“Todos en la corta línea eran mujeres”, dijo Steiner, de 70 años.

Su observación refleja una realidad nacional: más mujeres que hombres están recibiendo vacunas contra covid, incluso cuando a causa de la enfermedad.

KHN examinó los registros de vacunación de los 50 estados y el Distrito de Columbia a principios de abril y descubrió que cada uno de los 38 que desglosan por género mostraba que más mujeres que hombres habían recibido la vacuna.

Expertos en salud pública explican esta diferencia por muchas razones, una central: las mujeres constituyen las tres cuartas partes de la fuerza laboral en la atención médica y la educación, sectores priorizados en las primeras fases de vacunación.

También, , por lo que los residentes de hogares que recibieron las vacunas en la primera ronda tendieron a ser mujeres. Pero a medida que la elegibilidad se expande a todos los adultos y a más edades, esta brecha ha continuado.

Expertos señalan los roles de las mujeres como cuidadoras y su mayor probabilidad de buscar atención médica preventiva en general como factores que contribuyen a esta brecha.

En el caso de Steiner, su hija pasó horas en el teléfono y la computadora, buscando y programando citas de vacunación para cinco familiares. “En mi familia, las mujeres son un millón de veces más proactivas para la vacunación contra covid”, dijo Steiner. “Generalmente, las mujeres son más proactivas con respecto a la salud de la familia”.

A principios de abril, las estadísticas mostraban que el desglose de la vacuna entre mujeres y hombres generalmente se acercaba al 60% y al 40%. Por ejemplo, las mujeres constituían el 58% de las vacunadas en Alabama y el 57% en Florida.

Sin embargo, los estados no miden las vacunas por género de manera uniforme. Algunos desglosan las estadísticas por dosis totales de vacunas, mientras que otros informan personas que han recibido al menos una dosis. Algunos estados también tienen una categoría separada para personas no binarias o aquellas cuyo género se desconoce.

Un puñado de estados informan estadísticas de vacunación por género a lo largo del tiempo. Esos datos muestran que aunque la elegibilidad para recibir la vacuna se ha expandido, la brecha, aunque reducida, no ha desaparecido.

, por ejemplo, el 64% de los residentes que habían recibido al menos una dosis de la vacuna a principios de febrero eran mujeres y el 36% eran hombres. A principios de abril, las estadísticas habían cambiado al 57% de mujeres y al 43% de hombres.

En Rhode Island, uno de los estados más avanzados en la inmunización, con casi completamente vacunada, la brecha se ha reducido de 30 puntos porcentuales (65% mujeres y 35% hombres) la semana del 13 de diciembre, a 18 puntos (59% mujeres y 41% hombres) la semana del 21 de marzo.

Algunos estados desglosan las cifras por edad y por género, lo que revela que la diferencia entre hombres y mujeres persiste en todos los grupos de edad.

En , por ejemplo, el desglose por género de los receptores de la vacuna al 4 de abril fue ligeramente más amplio para las personas más jóvenes: el 61% de las personas vacunadas de entre 25 y 34 años eran mujeres, en comparación con el 57% de mujeres de 65 años o más.

El , profesor de la Escuela de Medicina de la Universidad de Washington en St. Louis, dijo que las mujeres de todos los grupos de edad, razas y etnias generalmente usan los servicios de salud más que los hombres, que es una de las razones por la que viven más tiempo.

Arrianna Planey, profesora asistente de geografía médica en la Universidad de Carolina del Norte-Chapel Hill, dijo que a menudo son las mujeres quienes organizan las citas médicas en sus hogares por lo que puedan estar más familiarizadas con la navegación de los sistemas de salud.

Décadas de investigación han documentado cómo y por qué es menos probable que los hombres busquen atención. en el American Journal of Men’s Health examinó el uso de la atención médica en hombres religiosos heterosexuales y concluyó que las normas masculinas, como la percepción de que son fuertes, eran la razón principal por la que muchos hombres evitaban buscar atención medica.

Las actitudes sobre la pandemia de covid y las vacunas también afectan a quién las recibe.

La , directora de administración y políticas de salud pública en la Universidad de Minnesota, dijo que las mujeres han tenido más probabilidades de perder sus trabajos durante la pandemia y, en muchos casos, son las que llevan la peor parte  en la enseñanza y el cuidado de los niños en el hogar.

“Las mujeres están preparadas para hacer esto incluso más que los hombres”, dijo Wurtz.

Las actitudes políticas también influyen en las opiniones de la gente sobre cómo afrontar la pandemia, dijeron expertos. Una de 2020 encontró que tanto entre demócratas como republicanos, las mujeres eran más propensas a decir que tomaban precauciones para prevenir contraer covid, como practicar siempre el distanciamiento físico y usar máscaras.

En una reciente realizada por KFF, el 29% de los republicanos y el 5% de los demócratas dijeron que definitivamente no recibirían la vacuna.

Paul Niehaus IV, de St. Louis, quien se describió a sí mismo como un libertario independiente con inclinaciones conservadoras, aseguró que no recibirá una vacuna contra covid. Dijo que el gobierno federal, junto con Big Tech y Big Pharma, están impulsando un medicamento experimental que no está completamente aprobado por la Administración de Alimentos y Medicamentos (FDA), y no confía en esas instituciones.

“Este es un problema de libertad. Es un tema de libertades civiles”, dijo Niehaus, músico independiente de 34 años. “Mi lema es ‘Deja que la gente elija'”.

Steiner, quien planea retirarse a fin de mes como editora de una revista para la Asociación de Salud Católica, dijo que estaba ansiosa por vacunarse. Tiene un trastorno inmunológico que la pone en alto riesgo de contraer una forma grave de covid, y no ha visto a algunos de sus nietos en un año y medio.

Pero dijo que algunos de los hombres de su vida estaban dispuestos a esperar más tiempo para recibir las dosis y que algunos sobrinos ni siquiera las querían. Su hermano, de 65 años, recibió la vacuna de Johnson & Johnson de un sola dosis a principios de abril después que su hija lo ayudara con la cita.

Steiner, que ahora ha recibido ambas dosis de la vacuna de Moderna, dijo que no se arrepiente de haber dado viajado cinco horas de ida y vuelta para recibir su primera dosis en febrero. (Pudo encontrar un lugar más cercano para su segunda dosis).

“Es por mi seguridad, por la seguridad de mis hijos, por la seguridad de mis vecinos, por la gente que va a mi iglesia”, dijo. “Realmente no entiendo la resistencia”.

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“Everyone in the very short line was a woman,” said Steiner, 70.

Her observation reflects a national reality: More women than men are getting covid vaccines, even as of the disease. KHN examined vaccination dashboards for all 50 states and the District of Columbia in early April and found that each of the 38 that listed gender breakdowns showed more women had received shots than men.

Public health experts cited many reasons for the difference, including that women make up three-quarters of the workforce in health care and education, sectors prioritized for initial vaccines. Women’s also mean that older people in the first rounds of vaccine eligibility were more likely to be female. But as eligibility expands to all adults, the gap has continued. Experts point to women’s roles as caregivers and their greater likelihood to seek out preventive health care in general as contributing factors.

In Steiner’s case, her daughter spent hours on the phone and computer, scoping out and setting up vaccine appointments for five relatives. “In my family, the women are about a million times more proactive” about getting a covid vaccine, Steiner said. “The females in families are often the ones who are more proactive about the health of the family.”

As of early April, statistics showed the vaccine breakdown between women and men was generally close to 60% and 40% — women made up 58% of those vaccinated in Alabama and 57% in Florida, for example.

States don’t measure vaccinations by gender uniformly, though. Some break down the statistics by total vaccine doses, for example, while others report people who have gotten at least one dose. Some states also have a separate category for nonbinary people or those whose gender is unknown.

A handful of states report gender vaccination statistics over time. That data shows the gap has narrowed but hasn’t disappeared as vaccine eligibility has expanded beyond people in long-term care and health care workers.

, for instance, 64% of residents who had received at least one dose of vaccine by early February were women and 36% were men. As of early April, the stats had shifted to 57% women and 43% men.

— one of the states furthest along in rolling out the vaccines, of the population fully vaccinated — the gap has narrowed from 30 percentage points (65% women and 35% men) the week of Dec. 13 to 18 points (59% women and 41% men) the week of March 21.

A few states break the numbers down by age as well as gender, revealing that the male-female difference persists across age groups. , for example, the gender breakdown of vaccine recipients as of April 4 was slightly wider for younger people: 61% of vaccinated people ages 25-34 were women compared with 57% female for age 65 and older.

Dr. , a professor at the medical school at Washington University in St. Louis, said women of all age groups, races and ethnicities generally use health services more than men — which is one reason they live longer.

, an assistant professor who specializes in medical geography at the University of North Carolina-Chapel Hill, said it’s often women who manage medical appointments for their households so they may be more familiar with navigating health systems.

Decades of research have documented how and why men are less likely to seek care. A 2019 in the American Journal of Men’s Health, for example, examined health care use in religious heterosexual men and concluded masculine norms — such as a perception that they are supposed to be tough — were the main reason many men avoided seeking care.

Attitudes about the covid pandemic and the vaccines also affect who gets the shots.

Dr. , director of public health administration and policy at the University of Minnesota, said women have been more likely to lose jobs during the pandemic, and in many cases bear the brunt of teaching and caring for children at home.

“Women are ready for this to be done even more than men are,” Wurtz said.

Political attitudes, too, play a part in people’s views on coping with the pandemic, experts said. A found that among both Democrats and Republicans, women were more likely to say they took precautions to avoid covid, such as always practicing physical distancing and wearing masks indoors when they couldn’t stay 6 feet apart from others.

In a by KFF, 29% of Republicans and 5% of Democrats said they definitely would not get the shot.

Paul Niehaus IV of St. Louis, who described himself as an independent libertarian with conservative leanings, said he won’t get a covid vaccine. He said the federal government, along with Big Tech and Big Pharma, are pushing an experimental medicine that is not fully approved by the Food and Drug Administration, and he doesn’t trust those institutions.

“This is a freedom issue. This is a civil liberties issue,” said Niehaus, a 34-year-old self-employed musician. “My motto is ‘Let people choose.’”

Steiner, who plans to retire at the end of the month from editing a magazine for the Catholic Health Association, said she was eager to be vaccinated. She has an immune disorder that puts her at high risk for severe illness from covid and hasn’t seen some of her grandchildren in a year and a half.

But she said some of the men in her life were willing to wait longer for the shots, and a few nephews haven’t wanted them. She said her brother, 65, received the one-shot Johnson & Johnson vaccine in early April after her daughter made it easy by arranging it for him.

Steiner, who has now received both doses of the Moderna vaccine, said she doesn’t regret taking the more difficult step of traveling five hours round trip to get her first shot in February. (She was able to find a closer location for her second dose.)

“It’s for my safety, for my kids’ safety, for my neighbors’ safety, for the people who go to my church’s safety,” she said. “I really don’t understand the resistance.”

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“¡Oh, Dios mío, huele tan bien!”, dijo Sierra, de 39 años, sobre el “tesoro” que acababa de recoger en un banco de alimentos, mientras sacaba una ensalada y un recipiente con sopa.

Sierra organizó la comida donada y planeó el almuerzo para Rachell y sus hermanos, de 9 y 2 años, mientras la reportera miraba a través de FaceTime. Le dijo que no sabía qué harían sin ayuda.

La familia vive en el condado de Bergen, Nueva Jersey, una zona densamente poblada de 70 municipios frente a Manhattan, con una población de 950,000 personas, la mayoría de ellas con salarios que representan al 1% de ingresos más altos a nivel nacional.

Pero Sierra y su esposo, Aramon Morales, nunca ganaron mucho dinero y ahora están sin trabajo debido a la pandemia.

Las consecuencias económicas de covid-19 han hecho que el hambre infantil aumentara a niveles récord. La necesidad ha sido extrema desde que comenzó la pandemia, y pone de relieve las enormes brechas en la red de seguridad de la nación.

Si bien todos los condados de los Estados Unidos han experimentado un aumento en las tasas de hambre, los incrementos más pronunciados se registran en algunos de los condados más adinerados, donde la riqueza general oscurece las frágiles finanzas de los trabajadores con salarios bajos.

Y estas comunidades no están tan preparadas para afrontar la situación como los lugares que han estado confrontado la pobreza por largo tiempo, y que ya están equipados con redes solidarias de distribución de alimentos sólidas y organizadas.

Los datos del grupo de defensa contra el hambre y la Oficina del Censo de los Estados Unidos muestran que los condados que experimentan los mayores aumentos estimados en la inseguridad alimentaria infantil en 2020, en comparación con 2018, generalmente tienen ingresos familiares medios mucho más altos que los condados con cambios más pequeños.

En Bergen, donde el ingreso familiar promedio es de $101,144, se estima que el hambre infantil ha aumentado en un 136%, en comparación con el 47% a nivel nacional.

Eso no significa que los condados ricos tengan la mayor proporción de niños hambrientos. Se estima que el 17% de los niños de Bergen padecen hambre, en comparación con un promedio nacional de alrededor del 25%.

Pero generalmente es más difícil encontrar ayuda en los lugares más ricos. El próspero condado de St. Charles, en Missouri, al norte de St. Louis, con una población de 402,000 habitantes, ha experimentado un aumento del hambre infantil de un 69% y tiene 20 sitios que distribuyen alimentos del St. Louis Area Foodbank. La ciudad de St. Louis, con una población de 311,000, tiene un incremento del 36%, pero cuenta con 100 sitios de distribución.

“Existe una gran diferencia en la forma en la que los distintos lugares están preparados, o no, para lidiar con esto y cómo han luchado para abordarlo”, dijo , profesora asistente de nutrición de salud pública en la Universidad de Harvard. “El sistema de alimentación solidaria se ha visto muy afectado”.

Eleni Towns, directora asociada de la campaña , dijo que la pandemia “deshizo el progreso de una década en la reducción de la inseguridad alimentaria”, que el año pasado amenazó al menos a 15 millones de niños.

Y aunque el plan de ayuda por covid del presidente Joe Biden, que promulgó como ley el 11 de marzo, promete ayudar con medidas contra la pobreza, como pagos mensuales a las familias de hasta $300 por niño este año, no está claro hasta dónde llegará la legislación para abordar la emergencia del hambre.

“Definitivamente es un paso en la dirección correcta”, dijo , directora del Rudd Center for Food Policy and Obesity de la Universidad de Connecticut. “Pero es difícil saber cuál será el impacto”.

Más necesidad en áreas de abundancia

Después que golpeara la pandemia, el gobierno federal aumentó los beneficios del Programa de Asistencia Nutricional Suplementaria (SNAP) y ofreció tarjetas de transferencia electrónica de beneficios para compensar las comidas escolares gratuitas o a precio reducido mientras los niños tomaban clases desde sus casas.

La familia de Sierra vio que sus beneficios SNAP, de aproximadamente $800, al mes aumentaron levemente y recibió dos de esos pagos electónicos, por un valor de $434 cada uno. Pero al mismo tiempo, perdieron sus principales fuentes de ingresos. Sierra tuvo que dejar su trabajo en un depósito de Amazon cuando la escuela de los niños se volvió virtual, y Morales dejó de conducir para Uber cuando los viajes se volvieron escasos y temía tener covid, además de su asma.

El alivio federal no fue suficiente para ellos y para muchos otros. Así que acudieron en masa a los bancos de alimentos.

En teoría, las despensas, y los bancos de alimentos que los abastecen, son parte de un sistema de emergencia diseñado para crisis de corto plazo, dijo Schwartz. “El problema es que en realidad se han convertido en una fuente estándar de alimentos para mucha gente”.

En el condado de Bergen, el año pasado, el Center for Food Action ayudó a 40,500 hogares, frente a los 23,000 del año anterior. En el condado de Eagle, Colorado, donde se encuentra la estación de esquí Tony Vail, el banco de alimentos Community Market cuadruplicó su número de clientes, a 4,000.

Y en las afueras de Boston, en el próspero condado de Norfolk, en Massachusetts, donde los datos de Feeding America muestran que el hambre infantil aumentó de un 6% estimado a un 16%, los clientes de Dedham Food Pantry se triplicaron: ahora son 1,800.

“Esto está simplemente fuera de control en comparación con otras épocas”, dijo Lynn Rogal, vicepresidenta de la despensa de Dedham, que abrió por primera vez en 1990.

Los gerentes de la despensa dijeron que un número desproporcionado de clientes pertenecen a grupos minoritarios. Muchos perdieron trabajos en el sector de servicios. Julie Yurko, directora ejecutiva del , dijo que hasta la mitad de sus clientes actuales nunca habían buscado ayuda antes.

“A principios de enero, tuvimos que empujar una minivan blanca con tres niños, de 5 años o menos. Se habían quedado sin gasolina allí ”, dijo Yurko. “La mamá estaba llorando y sus hermosos hijos estaban sentados mirándola”.

Kelly Sirimoglu, vocera del Center for Food Action de Nueva Jersey, dijo que el estigma en torno a buscar ayuda puede ser peor en las áreas ricas. Agregó que algunas personas le dicen: “Nunca pensé que estaría en la fila para buscar comida”.

Defensores dijeron que la renuencia a buscar ayuda significa que es probable que la necesidad sea aún mayor de lo que parece.

Katie Wilson de St. Charles, Missouri, dijo que un amigo de un amigo le comentó sobre una despensa de alimentos dirigida por . Casi no fue. La madre soltera con dos hijos, de 11 y 9, perdió su trabajo como auditora de hotel en junio y trató de sobrevivir sin sus ingresos durante dos meses.

“Nos encontramos en una situación en la que era ‘calefacción o comida'”, dijo Wilson, de 42 años, al describir tener que elegir entre calentar su casa o comprar comida. “Fue muy difícil mirar alrededor y decir: ‘No hay nada para comer'”.

Luchando por llegar a fin de mes

A medida que el hambre se ha vuelto más visible, han aumentado las donaciones a organizaciones de alimentos. Pero no abordan el problema central de una infraestructura que no se adapta a la nueva necesidad.

Algunas despensas están abiertas solo unas pocas horas a la semana en sótanos de iglesias, muy lejos de las que operan regularmente y parecen supermercados. Muchas despensas pequeñas tuvieron dificultades para cambiar a la distribución de alimentos al aire libre durante la pandemia o encontrar nuevos ayudantes cuando los pocos voluntarios, generalmente adultos mayores, se sentían inseguros haciendo el trabajo.

“Definitivamente es más difícil en estos lugares”, dijo Yurko, cuyo banco de alimentos distribuye en el condado de Kendall, Illinois, que tiene solo tres despensas para una población de 129,000. “Las redes de seguridad no son tan sólidas”.

Una red sólida también requiere que las despensas cooperen entre sí, y con la gama más amplia de servicios sociales locales. Eso ha estado sucediendo durante años en Flint, Michigan, dijo Denise Diller, directora ejecutiva de , que administra una despensa. Las agencias y los líderes comunitarios se unieron en 2014 cuando el plomo envenenó el agua potable.

“Por eso, cuando apareció covid, ya estábamos listos”, dijo Diller.

Atlanta también. Como en Flint, el hambre nunca estuvo Escondido en la ciudad; el 15% de los niños del condado de Fulton, que incluye a Atlanta, pasaban hambre antes de la pandemia.

Después que se suspendieran los turnos de voluntarios por covid, el Atlanta Community Food Bank le pidió a la Guardia Nacional de Georgia que ayudara a clasificar, empacar, almacenar y entregar alimentos para satisfacer las necesidades del 22% estimado de niños que padecen hambre.

El banco de alimentos también se asoció con siete distritos escolares en más de 30 despensas móviles.

Tal coordinación y conexiones faltaron en el condado de Bergen, donde 80 despensas trabajaban en su mayoría de forma aislada cuando golpeó la pandemia, explica Tracy Zur, comisionada del condado. “No estaban colaborando. Iban por el mismo camino que habían hecho durante décadas”, dijo. “Existía la necesidad de cambiar la antigua forma de hacer las cosas y trabajar juntos para tener más impacto”.

Zur lideró la creación de un grupo de trabajo de seguridad alimentaria en julio, llegando a líderes municipales y religiosos. Los objetivos incluyen alimentar a las personas, conectarlas con otros servicios y convertir algunos programas de alimentos de emergencia en despensas completas. “Construir una infraestructura es trabajoso y continuo”, dijo.

Ahora, agregó Zur, las despensas están comenzando a compartir entre sí cuando una recibe una gran donación de artículos perecederos, como huevos o leche.

Con la necesidad tan extendida, los residentes hacen lo mismo.

Durante un viaje reciente a la despensa, Sierra, la madre de Nueva Jersey, abrió el baúl de su Toyota 1999 y urgó en las dos cajas grandes que los voluntarios acababan de colocar allí. Había huevos, pollo, pan, mantequilla, queso y manzanas, y pensó: “Tengo más de lo que necesito”.

Dijo que nunca desperdiciaría alimentos. Cualquier extra iría a sus vecinos y a sus hijos hambrientos.

La corresponsal del Midwest Cara Anthony y la editora de datos Elizabeth Lucas colaboraron con esta historia.

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“Oh, my God, it smells so good!” Sierra, 39, said of the bounty she’d just picked up at a food pantry, pulling out a ready-made salad and a container of soup.

Sierra unpacked the donated food and planned lunch for Rachell and her siblings, ages 9 and 2, as a reporter watched through FaceTime. She said she doesn’t know what they’d do without the help.

The family lives in Bergen County, New Jersey, a dense grouping of 70 municipalities opposite Manhattan with about 950,000 people whose median household income ranks in the top 1% nationally. But Sierra and her husband, Aramon Morales, never earned a lot of money and are now out of work because of the pandemic.

The financial fallout of covid-19 has pushed child hunger to record levels. The need has been dire since the pandemic began and highlights the gaps in the nation’s safety net.

While every U.S. county has seen hunger rates rise, the steepest jumps have been in some of the wealthiest counties, where overall affluence obscures the tenuous finances of low-wage workers. Such sudden and unprecedented surges in hunger have overwhelmed many rich communities, which weren’t nearly as ready to cope as places that have long dealt with poverty and were already equipped with robust, organized charitable food networks.

Data from the anti-hunger advocacy group and the U.S. Census Bureau shows that counties seeing the largest estimated increases in child food insecurity in 2020 compared with 2018 generally have much higher median household incomes than counties with the smallest increases. In Bergen, where the median household income is $101,144, child hunger is estimated to have risen by 136%, compared with 47% nationally.

That doesn’t mean affluent counties have the greatest portion of hungry kids. An estimated 17% of children in Bergen face hunger, compared with a national average of around 25%.

But help is often harder to find in wealthier places. Missouri’s affluent St. Charles County, north of St. Louis, population 402,000, has seen child hunger rise by 69% and has 20 sites distributing food from the St. Louis Area Foodbank. The city of St. Louis, pop. 311,000, has seen child hunger rise by 36% and has 100 sites.

“There’s a huge variation in how different places are prepared or not prepared to deal with this and how they’ve struggled to address it,” said , assistant professor of public health nutrition at Harvard University. “The charitable food system has been very strained by this.”

Eleni Towns, associate director of the , said the pandemic “undid a decade’s worth of progress” on reducing food insecurity, which last year threatened at least 15 million kids.

And while President Joe Biden’s covid relief plan, which he signed into law March 11, promises to help with anti-poverty measures such as monthly payments to families of up to $300 per child this year, it’s unclear how far the recently passed legislation will go toward addressing hunger.

“It’s definitely a step in the right direction,” said , director of the Rudd Center for Food Policy and Obesity at the University of Connecticut. “But it’s hard to know what the impact is going to be.”

Need Grows in Places of Plenty

After the pandemic struck, the federal government boosted benefits from the Supplemental Nutrition Assistance Program and offered Pandemic Electronic Benefit Transfer cards to compensate for free or reduced-price school meals while children were schooled from home.

Sierra’s family saw their SNAP benefits of about $800 a month rise slightly and got two of those P-EBT payments, worth $434 each. But at the same time, they lost their main sources of income. Sierra had to leave her Amazon warehouse job when the kids’ school went remote, and Morales stopped driving for Uber when trips became scarce and he feared getting covid on top of his asthma.

Federal relief wasn’t enough for them and many others. So they flocked to food pantries.

In theory, pantries and the food banks that supply them are part of an emergency system designed for short-term crises, Schwartz said. “The problem is, they’ve actually become a standard source of food for a lot of people.”

In Bergen County, the Center for Food Action helped 40,500 households last year, up from 23,000 the year before. In Eagle County, Colorado, where the tony ski resort Vail is located, the Community Market food bank saw its client load nearly quadruple to 4,000. And outside Boston, in the affluent Massachusetts county of Norfolk — where Feeding America data shows child hunger jumped from an estimated 6% of kids to 16% — Dedham Food Pantry’s clients tripled to 1,800.

“This is just out of control compared to other times,” said Lynn Rogal, vice president of the Dedham pantry, which opened in 1990.

Pantry managers said a disproportionate number of clients are from minority groups. Many lost jobs in the eviscerated service sector that undergirds the wealthier parts of their counties. Julie Yurko, CEO of the , said up to half of her current clients have never sought help before.

“In early January, we had a white minivan pull up with three kids, 5 and younger. It ran out of gas sitting there,” Yurko said. “The mom was sobbing, and her beautiful children were sitting there watching her.”

Kelly Sirimoglu, spokesperson for New Jersey’s Center for Food Action, said the stigma around seeking help can be worse in wealthy areas. She said some people tell her, “I never thought I would be in line for food.”

Advocates said the reluctance to seek help means the need is likely even larger than it appears.

Katie Wilson of St. Charles, Missouri, said she heard about a food pantry run by the from a friend of a friend. She almost didn’t go. The single mom of two children, 11 and 9, lost her job as a hotel auditor in June and tried to squeak by without her income for two months.

“We found ourselves in a situation where it was a ‘heat or eat’ kind of thing,” said Wilson, 42, describing having to choose between heating her home or buying food. “It took me looking around and saying, ‘There is nothing to eat.’”

Struggling to Meet the Need

As hunger has become more visible, donations to food charities have risen. But they don’t address the core problem of an infrastructure that doesn’t match the new need. Some pantries are open just a few hours a week in church basements, a far cry from those that operate regularly and look like supermarkets. Many small pantries struggled to shift to outdoor food distribution during the pandemic or find new helpers when the few, often senior, volunteers felt unsafe doing the work.

“It definitely is harder in these places,” said Yurko, whose food bank distributes to Kendall County, Illinois, which has just three pantries for its population of 129,000. “The safety nets are not as robust.”

A strong safety net also requires pantries to cooperate with one another and the broader array of local social services. That’s been happening for years in Flint, Michigan, said Denise Diller, executive director of , which runs a pantry. Agencies and community leaders banded together in 2014 when lead poisoned the drinking water.

“When covid occurred, we were already kind of ready,” Diller said.

So was Atlanta. As in Flint, hunger was never hidden there; 15% of children in Fulton County, which includes Atlanta, faced hunger before the pandemic. After covid suspended volunteer shifts, the Atlanta Community Food Bank asked the Georgia National Guard to help sort, pack, warehouse and deliver food to help meet the needs of the estimated 22% of kids experiencing hunger. The food bank also partnered with seven school districts on more than 30 mobile pantries.

Such coordination and connections were lacking in Bergen County, where 80 pantries worked mostly in isolation when the pandemic hit, County Commissioner Tracy Zur said. “They weren’t collaborating. They were going along the same path they had for decades,” she said. “There was this need to break out of the old way of doing things and work together to be more impactful.”

Zur spearheaded the creation of a food security task force in July, reaching out to municipal and faith leaders. Goals include feeding people, connecting them to other services and turning some emergency food programs into full-fledged pantries. “Building an infrastructure is painstaking and ongoing,” she said.

Now, Zur said, pantries are starting to share with one another when one gets a large donation of perishable items such as eggs or milk.

With the need so widespread, residents do much the same.

During a recent pantry trip, Sierra, the New Jersey mom, opened the trunk of her 1999 Toyota and rummaged through the two big boxes volunteers had just placed there. She pointed to eggs, chicken, bread, butter, cheese and apples, observing, “I have more than I need.”

But she said it would never go to waste. Any extra would go to neighbors and their hungry children.

Midwest correspondent Cara Anthony and data editor Elizabeth Lucas contributed to this story.

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“We’re looking forward to having a season,” said the 18-year-old catcher for Dublin Coffman High School, outside Columbus, Ohio. “This game is something we really love.”

Kassis, whose team has started practices, is one of the millions of young people getting back onto ballfields, tennis courts and golf courses amid a decline in covid cases as spring approaches. But pandemic precautions portend a very different season this year, and some school districts still are delaying play — spurring spats among parents, coaches and public health experts across the nation.

Since fall, many parents have rallied for their kids to be allowed to play sports and objected to some safety policies, such as limits on spectators. Doctors, meanwhile, haven’t reached a consensus on whether contact sports are safe enough, especially indoors. While children are less likely than adults to become seriously ill from covid, they can still spread it, and those under 16 can’t be vaccinated yet.

Less was known about the virus early in the pandemic, so high school sports basically stopped last spring, starting up again in fits and spurts over the fall and winter in some places. Some kids turned to recreational leagues when their school teams weren’t an option.

But now, according to the , public high school sports are underway in every state, though not every district. Schedules in many places are being changed and condensed to allow as many sports as possible, including those not usually played in the spring, to make up for earlier cancellations.

Coaches and doctors agree that playing sports during a pandemic requires balancing the risk of covid with benefits such as improved cardiovascular fitness, strength and mental health. School sports can lead to college scholarships for the most elite student athletes, but even for those who end competitive athletics with high school, the rewards of playing can be extensive. Decisions about resuming sports, however, involve weighing the importance of academics against athletics, since adding covid risks from sports could jeopardize in-person learning during the pandemic.

Tim Saunders, executive director of the and coach at Dublin Coffman, said the pandemic has taken a significant mental and social toll on players. In a May survey of more than 3,000 teen athletes in Wisconsin, University of Wisconsin researchers found that about and the same portion reported symptoms of depression. Other studies have shown similar problems for students generally.

“You have to look at the kids and their depression,” Saunders said. “They need to be outside. They need to be with their friends.”

Before letting kids play sports, though, the Centers for Disease Control and Prevention said, coaches and school administrators should consider things like students’ underlying health conditions, the physical closeness of players in the specific sport and how widely covid is spreading locally.

Karissa Niehoff, executive director of the high school federation, that spring sports should be available to all students after last year’s cancellations. She said covid spread among student athletes — and the adults who live and work with them — is correlated to transmission rates in the community.

“Sports themselves are not spreaders when proper precautions are in place,” she said.

Still, outbreaks have occurred. A January report by CDC researchers pointed to a high school wrestling tournament in Florida after which . (Fewer than half were tested.) The report’s authors said outbreaks linked to youth sports suggest that close contact during practices, competitions and related social gatherings all raise the risk of the disease and “could jeopardize the safe operation of in-person education.”

Dr. , an infection control expert in Kentucky who runs the national patient safety group Health Watch USA, said contact sports are “very problematic,” especially those played indoors. He said heavy breathing during exertion could raise the risk of covid even if students wear cloth masks. Ideally, he said, indoor contact sports should not be played until after the pandemic.

“These are not professional athletes,” Kavanagh said. “They’re children.”

A released in January by University of Wisconsin researchers, who surveyed high school athletic directors representing more than 150,000 athletes nationally, bolsters the idea that indoor contact sports carry greater risks, finding a lower incidence of covid among athletes playing outdoor, non-contact sports such as golf and tennis.

Overall, “there’s not much evidence of transmission between players outdoors,” said Dr. Andrew Watson, lead author of the study, which he is submitting for peer-reviewed publication.

Dr. , a pediatrics professor at Washington University in St. Louis, said all sorts of youth sports, including indoor contact sports such as basketball, can be safe with the right prevention measures. He supported his daughter playing basketball while wearing a mask at her Kirkwood, Missouri, high school.

Doctors also pointed to other safety measures, such as forgoing locker rooms, keeping kids 6 feet apart when they’re not playing and requiring kids to bring their own water to games.

“The reality is, from a safety standpoint, sports can be played,” Newland said. “It’s the team dinner, the sleepover with the team — that’s where the issue shows up. It’s not the actual games.”

In Nevada’s Clark County School District, administrators said they’d restart sports only after students in grades 6-12 for in-person instruction as part of a hybrid model starting in late March. Cases in the county have in recent weeks, from a seven-day average of 1,924 cases a day on Jan. 10 to about 64 on March 3.

In early April, practices for spring sports such as track, swimming, golf and volleyball are scheduled to begin, with intramural fall sports held in April and May. No spectators will be allowed.

Parents who wanted sports to start much earlier created , one of many groups that popped up to protest the suspension of youth athletics. The Nevada group rallied late last month outside the Clark County school district’s offices shortly before the superintendent announced the reopening of schools to in-person learning.

Let Them Play Nevada organizer Dennis Goughnour said his son, Trey, a senior football player who also runs track, was “very, very distraught” this fall and winter about not playing.

With the reopening, he said, Trey will be able to run track, but the intramural football that will soon be allowed is “a joke,” essentially just practice with a scrimmage game.

“Basically, his senior year of football is a done deal. We are fighting for maybe one game, like a bowl game for the varsity squad at least,” he said. “They have done something, but too little, too late.”

Goughnour said Let Them Play is also fighting to have spectators at games. Limits on the numbers of spectators have riled parents across the nation, provoking “a ton of pushback,” said Niehoff, of the high school federation.

Parents have also objected to travel restrictions, quarantine rules and differing mask requirements. , Florida, hundreds of parents signed last fall against mandatory covid testing for football players.

Students, for their part, have quickly adjusted to pandemic requirements, including rules about masks, distancing and locker rooms, said , assistant executive director of the Illinois High School Association.

Kassis, the Ohio baseball player, said doing what’s required to stay safe is a small price to pay to get back in the game.

“We didn’t get to play at all last spring. I didn’t touch a baseball this summer,” he said. “It’s my senior year. I want to have a season and I’ll be devastated if we don’t.”

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Montana senators will soon decide whether to confirm Adam Meier, Republican Gov. Greg Gianforte’s for director of the state Department of Public Health and Human Services. He would earn leading Montana’s , which oversees 13 divisions and is a leader in the state’s pandemic response.

Gianforte is confident Meier “will bring greater transparency, accountability, and efficiency to the department as it serves Montanans, especially the most vulnerable among us,” Brooke Stroyke, a governor’s office spokesperson, said in an emailed statement.

For many Montana officials and health care industry players, the focus is on Montana’s future, not Kentucky’s past. But it can be instructive to see how Meier handled similar issues in his prior role, which he held from May 2018 through December 2019.

Some have praised the job he did in Kentucky, including his spearheading of a program that would have created work requirements in the state’s Medicaid program. But others criticized those proposed changes as well as his handling of a large hepatitis A outbreak that spread through rural Appalachia starting in 2017, ultimately sickening more than 5,000 Kentuckians and killing 62. The details of the state’s response to the outbreak came to light after in 2019.

“The hep A response is probably one of the darkest or most concerning things he did when he was in Kentucky. He also didn’t perform well in my eyes on other issues,” said , an assistant professor at Pennsylvania State University who studies politics, health care and public policy. “He didn’t do so well in Kentucky, so I don’t know how well he’s going to do in Montana.”

Dr. , a retired Kentucky physician who runs the national watchdog group Health Watch USA, is among those who said Meier and his team needed to do more early on to curb the hepatitis outbreak as it made its way into Appalachia. Kavanagh said Meier’s handling of the outbreak provides a window into how he might handle the covid crisis in Montana.

“But it could be a learning opportunity if failed strategies are corrected,” Kavanagh said. “The biggest question is: What did he learn in Kentucky?”

During Meier’s confirmation hearing before Montana’s Senate Public Health, Wellness and Safety Committee, the nominee said one lesson he learned was to invest in public health infrastructure. Because hepatitis A was spreading in rural Kentucky mountains, he said, standard outreach to vulnerable populations in settings like homeless shelters didn’t work. Instead, health officials started vaccinating people at convenience stores.

“One of the things I’ve learned there is, you have to be creative about how you reach folks,” Meier said.

Kentucky’s outbreak first centered in Louisville, where a more than 200-person health department was able to administer tens of thousands of vaccines against the highly contagious liver infection caused by a virus. The Centers for Disease Control and Prevention .”

But in spring 2018, the disease began to spread in Appalachia, which had thinly staffed county health departments.

Dr. Robert Brawley, then the state’s chief of infectious diseases, sounded the alarm to his bosses. Brawley asked state officials to spend $10 million for vaccines and temporary health workers. Instead, the acting public health commissioner, Dr. Jeffrey Howard, sent $2.2 million in state funds to local health departments. Brawley called the response “too low and too slow.”

In the months that followed, the outbreak metastasized into the nation’s largest.

Howard’s decisions at the time and the agency’s response. In Meier’s Feb. 10 Montana hearing, he said Kentucky lacked the infrastructure to buy $10 million worth of vaccines, and they would have gone bad anyway because the state didn’t have the necessary storage. Brawley’s proposal had called for sending $6 million to health departments to buy vaccines, however, and $4 million for temporary health workers.

“The ‘too low and too slow’ response to the hepatitis A outbreak in Kentucky, reported in The Courier Journal, may be an albatross around his neck for a long time,” Brawley, who resigned in June 2018, said of Meier in an email.

Montana’s Democratic Party cited the hepatitis A outbreak when Meier was nominated for the Treasure State job in January, him as unsuitable.

The health department declined KHN’s request for an interview with Meier but provided letters from local Kentucky officials written in 2019. Allison Adams, public health director of Buffalo Trace District Health Department in Kentucky, defended the state’s actions in one February 2019 letter, arguing Kentucky’s leadership “made sound decisions regarding the support and known resources available.”

Meier has pitched himself as someone who works well with others, bolstered Kentucky’s family services and cut through the state’s bureaucracy.

Meier, an attorney, lived in Fort Thomas, Kentucky, near Cincinnati, with his wife and three children, where he served on the City Council just before being named deputy chief of staff for former Gov. Matt Bevin in 2015. After leaving Kentucky’s health Cabinet, he worked as a policy consultant with .

During Meier’s confirmation hearing before Montana lawmakers, Erica Johnston, operations services branch manager for the health department, said she was already impressed by his knowledge of the agency’s programs and ideas for changes. Past colleagues said he listened to those he oversaw. John Tilley, a former Democratic Kentucky representative who served as the state’s former head of Kentucky’s Justice and Public Safety Cabinet, called Meier a problem-solver.

“What I got in Adam was this refreshing take on government, this less than bureaucratic take,” Tilley testified.

While deputy chief of staff for Bevin, Meier oversaw the development of a Medicaid overhaul plan called Kentucky HEALTH, which would have required recipients who were ages 19-64 and without disabilities to work or do “engagement” activities such as job training or community service.

Bevin, a Republican who, like Gianforte, joined politics after making a fortune in business, described the effort as a way to ensure the long-term financial stability of Medicaid and prepare enrollees to transition to private insurance. In Meier’s Montana hearing, he said the goal was for Medicaid recipients to be linked to employment and training. Kentucky opponents said the program would have caused people to lose coverage and increase the state’s administrative burden.

That debate is familiar in Montana, where lawmakers approved work requirements for people who joined Medicaid under its expansion. The work rules are awaiting federal approval.

Kentucky’s requirements never took effect. They were authorized by a federal waiver but were tied up in legal challenges until the state’s current Democratic Gov. Andy Beshear rescinded the rules.

Still, Meier has said Medicaid’s enrollment dropped during his leadership and benefits remained steady for those who stayed on the rolls. That drop paralleled an in Medicaid enrollment that lasted through 2019.

Penn State’s Haeder, who observed Meier’s tenure, criticized Meier’s support for Medicaid work requirements, saying “excessive amounts of data show how detrimental they are to public health” because vulnerable people lose coverage.

, executive director for the Behavioral Health Alliance of Montana, said work restrictions aren’t a good model for Medicaid. But she said it isn’t surprising Meier has been in favor of those steps, given Montana’s recent efforts.

Even so, Windecker is optimistic when she talks about Meier’s confirmation. She said she’s thrilled he has experience with another state health agency.

“These are very complicated systems to run,” Windecker said. “If you understand health care, you stand a better shot at getting this.”

The Montana Senate has to take up Meier’s confirmation, which moved out of a committee Feb. 17.

While Meier awaits confirmation, he is already engaged in the state’s covid vaccine efforts and is working on the agency’s daily tasks, department spokesperson Jon Ebelt said in a statement. Meier is “focused on the job at hand,” Ebelt said.

Houghton, Montana correspondent, reported from Missoula. Ungar, Midwest editor and correspondent, reported from Louisville and formerly worked for The Courier Journal.

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But the coronavirus is spreading too quickly to open schools in Alameda County, based on the current state standards. And the local teachers union hasn’t agreed to go back — even after teachers have been vaccinated. So she expects her kids will be logging on to school from home for a while.

“The impediments to opening are just too great,” said Bacigalupi, who is lobbying California lawmakers to establish firm, statewide health metrics that, once met, would require schools to open. “In the end, it comes down to a lack of political will to get the kids back in the classroom.”

Parents across the country, many of whom relied on schools to care for their children while they worked, are frustrated and angry that remote instruction has gone on so long, even as grocery store clerks, city bus drivers and other essential workers have braved the risks of their workplaces. Lawmakers are increasingly joining their calls to get kids into classrooms, citing the loss of worker productivity and parents’ concerns about the social, emotional and academic effects on children.

President Joe Biden has to open most schools within his first 100 days in office if Congress provides funding, and if states and cities adopt safety steps.

But that will be a herculean task. Nearly one year into the pandemic, fewer than half of students are attending schools that are teaching in person every day, and the question of how and when to get kids back into classrooms often depends less on science than politics — including the strength of local teachers unions.

The Centers for Disease Control and Prevention concluded that schools can reopen safely if their communities have low levels of the virus and they adhere strictly to measures such as requiring everyone to stay 6 feet apart and wear masks.

But in numerous communities, those basic measures haven’t been followed, even before the vaccine rollout — and many teachers aren’t convinced they will be safe on campus.

With infection rates starting to decline nationally, many parents, superintendents, school boards and politicians insist this is the moment to stop striving for perfection and embrace the health measures necessary to get kids into classrooms safely. Some are even taking dramatic measures, such as the city of San Francisco, which Wednesday to force it to open.

The same day, CDC Director Dr. Rochelle Walensky that schools can safely reopen even if teachers aren’t yet vaccinated.

“If we wait for the perfect, we might as well just pack it up and just be honest with folks that we’re not going to open for in-person instruction in the school year,” Democratic California Gov. Gavin Newsom recently — breaking with the politically powerful California Teachers Association, which wants all teachers vaccinated before reopening.

Teachers Fear for Safety

In many states, teachers lobbied to be among the first to be vaccinated after health care workers and nursing home residents. But they also argue the vaccines alone are not enough to open schools. They want low levels of community spread. They want as many school staffers as possible vaccinated, which could take months. And they want assurances that schools won’t relax masking, physical distancing and other safety measures.

“We’ve had concerns about some districts being more lax even before the vaccine,” said , president of the Ohio Education Association, the state’s largest teachers union.

Dr. Mark Schleiss, a pediatrics professor at the University of Minnesota Medical School, agreed that health measures must be enforced even after vaccination.

“It’s unfortunate that people think life goes back to normal, that once we get the vaccine, the masks come flying off,” he said. “Vaccination doesn’t take things back to normal.”

That’s because there are still unknowns about the vaccines: It’s unclear if vaccinated people can transmit the virus. Plus, not all adults can get a vaccine (for medical reasons), and about 5% of those who receive the Moderna or Pfizer-BioNTech versions might not be fully protected. Kids are another matter entirely: No covid vaccine has yet been approved for use in children younger than 16.

Teachers say they feel especially vulnerable when the virus is running rampant in a community, but health experts don’t agree on exactly what that means.

“We don’t know a definite threshold,” said Dr. , medical director of infection prevention and antimicrobial stewardship at Keck Medicine of the University of Southern California.

In Montgomery, Alabama, four educators died within 48 hours in January, spurring the city’s district to .

“We have educators who are dying from this. We know they’re taking it home,” said Theron Stokes, associate executive director of the teachers union.

The Politics of Reopening

As of late January, about 38% of K-12 public school students attended virtual-only schools, 38% attended in-person schools, and 24% attended hybrid schools that offered a mix of both, according to , a company tracking a representative sample of 1,200 school districts.

Decisions about returning to school have often been driven by ideology in the absence of firm scientific guidance about community spread.

Politics plays as big a role as health, said , practitioner-in-residence at the Center on Reinventing Education, a nonpartisan research center that has tracked 477 school districts since March. “Because the pandemic became so politicized, districts found themselves in political debates in their own communities.”

For instance, some politically motivated decisions to reopen schools were made despite dangerous surges in covid cases over the summer. In Texas, Republican Gov. Greg Abbott told schools in July they’d have to transition to in-person education after the state attorney general declared “” school closures unlawful. In Florida, Republican Gov. Ron DeSantis threatened to withhold state funding from schools that did not reopen in person.

In Democratic strongholds such as and , powerful unions have protested and delayed school reopenings.

Union opposition played a part in the Oakland school district’s decision to stick with remote-only learning in the fall, which boggled Bacigalupi’s mind because covid cases had dropped after the summer surge. At the time, restaurants, gyms and hair salons in her county were allowed to partially reopen, and some schools in neighboring counties had also opened.

“One of the reasons it’s so frustrating is that we can look at so many places and we see tens of thousands of kids back in school,” said Bacigalupi, whose children, ages 5 and 8, have been out of school for nearly a year. “I’m also just sad. And the sadness gets worse as you see what’s happening to your kid. It’s harming them.”

Bacigalupi said her second grader is like a different child — he’s quick to anger and struggles to regulate his emotions. He now gets counseling once a week.

Balancing Risks

Under pressure, more schools are reopening by the day. , city schools returned to a hybrid model of in-person and remote learning this month after a judge dismissed a teachers union lawsuit seeking to delay reopening.

Public health officials say districts must acknowledge that holding school in person is a calculated risk, and take concrete steps to minimize the danger for staff members and kids. These include separating desks in classrooms — even if that means holding class in a gymnasium — erecting plexiglass barriers where possible and limiting school sports.

“Implementing a combination of all of these layered approaches will make it a lot safer,” said , an assistant professor of environmental health sciences at the Yale School of Public Health, which last year issued to help schools determine when to reopen.

For example, the Los Angeles Unified School District, the second largest in the country, has taken a number of measures, including installing upgraded air filters, purchasing an ionized cleaning system to sanitize surfaces and rearranging furniture in classrooms, said , president of the school board.

But like the local and state teachers unions and the district superintendent, Gonez believes the rampant spread of covid in the region must be addressed first.

“Once the broader covid conditions are in a safer place in the community, I think we will be ready,” Gonez said. “We have the protocols in place to do this successfully.”

On Wednesday, the local American Academy of Pediatrics chapter that schools should reopen immediately because the social isolation, anxiety and lack of structure are “causing undue harm” to children.

“‘Safe’ is a relative term,” said Schleiss, the Minnesota professor. “Continuing to attend school with careful monitoring is reasonable. We don’t want the perfect to be the enemy of the good.”

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“I’m concerned,” said Lebo, who teaches at Avon High School in the Indianapolis suburbs. “We’re not controlling the virus in our county. We’re not controlling it in our state. And we’re not controlling it in our schools.”

President Joe Biden’s covid response proposes $130 billion to improve school safety, offers federal guidance for making schools safer and improves workplace protections to safeguard teachers and other workers from covid.

This comes after many school districts and states holding in-person classes have ignored recommendations from public health officials or written their own questionable safety rules — creating a tinderbox where covid can sicken and kill.

A KHN analysis of federal and state Occupational Safety and Health Administration data found more than 780 covid-related complaints covering more than 2,000 public and private K-12 schools. But those pleas for help likely represent only a small portion of the problems, because a federal loophole prevents public school employees from lodging them in for local and state employees. Still, the complaints filed provide a window into the safety lapses: Employees reported sick children coming to school, maskless students and teachers less than 6 feet apart, and administrators minimizing the dangers of the virus and punishing teachers who spoke out.

KHN also found that practices contradicting safety experts’ advice are codified into the patchwork of covid rules put out by states and districts. For instance, about half of states don’t require masks for all students — including 11 that have exempted schoolchildren of various ages from mandatory masks, with New Hampshire excluding all K-12 students. Districts can craft stricter rules than their states but often don’t.

“The response to the virus has been politicized,” said Dr. , an expert in pediatric infectious diseases at the Indiana University School of Medicine. “There’s a willingness to ignore data and facts and go with whatever you’re hearing from the internet or from political leaders who don’t have any scientific knowledge.”

But even with Biden’s rollout of new school safety steps, struggles over balancing the need for education with covid safety are sure to continue, since it will be months before the nationwide vaccine rollout reaches all school staff members, and the shots haven’t yet been approved for kids.

Meanwhile, the scope of covid in schools remains unknown. Biden’s order calls for tracking it on the federal level, which wasn’t happening. States haven’t collected uniform data either. The , a project launched by volunteers and public health researchers, has counted more than 505,000 cases in K-12 schools — more than a quarter of them among staffers. Although kids are less likely than adults to become seriously ill, suggests they can spread the virus even if asymptomatic. The American Federation of Teachers estimates covid-19 has killed at least 325 school employees, though it’s unclear whether they caught it at school.

Among them was Susanne Michael, 47, a fourth grade teacher at Harrisburg Elementary School in northeastern Arkansas. As a cancer survivor with diabetes, she rarely went anywhere outside her home this past fall, according to her husband, Keith. She told him she worried about catching the coronavirus while teaching, but she “went and did it because she loved it.”

She tried her best to keep more than 20 students 6 feet apart, he said, but told him it was nearly impossible.

Though she always wore a mask, he doesn’t know if every student did. According to the district’s , masks are required in grades 4-12 “when social distancing is not feasible,” and “physical distancing will be practiced to the extent practical.” District leaders did not respond to requests for comment.

Michael wound up hospitalized on a ventilator. Doctors let her husband visit in protective gear because he, too, had the virus. He held her hand as she slipped away Oct. 1.

The loss hits him hardest at night. “For 27 years, I always had somebody there next to me,” he said. “It’s difficult and weighs on your mind and heart a lot when you’re laying there in an empty bed and your best friend’s gone.”

She left five children, ages 3 to 22, including a former student and her two siblings adopted in July.

A Litany of Lapses

Doctors said covid risks can be drastically reduced by following straightforward safety practices.

“First and foremost, mask mandate, mask mandate, mask mandate,” said Dr. Jason Newland, a pediatrics and infectious diseases professor at Washington University in St. Louis.

But school employees across the nation complain such measures don’t exist or aren’t enforced.

“School officials openly scoff at covid-19 and believe it is a hoax. This attitude trickles down to staff, so hardly anyone has been wearing their mask or wearing it correctly,” an unidentified employee of Hart Public Schools, in rural western Michigan, wrote in an OSHA complaint in September. The complaint also described large crowds of students sitting too close in cafeterias. The employee alleges being terminated for whistleblowing.

Hart Superintendent Mark Platt said in an email that he won’t comment on personnel matters, but “takes seriously its health and safety protocols for students and staff.” The district’s covid requires staffers and older students to wear masks in classrooms, common areas and buses, while K-5 students must wear them everywhere except in their own classrooms with their own class.

At the public Avon Community School Corp. in Indiana, Lebo said, problems festered since the beginning of the fall semester in July, when an OSHA complaint was lodged. In addition to crowding in the halls and difficulty keeping students 6 feet apart in classrooms, Lebo said, the school’s many extracurricular activities — including football, wrestling and show choir — brought their own risks.

Avon schools spokesperson Kevin Carr wouldn’t comment except to say students and staff members have tried their best to abide by the district’s health and safety protocols.

Over the semester ending in December, Avon schools reported 346 covid cases among nearly 9,800 in-person students and staffers, a rate of 3.5% compared with 2.1% for 1,412 remote learners. The covid rate reached 5.5% at the high school, which went remote briefly in the fall after the number of people quarantining skyrocketed.

Like the vast majority of school OSHA complaints, the one about Avon was closed without an inspection. Across all industries, , just a small percentage of pandemic-related complaints have led to inspections or fines.

A Biden executive order on worker safety calls for OSHA to bolster enforcement and work with states and local governments to ensure workers, including those in the public sector, are protected from covid.

Without strong laws, “workers are facing big challenges: Do I speak up? Do I show up to work?” said Rebecca Reindel, director of occupational safety and health for the AFL-CIO. “They’re making a decision between needing a paycheck and risking bringing the virus home.”

Varied, Questionable Guidance

That decision gets even harder when potentially unsafe practices are written into official recommendations.

Missouri and Iowa, for example, advise that students exposed to covid don’t need to be quarantined as long as infected and exposed children are both wearing masks correctly — which goes against Centers for Disease Control and Prevention advice to quarantine anyone who has had close contact with a person who has the virus.

Some districts in South Carolina, Tennessee, Florida and Nebraska — with green lights from the Trump administration and their states — classified teachers as “critical infrastructure workers,” allowing them to keep working after exposure if they don’t develop symptoms.

A superintendent in Billings, Montana, told administrators in October to “disrupt the 15-minute timeline” required to be deemed a close contact “through movement, distancing or masking.” Following media reports, saying he hadn’t intended to “game the system” and no one should move students to avoid quarantines.

In many communities, mask rules are lax.

In Missouri, where there’s no statewide mask rule, Ozark School District requires them only “when social distancing is not an option,” according to its website, which describes spacing desks and using barriers to give people a “break” from masks.

Lakeland Joint School District in Idaho recommends masks when physical distancing isn’t possible. Dacia Chaffee, parent of an eighth grader and a high school freshman in the district, said “it’s almost like normal,” with few students wearing masks. Her kids don’t either, she said; they don’t want to stand out.

Public health experts said making schools safer will require clear, consistent data and guidance — and political will. They said governments also need to give public schools enough resources to keep more than 50 million students and 3.2 million teachers safe. A estimated that the cost of covid mitigation measures for the 2020-21 school year ranges from $55 per student for items such as masks, plexiglass barriers and face shields to $442 per student with added custodians and transportation, such as buses and drivers, to allow for better physical distancing.

And crucially, experts said, covid policies for schools must be rooted in science, not politics.

“Behaviors and attitudes flow from the top down,” said Dr. Mark Schleiss, a pediatrics professor at the University of Minnesota Medical School. “We have to hold people accountable. This is a life-and-death situation.”

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En ninguna parte de la lista de personas prioritarias están los cónyuges de los funcionarios públicos.

Sin embargo, las primeras damas de Kentucky y West Virginia; Karen Pence, la esposa del vicepresidente Mike Pence; Jill Biden, la esposa del presidente electo Joe Biden; y Doug Emhoff, el esposo de la vicepresidenta electa Kamala Harris, estuvieron entre los primeros estadounidenses en recibir las vacunas que podrían salvar vidas.

Kentucky también vacunó a seis ex gobernadores y cuatro ex primeras damas, incluidos los padres de Andy Beshear, el actual gobernador demócrata.

Las primeras vacunas a los cónyuges provocaron indignación en las redes sociales, y varios dijeron que no deberían poder “saltar la fila” antes que los médicos, enfermeras y personas mayores.

En la mayoría de los 29 estados que respondieron a las consultas de KHN (que llamó a las 50 oficinas de gobierno estatales), los principales funcionarios electos dijeron que ellos, y sus cónyuges, serán vacunados, pero han optado por esperar su turno detrás de electores más vulnerables.

Algunos miembros del Congreso de ambos partidos dijeron lo mismo cuando rechazaron las primeras dosis ofrecidas, en nombre de mantener al gobierno en funcionamiento.

Los gobernadores que recibieron las vacunas junto con sus cónyuges, y la oficina del vicepresidente, dijeron que querían dar el ejemplo a los residentes, generar confianza, salvar las divisiones ideológicas y demostrar que la vacuna es segura y eficaz.

Pero algunos cuestionan esta razón.

“Se parece más a hacer trampa. Los políticos pueden conseguir que los hospitales los vacunen bajo esta ilusión de generar confianza. Pero es una fachada”, dijo , profesor de bioética y director fundador de la división de ética médica de la Escuela de Medicina Grossman de la Universidad de Nueva York. “La gente podría decir: ‘Típica gente rica. No se puede confiar en ellos’. Esto socava la meta original”.

Caplan agregó que, de todos modos, el público no confía demasiado en los políticos, por lo que la vacunación de celebridades, líderes religiosos o figuras deportivas probablemente ayudaría más a aumentar la confianza en la vacuna.

en 1956 para ganar la confianza de los escépticos; las acciones de las esposas de los gobernadores de ese período se recuerdan menos.

El doctor José Romero, presidente del Comité Asesor de Prácticas de Inmunización de los Centros para el Control y Prevención de Enfermedades (CDC), dijo en un correo electrónico a KHN que si bien su grupo proporciona un esquema para distribuir dosis limitadas de vacunas, “las jurisdicciones tienen la flexibilidad de hacer lo que sea apropiado para su población”.

Los funcionarios de Kentucky y Texas señalaron que el , director de los CDC, alentó a los gobernadores a vacunarse públicamente.

Nadie mencionó razones médicas para que sus cónyuges se vacunaran; los hospitales generalmente no están vacunando a los cónyuges de los profesionales médicos que han recibido la vacuna.

La oficina del gobernador de West Virginia, el republicano Jim Justice, publicó fotografías de él, su esposa, Cathy Justice, y otros funcionarios recibiendo las dosis. También posteó su propia vacunación .

La oficina de Beshear en Kentucky también publicó fotos del gobernador recibiendo la vacuna en diciembre, el mismo día que su esposa, Britainy Beshear, y otros funcionarios estatales.

“Es cierto que hay dudas sobre las vacunas”, dijo Beshear en una reunión informativa sobre el coronavirus, el día en el que los ex gobernadores de Kentucky y sus cónyuges fueron vacunados. Aludió a un programa futuro que involucra a líderes religiosos y a otras personas influyentes.

Su padre, el ex gobernador demócrata Steve Beshear, publicó fotos de su vacunación en , diciendo que él y su esposa, Jane Beshear, junto con otros ex gobernadores de Kentucky de ambos partidos y sus cónyuges, intervinieron en parte para alentar a los residentes a vacunarse.

Kentucky se encuentra actualmente en la primera etapa de distribución de vacunas, dirigida a trabajadores de salud y a residentes de centros de vida asistida. Se habían distribuido menos de 15,000 de las 58,500 dosis para estas residencias cuando los ex gobernadores y sus cónyuges fueron vacunados.

Tres Watson, ex director de comunicaciones del Partido Republicano de Kentucky, que fundó una firma de consultoría política, se mostró escéptico sobre las intenciones detrás del evento. Dijo que parecía ser un esfuerzo de relaciones públicas creado para que el gobernador pudiera vacunar a sus padres.

“Entiendo la continuidad del gobierno, pero las primeras damas no tienen parte en la continuidad del gobierno”, dijo. “Tienes que ajustarte a las prioridades. Una vez que empiezas a hacer excepciones, es cuando tienes problemas”.

Los funcionarios que representan al equipo de transición de Biden-Harris y otros tres estados donde se vacunaron los gobernadores (West Virginia y Texas liderados por republicanos, y Kansas liderado por un demócrata) no respondieron a KHN. El gobernador republicano de Alabama, Kay Ivey, recibió la vacuna y está divorciado.

Políticos de otros estados han hecho lo opuesto.

En Arkansas, el gobernador republicano Asa Hutchinson se centra en garantizar que los grupos de alta prioridad, como los trabajadores de salud, y el personal y residentes de centros de vida asistida, se vacunen, dijo la vocera LaConda Watson. “Él y su esposa recibirán la vacuna cuando sea su turno”, informó.

En Missouri, Kelli Jones, directora de comunicaciones del gobernador republicano Mike Parson, dijo en un correo electrónico que él y la primera dama tienen la intención de vacunarse. Al igual que los gobernadores de Colorado, Nevada y otros lugares, ambos se han recuperado de covid-19, dijo Jones, y “esperarán hasta que su grupo de edad sea elegible” según el plan estatal. Los médicos recomiendan las vacunas incluso para personas que ya han tenido covid.

Cissy Sanders, de 52 años, directora de eventos que vive en Austin, Texas, dijo que entiende por qué los legisladores deberían vacunarse. Su propio gobernador, el republicano Greg Abbott, se vacunó por televisión en vivo para infundir confianza, dijo su secretaria de prensa, Renae Eze, quien no quiso comentar si la esposa de Abbott se había vacunado.

Pero Sanders dijo que los cónyuges de los políticos no deben vacunarse antes que los residentes de un asilo, como su propia madre de 71 años. La madre de Sanders recibió la vacuna a fines de diciembre pero dijo que todavía hay demasiados residentes de hogares esperando en todo el país.

“¿Por qué un grupo que no es de alto riesgo, es decir, estos cónyuges, va a vacunarse antes que el grupo de mayor riesgo? ¿Quién toma estas decisiones?, se preguntó. “Los cónyuges de los políticos no han estado en la zona cero del virus. Los residentes de hogares sí”.

La corresponsal de Montana, Katheryn Houghton, la corresponsal de California Healthline, Angela Hart y los corresponsales Markian Hawlyruk y JoNel Aleccia colaboraron con esta historia.

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Nowhere on the list of prioritized recipients are public officials’ spouses.

Yet the first ladies of Kentucky and West Virginia; Republican Vice President Mike Pence’s wife, Karen Pence; Democratic President-elect Joe Biden’s wife, Jill Biden; and Vice President-elect Kamala Harris’ husband, Doug Emhoff, were among the first Americans to get the potentially lifesaving shots.

Kentucky also vaccinated six former governors and four former first ladies, including current Democratic Gov. Andy Beshear’s parents.

The early vaccinations of political spouses spurred outrage on social media, with several Twitter users  they should not be able to “jump the line” ahead of doctors, nurses and older people.

In most of the 29 states that responded to KHN inquiries of all 50 governors’ offices, top elected officials said they — and their spouses — will be vaccinated but have chosen to wait their turn behind more vulnerable constituents. Some Congress members from both parties said much the same when they refused early doses offered in the name of keeping the government running. Those weren’t offered to their spouses.

Governors who got the shots along with their spouses, and the vice president’s office, said they wanted to set an example for residents, build trust, bridge ideological divides and show that the vaccine is safe and effective.

But that’s a rationale some critics don’t buy.

“It looks more like cutting in line than it does securing trust. The politicians can get the hospitals to give it to them under this illusion of building trust. But it’s a façade,” said , a bioethics professor and founding head of the medical ethics division at New York University Grossman School of Medicine. “People might say: ‘Yup, typical rich people. They can’t be trusted.’ This undermines what they set out to do.”

Besides, Caplan said, the public doesn’t trust politicians all that much anyway, so inoculating celebrities, religious leaders or sports figures would likely do more to boost confidence in the vaccine. Rock ’n’ roll king in 1956 to help win over those who were skeptical; the actions of governors’ wives from that period are less remembered.

Dr. José Romero, chairperson of the Centers for Disease Control and Prevention’s , said in an email to KHN that while his group provides an outline for distributing limited vaccine doses, “jurisdictions have the flexibility to do what’s appropriate for their population.” Kentucky and Texas officials pointed out that CDC Director Dr. encouraged governors to publicly get the vaccine.

No one mentioned medical reasons for their spouses to get vaccines; hospitals are generally not vaccinating the spouses of medical professionals who have gotten the shot. (It’s unclear whether vaccinated people can still spread the virus, so it’s possible that a vaccinated person could pass the virus to their spouse or have to quarantine if an unvaccinated spouse were to get covid.)

The office of West Virginia’s governor, Republican Jim Justice, released pictures of him, his wife, Cathy Justice, and other officials receiving shots. He also showed his own vaccination on .

Beshear’s office in Kentucky also released photos of him getting the vaccine in December on the same day as his wife, Britainy Beshear, and other state officials.

“There is no question that there is vaccine hesitancy out there,” Beshear said at a coronavirus briefing on Monday, the day former Kentucky governors and their spouses were vaccinated. He alluded to a future program involving faith leaders and others. “Validators are incredibly important to building that confidence.”

His father, Democratic former Gov. Steve Beshear, posted photos of his vaccination on , saying that he and his wife, Jane Beshear, along with other former Kentucky governors of both parties and their spouses, stepped up partly to show residents the vaccine is safe and encourage them to get it when it’s available to them.

Kentucky is currently in the first stage of vaccine distribution, which targets health care workers and residents of long-term care and assisted living facilities. Fewer than 15,000 of the 58,500 doses received for long-term care had been given out when the former governors and their spouses were vaccinated.

Tres Watson, a former communications director for the Republican Party of Kentucky who founded a political consulting firm, was skeptical about the intentions behind the event. He said it seemed to be a public relations effort created so the governor could vaccinate his parents.

“I understand the continuity of government, but first ladies have no part in the continuity of government,” he said. “You need to stick with the priorities. Once you start making exceptions, that’s when you run into problems.”

Officials representing the Biden-Harris transition team and three other states where governors got vaccinated — Republican-led West Virginia and Texas, and Democratic-led Kansas — either didn’t respond to KHN or didn’t answer questions about spouses. Alabama’s Republican governor, Kay Ivey, got the vaccine and is divorced.

Politicians in other states have taken the opposite tack.

In Arkansas, Republican Gov. Asa Hutchinson is focused on ensuring high-priority groups such as health care workers, long-term care staffers and residents are vaccinated, said spokesperson LaConda Watson. “He and his wife will receive the vaccination when it’s their turn,” she said.

In Missouri, Kelli Jones, communications director for Republican Gov. Mike Parson, said in an email that he and the first lady fully intend to get the vaccine. Like governors from Colorado, Nevada and elsewhere, they’ve both recovered from covid-19, Jones said, and will “wait until their age group is eligible” under the state plan. Doctors recommend vaccinations even for people who have already had covid.

Cissy Sanders, 52, an events manager who lives in Austin, Texas, said she understands why lawmakers would need to get the vaccine. Her own governor, Republican Greg Abbott, received it on live television to instill confidence, said his press secretary, Renae Eze, who wouldn’t address whether Abbott’s wife was vaccinated.

But Sanders said politicians’ spouses should not be vaccinated before nursing home residents like her 71-year-old mom. Sanders’ mother received the vaccine in late December — after some public officials’ spouses — but she said far too many nursing home residents across America are still waiting.

“Why is a non-high-risk group — i.e., these spouses — going before the most high-risk group? Who makes these decisions? Who thinks this is a good, responsible, safe decision to make?” she said. “Political spouses have not been at ground zero for the virus. Nursing home residents have been.”

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