From Health Care

Progressive Group Highlights Trump, Tillis Weakness on Insulin Price Tags

During the first presidential debate of 2020, President Donald Trump touted his efforts to curb skyrocketing drug prices and declared that insulin is now “so cheap, it’s like water.” The response on social media was swift, and divided, with some people sharing pharmacy bills showing thousands of dollars they’d spent on insulin, while others boasted of newfound savings.

The next day, a self-described progressive political action committee called Change Now jumped into the fray by releasing an ad that circulated on Facebook attacking Trump and Sen. Thom Tillis (R-N.C.) on this issue.

In the 30-second ad, a North Carolina woman in her 30s explains she was diagnosed with Type 1 diabetes at age 4.

“Donald Trump and Thom Tillis opposed legislation that would lower the price of insulin and other prescription drugs,” she says. “People with diabetes can’t afford to wait for Trump and Tillis to fight for us. … We need affordable insulin now.”

(Posts sharing the quote were flagged as part of Facebook’s efforts to combat false news and misinformation on its news feed. Read more about PolitiFact’s partnership with Facebook.)

In recent years, politicians on both sides of the aisle have committed to addressing the cost of insulin. This election cycle — coinciding with a looming threat to the Affordable Care Act and millions of people losing jobs and employer-sponsored health insurance during the pandemic — the high price of prescription drugs has gained new significance.

Tillis is in one of the most heated Senate races in the country and has been repeatedly criticized by his opponent for receiving more than $400,000 in campaign contributions from the pharmaceutical and health product industries. Across the country, many voters say lowering prescription drug costs should be the top health priority for elected officials.

So, did Trump and Tillis really oppose policies that would accomplish that goal? We decided to take a closer look.

It turns out they’ve both opposed certain pieces of legislation that could have lowered the price of insulin and other prescription drugs, but they’ve also offered alternatives. The question is how aggressive those alternatives are and how many Americans would benefit from them.

Opposing the Strongest Reforms

Change Now pointed to two congressional bills to support the ad’s claim: one opposed by Trump, and the other by Tillis.

The first bill, known as H.R. 3, passed the House in December 2019, largely due to Democratic votes. It contains three main elements: decreasing out-of-pocket costs for people on Medicare, penalizing pharmaceutical companies that raise the price of drugs faster than the rate of inflation and — the most aggressive and controversial feature — allowing the federal government, which administers Medicare, to negotiate the price of certain drugs, including insulin. It also requires manufacturers to offer those agreed-on prices to private insurers, extending the benefits to a wider swath of Americans.

Stacie Dusetzina, an associate professor of health policy at Vanderbilt University School of Medicine, called it “the broadest-reaching policy that has been put forward” on drug pricing.

“While a lot of reform has focused on Medicare beneficiaries, that misses many insulin users,” Dusetzina said. “H.R. 3 does the most to affect prices for young consumers, like the woman in the ad.”

At the time, Trump vowed to veto that bill, saying the price controls it imposed “would likely undermine access to lifesaving medications” by decreasing the incentive for companies to innovate. When we checked in with the Trump campaign about the ad, a spokesperson reiterated this position, adding that the president continues to seek better legislative options.

The House bill in question, though, never made it to the president’s desk because the Senate didn’t take it up. Instead, the Senate Finance Committee proposed its own bill, which brings us to the second piece of legislation cited by Change Now.

Known as the Prescription Drug Pricing Reduction Act of 2019, the Senate bill echoes two aims of the House proposal: decreasing out-of-pocket costs for people on Medicare and putting an inflation-based cap on some drug prices.

That bill, too, stalled, with several Republican senators wary of the inflation cap. Among them was Tillis, who expressed concern that the measure could hamper innovation.

So, it’s true that Trump and Tillis have both opposed legislation that could lower the cost of insulin and other prescription drugs. But that’s not the full picture of what either politician has done on this issue.

Alternative Solutions for a Smaller Group of Americans

The Trump campaign provided a long list of actions taken by his administration to curb the high costs of medication, including a flurry of executive orders related to insulin and prescription drugs. Tillis’ campaign highlighted an alternative bill the senator co-sponsored to target drug costs. Let’s break them down one at a time.

One of Trump’s orders aims to have Federally Qualified Health Centers provide insulin and EpiPens at a discounted rate to the low-income individuals they serve. These centers, however, are already required to offer sliding-scale payments, and a full discount to patients who earn below the federal poverty line, said Rachel Sachs, an associate professor of law at Washington University in St. Louis, who tracks drug-pricing laws.

Another order deals with the importation of drugs from Canada, where they are often cheaper. Although the order specifically excludes biologic drugs, including insulin, the administration has requested proposals from private companies on how insulin could be safely brought in from other countries.

The president also issued a particularly ambitious order that seeks to tie the price Medicare pays for drugs to a lower international reference price. The Trump administration, however, hasn’t released final regulations to implement that policy, which could take years. If implemented, the policy is expected to be challenged in court by the drug industry.

Perhaps the most notable measure on insulin at the moment, experts said, is a federal demonstration project that Medicare plans can voluntarily opt into, to cap the monthly copay for insulin at $35 for some seniors. The project is slated to begin in January 2021, but its long-term future is uncertain, Sachs said, because it relies on parts of the Affordable Care Act, which could be struck down by a Supreme Court ruling later this year.

In Congress, Tillis and five other Republican senators introduced an alternative drug-pricing bill last December, called the Lower Costs, More Cures Act.

Tillis believes this is “the better option,” campaign spokesperson Andrew Romeo said, because “in addition to helping control drug prices, the legislation also seeks to preserve America’s capacity to research and develop lifesaving medications.” It includes a monthly cap on insulin copays for Medicare beneficiaries and requires manufacturers to disclose prices in consumer ads.

But experts said Tillis’ proposal is weaker than other options before the House and Senate. It doesn’t include an inflation cap, Sachs said, and the bill’s benefit would likely be limited to some seniors on Medicare, leaving out the more than 150 million Americans covered by private insurance.

Jason Roberts, an associate professor of political science at the University of North Carolina-Chapel Hill, said the bill is largely symbolic.

“Tillis is getting hit for not supporting a bill that could move,” Roberts said. “Instead, he introduces something that has no chance of going anywhere, and he knows that. But it’s a way of trying to deflect that criticism without getting a lot accomplished.”

Our Ruling

An ad sponsored by a progressive political action committee claims that Trump and Tillis have opposed legislation that would decrease the cost of insulin and other prescription drugs.

Based on the two pieces of drug-pricing legislation Change Now points to, that’s accurate. Trump and Tillis have voiced opposition to prominent bills that experts say could decrease the cost of insulin for a broad group of Americans.

However, both politicians have also proposed alternative policies to lower the price of insulin and other prescription drugs. Most of their proposals have not taken effect yet and are largely targeted at seniors.

We rate the ad’s claim Mostly True.

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UVA Health Still Squeezing Money From Patients — By Seizing Their Home Equity

Doris Hutchinson wanted to use money from the sale of her late mother’s house to help her grandchildren go to college.

Then she learned the University of Virginia Health System was taking $38,000 of the proceeds because a 13-year-old medical bill owed by her deceased brother had somehow turned into a lien on the property.

“It was a mess,” she said. “There are bills I could pay with that money. I could pay off my car, for one thing.”

Property liens are the hidden icebergs of patient medical debt, legal experts say, lying unseen, often for decades, before they surface to claim hard-won family savings or inheritance proceeds.

An ongoing examination by KHN into hospital billing and collections in Virginia shows just how widespread and destructive they can be. KHN reported a year ago that UVA Health had sued patients 36,000 times over six years for more than $100 million, often for amounts far higher than what an insurer would have paid for their care. In response to the articles, the system temporarily suspended patient lawsuits and wage garnishments, increased discounts for the uninsured and broadened financial assistance, including for cases dating to 2017.

Those changes were “a first step” in reforming billing and collection practices, university officials said at the time.

However, UVA Health continues to rely on thousands of property liens to collect old bills, in contrast to VCU Health, another huge, state-owned medical system examined by KHN. VCU Health pledged in March to stop seizing patients’ wages over unpaid bills and to remove all property liens, which are created after a creditor wins a court judgment.

Working courthouse-by-courthouse, VCU Health now says it has discovered and released 45,000 property liens filed against patients just in Richmond, its home city, some dating to the 1990s. There are an estimated 35,000 more in other parts of the state. Fifteen thousand of those have been canceled and they are working on the rest, officials said. These figures have not been previously reported. The system is part of Virginia Commonwealth University.

VCU Health’s total caseload is “a huge number” but perhaps not astonishing given the energy with which many hospital systems sue their patients, said Carolyn Carter, deputy director of the National Consumer Law Center.

Despite having suspended patient lawsuits, UVA Health has continued to create property liens based on older court cases, court records show. The number of new liens is “small,” said UVA Health spokesperson Eric Swensen.

An advisory council of UVA Health officials and community leaders is expected to deliver new recommendations by the end of October, Swensen said. The council, whose schedule has been slowed by the coronavirus crisis, has discussed property liens, Don Gathers, an activist and council member, said in an interview this summer.

Nobody knows how many old or new UVA Health liens are scattered through scores of Virginia courthouses. The health system, which has sued patients in almost every county and city in the state, has failed to respond to repeated requests over two years to disclose the number and value of its property liens.

But in Albemarle County alone, which surrounds the university’s Charlottesville home, “there are thousands” of UVA Health judgments filed in the land records, which creates a lien, said Circuit Court Clerk Jon Zug.

Not just Virginia homes are at risk. UVA Health lawyers search the nation for property or other assets owned by patients with outstanding bills and have filed liens in Maryland, West Virginia, Ohio and Florida, court records show.

The system put a lien on a Nevada vacation condo owned by Veronica Musie’s family a decade ago over a $30,600 hospital bill, said Musie, who lives in northern Virginia. The family has since paid the debt.

Virginia property liens expire after 20 years. But UVA Health often renews them. Since 2017, just in Albemarle County, it has renewed more than three dozen liens. That means the medical system could seize families’ home equity until 2039 for bills dating to the last century.

UVA Health and other medical systems rarely force the sale of a home to claim money. Instead, they wait for families to refinance or sell, taking their cut at the settlement table. But with 6% simple interest accumulating year after year after the court judgment, as allowed by Virginia law, the final amount owed can be much more than the original charges.

UVA Health treated Hutchinson’s brother for heart disease in the early 2000s. The unpaid bill was $24,868. The system laid claim to their mother’s home because he was one of her heirs. The claim is up to $38,000 now, she said, because of interest charges. Hutchinson has been disputing it for more than a year.

VCU Health and its MCV Physicians affiliate estimate that eliminating two decades of property liens in courthouses across the state, which they began to do last year after KHN published its reports, won’t be finished until spring.

Richmond was especially problematic. Because releasing 40,000 Richmond liens by hand would have been impractical, VCU Health got a judge’s permission to do it with computer code.

Creditors such as UVA and VCU don’t need addresses to create liens. All they have to do is file a judgment in county or city land records. If debtors own any property there, title companies won’t approve a sale until the debt is paid, often with home equity.

Often owners don’t know debts exist until paralegals unearth them when homes are sold, property pros say. Old debts can create liens on newly acquired real estate.

“It could be your grandmother’s house, and as soon as you’ve inherited it, and you’ve got judgments, those [liens] are now attached,” said Richmond Court Clerk Edward Jewett.

Frequently debtors own no property, so judgments in the land records expire without hospitals or other creditors getting anything.

VCU and MCV had no idea how many liens they had placed across the state until they began investigating last year after KHN’s inquiries, officials said.

“It’s an incredibly manual process” to cancel the claims, partly because computer systems at many courthouses prohibit an easy tech solution, said Melinda Hancock, VCU Health’s chief administrative and financial officer. But it’s worth it to remove a burden on patients, she said, adding, “This is an outdated collections practice whose time has come and gone.”

But many medical systems still do it, consumer debt experts say, noting that obtaining a complete picture of hospital property liens is impossible.

Land and judgment records are held by thousands of local court clerks, often using separate computer systems. Records are difficult or impossible to obtain in bulk.

“There is not a good nationwide study that I know of that looks at how widespread this is, how many consumers are affected, what’s the average size of a lien,” said Erin Fuse Brown, a law professor at Georgia State University who studies hospital billing.

Mike Miller and Kitt Klein are among those hoping UVA Health follows VCU Health in canceling thousands of property liens. They fear a $129,000 judgment won by UVA in 2017 against Miller will cost them the equity in their home in Quicksburg, Virginia.

They make about $25,000 a year. Miller, a house painter, was insured but received out-of-network radiation at UVA that doctors said was necessary to treat his lung cancer.

After KHN wrote about his case a year ago, benefits firm WellRithms analyzed his UVA bill and found that a commercial insurer would have paid a little more than $13,000, not $129,000, for the treatment.

“We know all [health care] providers bill a lot, but usually ‘a lot’ is three to six times what reasonable prices would be,” said Jordan Weintraub, vice president of claims for WellRithms. Trying to collect 10 times as much, she said, “is really out there.”

UVA Health does not comment on individual patient cases, Swensen said.

KHN found last year that UVA frequently sued patients for far more than what the system could have collected from insurance.

Early this year Miller and Klein emailed UVA President James Ryan, asking for help in reducing or eliminating the judgment. His office phoned in February, saying it would review the case.

“I became very emotional, filled with gratitude,” Klein said. “I couldn’t talk.”

Months went by with no contact. Recently a lawyer from the office of Virginia Attorney General Mark Herring offered to settle the case for $120,000, Klein said, reducing the bill by only $9,000. They don’t have the money. Miller’s cancer has returned. Interest is mounting at 6%.

University officials do not comment on legal matters or individual cases, a Ryan spokesperson said. Herring’s office did not respond to requests for comment.

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Health Care Groups Dive Into Property Tax Ballot Fight, Eyeing Public Health Money

SACRAMENTO — A November ballot initiative to raise property taxes on big-business owners in California is drawing unconventional political support from health care power players and public health leaders.

They see Proposition 15 as a potential savior for chronically underfunded local health departments struggling to respond to the worst public health crisis in more than a century. The initiative would change California’s property tax system to tax some commercial properties higher than residential properties, which backers say could generate billions to help local governments pay for critical public health infrastructure and staffing.

Without such additional state or federal funding, local governments could be forced to make deeper budget cuts in health and other departments next year as the COVID-19 pandemic continues to strain city and county finances.

“When you’re talking about health care, you’re talking about money,” said Anthony Wright, executive director of Health Access California, a Sacramento-based consumer advocacy group. “This is the major revenue measure on the ballot this year, and it’s an opportunity to fund public health at the place where the main responsibility for public health lies — at the county level.”

At least that’s how health care advocates are casting the tax hike. But there’s no guarantee that if the measure passes counties would use new revenue to address COVID-19 or other health care needs. And some rural counties fear they would lose money if the ballot measure passes, which could undercut public health efforts.

Support within the health care and local government worlds is not unanimous. The powerful California Hospital Association opposes the measure because it would result in higher taxes on private and investor-owned hospitals, said spokesperson Jan Emerson-Shea. Nonprofit hospitals, including those run by Sutter Health, Kaiser Permanente and Dignity Health, are exempt from paying property taxes despite their regular high revenue. They would remain exempt under the initiative. (KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.)

“This new tax will mean millions of dollars will be taken away from patient care, in perpetuity,” Emerson-Shea said.

Proposition 15 would amend California’s landmark 1978 property tax initiative, Proposition 13, which capped commercial and residential property tax rates at 1% of assessed value at the time of purchase, and limited annual increases thereafter to 2%. The drop in property taxes as a result of the initiative decimated a major revenue source for public schools and social welfare programs, leaving many underfunded.

Voters are now being asked to allow higher taxes for business owners with commercial holdings valued at more than $3 million. If passed, the measure could generate up to $11.5 billion a year, according to the nonpartisan state Legislative Analyst’s Office. It would not apply to residential properties.

Forty percent of annual revenue would be distributed to K-12 schools and community colleges, with 60% sent to cities and counties. Nothing in the measure would require new local revenue to be spent on health care, but supporters say it’s their best hope after losing $134 million in state public health money this year as one-time funding for specific programs expired. At the same time, slammed by a projected $54 billion deficit, Gov. Gavin Newsom and state lawmakers declined this year to increase funding for local health departments to combat COVID-19 and rebuild public health infrastructure.

Sponsors of Proposition 15, including the California Teachers Association and the Service Employees International Union California, argue it’s an overdue change that would tax wealthier enterprises in exchange for funding vital school and health care programs. They point out that the initiative, supported by Newsom and Democratic presidential nominee Joe Biden, would require schools and local governments to disclose all new revenue they receive and how money is spent.

If passed, money from the measure would begin flowing to schools and counties in 2022 at the earliest.

Opponents of the measure, including the California Chamber of Commerce, the California Republican Party and the Howard Jarvis Taxpayers Association, say hiking taxes on commercial property owners would harm struggling businesses hit hard by COVID-related closures.

“This is being pushed as a panacea cure-all, but at the end of the day, there is no accountability for where these funds go,” said Michael Bustamante, a spokesperson for the “No on Prop 15” campaign. “There are, without question, an infinite number of needs, but there is no specificity with what it can or can’t be spent on.”

Kat DeBurgh, executive director of the Health Officers Association of California, which represents the state’s 61 local health officers and has not taken a position on the initiative, said ongoing, unrestricted revenue could actually benefit counties by allowing them to spearhead public health programs that address local needs.

At present, counties are limited in what they can do with their public health dollars, she said. Most additional funding in recent years has largely been earmarked for specific programs or diseases, such as hepatitis C and HIV, and counties are not allowed to spend it on their COVID-19 response or other public health activities.

“Maybe your community’s highest priority is not something easily funded by one of these grants. Many rural areas in our state don’t have access to clean drinking water, for example,” DeBurgh said. “And our greatest demand — more public health workers — can’t be funded with grants or one-time money.”

Health care leaders also argue the initiative could help support community clinics and public hospitals that provide care for uninsured people, who have also suffered financially during the pandemic.

“What we’re really trying to avoid is having to balance the budget on the backs of people who need services,” said Jodi Hicks, president and CEO of Planned Parenthood Affiliates of California. “Our public health system has clear inequities that we need to address, and additional funding can help fill in the gaps at the county level.”

Hicks said Planned Parenthood, which provides sex education in California public schools, is supporting the initiative not only to improve public health, but also because she worries programs like sex education will be on the chopping block as the state experiences unprecedented job and economic losses.

“Those types of programs are the first to get cut when there’s not enough funding,” she said.

Small, rural counties could also lose funding, county assessors said.

While the initiative would likely raise taxes on large commercial property owners who have seen their land and property appreciate in value over the years, it would eliminate property taxes for other business assets, such as machinery and equipment, for the first $500,000 in value.

Counties that haven’t seen land values climb as high as those in coastal regions like the Bay Area may not collect more property taxes while also losing revenue from the tax cut on other business assets.

Chuck Leonhardt, the elected assessor for rural Plumas County, projects that his county could be one of the losers.

“This would take $90 million in assessed value from our tax roll at the beginning, and then I’d have to reassess 2,000 commercial properties,” he said. “Many of us rural counties don’t feel we’ll benefit from doing these reappraisals and my expectation is we could lose some money.”

Even among supporters in public health, some fear that any potential windfall for counties would be allocated based on the whims of local politics.

“Even though I support it, I am skeptical that this money will go to the public health programs and basic infrastructure we so desperately need because public health has no constituency,” said Bruce Pomer, a public health expert and chief lobbyist for the California Association of Public Health Laboratory Directors.

He pointed to Sacramento County, where the sheriff’s department received a larger share of the $181 million in federal COVID-19 relief money than the county public health department.

“I’m worried we’ll see the same thing we saw with Sacramento County,” Pomer said.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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‘An Arm and a Leg’: Vetting TikTok Mom’s Advice for Dealing With Debt Collectors

Can’t see the audio player? Click here to listen.

TikTok mom Shaunna Burns used to be a debt collector, so she knows a few things about what’s legal and what’s not when a company contacts you to settle a debt. We fact-checked her advice with a legal expert: Jenifer Bosco, an attorney with the National Consumer Law Center.

Bosco said most of Burns’ advice totally checks out.

A recent report from ProPublica shows that debt collectors have thrived during the pandemic; they’re out in force to get people to pay up. But we have rights. Scroll down for some consumer protection resources.

You don’t need to have heard our earlier episode about Burns and her story; you can start right here. (Both conversations contain lots of strong language, so maybe listen when the kids aren’t around.)

Meanwhile, here are links to resources:

Burns’ Dealing-With-Debt-Collectors TikTok Videos

Be sure to note Jen Bosco’s legal caveats, but Burns will get you in the fighting spirit.

“An Arm and a Leg” is a co-production of Kaiser Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

To hear all Kaiser Health News podcasts, click here.

And subscribe to “An Arm and a Leg” on iTunesPocket CastsGoogle Play or Spotify.

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Al sopesar los temas de salud, la mayoría de los votantes se inclinan hacia Biden

Al menos la mitad de los votantes prefiere el enfoque de la atención médica del ex vicepresidente Joe Biden al del presidente Donald Trump, lo que sugiere que la preocupación por reducir los costos y manejar la pandemia podría influir en el resultado de esta elección, según revela una nueva encuesta.

Los hallazgos, de la encuesta mensual de KFF, indican que los votantes no confían en las garantías del presidente de que protegerá a las personas con condiciones preexistentes de las compañías de seguros si la Corte Suprema anulara la Ley de Cuidado de Salud a Bajo Precio (ACA).

Un mes antes de que el tribunal escuche los argumentos de los fiscales generales republicanos y la administración Trump a favor de revocar la ley, la encuesta muestra que el 79% del público no quiere que el Supremo cancele las protecciones de cobertura para los estadounidenses con afecciones preexistentes. La mayoría de los republicanos, el 66%, dijo que no quiere que se anulen esas garantías.

Además de dejar a unos 21 millones de estadounidenses sin seguro, revocar ACA podría permitir a las compañías de seguros cobrar más o negar cobertura a las personas porque tienen condiciones preexistentes, una práctica común antes que se estableciera la ley, y que un análisis del gobierno reveló en 2017 que podría afectar hasta a 133 millones de estadounidenses.

Casi 6 de cada 10 personas dijeron que tenían un familiar con una condición preexistente o crónica, como diabetes, hipertensión, o cáncer, y aproximadamente la mitad dijo que les preocupa que un ser querido no pueda pagar la cobertura, o la pierda por completo, si se anulara la ley.

La encuesta revela una preferencia sorprendente por Biden sobre Trump cuando se trata de proteger a las personas con condiciones preexistentes, un tema que el 94% de los votantes dijo que ayudaría a decidir por quién votar. Biden tiene una ventaja de 20 puntos: un 56% prefiere su enfoque, contra un 36% para Trump.

De hecho, el sondeo muestra una preferencia por Biden en todos los problemas de atención médica que se plantean, incluso entre los mayores de 65 años y en temas que Trump ha dicho que eran sus prioridades mientras estuviera en el cargo, lo que indica que los votantes no están satisfechos con el trabajo del presidente para reducir los costos de la atención médica, en particular. El apoyo a los esfuerzos de Trump para reducir el precio de los medicamentos recetados ha disminuido, y los votantes ahora prefieren el enfoque de Biden, del 50% al 43%.

La mayoría de los votantes dijeron que prefieren el plan de Biden para lidiar con el brote de COVID-19, 55% a 39%, y para desarrollar y distribuir una vacuna para COVID, 51% a 42%. Trump ha delegado en gran medida la gestión de la pandemia a los funcionarios estatales y locales, al tiempo que prometió que los científicos desafiarían las expectativas y producirían una vacuna antes del día de las elecciones.

Cuando se les preguntó qué tema era más importante para decidir por quién votar, la mayoría de los encuestados señaló a la atención médica. El 18% eligió el brote de COVID-19 y el 12% mencionó el cuidado de salud en general. Casi una proporción igual, el 29%, optó por la economía.

La encuesta se realizó del 7 al 12 de octubre, después del primer debate presidencial y el anuncio de Trump de que había dado positivo para COVID-19. El margen de error es más o menos 3 puntos porcentuales para la muestra completa y 4 puntos porcentuales para los votantes.

(KHN es un programa editorialmente independiente de KFF).

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Most Home Health Aides ‘Can’t Afford Not to Work’ — Even When Lacking PPE

In March, Sue Williams-Ward took a new job, with a $1-an-hour raise.

The employer, a home health care agency called Together We Can, was paying a premium — $13 an hour — after it started losing aides when COVID-19 safety concerns mounted.

Williams-Ward, a 68-year-old Indianapolis native, was a devoted caregiver who bathed, dressed and fed clients as if they were family. She was known to entertain clients with some of her own 26 grandchildren, even inviting her clients along on charitable deliveries of Thanksgiving turkeys and Christmas hams.

Without her, the city’s most vulnerable would have been “lost, alone or mistreated,” said her husband, Royal Davis.

Despite her husband’s fears for her health, Williams-Ward reported to work on March 16 at an apartment with three elderly women. One was blind, one was wheelchair-bound, and the third had a severe mental illness. None had been diagnosed with COVID-19 but, Williams-Ward confided in Davis, at least one had symptoms of fatigue and shortness of breath, now associated with the virus.

Even after a colleague on the night shift developed pneumonia, Williams-Ward tended to her patients — without protective equipment, which she told her husband she’d repeatedly requested from the agency. Together We Can did not respond to multiple phone and email requests for comment about the PPE available to its workers.

Still, Davis said, “Sue did all the little, unseen, everyday things that allowed them to maintain their liberty, dignity and freedom.”

He said that within three days Williams-Ward was coughing, too. After six weeks in a hospital and weeks on a ventilator, she died of COVID-19. Hers is one of more than 1,200 health worker COVID deaths that KHN and The Guardian are investigating, including those of dozens of home health aides.

During the pandemic, home health aides have buttressed the U.S. health care system by keeping the most vulnerable patients — seniors, the disabled, the infirm — out of hospitals. Yet even as they’ve put themselves at risk, this workforce of 2.3 million — of whom 9 in 10 are women, nearly two-thirds are minorities and almost one-third are foreign-born — has largely been overlooked.

Home health providers scavenged for their own face masks and other protective equipment, blended disinfectant and fabricated sanitizing wipes amid widespread shortages. They’ve often done it all on poverty wages, without overtime pay, hazard pay, sick leave and health insurance. And they’ve gotten sick and died — leaving little to their survivors.

Speaking out about their work conditions during the pandemic has triggered retaliation by employers, according to representatives of the Service Employees International Union in Massachusetts, California and Virginia. “It’s been shocking, egregious and unethical,” said David Broder, president of SEIU Virginia 512.

The pandemic has laid bare deeply ingrained inequities among health workers, as Broder puts it: “This is exactly what structural racism looks like today in our health care system.”

Every worker who spoke with KHN for this article said they felt intimidated by the prospect of voicing their concerns. All have seen colleagues fired for doing so. They agreed to talk candidly about their work environments on the condition their full names not be used.


Tina, a home health provider, said she has faced these challenges in Springfield, Massachusetts, one of the nation’s poorest cities.

Like many of her colleagues — 82%, according to a survey by the National Domestic Workers Alliance — Tina has lacked protective equipment throughout the pandemic. Her employer is a family-owned company that gave her one surgical mask and two pairs of latex gloves a week to clean body fluids, change wound dressings and administer medications to incontinent or bedridden clients.

When Tina received the company’s do-it-yourself blueprints — to make masks from hole-punched sheets of paper towel reinforced with tongue depressors and gloves from garbage bags looped with rubber bands — she balked. “It felt like I was in a Third World country,” she said.

The home health agencies that Tina and others in this article work for declined to comment on work conditions during the pandemic.

In other workplaces — hospitals, mines, factories — employers are responsible for the conditions in which their employees operate. Understanding the plight of home health providers begins with American labor law.

The Fair Labor Standards Act, which forms the basis of protections in the American workplace, was passed in an era dually marked by President Franklin Delano Roosevelt’s New Deal changes and marred by the barriers of the Jim Crow era. The act excluded domestic care workers — including maids, butlers and home health providers — from protections such as overtime pay, sick leave, hazard pay and insurance. Likewise, standards set by the Occupational Safety and Health Administration three decades later carved out “domestic household employment activities in private residences.”

“A deliberate decision was made to discriminate against colored people — mostly women — to unburden distinguished elderly white folks from the responsibility of employment,” said Ruqaiijah Yearby, a law professor at St. Louis University.

In 2015, several of these exceptions were eliminated, and protections for home health providers became “very well regulated on paper,” said Nina Kohn, a professor specializing in civil rights law at Syracuse University. “But the reality is, noncompliance is a norm and the penalties for noncompliance are toothless.”

Burkett McInturff, a civil rights lawyer working on behalf of home health workers, said, “The law itself is very clear. The problem lies in the ability to hold these companies accountable.”

The Occupational Safety and Health Administration has “abdicated its responsibility for protecting workers” in the pandemic, said Debbie Berkowitz, director of the National Employment Law Project. Berkowitz is also a former OSHA chief. In her view, political and financial decisions in recent years have hollowed out the agency: It now has the fewest inspectors and conducts the fewest inspections per year in its history.

Furthermore, some home health care agencies have classified home health providers as contractors, akin to gig workers such as Uber drivers. This loophole protects them from the responsibilities of employers, said Seema Mohapatra, an Indiana University associate professor of law. Furthermore, she said, “these workers are rarely in a position to question, or advocate or lobby for themselves.”

Should workers contract COVID-19, they are unlikely to receive remuneration or damages.

Demonstrating causality — that a person caught the coronavirus on the job — for workers’ compensation has been extremely difficult, Berkowitz said. As with other health care jobs, employers have been quick to point out that workers might have caught the virus at the gas station, grocery store or home.

Many home health providers care for multiple patients, who also bear the consequences of their work conditions. “If you think about perfect vectors for transmission, unprotected individuals going from house to house have to rank at the top of list,” Kohn said. “Even if someone didn’t care at all about these workers, we need to fix this to keep Grandma and Grandpa safe.”

Nonetheless, caregivers like Samira, in Richmond, Virginia, have little choice but to work. Samira — who makes $8.25 an hour with one client and $9.44 an hour with another, and owes tens of thousands of dollars in hospital bills from previous work injuries — has no other option but to risk getting sick.

“I can’t afford not to work. And my clients, they don’t have anybody but me,” she said. “So I just pray every day I don’t get it.”

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KHN on the Air This Week

California Healthline correspondent Angela Hart discussed how the coronavirus pandemic has derailed California’s efforts to deal with homelessness on KPBS “Midday Edition” on Oct. 8.

KHN Midwest correspondent Lauren Weber discussed the difference between D.O.s and M.D.s with Newsy’s “Morning Rush” on Tuesday.

KHN correspondent Anna Almendrala discussed how L.A. County’s enforcement of workplace coronavirus protocols has cut COVID-19 deaths with KPCC’s “Take Two” on Tuesday.

KHN senior correspondent Sarah Jane Tribble discussed rural hospitals and KHN’s “Where It Hurts” podcast with Illinois Public Media’s “The 21st” on Oct. 5 and “Tradeoffs” on Oct. 8.

KHN chief Washington correspondent Julie Rovner joined C-SPAN’s “Washington Journal” on Tuesday to discuss the Affordable Care Act case before the Supreme Court next month and what else to expect in the realm of health care after the election.

KHN freelancer Priscilla Blossom discussed Halloween safety tips with KUNC’s “Colorado Edition” on Tuesday.

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Musicians Improvise Masks for Wind Instruments to Keep the Band Together

Trombonist Jerrell Charleston loves the give-and-take of jazz, the creativity of riffing off other musicians. But as he looked toward his sophomore year at Indiana University, he feared that steps to avoid sharing the coronavirus would also keep students from sharing songs.

“Me and a lot of other cats were seriously considering taking a year off and practicing at home,” lamented the 19-year-old jazz studies major from Gary, Indiana.

His worries evaporated when he arrived on campus and discovered that music professor Tom Walsh had invented a special mask with a hole and a protective flap to allow musicians to play while masked.

Students also got masks for the ends of their wind instruments, known as bell covers, allowing them to jam in person, albeit 6 feet apart.

“It’s amazing to play together,” Charleston said. “Music has always been my safe space. It’s what’s in your soul, and you’re sharing that with other people.”

Of course, the very act of making music powered by human breath involves blowing air — and possibly virus particles — across a room. One infamous choral practice in Washington state earlier this year led to confirmed diagnoses of COVID-19 in more than half of the 61 attendees. Two died.

So musicians around the country are taking it upon themselves to reduce the risk of COVID-19 without silencing the music. With pantyhose, air filters, magnets, bolts of fabric and a fusion of creativity, those who play wind instruments or sing are improvising masks to keep the band together.

Solomon Keim rehearses in protective gear that doesn’t mask the sound.(Chris Bergin for KHN)

Brayden Wisley practices safe sax-playing. Other tips for musicians: Play in a big space with good ventilation, and break after 30 minutes to allow the air to clear.(Chris Bergin for KHN)

Brendan Sullivan plays trombone while both he and the instrument are masked. It has been recommended that most instrumentalists face the same direction while playing and stay 6 feet apart — with a distance of 9 feet in front and back of trombonists.(Chris Bergin for KHN)

A consortium of performing arts groups has commissioned research exploring ways for musicians to play safely. The group’s preliminary report from July recommends instrumentalists wear masks with small slits, use bell covers, face the same direction while playing and stay 6 feet apart for most instruments — with a distance of 9 feet in front and back of trombonists. Other research has shown cotton bell covers on brass instruments reduced airborne particles by an average of 79% compared with playing without one.

Jelena Srebric, a University of Maryland engineering researcher involved in the consortium’s study, said it’s also best to play in a big space with good ventilation, and musicians should break after 30 minutes to allow the air to clear. These rudimentary solutions, she said, promise at least some protection against the virus.

“Nothing is 100%. Being alive is a dangerous business,” Srebric said. This “gives some way to engage with music, which is fantastic in this day and age of despair.”

Dr. Adam Schwalje, a National Institutes of Health research fellow at the University of Iowa Hospitals and Clinics, is a bassoonist who has written about the COVID risk of wind instruments. He said a combination of bell covers, social distancing and limited time playing together could be helpful, but the effectiveness of bell covers or masks for musicians to wear while playing is “completely unproven” at this point. Schwalje’s paper said it’s not possible to quantify the risk of playing wind instruments, which involves deep breathing, sometimes forceful exhalation and possible aerosolizing of the mucus in the mouth and nose.

Still, early results of research at the universities of Maryland and Colorado are helping to inspire improvisational mask-making and other safety measures, said Mark Spede, national president of the College Band Directors National Association who is helping lead the commissioned research.

At Middle Tennessee State University, for example, tuba teacher Chris Combest said his students tie pillowcases over the bells of their instruments, and some wear masks that can be unbuttoned to play. At the University of Iowa, wind players in small ensembles must use bell covers and masks, but they can pull them down when playing as long as they pull them up during rests. Heather Ainsworth-Dobbins said her students at Southern Virginia University use surgical masks with slits cut in them and bell covers made of pantyhose and MERV-13 air filters, similar to what is used on a furnace.

Indiana University Jacobs School of Music professor Tom Walsh distributes custom masks he designed that allow students to play their instruments safely as a group.(Chris Bergin for KHN)

Skyler Floe tries out his horn’s bell cover to much fanfare at Indiana University Jacobs School of Music in Bloomington, Indiana.(Chris Bergin for KHN)

Kyle Cantrell’s sound carries while reducing the risk of virus transmission.(Chris Bergin for KHN)

At Indiana, Walsh sought out whatever research he could find as he designed his tight-fitting cotton musical mask, reinforced with a layer of polypropylene and with adjustable ties in the back. A flap hangs over the hole, outfitted with two magnets that allow it to close over the instrument. The professor’s mom, Julie Walsh — who made his clothes when he was a kid — has sewn more than 80 of the musical masks for free. The opera program’s costume shop makes bell covers with a layer of fabric over a layer of stiff woven material known as interfacing fabric.

Bailey Cates, a freshman trumpet player, said the quality of the sound is about the same with these masks and they make her feel safer.

Flutes present unique challenges, partly because flutists blow air across the mouthpiece. Alice Dade, an associate professor of flute at the University of Missouri, said she and her students clip on device called “wind guards” usually used outdoors, then sometimes fit surgical masks over them.

Alice Dade, an associate professor at the University of Missouri, recommends using clip-on devices for flutes called “wind guards,” which shield the lip plate of the flute from wind when playing outdoors. The ventilated design helps limit condensation and interference with the player’s air stream. Amid the pandemic, some flutists now use them with surgical masks on top to curb the spread of the coronavirus.(Alice Dade)

Indiana flute student Nathan Rakes uses a specially designed cloth mask with a slit and slips a silk sock on the instrument’s end. Rakes, a sophomore, said the fabric doesn’t affect the sound unless he’s playing a low B note, which he rarely plays.

Walsh is a stickler for finding big practice spaces, not playing together for more than half an hour and taking 20-minute breaks. All jazz ensemble musicians, for example, also must stay at least 10 feet apart.

“I carry a tape measure everywhere I go,” he said. “I feel responsible for our students.”

Some K-12 schools are trying similar strategies, said James Weaver, director of performing arts and sports for the National Federation of State High School Associations.

His son Cooper, a seventh grade sax player at Plainfield Community Middle School in Indiana, uses a surgical mask with a slit. It sometimes jerks to the side with the vibrations of playing, but Cooper said it “feels good as long as you have it in the right place.” Cooper also helped his dad make a bell cover with fabric and MERV-13 material.

While many groups use homemade bell covers, McCormick’s Group in Wheeling, Illinois, has transformed its 25-year-old business of making bell covers to display school colors and insignias into one that is making musicians safer with two-ply covers made of polyester/spandex fabric. CEO Alan Yefsky said his company started reinforcing the covers with the second layer this summer. Sales of the $20 covers have soared.

“It’s keeping people employed. We’re helping keep people safe,” Yefsky said. “All of a sudden, we got calls from nationally known symphony organizations.”

Other professional musicians take a different tack. Film and television soundtracks are often recorded in separate sessions; woodwinds and brass players in individual plexiglass cubicles and masked, with distanced string players recording elsewhere.

The U.S. Marine Band in Washington, D.C., practices in small, socially distanced groups, but string instrumentalists are the only ones wearing masks while playing.

For both professionals and students, the pandemic has virtually eliminated live audiences in favor of virtual performances. Many musicians say they miss traditional concerts but are not focusing on what they’ve lost.

“Creating that sense of community — an island to come together and play — is super important,” said Cates, the Indiana trumpet player. “Playing music feels like a mental release for a lot of us. When I’m playing, my mind is off of the pandemic.”

Indiana University Jacobs School of Music professor Tom Walsh works with students during rehearsal in Bloomington, Indiana. The professor’s mom, Julie Walsh — who made his clothes when he was a kid — has sewn more than 80 of the musical masks for free.(Chris Bergin for KHN)

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Majority of Voters Tilt Toward Biden as Health Issues Weigh Heavily

At least half of voters prefer former Vice President Joe Biden’s approach to health care over President Donald Trump’s, suggesting voter concern about lowering costs and managing the pandemic could sway the outcome of this election, a new poll shows.

The findings, from KFF’s monthly tracking poll, signal that voters do not trust assurances from the president that he will protect people with preexisting conditions from being penalized by insurance companies if the Supreme Court overturns the Affordable Care Act. (KHN is an editorially independent program of KFF.)

Coming a month before the court will hear arguments from Republican attorneys general and the Trump administration that the health law should be overturned, the poll shows 79% of the public does not want the court to cancel coverage protections for Americans with preexisting conditions. A majority of Republicans, 66%, said they do not want those safeguards overturned.

In addition to leaving about 21 million Americans uninsured, overturning the ACA could allow insurance companies to charge more or deny coverage to individuals because they have preexisting conditions — a common practice before the law was established, and one that a government analysis said in 2017 could affect as many as 133 million Americans.

Nearly 6 in 10 people said they have a family member with a preexisting or chronic condition, such as diabetes or cancer, and about half said they worry about a relative being unable to afford coverage, or lose it outright, if the law is overturned.

The poll reveals a striking preference for Biden over Trump when it comes to protecting preexisting conditions, an issue that 94% of voters said would help decide who they vote for. Biden has a 20-point advantage, with voters preferring his approach 56% to 36% for Trump.

In fact, it shows a preference for Biden on every health care issue posed, including among those age 65 and older and on issues that Trump has said were his priorities while in office — signaling voters are not satisfied with the president’s work to lower health care costs, in particular. Support for Trump’s efforts to lower prescription drug costs has been slipping, with voters now preferring Biden’s approach, 50% to 43%.

A majority of voters said they prefer Biden’s plan for dealing with the COVID-19 outbreak, 55% to 39%, and for developing and distributing a vaccine for COVID-19, 51% to 42%. Trump has largely left it up to state and local officials to manage the outbreak, while promising that scientists would defy expectations and produce a vaccine before Election Day.

Asked which issue is most important to deciding whom to vote for, most pointed to health care issues, with 18% choosing the COVID-19 outbreak and 12% saying health care overall. Nearly an equal share, 29%, selected the economy.

The survey was conducted Oct. 7-12, after the first presidential debate and Trump’s announcement that he had tested positive for COVID-19. The margin of error is plus or minus 3 percentage points for the full sample and 4 percentage points for voters.

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No, the WHO Didn’t Change Its Lockdown Stance or ‘Admit’ Trump Was Right

On Monday, President Donald Trump claimed that the World Health Organization (WHO) “admitted” he was correct that using lockdowns to control the spread of COVID-19 was more damaging than the illness.

In a post on Twitter, Trump wrote: “The World Health Organization just admitted that I was right. Lockdowns are killing countries all over the world. The cure cannot be worse than the problem itself. Open up your states, Democrat governors. Open up New York. A long battle, but they finally did the right thing!”

He reiterated his statement later that night during a campaign rally, saying, “But the World Health Organization, did you see what happened? They just came out a little while ago, and they admitted that Donald Trump was right. The lockdowns are doing tremendous damage to these Democrat-run states, where they’re locked out, sealed up. Suicide rates, drug rates, alcoholism, deaths by so many different forms. You can’t do that.”

Together, the tweet and these comments got considerable attention on social media.

But did the WHO change its stance on lockdowns or concede anything to Trump, as he said it did? Briefly, no.

Since May, Trump has been vocal about asking states to reopen businesses, schools, religious services and other social activities. He also took credit for locking down the U.S. in the early stages of the pandemic, however. And his administration largely delegated lockdown decisions to governors and local governments.

Yet those lockdowns — marked by stay-at-home orders and other restrictions — have been less stringent than those implemented in other countries, said Brooke Nichols, an assistant professor of global health at Boston University.

The “definition has differed country by country and state by state. I would argue that the U.S. has never had an actual enforced lockdown like there have been in some Asian countries and in Italy last spring,” Nichols wrote in an email.

We reached out to the Trump campaign and the White House to ask for more information about Trump’s assertion but didn’t receive a response.

A Clip Doesn’t Tell the Full Story

Although the Trump team didn’t get back to us, we noticed that the Trump War Room Twitter account responded to Trump’s tweet with a link to a video, appearing to back up the president’s claim.

The video is a clip from an Oct. 8 interview with Dr. David Nabarro, a special envoy on COVID-19 for the WHO, by Scottish journalist Andrew Neil. The segment was televised by the British news outlet Spectator TV.

In response to a question about the economic consequences of lockdowns, Nabarro said: “We in the World Health Organization do not advocate lockdowns as the primary means of control of this virus. The only time we believe a lockdown is justified is to buy you time to reorganize, regroup, rebalance your resources; protect your health workers who are exhausted. But by and large, we’d rather not do it.” Nabarro then went on to describe potential economic consequences, including effects on the tourism industry and farmers or the worsening of world poverty.

We checked with Nabarro to find out if the clip accurately reflected the points he raised during a nearly 20-minute interview. He responded, by email: “My comments were taken totally out of context. The WHO position is consistent.”

That context Nabarro mentioned covered a range of topics, such as the estimate that about 90% of the world’s population is still vulnerable to COVID-19, that lockdowns are only an effective pandemic response in extreme circumstances and what Nabarro means when he talks about finding the “middle path.”

“We’re saying we really do have to learn how to coexist with this virus in a way that doesn’t require constant closing down of economies, but at the same time in a way that is not associated with high levels of suffering and death,” Nabarro said in the interview.

To achieve that via the middle-path approach, robust defenses against the virus must be put in place, said Nabarro, including having well-organized public health services, such as testing, contact tracing and isolation. It also involves communities adhering to public health guidelines such as wearing masks, physical distancing and practicing good hygiene.

So, it’s really not accurate for the president to imply that the WHO has or has not supported lockdowns, said Lawrence Gostin, a global health law professor at Georgetown University. It’s not as simple as an either-or choice.

“No one is saying that lockdowns should never be used, just that they shouldn’t be used as a primary or only method,” Gostin wrote in an email.

And Josh Michaud, associate director of global health policy at KFF, said both the WHO and public health experts have acknowledged there are economic consequences to lockdowns. (KHN is an editorially independent program of KFF.)

“Strict lockdowns are best used sparingly and in a time-limited fashion because they can cause negative health and economic consequences,” said Michaud. “That is why Nabarro said lockdowns are not recommended as the ‘primary’ control measure. Critics like to frame lockdowns as being recommended as the only measure, when in reality that is not the case.”

Has the WHO Flipped on Its Stance on Lockdowns?

And what about Trump’s assertion that the WHO had changed its position and admitted he was right?

A member of the WHO media office told us in a statement, “Our position on lockdowns and other severe movement restrictions has been consistent since the beginning. We recognize that they are costly to societies, economies and individuals, but may need to be used if COVID-19 transmission is out of control.”

“WHO has never advocated for national lockdowns as a primary means for controlling the virus. Dr. Nabarro was repeating our advice to governments to ‘do it all,’” the spokesperson said.

To test this premise, we looked at statements by WHO leaders over the course of the pandemic. In the multiple media briefings we reviewed from February onward, the WHO appeared consistent in its messaging about what lockdowns should be deployed for: to give governments time to respond to a high number of COVID-19 cases and get a reprieve for health care workers. Although WHO leaders in February supported the shutting down of the city of Wuhan, China, the presumed source of the COVID-19 outbreak, they have also acknowledged that lockdowns can have serious economic effects, and that robust testing, contact tracing and physical distancing are usually preferable to completely locking down.

There is also no evidence the WHO “admitted” Trump was right about lockdowns.

Our Ruling

Trump tweeted on Monday and then said later that night at a campaign rally that the WHO admitted he was right about lockdowns.

We found no evidence the WHO made this admission. And, based on a review of WHO communications, we found its messaging on the topic has been consistent since the pandemic’s early days.

Trump also appears to have relied on a brief video clip of a wide-ranging interview with WHO special envoy Dr. David Nabarro that didn’t give an accurate portrayal of how Nabarro characterized the use of this intervention.

We rate this statement False.

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KHN’s ‘What the Health?’: Democrats May Lose on SCOTUS, But Hope to Win on ACA

Can’t see the audio player? Click here to listen on SoundCloud.

Republicans appear to be on track to confirm Judge Amy Coney Barrett to the Supreme Court before Election Day, cementing a 6-3 conservative majority on the high court regardless of what happens Nov. 3. Democrats, meanwhile, lacking the votes to block the nomination, used the high-profile hearings to batter Republicans for trying to overturn the Affordable Care Act.

Meanwhile, a number of scientific journals that typically eschew politics, including the prestigious New England Journal of Medicine, threw their support to Democratic presidential candidate Joe Biden, citing what they call the Trump administration’s bungling of the coronavirus pandemic.

This week’s panelists are Julie Rovner of Kaiser Health News, Mary Ellen McIntire of CQ Roll Call, Shefali Luthra of The 19th and Sarah Karlin-Smith of Pink Sheet.

Among the takeaways from this week’s podcast:

  • The lack of progress on a bipartisan coronavirus relief package is making both Democrats and Republicans nervous as they approach Election Day without something to help voters.
  • During hearings on the nomination of Judge Amy Coney Barrett for the Supreme Court, Democrats were consistently on message, seeking to focus public attention before the election on the threat that Republicans pose to the Affordable Care Act as the law goes before the court next month. Four members of the Senate Judiciary Committee, which will vote on the nomination, are up for reelection. Also on the committee is Sen. Kamala Harris, the Democrats’ vice presidential candidate.
  • The public health optics of the hearing were jarring for some viewers. Although the committee chairman said the room was set up to meet federal health guidelines, Republican senators often did not wear masks, including Sens. Thom Tillis (N.C.) and Mike Lee (Utah), who both were diagnosed with COVID-19 after attending a White House celebration for Barrett.
  • The lack of masks could add to confusion about public health messages. And voters sometimes find it insulting that politicians play down risks that the public is called upon to assume.
  • Barrett’s testimony did not change many perceptions of her. Although she was extremely careful not to reveal her personal views on issues that could come before the court, including the ACA and abortion, both Democrats and Republicans highlighted her strong conservative credentials.
  • Scientific American and the New England Journal of Medicine have published stinging critiques of the current administration’s policies on science and medicine. Although it’s not clear what impact the editorials will have, they are a sign of the further politicization of public health.

This week, Rovner also interviews Dr. Ashish Jha, dean of the Brown University School of Public Health. Jha talked about the challenges public health professionals have faced in trying to deal with the COVID-19 pandemic.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: The Atlantic’s “How to Tell If Socializing Indoors Is Safe,” by Olga Khazan

Shefali Luthra: The New York Times’ “A $52,112 Air Ambulance Ride: Coronavirus Patients Battle Surprise Bills,” by Sarah Kliff

Mary Ellen McIntire: KHN’s “Making Money Off Marks, COVID-Spawned Chain Store Aims to Become Obsolete,” by Markian Hawryluk

Sarah Karlin-Smith: Politico’s “Health Officials Scrambling to Produce Trump’s ‘Last-Minute’ Drug Cards by Election Day,” by Dan Diamond

Also mentioned in this week’s podcast:

Bill of the Month update: KHN’s “Moved by Plight of Young Heart Patient, Stranger Pays His Hospital Bill,” by Laura Ungar

Scientific journal endorsements: The New England Journal of Medicine’s “Dying in a Leadership Vacuum

Scientific American Endorses Joe Biden,” by The Editors

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

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COVID en LA: prevención en los trabajos ha salvado vidas de latinos, dicen oficiales

Funcionarios del condado de Los Angeles atribuyen la dramática disminución de casos y muertes por COVID-19 entre afroamericanos y latinos, en los últimos dos meses, a la agresiva aplicación de las normas de salud en los lugares de trabajo y a la apertura de líneas para denunciar si no se cumplen.

Ahora, los funcionarios buscan consolidar esos logros creando comités de empleados capacitados para detectar transgresiones en la prevención de COVID-19, y corregirlas o reportarlas, sin temor al despido o al castigo.

Cal/OSHA, la autoridad estatal de seguridad y salud en el trabajo, está abrumada con quejas y denuncias sobre el incumplimiento de las normas anti-COVID; y los supervisores de salud del condado —había 346 hasta el 9 de octubre— no pueden vigilar los más de 240,000 negocios de Los Angeles, según activistas.

Los comités ayudarían a evitar que Los Angeles retroceda en su esfuerzo por mitigar los casos y las disparidades raciales en el otoño, ya que es probable que más empresas vuelvan a la actividad, señaló Tia Koonse, investigadora del UCLA Labor Center y coautora de la evaluación sobre la propuesta para formar comités de empleados.

Se espera que la Junta de Supervisores del condado de Los Angeles apruebe una ordenanza este mes para que los negocios permitan que los empleados formen los comités, lo cual solucionaría los problemas de incumplimiento e informaría al departamento de salud cuando sea necesario.

Los críticos, incluyendo muchos líderes empresariales, dicen que la medida creará más burocracia en el peor momento posible para la economía. Pero grupos laborales y algunas empresas aseguran que es crucial para combatir la pandemia.

A trabajadores de diferentes partes del país se los despidió o castigó por quejarse de violaciones de seguridad relacionadas con COVID, y las leyes que los protegen no son consistentes.

“Los trabajadores tienen derecho a estar en un espacio seguro y no deben sufrir represalias” por señalar prácticas deficientes, dijo Barbara Ferrer, directora del Departamento de Salud Pública del condado de Los Angeles. Los trabajadores con bajos salarios han estado “en enorme desventaja” al tener que trabajar fuera de casa en contacto con otras personas, a menudo sin  protección suficiente, añadió Ferrer.

Durante el aumento de los casos de COVID que siguieron a las reuniones familiares del fin de semana de Memorial Day y a la apertura de negocios, los latinos (que pueden ser ser cualquier raza) en Los Angeles tenían una tasa de mortalidad cuatro veces mayor que la de los blancos no hispanos, mientras que las personas de raza negra tenían el doble de probabilidades que los blancos no hispanos de morir por la enfermedad.

Dos meses después, las tasas de mortalidad entre personas de raza negra y latinos habían disminuido a casi la mitad y se estaban acercando a la tasa de los blancos no hispanos, según los datos ajustados por edad del departamento de salud del condado.

Mientras que a finales de julio el número de latinos que daban positivo por COVID era cuatro veces mayor que el de blancos no hispanos, a mediados de septiembre los índices de casos de latinos eran sólo un 64% más altos. La tasa de positividad entre las personas de raza negra era un 60% más alta que la de los blancos a finales de julio, pero la disparidad había disminuido a mediados de septiembre.

Los expertos no saben si una política concreta es la responsable de esta disminución de muertes. Además, las tasas estatales y de los condados han disminuido para toda la población en las últimas semanas. Pero Ferrer atribuyó el progreso a que su departamento se centra en el cumplimiento de las directrices de salud en el lugar de trabajo, que incluyen reglas sobre el distanciamiento físico, proveer cubrebocas para los trabajadores y también exigir a los clientes que las usen.

“Para los que no cumplan con las directrices, en este momento podemos emitir citaciones, o hay casos en los que simplemente cerramos el lugar porque la transgresión es mayor”, explicó.

Las agudas disparidades raciales, que caracterizaron a la pandemia desde el principio, están ahora bajo mayor escrutinio ya que California se ha convertido en el primer estado que ha hecho de la “equidad en salud” un factor a la hora de permitir una reapertura ampliada.

Es posible que los condados grandes no avancen hacia la reapertura total hasta que sus vecindarios más desfavorecidos, y no sólo el condado en su conjunto, cumplan o estén por debajo de los niveles de enfermedad previstos. Los criterios obligan a los gobiernos locales a invertir más en pruebas, rastreo de contactos y educación en los barrios pobres con altos niveles de la enfermedad.

El enfoque de Ferrer en el lugar de trabajo se cristalizó durante una intervención en Los Angeles Apparel, una fábrica de ropa que se había puesto a fabricar máscaras faciales durante la pandemia. A pesar del inventario de máscaras, un brote en la fábrica resultó en al menos 300 casos, y cuatro muertes.

El departamento de salud intervino después de una denuncia de los centros de salud comunitarios que se vieron desbordados por los trabajadores enfermos de Los Angeles Apparel. El departamento cerró la fábrica el 27 de junio. Esa acción resaltó la necesidad de unir al gobierno y a los sindicatos para luchar contra la pandemia, indicó Jim Mangia, CEO de St. John’s Well Child & Family Center, una cadena de centros de salud comunitarios en el sur de L.A.

“En el St. John’s, casi todos nuestros pacientes son trabajadores pobres”, explicó Mangia. “Se contagiaban en el trabajo y lo llevaban a sus familias, y creo que intervenir en el lugar de trabajo es lo que realmente marcó la diferencia”.

Al principio de la pandemia, Ferrer también había establecido una línea de denuncia anónima para los empleados que quisieran reportar incuplimientos en el lugar de trabajo. Recibe unas 2,000 llamadas a la semana, según Ferrer. Hasta el 10 de octubre, el sitio web del departamento nombra 132 lugares de trabajo que han tenido tres o más casos confirmados de COVID-19, con un total de 2,191 positivos. Otra tabla, con fecha 7 de octubre, enumera 124 citaciones, la mayoría a gimnasios y lugares de culto, por no cumplir con una directriz de un oficial de salud.

“Afortunadamente, no somos como Cal/OSHA, en el sentido de que no nos lleva meses completar una investigación”, comentó Ferrer. “Somos capaces de movernos más rápidamente siguiendo las órdenes del oficial de salud para asegurarnos de que estamos protegiendo a los trabajadores”.

Los comités de salud pública son la siguiente fase del plan de Ferrer para mantener a los trabajadores seguros. El plan surgió de la respuesta de Overhill Farms, una factoría de alimentos congelados en Vernon, California, después de un brote de más de 20 casos y una muerte. La fábrica y su agencia de trabajo temporal fueron penalizadas con más de $200,000 en multas propuestas por Cal/OSHA en septiembre, pero antes de que llegaran las multas, la dirección de la fábrica reaccionó celebrando reuniones con los trabajadores para mejorar la seguridad.

“Encontraron que los trabajadores les ayudaron a bajar la tasa de infección y ayudaron a resolver los problemas”, dijo Roxana Tynan, directora ejecutiva de la Alianza de Los Angeles para una Nueva Economía, una organización de defensa de los trabajadores.

Si bien no es exactamente un caso que ensalce la generosidad corporativa, el cambio en Overhill Farms agregó credibilidad a los beneficios de los comités de trabajadores, señaló Koonse de UCLA.

Ninguna empresa tendría que gastar más del 0,44% de su nómina en los comités de salud, según Koonse.

Aún así, la idea ha sido recibida con división de opiniones por parte de las empresas. En una declaración del 24 de agosto, la CEO Tracy Hernández de la Federación de Negocios del Condado de Los Angeles escribió que la propuesta agregaría “programas onerosos y enrevesados que dificultarán, aún más, la capacidad de un empleador para cumplir con las demandas, recuperarse y servir adecuadamente a sus empleados y clientes”.

Pero Jim Amen, presidente de la cadena de supermercados Super A Foods, dijo que los negocios deberían dar la bienvenida a los comités, como una forma de mantener abiertas las líneas de comunicación. Tales prácticas han mantenido los índices de infección bajos en las tiendas, incluso sin un mandato, expresó Amen.

“En lo que respecta a Super A, nuestros empleados están muy involucrados en todo lo que hacemos”, añadió Amen.

Las organizaciones laborales ven a los comités como una forma crucial para que los trabajadores planteen sus preocupaciones sin temor a represalias.

“En industrias de bajos salarios, como la de la confección, el hecho de que los trabajadores se unan hace que los despidan”, dijo Marissa Nuncio, directora del Centro de Trabajadores de la Confección, una organización sin fines de lucro que sirve principalmente a inmigrantes de México y América Central.

Aunque las disparidades se están reduciendo en el condado de Los Angeles, algunas empresas siguen siendo inseguras y los posibles denunciantes no confían en que sus informes a la línea de denuncias del condado se lleven a cabo, añadió Nuncio.

“Seguimos recibiendo llamadas de miembros de nuestra organización que están enfermos, tienen COVID y están hospitalizados”, señaló Nuncio. “Y el lugar más obvio para que se hayan infectado es en su lugar de trabajo, porque no se están tomando precauciones”.

La reportera de datos Hannah Recht colaboró con esta historia.

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Insomnio, pérdida de cabello y rechinar de dientes: cómo superar el estrés pandémico

A fines de marzo, poco después que el estado de Nueva York cerrara negocios no esenciales y pidiera a la gente que se quedara en casa, Ashley Laderer comenzó a despertarse cada mañana con un terrible dolor de cabeza.

“Sentía que mi cabeza iba a estallar”, recordó la escritora de 27 años, residente de Long Island.

Laderer trató de pasar menos tiempo en la computadora y tomar analgésicos de venta libre, pero el dolor de cabeza aumentaba al ritmo de su preocupación por COVID-19.

Después de un mes y medio de dolor, Laderer hizo una cita con un neurólogo, quien ordenó una resonancia magnética. Pero el médico no encontró una causa física.

“Todos los días vivía con el temor de contraerlo e iba a infectar a toda mi familia”, dijo.

Entonces, me preguntó: ¿Estás bajo mucho estrés?

A lo largo de la pandemia, personas que nunca tuvieron el coronavirus reportan una serie de síntomas aparentemente no relacionados: dolores de cabeza insoportables, pérdida de cabello, malestar estomacal durante semanas, brotes repentinos de herpes zóster y de trastornos autoinmunes.

Los síntomas dispares, a menudo en personas sanas, han desconcertado a médicos y pacientes por igual, lo que a veces ha resultado en una serie de visitas a especialistas, sin encontrar respuestas. Pero resulta que hay un hilo conductor entre muchas de estas condiciones, uno que tarda meses en gestarse: el estrés crónico.

Después de un mes y medio de dolor, Ashley Laderer hizo una cita con un neurólogo, quien ordenó una resonancia magnética. Pero el médico no encontró una causa física.(Alissa Castleton)

Aunque las personas a menudo subestiman la influencia de la mente en el cuerpo, un gran número de investigaciones muestra que los altos niveles de estrés durante un tiempo prolongado pueden alterar drásticamente la función física y afectar a casi todos los sistemas del cuerpo.

Ahora, a unos ocho meses del comienzo de la pandemia, junto con un ciclo electoral divisivo y disturbios raciales, esos efectos se están manifestando en una variedad de síntomas.

“El componente de salud mental de COVID está impactando como un tsunami”, dijo la doctora Jennifer Love, psiquiatra de California y coautora de un libro de pronta publicación sobre cómo curar el estrés crónico.

A nivel nacional, encuestas han revelado tasas crecientes de depresión, ansiedad y pensamientos suicidas durante la pandemia. Pero muchos expertos dijeron que es demasiado pronto para medir los síntomas físicos relacionados, ya que generalmente aparecen meses después que comienza el estrés.

Aún así, algunas investigaciones preliminares, como un pequeño estudio chino y una encuesta en línea de más de 500 personas en Turquía, señalan un repunte.

En los Estados Unidos, un análisis de FAIR Health, una base de datos sin fines de lucro que brinda información sobre costos a la industria de la salud y a los consumidores, mostró aumentos leves a moderados en el porcentaje de reclamos médicos relacionados con afecciones desencadenadas o exacerbadas por el estrés, como la esclerosis múltiple y el herpes zóster.

La porción de reclamos por lupus, una enfermedad autoinmune, mostró uno de los mayores incrementos -12% este año- en comparación con el mismo período del año pasado (enero a agosto).

Express Scripts, una administradora de beneficios farmacéuticos, informó que las recetas de medicamentos para el insomnio aumentaron un 15% al ​​comienzo de la pandemia.

Pero quizás el indicador más fuerte proviene de los médicos que informan sobre un número creciente de pacientes con síntomas físicos para los que no pueden determinar una causa.

El doctor Shilpi Khetarpal, dermatólogo de la Clínica Cleveland, solía ver a unos cinco pacientes a la semana con pérdida de cabello relacionada con el estrés. Desde mediados de junio, ese número ha aumentado a 20 o 25. La mayoría de las mujeres, de entre 20 y 80 años, informan que pierden el cabello de a puñados, dijo Khetarpal.

En Houston, al menos una docena de pacientes le han dicho al doctor Rashmi Kudesia, especialista en fertilidad, que tienen ciclos menstruales irregulares, cambios en la secreción vaginal y sensibilidad en los senos, a pesar de presentar niveles hormonales normales.

El estrés también es el culpable al que apuntan los dentistas por el rápido aumento de pacientes con bruxismo y fracturas dentales.

“A nosotros, como humanos, nos gusta la idea de que tenemos todo bajo control y que el estrés no es un gran problema”, dijo Love. “Pero simplemente no es cierto”.

Cómo el estrés mental se vuelve físico

El estrés provoca cambios físicos en el cuerpo que pueden afectar a casi todos los sistemas del organismo.

Aunque los síntomas del estrés crónico a menudo se descartan como si estuvieran solo en la cabeza, el dolor es muy real, dijo Kate Harkness, profesora de Psicología y Psiquiatría en la Universidad Queens, en Ontario.

Cuando el cuerpo se siente inseguro, ya sea por una amenaza física de ataque o un miedo psicológico de perder un trabajo o contraer una enfermedad, el cerebro envía señales a las glándulas suprarrenales para que bombeen las hormonas del estrés.

La adrenalina y el cortisol inundan el cuerpo, activando la respuesta de lucha o escape. También interrumpen las funciones corporales que no son necesarias para la supervivencia inmediata, como la digestión y la reproducción.

Cuando pasa el peligro, las hormonas vuelven a niveles normales. Pero durante etapas de estrés constante, como una pandemia, el organismo sigue bombeando hormonas del estrés hasta que se cansa. Esto conduce a un aumento de la inflamación en todo el cuerpo y el cerebro, y a un sistema inmunológico deficiente.

Estudios relacionan el estrés crónico con enfermedades cardíacas, tensión muscular, problemas gastrointestinales e incluso encogimiento físico del hipocampo, un área del cerebro asociada con la memoria y el aprendizaje. A medida que el sistema inmunológico actúa, algunas personas pueden incluso desarrollar nuevas reacciones alérgicas, dijo Harkness.

La buena noticia es que muchos de estos síntomas son reversibles. Pero es importante reconocerlos temprano, especialmente cuando se trata del cerebro, dijo Barbara Sahakian, profesora de Neuropsicología Clínica en la Universidad de Cambridge.

“El cerebro es elástico, por lo que podemos modificarlo hasta cierto punto”, dijo Sahakian. “Pero no sabemos si hay un abismo más allá del cual no se pueda revertir un cambio”.

El impacto del día a día

De alguna manera, la conciencia sobre la salud mental ha aumentado durante la pandemia. Los programas de televisión están repletos de anuncios de aplicaciones para terapia y meditación, como Talkspace y Calm, y las empresas están anunciando días libres de salud mental para su personal.

Para Alex Kostka, el estrés relacionado con la pandemia le ha provocado cambios de humor, pesadillas y dolor de mandíbula.

Para Alex Kostka, el estrés relacionado con la pandemia le ha provocado cambios de humor, pesadillas y dolor de mandíbula.(Jordan Battiste)

Había estado trabajando en una cafetería de Whole Foods en la ciudad de Nueva York durante un mes antes que golpeara la pandemia, y de repente se convirtió en un trabajador esencial.

A medida que aumentaban las muertes en la ciudad, Kostka continuó viajando en metro al trabajo, interactuando con compañeros en la tienda y trabajando más horas por un aumento salarial de solo $2 por hora. (Meses después, recibiría un bono de $ 500). El joven de 28 años comenzó a sentirse sintiéndose inseguro e indefenso.

“Era difícil no quebrarme en el metro”, dijo Kostka.

Pronto comenzó a despertarse en medio de la noche con dolor por apretar la mandíbula con fuerza. A menudo, sus dientes rechinaban tan fuerte que despertaba a su novia.

Kostka probó Talkspace, pero descubrió que enviar mensajes de texto sobre sus problemas era algo impersonal. A fines del verano, decidió empezar a utilizar las siete sesiones de asesoramiento gratuitas que le ofrecía su empleador. Eso ha ayudado, dijo. Pero a medida que se agotan las sesiones, le preocupa que los síntomas vuelvan a aparecer si no puede encontrar un nuevo terapeuta cubierto por su seguro.

“Eventualmente, podré dejar esto atrás, pero tomará tiempo”, dijo Kostka.

Cómo mitigar el estrés crónico

Cuando se trata de estrés crónico, consultar a un médico por dolor de estómago, dolores de cabeza o erupciones cutáneas puede abordar esos síntomas físicos. Pero la causa principal es mental, dicen expertos.

Eso significa que la solución a menudo implicará técnicas de manejo del estrés. Y hay muchas cosas que podemos hacer para sentirnos mejor:

Ejercicio. Incluso la actividad física de intensidad baja a moderada puede ayudar a contrarrestar la inflamación en el cuerpo inducida por el estrés. También puede aumentar las conexiones neuronales en el cerebro.

Meditación y atención plena. La investigación muestra puede conducir a cambios positivos, estructurales y funcionales en el cerebro.

Conexiones sociales. Hablar con familiares y amigos, incluso virtualmente, o mirar fijo a los ojos de una mascota puede liberar una hormona que ayuda a contrarrestar la inflamación.

Aprender algo nuevo. Ya sea que se trate de una clase formal o de un pasatiempo informal, el aprendizaje apoya la elasticidad cerebral, la capacidad de cambiar y adaptarse como resultado de la experiencia, lo que puede proteger contra la depresión y otras enfermedades mentales.

“No debemos pensar en esta situación estresante como algo negativo para el cerebro”, dijo Harkness. “Debido a que el estrés cambia el cerebro, eso significa que las cosas positivas también pueden cambiarlo. Y hay muchas cosas que podemos hacer para sentirnos mejor frente a la adversidad “.

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Sleepless Nights, Hair Loss and Cracked Teeth: Pandemic Stress Takes Its Toll

In late March, shortly after New York state closed nonessential businesses and asked people to stay home, Ashley Laderer began waking each morning with a throbbing headache.

“The pressure was so intense it felt like my head was going to explode,” recalled the 27-year-old freelance writer from Long Island.

She tried spending less time on the computer and taking over-the-counter pain medication, but the pounding kept breaking through — a constant drumbeat to accompany her equally incessant worries about COVID-19.

After a month and a half with a pounding headache, Ashley Laderer decided to visit a neurologist, who ordered an MRI. But the doctor found no physical cause. The scan was clear.(Alissa Castleton)

“Every day I lived in fear that I was going to get it and I was going to infect my whole family,” she said.

After a month and a half, Laderer decided to visit a neurologist, who ordered an MRI. But the doctor found no physical cause. The scan was clear.

Then he asked: Are you under a lot of stress?

Throughout the pandemic, people who never had the coronavirus have been reporting a host of seemingly unrelated symptoms: excruciating headaches, episodes of hair loss, upset stomach for weeks on end, sudden outbreaks of shingles and flare-ups of autoimmune disorders. The disparate symptoms, often in otherwise healthy individuals, have puzzled doctors and patients alike, sometimes resulting in a series of visits to specialists with few answers. But it turns out there’s a common thread among many of these conditions, one that has been months in the making: chronic stress.

Although people often underestimate the influence of the mind on the body, a growing catalog of research shows that high levels of stress over an extended time can drastically alter physical function and affect nearly every organ system.

Now, at least eight months into the pandemic, alongside a divisive election cycle and racial unrest, those effects are showing up in a variety of symptoms.

“The mental health component of COVID is starting to come like a tsunami,” said Dr. Jennifer Love, a California-based psychiatrist and co-author of an upcoming book on how to heal from chronic stress.

Nationwide, surveys have found increasing rates of depression, anxiety and suicidal thoughts during the pandemic. But many medical experts said it’s too soon to measure the related physical symptoms, since they generally appear months after the stress begins.

Still, some early research, such as a small Chinese study and an online survey of more than 500 people in Turkey, points to an uptick.

In the U.S., data from FAIR Health, a nonprofit database that provides cost information to the health industry and consumers, showed slight to moderate increases in the percentage of medical claims related to conditions triggered or exacerbated by stress, like multiple sclerosis and shingles. The portion of claims for the autoimmune disease lupus, for example, showed one of the biggest increases — 12% this year — compared with the same period last year (January to August).

Express Scripts, a major pharmacy benefit manager, reported that prescriptions for anti-insomnia medications increased 15% early in the pandemic.

Perhaps the strongest indicator comes from doctors reporting a growing number of patients with physical symptoms for which they can’t determine a cause.

Dr. Shilpi Khetarpal, a dermatologist at the Cleveland Clinic, used to see about five patients a week with stress-related hair loss. Since mid-June, that number has jumped to 20 or 25. Mostly women, ages 20 to 80, are reporting hair coming out in fistfuls, Khetarpal said.

In Houston, at least a dozen patients have told fertility specialist Dr. Rashmi Kudesia they’re having irregular menstrual cycles, changes in cervical discharge and breast tenderness, despite normal hormone levels.

Stress is also the culprit dentists are pointing to for the rapid increase in patients with teeth grinding, teeth fractures and TMJ.

“We, as humans, like to have the idea that we are in control of our minds and that stress isn’t a big deal,” Love said. “But it’s simply not true.”

How Mental Stress Becomes Physical

Stress causes physical changes in the body that can affect nearly every organ system.

Although symptoms of chronic stress are often dismissed as being in one’s head, the pain is very real, said Kate Harkness, a professor of psychology and psychiatry at Queen’s University in Ontario.

When the body feels unsafe — whether it’s a physical threat of attack or a psychological fear of losing a job or catching a disease — the brain signals adrenal glands to pump stress hormones. Adrenaline and cortisol flood the body, activating the fight-or-flight response. They also disrupt bodily functions that aren’t necessary for immediate survival, like digestion and reproduction.

When the danger is over, the hormones return to normal levels. But during times of chronic stress, like a pandemic, the body keeps pumping out stress hormones until it tires itself out. This leads to increased inflammation throughout the body and brain, and a poorly functioning immune system.

Studies link chronic stress to heart disease, muscle tension, gastrointestinal issues and even physical shrinking of the hippocampus, an area of the brain associated with memory and learning. As the immune system acts up, some people can even develop new allergic reactions, Harkness said.

The good news is that many of these symptoms are reversible. But it’s important to recognize them early, especially when it comes to the brain, said Barbara Sahakian, a professor of clinical neuropsychology at the University of Cambridge.

“The brain is plastic, so we can to some extent modify it,” Sahakian said. “But we don’t know if there’s a cliff beyond which you can’t reverse a change. So the sooner you catch something, the better.”

The Day-to-Day Impact

In some ways, mental health awareness has increased during the pandemic. TV shows are flush with ads for therapy and meditation apps, like Talkspace and Calm, and companies are announcing mental health days off for staff.

For Alex Kostka, pandemic-related stress has brought on mood swings, nightmares and jaw pain.(Jordan Battiste)

But those spurts of attention fail to reveal the full impact of poor mental health on people’s daily lives.

For Alex Kostka, pandemic-related stress has brought on mood swings, nightmares and jaw pain.

He’d been working at a Whole Foods coffee bar in New York City for only about a month before the pandemic hit, suddenly anointing him an essential worker. As deaths in the city soared, Kostka continued riding the subway to work, interacting with co-workers in the store and working longer hours for just a $2-per-hour wage increase. (Months later, he’d get a $500 bonus.) It left the 28-year-old feeling constantly unsafe and helpless.

“It was hard not to break down on the subway the minute I got on it,” Kostka said.

Soon he began waking in the middle of the night with pain from clenching his jaw so tightly. Often his teeth grinding and chomping were loud enough to wake his girlfriend.

Kostka tried Talkspace, but found texting about his troubles felt impersonal. By the end of the summer, he decided to start using the seven free counseling sessions offered by his employer. That’s helped, he said. But as the sessions run out, he worries the symptoms might return if he’s unable to find a new therapist covered by his insurance.

“Eventually, I will be able to leave this behind me, but it will take time,” Kostka said. “I’m still very much a work in progress.”

How to Mitigate Chronic Stress

When it comes to chronic stress, seeing a doctor for stomach pain, headaches or skin rashes may address those physical symptoms. But the root cause is mental, medical experts say.

That means the solution will often involve stress-management techniques. And there’s plenty we can do to feel better:

Exercise. Even low- to moderate-intensity physical activity can help counteract stress-induced inflammation in the body. It can also increase neuronal connections in the brain.

Meditation and mindfulness. Research shows this can lead to positive, structural and functional changes in the brain.

Fostering social connections. Talking to family and friends, even virtually, or staring into a pet’s eyes can release a hormone that may counteract inflammation.

Learning something new. Whether it’s a formal class or taking up a casual hobby, learning supports brain plasticity, the ability to change and adapt as a result of experience, which can be protective against depression and other mental illness.

“We shouldn’t think of this stressful situation as a negative sentence for the brain,” said Harkness, the psychology professor in Ontario. “Because stress changes the brain, that means positive stuff can change the brain, too. And there is plenty we can do to help ourselves feel better in the face of adversity.”

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Outnumbered on High Court Nomination, Democrats Campaign for a Different Vote

Democrats on the Senate Judiciary Committee know that, barring something unexpected, they lack the votes to block President Donald Trump from installing his third justice in four years on the Supreme Court and creating a 6-3 conservative majority.

They also know that, in a normal year, by mid-October Congress would be out of session and members home campaigning. But 2020 is obviously no normal year. So, while the rest of Congress is home, Democratic Judiciary members are trying something very different in the hearings for nominee Amy Coney Barrett. Rather than prosecuting their case against Barrett, currently a federal appeals court judge, they are refighting the war that helped them pick up seats in 2018 — banging on Republicans for trying to eliminate the Affordable Care Act.

Conveniently, the ACA is relevant to the Supreme Court debate because the justices are scheduled to hear a case that could invalidate the law on Nov. 10 — exactly a week after Election Day.

As California Sen. Kamala Harris, a member of the Judiciary Committee and the Democratic vice presidential candidate, put it to Barrett on Tuesday, “Republicans are scrambling to confirm this nominee as fast as possible because they need one more Trump judge on the bench before Nov. 10th to win and strike down the entire Affordable Care Act. This is not hyperbole. This is not hypothetical. This is happening.”

Said Sen. Richard Durbin (D-Ill.), also on Tuesday: “We really believe the Supreme Court’s consideration of that case is going — could literally change America for millions of people.”

To be sure, Republicans too were playing to their electorate during the questioning of Barrett, as they expounded on her conservative credentials on issues such as gun rights.

Nonetheless, Democrats were uniformly disciplined in their assault on her potential vote in the ACA case. They chided both Barrett and the Republicans who are rushing her nomination to the floor literally days before a presidential election. In addition, Democrats criticized Republicans for spending time on a nonemergency nomination while continuing to ignore the need for financial and other relief for the COVID-19 pandemic.

And they raised what in more normal times would be the featured talking point for Democrats: the threat to abortion and other reproductive rights from Barrett, who before her elevation to the federal bench publicly opposed abortion and taught law at Notre Dame, one of the nation’s preeminent Catholic universities.

“For many people, and particularly for women, this is a fundamental question,” said Sen. Dianne Feinstein (D-Calif.), the committee’s top Democrat.

Barrett, like every other Supreme Court nominee for the past three decades, declined to offer positions that could suggest which way she might rule on hot-button issues, including abortion and the ACA.

She repeatedly cited what has come to be called the “Ginsburg rule” — after the justice she would replace, Ruth Bader Ginsburg — saying “no hints, no previews, no forecasts.”

Still, Democrats suggested that she may have tipped her hand on the Affordable Care Act case. In pointing out that the issues in the case, now known as California v. Texas, are different from the previous cases upholding the health law in 2012 and 2015, she said the current case will turn on “severability.”

She was referring to the question of whether, if one portion of a law is found to be unconstitutional, the rest of the law can stand without it. In the current ACA case, a group of Republican attorneys general — and the Trump administration — are arguing that when Congress reduced the ACA’s penalty for not having insurance to zero, the requirement to be covered no longer had a tax attached, and therefore the law is now unconstitutional. They based their argument on Chief Justice John Roberts’ 2012 conclusion that the ACA was valid because that penalty was a constitutionally appropriate tax.

The law’s opponents say the rest of the law cannot be “severed” and must therefore fall, too. A federal district judge in Texas agreed with them.

But merely saying the case turns on severability suggests that Barrett has already prejudged major parts of the case, Democrats said. Sen. Chris Coons (D-Del.) noted, “You don’t get to the question of severability if you haven’t already determined the question of constitutionality.”

Barrett insisted repeatedly that despite an article she wrote in 2017 suggesting that the 2012 case upholding the law was wrongly decided, “I have no animus to nor agenda for the ACA,” as she told Sen. Amy Klobuchar (D-Minn.) on Wednesday.

In their rare show of unity of message, Democrats made clear that their primary audience in these hearings was not their Senate colleagues, but the voting public. While this battle looks lost, they hope to win the War of Nov. 3.

HealthBent, a regular feature of KHN, offers insight and analysis of policies and politics from KHN’s chief Washington correspondent, Julie Rovner, who has covered health care for more than 30 years.

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COVID Crackdowns at Work Have Saved Black and Latino Lives, LA Officials Say

Los Angeles County officials attribute a dramatic decline in COVID-19 death and case rates among Blacks and Latinos over the past two months to aggressive workplace health enforcement and the opening of tip lines to report violations.

Now, officials intend to cement those gains by creating workplace councils among employees trained to look for COVID-19 prevention violations and correct or report them — without fear of being fired or punished.

Cal/OSHA, the state’s workplace safety and health authority, is overwhelmed with complaints and tips about COVID-19 violations, and the county’s health investigators — there were officially 346 of them as of last Friday — can’t possibly keep tabs on all of Los Angeles’ more than 240,000 businesses, labor advocates say.

The councils could help keep Los Angeles from backsliding on its progress in mitigating cases and racial disparities in the fall as more businesses are likely to reopen, said Tia Koonse, a researcher with the UCLA Labor Center and co-author of an assessment of the workplace council proposal. The L.A. County Board of Supervisors is expected to approve an ordinance this month requiring businesses to permit employees to form the councils, which would troubleshoot compliance issues and report to the health department when necessary.

Critics, including many business leaders, say the measure will create more red tape at the worst possible time for the economy. But labor groups and some businesses say it is crucial to fighting the pandemic. Workers around the country have been sacked or reprimanded for complaining about COVID-related safety violations, and laws protecting them are spotty.

“Workers have a right to be in a safe space and shouldn’t face any retaliation” for noting poor practices, said Barbara Ferrer, director of the L.A. County Public Health Department. Low-wage workers have been “tremendously disadvantaged” by having to work outside the home in contact with other people, often without sufficient protection, she said.

During the upsurge of COVID cases that followed Memorial Day weekend family gatherings and business openings, Latinos in Los Angeles were dying at a rate more than four times higher than that of whites, while Blacks were twice as likely as whites to die of the disease. Two months later, death rates among Blacks and Latinos had fallen by more than half and were approaching the rate for whites, according to age-adjusted data from the county health department.

While four times as many Latinos as whites were reported COVID-positive in late July, the Latino case rates were only 64% higher by mid-September. The positivity rate among Blacks was 60% higher than that of whites in late July, but the disparity had waned by mid-September.

Experts can’t be certain that any one policy is responsible for the decline in deaths among Blacks and Latinos in Los Angeles — and state and county rates have declined for the entire population in recent weeks. But Ferrer attributed the progress to her department’s focus on workplace enforcement of health orders, which include rules about physical distancing, providing face coverings for workers and requiring face coverings for customers.

“If you’re in violation, at this point we can either issue citations, or there are cases where we just close the place down because the violations are egregious,” she said.

The sharp racial disparities that characterized the pandemic from the beginning are under even more scrutiny now that California has become the first state to make “health equity” a factor in its decisions to allow expanded reopening.

Large counties may not advance toward full reopening until their most disadvantaged neighborhoods, and not just the county as a whole, meet or are lower than the targeted levels of disease. The criteria prod local governments to invest more in testing, contact tracing and education in poor neighborhoods with high levels of the disease.

Ferrer’s focus on workplaces crystallized during a crackdown on Los Angeles Apparel, a clothing factory that had pivoted to face mask manufacturing during the pandemic. Despite the ready inventory of masks, an outbreak at the factory resulted in at least 300 cases — and four deaths.

The health department, acting on a tip from community health centers flooded with sick Los Angeles Apparel workers, shut down the factory on June 27. That action highlighted the need to bring the government and labor unions together to fight the pandemic, said Jim Mangia, CEO of St. John’s Well Child & Family Center, a chain of community health centers in South L.A.

“At St. John’s, almost all of our patients are the working poor,” Mangia said. “They were getting infected at work and bringing it home to their families, and I think intervening at the workplace is what really made all the difference.”

Early in the pandemic, Ferrer had also set up an anonymous complaint line for employees who want to report workplace violations. It gets about 2,000 calls a week, she said. As of Oct. 10, the department’s website lists 132 workplaces that have had three or more confirmed COVID-19 cases, with a total of 2,191 positives. Another table dated Oct. 7 lists 124 citations — mostly to gyms and places of worship — for failing to comply with a health officer order.

“Fortunately, we’re not like Cal/OSHA, in the sense that it doesn’t take us months to complete an investigation,” Ferrer said. “We’re able to move more swiftly under the health officer orders to actually make sure that we’re protecting workers.”

Public health councils are the next phase in Ferrer’s plan to keep workers safe. The plan stemmed from the response of Overhill Farms, a frozen-food factory in Vernon, California, after an outbreak of more than 20 cases and one death. The factory and its temporary job agency were hit with more than $200,000 in proposed penalties from Cal/OSHA in September, but before the fines landed, the factory leadership was already responding by beginning to hold meetings with workers to improve safety there.

“They found that the workers helped them bring down infection rates and helped solve problems,” said Roxana Tynan, executive director of the Los Angeles Alliance for a New Economy, a worker advocacy organization.

While it’s not exactly a feel-good story about corporate beneficence, the turnaround at Overhill Farms added credence to the benefits of workplace councils, said Koonse of UCLA.

No company would have to spend more than 0.44% of its payroll cost on the health councils, she estimated.

Still, the idea has gotten a mixed reception from businesses. In an Aug. 24 statement, CEO Tracy Hernandez of the L.A. County Business Federation wrote that the proposal would add “burdensome and convoluted programs that will further hinder an employer’s ability to meet demands, get back on their feet, and adequately serve their employees and customers.”

But Jim Amen, president of the eight-store Super A Foods grocery chain, said businesses should welcome the councils as a way to keep lines of communication open. Such practices have kept infection rates low at his stores, even without a mandate, Amen said.

“All I know is, for Super A, our employees are heavily involved in everything we do,” Amen said.

Labor groups see the councils as a crucial way for workers to raise concerns without fear of retaliation.

“In low-wage industries like the garment industry, workers coming together gets them fired,” said Marissa Nuncio, director of the Garment Worker Center, a nonprofit that mainly serves immigrants from Mexico and Central America.

While disparities are narrowing in L.A. County, some shops are still unsafe and potential whistleblowers aren’t confident their reports to the county’s tip line are being acted on, she said.

“We continue to get calls from our members who are sick, have COVID and are hospitalized,” Nuncio said. “And the most obvious location for them to have been infected is in their workplace, because so many precautions are not being taken.”

KHN data reporter Hannah Recht contributed to this article.

Related Topics

California Multimedia Public Health Race and Health States

Aunque preferiría cerrar, la cadena de tiendas COVID-19 Essentials se expande

Lone Tree, Colorado.- Darcy Velásquez, de 42 años, y su madre, Roberta Truax, caminaban recientemente por el centro comercial Park Meadows, 15 millas al sur del centro de Denver, buscando regalos de Navidad para los dos hijos de Velásquez, cuando vieron una tienda con un exhibición de máscaras faciales adornadas con diamantes de fantasía.

Brillantes ideales para una nena de 9 años.

La tienda se llama COVID-19 Essentials. Y bien puede ser la primera cadena minorista del país dedicada exclusivamente a una enfermedad infecciosa.

Con el cierre de muchas tiendas en los Estados Unidos durante la pandemia de coronavirus, especialmente dentro de los centros comerciales, los propietarios de esta cadena han sacado provecho del espacio vacío, así como de la creciente aceptación de que usar máscaras es una realidad que puede durar hasta 2021, o más.

Las máscaras faciales han evolucionado de ser un producto utilitario, cualquier cosa podía servir para taparte la boca, a una forma de expresar la personalidad, las inclinaciones políticas o el fanatismo deportivo.

Y los propietarios de COVID-19 Essentials están apostando a que los estadounidenses están dispuestos a poner dinero en sus bocas. Los precios van desde $19,99 por una simple máscara para niños hasta $130 por una cubierta facial con un filtro N95 y un ventilador a batería.

La cadena COVID-19 Essentials reconoce que la máscara ya es algo más que un inconveniente temporal. Será la norma hasta 2021, y tal vez más allá. (Markian Hawryluk/KHN)

Casi todas las tiendas en el centro comercial Park Meadows ahora venden máscaras. Pero COVID-19 Essentials también ofrece otros accesorios para la pandemia, en un espacio exclusivo:  su logo es una imagen estilizada de una partícula de coronavirus.

Ubicado junto a la tienda de remeras UNTUCKit y frente a una sala de exhibición de Tesla, no tiene el reconocimiento de marca ni el historial de un J.C. Penney. Pero la longevidad no parece haber ayudado a que la cadena de ropa o muchas otras escaparan de la crisis por la pandemia. Según los analistas de S&P Global Market Intelligence, las quiebras minoristas de enero a mediados de agosto alcanzaron su punto más alto en 10 años.

No es que los propietarios de COVID-19 Essentials quieran que sus productos tengan demanda para siempre.

“Estoy ansioso por cerrar el negocio eventualmente”, dijo Nadav Benimetzky, un minorista de Miami que fundó COVID-19 Essentials, que ahora tiene ocho tiendas en todo el país.

Nathan Chen, propietario de la tienda Lone Tree con Benimetzky, tenía un negocio diferente en el aeropuerto de Denver, pero a medida que disminuyeron los vuelos, una alternativa  centrada en COVID se perfiló como una empresa mucho mejor.

Las máscaras han pasado de ser un producto utilitario a algo personalizado, que identifica al que la usa con un partido político o un equipo de fútbol americano.(Markian Hawryluk/KHN)

Benimetzky abrió la primera tienda COVID-19 Essentials en el Aventura Mall en los suburbios de Miami después de ver la demanda de máscaras N95 al principio de la pandemia. “Son feas e incómodas, y todo el mundo las odia”, dijo. “Si vas a usar una máscara, también puede estar a la moda y ser bonita”.

Eso podría significar una máscara de lentejuelas o satén para ocasiones más formales, o la sonrisa de una calavera para asuntos casuales. Algunos cubrebocas tienen cremalleras para facilitar la alimentación, o un orificio para una pajita, con cierre de velcro.

La cadena tiene tiendas en la ciudad de Nueva York, Nueva Jersey, Philadelphia y Las Vegas, y está buscando abrir otras en California, donde los incendios forestales han aumentado la demanda de máscaras.

Inicialmente, los propietarios realmente no estaban seguros de que la idea funcionara. Abrieron la primera tienda justo cuando los centros comerciales volvían a abrir después de las cuarentenas.

“Realmente no comprendimos qué tan grande sería”, dijo Benimetzky. “No lo analizamos con la idea de abrir muchas tiendas. Pero hemos estado ocupados desde el momento en que abrimos “.

Un empleado de COVID-19 Essentials decora una máscara con la palabra USA en piedras preciosas de fantasía.(Markian Hawryluk/KHN)

Nancy Caeti, de 76 años, se detuvo en la tienda Lone Tree para comprar máscaras para sus nietos. Compró una transparente para su nieta, cuyo instructor de lenguaje de señas necesita ver sus labios moverse. Le compró a su hija, profesora de música y fanática de los Denver Broncos, una máscara con el logo del equipo de fútbol americano.

“Sobreviví a la epidemia de polio”, contó Caeti. Recordó cómo su madre los puso en fila a ella y a sus hermanos para recibir la vacuna contra la polio, y dijo que ella sería la primera en la fila para recibir la vacuna para COVID.

Ese quizás sea el único “básico” que la tienda no vende. Pero tiene dispositivos similares a llaves para abrir puertas y presionar botones de ascensores sin tocarlos. Algunos tienen un abridor de botellas incorporado. Hay dispositivos de luz ultravioleta para desinfectar teléfonos y un desinfectante de manos exclusivo que los empleados rocían a los clientes como si fuera una muestra de perfume.

Pero las máscaras son el mayor atractivo porque la tienda las puede personalizar.

Al entrar, los clientes pueden verificar su temperatura con un escáner de frente digital con instrucciones audibles: “Acérquese. Acércate. Temperatura normal. Temperatura normal”.

La tienda también ha agregado un fregadero cerca de la entrada para que los clientes puedan lavarse las manos antes de tocar los productos.

Algunos pasan por la tienda desconcertados, deteniéndose para tomar fotos y publicarlas en las redes sociales. Una pareja mayor (blanca no hispana) con máscaras idénticas observó una máscara en el negocio con el lema “Black Lives Matter” y se alejó.

El negocio no toma partido politico: hay tres diseños de máscaras del presidente Donald Trump, y dos para el candidato presidencial demócrata Joe Biden.

COVID-19 Essentials vende dispositivos parecidos a llaves que sirven para abrir puertas y tocar el botón de los elevadores “a distancia”. (Markian Hawryluk/KHN)

Daniel Gurule, de 31 años, pasó por el centro comercial a la hora del almuerzo para comprar un Apple Watch, pero se aventuró a entrar en la tienda por una nueva máscara. Dijo que normalmente usaba una máscara con ventilación, pero que no todos los lugares las permiten. (Protegen a los usuarios, pero no a las personas que los rodean). Compró una por $24,99 con el logo del equipo de baloncesto Denver Nuggets.

“Nos quita un poco de nuestra personalidad cuando todo el mundo camina con máscaras desechables”, dijo Chen. “Parece un hospital, como si todo el mundo estuviera enfermo”.

La mayoría de las máscaras están cosidas específicamente para la cadena, incluidas muchas hechas a mano. Uno de sus proveedores es una familia de inmigrantes vietnamitas que cosen máscaras en su casa de Los Ángeles, dijo Benimetzky.

Chen dijo que era difícil tener máscaras en stock y que todos los días hay un nuevo diseño que es éxito de ventas.

Dorothy Lovett, de 80 años, se detuvo frente a la tienda, apoyada en un bastón con un diseño de estampado animal. “Tuve que retroceder y decir, ‘¿Qué diablos es esto?’”, dijo. “Nunca antes había visto una tienda de máscaras”.

Examinó la vitrina, notando que necesitaba encontrar una mejor opción que la versión de tela que estaba usando.

“No puedo respirar con ésta”, dijo Lovett, antes de decidirse por su favorita. “Me gusta la máscara Black Lives Matter”.

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Noticias En Español Public Health States

As Californians Get Older and Less Mobile, Fires Get Hotter and Faster

PETALUMA, Calif. — Late on the night of Sept. 27, a bumper-to-bumper caravan of fleeing cars, horse trailers, RVs and overstuffed pickup trucks snaked east on Highway 12, the flames of the Glass Fire glowing orange in their rearview mirrors.

With her cat, Bodhi, in his carrier in the back seat, 80-year-old Diana Dimas, who doesn’t see well at night, kept her eyes glued to the rear lights of her neighbor’s Toyota. She and Magdalena Mulay had met a few years before at a bingo night in their sprawling retirement community on the outskirts of Santa Rosa. Both Libras, each with two marriages behind her, the two women soon became the sort of friends who finish each other’s sentences.

Now, for the second time in three years, they heard the alarms and fled together as fire consumed the golden hills of Northern California’s wine country.

“I thought, where on earth are we going to go?” recalled Dimas. She remembered that when the catastrophic Tubbs Fire hit back in 2017, people had sought refuge outside well-lit supermarkets, which had water and bathrooms. Which is how Dimas and Mulay and dozens of other seniors ended up spending the night of the most recent evacuation in the parking lot of the Sonoma Safeway.

At midnight, Mulay was trying to get comfortable enough to catch a few winks in her driver’s seat when her phone began to chirp. A friend was calling to wish her a happy 74th birthday.

The stories of that Sunday night — as a 20-acre fire started that morning merged with two other fires to become an 11,000-acre conflagration forcing tens of thousands from their homes in two counties — spotlight the challenges of evacuating elderly and infirm residents from the deadly wildfires that have become an annual occurrence in California. This year, the coronavirus, which is especially dangerous to the elderly, has further complicated the problem.

While the 2020 fire season will go down as the state’s biggest on record, rescuers have so far managed to avoid horrors on the scale of three years ago, when the firestorm that raced through California’s wine country killed 45 people. Almost all were over 65 — found in wheelchairs, trapped in their garages, isolated and hard of hearing, or simply too stubborn to leave. The same grim pattern emerged from the Camp Fire, which leveled the Northern California town of Paradise in 2018.

Assisted care homes in particular came under scrutiny after the 2017 fire, when ill-equipped and untrained workers at two Santa Rosa facilities abandoned two dozen frail, elderly residents as the flames closed in, according to state investigators. They concluded the seniors would have died in the flames had emergency workers and relatives not arrived at the last minute to rescue them.

“The problem is we don’t value elders as a society,” said Debbie Toth, CEO of Choice in Aging, an advocacy group. “If children needed to be evacuated, we’d have a freaking Romper Room stood up overnight to entertain them so they wouldn’t be damaged by the experience.”

The destructive effects of climate change in California have dovetailed with a rapidly graying population — which in a decade is projected to include 8.6 million senior citizens. That has fueled a growing demand for senior housing, from assisted care homes to swanky “active adult” facilities complete with golf courses and pools.

Proximity to nature is a major selling point of Oakmont Village, Dimas and Mulay’s upscale community of nearly 5,000 over-55s, which has everything from bridge games to cannabis clubs. But the woodlands and vineyards surrounding this suburban sprawl have put thousands of elderly citizens in hazardous wildfire zones.

“With seniors, there’s mobility issues, hearing issues — even the sense of smell is often gone in the later years,” said Marrianne McBride, who heads Sonoma County’s Council on Aging. Getting out fast in an emergency is especially challenging for those who no longer drive. In Sunday’s evacuation, some residents who followed official advice to call ride services had to wait hours, until 3 or 4 a.m., for the overtaxed vans.

Dimas and Mulay managed to scramble into their cars and get on the road shortly after 10 p.m., when a mandatory evacuation order went out for the thousands of seniors in Oakmont Village. But it was after midnight when residents of two Santa Rosa assisted care homes in the evacuation zone were shuffled onto city buses in their bathrobes, some with the aid of walkers. Off-duty drivers braved thick smoke and falling embers to ferry some of them to safety, only to spend hours being sent from one shelter to another as evacuation sites filled up fast because of social distancing rules designed to prevent the spread of COVID-19.

Other precautions, including masks and temperature checks, were followed. But health officials nonetheless voiced concerns that vulnerable people in their 80s and 90s — especially residents of skilled nursing homes, the source of most of Sonoma County’s coronavirus deaths so far — had been moved among multiple locations, upping their chance for exposure.

In the following days, shelters were fielding frantic calls from out-of-town relatives searching for their loved ones. “We were getting phone calls from Michigan, other places across the country, saying, ‘I’m trying to find my mother!’” said Allison Keaney, CEO of the Sonoma-Marin Fairgrounds, which sheltered several hundred horses, chickens, goats and llamas as well as displaced people.

Bart Pettijohn rests on his cot with his dog, Clumsy, in an evacuation center at the Petaluma Veterans Memorial Building on Sept. 30. Volunteer health care workers and a veterinarian were among those who checked up on dozens of seniors and pets forced out of their homes during the biggest wildfire season in California history. (Rachel Scheier for KHN)

By Wednesday afternoon, a few dozen evacuees remained at the shelters, mostly seniors without relatives or friends nearby to take them in, like Dimas and Mulay. The two women had left the Safeway lot and were sleeping on folding cots in a gym at the Veterans Memorial Building in Petaluma, an old poultry industry town dotted with upscale subdivisions.

This was their first time out and around other people since March, when the two friends had been planning a big night out to see Il Volo, an Italian pop group. Seven months later, the new outfits they bought for the concert still hang unworn in their closets.

“All we do since the shutdown is stay home and talk on the phone,” said Mulay, who spoke to a reporter while sitting next to her friend on a folding chair outside the shelter. “Now, with all these crowds — it’s terrifying.”

Dimas likened the pandemic followed by the fires to “a ball rolling downhill, getting bigger and bigger. And then there we were, with the flashing lights all around us and the cops shouting, ‘Go this way!’ ‘Keep moving!’”

Listos California — an outreach program, for seniors and other vulnerable people, run out of the Governor’s Office of Emergency Services — allotted $50 million to engage dozens of nonprofits and community groups around the state to help warn and locate people during disasters. (Listos means “Ready” in Spanish.)

In Sonoma and Napa counties, where the Glass Fire had destroyed at least 630 structures by late last week, the bolstered threat of wildfires in recent years has promoted new alert systems — including a weather radio that has strobe lights for the deaf or can shake the bed to awaken you.

But while counties are legally responsible for alerting people and providing shelter for them once they’re out, no public agency is responsible for overseeing the evacuation. Practices differ widely from county to county, said Listos co-director Karen Baker.

If Sonoma County has learned anything from the disasters of the past few years, it’s not to depend too much on any system in an emergency. “You’ve got to have a neighborhood network,” McBride said. “As community members, we have to rely on each other when these things happen.”

Early last week, word filtered through the shelters that the fire had consumed a triplex and two single-family homes in the Oakmont neighborhood, but firefighters had battled the blaze through the night with hoses, shovels and chainsaws and miraculously managed to save the rest of the community.

A week later, to their relief, Oakmont’s senior residents were allowed to return home. By then, Mulay had developed severe back pain. Dimas missed her TV.

Back in her apartment with Bodhi, Dimas noted with horror that the blaze had come close enough to her building to incinerate several juniper bushes and scorch a redwood just 2 feet away.

“The whole thing feels surreal, like ‘Oh, my God, did that really happen, or did I dream it?’” she said.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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Aging Public Health

Making Money Off Masks, COVID-Spawned Chain Store Aims to Become Obsolete

LONE TREE, Colo. — Darcy Velasquez, 42, and her mother, Roberta Truax, were walking recently in the Park Meadows mall about 15 miles south of downtown Denver, looking for Christmas gifts for Velasquez’s two children, when they spotted a store with a display of rhinestone-studded masks.

It’s an immutable truth of fashion: Sparkles can go a long way with a 9-year-old.

The store is called COVID-19 Essentials. And it may well be the country’s first retail chain dedicated solely to an infectious disease.

With many U.S. stores closing during the coronavirus pandemic, especially inside malls, the owners of this chain have seized on the empty space, as well as the world’s growing acceptance that wearing masks is a reality that may last well into 2021, if not longer. Masks have evolved from a utilitarian, anything-you-can-find-that-works product into another way to express one’s personality, political leanings or sports fandom.

And the owners of COVID-19 Essentials are betting that Americans are willing to put their money where their mouth is. Prices range from $19.99 for a simple children’s mask to $130 for the top-of-the-line face covering, with an N95 filter and a battery-powered fan.

The COVID-19 Essentials chain recognizes that mask-wearing is more than a temporary inconvenience — it may become the norm well into 2021, or longer.(Markian Hawryluk/KHN)

Almost all shops and many pop-up kiosks in the Park Meadows mall now sell masks. But COVID-19 Essentials also carries other accessories for the pandemic, in a space that has a more established feel than a holiday pop-up store; permanent signage above its glass doors includes a stylized image of a coronavirus particle. Nestled beside the UNTUCKit shirt store and across from a Tesla showroom, it has neither the brand recognition nor the track record of a J.C. Penney. But longevity doesn’t seem to have helped that clothing chain or many others escape industry upheaval during the pandemic. According to analysts at S&P Global Market Intelligence, retail bankruptcies from January to mid-August reached a 10-year-high.

Not that the COVID-19 Essentials owners want their products to be in demand forever.

“I can’t wait to go out of business eventually,” said Nadav Benimetzky, a Miami retailer who founded COVID-19 Essentials, which now has eight locations around the country.

That seemed to be the attitude of most of the customers who walked into the store on a recent Friday afternoon. Most understood the need for masks — face coverings are required to even enter the mall — and thus they recognized the business case for a COVID-19 store. Still, they hoped masks would soon go the way of bell-bottoms or leg warmers. For the time being, they’re making the best of the situation.

Nathan Chen, who owns the Lone Tree store with Benimetzky, previously ran a different store at the Denver airport, but as air travel declined, a COVID-focused business seemed a much better venture. The pandemic giveth and the pandemic taketh away.

Benimetzky opened the first COVID-19 Essentials store in the Aventura Mall in suburban Miami after seeing the demand for N95 masks early in the pandemic. “They’re ugly and uncomfortable, and everybody hates them,” he said. “I piggybacked off of that. If you’re going to wear a mask, you might as well make it fashionable and pretty.”

Face masks have evolved from a utilitarian product into a customized accessory for personal expression.(Markian Hawryluk/KHN)

That could mean a sequin or satin mask for more formal occasions, or the toothy grin of a skull mask for casual affairs. Some masks have zippers to make eating easier, or a hole for a straw, with a Velcro closure for when the cup is sucked dry.

The chain has locations in New York City, New Jersey, Philadelphia and Las Vegas, and is looking to open stores in California, where wildfires have only added to the demand for masks.

Initially, the owners really weren’t sure the idea would fly. They opened the first store just as malls were reopening following the lockdowns.

“We really didn’t grasp how big it would get,” Benimetzky said. “We didn’t go into it with the idea of opening many stores. But we got busy from the second we opened.”

Nancy Caeti, 76, stopped in the Lone Tree store to buy masks for her grandchildren. She bought one with a clear panel for her granddaughter, whose sign language instructor needs to see her lips moving. She bought her daughter, a music teacher and Denver Broncos fan, a mask with the football team’s logo.

“I lived through the polio epidemic,” Caeti said, as her latex-gloved hand inserted her credit card into the card reader. “It reminds me of that, but that I don’t think was as bad.” She recalled how her mother had lined her and her siblings up to get the polio vaccine, and said she’d be first in line for a COVID shot.

That perhaps is the one essential the store does not carry. It hawks keylike devices for opening doors and pressing elevator buttons without touching them. Some have a built-in bottle opener. There are ultraviolet-light devices for disinfecting phones and upscale hand sanitizer that employees spray on customers as if it were a department store perfume sample.

But the masks are the biggest draw. The store can personalize them with rhinestone letters or the kind of iron-on patches that teens once wore on their jeans.

A COVID-19 Essentials employee decorates a face mask with rhinestone letters, spelling U-S-A.(Markian Hawryluk/KHN)

Upon entry, customers can check their temperature with a digital forehead scanner with audible directions: “Step closer. Step closer. Temperature normal. Temperature normal.”

The store also has added a sink near the entrance so customers can wash their hands before handling the merchandise.

Some mallgoers walk by the store in bewilderment, stopping to take photos to post to social media with a you’ve-got-to-be-kidding message. One older white couple in matching masks noticed a mask emblazoned with the slogan “Black Lives Matter” in the storefront display, and walked away in disgust.

The store takes no political sides; there are three designs of President Donald Trump campaign masks, two for Democratic presidential candidate and former Vice President Joe Biden. One woman, who declined to give her name, came in wearing a mask below her nose and wondered whether a Trump mask would fit her smallish face. The Trump masks are among the more popular sellers, Chen said, so he keeps them in a bigger cabinet to accommodate the extra stock. It’s not clear if that will forecast the election results, as some have posited with Halloween mask sales.

Daniel Gurule, 31, stopped by the mall on his lunch hour to pick up an Apple Watch but ventured into the store for a new mask. He said that he normally wore a vented mask but that not all places allowed those. (They protect users but not the people around them.) He bought a $24.99 mask with the logo of the Denver Nuggets basketball team.

“It takes away a little bit of our personalities when everybody is walking around in disposable masks,” Chen said. “It kind of looks like a hospital, like everybody is sick.”

Most of the masks are sewn specifically for the chain, including many by hand. One of their suppliers is a family of Vietnamese immigrants who sew masks at their Los Angeles home, Benimetzky said. Chen said that it was hard to keep masks in stock, and that every day it seemed some other design became their best seller.

COVID-19 Essentials sells keylike devices to open doors and press elevator buttons without touching them. Some even have built-in bottle openers.(Markian Hawryluk/KHN)

Dorothy Lovett, 80, paused outside the store, leaning on a cane with an animal print design.

“I had to back up and say, ‘What the heck is this?’” she said. “I’ve never seen a mask store before.”

She perused the display case, noting she needed to find a better option than the cloth version she was wearing.

“I can’t breathe in this one,” said Lovett, who is white, before deciding on her favorite. “I like the Black Lives Matter mask.”

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Public Health States

Pence Said Biden Copied Trump’s Pandemic Response Plan. Pants on Fire!

During last week’s vice presidential debate, moderator Susan Page, USA Today’s Washington bureau chief, asked Vice President Mike Pence about the U.S. COVID-19 death toll. Pence replied by touting the Trump administration’s actions to combat the pandemic, such as restrictions on travel from China, steps to expand testing and efforts to accelerate the production of a vaccine.

Pence also took a jab at Democratic presidential nominee Joe Biden, a strong critic of the Trump pandemic response. “The reality is, when you look at the Biden plan, it reads an awful lot like what President Trump and I and our task force have been doing every step of the way,” said Pence. “And, quite frankly, when I look at their plan,” he added, “it looks a little bit like plagiarism, which is something Joe Biden knows a little bit about.”

(Pence’s gibe about plagiarism is likely a reference to Biden copying phrases from a British politician’s speeches during his first run for president in 1987, an issue that caused him to drop out of the race. In 2019, the Biden campaign acknowledged it had inadvertently lifted language in its climate and education plans without attributing the sources.)

Because COVID-19 continues to spread throughout the United States, with nearly 8 million cases and upward of 215,000 deaths, we decided to examine both the Trump and Biden plans to curb the pandemic and investigate whether Pence was on target in his charge that the Biden plan is rooted in Trump’s ideas.

We reached out to both presidential campaigns for their candidates’ COVID-19 plans. The Trump campaign did not respond to our request, but we looked at a campaign website timeline of administration actions on COVID-19, as well as a coronavirus fact sheet from the White House. The Biden campaign sent us a link to Biden’s COVID-19 plan.

At first glance, there are obvious similarities. Both declare goals like vaccine development and expanding public availability of COVID-19 tests.

“Most pandemic response plans should be at their core fairly similar, if they’re well executed,” said Nicolette Louissaint, executive director of Healthcare Ready, a nonprofit organization focused on strengthening the U.S. health care supply chain.

But public health experts also pointed to significant philosophical differences in how the plans are put into action.

“You ought to think about it as two groups of people trying to make a car,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “They have to have four wheels, probably have to have a bumper, have some doors,” he said. It is how you build the car from that point forward that determines what the end product looks like.

What Trump Has Done

As Pence pointed out, the Trump administration has focused its efforts to combat COVID-19 along a couple of lines.

The administration formed the White House coronavirus task force in January and issued travel restrictions for some people traveling from China and other countries in February. Federal social distancing guidelines were issued in March and expired on April 30. The administration launched Operation Warp Speed in April, with the goal of producing and delivering 300 million doses of a coronavirus vaccine beginning in January 2021. A more detailed logistics plan to distribute a vaccine was issued later. Trump activated the Defense Production Act for certain protective equipment and ventilators. His administration also has talked about efforts to expand COVID-19 testing in partnership with the private sector, as well as initiatives to help cover costs for COVID-19 treatments and make tests free of charge.

Importantly, the administration also shifted significant decision-making responsibility to states, leaving the development of testing plans, procurement of personal protective equipment and decrees on stay-at-home orders and mask mandates to the discretion of the governor or local governments. Despite that, Trump still urged states to reopen beginning in May, though in many areas cases of COVID-19 remained high.

What Biden Proposes to Do

Biden’s plan would set out strong national standards for testing, contact tracing and social distancing — words that echo the Trump plan. It proposes working with states on mask mandates, establishing a “supply commander” in charge of shoring up PPE, aggressively using the Defense Production Act and accelerating vaccine development.

It also outlines plans to extend more fiscal relief, provide enhanced health insurance coverage, eliminate cost sharing for COVID treatments, reestablish a team on the National Security Council to address pandemic response and to maintain membership inthe World Health Organization. Trump announced earlier this summer that the U.S. would begin procedures to withdraw from the WHO, effective as of July 6, 2021.

Biden has said he would follow scientific advice if indicators pointed to a need to dial up social distancing guidelines in light of another wave of COVID-19 cases.

What’s the Same, What’s Different

Dr. Rachel Vreeman, director of the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, noted in an email that a key likeness is that the two plans “sometimes used similar words, such as testing, PPE and vaccines.”

But “the overall philosophy from the start, from the White House and from Trump, has been to let states and local governments deal with this problem,” said Josh Michaud, associate director for global health policy at KFF. “Biden would have a much more forceful role for the federal government in setting strategy and guidelines in regards to the public health response.” (KHN is an editorially independent program of KFF.)

Even Pence pointed out this philosophical difference during the debate, saying that Democrats want to exert government control while Trump and Republicans left health choices up to individual Americans.

Vreeman and others pointed to another contrast — that the Trump administration has yet to issue a comprehensive COVID-19 response plan.

“What plan? I would really love it if someone could show me a plan. A press release is not a plan,” said Dr. Leana Wen, a public health professor at George Washington University.

Wen is right that the Trump administration has not issued a detailed plan, such as Biden’s document. The Trump administration has, however, offered a road map for how vaccines would be distributed.

Behavior Matters, Too

Another major distinction emerged in the way the candidates have communicated the threat of the coronavirus to the public and reacted to public health guidelines, such as those issued by the Centers for Disease Control and Prevention.

During most public outings and campaign rallies, Trump has chosen not to wear a mask — even after he tested positive and was treated for COVID-19. He has been known to mock others, including reporters and Biden, for wearing masks. And, Trump and members of his administration have not adhered to social distancing guidelines at official events. The White House indoor reception and outdoor Rose Garden event held to mark the nomination of Amy Coney Barrett to the Supreme Court – at each one, few attendees followed these precautions – have been associated with the transmission of at least 11 cases of coronavirus, according to a website tracking the cases from public reports. There are also multiple reported cases among White House and Trump campaign staff members.

Throughout the pandemic, Trump has downplayed the threat of COVID-19, touted unproven treatments for the disease such as bleach, hydroxychloroquine or UV light, questioned the effectiveness of face masks and criticized or contradicted public health officials’ statements about the pandemic.

In comparison, Biden has worn masks during his public campaign events and has encouraged Americans to do so as well. His events strictly adhere to public health guidelines, including wearing masks, social distancing and limiting the number of attendees.

The two candidates’ approaches to listening to scientists are also different.

“Biden has said he is going to look at science and value the best scientists,” said Benjamin. “The Trump administration has not walked the talk; they have said one thing and done something else. If you go on the Trump administration website, you see guidelines that they didn’t follow themselves.”

In the end, the Biden campaign has the distinction of being able to learn from the Trump administration’s early missteps, said the experts.

There’s also a reality check: if Biden wins and attempts to implement his COVID-19 plan, it’s important to consider that no matter how well thought out it looks on paper, he may not be able to accomplish everything.

“There’s a lot of words in this plan,” said Joseph Antos, a resident scholar in health care policy at the American Enterprise Institute. “But until you’re in the job, a lot of this doesn’t really matter.”

Our Ruling

Pence claimed the Biden plan to address COVID-19 was similar to the Trump administration’s plan “every step of the way.”

A cursory, side-by-side look at the Trump administration’s COVID-19 actions — no actual comprehensive plan has been released — and the Biden plan indicates some big picture overlap on securing a vaccine and ramping up testing. But that’s where the similarities end.

Biden’s plan includes proposed actions the Trump administration has not pursued. It also is focused on federal rather than state authority, a significant distinction Pence himself pointed out during the debate.

Additionally, the candidates’ behaviors toward COVID-19 and views on science have been diametrically opposed, with Trump eschewing the use of face masks and social distancing, and Biden closely adhering to both.

Pence’s statement ignores critical facts and realities, making it inaccurate and ridiculous.

We rate it Pants On Fire.

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‘No Mercy’ Chapter 3: Patchwork of Urgent Care Frays After a Rural Hospital Closes

Can’t see the audio player? Click here to listen.

Emergency care gets complicated after a hospital closes. On a cold February evening, when Robert Findley fell and hit his head on a patch of ice, his wife, Linda, called 911. The delays that came next exposed the frayed patchwork that sometimes stands in for rural health care.

After Mercy Hospital Fort Scott shut down, many locals had big opinions about what kind of health care the town needed.

“Words of experience is, you don’t know when that tragedy is going to happen,” Linda Findley said.

Fort Scott’s free-standing ER and the new community health center aren’t enough, she said.

“I mean, my gosh, you need to feel like you’re safe and could be taken care of where you’re at,” she said.

Click here to read the episode transcript.

Linda Findley holds a photo of her husband, Robert.(Christopher Smith for KHN)

“Where It Hurts” is a podcast collaboration between KHN and St. Louis Public Radio. Season One extends the storytelling from Sarah Jane Tribble’s award-winning series, “No Mercy.”

Subscribe to Where It Hurts on iTunes, Stitcher, Google, Spotify or Pocket Casts.

And to hear all KHN podcasts, click here.

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Black Doctors Work to Make Coronavirus Testing More Equitable

When the coronavirus arrived in Philadelphia in March, Dr. Ala Stanford hunkered down at home with her husband and kids. A pediatric surgeon with a private practice, she has staff privileges at a few suburban Philadelphia hospitals. For weeks, most of her usual procedures and patient visits were canceled. So she found herself, like a lot of people, spending the days in her pajamas, glued to the TV.

And then, at the beginning of April, she started seeing media reports indicating that Black people were contracting the coronavirus and dying from COVID-19 at greater rates than other demographic groups.

“It just hit me like, what is going on?” said Stanford.

At the same time, she started hearing from Black friends who couldn’t get tested because they didn’t have a doctor’s referral or didn’t meet the testing criteria. In April, there were shortages of coronavirus tests in numerous locations across the country, but Stanford decided to call around to the hospitals where she works to learn more about why people were being turned away.

One explanation she heard was that a doctor had to sign on to be the “physician of record” for anyone seeking a test. In a siloed health system, it could be complicated to sort out the logistics of who would communicate test results to patients. And, in an effort to protect health care workers from being exposed to the virus, some test sites wouldn’t let people without cars simply walk up to the test site.

Stanford knew African Americans were less likely to have primary care physicians than white Americans, and more likely to rely on public transportation. She just couldn’t square all that with the disproportionate infection rates for Black people she was seeing on the news.

“All these reasons in my mind were barriers and excuses,” she said. “And, in essence, I decided in that moment we were going to test the city of Philadelphia.”

Stanford visits a Black Doctors Consortium testing site in Darby, Pennsylvania, on Sept. 9. Stanford has largely self-funded the testing initiative.(Nina Feldman/WHYY)

Black Philadelphians contract the coronavirus at a rate nearly twice that of their white counterparts. They also are more likely to have severe cases of the virus: African Americans make up 44% of Philadelphians but 55% of those hospitalized for COVID-19.

Black Philadelphians are more likely to work jobs that can’t be performed at home, putting them at a greater risk of exposure. In the city’s jails, sanitation and transportation departments, workers are predominantly Black, and as the pandemic progressed they contracted COVID-19 at high rates.

The increased severity of illness among African Americans may also be due in part to underlying health conditions more prevalent among Black people, but Stanford maintains that unequal access to health care is the greatest driver of the disparity.

“When an elderly funeral home director in West Philly tries to get tested and you turn him away because he doesn’t have a prescription, that has nothing to do with his hypertension, that has everything to do with your implicit bias,” she said, referring to an incident she encountered.

Before April was over, Stanford sprang into action. Her mom rented a minivan to serve as a mobile clinic, while Stanford started recruiting volunteers among the doctors, nurses and medical students in her network. She got testing kits from the diagnostic and testing company LabCorp, where she had an account through her private practice. Fueled by Stanford’s personal savings and donations collected through a GoFundMe campaign, the minivan posted up in church parking lots and open tents on busy street corners in Philadelphia.

It wasn’t long before she was facing her own logistical barriers. LabCorp asked her how she wanted to handle uninsured patients whose tests it processed.

“I said, for every person that does not have insurance, you’re gonna bill me, and I’m gonna figure out how to pay for it later,” said Stanford. “But I can’t have someone die for a test that costs $200.”

Philadelphians live-streamed themselves on social media while they got tested, and word spread. By May, it wasn’t unusual for the Black Doctors COVID-19 Consortium to test more than 350 people a day. Stanford brought the group under the umbrella of a nonprofit she already operated that offers tutoring and mentorship to youth in under-resourced schools.

Tavier Thomas found out about the group on Facebook in April. He works at a T-Mobile store, and his co-worker had tested positive. Not long after, he started feeling a bit short of breath.

“I probably touch 100 phones a day,” said Thomas, 23. “So I wanted to get tested, and I wanted to make sure the people testing me were Black.”

Many Black Americans seek out Black providers because they’ve experienced cultural indifference or mistreatment in the health system. Thomas’ preference is rooted in history, he said, pointing to times when white doctors and medical researchers have exploited Black patients. In the 19th century American South, for example, white surgeon J. Marion Sims performed experimental gynecological treatments without anesthesia on enslaved Black women. Perhaps the most notorious example began in the 1930s, when the United States government enrolled Black men with syphilis in a study at Tuskegee Institute, to see what would happen when the disease went untreated for years. The patients did not consent to the terms of the study and were not offered treatment, even when an effective one became widely available.

“They just watched them die of the disease,” said Thomas, of the Tuskegee experiments.

“So, to be truthful, when, like, new diseases drop? I’m a little weird about the mainstream testing me, or sticking anything in me.”

Brothers Tavier Thomas (left) and McKenzie Johnson were tested for the coronavirus at a Black Doctors COVID-19 Consortium testing site. Tavier, who studies history, says he feels more comfortable getting treatment from Black medical providers because of past abuses of Black people by white doctors and medical researchers in the U.S.(Nina Feldman/WHYY)

In April, Thomas tested positive for the coronavirus but recovered quickly. He returned recently to be tested again by Stanford’s group, even though the testing site that day was in a church parking lot in Darby, Pennsylvania, a solid 30-minute drive from where he lives.

Thomas said the second test was just for safety, because he lives with his grandfather and doesn’t want to risk infecting him. He also brought along his brother, McKenzie Johnson. Johnson lives in neighboring Delaware but said it was hard to get tested there without an appointment, and without health insurance. It was his first time being swabbed.

“It’s not as bad as I thought it was gonna be,” he joked afterward. “You cry a little bit — they search in your soul a little bit — but, naw, it’s fine.”

Each time it offers tests, the consortium sets up what amounts to an outdoor mini-hospital, complete with office supplies, printers and shredders. When they do antibody tests, they need to power their centrifuges. Those costs, plus the lab processing fee of $225 per test and compensation for 15-30 staff members, amounts to roughly $25,000 per day, by Stanford’s estimate.

“Sometimes you get reimbursed and sometimes you don’t,” she said. “It’s not an inexpensive operation at all.”

After its first few months, the consortium came to the attention of Philadelphia city leaders, who gave the group about $1 million in funding. The group also attracted funding from foundations and individuals. The regional transportation authority hired the group to test its front-line transit workers weekly.

To date, the Black Doctors COVID-19 Consortium has tested more than 10,000 people — and Stanford is the “doctor on record” for each of them. She appreciates the financial support from the local government agencies but still worries that the city, and Philadelphia’s well-resourced hospital systems, aren’t being proactive enough on their own. In July, wait times for results from national commercial labs like LabCorp sometimes stretched past two weeks. The delays rendered the work of the consortium’s testing sites essentially worthless, unless a person agreed to isolate completely while awaiting the results. Meanwhile, at the major Philadelphia-area hospitals, doctors could get results within hours, using their in-house processing labs. Stanford called on the local health systems to share their testing technology with the surrounding community, but she said she was told it was logistically impossible.

“Unfortunately, the value put on some of our poorest areas is not demonstrated,” Stanford said. “It’s not shown that those folks matter enough. That’s my opinion. They matter to me. That’s what keeps me going.”

Now, Stanford is working with Philadelphia’s health commissioner, trying to create a rotating schedule wherein each of the city’s health systems would offer free testing one day per week, from 9 a.m. to 9 p.m.

The medical infrastructure she has set up, Stanford said, and its popularity in the Black community, makes her group a likely candidate to help distribute a coronavirus vaccine when one becomes available. Representatives from the U.S. Department of Health and Human Services visited one of her consortium’s testing sites, to evaluate the potential for the group to pivot to vaccinations.

Overall, Stanford said she is happy to help out during the planning phases to make sure the most vulnerable Philadelphians can access the vaccine. However, she is distrustful of the federal oversight involved in vetting an eventual coronavirus vaccine. She said there are still too many unanswered questions about the process, and too many other instances of the Trump administration putting political pressure on the Centers for Disease Control and Prevention and the Food and Drug Administration, for her to commit now to doing actual vaccinations in Philadelphia’s neighborhoods.

“When the time comes, we’ll be ready,” she said. “But it’s not today.”

This story is part of a partnership that includes WHYY, NPR and KHN.

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New Moms Behind Bars Get Help From Someone Who’s Been There

INDIANAPOLIS — Nine years ago, Nina Porter gave birth in a hospital bed with one of her ankles chained to the frame.

Corrections officers stood watch as Porter held her daughter, Gianna, to her chest for the first time. Back at a nursery inside Indiana Women’s Prison, Gianna slept in a crib in her mother’s cell, about 2 feet from her pillow.

The prison program allowed Porter to keep her baby with her — including when she went out into the yard — until her discharge nearly a year later. She didn’t recall ever bonding so closely with her previous 11 kids. She finally felt her life moving in a positive direction.

“I didn’t want to be a messed-up person,” she said. “I didn’t want to be a messed-up mom once I realized what a real mom is.”

When Porter was released in 2012, however, she didn’t know how to stay on that path and resorted to what she knew: drugs and crime. She never returned to prison, but her struggles eventually led to a new mission of supporting incarcerated moms as they adjust to life on the outside.

This month, a program Porter developed called Mothers on the Rise is set to launch in the same unit where the 46-year-old raised her daughter. The project, among the first of its kind, aims to help formerly incarcerated mothers maneuver a post-prison world that can often be unwelcoming.

Research shows that recently incarcerated moms are likely to have a variety of mental and physical health problems and lack access to stable housing, employment, education and social services.

“They’re released with maybe no place to stay and go to. And if they do have a place, it may be transient. They don’t have money, might not have a cellphone — and they have to take care of a baby,” said Jack Turman, an Indiana University public health professor who is advising Porter on her project. “How does one navigate all of that?”

The number of incarcerated women in the United States exploded from about 26,000 in 1980 to roughly 231,000 today, with African American women imprisoned at twice the rate of white women.

But incarcerated women often lack programs that help them transition back into society, even though research has found they expressed more of a need for them than have men or juveniles. There are also few reentry resources outside of prison, especially those designed for the nearly two-thirds of imprisoned women who have children.

The Indiana Women’s Prison, located on Girls School Road in Indianapolis, is one of the few prisons in America that has a nursery for mothers and babies.(Giles Bruce for KHN)

The group “at the greatest disadvantage coming out of prison is going to be women,” said Pamela Lattimore, a leading expert on prison reentry and researcher for the nonprofit research organization RTI International. “Family support for women is — we found pretty consistently across our data — much less than what was available for men.”

An estimated 2,000 women a year give birth while incarcerated, but Indiana is one of the few states that allows new mothers to raise their babies in prison. The nursery — where moms and infants have private rooms and get help from inmates who are trained to be nannies — assists the women in planning for reentry with a checklist of needs and services. But until now, there’s been no peer support or mentoring for new moms or moms-to-be from anyone who’s been through it.

A Chance Encounter

Until recently, Porter lived such a chaotic, difficult life that she contemplated suicide. Her early years were filled with abuse and neglect. She’d spent much of her adulthood behind bars, mostly for fraud and forgery.

She thought the last time she left prison would be different. But when she and Gianna got out, they bounced around from place to place for a few years. Porter tried to survive the only way she knew how.

“My scum of the pond was I took advantage of anything — however I had to get money. I was just a con artist,” she said. “I’ve been charged with prostitution. I was actually charged with it, not doing it, but … when you’re a crack addict, you’re going to do anything you need to do to get that dope.”

So, in March 2019, she planned to take her life. She had a gun at the ready.

Then there was an unexpected visitor at her apartment. It was Ashley Phillips, project manager for a program Porter was involved in, Grassroots Maternal and Child Health Leadership Training Project.

Turman, the IU professor, had started that program in 2018 to help lower the infant death rate in a state — and city — with one of the highest in the nation. The project trains women who have overcome personal struggles to develop initiatives and policies that support other vulnerable moms.

Porter had begun attending the training that same year, but only because it offered $300 in gift cards. She never considered herself a community leader and didn’t think she had any business telling women how to be mothers.

When Phillips stopped by that day, she handed Porter a flower, comparing it to the women in the project: You plant a seed, watch it grow, and it eventually blossoms into something beautiful.

“She actually saved my life,” Porter said. “I had sent the kids to their dad’s. I was overwhelmed, and I wasn’t sad about taking my life. I was just so tired and ready. … Then Ashley came.”

From that day until she graduated last December, Porter stuck with the leadership training. She’d been hoping to help other moms since she was in prison, and the training gave her the tools to start her own program.

Mothers on the Rise was born.

Nina Porter watches her kids play outside their Indianapolis apartment on Sept. 15. Porter, who spent most of her adulthood behind bars, including raising an infant daughter in prison, has created a program to help other moms get by in a sometimes unwelcoming post-prison world.(Giles Bruce for KHN)

Program Offers Support and Savings

Porter’s idea drew the interest of the Indiana State Department of Health, which is providing nearly $60,000 in one-time funding for the project. Agency spokesperson Jeni O’Malley said it “aligns with our priorities of reducing preventable deaths among women and children, reducing health disparities and inequities, and strengthening mental, social and emotional well-being.” The program will be evaluated after the first year for possible future funds and expansion.

The state Department of Correction is allowing women in the prison nursery to join the initiative, albeit virtually for now, because of coronavirus. Indiana stands to save money if the women stay out of prison; it costs about $55 a day to keep them locked up.

Mothers on the Rise will initially assist 10 women, helping them secure housing, child care and, if needed, addiction and mental health treatment. Porter will advise them 90 days before their release and another 90 days afterward on tasks such as connecting with doctors, finding employment and opening bank accounts.

The program will also pay for three months of child care and bus fare for the women and provide infant supplies such as strollers, baby wipes and clothing.

Porter will operate in tandem with the nursery’s social worker.

“My advantage is I know the street mentality, if you will,” Porter said. “I can cut the crap with the women from the beginning.”

She will act as a trusted guide in returning to a society that isn’t always so forgiving to ex-offenders, particularly mothers of young children.

“We like to ostracize those in the justice system and then we’re surprised when they fail — fail at reentering the community they’re not welcome in,” said Maranda Sparks, transitional health care manager for the Indiana DOC.

After she last got out of prison in 2012, Porter visited Garfield Park, a historical, 126-acre green space on Indianapolis’ south side. She snapped a picture of Gianna sitting on the ground next to a fountain. From time to time, she still looks at it, reminding her of a hopeful yet precarious moment in their lives.

Porter went back to the park on a recent late-summer day, the sky powder-blue. Gianna, now almost 9, was there too. So were Porter’s younger kids, 6-year-old Kevin and nearly 2-year-old Kamiah. The children raced one another and scrambled up trees. Flowers bloomed all around.

Watching her children play, Porter pondered how her life might have been different had someone helped her navigate the post-prison experience.

“I think I would have gotten here, but with more healing,” she said. “Because I didn’t even realize a lot of the stuff I was doing was wrong, that life didn’t have to be like that.”

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COVID Takes Challenge of Tracking Infectious College Students to New Level

As the return of college students to campuses has fueled as many as 3,000 COVID-19 cases a day, keeping track of them is a logistical nightmare for local health departments and colleges.

Some students are putting down their home addresses instead of their college ones on their COVID testing forms — slowing the transfer of case data and hampering contact tracing across state and county lines.

The address issue has real consequences, as any delay in getting the case to the appropriate authorities allows the coronavirus to continue to spread unchecked. Making matters worse, college-age people already tend to be hard to trace because they are unlikely to answer a phone call from an unknown number.

“With that virus, you really need to be able to identify that case and their contacts in 72 hours,” said Indiana University’s assistant director for public health, Graham McKeen.

And if the students do go home once infected, where should their cases be counted? The Centers for Disease Control and Prevention highlighted this issue in a recent study of an unnamed North Carolina university’s COVID outbreak, stating that the number of cases was likely an underestimate. “For example, some cases were reported to students’ home jurisdictions, some students did not identify themselves as students to the county health department, some students did not report to the student health clinic, and not all students were tested,” it said.

The White House Coronavirus Task Force even addressed the problem in weekly memos sent to the governors of Missouri, Arkansas, Iowa, Kentucky and New Jersey. “Do not reassign cases that test positive in university settings to hometown as this lessens ability to track and control local spread,” it recommended late last month in the memos, made public by the Center for Public Integrity.

While the full scope of the address confusion is unclear, the health departments of California, Indiana, Iowa and Virginia all acknowledged the challenges that arise when college cases cross state and county lines.

The maze of calls needed to track such cases also lays bare a larger problem: the lack of an interconnected COVID tracking system. Colleges have been setting up their own contact tracing centers to supplement overstretched local and state health departments.

“It is very patchwork, and people operate very differently, and it also doesn’t translate during a pandemic,” said McKeen, whose own university has had more than 2,900 cases across its Indiana campuses. “It made it very clear the public health system in this country is horribly underfunded and understaffed.”

Colleges’ transient populations have forever bedeviled public health when it comes to reportable infectious diseases, such as measles and bacterial meningitis, Association of Public Health Laboratories spokesperson Michelle Forman said in an email to KHN. But the coronavirus infections spreading across the country’s universities, and the mass testing conducted to find them, are something else altogether.

“COVID is just a different scale,” she said.

Lisa Cox, a spokesperson for the Missouri Department of Health and Senior Services, said the issue of transient addresses affects more than just college students. Jails and rehab facilities also have people moving in and out, exacerbating the risk of disease spread and the difficulty in tracking it.

The crush of student cases at the start of a new term, though, can be overwhelming. As students returned to the University of Missouri, the Columbia/Boone County Department of Public Health and Human Services saw a COVID spike, with the peak reaching more than 200 new cases per day.

“So, first of all, we’re delayed anyway because we can’t keep up with the onslaught of cases,” said Scott Clardy, assistant director of the health department.

But then, he added, these address mishaps required his department to spend time attempting to reclassify counts and contact possibly infected people.

“It slows us down,” he said, estimating the department was up to five days behind in mid-September on contacting infected people and reaching out to those who may have been exposed to the virus.

The University of Missouri has had more than 1,600 cases so far, but spokesperson Christian Basi said the number of new cases has dropped significantly. By the end of September, the health department had finally caught up, Clardy said, letting staffers trace contacts more quickly.

This address issue can also mean some cases are potentially being undercounted, double counted or initially counted incorrectly as state health departments sort out where these infected students actually are staying, Indiana University’s McKeen said — potentially skewing case counts and positivity rates for local jurisdictions. He has noticed several such cases.

Iowa and Indiana officials said they were working with localities to ensure cases did not go miscounted, including developing directions for college students to put down their school address. Virginia officials said their contact tracers work diligently to identify the infected person’s current location and share it with other health departments if it is out of Virginia.

In Massachusetts, Pat Bruchmann, chief public health nurse for the Worcester Division of Public Health, said she had noticed some students at the 11 colleges in her district were getting tested off campus or when they went home for the weekend. In response, her department now proactively looks for positive test results among people who are of typical college age. So far, she’s had 10 or so cases reassigned to her department from other areas because of address issues, Bruchmann said.

Back in Missouri, freshman Kate Taylor said she fell through the cracks amid the initial rush of cases at the University of Missouri at the end of August.

After testing positive for COVID-19, Taylor said, she was told there wasn’t enough room for her to quarantine on campus. The university’s Basi denied that any students had been told the school didn’t have enough space but said he could not discuss details of Taylor’s case without her consent.

The 18-year-old student said she went home 2½ hours away to Jefferson County, where she was told her case would be transferred to local officials. But after nine days of quarantining, Taylor said, she never heard from anyone at her local health department.

She said her contact tracing experience wasn’t much better: Her boyfriend at the university got a call about her case, but the tracer got him confused with her roommate. The tracer then hung up.

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