In the early evening of March 7, 2020, I was on my cellphone in an airport terminal, telling a friend that I was afraid to write an article that risked ruining my journalistic reputation. I had been speaking with the small but close-knit aerobiologist community about the possibility that the new coronavirus could travel easily from person to person through the air—not just through large droplets that reach only a short distance from an infected person or through handshakes. The scientists had stressed that the idea of airborne transmission of the new virus was still mostly theoretical, but they’d seemed pretty concerned.

When my story came out the following week, it was, to my knowledge, the first article by a journalist to make the case that the virus causing COVID-19 might travel efficiently through the air, and could potentially cover many meters in a gaseous cloud emitted with a cough or a sneeze. To avoid stoking undue worry, I had argued against calling the virus “airborne” in the headline, which ran as “They Say Coronavirus Isn’t Airborne—But It’s Definitely Borne by Air.” That idea was not immediately accepted: Two weeks later, the World Health Organization tweeted, “FACT: #COVID19 is NOT airborne.” As the pandemic unfolded, though, it became clear that the coronavirus did indeed spread through airborne transmission—even if the WHO took more than a year and a half to officially describe the coronavirus as a long-range airborne pathogen.

By then, amid the loud debate over mask mandates, vaccine boosters, and individuals’ responsibility for the health of others, a parallel debate had emerged over ventilation. Wearing an N95 or receiving a third COVID shot were ultimately individual choices, but breathing safer air in indoor spaces required buy-in from bigger players such as education departments and transit agencies. Some advocates held up clean air as a kind of public good—one worth investing in for shared safety. If it had succeeded, this way of thinking would have represented one of the most lasting paths for governments to decrease people’s risks from COVID and from airborne diseases more generally.

In the United States, the federal government regulates the quality of air outdoors, but it has relatively little oversight of indoor air. State and local jurisdictions pick up some of the slack, but this creates a patchwork of rules about indoor air. Local investment in better air-quality infrastructure varies widely too. For example, a 2022 survey of COVID-ventilation measures in U.S. public-school districts found that only about a quarter of them used or planned to use HEPA filters, which have a dense mesh for trapping particles, for indoor air. An even smaller fraction—about 8 percent—had installed air-cleansing systems that incorporated ultraviolet light, which can kill germs.

For decades, experts have pushed the idea that the government should pay more attention to the quality of indoor air. In his new book, Air-Borne: The Hidden History of the Life We Breathe, the journalist Carl Zimmer shows the long arc of this argument. He notes that Richard Riley, a giant in the field of aerobiology who helped show that tuberculosis can be airborne, believed that individuals shouldn’t have to ensure that the air they breathe is clean. Just as the government regulates the safety of the water that flows into indoor pipes, it should oversee the safety of air in indoor public spaces.

More than half a century before the coronavirus pandemic, Riley positioned this idea as an alternative to requirements for widespread masking, which, he said, call for “a kind of benevolent despotism,” Zimmer reports. If cleaner air was the one of the best ways to reduce the societal burden of disease, then the two best ways to achieve it were to push people to wear masks in any public space or to install better ventilation. The latter approach—purifying the air—would mean that “the individual would be relieved of direct responsibility,” Riley reasoned in a 1961 book he co-authored: “This is preventive medicine at its best, but it can only be bought at the price of civic responsibility and vigilance.”

Medical breakthroughs in the years that followed may have deflated enthusiasm for this idea. Zimmer writes that the huge advances in vaccines during the 1960s made the world less interested in the details of airborne-disease transmission. Thanks to new vaccines, doctors had a way to prevent measles, the WHO launched a campaign to eradicate smallpox, and polio seemed on its way out. On top of that, researchers had come up with an arsenal of lifesaving antibiotics and antivirals. How viruses reached us mattered less when our defenses against them were so strong.

In the first year or so of the coronavirus pandemic, though, one of the only defenses against COVID was avoiding it. And as a debate raged over how well the virus spread in air, the science of aerobiology was thrust into the spotlight. Some members of the public started fighting for good ventilation. A grassroots effort emerged to put homemade air purifiers and portable HEPA filters in public places. Teachers opened classroom windows when they learned that their schools lacked proper ventilation, travelers started carrying carbon-monoxide monitors to gauge the air quality aboard planes, and restaurants began offering outdoor dining after diagrams were published showing how easily one person eating inside can expose those seated nearby to the virus.

The federal government did take some small steps toward encouraging better ventilation. In mid-2023, the CDC put out new recommendations urging five air changes an hour (essentially replacing all of the air within a room) in all buildings. But it was a recommendation, not a requirement, and local governments and owners of public buildings have been slow to take on the burden of installing or overhauling their ventilation systems. Part of this was surely because of the daunting price tag: In 2020, the Government Accountability Office estimated that approximately 36,000 school buildings had substandard systems for heating, ventilation, and cooling; the estimated cost for upgrading the systems and ensuring safe air quality in all of the country’s schools, some experts calculated, would be about $72 billion. Portable HEPA filters, meanwhile, can be noisy and require space, making them less-than-ideal long-term solutions.

For the most part, momentum for better indoor air quality has dissipated, just as interest in it faded in the 1960s. Five years after COVID-19 precipitated lockdowns in the U.S., the rate of hospitalizations and mortality from the disease are a fraction of what they once were, and public discussion about ventilation has waned. Truly improving indoor air quality on a societal scale would be a long-term investment (and one that the Trump administration seems very unlikely to take on, given that it is slashing other environmental-safety protections). But better ventilation would also limit the cost of diseases other than COVID. Tuberculosis is airborne, and measles is frighteningly good at spreading this way. There is also evidence for airborne dissemination of a range of common pathogens such as influenza, which in the U.S. led to an estimated 28,000 deaths in the 2023–24 flu season. The same holds true for RSV, or respiratory syncytial virus, which each year causes 58,000 to 80,000 hospitalizations of children under age 5 in the United States, and kills as many as 300 of them. Virologists are also now asking whether bird flu could evolve to efficiently transmit through air, too.

For those of us still concerned about airborne diseases, it feels as though little has changed. We’re right where we were at the start of the pandemic. I remember that moment in the airport and how I’d later worried about stoking panic in part because, during my flight, I was the only person wearing an N95—one that I had purchased months ago to wear in the dusty crawl space beneath my home. On the plane, I felt like a weirdo. These days, I am, once again, almost always the lone masker when I take public transportation. Sometimes I feel ridiculous. But just the other week, while I was seated on the metro, a woman coughed on my head. At that moment, I was glad to have a mask on. But I would have been even more relieved if the enclosed space of the metro car had been designed to cleanse the air of whatever she might have released and keep it from reaching me.

Photographs by Jake Dockins

Peter greeted me in the mostly empty gravel parking lot of a Mennonite church on the outskirts of Seminole, a small city in West Texas surrounded by cotton and peanut fields. The brick building was tucked in a cobbled-together neighborhood of scrapyards, metal barns, and modest homes with long dirt driveways. No sign out front advertised its name; no message board displayed a Bible verse. No cross, no steeple—nothing, in fact, that would let a passerby know they had stumbled on a place of worship. When my car pulled up, Peter emerged to find out who I was.

He hadn’t been expecting a stranger with a notepad, but he listened as I explained that I had come to town to write about the measles outbreak, which had by that point sent 20 people from the area to the hospital and caused the death of an unnamed child, the disease’s first victim in the United States in a decade.

Of course Peter knew why Seminole was in the news. He had heard that President Trump was asked about the outbreak here during a Cabinet meeting, and he told me that he didn’t like the attention. The Mennonites were being unjustly singled out. It wasn’t like they were the only ones who came down with measles. The coverage, he insisted, was “100 percent unfair.” He didn’t think it was just the Seminole area that had problems; he said that he had family in Canada and Mexico who had also gotten measles recently. I told him I’d heard that the child who’d passed away might have come from his congregation. He said that was true.

Peter dug the toe of his boot into the gravel. I asked him if he knew the family. His voice broke slightly as he answered. “That’s our kid,” he said.

Photograph by Jake Dockins

The first case in the West Texas outbreak was announced on January 29. The official tally in the region grew to six over the next week. By Valentine’s Day, it was up to 48. On February 26, news went out that a child had died; by that point, 124 cases had been confirmed across nine counties, making the outbreak the largest that the state had seen in 30 years. The official count now stands at just about 200, and another person who was diagnosed with measles just died across the border in New Mexico.

An outbreak—even one this big—should not have come as a surprise. Vaccination rates have dipped in many states, including Texas, since the start of the coronavirus pandemic. In Gaines County, where Seminole is located, the measles-vaccination rate among kindergartners is just 82 percent, well short of the estimated 95 percent threshold for maintaining herd immunity. Even that alarming figure would appear to undersell the local problem. Many children from the county’s Mennonite community, which numbers in the thousands, are unvaccinated, but they won’t get picked up in state tallies, because they are either homeschooled or enrolled in nonaccredited private schools, which are not required to collect such data.

Photograph by Jake Dockins

Even in the midst of a measles crisis, persuading parents in rural West Texas to vaccinate their children, or just to get tested for the virus, is an uphill battle. Zach Holbrooks, the executive director of the South Plains Public Health District, told me that he’s spent the past month trying to get the word out, particularly to the Low German–speaking Mennonite community. He asked three local churches if he could set up a mobile testing site on their property. They all refused. “I think there’s some sentiment that they’re being targeted,” he said, “and I don’t like the fact that they feel that way.” His team did create a drive-up testing site at a county events building next to the city park, and not far from the Masonic lodge. But he said that it gets very few visitors—about two or three a day. As a result, no one really knows the outbreak’s total size.

[Read: America is botching measles]

Help from the federal government has been slow to arrive. Weeks into the outbreak, the Department of Health and Human Services directed 2,000 doses of vaccine to be sent to Texas. But Robert F. Kennedy Jr., the newly confirmed HHS secretary, initially reacted to the outbreak by claiming that it was “not unusual.” Since then, he has repeatedly reminded the public that the decision to be immunized is a personal one, even while acknowledging that vaccines “not only protect individual children from measles, but also contribute to community immunity.” He has also claimed that good nutrition might be sufficient to protect people from the worst effects of measles. “If you are healthy, it’s almost impossible for you to be killed by an infectious disease in modern times,” Kennedy falsely told Fox News’s Marc Siegel in an interview last week. He’d had “a very, very emotional and long conversation” with the family of the child who had died, he said; and later added that “malnutrition may have been an issue in her death.” Local health officials told The New York Times that the child who died had “no known underlying conditions.” A spokesman for HHS declined to comment.

There are a half dozen Mennonite congregations in Seminole, according to Google Maps. Peter’s church isn’t listed among them. Aside from a nonprofit filing, it does not appear to have any online presence. I knew of its existence only because I’d met a Mennonite man from another congregation at a coffee shop that morning and asked whether he knew the family of the child that had died. He said he’d heard they were from this church. When I asked him where it was, he responded with a word in Low German. That turned out to be a nickname for a neighborhood a little ways outside of town. After circling county roads for a while, passing a mix of homes, horses, and farm equipment, I stopped and asked for help from a group of boys playing in a field with rocks and sticks. They pointed in unison. The church was just half a mile up the road.

That’s where I encountered Peter, a wiry 28-year-old man with an angular face who wore a dark-colored, Western-style shirt and jeans. His English was uncertain, and he spoke with a light German accent. Sometimes he responded to my questions with silence.

He declined to reveal his daughter’s name or the family’s last name. Peter was perplexed by the national news coverage, and he did not seem eager to draw more attention to his family and community. He gave only his daughter’s age: She was 6 years old. When I asked him to describe her in more detail, he waved his hand, said she liked what other kids liked. But as we stood in the parking lot, he told me the story of what happened.

Peter’s daughter had been sick for three weeks. The family knew it was measles. He said they took her to the hospital at one point, and she was given cough medicine. “That’s it,” he recalled. “They just say, ‘Go home.’ They don’t want to help us. They say, ‘It’s just normal; go home.’” (A spokeswoman for the Seminole Hospital District declined to comment, citing privacy laws.)

Photograph by Jake Dockins

It wasn’t normal, though. Her condition continued to deteriorate, so they brought her back to the doctors. “She just kept getting sicker and sicker,” he told me. “Her lungs plugged up.” Her heart rate and blood pressure dropped, and the doctors put her on a ventilator. “We were there Saturday ’til Monday, three days … and then it was worse, very bad.” Peter shook his head and stared at the ground. He said his daughter died on Tuesday night from pneumonia, which is a common infection in severe measles cases.

Peter’s daughter was not vaccinated. Mennonite doctrine does not prohibit inoculations or modern medicine in general, though I encountered plenty of suspicion among Mennonites I spoke with in Seminole. I met a father who said that he wanted to vaccinate his two daughters but that their mother didn’t think it was a good idea. A grandmother told me she knew of several children who had been given the measles vaccine and were “never the same after that.” A man who'd spent his career installing irrigation equipment said he was suspicious of vaccines in part because he believed that the government had lied about the origins of COVID.

Peter said that he has doubts about vaccines too. He told me that he considers getting measles a normal part of life, noting that his parents and grandparents had it. “Everybody has it,” he told me. “It’s not so new for us.” He’d also heard that getting measles might strengthen your immune system against other diseases, a view Kennedy has promoted in the past. But perhaps most of all, Peter worried about what the vaccine might do to his children. “The vaccination has stuff we don’t trust,” he said. “We don’t like the vaccinations, what they have these days. We heard too much, and we saw too much.”

During our conversation, several families arrived and went inside the building behind him. Mennonites are known for coming to the aid of fellow community members. Earlier in my visit, I’d heard a story about how Mennonites had paid off the mortgage of a young mother in the area whose husband had died in an accident. I asked Peter if he was getting enough support. He nodded: “Food, money—whatever we need.” Peter does construction for a living. He and his wife have four other small children. A couple of them appeared as we talked, grabbing at his sleeve, trying to get his attention. He leaned down to reassure them.

The death of his daughter, Peter told me, was God’s will. God created measles. God allowed the disease to take his daughter’s life. “Everybody has to die,” he said. Peter’s eyes closed, and he struggled to continue talking. “It’s very hard, very hard,” he said at last. “It’s a big hole.” His voice quavered and trailed off. “Our child is here,” he said, gesturing toward the building behind him. “That’s why we’re here.”

Peter invited me to come inside the church building. He walked over to the door and held it open. I entered a small, dark, airless room with about a dozen chairs. Peter’s daughter was lying in the middle in a handmade coffin covered with fabric. Her face, framed by blond, braided pigtails, showed no sign of illness. Everything was white: her skin, her dress, the lining of her coffin, the thin ribbons that formed little bows on the cuffs of her sleeves. Her hands were clasped just below her chest. Members of her family were seated all around. No one looked up when I walked into the room. The only sounds were the trill of someone’s cellphone alert and the dry, hacking cough coming from one of her sisters in the corner.

It’s easy to dismiss statistics, to forget what they represent. Before the measles shot was introduced in 1963, the number of deaths caused by the disease in the United States each year was somewhere from 400 to 500. The CDC puts the mortality rate for childhood measles at one to three in 1,000, with one in five cases requiring hospitalization. Thanks to vaccines, the memory of that suffering has largely faded from public consciousness, at least in the developed world.

What happened in Seminole, though, was a grim reminder. The day after meeting Peter, I visited the vaccination clinic across the street from the hospital where he had first taken his daughter. I had planned to interview people who were there to get their shots, but no one showed. It occurred to me that I was now at some modest risk myself. Families from Peter’s church had cycled through the visitation service the day before, sharing air inside that stuffy room amid their grief. Like a lot of people born before 1989, I’d gotten only one measles shot as a kid, so out of an abundance of caution, I rolled up my sleeve and got a booster. Later that day, I met up with Zach Holbrooks for lunch and asked him how many other people had gotten shots that morning. It turned out to be just one, and that one was him. He, too, had received just a single dose of the vaccine in childhood, so it seemed wise to get another.

Photograph by Jake Dockins

After lunch, I made the six-hour drive back to Austin, where I live, past the pumpjacks slowly bobbing for oil and the towering wind farms. There’s nothing I heard in Seminole that I haven’t also heard from crunchy liberal friends at home who choose not to vaccinate their kids because they believe that vaccines contain toxins that cause autism or that childhood diseases bolster the immune system. (For the record, the 1998 paper that purported to show a link between vaccines and autism has been retracted, and research indicates that contracting measles can degrade your body’s ability to fight other infections.) Nor are Peter’s views that unusual in conservative corners of the country. A recent poll found that nearly one-third of all Republican and Republican-leaning voters, for instance, think that routine inoculations are “more dangerous than the diseases they are designed to prevent.” That’s the gist of what I heard from multiple Mennonites I interviewed. They are far from alone.

At one point in the parking lot, Peter had asked me why his daughter matters to the rest of the country. I’d struggled in the moment to come up with an answer. For Peter and his family, the loss of their daughter is a private tragedy, one that would be excruciating no matter how she died. The fact that she died of measles, though, is a sign that something has gone wrong with the country’s approach to public health. Twenty-five years ago, measles was declared “eliminated” in the United States. Now a deadly crisis is unfolding in West Texas.

Before I left the church that day, Peter and I talked for a few more minutes. “You probably know how it goes when somebody passes away,” he said. “It’s hard to believe.” Peter told me he didn’t have anything more to say. Really, what more could be said? Something unbelievable had happened: A young father was grieving the death of his 6-year-old from measles.