Special Report-How a British COVID-19 vaccine went from pole position to troubled start

By Steve Stecklow, Andrew MacAskill, Ludwig Burger, Kate Kelland, Emilio Parodi
DECEMBER 24, 2020

LONG READ

LONDON (Reuters) - On June 5, researchers at the University of Oxford quietly made a change to a late-stage clinical trial of their COVID-19 vaccine. In an amendment noted in a document marked CONFIDENTIAL, they said they were adding a new group of participants.



FILE PHOTO: AstraZeneca's logo is reflected in a drop on a syringe needle in this illustration taken November 9, 2020. REUTERS/Dado Ruvic/Illustration/File Photo

The adjustment might seem minor in a large-scale study. But it masked a mistake that would have potentially far-reaching consequences: Many of the United Kingdom trial subjects had inadvertently been given only about a half dose of the vaccine.

The new volunteers would now receive the correct dose. The trial continued.

Much was riding on the Oxford vaccine, a British-led endeavour also involving UK drugs firm AstraZeneca. Prime Minister Boris Johnson’s government was desperate for a success story after its early mishandling of the pandemic contributed to one of the world’s highest death tolls from COVID-19 - around 65,000 by mid-December. The government has secured 100 million doses.

On Nov. 23, Oxford and AstraZeneca delivered positive news. They announced that the regimen of a half dose followed by a full dose booster appeared to be 90% effective in preventing COVID-19. Two full doses scored 62%. Oxford researchers have said they aren’t certain why the half-dose regimen was much more effective.

Johnson called the vaccine team and tweeted his thanks “for their brilliant work.” He went on, “These results are incredibly encouraging and a major step forward in our fight against COVID-19.”

Oxford and AstraZeneca are now hoping for quick authorization by Britain’s regulator. But questions about the trial and the results won’t go away.

Some experts say the dosing discrepancy raises doubts about the robustness of the study’s findings. And they worry about another acknowledged peculiarity of the study: The half-dose regimen wasn’t tested on anyone over 55 - the group considered at high risk from COVID-19. In contrast, a vaccine produced by Pfizer/BioNTech was tested on thousands of people over 65, with an efficacy of 94%.

John Moore, a professor of microbiology and immunology at Weill Cornell Medical College in New York, said there needed to be a better understanding of how the Oxford trial unfolded. “When you get corporate and academic scientists saying different things, it doesn’t give you the impression of confidence in what they’re doing,” he told Reuters. “Was the dosing thing a mistake or not?”

Now a Reuters review of hundreds of pages of clinical trial records, as well as interviews with scientists and industry figures, provides the most detailed account to date of what went wrong with the dosing in the Oxford/AstraZeneca vaccine study. The review found that Oxford researchers were responsible for what their own clinical trial documents called “a potency miscalculation.”

For Oxford and AstraZeneca, the stakes could not be higher. They hope to produce up to three billion doses of the low-cost vaccine by the end of next year, enough to inoculate much of the world, including many of its poorest inhabitants. For months, scientists at Oxford have been busily promoting the experimental vaccine’s prospects in bullish terms - beginning even before the first human test subjects were injected with the experimental vaccine.

In an interview that appeared on April 11 in Britain’s The Times newspaper, Sarah Gilbert, one of the vaccine’s chief researchers at Oxford, said she was 80% certain her team would be able to produce a successful vaccine, possibly as early as September. That was 12 days before a clinical trial to test its safety began.

Oxford didn’t answer detailed questions for this story, but provided a statement saying the trials have been “conducted under the strict national, ethical and regulatory requirements.” It added that “all trial protocols and trial amendments have been subject to review and approval by the relevant authorities. All safety data have been reviewed regularly” by regulators.

A spokesman for AstraZeneca referred questions about the UK clinical trial to Oxford, which sponsored it. A spokeswoman for Britain’s regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), declined to answer questions about the Oxford/AstraZeneca dosing issue. “Our rolling review is ongoing,” she said, “so this information is currently commercially confidential.”

The UK’s Department of Health and Social Care declined to comment.

AN EXACT SCIENCE

Vaccines are the world’s best hope of ending a pandemic that has claimed more than 1.7 million lives globally. More than 60 COVID-19 vaccine candidates are currently undergoing human trials, according to the World Health Organization.

Vaccines made by Pfizer/BioNTech and Moderna have already been authorized for use in some countries, including the United States. They use a relatively new technology called messenger RNA (mRNA) that instructs human cells to produce antigens, a type of protein, that stimulate the immune system. Late-stage clinical trials showed both vaccines appeared to be at least 94% effective. Until the UK approved the Pfizer/BioNTech vaccine on Dec. 2, no RNA vaccine had ever received authorization for general use.

The Oxford/AstraZeneca COVID-19 vaccine employs a more established technique called viral vector. The vaccine uses a bioengineered version of a harmless common-cold virus found in chimpanzees to instruct human cells to make antigens.

On Dec. 8, Oxford published an interim analysis of its trial results and more than 1,100 pages of supplementary documents in the scientific journal The Lancet. These show that measuring the concentration of viral materials can be tricky, and they shed light on the chain of events leading up to the dosing discrepancy.

Viral vectors are typically produced in bioreactors holding up to 2,000 liters, which are then filtered and purified into a concentrated batch of active substance of just a few liters.

“This is not about measuring pencils, pens, bricks, or fixed objects of a given size,” said Lucio Rovati, chief executive of Rottapharm, an Italian biotech company that is trying to develop a different type of vaccine using a genetic fragment. “It’s about live biological products.”

According to the Oxford documents, in May researchers received a vaccine delivery from Italy’s IRBM/Advent — one of the contract manufacturers Oxford enlisted to complement its own vaccine production. The late-stage trial of the Oxford vaccine was about to begin.

The shipment, batch K.0011, had undergone the Italian company’s quality check using an established genetic test - quantitative PCR, or qPCR - to determine viral matter per milliliter.

Oxford ran its own analysis for good measure. The university had been using a different method known as spectrophotometry, which measures viral material in liquids based on how much ultraviolet light the viral matter absorbs.



Oxford’s measurement showed that the batch was more potent than the Italian manufacturer had found, the documents show. Oxford trusted its own result and wanted to remain consistent with a measuring tool it had used throughout an earlier trial phase. So it asked Britain’s drugs regulator for permission to reduce the volume of vaccine injected into trial participants from the K.0011 batch. Permission was granted.

“The decisions about dosing were all done in discussion with the regulator. So when we started the trial, we had some discrepancies in the measurement of the concentration of virus in the vaccine,” Andrew Pollard, the Oxford trial’s chief investigator, told Reuters.

A spokeswoman for the regulator declined to discuss when it first became aware of the dosing issue.

“SERENDIPITY”

Trial participants who received shots from the Italian batch displayed milder than normal expected side effects, such as fever and fatigue. AstraZeneca executive vice president Mene Pangalos said the dose was measured incorrectly. “It ended up being half the dose,” he told Reuters. He called the mistake “serendipity,” given that data analysis later indicated the half dose, followed by a full-dose booster shot, was much more effective than two full doses.

He also recently told the BBC: “There is no doubt I think that we would have run the study a little bit differently if we had been doing it from scratch. But ultimately, it is what it is.”

IRBM/Advent told Reuters there was no manufacturing issue with the batch. The company said in a written statement that the measuring mishap was “the result of a change in the testing method” used to confirm the potency of the dose “once the material had been shipped.”

The documents published in The Lancet confirm that the error lay with the Oxford researchers. A common emulsifier, polysorbate 80, used in vaccines to facilitate mixing, had interfered with the ultraviolet-light meter that measures the quantity of viral material, according to the documents. As a result, the vaccine’s viral concentration was overstated and Oxford ended up administering half doses of vaccine, believing they were full doses.

The documents don’t give a detailed timeline, nor do they show that Oxford informed AstraZeneca at the time. But they do show that Oxford contacted the British regulator again, this time seeking approval to change its measuring method to the one used by the Italians, and to figure out how to proceed with a late-stage trial that had begun with participants receiving the wrong dose. The documents don’t provide full details of the communication between Oxford and the regulator.

In early June, the regulator gave the green light to continue injecting people with the half-dose, in an effort to keep the trial as large as possible and to try to speed up the results, according to the analysis published in The Lancet. The regulator also ruled that Oxford must add another test group to receive the full dose, in accordance with its original plan to test the safety and efficacy of full doses.

“We went back and discussed it again with the regulators and agreed with them,” said Pollard, the Oxford study’s chief investigator.

Ultimately, 1,367 trial participants - none of them over 55 - received the half-dose/full-dose regimen. Two full doses were given to 4,440 adult participants, from all age groups.

The MHRA, Britain’s regulator, is expected to decide soon whether to approve the vaccine. The agency is headed by June Raine, a doctor who trained in general medicine at Oxford. The university’s website shows she has made donations, given talks and performed volunteer work for the university’s Somerville College, which she attended.

The MHRA said that before any decision on the Oxford/AstraZeneca vaccine is made, Raine “will ensure, for complete transparency” her interactions with Oxford as an alumnus are declared. It added that “none of these ties are of a nature that could give rise to a conflict requiring recusal.”

CONTRADICTIONS

Deep within the more than 1,100 pages of supplemental appendices published in The Lancet appeared a description of the dosing discrepancy — “a potency miscalculation.” That admission is contained in a “Statistical Analysis Plan” by Oxford and AstraZeneca dated Nov. 17.

Six days later, Oxford and AstraZeneca announced the interim results of their clinical trials in the UK and in Brazil. “Oxford University breakthrough on global COVID-19 vaccine,” was the headline of an Oxford press release.

AstraZeneca’s news release was more muted. “Two different dosing regimens demonstrated efficacy with one showing a better profile,” it stated.

In interviews about the results with Reuters and the New York Times, AstraZeneca’s Pangalos spoke of “serendipity,” a “useful mistake” and a “dosing error.”

But the firm’s chief executive officer, Pascal Soriot, told Bloomberg: “People call it a mistake — it was not a mistake.” A spokesman for AstraZeneca declined to comment on the statements.

Meanwhile, the two scientists leading Oxford’s development of the vaccine — Sarah Gilbert and Adrian Hill — suggested that the half-dose was not administered by mistake. They didn’t provide evidence. Gilbert, an Oxford vaccinology professor, said it was normal for researchers to look at different dose levels during vaccine trials. “It wasn’t a mix-up in dosing,” she told the Financial Times in an article published on Nov. 27.

A few days later, Hill told Reuters it was a conscious decision by researchers to administer a lower dose. “There had been some confusion suggesting that we didn’t know we were giving a half dose when we gave it — that is really not true,” he said.

Gilbert and Hill together have about a 10% stake in a private biotech firm called Vaccitech that was spun out of Oxford University, according to a filing with
Companies House, the UK’s companies registry, dated Oct. 29. According to a spokeswoman for Vaccitech, the company transferred its rights to the vaccine to Oxford University’s research commercialization arm in exchange for a share of the revenue. “If the vaccine is successful then all shareholders and investors in the company could potentially indirectly benefit,” she wrote in an email.

Hill and Gilbert didn’t respond to detailed questions for this article.

The conflicting explanations of what went wrong have drawn criticism from some experts. “Personally, I can say that I think their vaccine is much better than their communication,” said Guido Rasi, who until last month was executive director of the European Medicines Agency, the European Union’s regulator. He said the agency eventually will evaluate the trial data.

‘AHEAD OF THE WORLD’

For months, the Oxford/AstraZeneca vaccine was described by officials and in the media as the front-runner in the global race to produce a COVID-19 vaccine.

Britain’s health minister, Matt Hancock, told a press conference in April that Britain was “at the forefront of the global effort” to find a vaccine.

On June 26, the World Health Organization’s chief scientist, Soumya Swaminathan, said at a press conference that Oxford’s vaccine was probably the world’s leading candidate.

Five days later, the then head of Britain’s vaccine procurement program, Kate Bingham, told a parliamentary committee: “Oxford is ahead of the world in that it is the most advanced vaccine anywhere.”

Some Oxford scientists did little to dampen the enthusiasm. Asked at the same science and technology parliamentary committee on July 1 whether the world would have to struggle through the coming winter without a vaccine, Gilbert said, “I hope we can improve on those timelines and come to your rescue.”

At the end of July, she alluded to competing vaccine efforts. In an interview on the Royal Society of Biology’s website, she said of the Oxford/AstraZeneca vaccine: “If this doesn’t work, I don’t think anything will work.”

Her main partner on the project, Hill, was equally bullish. On May 15, he told Reuters the Oxford/AstraZeneca candidate is “almost certainly the best single dose rapid-response vaccine.” He dismissed as “total unknowns” and a “wild card” the vaccines using mRNA technology, such as Pfizer/BioNTech and Moderna, which have since published results showing they were both at least 94% effective at preventing COVID-19. The Pfizer/BioNTech vaccine is already being distributed in the millions in the United States and the UK.

“Why would you take a vaccine technology that is new, unproven, maybe quick to manufacture, but expensive to manufacture - and has never been scaled up and has never been shown to protect against anything in humans, and prioritize that in a global emergency?” he asked. “It’s very odd.”

Ian Jones, a professor of virology at Britain’s University of Reading, told Reuters that the plethora of upbeat statements hasn’t benefited the Oxford/AstraZeneca vaccine candidate.

“I don’t want to take away from the fact everybody has worked very hard and (the vaccine) is fundamentally safe and sound,” he said. “But reporting has always had a slightly nationalistic tone, which I don’t think has been helpful.”

Steve Stecklow, Andrew MacAskill and Kate Kelland reported from London; Ludwig Burger from Frankfurt; and Emilio Parodi from Milan; Additional reporting by Alistair Smout in London and Zeba Siddiqui in Mumbai; editing by Janet McBride

Holy Grail treatment for COVID-19 remains out of reach. But options exist

© David Morrison/Eli Lilly/The Associated Press Monoclonal antibody treatment could help prevent people from developing severe COVID-19. Health Canada has authorized one such treatment from Eli Lilly, pending trial results.

A COVID-19 treatment showing early signs of promise is at risk of being overshadowed by the vaccine rollout.

Monoclonal antibody treatments have been used by doctors in the United States on people like President Donald Trump, who fought COVID-19 in October, and on others in an effort to try to keep people with the coronavirus out of hospital. Health Canada has authorized one such drug from Eli Lilly, pending the results of trials to verify its benefits to patients.

Our immune system naturally makes antibodies to fight off the coronavirus. But it can take several weeks to gain full protection and some patients go downhill too quickly to wait. The aim of giving a one-time monoclonal antibody treatment is to seize a window of opportunity early in the course of COVID-19.

Dr. Srinivas Murthy, an infectious disease physician and a clinical associate professor in pediatrics at the University of British Columbia in Vancouver, said a treatment that's simple and works to prevent COVID-19 from becoming severe is "the Holy Grail right now."

"The challenge with any of those treatments is that you have to give it to a lot of people to prevent hospitalizations or severe disease because a lot of people have mild-COVID," Murthy said. "Whatever you give has to be safe and convenient otherwise people won't take it."

© Lindsey Wasson/Reuters Phlebotomist Jenee Wilson talks with Melissa Cruz, an ER technician who recovered from COVID-19, as she donates convalescent plasma for a study. Unlike monoclonal antibodies, convalescent serum includes a range of antibodies.

The two monoclonal antibody treatments at the forefront of COVID-19 studies are Eli Lilly's product, bamlanivimab, and a cocktail from Regeneron Pharmaceuticals that Trump received.

Dr. Saahir Khan, a clinical professor in infectious diseases at the University of Southern California in Los Angeles, is a co-principal investigator of a clinical trial evaluating bamlanivimab.

"The goal of this trial is to find treatment that prevents these patients with what we call mild-to-moderate disease progressing to severe disease that would require hospitalization," Khan said in an interview.

Elderly people and those with underlying medical conditions such as heart disease or diabetes are at a greater risk of developing severe COVID. About 79 million cases have been reported worldwide. And the need for such drugs is especially pressing as the number of cases continues to climb.

"Unfortunately, as bad as it is now, it's almost a foregone conclusion that it's going to get worse for the next month," Khan said.

Vaccines offer hope, but health officials caution they won't be widely available to the general public in Canada for a few months.

In the meantime, effective treatments could help reduce the severity of disease and hospitalization rates, lower death rates and flatten the curve so health systems aren't overwhelmed.

The oldest way to apply antibody treatments is to use the plasma from blood of people who've naturally recovered from COVID-19 and give those antibodies to a patient in need. That's known as convalescent serum or polyclonal antibodies.

But convalescent serum includes a range of antibodies to various infections, such as influenza, as well as the virus that causes COVID-19, called SARS-CoV-2.

Monoclonal antibodies are synthetic, purer than convalescent serum and recognize a specific target, such as the proteins that SARS-CoV-2 uses to make copies of itself.

Before COVID-19 upended lives worldwide, other monoclonal antibody treatments were used to treat rheumatoid arthritis and Crohn's disease, including those with injections given at home using an auto-injector-type device.

For a treatment showing early promise, there hasn't been much pick up of monoclonal antibodies in COVID-19.

UBC's Murthy, who also co-chairs the World Health Organization's clinical research committee on COVID-19, said monoclonal antibodies haven't really been embraced in Canada yet because of access and feasibility questions.

To conduct the trial in southern California for instance, Khan's hospital set up a special tent outside, similar to COVID assessment centres at some Canadian hospitals. The site is staffed by health-care workers wearing full personal protective equipment to minimize the risk of people coming to participate in the trial spreading COVID-19 to any patients or staff.

What's more, current monoclonal antibody treatments for COVID-19 need to be given by infusion, similar to some chemotherapy agents. Khan said it takes an hour for patients to receive the monoclonal antibodies and then staff need to closely monitor them for another hour to check for any allergic reactions.

By mid-December in the U.S., less than 20 per cent of the doses of monoclonal antibodies that the federal government allocated had been used. Red tape, staff shortages, testing delays and skepticism are keeping patients and doctors from using the drugs. Evidence on their effectiveness is also thin so far.

Competition from vaccines

Meanwhile, hospitals and health-care systems in Canada and the U.S. are devoting more attention and resources to the vaccine rollout.

Dr. Donald Vinh, an infectious disease specialist and medical microbiologist at the McGill University Health Centre in Montreal, said monoclonal antibodies could help people with COVID-19 who need to keep their blood levels of oxygen up, while staying out of hospital.

© Brendan McDermid/Reuters An employee works in a lab at the Regeneron Pharmaceuticals Westchester campus in Tarrytown, New York. The company's monoclonal antibody cocktail was one of the treatments for COVID-19 that U.S. President Donald Trump received.

Vinh, who advises the federal government's COVID-19 Therapeutics Task Force, said to his knowledge, monoclonal antibodies aren't being used in Canada to treat COVID. In contrast, Pfizer-BioNtech's vaccine is going into arms across the country.

"These vaccines are extremely effective in stimulating people to produce polyantibodies that protect you against COVID," Vinh said.

Matthew Miller, an associate professor at the Institute for Infectious Disease Research at McMaster University in Hamilton, about 70 kilometres southwest of Toronto, said logistical and economic issues are hindering the use of monoclonal antibodies to treat COVID-19.

Before the treatments can be given, people need to be diagnosed with COVID-19 quickly, Miller said. And he estimated monoclonal antibodies are about 1,000 times more expensive than a vaccine.

The U.S. has paid $1,250 US per dose for 950,000 doses of Lilly's bamlanivimab. Eli Lilly Canada signed an agreement with the federal government to supply 26,000 initial doses of bamlanivimab, also at $1,250 per dose, between December 2020 and February 2021, pending the results of trials to verify its clinical benefits.

To maximize the potential of monoclonal antibodies and to take advantage of when they work best, Miller suggested using them to prevent infection, rather than treat it.

"The sort of obvious settings where these would be really useful is nursing homes, because obviously those people are at a really high risk of dying and that population is usually a population that's quite hard to vaccinate," Miller said.

Other people who could potentially receive the preventive option include employees at meat-packing plants with outbreaks, or households with confirmed COVID-19 cases.

The impact of the coronavirus pandemic on global gender equality - As Equals

© CNN/Photo Illustration/ AFP via Getty Images/G Smith

Bella says her unplanned pregnancy made her mother so furious that she beat her.

She had no idea that the 19-year-old had begun exchanging sex for cash in order to help pay for food for her three younger siblings and two cousins, who live together in a one-room house in a waterfront slum community in Mombasa, Kenya. When Bella came home with rice and other ingredients for dinner at the end of the day, she didn't explain how she had bought them.

"The pandemic broke down the economy, especially for my area. So I had to help in one way or another with expenses," said Bella over WhatsApp. The teen asked that her name be changed to protect her identity.

Before the pandemic, Bella was a sophomore at a high school in the city, where she was an avid history student and enjoyed playing table tennis with friends during breaks between classes. But in March, as Covid-19 spread, Kenya shut down and so did the schools.

Unable to continue her studies remotely due to a lack of electricity and internet access, and with her mother's income from selling vegetables on the street slashed, Bella began washing clothes to help supplement the family's income.

When one of her customers who was much older pressured her for sex, saying he would pay 1,000 Kenyan shillings ($9) or 1,500 shillings ($13) for unprotected sex -- triple what he was paying her for doing his laundry -- she felt like she couldn't say no. After he found out she was pregnant, he disappeared.

"The pandemic played the biggest role in me getting this pregnancy right now, because if the pandemic was not here, I would have been in school. Like this washing clothes, and all that stuff, meeting that man, it wouldn't have happened," said Bella, who is currently receiving social support and cash transfers through ActionAid, an international campaign group. She supplements this with odd jobs and laundry work.

Now three months pregnant, Bella said she won't be able to resume her education when Kenya's schools fully reopen in January -- a friend of her mother's, who had been helping to pay her fees, withdrew her support.

The United Nations Educational, Scientific and Cultural Organization (UNESCO) estimates that nearly 24 million children and adolescents, including 11 million girls and young women like Bella, may drop out of education next year due to the pandemic's economic impact alone (130 million girls were already out of school, according to the agency). That reality not only threatens to roll back decades of progress made toward gender equality, but also puts girls around the globe at risk of child labor, teen pregnancy, forced marriage and violence, experts say.

"It's a kind of vicious cycle," said Stefania Giannini, UNESCO's assistant director-general for education, noting that girls who have become pregnant during lockdowns are not only less likely to return to school, policies and practices in some countries specifically prohibit their participation in education. Adolescent pregnancy during the pandemic threatens to block one million girls from education just in sub-Saharan Africa, according to a report by World Vision, a member of UNESCO's Covid-19 Global Education Coalition.

For many girls, school is not only a place of learning and a pathway to a brighter future, Gianni adds, it's also a lifeline -- offering vital nutrition services, menstrual hygiene management, sexual health information and social support.

Previous crises have proven that girls are the first to be pulled from the classroom and the last to return. When the Ebola outbreak prompted school closures in West Africa from 2014 to 2016, girls faced increased poverty, child labor and teen pregnancy, preventing them in some cases from resuming their studies, reports by UNICEF, Save the Children and UNDP have shown.

In Sierra Leone, teen pregnancy more than doubled to 14,000, according to UNICEF. And many girls in the country never returned to the classroom, partly because of a recently overturned policy barring pregnant girls from going to school, Plan International reported. Enrollment dropped by 16 percentage points in Sierra Leone communities most impacted, per a working paper published by World Bank.

Using data on school dropouts from the Ebola epidemic in Sierra Leone, the Malala Fund estimated that 20 million more secondary school-aged girls could remain out of the classroom long after the coronavirus pandemic has passed.

The repercussions of the Covid-19 pandemic on girls could be felt for generations.

Earlier this year, UNFPA projected that lockdowns lasting at least six months could lead to an estimated 7 million additional unintended pregnancies and 31 million cases of gender-based violence, as well as 13 million child marriages and 2 million female genital mutilation cases over the next decade.

Covid-19 will also push 47 million more women and girls into poverty, according to an analysis commissioned by UN Women and UNDP, which estimates that around 435 million women and girls will be living on less than $1.90 a day by 2021. According to the report, the number of women and girls living in extreme poverty won't return to pre-pandemic levels until 2030.

"With the impact of Covid we're seeing a very quick and dramatic retreat of the progress we've made on gender equality," Julia Sánchez, secretary general of ActionAid, said, highlight issues where advocates have made strides in recent years, like in putting a stop to genital mutilation.

"All of a sudden it's like we've all turned our backs and we're starting to walk in the opposite direction."

In an ActionAid survey of 1,219 women mostly aged 18 to 30 in urban areas of India, Ghana, Kenya and South Africa, only about 22% of those who were studying said they were able to continue their education remotely. But the survey was limited by the fact that young women were interviewed based on their willingness and availability to respond -- only about 25% were currently in some form of education.

Out of school and facing extreme economic insecurity, many of the girls surveyed said they were forced to take on a bigger burden of unpaid care and domestic work, found themselves unable to access life-saving sexual health and reproductive services -- including birth control -- and were more vulnerable to gender-based violence.

Reported incidents of violence were particularly high in Kenya (76%), where young women surveyed repeatedly mentioned sexual abuse and early pregnancies. Echoing Bella's story, several girls and young women who were out of school told surveyors they were forced to exchange sex for money out of financial desperation, ActionAid wrote.

Like many other countries on the African continent, Kenya has committed to closing the gap on exclusion in education, providing all children access by 2030. But the scattershot approach to tackling teen pregnancy -- an issue before the pandemic hit -- has been criticized by campaign groups like Human Rights Watch. In July, Kenyan President Uhuru Kenyatta ordered an investigation into rising reports of violence against women and girls, noting that teen pregnancies had escalated during the pandemic.

Frustrated advocates say cuts to foreign aid by donor countries, like the United Kingdom, amid a wave of Covid-induced austerity measures will have devastating impacts on girls' education and leave them without the safety net that school offers. They warn that failing to place women and girls at the center of recovery plans comes at a steep cost to economic growth, especially when faced with one of the deepest recessions since World War II.

A World Bank report, released in partnership with the Malala Fund in 2018, showed that limited educational opportunities for women and girls who complete secondary school could cost the global economy between $15 trillion and $30 trillion.

"Governments are under the squeeze because aid is going to be cut, because revenues are going down because of the economic effects of Covid, and also because there are greater demands in the health sector," Lucia Fry, director of research and policy at the Malala Fund, said. "In some cases, not all, countries are actually diverting funds away from education at this time of great need."

A number of advocacy groups are calling on governments to maintain the priority that they've given to education, while simultaneously looking to the international community to provide fiscal stimulus in the form of debt relief and emergency aid. Longer term, they're looking at reforms in things like the international tax system so that countries can keep more of the revenues that they have for public services.

In the meantime, teenagers like Bella are having to shift their expectations from a future in school to one at home.

"It has been so hard for me. I lack words to explain how I feel," Bella said.

"Going back to school won't be possible ... and my baby's coming soon."

US layoffs remain elevated as 803,000 seek jobless aid


WASHINGTON — The number of Americans seeking unemployment benefits fell by 89,000 last week to a still-elevated 803,000, evidence that the job market remains under stress nine months after the coronavirus outbreak sent the U.S. economy into recession and caused millions of layoffs.

© Provided by The Canadian Press

The latest figure, released Wednesday by the Labor Department, shows that many employers are still cutting jobs as the pandemic tightens business restrictions and leads many consumers to stay home. Before the virus struck, jobless claims typically numbered around 225,000 a week before shooting up to 6.9 million in early spring when the virus — and efforts to contain it — flattened the economy. The pace of layoffs has since declined but remains historically high in the face of the resurgence of COVID-19 cases.

“The fact that more than nine months into the crisis, initial claims are still running at such a high level is, in absolute terms, bad news,” Joshua Shapiro, chief U.S. economist at the economic consulting firm Maria Fiorini Ramirez Inc., wrote in a research note. “With the pandemic again worsening, it is likely that claims will remain quite elevated for some time.’’

The latest data on unemployment claims came on the same day that the government reported that consumer spending — the principal driver of the economy — fell in November for the first time since April. The 0.4% drop, coming in the midst of the crucial holiday shopping season, added to concerns that weak consumer spending will slow the economy in coming months. Economists suggested that the viral crisis, combined with diminished income and colder weather, likely led Americans to pull back in November.

Also on Wednesday, the government said that sales of new single-family homes sank 11% from October to November, though purchases remain up nearly 21% from a year ago. Boosted by rock-bottom mortgage rates, housing has proved resilient since the health crisis erupted last spring.

Another report Wednesday showed that orders to U.S. factories for high-cost manufactured goods rose a moderate 0.9% in November, with a key category that tracks business investment plans showing a gain. The rise in orders for durable goods, which are items that are expected to last at least three years, followed even stronger gains in recent months. The pace of orders has now nearly regained its pre-pandemic level.

In its report on applications for unemployment aid, the government said the total number of people who are receiving traditional state benefits fell to 5.3 million for the week that ended Dec. 12 from a week earlier. That figure had peaked in early May at nearly 23 million. The steady decline since then means that some unemployed Americans are finding work and no longer receiving aid. But it also indicates that many of the unemployed have used up their state benefits, which typically expire after six months.

Millions more jobless Americans are now collecting checks under two federal programs that were created in March to ease the economic pain inflicted by the pandemic. Those programs had been set to expire the day after Christmas. On Monday, Congress agreed to extend them as part of a $900 billion pandemic rescue package.

On Tuesday night, though, President Donald Trump suddenly raised doubts about that aid and other federal money by attacking Congress' rescue package as inadequate and suggesting that he might not sign it into law.

The supplemental federal jobless benefit in Congress’ new measure has been set at $300 a week — only half the amount provided in March — and will expire in 11 weeks. A separate benefits program for jobless people who have exhausted their regular state aid and another benefits program for self-employed and gig workers will also be extended only until early spring, well before the economy will likely have fully recovered.

A tentative economic recovery from the springtime collapse has been faltering in the face of a resurgence of COVID-19 cases: An average of more than 200,000 confirmed cases a day, up from fewer than 35,000 in early September. Hiring in November slowed for a fifth straight month, with employers adding the fewest jobs since April. Nearly 10 million of the 22 million people who lost jobs when the pandemic hit in the spring are still unemployed.

According to the data firm Womply, closings are rising in some hard-hit businesses. For example, 42% of bars were closed as of Dec. 16, up from 33% at the start of November. Over the same period, closures rose from 25% to 29% at restaurants and from 27% to 35% at salons and other health and beauty shops.

The number of jobless people who are collecting aid from one of the two federal extended-benefit programs — the Pandemic Unemployment Assistance program, which offers coverage to gig workers and others who don’t qualify for traditional benefits — rose by nearly 27,000 to 9.3 million in the week that ended Dec. 5.

The number of people receiving aid under the second program — the Pandemic Emergency Unemployment Compensation program, which provides federal jobless benefits to people who have exhausted their state aid — fell by nearly 8,200 to 4.8 million.

All told, 20.4 million people are now receiving some type of unemployment benefits. (Figures for the two pandemic-related programs aren’t adjusted for seasonal variations.)

States and cities have been increasingly issuing mask mandates, limiting the size of gatherings, restricting or banning restaurant dining, closing gyms or reducing the hours and capacity of bars, stores and other businesses, all of which has slowed economic activity. With vaccines now beginning to be gradually distributed, though, optimism is rising about 2021.

Months from now, economists say, the widespread distribution and use of the vaccines could potentially unleash a robust economic rebound as the virus is quashed, businesses reopen, hiring picks up and consumers spend freely again.

Until then, the limited aid Congress has agreed to won’t likely be sufficient to stave off hardships for many households and small companies, especially if lawmakers balk at enacting further aid early next year. And a widening financial gap between the affluent and disadvantaged households will likely worsen.

“Recession risks are very high,? said Mark Zandi, chief economist at Moody’s Analytics. “I do think the economy’s going to start losing some jobs here. Unemployment will probably go higher. The only thing that will save us from recession is that $900 billion fiscal rescue package.

____

AP journalist Julie Walker in New York contributed to this report.

Paul Wiseman, The Associated Press

Millions of U.S. vaccine doses sit on ice, 

putting 2020 goal in doubt


By Rebecca Spalding, Carl O’Donnell

(Reuters) -Millions of COVID-19 vaccines are sitting unused in U.S. hospitals and elsewhere a week into the massive inoculation campaign, putting the government’s target for 20 million vaccinations this month in doubt.

As of Wednesday morning, only 1 million shots of the Pfizer-BioNTech COVID-19 vaccine had been given, about one-third of the first shipment sent last week. Over 9.5 million doses of vaccines, including Moderna’s, have now been sent to states, according to the U.S. Centers for Disease Control and Prevention.

While hospitals have started giving out Moderna’s vaccine, the CDC has not yet reported that data and there may be a lag in reporting shots given of both the Pfizer and Moderna vaccines.

The slow pace has barely picked up from the first week when 614,000 shots were given although nearly 2.9 million were shipped.

Hospitals said the first COVID-19 vaccinations started slowly last Monday as they navigated preparing the previously frozen shots for use, finding employees to run the vaccination clinics, and ensuring proper social distancing both before and after vaccination. Some said they did only about 100 shots the first day.

They were contending with a COVID-19 surge, as cases around the United States surpassed 18 million with 323,000 deaths. (Graphic: tmsnrt.rs/34pvUyi)

The Trump administration promised to vaccinate 20 million by the end of the year while providing little funding to achieve the goal.

That’s nine days to give out nearly 19 million shots or over 2 million people vaccinated a day including on Christmas Day.

Almost 5.9 million doses of Moderna Inc’s vaccine should go out this week and an additional 2 million doses from Pfizer and partner BioNTech.

“The commitment that we can make is to make vaccine doses available,” U.S. Operation Warp Speed chief adviser Dr. Moncef Slaoui said on a Wednesday press call. He noted the rate of people getting a shot in their arm is “slower than we thought it would be.”

Two more vaccines may be approved in February from Johnson & Johnson Inc and AstraZeneca Plc.

The government’s goal is 100 million Pfizer and Moderna shots in arms by March 1.

Operation Warp Speed’s General Gustave Perna, who is leading the vaccine distribution effort, on Monday said that the CDC data reflects a reporting lag and that the number of vaccinations will catch up as time goes on.

The CDC said its data may also reflect a lag between vaccine dosing and state reporting. Most nursing home vaccinations only began in mass this week, and the CDC data does not specify how many doses from the first shipment were being held by states for that group.

STAFF STRETCHED THIN

Margaret Mary Health, a 25-bed rural hospital in Indiana, built a drive-thru vaccination clinic at a local fire station and one at a local recreation center to vaccinate healthcare workers in the surrounding counties, according to Chief Executive Officer Tim Putnam.

Putnam, who has done traffic control at the clinic’s drive-thru, said they have used about 400 of 1,100 doses received.

“We’re asking for volunteers from our staff, volunteers from the local community college to step in and build this process from the ground up,” he said.

Some of the largest U.S. hospitals inoculated more than 1,000 people per day, having done dry runs of the vaccine delivery and rollout.

Vermont, Delaware and Idaho were among states that confirmed their states had given only thousands of doses - a fraction of those available to them - during the first week.

Jason Schwartz, assistant professor of health policy at Yale School of Public Health, described the initial tally as “discouraging” and said “the challenges of getting vaccines out as quickly as we’re able to manufacture them will only grow.”
Johnson & Johnson’s one-shot vaccine could speed deployment because it requires a conventional refrigerator and has no specialized procedures to thaw out and administer, said Claire Hannan, executive director of the Association for Immunization Managers trade group. AstraZeneca’s two dose vaccine also can be stored in a refrigerator.

“When it’s refrigerator-stable and a one-dose regimen, it can’t get any easier than that,” Hannan said.

HOSPITALS START SLOWLY BUT SPEED UP

Dr. Saul Weingart, the chief medical officer of Tufts Medical Center in Boston, said the hospital had given about 750 doses of the around 3,000 available as of Friday. It started with 100 shots per day and worked up to about 450, he said.

He said experts at the hospital modeled that giving Pfizer’s COVID-19 vaccine would take 10 minutes, about two to three times as long as a flu shot, due to the procedures needed because the vaccine is stored in a deep freeze. Patients need to socially distance before and after being given the vaccine and be monitored for allergic reactions.

The United States gives 170 million flu vaccinations each year within a few months, but for the COVID-19 pandemic, the United States must give about three times that number of shots - the Pfizer and Moderna shots are two doses - to reach most Americans by July. At its current pace, the U.S. appears to have the capacity to administer less than a third of the shots that are shipped in a given week, underscoring the gap.

A spokesperson for Houston Methodist, a hospital in Houston, Texas, said it had given 8,300 employees the vaccine as of Monday with about 7,000 doses left from the first shipment.

The University of Southern California’s Keck Medicine medical school has vaccinated over 3,000 employees and said it will take six weeks for everyone, similar to its flu vaccination schedule.

States and health departments need federal money to hire staff, from data center workers to track inoculations to call center employees to field questions, said Adriane Casalotti, chief of government and public affairs of the National Association of County and City Health Officials.

The U.S. Congress’s current coronavirus aid package sets aside more than $8 billion for vaccine distribution but is delayed.

“You can’t hire someone in December and train them up if you don’t know you can pay them in January,” Casalotti said.

Reporting by Rebecca Spalding and Carl O’Donnell; additional reporting by Deena Beasley in Los Angeles; Editing by Caroline Humer and Lisa Shumaker

USA

'Swept under the rug': Health care workers have died from Covid. How many is unclear.

Phil McCausland 

LONG READ 

Monica Leigh Newton said she turned on her car’s hazard lights and drove 100 miles an hour to get her mom, Elaine McRae, to the emergency room in Gulfport, Mississippi, where the older woman worked as a nurse on the Covid-19 floor.

© Provided by NBC News

McRae’s oxygen levels that August evening had dropped to a level that could incur brain damage. Newton’s mother never returned home after testing positive for Covid-19 at the hospital. Seventy-two days later in November, she died at the same hospital where she had treated coronavirus patients.

“I was literally watching her deteriorate slowly,” Newton said of her mom, whom she called her best friend and hero. “She was losing everything that I've ever seen in my mom. My mom is the strongest human being in the world and that was just slowly being sucked out of her by this virus.”

What bothers Newton is that no one knows exactly how many health care workers, like her mom, have died of the coronavirus — thus quantifying in some way the sacrifices they made and the suffering they experienced from a disease they worked so hard to defeat

As the U.S. Covid-19 death toll continues to mount, the deaths of front-line health care workers remain largely unaccounted for. Doctors, nurses, paramedics and support staff have courageously taken on enormous risk during the pandemic, the most consuming health crisis in more than 100 years, but there is no specific death count for them. These are the same people who have received rounds of applause at the end of their shifts and plaudits from the president and high-ranking members of government and industry.

That hits Newton particularly hard.

One of the last times she saw her mom, Newton shared the news that she had passed her board certifying test to become a registered nurse. Now working at a hospital in New Orleans, she is striving to follow in her mom’s footsteps and make sure her hero is remembered.

“We don’t even know what or who we’ve lost,” Newton said. “My mom served through this pandemic. She helped these people, and if my family hadn’t said anything, they would’ve just said she’s another number.”

Play Video
Coronavirus: hospitals struggle with surge amid holiday travel

Calculating the exact number of U.S. health care workers who have died of Covid-19 and related complications is not easy and is getting harder as time moves on. There is no accurate or central database with that information.

Dr. Claire Rezba, an anesthesiologist in Virginia, has kept a national tally that she has published on her Twitter account since March, when the pandemic began to sweep across the United States.

I don't think that the health care systems have done a service by not publicizing what's going on inside their walls.

She maintains her count using obituaries, media reports, social media, memorials and any other means she can find. Rezba tweets about the deaths of nurses, doctors, emergency medical technicians, specialists and members of staff every day.

Her count has reached nearly 1,700, a figure she’s certain is conservative.

“Every time I feel like it's time to stop — because it's hurting me, there's an aspect of this that hurts — I'll see another story or some posts,” Rezba said. “And I think, ‘Well, just this one more. I just have to make sure that people see this one more.’”

“It seems like there’s nobody else to really take the lead on it,” she added. “It shouldn’t be me. I mean, this is ridiculous. Really, it’s ridiculous.”

A September report by the National Nurses United, a nursing union, had an estimate that is slightly higher than Rezba’s at a little over 1,700 deaths among health care workers since the start of the pandemic.

The Centers for Disease Control and Prevention's latest tally, as of Dec. 22, is 955 deaths and more than 288,000 infections of health care personnel. Of those cases of Covid-19 among health care workers, the CDC has only confirmed 75.7 percent of the time whether or not that doctor, nurse, paramedic or member of support staff died.

A spokesperson for Health and Human Services said the numbers were not comprehensive and noted that state health departments may have more accurate data.

Critics of the federal coronavirus response say the national count may be hampered by White House meddling. The administration announced its decision very suddenly in July to have the Department of Health and Human Services take over hospital coronavirus data collection from the CDC, making it difficult to follow hospital trends and data reporting.

“There is widespread resistance on the part of the health care industry to transparently provide information on nurse and other health care worker fatalities due to Covid-19,” the National Nurses United said in its study. “At the same time, federal, state, and local governments have failed to compel health care facilities to provide this data.”

It’s difficult to know which count is correct. Only 15 states provide the infection number for health care workers on a weekly basis, according to the nursing union, and it wasn’t until May that nursing homes were required to provide its workers’ infection and mortality information to the Centers for Medicare and Medicaid Services.

While the public can now access that information from nursing homes, hospitals are not required to share their data.

“I don't think that the health care systems have done a service by not publicizing what's going on inside their walls,” Rezba said. “A lot of the deaths that I find for health care workers are really kind of secretive. They're swept under the rug.”

© Go Nakamura Image: A staff member places her hand on a patient in the Covid-19 ICU at United Memorial Medical Center in Houston on Dec. 7, 2020. (Go Nakamura / Getty Images file)

Rezba emphasized that those deaths also include the loss of an immense amount of expertise and knowledge that these health care workers had.

Newton said that was true of her mother, a nurse with decades of experience, who taught her elements of nursing she said she could never have learned in school.

“My mom fought 100 percent tooth and nail for her patients,” she said. “And we’ve lost that, society has lost that — we’ve lost someone who would have fought for everyone and anyone she came in contact with.”

The last time Newton was able to see her mom, the latter couldn’t speak because of the tubes in her mouth, but McRae acknowledged the news that her daughter had passed the nursing board exam.

“She was responsive, but she lost it,” Newton said between sobs. “She just wasn’t there anymore.”

The federal government does not require hospitals to provide data on health care workers’ infection and mortality rates and there is no central reporting structure for it to be housed, said Katherine Hancock, the chief caregiver officer at the Cleveland Clinic, who oversees 70,000 health care workers.

The Cleveland Clinic tracks outbreaks within its medical facilities, she said. It reports those figures and supports its staff through hospitalizations and quarantines. So far, it has had one death, but the staff remains overwhelmed physically and emotionally by the pandemic.

“We track it and talk about this all day: Not only are we obviously looking out for our patients, but we're also looking at the number of caregivers who are out due to Covid-19, those who are positive, those who are in the hospital and those who've returned to work,” Hancock said. “So we have a very good handle to be honest with you, and I don't know why others have had such difficulty.”

The Department of Health and Human Services did not respond to a request for comment regarding the disparity among different counts or the lack of a singular, overarching tally of health care workers who have died during the pandemic.

Without anyone tracking these deaths, it is left to families, friends and communities who have lost loved ones who were health care workers to ensure that their sacrifices aren’t forgotten. All of this comes into sharper relief for many as the holidays and the desire to check in with family have arrived.

© Go Nakamura Image: Medical staff members dance to Christmas songs at Houston's United Memorial Medical Center on Dec., 10, 2020. (Go Nakamura / Getty Images file)

Shon Matthews, 48, a paramedic in Texarkana, Arkansas, found out he caught the virus at the end of September — after he volunteered to fill in for a colleague who had tested positive for Covid-19. When he developed a cough and struggled to breathe, he packed a bag and told his wife, Jennifer, that she needed to drive him to the hospital.

Twelve days later, he called Jennifer to tell her that he would need to be put on a ventilator because he couldn’t breathe by himself anymore.

On Nov. 2, Matthews died at a hospital in Temple, Texas.

“He was my everything,” Jennifer said between sobs. “We started dating when I was 16 and got married when I was 18. He’s been in my life for 30 years. He was my best friend. We tried to do everything together.”

Matthews’ father, Willie, moved back to Texarkana in hopes of spending more time with his son, whom he’d only been able to see once or twice a year because work had caused him to move away.

They were able to spend two weeks together before Matthews tested positive. The holidays without him — a prodigious cook, lover of family games and terrific jokester — have been and will be difficult, Willie Matthews said.

“We just try to keep going forward and try to make things as happy as possible,” he said, his voice trembling. “Sometimes people say things that are meant to comfort you and they really break your heart, but that’s because it’s about Shon.”

But the remembrances, the accolades, the acknowledgments of Matthews’ work, sacrifice and commitment to his job as a paramedic, have warmed his dad’s heart and made coping with that loss a little easier.

“They've had several fundraisers here, the community has really come out for Shon and his family,” Willie Matthews said. “And so, we're really appreciative of all the things that they've done in his honor because we’re really, very proud of our son.”

Doctors and nurses in California released a harrowing video begging people not to gather for the holidays, saying it will 'cripple our hospital system'

© Mario Tama/Getty Images A patient lies on a stretcher in the hallway of an overloaded ER in a hospital in Apple Valley, California, on December 23, 2020. Mario Tama/Getty Images

Frontline workers in California filmed a video urging people to stay home and not gather over the upcoming holidays.

In the video, doctors said that a lack of social distancing could "cripple" the hospital system and result in more deaths.

Nurses also discussed the devastating impact of the latest surge in the state's COVID-19 cases on their mental health.

Earlier this week health authorities reported that ICUs in the San Joaquin Valley and Southern California were already at full capacity, meaning there is no space left for new patients.

As California struggles to deal with a spike in case numbers and an alarming number of COVID-19 deaths, frontline workers in the state are begging people to stay home and not gather for the holidays.

Doctors and nurses from three California health systems - Kaiser Permanente, Sutter Health, and Dignity Health - made the plea in a video posted on YouTube on Wednesday.

In the clip, several workers warned that choosing to celebrate the Christmas and New Year holidays indoors could overwhelm the state's healthcare system, and shared the devastating impact that the surge in cases was having on their mental health.

The video also included footage of patients lying on stretchers outside crowded hospitals.

"This surge is beyond what anyone could have imagined," Dr. Pravin Acharya, an emergency physician, said in the video. "If people continue to gather for the upcoming holiday, we are going to cripple our hospital system."

The hospital system Acharya works for - Kaiser Permanente - said on Tuesday that 100% of their ICU beds were being used. They are now preparing to double up rooms in their 36 hospitals to meet the 220% increase in COVID-19 patients in the last month alone.

An intensive-care specialist, Dr. Vanessa Walker, also said in the video: "If we continue to gather indoors at the rate that we are, many more of us will not see the holiday next year."

California has averaged 252 daily coronavirus deaths over the last week, an increase of 73% from two weeks prior to that, according to a tracker from the Los Angeles Times.

Last week, the state reported its highest daily death toll of the entire pandemic - 398 deaths in the space of 24 hours, The New York times reported.

The US remains the worst-hit country in the COVID-19 pandemic, having recorded nearly 18.5 million cases and more than 326,000 deaths, according to Johns Hopkins University data.

© Worldometer Graph showing active COVID-19 cases in California as of early December 24, 2020. 

In the Wednesday video, doctors also expressed their concern about how healthcare workers will be able to handle this alarming surge.

Acharya warned: "I worry about the stamina and mental health of us providers, our nursing staff. What happens if they get sick? Who is going to come to the hospital and work?"

Hans Vega, a registered nurse, also said in the video: "I'm doing all this work for your families, for your friends, for people that you may know, and some people don't take it seriously out there. Sometimes it feels like a slap in the face."

Healthcare workers in the US and around the world are facing a mental-health crisis in the face of the COVID-19 pandemic, with psychologists telling Insider in April that the stress could flare into chronic psychological problems if it is not managed.

On Monday, the California Department of Public Health reported that ICUs in both the San Joaquin Valley and Southern California were at full capacity.

On Monday, California's director of Health and Human Services also warned that non-ICU units could also fill up shortly.

"It is true that some regions may begin to exceed their existing stated hospital capacity, not just ICU capacity, by the end of the month and early in January," Dr. Mark Ghaly told a press conference.

Some hospitals are already setting up tents and trailers as field hospitals to treat more patients.

Read the original article on Business Insider

THIRD WORLD USA

In pandemic America's tent cities, a grim future grows darker

By Michelle Conlin

LONG READ

PHOENIX, Ariz. (Reuters) - Nadeen Bender stood outside her home, a tattered two-man tent, surrounded by the re-purposed Amazon Prime boxes she uses to store her life’s belongings. One by one, she checked the cartons to make sure nothing had been stolen in the night.

Nadeen Bender stands outside her tent at a homeless encampment in Phoenix, Arizona, U.S., December 18, 2020. REUTERS/Michelle Conlin

When asked about her Christmas plans, the rail-thin 43-year-old said through a face mask, “to try to avoid it.” Then she burst into tears.

The tent city that has served as Bender’s neighborhood for the past seven months is in the middle of downtown Phoenix, just down the road from luxury high-rise apartments and expensive restaurants.

To deal with an exploding homeless population and encourage social distancing during the pandemic, Marcipoa County officials turned this pair of asphalt-topped parking lots into the area’s newest homeless shelter. The county has more than 7,500 people on the streets, and nearly 5,000 dead from COVID-19.

Inside the crowded encampment, ringed by security fencing and barbed wire, each family has been allotted a 12-by-12-foot lot, marked by paint, to separate people as much as possible.

Phoenix is just one example of a slow-motion disaster unfolding in many large U.S. cities as homeless numbers, already growing in recent years, spike during the global pandemic.

The virus presents a compounding threat. Not only are these populations some of the most vulnerable to the coronavirus, but by destroying millions of jobs, the pandemic threatens a wave of evictions that experts warn could lead to a catastrophic housing displacement and even more people living on the streets.

With cities facing a steep hit to their tax bases due to lockdowns aimed at curbing the virus’s spread, homeless advocates say the federal government must step in, and estimate another $11.5 billion is needed immediately.

New funding for the homeless is not included in a $900-billion pandemic relief package passed by Congress on Monday. The fate of the bill was thrown up in the air the next day after outgoing President Donald Trump threatened not to sign it.

Meanwhile, the $4 billion provided earlier this year through the March CARES Act bailout and the U.S. Department of Housing and Urban Development is running out, advocates say.

“It’s not just the pandemic, it’s the financial fallout from the pandemic and the complete lack of a comprehensive response to the pandemic from the federal government,” said Diane Yentel, who advised the transition team of President-elect Joe Biden and is the president of the Washington-based National Low Income Housing Coalition.

Biden’s transition team did not respond to requests for comment. But fixing the affordable housing crisis was a pillar of his campaign platform, and included a pledge to spend $640 billion over 10 years to create affordable housing and “end” homelessness.

“Addressing homelessness remains the most pressing health equity challenge of our time. And it’s about to get worse,” said Dr. Howard K. Koh, a professor of the Harvard T.H. Chan School of Public Health who chairs its new initiative on health and homelessness.

EVICTION SURGE

As the coronavirus began to ravage the United States in the spring of 2020, federal, state and local governments issued temporary bans on many evictions, with an eye on the economic and health consequences of increased homelessness.

The Centers for Disease Control and Prevention (CDC) in September followed up with a nationwide ban that the stimulus deal would extend to Jan. 31.

Still, since the pandemic began, more than 162,000 evictions have been filed in the 27 cities tracked by the Princeton University Eviction Lab.

So far, Congress has no clear plan to deal with the expiration of the CDC’s ban, when up to 40 million people will be at risk of eviction, according to the Aspen Institute. Overnight, more than $70 billion will be owed in back rent and utilities, said Moody’s Analytics Chief Economist Mark Zandi.

The National Alliance to End Homelessness estimated the U.S. homeless population at nearly 600,000 in 2019, before the pandemic hit. The potential health repercussions of a significant increase in that number due to evictions and joblessness are enormous, made exponentially worse by the pandemic, academics and health experts say.

Already, homeless families with babies in New York City shelters live amidst mold, mildew and vermin, according to an audit released on Monday by the city comptroller. Subway closures between 1 and 5 a.m. for COVID cleanings have forced many of the city’s homeless who go there for warmth to burrow deeper into the system’s tunnels or freeze in the tarp encampments and grocery-cart hovels that have become a feature of the city’s sidewalks.

New York City’s homeless die of COVID at a rate 78% higher than the general population, according to the Coalition for the Homeless.

In Los Angeles, several members of the city council want the city to use the convention center as a homeless shelter. San Diego already did that - and now its convention center is suffering a COVID-19 outbreak, with 190 residents and staff testing positive.




Another homeless shelter in Chicago is reeling from an outbreak just as freezing temperatures fuel demand.

Twenty-seven states that let local moratoriums on evictions expire over the summer, before the CDC ban, had a 5.4-times higher COVID mortality rate, according to a report released on Nov. 30 by researchers from Johns Hopkins University and other four other universities.

TRUMPVILLE

Phoenix’s unshaded tent city is called “The Zone” by its inhabitants. Some of them call it “Trumpville,” an echo of Depression-era shantytowns named “Hoovervilles” after President Herbert Hoover, who was accused of not doing enough to keep people sheltered.

The Zone’s hundreds of residents are packed together - often not wearing masks, with many living just in sleeping bags or on a tarp. Without running water or plumbing, simple pandemic health protocols, like handwashing, are difficult. Although the city has posted portable toilets and washing stations along the perimeter, feces and garbage litter the property. In some spots, the stench is overwhelming.

COVID is a constant worry. Those who test positive for the virus can check into a 136-bed hotel provided by a nonprofit — if they can get a spot. If they prefer to remain on the streets, there’s a “shelter-in-place duffle” that contains food, water, hygienic supplies, masks and a tent.

Bender, a former foster mom with the leathered tan of someone who lives outside, said the homeless population has become more varied since the pandemic hit - she’s met a former doctor, paralegal and even an opera singer.

“A lot of us want to work, we want to get off the streets,” she said.

But the pandemic has made that seem even more impossible, she said.

“I can’t even get online” to apply for jobs, she said, “because the libraries are closed.” Her congressional stimulus check? “How would I even sign up for that or get that without a computer, or an address?”

“I didn’t think my life could get any worse,” said Bender. “But it did.”

(This story corrects paragraph 11 to make clear Diane Yentel advised Biden’s transition team rather than Biden)

Reporting by Michelle Conlin; Editing by Tom Lasseter and Sonya Hepinstall

COVID IN PRISON

'Grave risk:' Advocates say inmates should get speedy access to COVID-19 vaccine

Advocates say inmates should have speedy access to the COVID-19 vaccine, given how susceptible prisons and jails have been to outbreaks and how prevalent chronic disease is in that population.

© Provided by The Canadian Press

"I don't think they should go to the front of the line, but I certainly don't think they should be denied their rightful place in the priority line simply because they're prisoners," said Catherine Latimer, executive director of the John Howard Society of Canada.


The Correctional Service of Canada said that, as of Tuesday, there were a total of 276 active COVID-19 cases in federal prisons. The bulk were at Joyceville Institution near Kingston, Ont., Stony Mountain Institution near Winnipeg and the Saskatchewan Penitentiary near Prince Albert, Sask.

There have also been several outbreaks in provincially run jails.

Martha Paynter, a registered nurse in Halifax who provides reproductive care to inmates, said hygiene and ventilation in correctional institutions are issues at the best of times.

There is also high turnover in remand centres and staff are constantly coming and going, she added.

Inmates are "living in this incredibly restrictive experience, but also facing very grave risk of illness transmission," said Paynter, a doctoral candidate at Dalhousie University.

Inmates 50 and older account for one-quarter of the federal prison population. Advocates note people age faster behind bars and are in poorer health than the general public.

"Of course this population should have very quick access to the vaccines," said Paynter, who added that some might not trust the shots due to bad experiences with health care behind bars.

She said the bigger issue is why there are so many people incarcerated in the first place.

"What are we choosing to police? What are we choosing to criminalize?"

Anita Ho, associate professor in bioethics and health services research at the University of British Columbia, noted Indigenous people are disproportionately represented in the corrections system.

"In general, health among Indigenous peoples in Canada, because of various social determinants of health, are poorer to start with," she said.

Video: Alberta health-care workers, paramedics concerned with COVID-19 vaccine prioritization (Global News)

The National Advisory Committee on Immunizations recommends adult Indigenous communities be included in Stage 1 of vaccine delivery. It recommends congregate settings, including correctional facilities, be included in Stage 2.

The Correctional Service of Canada, which is responsible for providing health services for inmates in its care, says in a statement it is aligning its strategy with the national guidelines.

"CSC has worked very closely with the Public Health Agency of Canada to respond to every aspect of the pandemic, including the provision of vaccines to inmates."

Priority groups such as long-term care residents and health-care workers began receiving doses earlier this month.

Dr. Joss Reimer, medical health officer for the Winnipeg Regional Health Authority, said criteria for who gets the vaccine in Manitoba in the new year will be expanded to include “correctional facilities," but did not specify whether that would be inmates, staff or both.

Other provinces have not detailed their plans.

Ontario's Ministry of the Solicitor General said it will be looking at the availability of doses and would carry out immunizations "based on the latest medical advice and scientific evidence."

Saskatchewan Health Minister Paul Merriman said: "We will consider based on what the needs are at that specific time and ... the amount of vaccines that we have flowing into the province."

In Alberta, chief medical health officer Dr. Deena Hinshaw said, "We'll have a clear ethical dimension that we need to make sure we're considering."

University of Toronto bioethicist Kerry Bowman said there was a consensus about who would receive the first batch of vaccines, but determining who should be next is trickier.

He said it's not clear whether the goal of the second phase will be to boost the economy or to reach more vulnerable people.

In the United States, there has been some pushback against inmates getting dibs earlier.

"There’s no way it’s going to go to prisoners before it goes to the people who haven’t committed any crime," Colorado Gov. Jared Polis said after the state's vaccination rollout plan was criticized.

Bowman said that kind of argument is neither scientifically nor ethically sound.

"It's a very dangerous precedent in any society when you start saying these lives are more valuable than those lives."

This report by The Canadian Press was first published Dec. 24, 2020.

— With files from Fakiha Baig in Edmonton and Shawn Jeffords in Toronto

Lauren Krugel, The Canadian Press