usatoday--2020-12-06--After losses on Election Day, Democrats have a second shot in Georgia. Here's their winning formula

After losses on Election Day, Democrats have a second shot in Georgia. Here's their winning formula for the Senate

WASHINGTON – Democrats were forecasted to win big on Election Day .
But in races across the country , they saw loss after loss .
At least 10 Democratic incumbents fell to Republicans in the House , though the party clung on to control of the chamber .
Aspirations to take the Senate majority seemed to wither as race after race was called for Republicans – even in states where Democrats polled significantly higher than incumbents .
Democrats have promised methodical after-action reports to examine what went wrong and how to how to learn from it .
But the party @ @ @ @ @ @ @ battle over the Senate with the majority hanging in the balance – all coming down to Georgia and two runoff races on Jan. 5 .
While Democrats are still licking their wounds from the Nov. 3 Election Day , experts say the party will need to make changes and resist making some of the same errors in hopes of claiming victory in the state .
Flipping the seats held by incumbent Republicans David Perdue and Kelly Loeffler will be an uphill battle for Jon Ossoff and Raphael Warnock , but a victory will @ @ @ @ @ @ @ Joe Biden ’ s legislative agenda .
`` You rarely get a second chance in politics but Democrats have gotten one in Georgia , '' said Jim Manley , a Democratic strategist and former senior aide to Senate Majority Leader Harry Reid , D-Nev. Manley pointed to Biden ’ s ability to flip the state blue this year for the first time since 1992 .
`` It ’ s definitely doable for us .
But I think we as a party have to be cautious and resist some of worst urges , '' @ @ @ @ @ @ @ divided Americans as they voted by mail and at the ballot box .
Healthcare , the coronavirus pandemic , racial justice were all rated as the key issues that decided people 's vote .
But one issue at top of the list in many exit polls seemed to trouble Democrats : the economy .
The split among Republican and Democratic voters seemed to rest on a choice between getting a handle on the coronavirus pandemic or reopening efforts to help rescue the economy .
Sen. Joe Manchin , one of the few red-state @ @ @ @ @ @ @ split displayed a clear issue the party needs to address .
“ When you do n't have a message on the economy , ( voters ) believe that that ( Democratic ) brand basically is more concerned and interested in people that do n't work or wo n't work , more so than the people that do work and will work , '' the West Virginia Democrat said .
`` There 's a problem.
” More : Failing to convince Gov .
Kemp to flip election , Trump vows to 'win back the @ @ @ @ @ @ @ while the party will have several years before the next election battle , Democrats in Georgia are already in the middle of campaigning , with only weeks until the runoff races .
Experts argue shifts in messaging simply won ’ t be able to move voters this late in the race .
`` I think it ’ s too late in the game for a policy shift , '' Manley said .
Democratic strategists across the board and in the state say the focus on healthcare and beating the coronavirus pandemic was largely @ @ @ @ @ @ @ off GOP attacks focusing on socialism and the defund the police movement , attacks that have been blamed for some Democrats ' losses .
`` Republicans have worked very hard to tar these slogans , '' said Danny Barefoot , a Democratic strategist , admitting that Democrats need to learn from the struggles they saw in this cycle .
`` We have a branding problem . ''
He said while Ossoff and Warnock should veer away from `` dabbling in these issues , '' but should make clear where they stand .
While @ @ @ @ @ @ @ some losses , including within the Hispanic communities of South Florida , it might not be as big of an issue in Georgia , Barefoot said .
`` Both of these candidates need to ignore the noise .
They understand their communities and what voters are hoping to see from them , '' he added .
'It was a failure ' : Furious House Democrats unload as leadership promises answers after election losses Barefoot said in a post-election focus group he conducted , many voters were weary that the country could again impose @ @ @ @ @ @ @ `` I think we really missed the COVID fatigue , '' he explained .
`` I think Trump ’ s reopening message resonated more than we thought . ''
With cases rising and some communities already issuing restrictions that force businesses to close and residents to stay home again , that is likely to weigh heavily on voters ’ minds .
`` There ’ s a middle ground approach here on being empathetic , being worried about the economy and continuing to live amid the pandemic , '' Barefoot said .
`` There @ @ @ @ @ @ @ your life and not isolate at home . ''
Many have also attributed Democratic losses on Election Day to a lack of ground game .
As COVID-19 ravaged the country and continued to spread , campaigns had to shift to a more digitally focused operation than ever before .
Most restrained from holding in-person events or having campaign workers knock on doors , key aspects that help turn out voters .
As the pandemic wore on , Republicans were quicker to restart holding typical events .
President Donald Trump led the way with @ @ @ @ @ @ @ or social distancing .
Trump appeared in Georgia Saturday to rally for Loeffler and Perdue , urging voters to cast their ballots for the Republicans , railing against election integrity and highlighting what is at stake with the two races .
More : Biden plans to campaign in Georgia for Senate candidates '' This election is control of the U.S. Senate and that really means control of this country , ” Trump said .
`` The voters of Georgia will determine which party runs every committee , writes every piece of legislation , @ @ @ @ @ @ @ Democrats have been resistant to holding such large in-person events over safety concerns amid the pandemic but have focused on virtual rallies and drive-in events where voters can stay in their cars .
Biden said he plans to campaign in the state for the Senate race , though it ’ s unclear whether he will do so virtually or in-person .
Democrats are keenly aware of the dynamics in the state that allowed Biden to win , including shifts in the suburbs and know the keys to victory are turning out more voters @ @ @ @ @ @ @ .
Democrats and liberal groups have invested millions into the race , allowing Democrats to hire more staff and recruit more volunteers for a wide on-the ground organization , which includes more voter calls and texts .
`` Up until now , the reality is we weren ’ t knocking on doors or really doing a ton of connecting with voters , '' said Stefan Turkheimer , a Democratic strategist in Georgia .
`` The No .
1 question is how do you turn out people that previously turned out for you and @ @ @ @ @ @ @ that . ''
'They have not earned your vote ' : Trump allies urge Georgia Republicans to sit out Senate runoffs 'We 're going to keep fighting ' : Pence tells Georgia voters presidential election not over Republicans have similarly been investing heavily in Georgia , promising to build a presidential-level voter contact operation with staff embedded to work with both campaigns .
Both Loeffler and Perdue have continued to host large events , including appearing with Trump on Saturday .
But the party is weathering an internal crisis in the state over @ @ @ @ @ @ @ voter fraud and that the election was stolen from him , something that could help Democrats if Trump voters don ’ t turn out due to distrust in the electoral process .
`` When the talking points are all about internal party mechanics in D.C. , that just turns people off .
It ’ s the last thing you want , '' Turkheimer said .
He said Trump ’ s claims have caused a mess for the GOP because their messaging boils down to : “ You ’ ve told them that their @ @ @ @ @ @ @ would they waste their time to vote then ?
” Typically , Republicans have been successful in such runoff races , winning seven out of eight in Georgia since 1992 , including two U.S. Senate races .
Loeffler and Perdue have supported Trump ’ s baseless election fraud claims , hoping Trump 's passionate followers back them in January .
Despite concerns over voter turnout , Trump continued to rail about the Nov. 3 election on Saturday at his rally in the state .
He also targeted Republican officials in Georgia , including @ @ @ @ @ @ @ unproven claims of fraud .
Trump urged voters to elect Loeffler and Perdue , insisting the two races will determine control of the Senate – something that would only be true if Biden did indeed win the presidential race since Democratic wins would mean the vice president will have to break a 50-50 Senate tie .
“ They rigged our presidential election , but we will still win it , ” Trump said at his rally in Valdosta , Ga. , as those in the audience started chanting , `` Stop the steal @ @ @ @ @ @ @ to try and rig this election , too , '' the president continued before pulling a piece of paper from his coat with statistics aiming to discredit Biden ’ s presidential win .
Key to the race : Voter turnout and resisting urges It was about eight years ago that Stacey Abrams offered a 20-page PowerPoint presentation outlining a multi-year strategy to turn Georgia blue .
Steve Phillips , a Democratic donor and founder of the progressive organization Democracy in Color , still remembers that day and her proposal .
Abrams ' plan @ @ @ @ @ @ @ critical to Biden ’ s victory in the state .
At the heart of the effort : energizing the state ’ s large African American population .
`` It ’ s not rocket science .
It ’ s also what is going to make these Senate races , '' he said .
`` This is going to be 90 % about turnout .
That ’ s what this battle will be .
It ’ s a labor intensive , person-to-person movement . ''
'The place where we put this country back on track @ @ @ @ @ @ @ purple Phillips said the biggest variable is that Trump and Biden wo n't be on the Jan 5 ballot .
Many voters were not only energized to vote for Biden , but against another four years under Trump .
`` The votes are clearly there to win , '' he said .
`` But now the question is , can you get them back out ? ''
Millions has poured into the race for both Republicans and Democrats and with control of the Senate at stake , some high profile Democrats have gotten @ @ @ @ @ @ @ a concern for some strategists .
“ We always want to send in these D.C. hotshots , but I really think we have to let the folks on the ground take the lead .
They know the state best , ” Manley said .
“ We need to empower the folks down there to get the job done.
” Manley added : “ Raising money hand over fist does not equal victory , '' pointing to races lost by Amy McGrath in Kentucky and Jamie Harrison in South Carolina despite millions pouring in @ @ @ @ @ @ @ Mitch McConnell and Sen. Lindsey Graham , R-S.C. , a close ally of Trump .

In Georgia, Democrats have a fresh shot at the Senate after Election Day losses
Show Caption Hide Caption Georgia Senate candidates attack each other's backgrounds All eyes are on Georgia as control of the Senate is up for grabs during runoff elections on Jan. 5. USA TODAY Handout
WASHINGTON – Democrats were forecast to win big on Election Day. But in congressional races across the country, they saw loss after loss even as President-elect Joe Biden defeated Donald Trump in the White House race.
At least 10 Democratic incumbents fell to Republicans in the House, though the party clung on to control of the chamber. Aspirations to take the Senate majority seemed to wither as race after race was called for Republicans – even in states where Democrats polled significantly higher than incumbents.
Democrats have promised methodical after-action reports to examine what went wrong and how to how to learn from it. But the party is still in the midst of a battle over the Senate with the majority hanging in the balance – all coming down to Georgia and two runoff races on Jan. 5.
While Democrats are still licking their wounds from the Nov. 3 Election Day, experts say the party will need to make changes and resist making some of the same errors in hopes of claiming victory in the state. Flipping the seats held by incumbent Republicans David Perdue and Kelly Loeffler will be an uphill battle for Jon Ossoff and Raphael Warnock, but a victory will give Democrats the power to pass Biden’s legislative agenda.
"You rarely get a second chance in politics but Democrats have gotten one in Georgia," said Jim Manley, a Democratic strategist and former senior aide to Senate Majority Leader Harry Reid, D-Nev. Manley pointed to Biden’s ability to flip the state blue this year for the first time since 1992.
"It’s definitely doable for us. But I think we as a party have to be cautious and resist some of worst urges," he said.
Runoffs: History, how they work, and their roots in racism As Georgia heads towards a highly anticipated runoff election, it begs the question: Why do some states have runoffs? And what's the purpose of them? Just the FAQs, USA TODAY
Struggle with economy, defending against GOP attacks
A host of issues divided Americans as they voted by mail and at the ballot box. Health care, the coronavirus pandemic and racial justice were all rated as the key issues that decided people's vote.
But one issue at top of the list in many exit polls seemed to trouble Democrats: the economy.
The split among Republican and Democratic voters seemed to rest on a choice between getting a handle on the coronavirus pandemic or reopening efforts to help rescue the economy.
Sen. Joe Manchin, one of the few red-state Democrats still in Congress, said the split displayed a clear issue the party needs to address.
“When you don't have a message on the economy, (voters) believe that that (Democratic) brand basically is more concerned and interested in people that don't work or won't work, more so than the people that do work and will work," the West Virginia Democrat said. "There's a problem.”
More: Failing to convince Gov. Kemp to flip election, Trump vows to 'win back the White House' at Georgia rally
Opinion: Georgia, if you’re listening, ignore conservatives peddling socialist Senate hallucinations
But while the party will have several years before the next election battle, Democrats in Georgia are already in the middle of campaigning, with only weeks until the runoff races. Experts argue shifts in messaging simply won’t be able to move voters this late in the race.
"I think it’s too late in the game for a policy shift," Manley said.
Democratic strategists across the board and in the state say the focus on health care and beating the coronavirus pandemic was largely successful, but candidates had issues fending off GOP attacks focusing on socialism and the defund the police movement, attacks that have been blamed for some Democrats' losses.
"Republicans have worked very hard to tar these slogans," said Danny Barefoot, a Democratic strategist, admitting that Democrats need to learn from the struggles they saw in this cycle. "We have a branding problem."
He said Ossoff and Warnock should veer away from "dabbling in these issues," but should make clear where they stand.
While messaging on socialism has been blamed for some losses, including within the Hispanic communities of South Florida, it might not be as big of an issue in Georgia, Barefoot said.
"Both of these candidates need to ignore the noise. They understand their communities and what voters are hoping to see from them," he added.
'It was a failure': Furious House Democrats unload as leadership promises answers after election losses
Barefoot said in a post-election focus group he conducted, many voters were wary that the country could again impose strict mandates as COVID-19 cases rise. "I think we really missed the COVID fatigue," he explained. "I think Trump’s reopening message resonated more than we thought."
With cases rising and some communities already issuing restrictions that force businesses to close and residents to stay home again, that is likely to weigh heavily on voters’ minds.
"There’s a middle ground approach here on being empathetic, being worried about the economy and continuing to live amid the pandemic," Barefoot said. "There’s a way to safely live your life and not isolate at home."
Ground efforts, money and GOP's conflicting message
Many have also attributed Democratic losses on Election Day to a lack of ground game. As COVID-19 ravaged the country and continued to spread, campaigns had to shift to a more digitally focused operation than ever before.
Most restrained from holding in-person events or having campaign workers knock on doors, key aspects that help turn out voters. As the pandemic wore on, Republicans were quicker to restart holding typical events. President Donald Trump led the way with packed rallies, not mandating face masks or social distancing.
Trump appeared in Georgia Saturday to rally for Loeffler and Perdue, urging voters to cast their ballots for the Republicans, railing against election integrity and highlighting what is at stake with the two races.
More: Biden plans to campaign in Georgia for Senate candidates
Voters look to Georgia to decide if GOP or Democrats will run Senate Phillip M Bailey and Rana Cash discuss Georgia's effect on control of the Senate, its journey to becoming a purple state and Stacey Abrams' impact. States of America, USA TODAY
"This election is control of the U.S. Senate and that really means control of this country,” Trump said. "The voters of Georgia will determine which party runs every committee, writes every piece of legislation, controls every single taxpayer dollar."
Democrats have been resistant to holding such large in-person events over safety concerns amid the pandemic but have focused on virtual rallies and drive-in events where voters can stay in their cars. Biden said he plans to campaign in the state for the Senate race, though it’s unclear whether he will do so virtually or in-person.
Democrats are keenly aware of the dynamics in the state that allowed Biden to win, including shifts in the suburbs and know the keys to victory are turning out more voters and energizing African Americans in the state. Democrats and liberal groups have invested millions into the race, allowing Democrats to hire more staff and recruit more volunteers for a wide on-the-ground organization, which includes more voter calls and texts.
"Up until now, the reality is we weren’t knocking on doors or really doing a ton of connecting with voters," said Stefan Turkheimer, a Democratic strategist in Georgia. "The No. 1 question is how do you turn out people that previously turned out for you and a strong ground game is key to that."
'They have not earned your vote': Trump allies urge Georgia Republicans to sit out Senate runoffs
'We're going to keep fighting': Pence tells Georgia voters presidential election not over
Former President Obama rallies for Georgia Dems Former President Barack Obama took part in a virtual rally for two Georgia Senate races that will determine control of the U.S. Senate. (Dec. 4) AP
Republicans have similarly been investing heavily in Georgia, promising to build a presidential-level voter contact operation with staff embedded to work with both campaigns. Both Loeffler and Perdue have continued to host large events, including appearing with Trump on Saturday.
But the party is weathering an internal crisis in the state over Trump’s unfounded claims of widespread voter fraud and that the election was stolen from him, something that could help Democrats if Trump voters don’t turn out due to distrust in the electoral process.
"When the talking points are all about internal party mechanics in D.C., that just turns people off. It’s the last thing you want," Turkheimer said.
He said Trump’s claims have caused a mess for the GOP because their messaging boils down to: “You’ve told them that their votes haven’t counted. Why would they waste their time to vote then?”
Typically, Republicans have been successful in such runoff races, winning seven out of eight in Georgia since 1992, including two U.S. Senate races. Loeffler and Perdue have supported Trump’s baseless election fraud claims, hoping Trump's passionate followers back them in January.
Despite concerns over voter turnout, Trump continued to rail about the Nov. 3 election on Saturday at his rally in the state.
He also targeted Republican officials in Georgia, including Gov. Brian Kemp, over the unproven claims of fraud. Trump urged voters to elect Loeffler and Perdue, insisting the two races will determine control of the Senate – something that would only be true if Biden did indeed win the presidential race since Democratic wins would mean the vice president will have to break a 50-50 Senate tie.
“They rigged our presidential election, but we will still win it,” Trump said at his rally in Valdosta, Georgia, as those in the audience started chanting, "Stop the steal."
"They’re going to try and rig this election, too," the president continued before pulling a piece of paper from his coat with statistics aiming to discredit Biden’s presidential win.
Key to the race: Voter turnout and resisting urges
It was about eight years ago that Stacey Abrams offered a 20-page PowerPoint presentation outlining a multiyear strategy to turn Georgia blue.
Steve Phillips, a Democratic donor and founder of the progressive organization Democracy in Color, still remembers that day and her proposal. Abrams' plan worked and was critical to Biden’s victory in the state, he said. At the heart of the effort: energizing the state’s large African American population.
"It’s not rocket science. It’s also what is going to make these Senate races," he said. "This is going to be 90% about turnout. That’s what this battle will be. It’s a labor-intensive, person-to-person movement."
More: Former President Obama rallies for Georgia Dems
'The place where we put this country back on track': How Joe Biden turned Georgia purple
Stacey Abrams says investments pay off in Georgia The voting rights advocate says she's been dedicating her life to fighting for equal access to the ballot, especially for Black voters. (Nov. 6) AP
Phillips said the biggest variable is that Trump and Biden won't be on the Jan. 5 ballot. Many voters were not only energized to vote for Biden but against another four years under Trump.
"The votes are clearly there to win," he said. "But now the question is, can you get them back out?"
Millions have poured into the race for both Republicans and Democrats and with control of the Senate at stake, some high profile Democrats have gotten involved in fundraising for the race – a concern for some strategists.
“We always want to send in these D.C. hotshots, but I really think we have to let the folks on the ground take the lead. They know the state best,” Manley said. “We need to empower the folks down there to get the job done.”
Manley added: “Raising money hand over fist does not equal victory," pointing to races lost by Amy McGrath in Kentucky and Jaime Harrison in South Carolina despite millions pouring in this cycle to unseat Senate Majority Leader Mitch McConnell and Sen. Lindsey Graham, R-S.C., a close ally of Trump.
More: How Stacey Abrams blew up Georgia’s electoral map


usatoday--2020-12-06--What vaccination rates in rural America tell us about the advent of COVID vaccines

America ’ s poor track record vaccinating people against the flu spells trouble for the coming effort to immunize the nation against COVID-19 , experts say , particularly in rural areas where the virus is raging out of control .
A USA TODAY analysis of flu vaccine rates among Medicare participants shows that rural counties from West Texas to northern Nebraska to the Upper Peninsula of Michigan had some of the country ’ s lowest vaccination rates in 2017 , the most recent year with data .
It ’ s a pattern that holds true across America .
The more @ @ @ @ @ @ @ vaccination rates tended to be .
Data for the analysis came from the County Health Rankings project and the Index of Relative Rurality , a metric that ranks counties based on population size , density , remoteness , and built-up area .
The analysis identified 604 counties where fewer than a third of Medicare participants received flu vaccines , 580 of which were predominantly rural .
These places were home to more than 13 million people and were spread across the nation ; all but nine states had at least one low-vaccination county @ @ @ @ @ @ @ 215 counties where fewer than 1 in 4 residents on Medicare were vaccinated .
“ We do n't have the convenience of jumping into a Walgreens , CVS or Walmart and getting our flu shot .
Our nearest Walgreens and Walmart are 30 miles away , ” said Dr. Jennifer Bacani McKenney , a family physician and the Wilson County Health Officer in Fredonia , Kansas , explaining some of the barriers in rural areas that exist in addition to vaccine hesitancy and distrust .
Due to financial , storage and staffing issues @ @ @ @ @ @ @ the providers in our county and many private clinics across the state do not provide in-clinic vaccinations , so the patient is required to make an additional appointment to get vaccines at a health department . ''
Of course , people who opt out of the flu vaccine might seek it for the coronavirus because the pandemic has killed more people than the annual flu .
At the same time , people who previously took the flu vaccine might not get their shots for COVID-19 because the pandemic has intensified Americans ’ skepticism @ @ @ @ @ @ @ flu vaccination rates can at least provide clues to how rural America will respond to the arrival of the COVID-19 vaccine .
Data on flu vaccination among Medicare enrollees -- primary elderly Americans -- provide a detailed geographic window into how the COVID-19 vaccine will be accepted by that key at-risk group , said Dr. Randy Hubach , an associate professor of rural health and director of the Sexual Health Research Lab at Oklahoma State University .
“ I think it ’ s an accurate contextual representation of what we can probably expect @ @ @ @ @ @ @ consequences for rural America can be seen in flu data .
Historic data from the U.S. Centers for Disease Control and Prevention Wonder database show that the flu virus tends to kill at higher rates in more rural counties .
Experts say if COVID-19 vaccination follows the same pattern as the flu , the flow of people between these communities and the rest of the country will put both city dwellers and rural residents at risk .
Flu vaccination has largely skipped much of rural America because , in part , it ’ @ @ @ @ @ @ @ to get to pharmacies , clinics or hospitals offering vaccines .
There ’ s also a long-standing distrust in the medical system in these areas .
Yet getting the COVID vaccine to these areas will be key to tamping down a virus that ’ s ravaged rural communities , experts said .
“ Ensuring vaccine coverage of rural communities is an essential part of the strategy to protect rural communities from COVID-19 , ” Dr. Thomas Tsai , a surgeon and health policy researcher at Harvard 's T.H .
Chan School of Public @ @ @ @ @ @ @ Researchers don ’ t know how much of the U.S. population will need to be protected to stop the spread of COVID-19 .
Estimates range from 50 % to as high as 90 % of the population to achieve a threshold epidemiologists describe as “ herd immunity.
” Reaching that threshold will be a struggle , if the flu vaccine is any indication .
Only half the country gets vaccinated for the flu , on average , and surveys show a growing number of people intend to refuse a COVID-19 vaccine .
Achieving @ @ @ @ @ @ @ COVID-19 vaccine will be the difference between a coronavirus that ’ s endemic and actively circulating and a coronavirus that ’ s all but wiped out , a goal the nation has attained with the smallpox , mumps and diphtheria viruses .
“ How you are going to move that needle from 50 % up to 75 % really becomes the question , ” said Dr. Hubach .
More : When could the first COVID-19 vaccines be given in the US ?
And the prickly problem of vaccine uptake is one that health @ @ @ @ @ @ @ With two COVID vaccine candidates expected to receive emergency use authorization from the U.S. Food and Drug Administration later this month , federal and state health officials are finalizing vaccine distribution plans to immunize the front-line health care workers and nursing home residents that comprise the so-called Phase 1a group , the Americans who will first receive the vaccine against the coronavirus .
That wave of immunizations is expected to occur before the end of the year .
Dr. Mancef Slaoui , the chief science advisor to Operation Warp Speed , recently said @ @ @ @ @ @ @ vaccinated within two days of the FDA ’ s authorization .
Dr. Nancy Messionier , director of CDC ’ s National Center for Immunization and Respiratory Diseases , said last week that everyone in phase 1a should expect their first dose within three weeks of a vaccine being authorized .
The rollout thereafter should proceed quickly .
On a Dec. 2 Operation Warp Speed call with reporters , Dr. Slaoui said he expected that 20 million people would receive either the Pfizer or Moderna vaccine in December , followed by 30 million people @ @ @ @ @ @ @ February , pending FDA authorization .
In early 2021 , vaccinations will proceed beyond front-line health care workers and nursing home residents to essential workers followed by adults with high-risk medical conditions and people aged 65 and older .
But getting vaccines to essential workers and seniors , especially in rural areas , will be an ongoing challenge given the historically low vaccination rates , which researchers sometimes refer to as 'uptake , ’ in rural counties .
The reason for low vaccine uptake ?
A variety of factors including long-standing systemic health @ @ @ @ @ @ @ distrust of medical providers , says Dr. Hubach .
Dr. McKenney in Kansas is seeing vaccine distrust play out both in private clinic visits and in public town hall discussions about the coronavirus .
“ I hear people saying they ’ re hesitant to take this vaccine , ” said McKenney .
“ They ’ re nervous .
They don ’ t want to be the first ones .
It goes along with the rural mentality of being suspicious of the government and science.
” That worries McKenney because of how hard communities @ @ @ @ @ @ @ been hit by COVID-19 in recent months .
“ The numbers that we ’ re seeing right now in our communities actually makes me kind of terrified about what ’ s going to happen before we ever start vaccinating , ” she said .
“ What ’ s going to happen in the next month or two months ?
” Yet despite that damage , people aren ’ t changing their behaviors .
“ Even with those high numbers of cases and deaths , it ’ s still not hitting home for people @ @ @ @ @ @ @ ’ re saying , ‘ Only 1 percent die .
It ’ s not a big deal.
’ ” Rural counties in the Dakotas , Kansas , Montana and Mississippi have seen some of the highest COVID surges with over 300 deaths per 100,000 people .
Influenza and other respiratory diseases have also hit many of those same counties hard in the past , though at much lower levels – around 25 deaths per 100,000 on average , according to CDC data from 2018 .
Rural residents who opt out of vaccination are @ @ @ @ @ @ @ Lynn Ogren said she routinely passes on the flu shot and all other vaccines in Jerauld County , South Dakota , where just over one in five residents was immunized in 2017 .
The 69-year-old retired rancher and substitute teacher said she instead takes dietary supplements and minds a strict diet to keep in good health .
She won ’ t be getting vaccinated for COVID-19 either , she said .
“ I don ’ t put anything foreign into my body that I don ’ t need to , ” Ogren said @ @ @ @ @ @ @ vaccinated for the flu , and I don ’ t get vaccinated for anything.
” Jerauld County residents have died of COVID-19 at a rate of more than 640 per 100,000 residents , one of the highest rates in the country .
Health experts warn that if a population doesn ’ t attain herd immunity , places that haven ’ t been immunized will continue to see surges in cases and deaths from the virus known by the scientific name SARS-CoV-2 .
But achieving herd immunity will be a serious challenge in countries @ @ @ @ @ @ @ is widespread .
The consequence is a coronavirus that returns seasonally , guaranteeing continued suffering .
“ What happens if countries do not reach high vaccine coverage levels ?
First , SARS-CoV-2 will become endemic but at a low level… with peaks in winter and troughs in summer in the northern hemisphere , ” wrote the authors of a letter published last month in The Lancet journal pointing out challenges to herd immunity .
Dr. Roy Anderson , one of the authors and a professor in the School of Public Health at Imperial @ @ @ @ @ @ @ that the virus will continue to circulate if herd immunity isn ’ t reached .
Rural areas will not be spared .
“ The virus will remain endemic , but cities will be major reservoirs seeding rural regions , ” said Dr. Anderson , who was adamant that the virus would likely not ever go away .
“ It will be endemic and seasonal.
” Dr. Krutika Kuppalli , an assistant professor in the division of infectious disease at the Medical University of South Carolina , is also concerned .
“ Do I @ @ @ @ @ @ @ endemic ?
” said Kuppalli .
“ Yeah , I do .
When we have millions and millions of cases , it seems like it ’ s going to become endemic .
My hope is we get enough people to take up the vaccine.
” Despite rural counties ’ historically low rates of vaccine uptake , Hubach sees an opportunity to better communicate with those communities about the COVID-19 vaccine .
Tapping faith leaders and community outreach workers that have an understanding of local context and climate is going to be very important @ @ @ @ @ @ @ say , ‘ Vaccination is one thing we can do for the common good ?
’ , ” he said .
More : Side effects from the COVID-19 vaccine means 'your body responded the way it 's supposed to , ' experts say In addition to tailoring public health messages to specific communities in rural counties , relying on the patient-doctor bond is an important way to build trust in the COVID-19 vaccine and boost vaccination rates , says Dr. Brian Chow , a physician and principal investigator on AstraZeneca ’ s COVID @ @ @ @ @ @ @ Boston .
Many rural communities have been historically marginalized and denied health care or worse , Chow explained .
Promoting COVID vaccination needs to surmount distrust in medical care .
“ The majority of people will get vaccinated through their doctor ’ s office , ” said Chow .
“ Leveraging those relationships will be key .
A strong recommendation from their primary care provider really influences whether or not people accept a vaccine.
” Aleszu Bajak is on Twitter at @ aleszubajak or can be emailed at abajak @ usatoday.com

What vaccination rates in rural America tell us about the advent of COVID-19 vaccines Rural counties have some of the lowest flu vaccination rates. That’s a serious problem for the COVID vaccine rollout.
Show Caption Hide Caption COVID-19 vaccine concerns: You Asked, We Answered We asked you to tell us your biggest questions about the COVID-19 vaccines. Here are some answers. USA TODAY
America’s poor track record vaccinating people against the flu spells trouble for the coming effort to immunize the nation against COVID-19, experts say, particularly in rural areas where the novel coronavirus is raging out of control.
A USA TODAY analysis of flu vaccine rates among Medicare participants shows that rural counties from West Texas to northern Nebraska to the Upper Peninsula of Michigan had some of the country’s lowest vaccination rates in 2017, the most recent year with data. It’s a pattern that holds true across America. The more rural the county, the lower flu vaccination rates tended to be.
Data for the analysis came from the County Health Rankings project and the Index of Relative Rurality, a metric that ranks counties based on population size, density, remoteness, and built-up area. The analysis identified 604 counties where fewer than a third of Medicare participants received flu vaccines, 580 of which were predominantly rural.
These places were home to more than 13 million people and were spread across the nation; all but nine states had at least one low-vaccination county.
At the extreme, there were 215 counties where fewer than 1 in 4 residents on Medicare were vaccinated.
“We don't have the convenience of jumping into a Walgreens, CVS or Walmart and getting our flu shot. Our nearest Walgreens and Walmart are 30 miles away,” said Dr. Jennifer Bacani McKenney, a family physician and the Wilson County Health Officer in Fredonia, Kansas, explaining some of the barriers in rural areas that exist in addition to vaccine hesitancy and distrust.
Because of financial, storage and staffing issues, she said, "none of the providers in our county and many private clinics across the state do not provide in-clinic vaccinations, so the patient is required to make an additional appointment to get vaccines at a health department."
Of course, people who opt out of the flu vaccine might seek it for the coronavirus because the pandemic has killed more people than the annual flu. At the same time, people who previously took the flu vaccine might not get their shots for COVID-19 because the pandemic has intensified Americans’ skepticism of science and drug regulators.
But flu vaccination rates can at least provide clues to how rural America will respond to the arrival of the COVID-19 vaccine. Data on flu vaccination among Medicare enrollees – primary elderly Americans – provide a detailed geographic window into how the COVID-19 vaccine will be accepted by that key at-risk group, said Dr. Randy Hubach, an associate professor of rural health and director of the Sexual Health Research Lab at Oklahoma State University. “I think it’s an accurate contextual representation of what we can probably expect with the COVID vaccine.”
The potential consequences for rural America can be seen in flu data. Historic data from the U.S. Centers for Disease Control and Prevention Wonder database show that the flu virus tends to kill at higher rates in more rural counties.
Experts say if COVID-19 vaccination follows the same pattern as the flu, the flow of people between these communities and the rest of the country will put both city dwellers and rural residents at risk.
Flu vaccination has largely skipped much of rural America because, in part, it’s harder for people in remote communities to get to pharmacies, clinics or hospitals offering vaccines. There’s also a longstanding distrust in the medical system in these areas. Yet getting the COVID-19 vaccine to these areas will be key to tamping down a virus that’s ravaged rural communities, experts said.
“Ensuring vaccine coverage of rural communities is an essential part of the strategy to protect rural communities from COVID-19,” Dr. Thomas Tsai, a surgeon and health policy researcher at Harvard's T.H. Chan School of Public Health, said in an email.
Herd immunity
Researchers don’t know how much of the U.S. population will need to be protected to stop the spread of COVID-19. Estimates range from 50% to as high as 90% of the population to achieve a threshold epidemiologists describe as “herd immunity.”
Reaching that threshold will be a struggle, if the flu vaccine is any indication. Only half the country gets vaccinated for the flu, on average, and surveys show a growing number of people intend to refuse a COVID-19 vaccine. Achieving a much higher vaccination rate with the COVID-19 vaccine will be the difference between a coronavirus that’s endemic and actively circulating and a coronavirus that’s all but wiped out, a goal the nation has attained with the smallpox, mumps and diphtheria viruses.
“How you are going to move that needle from 50% up to 75% really becomes the question,” Hubach said.
More: When could the first COVID-19 vaccines be given in the US?
And the prickly problem of vaccine uptake is one that health officials need to figure out quickly. With two COVID-19 vaccine candidates expected to receive emergency use authorization from the U.S. Food and Drug Administration later this month, federal and state health officials are finalizing vaccine distribution plans to immunize the front-line health care workers and nursing home residents that comprise the Phase 1a group, the Americans who will first receive the vaccine against the coronavirus.
That wave of immunizations is expected to occur before the end of the year. Mancef Slaoui, the chief science advisor to Operation Warp Speed, recently said he expected the first Americans to be vaccinated within two days of the FDA’s authorization. Dr. Nancy Messionier, director of CDC’s National Center for Immunization and Respiratory Diseases, said last week that everyone in phase 1a should expect their first dose within three weeks of a vaccine being authorized.
The rollout thereafter should proceed quickly. On a Dec. 2 Operation Warp Speed call with reporters, Slaoui said he expected that 20 million people would receive either the Pfizer or Moderna vaccine in December, followed by 30 million people in January and 50 million people in February, pending FDA authorization. In early 2021, vaccinations will proceed beyond front-line health care workers and nursing home residents to essential workers followed by adults with high-risk medical conditions and people aged 65 and older.
But getting vaccines to essential workers and seniors, especially in rural areas, will be an ongoing challenge given the historically low vaccination rates, which researchers sometimes refer to as 'uptake,’ in rural counties. The reason for low vaccine uptake? A variety of factors including long-standing systemic health and social inequities as well as a distrust of medical providers, says Hubach.
McKenney in Kansas is seeing vaccine distrust play out both in private clinic visits and in public town hall discussions about the coronavirus.
“I hear people saying they’re hesitant to take this vaccine,” said McKenney. “They’re nervous. They don’t want to be the first ones. It goes along with the rural mentality of being suspicious of the government and science.”
More: Kentucky legislator pre-files bill prohibiting colleges from mandating vaccines
That worries McKenney because of how hard communities in Kansas and across the Plains have been hit by COVID-19 in recent months.
“The numbers that we’re seeing right now in our communities actually makes me kind of terrified about what’s going to happen before we ever start vaccinating,” she said. “What’s going to happen in the next month or two months?”
Yet despite that damage, people aren’t changing their behaviors. “Even with those high numbers of cases and deaths, it’s still not hitting home for people,” said McKenney. “They’re saying, ‘Only 1 percent die. It’s not a big deal.’”
Rural counties in the Dakotas, Kansas, Montana and Mississippi have seen some of the highest COVID-19 surges with over 300 deaths per 100,000 people. Influenza and other respiratory diseases have also hit many of those same counties hard in the past, though at much lower levels – around 25 deaths per 100,000 on average, according to CDC data from 2018.
Endemic illness
Rural residents who opt out of vaccination are far from monolithic in their reasons.
Lynn Ogren said she routinely passes on the flu shot and all other vaccines in Jerauld County, South Dakota, where just over one in five residents was immunized in 2017. The 69-year-old retired rancher and substitute teacher said she instead takes dietary supplements and minds a strict diet to keep in good health. She won’t be getting vaccinated for COVID-19 either, she said.
“I don’t put anything foreign into my body that I don’t need to,” Ogren said. “I’ve never been vaccinated for the flu, and I don’t get vaccinated for anything.”
Jerauld County residents have died of COVID-19 at a rate of more than 640 per 100,000 residents, one of the highest rates in the country.
Health experts warn that if a population doesn’t attain herd immunity, places that haven’t been immunized will continue to see surges in cases and deaths from the virus known by the scientific name SARS-CoV-2. But achieving herd immunity will be a serious challenge in countries like the United States where vaccine hesitancy is widespread. The consequence is a coronavirus that returns seasonally, guaranteeing continued suffering.
“What happens if countries do not reach high vaccine coverage levels? First, SARS-CoV-2 will become endemic but at a low level … with peaks in winter and troughs in summer in the northern hemisphere,” wrote the authors of a letter published last month in The Lancet journal pointing out challenges to herd immunity.
Dr. Roy Anderson, one of the authors and a professor in the School of Public Health at Imperial College London, said in an interview that the virus will continue to circulate if herd immunity isn’t reached. Rural areas will not be spared.
“The virus will remain endemic, but cities will be major reservoirs seeding rural regions,” said Anderson, who was adamant that the virus would likely not ever go away. “It will be endemic and seasonal.”
Dr. Krutika Kuppalli, an assistant professor in the division of infectious disease at the Medical University of South Carolina, is also concerned.
“Do I think it’s going to become endemic?” said Kuppalli. “Yeah, I do. When we have millions and millions of cases, it seems like it’s going to become endemic. My hope is we get enough people to take up the vaccine.”
Promoting vaccination
Despite rural counties’ historically low rates of vaccine uptake, Hubach sees an opportunity to better communicate with those communities about the COVID-19 vaccine. Tapping faith leaders and community outreach workers that have an understanding of local context and climate is going to be very important. “How do you have them say, ‘Vaccination is one thing we can do for the common good?’,” he said.
More: Side effects from the COVID-19 vaccine means 'your body responded the way it's supposed to,' experts say
In addition to tailoring public health messages to specific communities in rural counties, relying on the patient-doctor bond is an important way to build trust in the COVID-19 vaccine and boost vaccination rates, says Dr. Brian Chow, a physician and principal investigator on AstraZeneca’s COVID-9 vaccine trial at Tufts Medical Center in Boston. Many rural communities have been historically marginalized and denied health care or worse, Chow explained. Promoting COVID-19 vaccination needs to surmount distrust in medical care.
“The majority of people will get vaccinated through their doctor’s office,” said Chow. “Leveraging those relationships will be key. A strong recommendation from their primary care provider really influences whether or not people accept a vaccine.”
Aleszu Bajak is on Twitter at @aleszubajak or can be emailed at abajak@usatoday.com


usatoday--2020-12-06--A reporter's harrowing COVID-19 experience: 'I am more afraid of this virus' than ever

MANITOWOC , Wis. – I lay in the hospital bed , trying to concentrate on what the doctor was saying .
I had been sick with COVID-19 for 12 days and breathing had become a struggle .
He was telling me about the course of Remdesivir he wanted to give me .
“ How long is that going to take ?
” I had asked , still expecting to be home in a few hours .
I was already looking forward to a bowl of leftover chicken soup we had in the fridge .
“ We ’ ll give you @ @ @ @ @ @ @ course takes five days , ” he said .
Five days of medication .
Five days of blood draws and tests .
Five days of sleeping in a strange bed .
Five days … alone .
I felt myself nodding at the doctor ’ s explanation , putting on a smile — a habit left over from the days before masks — as the words seemed to drift around the room .
I didn ’ t know him very well , but his absence left a vacuum .
I could hear nurses talking @ @ @ @ @ @ @ another room coughed , but hearing those sounds only accentuated how alone I was in this empty , sterile room .
There I was , 30 years old and relatively healthy , experiencing the kind of symptoms from COVID-19 that I thought only those with chronic health conditions or previous breathing struggles would face .
Quietly , I let tears wash down my face .
My husband , Ken , and I had been diagnosed with COVID-19 almost two weeks before I was admitted to the hospital on Oct. 6 .
It came @ @ @ @ @ @ @ over the weekend .
We had all been careful and taken precautions recommended by experts — wearing masks , staying 6 feet apart , avoiding large gatherings — and felt we would be reasonably safe to spend some long-awaited quality time with each other .
A few days after that weekend , our friend called to say he had just tested positive .
Someone at the place he worked had fallen ill , so our friend took a test even though he felt fine .
When his positive results came in , he @ @ @ @ @ @ @ the recommended 14-day quarantine and take tests to find out if he had passed it on to us .
The U.S. Centers for Disease Control and Prevention recommends people quarantine for 14 days if they have been exposed to coronavirus , even if they test negative .
Those who test positive for the virus are urged to quarantine until at least 10 days after they get the diagnosis , and more than 24 hours after having a fever .
By the time our friend told us about his positive test , Ken had @ @ @ @ @ @ @ for a day , and I had woken up that morning with a sore throat .
We had already canceled all plans with family , and Ken called in sick at his job .
Hearing the news from our friend confirmed what we had already begun to suspect .
A day later , we were both tethered to our bed , sicker than we had been in years .
Fever became our constant companion and we marked time by how many blankets we piled on ourselves when we had chills .
Ken dealt @ @ @ @ @ @ @ brought low by body aches and a splitting migraine .
Somehow , we managed to take care of each other , taking turns bringing fresh water , ice packs and doses of Tylenol .
On good days , we hobbled a few steps to the couch , but no farther .
I was tired and couldn ’ t keep my eyes open , but pain chased sleep away and I would lie awake for hours on end .
The days blended together and time slowed to a crawl at night .
Just when @ @ @ @ @ @ @ , Ken ’ s fever broke and he began getting stronger each day , spending less and less time in bed .
My body aches and migraine slowly faded and I began to regain my appetite .
We started to see a light at the end of our COVID-19 tunnel .
I didn ’ t notice it much at first .
Coughing goes hand-in-hand with illness in my mind and it made sense that I would breathe harder after walking to the kitchen .
I was just happy that Ken and I seemed @ @ @ @ @ @ @ more days of recovery , I thought , and we could get back to living our lives .
The next day , my cough was worse .
A lot worse .
And I started to feel out of breath just standing up from the couch .
Soon , I was having to stop to catch my breath halfway through the 15-foot walk from the bedroom to the bathroom .
I ’ d have to sit at the edge of my bed after sitting up until the coughing abated .
Just trying to hold @ @ @ @ @ @ @ cause a fit of coughing .
When I started having trouble breathing , even when I was laying down and resting , I finally agreed with my husband .
It was time to seek medical help .
Ken drove me to Aurora Medical Center in Two Rivers , Wisconsin after talking with a nurse over the phone who encouraged us to come directly to the emergency room .
He brought the car up to the doors and told me to wait .
I thought he was going to check in for me so @ @ @ @ @ @ @ for the walk inside .
Moments later , he opened my door and I saw that he had brought out a wheelchair .
Was I really that weak ?
I got out of the car and took three steps to the chair .
In just that time , I felt like I had gone through a strenuous workout .
My breathing was heavy ; my energy sapped .
Once inside , Ken gave the nurse my information and why we were there , but because of our COVID-19 diagnoses , he had to @ @ @ @ @ @ @ inside the hospital alone .
At that point , I still hoped they ’ d give me some medication and send me home .
My husband and the cats could care for me .
I was taken to a room quickly after arriving .
The nurse checked my temperature — which was just under 100 degrees , the lowest it had been in days — and a few other vitals .
A paper gown covered her scrubs and was tucked into a pair of disposable latex gloves ; her face was covered by @ @ @ @ @ @ @ around her nose and mouth .
Soon after , the ER doctor told me my oxygen levels were low and started me on oxygen therapy .
My breathing calmed down after that , but there were more tests and evaluations to come .
Not long after , I was admitted to the hospital .
That 's when I learned what seems so obvious in retrospect , but was a shock at the time : I would need to stay for days instead of hours .
Two gifts of comfort from home That first @ @ @ @ @ @ @ pass along a few items from home Ken had dropped off for me — fuzzy socks , an iPad and earbuds , my phone charger and a few overnight items I would need .
I thought that was all , since that ’ s all I had asked for , but then I realized there was more in the bag .
Ken had packed two small crocheted cats I made earlier in the year as replicas of our own cats , Josie and Mr .
Snow .
“ I just thought , since @ @ @ @ @ @ @ cats in , that this might be the next best thing , ” he said when we video chatted afterward .
“ I didn ’ t want you to feel so alone.
” My eyes filled with tears again .
My husband knew how much I would hate being away from home and how I would need any source of comfort I could find .
Aside from continued breathing difficulties , I felt tired — but not sick like I had been for more than a week .
My body aches and migraine @ @ @ @ @ @ @ taste and smell had disappeared and showed no signs of returning , I no longer had periods of cold sweats and my appetite was nearly back to normal .
More than anything , I struggled with isolation and loneliness .
Visits from nurses and doctors broke the monotony .
But I found myself savoring video chats with Ken and anyone else who had time to call me .
Just seeing a familiar face was enough to lift my spirits and bring a smile to my face .
I responded well to the oxygen @ @ @ @ @ @ @ drug that some studies say could be moderately effective in shortening the recovery time of those with COVID-19 .
I also was given steroids to treat the pneumonia that had developed in my lungs .
Remdesivir : FDA approves drug as treatment for COVID-19 patients in hospital At the end of the second day , doctors took me off oxygen to see how I would respond .
The next morning , my levels continued to hold above the minimum threshold .
The end was in sight .
When I left the hospital , @ @ @ @ @ @ @ to continue my recovery .
Moving around felt easier , although I still lost my breath easily and had a mild cough .
It was more than a week before I could return to work .
Had I been in the newsroom at the Herald Times Reporter instead of working from home , it surely would have been longer .
Now , more than two months later , I am still feeling the effects of being sick with COVID-19 .
I still have a persistent cough that worsens when I walk around or @ @ @ @ @ @ @ was recently prescribed an inhaler .
I get tired very easily and still find it difficult to get through a full day without resting or taking a nap .
I find myself becoming lightheaded more often and my hands have a slight tremor that gets worse when I am tired .
I ’ ve had a few visits with my primary doctor since being discharged from the hospital .
Because I developed pneumonia , I will be more susceptible to it for the rest of my life .
Illnesses like influenza or even @ @ @ @ @ @ @ more severe for me , and it will probably take me longer to recover from those illnesses .
At my first check-up , my doctor told me that X-rays had shown my heart was enlarged while I was in the hospital , something seen in many other COVID-19 patients who had to be hospitalized .
She said subsequent X-rays had shown it was returning to a normal size , but that doesn ’ t happen for everybody .
If it had remained enlarged , I would have an increased risk of heart failure @ @ @ @ @ @ @ standstill for two and a half weeks , and it continues to threaten the quality of my life .
Those are just the effects that we know about .
Though we are on the brink of a vaccine , doctors still know very little still about the disease and the virus that causes it .
Some studies suggest there could be long-term damage to internal organs and even to the brain .
Cases continue to rise , including in Wisconsin 's Manitowoc County where I live and where almost 5,000 people have tested @ @ @ @ @ @ @ rise comes an increased number of deaths .
People are in denial of the dangers — some aggressively — or just tired of living in fear , not seeing loved ones , not doing activities they enjoy .
They are taking more and more risks .
I can tell you that I am more afraid of this virus than I ever have been .
I am terrified of contracting it again , because it was such a struggle to survive it the first time .
I am worried about the effects it will @ @ @ @ @ @ @ .
More than that , I am frightened for the people I love .
Just before this story published , my mom fell ill and is awaiting results from her COVID-19 test .
The thought that she , a 10-year breast cancer survivor , could experience symptoms as severe as I did or worse is keeping me awake at night .
The virus is unpredictable and anybody who catches it , regardless of previous risk factors , could end up experiencing severe , life-threatening symptoms .
Even if they survive , their life @ @ @ @ @ @ @ months or years afterward .

Alisa M. Schafer, Manitowoc Herald Times Reporter

A reporter’s harrowing COVID-19 experience: ‘I am more afraid of this virus' than ever
Show Caption Hide Caption COVID-19 cases: Unsettling statistics about coronavirus in the US Coronavirus cases are surging across the country ahead of the holiday season. Here are some unsettling statistics from the month of November. USA TODAY
MANITOWOC, Wis. – I lay in the hospital bed, trying to concentrate on what the doctor was saying. I had been sick with COVID-19 for 12 days and breathing had become a struggle.
He was telling me about the course of remdesivir he wanted to give me.
“How long is that going to take?” I had asked, still expecting to be home in a few hours. I was already looking forward to a bowl of leftover chicken soup we had in the fridge.
“We’ll give you a dose every day and the usual course takes five days,” he said.
Five days.
Five days of medication. Five days of blood draws and tests. Five days of sleeping in a strange bed. Five days … alone.
I felt myself nodding at the doctor’s explanation, putting on a smile – a habit leftover from the days before masks – as the words seemed to drift around the room.
Then he left.
I didn’t know him very well, but his absence left a vacuum. I could hear nurses talking outside my door and then someone in another room coughed but hearing those sounds only accentuated how alone I was in this empty, sterile room.
There I was, 30 years old and relatively healthy, experiencing the kind of symptoms from COVID-19 that I thought only those with chronic health conditions or previous breathing struggles would face.
Quietly, I let tears wash down my face.
Exposure, and then agony
My husband, Ken, and I had been diagnosed with COVID-19 almost two weeks before I was admitted to the hospital on Oct. 6. It came just after seeing a close family friend over the weekend. We had all been careful and taken precautions recommended by experts – wearing masks, staying 6 feet apart, avoiding large gatherings – and felt we would be reasonably safe to spend some long-awaited quality time with each other.
A few days after that weekend, our friend called to say he had just tested positive. Someone at the place he worked had fallen ill, so our friend took a test even though he felt fine. When his positive results came in, he immediately called us so we could begin the recommended 14-day quarantine and take tests to find out if he had passed it on to us.
The Centers for Disease Control and Prevention recommends people quarantine for 14 days if they have been exposed to coronavirus, even if they test negative. Those who test positive for the virus are urged to quarantine until at least 10 days after they get the diagnosis, and more than 24 hours after having a fever.
By the time our friend told us about his positive test, Ken had already been sick with fatigue and nausea for a day, and I had woken up that morning with a sore throat. We had already canceled all plans with family, and Ken called in sick at his job. Hearing the news from our friend confirmed what we had already begun to suspect.
A day later, we were both tethered to our bed, sicker than we had been in years.
Fever became our constant companion and we marked time by how many blankets we piled on ourselves when we had chills. Ken dealt with waves of nausea while I was brought low by body aches and a splitting migraine. Somehow, we managed to take care of each other, taking turns bringing fresh water, ice packs and doses of Tylenol.
On good days, we hobbled a few steps to the couch, but no farther. I was tired and couldn’t keep my eyes open, but pain chased sleep away and I would lie awake for hours on end. The days blended together and time slowed to a crawl at night.
Just when I wondered if we could take more, Ken’s fever broke and he began getting stronger each day, spending less and less time in bed. My body aches and migraine slowly faded and I began to regain my appetite. We started to see a light at the end of our COVID-19 tunnel.
Time to seek medical help
I didn’t notice it much at first. Coughing goes hand-in-hand with illness in my mind and it made sense that I would breathe harder after walking to the kitchen. I was just happy that Ken and I seemed to be getting better. A few more days of recovery, I thought, and we could get back to living our lives.
The next day, my cough was worse. A lot worse. And I started to feel out of breath just standing up from the couch. Soon, I was having to stop to catch my breath halfway through the 15-foot walk from the bedroom to the bathroom. I’d have to sit at the edge of my bed after sitting up until the coughing abated. Just trying to hold a conversation became difficult; talking would cause a fit of coughing.
When I started having trouble breathing, even when I was laying down and resting, I finally agreed with my husband.
It was time to seek medical help.
Ken drove me to Aurora Medical Center in Two Rivers, Wisconsin, after talking with a nurse over the phone who encouraged us to come directly to the emergency room. He brought the car up to the doors and told me to wait. I thought he was going to check in for me so I closed my eyes, mentally preparing for the walk inside.
Moments later, he opened my door and I saw that he had brought out a wheelchair. Was I really that weak?
I got out of the car and took three steps to the chair. In just that time, I felt like I had gone through a strenuous workout. My breathing was heavy; my energy sapped.
Once inside, Ken gave the nurse my information and why we were there, but because of our COVID-19 diagnoses, he had to leave shortly after, and I was brought inside the hospital alone. At that point, I still hoped they’d give me some medication and send me home. My husband and the cats could care for me.
I was taken to a room quickly after arriving. The nurse checked my temperature – which was just under 100 degrees, the lowest it had been in days – and a few other vitals. A paper gown covered her scrubs and was tucked into a pair of disposable latex gloves; her face was covered by a plastic face shield and a mask around her nose and mouth.
Soon after, the ER doctor told me my oxygen levels were low and started me on oxygen therapy. My breathing calmed down after that, but there were more tests and evaluations to come.
Not long after, I was admitted to the hospital. That's when I learned what seems so obvious in retrospect, but was a shock at the time: I would need to stay for days instead of hours.
US coronavirus map: Tracking the outbreak
Two gifts of comfort from home
That first day, a nurse came by to pass along a few items from home Ken had dropped off for me – fuzzy socks, an iPad and earbuds, my phone charger and a few overnight items I would need. I thought that was all since that’s all I had asked for, but then I realized there was more in the bag.
Ken had packed two small crocheted cats I made earlier in the year as replicas of our own cats, Josie and Mr. Snow.
“I just thought, since I couldn’t actually bring the cats in, that this might be the next best thing,” he said when we video chatted afterward. “I didn’t want you to feel so alone.”
My eyes filled with tears again. My husband knew how much I would hate being away from home and how I would need any source of comfort I could find.
Aside from continued breathing difficulties, I felt tired – but not sick as I had been for more than a week. My body aches and migraine were gone. Although my sense of taste and smell had disappeared and showed no signs of returning, I no longer had periods of cold sweats and my appetite was nearly back to normal.
More than anything, I struggled with isolation and loneliness.
Visits from nurses and doctors broke the monotony. But I found myself savoring video chats with Ken and anyone else who had time to call me. Just seeing a familiar face was enough to lift my spirits and bring a smile to my face.
I responded well to the oxygen therapy and the remdesivir, an anti-viral drug that some studies say could be moderately effective in shortening the recovery time of those with COVID-19. I also was given steroids to treat pneumonia that had developed in my lungs.
Remdesivir: FDA approves drug as treatment for COVID-19 patients in hospital
At the end of the second day, doctors took me off oxygen to see how I would respond. The next morning, my levels continued to hold above the minimum threshold. The end was in sight.
A gradual recovery but lifelong effects
When I left the hospital, doctors gave me a prescription for steroids to continue my recovery. Moving around felt easier, although I still lost my breath easily and had a mild cough. It was more than a week before I could return to work. Had I been in the newsroom at the Herald Times Reporter instead of working from home, it surely would have been longer.
Now, more than two months later, I am still feeling the effects of being sick with COVID-19. I still have a persistent cough that worsens when I walk around or even talk too much, and I was recently prescribed an inhaler. I get tired very easily and still find it difficult to get through a full day without resting or taking a nap. I find myself becoming lightheaded more often and my hands have a slight tremor that gets worse when I am tired.
I’ve had a few visits with my primary doctor since being discharged from the hospital. Because I developed pneumonia, I will be more susceptible to it for the rest of my life. Illnesses like influenza or even the common cold are likely to be more severe for me, and it will probably take me longer to recover from those illnesses.
At my first check-up, my doctor told me that X-rays had shown my heart was enlarged while I was in the hospital, something seen in many other COVID-19 patients who had to be hospitalized. She said subsequent X-rays had shown it was returning to a normal size, but that doesn’t happen for everybody. If it had remained enlarged, I would have an increased risk of heart failure.
COVID-19 brought my life to a standstill for two and a half weeks, and it continues to threaten the quality of my life. Those are just the effects that we know about. Though we are on the brink of a vaccine, doctors still know very little still about the disease and the virus that causes it. Some studies suggest there could be long-term damage to internal organs and even to the brain.
Cases continue to rise, including in Wisconsin's Manitowoc County where I live and where almost 5,000 people have tested positive so far, and with that rise comes an increased number of deaths. People are in denial of the dangers – some aggressively – or just tired of living in fear, not seeing loved ones, not doing activities they enjoy. They are taking more and more risks.
I can tell you that I am more afraid of this virus than I ever have been. I am terrified of contracting it again because it was such a struggle to survive it the first time. I am worried about the effects it will have on my health in the future.
More than that, I am frightened for the people I love.
Just before this story published, my mom fell ill and is awaiting results from her COVID-19 test. The thought that she, a 10-year breast cancer survivor, could experience symptoms as severe as I did or worse is keeping me awake at night.
The virus is unpredictable and anybody who catches it, regardless of previous risk factors, could end up experiencing severe, life-threatening symptoms. Even if they survive, their life and their health could be affected for months or years afterward.
Follow Wisconsin reporter Alisa Schafer on Twitter at @AlisaMSchafer.


usatoday--2020-12-06--'SNL': Morgan Wallen stars in maskless partying skit months after his own COVID-19 scandal

After being booted from `` Saturday Night Live '' two months prior for not following COVID-19 protocols , musical guest Morgan Wallen starred in a sketch about just that in Saturday 's episode .
Three days before he was set to make his `` SNL '' debut in October , the country singer was told he would not perform on the show after social media captured him partying with strangers without a mask .
In the sketch , which is described with on-screen text as taking place at `` The University of Alabama , two months ago , '' Morgan @ @ @ @ @ @ @ a face mask .
`` To no consequences ! ''
he shouts , before agreeing to kiss someone as long as she did n't post it to social media .
`` OK , just on TikTok , I promise , '' the girl , played by Chloe Fineman , says .
Then comes host Jason Bateman dressed in an identical outfit as Wallen : `` See I 'm you from the future , and I came back here to stop you from partying tonight . ''
He explained : `` Trust me , @ @ @ @ @ @ @ of you ignoring COVID protocol and the whole internet is gon na freak out . ''
`` Nah , I just specifically asked her not to post it , '' the real Wallen said .
`` I know , I thought it was an airtight approach as well , '' Bateman 's character replied .
`` But once people hear about the party , you 're in big trouble , man .
You 're gon na get kicked off 'Saturday Night Live . '
'' Wallen said he did n't want to `` @ @ @ @ @ @ @ '' but then gets persuaded by his future self to stick around for a bit .
`` I know it 's hard , I forgot how fun this party was , '' Bateman 's Wallen said .
`` Maybe we stay for like , I do n't know , another five to 10 more minutes ... just to really understand why it 's so wrong . ''
Later in the show , Wallen played hits including `` 7 Summers . ''
Related : Morgan Wallen , singer 'SNL ' booted for maskless partying @ @ @ @ @ @ @ celebrations In October , the 27-year-old East Tennessee native attended an Alabama Crimson Tide football game in Tuscaloosa , per his Instagram feed .
Multiple videos posted to TikTok show the singer posing maskless for photos , kissing women and playing guitar in a close circle of onlookers .
Wallen later shared a statement on his Instagram about his removal from the show .
`` I 'm not positive for COVID , '' he said .
`` But my actions this past weekend were pretty short-sighted , and they 've obviously affected my @ @ @ @ @ @ @ I respect the show 's decision , because I know that I put them in jeopardy . ''
`` SNL '' has returned to its Manhattan studio under strict safety precautions .
Performers , staff and audience members must undergo rapid COVID-19 testing , and all non-performers must wear masks at all times .

'SNL': Morgan Wallen stars in maskless partying skit months after his own COVID-19 scandal
Show Caption Hide Caption 'SNL' features farting 'Rudy Giuliani' and viral 'star witness' Cecily Strong played Rudy Giuliani's 'star witness.' It was the first 'Saturday Night Live' since the 2020 presidential election. USA TODAY, Wochit
After being booted from "Saturday Night Live" two months prior for not following COVID-19 protocols, musical guest Morgan Wallen starred in a sketch about just that in Saturday's episode.
Three days before he was set to make his "SNL" debut in October, the country singer was told he would not perform on the show after social media captured him partying with strangers without a mask.
In the sketch, which is described with on-screen text as taking place at "The University of Alabama, two months ago," Morgan is seen barging into a bar without a face mask.
"To no consequences!" he shouts, before agreeing to kiss someone as long as she didn't post it to social media.
"OK, just on TikTok, I promise," the girl, played by Chloe Fineman, says.
Then comes host Jason Bateman dressed in an identical outfit as Wallen: "See I'm you from the future, and I came back here to stop you from partying tonight."
He explained: "Trust me, someone's gonna post a video of you ignoring COVID protocol and the whole internet is gonna freak out."
"Nah, I just specifically asked her not to post it," the real Wallen said.
"I know, I thought it was an airtight approach as well," Bateman's character replied. "But once people hear about the party, you're in big trouble, man. You're gonna get kicked off 'Saturday Night Live.'"
Wallen said he didn't want to "screw up an opportunity like that," but then gets persuaded by his future self to stick around for a bit.
"I know it's hard, I forgot how fun this party was," Bateman's Wallen said. "Maybe we stay for like, I don't know, another five to 10 more minutes... just to really understand why it's so wrong."
Later in the show, Wallen played hits including "7 Summers."
Related: Morgan Wallen, singer 'SNL' booted for maskless partying, calls out 'hypocrisy' of election celebrations
In October, the 27-year-old East Tennessee native attended an Alabama Crimson Tide football game in Tuscaloosa, per his Instagram feed. Multiple videos posted to TikTok show the singer posing maskless for photos, kissing women and playing guitar in a close circle of onlookers.
Two months ago at The University of Alabama... pic.twitter.com/IVkNMUoLUf — Saturday Night Live - SNL (@nbcsnl) December 6, 2020
Wallen later shared a statement on his Instagram about his removal from the show.
"I'm not positive for COVID," he said. "But my actions this past weekend were pretty short-sighted, and they've obviously affected my long term goals and my dreams... I respect the show's decision, because I know that I put them in jeopardy."
"SNL" has returned to its Manhattan studio under strict safety precautions. Performers, staff and audience members must undergo rapid COVID-19 testing, and all non-performers must wear masks at all times.
Contributing: Matthew Leimkuehler and Dave Paulson, Nashville Tennessean


usatoday--2020-12-06--DeVonta Smith, Alabama offense runs wild in record-setting showing vs. LSU

Twelve minutes erased the rhetoric of an entire year .
Alabama ’ s domination of the first quarter took LSU out of the game , and dominating the final three quarters led to a final score of 55-17 .
The 55 points are the most the Crimson Tide have ever scored in a game against LSU .
Here are three things we learned in the Crimson Tide ’ s win over LSU , which clinched Alabama a spot in the Southeastern Conference championship game .
Alabama coach Nick Saban has generally been cordial with opponents his teams are overwhelming .
@ @ @ @ @ @ @ the Crimson Tide pulled most of its starting offense with five minutes left in the third quarter , up by 39 points .
On Saturday , Mac Jones and the starting offense were on the field as the fourth quarter started while up 35 points .
Saban said early in the week he is not one to use revenge as a motivational tactic , but recognized his players would likely be motivated by last year ’ s loss to the Tigers and the antics that followed .
UA ’ s personnel decisions on @ @ @ @ @ @ @ more than just beating LSU .
Week 14 winners and losers : Ohio State , Texas A & M stay on playoff track Eyes on Texas : Tom Herman has only himself to blame for the situation he 's in at Texas Alabama has the best offensive line in the nation LSU has several shortcomings , but defensive front play is not one of them .
The Tigers entered the game fourth in the SEC in tackles for a loss , and two Tigers ( BJ Ojulari and Andre Anthony ) were in @ @ @ @ @ @ @ sacks .
Yet , UA mauled LSU on the ground , clearing the way for three Najee Harris rushing touchdowns and nearly 150 yards in the first three quarters .
It also gave Jones more than enough time to pick LSU apart , often taking his time in the pocket to do so .
This offensive line — made up of Alex Leatherwood , Deonte Brown , Landon Dickerson , Emil Ekiyor Jr. and Evan Neal — will have to wait until the College Football Playoff to find an equal , if it @ @ @ @ @ @ @ DeVonta Smith is no stranger to 200-yard receiving games .
He now has four of them , the most in the history of Alabama football .
Saturday ’ s exhibition of excellence was different .
He reached the 200-yard threshold in the first half .
Smith exited with eight catches for 231 yards and three touchdowns , but only after he continued to drive home his case as the best wide receiver in the nation .
The production may have been more impressive against a more capable opponent — LSU entered the game @ @ @ @ @ @ @ pass attempt allowed — but it was enough to garner attention .
It is certainly too little and too late , but nationally , months of Heisman Trophy chatter surrounding Jones is beginning to transition to Smith .

DeVonta Smith, Alabama offense runs wild in record-setting showing vs. LSU
Twelve minutes erased the rhetoric of an entire year.
Alabama’s domination of the first quarter took LSU out of the game, and dominating the final three quarters led to a final score of 55-17. The 55 points are the most the Crimson Tide have ever scored in a game against LSU.
Here are three things we learned in the Crimson Tide’s win over LSU, which clinched Alabama a spot in the Southeastern Conference championship game.
Alabama sent a message
Alabama coach Nick Saban has generally been cordial with opponents his teams are overwhelming. Just two weeks ago against Kentucky, the Crimson Tide pulled most of its starting offense with five minutes left in the third quarter, up by 39 points.
On Saturday, Mac Jones and the starting offense were on the field as the fourth quarter started while up 35 points.
Saban said early in the week he is not one to use revenge as a motivational tactic, but recognized his players would likely be motivated by last year’s loss to the Tigers and the antics that followed. UA’s personnel decisions on Saturday suggested it was interested in doing more than just beating LSU.
Week 14 winners and losers: Ohio State, Texas A&M stay on playoff track
Eyes on Texas: Tom Herman has only himself to blame for the situation he's in at Texas
Alabama has the best offensive line in the nation
LSU has several shortcomings, but defensive front play is not one of them. The Tigers entered the game fourth in the SEC in tackles for a loss, and two Tigers (BJ Ojulari and Andre Anthony) were in the top 10 in the SEC in sacks.
Yet, UA mauled LSU on the ground, clearing the way for three Najee Harris rushing touchdowns and nearly 150 yards in the first three quarters. It also gave Jones more than enough time to pick LSU apart, often taking his time in the pocket to do so.
This offensive line — made up of Alex Leatherwood, Deonte Brown, Landon Dickerson, Emil Ekiyor Jr. and Evan Neal — will have to wait until the College Football Playoff to find an equal, if it is able to find one there.
DeVonta Smith cannot be contained
DeVonta Smith is no stranger to 200-yard receiving games. He now has four of them, the most in the history of Alabama football.
Saturday’s exhibition of excellence was different. He reached the 200-yard threshold in the first half.
Another amazing touchdown grab by DeVonta Smith puts Alabama up *checks notes* 45-14(!!) over the defending national champs. pic.twitter.com/3A2CsemLWs — USA TODAY Sports (@usatodaysports) December 6, 2020
Smith exited with eight catches for 231 yards and three touchdowns, but only after he continued to drive home his case as the best wide receiver in the nation. The production may have been more impressive against a more capable opponent — LSU entered the game last in the SEC in yards per pass attempt allowed — but it was enough to garner attention.
It is certainly too little and too late, but nationally, months of Heisman Trophy chatter surrounding Jones is beginning to transition to Smith.


usatoday--2020-12-05--Devastating New York City fire destroys 19th-century church, a 'beloved' institution

A six-alarm fire on Saturday all but destroyed a historic 120-year-old church in New York City 's East Village .
The fire also decimated an abandoned building , which was already in poor shape following a fire earlier this year , and it left a nearby building damaged , according to the New York Fire Department .
The fire began around 5 a.m. and firefighters arrived at the scene in three minutes , said New York Fire Department Assistant Chief John Hodgens .
“ We had heavy fire showing from the corner building , ” he said in a statement @ @ @ @ @ @ @ We quickly transmitted additional alarms to get more help here .
We knew this was going to be a big operation.
” Video from the fire posted shortly after FDNY arrived showed a sea of red and orange smoke , with the church still standing but the building in front of it engulfed in flames .
The fire eventually spread to the Middle Collegiate Church , which is located right behind the building .
The church , built in 1891 , is a Protestant Reformed ministry with an emphasis on inclusivity and diversity @ @ @ @ @ @ @ as a place `` to heal the soul and the world by dismantling racist , classist , sexist , and homophobic systems of oppression . ''
By late Saturday morning , New York firefighters had taken out much of the fire , according to local reporters at the scene .
But the wreckage was severe , both for the church and the building , Hodgens said , describing both as “ total losses , '' the New York Daily News reported .
At least four firefighters were injured , Hodgens said .
It @ @ @ @ @ @ @ .
“ We are devastated and crushed that our beloved physical sanctuary at Middle Collegiate Church has burned .
And yet no fire can stop Revolutionary Love , ” said Middle Collegiate Church ’ s Rev .
Jacqui Lewis in a statement .
“ We thank God that there has been no loss of life .
”

Devastating New York City fire burns 19th-century church, a 'beloved' institution
Show Caption Hide Caption NYC church engulfed in flames, more than 100 firefighters called out More than 100 firefighters were called out to a building fire that spread to the Middle Collegiate Church in Manhattan, reports said. Storyful, Wochit
A six-alarm fire on Saturday all but destroyed a historic 120-year-old church in New York City's East Village.
The fire also decimated an abandoned building, which was already in poor shape following a fire earlier this year, and it left a nearby building damaged, according to the New York Fire Department.
The fire began around 5 a.m. and firefighters arrived at the scene in three minutes, said New York Fire Department Assistant Chief John Hodgens.
“We had heavy fire showing from the corner building,” he said in a statement shared on Instagram early Saturday. “We quickly transmitted additional alarms to get more help here. We knew this was going to be a big operation.”
Video from the fire posted shortly after FDNY arrived showed a sea of red and orange smoke, with the church still standing but the building in front of it engulfed in flames.
The fire eventually spread to the Middle Collegiate Church, which is located right behind the building. The church, built in 1891, is a Protestant Reformed ministry with an emphasis on inclusivity and diversity. It brands itself on its website as a place "to heal the soul and the world by dismantling racist, classist, sexist, and homophobic systems of oppression."
By late Saturday morning, New York firefighters had taken out much of the fire, according to local reporters at the scene.
But the wreckage was severe, both for the church and the building, Hodgens said, describing both as “total losses," the New York Daily News reported.
At least four firefighters were injured, Hodgens said. It remains unclear what caused the initial fire.
“We are devastated and crushed that our beloved physical sanctuary at Middle Collegiate Church has burned. And yet no fire can stop Revolutionary Love,” said Middle Collegiate Church’s Rev. Jacqui Lewis in a statement. “We thank God that there has been no loss of life.”
Follow Joshua Bote on Twitter: @joshua_bote.


usatoday--2020-12-06--I've made tough decisions about human lives. The COVID-19 vaccine is a similar challenge.

Just 11 days after the Sept. 11 terrorist attacks , Congress enacted the 9/11 Victim Compensation Fund and I became its administrator .
Over the next 33 months , the Fund paid over $ 7.1 billion in public taxpayer money to 5,300 individual victims .
The law made clear that eligibility was limited to the families of those who died on 9/11 and those individual victims who survived but suffered physical injury .
The law expressly prohibited individual claims of mental injury .
Congress made a hard decision to restrict eligibility to death and physical injury .
Today , people @ @ @ @ @ @ @ globe eagerly await the development , manufacture and distribution of a COVID-19 vaccine .
Billions of dollars are being invested in the ongoing effort and vaccine availability is anticipated in the next few months , even weeks .
That means a determination must be made — and soon — as to who will be eligible to receive the COVID-19 vaccine ahead of others .
An advisory panel to the Centers for Disease Control and Prevention last week recommended that front-line health care workers and nursing home residents should be first in line .
@ @ @ @ @ @ @ of the tough eligibility choices ahead .
If “ essential worker ” is defined narrowly to encompass doctors and other health professionals staffing the front line in treating virus illnesses , for instance , that is an easy call .
But if the janitor , the security guard and administrative staff , all employed by the hospital , are also deemed to be “ essential workers , ” the issue becomes more problematic .
Nor is it a given that the definition should only include health professionals and related employees .
One can @ @ @ @ @ @ @ fighters , postal service workers , subway and bus drivers , farmers , employees in food plants and other factories should also be deemed “ essential.
” Others assert that a priority should be recognized for elderly citizens ( a demographic more vulnerable to the virus ) ; individuals with preexisting medical conditions regardless of age ; our military personnel stationed around the world ; and foreigners also suffering from a pandemic worldwide in scope .
We will need to decide what lives should be valued ahead of others .
The process for @ @ @ @ @ @ @ , although sure to be controversial .
As with the 9/11 Fund , either Congress or federal and state health agencies will need to establish who should be first to receive initial limited availability of a COVID-19 vaccine .
This will not be easy .
But resolving issues like this is reserved for elected officials or health regulators with authority to oversee the vaccine effort .
In our democracy such decisions are made every day by those who have the official responsibility and authority to measure the value of lives and determine eligibility @ @ @ @ @ @ @ 's health depends on how fast and well we distribute the COVID vaccine Although our most sacred public documents — the Declaration of Independence and the Constitution — reiterate and reinforce the concept that “ all lives are equal , ” in truth , they are not .
Just as the 9/11 Fund restricted eligibility to death and physical injury so , too , do our judges and juries assess the value of lives .
The banker , stockbroker , lawyer and doctor are deemed eligible for greater compensation than the waiter , @ @ @ @ @ @ @ , those who earn more receive greater compensation than those earning less .
Contention no matter who comes first And our most cherished and respected federal programs — Social Security , Medicare and Medicaid — all maintain fixed eligibility requirements .
Hard decisions about age , income , work status and disability are made every day in America when it comes to determining who qualifies for federal benefits .
Abstract considerations of “ equal justice ” and “ equal protection of the law ” often yield to practical considerations regarding human differences .
@ @ @ @ @ @ @ to vaccine priorities .
We rely on our elected representatives and health regulators to determine “ who gets what , ” who should be deemed a priority when it comes to limited vaccine availability .
I have learned over the years that disagreement , frustration , and anger result no matter what decisions are made concerning eligibility and money .
Human nature has taught me that individuals often calculate other people ’ s eligibility and compensation and compare that to themselves .
There will always be disagreement as to who gets what , @ @ @ @ @ @ @ the territory in a free society .
Reviewing the COVID vaccine : States ' vaccine reviews could be unnecessary , counterproductive But , ultimately , it is up to our policymakers — elected officials and health regulators coordinating with private health authorities .
They have been given the responsibility to make these tough decisions and prioritize who is entitled to be placed at the front of the line .
They are accountable to Americans and their ultimate decisions will not please all .
Criticism and recrimination will follow .
But in a healthy @ @ @ @ @ @ @ such decisions are made and carried out — whether it be the 9/11 Victim Compensation Fund , eligibility for government benefits , judge and jury deciding issues in the courtroom or , in the case of an anticipated vaccine , determining which lives should be valued ahead of others .
Kenneth R. Feinberg is the former Administrator of the 9/11 Victim Compensation Fund , the BP Oil Spill Fund , and numerous other compensation programs .

Kenneth R. Feinberg, Opinion contributor

I've made tough decisions about human lives. The COVID-19 vaccine is a similar challenge. When it comes to eligibility and money, there will always be disagreement about who gets what, when and how. It goes with the territory in a free society.
Show Caption Hide Caption COVID-19: How Herd Immunity works, why you still need to wear a mask Without masks and a vaccine, we could reach Herd Immunity from COVID-19, but deaths would skyrocket. We break down the science of it. Just the FAQs, USA TODAY
Just 11 days after the Sept. 11 terrorist attacks, Congress enacted the 9/11 Victim Compensation Fund and I became its administrator. Over the next 33 months, the fund paid over $7.1 billion in public taxpayer money to 5,300 individual victims. The law made clear that eligibility was limited to the families of those who died on 9/11 and those individual victims who survived but suffered physical injury. The law expressly prohibited individual claims of mental injury. Congress made a hard decision to restrict eligibility to death and physical injury.
Today, people in the United States and around the globe eagerly await the development, manufacture and distribution of a COVID-19 vaccine. Billions of dollars are being invested in the ongoing effort, and vaccine availability is anticipated in the next few months, even weeks. That means a determination must be made — and soon — as to who will be eligible to receive the COVID-19 vaccine ahead of others.
Tough vaccine eligibility choices ahead
An advisory panel to the Centers for Disease Control and Prevention last week recommended that front-line health care workers and nursing home residents should be first in line. But that’s just the beginning of the tough eligibility choices ahead.
If “essential worker” is defined narrowly to encompass doctors and other health professionals staffing the front line in treating virus illnesses, for instance, that is an easy call. But if the janitor, the security guard and administrative staff, all employed by the hospital, are also deemed to be “essential workers,” the issue becomes more problematic. Nor is it a given that the definition should only include health professionals and related employees. One can also maintain that police officers, firefighters, postal service workers, subway and bus drivers, farmers, and employees in food plants and other factories should also be deemed essential.
Others assert that a priority should be recognized for elderly citizens (a demographic more vulnerable to the virus), individuals with preexisting medical conditions regardless of age, our military personnel stationed around the world, and foreigners also suffering from a pandemic worldwide in scope.
We will need to decide what lives should be valued ahead of others. The process for resolving this emotional issue is clear enough, although sure to be controversial. As with the 9/11 fund, either Congress or federal and state health agencies will need to establish who should be first to receive initial limited availability of a COVID-19 vaccine.
This will not be easy, but resolving issues like this is reserved for elected officials or health regulators with authority to oversee the vaccine effort. In our democracy, such decisions are made every day by those who have the official responsibility and authority to measure the value of lives and determine eligibility for public benefits.
Researchers: America's health depends on how fast and well we distribute the COVID vaccine
Although our most sacred public documents — the Declaration of Independence and the Constitution — reiterate and reinforce the concept that all lives are equal, in truth, they are not. Just as the 9/11 fund restricted eligibility to death and physical injury so, too, do our judges and juries assess the value of lives. The banker, stockbroker, lawyer and doctor are deemed eligible for greater compensation than the waiter, soldier and policeman. In valuing lives, those who earn more receive greater compensation than those earning less.
Contention no matter who comes first
And our most cherished and respected federal programs — Social Security, Medicare and Medicaid — all maintain fixed eligibility requirements. Hard decisions about age, income, work status and disability are made every day in America when it comes to determining who qualifies for federal benefits. Abstract considerations of “equal justice” and “equal protection under the law” often yield to practical considerations regarding human differences.
So, too, when it comes to vaccine priorities. We rely on our elected representatives and health regulators to determine “who gets what,” who should be deemed a priority when it comes to limited vaccine availability.
I have learned over the years that disagreement, frustration and anger result no matter what decisions are made concerning eligibility and money. Human nature has taught me that individuals often calculate other people’s eligibility and compensation and compare that with themselves. There will always be disagreement as to who gets what, when and how. It goes with the territory in a free society.
Reviewing the COVID vaccine: States' vaccine reviews could be unnecessary, counterproductive
Ultimately, it is up to our policymakers — elected officials and health regulators coordinating with private health authorities. They have been given the responsibility to make these tough decisions and prioritize who is entitled to be placed at the front of the line.
They are accountable to Americans, and their ultimate decisions will not please all. Criticism and recrimination will follow. But in a healthy and vibrant democracy, these are how such decisions are made and carried out — whether it be the September 11th Victim Compensation Fund, eligibility for government benefits, judge and jury deciding issues in the courtroom or, in the case of an anticipated vaccine, determining whose lives should be valued ahead of others.
Kenneth R. Feinberg is the former administrator of the September 11th Victim Compensation Fund, the BP oil spill fund and numerous other compensation programs.