In May of last year, ProPublica health care reporter Caroline Chen reflected on the first 100,000 lives lost to COVID-19 and posed an important question: “How do we stop the next 100,000?” Eight months later, with 300,000 additional American lives lost and the chaotic distribution of the vaccine underway, Chen shares her thoughts on where we are and what happens next.

In your 100,000 lives lost piece, you wrote about questions we needed to ask at that moment: “How do we prevent the next 100,000 deaths from happening? How do we better protect our most vulnerable in the coming months? Even while we mourn, how can we take action, so we do not repeat this horror all over again?” It’s been almost eight months since then. What are the biggest questions we need to be asking now?

I’m afraid that we did end up repeating this horror all over again — and again — and again. There’s no way of dancing around this: We’ve failed to protect our most vulnerable. We’ve let the virus spread out of control across America. We’ve let the worst happen.

So here’s the question on my mind now: How are we going to end the pandemic? We have a vaccine in hand, and I’m so grateful for it. It is, truly, a game changer. But there are different ways that this story can go from this moment in January. We can end the pandemic as quickly as possible, with rapid distribution and uptake of the vaccine, with everyone doing their best to maintain best practices (social distancing, etc.) while they wait their turn, prioritizing those who need the vaccine most, doing whatever we can to alleviate the pressure on exhausted health care workers and public health officials.

Or we can drag it out, with a chaotic and sputtering vaccine rollout, exacerbating inequities in society by letting those who have connections, or money, or power get the vaccine first, and continue to ignore what science tells us, so we have so many more COVID-19 cases that we give the virus evermore chances to mutate away from our currently effective vaccine. We are the authors of the final chapters of this story. How are we going to determine its ending?

You also wrote about choices our nation’s leaders have had to make. What choices are the most pressing right now for the Biden administration?

Biden’s administration does not have the luxury of doing one thing at a time. I’ve watched America lurch from one pandemic theme du jour to another. For a while contact tracing was really hot. Then we all got into antibody testing. Now the hype is about vaccines. This virus is incredibly wily, it’s spreading out of control and front-line workers are exhausted. The administration really needs to be able to work on multiple fronts, bringing in funding, staffing and supplies to sustain public health officials who are trying to do testing while conducting contact tracing interviews while also setting up vaccine clinics.

We can’t rush to vaccinate then drop the testing ball. We still do not have a clear strategy for testing asymptomatic people. I’d love to see a nationwide sharing of sequencing data so we can track and evaluate variants more robustly. Every single health care staff — and hey, what about meatpacking workers and other front-line laborers — should have access to N95s. It’s insane to me that I am still told by some nurses that they have to reuse their masks for two weeks. Last but not least: Clear, consistent and transparent communication from the White House, the Department of Health and Human Services, the Centers for Disease Control and Prevention, the Food and Drug Administration and all branches of government would be desperately welcome.

We’re hearing a lot about mutations and new variants of the virus that spread more quickly. Should we be changing our behavior?

Viruses are constantly mutating; it’s just what viruses do. A lot of these mutations aren’t actually meaningful, and it’s only when they have some sort of functional difference that we consider them a new variant, like the B.1.1.7 variant (also known as the U.K. variant). When a new variant is detected, the question is always, what’s the significance? In the case of the B.1.1.7 variant, it’s pretty clear now that it’s more transmissible, but there isn’t enough data so far to say whether it causes more severe disease.

Still, a more transmissible variant will result in the virus spreading faster, meaning more cases, more overloaded hospitals, diminished therapeutic resources and thus probably a worse outcome if you do get sick — not because you got more severely ill in the first place, but because you didn’t get as good care as you would have otherwise if hospitals weren’t stretched so thin. So far, some B.1.1.7 cases have been found in the U.S., but it doesn’t appear to be dominant. And we need to make sure that doesn’t happen. Epidemiology Professor Andrew Lover at the University of Massachusetts Amherst told me he thinks we’re in a critical period right now — with hospitals still recovering from post-holiday surges, vaccine protection yet to kick in and pandemic fatigue at an all time high. “The vaccine is on the horizon, but it’s really challenging to message that it won’t have a major impact for months,” he said.

Epidemiologist Marc Lipsitch at the Harvard T.H. Chan School of Public Health has argued that contact tracers should prioritize any case that involves a B.1.1.7 variant, because those cases will spread faster. To be able to do that, testing resources — specifically the type of tests that can identify B.1.1.7 — need to be ramped up and widely distributed. As for individuals, however, there’s nothing you need to change about your behavior if you’re worried about variants. You already know what to do, you just have to fight the fatigue and do it. Wash your hands. Wear a mask. Social distance. Seek the outdoors. Get your vaccine when it’s your turn. Do whatever you can to not be a case.

Of all of the great reporting you and other science reporters have done on the pandemic, most people experience only a swath of what the big picture of the pandemic is — the bigger picture that you as a reporter have. You’ve reported on some of these smaller swaths, individual stories and experiences, but also the larger systemic failures. What do we lose sight of with the big picture, and what do we lose sight of with the small picture?

Sometimes when I’m looking at the charts, I have to remind myself what the numbers mean. It’s become so easy after months and months of this to become numb. For example, even though the case count is finally starting to go down in Los Angeles County, and that is good news, it’s not just a trend line. Those are people. And even if I can be happy on one level that the tide seems to be turning in LA County, I should also keep in mind that that’s still 7,900 individuals who were diagnosed with COVID-19 yesterday, and close to 200 people who died. Each person — as my May essay said — was somebody’s everything. I have to remember that, so I don’t ever treat the numbers like just numbers in my reporting.

On the flip side, when I’m listening to people’s stories, I always keep in mind that one person’s experience may not speak for the whole. There are a lot of vaccine snafus happening across the country right now. Some of them are dysfunctions unique to that particular vaccine site, and as a national reporter, they’re not my story to tell. So I talk to a lot of people and gather as many stories as I can. And when I start to hear the same themes repeat over and over, that’s when I start to think, Hmmm, there’s something going on here. It’s not a good sign when clinics across the country are all canceling appointments on the same day. That’s when I swing into action to try and find out the Why. That’s a ProPublica story.

You wrote eight months ago: “I refuse to succumb to fatalism, to just accepting the ever higher death toll as inevitable. I want us to make it harder for this virus to take each precious life from us. And I believe we can.” What were you feeling then that fueled you to write about refusing to succumb to fatalism, and what are you feeling now?

What was I feeling? Oh, boy. I was leaking tears and writing at the same time because our brilliant visuals editor Andrea Wise was sending me her selections for that essay and I was looking at the images just thinking how awful it was for people to have to be going through this: not just to be sick and die, but in so many cases to have to die alone — or to have a loved one in the hospital and not be able to be by their side. There’s one image in there of a funeral home in New Jersey with the spaced out chairs that seemed so bleak to me. Even after your loved one’s death, you couldn’t lean close to a friend or relative for comfort.

I didn’t want people to just roll over and accept that more people would die. It angered me that some people were ignoring the guidance of public health officials and what science told us could help reduce cases. I wanted people to realize that there’s accountability at all levels: from federal policies all the way down to your own actions, every day.

And now? I’m tired. I miss my family so much (they’re mostly overseas). But I still haven’t given up. I remind myself that I can’t solve the world’s problems, but I can do my little bit as a health reporter and hope it helps, somehow. And now there’s a new administration. I don’t think it’ll be perfect by any means, but I am hopeful to see that President Biden takes the pandemic seriously and I look forward to seeing what actions his administration takes in the coming weeks.

We know the vaccine distribution isn’t going well. But what reasons do we have to be hopeful?

Well for starters, we have a vaccine that works! Two, in fact, and potentially another on the way (Johnson & Johnson’s). As a former biotech reporter, I know that drug development is a slog, so the fact that we have two very efficacious vaccines that made it to market in under a year is truly amazing.

But of course, shots in the vial are pointless if they don’t get to people’s arms. So where am I seeing hope? So far, production appears to be going OK. There obviously isn’t as much available vaccine as the demand, but there haven’t been any major manufacturing snafus, so I expect Pfizer and Moderna to continue to ramp up as planned.

I am also hoping that as more vaccines become available, this should (fingers crossed) coincide with federal, state and local entities sorting out the logistical issues that have plagued the rollout so far. Ideally, things will go more smoothly when the bulk of the supply becomes available. I’ll stay optimistic, while looking out for everything that may be going wrong, of course. That’s my job.

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