Glossen

von Anna Rosmus

To document the information on COVID response in the following text, Anna Rosmus interviewed and e-mailed with staff at University of Maryland Upper Chesapeake Health. Quotes not cited are from her conversation and correspondence.

Robert Redfield, “an HIV/AIDS expert and former military physician, lacked experience running a public health agency when Trump selected him”^[1] to head the U.S. Centers for Disease Control and Prevention (CDC) in 2018. As the World Health Organization (WHO) shipped hundreds of thousands of COVID-19 tests to countries around the world, the CDC never even discussed international test kits for the U.S. Instead, the “US chose to design its own coronavirus test,”^[2] and days after these shipped, some labs already reported glitches that required reworking.^[3]

On March 5, 2020, the first COVID-19 patient arrived at the University of Maryland Upper Chesapeake Health (UM UCH) emergency department in Bel Air. She was an elderly lady, who had returned from a trip to the Middle East.^[4] A few days later, when a male patient arrived with unexplained heart failure, test kits for COVID-19 were neither available in rural Maryland, nor was it permissible to test what was deemed asymptomatic cases. On March 26, 2020, Maryland began to report hospitalizations, and on March 28, negative test results.^[5]

Gloves, gowns, and face masks for health care workers quickly ran scarce. The U.S. produced merely 10% of its daily PPE needs. The overwhelming majority used to come from China. Negative pressure rooms help to protect patients and staff, but UM UCH had only a few rooms properly equipped to treat patients with an airborne illness. As case after case arrived, many with obvious symptoms, medical staff with asthma and other health problems began to panic.

Bill Rogers, a maintenance mechanic with German-Irish roots, and his coworkers went from room to room, cutting large holes in window panes to retrofit entire units with 90 large, cubic suction devices that would filter the air three times before they blow it outside of the building.

On May 5, 2020, the University of Maryland Medical System (UMMS), one of the largest private, nonprofit health care providers in the mid-Atlantic region, announced that the Nora Roberts Foundation granted its hospitals and other medical facilities $168,000 to support their COVID-19 Response.

At that time, in spite of very limited laboratory capacities, UM UCH began to test symptomatic patients in house. That reduced the result time from 10-14 days to 12-24 hours. Hydroxy Chloroquine, a malaria medicine created in Nazi-Germany, was affordable, readily available,^[6] and touted by then US-President Trump as a cure.^[7] Heart failure, kidney failure, and stroke, however, were also frequent results. Remdezivir, sold under the brand name Veklury, is a broad-spectrum antiviral medication which prevented the virus from reproducing and tended to shorten hospitalizations by several days, but it was expensive,[8] administered intravenously, and it may have caused liver inflammation.^[9]

Dexamethasone, which prevented the body from releasing substances that cause inflammation, was only helping very sick patients, and could be harmful when given in milder cases. Because many patients lacked interferon molecules, especially in their blood and lungs, adding Interferon beta-1a to Remdezivir was explored.^[10] Sold under the brand name Rebif, the drug was administered as a subcutaneous injection, but it was exorbitantly pricey. Plasma gave hope.^[11] Dr. Muhannad Kanbour, an experienced hospitalist from Iraq, recalled, “In the beginning we were mainly using dexamethasone and plasma taken from COVID-healed patients because antibodies are present in the plasma, as part of a study. Later, the plasma trial was removed because it lacked evidence to support its effectiveness.”

Proning increased a patient’s natural, even lung function, but lifting and turning an intubated, comatose person every six hours required multiple, qualified staff members in full PPE gear. When RN Brandon Russell^[12] realized how difficult it was for some UM UCH patients to lay on their stomach for extended periods of time, he turned to the internet and learned that a New York physician used pregnancy support pillows. At his initiative, UM UCH purchased some.

 

Nurse behind IV-poles with fluids for one COVID-patient

 

Blood pressure medications relieved the heart, and dialysis supported stressed kidneys. To increase physical distancing, IV-poles were hooked up to extension cords, additional COWs and other equipment lined the hallways; double rooms were converted to isolation rooms. Before long, however, 37 of the hospital’s 38 ventilators were in use, and secondary infections from intubations created new problems. To save PPE,^[13] additional walls and doors were installed to close off entire wings, where staff was “locked inside” for twelve hours at a time, without changing their protective gear. Meals for patients on cluster care were delivered at a set time, and a visitor room was converted for material storage.

Bold combinations, occasionally by trial and error,^[14] kept the local survival rate somewhat higher than elsewhere in the region and across the USA.^[15] “Helping patients get over that bump, where their own body can shed the virus and move on,” as John Haacke,^[16] a critical care nurse, summarized, was perhaps all that medical staff could offer. When a Hispanic patient passed away, however, he took the loss “almost personal. He had four or five kids. Until the end, none of them were allowed to visit. For weeks, I was his main contact. I got to know everything about him.”

Unlike other hospitals in this area, UM UCH did not close its doors to COVID-19 patients. It even treated patients from other counties.^[17] On June 30, one COVID-19 patient was discharged – after two months. In July, the University of Maryland Medical Center discharged its 1,000^th COVID-19 patient – after three months. At that time, UM UCH announced a fund for staff facing emergencies such as eviction or bankruptcy due to job loss or medical bills. The impact was so severe that even staffing shortages seemed insurmountable, and in the Unites States not enough was done to prevent that: not until August did the U.S. Food and Drug Administration authorize emergency use of a new saliva-based screening.^[18]

In charge of most COVID-19 measures was Dr. Fermin Barrueto Jr., MD, the UM UCH Senior Vice President and Chief Medical Officer. His father, Dr. Fermin Barrueto Sr., MD, was born in a small mountain town in northern Peru. The son stated:

“It was an isolated town and required a horseback ride to get to the nearest city, Cajamarca. His father was the principal of the high school he went to, and he was able to get a scholarship to go to medical school. He became a physician in Peru but wanted to both provide for a future family and practice medicine in the USA. He and his wife, Rosa, traveled to Brooklyn, NY in 1970 where he was able to secure a residency position in OB/GYN at Brooklyn Jewish Hospital. I was born on December 15, 1970 in Brooklyn, NY.”

Keenly aware of his ethnic roots, Barrueto recalled:

“As a child, I often went to Peru for extended periods. My parents did not have any family in the USA, and my mother longed to be back in Peru. I learned how to speak Spanish from listening to my mother who barely knew English. She often states she learned English from watching soap operas on television. Though I am fluent in Spanish, I have difficulty writing as I did not take many academic Spanish classes.

Peru has a vibrant culture with people who are friendly and have a love of life that makes one envious. It is a third world country with a poor healthcare system, but its cuisine is unique and bursting with flavor, from the ceviche to the arroz con pollo. My favorite times were eating either in restaurants or street food that was cooked on grills (a la parilla).

[In Brooklyn,] I was always different – from my name to skin color. I became a rebellious teenager trying to fit in. I loved working, creating things and playing. Before the age of 14, I had a lawn mowing business and made a FIDO Bulletin Board System (BBS) which was the beginning of the internet bulletin boards. I always loved sciences and won awards for my science projects. However, I was always jealous that my father was so dedicated to the hospital and wasn’t at home as much as I wanted. Despite knowing that my strength was sciences and most of my volunteering was done in a hospital, when I finally got to college, I first tried to major in English and then engineering. It was a biology class that finally showed me my passion and strength. Thus, finally by sophomore year, I chose biology, and I knew I wanted to get into medical school. Unfortunately, with my jumping around between majors and some immaturity, I was unlikely to get into medical school. So, I began my master’s at Pennsylvania State University in biochemistry. When I came across Caribbean medical schools, however, I researched them, and I decided to apply.”

The Medical school at Ross University on Barbados accepted Barrueto. Among its top slogans are “FIND PURPOSE IN PARADISE” and “PEOPLE FIRST. SCIENCE ALWAYS.” The website states, “RUSM strives to educate and empower a truly diverse and dedicated population of students who are determined to make an undeniable impact on the communities they serve.” Barrueto recalled his time there as

“an adventure. Though it may sound glamorous, it was anything but that. The island was poorly developed with one main road that circled the island. It was a wonderful and life altering experience however, as I ate the island food and dedicated myself to the studies. Though I was a good student for most of my career, it was in medical school where I performed the best. I graduated third in my class with one of the highest GPAs and was able to place in the highly competitive emergency medicine specialty at East Carolina University. After finishing my three years of training there, I went to NYU-Bellevue and was accepted into the medical toxicology fellowship, which is nationally renowned. Medical Toxicology became an interest because of my attraction to Biochemistry. I also thought I was going to be solely in academic medicine. My first year there [began in] July 2001.

Prompted as to why he specialized in emergency medicine, Barrueto explained:

“I have been through a major hurricane disaster during medical school, Hurricane Marilyn in September 1995, and during my residency, Hurricane Floyd in September 1999.

My third disaster was the one that impacted my soul. I was at Ground Zero shortly after the North and South Towers of the World Trade Center fell, trying to find survivors. We were pulled away when Tower 7 fell, and I continued the rest of my work in the Emergency Department at Bellevue hospital. The medical examiner’s office was two blocks north of Bellevue. We saw the bodies, and the fence had hundreds of pictures of people trying to find their loved ones. I knew then that I wanted my life to make a difference, and I realized how truly precious life is.

I loved the decisiveness that was required for Emergency Medicine as well as the acuity/stress. When the Emergency Department was the busiest, I was the most at peace. I joined UM School of medicine Department of Emergency Medicine in 2003. Falling in love with the Upper Chesapeake when I arrived in 2007, I was quickly promoted to Chair of Emergency Medicine at UM UCH in 2008.

Though I initially loved educating residents and medical students, there was a larger pull for me in developing a highly efficient/effective Emergency Department so that the nurses and doctors could perform the incredible work they do – saving lives. In 2016, I had the opportunity to become the Chief Medical Officer.

Barrueto then stated that

“US Healthcare has some incredible, admirable strengths. From primary care to specialists, technology enables great advancements to help care for patients, and innovation has created robotic surgical programs. My North Star has been patient safety, quality, and patient experience. Things we need to work on is the diet, nutrition, and overall mental well-being.”

Sugar-coating was not on Barrueto’s menu, and not everybody appreciated what may amount to his most relevant strength, analyzing very ugly data with an indomitable determination to face them head-on. For daily briefings in mid-2020, for example, Barrueto took turns with another physician. After the assistant director of the dietary department listened in over the telephone, he left shell-shocked, exasperatedly announcing in an impromptu kitchen-meeting that Barrueto “just put the facts on the table.”

In public, politics played an ongoing role as well. Holding big rallies and gathering maskless guests at the White House, the President had somehow dodged the virus. On October 1, 2020, when Hope Hicks, one of Trump’s closest advisers, fell ill, monoclonal antibodies were still in clinical trials. Shortly after the Food and Drug Administration (FDA) granted her a “compassionate use” exception, the President was due. Obese and at the age of 74, he “was in the highest-risk category for severe disease from COVID-19,” and received Regeneron’s, known as Regen-Cov.^[19] Returning from Walter Reed Medical Center, he defiantly removed his facial mask but struggled to breathe.^[20] Dr. Sanjay Gupta told CNN, “He is likely expelling virus into the air…This breaks every protocol.”^[21] Triumphantly, Trump urged the public not to be afraid of the virus. That he had access to treatments unavailable to others seemed irrelevant.

Before long, however, vaccines became available. Squalene, used in U.S. flu vaccines since 2016, was deemed safe, and it may have lowered the amount of ingredients needed per person.^[22] At the end of 2020, vaccinations were in short supply, but rational residents experienced the benefits. Various UM UCH nurses signed up for health link, offering staff and selected groups of residents inoculations. After more than 40 years of nursing, RN Patricia Stranger, a native of New Zealand, was one of them. Although partially retired, the lactation consultant began to administer Moderna, Pfizer^[23]or Johnson & Johnson,^[24] whatever was available on any given day. The nicest surprise, she said, was that “nobody complained. Everybody was just happy, excited, glad to get any appointment. And staff was looking out for each other. When one looked tired, another one stepped in to cover breaks. It was a pleasure to work.” After three months, when locations became available, that service was no longer necessary.

Whereas Maryland was “blue,” Harford County remained “red.” At UM UCH, some staff members doggedly chose getting “fired” instead of fully vaccinated. As an alternative, various Republicans promoted ivermectin, a drug primarily used to deworm horses.^[25] On September 6, 2021 Tim Stelloh reported in NBC News that an Ohio “hospital cannot be forced to administer ivermectin,” because evidence showed “is not an effective treatment for COVID-19.” When a caller on the Baltimore radio show “Casey & Company” said he wanted to use it a few times a week to boost his immune system, but his doctor objected, Republican Representative Andy Harris, an anesthesiologist from Maryland’s 1^st District, replied, “You can go all the doctor-shopping you want; I don’t think you’re going to find a pharmacist to fill the prescription. That’s the problem.”^[26] UM UCH stayed away from it, too.

When a Wisconsin pharmacist, who followed conspiracy theories,^[27] spoiled hundreds of COIVD-19 vaccine doses,” a judge sentenced him to three years in prison.^[28] At the UM UCH cafeteria, ardent Trump fans led heated discussions about many news reports like these. Outside, it was not uncommon for groups of heavily armed men to drive by in paramilitary-clad convoys. In an atmosphere like this, even minor gestures of demonstrated inclusion seemed to require some measure of civil courage. Attentive visitors could hear a seemingly unfazed Barrueto talking in Spanish to Alfredo Jimenez, a cook from Mexico. Susan Coyle, a cashier with German ancestors, refused vaccinations and contracted the virus, but she appreciated Barrueto talking sports to Chris Hall, a handicapped man, who had stocked food supplies for many years.

Medical news, good and bad, kept coming. Whereas people with blood type O might be less vulnerable, those with A or AB required longer intensive care.^[29] On January 26, 2021, Peter Weber reported in THE WEEK that Aplidin or Plitidepsin, developed to fight multiple myeloma, “is 27.5 times more effective at treating COVID-19 than remdesivir.”

The exact death toll was shrouded.^[30] Initial data showed a high mortality among those who required mechanical ventilation. Most of the dead were unvaccinated.^[31] Children,^[32] Black, Indigenous and Latinx minorities were particularly affected,^[33] and months after a first bout with Covid-19, many patients were hospitalized again. They developed blood clots or suffered from kidney problems.^[34] UK studies showed that “women in 40s, 50s who survive COVID, [are] more likely to suffer persistent problems.”^[35] Researchers learned about “brain fog,” ranging from difficulty concentrating or short-term memory loss to delirium and psychosis.^[36] Barrueto specified,

“COVID has a lasting impact, and research now shows an increase in cardiovascular effects even one year from the initial infection. There are complications related to pulmonary embolism and deep venous thrombosis. There is also a constellation of symptoms that are varied and continue even 14 days after the initial infection that were termed long COVID or technically – Post-Acute Sequelae of SARS CoV-2 (PASC).”

On June 17, The Washington Post headlined that “The delta variant adds a speed bump to the pandemic escape route.” Hospital costs were not only mind-boggling, but they also depended greatly on the case severity and on a patient’s location.^[37] On August 6, Jonathan Meer headlined in MarketWatch, “Don’t want the COVID-19 vaccine? Then pay the full cost if you land in the hospital.” On August 21, Aria Bendix announced in the BUSINESS INSIDER, that “Large insurers have stopped waiving COVID-19 treatment costs…Those hospitalized with COVID-19 may pay $1,300, on average.”

On average, Maryland was charging the least amount, and Barrueto was relieved that “our staff – though declining – was holding up.” On September 23, however, Senior Vice President and Chief Operating Officer Colin Ward, DrPH, MHS announced,

“Department Leaders [DL] are being asked to participate more directly in the care that we provide every day and support our frontline teams. All DL members …. Will be required to sign up for the Labor Pool totaling 8 hours per month. … anyone signing up for a weekend shift will get double the hourly credit.”

As time passed not only the public attitude toward the virus changed, but Barrueto noted that

“healthcare workers had a schism. They, [too], had moved on, were out in society and carried on with life as normal. But then, they entered the hospital, and it is [sic] a war zone. Some people had retired, others were burned out, angry and yet had to care for the patients who were coming. Healthcare workers and their resiliency were tested. Myself [sic] and the [leading] team were doing all we could to keep our staff motivated. Our UM UCH board members came in to serve food, and they bought lunches for healthcare workers. The broader community did also come to our aid when we communicated our challenges with them. This was heartwarming. We needed the help.”

On December 20, Governor Larry Hogan, a moderate Republican with an active immigrant spouse^[38] tweeted that he had tested positive. Three days later, Maryland reported 6,869 new positive tests, its highest single-day count. At health care facilities staffing become a prevalent problem. On December 24, Paul Schwartzman’s headline in The Washington Post read: “Two Maryland hospitals declare ‘disaster’ as coronavirus cases rise.”^[39]

At UM UCH, where the caseload increased 733%,^[40] Barrueto frankly admitted, “The demand for our services has outstripped our resources, which includes staffing” in the hospitals’ intensive care and emergency departments. He detailed,

“We started to hit our crisis point just as Omicron began to hit us. It caused fewer hospitalizations, but it was so infectious that the spike up in hospitalizations was unprecedented. Over two times our highest surge, we had [simultaneously] over 150 COVID patients in U[M U]CH with Omicron.

We had to adopt crisis standards of care that would allow unconventional staffing models, cancellation of elective surgeries and pushing for alternative care models like discharging earlier with telemedicine/home health follow up.”

When staff shortages, brought on by some too sick to work and others walking out in protest over enforced vaccinations, brought this hospital to the brink of collapse, desperate measures aimed at bridging gaps. To boost morale and to cover at least some unfilled shifts in departments with particularly crass gaps, Ginal Shah from India, the newly appointed Director of Planning and Business Development, now alternated between serving pizza and tacos in the cafeteria. Energetic Barrueto was also taking on the role of a phlebotomist. Piling laundry into towering, movable wire shelves, heating blankets for patients and relentlessly removing a wide variety of trash from the Emergency Department was Senior Vice President and Chief Operating Officer Colin Ward, DrPH, MHS.

On a Saturday evening, shortly before seven PM, a small group of visibly exasperated critical care nurses gathered in front of IMC Room 240 where Barrueto arrived in scrubs. One or two minutes later, Ward frantically entered ICU in “leisure” clothes, clearly not anticipating this trip. He asked for Barrueto, who he said had requested his assistance.

Until then, hardly anybody would ever have envisioned senior leadership taking action like that. Prompted on what he thought of Barrueto, Ward acknowledged,

“Dr. Barrueto is the embodiment of the Upper Chesapeake culture. He always advocates for the highest quality care for patients and supports our team. Throughout the pandemic, Dr. Barrueto was faced with tough decisions as volumes increased, resources dwindled, and the scientific evidence changed. He guided our team and the community through the Covid response through his collaboration, and teamwork and leadership.”

As if that would not keep Barrueto sufficiently occupied, he also served as Medical Director of the Comprehensive Care Center, a group practice in the adjacent Pavilion II.

Political agendas remained a problem. One day after Democratic and GOP bargainers agreed to provide $10 billion for treatments, vaccines, and testing, a Democratic move to push the measure passed a procedural hurdle failed.^[41] Whereas essential workers “bore the brunt of deaths during the pandemic’s first year,”^[42] now it was increasingly “the elderly and immunocompromised.”^[43] In May 2022, the United States reported more than one million deaths.^[44] Among the survivors, POTS^[45] and the risk of long-term brain injury was on the rise.^[46] Others miraculously managed to dodge COVID.^[47] After 1,124 days, the national emergency proclaimed by President Trump on March 13, 2020 expired.^[48]

Looking back at two years of the pandemic in March 2022, however, Barrueto pointed out that

“Our Governor did an admirable job, followed the science and supported our healthcare. In general, 70% of our patients who were admitted were either unvaccinated or partially vaccinated. 30% were fully vaccinated.

UM UCH was the first to [offer] testing for the community. We were the most active monoclonal antibody infusion site outside of the Baltimore Convention Center, and we saw the highest number of COVID patients in the hospital through the omicron surge.

I have treated hundreds of COVID patients. I took care of them in the hospital but saw the majority in the Comprehensive Care Center where we created a COVID clinic. I cared for those who were hospitalized or who recently contracted COVID, trying to keep them out of the hospital. I also saw many COVID patients when we had our monoclonal antibody clinic.

My prior experience from 9/11 helped me manage incident command^[49] with calm. I have been there before, regarding the fear and nervousness of a disaster. What no one would know is how long this would last, and it was that grind that tested everyone including myself.”

RN Heather Beauchamp, whose ancestors lived in Sweden and Finland, focused on team coordination. Leading nurses and providers to improve patient services in Emergency and Critical Care, she said, “it was a pleasure working with him.”

Jason M. Birnbaum, chairman of the department of medicine, and Medical Director of the ICU, who also served on the hospital’s Board of Directors, summarized, “A steadfast leader through chaos. Level-headed and sympathetic voice of reason during a very challenging time.”

 

Collage in a COVID cohort unit featuring Drs. Barrueto and Birnbaum

 

Barrueto’s most pleasant surprise was “how we came together as an UMMS system, and how other hospitals helped and supported us.” His harshest disappointment was “how political things like masks and vaccines became.” The greatest success was “the lives we saved, the many firsts and high achieving initiatives like testing, vaccinations, monoclonal antibodies. Keeping our team members safe.” The steepest loss was “losing a team member to COVID and another who did not die but was disabled due to severe disease and left healthcare.”

When asked what he would do differently in hindsight, a pensive Barrueto stated,

“I gave everything I had, to the team, the hospital and my community. In doing so, there was a sacrifice of my family and a certain detachment that occurred. Thankfully, they understood but I would have worked harder to connect during this prolonged crisis.”

^[1] Murphy, Brett and Stein, Letitia. “‘It is a slaughter’: Public health champion asks CDC director to expose White House, orchestrate his own firing.” In: USA TODAY, October 7, 2020.

^[2] Azad, Arman. “WHO and CDC never discussed providing international test kits to the US, global health agency says” CNN health on March 18, 2020.

^[3] By comparison, on April 2, 2020, Tim Loh and Naomi Kresge reported for Bloomberg that “Private Labs Helped Germany Test 1 Million For Covid-19 Virus,” and that this nation had “one of the continent’s highest rates of hospital beds in relation to population size.”

^[4] As that patient’s condition began to improve, she was taken off a ventilator. Translators were coming and going, her meals were served on disposable trays, and after approximately three weeks, the woman was discharged.

^[5] “Here are the known cases of coronavirus in Maryland.” In: The BALTIMORE SUN, April 24, 2020.

^[6] “Bayer Partners with U.S. Government on Major Product Donation to Fight Coronavirus.” In: businesswire, March 19, 2020.

^[7] Rosmus, Anna. “(Hydroxy)Chloroquine: From Himmler’s Poison to Trump’s Miracle Cure.” In: Glossen, 2020.

[8] Gilead, the manufacturer, announced in June 2020 that it will charge more than $2,000 per person for a typical treatment.

^[9] According to the manufacturer, “Increases in the amount of liver enzymes are common in people who have received VEKLURY and may be a sign of liver injury.” January 9, 2023.

^[10] Edwards, Erika. “Multiple sclerosis drug to be studied for COVID-19 treatment.” In: NBC News, August 6, 2020.

^[11] “Antikörper bieten vermutlich längerfristig Corona-Immunität.” In: Passauer Neue Presse, 21. Juli 2020.

^[12] Prompted, why he became a nurse, Russell mentioned several very sick relatives. “Growing up I questioned everything, and I figured that this is what god wanted me to do. I compared religions, and I found Christianity to be the most true.”

^[13] UMMS Unified Command helped with system policies, infection prevention practices and supply chain assurances.

^[14] WHITLOW, JAMES. “We all have fears and anxieties’: Doctors, nurses in Bel Air face threats on front line of coronavirus fight.” in: THE AEGIS, MAY 15, 2020.

^[15] Knapton, Sarah. “Almost a third of recovered Covid patients return to hospital in five months and one in eight die.” In: The Telegraph January 17, 2021.

^[16] Haacke was studying bass at the Peabody Institute of The Johns Hopkins University, when his mother fell ill. To take care of her, he dropped out. Picking up where he left off was not possible. Nursing, however, “was an accessible option,” he explained in the fall of 2021.

^[17] In March 2022, Barrueto specified, “UM UCH, in the first few surges, accepted COVID patients from around the state/UMMS to help. We saw patients from Capital Region and Shore Health to freestanding medical facilities like Queen Anne’s and Bowie.”

^[18] Pezenik, Sasha, Flaherty, Anne and Mosk, Matthew. “FDA authorizes faster, cheaper COVID test in push to pioneer progress.” In: abc news August 15, 2020.

^[19] Paletta, Damian and Abutaleb, Yasmeen: “Inside the extraordinary effort to save Trump from covid-19.” In: The Washington Post June 24, 2021.

^[20] Krawczyk, Kathryn. “Trump still seemingly struggling to breathe after hospital return, White House aides say.” In: theweek.com October 7, 2020.

^[21] “President Trump Appears Winded After Climbing White House Steps.” In: Inside Edition October 6, 2020.

^[22] Camero, Katie. “500,000 sharks may have to die in the fight against COVID-19.” In: Miami Herald September 28, 2020.

^[23] “BioNTech says [it] has supplied over 1 bln vaccines.” In: Reuters August 9, 2021.

^[24] According to federal data people who received the Johnson & Johnson vaccine were less protected than those with Pfizer-BioNTech and Moderna shots. Sun, Lena H. “If you got J&J vaccine, consider two mRNA booster shots, CDC data suggest.” In: The Washington Post March 29, 2022.

^[25] Merck, the manufacturer, stated there is no indication it is safe or effective against COVID-19. The Food and Drug Administration did not approve it for COVID-19 and has warned people to avoid it.

^[26] “Maryland Congressman Says He Prescribes Ivermectin For COVID.” In: CBS Baltimore October 20, 2021.

^[27] Haroun, Azmi. “Wisconsin pharmacist who health care center said ‘intentionally’ removed 57 coronavirus vaccine vials is a conspiracy theorist, according to new court documents.” In: Business Insider January 5, 2021.

^[28] Li, David K. nbc news June 8, 2021.

^[29] Schladebeck, Jessica. “Blood type could be linked to severity of coronavirus infections, new studies say.” In: New York Daily News October 15, 2020.

^[30] On August 4, 2021, for example, The Washington Post headlined an Andrew Jeong article, “Missouri county coroner removed covid from death certificates to ‘please’ grieving families.”

^[31] A Connor Perrett article, for instance, was headlined, “Just 26 of the 11,600 people who have died of COVID-19 in Alabama were vaccinated, official says.” In: Business Insider August 7, 2021.

^[32] Belluck, Pam. “COVID-Linked Syndrome in Children Is Growing and Cases Are More Severe.” In: The New York Times February 16, 2021.

^[33] “Dr. Fauci on why coronavirus is wreaking havoc on Black communities.” In: CBS News July 30, 2020.

^[34] Lapid, Nancy from Reuters reported, on March 12, 2021, that “sudden kidney problems” from severe COVID-19 actually “appear to be worse, and longer-lasting, than kidney problems that develop in other seriously ill patients.”

^[35] Kelland, Kate. Reuters March 24, 2021.

^[36] MALIM, NASIR. “Scientists inch closer to explaining the mysterious ‘brain fog’ symptom of COVID-19.” in: abc news March 3, 2021.

^[37] Hardy, Adam: “Average Costs for a COVID-19 Hospital Stay Top $400,000 in Some States: Study.” In: Money October 21, 2021.

^[38] Kate Bennett and Betsy Klein, “Maryland’s first lady capitalizes on her South Korean heritage to secure test kits” in: CNN, July 16, 2020.

^[39] That status change allowed UM UCH to modify surgical schedules and redeploy staff.

^[40] See UM UCH press release from Dec. 24, 2021. When compared to other UMMS hospitals, statistics show that COVID hit UM UCH disproportionately hard. Aside from Harford County being “red,” which may have contributed to higher case rates and more admissions, a confounding factor was that it had no other hospitals.

^[41] FRAM, ALAN. “GOP blocks Senate COVID bill, demands votes on immigration” In: Associated Press April 6, 2022.

^[42] Daniel Chang, “Most people who died of COVID in 2020 had something essential in common, study finds,” in: Miami Herald, June 4, 2022.

^[43] Fenit Nirappil and Dan Keating: “Covid deaths no longer overwhelmingly among unvaccinated as toll on elderly grows,”in: The Washington Post, April 29, 2022.

^[44] McPhillips, Deidre. “More than 1 million people have died of Covid-19 in the US,” CNN May 17, 2022.

^[45] Amanda Morris, “A condition called POTS rose after covid, but patients can’t find care,” in: The Washington Post , February 27, 2023.

^[46] Julie Steenhuysen, “COVID raises risk of long-term brain injury, large U.S. study finds,” in: Reuters, September 22, 2022.

^[47] Erika Edwards, “What people with ‘super immunity’ can teach us about Covid and other viruses,” in: NBC News, March 11, 2023.

^[48] Alexander Nazaryan, Senior White House Correspondent, “Is the COVID pandemic really over?”, in: yahoo!news, April 11, 2023

^[49] “Incident Command,ˮ Barrueto explained in March 2022, “implemented a multitude of changes to the hospital – from the negative pressure machines and extension tubing for IV fluids to cohort areas for COVID patients.”