We Celebrate Juneteenth But Not Free From COVID-19

Despite pronouncements to the contrary from the White House, the actual numbers show that COVID-19 is still running rampant in the United States. Our country’s daily average of new cases has plateaued at around 20,000 per day. It appears that a larger number of people under 40 years old are now being diagnosed as infected. Fortunately, they generally experience less lethal outcomes. This changing demographic of positive tests is probably partly attributable to testing now being expanded to include more young people. Older Americans have probably gotten the message and are more likely to remain safe at home, properly socially distance when they go out, or wear masks. Experts note that this trend toward a younger demographic, at the current time, is not likely to last because these young individuals are likely to infect the older people in their lives. Twenty-three states are reporting higher case numbers than last week.  These increases are out of proportion to the increased numbers of tests. Florida, which was one of the last states to shut down and among the earliest to reopen just this week experienced a day with its largest single day count since the pandemic began.  Concerns are that it may well be the next epicenter for this very contagious virus. Eight other states experienced record high 7-day averages of new cases. Hospitalizations and ICU bed usage in several states, mostly in the Southern and Southwestern states, is still rising.  We have lost 118,000 Americans and 2.1 million citizens have been diagnosed as COVID-19 positive. To successfully fight this continuation of the first wave of this pandemic, several states, and large cities (California, Oregon, Montgomery, AL., Dallas, and Phoenix) are initiating processes to implement mandatory mask wearing while in public. On the treatment front, a commonly used steroid, dexamethasone, has reportedly shown to decrease deaths by one third when used in extremely ill patients who are on ventilators. The USA is saddled with 63 million doses of hydroxychloroquine after the FDA revoked the emergency use authorization and the WHO stopped the clinical trials because of a lack of efficacy and increased incidence of severe cardiac side effects. 

As we celebrate Juneteenth, we note that the atrocity of delayed and ineffective communication is still present today.  The Emancipation Proclamation became effective on January 1, 1863 and it was not until June 19, 1865 that the last enslaved Africans in the Confederacy were informed about their freedom. Contradictory and delayed messaging continue in this COVID-19 pandemic. There seems to be no rush to do anything about the disproportionate number of African Americans affected by this virus.  A Brookings Institute study this week reveals that the death rates from COVID-19 is higher amongst African Americans compared to whites and Hispanic/Latino.  It is starker in certain age groups. Specifically, the death rate (per thousand) in the 45-54 age group is six times higher for Black and Hispanic/Latino compared to Caucasians, and TEN times higher in the 35-44-year age group. Partial explanations for these disparities include unequal access to healthcare, the increased incidence and severity of pre-existing chronic conditions such as hypertension, diabetes, obesity, and lung disease; and occupations allowing for less social distancing. Nothing but cursory lip service has been given to this plight. Secondly, the messaging regarding the benefit of wearing of a face mask is absent.  The President, VP, and people in their control do not wear masks while the medical experts and the CDC advocate just the opposite for people out in public. Thirdly, the continuing need to socially distance remains a mainstay of treatment for COVID-19.  Yet more mixed messaging arises from the Administration.  In multiple appearances by the President and VP, there is no social distancing.  This behavior is averse to the recommendations of the CDC.  There is even a Tulsa campaign rally scheduled by the President soon.   The medical experts in Tulsa and Dr. Anthony Fauci, from the NIH, both feel that it is a bad idea to conduct or attend large gatherings of people, particularly indoors. Further mixed messaging arises from the President saying that he is not worried about attendees becoming infected yet those who attend must sign a “hold harmless” waiver. 

As healthcare providers we are committed to empowering our patients by providing truth and updated information. Our job is made immensely more difficult by the mixed messaging and by our federal government’s lack of commitment for addressing racial health disparities. Though freed from slavery, we are not free from systemic racism and the economic and health disparities of this COVID-19 scourge.

COVID-19 Weary but Not Complacent

COVID-19 continues to wreak havoc upon the USA.  We have just passed the milestone of 2,000,000 cases and the very depressing occurrence of over 114,000 deaths.  It is projected that the US will have lost 140,000 people by this July 4th. We are beginning to see the results of reopening and Memorial Day activities. Utah, Oregon, and Nashville, TN. have paused their reopening efforts. Fourteen states are showing an increase in cases of 25% or more. Phoenix, AZ.  and Montgomery, AL. are nearing their ICU bed capacity.  Note that the impact of the hundreds of thousands of Americans involved in righteous protests over the last two weeks will be realized soon. Many states, now including Ohio, allow for testing on request.  If you have been involved in protests, it would be prudent for you to be tested for COVID-19 7-10 days after your participation in protest activity. Protect others by self-isolating or at least by wearing a mask when around others until the test result is known. Additionally, the economic impact of this health pandemic is still being felt, as it will be long lasting.  If you are not able to be tested, then self-isolate for 14 days. Approximately 44 million Americans have filed for unemployment benefits, including 1.5 million over the last week. 

We know that people are becoming not only tired of hearing/reading about social distancing, wearing a mask, hand washing, and surface cleaning, but also of complying with these measures. It is remarkable that we have done so well with compliance and thus “the curve has flattened in the USA. With that said, our case numbers have only plateaued as a country and this is still no time to let our guard down. A very recent CDC telebriefing and a press conference yesterday confirms that it is not appropriate to conduct large gatherings because of the ongoing threat of spreading this novel coronavirus. Additionally, the CDC’s guidance (cdc.gov/coronavirus/2019) reconfirms that COVID-19 spread increases as the number of people in a group become larger and the longer period of time people are exposed to each other.  Gatherings which are outdoors lessen the risk of spread but does not eliminate the risk.  The CDC recommends wearing a mask or face covering when unable to partake in proper social distancing. Yet it is recognized that people are experiencing a “quarantine fatigue” so mask wearing, social distancing, and hand hygiene, though applauded, are being openly disregarded.  This type of abandonment citizenry behavior is being green lighted by top figures in the federal administration that publicly disregards the preventative measures that have brought the country this far. They are reverting to the same science denying, head in the sand, “moving on”, mentality that many say resulted in the severe health and economic impacts under which our country is currently suffering. There is no policy prescription to address the 2.4 times higher death rate among African Americans vs white Americans from COVID-19.  There is no national policy to compensate for the unequal economic impact of the virus nor to address PPE needs of working people and the public.  

Be that as it may, it is incumbent upon each of us to take individual control of our own health and the health of those around us.  This pandemic is nowhere close to being over! Clearly, we all would like to return to the socialization aspects of our lives that predated the pandemic.  The opportunity for as many people as possible to still be alive and healthy until there is a cure or vaccine is dependent on our behavior.  Although we are weary, we must remain vigilant and follow CDC guidelines. The vulnerable need to be extra careful.

100,000/40 million! Where Do We Go From Here?

Our country has reached two very tragic milestones in our fight against COVID-19.  We grieve the deaths of over 101,000 Americans and 1.7 million cases in just over 4 months.  US citizens over the age of 65 account for 80% of the deaths. African Americans are dying at 2.4 times the rate of white folks.  This data is from the 40 states and D.C. which do report data by race and ethnicity.  Emerging information from various parts of the country shows that younger people are being infected more frequently, probably a function of behavior, with nearly half of the newly infected people in Washington state being under the age of 40. Twelve states are showing increasing case counts and some with rising hospitalizations and deaths, as our country continues this patchwork reopening. 

African Americans suffer disproportionately from the work and economic changes brought by COVID-19.  The number of unemployed Americans has reached 40 million.  Weekly unemployment claims, though still massively high, are trending down from the high of 6.9 million in late March to 2.1 million this week. In all these numbers the service sector is particularly hard hit, which disproportionately affects African Americans. Our physical health is at risk, not only because of health disparities, but also because many of the occupations which we hold are not amenable to working from home. We therefore are exposed to public transportation and places of work without adequate PPE. The burden of our economic suffering is exemplified by the 40 per cent decrease in working African American business owners due to the economic shutdown, much worse than other ethnicities. Before the shutdown, we already had the lowest level of business ownership. 

It is clear that the federal government is not going to use all the measures at its disposal, such as the Defense Production Act, to support the state managed testing, contact tracing, and isolation. These are the means which experience, and experts, say will lessen lives lost and speed economic recovery. As citizens we must all do our part to empower our best health. Social distancing remains the hallmark of prevention of spread of this very contagious virus. Although 6 feet has been advocated as the proper distance of separation, recent work indicates that this may not be enough.  Your risk of being exposed increases when you are indoors and particularly with poor room ventilation. The evolving research on effective social distancing further magnifies the need to wear a face covering certainly when you are within 6 feet of any other individual with whom you do not live. 

There are great mental and physical health benefits to being outdoors, especially with the pandemic. The vulnerable population (meaning those with pre-existing conditions such as diabetes, hypertension, chronic lung, heart, or kidney diseases; and decreased immune system) needs to particularly weigh the risk and be sure to safeguard. Everybody is weary of being cooped up for the last several months and there is peace of mind derived from being outside. Social distancing still needs to be observed. The sunshine helps increase your body’s Vit D, which boosts your immune system. Taking walks, running, and bicycling are excellent. Playing golf, tennis and other one on one sports are fine with sport specific precautions.  It is okay to visit the park or to go hiking on a trail. Always remember to take your own water and snacks. Being in a swimming pool is of low risk unless you are within inappropriate social distance of another swimmer.  The big risk from swimming pools is around the pool, which can easily lead to violation of proper social distancing. Before you leave home, plan to avoid public restrooms. If you must use the facility, wait until the room is empty, if it is small.  By all means, wash your hands or use hand sanitizer when finished. According to our CDC, everyone should wear a face covering when they are around others, if not able to socially distance. 

Take control of you mental and physical health by safely getting outdoors during these summer months. Socially distance, wear a face covering, wash your hands and enjoy yourself while we wait for a vaccine against COVID-19. 

Follow the Science as We Reopen

The USA has suffered nearly 96,000 COVID-19 deaths and approximately 1.6 million known cases. There are approximately 5 million cases worldwide and 334,000 deaths across the earth.  On the economic side, many children are hungry and there are over 39 million Americans unemployed. The CDC updated its recommendations regarding re-opening only certain aspects of American society, although many states continue their own path without regard to even the initial recommendations.  The CDC also cautioned that we are destined to see a second wave of infections later this year. Ohio’s governor DeWine has taken a very measured approach and Ohio is doing better than many other states, yet Ohio has 30,167 cases and 1,836 deaths.  Information regarding how to proceed with day to day activities in Ohio can be found at “Responsible Restart Ohio” on www.coronavirus.ohio.gov .  There remains no proven medication for either prevention or treatment.  Vaccine research has revealed positive results in animal studies against the virus. Early, very preliminary, human studies are promising as well. Nevertheless, it is still projected that it will be 12-18 months before a proper vaccine will be ready for widespread distribution.  The Whitehouse has named the push to develop a COVID-19 vaccine, “Project Warp Speed”.  As healthcare providers, we caution that vaccine development cannot sacrifice safety for speed.  

Every state has embarked upon the journey to reopen its economy. This is occurring despite the absence of a federally directed program to ensure adequate PPE for essential workers (and the public), TESTING, and contact tracing, as well as the failure to fully use the Defense Production Act.  Reopening of the economy is indeed necessary, but it serves us best if done in a manner which saves the most lives. Safely reopening the economy will be accomplished by the citizenry adhering to appropriate social distancing, wearing of face covering, and washing our hands as we return to activities. 

There is science, which is both intellectual and practical, behind each of these measures, starting with why we “shut down” the economy in the first place through why certain behaviors are necessary to save lives. We will all benefit from following the science even though some seek individual and/or political gain by couching these measures purely in a divisive political light. Although it now seems like an eternity ago, the practical and economic rationale for shutting down the economy in March was to save lives by not overwhelming our healthcare system, especially the ICU capacity. Economists from Northwestern University declared that the short-term economic impact is a recession, but in the long run there is less death and more, still alive, workers to run the economy.  A separate group of U. of Chicago economists projected that “the mortality benefits of social distancing are about $8 trillion”.  Saving lives saves money!  Since physicians’ focus is life and health, it cannot be left unsaid that a Columbia University study released this week estimated that 54,000 American lives could have been saved IF the shutdown had been implemented two weeks earlier.

The wearing of a face cover or mask has been made a political football by those who prefer to ignore the science and the concern for the health of others, and by extension their own. They are also ignoring the benefits derived by the economy if less people are ill. The simple facts are that the main mechanism of spread of the virus which causes COVID-19 is by airborne particles and droplets released by sneeze, cough, talking, laughing, or breathing.  This was reconfirmed by a CDC update yesterday. The virus can easily travel up to six feet before falling to a surface. Additionally, 20-25% of people who test positive for the virus are not symptomatic. Lastly, some of the testing results are falsely negative. These facts are not political red or blue, but it is in black and white. Your wearing a face covering protects others from you and thereby increases everybody’s chance of remaining healthy and participating in our economy! 

For the sake of maximizing our health and restoring our economy, while we wait for a vaccine or treatment, the science dictates that we need to socially distance and wear a face covering when we cannot socially distance.  Please also cover your cough/sneeze and wash your hands frequently. All these simple things can be done as we enjoy the warm weather outdoors. The vulnerable among us need to maximize their social distancing, for now.

Update and Testing Will Empower Personal Decisions

COVID-19 continues to wreak havoc with the personal and public health, as well as the economies of the world. The USA (3rd in world population) continues to lead the world in both COVID-19 infections, approximately 1.4 million, and in deaths, approximately 87,000. Some 160,000 Americans have been hospitalized and recovered. Jobs lost in the USA have now reached 36 million. Recent information from the British medical journal, Lancet, confirmed that the particles that contain the virus can be transmitted by just talking. Amidst all that bad news, the risk of infection is decreasing in the US due to the measures of social distancing, wearing face covering, washing hands, and minimizing the touching of surfaces. We may also be seeing some lessening of infection rate of transmission because of the seasonal effect of warmer weather in some parts of the country.  There remains no proven preventative medication. A large study came out this week concluding that hydroxychloroquine not only failed to show any beneficial effect, but study patients were twice as likely to experience cardiac side effects. An antiviral intravenous medication named Remdesivir has been proven to shorten the length of hospital stay, by an average of 4 days, for people with moderate and severe infection. Early studies show a trend toward Remdesivir improving mortality, but further research is needed. An effective vaccine is still projected to be 12-18 months away. 

The journey to returning our citizens toward our desired way of life will be paved by social distancing, testing, contact tracing, isolation, and treatment. Rapid and accurate results of testing is the key to getting people back to work, school, places of worship, entertainment, restaurants, sporting events, non-emergent healthcare, travel, vacations, beauty salons and barber shops, spa/gyms, etc.  A test that does not accurately detect the presence or absence of COVID-19 is worse than no test at all. Let us step back and discuss the purpose of testing. 

There are two general types of tests in the COVID-19 context.  The first type is the diagnostic test which detects the actual presence of the virus (SARS-CoV-2) that causes COVID-19. Typically, in the USA, it requires a swab of the nose/nasal pharynx. A recently released test can be done with a mouth or throat swab.  South Korea uses a test that requires a patient to spit into a tube.  Their test is reliable and so quick that it is done at the airport for people flying into South Korean. The company that produces it is scheduled to ship supplies to the US by the end of May, which will allow 20 million tests to be performed.  As a health care organization, we again ask why the Defense Production Act has not been used for US to produce this product as well as adequate PPE.  It is not a new test, as South Korea has used it very extensively since early March. They have 260 deaths, to-date although their first death occurred on January 20, 2020 (vs Feb. 6,2020 in the USA). We use at least three brands of diagnostic tests around the country.  The FDA issued a warning today about the Abbott test being used at the White House. Various studies show that it has a false negative rate between 15% and 48%. Clearly, there is work that needs to be done. 

The second general class of tests are blood antibody (serologic) tests which are designed to detect whether a person has been infected by the virus and has recovered. Remember that up to 25% of infected people are totally without symptoms. Dozens of companies around the world have manufactured these tests. There is considerable variability as far as accuracy is concerned. 

Although there are some states where wanting a diagnostic test means you can get a diagnostic test, Ohio is not one of those states.  The availability of reliable, rapid results testing would allow us to achieve the steps laid out in the CDC coronavirus -19 flowsheets just released yesterday. 

There is indeed a great deal of anxiety about, not only our day to day lives, but about our futures. We know the measures that will help protect us as individuals (social distancing, hand washing, wearing a face covering). If you are in a vulnerable group, do your part by just staying home except for essential reasons. As an organization of healthcare providers, we ask the our government, on all levels to do their part by providing universal, reliable, and widespread testing as well as contact tracing in a federally coordinated manner.

Update and Why are They Willing to Accept So Much Death

The scourge of COVID-19 continues in the USA.  Our country continues to lead the world in cases, 1.3 million, and in deaths, approximately 76,000. Research is continuing aimed at finding medications for treatment as well as vaccines.  The USA accounts for 32% of the total COVID-19 deaths worldwide. Optimistic projections for a vaccine availability remain during 2021.  The medical community continues to learn about this disease. There is, yet to be peer-reviewed, research that hypothesizes the mutation of this SARS-CoV-2 virus (scientific name for the COVID-19 virus) to different strains. The researchers theorize that the strain on the US west coast came directly from China and is different, and less contagious, than the one that came from China, through Europe, then to the east coast of the US.  This concept is still being debated at this point.  Another alarming occurrence is the diagnosis of a severe multisystem inflammatory response (Kawasaki Disease) that is being seen with increasing frequency in children with COVID-19 infection.  This too is being studied further.  The major point here is that children are not immune to this infection and this COVID-19 affects all age groups. 

Despite a different locale in the US reaching its peak number of COVID-19 deaths daily, states continue to open.  They are nearly uniformly violating the minimal guidelines set forth by the Coronavirus Taskforce. Even those guidelines were put forth with the acceptance of the deaths that will occur as the social distancing is abandoned. The Washington University (IHME model) which the taskforce has relied upon, alluded to a twofold increase in daily deaths by the end of June. 

Let us explore which Americans are most susceptible to succumb from COVID-19.  African American make up 13% of the US population but are 30-34% of the deaths. Black folks who live in majority black counties have three times the infection rate and six times the mortality rate compared to majority-white counties. Americans over age 65 make up 80% of the deaths. Several weeks ago, the media and government officials gave fleeting lip service to the health disparities which are part of the fabric of America. Our government has moved on to demonstrating that the economy is a more significant consideration.  It is ironic that this preexisting focus on economic prosperity over health, actually contributes to the disparities which are being magnified by COVID-19. 

So, one must ask why are they so willing to accept the possible death of up to 3,000 Americans a day (CDC draft report)? Is it because the people who are dying are not those in power? We continue to believe that the sacrifice of lives at the altar of livelihood is a false choice.  Our country needs a federal response to coordinate proper social distancing, robust testing, contact tracing, isolation, and treatment as well as research for a cure and/or vaccination. Disaster response has traditionally been locally executed, managed by the state, and supported by the federal government.  The federal government needs to step up to the plate and do its part.  The Defense Production Act needs to be used to assure that adequate testing materials and PPE is available for the public. Curiously, the President was not reluctant to use the Act to mandate that meat production facilities stay open, even though COVID-19 is rampant at many meat processing facilities. 

Citizens will have confidence to return to work, go out and spend money when they feel safe. That will not happen until we can see that mechanisms are in place to protect us. The current haphazard “re-opening’, from state to state, lacks federal coordination and support. It is being perceived as valuing the economy over lives.  It is often said that “perception is reality”.

TEST for COVID-19 to Restore Our Economy

The impact to the US economy from COVID-19 can be summarized by the loss of 30+ million jobs, 10+ TRILLION dollars borrowed and spent by Congress, and hundreds of businesses which may never come back. The Coronavirus Taskforce put forth minimal guidelines recommended for states and regions to reopen their economies. The very next day the President implied that several states disregard those guidelines.  Multiple states have decided that reopening of their economies takes precedence over the likely increase in loss of life and are therefore violating even these minimal guidelines.  This week the future projected death toll from COVID-19 has already been increased from 68,000 up to 74,000, even before these states announced plans for reopening. 

No one is advocating keeping the US economy shutdown any longer than necessary. Unfortunately, the mainstay of defense against this scourge is “social distancing”, meaning staying at home.  While we await effective medications and/or a vaccine, we are best served by going on offense. An offensive approach consists of supplementing the social distancing with TESTING (accurate and rapid results), contact tracing (and testing), isolation of the known and suspected positives (and testing), and treatment of the infected. Testing in the USA and Ohio remains woefully inadequate.  A recent Harvard study places Ohio testing near the bottom 20% of states. Ohio is testing 20 people per 100,000 compared to a national average of 45 per 100,000. The Harvard group projects that Ohio needs 152 tests per 100,000 in order to safely reopen.  Governor DeWine states that he expects that Ohio testing will improve from the current 4,000 tests per day, to 20,000 per day by mid-May. We believe that adequate testing and contact tracing needs to be in place before Ohio reopens. 

As African Americans, we too have a huge stake in the responsible reopening of our economy both from a healthcare (life and death) standpoint as well as a financial standpoint.  The two are not mutually exclusive. We account for 34% of the US deaths from COVID-19, although we represent only 13% of the population.  African Americans bear a disparate burden of preexisting conditions of hypertension, diabetes, asthma, obesity and chronic medical problems. These preexisting conditions cause us to be in the “vulnerable population” which the Taskforce’s reopening guidelines recommends stay home until the later stages of economic reopening.  Yet so many of us are either essential workers, who have already been out there risking our personal wellbeing, or work in jobs which will be the first called back. Because our nation’s health insurance system is so intimately attached to employment, the loss of jobs means a loss of health insurance coverage. Essential workers, many of whom use public transportation to get to work, face the choice of life versus livelihood. There are physical and mental health, as well as economic issues, to be considered in the decision to return to work. The testing that would help to reassure people must be made available. Our federal government is best equipped to make the necessary testing available. We are screaming for the Defense Production Act to be used to produce enough gloves, masks, hand sanitizer, face shields and appropriate Personal Protective Equipment for the general public to be better protected. 

Although, there is enormous pressure and possibly less control over the decision to return to work, Americans are clearly not willing to return to the typical, more optional. tenets of American life.  Again, this insecurity ties into the necessity of rapid result and accurate TESTING for COVID-19! Americans are smart enough to know that COVID-19 is a highly contagious disease, which does not have a cure nor vaccine currently and testing is inadequate.  A new NPR/Marist poll finds that, by large percentages, Americans believe that it is a bad idea to resume the following specific activities without further testing: 1) 91%- large sporting events 2) 80%- sit down meal in a restaurant 3) 85%- children return to school 4) 65%- return to work. Americans know that adequate testing is necessary before we return to even a new normal. 

The individual decision to join the reopen is a difficult one. It has life and death ramifications. Protect yourself as you continue to protect others. We need rapid result, accurate, and widespread testing to protect our health and boost our economy. There are levers in the federal governmental arsenal which, if used, might lessen the anxiety about getting back to our “normal” activities.

Covid-19 Update and Test Then We Will Reopen Ohio Responsibly

The devastating effect of COVID-19 is continuing to slowly abate.  Yet, more than 63,000 Americans have lost their lives to this disease that has been diagnosed in over 1.1 million US citizens. Fortunately, over 100,000 have been hospitalized and discharged. This human toll has been great and unfortunately deaths and hospitalizations will continue, hopefully at a slower pace, until we get a vaccine in 12-18 months or so.  

The economic impact can be summarized by the loss of 30 million jobs, 10+ TRILLION dollars borrowed and spent by Congress, and hundreds of businesses which may never come back. The Coronavirus Taskforce put forth minimal guidelines for states and regions to reopen their economies. The very next day the President implied that several states disregard those guidelines.  Multiple states have decided that reopening of their economies takes precedence over the likely increase in loss of life and are therefore violating even these minimal guidelines.  This week the future projected death toll from COVID-19 has already been increased from 68,000 up to 74,000, even before these states announced plans for reopening. 

No one is advocating keeping the US economy shutdown any longer than necessary. Unfortunately, the mainstay of defense against this scourge is “social distancing” meaning staying at home.  This needs to be part of the defense until we get a large portion of the population vaccinated, at the earliest 12-18 months from now; or a medication cure is discovered. It should be noted that one antiviral, remdesivir, looks like it will be effective for severe form of COVID-19. While we wait for further research, we are best served by going on offense consisting of supplementing the social distancing with TESTING (accurate and rapid results), contact tracing (and testing), isolation of the known and suspected positives (and testing), and treatment of the infected. The mainstay of this life and economy saving strategy is obviously testing.  Despite what you may hear from the White House podium, testing in the USA remains woefully inadequate.  Everybody that needs a test, cannot get a test and certainly “everybody that wants a test” still cannot get a test. Currently approximately 200,000 tests per day are being performed and a robust testing strategy requires anywhere from 500,000 to 5 million tests per day.  To this date we have only tested just over 5 million Americans (just short of 2%). Dr. Anthony Fauci, one of the lead Taskforce medical consultants, states they he will be overly concerned if we do not have the 500,000 daily tests that we have again been promised by early June.  We, as a medical organization, again call for a federally coordinated approach and for the President to fully implement the Defense Production Act (DPA). American manufacturing, mandated by the DPA, can produce all the supplies necessary to get universal USA testing done!

As African Americans, we too have a huge stake in the responsible reopening of our economy both from a healthcare (life and death) standpoint as well as an economy standpoint.  The two are not mutually exclusive. We account for 34% of the US deaths from COVID-19, although we represent only 13% of the population.  African Americans bear a disparate burden of preexisting conditions of hypertension, diabetes, asthma, obesity and chronic medical problems. These preexisting conditions cause us to be in the “vulnerable population” which the Taskforce’s reopening guidelines recommends stay home until the later stages of economic reopening.  Yet so many of us are either essential workers, who have already been out there risking our personal wellbeing, or work in jobs which will be the first called back. Because our nation’s health insurance system is so intimately attached to employment, the loss of jobs means a loss of health insurance coverage. This is another concern of the “essential workers” along with getting to work on public transportation. There are physical and mental health, as well as economic issues, to be considered in the decision to return to work. The testing that would help to reassure people must be made available. Our federal government is best equipped to make the necessary testing available. We are screaming for the Defense Production Act to be used to produce enough gloves, masks, hand sanitizer, face shields and appropriate Personal Protective Equipment for the general public to be better protected. 

Although, there is enormous pressure and possibly less control over the decision to return to work, Americans are clearly not willing to return to optional, albeit typical, tenets of American life.  Again, this ties into the necessity of rapid result and accurate TESTING for COVID-19! Americans are smart enough to know that COVID-19 is a highly contagious disease, which does not have a cure nor vaccine currently. We are not even able to adequately test for the presence of the disease.  A new NPR/Marist poll finds that, by large percentages, Americans believe that it is a bad idea to resume specific activities without further testing: 1) 91%- large sporting events 2) 80%- sit down meal in a restaurant 3) 85%- children return to school 4) 65%- return to work. Americans know that adequate testing is necessary before we return to even a new normal. 

Government, at all levels, can help more, but as we wait, we must protect ourselves at the current time. Take your medications and do what is necessary to control any health problems.  “Stay home” if you can. When you must go out, wear a mask or nose/mouth covering at any time where you are not able to stay six (6) feet from any other person who does not live with you. As physicians, we hope that Governor DeWine’s recent decision to make the wearing of a mask voluntary for Ohio citizens visiting retail stores be changed back to requiring mandatory usage. The science is clear that the wearing of a mask protects others from the wearer of the mask, who may be among the 20% of people who might be asymptomatic.  Additionally, wear gloves if you need to touch anything and wash your hands (20 seconds) or use hand sanitizer. Avoid touching your face. If you sneeze or cough, do so into the bend of your elbow. Change your mask, as necessary. 

The individual decision to join the reopen is a difficult one. It has life and death ramifications. Protect yourself as you continue to protect others. We need rapid result, accurate, and widespread testing to protect our health and boost our economy. There are levers in the federal governmental arsenal which, if used, might lessen the anxiety about getting back to our “normal” activities.

Update and Saving Black Lives During The COVID-19 Pandemic

The USA now leads the world in the death toll and diagnosed cases of COVID-19.  Although we have lost over 33,000 souls and know of at least 650,000 people infected, the disease appears to be slowing in several states. Nevertheless, this is no time be ease up on the ‘stay at home” recommendations. When you must go out, wear a mask or nose/mouth covering at any time where you are not able to stay six (6) feet from any another person that doesn’t live with you. Wear gloves if you need to touch anything and wash your hands (20 seconds) or use hand sanitizer.

We have previously detailed the staggering statistics of the disproportionate death and infection rates from COVID-19 in the African American community. This is partly due to the healthcare disparities that exist in our communities.  Many people suffer with hypertension, diabetes, obesity, asthma, depressed immune systems, and chronic heart, lung, and kidney disease. There are no proven medications to treat this coronavirus infection and it is estimated that it will be 12-18 months before a vaccine is available. The mainstay of treatment is therefore “social distancing” which means staying at home from school, work, religious gatherings, sporting events, travel, vacations, and the usual activities of our prior lives.  The health problems that plague us and make us more vulnerable to COVID-19 still require treatment and access to medical advice. This access was difficult even before the pandemic.  We still rely upon our primary care providers for advice and they are just a phone call away. In past times, the emergency rooms have often been used for routine care. In this pandemic age, being in an emergency unit potentially exposes us to disease and uses up scarce resources. Therefore, it is necessary to use the telemedicine services of the hospitals, health department, and online resources before venturing out for non-emergent problems, if one has no primary care provider. 

There are many factors, commonly known as the social determinants of health, which result in massive disparities in our health and healthcare. It is commonly said that “When Americans catch a cold, black folk catch pneumonia”.  In this age a more appropriate saying is “Racism is a killer; a pandemic is a mass murderer”. With this said we cannot afford to wait until after the pandemic is over before we do something about those who are the victims of these disparities. 

It has become clear that our pandemic-stricken country is being held up by essential workers.  These are not only our nurses, doctors, medical technicians and therapists, but also the overlooked mass transit workers, truck drivers, janitors, home health aides, grocery store workers, farm and food processing workers, sanitation workers, etc. These individuals are underpaid and what is worse, under-protected. They continue to serve us without adequate testing, masks, gloves, and necessary protective gear. Full implementation of the Defense Production Act could address not only their shortages, but also the shortfall in the general public. Remember, the public is supposed to be wearing masks as well. Additionally, we should provide essential workers with health insurance coverage, either by Medicaid expansion or new enrollment into the Affordable Care Act (with subsidies to pay premiums).  Another means of addressing their current vulnerability would be to provide appropriate housing away from their loved ones if they normally live in cramped conditions.  

The people who are risking their lives, while the rest of us stay home, deserve to be protected by our governments’ best efforts, NOW. When this pandemic is over, we must focus on addressing the systemic reasons for this tragic persistence of healthcare disparities.