COVID-19 and Its Detrimental Affect on Health Disparities

Hi there my lovelies! Hope you guys are doing well and staying safe. Today, I will updated you on COVID-19 in the US and health disparities it has revealed.

COVID-19 Update

As of the last data from Johns Hopkins University, over 227,000 Americans died from COVID-19, while 8.8 million are infected. In addition, just on 10/27/2020, over 985 people died from COVID-19, while 73,240 individuals were newly infected with COVID-19. That my friend is a big wave coming to down us.

The above figures do not show the number is US for October 27. However, according to CDC, on October 27th, there were 72,183 new infections and 901 death. In other words on October 27th, the United States had 20% of global new cases, and 19.5% of global death due to COVID-19. The US only represent 4% of global population but 20% of global new infections and death.

What is surprising, we hear about eminent hurricane and/or Tsunami warnings, we do everything possible to protect ourselves, our loved ones and our possessions. Why can’t we do the same for COVID-19? After all, COVID is killing so much more than an average hurricane. Why are we putting us and our loved ones on harm’s way? Those who advocate for their 2nd amendment right to carry fire arms, would not hesitate to use that gun to protect themselves and their family. Yet, we are drowning ourselves with accelerant and playing with fires. When did we start losing our basic moral compass?

Virus Spread Prevention:

As Thanksgiving is coming around, we are all struggling to decide what to do. As for me, it’s simple. Do a Zoom Thanksgiving gathering. The most important thing is to keep my loved ones and my extended family safe. I do not want to be responsible for any possible outcome of family gathering. I rather have them be safe and gather virtually from in the comfort of their own socially distant homes.

COVID-19 and Healthcare Vulnerabilities:

COVID-19 has revealed some key vulnerabilities of our healthcare system. It is racial disparities. What is racial disparities? It’s when one race is affected disproportionately than another. We have seen that with various cancers such as cervical cancer (co-authors by me and accepted for publication). No part of the US has been fully spared. Nonetheless the burdens of the pandemic are unequally distributed. At every point, from initial infection to intensive care, COVID-19 exposed disparities by race/ethnicity and immigration status, by income and wealth.

According to CDC, American Indian, Alaska Native, and Black individuals are five times more likely, and Latin individuals four times more likely, to be hospitalized for COVID-19 than are non-Hispanic Whites. Low-income Americans are more likely to experience comorbidities, including diabetes and cardiovascular disease that make COVID-19 more burdensome and lethal. Immigrants represent 15 percent of the US labor force; one-third of these workers are undocumented. Almost three-quarters of undocumented immigrants work in essential, often people-facing, roles. Many immigrants face additional risks because they reside in crowded households.

According to a New York Times article, roughly 40 percent of COVID-19 deaths in the US, at least 77,000, have occurred in nursing homes and long-term care facilities. More than 760 nursing home staff members have died, making this one of the most dangerous occupations in the US. Moreover, according to Health Affairs, Right now, facilities that are less Medicaid-dependent with higher-quality ratings are less likely to report shortages of staff or protective equipment, suggesting that we will see widening COVID-19 disparities within the long-term care population and among the staff who serve them.

Furthermore, disparities are also seen increasing with proficiency and intensity of care. Critically ill COVID-19 patients admitted to hospitals with fewer than 50 ICU beds were markedly 3 times more likely to die than were patients admitted to larger hospitals according to an article published in the Journal of American Medical Association Internal Medicine, on July, 2020.

From Emergency Medicine Journal – The BMJ

As studies have shown that the frequency of prone positioning (putting patient on their stomach) —a key evidence-based therapy for COVID-19 patients at risk from Acute Respiratory Distress Syndrome (ARDS)—ranged from almost 5 percent at one hospital to nearly 80 percent at another.

Such disparities align with other social and economic cleavages. Additionally, another study published in Health Affairs on August, 2020 revealed that there was a large gap in access to COVID-19 care by income: 49 percent of the lowest-income communities had no ICU beds in their communities, whereas only 3 percent of the highest-income communities had no ICU beds.

Access to Care:

The failures and successes of our national COVID-19 response underscore the need for a nationally coordinated, administratively capable, emergency response and public health system at every level of government. This disproportionate impact is linked to poverty, crowded housing, and other social determinants. Many low-income workers are ineligible for unemployment insurance or are uninsured. Although people can obtain free testing and some free COVID-19-related care, many avoid medical care, fearing its financial burdens. In addition, many avoid testing, in part due to practical logistical barriers, in part due to fears regarding the implications of a positive result. Without social insurance protections, many continue to work even when they experience symptoms of COVID-19.

When it comes to access care, the submarket Medicaid reimbursement doubly undermines ICU care. Medicaid-dependent hospitals lack funding to support facilities and staff. Hospitals with greater resources are correspondingly hesitant to fill this gap by accepting transfers of Medicaid patients. Long-term federal commitment to provide Medicare rather than Medicaid reimbursement rates—at minimum during public health emergencies—would reduce these barriers. Furthermore, the federal government leaves states and localities to foot the majority of our public health care bill. A state-federal matching formula similar to Medicaid would provide greater incentives for states to do more.

A sustainable funding model requires a geographically and ideologically diverse national coalition that will defend public health investments once the immediate emergency has passed (As mentioned by Eric M. Patashnik on Unhealthy Politics The Battle Over Evidence-Based Medicine (ISBN: 9780691203225). The Affordable Care Act (ACA) provides a humbling example. The ACA included supports for worthy endeavors in health care outcomes research and in the prevention and public health fund.

Moreover, Public health requires sustained investment in the social work profession and workforce. Building relationship and engagement with vulnerable people, communities, and groups, helping people gain access to basic resources and reduce personal risks—these are core tasks of the social work profession, shamefully underused and under resourced during the COVID-19 pandemic.

My dear lovelies, as mentioned in Health Affairs, we can’t turn back the clock to undo our missteps in addressing COVID-19; nor can we undo decades of public health infrastructure neglect. We can still learn from the tragedy and build on our best responses. We owe that to over 227,000 fellow Americans (and counting), whose lives were so tragically, and often so needlessly, lost this year.

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