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In crisis, public health comes undone

January 8, 2021 Category: FeaturedLongPurpose
Last year this time we were paying scant attention to a cluster of pneumonia cases in Wuhan city, China. A novel virus that had resulted in an outbreak of pneumonia was reported to WHO on the last day of 2019.

That was then.

Now, Americans rang in the first day of 2021 confirming the 20 millionth case of COVID-19. Where once America was touted for having the world’s best health protection systems, we now lead the world in the number of deaths due to the virus. Each day local governments throughout the country give COVID-19 updates.  To date 2,550 have died from the virus in Philadelphia.

What a difference a year makes.

Hardest hit has been the elderly in long-term care facilities. While they represent only 1% of the population, they have been about 40% of the COVID-19 deaths nationally and over 50% in Pennsylvania. According to the Centers for Disease Control and Prevention (CDC), African Americans are 1.4 times more likely to contract COVID-19 and 2.8 times more likely to die from it than whites. For Latinxs, the numbers are 1.7 and 2.8 times more likely, respectively.

Traditionally differences in health outcomes were related to poverty. “Health disparities are intrinsically linked to socioeconomic inequality, and Greater Philadelphia is no exception,” reported the Economy League in 2019, pointing out genetic predispositions, environmental factors and lifestyle choices as major reasons.

But seen through a social justice lens, the view changes dramatically. COVID-19 has exposed deep flaws in a public health system that is failing in its mission to protect the health of, promote wellness for, and provide safety net healthcare services to the most vulnerable.

A report from the Shriver Center on Poverty and Law starts, “Every time America is tested, from natural disasters to economic crashes, we fail to acknowledge these inequities and protect our Black and brown communities. This pandemic follows the path we laid.”  Health disparities in the outcome of structural racism even in the medical community.

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One of the first areas showing significant inequality was coronavirus testing.

“All the testing sites were primarily in affluent areas that were predominantly white and the reduced number of testing sites were in all the poor neighborhoods or middle-class neighborhoods that were predominantly Black,” Dr. Ala Stanford said in explaining her reason for creating the Black Doctors COVID-19 Consortium.

Dr. Ala Stanford. (Photo by Brandon Dorfman)

COVID-19 exposed the plummeting level of trust for the most vulnerable in the medical system. Dr. Stanford has described the healthcare system for African Americans as “untrustworthy.”

“I was intentional about the consortium’s name. I wanted the Black population to know that we as Black health care professionals are coming to your neighborhood to take care of you.” Stanford added. Trust is also the foundation of the community health worker or the promotora model for Latinx community.  Vulnerable people want trusted messengers.

The major consequence of mistrust is poorer health outcomes.

Lack of early testing was also considered the single greatest error with long-term care and nursing home facilities which resulted in these centers being at the center of COVID deaths. According to Kaiser Family Foundation, about 100,000 residents and workers at long-term care facilities have died of coronavirus in the past nine months.  Long-term nursing facilities are often the home of last resort for the elderly who can no longer remain safely in their own homes.

For the ill there is also substantial personal costs to managing COVID-19. Isolation and quarantine could mean lost pay days and an inability to pay essential bills.  According to a report by the Economic Policy Institute,  less than 1 in 5 African Americans and 1 in 6 Latinxs have the option to work from home compared to nearly 1 in 3 white Americans. For COVID positive workers housing insecurity and food insecurity issues has become a related issue.

The Pennsylvania Department of Health discovered this after hiring over 1,000 contract tracers with the goal of identifying potentially infected people. Yet in the process of gathering the health data, the tracers learned of individuals’ personal hardships including food and housing insecurity. The department was initially ill-prepared to address these issues, but additional funding allowed them to expand their social services.

“We are fortunate to have 10 social support coordinators in the commonwealth today,” Lindsey Mauldin, special assistant on contact tracing for the commonwealth’s Department of Health, explained. “Expanding our contact tracing program and building a public health infrastructure to support the needs of COVID-19 cases could not have been done without federal funding support from the Centers for Disease Control and Prevention.”

(Photo from phila.gov)

There have been moves to make local public health services more accessible. For example, at the end of December the Philadelphia Department of Public Health announced they had mobile COVID-19 testing unit that could be sent to small outbreak areas to staunch an outbreak, and they have issued a Request for Proposals for community organizations to get more involved with the vaccination of Philadelphia residents.

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