H5N1

Southeast LA County now the epicenter of COVID-19

Via The Los Angeles Times: Southeast L.A. County now the epicenter of coronavirus. Excerpt:

Southeast Los Angeles County has become the epicenter for the resurgence of the coronavirus, according to a Times analysis of county health data that found infections skyrocketing in its mostly working-class Latino communities.  

The sharp increase since the economy reopened around Memorial Day shows the virus is spreading rapidly through factories, stores and other workplaces and into communities with higher rates of poverty, more crowding and many essential workers who make the economy tick. Hit hard by job losses during the shutdown, they are increasingly suffering from the virus itself.  

The region reported more than 27,000 new COVID-19 cases over the last two months, the most in the county. The area now accounts for 19% of new infections, although it comprises just 12% of the countywide population, the Times analysis shows. That vaulted its once-modest infection rate into one of the highest in the county, and just below the already hard-hit Eastside and South L.A. areas, according to the Times analysis through Aug. 2 

The trend is part of a statewide spike in infections among Latinos, both in rural, farm-working communities and urban areas. It’s only the latest burden for a corner of Southern California long beset by pollution from nearby industry, a lack of access to healthcare and a host of other ills. 

The southeast region, with 1.2 million people living in more than a dozen communities along the 710 and 605 freeways, has seen infection rates jump to some of the highest in the county, including Maywood, Huntington Park, South Gate, Cudahy and Lynwood. The area is home to many low-wage, front-line workers, and residents there are more likely to live in overcrowded, multigenerational households — key risk factors in the accelerating spread of the virus, according to experts. 

By contrast, the more affluent and majority-white Westside — which early in the outbreak reported higher infection rates because of travel abroad and better access to testing — recorded about 3,000 new cases and showed a much slower increase, the Times analysis found.

'The hotspot of a hotspot of a hotspot': COVID-19 takes heavy toll in south Texas

Via The Guardian: 'The hotspot of a hotspot of a hotspot': coronavirus takes heavy toll in south Texas. Excerpt:

Seventy-two death notices sprawled across an entire page of the Monitor newspaper in Hidalgo county recently. 

The small-print entries, stacked in five tidy columns, didn’t mention Covid-19. But 27 residents of the south Texas community had died from the virus that day, 22 the day before, and 35 the day before that.

“I’ve never seen that ever in my life,” recalled John M Kreidler, a local funeral director, whose family has run Kreidler Funeral Home in McAllen for over a century. 

That was earlier this month, but things have worsened since. The coronavirus pandemic haunts almost everything in this part of the Rio Grande valley, where more than 92% of the almost 900,000 strong population identifies as Hispanic or Latino. 

Hand-sanitizing machines and big bins with masks and gloves surround shoppers at the regional grocery store. Outside of Nomad Shrine Club, a rundown event space turned drive-thru pop-up, residents join a long line of people in cars in search of a Covid-19 test with rapid results. Even Tex Mex, a gentlemen’s club, has a somber message for patrons: “Clothed Again.”  

“The Rio Grande Valley has become the hotspot of a hotspot of a hotspot,” said Ivan Melendez, Hidalgo county’s health authority and a practicing clinician. “We’re at the epicenter of the coronavirus in the United States.”  

Melendez recalled recently encountering a critically ill patient with an alarmingly low pulse. He tried to warn someone, but nurses informed him that a different doctor had already decided not to intervene because they “didn’t expect for [the patient] to survive”. 

In the United States, where the prevailing mantra for physicians is “do no harm”, that kind of ruthless calculation strikes deep, especially when so many of the lives at stake are medically vulnerable and easily exploited. 

In Hidalgo county – “a poor, fat, diabetic population”, Melendez said bluntly – nearly one in three people under age 65 lack health insurance. Thirty percent live in poverty, and a 2020 WalletHub report found that three local cities hold the distinction as the “fattest” metropolitan area in the nation.  

Type 2 diabetes and obesity are among the pre-existing conditions listed by the Centers for Disease Control and Prevention as risk factors for “severe illness” related to Covid-19. Meanwhile, concern over exorbitant hospital bills deters some who don’t have insurance from seeking medical care. These and other socioeconomic factors have caused the virus’ greatest tragedies to disproportionately impact minorities in the US, with Latinos hospitalized at more than four times the rate of their white counterparts. 

Hidalgo county also sits along the US-Mexico border, and an estimated 102,000 unauthorized immigrants who may be afraid to seek care exist within its margins. Large families serve as an ideal vector for the virus, as do those who still flock to beaches and flea markets on weekends.  

Already, 467 members of the community have died from Covid-19, according to the county, most of them since Texas reopened in May. But the state government has actively thwarted efforts to go back into lockdown, prioritizing economic vitality even as the death toll skyrockets.  

Leonardo Tremari worries about going to his job inside a Walmart supercenter in McAllen, but he – and countless other employees – still have to work. “I don’t have a choice,” he told the Guardian, laughing tensely.

Racial and ethnic disparities in COVID-19: Evidence from six large cities

Via the National Bureau of Economic Research: Racial and Ethnic Disparities in COVID-19: Evidence from Six Large Cities. The abstract:

As of June 2020, the coronavirus pandemic has led to more than 2.3 million confirmed infections and 121 thousand fatalities in the United States, with starkly different incidence by race and ethnicity. Our study examines racial and ethnic disparities in confirmed COVID-19 cases across six diverse cities – Atlanta, Baltimore, Chicago, New York City, San Diego, and St. Louis – at the ZIP code level (covering 436 “neighborhoods” with a population of 17.7 million). 

Our analysis links these outcomes to six separate data sources to control for demographics; housing; socioeconomic status; occupation; transportation modes; health care access; long-run opportunity, as measured by income mobility and incarceration rates; human mobility; and underlying population health. 

We find that the proportions of black and Hispanic residents in a ZIP code are both positively and statistically significantly associated with COVID-19 cases per capita. The magnitudes are sizeable for both black and Hispanic, but even larger for Hispanic. Although some of these disparities can be explained by differences in long-run opportunity, human mobility, and demographics, most of the disparities remain unexplained even after including an extensive list of covariates related to possible mechanisms. 

For two cities – Chicago and New York – we also examine COVID-19 fatalities, finding that differences in confirmed COVID-19 cases explain the majority of the observed disparities in fatalities. In other words, the higher death toll of COVID-19 in predominantly black and Hispanic communities mostly reflects higher case rates, rather than higher fatality rates for confirmed cases.

COVID-19: From a PHEIC to a public mental health crisis?

An editorial in The Lancet Public Health: COVID-19: from a PHEIC to a public mental health crisis?

On Jan 30, 2020, the WHO declared the outbreak of COVID-19 a public health emergency of international concern (PHEIC). 6 months later, more than 14 million confirmed cases, more than 600 000 deaths, and unprecedented public health measures are impacting the lives of billions of individuals around the world and all aspects of society. While the focus has been—understandably—on the physical health crisis, the direct and indirect psychological and social effects of the pandemic could be all-pervading. Will the public health emergency of international concern morph into a public mental health crisis? 

Several surveys are capturing the immediate mental health impacts of the pandemic. Findings from the University College London revealed that of 44 000 people surveyed, 18% reported thoughts of self-harm or suicide during lockdown. Matthias Pierce and colleagues' large survey of UK households in The Lancet Psychiatry showed that mental health declined substantially after the first month of COVID-19 lockdown. More than one quarter reported clinically relevant levels of mental distress in late April, 2020, compared with one in five before the lockdown. Women, young people, and those living with pre-school children were the most affected. 

The COVID-19 and the nation's mental health: forecasting needs and risks in the UK report from the Centre for Mental Health released on July 17, lays out the need to prepare for a rising tide of mental health difficulties in the coming months. This follows the Centre's previous briefing, which projected that about half a million people in the UK could experience a mental health difficulty over the next year as a result of the pandemic. The Centre's latest assessment reviews the evidence on the impact of COVID-19 on mental health. In particular, the report identifies that children and young adults are at high risk and that the impact of the pandemic on children and young people's mental health is greater in areas and communities hardest hit by the virus and by lockdowns. 

Children from low-income families, from Black, Asian, and minority ethnic communities, and young carers are all more likely to experience poor mental health. Children's wellbeing has been affected by large and sustained disruptions to their education and environment. For young adults, the deterioration of the economy is of particular concern. Youth unemployment has both short-term and long-term consequences for mental health and there is a high risk that young people will be particularly affected by the economic recession. The economic consequences of COVID-19 could further exacerbate and entrench inequalities. 

Moreover, the impact of loneliness and isolation on the mental health and morbidity of the elderly should also be a source of concern. A survey from the Office of National Statistics showed that more than 70% of people aged over 70 years in the UK are concerned about the impact of COVID-19 on their lives and 20% said that their mental health had been affected. 

Crucially for health-care workers and the social care workforce, data from previous pandemics show clear mental health effects and early reports of frontline health-care workers experiencing a variety of mental health challenges, especially burnout and fear, are emerging. 

Some will dispute the use of mental health to discuss an understandable response to stressors such as isolation and poverty. What is important, however, is the accurate monitoring of the distress and the loss of function that individuals experience in the wake of COVID-19, and the provision of appropriate support. If health professionals, as well as individuals with lived experience, can help the population as a whole, this should be facilitated by policymakers. 

The COVID-19 pandemic presents a public mental health challenge. As Jonathan Campion and colleagues noted in The Lancet Psychiatry, it will be key for countries to prevent an increase in mental issues and a reduction in mental wellbeing across populations, as well as to provide appropriate public mental health interventions. Despite the existence of effective public mental health interventions, implementation is far from adequate. Public mental health interventions will need to be proportionately targeted to groups at a high risk of mental disorder and poor mental wellbeing. 

The unequal impacts of COVID-19, the lockdown, and its socioeconomics consequences are putting greater pressure on groups whose mental health was already more precarious before the pandemic. The COVID-19 pandemic is a public mental health emergency that could exacerbate inequalities in mental health—unless concerted actions are urgently taken.

Potential factors linked to high COVID-19 death rates in British minority ethnic groups

Via The Lancet Infectious Diseases: Potential factors linked to high COVID-19 death rates in British minority ethnic groups.

The Institute for Fiscal Studies (IFS), in their investigation into the vulnerability of the UK's minority ethnic groups to COVID-19,1 found hospital deaths in England of Black and south Asian ethnic groups to be inexplicably higher than those of the white British majority after taking into consideration demographic and geographical profiles. However, they did not consider as possible factors the prevalence of sickle cell anaemia or β-thalassaemia. 

Sickle cell anaemia is inherited in an autosomal recessive pattern, with homozygotes having sickle cell disease and heterozygous carriers having sickle cell trait. Sickle cell trait is asymptomatic. However, it is occasionally associated with sudden death induced by severe hypoxia. Hypoxaemia is a complication of COVID-19.

Another complication of COVID-19 is pulmonary embolism: in one study, 23% of patients with severe clinical features of COVID-19 had acute pulmonary embolism. People who have sickle cell trait have twice the risk of pulmonary embolism compared with the general population. 

The relative frequency of sickle cell trait is higher in Black ethnic groups than in the white ethnic majority in the UK (appendix). Of interest, the Black African ethnic group has twice the number of fatalities and frequency of sickle cell trait as does the Black Caribbean group (appendix). 

Similar to sickle cell anaemia, β-thalassaemia is inherited in an autosomal recessive manner, with heterozygous carriers having β-thalassaemia trait. The relative frequency of β-thalassaemia is higher in the south Asian ethnic groups than in the white ethnic majority (appendix). The only known symptom of β-thalassaemia trait is a tendency for mild anaemia, which could aggravate hypoxaemia due to COVID-19. 

The IFS found the white Irish minority to have half the number of fatalities as the white British majority. Haemochromatosis type 1, whose prevalence is higher in the white Irish ethnic group than in the white British ethnic group (appendix), could be having an effect here. The mutation C282Y is inherited in an autosomal recessive pattern. People with the C282Y allele are less likely than those without to be anaemic, homozygotes sometimes having to be regularly bled to reduce their iron overload. 

Iron-deficiency anaemia could aggravate hypoxaemia due to COVID-19. The prevalence of iron-deficiency anaemia has been reported to be lower in white Irish than in white British men (appendix). 

These data highlight the potential hypoxic effect of anaemia in COVID-19 fatalities for sickle cell anaemia carriers and for β-thalassaemia carriers. They also indicate that haemochromatosis type 1 might confer some protection.

In Guatemala, COVID-19 shows its power to kill trust

Via The Tyee, my colleague Emi Sasagawa writes: In Guatemala, the Virus Shows Its Power to Kill Trust. Excerpt:

It’s the start of month six of the world living with the threat of coronavirus. While restrictions are easing in Canada, a first wave of COVID-19 cases is resurging just south of the border in the U.S.  

Further south, in many less-developed countries, the first wave is just now picking up speed. With fewer resources and restless populations, some of those nations’ governments are seeing their political lives put in danger by the coronavirus.  

As citizens are asked to endure lockdowns and economic deprivation as a result of pandemic measures, trust becomes a currency increasingly precious. Eroding it are doubts about the statistics their leaders share, what competence they show in managing the virus and the economy, and where government money flows. 

Guatemala is a case in point — one The Tyee is looking in on occasionally as part of a project in partnership with the TulaSalud Foundation, which funds rural public health work in that Central American country. Grassroots opposition to corruption in Guatemala has roiled the country for years, playing a key role in unseating the previous president who was replaced in January by Alejandro Giammattei, a right-wing former physician and director of the prison system. He, too, under the harsh glare of the pandemic, faces severe trust issues. 

 As July arrives, Guatemala is struggling to deal with a steepening infection curve and a health system leaning towards collapse. The reported numbers have soared from 644 cases and 16 deaths on May 1 to 20,072 cases and 843 deaths on July 2. There is no indication the curve with be flattened any time soon. What took months to unfold across Canada — the outbreaks, the overwhelmed health system in certain regions, the economic and financial repercussions of the pandemic — has been compressed into a matter of weeks. 

Still, there were months to prepare. Yet Giammattei’s government is taking fire for not yet managing to provide personal protective equipment for frontline workers.  

“At this point, doctors still don’t have the appropriate health equipment,” said Dr. Rubén Gonzalez, former vice-minister of health and one of the leading voices in an alternative COVID-19 response exercise. “Of the total budget assigned for this emergency, only a small fraction, less than five per cent is being used, because the government hasn’t been able to negotiate a price with providers and, as a result, all plans by the government collapse. In the meantime, our health-care workers suffer.”

Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: A cross-sectional observational study

Via The Lancet Global Health: Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study. The summary:

Background 

Brazil ranks second worldwide in total number of COVID-19 cases and deaths. Understanding the possible socioeconomic and ethnic health inequities is particularly important given the diverse population and fragile political and economic situation. We aimed to characterise the COVID-19 pandemic in Brazil and assess variations in mortality according to region, ethnicity, comorbidities, and symptoms. 

Methods 

We conducted a cross-sectional observational study of COVID-19 hospital mortality using data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) dataset to characterise the COVID-19 pandemic in Brazil. In the study, we included hospitalised patients who had a positive RT-PCR test for severe acute respiratory syndrome coronavirus 2 and who had ethnicity information in the dataset. 

Ethnicity of participants was classified according to the five categories used by the Brazilian Institute of Geography and Statistics: Branco (White), Preto (Black), Amarelo (East Asian), Indígeno (Indigenous), or Pardo (mixed ethnicity). We assessed regional variations in patients with COVID-19 admitted to hospital by state and by two socioeconomically grouped regions (north and central-south). We used mixed-effects Cox regression survival analysis to estimate the effects of ethnicity and comorbidity at an individual level in the context of regional variation. 

Findings 

Of 99 557 patients in the SIVEP-Gripe dataset, we included 11 321 patients in our study. 9278 (82·0%) of these patients were from the central-south region, and 2043 (18·0%) were from the north region. 

Compared with White Brazilians, Pardo and Black Brazilians with COVID-19 who were admitted to hospital had significantly higher risk of mortality (hazard ratio [HR] 1·45, 95% CI 1·33–1·58 for Pardo Brazilians; 1·32, 1·15–1·52 for Black Brazilians). Pardo ethnicity was the second most important risk factor (after age) for death. Comorbidities were more common in Brazilians admitted to hospital in the north region than in the central-south, with similar proportions between the various ethnic groups. States in the north had higher HRs compared with those of the central-south, except for Rio de Janeiro, which had a much higher HR than that of the other central-south states. 

Interpretation 

We found evidence of two distinct but associated effects: increased mortality in the north region (regional effect) and in the Pardo and Black populations (ethnicity effect). We speculate that the regional effect is driven by increasing comorbidity burden in regions with lower levels of socioeconomic development. 

The ethnicity effect might be related to differences in susceptibility to COVID-19 and access to health care (including intensive care) across ethnicities. Our analysis supports an urgent effort on the part of Brazilian authorities to consider how the national response to COVID-19 can better protect Pardo and Black Brazilians, as well as the population of poorer states, from their higher risk of dying of COVID-19.

Early lessons from a second COVID-19 lockdown in Leicester, UK

Via The Lancet: Early lessons from a second COVID-19 lockdown in Leicester, UK.

As the number of new cases of COVID-19 continues to decline in the UK, national lockdown measures are being cautiously relaxed. However, Leicester has become the first city in England to have lockdown measures re-imposed. There are growing concerns about further local outbreaks, with the potential to culminate in a second wave. 

The national strategy for managing, if not mitigating, these risks has been centralised and primarily focused on so-called pillar 2 community-based swab testing completed by remote lighthouse laboratories and contact tracing. This is supported by continued pillar 1 testing, in National Health Service hospital laboratories, of patients admitted to hospital.1 Here we report our early experience of the second spike in COVID-19 cases in Leicester. 

The ethnic pluralism and cultural diversity celebrated by the city now presents complex and considerable public health challenges. As the city enters a local lockdown, we consider whether lessons should be learnt to avoid or better manage similar inevitable surges across other areas of the UK. 

News of this outbreak, first announced by the Health Secretary on June 18, 2020, based on pillar 2 data, was a surprise to local health organisations. These local services only had access to pillar 1 data, which showed that the number of new cases per day was low through the first half of June, 2020. It was subsequently reported that a quarter of all cases in Leicester were confirmed between June 1 and June 15, 2020. Most of these new cases were reportedly concentrated in ten wards in the east of the city (appendix). 

Census results and official estimates of populations of local wards in Leicester show that 72·5% of the population of these wards are from Black, Asian, and Minority Ethnic backgrounds, mostly of South Asian ethnicity, who are disproportionately affected by adverse outcomes of COVID-19.

As the situation continues to rapidly evolve, this second spike in COVID-19 cases in Leicester has exposed key problems that must be urgently addressed. In particular, the opportunity to escalate interventions locally has been stymied by the inadequacy of information sharing. Pillar 2 data, which indicated this ongoing spike, were not communicated in a timely manner to the local authority and local health organisations that had been tasked with local public health preparedness, and they did not contain full information on key demographics (age, address, place of work, and ethnicity). 

Instead, a nationally mandated increase in pillar 2 testing capacity, including mobile testing units run by the Ministry of Defence, was introduced. This was ineffective in the absence of a locally directed coordinated response, leading to lockdown measures being reintroduced on June 30, 2020. 

What can be done to improve the management of local outbreaks? The current centralised platform cannot function effectively in isolation and must be revised to adopt a network structure that integrates with the local authority and local health services in every region. 

In this respect, the success of the multi-disciplinary network structure of the National Tuberculosis control strategy to manage the growing epidemic of another deadly airborne infection offers an effective precedent. We know that health-care needs can vary widely between regions, influenced by demography, deprivation, and other socioeconomic parameters. A one-size-fits-all approach is myopic—local authorities, public health teams, and clinicians are best placed to understand the needs of their communities and should be empowered to implement context-specific and area-specific interventions developed within existing programmes. 

For Leicester, the relationships established with community leaders and services to tackle inequality of health provision in ethnic minority groups are acutely relevant to support measures for effective control. These includes culturally appropriate implementation of the test, track, and trace programme, alongside public health messaging that these communities can easily access. 

Although increased local lockdown restrictions are being imposed in Leicester, we must be careful to consider whether this will necessarily have the desired impact in areas of high ethnic diversity. An area-specific imposition will necessarily target and disproportionately affect ethnic minority communities, many of whom live in areas of high social deprivation and work in care, health, and transport sectors. Their support will be needed for adherence to any proposed measures, and this will require effective community engagement. We should remain mindful that lockdown is a blunt and damaging tool of last resort that represents a failure of timely intervention. 

Our experience brings into sharp focus the shortfalls in the current identification and management of local COVID-19 outbreaks. As we enter the second phase of the COVID-19 pandemic, we all remain in this together. This philosophy needs now to be applied to tackling the challenges ahead with an inclusive and coordinated public health response that is locally led, agile, and responsive to prevent unnecessary morbidity and mortality.

Social divisions drive astronomical COVID-19 rate in Chile

Via NPR's Goats and Soda blog: Social Divisions Drive Astronomical COVID-19 Rate In Chile. Chile's COVID-19 case count is here. Excerpt:

Chile looked as if it were well prepared to deal with the new coronavirus. 

It's a rich country — classified as high income by the World Bank. Life expectancy is roughly 80 years — better than the United States'. It has a solid, modern health care system, and when the outbreak began spreading, officials made sure they had plenty of ventilators and intensive care beds at the ready.  

But the virus exploited the cracks in Chilean society. The country now has the highest per capita infection rate of any major country — 13,000 cases for every 1 million people. That's more than 10 times the rate in neighboring Argentina and twice the rate in Brazil.  

Like many well-to-do countries, Chile saw its first cases of COVID-19 among its elite — people who'd recently traveled to Europe and the United States. That was in April. The government quickly rolled out a plan to provide testing and treatment. Health officials quarantined hard-hit neighborhoods. Residents had to apply for a pass online before they could go out of their homes even to buy groceries. In late April, things were going so well that Chile was starting to talk about reopening. 

"And then May started bringing more cases and more cases. Currently we have, in my opinion, more cases than we are able to handle," says Thomas Leisewitz, a physician in Santiago. Leisewitz is a professor at Pontificia Universidad Católica de Chile and heads up strategic development at Red de Salud UC Christus, a nonprofit Catholic health care network. 

Since May, the number of cases has been rising steadily, with the country recording at one time 5,000 to 6,000 new cases a day in June. The virus spread out of the affluent parts of Santiago to low-income neighborhoods where many residents don't have the luxury of being able to work from home.  

And the high numbers are not just a reflection of an efficient testing infrastructure. Chile's per capita testing rate is lower than most European nations' and almost half the rate in the United States. 

So how did this particular virus come to spread incredibly rapidly in wealthy, well-prepared Chile? 

Andrea Insunza, a journalist in Santiago, says the reason is something unrelated to the virus itself. That something is social inequity. 

"In Chile, there are two countries," says Insunza, who runs the center for investigative journalism at Universidad Diego Portales. "There's a country for people like me. I have a good education. I have a good salary, and all my social security is privatized."  

By this she means she has access to high-quality private hospitals and clinics. 

But there's another Chile.  

"And that Chile is poor and you depend on the public health [system]," says Insunza. 

Last October, violent street protests erupted in Santiago over a fare hike on the subway of 30 pesos, or less than 5 U.S. cents. The protests became about far more than the price of a subway ride. 

Chile is one of the most unequal countries in Latin America, according to the World Bank. The elite, the top 10%, controls more than half the country's wealth. And while extreme poverty has been driven down significantly over the last decade, the social unrest in October centered on the frustrations of lower- and middle-class Chileans who view their economic opportunities as unfairly limited. 

Insunza says part of the frustration is driven by the elite often not even seeming to recognize their privileged lifestyles. 

"Santiago, it's a very segregated place," Insunza says. "You can actually live your whole life and not see poverty. Never."  

Chile's initial plan to deal with the coronavirus outbreak — which at first affected mainly the elite in Santiago — failed to recognize that the affluent have maids, gardeners and cooks who might also get infected.  

The country's response went well in those early weeks. Case numbers were holding steady. The fatality rate was low. 

Then the virus started spreading in lower-income neighborhoods and quickly got out of control.

Hollowed-out public health system faces more cuts amid COVID-19 pandemic

Many thanks to Lauren Weber for sending this major report by Kaiser Health News and The Associated Press: Hollowed out public health system faces more cuts amid virus. Here's an excerpt and then a comment, but you should just click through and read the whole long, grim story. Don't let it depress you, but do let it enrage you.

The U.S. public health system has been starved for decades and lacks the resources to confront the worst health crisis in a century. 

Marshaled against a virus that has sickened at least 2.6 million in the U.S., killed more than 126,000 people and cost tens of millions of jobs and $3 trillion in federal rescue money, state and local government health workers on the ground are sometimes paid so little, they qualify for public aid.  

They track the coronavirus on paper records shared via fax. Working seven-day weeks for months on end, they fear pay freezes, public backlash and even losing their jobs.  

Since 2010, spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%, according to a KHN and Associated Press analysis of government spending on public health. At least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a skeletal workforce for what was once viewed as one of the world’s top public health systems. 

An Associated Press-KHN investigation has found a skeletal workforce facing more possible county budget cuts. KHN, also known as Kaiser Health News, and AP interviewed more than 150 public health workers, policymakers and experts, analyzed spending records from hundreds of state and local health departments, and surveyed statehouses. On every level, the investigation found, the system is underfunded and under threat, unable to protect the nation’s health.  

Robert Redfield, the director of the Centers for Disease Control and Prevention, said in an interview in April that his “biggest regret” was “that our nation failed over decades to effectively invest in public health.”  

So when this outbreak arrived — and when, according to public health experts, the federal government bungled its response — hollowed-out state and local health departments were ill-equipped to step into the breach.

Over time, their work had received so little support that they found themselves without direction, disrespected, ignored, even vilified. The desperate struggle against COVID-19 became increasingly politicized and grew more difficult. 

States, cities and counties in dire straits have begun laying off and furloughing their limited staff, and even more devastation looms, as states reopen and cases surge. Historically, even when money pours in following crises such as Zika and H1N1, it disappears after the emergency subsides. Officials fear the same thing is happening now. 

“We don’t say to the fire department, ‘Oh, I’m sorry. There were no fires last year, so we’re going to take 30% of your budget away.’ That would be crazy, right?” said Dr. Gianfranco Pezzino, the health officer in Shawnee County, Kansas. “But we do that with public health, day in and day out.”

This is not just a Republican failure; the Democrats are equally to blame. Both parties, since about 1980, have presided over an enormous project of social engineering: the transfer of wealth from working people and the middle class to the 0.1%.

"Government is the problem" was Reagan's mantra, and as people began to notice that their incomes couldn't quite cover all their bills any more, they were taught to blame government spending for their suddenly heavy taxes. (Never mind that Americans were already among the most lightly taxed citizens of any industrialized country.)

 

So tax cut after tax cut came from Republican and Democratic administrations alike, on all levels of government. Somehow the taxes were always too burdensome, the government spending too wasteful. Universal health care was for those overtaxed "socialist" Europeans and Canadians, and a little grudging support for public health came only to provide symptomatic relief—to provide a Band-Aid, not to prevent the cut in the first place.

 

"We're all in this together" rings hollow in a country that's been taught for 40 years that everyone is personally responsible for his or her success or failure, health or sickness. And now that the consequences of 40 years of wealth transfer are manifest, 126,000 rugged American individualists are dead, 2.6 million have been sickened (so far), and everyone but the 0.1% have been further impoverished. (The 0.1% have been doing just fine, thanks.)

 

It will take more than yet another transfer of power from Republicans to Democrats to roll back COVID-19. It will take a rollback of 40 years of systemic theft from the 99%.