‘More Kids Will Die’: Measles Are on the Rise — and Doctors Say There’s No End in Sight

Richard Eby knew things were getting bad when the schools shut down.

Eby is a family medicine doctor based in Andrews, in West Texas. It’s a quiet town of 14,000, chock full of all-American touches — a Buffalo Wild Wings sits a few doors down from La Hacienda, a bottomless Mexican buffet with neon cacti on its facade and brightly colored papel picado strung across its interior.

Like many other towns nestled in Texas’ Permian Basin — of Friday Night Lights fame — it is also unapologetically high-school-football-crazy: Andrews High School’s astroturfed Mustang Bowl, capacity 8,000, sits at the northwestern border of Mustang Drive, which forms a necklace around town. (The Mustangs, who have a long legacy of district championships tracing back to 1953, went 5-7 last year — though they refused to go down without notching three blowout wins against district rivals.)

Come last January, there were new whispers around town. Eby had heard from colleagues that measles was circulating in Gaines County, 30 miles north. And by the end of the month, he’d seen a few cases himself.

That was, in some respects, to be expected. After a 2019 outbreak in West Texas, a couple more confirmed cases in the South in 2023, and given that neighboring counties’ school districts have some of the highest vaccine exemption rates in the state —13 times the national average — Eby has gotten used to keeping the potentially life-threatening virus on his radar.

“It’s always at the back of your mind,” he says.

But it wasn’t until some local schools started shutting down in the ensuing weeks that Eby realized how bad this outbreak could get. Something felt off to the pediatrician — he says that, at the time, he recalls the official case count being a dozen. “That just tells you how far undercounted the cases were,” Eby says.

In the months that followed, more than 750 measles cases were diagnosed — 414 in Gaines County alone. Ninety-nine patients were hospitalized for severe symptoms such as inability to breathe and inflammation in the brain. Two otherwise healthy, stone-cold-normal children died.

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To pediatricians like Eby, the outbreaks meant every typically innocuous symptom in clinic — every cough or sniffle, every hive or wheal or welt — put him and his staff on high alert. That’s because measles can start as just a stuffy nose and a red dot on the abdomen, but the illness rapidly evolves into whole-body bumps and blisters accompanied by difficulty breathing. In severe cases, it produces a child so sleepy they can’t be woken up, or seizures that won’t stop, because of swelling in the brain. And it can all happen within days of the itch starting.

So, Eby hasn’t been taking chances. “All of a sudden, a same-day appointment that’s on the schedule as a cough and rash,” he says, “you need to ask, ‘Did anyone clarify?’”

That style of medicine — the kind where a previously largely-forgotten foe was now lurking in the community, in the waiting room, and in doctors’ minds — also felt a bit like a step back in time, Eby says. At various points during the outbreak, he found himself thinking, “Is every kid going to have measles for the next couple weeks?”

That style of medicine is also becoming the norm, and not just in Texas. Even as attention has turned elsewhere — shutdowns, boat strikes, Epstein — the measles outbreak continues to rage throughout the country.

As of Dec. 2, almost 2,000 cases have been confirmed across 43 states. (The Centers for Disease Control is not publicly sharing the number of so-called probable cases — ones that were not tested. During previous international outbreaks, between 10 percent and 70 percent of cases were not tested.) That number is the highest in the United States since 1992. And after a summer lull, cases are climbing again: The week before Thanksgiving, the number of cases was the highest since May.

Code Lavender

Somewhere in Lubbock, Texas, stashed away in the corner of a hospital closet, there’s a cart stocked to the teeth with lavender-scented products. There are rollerballs and brushes. There are sachets and steamers. There are lavender-colored journals and pens, too.

The cart — and the team of counselors, chaplains, peer coaches, and therapy dogs that accompany it — was borne out of necessity during the Covid pandemic, says Shannon Bates, chief nursing officer at Covenant Children’s Hospital. The goal, she says, was to use aromatherapy, reflection, dialogue, and community to combat the “secondary trauma response” associated with death after death from that virus.

For a while after the height of the pandemic, the cart got less mileage. But during the measles outbreak, the Covenant team has been pulling it out again. That’s partially because, in some ways, the script has flipped on clinical staff. With the unavoidable, politically charged conversations around vaccines that accompany the outbreak, “it’s kind of the opposite of Covid, where everyone was the health-care hero,” Bates says. “Now, you’re seen as the bad guy, the one who can’t be trusted.”

It’s also because, in addition to staff enduring rhetoric around health workers that’s ranged from distrust to resentment, they’ve witnessed firsthand just how harmful the measles outbreak can be. In February, a six-year-old girl died after being admitted to Covenant — the nation’s first death from the outbreak. That “definitely has taken a toll on staff,” Bates says. Since then, she adds, “we have done some proactive rounding.” In other words, rather than waiting for someone to ask for a rollerball or a sachet, they’ve taken to roaming the halls with the cart, the chaplains, and the puppies.

Summer Davies also recalls the start of the outbreak, when the first call came in. It was the early afternoon, just after the team finished rounding. Davies, a pediatrician and associate professor at Texas Tech University, was patched through to a doctor who told her the child had a fever, and a rash, and needed to be admitted precautionarily. “I remember thinking at the time, ‘I don’t know, maybe it’s not measles,’” Davies says. That changed within moments of seeing just how sick the child was.

Davies was there when the six-year-old died, too — an experience she calls “devastating.” The death stuck with her: Long after it happened, she and her colleagues wondered, “Could we have done something different to help that child?”

Last spring, Health and Human Services Secretary Robert F. Kennedy Jr.’s Make America Healthy Again Commission recommended reassessing the nation’s childhood vaccine schedule.

Chip Somodevilla/Getty Images

Amid the circumstances, Davies says her hospital, as well as the county and state public health departments, was incredibly supportive. “We have had people…advocating for us, taking all of the right steps, making sure we’re safe and that patients are safe,” she says.

Off the wards, though, things were harder.

As the outbreak raged, federal agencies ignored pleas for help from Texas officials. “My staff feels like we are out here all alone,” Katherine Wells, the public health director in Lubbock, wrote in emails obtained by KFF Health News just days after children with measles started getting hospitalized. “We weren’t allowed to do anything,” a CDC official told KFF Health News. It took weeks until any agency officials dispatched to Texas — at which point HHS pressured them to highlight Vitamin A, rather than vaccines, as a solution to the outbreak. (In multiple interviews since January, Secretary Kennedy has claimed that Vitamin A can reduce measles deaths. Studies have consistently found that the salve demonstrates no effect in the greater than 99 percent of Americans who have adequate levels of the vitamin.)

“As a health-care professional, that’s scary to hear,” Davies says of being all but abandoned by the federal government. “[But] it makes a big difference to feel supported by your hospital system,” she adds, “to know that they’re in our corner, if nobody else is.”

Then there are the anti-vax politics — including baseless allegations made by Robert Malone, a pathologist turned biotechnology executive, on his personal Substack. Malone’s influencer era kicked off in part thanks to a 2021 Joe Rogan interview in which he claimed, without evidence, that antacids cured his case of Covid and that the vaccine could cause narcolepsy. When it came to measles, he claimed that the two deaths from measles were the hospitals’ fault, the result of “medical mismanagement” rather than anything to do with vaccination. Those allegations were never refuted by the administration. And two months after they were posted, Secretary Kennedy appointed Malone as vice chair of the CDC vaccine advisory committee. “It’s impossible not to read some of those comments,” Davies says. Since then, though, she’s tried to stop reading the news.

Despite it all, Davies and her colleagues have pressed on. “We’ve really had tunnel vision: Let’s take care of our patients and do our job, boots on the ground,” she says. And on Aug. 18, the Texas outbreak was declared over.

While that means Covenant’s staff can breathe a little easier — for now — in hindsight, Davies says, “it makes it even harder to know [that] this could have been prevented.”

Likewise, her experience has made her fear for colleagues across the country. “With the nature of the disease and the high mortality rate from it,” Davies says, “more kids will die.”

‘Purposeful chaos’

Across the country, Davies’ compatriots are steeling themselves.

To Dana Hawkinson, an infectious disease specialist at University of Kansas Medical Center, every child with a cough is “very high stakes” right now. “It’s only a matter of time” until an outbreak happens in his state, too, Hawkinson says.

To Alexandra Cvijanovich, pediatrician at Presbyterian Medical Group in Albuquerque, New Mexico, in today’s environment, “well child checks aren’t always well child checks.” Cvijanovich isn’t leaving any stones unturned: “I always worry: When am I going to have a child in my waiting room who has measles?” she says. The level of vigilance is in part from a deadly measles case she saw during residency that she described as “the worst death of my pediatric career.” The current outbreak, Cvijanovich says, “has brought back all those memories.”

And to Douglas Fleck, pediatrician and medical director of quality at University Hospital Rainbow Babies & Children’s in Ashtabula, Ohio, even figuring out where to put sick patients is “straight-up a challenge.” Fleck doesn’t want to put them in the waiting room because “we take an oath to do no harm,” he says. But he also doesn’t want to turn them away, since that could lead patients who already distrust the health-care system to become even more entrenched. As a result, “we’re dusting off the Covid playbook,” Fleck says — doing as much as they can by telehealth, triaging patients in the parking lot, and so on.

Try as they may, all three doctors know their clinics may need help should things get out of hand. But ever since the first days of Trump’s second term, whether counties and states will have the resources to do so remains an open question.

One of the earliest threats came on March 24, when HHS summarily terminated $11 billion in funding to states under the premise that those dollars, initially granted during Covid, were “no longer necessary…now that the pandemic is over,” according to a notice issued by the agency. That “immediately triggered chaos for State and local health jurisdictions,” according to an April 1 lawsuit brought by nearly two dozen states against HHS and RFK Jr. In May, a district court judge ruled in favor of the states; by July, HHS had appealed that ruling. As of this writing , the case continues to snake its way through the courts.

According to Sameer Vohra, pediatrician and director of the Illinois Department of Health, HHS’ logic is nonsensical. All the public health measures required to combat Covid — promoting vaccination, purchasing essential equipment, expanding labs, conducting contact tracing, assisting localities during outbreaks — serve as “infrastructure to allow us to be prepared for future emergencies as well,” Vohra says. His state saw nearly $500 million disappear overnight, $125 million of which had already been allocated. “This will have a debilitating impact,” Vohra says , should the federal government win its appeal.

In New York, commissioner McDonald is reckoning with similar whiplash. In the immediate aftermath of the clawback, they laid off the majority of contract employees needed to support the department’s efforts. Other states, like Utah and Maine, likewise were forced to fire dozens of employees — further intensifying public health workforce shortages that the federal Government Accountability Office, in January , described as so severe as to threaten the nation’s ability to “conduct key public health functions…[and]respond to emergencies.”

“Nationally, public health is really being threatened,” McDonald says.

Simultaneously, at the federal level, HHS — the backstop for states in situations of crisis — is roiling.

In late March, HHS slashed over 10,000 jobs, closed half its regional offices, and shuttered entire divisions, like those responsible for ensuring workplace safety standards, monitoring levels of environmental toxins, and supporting children with birth defects. National databases upon which public health departments, researchers, and clinicians depend are also fading to black as the data collectors are fired. Some of the gold-standard labs responsible for performing testing on illnesses like measles were shuttered, smack in the middle of the measles outbreak. And the disease detectives responsible for on-the-ground response in places like Texas were gutted, too. Which is perhaps in part why Katherine Wells, the public health director in Lubbock, heard crickets in response to her pleas for help in February.

“It is unheard of that, in an active outbreak, [CDC] just says, ‘No…we’re not going to send people,’” Demetre Daskalakis, physician and former director of the CDC’s National Center for Immunization and Respiratory Diseases, says. “[But] I don’t know who’s left.”

“[They] are paralyzing the organization,” Daskalakis adds in reference to the federal government’s actions. “It is purposeful chaos.”

For doctors like Fleck in Ashtabula, it’s hard not to notice all of this — or, what it means about how the administration sees public health.

“It’s hard to feel we’re being supported,” Fleck says. “Actions speak louder than words…and I think there are a lot of actions that they’re taking that raise a red flag.”

Still, Fleck will keep seeing the kids with the fevers, the coughs, the rashes. He’ll keep juggling the safety of that child with the others in the waiting room. And, even as it seems the scales are increasingly tilted against him, he’ll keep doing what he does. Because, for kids’ sake, there’s no other choice.

“Day by day,” Fleck says, “patient by patient.”