But the hospital denied his request, said Kelly Indish, president of the American Federation of State, County and Municipal Employees Local 875.

On March 30, Liddell posted on Facebook that he had worked the previous week in both the critical care unit and the ICU and had contracted the virus. “Pray for me God is still in control,” he wrote. He died April 10.

The hospital’s problems with personal protective equipment (PPE) were well documented. In mid-March, the state office of the Occupational Safety and Health Administration (OSHA) received five complaints, which described employees receiving “zero PPE.” The cases were closed April 21, after the hospital presented paperwork saying problems had been resolved. There was no onsite inspection, and the hospital’s written response was deemed sufficient to close the complaints, a local OSHA spokesperson confirmed.

The grief and fear gripping workers and their families reflect a far larger pattern. Since March, more than 4,100 regarding health care facilities have poured into the nation’s network of federal and state OSHA offices, which are tasked with protecting workers from harm on the job.

A KHN investigation found that at least 35 health care workers died after OSHA received safety complaints about their workplaces. Yet by June 21, the agency had quietly closed almost all of those complaints, and none of them led to a citation or a fine.

The complaint logs, which have been made public, show thousands of desperate pleas from workers seeking better protective gear for their hospitals, medical offices and nursing homes.

The quick closure of complaints underscores the Trump administration’s hands-off approach to oversight, said former OSHA official Deborah Berkowitz. Instead of cracking down, the agency simply sent letters reminding employers to follow Centers for Disease Control and Prevention guidelines, said Berkowitz, now a director at the National Employment Law Project.

“This is a travesty,” she said.

A third of the health care-related COVID-19 complaints, about 1,300, remain open and about 275 fatality investigations are ongoing.

During a June 9 legislative hearing, Labor Secretary Eugene Scalia said OSHA had issued one coronavirus-related citation for violating federal standards. A Georgia nursing home was fined $3,900 for failing to report worker hospitalizations on time, OSHA’s .

“We have a number of cases we are investigating,” Scalia said at the Senate Finance Committee hearing. “If we find violations, we will certainly not hesitate to bring a case.”

A March 16 complaint regarding Clara Maass Medical Center in Belleville, New Jersey, illustrates the life-or-death stakes for workers on the front lines. The complaint says workers were “not allowed to wear” masks in the hallway outside COVID-19 patients’ rooms even though the highly contagious virus can spread throughout a health care facility. It also said workers “were not allowed adequate access” to PPE.

Nine days later, veteran Clara Maass registered nurse Barbara Birchenough texted her daughter: “The ICU nurses were making gowns out of garbage bags. … Dad is going to pick up large garbage bags for me just in case.”

Kristin Carbone, the eldest of four, said her mother was not working in a COVID area but was upset that patients with suspicious symptoms were under her care.

In a text later that day, Birchenough admitted: “I have a cough and a headache … we were exposed to six patients who we are now testing for COVID 19. They all of a sudden got coughs and fevers.”

“Please pray for all health care workers,” the text went on. “We are running out of supplies.”

By April 15, Birchenough, 65, had died of the virus. “They were not protecting their employees in my opinion,” Carbone said. “It’s beyond sad, but then I go to a different place where I’m infuriated.”

OSHA records show six investigations into a fatality or cluster of worker hospitalizations at the hospital. A Labor Department spokesperson said the initial complaints about Clara Maass remain open and did not explain why they continue to appear on a “closed” case list.

Nestor Bautista, 62, who worked closely with Birchenough, died of COVID-19 the same day as she did, according to Nestor’s sister, Cecilia Bautista. She said her brother, a nursing aide at Clara Maass for 24 years, was a quiet and devoted employee: “He was just work, work, work,” she said.

Responding to allegations in the OSHA complaint, Clara Maass Medical Center spokesperson Stacie Newton said the virus has “presented unprecedented challenges.”

“Although the source of the exposure has not been determined, several staff members” contracted the virus and “a few” have died, Newton said in an email. “Our staff has been in regular contact with OSHA, providing notifications and cooperating fully with all inquiries.”

Other complaints have been filed with OSHA offices across the U.S.

Twenty-one closed complaints alleged that workers faced threats of retaliation for actions such as speaking up about the lack of PPE. At a Delaware hospital, workers said they were not allowed to wear N95 masks, which protected them better than surgical masks, “for fear of termination or retaliation.” At an Atlanta hospital, workers said they were not provided proper PPE and were also threatened to be fired if they “raise[d] concerns about PPE when working with patients with Covid-19.”

Of the 4,100-plus complaints that flooded OSHA offices, over two-thirds are now marked as “closed” in an OSHA database. Among them was a complaint that staffers handling dead bodies in a small room off the lobby of a Manhattan nursing home weren’t given appropriate protective gear.

More than 100 of those cases were resolved within 10 days. One of those complaints said home health nurses in the Bronx were sent to treat COVID-19 patients without full protective gear. At a Massachusetts nursing home that housed COVID patients, staff members were asked to wash and reuse masks and disposable gloves, another complaint said. A complaint about an Ohio nursing home said workers were not required to wear protective equipment when caring for COVID patients. That complaint was closed three days after OSHA received it.

It remains unclear how OSHA resolved hundreds of the complaints. A Department of Labor spokesperson said in an email that some are closed based on an exchange of information between the employer and OSHA, and advised reporters to file Freedom of Information Act requests for details on others.

“The Department is committed to protecting America’s workers during the pandemic,” the Labor Department said in a statement. “OSHA has standards in place to protect employees, and employers who fail to take appropriate steps to protect their employees may be violating them.”

The agency on May 19 to place reports of fatalities and imminent danger as a top priority, with a special focus on health care settings. Since late March, OSHA has opened more than 250 investigations into fatalities at health care facilities, government records show. Most of those cases are ongoing.

According to the mid-March complaints against McLaren Flint, workers did not receive needed N95 masks and “are not allowed to bring them from home.” They also said patients with COVID-19 were kept throughout the hospital.

Filing complaints, though, did little for Liddell, or for his colleague, Patrick Cain, 52. After the complaints were filed, Cain, a registered nurse, was treating people still awaiting the results of COVID-19 diagnostic tests — potentially positive patients ― without an N95 respirator. He was also working outside a room where potential COVID-19 patients were undergoing treatments that can spread the virus widely in the air.

At the time, there was a debate over whether supply chain breakdowns of PPE and on protective gear were putting workers at risk.

Cain felt vulnerable working outside of rooms where COVID patients were undergoing infection-spreading treatments, he wrote in a text to Indish on March 26.

“McLaren screwed us,” he wrote.

He fell ill in mid-March and died April 4.

McLaren has since revised its face-covering policy to provide N95s or controlled air-purifying respirators (CAPRs) to workers on the COVID floor, union members said.

A spokesperson for the McLaren Health Care system said the OSHA complaints are “unsubstantiated” and that its protocols have consistently followed government guidelines. “We have always provided appropriate PPE and staff training that adheres to the evolving federal, state, and local PPE guidelines,” Brian Brown said in an email.

Separate from the closed complaints, OSHA into Liddell and Cain’s deaths are ongoing, according to a spokesperson for the state’s Department of Labor and Economic Opportunity.

Nurses at Kaiser Permanente Fresno Medical Center also said the complaints they aired before a nurse’s death have not been resolved. (KHN is not affiliated with Kaiser Permanente.)

On March 18, nurses filed an initial complaint. They told OSHA they were given surgical masks, instead of N95s. Less than a week later, other complaints said staffers were forced to reuse those surgical masks and evaluate patients for COVID without wearing an N95 respirator.

Several nurses who cared for one patient who wasn’t initially suspected of having COVID-19 in mid-March wore no protective gear, according to Amy Arlund, a Kaiser Fresno nurse and board member of the National Nurses Organizing Committee board of directors. Sandra Oldfield, a 53-year-old RN, was among them.

Arlund said Oldfield had filed an internal complaint with management about inadequate PPE around that time. Arlund said the patient’s illness was difficult to pin down, so dozens of workers were exposed to him and 10 came down with COVID-19, including Oldfield.

Lori Rodriguez, Oldfield’s sister, said Sandra was upset that the patient she cared for who ended up testing positive for COVID-19 hadn’t been screened earlier.

“I don’t want to see anyone else lose their life like my sister did,” she said. “It’s just not right.”

Wade Nogy, senior vice president and area manager of Kaiser Permanente Fresno, confirmed that Oldfield had exposure to a patient before COVID-19 was suspected. He said Kaiser Permanente “has years of experience managing highly infectious diseases, and we are safely treating patients who have been infected with this virus.”

Kaiser Permanente spokesperson Marc Brown said KP “responded to these complaints with information, documents and interviews that demonstrated we are in compliance with OSHA regulations to protect our employees.” He said the health system provides nurses and other staff “with the appropriate protective equipment.”

California OSHA officials said the initial complaints were accurate and the hospital was not in compliance with a state law requiring workers treating COVID patients to have respirators. However, the officials said the requirement had been waived due to global shortages.

Kaiser Fresno is now in compliance, Cal/OSHA said in a statement, but the agency has ongoing investigations at the facility.

Arlund said tension around protective gear remains high at the hospital. On each shift, she said, nurses must justify their need for a respirator, face shield or hair cap. She expressed surprise that the OSHA complaints were considered “closed.”

“I’m very concerned to hear they are closing cases when I know they haven’t reached out to front-line nurses,” Arlund said. “We do not consider any of them closed.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

“Of course I will always protect those with preexisting conditions. Always.”

— U.S. Sen. Martha McSally, in a campaign ad released June 22

Trailing Democratic challenger Mark Kelly in one of the country’s most hotly contested Senate races, Arizona Sen. Martha McSally is seeking to tie herself to an issue with across-the-aisle appeal: insurance protections for people with preexisting health conditions.

It can be republished for free.

“Of course I will always protect those with preexisting conditions. Always,” the Republican said in a TV ad released June 22.

The ad comes in response to criticisms by Kelly, who has highlighted McSally’s votes to undo the Affordable Care Act. That, he argued, would leave Americans with medical conditions vulnerable to higher-priced insurance.

The Arizona Senate race national and is considered a toss-up, though Kelly is. McSally’s attempt to present herself as a supporter of protecting people with preexisting conditions — a major component of the 2010 health law — is part of a pattern in which Republican incumbents stake out positions advocating for this protection while also maintaining the GOP’s strong stance against the ACA.

McSally, who was appointed by the governor to take over John McCain’s Senate seat in 2019, in her failed 2018 bid for the state’s other Senate position. And echoed the declaration at a June 23 rally in Phoenix, saying McSally — along with the rest of the Republican Party — “will always protect people with preexisting conditions.”

With that in mind, we decided to take a closer look. We contacted McSally’s campaign, which cited her support of a different piece of legislation, the Protect Act. But independent experts told us that legislation doesn’t satisfy the standard she sets out.

Past and Present

Only one national law makes sure people with preexisting medical conditions don’t face discrimination or higher prices from insurers. It’s the Affordable Care Act.

Both as a member of the House of Representatives and as a senator, McSally has supported efforts to undo the health law — voting in 2015 to repeal it and in 2017 to replace it with the Republican-backed, which would have permitted insurers to charge higher premiums for people with complicated medical histories.

“Anyone who voted for that bill was voting to take away the ACA’s preexisting condition protections,” said Jonathan Oberlander, a health policy professor at the University of North Carolina-Chapel Hill. “Sen. McSally is trying to erase history for electoral purposes.”

Especially as COVID-19 cases climb, health care — and, in particular, the ACA — has emerged as a flashpoint in the Arizona election, said Dr. Daniel Derksen, a professor of public health, medicine and nursing at the University of Arizona.

“Martha McSally has in her actions, in her votes, been pretty consistent about cutting back benefits and trying to repeal the ACA without any clear plan in mind that would protect people who gained insurance through the ACA,” Derksen added. “Her words on preexisting condition protections don’t align with any votes I’ve seen.”

McSally’s campaign argued that the ACA is just one strategy, and a flawed one at that. Dylan Lefler, her campaign manager, instead pointed to her support of the Republican-backed as evidence to back up her promise. Specifically, it ostensibly bans insurance plans from “impos[ing] any preexisting condition exclusion with respect to … coverage,” per the bill text.

The problem, though, is that simply banning that exclusion isn’t enough, because the law also has to make sure the health insurance plans that cover preexisting conditions remain affordable. The bill, sponsored by Sen. Thom Tillis (R-N.C.), does nothing to provide subsidies or cost-sharing mechanisms — meaning people both with and without preexisting conditions wouldn’t necessarily be able to afford those plans. Without that framework, the act remains a “meaningless promise,” argued Linda Blumberg, a fellow at the, a social policy think tank.

And it has other holes: for instance, permitting insurers to charge women more than men.

“No six-page bill is ever the way of achieving something,” said Thomas Miller, a scholar at the. “This is a check-the-box effort to try to say, ‘We’re [moving] in that direction.’”

It’s not just legislation. There’s also, a pending case in which a group of Republican attorneys general are arguing the Supreme Court should strike the entire health law, including its preexisting condition protections. The Trump administration has sided with the Republican states.

McSally has consistently declined to comment on the lawsuit, saying she doesn’t want to weigh in on “a judicial proceeding.” In reporting this fact check, we asked where she stood on the case. The campaign didn’t specifically answer but pointed to her general disapproval of the ACA. Meanwhile, Senate Democrats have called on the administration to reverse its stance.

That context makes McSally’s silence especially relevant, said Sabrina Corlette, a research professor at Georgetown University.

“When given the opportunity, she has declined to oppose this lawsuit, which would essentially eliminate the protections that exist,” Corlette said.

So — big picture? McSally’s record in Washington hasn’t been one of preserving or building on preexisting condition protections.

Our Ruling

In her new TV ad, McSally claims she will “always protect those with preexisting conditions.”

But nothing in her voting record, which tracks closely with the Republican repeal-and-replace philosophy, supports this claim. And she has continually declined opportunities to oppose a pending legal threat to the ACA, including its provisions related to preexisting conditions, by a group of GOP governors and supported by the Trump administration.

Meanwhile, the legislation her campaign cited to justify her stance falls short in terms of meaningfully protecting Americans with preexisting medical conditions.

McSally has not in the past or present taken actions that back up her statement. We rate it False.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

Fargis runs Summit Hills — a health and retirement community in Spartanburg, South Carolina, that offers skilled nursing, activities and communal meals for its residents, most of whom are over 60, the highest-risk category for coronavirus complications. In South Carolina, more than a hundred new cases were emerging daily. So she took precautions: no visitors, hand sanitizer everywhere and regular reminders for residents about the importance of social distancing.

For a time, it worked. Many similar facilities were hit hard by the virus, but Summit Hills remained COVID-free. Summit Hills’ first cases didn’t emerge until mid-June. Three residents and four employees have now tested positive and are being quarantined. For months, though, Fargis was able to protect her residents.

Still, even under the best circumstances, she couldn’t prevent one thing. By mid-May, two residents had become convinced that the COVID-19 death count — which has surpassed in the U.S. — was a talking point manufactured by Democrats. Some people may be dying, they said, but it wasn’t actually that severe. They didn’t think her precautions were necessary.

“I don’t know how to respond, to tell you the truth,” Fargis said. “If someone has that kind of mindset, what kind of conversation do you have” to convince them of the pandemic’s severity and the need for strict precautions?

Since the start of the pandemic, the public has been barraged by conflicting messages in part because the country is dealing with a new and still poorly understood virus and in part because politicians and scientists deliver conflicting advice. But rumors, misinformation and outright falsehoods — some intentionally propagated — have also flourished in that cauldron of confusion.

As the nation reopens for business and retreats from protective stay-at-home orders, those widely circulating lies could prove deadly.

NewsGuard, a startup by two former journalists that vets the internet for misinformation, has identified 217 websites in Europe and the United States that publish “materially false” information about COVID-19. The volume is so great that NewsGuard, which was launched to check political fabrications, has pivoted to full-time COVID-19 fact-checking.

The misinformation includes the “Plandemic” video, Facebook posts claiming 5G cell networks cause the virus and articles suggesting it can be cured with garlic or using a combination of hot water with baking soda and lemon.

Health scares always spawn scurrilous stories. But with COVID-19, “there’s lots of opportunity for misinformation,” said Dhavan Shah, a professor of mass communication at the University of Wisconsin-Madison.

That is particularly true in the United States, where the coronavirus has somehow morphed into a right-versus-left political issue — and Americans increasingly reject information that doesn’t match their leanings.

shows people who support the Trump administration and rely on right-leaning news organizations are more likely to believe the virus has been exaggerated. Republicans are more likely, according to recent polling, than Democrats to think that COVID-19 was never a threat and that the worst is over. That possibly contributed to the push for early reopening in some states that had not met the requirements recommended by the Centers for Disease Control and Prevention for doing so. In many of them, are now spiking. And Republicans are less likely than Democrats to don protective masks, which are believed to reduce the spread of the virus. (President Donald Trump famously has refused to wear a mask in public.)

Groups like anti-vaxxers, conspiracy theorists and immigration opponents have also used the virus to push their own misinformation, from Data & Society, a research institute in New York.

“It’s become a political football now,” said Steven Brill, a co-CEO of NewsGuard. “That tends to get the misinformation and disinformation amplified. People on one side or the other tend to want to amplify what endorses or strengthens their position.”

Misinformation Grows In A Vacuum

Federal health officials from agencies such as the CDC and the Food and Drug Administration usually are tasked with providing the public with understandable, scientifically supported guidance. But the advice from experts like Dr. Anthony Fauci, who heads the National Institute of Allergy and Infectious Diseases, has consistently been undermined by Trump, who instead touts unproven treatments and frequently challenges the severity of the virus.

In fact, political figures like Trump have held outsize influence in shaping public understanding. “The news feed abhors a vacuum,” said Jeff Hancock, a professor of communication at Stanford University who has studied the implications of COVID misinformation. “Since the expertise of the CDC and others have been called into question … it exacerbates the problem.”

Experts’ initial confusion about how to respond to a new virus has also allowed for suspicion. When the coronavirus arrived in the United States, the prevailing thought was that asymptomatic patients couldn’t spread it and that people needn’t wear face coverings. Subsequent studies reversed those judgments.

All that helps explain why falsehoods took hold. Researchers from the University of Oxford’s Reuters Institute for the Study of Journalism reviewed 225 pieces of online misinformation about COVID-19. Misinformation spread by political figures and celebrities made up only 20% of the sample but accounted for 69% of engagement.

Independent groups, including NewsGuard and Hancock’s Stanford Social Media Lab, have launched projects meant to combat misinformation — teaching older people through peer-to-peer tutoring to navigate digital content or launching websites that point people toward more credible data and analysis. But these efforts, usually difficult, are almost impossible now in the age of social distancing.

The “volume and velocity” of social media spread means claims spread farther, faster, Shah said.

At Summit Hills, the politicization of COVID-19 has “without a doubt” made it harder for Fargis, its executive director, to convince her residents — many of whom would typically look to the federal government for credible information — of the pandemic’s severity.

Some cons deliberately target seniors, offering more than misinformation: Bad actors pretended to have access to their victims’ stimulus checks, asking for bank account and Social Security information. Others sell fake protective equipment.

At Hebrew SeniorLife, a hospital and living center in Massachusetts, which operates rehab centers and senior-living facilities around the Boston area, misinformation and online scams — such as fake fundraisers on Facebook for first responders — are serious concerns, said Rachel Lerner, the organization’s general counsel.

Older Americans experience a “perfect storm,” Hancock said. “They’re more susceptible to the virus. They are targets of misinformation and online scams at a much higher rate than regular folks are.”

When South Carolina began opening up, Fargis decided to see if the numbers of new COVID-19 cases declined significantly before lifting precautions. Now, with the virus in her facility, she has no intention of letting up social distancing rules and other prevention strategies.

And since May, at least one of her residents has since come around to understanding the pandemic’s severity. But another, she said, still emails her arguing that the virus has been overblown or that social distancing does not work and suggesting that unproven medicines — like hydroxychloroquine or beta-glucans — can treat or prevent the illness.

“We’d all be far better off if we kept those nonsensical remarks out of the news,” she said. “The more misinformation we have, the more likely we are going to have lives at stake.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

“If we stopped testing right now, we’d have very few cases, if any.”

— President Donald Trump in remarks during a June 15 roundtable discussion

President Donald Trump sought to downplay the numbers associated with COVID-19 in the United States — which have passed 2 million confirmed cases and are nearing 120,000 lives lost — by arguing that the soaring national count was simply the result of superior testing.

“If you don’t test, you don’t have any cases,” Trump at a at the White House. “If we stopped testing right now, we’d have very few cases, if any.”

It’s a talking point the administration is emphasizing. Vice President Mike Pence during a phone call to Republican governors that evening, recommending they use the argument as a strategy to quiet public concern about surging case tallies in some states. It’s also a variation on a the president sent earlier in the day.

With that in mind, we wanted to dig deeper. We reached out to the White House for comment or clarification, but we never heard back. Independent researchers told us, though, that the president’s remarks are not only misleading — they’re also counterproductive in terms of thinking through what’s needed to combat the coronavirus pandemic.

The Big Picture

Essentially, the president is arguing that the United States is finding more cases of COVID-19 because we are testing more — and that our increased testing makes it appear the pandemic is worse in the U.S. than in other countries.

“We will show more — more cases when other countries have far more cases than we do; they just don’t talk about it,” he added.

But that isn’t true.

The numbers paint a stark picture. The United States has recorded of the novel virus so far, about a quarter of the global total and more than any other country. To Trump’s point, the country now than it did at the start of the outbreak — per capita, the U.S. is in the top 20% of countries when it comes to cumulative tests run.

This beefed-up testing still likely reflects an undercount in cases, though. The problem is that the U.S. outbreak is worse than that of many other countries — so we need to be testing a higher percentage of our population than do others.

To best understand this, consider the to identify a positive case. If it’s easier to find a positive case, that suggests the virus has spread further and more testing is necessary to track the spread of COVID-19.

For instance, statistics from the United States and the United Kingdom are fairly similar in terms of how many coronavirus tests are done daily per million people. But those tests yield far more positive cases in the United States. That suggests the outbreak here requires more per capita testing than does the U.K.’s.

“We have a much bigger epidemic, so you have to test more proportionately,” said Jennifer Kates, a senior vice president at KFF.

Put another way, a larger health crisis means — even after controlling for population size — the United States will have to test more people to find out where and how the virus has spread. (KHN is an editorially independent program of KFF, the Kaiser Family Foundation.)

And while the U.S. has ramped up its testing since March, many parts of the country still don’t have sufficient systems in place — from facilities to staff to medical supplies — for diagnosing COVID-19, researchers told us.

What If We Stopped Testing?

And what about the president’s assertion that “if we stopped testing right now, we’d have very few cases” or none at all?

On its literal phrasing, it’s absurd, experts said.

“The implication that not testing makes the problem go away is completely false. It could not be more false,” said Dr. Joshua Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health in Baltimore. That’s because testing doesn’t create instances of the virus — it is just a way of showing and tracking them. (The president made a similar point during the same White House roundtable event.)

But even if you take it figuratively — the idea that our expanded testing resources have inflated our sense of the epidemic — it’s still misleading.

“We’re seeing a lot of cases because we’re testing? It just doesn’t ring true,” Kates said. “The U.S. has made a lot of progress for sure. But that job is not finished.”

The president’s claim is part of a larger reelection strategy, argued Robert Blendon, a health care pollster at the Harvard T.H. Chan School of Public Health. The idea is to suggest that the health crisis is mostly exaggerated — and that things are getting better, and Americans should feel comfortable going back to work. “If the economy takes off, the president has a chance of reelection,” Blendon said. “If it contracts as a result of expansion of cases, and the only way we know how to respond is restriction of economic activity, he’s gone.”

But the problem, Blendon added, is that COVID-19 counts are still climbing in multiple states. And people are still dying of the virus.

That gets at another point: Diagnostic testing isn’t the only data source to reveal the pandemic’s existence. Let’s not forget about hospitalization rates and death counts. The number of deaths continues to rise, and hospitalizations are higher than they would be in the virus’s absence.

Our Ruling

Trump argued that the nation’s high count of COVID-19 cases is simply a result of our expanded testing capacity. His point is entirely incorrect.

The most relevant data suggests that the U.S. isn’t testing enough to match the severity of the pandemic. Even with our higher testing ratio, we’re probably still undercounting compared with other countries.

Testing doesn’t create the virus. Even without diagnostics, COVID-19 would still pose a problem. We just would know less about it.

And, in fact, eliminating testing may alter the public’s perception of the pandemic but it wouldn’t conceal it. If anything, it would likely worsen the crisis, since the public health system wouldn’t know how to accurately track and prevent the spread of the coronavirus.

The president’s claim has no merit and seriously misrepresents the severity of the public health crisis. We rate it Pants on Fire.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

“Germany and the United States are the two best in deaths per 100,000 people, which, frankly, to me, that’s perhaps the most important number there is.”  — President Donald Trump in comments during a Rose Garden press briefing on May 11.

Following weeks of criticism over his administration’s COVID-19 response, President Donald Trump pulled out new statistics to claim the nation is actually among the best in the world in fighting the lethal coronavirus.  

“Germany and the United States are the two best in deaths per 100,000 people, which, frankly, to me, that’s perhaps the most important number there is,” Trump said at a May 11 Rose Garden press briefing.

We’ve followed the numbers closely on this. Germany has won praise for its early and aggressive testing-and-tracing to the pandemic. The United States has not.

With that in mind, we wondered: Are these countries so similar? And are they really the “two best”?

We contacted the White House to find out the basis for the president’s statement and never heard back. But of all the datasets tracking COVID-19 deaths, none supports anything near Trump’s assertion.

And when you look at the numbers on which experts rely, Trump’s claim is at best misleading. The United States’ rate of COVID deaths per capita is better than many countries — but in no universe is it one of “the two best.”

The Numbers

Deaths per 100,000 people — the per capita metric Trump used — is generally considered a valuable public health measure that helps quantify the intensity of an epidemic. In this situation, it tracks how many people have died from COVID-19 in relation to countries’ populations.

It’s an imperfect measure, to be sure. Globally, COVID-19 deaths are typically undercounted, since countries aren’t testing all the people who have been infected, let alone counting all deaths attributed to the virus. And comparing the numbers gets trickier when you place countries like Germany, which has tested large swaths of the population, against the United States, which has not.

But even when comparing apples to oranges, Trump’s claim inflated just how well the United States has performed.

“It is not supported by the facts,” said Jennifer Kates, a senior vice president at the Kaiser Family Foundation.

We looked at four credible estimates, all of which were recommended by health researchers: Johns Hopkins University’s coronavirus death count, along with global estimates published by the , and . (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

The estimates that, in the United States, 24.66 people per 100,000 have died of COVID-19, as of Tuesday. In Germany, meanwhile, the rate is 9.24 — meaning the American death rate is 2.5 times that of Germany.

And that’s only part of the issue.

When compared with many other countries — including Canada, South Korea, Iran, Russia, Poland and Switzerland — the U.S. numbers don’t do very well. “We have higher levels of deaths per capita than [those] countries and many others,” said Jeffrey Shaman, a professor of environmental health sciences at Columbia University.

That’s true no matter the dataset. The United States performs better than countries like Spain and Italy, but still far worse than Germany and worse than numerous other countries.

In fact, per Our World in Data’s estimates, the United States’ rate of COVID deaths per capita isn’t just worse than what we see in countries like Canada and South Korea. It’s also worse than the global average. As of May 12, 36.66 per million people had died of COVID for the entire world — in the United States, it was 243.76 deaths per million people.

There is another way to look at the numbers, Kates said. Instead of the cumulative number of people who have died per capita since the pandemic began, one can consider whether the United States is performing better when it comes to recent deaths. If American numbers were similar to that of Germany within a specific window of time, it would suggest that the United States is approaching a similar point in efforts to alleviate the crisis.

Even then, the United States falls short. , numerous countries, including Canada, France, Germany, Russia and Italy, had fewer daily deaths per capita based on a seven-day average than did the U.S. — suggesting that the risks here are still greater than they are in those nations.

So, big picture? It is misleading to suggest the United States and Germany are in the same league, especially when it comes to COVID deaths per capita. It’s flat-out untrue to suggest that the United States is one of the “two best,” when countless other nations are seeing far lower death rates per 100,000 people.

“The claim is false,” Shaman said.

Our Ruling

Trump claimed that, when it comes to COVID-19 fatalities, “Germany and the United States are the two best in deaths per 100,000 people.”

This is untrue. While the metric Trump highlighted is important, there are countless countries performing far better than the United States on COVID deaths per capita. And it is misleading at best to categorize the American fatality count in the same group as Germany’s; Germany’s numbers are better.

We rate this claim False.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

“We’ve tested more than every country combined.”

— President Donald Trump at White House press briefing on April 27, 2020

Responding to weeks of over COVID-19 , President Donald Trump claimed at a White House briefing that the United States has well surpassed other countries in testing people for the virus.

“We’ve tested more than every country combined,” April 27.

It was a variation on claims he had made

target=”_blank” rel=”noopener noreferrer”>April 24

The president made of the United States’ for COVID-19 diagnostic testing. But the health system has ramped up its testing since its slow start during the first weeks of the American outbreak. So we wanted to check back. How many people here have been tested? And has the U.S. tested more people than “every country combined”?

We emailed the White House for comment but never heard back, so we turned to the data. Trump’s claim didn’t stand up to scrutiny.

In raw numbers, the United States has tested more people than any other individual country — but nowhere near more than “every country combined” or, as he said in his tweet, more than “all major countries combined.”

Regardless, raw test numbers aren’t a meaningful metric in gauging the nation’s coronavirus response. When you factor in population size — which experts say is essential in understanding how well we are doing — the U.S. still falls short.

The Numbers

We consulted a few independent estimates, all of which were recommended to us by global health experts: the , and .

All of them place the U.S. total above 5 million tests — the figures range between 5.59 and 5.7 million. And it is correct that no other country has run so many diagnostic tests. But that’s where any semblance of accuracy ends.

A on global testing — which sources its numbers from Our World in Data — notes that the United States has done more testing than the combined totals of Australia, Austria, Canada, France, India, Italy, Japan, Singapore, South Korea, Sweden and the United Kingdom. (That addition checks out.)

But those are hardly all the world’s “major countries” — let alone “every country.” And to argue the list is exhaustive — especially when Germany and Spain are among Europe’s biggest economies, Russia is obviously a major player on the world stage and when Germany’s robust testing strategy has been credited with its low coronavirus death rate — is absurd, experts said.

And when you look at European countries alone — which again, is far short of what he claimed — Trump’s comparison quickly falls apart.

The Worldometer data shows that, when you add up the number of tests run in Russia, Germany and Italy, the total lands around 6.72 million. You could also tally the number of tests run in Spain, Italy, France, Germany and the U.K. Both Worldometer and Our World in Data place that total above 6 million. Either way, it’s more than what the U.S. has done.

Big picture, a truly exhaustive sum of testing by “every country” or even “all major countries” would generate higher numbers.

A Meaningful Metric?

Trump is also fixating on the wrong figures, global health experts said.

“The highest number of raw tests in and of itself is not meaningful for any particular country or location within a country,” said Jennifer Kates, a vice president at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

The United States has a far bigger population than many of the “major countries” Trump often mentions. So it could have run far more tests but still have a much larger burden ahead than do nations like Germany, France or Canada.

There are other useful metrics: for one, how many people tested positive for COVID-19 compared with the overall number of people tested. Another useful measure is the per capita rate of testing, or the percentage of the nation’s population that has been tested for the virus.

On both counts, the United States still underperforms.

Hanage pointed out that Germany, Ireland, Belgium and Canada have all tested a much larger percentage of the population than the United States has.

Arguably the more important metric, Hanage said, is the percentage of positive test results. A low percentage indicates a nation is aggressively testing, while a higher percentage suggests the country is testing only very sick people — increasing the likelihood that its tracking system is missing cases of infection, undercounting how many people are COVID-positive. And by this measure, the United States fares far worse than a number of countries, including Canada and Germany.

As Kates put it, “increasing the number of tests is important, but a raw number of tests doesn’t tell you much” about what’s needed, or how well the country is faring.

Our Ruling

Trump claimed that the United States has “tested more than every country combined.”

There is no reasonable way to conclude that the American system has run more diagnostics than “all other major countries combined.” Just by adding up a few other nations’ totals, you can quickly see Trump’s claim fall apart.

Plus, focusing on the 5 million figure distracts from the real issue — by any meaningful metric of diagnosing and tracking, the United States is still well behind countries like Germany and Canada.

The president’s claim is not only inaccurate but also ridiculous. We rate it Pants on Fire.

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“We’re also using a sterilization process ― some great equipment that will sterilize masks up to 20 times per mask. So that’s like ordering 20 times more masks.”

– President Donald Trump at an April 23 White House briefing.

As COVID-19 cases continue to climb, front-line health care workers are decrying unsafe working conditions — in particular, describing inadequate access to personal protective equipment, or PPE. Many hospitals and state lawmakers blame Washington, saying the Trump administration has not done enough to make this critical protective gear available.

But at a recent press conference, President Donald Trump suggested those claims are overblown, asserting instead that hospitals have the tools they need to sanitize and reuse protective facewear.

“We’re also using a sterilization process — some great equipment that will sterilize masks up to 20 times per mask. So that’s like ordering 20 times more masks. And it’s working very well,” Trump said at the April 23 briefing.

In fact, the question of reusing masks — specifically, the highly effective N95 respirators that best protect wearers from COVID-19 ― has emerged as a major worker-safety concern. Traditionally, the masks have been designated only for single use.

But with hospitals running low on protective equipment, many seek to stretch their supplies.

With that context, we were curious — can N95s be sterilized and reused, as Trump suggested? And if so, are disinfected masks as protective as new ones?

We contacted the White House but never heard back. Our own research revealed the situation is more complex than Trump suggested. Hospitals are using new technology to sterilize masks. Some procedures do show promise. Still, according to experts we consulted, it’s an overstatement to suggest they are as effective as getting new equipment.

The Battelle Process

Trump appears to be referencing technology from the Battelle Memorial Institute, a nonprofit technology company in Ohio. Battelle, which has an in-house “critical care decontamination system,” received from the Food and Drug Administration to sanitize N95s for reuse.

Hospitals send used N95s to , which has also in coronavirus hot spots, including New York, Boston, Seattle and Washington, D.C.

Workers wearing protective gear load the respirators into a sealed container. Masks are cleaned with vapor-phase hydrogen peroxide, aerated and then sent back to the originating hospitals. The decontamination process takes about 12 hours. A mask’s round-trip journey from a hospital to Battelle in Ohio and back again can take about

Battelle said masks can withstand the decontamination process without losing their ability to filter out viral particles.

So, the president is right that this technology exists. But is it fair to say the approach is the equivalent of buying new gear?

Put simply, no. Experts are clear that decontamination works in the current emergency. But ― despite Trump’s enthusiasm — it is not a best practice.

“It’s not accurate to say that reprocessing respirators is as good as purchasing 20 of them,” said Dr. Patrick Kenney, medical director of Yale-New Haven Health’s supply chain, who has also researched decontamination technology and processing. “This is not a renewable resource. The respirators are intended for single use.”

In fact, in its letter designating emergency approval, the FDA specified that Battelle’s decontamination system “may be effective” at protecting wearers but advised it specifically for “when there are insufficient supplies.” The Centers for Disease Control and Prevention also recommends reuse “only be practiced as a crisis capacity strategy.”

The reasons are multiple. For one thing, research is limited on how effective this type of decontamination is. Also, masks vary in how they stand up to the procedure.

And it’s not as simple as doing a load of laundry. “Decontamination is a complicated process,” said Hana El-Samad, a professor of biochemistry and biophysics at the University of California-San Francisco, who researches N95 sanitization. “Assessing how well it works and which N95 makes and models remain unaffected is an area of active research,” she said.

N95Decon, a research collaborative with which El-Samad works, has examined Battelle’s hydrogen peroxide approach and found the chemicals appear to eliminate COVID-19 spores without damaging the mask’s filtration.

Mask Integrity

Performance is only part of the equation. Another is mask structure: N95s work only when properly fitted to the face.

When workers reuse and re-wear the masks, they can lose their shape, which undermines the quality of fit and renders them less protective. For some masks, per an N95 report on hydrogen peroxide, fit quality declined substantially after just five uses. For others, it took 15 wearings to see a meaningful difference.

At Yale-New Haven, Kenney said, the hospital discards 20% to 30% of respirators that could have been refurbished before they hit the 20-reuse mark because they had sustained too much wear and tear. Battelle’s 20-time reusability metric, he added, was calculated without factoring in the impact of regular hospital use.

In addition, decontamination can in some cases worsen the respirator’s fit.

“If [an N95] doesn’t fit well, then air will leak around the sides and it doesn’t matter how good a filter it is,” Kenney said.

Plus, using this technology requires hospitals to have other protocols in place. Used masks must be safely collected ― since they could be COVID-contaminated and pose a biohazard — and a plan must be in place to move them to and from the sanitization facility.

“These are all complicated processes that need to be done right,” El-Samad said.

She offered a key takeaway: Technology like Battelle’s can help. But nothing substitutes for new N95s.

Our Ruling

In describing ongoing efforts to reuse protective respirators, Trump said the United States is using “some great equipment that will sterilize masks up to 20 times per mask.” That, he argued, “is like ordering 20 times more masks.”

It is true that technology exists to sterilize N95s up to 20 times. But there are knowledge gaps and other shortcomings that limit how effective this process is. Government authorities and health care researchers are clear that this is a crisis measure and it is in no way as effective as “ordering 20 times more masks.”

The statement is partially accurate but leaves out important details that undermine the president’s point. We rate it Half True.

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With medical supplies in high demand, federal authorities say health workers can wear surgical masks for protection while treating COVID-19 patients — but growing evidence suggests the practice is putting workers in jeopardy.

The Centers for Disease Control and Prevention recently said surgical masks are “an acceptable alternative” to N95 masks unless workers are performing an intubation or another procedure on a COVID patient that could unleash a high volume of virus particles.

But scholars, nonprofit leaders and former regulators in the specialized field of occupational safety say relying on surgical masks — which are considerably less protective than N95 respirators — is almost certainly fueling illness among front-line health workers, who likely make up about 11% of all known COVID-19 cases.

“There’s no doubt in my mind that that’s one of the reasons that so many health care workers are getting sick and many are dying,” said Jonathan Rosen, a health and safety expert who advises unions, states and the federal government.

As of April 23, more than 21,800 health care workers had gotten the coronavirus and 71 had died, according to a House Education and Labor Committee staffer briefed by the CDC.

The CDC’s advice contrasts webpage that says a surgical mask does “NOT provide the wearer with a reliable level of protection from inhaling smaller airborne particles and is not considered respiratory protection.”

Put simply, in worker safety, “a surgical mask is not PPE,” or personal protective equipment, said Amber Mitchell, president and executive director of the International Safety Center and immediate past chair of the occupational health and safety section of the American Public Health Association.

The allowance for surgical masks made more sense when scientists initially thought the virus was spread by large droplets. But a growing body of research shows it’s spread by minuscule viral that can linger in the air, and are “unusually persistent” in spreading infection, said Chad Roy, director of infectious disease aerobiology at the Tulane National Primate Research Center and one of the study authors.

A properly fitted N95 will block 95% of tiny air particles — down to three-tenths of a micron in diameter, which is the hardest to catch — from reaching the wearer’s face. But surgical masks, designed to protect patients from a surgeon’s respiratory droplets, aren’t effective at blocking particles smaller than 100 microns, .

A COVID-19 particle is about 1 to 4 microns, according to .

Research from , examining two hospitals in South Korea, found surgical masks “seem to be ineffective in preventing the dissemination” of coronavirus particles. A 2013 Chinese study found that twice as many health workers, 17%, got a respiratory illness if they wore a surgical mask treating sick patients, compared with 7% of those who continuously used an N95, per the .

“My personal opinion would be, since there’s evidence of aerosol transmission, [at least] an N95 should be used for direct care of suspect or COVID-confirmed patients,” said Dr. Robert Harrison, a physician and professor at the University of California-San Francisco medical school who founded UCSF Occupational Health Services.

In an emailed statement, the CDC suggested that its guidance is meant to conserve scarce resources and applies primarily to shortage situations.

Surgical masks should be used when N95s “are so limited that routinely practiced standards of care … are no longer possible,” said Martha Sharan, an agency spokesperson. “N95 respirators beyond their manufacture-designated shelf life, when available, are preferable to use of facemasks.”

Yet many health facilities — citing the CDC guidelines and scarce supply — are providing N95s in only limited medical settings.

Earlier this month, the national Teamsters union reported that 64% of its health care worker membership — which includes people working in nursing homes, hospitals and other medical facilities — could not get N95 masks.

At Michigan Medicine, the University of Michigan’s medical center, employees don’t get N95s except for performing specific procedures on COVID-positive patients — such as intubation or a bronchoscopy — or treating them in the intensive care unit, said Katie Scott, a registered nurse at the hospital and vice president of the Michigan Nurses Association. Employees who otherwise treat COVID-19 patients receive surgical masks.

That matches CDC protocol but leaves nurses like Scott — who has read the research on surgical masks versus N95s — feeling exposed.

“We are at a risk of getting this virus, and we are at a risk of bringing it home to our families,” Scott said. “It’s clear these surgical mask guidelines aren’t working.”

Nearly 3,000 health workers in the Detroit area — which includes Ann Arbor, the home of Michigan Medicine — have suspected or confirmed COVID-19 infections, according to recent news .

At Michigan Medicine, employees cannot bring in their own protective equipment, according to a complaint the nurses union filed with the Michigan Occupational Safety and Health Administration. Scott has PPE that her friends and family have mailed her, including N95 masks. It sits at home while she cares for patients.

“To think I’m going to work and am leaving this mask at home on my kitchen table because the employer won’t let me wear it,” Scott said. “You feel sacrificial in a way.”

News reports from to to have documented nurses facing retaliation or pressure to step down when they’ve brought their own N95 respirators.

A spokesperson for Michigan Medicine declined to answer questions about the hospital’s protective equipment protocols. The American Hospital Association does not have a stance on letting employees bring their own N95s to work, said Robyn Begley, the trade group’s senior vice president and chief nursing officer.

In New York, the epicenter of the nation’s coronavirus outbreak, nurses across the state report receiving surgical masks, not N95s, to wear when treating COVID-19 patients, according to a court affidavit submitted by Lisa Baum, the lead occupational health and safety representative for the New York State Nurses Association.

“A surgical mask is not a form of PPE. … [If you] cough or sneeze, it catches some of the virus. It does not protect the wearer,” Baum said in an interview with Kaiser Health News.

So far, at least 16 NYSNA members have died from the coronavirus, at least 94 have been hospitalized and more than 1,000 have tested positive, according to union estimates.

National Nurses United has pushed Washington lawmakers to pass legislation that would ramp up production of N95s by compelling the White House to invoke the Defense Production Act, a Korean War-era law that allows the federal government, in an emergency, to .

It is also calling on Congress to require that the Occupational Safety and Health Administration put forth an emergency temporary standard to mandate that employers provide health care workers with protective equipment, including N95 masks, when they interact with patients suspected to have COVID-19.

“The employer has a responsibility to protect their employees,” said Amirah Sequeira, the union’s lead legislative advocate. “At the same time, when you have a crisis at this scale, the federal government also has a responsibility to ensure the very increase in purchasing, and, if not purchasing, production.”

The AHA has lobbied against a mandate that would expand use of N95s. Begley acknowledged that “supplies are inadequate” and said heightened global demand makes getting N95s much more difficult.

“If we fail to conserve already limited supplies, there will be no N95s remaining for health care staff performing aerosolizing procedures,” Begley said.

But the failure to get more and better protective gear to health workers could cost more lives, union leaders warned in a recent teleconference about the dangerous conditions workers are facing.

“Nurses are not afraid to care for our patients if we have the right protections,” said Bonnie Castillo, the executive director of National Nurses United, “but we’re not martyrs sacrificing our lives because our government and our employers didn’t do their job.”

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Until mid-March, these numbers commanded attention. But as the coronavirus death toll climbs and the economic costs of attempting to control its spread wreak havoc, the public health focus is now dramatically different.

In the background, though, these other issues — the opioid epidemic and vaping crisis — persist in heaping complications on an overwhelmed public health system.

It is creating a distinctly American problem, said Dr. Nora Volkow, who heads the National Institute on Drug Abuse.

Volkow spoke with Kaiser Health News about the emerging science around COVID-19’s relationship to vaping and to opioid use disorder, as well as how these underlying epidemics could increase people’s risks. Her remarks have been edited for length and clarity.

Q: We’ve already been experiencing two epidemics at once — vaping and the opioid crisis — and now we’re in the midst of a third. Does that change the nature of addressing the coronavirus in the United States?

It makes a different kind of situation than we see abroad. It forces us as a country to be urgently multitasking, to focus on the urgent needs of COVID while not ignoring the other epidemics devastating America. That’s certainly challenging.

Q: What is the evidence around the relationship between vaping and the coronavirus?

Because of the recency, there’s no data to show if there are differences in outcomes between people who vape and people who do not vape. There’s no reported scientific evidence. We will start seeing it.

We know from all the cases of acute lung injury that vaping, particularly certain combinations of chemicals that were related to vaping of THC, actually led to death. The cause of death was pulmonary dysfunction. We know from animal experiments that vaping itself — not even giving any drugs with it — can produce inflammatory changes in the lung.

We already know for COVID that, with comorbid conditions — particularly those that affect the lungs, the heart, the immune system — [patients] are more likely to have negative outcomes.

One can predict an association. In the meantime, because of the data that already exist, we should be very cautious. The prudent thing is to strongly advise individuals who are vaping to stop.

Q: Young people so far appear to have lower risks of COVID complications. Does vaping change that?

We know there have been fatalities among young people. One very important area of research is to try to understand the specific vulnerabilities among young people.

Why would you want to risk it when you already know vaping produces inflammatory changes in the lungs? We know in medicine, a tissue that has suffered harm is more vulnerable.

The big centers where you are observing the rise in COVID-19 cases, that’s where you are more likely to see the comorbidity of vaping.

It’s young people that are mostly vaping, but also older people, many of whom otherwise would be smoking tobacco. [Smoking] also raises the risk. Even though the samples have not been large enough, overall, smokers have done worse than nonsmokers when they have COVID.

Q: Let’s talk about opioid use disorder. What kind of comorbidities are we starting to see between opioid use disorder and COVID-19?

People who have opioid use disorder are also likely to be smokers. Smoking itself increases harm to your lungs.

We do know that opioids actually are immunosuppressants. This has been extensively studied. Nicotine also can disrupt immunity and actually impair the capacity of the cell to respond to viral infections.

One of the things opioids do is they depress your respiration. If it’s severe enough, they stop breathing. That’s what leads to death.

Whether you overdose or not, when you are taking opioids, the frequency of your breathing is down, and the oxygen in your blood tends to be lower.

The [COVID] infection targets the respiratory tissues in the lungs. It interferes with the capacity to transfer oxygen into the blood.

If you get COVID and you are taking opioids, the physiological consequences are going to be much worse. You’re not only going to have the effects of the virus itself, but you’ll have the depressive effects of opioids in the respiratory system [and] in the brain that lead to much less circulation in the lungs.

Q: What about other supports for people in recovery?

Community support systems like syringe exchange programs are closing. Methadone clinics are closing. If they’re not closing, they’re unable to process the same number of patients — because the staff is getting sick or the place where the methadone clinic was does not allow for so many people. Public transportation is not available for people to attend their methadone clinics.

We’re also hearing from our investigators they have observed a significant reduction in the capacity of the health care system to initiate people on medication for opioid use disorder — especially buprenorphine. Many of the buprenorphine initiations were done in health care facilities that are saturated with COVID.

Q: What’s happening to address those problems?

If in the past, if you were a physician or a nurse practitioner and you wanted to initiate someone on buprenorphine, the laws were that you needed to see that person physically. That’s changed. It’s now possible you can initiate someone on buprenorphine through telehealth. That’s incredibly valuable.

There’s extended reimbursement for telehealth, which expands access to treatment. There are also apps that have been created that provide individuals who have addiction [access] to mentors or coaches, as well as access to therapies and group therapies.

That is one of the aspects that has actually been accelerated by the COVID crisis. These may facilitate treatment into the future, even when COVID’s no longer there.

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The investigations come as health care workers have aired on social media and to lawmakers about a , pressure to work while sick, and safety concerns as they have cared for more than 826,000 patients stricken by the coronavirus.

Despite those concerns, the nation’s top worker safety agency is not viewed as an advocate likely to rush to workers’ aid. President Donald Trump tapped a Labor Department leader who has represented corporations railing against the very agency he leads.

“It’s a worker safety crisis of monstrous proportions and OSHA is nowhere to be found,” said David Michaels, an epidemiologist and George Washington University professor who was assistant secretary of Labor and ran OSHA from 2009 to 2017.

Employers are required to report a work-related death to OSHA or face fines for failing to do so. Yet former OSHA leaders say the agency has not openly reminded hospitals and nursing homes to file such reports in recent weeks.

Last week, the Centers for Disease Control and Prevention reported that more than 9,200 health workers had been infected with the coronavirus, a number the agency concedes is a vast undercount. The estimate was based on a set of lab-generated reports in which only 16% included the patient’s profession. The agency said the true number is probably closer to 11% of all known cases.

Federal records show the OSHA fatality investigations ― — involve hospitals, an emergency medical service agency, a jail health department and nursing homes. Its investigations can be prompted by the complaint of a worker, a former worker or even an OSHA official who sees a news report about a workplace death. They can be conducted by phone and fax or involve an on-site inspection.

One fatality investigation launched April 7 focuses on Marion Regional Nursing home in Hamilton, Alabama, where nurse Rose Harrison, 60, worked before she died of COVID-19, her daughter Amanda Williams said.

Williams said her mother was not given a mask when caring for a patient on March 25 ― 10 days after the county’s first coronavirus case — who later tested positive for the virus. Williams said her mother felt pressured to keep going to work even as she was coughing, fatigued and running a low-grade fever.

“She kept telling me ‘Amanda, I have to work, I have to get my house paid off,’” Williams said, noting her mother said she was urged to work unless her temperature reached 100.4.

Williams said that she drove her mother to the hospital on April 3 and that Harrison was unhappy she’d spent the week working. Harrison went on a ventilator the following day, fully expecting to recover. She died April 6.

“When your mother dies mad, you’re pretty much mad,” Williams, one of Harrison’s three daughters, said. “I think if proper steps were taken from the beginning, this would have been different.”

North Mississippi Health Services, which owns the nursing home, and the home’s administrator did not reply to calls or emails.

An April 13 OSHA memo said the agency death investigations involving health care workers and first responders. It said “formal complaints alleging unprotected exposures to COVID-19 … may warrant an on-site inspection.”

Michaels, the former Labor Department official, said a subsequent suggested that officials are unlikely to penalize all but the most careless employers.

The memo about employers’ “good faith” efforts said a citation may be issued “where the employer cannot demonstrate any efforts to comply.”

Michaels said that “any efforts” to comply with work safety rules could amount to making even one phone call to try to buy masks for workers.

Federal OSHA officials did not respond to a request for comment.

Democrats criticized Trump last year when he tapped Eugene Scalia, who spent years of his legal career defending major corporations, to head the Labor Department.

Scalia fought OSHA on behalf of SeaWorld after it was cited over the death of a woman training killer whales, . Scalia’s team argued the work-safety agency was not meant to regulate the training of killer whales. He also argued that SeaWorld had adequate safety measures in place, but ultimately lost the case.

Sen. Bernie Sanders, alluding to Scalia’s record of defending firms like Chevron and Goldman Sachs, “obscene.”

Since March 27, the ongoing fatality investigations have been mostly categorized as “partial” investigations, which initially focus on one area of noncompliance. Four are labeled “complete,” meaning they cover a wide range of hospital operations.

One of the “complete” investigations is listed at Coral Gables Hospital in South Florida, where respiratory therapist Jorge Mateo, 82, worked before he died of coronavirus complications, his daughter said.

The hospital reported the death, according to a statement from Shelly Weiss Friedberg of Tenet Healthcare, which owns the hospital. She said Mateo was with the hospital for four decades and “the loss of Jorge Mateo is felt throughout our entire community.”

A subsequent investigation — also labeled as “complete” ― was opened April 10 at Palmetto General Hospital, in South Florida.

There, 33-year-old Danielle Dicenso worked for a staffing agency as an ICU nurse, treating coronavirus patients. Dicenso died after developing COVID-19 symptoms, including fever and a cough, according to reports in the . The Palm Beach County medical examiner has not yet determined a cause of death, a spokesperson told Kaiser Health News.

Her husband, David Dicenso, told local news station WSVN she had not been given and was “very scared of going to work.”

Weiss Friedberg, of Tenet, which also owns Palmetto, said in an email that “nurses are provided appropriate personal protective equipment (PPE) in compliance with Centers for Disease Control (CDC) guidelines.”

say staff can wear a face mask if no N95 respirator is available when performing routine care with COVID-19 patients. For higher-risk procedures, such as intubation, workers must receive N95 masks.

OSHA opened an inspection at St. Catherine of Siena Medical Center, a Long Island hospital, on April 11. Federal officials had learned from a local news story about a patient care assistant dying of COVID-19, hospital leadership confirmed.

The hospital has no record of that employee having any interaction with COVID patients, said James O’Connor, its executive vice president. The hospital tests employees for COVID-19 only if they have had confirmed exposure to someone who tested positive and if they develop symptoms.

O’Connor said all employees who are in contact with suspected COVID-19 patients get the full suite of PPE; they are told to clean their N95 masks after each shift, he said, and to change masks entirely every three shifts.

That can mean workers wear the same equipment for multiple days.

Early research suggests that N95s can be sanitized and reused up to three times. But that paper has not yet undergone peer review. In an affidavit the New York State Nurses Association filed regarding another state hospital, the union argued that it has “yet to be adequately proven that disposable respirators can be effectively decontaminated” without putting the wearer at risk.

As recently as April 16, the local nurses union that St. Catherine workers on are being told to share PPE.

While OSHA does have a “general duty” clause urging employers to keep workers safe and a standard for respiratory protection, it has no written rule on protecting workers from airborne disease, said Debbie Berkowitz, a former OSHA chief of staff and director of the National Employment Law Project’s worker safety and health program.

As OSHA and the Centers for Disease Control and Prevention downgrade their requirements week by week, workers are left with the choice in some places to wear a bandana in situations that had called for a properly fitted N95 mask, which can filter out particles as small as 0.1 microns.

“OSHA has really completely abandoned their mandate to protect workers,” Berkowitz said, “and every worker is on their own.”

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