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Tensions over vaccine equity pit rural against urban America

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Tensions over vaccine equity pit rural against urban America

NASHVILLE, Tenn. — Rita Fentress was worried she might get lost as she traveled down the unfamiliar forested, one-lane road in rural Tennessee in search of a coronavirus vaccine. Then the trees cleared and the Hickman County Agricultural Pavilion appeared.

The 74-year-old woman wasn’t eligible to be vaccinated in Nashville, where she lives, because there were so many health care workers to vaccinate there. But a neighbor told her the state’s rural counties had already moved to younger age groups and she found an appointment 60 miles away.

“I felt kind of guilty about it,” she said. “I thought maybe I was taking it from someone else.” But late that February day, she said there were still five openings for the next morning.

The U.S. vaccine campaign has heightened tensions between rural and urban America, where from Oregon to Tennessee to upstate New York complaints are surfacing of a real — or perceived — inequity in vaccine allocation.

In some cases, recriminations over how scarce vaccines are distributed have taken on partisan tones, with rural Republican lawmakers in Democrat-led states complaining of “picking winners and losers,” and urbanites traveling hours to rural GOP-leaning communities to score COVID-19 shots when there are none in their city.

In Oregon, state GOP lawmakers walked out of a Legislative session last week over the Democratic governor’s vaccine plans, citing rural vaccine distribution among their concerns. In upstate New York, public health officials in rural counties have complained of disparities in vaccine allocation and in North Carolina, rural lawmakers say too many doses were going to mass vaccine centers in big cities.

In Tennessee, Missouri and Alabama, a dearth of shots in urban areas with the greatest number of health care workers has led senior citizens to snap up appointments hours from their homes. The result is a hodgepodge of approaches that can look like the exact opposite of equity, where those most likely to be vaccinated are people with the savvy and means to search out a shot and travel to wherever it is.

“It’s really, really flawed,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, who noted there are even vaccine hunters who will find a dose for money. “Ideally, allocations would meet the population’s needs.”

With little more than general guidance from the federal government, states have taken it upon themselves to decide what it means to distribute the vaccine fairly and reach vulnerable populations.

Tennessee, like many states, has divvied up doses based primarily on county population, not on how many residents belong to eligible groups — such as health care workers. The Tennessee health commissioner has defended the allocation as the “most equitable,” but the approach has also exposed yet another layer of haves and have-nots as the vaccine rollout accelerates.

In Oregon, the issue led state officials to pause dose deliveries in some rural areas that had finished inoculating their health care workers while clinics elsewhere, including the Portland metro area, caught up. The dust-up last month prompted an angry response, with some state GOP lawmakers accusing the Democratic governor of playing favorites with the urban dwellers who elected her.

Public health leaders in Morrow County, a farming region in northeastern Oregon with one of the highest COVID-19 infection rates, said they had to delay two vaccine clinics because of the state’s decision. Other rural counties delayed vaccines for seniors.

States face plenty of challenges. Rural counties are less likely to have the deep-freeze equipment necessary to store Pfizer vaccines. Health care workers are often concentrated in big cities. And rural counties were particularly hard hit by COVID-19 in many states, but their residents are among the most likely to say they’re “definitely not” going to get vaccinated, according to recent Kaiser Family Foundation polling.

Adalja said most of these complications were foreseeable and could have been avoided with proper planning and funding.

“There are people who know how to do this,” he said. “They’re just not in charge of it.”

In Missouri, where Facebook groups have emerged with postings about appointment availabilities in rural areas, state Senate Minority Leader John Rizzo, a Democrat from the Kansas City suburb of Independence, cited a need to direct more vaccine to urban areas.

The criticism drew an angry rebuke from Republican Gov. Mike Parson, who said vaccine distribution has been proportional to the population and critics are using “cherry-picked” data.

“There is no division between rural and urban Missouri,” Parson said during his weekly COVID-19 update last week.

In Republican-led Tennessee, Health Commissioner Lisa Piercey notes that the Trump administration deemed the state’s plan among the nation’s most equitable. Extra doses go to 35 counties with a high social vulnerability index score — many small and rural, but also Shelby County, which includes Memphis, with a large Black population.

Last week, state officials revealed some 2,400 doses had been wasted in Shelby County over the past month due to miscommunication and insufficient record-keeping. The county also built up nearly 30,000 excessive doses in its inventory. The situation caused the Centers for Disease Control and Prevention to investigate and the county health director to resign.

In Nashville, Democratic Mayor John Cooper says the fact that city residents can get shots elsewhere is a positive, even if the road trips are “a little bit of a pain.”

“I’m grateful that other counties have not said, ‘Oh my gosh, you have to be a resident of this county always to get the vaccine,’” Cooper said.

Nashville educators Jennifer Simon and Jessica Morris took sick days last week to make the four-hour round-trip to tiny Van Buren County, population less than 6,000.

They got their first shots there in January, when Republican Gov. Bill Lee was pushing Nashville and Memphis area schools to return to in-person classes. Republican lawmakers even threatened to pull funding from districts that remained online.

In-person classes started a couple weeks ago, but the city only began vaccinating teachers last week.

“It was scary, frustrating, and feeling really betrayed,” Simon said.

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Author reveals how his brother killed his mother in new memoir

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Author reveals how his brother killed his mother in new memoir

Most memoirs are a recounting of the author’s own life and experiences. “Everything is Fine” by Vince Granata (Atria Books), out April 27, is a memoir of an entire family — and a tragedy that forever changed its members. 

Granata was an only child for the first 4 ½ years of his life. On the day his mother and father returned home from the hospital, he remembers writing “welcome home mommy” in sidewalk chalk outside their Connecticut home. His parents had arrived home with not one but three siblings in tow — triplets Christopher, Timothy and Elizabeth. It was a joyful event. But the birth of his siblings put in motion a tragedy that would take years to unfold. 

On July 24, 2014, his brother Tim, 24, attacked and killed their mother in the family home. Claudia Dinan Granata was 58. Tim suffered from schizophrenia. “I won’t take the medication, the medication destroys me, takes my mind, takes me away from God,” he ranted to his mother on the morning of the attack. He had frequently threatened suicide. 

“Tim’s demons, electric in his ill mind, convinced him that the woman who had made him peanut butter sandwiches when he was a grass-stained child was the source of his constant pain,” Granata writes. “…After he killed her, he dialed 911, sitting on our front steps, clutching a white Bible.” 

This is a memoir about a horrifying crime, but it is also a book about mental illness, and the family’s ongoing attempts to get help for Tim in a system that is hopelessly flawed. Tim was hospitalized at the Yale New Haven Psychiatric Hospital in February 2014. In the weeks leading up to the murder, there were numerous signs that he needed to return, but he refused to go back. 

“Eventually, I had no choice but to look at loss and pain, at all the pieces of my family’s story that I didn’t think I could ever understand,” Vince writes. “It was this process, recognizing the pieces, struggling to put them in order, that almost destroyed me. It’s also what allowed me to live again.” 

Tim was found not guilty by reason of insanity.

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These colleges require students to get vaccinated if they want to live on campus

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These colleges require students to get vaccinated if they want to live on campus

As academic institutions look toward the post-COVID-19 future of education, some are implementing strict vaccine requirements ahead of the upcoming semester as others incentivize or urge students to pick up the inoculations.

Many colleges already require students to provide proof of certain vaccines, but those have been in use for years. The three FDA-approved COVID-19 vaccines are all less than a year old.

But now that vaccines are open in many places to people age 16 and up, colleges are beginning to look into how that can benefit their reopening plans.

Colleges that will require proof of vaccination for students who want to live on campus include Oakland University in Michigan, Cornell University in upstate New York, Rutgers University in New Jersey, and Brown University in Rhode Island.

“Students have an option to come to Oakland University and not stay in residence halls,” Oakland President Dr. Ora Pescovitz told Fox 2 Detroit this week. “Only 20% of our students live on campus. The other 80% are commuter students.”

The school is offering religious and medical exemptions to students who provide proof to the dean of students.

But she said more than 1,000 people signed up for vaccines within the first six hours after the school announced the new requirement.

Northeastern University in Boston is going a step further and requiring COVID-19 vaccinations for all students before the fall 2021 semester as part of its plan to return to full-time, in-person learning.

Nova Southeastern University announced last week it would require vaccinations by Aug. 1 – then backtracked after Florida Gov. Ron DeSantis announced a statewide ban on “vaccine passports,” citing concerns about individual liberty and patient privacy.

“We will continue to follow all state and federal laws as they evolve,” Nova President George L. Hanbury II said in a statement.

The Associated Press contributed to this report.

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Mars Perseverance rover takes selfie with Ingenuity helicopter ahead of historic flight

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NASA's Perseverance Mars rover took a selfie with the Ingenuity helicopter on April 6, 2021, using the WATSON (Wide Angle Topographic Sensor for Operations and eNgineering) camera located at the end of the rover's long robotic arm. Perseverance's selfie with Ingenuity is constructed of 62 individual images, taken in sequence while the rover was looking at the helicopter, then again while looking at the WATSON camera, stitched together once they are sent back to Earth.

To the delight of social media users, NASA’s Perseverance rover used a camera on the end of its robotic arm to snap a selfie with the Mars Ingenuity helicopter this week ahead of its historic flight mission.

Shown about 13 feet apart in the pictures taken on April 6, 2021, or the 48th Martian day of the mission, the rover used its WATSON (Wide Angle Topographic Sensor for Operations and Engineering) camera on the SHERLOC (Scanning Habitable Environments with Raman and Luminescence for Organics and Chemicals) instrument.

In a release, NASA’s Jet Propulsion Laboratory (JPL) said Wednesday that the selfie had been constructed using 62 individual images — taken in sequence — that were stitched together.

It noted that the Curiosity Mars rover, which landed on the red planet in 2011, takes similar “selfies.”

Ingenuity, which has been released on the Martian surface, is scheduled to attempt the first-ever powered and controlled flight of an aircraft on another planet no sooner than April 11.

NASA's Ingenuity Helicopter with its blades unlocked acquired by NASA's Perseverance Mars rover using its Left Mastcam-Z camera, on Sol 47, 08 April 2021. Mastcam-Z is a pair of cameras located high on the rover's mastcam-Z.
NASA’s Ingenuity Helicopter with its blades unlocked acquired by NASA’s Perseverance Mars rover using its Left Mastcam-Z camera, on Sol 47, 08 April 2021. Mastcam-Z is a pair of cameras located high on the rover’s mastcam-Z.
NASA/JPL-Caltech/HANDOUT/EPA-EFE

Once the team at JPL is ready, Perseverance will relay the helicopter’s final flight instruction from mission controllers, according to NASA.

If all final checks and atmospheric conditions look good, the helicopter will lift off climbing at a rate of 3 feet per second and hover at 10 feet above the surface for up to 30 seconds.

After data and potentially images from the rover’s Navigation Cameras and Mastcam-Z are downloaded, the Ingenuity team will determine whether the flight was a success. 

The results will be discussed by the team at a media conference that same day.

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