H5N1

As Covid-19 vaccine rollout expands, Black Americans still left behind

Via NBC News, a KHN report by Hannah Recht and Lauren Weber: As Covid vaccine rollout expands, Black Americans still left behind. Excerpt:

Black Americans are still receiving Covid-19 vaccinations at dramatically lower rates than white Americans even as the chaotic rollout reaches more people, according to a new KHN analysis. 

Almost seven weeks into the vaccine rollout, states have expanded eligibility beyond front-line health care workers to more of the public — in some states to more older adults, in others to essential workers such as teachers. But new data shows that vaccination rates for Black Americans have not caught up to those of white Americans. 

Seven more states published the demographics of residents who have been vaccinated after KHN released an analysis of 16 states two weeks ago, bringing the total to 23 states with available data.  

In all 23 states, data shows white residents are being vaccinated at higher rates than Black residents, often at double the rate — or even higher. The disparities haven’t significantly changed with an additional two weeks of vaccinations.  

In Florida, for example, 5.5 percent of white residents had received at least one vaccine dose by Jan. 26, compared with 2.0 percent of Black residents. That’s about the same ratio as it was two weeks ago, when the rates were 3.1 percent and 1.1 percent, respectively. 

Black Americans are being left behind due to barriers stemming from structural racism, as well as a failure to address nuanced hesitancy and mistrust about the vaccines and the medical system overall. The ongoing vaccination gap has prompted officials from around the nation to call for action. 

“With Covid-19 continuing to take a disproportionate and deadly toll on communities of color, we need urgent solutions to address health inequities and crush this virus," said Rep. Steven Horsford (D-Nev.), first vice chair of the Congressional Black Caucus. He said he is working to pass legislation to address equity issues.

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."

COVID-19 in California, January 7

Via The Los Angeles Times: California coronavirus cases: Tracking the outbreak. Today saw 37,000 new cases and 451 deaths. Excerpt:

• Stay-at-home orders remain. 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 38,955 cases per day, a significant jump from before the holidays. Roughly 13.7% of tests this past week have come back positive. 

• Deaths are on the rise. The state has averaged 381.1 daily deaths over the last week, an increase of 51.3% from two weeks ago. 

• Hospitalizations have never been higher. Statewide, there are 21,936 people hospitalized with a confirmed case, 16% more than two weeks ago. Check the status of facilities with The Times' new hospital tracker. 

• Disparities in age and race persist. Roughly 75% of the dead were 65 or older. After adjusting for population, Latinos are now 2.6 times more likely than whites to test positive.

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.

Deaths of despair and the incidence of excess mortality in 2020

Via the National Bureau for Economic Research: Deaths of Despair and the Incidence of Excess Mortality in 2020. The abstract, with my bolding:

Weekly mortality through October 3 is partitioned into normal deaths, COVID, and nonCOVID excess deaths (NCEDs). Before March, the excess is negative for the elderly, likely due to the mild flu season. From March onward, excess deaths are approximately 250,000 of which about 17,000 appear to be a COVID undercount and 30,000 non-COVID. 

Deaths of despair (drug overdose, suicide, alcohol) in 2017 and 2018 are good predictors of the demographic groups with NCEDs in 2020. The NCEDs are disproportionately experienced by men aged 15-55, including men aged 15-25. 

Local data on opioid overdoses further support the hypothesis that the pandemic and recession were associated with a 10 to 60 percent increase in deaths of despair above already high pre-pandemic levels.

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.

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.

A vaccine arrives as deaths rise and Southern California cases soar: This week in COVID-19 data, Dec 17

From the blog of The COVID Tracking Project: A Vaccine Arrives as Deaths Rise and Southern California Cases Soar: This Week in COVID-19 Data, Dec 17 | The COVID Tracking Project. Click or tap through for many links and graphs. Excerpts:

This week, American healthcare workers started receiving their first doses of a new COVID-19 vaccine. Early data has shown that the Pfizer/BioNTech vaccine is safe and highly effective, reaching 95 percent efficacy about a week after the second of two doses. The second COVID-19 vaccine under evaluation for use in the United States is expected to receive an FDA emergency use authorization as soon as tomorrow.   

COVID-19 vaccine doses won’t arrive in many US nursing homes until next week or the week after that, but a few residents in West Virginia and Florida got their first shot this week. While staff and residents in nursing homes and other long-term-care facilities wait for doses to arrive, 863 more US facilities reported outbreaks than in the previous week, and known cases of COVID-19 in long-term-care facilities are high and rising. Vaccinations in these facilities have the potential to save tens of thousands of lives over the next few months: In the past seven days, states reported more than 5,000 deaths linked to long-term-care facilities.  

In the United States as a whole, cases rose only slightly this week (Thursday, December 10 through Wednesday, December 16) compared with the previous week’s numbers, which included Thanksgiving reporting backlogs. Hospitalizations continue to climb, and deaths are rising across the country, reflecting the high cases and hospitalizations we’ve seen since early November. For the second week in a row, more COVID-19 deaths were reported in the United States than at any other time in the pandemic. Yesterday alone, states and territories reported 3,448 COVID-19 deaths, 25 percent more than were reported on the worst day of the spring surge.  

Our count of US COVID-19 deaths currently stands at 298,823, and will almost certainly reach 300,000 this week. It’s worth noting that from March through early November, when official COVID-19 deaths remained well under 250,000, at least 350,000 more people died than usual in the United States. A quarter of those “excess deaths” were officially attributed to causes other than COVID-19, but may actually have been due to the virus. The New York Times offers a close look at where deaths are above normal in the United States. 

These COVID-19 deaths haven’t affected all Americans equally. As of this week, US states report that more than 50,000 Black people have died of COVID-19. As stark as this number is, it’s also an undercount, in part because for more than 20,000 US COVID-19 deaths reported to date, no racial or ethnic demographic data was reported. 

Since the beginning of the pandemic, the data has shown that Black people have been much more likely to die than white people in the same jurisdiction. In Washington, DC, where the known disparity is the most extreme, Black residents have been more than six times as likely to die from COVID-19 as white residents. Nationwide, if these disparities did not exist—if Black people were only as likely to die of COVID-19 as white people are—more than 22,000 Black Americans would still be alive.