDC presentation obtained by NPR showed that @ @ @ @ @ @ @ , just 24 % of hospitals reported all the required elements every day .
CMS did not share the number of noncompliance letters that would be sent tomorrow , but they will likely number in the thousands .

Hospitals That Don't Report COVID-19 Data Daily Will Get Warning Letter
Enlarge this image toggle caption Studio 642/Getty Images/Tetra images RF Studio 642/Getty Images/Tetra images RF
The federal government is starting to crack down on the nation's hospitals for not reporting complete COVID-19 data into a federal data collection system.
The enforcement timeline starts Wednesday, said Seema Verma, administrator for the Centers for Medicare & Medicaid Services, in a call with reporters Tuesday. CMS issued a rule in early September requiring hospitals to report full, daily COVID-19 data to the federal government, including such information as the number of patients and ventilators they have. On Wednesday, CMS is sending letters to hospitals across America alerting many that they have not been in compliance.
Later this month, the Department of Health and Human Services will start posting a list of hospitals noting whether they are out of compliance.
The consequences are potentially severe. After multiple notifications, hospitals are subject to "termination from both Medicare and Medicaid, meaning the hospital would not receive reimbursement from these programs," Verma says. This would be a major loss of funding and could go into effect as early as mid-January.
The warning letters are the latest in a string of actions, over several months, designed to get hospitals to provide more daily COVID-19 data to the federal government. Getting more complete COVID-19 data has been a mission of Dr. Deborah Birx, a lead on the White House Coronavirus Task Force.
Daily hospital admission data is being used "to understand where this epidemic is, how it's moving through different populations and ensuring that we're meeting the needs of specific hospitals and communities," Birx said on the call. "In order to make that data useful, it also has to be timely, complete and valid."
Hospitals have struggled with the reporting requests, which increased in July and became mandatory in September, and have added to their administrative burdens in the midst of a pandemic. Hospitals have been asked, cajoled and are now being forced to provide that data daily. The industry is very concerned.
"Tying data reporting to participation in the Medicare program remains an overly heavy-handed approach that could jeopardize access to hospital care for all Americans," Rick Pollack, head of the American Hospital Association, said in a statement.
The hospital data reporting system drew controversy in mid-July when the Department of Health and Human Services instructed hospitals to stop reporting data to the Centers for Disease Control and Prevention, which had been collecting the data — reported voluntarily by hospitals — through a system many had used for decades. Instead, hospitals were told to report to a newer system directly managed by HHS, which oversees the CDC, raising concerns among politicians and public health experts of political interference in public health surveillance.
Hospitals were initially incentivized to report into the newer system by a threat that if they didn't report they might not receive remdesivir, one of the few drugs known to work against COVID-19, then in short supply. Now that remdesivir is more widely available, the government will no longer oversee its distribution. In new CMS guidance issued Tuesday, to accompany the letters, the reporting requirement for remdesivir will be dropped in early November.
The new guidance also says hospitals can now report their supply of gloves, masks and gowns once a week, instead of daily as previously required. But it has added six daily questions about influenza, such as the number of patients who are hospitalized with flu and whether they also have COVID-19, despite the fact that a CDC surveillance system to track flu in hospitals has been up and running for years.
Hospitals have struggled to adapt to the shifting requirements. "The constantly changing goal posts are going to be a real challenge for hospitals," says Carrie Williams, vice president of communications at the Texas Hospital Association. "We want to be in compliance, we want to make sure that we're providing the federal government with whatever they need for planning and resources. It's just — another change is a challenge in the middle of a pandemic."
Most U.S. hospitals have been participating in the reporting to some extent; 86% are now reporting at least one element daily, says Birx. But full compliance has been low. An internal CDC presentation obtained by NPR showed that for the week of Sept. 14, just 24% of hospitals reported all the required elements every day. CMS did not share the number of noncompliance letters that would be sent Wednesday, but they will likely number in the thousands.


npr--2020-10-07--5 Questions Ahead Of The Pence-Harris Vice Presidential Debate

Vice President Pence and California Sen. Kamala Harris square off in the first and only vice presidential debate Wednesday at 9 p.m .
ET in Salt Lake City .
Pence has laid low with Trump undergoing treatment for the coronavirus , a threat the president had downplayed for months .
But Pence is going to need to show up in a big way to try to inject some needed positive energy into the Trump-Pence presidential campaign , which has been consistently lagging Biden-Harris in the polls .
Progressives , frustrated with Joe Biden 's sometimes uneven public speaking appearances , @ @ @ @ @ @ @ They think Harris , who is more than 20 years younger than Biden , can deliver a better rhetorical punch .
Both vice presidential candidates have said they are looking forward to the debate .
`` My message to the Democratic nominee for vice president : congratulations .
I 'll see you in Salt Lake City , '' Pence said after Harris was selected as Biden 's running mate .
Harris responded wryly and with a wide smile in an interview with ABC , simply saying : `` Oh good .
Me , @ @ @ @ @ @ @ forward to seeing him .
Absolutely . ''
Well , game on .
Here are five questions ahead of Wednesday night 's debate : 1 .
Can Pence right the ship ?
Eight years ago , it was Biden who helped steady the Obama reelection campaign with his solid performance in the vice presidential debate .
It stabilized the narrative of the presidential race after a shaky first debate for then-President Barack Obama .
On Wednesday , the same task falls to Pence , ironically .
He needs to have a good debate @ @ @ @ @ @ @ message after Trump 's widely panned first debate performance followed by testing positive for COVID-19 , which landed him in the hospital over the weekend .
It 's been chaotic for the Trump campaign and White House .
If anyone can take the temperature down , it 's the understated Pence .
Pence , though , is very conservative , and while that appeals to the base , especially white evangelicals , he and Trump are n't lining up with the middle of the electorate .
Independents and suburban voters have abandoned Trump @ @ @ @ @ @ @ , and Trump did nothing to reach out beyond the base in the first debate .
That has to be a task for Pence , but how does he do it given his politics ?
Harris has shown an ability to go viral and speak in soundbites , whether at high-profile hearings or some of the Democratic primary debates .
She will aim to put Pence on his heels , and he 's not dealing with the more staid Sen. Tim Kaine of Virginia , Hillary Clinton 's vice presidential pick , who @ @ @ @ @ @ @ Harris can be a strong debater and will certainly look for ways to bring the hammer down on Pence and make him defend unpopular Trump policies , positions and statements .
How and whether Pence can counter could determine who wins the debate .
Harris has the added hurdle of being the first woman of color on a major-party presidential ticket , and her team is well aware that she has to navigate everything that comes with that , as well .
Of course , Harris has been dealing with that her entire @ @ @ @ @ @ @ potential pitfalls on race and gender that Pence has to be careful about in responding and attacking .
3 .
Does Harris live up to the hype ?
This is the moment progressives have been waiting for .
They desperately want someone to stick it to Team Trump .
But remember that debates can be all about expectations .
The bar was very low for Biden because Trump and his campaign have cast him as incompetent and `` not all there . ''
Trump 's antics made it easy for Biden to clear @ @ @ @ @ @ @ of expectations for Harris , and she needs to deliver a solid performance to keep the Biden train moving forward .
Also , because of Biden 's age , the spotlight may be brighter on Harris than for past vice presidential nominees .
Democrats have set her up as the heir apparent after a Biden presidency , whether Biden runs for reelection or not .
So this is a chance for her to show not just that she will be an attack dog for Biden , but for a large audience to see @ @ @ @ @ @ @ be .
4 .
Can Harris stick to the Biden line ?
One way Pence has signaled pretty loudly that he will go after Harris is painting her as tied to the `` radical left , '' someone who will try to drag Biden further than his public statements are leading on .
`` As you all know , Joe Biden and the Democratic Party have been overtaken by the radical left , '' Pence told a crowd in Mesa , Ariz. , after Harris was named Biden 's running mate .
`` @ @ @ @ @ @ @ , open borders , socialized medicine and abortion on demand , it 's no surprise that he chose Sen. Harris .
You all might like to know that the vice presidential debate is on Oct. 7 in Utah . ''
The next day , Pence said this on Fox News : `` I ca n't wait to get to Salt Lake City and be on the stage with her , to compare Joe Biden 's nearly 50 years in public life — the agenda of the radical left , the agenda that she @ @ @ @ @ @ @ with the results of this president and this administration . ''
This is the Trump campaign 's Trojan horse theory — despite Biden making it clear he 's in charge and not on board with withdrawing funding from the police , `` Medicare for All '' or the Green New Deal .
This is coming right down the train tracks at Harris with lights blaring and the horn blowing .
This wo n't be a sneak attack .
Harris ' challenge will be to make a bold moral argument against the Trump administration @ @ @ @ @ @ @ and articulating the Biden campaign line clearly , forcefully and believably .
5 .
How does Trump 's health come up ?
The elephant in the room of this debate is President Trump 's health .
The president tested positive for COVID-19 last week .
While he 's back at the White House and says he 's `` FEELING GREAT ! ''
his doctors caution that he 's not `` out of the woods . ''
The administration and the president 's doctors have delivered conflicting messages over the past few days , @ @ @ @ @ @ @ in a hermetically sealed car with aides and Secret Service in the vehicle to visit supporters outside Walter Reed , where he was hospitalized , on Sunday .
When he returned to the White House on Monday evening , he waved from a balcony , without a mask , and recorded a video urging Americans not to let the coronavirus `` dominate you . ''
The succession plan — in case his health does decline further — also has n't been clear , and continuity of government is an important thing to reflect @ @ @ @ @ @ @ are always looking for American weakness .
Pence is likely going to have to be spokesman for how the administration has dealt with not just this situation , but the coronavirus more broadly — to a large audience — especially since he is ostensibly still in charge of the White House Coronavirus Task Force .
On Tuesday , Trump announced a halt to negotiations on a new coronavirus relief package — talks that had largely stalled on their own — until after the election .
The administration has gotten criticized for its response @ @ @ @ @ @ @ it ; and Pence is going to have to give voters who could be open to voting for Trump the confidence that the administration can handle the ongoing pandemic .
Trump getting the virus may also mean Harris adjusting her approach on how personal she can get about his handling of the pandemic .
The Biden campaign has been trying to walk that line already , wishing the president and first lady well , but criticizing his approach to COVID-19 .

5 Questions Ahead Of The Pence-Harris Vice Presidential Debate
Enlarge this image toggle caption Robyn Beck/AFP via Getty Images Robyn Beck/AFP via Getty Images
Vice President Pence and California Sen. Kamala Harris square off in the first and only vice presidential debate Wednesday at 9 p.m. ET in Salt Lake City.
Pence has laid low with President Trump undergoing treatment for the coronavirus, a threat the president had downplayed for months. But Pence is going to need to show up in a big way to try to inject some needed positive energy into the Trump-Pence presidential campaign, which has been consistently lagging Biden-Harris in the polls.
Progressives, frustrated with Joe Biden's sometimes uneven public speaking appearances, have been waiting for this moment. They think Harris, who is more than 20 years younger than Biden, can deliver a better rhetorical punch.
Both vice presidential candidates have said they are looking forward to the debate.
"My message to the Democratic nominee for vice president: congratulations. I'll see you in Salt Lake City," Pence said after Harris was selected as Biden's running mate.
Harris responded wryly and with a wide smile in an interview with ABC, simply saying: "Oh good. Me, too. Oh, I'm looking forward to seeing him. Absolutely."
Well, game on. Here are five questions ahead of Wednesday night's debate:
1. Can Pence right the ship?
toggle caption Jacquelyn Martin/AP
Eight years ago, it was Biden who helped steady the Obama reelection campaign with his solid performance in the vice presidential debate. It stabilized the narrative of the presidential race after a shaky first debate for then-President Barack Obama.
On Wednesday, the same task falls to Pence, ironically. He needs to have a good debate showing and articulate a clear Trump campaign message after Trump's widely panned first debate performance followed by testing positive for COVID-19, which landed him in the hospital over the weekend.
It's been chaotic for the Trump campaign and White House. If anyone can take the temperature down, it's the understated Pence.
Pence, though, is very conservative, and while that appeals to the base, especially white evangelicals, he and Trump aren't lining up with the middle of the electorate. Independents and suburban voters have abandoned Trump on most issues during the Trump presidency, and Trump did nothing to reach out beyond the base in the first debate. That has to be a task for Pence, but how does he do it given his politics?
2. How does Pence counter a Harris punch?
Harris has shown an ability to go viral and speak in soundbites, whether at high-profile hearings or some of the Democratic primary debates. She will aim to put Pence on his heels, and he's not dealing with the more staid Sen. Tim Kaine of Virginia, Hillary Clinton's vice presidential pick, who went up against Pence in 2016.
Harris can be a strong debater and will certainly look for ways to bring the hammer down on Pence and make him defend unpopular Trump policies, positions and statements. How and whether Pence can counter could determine who wins the debate.
Harris has the added hurdle of being the first woman of color on a major-party presidential ticket, and her team is well aware that she has to navigate everything that comes with that, as well. Of course, Harris has been dealing with that her entire career and life.
But there are potential pitfalls on race and gender that Pence has to be careful about in responding and attacking.
3. Does Harris live up to the hype?
Enlarge this image toggle caption Ethan Miller/Getty Images Ethan Miller/Getty Images
This is the moment progressives have been waiting for. They desperately want someone to stick it to Team Trump.
But remember that debates can be all about expectations. The bar was very low for Biden because Trump and his campaign have cast him as incompetent and "not all there." Trump's antics made it easy for Biden to clear that bar. But there are lots of expectations for Harris, and she needs to deliver a solid performance to keep the Biden train moving forward.
Also, because of Biden's age, the spotlight may be brighter on Harris than for past vice presidential nominees. Democrats have set her up as the heir apparent after a Biden presidency, whether Biden runs for reelection or not. So this is a chance for her to show not just that she will be an attack dog for Biden, but for a large audience to see what kind of potential president she would be.
4. Can Harris stick to the Biden line?
One way Pence has signaled pretty loudly that he will go after Harris is painting her as tied to the "radical left," someone who will try to drag Biden further than his public statements are leading on.
"As you all know, Joe Biden and the Democratic Party have been overtaken by the radical left," Pence told a crowd in Mesa, Ariz., after Harris was named Biden's running mate. "So given their promises of higher taxes, open borders, socialized medicine and abortion on demand, it's no surprise that he chose Sen. Harris. You all might like to know that the vice presidential debate is on Oct. 7 in Utah."
The next day, Pence said this on Fox News: "I can't wait to get to Salt Lake City and be on the stage with her, to compare Joe Biden's nearly 50 years in public life — the agenda of the radical left, the agenda that she's embraced throughout her political career — with the results of this president and this administration."
This is the Trump campaign's Trojan horse theory — despite Biden making it clear he's in charge and not on board with withdrawing funding from the police, "Medicare for All" or the Green New Deal.
This is coming right down the train tracks at Harris with lights blaring and the horn blowing. This won't be a sneak attack. Harris' challenge will be to make a bold moral argument against the Trump administration, while also playing the good soldier and articulating the Biden campaign line clearly, forcefully and believably.
5. How does Trump's health come up?
toggle caption J. Scott Applewhite/AP
The elephant in the room of this debate is Trump's health. The president tested positive for COVID-19 last week. While he's back at the White House and says he's "FEELING GREAT!" his doctors caution that he's not "out of the woods."
The administration and the president's doctors have delivered conflicting messages over the past few days, and the president made an impromptu trip in a hermetically sealed car with aides and Secret Service in the vehicle to visit supporters outside Walter Reed, where he was hospitalized, on Sunday.
When he returned to the White House on Monday evening, he waved from a balcony, without a mask, and recorded a video urging Americans not to let the coronavirus "dominate you."
The succession plan — in case his health does decline further — also hasn't been clear, and continuity of government is an important thing to reflect to the world, especially adversaries who are always looking for American weakness.
Pence is likely going to have to be spokesman for how the administration has dealt with not just this situation, but the coronavirus more broadly — to a large audience — especially since he is ostensibly still in charge of the White House Coronavirus Task Force.
On Tuesday, Trump announced a halt to negotiations on a new coronavirus relief package — talks that had largely stalled on their own — until after the election.
The administration has gotten criticized for its response; Trump is suffering politically because of it; and Pence is going to have to give voters who could be open to voting for Trump the confidence that the administration can handle the ongoing pandemic.
Trump getting the virus may also mean Harris adjusting her approach on how personal she can get about his handling of the pandemic. The Biden campaign has been trying to walk that line already, wishing the president and first lady well, but criticizing his approach to COVID-19.


npr--2020-10-07--Massachusetts Voters Split On Trump's Handling Of Coronavirus

Voters are both denouncing and defending President Trump for how he 's handling his COVID-19 diagnosis , reflecting the deep political divide over how he has managed the pandemic as a whole .
Even in blue Massachusetts , the president is getting both criticism and kudos .
Tony Beaulieu never goes anywhere without his `` Trump 2020 '' hat on the front windshield of his truck , and his Trump flag in the back .
His face mask is usually somewhere on the floor .
`` I only wear a mask when I have to go in the store or @ @ @ @ @ @ @ I take zero precautions .
And all the people in my circle , same thing .
They do n't wear masks either . ''
Finishing lunch in his truck , outside a sandwich place in Waltham , Mass.
, Beaulieu , who owns a construction business , said he believes Democrats have been exaggerating the threat of COVID-19 , just to make Trump look bad before the election .
`` This coronavirus is nothing like what they 're saying .
They make up the numbers , '' he said last week , just @ @ @ @ @ @ @ infected .
But reached by phone afterward , Beaulieu conceded that Trump 's diagnosis left him feeling a little more concerned .
`` It does make you think a little bit , '' he sighed .
`` Now that it 's in the White House and the president can get it , I guess I could get it too .
You know , I would hate to get COVID and die . ''
But Beaulieu 's worry would n't last long .
When Trump left the hospital Monday evening , tweeting that he @ @ @ @ @ @ @ afraid of Covid , '' Beaulieu was once again reassured .
`` I do n't know , maybe [ the risk ] is , you know , not as bad as it 's cracked up to be . ''
That infuriated Massachusetts ' many pandemic-prudent Democrats , out shopping at the same strip mall yesterday .
`` Trump is [ saying ] 'Look , I told you it 's nothing .
Look , I got over it in two days .
You can too , ' '' said fashion designer David Josef .
@ @ @ @ @ @ @ I think it is very selfish , very irresponsible and very ignorant , '' said Jennifer Craig , who works in development at a nearby museum .
The president continues to discourage social distancing and mask wearing , Craig said , which will `` result in more people becoming sick , more people dying and more people infecting others . ''
Josef and his husband , Dan Forrester , say they were especially outraged to see Trump mask-less in the White House while contagious , grossly downplaying the dangers of the deadly virus @ @ @ @ @ @ @ alarming records in many states .
`` He 's throwing gas kerosene on the fire , '' said Forrester .
`` It 's a disgrace , '' added Josef .
`` It 's such a slap in the face to the [ more than ] 200,000 Americans who have died . ''
It felt especially irresponsible to some , that Trump did n't just say his condition was `` improving '' or `` good , '' but instead tweeted a characteristically over-the-top pronouncement that `` I feel better than I did 20 years @ @ @ @ @ @ @ the drugs are impacting his mental acuity to be honest , '' quipped grad student Alex Berlin , who works as a contact tracer .
`` I talk to people for my job about having coronavirus , and [ none of them ] feel like they 're 20 years younger , '' he said .
Fellow grad student Aislinn Mayfield said she too finds Trump 's tweets dangerously misleading , especially since he is benefiting from taking drugs that are unavailable to other Americans .
`` For him to just brush it off @ @ @ @ @ @ @ he 's saying .
But I think he has definitely not thought about a lot of people in communities of color who need to take it seriously because there 's a lot more risk there . ''
Trump loyalists , however , dismiss such criticism as partisan attacks .
No one could have done better battling such a deadly virus , they say .
And Trump had an equally important role to play as a kind of `` Calmer-in-Chief . ''
`` He 's just trying to not panic people .
You have @ @ @ @ @ @ @ Lampron , who traveled from Florida to work on a construction project in Massachusetts .
`` Look what happened with the toilet paper . ''
Lampron said Trump is also right to reassure people about the progress made on COVID treatment options .
`` There are more drugs now than we had at the beginning of the pandemic , so we are better off , '' he said .
Another die-hard Trumper sees the president 's weekend drive-by outside the hospital , as reassuring as well , and defends the move that was @ @ @ @ @ @ @ agents .
`` These people take a bullet for him .
So he has COVID-19 , and they 're supposed to do what ?
Social distance ?
They 're not supposed to protect the leader of the free world because he has COVID-19 ?
They ca n't say , 'Sorry , Mr. President , you have COVID-19 so we 're going to have to stay 20 feet back from you , ' `` said the Trump supporter , who asked that his name not be used .
`` I do n't want to @ @ @ @ @ @ @ he said , `` because I do n't want those quacks out there who are rioting and burning things down to come by my house because they do n't like Trump . ''
`` It 's unfortunate , '' he said , that the country is so divided that `` no matter what [ Trump ] does , it 's always going to be wrong . ''
Though , he noted , he distinguishes between liking the president personally , and liking his policies .
Another voter , Kevin Mac , a former @ @ @ @ @ @ @ said he too bristles sometimes at things the president says or tweets , but he chooses to look the other way , and focus instead on what he sees as the president 's strong leadership on the economy , and trade .
`` You know , the president spews stuff .
I 'm not saying it 's right , '' said Mac .
`` But you know what ?
I do n't want no cupcakes in [ the White House . ]
You 've got to take care of your own country .
@ @ @ @ @ @ @ , bamboozled . ''
Polls however suggest fewer voters may see it that way .
Trump 's handling of his own illness and of the pandemic more broadly appears to be eroding public trust in him , leaving more voters wondering if they 're being bamboozled by their president .

How Massachusetts Voters View Trump's Handling Of The Coronavirus
Enlarge this image toggle caption Tovia Smith/NPR Tovia Smith/NPR
Voters are both denouncing and defending President Trump for how he's handling his COVID-19 diagnosis, reflecting the deep political divide over how he has managed the pandemic as a whole. Even in blue Massachusetts, the president is getting both criticism and kudos.
Tony Beaulieu never goes anywhere without his "Trump 2020" hat on the front windshield of his truck, and his Trump flag in the back. His face mask is usually somewhere on the floor.
"I only wear a mask when I have to go in the store or something," he said. "I take zero precautions. And all the people in my circle, same thing. They don't wear masks either."
Finishing lunch in his truck, outside a sandwich place in Waltham, Mass., Beaulieu, who owns a construction business, said he believes Democrats have been exaggerating the threat of COVID-19, just to make Trump look bad before the election.
"This coronavirus is nothing like what they're saying. They make up the numbers," he said last week, just before news broke that the president was infected.
But reached by phone afterward, Beaulieu conceded that Trump's diagnosis left him feeling a little more concerned.
"It does make you think a little bit," he sighed. "Now that it's in the White House and the president can get it, I guess I could get it too. You know, I would hate to get COVID and die."
But Beaulieu's worry wouldn't last long. When Trump left the hospital Monday evening, tweeting that he felt great and "Don't be afraid of Covid," Beaulieu was once again reassured.
"I don't know, maybe [the risk] is, you know, not as bad as it's cracked up to be."
That infuriated Massachusetts' many pandemic-prudent Democrats, out shopping at the same strip mall yesterday.
"Trump is [saying] 'Look, I told you it's nothing. Look, I got over it in two days. You can too,'" said fashion designer David Josef. "This is insanity."
"I think it is very selfish, very irresponsible and very ignorant," said Jennifer Craig, who works in development at a nearby museum. The president continues to discourage social distancing and mask wearing, Craig said, which will "result in more people becoming sick, more people dying and more people infecting others."
Josef and his husband, Dan Forrester, say they were especially outraged to see Trump mask-less in the White House while contagious, grossly downplaying the dangers of the deadly virus even as cases are rising and setting alarming records in many states.
"He's throwing gas kerosene on the fire," said Forrester.
"It's a disgrace," added Josef. "It's such a slap in the face to the [more than] 200,000 Americans who have died."
It felt especially irresponsible to some, that Trump didn't just say his condition was "improving" or "good," but instead tweeted a characteristically over-the-top pronouncement that "I feel better than I did 20 years ago!"
"It sounds like the drugs are impacting his mental acuity to be honest," quipped grad student Alex Berlin, who works as a contact tracer. "I talk to people for my job about having coronavirus, and [none of them] feel like they're 20 years younger," he said.
Fellow grad student Aislinn Mayfield said she too finds Trump's tweets dangerously misleading, especially since he is benefiting from taking drugs that are unavailable to other Americans.
"For him to just brush it off, he's privileged to say what he's saying. But I think he has definitely not thought about a lot of people in communities of color who need to take it seriously because there's a lot more risk there."
Trump loyalists, however, dismiss such criticism as partisan attacks. No one could have done better battling such a deadly virus, they say. And Trump had an equally important role to play as a kind of "Calmer-in-Chief."
"He's just trying to not panic people. You have to do that," said Rick Lampron, who traveled from Florida to work on a construction project in Massachusetts. "Look what happened with the toilet paper."
Lampron said Trump is also right to reassure people about the progress made on COVID treatment options. "There are more drugs now than we had at the beginning of the pandemic, so we are better off," he said.
Another die-hard Trumper sees the president's weekend drive-by outside the hospital, as reassuring as well, and defends the move that was widely panned for endangering his Secret Service agents.
"These people take a bullet for him. So he has COVID-19, and they're supposed to do what? Social distance? They're not supposed to protect the leader of the free world because he has COVID-19? They can't say, 'Sorry, Mr. President, you have COVID-19 so we're going to have to stay 20 feet back from you,' " said the Trump supporter, who asked that his name not be used.
"I don't want to put my family in jeopardy," he said, "because I don't want those quacks out there who are rioting and burning things down to come by my house because they don't like Trump."
"It's unfortunate," he said, that the country is so divided that "no matter what [Trump] does, it's always going to be wrong." Though, he noted, he distinguishes between liking the president personally, and liking his policies.
Enlarge this image toggle caption Tovia Smith/NPR Tovia Smith/NPR
Another voter, Kevin Mac, a former corrections officer and a former Democrat, said he too bristles sometimes at things the president says or tweets, but he chooses to look the other way, and focus instead on what he sees as the president's strong leadership on the economy, and trade.
"You know, the president spews stuff. I'm not saying it's right," said Mac. "But you know what? I don't want no cupcakes in [the White House.] You've got to take care of your own country. We can't be, you know, bamboozled."
Polls however suggest fewer voters may see it that way. Trump's handling of his own illness and of the pandemic more broadly appears to be eroding public trust in him, leaving more voters wondering if they're being bamboozled by their president.


npr--2020-10-07--Getting Health Care Was Already Tough In Rural Areas. The Pandemic Has Made It Worse

Getting Health Care Was Already Tough In Rural Areas .
The Pandemic Has Made It Worse Even when there is n't a pandemic , finding the right doctor can be tough in rural eastern Ohio .
Reid Davis , 21 , and his mother Crystal live in Jefferson County , which hugs the Ohio River near West Virginia .
Their home is surrounded by farms , hayfields and just a few neighbors .
`` To the nearest hospital , you 're talking about 50 minutes to an hour , '' Reid Davis says .
Davis ' mother has rheumatoid arthritis @ @ @ @ @ @ @ which she sees a specialist .
That doctor prescribes an injectable medication and also works on her joints to ease inflammation and pain , he says .
But when the pandemic began , that doctor stopped seeing patients .
Nearly six months went by , and only recently was Crystal Davis able to resume in-person visits .
In the meantime , her condition got worse .
`` There have been days where she 's just been unwilling to get out of bed because of pain , '' Davis says .
There were only @ @ @ @ @ @ @ drive and none of them were accepting new patients at the time .
Even before the pandemic , the health care systems that serve rural Americans were in decline : rural hospitals were closing their doors , and the medical workforce was shrinking .
This year , as the coronavirus outbreak has made its way from major cities to rural America , threats to the rural health care infrastructure have only increased .
A new nationwide poll shows that one in every four rural U.S households have been unable to get medical care @ @ @ @ @ @ @ that had trouble getting care , more than half reported that a family member experienced negative health consequences as a result .
The poll was conducted by NPR , the Harvard T.H .
Chan School of Public School and the Robert Wood Johnson Foundation .
`` The crisis is really widening the fractures that have already existed in rural communities , '' says Brock Slabach , senior vice president of the National Rural Health Association , based in Kansas .
New coronavirus infections in rural America are now at record levels , with @ @ @ @ @ @ @ `` red zone , '' defined as places with an infection rate of 100 or more new cases per 100,000 residents .
Only 14 % of the U.S. population lives in rural counties , but last week 20 % of new cases and 23 % of COVID-19-related deaths were in rural counties , according to an analysis by The Daily Yonder , an online newspaper that covers rural America .
Rural Americans contacted for the NPR poll — from Montana to Georgia to upstate New York — discussed problems getting treatment for many @ @ @ @ @ @ @ virus .
In the U.S. , one of the biggest obstacles to getting health care is the simple fact of not having health coverage , and people living in rural areas are more likely to be uninsured compared to other Americans .
Not having insurance can also mean higher out-of-pocket payments for treatments or medications , on top of other pandemic-related financial stresses .
But the poll also revealed many non-financial obstacles .
In interviews with NPR , rural respondents talked about being forced to cancel surgeries and procedures , waiting months for @ @ @ @ @ @ @ hold , or spending hours on the road in search of specialists .
Some talked specifically about their struggles to get a coronavirus test .
Because of these problems , many were experiencing increased pain , anxiety or financial hardship .
Over the past 15 years , 174 rural hospitals have closed in the U.S. and the pandemic may be accelerating the trend .
So far , 15 rural hospitals have closed in 2020 , casualties of the pandemic-related shutdowns that forced hospitals to cancel elective surgeries , an important source of their @ @ @ @ @ @ @ some people also avoided going to the hospital , even for life-threatening emergencies .
Among the rural hospitals that remain , more than half do n't have an intensive care unit , according to Slabach .
`` As the hotspots grow , where do these people go ?
A lot of them have serious illnesses , '' says Harvard professor Robert J. Blendon , a co-director for the NPR poll .
Unlike major metro areas where hospitals have lots of beds , many smaller hospitals in geographically isolated places are not equipped to @ @ @ @ @ @ @ the same time , Blendon says .
`` People are hundreds of miles away and many rural hospitals have been deciding , 'Can I take anybody else but COVID ? '
`` he says .
The poll looked closely at two especially vulnerable groups : rural households that include someone living with a chronic illness , and rural households that include someone at high risk for a serious case of COVID-19 ( due to age or underlying health conditions ) .
In both groups , about a third of the households reported problems @ @ @ @ @ @ @ really scary that there 's a very large number of rural households at risk at this point , and we have n't figured out a better way to provide care for them , '' says Mary Gorski Findling , a researcher with Harvard 's polling team .
`` The rural health care workforce was already disproportionately small , '' says professor Carrie Henning-Smith , who studies rural health at the University of Minnesota .
The pandemic disrupted a root canal for Stephen McDonald , and he ended up losing the entire tooth , @ @ @ @ @ @ @ about 70 miles outside of Missoula , Mont.
, and was left stranded after many doctors and dentists temporarily shut down their offices in the spring .
His dentist had begun the root canal , but had to call off the follow-up appointment .
With limited options in his area , McDonald had to make do with the temporary filling .
`` During that period of waiting , my tooth cracked and the tooth was no longer salvageable , '' McDonald says .
Even to remove the cracked tooth proved difficult .
A @ @ @ @ @ @ @ so McDonald went to a different dentist an hour away .
But that dentist could only extract a portion of the cracked tooth .
`` Because of the procedures they had to follow for COVID , they were n't able to extract the rest of the tooth , so I had to go to an oral surgeon , '' he says .
While many health care providers tried to cope by using telehealth , it does n't cover urgent problems that require hands-on treatment .
In addition , the NPR poll found that @ @ @ @ @ @ @ problems connecting to the Internet .
Slabach says ensuring people have adequate broadband connections would help , but even that would n't be enough .
`` Many of our rural citizens are older , poorer and sicker , and so they do n't have iPads .
They do n't have the necessary means , perhaps , to communicate , '' Slabach says .
Cynthia Davis , who lives in central Missouri , says she had lots of trouble using telehealth .
`` I 've got a small phone so I had a three-inch @ @ @ @ @ @ @ , '' Davis says of her efforts to use telehealth .
`` That did not work well , and even the phone would not work half the time . ''
Along with obstacles to health care , many rural households are under immense financial pressure during the pandemic , according to the NPR poll .
More than 40 % reported they are facing serious financial problems .
For Black and Latino households , the economic toll is especially stark in rural America .
More than 80 % of those households are facing serious @ @ @ @ @ @ @ % of white rural households .
More than 40 % of rural families also said at least one person in their household had lost a job , been furloughed , or had wages or hours reduced .
In addition , more than half of families also shared that they are having serious problems caring for their children .
Even as more clinics and doctors have resumed in-person appointments , some patients are encountering long wait times because there are not enough providers in rural areas to handle the backlog of patients .
In @ @ @ @ @ @ @ to get her husband to the right doctors , when he started having severe abdominal pain in early August .
Until last week , she kept hearing that the earliest he could get surgery was late October .
`` He 's lost a ton of weight because he ca n't eat , '' Booher says .
`` I feel like this is being elongated because doctors have been closed , and now they 're just trying to play catch up . ''
Brett Corbett of Glens Falls , N.Y. , says that last @ @ @ @ @ @ @ were called off .
Corbett is in recovery for substance use disorder .
`` All my mental health appointments got cancelled across the board , '' Corbett says .
`` It 's December before anyone can get a doctor 's appointment around here . ''
Even with so much attention on the coronavirus , some living in rural America are barely able to find tests .
Sunshine Peebles , who lives an hour outside Syracuse , N.Y. , worried she might have COVID-19 when she spiked a fever .
`` There 's a @ @ @ @ @ @ @ free testing , where I am in upstate New York , that 's not an option , '' Peebles says .
Peebles ca n't afford health insurance and says money was tight because her family 's small construction business was out of work because of the pandemic .
`` I should have gone sooner .
I just could n't wait any longer .
I had to go to an urgent care , '' she says .
She had to pay $ 150 out of pocket .
Luckily , her test result came back @ @ @ @ @ @ @ her community have encountered similar problems .
`` I think it 's a big dilemma for people who live in the more rural areas , '' she says .

Getting Health Care Was Already Tough In Rural Areas. The Pandemic Has Made It Worse
Enlarge this image toggle caption Daniel Acker/Bloomberg via Getty Images Daniel Acker/Bloomberg via Getty Images
Even when there isn't a pandemic, finding the right doctor can be tough in rural eastern Ohio. Reid Davis, 21, and his mother Crystal live in Jefferson County, which hugs the Ohio River near West Virginia. Their home is surrounded by farms, hayfields and just a few neighbors.
"To the nearest hospital, you're talking about 50 minutes to an hour," Reid Davis says.
Davis' mother has rheumatoid arthritis, a severe autoimmune condition, for which she sees a specialist. That doctor prescribes an injectable medication and also works on her joints to ease inflammation and pain, he says.
But when the pandemic began, that doctor stopped seeing patients. Nearly six months went by, and only recently was Crystal Davis able to resume in-person visits.
In the meantime, her condition got worse.
"There have been days where she's just been unwilling to get out of bed because of pain," Davis says.
There were only a few other rheumatologists within a two-hour drive and none of them were accepting new patients at the time.
Even before the pandemic, the health care systems that serve rural Americans were in decline: rural hospitals were closing their doors, and the medical workforce was shrinking. This year, as the coronavirus outbreak has made its way from major cities to rural America, threats to the rural health care infrastructure have only increased.
A new nationwide poll shows that one in every four rural U.S households have been unable to get medical care for serious problems. Among those households that had trouble getting care, more than half reported that a family member experienced negative health consequences as a result.
The poll was conducted by NPR, the Harvard T.H. Chan School of Public School and the Robert Wood Johnson Foundation.
"The crisis is really widening the fractures that have already existed in rural communities," says Brock Slabach, senior vice president of the National Rural Health Association, based in Kansas.
New coronavirus infections in rural America are now at record levels, with 54% of rural counties in the "red zone," defined as places with an infection rate of 100 or more new cases per 100,000 residents.
Only 14% of the U.S. population lives in rural counties, but last week 20% of new cases and 23% of COVID-19-related deaths were in rural counties, according to an analysis by The Daily Yonder, an online newspaper that covers rural America.
Rural Americans contacted for the NPR poll — from Montana to Georgia to upstate New York — discussed problems getting treatment for many types of health problems, including the virus.
In the U.S., one of the biggest obstacles to getting health care is the simple fact of not having health coverage, and people living in rural areas are more likely to be uninsured compared to other Americans. Not having insurance can also mean higher out-of-pocket payments for treatments or medications, on top of other pandemic-related financial stresses.
But the poll also revealed many non-financial obstacles. In interviews with NPR, rural respondents talked about being forced to cancel surgeries and procedures, waiting months for appointments, putting mental health care on hold, or spending hours on the road in search of specialists. Some talked specifically about their struggles to get a coronavirus test. Because of these problems, many were experiencing increased pain, anxiety or financial hardship.
Over the past 15 years, 174 rural hospitals have closed in the U.S. and the pandemic may be accelerating the trend. So far, 15 rural hospitals have closed in 2020, casualties of the pandemic-related shutdowns that forced hospitals to cancel elective surgeries, an important source of their revenue. Because of the pandemic, some people also avoided going to the hospital, even for life-threatening emergencies. Among the rural hospitals that remain, more than half don't have an intensive care unit, according to Slabach.
"As the hotspots grow, where do these people go? A lot of them have serious illnesses," says Harvard professor Robert J. Blendon, a co-director for the NPR poll.
Unlike major metro areas where hospitals have lots of beds, many smaller hospitals in geographically isolated places are not equipped to handle COVID-19 patients and other emergencies at the same time, Blendon says.
"People are hundreds of miles away and many rural hospitals have been deciding, 'Can I take anybody else but COVID?' " he says.
Long waits mean pain, delayed surgeries, and dental problems
The poll looked closely at two especially vulnerable groups: rural households that include someone living with a chronic illness, and rural households that include someone at high risk for a serious case of COVID-19 (due to age or underlying health conditions). In both groups, about a third of the households reported problems getting medical care.
"It's really scary that there's a very large number of rural households at risk at this point, and we haven't figured out a better way to provide care for them," says Mary Gorski Findling, a researcher with Harvard's polling team.
"The rural health care workforce was already disproportionately small," says professor Carrie Henning-Smith, who studies rural health at the University of Minnesota.
The pandemic disrupted a root canal for Stephen McDonald, and he ended up losing the entire tooth, and incurring additional costs.
McDonald lives about 70 miles outside of Missoula, Mont., and was left stranded after many doctors and dentists temporarily shut down their offices in the spring. His dentist had begun the root canal, but had to call off the follow-up appointment.
With limited options in his area, McDonald had to make do with the temporary filling.
"During that period of waiting, my tooth cracked and the tooth was no longer salvageable," McDonald says.
Even to remove the cracked tooth proved difficult. A local dentist couldn't see him, so McDonald went to a different dentist an hour away.
But that dentist could only extract a portion of the cracked tooth.
"Because of the procedures they had to follow for COVID, they weren't able to extract the rest of the tooth, so I had to go to an oral surgeon," he says.
While many health care providers tried to cope by using telehealth, it doesn't cover urgent problems that require hands-on treatment. In addition, the NPR poll found that a third of rural households have serious problems connecting to the Internet.
Slabach says ensuring people have adequate broadband connections would help, but even that wouldn't be enough.
"Many of our rural citizens are older, poorer and sicker, and so they don't have iPads. They don't have the necessary means, perhaps, to communicate," Slabach says.
Cynthia Davis, who lives in central Missouri, says she had lots of trouble using telehealth.
"I've got a small phone so I had a three-inch screen to do these online video appointments," Davis says of her efforts to use telehealth. "That did not work well, and even the phone would not work half the time."
Along with obstacles to health care, many rural households are under immense financial pressure during the pandemic, according to the NPR poll. More than 40% reported they are facing serious financial problems.
For Black and Latino households, the economic toll is especially stark in rural America. More than 80% of those households are facing serious financial problems, compared to only 36% of white rural households.
More than 40% of rural families also said at least one person in their household had lost a job, been furloughed, or had wages or hours reduced. In addition, more than half of families also shared that they are having serious problems caring for their children.
Even as more clinics and doctors have resumed in-person appointments, some patients are encountering long wait times because there are not enough providers in rural areas to handle the backlog of patients.
In Arkansas, Elizabeth Booher says she scrambled to get her husband to the right doctors, when he started having severe abdominal pain in early August.
Until last week, she kept hearing that the earliest he could get surgery was late October.
"He's lost a ton of weight because he can't eat," Booher says. "I feel like this is being elongated because doctors have been closed, and now they're just trying to play catch up."
Brett Corbett of Glens Falls, N.Y., says that last spring all of his doctor's appointments were called off. Corbett is in recovery for substance use disorder.
"All my mental health appointments got cancelled across the board," Corbett says. "It's December before anyone can get a doctor's appointment around here."
Even with so much attention on the coronavirus, some living in rural America are barely able to find tests.
Sunshine Peebles, who lives an hour outside Syracuse, N.Y., worried she might have COVID-19 when she spiked a fever.
"There's a lot of people who have access to free testing, where I am in upstate New York, that's not an option," Peebles says.
Peebles can't afford health insurance and says money was tight because her family's small construction business was out of work because of the pandemic.
"I should have gone sooner. I just couldn't wait any longer. I had to go to an urgent care," she says.
She had to pay $150 out of pocket. Luckily, her test result came back negative, but she knows others in her community have encountered similar problems.
"I think it's a big dilemma for people who live in the more rural areas," she says.


npr--2020-10-07--An Impossible Choice For Homeless Parents: A Job, Or Their Child's Education

An Impossible Choice For Homeless Parents : A Job , Or Their Child 's Education The closure of school buildings in response to the coronavirus has been disruptive and inconvenient for many families , but for those living in homeless shelters or hotel rooms — including roughly 1.5 million school-aged children — the shuttering of classrooms and cafeterias has been disastrous .
For Rachel , a 17-year-old sharing a hotel room in Cincinnati with her mother , the disaster has been academic .
Her school gave her a laptop , but `` hotel Wi-Fi is the worst , '' she @ @ @ @ @ @ @ my teacher is ] like , 'Rachel , you 're glitching .
Rachel , you 're not moving . '
'' For Vanessa Shefer , the disaster has made her feel `` defeated . ''
Since May , when the family home burned , she and her four children have stayed in a hotel , a campground and recently left rural New Hampshire to stay with extended family in St. Johnsbury , Vt .
Her kids ask , `` When are we going to have a home ? ''
But Shefer says she @ @ @ @ @ @ @ without a good-paying job , and she ca n't get a job while her kids need help with school .
For this story , NPR spoke with students , parents , caregivers , shelter managers and school leaders across the country about what it means , in this moment , to be homeless and schoolless .
`` How do you choose between working and ... your child 's education ? ''
Remote learning can be difficult for children without an adult at home to supervise everything from logging on to the learning itself @ @ @ @ @ @ @ all parents and caregivers in a bind , but many families who are homeless now find themselves in an impossible situation .
`` How do you choose between working and providing for your family , and your child 's education ?
I mean , what is your priority ? ''
says Patricia Rivera , a former Chicago Public Schools social worker and founder of Chicago HOPES For Kids , an afterschool program for homeless youth .
Rivera points out that many homeless shelters do n't allow parents to leave their children while they @ @ @ @ @ @ @ , kids have simply gone to school or parents have found low-cost childcare .
But , because of the pandemic , those options have disappeared for many families .
Parents and caregivers experiencing homelessness are also more likely to work low-wage jobs that can not be done remotely and that offer little schedule flexibility .
In May , Vanessa Shefer felt torn between her job at Dollar Tree and helping her kids with remote learning .
`` It was just getting crazy , '' she remembers .
She would work from 6 a.m. @ @ @ @ @ @ @ were having to log on , I just had to trust that that 's what was happening there . ''
The kids ' father dropped in to help , Shefer says , but their two eldest sons struggled .
Both have specialized education plans , and both had trouble navigating school online .
`` It 's hard for them to grasp what to do , '' Shefer says .
`` And they get frustrated and give up before they even try ... My children were required to have four Zoom meetings a day @ @ @ @ @ @ @ them assigned work .
So it was too much . ''
Shefer ultimately chose to quit her job to be with her children full-time .
April , a mother in Chatham , N.J. , also felt torn about leaving her children , in her case to look for work .
She and her four kids were placed in a cramped hotel room earlier this year , after they lost their home .
She described her experience to federal lawmakers in a July online briefing , in which she was identified only by her @ @ @ @ @ @ @ train , looking for work in the midst of the pandemic , and her kids calling , `` complaining , 'We ca n't log on .
The Internet 's not working . '
'' The hotel was about 45 minutes away from their school , April said .
`` My kids had nowhere to go , nowhere to be , no outlet .
I found a job , and they were angry at me because I 'm leaving and they ca n't . ''
Even if they do n't need adult supervision , @ @ @ @ @ @ @ have access to a computer and the Internet .
While many districts have provided the former , several families experiencing homelessness tell NPR they still struggle to get online .
Freda , in Cincinnati , says her five children have tablets , thanks to their district , and free Wi-Fi , thanks to a partnership between the schools and the service provider , Cincinnati Bell .
But the download speed is too slow for all of them to use at once , Freda says .
`` It sucks .
Bad . ''
( @ @ @ @ @ @ @ name because she and her children say they fear the societal stigma that 's sometimes associated with homelessness . )
April told lawmakers the poor Wi-Fi at her hotel discouraged her kids from participating in online learning .
`` It was just impossible .
They just did n't want to do the work at all because they felt so hopeless .
I had nothing to take away from them if they did n't do their work .
What was I going to take away ?
Nothing . ''
Rebekah Lopez , a mother @ @ @ @ @ @ @ worried about her 7-year-old daughter falling behind .
They 've been living in a camper , without steady Internet .
When schools moved online in the spring , learning essentially stopped for Lopez 's family .
`` I feel like [ my children ] have kind of regressed since all this has happened because they have n't been in school like they should be , '' Lopez says .
Even in districts that are handing out Internet hotspots , families experiencing homelessness may not know about the giveaways because they 've moved , @ @ @ @ @ @ @ they search for stable housing , and may not have reliable access to email or a phone .
For children experiencing homelessness , the greatest challenge of remote learning may not be logistical at all — but emotional .
Freda and her children — ages 17 , 13 , 11 , 9 and 7 — share the front room of a friend 's apartment , sleeping on the floor on pads of bunched-up comforters .
A few weeks ago , she and her youngest were watching a cartoon , about a group of @ @ @ @ @ @ @ , `` I miss school .
When are we going back ? ''
Freda knew immediately what he meant .
He missed his friends .
He missed his teachers .
He missed the familiarity of the building itself .
Life in a shelter , hotel or a distant relative 's home can be isolating for a child if they 're not living near friends .
Freda says the place they 're living now is far from school , and her kids have not been able to play with friends .
Many families do @ @ @ @ @ @ @ with public transit still disrupted , the social isolation will continue until in-person school resumes .
`` [ School ] gives them that stability , '' says Julie White , who lost her home to Hurricane Harvey in 2017 , and is living in a shelter in Bastrop , Texas , with her 18-year-old daughter and 11-year-old granddaughter .
A few weeks ago , her granddaughter told her , `` ' I really want to go back to school .
I just do n't like being away from people . '
'' Making @ @ @ @ @ @ @ homelessness had already experienced stress and trauma before the pandemic — from changing addresses , food insecurity and physical or emotional abuse .
That makes the consistency of friends and the kind of adult support a school can provide that much more important — and its absence , that much more destabilizing .
`` There is nothing equitable about distance learning '' None of this is news to school leaders , who say it is these children — their most vulnerable students — who keep them up at night with worry .
In @ @ @ @ @ @ @ the shadow of Mount Rainier , school superintendent Krestin Bahr remembers two children in particular .
Last spring , with schools closed , they had come to pick up their free meals , then lingered outside the elementary school so they could use the Wi-Fi to work .
`` It was freezing cold , '' Bahr remembers .
`` They were huddled right in the doorway up against the closed doors ... We knew that the family was living in their car , but they did n't have any connectivity .
It just @ @ @ @ @ @ @ 'You know what ?
That just can not happen in America . '
`` In her remote town , Bahr says school is the only social safety net for homeless youth .
After seeing those two students , huddled in the cold , she told herself : `` We are never closing our doors again ...
It 's our moral obligation . ''
This fall , as Bahr has slowly reopened Eatonville 's schools , she quickly welcomed her most vulnerable students back into the buildings so they could at least log onto @ @ @ @ @ @ @ the safety of the cafeteria .
Several school leaders say the toll of closing schools haunted them this summer , as they debated how and when to reopen .
They understood that , for their most at-risk kids , especially students who are homeless , closing schools put them at even greater risk — of falling behind academically , not eating three healthy meals a day and experiencing abuse or trauma .
`` There is nothing equitable about distance learning for children and youth who are homeless , '' says Barbara Duffield , @ @ @ @ @ @ @ national nonprofit that advocates for homeless youth .
`` The cost of keeping everyone safe is costing some children much more . ''
Even in a pandemic , Duffield says , schools must do more to serve students experiencing homelessness .
It 's not only the right thing to do , she says , it 's required by the McKinney-Vento Act , a federal law that guarantees homeless children the ability to go to school , no matter where they 're staying , what paperwork they have or whether they have a parent @ @ @ @ @ @ @ are closed right now , it 's still a lifeline , '' Duffield says of the law .
`` It 's been consistent , and it 's not implemented everywhere well or at all . ''
That 's another reason many districts that remain closed for the majority of kids are slowly re-opening for students who are homeless .
Vanessa Shefer 's new district , in Vermont , is now open part-time .
Her kids recently began attending in-person two to three days a week .
With that time , Shefer hopes to @ @ @ @ @ @ @ certification to become an EMT , her dream job .
Julie White 's granddaughter also just began in-person classes at a new school , full-time .
At first , White says , the 11-year-old was scared — of having to make friends and of contracting COVID-19 .
`` But not anymore , '' her granddaughter says .
`` I love the new friends I just made , and I even ran into some old ones . ''
In Flagstaff , Rebekah Lopez and her husband now send their two children and niece to @ @ @ @ @ @ @ can at least access Wi-Fi while they continue remote learning .
It 's an improvement , Lopez says , but she 's still worried about the ground they lost .
`` They 're not getting the education that they need . ''
And in Cincinnati , where Freda has struggled to work and help her kids with remote learning , plans to reopen schools were recently scuttled because of rising infection rates .
`` My children are devastated , '' she says .
`` I 'm devastated . ''

Homeless Families Struggle With Impossible Choices As School Closures Continue
Enlarge this image toggle caption Maddie McGarvey for NPR Maddie McGarvey for NPR
The closure of school buildings in response to the coronavirus has been disruptive and inconvenient for many families, but for those living in homeless shelters or hotel rooms — including roughly 1.5 million school-aged children — the shuttering of classrooms and cafeterias has been disastrous.
For Rachel, a 17-year-old sharing a hotel room in Cincinnati with her mother, the disaster has been academic. Her school gave her a laptop, but "hotel Wi-Fi is the worst," she says. "Every three seconds [my teacher is] like, 'Rachel, you're glitching. Rachel, you're not moving.'"
For Vanessa Shefer, the disaster has made her feel "defeated." Since May, when the family home burned, she and her four children have stayed in a hotel, a campground and recently left rural New Hampshire to stay with extended family in St. Johnsbury, Vt. Her kids ask, "When are we going to have a home?" But Shefer says she can't afford a "home" without a good-paying job, and she can't get a job while her kids need help with school.
For this story, NPR spoke with students, parents, caregivers, shelter managers and school leaders across the country about what it means, in this moment, to be homeless and schoolless.
Enlarge this image toggle caption Ian Thomas Janssen-Lonnquist for NPR Ian Thomas Janssen-Lonnquist for NPR
"How do you choose between working and ... your child's education?"
Remote learning can be difficult for children without an adult at home to supervise everything from logging on to the learning itself. The past six months have put all parents and caregivers in a bind, but many families who are homeless now find themselves in an impossible situation.
"How do you choose between working and providing for your family, and your child's education? I mean, what is your priority?" says Patricia Rivera, a former Chicago Public Schools social worker and founder of Chicago HOPES For Kids, an afterschool program for homeless youth.
Rivera points out that many homeless shelters don't allow parents to leave their children while they go to work. In the past, kids have simply gone to school or parents have found low-cost childcare. But, because of the pandemic, those options have disappeared for many families.
Parents and caregivers experiencing homelessness are also more likely to work low-wage jobs that cannot be done remotely and that offer little schedule flexibility.
In May, Vanessa Shefer felt torn between her job at Dollar Tree and helping her kids with remote learning. "It was just getting crazy," she remembers. She would work from 6 a.m. to 2 p.m. "When the kids were having to log on, I just had to trust that that's what was happening there."
toggle caption Ian Thomas Jansen-Lonnquist for NPR
The kids' father dropped in to help, Shefer says, but their two eldest sons struggled. Both have specialized education plans, and both had trouble navigating school online.
"It's hard for them to grasp what to do," Shefer says. "And they get frustrated and give up before they even try... My children were required to have four Zoom meetings a day with different teachers, and all of them assigned work. So it was too much."
Shefer ultimately chose to quit her job to be with her children full-time.
April, a mother in Chatham, N.J., also felt torn about leaving her children, in her case to look for work. She and her four kids were placed in a cramped hotel room earlier this year, after they lost their home. She described her experience to federal lawmakers in a July online briefing, in which she was identified only by her first name. She recalled riding the train, looking for work in the midst of the pandemic, and her kids calling, "complaining, 'We can't log on. The Internet's not working.'"
The hotel was about 45 minutes away from their school, April said. "My kids had nowhere to go, nowhere to be, no outlet. I found a job, and they were angry at me because I'm leaving and they can't."
Enlarge this image toggle caption Ian Thomas Jansen-Lonnquist for NPR Ian Thomas Jansen-Lonnquist for NPR
A struggle to get online
Even if they don't need adult supervision, every student trying to learn remotely must have access to a computer and the Internet. While many districts have provided the former, several families experiencing homelessness tell NPR they still struggle to get online.
Freda, in Cincinnati, says her five children have tablets, thanks to their district, and free Wi-Fi, thanks to a partnership between the schools and the service provider, Cincinnati Bell. But the download speed is too slow for all of them to use at once, Freda says. "It sucks. Bad." (We aren't using Freda's last name because she and her children say they fear the societal stigma that's sometimes associated with homelessness.)
April told lawmakers the poor Wi-Fi at her hotel discouraged her kids from participating in online learning.
"It was just impossible. They just didn't want to do the work at all because they felt so hopeless. I had nothing to take away from them if they didn't do their work. What was I going to take away? Nothing."
Rebekah Lopez, a mother in Flagstaff, Ariz., is especially worried about her 7-year-old daughter falling behind. They've been living in a camper, without steady Internet. When schools moved online in the spring, learning essentially stopped for Lopez's family.
"I feel like [my children] have kind of regressed since all this has happened because they haven't been in school like they should be," Lopez says.
Even in districts that are handing out Internet hotspots, families experiencing homelessness may not know about the giveaways because they've moved, often farther from a school, as they search for stable housing, and may not have reliable access to email or a phone.
The consistency of school
For children experiencing homelessness, the greatest challenge of remote learning may not be logistical at all — but emotional.
Freda and her children — ages 17, 13, 11, 9 and 7 — share the front room of a friend's apartment, sleeping on the floor on pads of bunched-up comforters. A few weeks ago, she and her youngest were watching a cartoon, about a group of friends playing, when her son said, "I miss school. When are we going back?"
Freda knew immediately what he meant. He missed his friends. He missed his teachers. He missed the familiarity of the building itself.
Life in a shelter, hotel or a distant relative's home can be isolating for a child if they're not living near friends. Freda says the place they're living now is far from school, and her kids have not been able to play with friends. Many families don't have transportation either, and, with public transit still disrupted, the social isolation will continue until in-person school resumes.
"[School] gives them that stability," says Julie White, who lost her home to Hurricane Harvey in 2017, and is living in a shelter in Bastrop, Texas, with her 18-year-old daughter and 11-year-old granddaughter. A few weeks ago, her granddaughter told her, "'I really want to go back to school. I just don't like being away from people.'"
Making matters worse, many children living through homelessness had already experienced stress and trauma before the pandemic — from changing addresses, food insecurity and physical or emotional abuse. That makes the consistency of friends and the kind of adult support a school can provide that much more important — and its absence, that much more destabilizing.
"There is nothing equitable about distance learning"
None of this is news to school leaders, who say it is these children — their most vulnerable students — who keep them up at night with worry.
In Eatonville, Wash., which sits in the shadow of Mount Rainier, school superintendent Krestin Bahr remembers two children in particular. Last spring, with schools closed, they had come to pick up their free meals, then lingered outside the elementary school so they could use the Wi-Fi to work.
"It was freezing cold," Bahr remembers. "They were huddled right in the doorway up against the closed doors... We knew that the family was living in their car, but they didn't have any connectivity. It just tore my heart. I thought, 'You know what? That just cannot happen in America.' "
In her remote town, Bahr says school is the only social safety net for homeless youth. After seeing those two students, huddled in the cold, she told herself: "We are never closing our doors again... It's our moral obligation."
This fall, as Bahr has slowly reopened Eatonville's schools, she quickly welcomed her most vulnerable students back into the buildings so they could at least log onto district Wi-Fi and stream their lessons from the safety of the cafeteria.
Enlarge this image toggle caption Ian Thomas Jansen-Lonnquist for NPR Ian Thomas Jansen-Lonnquist for NPR
Several school leaders say the toll of closing schools haunted them this summer, as they debated how and when to reopen. They understood that, for their most at-risk kids, especially students who are homeless, closing schools put them at even greater risk — of falling behind academically, not eating three healthy meals a day and experiencing abuse or trauma.
"There is nothing equitable about distance learning for children and youth who are homeless," says Barbara Duffield, the head of SchoolHouse Connection, a national nonprofit that advocates for homeless youth. "The cost of keeping everyone safe is costing some children much more."
Even in a pandemic, Duffield says, schools must do more to serve students experiencing homelessness. It's not only the right thing to do, she says, it's required by the McKinney-Vento Act, a federal law that guarantees homeless children the ability to go to school, no matter where they're staying, what paperwork they have or whether they have a parent with them.
"Even though schools are closed right now, it's still a lifeline," Duffield says of the law. "It's been consistent, and it's not implemented everywhere well or at all."
That's another reason many districts that remain closed for the majority of kids are slowly re-opening for students who are homeless.
Vanessa Shefer's new district, in Vermont, is now open part-time. Her kids recently began attending in-person two to three days a week. With that time, Shefer hopes to re-focus on finding work and completing her certification to become an EMT, her dream job.
Julie White's granddaughter also just began in-person classes at a new school, full-time. At first, White says, the 11-year-old was scared — of having to make friends and of contracting COVID-19. "But not anymore," her granddaughter says. "I love the new friends I just made, and I even ran into some old ones."
In Flagstaff, Rebekah Lopez and her husband now send their two children and niece to a district-run learning center, where they can at least access Wi-Fi while they continue remote learning. It's an improvement, Lopez says, but she's still worried about the ground they lost.
"They're not getting the education that they need."
And in Cincinnati, where Freda has struggled to work and help her kids with remote learning, plans to reopen schools were recently scuttled because of rising infection rates.
"My children are devastated," she says. "I'm devastated."