Photographs and Text by Adam Ferguson
Hospitals in Gallup are nearly full. Most stores are empty. The unemployment rate in the county where the city sits is one and a half times the national average. Earlier this month, it had the most cases per capita of any metro area in the United States, according to a New York Times database.
As the pandemic has steadily marched across the country in recent months, places like Gallup have been among the hardest hit.
Perched between the Navajo Nation to the north and Zuni Nation to the south, almost half of Gallups residents are Native American, according to census data.
Native American communities have been particularly vulnerable to the virus, at one point accounting for nearly 40 percent of all cases in New Mexico, even though those communities make up less than a tenth of the states population. And some who have so far been spared by the virus are nonetheless reeling from the consequences of the economic slowdown.
Eric-Paul Riege, a 26-year-old artist, is the son of a veteran and hotel manager and a Navajo mother who taught him the art of weaving. His work has appeared in galleries and collections around the country. But paid projects this year all but dried up.
When I met Mr. Riege, he was working shifts at a diner called Grandpas Grill, processing orders for takeout food.
Route 66 cuts through Gallup. The town has relied on tourism to help drive its economy, counting on visitors to shop at local galleries and trading posts selling Native American art and crafts. But limits on activity in the area have made that hard.
When the region was experiencing an extreme wave of virus cases in May, the city locked down, and state police officers and the National Guard barricaded highway exits to prevent people who didnt live in Gallup from entering town unless it was an emergency.
Last month, long after the barricades came down, trading posts were open but closed for indoor shopping, limiting the chances of anyone passing by to stop and browse.
The iconic El Rancho hotel, where John Wayne and Katharine Hepburn and other Hollywood stars once stayed, was roughly a quarter full.
Gallup is in many ways a relic of conquered Indigenous lands and American expansion. Many of the trading posts, for example, are owned and operated by white people. Those small shops sit in the shadows of McDonalds, Walmart and other big American franchises, where cars and people often spill out of parking lots now.
Bill Lee, the head of Gallups Chamber of Commerce, said there has been a growing economic divide because of the restrictions put in place by local and state officials. Smaller businesses often have to operate with stricter guidelines, including rules preventing in-store shopping, while bigger box stores, especially those deemed essential, could operate with fewer limits. The governor has chosen winners and losers, Mr. Lee told me.
Dec. 28, 2020, 1:38 a.m. ET
When the barricades were erected earlier this year, Walmart was inundated by shoppers stocking up on weeks worth of supplies, especially because grocery stores on Indigenous lands are few and far between. The barricades, however, also had the effect of preventing members of Native American groups from coming into town to shop.
Indigenous groups in the area have long suffered from a lack of information and resources.
Even before the pandemic, the Indian Health Service, the government program that provides health care to the 2.2 million members of the nations tribal communities, had severe shortages of funding and supplies, in addition to a lack of doctors and aging facilities.
The virus made those weaknesses that much more apparent.
Amid the devastation of the pandemic, some people have gotten lucky. Dan Bonaguidi, the son of the towns mayor who owns Micheles Ready Mix Rock and Recycle with his wife, Michele, is one of them. His business has been thriving as government grants in the pandemic have led to greater demand for building materials for home renovations and projects like new or expanded health care facilities.
But even with bright spots, there are many more stories of businesses sitting empty or being shuttered small and large.
After an oil and natural gas boom in New Mexico and Texas in recent years, the pandemic has cut into oil demand and prices. Marathon Petroleum announced plans in August to shut down its operations in the area and lay off more than 200 workers roughly 1 percent of the citys population.
Operations like Marathons are vital to Gallups economy, and the job losses helped push the areas unemployment rate to 10.6 percent in October. Raul Sanchez is one of the workers who lost his job.
As I drove by his home on a hill overlooking the western part of town one afternoon two days before Thanksgiving, Mr. Sanchez was tinkering with a red pickup truck. Hed worked at Marathon for 10 years. No other jobs in this town pay as well, Mr. Sanchez, 39, said.
Its going to have an effect on us, the citys mayor, Louis Bonaguidi, said earlier this year about the closing of the Marathon plant. Its going to affect the housing market for sure. But its going to affect all the businesses, too.
When I drove through Gallup the day before Thanksgiving, the last few minutes of sun lit up the railroad rails Despite the towns struggles, I could still feel a sense a pride in the community as I drove around.
But the sense of vulnerability was just as apparent. Even before the pandemic hit, more than a quarter of the citys residents lived in poverty, and those numbers have swelled this year.
Not long after my visit to the Rehoboth medical center, I watched a group of Navajo men lower a bronze-colored coffin into a grave at a cemetery 50 miles north of Gallup. It was not the only virus-related funeral scheduled there that week.
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Ever since the race to develop a coronavirus vaccine began last spring, upbeat announcements were stalked by ominous polls: No matter how encouraging the news, growing numbers of people said they would refuse to get the shot.
The time frame was dangerously accelerated, many people warned. The vaccine was a scam from Big Pharma, others said. A political ploy by the Trump administration, many Democrats charged. The internet pulsed with apocalyptic predictions from longtime vaccine opponents, who decried the new shot as the epitome of every concern theyd ever put forth.
But over the past few weeks, as the vaccine went from a hypothetical to a reality, something happened. Fresh surveys show attitudes shifting and a clear majority of Americans now eager to get vaccinated.
In polls by Gallup, the Kaiser Family Foundation and the Pew Research Center, the portion of people saying they are now likely or certain to take the vaccine has grown from about 50 percent this summer to more than 60 percent, and in one poll 73 percent a figure that approaches what some public health experts say would be sufficient for herd immunity.
Resistance to the vaccine is certainly not vanishing. Misinformation and dire warnings are gathering force across social media. At a meeting on December 20, members of an advisory panel to the Centers for Disease Control and Prevention cited strong indications that vaccine denouncements as well as acceptance are growing, so they could not predict whether the public would gobble up limited supplies or take a pass.
But the attitude improvement is striking. A similar shift on another heated pandemic issue was reflected in a different Kaiser poll this month. It found that nearly 75 percent of Americans are now wearing masks when they leave their homes.
The change reflects a constellation of recent events: the uncoupling of the vaccine from Election Day; clinical trial results showing about 95 percent efficacy and relatively modest side effects for the vaccines made by Pfizer-BioNTech and Moderna; and the alarming surge in new coronavirus infections and deaths.
As soon as it is my turn to get the vaccine, I will be there front and center! I am very excited and hopeful, said Joanne Barnes, 68, a retired elementary school teacher from Fairbanks, Alaska, who told The New York Times last summer that she would not get it.
What changed her mind?
The Biden administration, returning to listening to science and the fantastic stats associated with the vaccines, she replied.
The lure of the vaccines modest quantities also cant be underestimated as a driver of desire, somewhat like the must-have frenzy generated by a limited-edition Christmas gift, according to public opinion experts.
That sentiment can also be seen in the shifting nature of some of the skepticism. Rather than just targeting the vaccine itself, eyebrows are being raised across the political spectrum over who will get it first which rich individuals and celebrities, demographic groups or industries?
But the grim reality of the pandemic with more than 200,000 new cases and some 3,000 deaths daily and the wanness of this holiday season are perhaps among the biggest factors.
More people have either been affected or infected by Covid, said Rupali J. Limaye, an expert on vaccine behavior at the Johns Hopkins Bloomberg School of Public Health. They know someone who had a severe case or died.
Dr. Limaye concluded: They are fatigued and want to get back to their normal lives.
A barrage of feel-good media coverage, including rapt attention given to leading scientists and politicians when they get jabbed and joyous scrums surrounding local health care workers who become the first to be vaccinated, has amplified the excitement, public opinion experts say.
There remain notable discrepancies among demographic groups. The divide between women and men has become pronounced, with women being more hesitant. Black people remain the most skeptical racial group, although their acceptance is inching up: In September, a Pew Research poll said that only 32 percent of Black people were willing to get the vaccine, while the latest poll shows a rise to 42 percent. And though people of all political persuasions are warming to the vaccine, more Republicans than Democrats view the shot suspiciously.
The association between vaccine attitudes and political affiliation is worrisome to many behavioral experts, who fear that vaccine uptake will become tied to partisan views, impeding the achievement of a broad immunity.
Dec. 28, 2020, 1:38 a.m. ET
Weve seen a growth among both Democrats and Republicans about their intent to vaccinate, said Matthew P. Motta, a political scientist at Oklahoma State University who studies political opinions and vaccine views. But its twice the size in Democrats, who, he added, had been souring on the vaccine following President Trumps avowal that it would arrive by Election Day.
A brighter indication, he said, is that two-thirds of the public say they are at least somewhat confident that a coronavirus vaccine will be distributed in a way that is fair, up from 52 percent in September.
The most pronounced pockets of resistance include rural residents and people between the ages of 30 and 49.
Timothy H. Callaghan, a scholar at the Southwest Rural Health Research Center at Texas A&M School of Public Health, said that rural residents tend to be conservative and Republican, characteristics that also show up among the vaccine hesitant. They also include immigrants and day laborers, many of whom do not have college degrees or even high school diplomas and so may be more dismissive of vaccine science.
They appear less likely to wear masks, less likely to work from home and there is an opposition to evidence-based practices, Dr. Callaghan said.
The resistance also springs from their hampered access to health care in remote areas. In addition, the need to take off several hours of work from the inflexible demands of farming for travel and recovery from vaccine side effects makes the shots seem even less compelling, he added.
About 35 percent of adults between 30 and 49 over all expressed skepticism about the vaccine, according to the Kaiser poll. Dr. Scott C. Ratzan, whose vaccine surveys in New York with the City University of New York Graduate School of Public Health echo findings similar to the national polls, noted that this group doesnt keep up on flu shots either. They are well out of the age range for routine vaccines.
There is no normalizing or habit for this age group to get vaccinated, he said.
Black people have remained the most resistant to taking a coronavirus vaccine, largely because of the history of abusive research on them by white doctors. But their willingness to consider it is ticking up. In the Kaiser poll, the share of Black respondents who believe the vaccine will be distributed fairly has nearly doubled, to 62 percent from 32 percent.
Mike Brown, who is Black, manages the Shop Spa, a large barbershop with a Black and Latino clientele in Hyattsville, Md. This summer he told The Times that he was happy to sit back and watch others get the vaccine, while he bided his time.
That was then.
The news that it was 95 percent effective sold me, Mr. Brown said. The side effects sound like what you get after a bad night of drinking and you hurt the next day. Well, Ive had many of those and I can deal with that to get rid of the face masks.
Still, he says, many customers remain skeptical. He tells them: What questions do you have that youre leery about? Just do your investigation and follow the science! Because if youre just talking about what you wont do, youre becoming part of the problem.
He does see progress. A couple of people who were more militant about not taking it are more quiet now, he said. The seeds are being planted.
Another group that has been uncertain about taking the vaccine is health care workers, who typically have high rates of acceptance for established vaccines. In recent weeks, some hospital executives have said that many on their staffs were balking. ProPublica reported that a hospital in the Rio Grande Valley in Texas had to offer some allotted doses to other medical workers in the area, because an insufficient number of their own workers came forward. A sheriffs deputy and a state senator got in line.
But other hospitals say that staff time slots for the vaccine are becoming a hot commodity.
For months, Tina Kleinfeldt, a surgical recovery nurse at Long Island Jewish Medical Center, a hospital in the Northwell Health network, had absolutely no intention of getting the vaccine until long after the science and side effects had been established.
Last week, she was randomly offered a rare vaccination slot. Still she refused, despite the admonitions of envious colleagues.
Then she began thinking of all the Covid-19 patients she had cared for and the new ones she would inevitably encounter. She thought about her husband and three children. She thought: Well, I can always cancel the appointment at the last minute, right?
Then she realized that doses were still so scarce that she might not get another opportunity soon. So she said yes. She became the first nurse on her unit to get the shot.
Afterwards , she felt some muscle soreness at the site of injection. But she also felt elated, excited and relieved.
I felt like I did a good thing, for myself, my family, my patients, the world, Ms. Kleinfeldt said. And now I hope everyone will get it. Isnt that crazy?
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Editors note: Three topics kept us transfixed this year: the deadly coronavirus pandemic, the election and a wave of protests demanding racial justice. As the year comes to an end, the Tribune-Review explores the moments that defined the year.
Amid a pandemic that dominated the news cycle day in and day out for most of the year, 2020 might still be remembered as the year that nothing happened no concerts or festivals, no vacations or far-flung flights, no parties or late nights out at the bar, no graduations, proms, new movie premieres, Black Friday, hugs, reunions or holidays.
The year that changed everything, for most, stole something sacred. For the friends and families of nearly 15,000 who died in Pennsylvania including 899 in Allegheny County and 379 in Westmoreland even more was stolen. For hundreds of thousands of others across the state, life stood still for weeks at a time as they isolated or quarantined from positive tests or possible exposures. Untold numbers will continue on with lingering effects of a virus that at this time one year ago still seemed like a far-off threat one not to cloud the holiday spirit and close of a decade.
Hindsight, though
Spring-summer
On March 6, the virus became a reality in Pennsylvania when Gov. Tom Wolf and Secretary of Health Rachel Levine announced the first two presumed positive cases in the commonwealth. The two ill patients residents of Delaware and Wayne counties contracted the virus through travel, not community transmission, Levine said. Two more presumed positive cases were announced the next day.
By March 10, long-term care facilities in and around Pittsburgh began limiting visits as a precautionary measure, and some schools began closing because of exposure scares. Three days later, Wolf ordered a two-week closure of all districts across the state.
The same day, March 13, the first case of the virus in Southwestern Pennsylvania was reported in Washington County. One day later, the virus arrived in Allegheny County in two Pittsburgh residents living in the same household, according to county health director Debra Bogen. By March 15, the governor ordered in-person dining at Allegheny County bars and restaurants to halt, and the county saw its first virus-related hospitalization.
When the county announced its first cases on March 14, I was only two days into a job I wasnt supposed to start for a couple of months, Bogen said last week looking back on the year.
She said she was excited for the opportunities before her in Allegheny County, but the pandemic was still on her mind.
Even though I knew the pandemic was coming and would eventually make it to Allegheny County, it didnt quite feel real at the beginning, she said. I was reading about it every day in the news and thinking about it, but I just couldnt quite operationalize it in my head at that point. I wish I had a crystal ball for this pandemic, but sadly I do not.
On March 16, the shutdown went into place, and all nonessential businesses were ordered to close for what began as two weeks. Locally, Allegheny and Westmoreland counties would not see even the beginnings of a phased reopening until May. March 18 saw the states first death from the virus, and Westmoreland County reported its first case March 19.
Bud Mertz, Westmorelands director of public safety, said hed hoped in the beginning the situation would not become as dire as it has, with totals in the county standing at 17,989 cases and 379 deaths as of Dec. 26.
I was hoping we didnt get to that point, he said.
In early April, officials asked residents to wear a mask when in public, and the first hints of how a public health issue would become a political issue were seen. The state surpassed 10,000 cases April 4. Pennsylvania in November crossed that same grim level in covid-19 deaths. The state would hit 100,000 cases one month later.
In mid-May, most Southwestern Pennsylvania counties moved into the yellow phase of Wolfs reopening plan. The move allowed retail stores to reopen, along with child care facilities and liquor stores. Restaurants still could not allow in-person dining, and social gatherings remained limited, though that limit increased from 10 to 25. Later, restaurants received guidance for allowing outdoor dining.
In early June, the region moved into the green phase all types of establishments were permitted to reopen but with capacity limitations. Cases in Allegheny County surged in the weeks after, and Bogen ordered all bars and restaurants to halt on-premise alcohol sales for two weeks.
A rise in cases after weeks of decline prompted state officials to make masks mandatory.
Fall-winter
The long-talked-about resurgence came to fruition and was seen daily as new case counts rose from the hundreds to more than 12,000 some days. The surge has been reflected at the county level as well, with Allegheny County posting new case counts in the thousands and Westmoreland County hitting more than 600 one day in mid-December.
In Westmoreland County, Decembers cases represent 45% of total cases and the months deaths mark 44% of total deaths. At the current rate of cases, its possible, if not likely, that 50% of Westmoreland Countys covid cases occurred in December.
Mertz said one upside, if it can be called that, has been new relationships forged between his department and others across the county.
This pandemic has allowed us to expand and work with and partner with a lot of entities and agencies we were never partnered with before, he said. The relationships have been astronomical to say the least.
Onward
Mertz said he understands how tired people are.
Its going to take some time, and we need to have some patience, he said. I can totally understand everybodys pandemic fatigue, but we dont have any alternative right now. I just hope and pray that everybody stays on board and understands that we can put an end to this.
The end appeared closer in December when two vaccines from Pfizer-BioNTech and Moderna were reported to be safe and effective. Both vaccines, approved by the U.S. Food and Drug Administration within days of each other were developed faster than any previously approved vaccine in the United States. Scientists said they took advantage of years of technological advances.
The first batches of the Pfizer vaccine using so-called messenger RNA technology arrived in Pittsburgh on Dec. 13. Five UPMC employees, with pomp and circumstance and TV cameras, received the first of their two injections. The event made tangible the long-awaited light at the end of the covid tunnel.
A few days later, frontline workers at Excela Health and Allegheny Health Network began to receive the vaccine. The arrival of the vaccines was called historic, remarkable and unprecedented.
You feel hope, said John Giesey, Emergency department Clinical Director at Excela, one of dozens of workers to get the vaccine.
The vaccines will next be distributed to other groups such as seniors and residents of the regions long-term care facilities. They wont be widely available for the public until late spring or early summer.
Researchers at the University of Pittsburgh continue to work on another version of a covid vaccine.
Bogen expressed optimism for the new year.
For 2021, know that it will get better, she said. Mitigation measures will work and will start to bring down the case counts. Fewer people will be hospitalized. Fewer people will die. And the vaccine is here. Yes, rollout will seem slow, and I know there is going to be frustration as people wait, but please be patient. There will be vaccine for you.
Allegheny County, Pittsburgh, the whole region, is strongest when we work together. Weve seen this time and time again, so lets make 2021 a year of unity and push back the virus so we can return to the way of life we love and are so fiercely proud of.
Megan Guza is a Tribune-Review staff writer. You can contact Megan at 412-380-8519, mguza@triblive.com or via Twitter .
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Mel and Sue Awes spent the last weeks of their lives in a shared double room in Fairview Southdale Hospital's ICU sedated and on ventilators fighting COVID-19 complications.
The Edina couple began dating when they were students at the University of Minnesota. In six decades of marriage, they had done everything together: moved around the country, raised five children, built careers in sales, amassed a passel of friends.
Breaking with protocol, the hospital staff drew back the divider curtain and placed the couple's beds feet-to-feet, a few yards apart.
In the face of an inhumane disease, it was a humanizing gesture, one that brought their loved ones great comfort. "Mom and Dad were Frick and Frack, they were always together," their son Ben Awes of St. Paul explained.
"We were relatively untouched," he said of the period before the virus infected his parents, who passed it to his brother's household. "And then it hit our family with a fury."
As COVID-19 has ravaged the elderly, couples who have spent nearly a lifetime together are dying together days, sometimes hours apart. For some families left behind, the unexpected double losses are even more painful because a vaccine that could have prevented many of these deaths was almost within reach.
But amid the heartache, they sometimes find comfort.
"It's a mixed bag of grief and gratitude," said Carla Smith of Independence, Minn. Her parents died Dec. 6, just seven hours apart in the same nursing home room. "Neither of them had to grieve and live without the other."
Mary Agnes and Jim Smith moved out of their Independence home into a long-term care facility as their health issues required more care. Although they slept in separate rooms, the couple who had been together for 65 years were almost inseparable during the day, sharing meals, joining activities and spending time together to talk and hold hands.
"They were completely intertwined with each other," daughter Carla Smith said.
When the couple tested positive for COVID-19 just before Thanksgiving, Mary Agnes Smith's decline accelerated. As she slept, her husband pulled his wheelchair close to her bedside, talking to her, patting her on the arm. At times, he sang words of comfort: "I love you. Hallelujah. It's a good day."
"He was just trying to connect to her and make her happy," Carla Smith said.
But eventually, he fell silent as COVID-19 took its toll, she said. He was sleeping when his 93-year-old wife died. Hours later he, too, passed.
He had recently turned 90 years old and said he intended to live to 100.
"They're both gone and my life changed abruptly," Smith said. "I just thought I would have more time with them."
Adrian and Jackie Kapsner were wedded to their lifestyle as much as they were to each other.
"They dearly loved each other," said son Matt Kapsner of Sweetwater Creek, Colo. "They had a symbiotic relationship. They got from one another what they didn't have themselves."
Jackie brought a love of art, music and books to the union while Adrian brought a love for skiing, golf and travel. "They gave value to one another's lives," Matt Kapsner said. "They were attached at the hip."
But when COVID-19 hit, the social isolation imposed to stop the spread of the disease chipped away at the very things that kept the Kapsners and many others their age active and engaged.
"COVID shrunk their entire life and that was sad," said their daughter, Kitty Kapsner of St. Louis Park.
Meanwhile, health issues began taking a toll on 85-year-old Adrian Kapsner while a tumor on his wife's spine caused balance and mobility issues for her. Surgery and rehabilitation remedied most of that for Jackie Kapsner, 81. The long-term prognosis for her husband, however, wasn't as good.
The couple moved out of their Edina home in October and into a Golden Valley senior living community where Adrian Kapsner got round-the-clock care on the first floor and his wife got the help she needed in a fifth-floor apartment.
Weeks after moving in, they tested positive for COVID-19. Eventually, breathing became difficult and the pain unbearable.
Taken to the hospital, Jackie Kapsner improved, then abruptly worsened. She died Dec. 3 as a nurse held her hand.
"I was prepared to lose my dad this year," Kitty Kapsner said. "His heart was failing. But I never thought my mom would die. I look at her obituary every now and then because I still feel like my mom is going to call me again."
With little time to grieve his mother's death two days earlier, Matt Kapsner was on the phone from his Colorado home, struggling to say goodbye to his dad who was losing his fight with COVID-19.
"'Dad, we love you,'" Matt Kapsner said into the phone, crying and searching for words to ease his father's pain. "I stopped my blubbering and told him, 'Mom has died. Jackie isn't here anymore. You need to follow her."
His father let out a painful gasp, later passing away in the early hours of Dec. 6.
Their deaths leave a gaping hole, said Chris Kapsner, the oldest of the four adult children, who lives near Boyceville, Wis., on the family farm. "These were tough days."
As medical director of the emergency department at Abbott Northwestern Hospital, he has seen COVID-19 close-up.
"Becoming orphans at any age is hard," Chris Kapsner said. "You're accustomed to having your parents in your life and then it's all gone."
Mel Awes was a firecracker and a fun-maker, prone to spontaneity, whose energy filled a room. He was famous for calling every friend and relative on their birthdays and cheering Minnesota's sports teams. Sue, a writer and folk painter known for her hospitality, exuded a quieter warmth and anchored her spouse.
At 81 and 80, respectively, they were vibrant and healthy, active in their church and charitable work.
Conversations with either could go from depth to hilarity, their children said. They wanted to know your story, accept you for who you were and be your biggest cheerleader.
Faith and family were the couple's foundation. In a July blog post, Sue described her children and their spouses, grandchildren and great-grandchild as "the joy of our old age."
When the coronavirus arrived, family birthday gatherings and vacations were curtailed, and the couple had only a few relatives in their bubble. In late October, after months of isolation, Mel and Sue attended a small indoor gathering, where everyone wore masks and socially distanced. A few days later, they began to feel ill.
By mid-November, both were hospitalized, and their children called for updates three times a day. Staff taped a paper heart on Sue's window, which faced the parking lot, and loved ones gathered below it to hold vigil. One day, their youngest daughter sat in her car and watched "Notting Hill," her mom's favorite, as a way to connect. They prayed for a miracle but prepared for the worst.
The couple's conditions slowly declined, in tandem: first Sue's, then Mel's, as if he were following her.
On Dec. 10, when it was time to say goodbye, the children entered their parents' room to find that staff had positioned them side-by-side, hand-in-hand.
The children touched their parents' skin and ran fingers through their hair. They listed every family member's name and reminded them how much they were loved by each one.
Before the couple had been sedated, and could still speak with labored breath, Mel and Sue told their children they were not afraid to die. Sue went first and then Mel followed, about 25 minutes later.
Sharing the news on Facebook, their daughter Emily Awes Anderson of Minneapolis described her belief that her parents were now in a better place and the agony of being without them.
"What now for us," she wrote. "And our Christmas, and New Years, and birthdays, and Florida, and Mondays, and Tuesdays, and North Shore, and drop ins, and growing ups, and years, and tomorrow, and this afternoon?"
MaryLynn.Smith@startribune.com 612-673-4788
Rachel.Hutton@startirbune.com 612-673-4569
The West VirginiaDepartment of Health and Human Resources (DHHR) reports as of December 27, 2020, there have been 1,452,115total confirmatorylaboratory results received for COVID-19, with 80,710 total cases and 1,254deaths.
DHHR has confirmed the death of a 90-yearold female from Kanawha County.
Thecontinued loss of West Virginia lives weighs heavily on all of us, with thegreatest sadness borne by family and friends, said Bill J. Crouch, DHHRCabinet Secretary. We extend our deepest sympathy.
CASESPER COUNTY: Barbour (693),Berkeley (5,901), Boone (1,005), Braxton (265), Brooke (1,305), Cabell (4,924),Calhoun (122), Clay (245), Doddridge (235), Fayette (1,657), Gilmer (372),Grant (732), Greenbrier (1,349), Hampshire (923), Hancock (1,740), Hardy (726),Harrison (2,746), Jackson (1,091), Jefferson (2,230), Kanawha (8,296), Lewis(467), Lincoln (713), Logan (1,554), Marion (1,664), Marshall (1,874), Mason(969), McDowell (925), Mercer (2,574), Mineral (2,057), Mingo (1,372),Monongalia (5,076), Monroe (604), Morgan (621), Nicholas (618), Ohio (2,389),Pendleton (274), Pleasants (531), Pocahontas (337), Preston (1,564), Putnam(2,869), Raleigh (2,532), Randolph (1,059), Ritchie (321), Roane (282), Summers(401), Taylor (651), Tucker (302), Tyler (331), Upshur (827), Wayne (1,615),Webster (131), Wetzel (654), Wirt (206), Wood (4,686), Wyoming (1,103).
Delays may be experienced with the reporting ofinformation from the local health department to DHHR. As case surveillancecontinues at the local health department level, it may reveal that those testedin a certain county may not be a resident of that county, or even the state asan individual in question may have crossed the state border to be tested. Such is the caseof Clay, Lewis, Randolph, and Tucker counties in this report.
The total number of vaccines received andadministered is shown on the Dashboard Overview page and is included on thedaily dashboard update. Please visit the dashboard located at www.coronavirus.wv.gov for more information.
Free COVID-19 testing is available daily to all West Virginiaresidents. Please visithttps://dhhr.wv.gov/COVID-19/pages/testing.aspx to view the testing site map and location list.
Eileen Carroll, left, sits for a portrait as her daughter, Lily, 11, attends school remotely from their home in Warwick, R.I. on Dec. 16. When Carroll's other daughter tested positive for the coronavirus, state health officials told her to notify anyone her daughter might have been around. Contact tracers, she was told, were simply too overwhelmed to do it. David Goldman/AP hide caption
Eileen Carroll, left, sits for a portrait as her daughter, Lily, 11, attends school remotely from their home in Warwick, R.I. on Dec. 16. When Carroll's other daughter tested positive for the coronavirus, state health officials told her to notify anyone her daughter might have been around. Contact tracers, she was told, were simply too overwhelmed to do it.
COVID-19 cases are spreading so fast that they're outpacing the contact-tracing capacities of some local health departments. Faced with mounting case loads, those departments are asking people who test positive for the novel coronavirus to do their own contact tracing.
The contact tracers of Washtenaw County in Michigan have been deluged with work.
Washtenaw is a county of about 350,000 residents who live in and around the city of Ann Arbor, about 45 minutes from Detroit. Until mid-October, a county team of 15 contact tracers was managing to keep up with the workload. But when coronavirus cases started to surge in the fall, they struggled to keep up. By Thanksgiving, more than 1,000 residents were testing positive for the novel coronavirus every week, and the tracers could not keep pace.
In Washtenaw County, the process starts with a group of people called case investigators, who receive lab reports of positive coronavirus tests. Their job is to call everyone who's tested positive for the virus, tell them they need to isolate themselves, and ask them for the names of people with whom they had close contact. After creating this list of potentially exposed "contacts," the investigators pass the list over to a new team, who use it to start the actual contact tracing.
The county's contact tracers are then responsible for calling infected people's close contacts and telling those people they need to quarantine. Each person who tests positive typically has several contacts, so as the number of positive cases builds, the number of calls that tracers have to make swells too.
In recent weeks, it's not just the number of positive cases that has increased, overwhelming the capacity of case investigators, but also the number of contacts that each of those people has, says contact tracer Madeline Bacolor.
"There's just so many more people that are gathering and that are exposed," she says. "It used to be, we had a case, and maybe that person had seen two people, and now it's a whole classroom full of daycare students or a whole workplace."
Bacolor says the motivation behind all the phone calls is simple: She tries to keep people who have been exposed to the virus away from people who have not.
That's crucial work, according to public health professor Angela Beck, because it breaks viral transmission chains and prevents the virus from spreading unchecked through a community.
Beck teaches at the University of Michigan, where she also runs the campus program for tracing coronavirus exposures among students.
When you're trying to contain an infectious disease, she says, running out of contact tracers is "not a situation that you want to be in."
But it's happening now in health departments in Michigan and around the U.S. where contact tracing workforces have grown, but not fast enough to keep pace with the pandemic's spread. To cope, the overburdened health departments have a new tactic: asking residents who test positive for the virus to do their own contact tracing.
Overwhelmed health officials forced to try 'a compromised strategy'
Once billed as one of the fundamental tools for stemming the spread of the virus, contact tracing has fallen apart in many regions of the country. It's a systematic breakdown that Lawrence Gostin, a professor of global health law at Georgetown University, says hasn't happened since the spread and stigma of HIV and AIDS in the 1980s and '90s.
In Michigan's rural northern peninsula, a public health district spanning five counties warned residents last month that their tracers were overwhelmed, and they might not receive a call at all, despite testing positive. The health workers had to focus their efforts on residents over 65, teens and children attending school in person, and people living in group settings.
In the state's southwest corner, contact tracers in Van Buren and Cass counties can no longer keep up with their calls. It's the same situation in Berrien County: "If you test positive, take action immediately by isolating and notifying close contacts," the Berrien County health officer urged residents in a press release.
Health officials have taken similar actions in all regions of the country, including Oregon, North Dakota, Ohio and Virginia.
In many health departments, the shortage of contact tracers has been exacerbated by a recent change in the quarantine guidance from the Centers for Disease Control and Prevention reducing the quarantine period from 14 days to 10 for some individuals exposed to the virus.
The idea behind the change was that the risk of transmission after 10 days of quarantine was low, and shorter quarantine periods might increase people's willingness to comply with the orders. But the shift also meant that contact tracers had to spend time learning and explaining the new procedures, at the same time as caseloads were exploding.
Tedi Milgrom, a contact tracer for the health department in Washtenaw County, Michigan, calls a person who may have been exposed to the novel coronavirus. Milgrom and her colleagues have been overwhelmed by a surge in COVID-19 cases over the last month. Washtenaw County Health Department hide caption
Tedi Milgrom, a contact tracer for the health department in Washtenaw County, Michigan, calls a person who may have been exposed to the novel coronavirus. Milgrom and her colleagues have been overwhelmed by a surge in COVID-19 cases over the last month.
"It makes things more confusing," says Bacolor, the contact tracer in Washtenaw County. "People might be hearing something different from their job or school than they are from the health department."
Bacolor's experience was common among contact tracers, says Lori Tremmel Freeman, the CEO of the National Association of County and City Health Officials. She said local health officials had little warning from the CDC about how the quarantine guidance would be changing.
"To just issue [new quarantine guidance] at the federal level and expect it to be implemented across the country really is a disservice to local health departments who have to explain it on top of dealing with the pandemic," Tremmel Freeman says. "They are scrambling right now."
Asking infected people, some of whom might be sick, to call their own friends and families in effect, conduct their own contact tracing operation is far from ideal, public health experts agree.
"It is a last resort tool," says Beck, the University of Michigan professor. "It is the best that we can do in the situation that we're in, but it's a compromised strategy."
Contact tracing is more than just alerting people to a potential exposure, so they can quarantine. Part of the process is to do carefully structured interviews with the exposees, to determine if they've developed symptoms of COVID-19. If so, contacts of those people also need to be traced and told to quarantine, to prevent the virus from proliferating through successive chains of people in the community.
Trained contact tracers also often ask valuable questions to learn more about how the virus was transmitted from person to person, so that local health officials can piece together an understanding about which settings and activities seem particularly likely to promote spread in-person choir rehearsals and crowded bars, for example and which are unlikely to generate outbreaks.
Contact tracing is one key part of a tried-and-true strategy known as "test, trace and isolate." Public health professor Angela Beck says that the strategy has been used all over the world, and it works when there are enough people and enough time to do it properly.
Effective contact tracing can help mitigate the economic pain of a pandemic because it means that only people with known exposures to the virus must keep away from work, school and other activities, she says.
But success requires significant investment in public health infrastructure, something that Beck and other researchers say has been lacking for decades in the U.S.
This story comes from NPR's health reporting partnership with Kaiser Health News.
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The COVID-19 pandemic has helped revive the autopsy.
When the virus first arrived in U.S. hospitals, doctors could only guess what was causing its strange constellation of symptoms: What could explain why patients were losing their sense of smell and taste, developing skin rashes, struggling to breathe and reporting memory loss on top of flu-like coughs and aches?
At hospital morgues, which have been steadily losing prominence and funding over several decades, pathologists were busily dissecting the disease's first victims and finding some answers.
"We were getting emails from clinicians, kind of desperate, asking, 'What are you seeing?'" said NYU Langone's Dr. Amy Rapkiewicz. 'Autopsy,' she pointed out, means to see for yourself. "That's exactly what we had to do."
Early autopsies of deceased patients confirmed the coronavirus does not just cause respiratory disease, but can also attack other vital organs. They also led doctors to try blood thinners in some COVID-19 patients and reconsider how long others should be on ventilators.
"You can't treat what you don't know about," said Dr. Alex Williamson, a pathologist at Northwell Health in New York. "Many lives have been saved by looking closely at someone's death."
Autopsies have informed medicine for centuries most recently helping to reveal the extent of the opioid epidemic, improve cancer care and demystify AIDS and anthrax. Hospitals were once judged by how many autopsies they performed.
But they've lost stature over the years as the medical world instead turned to lab tests and imaging scans. In 1950, the practice was conducted on about half of deceased hospital patients. Today, those rates have shrunk to somewhere between 5% and 11%.
"It's really kind of a lost tool," said Louisiana State University pathologist Dr. Richard Vander Heide.
Some hospitals found it even harder this year. Safety concerns about transmission forced many hospital administrators to stop or seriously curb autopsies in 2020. The pandemic also led to a general dip in the total number patients at many hospitals, which drove down autopsy rates in some places. Large hospitals around the country have reported conducting fewer autopsies in 2020.
"Overall, our numbers are down, pretty significantly," from 270 autopsies in recent years to about 200 so far this year, said Dr. Allecia Wilson, director of autopsies and forensic services at Michigan Medicine in Ann Arbor.
At the University of Washington in Seattle, pathologist Dr. Desiree Marshall couldn't conduct COVID-19 autopsies in her usual suite because, as one of the hospital's oldest facilities, it lacks the proper ventilation to safely conduct the procedure. Marshall ended up borrowing the county medical examiner offices for a few cases early on, and has been working out of the school's animal research facilities since April.
Other hospitals went the opposite way, performing far more autopsies even under difficult circumstances to try to better understand the pandemic and keep up with a surge of deaths that has resulted in at least 400,000 more U.S. deaths than normal.
At New Orleans University Medical Center, where Vander Heide works, pathologists have performed about 50% more autopsies than they have in recent years. Other hospitals in Alabama, California, Tennessee, New York and Virginia say they'll also surpass their usual annual tally for the procedure.
Their results have shaped our understanding of what COVID-19 does to the body and how we might combat it.
In spring and early summer, for example, some seriously sick coronavirus patients were on ventilators for weeks at a time. Later, pathologists discovered such extended ventilation could cause extensive lung injury, leading doctors to rethink how they use ventilators during the pandemic.
Doctors are now exploring whether blood thinners can prevent microscopic blood clots that had been discovered in patients early in the pandemic.
Autopsy studies also indicated the virus may travel through the blood stream or hitch a ride on infected cells, spreading to and impacting a person's blood vessels, heart, brain, liver, kidneys and colon. This finding helped explain the virus's wide range of symptoms.
More findings are sure to come: Pathologists have stocked freezers with coronavirus-infected organs and tissues collected during autopsies, which will help researchers study the disease as well as possible cures and treatments. Future autopsies will also help them understand the disease's toll on long haulers, those who suffer symptoms for weeks or months after infection.
Despite these life-saving discoveries being made during the pandemic, financial realities and a dwindling workforce mean it's unlikely that the ancient medical practice will fully rebound when the outbreak wanes.
Hospitals are not required to provide autopsy services, and in those that do perform them, the procedure's costs are not directly covered by most private insurance or by Medicare.
"When you consider there's no reimbursement for this, it's almost an altruistic practice," said Rutgers University pathologist Dr. Billie Fyfe-Kirschner. "It's vitally important but we don't have to fund it."
Added into the mix: The number of experts who can actually perform autopsies is critically low. Estimates suggest the U.S. has only a few hundred forensic pathologists but could use several thousand and less than one in 100 graduating medical school students enters the profession each year.
Some in the field hope the 2020 pandemic could boost recruitment to the field just like the "CSI boom" of the early 2000s, Northwell's Williamson said.
Michigan Medicine's Wilson is more skeptical, but even still she can't imagine her work becoming totally obsolete. Learning from the dead to treat the living it's a pillar of medicine, she said.
It helped doctors understand the mysteries of 1918s influenza pandemic, just at is now helping them understand the mysteries of COVID-19 more than a century later.
"They were in the same situation," Vander Heide said of the doctors trying to save lives in 1918. "The only way to learn what was going on was to open up the body and see."
Breaking from their earlier guidance, the CDC now says pregnant women with COVID-19 are at higher risk than non-pregnant women. USA TODAY
Weeks before she was diagnosed with COVID-19,Vanessa Cardenas Gonzalez picked the name "Heaven" for the child she would soon deliver herfirst girl.
That name now comforts the husband she left behind, who caresfor the daughter Vanessa never held.
The name is prophetic of what was about to happen to mom,"Alfonso Gonzaleztold USA TODAY."Mom was about to go to heaven.
Vanessa the mother of two boys and newborn Heaven died Dec. 14 in Los Angeles at the age of 33 after battling COVID-19 complications for about a month.
Heaven was born in November, before the worst of Vanessa's illness.But becauseVanessawas positive for the virus at the time, theonly interactions she had with her daughter were through video calls,family friendDesiree Vera who has organized a crowdfunding campaign to benefit the family told USA TODAY.
Vanessa Cardenas Gonzalez and husband Alfonso Gonzalez celebrated the news that Vanessa was expecting a girl at a live-streamed gender reveal party in July.(Photo: Courtesy Alfonso Gonzalez)
Vera, who became close withVanessa andAlfonso through a church small group, knows the story is "heartbreaking."
Vanessa was a healthy young mother, who spent months eagerly awaitingthe birth of her first daughter.She even began buying items for a baby girl before they knew the baby's gender.
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In July, Vanessa wore pink as she and Alfonso popped a confetti-filled balloon in a live-streamed gender reveal, which was held virtually due to the pandemic. When the confetti that explodedwas also pink,the two laughed and smiled with joy.Vanessa dabbed her eyes before ending the livestream.
But when Heaven was delivered in November, doctors and nurses whisked the baby away to preventVanessa from infecting the newborn. When she returned home,Alfonso had more bad news:Vanessa would still need to isolate from the child at home, even though she longed to be in the same room as Heaven.
It cant happen like that;Im sorry, Vanessa, he remembers telling her.
Soonher condition deteriorated. After a heart attack, she spent her final days on life support withAlfonso virtually by her side praying, readingand playing music to comfort her.
But amid the tragedy of her death,Alfonso speaks of gratitude and hope.
He's grateful fora church family that has supported him at every turn buying groceries, helping him navigateVanessa's medical care, raising funds to help his family.
Im so blessed to have a family in church theyre so selfless, he said of close friends from New BeginningCommunity Ministries. He credits his faith with giving him the strength to carry on and begin to rebuild.
As Vanessa's story gains attention, he hopes she will be remembered for more than her final days.
I just want people to remember her as a loving mother, a loving wifeand a loving friend," he said. She was the kind of person who would "stop in her tracks and give and he hopes her memory will encourage others to do the same.
Vera remembersVanessa as shy but giving someone who fed the homeless and loved teaching her children.
She hopes Vanessa's story will help others better understand the devastation of the ongoing COVID-19 pandemic, which has killed more than 325,000 Americans so far includingVera's father.
This virus is very, very real to us."
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