We look at the need to accelerate the U.S. vaccination program.

Three million shots a day
The Biden administration has been quite cautious in setting its public vaccination goals.
During the transition, officials said they hoped to give shots to one million Americans per day — a level the Trump administration nearly reached in its final days, despite being badly behind its own goals. In President Biden’s first week in office, he raised the target to 1.5 million, although his aides quickly added that it was more of a “hope” than a “goal.” Either way, the country is now giving about 1.7 million shots per day.
I have spent some time recently interviewing public-health experts about what the real goal should be, and I came away with a clear message: The Biden administration is not being ambitious enough about vaccinations, at least not in its public statements.
An appropriate goal, experts say, is three million shots per day — probably by April. At that pace, half of adults would receive their first shot by April and all adults who wanted a shot could receive one by June, saving thousands of lives and allowing normal life to return by midsummer.
Biden struck a somewhat more ambitious tone yesterday, telling CNN that anybody who wanted a vaccine would be able to get one “by the end of July.” But Dr. Anthony Fauci also said that the timeline for when the general population could receive shots was slipping from April to May or June.
The shots are on their way
The key fact is that the delivery of vaccine doses is on the verge of accelerating rapidly. Since December, Moderna and Pfizer have delivered fewer than one million shots per day to the government.
But over the next month and a half, the two companies have promised to deliver at least three million shots per day — and to accelerate the pace to about 3.3 million per day starting in April. Johnson & Johnson is likely to add to that total if, as expected, it receives the go-ahead to start distributing shots in coming weeks.
Very soon, the major issue won’t be supply. It will be logistics: Can the Biden administration and state and local governments administer the shots at close to the same rate that they receive them?
“I’m not hearing a plan,” Dr. Peter Hotez, a vaccine expert at Baylor College of Medicine, told me. “In the public statements, I don’t hear that sense of urgency.”
Bankers’ hours for vaccine clinics
The experts I interviewed said they understood why Biden had set only modest public goals so far. Manufacturing vaccines is complex, and falling short of a high-profile goal would sew doubt during a public-health emergency, as Barry Bloom, a Harvard immunologist, told me. If he were president, Bloom added, he would also want to exceed whatever goal was appearing in the media.
But setting aside public relations, experts say that the appropriate goal is to administer vaccine shots at roughly the same rate that drug makers deliver them — with a short delay, of a week or two, for logistics. Otherwise, millions of doses will languish in storage while Americans are dying and the country remains partially shut down.
“We should be doing more,” Jennifer Nuzzo, an epidemiologist at Johns Hopkins, said. “I am kind of surprised by how constrained we’ve been.” Many vaccine clinics operate only during business hours, she noted. And the government has not done much to expand the pool of vaccine workers — say, by training E.M.T. workers.
The newly contagious variants of the virus add another reason for urgency. They could cause an explosion of cases in the spring, Hotez said, and lead to mutations that are resistant to the current vaccines. But if the vaccines can crush the spread before then, the mutations may not take hold.
“We need to be laser focused on getting as many people vaccinated now as possible,” Dr. Paul Sax, a top infectious-disease official at Brigham and Women’s Hospital in Boston, told me.
As my colleague Katie Thomas, who covers the vaccines, said: “The future looks bright — if we can do vaccination quickly enough, if people actually want the vaccines and if the variants don’t mess with the plan.”
‘Our historic moment of crisis’
Nobody doubts that vaccinating three million Americans every day for months on end would be a herculean task.
When I asked Biden about his virus plan during a December phone call, he used the term “logistical nightmare” to describe a rapid national vaccination program. “This is going to be one of the hardest and most costly challenges in American history,” he said.
Since then, his aides have emphasized the challenges — the possibility of manufacturing problems, the difficulty of working with hundreds of local agencies, the need to distribute vaccines equitably. They also point out that they have nearly doubled the pace of vaccination in their first month in office, accelerated the pace of delivery from drugmakers and have plans to do more, like open mass-vaccination clinics and expand the pool of vaccine workers.
Part of me wonders whether the White House knows that three million shots per day is the right goal and simply doesn’t want to say so.
When Biden and his advisers talk about the fight against Covid-19, they sometimes compare it to wartime mobilization. And the U.S. has accomplished amazing logistical feats during wartime. A single Michigan auto plant figured out how to manufacture a new B-24 bomber plane every hour during World War II, and a network of West Coast factories built one warship per day — for four years.
“This is our historic moment of crisis and challenge,” Biden said during his inaugural address. “We have never, ever, ever failed in America when we have acted together.”
Near the end of the speech, he added a question: “Will we rise to the occasion?”

The perils of prolonged unemployment

Image result for The perils of prolonged unemployment

Nearly 4 million Americans have been unemployed for 27 weeks or longer — trapped in a vicious cycle that makes it harder to get back to work.

The big picture: Long-term unemployment during a pandemic is a double whammy. Millions are experiencing food and housing insecurity and lack health care when they need it most.

What’s happening: “The troubling amount of long-term unemployment and its continuing rise is dangerous for the U.S. labor market,” says Nick Bunker, an economist at the jobs site Indeed. “A fast labor market recovery will help alleviate these concerns, but that bounce back is still a ways away and dependent on controlling the coronavirus.”

  • The number of Americans experiencing long-term unemployment — around 4 million — is far from the worst of the Great Recession, when long-term unemployment reached 7 million.
  • But it’s remarkable considering where the U.S. was before the pandemic. The long-term unemployment rate is 2.5%, which is comparable to the 3.5% overall unemployment rate in January 2020, Bunker notes.

Why it matters: Studies have shown that long-term unemployment hurts workers’ physical and mental health, reports Bloomberg. And the longer someone is unemployed, the harder it is for that person to get another job — let alone another job at the same pay level.

Job-seeking is even more exhausting during a pandemic, says Tim Classen, an economist at the Quinlan School of Business at Loyola University in Chicago.

  • To start, there are fewer jobs out there than there are unemployed people.
  • On top of that, people may be attempting to juggle job-hunting with parenting kids who are learning remotely.
  • Not everyone is comfortable interviewing over video calls, and not everyone has the broadband access required to even attend those interviews.

“The fluctuations in uncertainty play into this, too,” Classen says. Millions of restaurant workers, flight attendants, retail workers and more aren’t sure when the pandemic will end — or if their employers will even survive it.

There’s a bit of a silver lining, though.

  • While losing a job is a traumatic event and can really chip away at someone’s sense of self-worth, it can also be easier to bear if millions are going through the same thing. Job loss doesn’t feel as personal in a pandemic, says Classen.
  • “There’s a sense of, ‘Yeah, I’m depressed, and I’ve lost my job, but I’m not alone in my suffering,'” he says. “Maybe in some way that tempers it.”

What America’s Richest Ski Town’s Handling of COVID-19 Says About the Country

A view of the JHMR slopes and the village at the base of the mountain in Jackson, Wyoming.

Tucked in the shadow of the Tetons, the town of Jackson, Wy., and surrounding Teton County is home to less than 25,000 fulltime residents, but annually hosts over 2.5 million visitors. The valley’s natural beauty attracts an influx of tourists, who in turn are responsible for roughly 30% of the region’s jobs and over $1 billion in annual revenue, but this year, visitors came with an unwelcome price tag for locals: “Every time in this pandemic that we’ve had an influx of visitation, whether that’s second homeowners, or people just coming for a weekend, it follows with an uptick in cases and hospitalizations” says Dr. Jeff Greenbaum, medical director at the Emergency Department for St. John’s hospital and the Jackson Hole Mountain Ski Resort (JHMR) ski patrol.

With just one major hospital and eight emergency room physicians serving Teton County, any increase in COVID-19 cases is cause for concern. And in January, following the Christmas and New Year’s tourism rush, COVID-19 cases in Teton County skyrocketed to some of their highest levels since the pandemic began. Despite these developments, the ski resort, hotels, bars and restaurants remain open in the town. And Greenbaum remains optimistic that with the right strategies and precautions, the small hospital will not be overwhelmed by cases and skiing can stay open during the season for both visitors and locals. “The nightmare scenario is if the patients are stacking up in the emergency room and we don’t have enough personnel to treat them,” says Greenbaum. “But we’ll see that coming in advance, and we are not there yet.” The local hospital still has over 50% of its ICU beds unoccupied and has no COVID-19 patient on a ventilator. JHMR is similarly optimistic that it can stay open the entire season, trusting in the protocols it has put in place to protect both guests and staff.

Teton is the wealthiest county in the U.S., with a per capita income of over $250,000. At the start of the pandemic, a flurry of private jets landed at the Jackson Hole Airport, sometimes with a private ventilator in tow, as second homeowners and new buyers escaped to this rural paradise. Greenbaum posits that part of the reason why St. John’s hasn’t been overrun by cases is that many of the tourists that get COVID-19 in Teton County might not stay to get treatment in Teton County. At a time when millions of Americans are out of work, when daily infection rates are at an all-time high, and when thousands across the country are dying daily from the virus, should the wealthy indulge in an après ski, looking out onto the beautiful Teton mountains, all while potentially shuttling COVID-19 into and out of Jackson?

This place is pretty much a gigantic country club, relying on second homeowners and tourism for its revenue,” says Jesse Bryant, a doctoral candidate in American Sociology at Yale University and creator of Yonder Liesa podcast exploring the history of Jackson Hole. “But Jackson has to balance the ultra-wealthy with the real reality of people eking out a living here. Teton County has the largest income gap of any county in the U.S., with the top 1% making almost 150 times more than the other 99%. From mountain guides to house cleaners to bartenders, much of the employment in Jackson cannot easily be transitioned to remote work, meaning that Jackson’s working class are among the most susceptible to unemployment from the pandemicAll across America the costs of the pandemic are being born by the poorest members of society; Pew Research Center survey from September found that about 50% of low-income Americans say they or someone in their household has lost employment or had take a pay cut due to the pandemic, and similarly about 50% of low-income Americans reported having trouble paying their bills since the pandemic started.

During the spring and summer, the Coronavirus Aid, Relief, and Economic Security Act passed by the federal government at the start of the pandemic had provided $600 in additional unemployment payment per week, assuring many local and seasonal workers that their livelihoods were safe even if their jobs weren’t. But almost a year into the pandemic, Jackson’s working class are left with far fewer options: federal unemployment relief dropped to $300 and state unemployment benefits in Wyoming, although extended by 13 weeks, dry up after 39 weeks. “Many of the workers here don’t have a six-month buffer saved up,” said one restaurant worker who wished to remain anonymous for risk of losing their job, “so, while tourism presents a risk, we’re willing to take it to keep our paychecks coming in.”

This is the predicament that America has put herself in: a country with a limited safety net during the pandemic forces her workers to choose between the risk of getting sick, or losing their livelihoods. The mountain and the town are left trying to find a balance between keeping the economy open for tourists, and keeping COVID-19 out. As the second largest employer in Teton County, JHMR takes center stage in this unfolding drama. The resort is responsible for the livelihood of around 2,000 seasonal and local workers, and if the mountain were to shut down, many of the ancillary services in the town, like hotels, restaurants, rental shops, clothing stores and other retailers, would likely shutter their doors as well. In 2017, when the resort had to close for five days because of a power outage, the net economic impact to the local economy topped $5.5 million. “What’s happening in Jackson isn’t just a story of wealthy people coming into the rural west and getting the locals sick,” says Bryant. “This place has become more like a symbiotic relationship.”

One particularly vulnerable population is the Latino community, a significant number of which is undocumented, that lives in Jackson, and in the neighboring towns of Victor and Driggs. While it’s difficult to get exact numbers of their contribution to the economy, these workers keep Jackson running by filling jobs in all sectors, from house cleaners and construction workers to cooks and waiters.

“I’ve lived in Jackson for 25 years and used to go back to Mexico every winter because it was just too cold,” says Jorge, an undocumented construction worker in the town. “But then I got used to the cold and began skiing every single day.” Asked whether opening up the resort is worth the risk of bringing more COVID-19 into Jackson, Jorge says that by and large the Latino community welcomes the tourism with open arms, because it means job security. This lines up with findings from a survey undertaken by the Yale School of Environment this past summer, showing that Latino residents in the rural West had some of the highest rates of COVID-related unemployment in the country. “My wife and I work hard, her as a house cleaner, me in construction,” said Jorge. “The resort opening up and tourists coming to town is how many of us make our living.”

For its part, JHMR has been doing nearly everything within its power to keep COVID-19 from spreading on its slopes, iterating as the situation evolves to try to keep the 2021 season operating. In March of 2020, as the first wave of the pandemic was sweeping across the globe, the Wyoming State Health Officer shut down JHMR for the remainder of the season. The resort reopened in May, first for hikers and then mountain bikers—the summer tourists that in total are only about 10% the size of the winter tourist population. Before reopening for the summer crowd, it tested every single one of its staff members for COVID-19, and the resort’s human resources department transitioned into a contact-tracing team, coordinating with town officials whenever a case arose. While Wyoming didn’t issue a statewide mask mandate until Dec. 7, the resort instituted a mandatory mask policy during the summer. JHMR also learned to be more flexible in its operations: staff are now trained to perform a number of different functions, so they can sub in if there’s a shortage in a department, and shifts function as separate pods, meaning that if a person in one group has been exposed to COVID-19, another totally isolated pod can come in to take its place.

Over the summer and fall, tourists came in droves to Jackson, with as many as 40,000 total visitors in a dayAccording to the Jackson Hole Chamber of Commerce, both Yellowstone and Grand Teton National Parks—both within a quick drive from of Jackson—had about 50% more visitors in October of 2020 than they did for the same month in 2019. While many of the outdoor activities that bring people to Teton County during the summer—hiking, biking, climbing—have been deemed relatively safe during the pandemic, tourists also flocked indoors to the bars, restaurants and stores that remained open throughout most of the summer and fall. As a result, Teton County experienced large COVID-19 spikes in July and again at the end of October and into November.

Unsurprisingly, workers got sick. In response, Teton County’s Health Officer, Travis Riddell, sent out a series of recommendations pressing citizens to not gather with groups outside of their immediate family, avoid crowded indoor spaces and not congregate at trail heads, parks or other outside spaces. Still, most businesses stayed open as patrons kept coming. Riddell noted that the town had little choice: “Economic disasters are public health disasters,” Riddell said in an interview in July 2020 to National Geographic. “We know that when there are economic downturns, where there is an increase in poverty, an increase in uninsured numbers—that has direct health effects.”

Once JHMR opened for skiing the weekend after Thanksgiving, it was clear that demand for outdoor recreation would carry into winter; even with almost no international travel, JHMR expects demand during the 2021 winter months to be comparable to past years, at least. “If we just opened up [completely], the mountain would be packed, because demand itself is through the roof,” says LaMotte, “but we’ve imposed a maximum daily capacity for the mountain, to keep guests and staff safe.”

On a bluebird day near Christmas, the resort was sold out. It had snowed almost 15 inches the day before, and cars inched into the packed parking lot. Skiers and snowboarders waited in line for the lot shuttle bus, which, despite operating at 25% capacity, still felt uncomfortably full. The restaurants and bars looking out onto the sunny mountain were similarly capped at 25% capacity, and while masks and social distancing were required, patrons waiting for tables escaped the cold by standing shoulder to shoulder in the foyer.

At the resort, the socially distanced lines for the gondola were dangerously compressing. A resort worker cheerfully reminded guests from every corner of the U.S. to keep their distance and their masks above their noses. “We’re going to make it all the way through the season, without closing” yelled the worker, to cheers from the crowds. The lines moved slow—normally eight people fit onto the gondola, but under the new policies there was no mixing between groups, so often times the gondola ascends with just one or two passengers. At the top of the mountain, with views of the valley floor against the backdrop of the jagged Tetons, everyone breathed a bit easier.

Rob Kingwill and Emilé Zynobia, professional snowboarders based out of Jackson, stepped off the gondola into the cold Wyoming air, about 4,000 feet above the valley floor. Both sported COVID-19 masks made by Kingwill’s apparel company, Avalon 7. “I feel like this is almost an essential service, to give people the opportunity to be outside, said Kingwill. “We need this for our mental health.” When JHMR shut down in March of 2020, Kingwill strapped his snowboard to his backpack and hiked up Teton Pass’s infamous 1,300-foot Glory Boot Pack—every day for 77 days until all the snow had melted. But, he points out, most recreational skiers don’t have the knowledge and skills to navigate such technical terrain—and without the money those tourists bring in, Jackson’s working class would suffer. “It seems like the benefits outweigh the costs of keeping the resort open,” agreed Zynobia, as she and Kingwill strapped onto their boards. “Even though this is an activity skewed towards to wealthier people, it is helping a remote economy, and it is getting people outside at a time when we feel caged in.”

By the middle of January, Teton County’s COVID-19 cases were skyrocketing. Teton County currently has the highest caseload per capita of any county in the state of Wyoming and the highly contagious U.K. variant of COVID-19 was found to be circulating in the area. While the state of Wyoming had loosened COVID-19 gathering restrictions, the county reissued a series of guidelines on Jan. 25 that kept indoor gatherings capped at 25% and limited outdoor gatherings to 250 guests. At the resort, group ski lessons have been replaced by private lessons (at no extra cost), and the gondolas and lifts are ascending the mountain with minimal group mixing. Still JHMR can only control what happens on the mountain; “My main concern is not skiing itself,” says Greenbaum. “But rather I’m concerned about peripheral activity to skiing that lead people indoors, whether it’s a bar, a restaurant, a hotel lobby, a rental shop, a bus.”

Across the nation cases are surging, and other Colorado mountain towns like Telluride and Crested Butte have had similar spikes, likely due to an influx of winter tourism. The infection rate in Pitkin County, Colo., home to the Aspen and Snowmass ski resorts, was skyrocketing in the middle of January, with an incidence rate of about 3,500 per 100,000 people. In response, the county’s health department shut down all indoor dinning operations, but left the ski resorts open. The results were promising: in the past two weeks the COVID-19 rates for Pitkin County dropped by over 50%. “We’re on pace to be below 700 [cases per 100,000 people] in early February and I don’t think any of us thought that would happen so quickly,” said Josh Vance, the county’s epidemiologist, in an interview with the Aspen Times. “I’ll be honest—I think not having indoor dining plays a role.”

In Teton County, restaurants and bars remain open for indoor operations long as they follow social distancing guidelines. The reliance on the ultra-rich creates an undeniable risk to the livelihood of Jackson residents and workers. In the early days of the pandemic, ski resorts across Europe became super spreaders, with visitors transporting the virus like carry-on luggage, threatening other tourists and locals alike. As a result, resorts have been closed this winter across much of Europe, including in France, Germany and Italy. These precautions protect remote mountain towns from an influx of the virus, but there are other, massive costs associated with closing down. Without government support, there is little option for communities like Jackson but to stay open, follow existing public health guidelines and hope for the best. “When the pandemic first started coming to work felt like entering the lion’s den,” said the restaurant worker from Jackson who wished to remain anonymous. “But by now we’re all used to the risk, and really what choice do we have?”