H5N1

Deadly Donald Trump and 40 years of health failures

The Tyee has published my article: Deadly Donald Trump and 40 Years of Health Failures. Excerpt:

Four years ago, in the early weeks of Donald Trump’s presidency, I wrote an article describing him as an Ebola-level global health threat.

That was obviously a gross under-estimate. And Ebola was the wrong comparison. The outbreak that began in 2013 in West Africa, the worst in history, took about 11,000 lives. (Another outbreak has just started in Guinea, but now it can be fought with experienced health care workers and vaccine.) 

Compared to the lives Trump is responsible for shortening or ending, Ebola was a rounding error. In a recent article, science writer Laurie Garrett charged him with pandemicide. But COVID-19 is only one factor in the deaths caused by Trump and a 40-year attack on American public health. 

Soon after I wrote my 2017 article, The Lancet, a major British medical journal, established one of its commissions. Unlike its other commissions that look at the impact of this or that disease, this one was to focus on the impact of Trump and his policies. 

That commission has now published “Public policy and health in the Trump era,” an indictment not only of Trump but of the 40 years of neoliberal policies begun by Ronald Reagan. It may take another 40 years to repair the damage.

US could have averted 40% of Covid-19 deaths, says panel examining Trump's policies

The new Lancet commission is already making waves. Via The Guardian: US could have averted 40% of Covid deaths, says panel examining Trump's policies. Excerpt:

The US could have averted 40% of the deaths from Covid-19, had the country’s death rates corresponded with the rates in other high-income G7 countries, according to a Lancet commission tasked with assessing Donald Trump’s health policy record. 

Almost 470,000 Americans have died from the coronavirus so far, with the number widely expected to go above half a million in the next few weeks. At the same time some 27 million people in the US have been infected. Both figures are by far the highest in the world. 

In seeking to respond to the pandemic, Trump has been widely condemned for not taking the pandemic seriously enough soon enough, spreading conspiracy theories, not encouraging mask wearing and undermining scientists and others seeking to combat the virus’ spread.

Dr Mary T Bassett, a commission member and director of Harvard University’s FXB Center for Health and Human Rights, told the Guardian: “The US has fared so badly with this pandemic, but the bungling can’t be attributed only to Mr Trump, it also has to do with these societal failures … That’s not going to be solved by a vaccine.” 

In a wide-ranging assessment published on Thursday, the commission said Trump “brought misfortune to the USA and the planet” during his four years in office. The stinging critique not only blamed Trump, but also tied his actions to the historical conditions which made his presidency possible. 

“He was sort of a crowning achievement of a certain period but he’s not the only architect,” said Bassett, “And so we decided it’s important to put him in context, not to minimize how destructive his policy agenda has been and his personal fanning the flames of white supremacy, but to put it in context.” 

The commission condemned Trump’s response to Covid, but emphasized that the country entered the pandemic with a degraded public health infrastructure. Between 2002 and 2019, US public health spending fell from 3.21% to 2.45% – approximately half the share of spending in Canada and the UK. 

To determine how many deaths from Covid the US could have avoided, the commission weighted the average death rate in the other G7 countries – Canada, France, Germany, Italy, Japan and the UK – and compared it to the US death rate. 

In another comparison, the commission found if US life expectancy was equivalent to the average in the other G7 countries, 461,000 fewer Americans would have died in 2018. 

The Lancet commission on public policy and health in the Trump era, launched in April 2017 to catalogue Trump health policies, examines the driving forces of his 2016 election win and offers policy recommendations. The 33 commissioners are from the US, UK and Canada and work in public health, law schools, medicine, unions, indigenous communities and other groups. 

The commission devotes as much time in the report to its namesake as it does to the conditions that made him possible. 

A line is drawn from neoliberal policies pushed in the past 40 years, such as those that intensified the drug war and resulted in mass incarceration, to health inequities Trump exacerbated while in office. Many of the connections date back even further, to the colonization of the Americas and the persistence of white supremacy in society.

Ensure Palestinians have access to COVID-19 vaccines

A letter in The Lancet: Ensure Palestinians have access to COVID-19 vaccines.

The health predicament in the occupied Palestinian territory has been inexcusable, and the COVID-19 pandemic is exacerbating problems. As of Feb 8, 2021, WHO reports that more than 183 000 Palestinians have tested positive for severe acute respiratory syndrome coronavirus 2, and more than 2000 people have died from COVID-19. According to the UN, “Israel has not ensured that Palestinians under occupation in the West Bank and Gaza will have any near-future access to the available vaccines”. This statement is despite WHO's roadmap for COVID-19 vaccine prioritisation stating that people in particular settings (eg, refugee and detention camps, prisons) should be prioritised for vaccination. 

We recognise that Palestinians have the right to life, health, and dignity. Differential access to necessary health care is ethically and legally unacceptable and, under the terms of The Geneva Conventions, Israel has a responsibility for those living under its occupation; the 1995 Israeli–Palestinian Interim Agreement cannot be used as a justification for Israeli inaction. 

We call on media organisations to report on the serious health burden and increasing number of lives at risk as COVID-19 spreads among the Palestinian people. Media organisations have a moral responsibility to report on this situation without discrimination and with moral courage. 

We support agencies, such as WHO and Amnesty International, in their efforts to demand that Israel ensure swift and equitable access to vaccines and increase the health-care system's capacity in the occupied Palestinian territory. However, theseorganisations do not have the executive power to force states to respect rights. Israel needs to fulfil its international obligations by providing full financial support to ensure that any programmes meet minimum standards. 

We call on multilateral development banks to support the expansion of Palestinian public health-care infrastructure and capacity to allow Palestinians a dignified life that any person deserves, as per the Universal Declaration of Human Rights. 

We call on manufacturers developing these crucial vaccines to ensure access for all Palestinian people under occupation, including those living in refugee and detention camps, which could involve donations of storage units and equipment. 

Finally, we call on individuals and civil society organisations to raise global awareness of the situation in the occupied Palestinian territory and ask Israel to honour its commitment to medical ethics and human rights by ensuring access to COVID-19 vaccines for Palestinians living under occupation. 

Israel has a moral obligation to ensure that Palestinians have access to COVID-19 vaccines available under emergency use mechanisms or compassionate use and to support such a vaccination programme. Anything short of that is a breach of medical and professional ethics and a clear act of discrimination.

Brazil's wealthy cause a stir trying to score quick COVID-19 vaccines

A report by The Associated Press: Brazil's wealthy cause a stir trying to score quick vaccines. Excerpt;

SAO PAULO (AP) — Brazilian marketing executive Eduardo Menga is extra cautious when it comes to his health. During the pandemic, he consulted a slew of doctors to ensure he was in good shape and uprooted his family from Rio de Janeiro to a quiet city in the countryside where he works remotely. His wife Bianca Rinaldi, an actress, hasn’t worked since March. 

Menga and Rinaldi are among a minority of Brazilians who will pay for a COVID-19 vaccine if an association of private clinics can close a deal to bring 5 million shots to Latin America’s most unequal country. President Jair Bolsonaro, under fire for his government’s handling of the pandemic, has promised not to interfere. 

“When I go to a restaurant and I pay for my own food, I’m not taking anyone else’s food,” the 68-year-old Menga said from his home in Jundiai in Sao Paulo state. “I don’t think getting a vaccine from a private clinic will take it from someone else waiting in the public system. It could be an alternative line, and those who have the chance should take it.”

Amid the government’s stumbling vaccine rollout, many moneyed Brazilians want to find a swift path to vaccination, sparking backlash from some public health experts and igniting debate on social media, editorial pages and talk shows. 

There has been concern globally that the privileged could game the system to get themselves vaccinated before others. When the connected have been caught leapfrogging ahead, in countries like Turkey, Morocco and Spain, they have faced criticism, investigations or forced resignations.

Brazil has had its reports of line-jumpers, too, but the nation stands apart because maneuvering isn’t only done in the shadows. Some is out in the open, with the prosperous coordinating efforts that the government endorses, according to Roberto DaMatta, an emeritus anthropology professor at the University of Notre Dame. 

“The pandemic makes Brazil’s inequality more obvious, because the virus doesn’t choose social class, but the cure just might,” said DaMatta, who authored the book “Do You Know With Whom You’re Speaking?” a portrait of Brazilian privilege. It was inspired by episodes during the pandemic, including a judge who refused a policeman’s order to don a mask, then called the state’s security chief to protest and ripped up his 100 reais ($20) fine. 

“Brazil’s wealthy normalized slavery for ages. Now, they accept that more poor and Black people die of COVID, and put little pressure on a government that has sabotaged the rollout. Taking the vaccine in this scenario might depend on organization, so the well-off are organizing,” DaMatta told The Associated Press.

COVID-19 in California: A different kind of double jeopardy

Via The Los Angeles Times: Coronavirus Today: A different kind of double jeopardy. Excerpt:

At a time when public officials are practically begging residents to not leave their homes because of COVID-19, the Los Angeles County Superior Court system — the largest in the country — is still requiring people to venture forth for in-person hearings, including eviction proceedings and trials. That’s despite the recent deaths of three court employees from COVID-19, and despite the fact that being in enclosed spaces with other people provides an easy opportunity for the coronavirus to spread. 

In traffic courts, scores of people wait in hallways and courtrooms to contest speeding citations, my colleague Matt Hamilton reports. In criminal courts, shackled defendants sit with masks drooping off their faces, and some lawyers remove their masks when addressing a judge. One judge even allowed a witness to testify without a mask. 

“Every single day the courts are going through procedures without precautions to keep people safe and holding proceedings that result in people getting kicked out onto the street. It’s a public health disaster,” said Adam Murray, executive director of Inner City Law Center. “If you walk into eviction or traffic courtrooms, you are not seeing wealthy or middle-income people. It’s poor people who have to go in and adjudicate their cases in person.” 

Staff and legal groups have pushed for more rigorous methods of screening the public, such as temperature checks. But they haven’t gotten them. 

Although lawmakers instituted some eviction moratoriums, which have reduced the flow of eviction cases, such measures typically require tenants to come to court to demonstrate why the moratorium applies. Often, moratorium is a bit of a misnomer, as the measures don’t necessarily stop landlords from filing eviction lawsuits. 

These practices pose real exposure risks for Angelenos like Juan Garcia, who rode the bus to a downtown L.A. court to contest an eviction. The disabled widower used a cane as he navigated the Stanley Mosk Courthouse, waited among dozens in a hallway for his hearing, then asked a judge for more time to secure low-income housing — at least another month or two. The judge set an eviction trial for April. 

“I don’t know what I’m going to do,” Garcia, 60, said outside the courtroom, wrestling with the prospect of homelessness. 

L.A. Superior Court has taken steps to significantly reduce foot traffic, and officials estimate 65% fewer people circulate in the system’s 38 courthouses than before the pandemic. Roughly 4,500 people appear remotely each day for hearings. And all of the 600 or so courtrooms across the county have the capability to conduct remote proceedings, said court spokeswoman Ann Donlan. 

But many in-person hearings are still taking place, and the criminal courts held nearly 70 jury trials in the final four months of 2020. Sometimes, the parties in a case insist on an in-person hearing. Some litigants lack internet or phone access, or don’t know a remote option is available. And unless a litigant has taken the steps to secure a waiver from the court, each remote appearance comes at a cost: $15 for audio and $23 for video. 

In eviction cases like Garcia’s, where tenants have just five court days to respond and most tenants lack legal representation, attorneys say that judges often require in-person proceedings, jeopardizing the health of lawyers, clients and court staff. 

Court officials say its operations are essential and its services, like providing restraining orders in domestic violence cases and protecting defendants’ due process rights, require keeping courthouses open. But others say many operations can be put off for now. 

“There is no urgency for a person with a traffic citation to be there now,” said Lauren Zack, an attorney with Public Counsel.

Racial inequities in LA vaccine rollout raise concern

Via The Los Angeles Times: Racial inequities in L.A. vaccine rollout raise concern. Excerpt:

Just weeks into California’s rocky rollout of the coronavirus vaccine, evidence is emerging of inequities in who is getting the medicine, prompting growing demands that vulnerable communities receive more attention. 

Los Angeles County officials said Tuesday they are concerned about low vaccination numbers among healthcare workers in South L.A. and other communities of color, while advocates for essential workers worry that California’s new vaccine priority plan slows their ability to get inoculated despite the dangers inherent in their jobs. 

The county Department of Public Health released demographic data Tuesday showing a significantly lower rate of vaccinations for healthcare workers who live in South L.A., home to large populations of Black and Latino residents, compared with other regions. 

Public Health Director Barbara Ferrer told the Board of Supervisors that her agency was “particularly concerned” about the low vaccination rate among healthcare workers living in South L.A. In response, the county will open six vaccination sites there, including at the outpatient center at Martin Luther King Jr. Community Hospital, St. John’s Well Child & Family Center and three Rite Aid pharmacies. 

“There may be many issues that contribute to the lower vaccination rates that we’re seeing in some communities, but the one issue that we don’t want to have accounting for a lower vaccination rate is that there wasn’t good access to places for people to get vaccinated,” Ferrer said. 

The data presented did not include vaccinations given by the Pasadena and Long Beach health departments, by Walgreens or CVS, or by large health systems, including Kaiser Permanente. But it showed the number of doses given to workers who live on the Westside, the west San Fernando Valley, the South Bay and parts of the San Gabriel Valley were relatively higher than in South L.A.  

But even with the incomplete snapshot, Supervisor Hilda Solis said it was clear there was a disparity among Black healthcare workers who’ve been vaccinated compared with other racial groups. She said the rates among Native American residents and Latinos were also far too low.  

“I know there’s large numbers of other populations that are getting the vaccine at higher rates than others, and I would just ask: What are we going to do?” Solis said.

Association of social and economic inequality with COVID-19 incidence and mortality across US counties

Via JAMA Network: Association of Social and Economic Inequality With Coronavirus Disease 2019 Incidence and Mortality Across US Counties. The key points and abstract:

Key Points 

Question  Are racial/ethnic population composition and economic inequality associated with coronavirus disease 2019 (COVID-19) incidence and mortality?  

Findings  This cross-sectional ecological analysis of cumulative COVID-19 incidence and mortality rates for the first 200 days of the pandemic in 3141 US counties confirmed positive associations of incidence and mortality rates with racial/ethnic composition and with income inequality well as a joint association of incidence and mortality with both structural factors.  

Meaning  This study suggests that COVID-19 surveillance systems should take into account county-level income inequality to better understand the social patterning of COVID-19. 

Abstract 

Importance  It is now established that across the United States, minoritized populations have borne a disproportionate burden from coronavirus disease 2019 (COVID-19). However, little is known about the interaction among a county’s racial/ethnic composition, its level of income inequality, political factors, and COVID-19 outcomes in the population. 

Objective  To quantify the association of economic inequality, racial/ethnic composition, political factors, and state health care policy with the incidence and mortality burden associated with COVID-19. 

Design, Setting, and Participants  This cross-sectional study used data from the 3142 counties in the 50 US states and for Washington, DC. Data on the first 200 days of the COVID-19 pandemic, from the first confirmed US case on January 22 to August 8, 2020, were gathered from the Centers for Disease Control and Prevention and USAFacts.org, the US Census Bureau, the American Community Survey, GitHub, the Kaiser Family Foundation, the Council of State Governments, and the National Governors Association.  

Exposures  Racial/ethnic composition was determined as percentage of the population that is Black or Hispanic; income inequality, using the Gini index; politics, political affiliation and sex of the state governor, gubernatorial term limits, and percentage of the county’s population that voted Republican in 2016; and state health care policy, participation in the expansion of Medicaid under the Affordable Care Act. Six additional covariates were assessed. 

Main Outcomes and Measures  Cumulative COVID-19 incidence and mortality rates for US counties during the first 200 days of the pandemic. Main measures include percentage Black and Hispanic population composition, income inequality, and a set of additional covariates. 

Results  This study included 3141 of 3142 US counties. The mean Black population was 9.365% (range, 0-86.593%); the mean Hispanic population was 9.754% (range, 0.648%-96.353%); the mean Gini ratio was 44.538 (range, 25.670-66.470); the proportion of counties within states that implemented Medicaid expansion was 0.577 (range, 0-1); the mean number of confirmed COVID-19 cases per 100 000 population was 1093.882 (range, 0-14 019.852); and the mean number of COVID-19–related deaths per 100 000 population was 26.173 (range, 0-413.858). 

A 1.0% increase in a county’s income inequality corresponded to an adjusted risk ratio (RR) of 1.020 (95% CI, 1.012-1.027) for COVID-19 incidence and adjusted RR of 1.030 (95% CI, 1.012-1.047) for COVID-19 mortality. Inequality compounded the association of racial/ethnic composition through interaction, with higher income inequality raising the intercepts of the incidence curve RR by a factor of 1.041 (95% CI, 1.031-1.051) and that of the mortality curve RR by a factor of 1.068 (95% CI, 1.042-1.094) but slightly lowering their curvatures, especially for Hispanic composition. 

When state-level specificities were controlled, none of the state political factors were associated with COVID-19 incidence or mortality. However, a county in a state with Medicaid expansion implemented would see the incidence rate RR decreased by a multiplicative factor of 0.678 (95% CI, 0.501-0.918).  

Conclusions and Relevance  This county-level ecological analysis suggests that COVID-19 surveillance systems should account for county-level income inequality to better understand the social patterning of COVID-19 incidence and mortality. High levels of income inequality may harm population health irrespective of racial/ethnic composition.

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.”

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.