H5N1

COVID-19: Black Americans are getting vaccinated at lower rates than white Americans

Via NBC News, a KHN report by Hannah Recht and Lauren Weber: Black Americans are getting vaccinated at lower rates than white Americans. Excerpt:

Black Americans are receiving Covid vaccinations at dramatically lower rates than white Americans in the first weeks of the chaotic rollout, according to a new Kaiser Health News analysis. 

About 3 percent of Americans have received at least one dose of a coronavirus vaccine so far. But in 16 states that released data by race, white residents are being vaccinated at significantly higher rates than Black residents, according to the analysis — in many cases two to three times higher. 

In the most dramatic case, 1.2 percent of white Pennsylvanians had been vaccinated as of Jan. 14, compared with 0.3 percent of Black Pennsylvanians. 

The vast majority of the initial round of vaccines has gone to health care workers and staffers on the front lines of the pandemic — a workforce that’s typically racially diverse made up of physicians, hospital cafeteria workers, nurses and janitorial staffers.

If the rollout were reaching people of all races equally, the shares of people vaccinated whose race is known should loosely align with the demographics of health care workers. But in every state, Black Americans were significantly underrepresented among people vaccinated so far.

Access issues and mistrust rooted in structural racism appear to be the major factors leaving Black health care workers behind in the quest to vaccinate the nation. The unbalanced uptake among what might seem like a relatively easy-to-vaccinate workforce doesn’t bode well for the rest of the country’s dispersed population. 

Black, Hispanic and Native Americans are dying from Covid at nearly three times the rate of white Americans, according to a Centers for Disease Control and Prevention analysis. And non-Hispanic Black and Asian health care workers are more likely to contract Covid and to die from it than white workers. (Hispanics can be of any race.) 

“My concern now is if we don’t vaccinate the population that’s highest-risk, we’re going to see even more disproportional deaths in Black and brown communities,” said Dr. Fola May, a UCLA physician and health equity researcher. “It breaks my heart.”

Characterisation of the first 250 000 hospital admissions for COVID-19 in Brazil

Via The Lancet Respiratory Medicine: Characterisation of the first 250 000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data. The summary:

Background 

Most low-income and middle-income countries (LMICs) have little or no data integrated into a national surveillance system to identify characteristics or outcomes of COVID-19 hospital admissions and the impact of the COVID-19 pandemic on their national health systems. We aimed to analyse characteristics of patients admitted to hospital with COVID-19 in Brazil, and to examine the impact of COVID-19 on health-care resources and in-hospital mortality. 

Methods 

We did a retrospective analysis of all patients aged 20 years or older with quantitative RT-PCR (RT-qPCR)-confirmed COVID-19 who were admitted to hospital and registered in SIVEP-Gripe, a nationwide surveillance database in Brazil, between Feb 16 and Aug 15, 2020 (epidemiological weeks 8–33). We also examined the progression of the COVID-19 pandemic across three 4-week periods within this timeframe (epidemiological weeks 8–12, 19–22, and 27–30). The primary outcome was in-hospital mortality. We compared the regional burden of hospital admissions stratified by age, intensive care unit (ICU) admission, and respiratory support. We analysed data from the whole country and its five regions: North, Northeast, Central-West, Southeast, and South. 

Findings 

Between Feb 16 and Aug 15, 2020, 254 288 patients with RT-qPCR-confirmed COVID-19 were admitted to hospital and registered in SIVEP-Gripe. The mean age of patients was 60 (SD 17) years, 119 657 (47%) of 254 288 were aged younger than 60 years, 143 521 (56%) of 254 243 were male, and 14 979 (16%) of 90 829 had no comorbidities. 

Case numbers increased across the three 4-week periods studied: by epidemiological weeks 19–22, cases were concentrated in the North, Northeast, and Southeast; by weeks 27–30, cases had spread to the Central-West and South regions. 232 036 (91%) of 254 288 patients had a defined hospital outcome when the data were exported; in-hospital mortality was 38% (87 515 of 232 036 patients) overall, 59% (47 002 of 79 687) among patients admitted to the ICU, and 80% (36 046 of 45 205) among those who were mechanically ventilated. 

The overall burden of ICU admissions per ICU beds was more pronounced in the North, Southeast, and Northeast, than in the Central-West and South. In the Northeast, 1545 (16%) of 9960 patients received invasive mechanical ventilation outside the ICU compared with 431 (8%) of 5388 in the South. In-hospital mortality among patients younger than 60 years was 31% (4204 of 13 468) in the Northeast versus 15% (1694 of 11 196) in the South. 

Interpretation 

We observed a widespread distribution of COVID-19 across all regions in Brazil, resulting in a high overall disease burden. In-hospital mortality was high, even in patients younger than 60 years, and worsened by existing regional disparities within the health system. 

The COVID-19 pandemic highlights the need to improve access to high-quality care for critically ill patients admitted to hospital with COVID-19, particularly in LMICs.

Survey: A third of Americans don't see systemic racism as a barrier to good health

Via WRCBtv.com in Chattanooga, Tennessee: A third of Americans don't see systemic racism as a barrier to good health. Excerpt:

A third of Americans don't see systemic racism as a barrier to good health even after communities of color have been hit the hardest by the Covid-19 pandemic, researchers say.  

The new findings of the ongoing national survey conducted by the RAND Corporation with support from the Robert Wood Johnson Foundation were released Wednesday.  

Among the respondents, 42% do believe that systemic racism is one of the main reasons people of color have poorer health outcomes and 24% said they were neutral. 

A total of 4,143 adults with household incomes of less than $125,000 were part of the survey aiming to measure attitudes and views toward health equity, civic engagement, systemic racism during the Covid-19 pandemic. 

"It really struck us that -- despite the virus's spread across the country to all types of communities -- there's not a consensus view on the effects of systemic racism. Respondents see the impact of low incomes and living in a rural community on a person's health, but race isn't viewed with the same gravity," Katherine Grace Carman, a senior economist at RAND Corporation and the lead author of the report said in a statement. 

Researchers noted that Black respondents (72.5%) are much more likely than White respondents, (33.2%) to believe that systemic racism affects the health of people of color.  

"Our leaders need to understand that we have a lot more work to do to educate people about the root causes of inequities and then enact policies to ensure better health for all," Carman added.  

Medical professionals and public health leaders have previously said that racism, whether intentional or implicit, can help drive racial disparities in health.  

Last month, Dr. Marcella Nunez-Smith, chair of President-elect Joe Biden's Covid-19 equity task force, said that Covid-19 has exacerbated existing health disparities.  

"It is time for us to respond to the crisis of discrimination in healthcare," Nunez-Smith said. 

Since the beginning of the coronavirus pandemic, Black, Latino and Native Americans have disproportionately been hospitalized and died from the virus.  

Several studies have previously suggested that experiences of racism or discrimination raise the risk of emotional and physical health problems, including depression, cardiovascular disease, hypertension -- more than 40% of Black adults have high blood pressure -- and even death. 

The RAND Corporation survey also shows more than 70% of respondents see the pandemic as a moment for positive change and they "believe society should prioritize expanding access to health care and reducing income inequality."

San Bernardino County hospital slammed by COVID-19 cases

Via The Los Angeles Times: San Bernardino County hospital slammed by COVID-19 cases. Excerpt:

As Dr. Louis Tran walked through the field hospital outside Arrowhead Regional Medical Center in Colton, he passed weary casualties of a COVID-19 surge with no peak yet in sight. Young and old, they slept on cots while receiving oxygen through nasal tubes. 

One of the largest hospitals in San Bernardino County, the 456-bed facility ran out of intensive care unit space two weeks ago amid an onslaught of COVID cases across Southern California.

By now, the effects of the surge on hospitals have become familiar: Ambulances waiting up to six hours to offload patients. People suffering from other ailments, including one with kidney failure, getting treated outside the hospital for more than two hours before a bed opened up. Medical staff thinking about what other areas of the hospital, including conference rooms, can be used to treat the ill.  

And yet, Tran said, he believes the worst is yet to come. “We knew there was [another] wave coming in the wintertime,” Tran said. “But I did not expect to have as many sick people who required ICU care like we’ve been having.” 

Hospitals across Southern California have been hit hard by the recent COVID-19 surge. Many of them are operating at peak capacity and are concerned about an even larger surge after Christmas and New Year’s gatherings. The feeling that the other shoe — a larger and heavier one — has yet to fall is pervasive among healthcare workers.

“We are short-staffed because there are not enough nurses to take care of all these patients,” said Vanessa Heaton, 34, a charge nurse. “I just don’t know, if it gets any worse, how we’re going to be able to handle it. 

“We hope that it slows down at some point, but we’re kind of scared of post-Christmas,” she added.  

Heaton worries that if the hospital becomes too inundated with COVID-19 patients, it will be harder to care for people having other emergencies, including victims of crimes.  

“People are still going out, they’re still getting shot or stabbed, and our hospital has to deal with all that on top of COVID,” she said. 

If ever a region was susceptible to faring poorly during a pandemic, it is one like the Inland Empire, with rampant poverty and high rates of people with just the kind of underlying health issues that COVID-19 preys on. And San Bernardino County has been more resistant to state mandates than L.A., with officials clashing with Gov. Gavin Newsom over the latest stay-at-home order.

The long-term impact of the COVID-19 unemployment shock on life expectancy and mortality rates

Via the National Bureau of Economic Research: The Long-Term Impact of the COVID-19 Unemployment Shock on Life Expectancy and Mortality Rates. The abstract, with my bolding:

We adopt a time series approach to investigate the historical relation between unemployment, life expectancy, and mortality rates. We fit a Vector-autoregression (VAR) for the overall US population and for groups identified based on gender and race. 

We find that shocks to unemployment are followed by statistically significant increases in mortality rates and declines in life expectancy. We use our results to assess the long-run effects of the COVID-19 economic recession on mortality and life expectancy. 

We estimate the size of the COVID-19-related unemployment to be between 2 and 5 times larger than the typical unemployment shock, depending on race/gender, resulting in a 3.0% increase in mortality rate and a 0.5% drop in life expectancy over the next 15 years for the overall American population. 

We also predict that the shock will disproportionately affect African-Americans and women, over a short horizon, while white men might suffer large consequences over longer horizons. These figures translate in a staggering 0.89 million additional deaths over the next 15 years.

Dr. Susan Moore dies of Covid-19 after complaining of racism at Indiana hospital

Via The New York Times: Dr. Susan Moore Dies of Covid-19 After Complaining of Racism at Indiana Hospital. Excerpt:

Lying in a hospital bed with an oxygen tube hugging her nostrils, the Black patient gazed into her smartphone and, with a strained voice, complained of an experience all too common among Black people in America.  

Susan Moore, the patient, said the white doctor at the hospital in suburban Indianapolis where she was being treated for Covid-19 had downplayed her complaints of pain. He told her that he felt uncomfortable giving her more narcotics, she said, and suggested that she would be discharged. 

“I was crushed,” she said in a video posted to Facebook. “He made me feel like I was a drug addict.” 

In her post, which has since circulated widely on social media, she showed a command of complicated medical terminology and an intricate knowledge of treatment protocols as she detailed the ways in which she had advocated for herself with the medical staff. She knew what to ask for because she, too, was a medical doctor.  

But that was not enough to get her treatment and respect she said she deserved. “I put forth and I maintain if I was white,” she said in the video, “I wouldn’t have to go through that.” 

After Dr. Moore, 52, complained about her treatment, she received care that she said “adequately treated” her pain. She was eventually sent home, and on Sunday, just more than two weeks after posting the video, Dr. Moore died of complications from Covid-19, said her son, Henry Muhammed. 

Dr. Moore’s case has generated outrage and renewed calls to grapple with biased medical treatment of Black patients. Voluminous research suggests that Black patients often receive treatment inferior to their white counterparts, particularly when it comes to relieving pain.  

“It’s had a huge impact,” said Dr. Christina Council, a primary care physician in Maryland who is Black, of Dr. Moore’s experience. “Sometimes when we think about medical bias it seems so far removed. We can sit there and say, ‘OK, it can happen to someone that may be poorer.’ But when you actually see it happen to a colleague and you’re seeing her in the hospital bed and literally pleading for her life, it just hits a different way and really hits home and says, ‘Wow, we need to do something.’” 

A spokesman for Indiana University Health, the hospital system where Dr. Moore complained of poor treatment, said in a statement that he could not comment on specific cases because of privacy laws.

Did they have to die? How America's Covid-19 response left 3,000 health workers dead

Via The Guardian: Did they have to die? How America's Covid response left 3,000 health workers dead. Excerpt:

Workers at Garfield medical center in suburban Los Angeles were on edge as the pandemic ramped up in March and April. Staffers in a 30-patient unit were rationing a single tub of sanitizing wipes all day. A May memo from the chief executive said N95 masks could be cleaned up to 20 times before replacement. 

Patients showed up Covid-negative but some still developed symptoms a few days later. Contact tracing took the form of texts and whispers about exposures. 

By summer, frustration gave way to fear. At least 60 staff members at the 210-bed community hospital caught Covid-19, according to records obtained by KHN and interviews with eight staff members and others familiar with hospital operations.  

The first to die was Dawei Liang, 60, a quiet radiology technician who never said “no” when a colleague needed help. A cardiology technician became infected and changed his final wishes – agreeing to intubation – hoping for more years to dote on his grandchildren. 

Few felt safe.  

Ten months into the pandemic, it has become far clearer why tens of thousands of healthcare workers have been infected by the virus and why so many have died: dire PPE shortages. Limited Covid tests. Sparse tracking of viral spread. Layers of flawed policies handed down by healthcare executives and politicians, and lax enforcement by government regulators.  

All of those breakdowns, across cities and states, have contributed to the deaths of more than 2,900 healthcare workers, a nine-month investigation by over 70 reporters at KHN and the Guardian has found. This number is far higher than that reported by the US government, which does not have a comprehensive national count. 

The healthcare worker fatalities have skewed young, with the majority under age 60 in the cases for which there is age data. People of color were disproportionately affected, and account for about 65% of fatalities in cases in which there is race and ethnicity data. After conducting interviews with relatives and friends of about 300 victims, Guardian and KHN learned that one-third of the deaths involved concerns over inadequate PPE.  

Many of the deaths occurred in New York and New Jersey, and significant numbers also died in southern and western states as the pandemic wore on. 

Workers at well-funded academic medical centers – hubs of policymaking clout and prestigious research – were largely spared. Those who died tended to work in less prestigious community hospitals like Garfield, nursing homes and other health centers in roles where access to critical information was low and patient contact was high.

Garfield medical center and its parent company, AHMC Healthcare, did not respond to multiple calls or emails regarding workers’ concerns and circumstances leading to the worker deaths.

So as 2020 draws to a close, we ask: did so many of the nation’s healthcare workers have to die?

California COVID-19 cases: Tracking the outbreak

Via The Los Angeles Times: California coronavirus cases: Tracking the outbreak. Excerpt:

• Stay-at-home orders have returned. Most of the state, including Los Angeles County, is currently under stricter rules. 

• New cases have been surging. Over the last seven days, the state has averaged 41,504 cases per day, a 118.5% increase from two weeks ago. Roughly 12.9% of tests this past week have come back positive. 

• Deaths are on the rise. The state has averaged 231.9 daily deaths over the last week, an increase of 116.7% from two weeks ago. 

• Hospitalizations have never been higher. Statewide, there are 16,465 people hospitalized with a confirmed case, 74% more than two weeks ago. Among those patients, 3,523 are in intensive care. 

• Disparities in age and race persist. Roughly 74% of the dead were 65 or older. After adjusting for population, Latinos are now 2.7 times more likely than whites to test positive.

Evictions have led to hundreds of thousands of extra Covid-19 cases

Via CNBC: Evictions have led to hundreds of thousands of extra Covid cases.

Expiring state eviction bans have led to hundreds of thousands of additional coronavirus cases, new research finds, raising alarm about what will happen when the national eviction moratorium lapses next month. 

During the pandemic, which at one point was estimated it would displace as many as 40 million people, 43 states, plus Washington, D.C., temporarily barred evictions. Many of the moratoriums lasted just 10 weeks, while some states continue to ban the proceedings. 

The researchers, from the University of California, Los Angeles, University of California, San Francisco, Johns Hopkins University, Boston University and Wake Forest University School of Law, found that lifting state moratoriums and allowing eviction proceedings to continue caused as many as 433,700 excess cases of Covid-19 and 10,700 additional deaths in the U.S. between March and September.

The findings are not yet published in a journal but will be available online Monday.  

“When people are evicted, they often move in with friends and family, and that increases your number of contacts,” said Kathryn Leifheit, one of the authors on the research and a postdoctoral fellow at the UCLA Fielding School of Public Health. “If people have to enter a homeless shelter, these are indoor places that can be quite crowded.”  

To best understand the direct impact that evictions continuing in a state has on the spread of the coronavirus, the researchers controlled for stay-at-home orders, mask orders, school closures, testing rates and other factors. The study period was from March to early September, before the most recent spike in cases. 

It was also in September that the Centers for Disease Control and Prevention ordered a nationwide halt to most evictions through the end of the year to curb the outbreak that, in the U.S., has sickened more than 12.9 million people and left over 263,000 dead. 

If the CDC’s eviction ban isn’t extended until 2021, experts say, many new cases are likely to emerge from people being forced out of their houses and apartments. 

“This is a time where it’s not an overstatement to say that for many people, eviction can lead to death,” said Helen Matthews, communications manager at City Life Vita Urbana, a nonprofit in Boston.

The COVID-19 syndemic is not global: Context matters

A letter in The Lancet: The COVID-19 syndemic is not global: context matters.

Richard Horton recently called COVID-19 a syndemic. He aptly used this concept to describe how COVID-19 clusters with pre-existing conditions, interacts with them, and is driven by larger political, economic, and social factors. 

Calling COVID-19 a global syndemic is misguided. Syndemics matter because they focus on what drives diseases to cluster and interact. What is driving coronavirus to move through the population in the USA and interact with biological and social factors, however, differs from other contexts. US political failures have driven COVID-19 morbidity and mortality, and this cannot be divorced from our historical legacy of systemic racism4 or our crisis of political leadership.  

This matters because in other contexts COVID-19 is not syndemic. New Zealand's political leadership in response to the crisis has been exemplary. COVID-19 is not syndemic there. 

In this sense, syndemics allow us to recognise how political and social factors drive, perpetuate, or worsen the emergence and clustering of diseases. Recognising contexts are different matters a great deal. For instance, contexts throughout sub-Saharan Africa are doing much better than the most burdened contexts, like the USA, Brazil, and India. Many people have questioned, why? Some have argued that this reflects a racist frame thinking that African contexts should suffer more. Yet, many African governments acted more swiftly and confidently than wealthier countries. The political leadership in these contexts, therefore, prevented the extensive death tolls, compared to contexts like the UK and the USA, where political leadership failed. 

Recognising political determinants of health is central to the syndemic construct. By calling the COVID-19 syndemic global, we miss the point of the concept entirely. 

I do not write this to dampen Horton's use of the term, as I believe COVID-19 is syndemic in my country (the USA). This is precisely because pre-existing conditions such as hypertension, diabetes, respiratory disorders, systemic racism, mistrust in science and leadership, and a fragmented health-care system have driven the spread and interacted with the virus. These synergistic failures have caused more death and devastation than many other contexts. 

Recognising failures of wealthy countries is imperative as we think about where global knowledge and power sit within fields like global health. Syndemic frames provide us with an opportunity to do this.