As a reporter who’s covered the coronavirus since the first confirmed U.S. case landed in Seattle, where I live, I should have known what was coming, but there was some part of me that couldn’t quite believe it. I had a breakthrough case of covid-19 — despite my two shots of the Pfizer-BioNTech vaccine, the second one in April.

I was just one more example of our country’s tug and pull between fantasies of a post-covid summer and the realities of our still-raging pandemic, in which even the vaccinated can get sick.

Not only was I sick, but I’d exposed my 67-year-old father and extended family during my first trip back to the East Coast since the start of the pandemic. It was just the scenario I had tried to avoid for a year and a half.

Where did I get it? Who knows. Like so many Americans, I had loosened up on wearing masks all the time and physical distancing after getting fully vaccinated. We had flown across the country, seen friends, stayed at a hotel, eaten indoors and, yes, even gone to a long-delayed wedding with other vaccinated people.

I ended up in quarantine at my father’s house. (taken a day apart) came back negative, but I could tell I was starting to feel sick. After my second negative test, the nurse leveled with me. “Don’t hang your hat on this,” she said of the results. Sure enough, a few days later the results of a PCR test for the coronavirus (this one sent to a lab) confirmed what had become obvious by then.

It was a miserable five days. My legs and arms ached, my fever crept up to 103 and every few hours of sleep would leave my sheets drenched in sweat. I’d drop into bed exhausted after a quick trip to the kitchen. To sum it up, I’d put my breakthrough case of covid right up there with my worst bouts of flu. Even after my fever broke, I spent the next few weeks feeling low.

Of course, I am very lucky. I didn’t go up against the virus with a naive immune system, like millions of Americans did before vaccines were widely available. And, in much of the world, vaccines are ²õ³Ù¾±±ô±ôÌýa distant promise.

“You probably would have gotten much sicker if you had not been vaccinated,” Dr. , an infectious-disease physician at the University of California-San Diego, explained to me recently.

As I shuffled around my room checking my fever, it was also reassuring to know that my chances of ending up in the hospital were slim, even with the delta variant. And now, about a month later, I’ve made a full recovery.

The reality is breakthrough cases are becoming more common. Here’s what I wish I’d known when those first symptoms laid me low.

1. Is it time for a reality check about what the vaccines can — and can’t do?

The vaccines aren’t a force field that wards off all things covid. They were given the green light because they greatly lower your chance of getting seriously ill or dying.

But it was easy for me — and I’m not the only one — to grab onto the idea that, after so many months of trying not to get covid, the vaccine was, more or less, the finish line. And that made getting sick from the virus unnerving.

After all, there were reassuring findings that the vaccine was remarkably good at stopping any infection, even mild ones.

“There was so much initial euphoria about how well these vaccines work,” said Dr. , an infectious-disease physician and the public health officer for Seattle and King County. “I think we — in the public health community, in the medical community — facilitated the impression that these vaccines are bulletproof.”

It’s hard to keep adjusting your risk calculations. So if you’d hoped to avoid getting sick at all, even slightly, it may be time for a “reset,” Duchin said. This isn’t to be alarmist but a reminder to clear away expectations that covid is out of your life, and stay vigilant about commonsense precautions.

2. How high are my chances of getting a breakthrough case these days?

It used to be quite rare, but the rise of delta has changed the odds.

“It’s a totally different ballgame with this delta phase,” said , a professor of molecular medicine and director of the Scripps Research Translational Institute in San Diego. “I think the chance of having a symptomatic infection has gone up substantially.”

But “quantifying that in the U.S. is very challenging” because our “data is so shoddy,” he said.

The vaccinated still have a considerably lower chance of getting infected than those who aren’t protected that way. Los Angeles County collected data over the summer as the delta variant started to surge: Unvaccinated people were  than those who were vaccinated.

3. How careful do I need to be if I want to avoid a breakthrough?

Looking back, I wish I’d taken more precautions.

And my advice to friends and family now is: Wear masks, stay away from big gatherings with unvaccinated people and cut down on travel, at least until things calm down.

The U.S. is averaging a day (about twice what it was when I fell sick), hospitals are overwhelmed, and the White House has proposed booster shots. Scientists are still making sense of what’s happening with breakthrough cases.

In many parts of the U.S., we’re all more likely to run into the virus than we were in the spring. “Your risk is going to be different if you are in a place that’s very highly vaccinated, with very low level of community spread,” said Dr. , a specialist in infectious diseases at the University of Michigan. “The piece that’s important is what’s happening in your community.”

4. What does a “mild” case of covid feel like?

In my case, it was worse than I expected, but in the parlance of public health, it was “mild,” meaning I didn’t end up in the hospital or require oxygen.

This mild category is essentially a catchall, said , who chairs the Department of Medicine at the University of California-San Francisco. “Mild” can range from “a day of feeling crummy to being completely laid up in bed for a week, all of your bones hurt and your brain isn’t working well.”

There’s not great data on the details of these mild breakthrough infections, but so far it appears that “you do way better than those who are not vaccinated,” said, an occupational medicine specialist at the University of Utah who was part of a by the Centers for Disease Control and Prevention on breakthrough infections.

Yoon’s study, published in June with data collected before the delta surge, found that the presence of fever was cut in half, and the days spent in bed reduced by 60% among people with breakthrough infections, compared with unvaccinated people who got sick.

If you’re vaccinated, the that of the unvaccinated, according to the latest data from the CDC. Those who get severely and critically ill with a breakthrough case tend to be older — in one study done before delta,  — with underlying medical conditions such as cardiovascular disease.

5. Can I spread it to others, and do I need to isolate?

Unfortunately, you still have covid and need to act like it.

Even though my first two tests were negative, I started wearing a mask at my house and keeping my distance from my vaccinated family members. I’m glad I did: No one else got sick.

The delta variant is more than twice as contagious as the original strain of the virus and can build up quickly in your upper respiratory tract, as was shown in , over the summer.

“Even in fully vaccinated, asymptomatic individuals, they can have enough virus to transmit it,” said Dr. Robert Darnell, a physician-scientist at The Rockefeller University.

The science isn’t settled about just how likely vaccinated people are to spread the virus, and it does appear that  faster in people who are vaccinated.

Still, wearing masks and staying isolated from others if you test positive or have symptoms is absolutely critical, Darnell said.

6. Could I get long covid after a breakthrough infection?

While there’s not a lot of data yet, research does show that breakthrough infections can lead to the kind of persistent symptoms that characterize , including brain fog, fatigue and headaches. “Hopefully that number is low. Hopefully it doesn’t last as long and it’s not as severe, but it’s just too early to know these things,” Topol said.

Recent research from the United Kingdom  are about 50% less likely to develop long covid than those who are unvaccinated.

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She assumed her comments would end up in a straightforward documentary that addressed some of the most pressing concerns of the pandemic, such as the legacy of racism in medicine and how that plays into current mistrust in some communities of color. The subject of vaccines was also mentioned, but the focus wasn’t clear to Rogers.

The director wanted something more polished than a Zoom call, so a well-outfitted camera crew arrived at Rogers’ home in Connecticut last fall. They showed up wearing masks and gloves. Before the interview, crew members cleaned the room thoroughly. Then they spent about an hour interviewing Rogers. She discussed her research and in particular controversial figures such as Dr. James Marion Sims, who was influential in the field of gynecology but who  during the 1800s without anesthesia.

“We were talking about issues of racism and experimentation, and they seemed to be handled appropriately,” Rogers recalled. At the time, there were few indications that anything was out of the ordinary — except one. During a short break, she asked who else was being interviewed for the film. The producer’s response struck Rogers as curiously vague.

“They said, ‘Well, there’s ‘a guy’ in New York, and we talked to ‘somebody in New Jersey, and California,'” Rogers told NPR. “I thought it’s so odd that they wouldn’t tell me who these people were.”

It wasn’t until March that Rogers would stumble upon the answer.

She received an email from a group called Children’s Health Defense — prominent in the anti-vaccine movement — promoting its new film, “Medical Racism: The New Apartheid.”

When she clicked on the link and began watching the 57-minute film, she was shocked to discover ³Ù³ó¾±²õÌýwas the movie she had sat down for back in October.

“I was naive, certainly, in assuming that this was actually a documentary, which I would say it is not. I think that it is an advocacy piece for anti-vaxxers,” Rogers said. “I’m still very angry. I feel that I was used.”

The free online film is the latest effort by Robert F. Kennedy Jr., the founder of Children’s Health Defense. (He’s a son of former U.S. Attorney General Robert “Bobby” Kennedy and nephew of President John F. Kennedy.) With this film, Kennedy and his allies in the anti-vaccine movement  about the dangers of vaccines, while aiming squarely at a specific demographic: Black Americans.

The film draws a line from the real and disturbing history of racism and atrocities in the medical field — such as the  — to interviews with anti-vaccine activists who warn communities of color to be suspicious of modern-day vaccines.

At one point in “Medical Racism,” viewers are warned that “in Black communities something is very sinister” and “the same thing that happened in the 1930s ” is happening again.

There is a lengthy discussion of the Ìý²ú±ð³Ù·É±ð±ð²ÔÌý. For example, the film references a study from the about the measles, mumps and rubella vaccine and autism rates as evidence that African American children are being particularly harmed,  are at increased risk of autism because of vaccination.

The movie then displays a chart claiming to use that same CDC data — obtained through a Freedom of Information Act request — to make a connection between vaccinating Black children and autism risk. The findings in the chart closely resemble another study sometimes mentioned by anti-vaccine activists, but the medical journal  the study, because of “undeclared competing interests on the part of the author” and “concerns about the validity of the methods and statistical analysis.” (That study’s author was a paid independent contractor for Kennedy’s group as of 2020 and sits .)

The film also that showed Somali Americans and other African Americans have a more robust immune response to the rubella vaccine than Caucasians and Hispanic Americans. One of those interviewed in Kennedy’s film then asks, “So if you have that process that could be caused by vaccines, why wouldn’t there be a link between vaccines and developmental delays?”

But the study’s author, leading vaccine researcher Dr. Gregory Poland, said this conjecture is not accurate.

According to a statement provided to NPR by the Mayo Clinic, the study demonstrated “higher protective immune responses in African-American subjects with no evidence of increased vaccine side effects,” and any claim of “‘increased vulnerability’ among African-Americans who receive the rubella vaccine is simply not supported by either this study or the science.”

For her part, Rogers, the Yale professor, appears for only about 14 seconds in the film. Her quotes are accurate. But her remarks are embedded in a wider narrative that she has “enormous problems with” — namely that the anti-vaccine movement is heroically engaged in a new civil rights campaign, one meant to stop experimentation on the Black community.

Rogers said the film uses many ideas she holds “passionately, like health disparities, fighting racism in health, working against discrimination, and it’s been twisted for the purposes of this anti-vax movement.”

Another credible expert from mainstream medicine also appears in the film: , the immediate past president of the . The group is the largest organization representing African American physicians in the United States.

Brooks said he agreed to be in the film because he wanted to provide balance, but after seeing it he regrets doing the interview.

“The crux of the documentary is generally ‘Don’t get vaccinated,'” Brooks told NPR in a recent interview. “There ¾±²õÌýan understandable concern in the African American community regarding vaccines — however, in the end, my position is you look past those, have an understanding of those and still get vaccinated. … That nuance was not felt or presented in the documentary.”

Kennedy’s group released the film in early March, just as the covid-19 vaccine was becoming widely available to the American public.

“The film basically wants people to recognize this history that leads right into the present, and especially when they’re facing decisions about whether they should take any vaccine, including covid,” said Curtis Cost, one of the film’s co-producers and a longtime anti-vaccine activist.

Cost said the film does not explicitly tell people to refuse the covid vaccine, but it “goes all the way to the present experimentations and bad things have been done by the medical establishment in America and in Africa and other parts of the world.”

In an emailed statement, a spokesperson for Children’s Health Defense denied that the film is misinformation and said it contains “peer reviewed science and historical data.”

But the movie is “a classic example of the anti-vaccine industry with a highly targeted message using sophisticated marketing techniques and building alliances with affiliate organizations,” said Imran Ahmed, CEO of the nonprofit Center for Countering Digital Hate, which has .

“They’ve seen the opportunity to target a specifically African American audience,” he said, during a particular moment of heightened national attention on racial injustices and health disparities.

Black Americans have  compared with white Americans. Racial disparities in vaccination uptake persist across the United States.

While there are to improve access to the vaccine, media coverage has also focused heavily on historical reasons for vaccine skepticism — too much,  scholars argue, when the focus should be on how Black Americans experience the impact of systemic racism in health care today — and how to fix those problems and improve trust.

“We’re in this moment where we’re having some necessary discussions about health equity,” said Victor Agbafe, a medical student at the University of Michigan. “It’s not a good thing to sort of exploit that as a means to undermine trust in the vaccine today, instead of focusing on how we can make the vaccine more accessible for all communities.”

Agbafe, who helps lead his school’s Black medical student association, was surprised to get an email from Children’s Health Defense asking him to promote the movie among his peers.

When it was released, the film did not seem to gain much traction on major social media platforms such as Twitter, although tracking how often this kind of video is being shared privately can be difficult, said , a University of Washington researcher who studies the anti-vaccine movement online.

But Kennedy’s anti-vaccine activities during the pandemic involve more than this movie.

In February, he  from Instagram for posting misinformation on vaccines, but he still has a home on Facebook and Twitter. Ahmed’s organization has labeled Kennedy one of the  — a group of people responsible for 65% of the shares of anti-vaccine misinformation on social media platforms.

In a recent  about the film, Kennedy said those who agree with the film need to use “the tools of advocacy that Martin Luther King Jr. talked about” and promote it “guerrilla-style” against the “darkening cloud of totalitarianism.”

Although more than half of American adults have gotten a covid vaccine, demand is falling fast, and polls  almost one-third of adults still either want to “wait and see” or do not want to get the shot. When asked why, many say the vaccine is unsafe, based on false conspiracy theories.

“I see the downstream ripple effects of disinformation every day in practice, every day in the patients’ lives I treat,” said  with the Los Angeles County Department of Health Services and co-founder of the online campaign , which aims to encourage trust in the covid vaccines.

“We know people have uncertainties, and we need to acknowledge that and have humble, respectful conversations, but for someone to actively subvert that trust is unconscionable,” Nakhasi said.

According to the , the ideal strategy for stopping the spread of online misinformation is to cut it off at the source: meaning “deplatform” the most notorious spreaders of that information so they can’t gain a following on social media in the first place. But Ahmed said that all too often tech companies don’t take those steps themselves. In that case, the next best tactic is to try to “inoculate” people against false and misleading claims.

“You tell people in advance, ‘Hey, something terrible is happening. Be careful — they’re targeting you,'” Ahmed said.

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Es tanto una señal del éxito del país en la protección de los adultos mayores con la vacunación como un recordatorio urgente de que las generaciones más jóvenes pagarán un alto precio si se permite que siga habiendo brotes en todo el país.

“Ahora vemos personas de 30, 40 y 50 años, jóvenes que están realmente enfermos”, dijo el , especialista en enfermedades infecciosas y presidente del grupo de trabajo de covid de la Sociedad Médica de Chicago. “La mayoría de ellos lo superan, pero algunos no… acabo de perder a un hombre de 32 años con dos hijos, es desgarrador”.

Aproximadamente el de los Estados Unidos ya está completamente vacunada, pero la gran mayoría son personas mayores de 65 años, un grupo al que se le dio prioridad en la fase inicial de inmunización.

A nivel nacional, los adultos menores de 50 años representan ahora los pacientes con covid más hospitalizados en el país, alrededor del 36% de todas las admisiones. Las personas de 50 a 64 años representan el segundo grupo con más internaciones, alrededor del 31%. Las hospitalizaciones entre los adultos mayores de 65 años se han reducido significativamente.

Aunque las nuevas infecciones están disminuyendo gradualmente en todo el país, algunas regiones han enfrentado un resurgimiento del coronavirus en los últimos meses, lo que algunos han llamado una , impulsado por la variante B.1.1.7, identificada por primera vez en el Reino Unido, que se estima que es entre un 40% y un 70% más contagiosa.

Como muchos estados abandonan las precauciones por la pandemia, esta cepa más virulenta todavía tiene un amplio margen para propagarse entre la población más joven, que sigue siendo ampliamente susceptible a la enfermedad.

La aparición de cepas más peligrosas del virus en el país, Incluidas las variantes descubiertas por primera vez en Sudáfrica y Brasil, ha hecho que el esfuerzo de vacunación sea aún más urgente.

“Estamos en un juego completamente diferente”, dijo , epidemióloga de la Universidad de Washington.

El aumento de las infecciones entre los adultos jóvenes crea un “reservorio de enfermedad” que eventualmente “se extiende al resto de la sociedad”, sociedad que aún no ha alcanzado la , y presagia un aumento más amplio de casos, dijo.

Afortunadamente, la posibilidad de morir por covid sigue siendo muy pequeña para las personas menores de 50 años, pero este grupo de edad puede enfermarse gravemente o experimentar síntomas a largo plazo después de la infección inicial. Las personas con afecciones subyacentes, como obesidad y enfermedades cardíacas, también tienen más probabilidades de enfermarse gravemente.

“B.1.1.7 no discrimina por edad, y cuando se trata de jóvenes, nuestro mensaje al respecto sigue siendo demasiado suave”, dijo Malmgren.

En todo el país, la afluencia de pacientes más jóvenes con covid ha sorprendido a los médicos que describen salas de hospital llenas de pacientes, muchos de los cuales parecen estar más enfermos de lo que se vio durante las oleadas anteriores de la pandemia.

“Muchos de ellos requieren atención en terapia intensiva”, dijo la , jefa de prevención y control de infecciones en UCHealth, uno de los grandes sistemas hospitalarios de Colorado.

La edad promedio de los pacientes con covid en los hospitales de UCHealth ha disminuido en más de 10 años en las últimas semanas, de 59 a 48 años, agregó Barron.

“Creo que seguiremos viendo eso, especialmente si no hay mucha aceptación de la vacuna en estos grupos”, dijo.

Si bien la mayoría de los hospitales están lejos de la avalancha de casos durante el invierno, subraya las posibles consecuencias de flexibilizar las restricciones cuando una gran parte de los adultos aún no están vacunados.

Existe una fuerte evidencia de que las tres vacunas que se están utilizando en el país rindan una buena protección contra la variante del Reino Unido.

Un que la variante B.1.1.7 no causa complicaciones graves, como se pensaba anteriormente. Sin embargo, los pacientes infectados con esta variante parecen tener más probabilidades de tener más virus en sus cuerpos que aquellos con la cepa que dominaba antes, lo que puede ayudar a explicar por qué se propaga más fácilmente.

“Creemos que esto puede estar causando más de estas hospitalizaciones en personas más jóvenes”, dijo la en el hospital de la Universidad de Alabama-Birmingham.

El hospital de Lee también ha observado un aumento en los pacientes más jóvenes. Al igual que en otros estados del sur, Alabama tiene una tasa baja de absorción de vacunas.

Pero incluso en el estado de Washington, donde gran parte de la población está optando por vacunarse, las hospitalizaciones han aumentado constantemente desde principios de marzo, especialmente entre los jóvenes. En el área de Seattle, actualmente se interna a más personas de 20 años por covid que personas de 70, según el doctor Jeff Duchin, director de salud pública de Seattle y el condado de King.

“Todavía no tenemos suficientes adultos jóvenes vacunados para contrarrestar la mayor facilidad con la que se propagan las variantes”, dijo Duchin en una conferencia de prensa reciente.

A nivel nacional, alrededor del están completamente vacunadas, en comparación con el 27% de las personas de 30 años. Esa proporción se reduce a aproximadamente el 18% para los jóvenes de 18 a 29 años.

“Tengo la esperanza de que la curva de muerte no aumente tan rápido, pero está ejerciendo presión sobre el sistema de salud”, dijo el , médico de emergencias y presidente de la Asociación Médica del Estado de Washington.

Schlicher, también de unos 30 años, recuerda con horror a dos de sus pacientes recientes, cercanos a su edad y previamente sanos, que ingresaron con insuficiencia cardíaca causada por covid.

“Lo he visto de cerca y eso es lo que más me asusta”, dijo.

“Entiendo que los jóvenes se sientan invencibles, pero lo que les diría es que no tengan miedo de morir, tengan miedo de la insuficiencia cardíaca, el daño pulmonar y no poder hacer las cosas que amas hacer”.

Los médicos y los expertos en salud pública esperan que el preocupante aumento de las hospitalizaciones entre la población más joven sea temporal, algo que las vacunas contrarrestarán pronto. Solo desde el 19 de abril todos los adultos se volvieron elegibles para la vacuna.

Pero algunas preocupantes indican que una parte considerable de los adolescentes y adultos de entre 20 y 30 años no necesariamente tienen planes de vacunarse.

“Solo tenemos que hacer que sea muy fácil, sin inconvenientes”, apuntó Malmgren, el epidemiólogo de Washington. “Tenemos que pensar un poco diferente”.

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It’s both a sign of the country’s success in protecting the elderly through vaccination and an urgent reminder that younger generations will pay a heavy price if the outbreak is allowed to simmer in communities across the country.

“We’re now seeing people in their 30s, 40s and 50s — young people who are really sick,” said , a specialist in infectious diseases and chair of the Chicago Medical Society’s covid-19 task force. “Most of them make it, but some do not. … I just lost a 32-year-old with two children, so it’s heartbreaking.”

Nationally, adults under 50 now  for the most hospitalized covid patients in the country — about 36% of all hospital admissions. Those ages 50 to 64 account for the second-highest number of hospitalizations, or about 31%. Meanwhile, hospitalizations among adults 65 and older have fallen significantly.

´¡²ú´Ç³Ü³ÙÌý is now fully vaccinated, but the vast majority are people older than 65 — a group that was prioritized in the initial phase of the vaccine rollout.

Although new infections are  nationwide, some regions have contended with a resurgence of the coronavirus in recent months — what some have called a “” — propelled by the B.1.1.7 variant, first identified in the United Kingdom, which is estimated to be somewhere between 40% and 70% more contagious.

As many states ditch pandemic precautions, this more virulent strain still has ample room to spread among the younger population, which remains broadly susceptible to the disease.

The emergence of more dangerous strains of the virus in the U.S. — including variants first discovered in South Africa and Brazil — has made the vaccination effort all the more urgent.

“We are in a whole different ballgame,” said , an epidemiologist at the University of Washington.

Rising infections among young adults create a “reservoir of disease” that eventually “spills over into the rest of society” — one that has  — and portends a broader surge in cases, she said.

Fortunately, the chance of dying of covid remains very small for people under 50, but this age group can become seriously ill or experience long-term symptoms after the initial infection. People with underlying conditions such as obesity and heart disease are also more likely to become seriously ill.

“B.1.1.7 doesn’t discriminate by age, and when it comes to young people, our messaging on this is still too soft,” Malmgren said.

Hospitals Filled With Younger, Sicker People

Across the country, the influx of younger patients with covid has startled clinicians who describe hospital beds filled with patients, many of whom appear sicker than what was seen during previous waves of the pandemic.

“A lot of them are requiring ICU care,” said, head of infection prevention and control at UCHealth, one of Colorado’s large hospital systems, as compared with earlier in the pandemic.

The median age of covid patients at UCHealth hospitals has dropped by more than 10 years in the past few weeks, from 59 down to about 48 years old, Barron said.

“I think we will continue to see that, especially if there’s not a lot of vaccine uptake in these groups,” she said.

While most hospitals are far from the onslaught of illness seen during the winter, the  underscores the potential fallout of loosening restrictions when a large share of adults are not yet vaccinated.

There’s strong evidence that all three vaccines being used in the U.S. provide good protection against the U.K. variant.

 that the B.1.1.7 variant doesn’t lead to more severe illness, as was previously thought. However, patients infected with the variant appear more likely to have more of the virus in their bodies than those with the previously dominant strain, which may help explain why it spreads more easily.

“We think that this may be causing more of these hospitalizations in younger people,” said  at the University of Alabama-Birmingham hospital.

Lee’s hospital also has observed an uptick in younger patients. As in other Southern states, Alabama has a  rate of vaccine uptake.

But even in Washington state, where much of the population is opting to get the vaccine, hospitalizations  since early March, especially among young people. In the Seattle area, more people in their 20s are now being hospitalized for covid than people in their 70s, according to Dr. Jeff Duchin, public health chief officer for Seattle and King County.

“We don’t yet have enough younger adults vaccinated to counteract the increased ease with which the variants spread,” said Duchin at a recent press briefing.

±·²¹³Ù¾±´Ç²Ô·É¾±»å±ð,Ìý are fully vaccinated, compared with 27% of people in their 30s. That share drops to about 18% for 18- to 29-year-olds.

“I’m hopeful that the death curve is not going to rise as fast, but it is putting a strain on the health system,” said , an emergency physician and president of the Washington State Medical Association.

Schlicher, also in his late 30s, recalls with horror two of his recent patients — close to his age and previously healthy — who were admitted with new-onset heart failure caused by covid.

“I’ve seen that up close and that’s what scares the hell out of me,” he said.

“I understand young people feeling invincible, but what I would just tell them is — don’t be afraid of dying, be afraid of heart failure, lung damage and not being able to do the things that you love to do.”

Will Younger Adults Get Vaccinated?

Doctors and public health experts hope that the troubling spike in hospitalizations among the younger demographic will be temporary — one that vaccines will soon counteract. It was only on April 19 that all adults became eligible for a covid vaccine, although they were available in some states much sooner.

But Ìý³¦´Ç²Ô³¦±ð°ù²Ô¾±²Ô²µÌý polls indicate a sizable portion of teens and adults in their 20s and 30s don’t necessarily have plans to get vaccinated.

“We just need to make it super easy — not inconvenient in any way,” said Malmgren, the Washington epidemiologist. “We have to put our minds to it and think a little differently.”

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Judy Dodd, que vive en Nueva York, es una de ellas. Pasó casi un año aquejada de dolores de cabeza, falta de aliento, fatiga extrema y problemas de olfato, entre otros síntomas.

Le preocupaba que esta “lucha por la vida” se convirtiera en su nueva normalidad.

Pero todo cambió después de recibir la vacuna contra el virus.

“Me sentí como nueva. Fue una locura”, dijo Dodd, refiriéndose a cómo muchos de sus problemas de salud disminuyeron significativamente después de su segunda inyección.

A medida que en Estados Unidos aumenta el número de personas vacunadas, surge un curioso beneficio para los que padecen este síndrome posterior a la enfermedad: Sus síntomas se alivian y, en algunos casos, desaparecen por completo tras la vacunación.

Es la nueva pista en el rompecabezas inmunológico de covid de largo plazo, una afección aún poco conocida que deja a algunos infectados con síntomas muy variados meses después de la enfermedad inicial.

La idea de que una vacuna destinada a prevenir la enfermedad pueda también tratarla ha despertado el optimismo entre los pacientes, y a los científicos que estudian el síndrome posterior a la enfermedad les interesan mucho estas historias.

“No esperaba que la vacuna te hiciera sentir mejor”, afirmó , inmunóloga de la Facultad de Medicina de Yale e investigadora de covid de largo plazo.

“Cada vez que escuchaba que los síntomas de las personas con covid persistente se reducían o se recuperaban por completo, más me ilusionaba porque esto podría ser una cura potencial para algunas personas”.

Aunque parece prometedor, aún es demasiado pronto para saber cuántas personas con covid de largo plazo se sienten mejor, como resultado de la vacunación, y si eso supone una diferencia estadísticamente significativa.

Mientras tanto, Iwasaki y otros investigadores ya han incorporado esta cuestión en los estudios en curso de los enfermos de covid persistente mediante el seguimiento de sus síntomas antes y después de la vacunación y la recogida de muestras de sangre para estudiar su respuesta inmunitaria.

Hay varias teorías sobre por qué las vacunas podrían aliviar los síntomas de covid persistente. Es posible que las vacunas eliminen restos del virus o sus fragmentos, que interrumpan una respuesta autoinmune perjudicial o que, de alguna otra manera, “restablezcan” el sistema inmunitario.

“Todo es biológicamente plausible y, lo que es más importante, debería ser fácil de comprobar”, dijo el , de la Universidad de California-San Francisco (UCSF), que también estudia los en los pacientes.

Las historias de los pacientes ofrecen esperanza

Antes de recibir la vacuna, Dodd, que tiene unos 50 años, dijo que se sentía como si hubiera envejecido 20 años.

Le costó volver al trabajo, e incluso las tareas más sencillas la dejaban agotada y con un insoportable dolor de cabeza.

“Subía las escaleras del metro y tenía que detenerme en la cima, quitarme la máscara sólo para tomar aire”, explicó Dodd.

Después de recibir su primera dosis de la vacuna de Pfizer en enero, muchos de sus síntomas se agravaron, por lo que consideró negarse a recibir la segunda dosis.

Pero lo hizo, y a los pocos días notó que había recuperado la energía, que respiraba mejor y, poco después, incluso sus problemas de olfato se habían resuelto.

“Fue como si el cielo se hubiera abierto. Salió el sol”, exclamó. “Me siento casi igual a como estaba antes de covid”.

A falta de estudios significativos, los investigadores extraen la información que pueden de las historias de los pacientes, las encuestas informales y las experiencias de los médicos. Por ejemplo, de los 577 pacientes con covid prolongado, con los que se puso en contacto el grupo , un 40% dijo que se sentía mejor después de vacunarse.

Entre los pacientes del , del Centro Médico de la Universidad de Columbia, en Nueva York, la “niebla cerebral” y los problemas gastrointestinales son dos de los síntomas más comunes que parecen resolverse tras la vacunación.

Griffin, que investiga la enfermedad de covid de largo plazo, al principio de su estudio estimó que entre el 30% y el 40% de sus pacientes se sentían mejor. Ahora cree que la cifra puede ser mayor, ya que más pacientes reciben su segunda dosis y experimentan más mejoras.

“Hemos ido desgranándolo [covid de largo plazo] tratando cada síntoma”, señaló. “Si verificamos que al menos el 40% de las personas se recuperan de forma significativa con una terapia de vacunación, entonces, hasta la fecha, ésta es la intervención más eficaz que tenemos contra la enfermedad”.

Un , que aún no ha sido revisado por otros expertos, descubrió que un 23% de los pacientes con covid prolongado presentaban un “aumento en la resolución de los síntomas” tras la vacunación, en comparación con alrededor del 15% de los que no estaban vacunados.

Pero no todos los médicos observan el mismo nivel de mejora.

Médicos de clínicas post-covid de la Universidad de Washington en Seattle, de la Oregon Health & Science University en Portland, el National Jewish Health en Denver y el Centro Médico de la Universidad de Pittsburgh dijeron a NPR y KHN que, hasta ahora, sólo un pequeño número de pacientes, o ninguno, ha informado de que se sentían mejor después de vacunarse, pero no era un fenómeno generalizado.

“He oído anécdotas de personas que se sienten peor, y se puede dar una explicación científica para ello y movernos en cualquier dirección”, apuntó Deeks, de la UCSF.

¿Por qué los pacientes se sienten mejor?

Hay varias teorías para explicar por qué las vacunas podrían ayudar a algunos pacientes, cada una de ellas basada en diferentes interpretaciones fisiológicas de covid de largo plazo, que se manifiesta de diversas maneras.

“Lo que está claro es que covid de largo plazo no es un solo problema”, explicó el , director del Scripps Research Translational Institute, quien también estudia el covid persistente y los posibles efectos terapéuticos de la vacunación.

Algunas personas tienen frecuencias cardíacas en reposo rápidas y no toleran el ejercicio. Otras sufren principalmente problemas cognitivos, o alguna combinación de síntomas como agotamiento, problemas para dormir y problemas con el olfato y el gusto, señaló Topol.

Por lo tanto, es probable que unas terapias funcionen mejor para algunas versiones de covid de largo plazo que para otras, afirmó Deeks.

Una de las teorías es que las personas infectadas nunca eliminan por completo el coronavirus, y un “depósito” viral, o fragmentos del virus, persiste en partes del cuerpo causando inflamación y síntomas a largo plazo, apuntó Iwasaki, la inmunóloga de Yale.

Según esta explicación, la vacuna podría inducir una respuesta inmunitaria que le proporcionara al cuerpo un poder adicional para rechazar la infección persistente.

“En realidad, ésta sería la forma más directa de eliminar la enfermedad, ya que se está eliminando la fuente de inflamación”, dijo Iwasaki.

Griffin, del Centro Médico de Columbia, sugirió que esta idea de la “persistencia viral” está respaldada por lo que ve en sus pacientes y por lo que le dicen otros investigadores y médicos.

Dijo que los pacientes parecen mejorar después de recibir cualquiera de las vacunas, generalmente unas “dos semanas después, cuando parece que experimentan lo que sería una respuesta efectiva y protectora”.

Otra posible razón por la que algunos pacientes mejoran es entender covid de largo plazo como una enfermedad autoinmune, en la que las células inmunitarias del cuerpo acaban dañando sus propios tejidos.

Una vacuna podría, hipotéticamente, poner en marcha el “sistema inmunitario innato” y “amortiguar los síntomas”, pero sólo temporalmente, comentó Iwasaki, que ha estudiado el papel de las proteínas dañinas, llamadas autoanticuerpos, en covid.

Esta respuesta inmunitaria autodestructiva se produce en un subgrupo de pacientes con covid mientras están enfermos, y los autoanticuerpos producidos pueden circular durante meses. Pero aún no está claro cómo esto puede contribuir a la aparición de covid persistente, según , director del Instituto de Inmunología de la Universidad de Pennsylvania.

Otra teoría es que la infección haya “desconfigurado” el sistema inmunitario de alguna otra manera y haya provocado una inflamación crónica, similar al síndrome de fatiga crónica, dijo Wherry. En ese caso, la vacunación podría “restablecer” de algún modo el sistema inmunitario.

Con , es difícil determinar cuántos de los que padecen covid de largo plazo habrían mejorado incluso sin ninguna intervención.

“Ahora mismo, sólo tenemos anécdotas; nos encantaría que fuera cierto. Esperemos a contar con datos reales”, concluyó Wherry.

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Judy Dodd, who lives in New York City, is one of them. She spent nearly a year plagued by headaches, shortness of breath, extreme fatigue and problems with her sense of smell, among other symptoms.

She said she worried that this “slog through life” was going to be her new normal.

Everything changed after she got her covid vaccine.

“I was like a new person. It was the craziest thing ever,” said Dodd, referring to how many of her health problems subsided significantly after her second shot.

As the U.S. pushes to get people vaccinated, a curious benefit is emerging for those with this post-illness syndrome: Their symptoms are easing and, in some cases, fully resolving after vaccination.

It’s the latest clue in the immunological puzzle of long covid, a still poorly understood condition that leaves some who get infected with wide-ranging symptoms months after the initial illness.

The notion that a vaccine aimed at preventing the disease may also treat it has sparked optimism among patients, and scientists who study the post-illness syndrome are taking a close look at these stories.

“I didn’t expect the vaccine to make people feel better,” said , an immunologist at the Yale School of Medicine who’s researching long covid.

“More and more, I started hearing from people with long covid having their symptoms reduced or completely recovering, and that’s when I started to get excited because this might be a potential cure for some people.”

While promising, it’s still too early to know just how many people with long covid feel better as a result of being vaccinated and whether that amounts to a statistically meaningful difference.

In the meantime, Iwasaki and other researchers are beginning to incorporate this question into ongoing studies of long haulers by monitoring their symptoms pre- and post-vaccination and collecting blood samples to study their immune response.

There are several leading theories for why vaccines could alleviate the symptoms of long covid: It’s possible the vaccines clear up leftover virus or fragments, interrupt a damaging autoimmune response or in some other way “reset” the immune system.

“It’s all biologically plausible and, importantly, should be easy to test,” said  of the University of California-San Francisco, who is also  on patients.

Patient Stories Offer Hope

Before getting the vaccine, Dodd, who’s in her early 50s, said she felt as if she had aged 20 years.

She had trouble returning to work, and even simple tasks left her with a crushing headache and exhaustion.

“I’d climb the subway stairs and I’d have to stop at the top, take my mask off just to get air,” Dodd said.

After she got her first dose of the Pfizer vaccine in January, many of Dodd’s symptoms flared up, so much so that she almost didn’t get her second dose.

But she did — and a few days later, she noticed her energy was back, breathing was easier and soon even her problems with smell were resolving.

“It was like the sky had opened up. The sun was out,” she said. “It’s the closest I’ve felt to pre-covid.”

In the absence of large studies, researchers are culling what information they can from patient stories, informal surveys and clinicians’ experiences. For instance, about 40% of the 577 long-covid patients contacted by the group  said they felt better after getting vaccinated.

Among the patients of  at Columbia University Medical Center in New York, “brain fog” and gastrointestinal problems are two of the most common symptoms that seem to resolve post-vaccination.

Griffin, who is running a long-term study of post-covid illness, initially estimated that about 30% to 40% of his patients felt better. Now, he believes the number may be higher, as more patients receive their second dose and see further improvements.

“We’ve been sort of chipping away at this [long covid] by treating each symptom,” he said. “If it’s really true that at least 40% of people have significant recovery with a therapeutic vaccination, then, to date, this is the most effective intervention we have for long covid.”

A small , not yet peer-reviewed, found about 23% of long-covid patients had an “increase in symptom resolution” post-vaccination, compared with about 15% of those who were unvaccinated.

But not all clinicians are seeing the same level of improvement.

Clinicians at post-covid clinics at the University of Washington in Seattle, Oregon Health & Science University in Portland, National Jewish Health in Denver and the University of Pittsburgh Medical Center told NPR and KHN that, so far, a small number of patients — or none at all — have reported feeling better after vaccination, but it wasn’t a widespread phenomenon.

“I’ve heard anecdotes of people feeling worse, and you can scientifically come up with an explanation for it going in either direction,” said UCSF’s Deeks.

Why Are Patients Feeling Better?

There are several theories for why vaccines could help some patients — each relying on different physiological understandings of long covid, which manifests in a variety of ways.

“The clear story is that long covid isn’t just one issue,” said , director of the Scripps Research Translational Institute, which is also studying long covid and the possible therapeutic effects of vaccination.

Some people have fast resting heart rates and can’t tolerate exercise. Others suffer primarily from cognitive problems, or some combination of symptoms like exhaustion, trouble sleeping and issues with smell and taste, he said.

As a result, it’s likely that different therapies will work better for some versions of long covid than others, said Deeks.

One theory is that people who are infected never fully clear the coronavirus, and a viral “reservoir,” or fragments of the virus, persist in parts of the body and cause inflammation and long-term symptoms, said Iwasaki, the Yale immunologist.

According to that explanation, the vaccine might induce an immune response that gives the body extra firepower to beat back the residual infection.

“That would actually be the most straightforward way of getting rid of the disease, because you’re getting rid of the source of inflammation,” Iwasaki said.

Griffin at Columbia Medical Center said this “viral persistence” idea is supported by what he’s seeing in his patients and hearing from other researchers and clinicians. He said patients seem to be improving after receiving any of the covid vaccines, generally about “two weeks later, when it looks like they’re having what would be an effective, protective response.”

Another possible reason that some patients improve comes from the understanding of long covid as an autoimmune condition, in which the body’s immune cells end up damaging its own tissues.

A vaccine could hypothetically kick into gear the “innate immune system” and “dampen the symptoms,” but only temporarily, said Iwasaki, who has  of harmful proteins, called autoantibodies, in covid.

This self-destructive immune response happens in a subset of covid patients while they are ill, and the autoantibodies produced can circulate for months later. But it’s not yet clear how that may contribute to long covid, said  director of the Institute for Immunology at the University of Pennsylvania.

Another theory is that the infection has “miswired” the immune system in some other way and caused chronic inflammation, perhaps like chronic fatigue syndrome, Wherry said. In that scenario, the vaccination might somehow “reset” the immune system.

°Â¾±³Ù³óÌý, teasing apart how many of those with long covid would have improved even without any intervention is difficult.

“Right now, we have anecdotes; we’d love it to be true. Let’s wait for some real data,” said Wherry.

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Some have borne the tragedy more than others, with multiple family members lost to covid-19 in a matter of months.

For the Aldaco family of Phoenix, it has shattered a generation of brothers.

All three men — Jose, Heriberto Jr. and Gonzalo Aldaco — were lost to covid, each at different moments in the pandemic: first in July, then December, and finally last month.

Their deaths are now among more than in the United States, where, even as millions are vaccinated, the virus still leaves families grieving the new loss of a loved one each day.

“Those three men, they drove the family. They were like the strong pillars, the bones of the family. And now they’re all gone,” said Miguel Lerma, 31, whose grandfather Jose Aldaco raised him as his own son.

To Lerma, their deaths feel like an epic American story of resilience, courage and hard work cut short. All three came to the U.S. from Mexico and over the decades made it home for their families.

“They literally showed that you can come from nothing and struggle through all that and still build a life for yourself and your kids,” said Lerma. “It just upsets me this is the way their story has to end.”

Jose’s daughter Brenda Aldaco said that, with so many Americans gone, the magnitude of each death and its reverberations are profound.

“When you really think about each single person, each person individually, what did that person mean to someone? It’s just overwhelming. It’s overwhelming,” she said.

A Family ‘Ready to Create Memories’

Jose Aldaco, 69 when he died, arrived in the Southwest in the early ’80s when Brenda was still an infant, following his sister, Delia, and older brother, Gonzalo, who had both left Mexico not long before him.

“They came out here for a better opportunity — I don’t even want to say a more comfortable life — but a more attainable, elevated life than what they had,” said Priscilla Gomez, Jose’s niece and Delia’s daughter.

Gomez thinks of all three uncles as central figures — symbols of strength — for her and the entire extended family.

“They were so consistent, the most consistent male figures for me,” said Gomez.

Big family gatherings were a staple of life in the Aldaco households.

“Those three men, when they were in the same room, it was just a good time,” said Lerma, a dance teacher in Phoenix.

Reunions and holidays often evolved into joyous, music-filled events, where Gonzalo, the oldest, would pull out the guitar and the family would dance and sing together till the early hours of the morning.

“If it was someone’s birthday, they would sing ‘Las Mañanitas.’ … They were just always ready to create memories for us,” recalled Gomez.

Lerma said what Jose cultivated most of all was a family where love and affection was the main currency. “He’s the one who taught us to be so amorous,” said Lerma. “He was that warmth. He was that love for us.”

Wave After Wave in Arizona

After a calm spring, the pandemic hit Arizona with terrifying force — the first of two waves that would rip through a state where pandemic precautions were slow to come and quick to disappear. Lerma said his family heeded the warnings.

“We were a family that accepted the pandemic was real,” he said. “We did take it seriously.”

Jose and his wife, Virginia, lived at their daughter Brenda’s house, where they helped raise their teenage grandson.

Brenda’s father worked a few days a week at his job in a hotel restaurant, but was mostly retired. “He was perfectly able — doing yardwork, cooking every day, jogging three times a week at the park,” said Brenda.

Despite the family’s effort to stay safe, the virus found a way into their household that summer. Jose was the first to get sick, but soon all four were ill and isolating in their bedrooms.

They waited on test results. Both elders were getting worse. When the bedroom door was open, Brenda’s son would hear his grandfather.

“My son would say, ‘Mom, Abuelo doesn’t sound good. … He sounds like he’s dying,’” recalled Brenda.

She felt paralyzed, though. Her mother was adamant that she didn’t want him to go to the hospital.

Eventually, Lerma, who lives separately and did not have covid, put on a mask and came to coax Virginia and Jose to go to the hospital. Lerma found Jose lying in bed, covered in a sheet, with a sky-high fever.

“He was forcing fast breaths to try to get any air that he could into his lungs,” said Lerma. “That’s when I started freaking out and losing it.”

Virginia and Jose were admitted to the hospital. A few days later, Virginia was doing well enough to go home, but Jose’s condition only got worse.

The last time Lerma saw him it was over FaceTime, while Jose was being wheeled through the hospital to be put on life support. “Losing my dad, this is what heartbreak is,” said Lerma. “This is what the sad songs are about.”

Three Brothers — ‘Family Men’ — Gone

By the time of Jose’s death, the virus had already killed about 150,000 Americans. Like so many other families, the Aldacos were not able to have a proper funeral.

“It felt like his death was just brushed under the rug, like he’s just another statistic,” said Lerma.

Priscilla Gomez said she’ll never forget hearing her mother take the phone call when she learned of her brother’s death.

“To not be there in-person to comfort them or to hold them up when they feel like they just want to throw themselves on the ground and just sob … you feel completely helpless,” she said.

As the pandemic stretched into the winter months, a new wave of infections and deaths gripped Arizona and much of the rest of the U.S. By late December, the total U.S death toll had surpassed 300,000, and Heriberto Aldaco Jr. — the youngest, in his late 50s — was now also hospitalized with covid.

“You think you’ve gone to a particular point in your grieving, and then it’s not done — here it comes again. … Now my dad’s baby brother is sick,” said Brenda Aldaco. “Then he passes away.”

Less than two months later, yet more shattering news would come to the family.

The last remaining brother, Gonzalo Aldaco, the eldest in his early 70s, was hospitalized with covid. He died in February.

Brenda Aldaco described her father and uncles as above all else “family men.”

“They were totally and completely devoted to the people they loved — always present, always someone you could rely on,” she said.

Sometimes, she still expects her father to come home from the hospital: “It was just hard for me to even grasp the concept of ‘He’s gone’… that the three of them are now gone and under the same circumstances and within a period of six months.”

This story is from a reporting partnership between and .

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This dark but necessary arithmetic has become all too routine during the covid-19 outbreak.

The total U.S death toll has  surpassed 450,000.

Each death is unique, a devastating loss that ripples through a family, a network, a community. But in the aggregate, the national death toll can feel abstract, and its repetition in the news can become numbing. Journalists, commentators and public officials are left searching for new ways to convey the deadliness of this pathogen, and the significance of its mounting fatality rate.

Many have turned to history, citing  (2,403 killed) or the  (at least 2,977 killed) as a way of providing perspective when the number of daily covid deaths in the U.S. reached those levels. (Currently, more than 3,000 Americans are dying from covid every day.)

Jan. 21, 2021, offered another opportunity for historical comparison: That was the day when the covid death toll in the U.S. reached — and then exceeded — the Americans who died in World War II.

For many, attempting to compare the two death tolls — or even take note of their brief conjunction — is misguided or offensive. It is certainly a morally fraught exercise. The true emotional and social impact of either event can never be quantified, but many media outlets still mentioned it.

This raises the question: Are we as a society too quick to reach for these historical comparisons? Should a politically driven world war and a biologically driven pandemic, more than seven decades apart, be put side by side at all?

“This is comparing apples to oranges,” wrote NPR listener Kris Petron in December in response to a story . “It is extremely disrespectful to our nation’s veterans, who write a blank check with their lives, to defend our Constitution.”

This type of response, over time, has convinced medical historian  not to draw parallels between death tolls from war and a pandemic.

“I try not to make comparisons to an event or group that I know contains within it a great deal of sentiment, feeling and pain,” said Markel, a professor at the University of Michigan and author of “.”

The notion that combat deaths carry a unique meaning or value is deeply rooted in human culture. Societies tend to valorize those who died for a cause on a battlefield.

But in this pandemic it’s the frail elderly — many of them living in nursing homes and assisted living facilities — who have died in vast numbers.

“To the watching world, that’s not the same as the death of a young soldier in their 20s, let’s say, on the front lines in a war,” said Yale historian  author of “”

“But, I don’t think we have a right to weigh up lives and say which is more important,” Snowden added.

Unlike covid-19, the global influenza pandemic of 1918-19 killed many people in their 20s and 30s — yet, as Snowden noted, there wasn’t much collective mourning for those young adults, despite dying in the prime of life.

“People were so used to mortality because of the [first world] war that even the horrible tallies that were coming with the ‘Spanish’ influenza had lost their capacity to horrify the way that one might expect,” he said.

When We Do Compare Death Tolls, What Exactly Are We Comparing?

The effort to compare the death toll of the pandemic with that of a war strikes historian Samuel Biagetti as an especially “modern” exercise.

“Through the vast majority of human history, people have understood warfare and disease to go hand in hand and to be inextricably linked,” said Biagetti, who is the creator and host of the podcast “.”

The flu pandemic 100 years ago was fueled by the conditions of World War I and ultimately killed more people than the war, with an estimated 50 million flu deaths worldwide and upward of 700,000 flu deaths in the U.S.

Biagetti pointed out that World War II was the first conflict in American history in which combat killed more fighters than disease, a  that has continued since and reflects medical advances such as vaccines and antibiotics.

The carnage of war doesn’t end just because peace is declared. The spillover effects of war continue long after formal hostilities end, and include disability and disfigurement, mental trauma, addiction, homelessness and suicide.

One example is the ongoing suicide crisis among U.S. veterans. From 2005 to 2017, 78,875 veterans  — more than the number of soldiers killed in Vietnam, 58,220.

For all these reasons, Biagetti said he worries about comparing the current pandemic to any war, even if just for the purpose of counting the dead: “You can’t just try to sum up in a simple statistic how big is this disaster versus that disaster, as if they can even be summed up in a simple number at all.”

And yet the language of warfare permeates so much of the national discourse about the pandemic.

Nurses work on the “front lines.” Coronavirus is described as an invisible “enemy.” The country is “battling” the virus. In h¾±²õÌý, President Joe Biden said the pandemic has “taken as many lives in one year as America lost in all of World War II.”

‘War’ Metaphor Is a Call to Action, a Recognition of Sacrifice

Some Americans whose relatives have died of covid embrace the rhetoric of war and believe comparing the pandemic to past wars is imperative.

“The scale of ³Ù³ó¾±²õÌý¾±²õÌýthat of a war, it’s just a different type of war and it’s not one that we’re necessarily taught in our history books,” said Kristen Urquiza, who co-founded the advocacy group  after her father died from the disease over the summer.

Urquiza said the country struggled collectively to respond to the coronavirus because Americans have little understanding about what it takes to overcome a pandemic.

“In a way, it’s sort of more dangerous [than war] because we are culturally unprepared for it.”

There are also veterans who feel the war analogies are appropriate, and even helpful. , an emergency physician in Yuma, Arizona, has treated covid patients from the early days of the outbreak and readily compares the pandemic to a war.

“It’s very hard to communicate the severity of this pandemic if you’re not in a hospital, where this war is being waged,” said Gilman, who served as a Marine combat medic in Iraq in 2004.

World War II was the deadliest war in world history, but not in American history: That distinction belongs to the Civil War. The death toll has traditionally been estimated to be about 618,000, but  indicates 750,000 may be more accurate.

But World War II looms large in America’s cultural memory as a “good war,” one that united the country against a clear-cut enemy, said , a professor at Florida International University who studies the history of medicine, race and religion.

In retrospect, the American response to World War II stands in sharp contrast to the current political divisions over the coronavirus, and the fragmented and uneven national response.

Despite the differences, Mas said the comparisons can still be powerful tools as the country tries to reckon with a crisis that has taken place out of sight for many Americans. People are dying in hospitals without family members at the bedside, and only health care workers are there to bear witness.

“The reason we want to compare covid-19 deaths to something like World War II is not just because the numbers are there, but to acknowledge this is a significant rupture in society,” she said.

“This mass death is going to create trauma: How are we going to deal with that? How have we dealt with that in the past? I think it’s part of our human condition to try to search for some reference points.”

This story was produced in partnership with  and KHN.

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The efforts to vaccinate people 65 and older have strained under the enormous demand that has overwhelmed cumbersome, inconsistent scheduling systems.

The struggle represents a shift from the first wave of vaccinations — health care workers in health care settings — which went comparatively smoothly. Now, in most places, elderly people are pitted against one another, competing on an unstable technological playing field for limited shots.

“You can’t have the vaccine distribution be a race between elderly people typing and younger people typing,” said Jeremy Novich, a clinical psychologist in New York City who has begun a group to help people navigate the technology to get appointments. “That’s not a race. That’s just cruel.”

While the demand is an encouraging sign of public trust in the vaccines, the challenges facing seniors also speak to the country’s fragmented approach, which has left many confused and enlisting family members to hunt down appointments. 

“It’s just maddening,” said Bill Walsh, with AARP. “It should be a smooth pathway from signing up to getting the vaccine, and that’s just not what we’re seeing so far.” 

Glitchy websites, jammed phone lines and long lines outside clinics have become commonplace as states expand who’s eligible — sometimes triggering a mad dash for shots that can sound more like trying to score a ticket for a music festival than obtaining a lifesaving vaccine. 

After being inundated, some public health departments are trying to more staff members to handle their vaccination hotlines and specifically target seniors who may not be able to navigate a complicated online sign-up process.  

“Just posting a website and urging people to go there is not a recipe for success,” said Walsh. 

‘Terribly Competitive’ 

Like many other seniors, Colleen Brooks, 85, had trouble sorting through the myriad online resources about how to find the vaccine where she lives, on Vashon Island in the Puget Sound near Seattle.

“It was an overwhelming amount of information,” she said. “I knew it was here someplace, but it wasn’t easy to find out how to get it.”

After making calls, Brooks eventually got a tip from a friend who had spotted the vaccines being unloaded at their town pharmacy. When she dropped by her health clinic to inquire about how to sign up, it happened they were giving out shots that same day.  

“That was totally serendipitous for me, but I actually personally know several seniors who just kind of gave up,” said Brooks. 

Finding out how to get a vaccine appointment was more straightforward for Gerald Kahn, 76, who lives in Madison, Connecticut. 

Kahn got an email notice from the state’s vaccine registration system telling him to make an appointment, but he ran into problems at the very end of the sign-up process. 

“As much as I would pound my finger on the face of my iPad, it didn’t do me any good,” he said.

So Kahn did what many have and called a younger family member, who was able to help him finish signing up. 

“I think there are a lot of people my age, maybe the preponderance, who can only go so far into the internet, and then we’re not only stymied but also frustrated,” he said. 

When Helen Francke, 92, logged on for a vaccine at the designated time, she discovered the spots available in Washington, D.C., filled up almost instantaneously. 

“It was evident that I was much too slow,” she said. “It’s terribly competitive and clearly favors those with advanced computer skills.” 

The next week, Francke tried calling and going online — this time with the help of her neighbors — without success.

“If I had had to depend on the D.C. vaccination website and telephone, I’d still be anxious and unsuccessful,” said Francke, who got a shot only after finding information on a neighborhood discussion group that directed her to a hospital. 

In Arizona, Karen Davis, 80, ended up on a roundabout quest through state and hospital websites with no clear sense of how to actually book an appointment. 

“I kept trying to do it and kind of banged my head against the wall too many times,” she said. 

Davis, a retired nurse, called her doctor and the pharmacy and then eventually turned to a younger relative, who managed to book a 5 a.m. appointment at a mass vaccination site. 

“I’m sure they did not expect older people to be able to do this,” she said. 

Miguel Lerma, who lives in Phoenix, said his 69-year-old mother has been unsuccessful in finding a shot. 

“She’s not an English speaker and doesn’t know technology well, and that’s how everything is being done,” said Lerma, 31. 

Lerma said it’s especially painful to watch his mother struggle to get the vaccine — because he lost his father to covid last year. 

“She’s mourning not only for my dad, but she’s also suffering as an adult now because she depended on him for certain tasks,” Lerma said. “He would’ve handled all this.” 

‘Desperate’ Seniors Look for Help  

a primary care doctor in Southern California, said his older patients would typically call him or visit a pharmacy for vaccines like the annual flu shot, rather than rely on novel online scheduling systems. 

“That’s not how 85-year-olds have interacted with the health care system, so it’s a complete disconnect,” he said. “These folks are basically just investing a lot of time and not getting anything out of it.” 

California’s decision to change its vaccination plan and open it up to those over 65 only adds to the confusion. 

Bretsky said his patients are being told to call their doctor for information, but he isn’t even sure when his office, which is authorized to give the vaccines, will receive any. 

“Patients in this age group want to know that they’re at least being heard or somebody is thinking about the challenges they have,” he said. 

There are some local efforts to make that happen.  

In the village of Los Lunas, New Mexico, public health workers an in-person sign-up event for seniors who needed assistance or simply a device connected to the internet. 

A center recently held a vaccination registration event and a clinic specifically for people over 80 who might not have a computer. 

Novich, the clinical psychologist in New York, teamed up with a few other people to create an informal help service for older adults. It began as a small endeavor, advertised through a few synagogues and his Facebook page. They’ve now helped more than 100 people get shots.  

“We have a huge number of requests that are just piling up,” said Novich. 

“People are really desperate and they’re also confused because nobody has actually explained to them when they are expected to get vaccinated. … It’s a big mess.” 

The ongoing shortage of vaccines has led Novich to halt the service for now. 

This story is part of a partnership that includes  and KHN.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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In Washington state, Starbucks, Microsoft and Costco are lending logistical expertise and manpower to public health agencies that are trying to dispatch their doses of vaccines more efficiently.

Over the weekend, thousands of people filed through the Charlotte Motor Speedway in North Carolina — now serving as a mass vaccine site — run by Honeywell and other local businesses that have partnered with the state.

And on Monday, Google $150 million to “promote vaccine education and equitable distribution” and to make it easier for people to find “when and where to get the vaccine.”

This backup from businesses comes as states continue to navigate uncertainty around when they’ll receive doses. A patchwork of vaccination eligibility rules and ways to sign up for a shot have left many Americans confused, frustrated and even frightened, as those at high risk of serious complications from the covid virus continue to wait with little news on when they’ll be inoculated.

Washington Gov. Jay Inslee calls private enterprise the “arsenal” of the coronavirus vaccination campaign, comparing the partnership to the production of battleships during World War II, but even Inslee, a Democrat, did not oversell the immediate impact.

“This is not going to be an expectation of an Amazon delivery system,” Inslee said while announcing his state’s plan last week. “There will be times when people will not have dosages available in their community because there isn’t enough being delivered.”

Washington and have opened up vaccines to anyone 65 and older — greatly spiking demand — yet a major hang-up continues to be making use of all the delivered vaccines.

Of the approximately 41 million vaccines delivered to states, more than 19 million have not yet been given, from the Centers for Disease Control and Prevention.

“It’s a dance that requires a lot of complex choreography,” said , an associate professor of nursing and health policy at the University of Pennsylvania.

“We aren’t always so innovative and nimble in public health and this is the moment where we need that — we need innovation and we need states trying different things.”

The Washington state partnership is using Starbucks to streamline the vaccine clinics, Microsoft to provide tech support and space on its campus, and Costco to manage logistics around delivering the shots.

Every state should be looking to its businesses to fill gaps in the vaccination operations, whether around online scheduling, public messaging or the nitty-gritty details of coordinating delivery and clinics, Buttenheim said.

“There’s no one corporate entity that’s going to solve this, but most have something to offer,” she said.

Many public health departments have struggled with making the vaccine process “customer friendly” because they don’t typically provide this kind of direct service, said , chief medical officer for the Association of State and Territorial Health Officials (ASTHO), which represents state health directors.

“It has been challenging to scale those kinds of things up,” he said. “Then you add in that public health departments have been dealing with covid for a year, with limited resources and people are tired.”

In North Carolina, Atrium Health, a nonprofit health care system, is part of the business partnership with Honeywell that aims to give 1 million shots by July.

“It allows us as the health care system to focus on what we do best — getting the shots in the arms and making sure people are tolerating it and the aftercare,” said , Atrium’s executive vice president.

“Our hospitals are full, and it’s the same people that are working in our hospitals that we are needing to redeploy for the vaccines.”

Looking Ahead 

The Biden administration has pledged more transparency around the availability of doses and the Federal Emergency Management Agency to set up mass vaccination sites, as many as 100 in the next month.

While the pace of vaccination has picked up, public health experts warn the U.S. must move faster as at least one more contagious variant of the virus shows up in a growing number of states and threatens to drive another devastating surge.

A federal partnership with large pharmacies has faced criticism for not moving more quickly. Some states have gone through the majority of their doses, while have used fewer than half of what’s been delivered.

Public health can get a boost from the private sector, but there are limits to what can be outsourced, said epidemiologist Jennifer Nuzzo of Johns Hopkins University.

“This isn’t just handing somebody a package; this is a clinical encounter,” said Nuzzo.

Data entry involves sensitive personal information, and the actual vaccinators need to be trained and credentialed.

Nuzzo, who has the U.S. capacity for mass vaccination, estimates the U.S. will need anywhere from 100,000 to 184,000 people to staff vaccine clinics, of which 17,000 would have to be vaccinators, to meet the Biden administration’s goal of 100 million shots in 100 days.

“I think it would be extraordinarily difficult to just find those vaccinators,” she said.

The private sector may be able to contribute, but Nuzzo cautioned that any partnerships cannot appear to favor the employees of the company.

Last week, Amazon to assist the Biden administration on the vaccine rollout and has signaled it hopes to vaccinate its own front-line workers as soon as possible.

The shaky supply has the ability of some states to pursue mass vaccine sites, and many providers are still hesitant to schedule vaccines too far in advance. A hospital in Arlington, Virginia, after the state changed how it allocates its supply of vaccines.

In Arizona, which has two mass vaccine sites so far, appointments are through February.

Since the early days of the vaccine rollout — when the Trump administration promised 20 million doses before 2021 — the public has received confusing messages about when they’ll be able to get a shot.

States still face the challenge of how to set realistic expectations. Many are ramping up their capacity for giving vaccines, even before the supply has caught up.

“The worry I have is that if we create expectations for how quickly people can get vaccinated and then don’t deliver, people will become perhaps jaded or disappointed or, worse, mistrustful of vaccination efforts,” she said.

More than half of unvaccinated Americans say they need more information about when or where they’ll get vaccinated, to a national survey from the Kaiser Family Foundation. (KHN is an editorially independent program of KFF.)

At his grocery store in Everett, Wash., Wil Peterson, a cashier, hears this confusion around the vaccine process from his co-workers.

“There’s a lot of information that’s been floating around, so I’m just trying to keep up with the latest developments,” said Peterson, who’s in his 50s and expects his turn to get a shot will come sometime in February.

Peterson worries about catching the virus every day he goes to work and still deals with customers who refuse to wear masks, so he’s eager to get vaccinated.

But he also knows it may not go smoothly, after hearing from a friend who tried to sign up for his shot.

“But the site crashed, so I’m kind of bracing for maybe that happening when I try to do it, but I’m hoping that won’t be the case,” he said.

This story is part of a partnership that includes  and KHN.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).