12 Apr Briefing for April 12-16, 2021 on COVID-19 and Low-Income Communities
We are struck that one of the few certainties about the coronavirus outbreak is that low-income communities and workers in low-income, service sector occupations will be disproportionately impacted — likely in devastating fashion.
One step in combatting this will be to share information about what is happening and what can be done. That’s why we are offering a daily news service summarizing relevant stories, which you can read below.
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Briefing for April 13, 2021
CDC studies find racial inequities in COVID hospitalizations, ER visits: Days after declaring racism a serious public health threat, the Centers for Disease Control and Prevention released a pair of studies further quantifying the disproportionate impact of COVID-19 on communities of color. The studies, published Monday in Morbidity and Mortality Weekly Report, examine trends in racial and ethnic disparities in hospitalizations and emergency room visits associated with COVID-19 in 2020. CDC Director Rochelle Walensky said at a regular White House COVID-19 Response Team briefing that the new literature underscores the need to prioritize health equity, including in the country’s accelerating vaccine rollout. “These disparities were not caused by the pandemic, but they were certainly exacerbated by [it],” Walensky said. After assessing administrative discharge data from March to December 2020, the CDC found that the proportion of hospitalized patients with COVID-19 was highest for Hispanic and Latino patients in all four census regions of the U.S. Racial and ethnic disparities were most pronounced between May and July, it said, and declined over the course of the pandemic as hospitalizations increased among non-Hispanic white people. But such disparities persisted across the country as of December, most notably among Hispanic patients in the West. The second study examined COVID-19-related emergency department visits in 13 states between October and December and found similar disparities between racial and ethnic groups. During that period, Hispanic and American Indian or Alaska Native people were 1.7 times more likely to seek care than white people, and Black individuals 1.4 times more likely.
COVID-19, racial inequities are part of a growing medical debt crisis: A new report from the Greenlining Institute finds that COVID-19 has greatly contributed to the problem of medical debt in the U.S., and that communities of color are especially vulnerable to medical debt—just as they are more vulnerable to the pandemic. “The COVID-19 pandemic threatens to worsen health disparities and the burden of medical debt on communities of color,” the report said. “Health care costs due to COVID-19 have already left people in severe debt, and layoffs due to COVID leave historical numbers of people unemployed and uninsured.” Medical debt is the number one cause of bankruptcy in the United States, with 62% of bankruptcies caused by medical bills. In 2016, one in six Americans had past due medical bills, resulting in $81 billion in debt.
U.S. colleges divided over requiring student vaccinations: From the Associated Press: “U.S. colleges hoping for a return to normalcy next fall are weighing how far they should go in urging students to get the COVID-19 vaccine, including whether they should — or legally can — require it. Universities including Rutgers, Brown, Cornell and Northeastern recently told students they must get vaccinated before returning to campus next fall. They hope to achieve herd immunity on campus, which they say would allow them to loosen spacing restrictions in classrooms and dorms. But some colleges are leaving the decision to students, and others believe they can’t legally require vaccinations. At Virginia Tech, officials determined that they can’t because the U.S. Food and Drug Administration has only allowed the emergency use of the vaccines and hasn’t given them its full approval. The question looms large as more colleges plan to shift back from remote to in-person instruction. Many schools have launched vaccination blitzes to get students immunized before they leave for the summer. At some schools, the added requirement is meant to encourage holdouts and to build confidence that students and faculty will be safe on campus. “It takes away any ambiguity about whether individuals should be vaccinated,” said Kenneth Henderson, the chancellor of Northeastern University in Boston.”
Parents should stop talking about a ‘lost year’ for students: Child development experts tell the New York Times that anxious parents, particularly those of middle school students, should not panic that their kids will suffer long-term effects from a year-plus of virtual school. “As the nation begins to pivot from trauma to recovery, many mental-health experts and educators are trying to spread the message that parents, too, need a reset. If adults want to guide their children toward resilience, these experts say, then they need to get their own minds out of crisis mode. That challenge is likely to be especially tough for the parents of young adolescents, whose emotions run high and whose ability to put feelings into words tends to be limited. But it’s also one that parents of middle schoolers in particular really need to try to meet.”
The U.S. health system is not equipped to vaccinate rural communities: Writing for the Dallas Morning News, Dr. Adrian N. Billings and Dr. Janice Blanchard of the Atlantic Fellows for Health Equity make the case for increased help for rural residents who may not live anywhere near a facility that can offer a COVID vaccine: “President Joe Biden has boldly announced that 90% of Americans are eligible for the COVID-19 vaccine this month. As new COVID variants continue to threaten the United States and increase our susceptibility to the coronavirus, achieving herd immunity through mass vaccination is paramount. Despite this need, many Americans still face major barriers to obtaining the vaccine, especially the 1 in 5 residents who live in rural parts of the country. The reality is that our health care system is not equipped to vaccinate rural communities. We need emergency measures to support vaccine distribution, but our response shouldn’t stop there. This pandemic should serve as a wake-up call: Rural health care can deliver during public health emergencies and otherwise if we invest in the people and infrastructure required.” Pandemic swells the numbers of ‘invisible’ homeless in rural America: The Texas Tribune reports that the increased homelessness resulting from the pandemic is not just an urban problem. “Rural counties don’t typically conduct the homelessness counts that urban areas like Austin, Dallas or Houston organize each January. But the Texas Homeless Network estimates that in 2019, more than 8,000 people experienced homelessness in 215 Texas counties outside the state’s urban regions. That’s almost how many people experience homelessness in Dallas and Houston combined. And since 2016, homelessness in those less populated counties has increased by 33%. “In the last few winters, the number of people coming in to ask for help have gone up here,” said Sherry Carroll, director of Grace Place Ministries in Stephenville. Big cities are much more likely to have homeless shelters, millions in federal funds and networks of nonprofits. But because sparsely populated areas lack the resources to find and help people experiencing homelessness, churches and faith-based organizations become one of their few lifelines.”
Briefing for April 12, 2021
IDs prove to be a barrier for vaccination for immigrants: From the Washington Post: “Immigrants have been turned away from pharmacies and other places after being asked for driver’s licenses, Social Security numbers or health insurance cards — specific documentation not mandated by states or the federal government but often requested at vaccination sites across the country, including right down the road from here. Often the request comes in English, a language many of the vaccine-seekers don’t fully understand. Some state agencies and businesses that provide vaccinations have acknowledged the problem and vowed that it will stop . . . . “We’ve done a good job of equality in rolling out the vaccine. A lot of states have opened to everyone 16 and over now,” said Jeffrey Hines, medical director for diversity, inclusion and health equity at Wellstar Health System in Atlanta. “But equality is not equity.”
Black women are three times more likely to die from COVID than white men: Since the earliest days of the coronavirus pandemic, it’s been widely believed that men are more likely to die of COVID-19 than women. Now, research is challenging the notion that the likelihood of dying of the disease largely comes down to biology, finding that coronavirus mortality rates for Black women in the U.S. are more than three times that of white and Asian men. Black women in the U.S. are dying from the virus at a higher rate than any other group, male or female, except Black men, according to an analysis of COVID-19 mortality patterns by race and gender in Georgia and Michigan published last week in the Journal of Internal Medicine. “The deaths we see in the pandemic reflect pre-existing structural inequities; after the pandemic is gone, those will still be there,” Heather Shattuck-Heidorn, assistant professor of gender and women studies at the University of Maine and the study’s senior author, told CBS MoneyWatch.
Black adults subjected to greater health care discrimination, study finds: An Urban Institute study finds that “Black adults were more likely than white or Hispanic/Latinx adults to report having been discriminated against or judged unfairly by a doctor, other health care provider, or their staff in the past 12 months for one of the reasons (race, ethnicity, gender or gender identity, sexual orientation, a disability, or a health condition) examined in this study. Among Black adults, women and low-income adults reported discrimination or unfair judgment by a health care provider or their staff at particularly high rates. These experiences can have severe consequences (including delayed or forgone care) that have cumulative adverse effects on people’s lives. To fully ameliorate racial and ethnic inequities in health outcomes, policymakers and the health care system will need to confront and address the adverse experiences patients have when seeking health care and hold payers, providers, and their staff accountable for discriminatory practices and unfair treatment.”
COVID racial disparities loom large in rural counties: From the Pew Charitable Trust’s Stateline: “Although deaths were initially higher in urban areas, since September death rates have been higher in rural communities. Compared with their urban and suburban counterparts, the 60 million residents of rural America have limited access to health care. Rural hospital closures and a lack of affordable health insurance exacerbate the problem. Rural residents, on average, tend to be older, poorer and sicker or have underlying health conditions, all of which contribute to higher COVID-19 mortality rates. The situation is especially dire for rural people of color, who have higher rates of premature deaths, poverty and chronic diseases and more often lack health insurance. A recent report from management consultant firm McKinsey & Company shows just how dangerous the pandemic has been for rural people of color. From March 2020 through February, rural residents experienced 175 COVID-19 deaths per 100,000 people, compared with 151 deaths per 100,000 for urban communities. And in highly diverse rural counties where people of color made up at least a third of the population, 258 people died per 100,000.”
Prisoners have contracted the coronavirus at rates 3 times as high as others in the U.S.: The New York Times reports: “America’s prisons, jails and detention centers have been among the nation’s most dangerous places during the pandemic. Over the past year, more than 1,400 new inmate infections and seven deaths, on average, have been reported inside those facilities each day. The cramped, often unsanitary settings have been ideal for incubating and transmitting disease. Social distancing is not an option. Testing was not a priority inside prisons early in the pandemic. Since March 2020, The New York Times has tracked every known coronavirus case in every correctional setting in the United States. More than 2,700 inmates have died. A year later, reporters found that one in three inmates in state prisons are known to have had the virus. In federal facilities, at least 39 percent of prisoners are known to have been infected. The true count is most likely higher because of a dearth of testing, but the findings align with reports from The Marshall Project, The Associated Press, U.C.L.A. Law and The Covid Prison Project that track Covid-19 in prisons. The virus has killed prisoners at higher rates than the general population, the data shows, and at least 2,700 people have died in custody, where access to quality health care is poor.”
High vaccination rates among American Indian and Alaska Native people: Despite being disproportionately impacted by the pandemic and facing significant healthcare inequities, the Kaiser Family Foundation reports that vaccination rates among AIAN people have been higher than average to date. “Federal data show that 32% of AIAN people had received at least one dose of a COVID-19 vaccine, compared to 19% of White people, 16% of Asian people, 12% of Black people and 9% Hispanic people of as of April 5, 2021.State data similarly find higher vaccination rates among AIAN people compared to other groups. The high vaccination rate among AIAN people largely reflects Tribal leadership in implementing vaccine prioritization and distribution strategies that meet the preferences and needs of their communities.The high rates may also, in part, reflect the greater supply of vaccine doses delivered to the IHS relative to the number of people served compared to state vaccination programs. Tribes have supported and built on existing trusted community resources and providers to distribute vaccines.”
Why Mississippi has few takers for 73,000 COVID shots: From the New York Times: “When it comes to getting the coronavirus vaccine, Mississippi residents have an abundance of options. On Thursday, there were more than 73,000 slots to be had on the state’s scheduling website, up from 68,000 on Tuesday. In some ways, the growing glut of appointments in Mississippi is something to celebrate: It reflects the mounting supplies that have prompted states across the country to open up eligibility to anyone over 16. But public health experts say the pileup of unclaimed appointments in Mississippi exposes something more worrisome: the large number of people who are reluctant to get vaccinated. “It’s time to do the heavy lifting needed to overcome the hesitancy we’re encountering,” said Dr. Obie McNair, an internal medicine practitioner in Jackson, the state capital, whose office has a plentiful supply of vaccines but not enough takers. Though access remains a problem in rural Mississippi, experts say that the state — one of the first to open eligibility to all adults three weeks ago — may be a harbinger of what much of the country will confront in the coming weeks, as increasing supplies enable most Americans who want the vaccine to easily make appointments. The hesitancy has national implications. Experts say between 70 percent to 90 percent of all Americans must be vaccinated for the country to reach herd immunity, the point at which the virus can no longer spread through the population.”
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