Tagged California

In Los Angeles, Latinos Hit Hard By Pandemic’s Economic Storm

Working as a fast-food cashier in Los Angeles, Juan Quezada spends a lot of his time these days telling customers how to wear a mask.

“They cover their mouth but not their nose,” he said. “And we’re like, ‘You gotta put your mask on right.’”

Quezada didn’t expect to be enforcing mask-wearing. Six months ago, he was a restaurant manager, making $30 an hour, working full time and saving for retirement. But when Los Angeles County health officials shut down most restaurants in March because of the spreading pandemic, Quezada lost his job. The only work he could find pays a lot less and is part time.

“I only work three hours and four hours rather than eight or 10 or 12 like I used to work,” he said.

Quezada doesn’t know anyone who has gotten COVID-19, but the pandemic has affected nearly every aspect of his life. “I am just draining my savings — draining and draining and draining,” he said. “I have to sell my car. Uber is a luxury.” Mostly, he now bikes or rides the bus to his part-time job.

Quezada is one of hundreds of people who responded in a newly published poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. Among other things, the poll, which surveyed people from July 1 to Aug. 3, found that a whopping 71% of Latino households in Los Angeles County have experienced serious financial problems during the pandemic, compared overall with 52% of Black households there and 37% of whites. (Latinos can be of any race or combination of races.)

Like Quezada, many are burning through their savings and are having a hard time paying for necessities such as food. Quezada estimated he has about six months of savings left.

In Los Angeles, more than 35% of households report serious problems with paying credit cards, loans or other bills, while the same percentage report having depleted all or most of their savings. Eleven percent of Angelenos polled said they didn’t have any savings at the start of the outbreak.

Nationally, the picture is similar. In results released last week, the poll found that 72% of Latino households around the country reported they’re facing serious financial problems, double the share of whites who said so. And 46% of Latino households reported they have used up all or most of their savings during the pandemic.

How Poverty Differs for Latinos

Nationally, the poll found that 63% of Latinos reported loss of household income either through reduced hours or wages, furloughs or job loss since the start of the pandemic.

But Latinos have kept working through the crisis, said David Hayes-Bautista, a professor of medicine and public health at UCLA.

“In Washington, the idea is you’re poor because you don’t work. That’s not the issue with Latinos,” he said. “Latinos work. But they’re poor. The problem is, we don’t pay them.”

Latinos have the highest rate of labor force participation of any group in California. In March, when state and local officials shut down many businesses, Latinos lost jobs like everyone else. But Latinos got back to work faster.

“In April, the Latino [labor force participation] rate bounced right back up and actually has continued to increase slowly, whereas the non-Latino rate is dropping,” Hayes-Bautista said. “The reward that Latinos have for their high work ethic is a high rate of poverty.”

That work ethic has also contributed to a much higher rate of COVID-19. Hayes-Bautista pointed out that in California, as in some other regions in the U.S., Latinos tend to hold many of the jobs that have been deemed essential, and that’s made them highly susceptible to the coronavirus. Latinos now account for 60% of COVID-19 cases in California, even though they’re about 40% of the population.

Not only are they getting infected, but there’s been nearly a fivefold increase in working-age Latinos dying from the coronavirus since May.

“These are workers usually in their prime years — peak earning power and everything else,” Hayes-Bautista said. “Latinos between 50 and 69, those are the ones that are being hit the hardest. That’s pretty worrying.”

Exposed — And Often Without Health Insurance

Nationally, according to the poll, 1 in 4 Latino households report serious problems affording medical care during the pandemic.

Many of the essential jobs that Latinos are more likely to perform — farmworker or nursing home aide or other contract work, for example — lack benefits. That means some Latinos are more exposed to the coronavirus and less likely to have health insurance because they don’t get coverage through an employer.

Others, such as Mariel Alvarez, lack health insurance because of citizenship restrictions. She lives with her parents and sisters in Los Angeles County’s San Fernando Valley. Alvarez lost her sales job and her employer-sponsored health insurance when the pandemic hit in March, she said. Then she got sick.

Eventually, her whole family was ill. Alvarez had to pay out-of-pocket to go to a CVS clinic near her home. But after a couple of $50 visits, it got too expensive.

“I just couldn’t afford to continue to go to the doctor,” she said. She suspected it was COVID-19 but was unable to get tested.

Now that she’s recovered, getting a job with health insurance is crucial because she doesn’t qualify for any state or federal support. Alvarez is undocumented and was brought to the U.S. by her parents as a child from Bolivia. She’s one of roughly 640,000 immigrants who has a permit allowing her to work and defer deportation under the Deferred Action for Childhood Arrivals program, or DACA.

“I don’t want to jeopardize that,” Alvarez said. “You’re not supposed to use any of the government assistance when you’re on that. You’re only supposed to work, and that’s it.”

The pandemic has created a big need for one job: contact tracers. So Alvarez completed a free certificate online in the hope it will give her an edge. She’s going through the application process; if she gets hired, she hopes to have benefits again.

In the meantime, she’ll do her best not to get sick.

Jackie Fortiér is a health reporter for KPCC and LAist.com.

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

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En Los Angeles, la tormenta económica por la pandemia ha pegado fuerte en los latinos

Al trabajar como cajero de comida rápida en Los Angeles, Juan Quezada pasa mucho de su tiempo estos días diciéndole a los clientes cómo usar una máscara.

“Se cubren la boca pero no la nariz”, dijo. “Y nosotros les decimos: ‘Tienes que ponerte la máscara bien’”.

Quezada nunca imaginó que acabaría haciendo cumplir el uso de la máscara. Hace seis meses, era gerente de un restaurante, ganaba $30 la hora, trabajaba a tiempo completo y ahorraba para su jubilación.

Pero cuando los funcionarios de salud del condado de Los Angeles cerraron la mayoría de los restaurantes, en marzo, por la pandemia, Quezada perdió su trabajo. El único que pudo encontrar paga mucho menos y es de medio tiempo.

“Sólo trabajo tres o cuatro horas en lugar de ocho, 10 o 12 horas como solía trabajar”, contó.

No conoce a nadie que haya contraído COVID-19, pero la pandemia ha afectado casi todos los aspectos de su vida. “Estoy agotando mis ahorros, agotando y agotando y agotando”, dijo. “Tengo que vender mi coche. Uber es un lujo”. Ahora va en bicicleta o en autobús a su trabajo.

Quezada es una de las cientos de personas que respondieron a una encuesta publicada recientemente por NPR, la Fundación Robert Wood Johnson y la Escuela de Salud Pública T.H. Chan de la Universidad de Harvard.

Entre otras cosas, el sondeo, que encuestó a la gente del 1 de julio al 3 de agosto, encontró que un cifra enorme, el 71% de los hogares latinos en el condado de Los Angeles han experimentado serios problemas financieros durante la pandemia, en comparación con el 52% de los hogares afroamericanos, y el 37% de los blancos. (Los latinos pueden ser de cualquier raza o combinación de razas).

Como Quezada, muchos están quemando sus ahorros y tienen dificultades para pagar necesidades básicas como la comida. Al hombre le quedan unos seis meses de ahorros.

En Los Angeles, más del 35% de los hogares reportan serios problemas para pagar tarjetas de crédito, préstamos u otras cuentas, mientras que el mismo porcentaje dice haber agotado todos o la mayoría de sus ahorros.

El 11% de los angelinos encuestados dijo que no tenían ahorros al comienzo del brote.

A nivel nacional, el panorama es similar. En los resultados publicados, la encuesta reveló que el 72% de los hogares latinos en todo el país enfrentan serios problemas financieros, el doble de la proporción de los blancos no hispanos que participaron en la encuesta.

Y el 46% de los hogares latinos reportaron que han usado todos o la mayoría de sus ahorros durante la pandemia.

A nivel nacional, la encuesta encontró que el 63% de los latinos reportaron pérdida de ingresos familiares ya sea por reducción de horas o salarios, permisos o pérdida de trabajo, desde el comienzo de la pandemia.

Pero los latinos han seguido trabajando durante la crisis, dijo David Hayes-Bautista, profesor de medicina y salud pública en la UCLA.

“En Washington, la idea es que eres pobre porque no trabajas. Ese no es el problema con los latinos”, señaló. “Los latinos trabajan. Pero son pobres. El problema es que no les pagamos”.

Los latinos tienen la mayor tasa de participación en la fuerza laboral de cualquier grupo en California. En marzo, cuando los funcionarios estatales y locales cerraron muchos negocios, los hispanos perdieron sus trabajos como todos los demás. Pero volvieron a trabajar más rápido.

“En abril, la tasa de participación de los latinos [en la fuerza laboral] se recuperó y ha seguido aumentando lentamente, mientras que la tasa de los no latinos está bajando”, explicó Hayes-Bautista. “La recompensa que tienen los latinos por su alta ética de trabajo es una alta tasa de pobreza”.

Esa ética de trabajo también ha contribuido a una tasa mucho más alta de COVID-19. Hayes-Bautista señaló que en California, como en algunas otras regiones de los Estados Unidos, los latinos suelen hacer muchos de los trabajos que se han considerado esenciales, y eso los ha hecho altamente susceptibles al coronavirus.

Los latinos ahora representan el 60% de los casos de COVID-19 en California, aunque son alrededor del 40% de la población.

No sólo se están infectando, sino que, desde mayo, casi se ha quintuplicado el número de latinos en edad laboral  que mueren por el coronavirus.

“Estos son trabajadores que normalmente están en sus mejores años, con mayores ingresos y todo lo demás”, expresó Hayes-Bautista. “Los latinos de entre 50 y 69 años son los más afectados. Es muy preocupante”.

Expuestos y, a menudo, sin seguro médico

A nivel nacional, según la encuesta, 1 de cada 4 hogares latinos reportan serios problemas para pagar por la atención médica durante la pandemia.

Muchos de los trabajos esenciales que los latinos suelen realizar —como el agrícola o asistente en residencia de mayores u otro trabajo por contrato, por ejemplo— carecen de beneficios. Esto significa que algunos latinos están más expuestos al coronavirus y es menos probable que tengan seguro médico porque no reciben cobertura a través de un empleador.

Otros, como Mariel Álvarez, carecen de cobertura debido a las restricciones al no tener la ciudadanía. Vive con sus padres y hermanas en el Valle de San Fernando, condado de Los Angeles. Álvarez perdió su trabajo de ventas y su seguro médico patrocinado por el empleador cuando la pandemia golpeó en marzo, dijo. Luego se enfermó.

Luego, toda su familia se enfermó. Álvarez tuvo que pagar de su bolsillo para ir a una clínica de CVS cerca de su casa. Pero después de un par de visitas a $50 cada una, le resultó demasiado caro.

“No podía permitirme seguir yendo al médico”, explicó. Sospechaba que era COVID-19 pero no pudo hacerse la prueba.

Ahora que se ha recuperado, conseguir un trabajo con seguro médico es crucial porque no califica para ninguna ayuda estatal o federal. Álvarez es indocumentada y fue traída a los Estados Unidos por sus padres, cuando era niña, desde Bolivia. Es una de los aproximadamente 640,000 inmigrantes que tiene un permiso que le permite trabajar y aplazar la deportación bajo el programa de Acción Diferida para los Llegados en la Infancia, o DACA.

“No quiero poner en peligro eso”, dijo Álvarez. “Se supone que no debes usar ninguna de las ayudas del gobierno cuando estás en eso. Se supone que sólo debes trabajar, y eso es todo”.

La pandemia ha creado gran demanda de un trabajo: los rastreadores de contactos. Así que Álvarez completó un certificado gratuito en línea para estar más preparada. Ahora está en el proceso de solicitud; si la contratan, espera tener beneficios de nuevo.

Mientras tanto, hará todo lo posible para no enfermarse.

Fortiér es reportera de salud para KPCC y LAist.com

Esta historia es parte de una asociación que incluye a KPCC, NPR y KHN, un programa editorialmente independiente de KFF.

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California Expands Privacy Protection to Public Health Workers Amid Threats

SANTA CRUZ, Calif. — California will allow public health officials to participate in a program to keep their home addresses confidential, a protection previously reserved for victims of violence, abuse and stalking and reproductive health care workers.

The executive order signed by Democratic Gov. Gavin Newsom late Wednesday is a response to threats made to health officers across California during the coronavirus pandemic. More than a dozen public health leaders have left their jobs amid such harassment over their role in mask rules and stay-at-home orders.

“Our public health officers have all too often faced targeted harassment and stalking,” wrote Secretary of State Alex Padilla in a statement. This “program can help provide more peace of mind to the public health officials who have been on the frontlines of California’s COVID-19 response.”

A community college instructor accused of stalking and threatening Santa Clara health officer Sara Cody was arrested in late August. The Santa Clara County sheriff said it believes the suspect, Alan Viarengo, has ties to the “Boogaloo” movement, a right-wing, anti-government group that promotes violence and is associated with multiple killings, including the murders of a federal security officer and a sheriff deputy in the Bay Area. Thousands of rounds of ammunition, 138 firearms and explosive materials were found in his home, the sheriff’s office said.

In Santa Cruz County, two top health officials have received death threats, including one allegedly signed by a far-right extremist group.

In May, a member of the public read aloud the home address of former Orange County health officer Nichole Quick at a supervisors’ meeting and called for protesters to go to her home. “You have seen firsthand how people have been forced to exercise their First Amendment. Be wise, and do not force the residents of this county into feeling they have no other choice than to exercise their Second Amendment,” said another attendee. Quick later resigned.

Protesters angry over mask mandates and stay-at-home orders have gone to the homes of health officers in multiple counties, including Orange and Contra Costa.

The executive order would allow health officials to register with the Secretary of State’s Safe at Home program. Those in the program are given an alternative mailing address to use for public records so that their home addresses are not revealed.

Threats of violence have added to the already immense pressure public health officials have experienced since the beginning of the year. Amid chronic underfunding and staffing shortages, they have been working to limit the spread of the coronavirus, while also deflecting political pressure from other officials and anger from the public over business closures and mask mandates.

“California’s local health officers have been working tirelessly since the start of the pandemic, using science to guide policy,” said Kat DeBurgh, the executive director of the Health Officers Association of California. “It is regrettable that this order was necessary — but we are grateful for it nevertheless.”

Nationwide, at least 61 state or local health leaders in 27 states have resigned, retired or been fired since April, according to a review by The Associated Press and KHN, a figure that has doubled since the newsrooms first began tracking the departures in June.

Thirteen of those departures have been in California, including 11 county health officials and the state’s two top public health officials.

Dr. Sonia Angell, former director of the California Department of Public Health and state public health officer, quit in early August after a series of glitches in the state’s infectious disease reporting system caused weeks-long delays in reporting cases of COVID-19.

In Placer County, north of Sacramento, health officer Dr. Aimee Sisson resigned effective Sept. 25 after the county Board of Supervisors voted to end its local COVID-19 health emergency. “It is with a heavy heart that I submit this letter of resignation,” she wrote in her resignation letter. “Today’s action by the Placer County Board of Supervisors made it clear that I can no longer effectively serve in my role.”

Organizations across the state have expressed concern over the treatment of health officials during the pandemic, including the California Medical Association.

“Basic science has become politicized in so many parts of our state, and our country,” wrote California Medical Association president Dr. Peter N. Bretan Jr. in a statement after Sisson’s departure. “Public health officers are public servants who seek to do what their job description states — to protect public health.”

The executive order also directs the state to assess impacts of the pandemic on health care providers and health care service plans, and halts evictions for commercial renters through March 31, 2021, among other pandemic-related matters.

KHN and California Healthline correspondent Angela Hart contributed to this report.

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

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As Fires and Floods Wreak Havoc on Health, New Climate Center Seeks Solutions

For the past month, record-breaking wildfires have torched millions of acres from the Mexican border well into Canada, their smoke producing air so toxic that millions of people remained indoors for days on end while many visited hospitals because of respiratory distress.

Last week, Hurricane Sally left a trail of watery devastation in Mississippi, Alabama and the Florida Panhandle, even as more storms brewed offshore.

All of that on top of the COVID-19 pandemic, which has killed nearly 1 million people worldwide.

The timing couldn’t have been better for the opening this month of the Center for Healthy Climate Solutions at UCLA’s Fielding School of Public Health.

Its mission is to work with policymakers and community groups to help safeguard human health against the ravages of climate change. The center was founded on the premise that the long-feared effects of climate change are already here and must be met with policies not only to slow the warming of the planet but also to help people adapt to its reality.

The center’s co-directors, Dr. Jonathan Fielding and Michael Jerrett, believe the clock is running out and we must quickly reduce the amount of carbon being pumped into the atmosphere to have any hope of preserving a viable planet.

“A lot of the predictions of what could happen with climate change have been wrong. But the predictions have been wrong in that they haven’t been catastrophic enough,” Fielding, a professor of medicine and public health at UCLA and former head of the Los Angeles County Department of Public Health, said in an interview last week.

Jerrett, a professor of environmental health sciences at UCLA’s Fielding School who also participated in the interview, is the principal investigator on a study hypothesizing that long-term exposure to air pollution elevates the risk of severe COVID-19 outcomes. Other studies have yielded similar findings.

The following excerpts of the interview with Fielding and Jerrett were edited for length and clarity:

Q: Could the hazardous air quality from the wildfires burning across much of the West Coast fuel an increase in severe COVID-19 cases and deaths?

Jonathan Fielding: There’s a very good chance of that. There is no doubt the effects of air pollution on the lungs and other organs are substantial and contribute to people with chronic problems being more susceptible to the severe effects of COVID.

Michael Jerrett: When we have wildfire events like this, as people are exposed to these high levels of smoke, we see increases in those indicators of morbidity and mortality. And we’ve seen those effects for several lung diseases that have similarities to COVID, like pneumonia.

Q: How does climate change exacerbate the racial, ethnic and socioeconomic health disparities that are so prevalent in our society?

Fielding: You already have people who have a higher rate and burden of chronic illness. Just look at the rates of obesity, for example, as well as the rate of cardiovascular disease. Those are certainly exacerbated by increased heat and by where people can afford to live. A lot of people can only afford a place that’s going to have a lot of heat islands, it’s not going to be air-conditioned, it might not have much in the way even of public transportation.

Jerrett: If you look through very long periods of time, people who have more resources — whether that’s better social contacts or they’re more highly educated, or have higher incomes, or other factors that put them at a social advantage — have always been able to protect themselves from environmental risks better than people who lack those resources.

Q: Can you explain how wildfires affect mental health?

Jerrett: There’s emerging and increasingly convincing literature that shows air pollution is related to anxiety and depression. It’s thought that the change in the nervous system that seems to be stimulated by air pollution, and perhaps the vascular system changes, can affect brain function and lead people into a more depressive state. … Secondly, the loss of immediate surroundings that people are familiar with: So if you are used to looking out and seeing a beautiful forest, and you walk out and you look in your backyard and you see nothing but smoke, and the whole forest is gone, that can affect mental health.

Q: Can we expect to see pandemics more frequently?

Fielding: What I think most people are missing in discussing this issue is population growth. We’re increasing the interface between humans and other species that have viruses that may not affect them but very severely affect humans. So, that’s one issue. The second issue is that climate change is increasing the area where you have vectors that can thrive. So, for example, we’re going to wind up with mosquitoes that can transmit dengue fever and malaria in the U.S.

Q: You talk about the “health co-benefits” of programs that can help slow climate change while mitigating its impact on public health. What are some examples?

Jerrett: Some of the leading practices in terms of generating benefits involve, say, increasing the green cover. As we increase green cover, we absorb more carbon, so we’re going to reduce the risk of long-term climate change, but you can also have substantial health benefits from that. We know that the introduction of more vegetation generally lowers extreme heat, particularly in disadvantaged neighborhoods where they don’t have a lot of park space or a lot of trees. Another leading practice, where the Europeans are way ahead of us — but we do see signs of improvement across California, in places like Santa Monica — is promoting what’s known as active travel: to get people out of their cars and get them on a bicycle or walking for incidental trips or going to work. We get a benefit in terms of their increased physical activity, and we also reduce the amount of emissions.

Q: Are the climate changes we are already seeing permanent, or can they be halted or even reversed?

Jerrett: We’re already in what I would call a climate crisis. It’s elevating to a climate catastrophe, and that’s going to happen in the next 20 years. We still have a chance to pull back. If we don’t, then we’re going to start seeing massive species die-offs; it’s going to affect the ability of people all over the world to feed themselves. We’re going to have these extraordinary, extreme events like wildfires that are going to dwarf what we’ve seen in the past, and large portions of the planet may become uninhabitable.

Fielding: Here I would draw a parallel to COVID. Even though many of us predicted a pandemic, most people didn’t really believe it, the government didn’t prepare well for it, and we’re learning the same thing with climate change. The difference is we have a way, through vaccination and maybe drugs, to reverse what’s going on with COVID. We don’t know that we have the ability to do that with climate change. You have people politicizing it and calling it a hoax, and that, unfortunately, is very detrimental to what we all want, which is to have a habitable planet.

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Native Americans Feel Double Pain of COVID and Fires ‘Gobbling Up the Ground’

When the first fire of the season broke out on the Hoopa Valley Reservation in Northern California in July, Greg Moon faced a dilemma.

As Hoopa’s fire chief and its pandemic team leader, Moon feared the impact of the blaze on the dense coniferous forests of the reservation, near Redwood National and State Parks, where 3,000 tribal members depend on steelhead trout and coho salmon fishing. He was even more terrified of a deadly viral outbreak in his tribe, which closed its land to visitors in March.

“We’re a high-risk community because we have a lot of diabetes, heart disease and elders that live in multigenerational homes. If a young person gets it, the whole household is going to get it,” Moon said.

Eventually, the three major blazes that burned nearly 100,000 acres around Hoopa were too much for the tribe’s 25-member fire team. Moon had no choice but to request help from federal wildland rangers and other tribal firefighters.

Native American tribes are no strangers to fire. Working with flames to burn away undergrowth and bring nutrients and biodiversity back to lands is an ingrained part of their heritage. But epidemics are also a familiar scourge. With the devastation that pathogens like smallpox and measles brought to Native populations following the arrival of Europeans, tribes are especially wary of COVID-19’s impact.

“When thinking about the potential of COVID-19 repeating history and wiping out entire communities and tribes, there is concern,” said Vernon Stearns, who as the fuels manager for the Spokane Tribe in eastern Washington is responsible for organizing controlled burns.

Some tribes have abandoned traditional fire suppression techniques, watching large swaths of land burn in order to protect a more fragile and essential resource: their people.

“The biggest fear the tribe had was COVID would hit our elders. And they are a very valuable resource of knowledge and connection to our ancestry and teaching of our ways to our children, who we also felt were at risk, and we obviously want to protect them,” said Ron Swaney, fire management officer for the Confederated Salish and Kootenai Tribes in Montana.

“I’ve seen how [the virus] has affected families close to me. I know the grief,” said Don Jones, fire chief of the Yakama Nation reservation in central Washington, where there have been at least 28 COVID-19 deaths. “I’m not going to send sick people out to fight the fire. I’m not going to say, ‘Come on, guys, toughen up, go out there.’ Life takes precedence over that.”

Around the country, many tribes have full-time fire crews that traditionally aid one another and federal firefighters, sending out teams to help with blazes. But COVID-19 has pushed them to reconsider how much help they can give and receive. (CSKT Division of Fire)

Around the country, many tribes have full-time fire crews that traditionally aid one another and federal firefighters, sending out teams to help with blazes. But this year’s COVID-19 pandemic has pushed them to reconsider how much help they can give and receive in the face of encroaching infernos.

A Centers for Disease Control and Prevention study found Native Americans and Alaskans were 3.5 times more likely than whites to test positive for the coronavirus. The rapid spread of the virus within tribes early in the pandemic led many reservations to aggressively control outside access. Casinos closed. Entrances to tourist areas such as lakes, hiking trails and fisheries were blocked off. Economically many tribes suffered, but COVID caseloads stabilized or declined.

The ongoing fire season is now threatening that progress.

Tribal families often live in multigenerational housing, sometimes in trailers or other small homes with no running water. Their isolated, tightknit communities can be sequestered from COVID-19 spikes in nearby towns but are ripe for an outbreak if the virus enters. Social distancing is a challenge on small, remote reservations. There may be only a single gas station or supermarket, where visiting fire crews would be likely to interact with the tribal population. Many tribes also lack strong internet connections, forcing fire crews to meet in person rather than stage briefings via Zoom, as federal crews have done elsewhere during the pandemic.

On the Flathead Reservation north of Missoula, Montana, COVID-19 hit the fire crew of the Confederated Salish and Kootenai Tribes before the fires did. A firefighter who came in direct contact with someone who was sick with the virus in early July took the tribe’s entire 12-person aviation team, consisting of an air attack plane and a helicopter crew, out of business for four days. While no fires were burning at the time, it was a worrisome wake-up call for Swaney.

“For a minute there, I really thought we would all be infected with COVID-19 and I was wondering who would be responding to the fires,” he said.

It was enough to convince Swaney that this year the tribe wouldn’t share any of its 60 firefighters with neighbors. It was a tough call because historically “in fire, when our neighbors need help, we go help,” he said.

At the end of July, Swaney had to accept help from nearly 300 outside firefighters when lightning started a blaze in the mountains surrounding the bison-dotted grass valley his tribe calls home.

After the 3,500-acre Magpie Rock Fire was under control, Swaney learned that a federal wildland firefighter involved had tested positive for COVID-19 during his next assignment. He didn’t appear to have infected Swaney’s team, though four members have tested positive this season.

“We’ve had a lot of close calls,” he said.

Other tribes have sought to bolster their fire crews to do without the help of off-reservation teams. The Spokane Tribe in Washington earmarked some of the $19 million it received from the CARES Act to hire an additional 10-person seasonal crew. It hoped to aggressively attack any fire and keep it small, thereby avoiding the need for outside firefighters who might also bring in the coronavirus, Stearns said.

The Yakama Nation, near the Oregon border, was still struggling with a coronavirus outbreak that had infected at least 6% of its population when fires started in July. The crews learned quickly that facing wildfire and a pandemic simultaneously would be an exercise in trade-offs.

Early in the effort, five fire crew members were taken off the line when several people got sick, leaving the 20 remaining members to make do. Federal firefighting is stretched thin as megafires consume vast areas of the West Coast — and other tribes were no help because they’ve restricted their fire teams’ movement to prevent COVID spread.

“We had no one else to call on. … It was pretty tough,” said Jones. “The stress level has gone up. You’re worried about exposure all the time.”

Ultimately, eight Yakama crew members tested positive for COVID-19. One of the firefighters who tested positive had already lost two family members to the virus. Another spread COVID-19 to a family member who ended up at the hospital on a ventilator but survived.

“Everyone in my program was affected one way or another,” Jones said. “Everyone lost somebody.”

The West’s brutal fire season is forcing tribes to concentrate on fires that start by lightning or accident, with no resources to give to prescribed burning.

“These fires are just gobbling up the ground,” said Jones. His tribe canceled the carefully controlled fires it normally conducts in September to avoid bringing together the large numbers of people needed to do them.

“Fires are just going to get bigger,” Jones said. “If we can’t do anything about it, we can’t do anything about it. We have to make sure everyone’s healthy first.”

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

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California’s Deadliest Spring in 20 Years Suggests COVID Undercount

The first five months of the COVID-19 pandemic in California rank among the deadliest in state history, deadlier than any other consecutive five-month period in at least 20 years.

And the grim milestone encompasses thousands of “excess” deaths not accounted for in the state’s official COVID death tally: a loss of life concentrated among Blacks, Asians and Latinos, afflicting people who experts say likely didn’t get preventive medical care amid the far-reaching shutdowns or who were wrongly excluded from the coronavirus death count.

About 125,000 Californians died from March through July, up by 14,200, or 13%, from the average for the same five months during the prior three years, according to a review of data from the state Department of Public Health.

By the end of July, California had logged about 9,200 deaths officially attributed to COVID-19 in county death records. That left about 5,000 “excess” deaths for those months — meaning deaths above the norm not attributed to COVID-19. Deaths tend to increase from year to year as the population grows, but typically not by that much.

A closer look at California’s excess deaths during the period reveal a disturbing racial and ethnic variance: All the excess deaths not officially linked to COVID infection were concentrated in minority communities. Latinos make up the vast majority, accounting for 3,350 of those excess deaths, followed by Asians (1,150), Blacks (860) and other Californians of color (350).

The overall number of excess deaths across all races and ethnicities was ultimately tempered because, compared with the three prior years, there were actually 383 fewer deaths among white Californians than would be expected in the absence of COVID-19. In addition, California Healthline adjusted the overall numbers to reflect more than 320 COVID deaths that could not be categorized by race or ethnicity because that information was missing from state records.

Several epidemiologists interviewed said they believe a sizable portion of the excess deaths among people of color did, in fact, stem from COVID infections but went undetected for a variety of reasons. Among them: a shortage of coronavirus tests in the early months of the pandemic; an uneven strategy for how and when to administer those tests, which persists; and inadequate access to health care providers in many low-income and immigrant communities.

Dr. Kirsten Bibbins-Domingo, chair of the Department of Epidemiology and Biostatistics at the University of California-San Francisco, is among those who suspect the excess deaths reflect a COVID undercount in minority communities. She noted that several chronic health conditions that disproportionately affect Blacks and Latinos — including diabetes, high blood pressure and heart disease — also place them at higher risk for severe complications from COVID-19.

In addition, Bibbins-Domingo said, the prolonged shutdown of medical offices in the early months of the pandemic — and with them non-urgent surgeries and routine medical care — likely accelerated death among people with those chronic conditions.

“Shutdowns always come at a cost,” she said. “It is our most marginalized communities that experience the cost of a shutdown.”

According to state Department of Public Health data, deaths in California attributed to diabetes rose 12% from March through July when compared with the average for the same period over the past three years. In addition, deaths attributed to Alzheimer’s disease rose 11%.

“Dementia is also a disease where we have racial, ethnic minorities already at greater risk,” said Andrea Polonijo, a medical sociologist at the University of California-Riverside. “Now that we have the pandemic, they’re more socially isolated. Social isolation we know can cause deeper cognitive decline.”

It’s hard to determine whether a death is due to COVID-19 if the victim never sought medical care, said Jeffrey Reynoso, executive director of the nonprofit Latino Coalition for a Healthy California. Latinos in California are less likely to have health insurance, he said. They may face language barriers if their medical provider — or contact tracer — does not speak Spanish. Latino immigrants working in the U.S. without authorization may hesitate to visit the doctor.

“Immigration is definitely a driver in creating a fear and a mistrust of systems, and that includes our health care system,” Reynoso said.

Polonijo said the fact that Latinos make up the bulk of the excess deaths correlates with their dominant role in farming, meat processing, manufacturing and food service, jobs all deemed essential during the pandemic.

“This population is also more likely to live in more crowded conditions,” she said. “So not only are they exposed at work, but they are bringing disease home and with it the possibility of spreading it to their family, bringing it to the community.”

Bibbins-Domingo noted that, while a major portion of COVID deaths overall have occurred among seniors and nursing home residents, a disproportionate number of the state’s excess deaths are of working-age adults.

“The excess deaths that we’re seeing in communities of color and in low-income communities are deaths that are occurring at younger ages,” she said. “These are deaths that are occurring in these ages from 20 to 60, generally speaking — the ages when people would be out working.”

Kathy Ko Chin, president of the Oakland-based Asian & Pacific Islander American Health Forum, said Asian Americans also tend to be overrepresented in essential worker occupations, noting that a large proportion of the state’s nurses are Filipino. In addition, she said, government officials have not done enough to translate COVID educational materials into the many languages spoken by California’s Asian Americans. The Trump administration’s rhetoric on immigration during the past four years, she added, has had a “chilling effect” that has kept many foreign-born Asian Americans from visiting a doctor.

“People were really, really scared,” Chin said.

Counties in Southern California and the largely rural Central Valley — places with a high proportion of Latino residents — tended to have high rates of excess deaths from March to July. Among counties with at least 100,000 people, Kings County, an arid expanse north of Los Angeles that is home to industrial-scale agriculture, had the highest rate of excess deaths per capita.

Officials at the Kings County Department of Public Health did not return a message seeking comment.

Bibbins-Domingo and others said it is important for state and county health officials to take a hard look at their excess death numbers. Excess deaths matter, she said, because they expose shortcomings in health care delivery. In addition, local and state responses to COVID-19 are grounded in data; if that data is inaccurate, the responses may be misguided.

“Deaths are important because they also help us to understand how much severe COVID is there in the community that we have to worry about,” Bibbins-Domingo said. “I think when we undercount that, we both fly blind for the overall pandemic management, and we might fly particularly blind in understanding the impact of the pandemic in particular communities.”

Phillip Reese is a data reporting specialist and an assistant professor of journalism at California State University-Sacramento.

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

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In Face of COVID Threat, More Dialysis Patients Bring Treatment Home

Maria Duenas, 60, has kidney failure and is on the kidney transplant list. But until she finds a match, she will administer her own dialysis treatment at home.(Heidi de Marco/KHN)

NIPOMO, Calif. — After Maria Duenas was diagnosed with Type 2 diabetes about a decade ago, she managed the disease with diet and medication.

But Duenas’ kidneys started to fail just as the novel coronavirus established its lethal foothold in the U.S.

On March 19, three days after Duenas, 60, was rushed to the emergency room with dangerously high blood pressure and blood sugar, Gov. Gavin Newsom implemented the nation’s first statewide stay-at-home order.

Less than one week later, Duenas was hooked up to a dialysis machine in the Century City neighborhood of Los Angeles, 160 miles from her Central Coast home, where tubes, pumps and tiny filters cleansed her blood of waste for 3½ hours, doing the work her kidneys could no longer do.

In the beginning, Duenas said she didn’t understand the severity of COVID-19, or her increased vulnerability to it. “It’s not going to happen to me,” she thought. “We’re in a small little town.”

But she was unable to find a spot in a dialysis clinic in, or near, Nipomo. So, with her husband, Jose, at her side, Duenas made long road trips to Century City for more than two months.

In May, Duenas’ doctor told her she was a good candidate for home dialysis, which would save her drive time and stress — and reduce her exposure to the virus.

The closet in Duenas’ grandchildren’s playroom is crammed with peritoneal dialysis solution, a mixture of dextrose, calcium and magnesium. She uses two bags for every treatment. Cabinets and drawers in her bedroom are filled with disinfectant wipes, gauze, masks and gloves.(Heidi de Marco/KHN)

Now, Duenas assiduously sterilizes herself and her surroundings five nights a week so she can administer dialysis to herself at home while she sleeps.

“There’s always a chance going in that somebody’s going to have COVID and still need dialysis” in a clinic, Duenas said. “I’m very grateful to have this option.”

The increase in home dialysis has accelerated recently, spurred by social-distancing requirements, increased use of telehealth and remote monitoring technologies — and fear of the virus.

Duenas starts her home dialysis routine around 8 p.m. She must maintain a sterile environment and uses masks and gloves. Her husband, Jose, installed an automatic paper towel dispenser in their bathroom to help ensure proper hygiene.(Heidi de Marco/KHN)

While recent, comprehensive data is hard to come by, experts confirm the trend based on what they’re seeing in their own practices. Fresenius Medical Care North America, one of the country’s two dominant dialysis providers, said it conducted 25% more home dialysis training sessions in the first quarter of 2020 than in the same period last year, according to Renal & Urology News.

“People recognized it would be better if they did it at home,” said Dr. Susan Quaggin, president-elect of the American Society of Nephrology. “And certainly from a health provider’s perspective, we feel it’s a great option.”

Duenas vigorously washes her hands before she cleans the area around the catheter in her abdomen. She also sterilizes the dialysis equipment before hooking herself up for the night.(Heidi de Marco/KHN)

Nearly half a million people in the United States are on dialysis, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Roughly 85% of them travel to a clinic for their treatments.

Dialysis patients are at higher risk of contracting COVID-19 and getting seriously ill with it, said Dr. Anjay Rastogi, director of the UCLA CORE Kidney Program, where Duenas is a patient.

In an analysis of more than 10,000 deaths in 15 states and New York City, the Centers for Disease Control and Prevention found about 40% of people killed by COVID-19 had diabetes. That percentage rose to half among people under 65.

But people on dialysis are also vulnerable to COVID-19 because they usually visit dialysis clinics two to three times a week for an average of four hours at a time, exposing themselves to other patients and, potentially, the virus, Rastogi said.

“Now even more so, we are strongly urging our patients to consider home dialysis,” he said.

Although patients on home dialysis reduce their exposure to COVID-19 by avoiding clinics, they face other challenges. Home dialysis requires supplies such as dialysis fluid, drain bags, tubing, disinfectant and personal protective equipment. According to a recent study, patients may have problems obtaining dialysis supplies because supply chains are strained.(Heidi de Marco/KHN)

Duenas uses her bedroom mirror to make sure her catheter is properly covered with gauze before she goes to bed. She will be tethered to the machine overnight.(Heidi de Marco/KHN)

There are two kinds of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, which is administered in a hospital or clinic, or sometimes at home, a dialysis machine pumps blood out of the body and through a special filter called a dialyzer, which clears waste and extra fluid from the blood before it is returned to the body.

Dialysis treatment centers that offer hemodialysis have intensified their infection-control procedures in response to COVID-19, said Dr. Kevin Stiles, a nephrologist at Kaiser Permanente in Bakersfield. Visitors are no longer allowed to accompany patients, and patients get temperature checks and must wear masks during treatment, he said. (KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.)

In peritoneal dialysis, which is the more popular home option because it is less cumbersome and restrictive, the inside lining of the stomach acts as a natural filter. Dialysis solution cleanses waste from the body as it is washed into and out of the stomach through a catheter in the abdomen.

It takes Duenas about 45 minutes to prepare her overnight treatment. Her tubing allows her to get as far as her bathroom, but she sometimes gets tangled in it at night.(Heidi de Marco/KHN)

Not everyone is eligible for home dialysis, which comes with its own challenges.

Home dialysis requires patients or their caregivers to lift bags of dialysis solution that weigh 5 to 10 pounds, Stiles said. Good eyesight and hand dexterity are also critical because patients must be able to maintain sterile environments.

Home patients need dialysis equipment and regular deliveries of supplies such as dialysis fluid, drain bags, tubing, disinfectant and personal protective equipment. In response to COVID-19, some clinics have arranged courier services and contracted with labs to deliver supplies to patients.

The Trump administration has encouraged greater use of home dialysis and in July proposed increasing Medicare reimbursement rates for home dialysis machines, citing “the importance that this population stay at home during the public health emergency to reduce risk of exposure to the virus.”

The morning after her treatment, Duenas disinfects the dialysis machine and then disconnects her catheter tube from the machine so that she can move around freely.(Heidi de Marco/KHN)

Medicare covers almost all patients who receive dialysis treatment, including home dialysis, and patients typically pay 20% as coinsurance.

Medicare, which spends an average of $90,000 per hemodialysis patient annually, spent more than $35 billion on patients with end-stage renal disease in 2016.

Duenas is awaiting a kidney transplant. Until she finds a match, she’ll be administering her own peritoneal dialysis at home.

Duenas inspects her drain bag in the morning for fibrin, a protein that can clog her catheter. She must alert her doctor if she finds any floating in the fluid.(Heidi de Marco/KHN)

“To be honest, I didn’t want to do it,” she said of home dialysis. “It was scary having to think about taking care of my own treatment.”

Now, three months later, guided by training and the prompts on the dialysis machine, Duenas feels comfortable, capable and safe.

Looking back, she said, “it was a blessing in disguise.”

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

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Black Women Turn to Midwives to Avoid COVID and ‘Feel Cared For’

From the moment she learned she was pregnant late last year, TaNefer Camara knew she didn’t want to have her baby in a hospital bed.

Already a mother of three and a part-time lactation consultant at Highland Hospital in Oakland, Camara knew a bit about childbirth. She wanted to deliver at home, surrounded by her family, into the hands of an experienced female birth worker, as her female ancestors once did. And she wanted a Black midwife.

It took the COVID-19 pandemic to get her husband on board. “Up until then, he was like, ‘You’re crazy. We’re going to the hospital,’” she said.

As the COVID-19 pandemic has laid bare health care inequities, more Black women are looking to home birth as a way not only to avoid the coronavirus but also to shun a health system that has contributed to African American women being three to four times more likely to die of childbirth-related causes than white women, regardless of income or education. Researchers argue that the roots of this disparity — one of the widest in women’s health care — lie in long-standing social inequities, from lack of safe housing and healthy food to inferior care provided at the hospitals where Black women tend to give birth.

“It feels like we are needed,” said midwife Kiki Jordan, who co-owns Birthland, a prenatal practice that opened early this year in a 400-square-foot storefront in Oakland’s Temescal neighborhood targeting low-income women of color.

Since the COVID-19 pandemic hit in March, she said, the practice’s clientele has more than tripled.

Images of hospitals inundated with coronavirus patients have sparked a flurry of new interest among women of all races in home births, which account for just over 1% of deliveries in the United States. Birth centers and midwives who attend home births say they’ve been swamped by new clients since the pandemic.

“Every midwife I’m talking to has seen their practice double or sometimes triple in the wake of COVID,” said Jamarah Amani, a Florida midwife and co-founder of the National Black Midwives Alliance.

Many Americans think of giving birth at home as backward and scary, or as a quixotic practice of privileged white women, akin to cloth diaper services and home-cooked baby food.

But the growing interest in home births in recent years has fueled a growing Black midwifery movement that harks back to a venerable, if long-forgotten, tradition in the United States.

Jordan’s practice is now 98% Black, “something I’ve never seen before,” she said. She provides pre- and postnatal care regardless of where women plan to deliver, though the majority of her clientele choose home births.

A Florida midwife holds twins in this undated photo. Black midwives in the South continued delivering babies for disadvantaged women in rural communities until well into the 1970s, despite a campaign by modern gynecologists to portray them as superstitious and unfit. (Florida Memory)

African American infants are more than twice as likely to die as white infants, and the risks extend across social class. Tennis superstar Serena Williams’ harrowing 2018 account of her own near-death postpartum experience with a blood clot in her lungs and a cascade of life-threatening complications was a sobering reminder that even wealth and fame are no protection from being dismissed or mistreated during one of the most vulnerable moments of a woman’s life.

At least three Black women have died in childbirth since March in New York City, which was hit hard early on by the coronavirus. One of the women, 26-year-old Amber Isaac, had reportedly tried to switch to a home or birth-center delivery after not getting an in-person appointment with her obstetrician as providers abruptly switched to telemedicine in the wake of the shutdown.

For Katrina Ayoola, 29, avoiding unnecessary medical interventions that researchers say can lead to dangerous maternal complications was a key reason for switching to a home birth. As the coronavirus hit last spring, when Ayoola was around five months pregnant with her first baby, she was already frustrated with her obstetricians in Martinez, California. She didn’t like their system of rotating providers, to whom she felt she constantly had to reexplain herself. The last straw was being told to go shopping for a home blood pressure monitor. They were sold out everywhere. “I ended up canceling what would have been an online appointment, and I haven’t heard from them since,” said Ayoola.

“I did not feel cared for,” she said.

On Aug. 1, Ayoola delivered her son, Oluwatayo, at home in Fairfield with her husband, Daré, and her mother at her side following a 29-hour labor supervised by Jordan and her partner, Anjali Sardeshmukh.

“At the hospital, I’d probably have had a C-section,” said Ayoola, who said her home birth was “an amazing, empowering experience,” worth every penny of the out-of-pocket $4,500 the couple paid for it — a discount, based on their insurance and income, from Birthland’s typical $6,500 fee.

Cost is a major barrier for poor people to access out-of-hospital births. Medicaid, the federal-state health insurance program that covers many low-income pregnant women, pays for home births in only a handful of states. Since 2015 these have included California, but reimbursement is low and bureaucratic requirements make it difficult for most midwives to accept Medi-Cal, California’s Medicaid program. A quarter of U.S. states do not even offer midwife licenses, making the practice of home birth effectively illegal.

Jordan led a free-standing birth center in San Rafael that was the first in the state to accept Medi-Cal when it opened in 2016. She and a handful of other Black midwives around the country are leading the effort to make out-of-hospital births more accessible to low-income women, a group that could particularly benefit from community-based midwifery, according to a 2018 study.

Many of these birth workers are struggling to break even, but that’s nothing new.

Since her home birth in August, TaNefer Camara has been posting videos and the story of her delivery on social media as an example to other African American women. “Now I’m hearing from Black women who didn’t even know that home birth was an option for them,” she says. (Photo by Rachel Scheier)

In past generations, Black midwives sometimes walked miles and stayed days with laboring women, massaging their feet, cooking and babysitting, and reading from the Bible in exchange for a few dollars or a chicken, according to historical accounts. Immigrants and African Americans dominated midwifery during much of this country’s history, and in the South, enslaved women passed from mother to daughter childbirth techniques and remedies brought from West Africa starting in the 1600s.

In certain rural pockets, Black midwives continued to deliver babies for poor Black and white families alike, even into the last century, as modern obstetrics regulated traditional birth attendants virtually out of existence. Midwives delivered half of the nation’s babies in 1900 and just over 10% by the 1930s, as physicians launched a campaign to promote hospital birth as safe and hygienic, while dismissing midwives as “relics of barbarism.”

But in recent years, with hospital birth as the norm, the United States has registered the poorest birth outcomes in the industrialized world. The numbers have worsened during the past 25 years even as they’ve improved in most of the world, largely because of the disproportionate toll on African Americans.

California has led the effort to reverse that trend, cutting its maternal death rate by 55% between 2006 and 2013, though the disparity for Black mothers has persisted.

Researchers have documented countless instances of pregnant African American women being ignored, drug-tested without permission, or sutured without pain medication.

A midwife readies her kit to go on a call in Greene County, Georgia, in 1941. Midwives all but disappeared in the following decades but enjoyed a rebirth sparked by feminism in the 1970s, as women sought to rekindle the idea of pregnancy as a normal process to be supported rather than a pathological condition to be managed by medical intervention. (Library of Congress)

There is a growing consensus among medical researchers and social scientists that discrimination can result in toxic stress that causes maternal complications or premature births. Respectful, holistic prenatal care can improve outcomes, said Jennie Joseph, a British-trained midwife. Her prenatal clinic in Florida serving mostly low-income women of color has had consistently low rates of maternal complications and premature and low-birth-weight babies.

Joseph believes it matters less where a woman gives birth than how she is treated during the previous nine months, and most of her clients deliver in hospitals.

Groups like Amani’s are encouraging more midwives of color to penetrate what she calls the profession’s “old girls’ network.” Just 2% of American midwives are Black, and research has shown that Black patients tend to do better with Black providers.

There is evidence that their numbers are growing with demand, however. California now has about half a dozen licensed Black midwifery practices, including three that have opened in the San Francisco Bay Area since 2017.

Camara said she wanted to support them: She’s had supportive, competent white birth attendants in the past, “but it wasn’t the same,” she said. “This is returning to what we did before.”

At around 6 on a Saturday morning in mid-August, as a heat wave gripped the Bay Area, she phoned Jordan to tell her she was having contractions. Barely two hours later, the midwives helped her give birth to her son, Esangu, 8 pounds, 6 ounces, on her hands and knees on her living room floor.

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

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Tough to Tell COVID From Smoke Inhalation Symptoms — And Flu Season’s Coming

The patients walk into Dr. Melissa Marshall’s community clinics in Northern California with the telltale symptoms. They’re having trouble breathing. It may even hurt to inhale. They’ve got a cough, and the sore throat is definitely there.

A straight case of COVID-19? Not so fast. This is wildfire country.

Up and down the West Coast, hospitals and health facilities are reporting an influx of patients with problems most likely related to smoke inhalation. As fires rage largely uncontrolled amid dry heat and high winds, smoke and ash are billowing and settling on coastal areas like San Francisco and cities and towns hundreds of miles inland as well, turning the sky orange or gray and making even ordinary breathing difficult.

But that, Marshall said, is only part of the challenge. Facilities already strapped for testing supplies and personal protective equipment must first rule out COVID-19 in these patients, because many of the symptoms they present with are the same as those caused by the virus.

“Obviously, there’s overlap in the symptoms,” said Marshall, the CEO of CommuniCare, a collection of six clinics in Yolo County, near Sacramento, that treats mostly underinsured and uninsured patients. “Any time someone comes in with even some of those symptoms, we ask ourselves, ‘Is it COVID?’ At the end of the day, clinically speaking, I still want to rule out the virus.”

The protocol is to treat the symptoms, whatever their cause, while recommending that the patient quarantine until test results for the virus come back, she said.

It is a scene playing out in numerous hospitals. Administrators and physicians, finely attuned to COVID-19’s ability to spread quickly and wreak havoc, simply won’t take a chance when they recognize symptoms that could emanate from the virus.

“We’ve seen an increase in patients presenting to the emergency department with respiratory distress,” said Dr. Nanette Mickiewicz, president and CEO of Dominican Hospital in Santa Cruz. “As this can also be a symptom of COVID-19, we’re treating these patients as we would any person under investigation for coronavirus until we can rule them out through our screening process.” During the workup, symptoms that are more specific to COVID-19, like fever, would become apparent.

For the workers at Dominican, the issue moved to the top of the list quickly. Santa Cruz and San Mateo counties have borne the brunt of the CZU Lightning Complex fires, which as of Sept. 10 had burned more than 86,000 acres, destroying 1,100 structures and threatening more than 7,600 others. Nearly a month after they began, the fires were approximately 84% contained, but thousands of people remained evacuated.

Dominican, a Dignity Health hospital, is “open, safe and providing care,” Mickiewicz said. Multiple tents erected outside the building serve as an extension of its ER waiting room. They also are used to perform what has come to be understood as an essential role: separating those with symptoms of COVID-19 from those without.

At the two Solano County hospitals operated by NorthBay Healthcare, the path of some of the wildfires prompted officials to review their evacuation procedures, said spokesperson Steve Huddleston. They ultimately avoided the need to evacuate patients, and new ones arrived with COVID-like symptoms that may actually have been from smoke inhalation.

Huddleston said NorthBay’s intake process “calls for anyone with COVID characteristics to be handled as [a] patient under investigation for COVID, which means they’re separated, screened and managed by staff in special PPE.” At the two hospitals, which have handled nearly 200 COVID cases so far, the protocol is well established.

Hospitals in California, though not under siege in most cases, are dealing with multiple issues they might typically face only sporadically. In Napa County, Adventist Health St. Helena hospital evacuated 51 patients on a single August night as a fire approached, moving them to 10 other facilities according to their needs and bed space. After a 10-day closure, the hospital was allowed to reopen as evacuation orders were lifted, the fire having been contained some distance away.

The wildfires are also taking a personal toll on health care workers. CommuniCare’s Marshall lost her family’s home in rural Winters, along with 20 acres of olive trees and other plantings that surrounded it, in the Aug. 19 fires that swept through Solano County.

“They called it a ‘firenado,’” Marshall said. An apparent confluence of three fires raged out of control, demolishing thousands of acres. With her family safely accounted for and temporary housing arranged by a friend, she returned to work. “Our clinics interact with a very vulnerable population,” she said, “and this is a critical time for them.”

While she pondered how her family would rebuild, the CEO was faced with another immediate crisis: the clinic’s shortage of supplies. Last month, CommuniCare got down to 19 COVID test kits on hand, and ran so low on swabs “that we were literally turning to our veterinary friends for reinforcements,” the doctor said. The clinic’s COVID test results, meanwhile, were taking nearly two weeks to be returned from an overwhelmed outside lab, rendering contact tracing almost useless.

Those situations have been addressed, at least temporarily, Marshall said. But although the West Coast is in the most dangerous time of year for wildfires, generally September to December, another complication for health providers lies on the horizon: flu season.

The Southern Hemisphere, whose influenza trends during our summer months typically predict what’s to come for the U.S., has had very little of the disease this year, presumably because of restricted travel, social distancing and face masks. But it’s too early to be sure what the U.S. flu season will entail.

“You can start to see some cases of the flu in late October,” said Marshall, “and the reality is that it’s going to carry a number of characteristics that could also be symptomatic of COVID. And nothing changes: You have to rule it out, just to eliminate the risk.”

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

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Luz, cámara… sin acción: problemas con el seguro de salud en Hollywood por COVID

Antes que la pandemia paralizara la industria del entretenimiento en marzo, Jeffrey Farber tenía un flujo constante de trabajo en cine y televisión, incluyendo apariciones en “Hunters” y “Blue Boods”.

Pero cuando se cancelaron las producciones teatro, cine y TV, Farber no sólo perdió sus ingresos como actor, sino que también dejó de acumular las horas y ganancias que necesitaba para calificar para el seguro médico a través de su sindicato, SAG-AFTRA.

Sin estos trabajos en actuación, su seguro terminaría en septiembre.

“Es una situación increíble”, dijo Farber, de 65 años y sobreviviente de cáncer de páncreas. “Va a haber mucha gente que no va a poder vivir así”.

Desde Broadway hasta Hollywood, muchos actores, directores, trabajadores de producción, músicos y otros se enfrentan a situaciones similares. Los trabajadores en la industria del entretenimiento a menudo tienen varios empleadores en el transcurso de un año, a medida que pasan de un espectáculo a otro. En cierto modo, son trabajadores por cuenta propia.

Sus empleadores generalmente hacen contribuciones financieras a un fondo de beneficios bajo los términos del contrato del sindicato. Y los trabajadores pagan primas por su cobertura.

Si acumulan un número predeterminado de horas o ganancias, pueden calificar para la cobertura por un año. La cobertura suele ser amplia y bastante económica. Farber pagaba sólo $408 cada tres meses para él y su esposo.

Es un modelo que algunos académicos piensan que podría funcionar para otros en este tipo de industria. “Hace posible la cobertura en sectores como la venta al por menor, la construcción y el entretenimiento donde de otra manera no se ofrecería”, señaló JoAnn Volk, investigadora del Centro de Reformas del Seguro de Salud de la Universidad Georgetown.

Cuando la pandemia paralizó las producciones de TV y cine, Jeffrey Farber perdió sus ingresos como actor y no pudo acumular las horas necesarias para calificar para el seguro de salud a través de su sindicato SAG-AFTRA. (Michael Roman)

Pero como ha mostrado este tiempo de pandemia, no siempre funciona bien. Alguien en la industria del entretenimiento puede ser capaz de  sobrellevar un período de sequía, sin trabajo, porque califica para la cobertura basada en un empleo anterior.

Pero una vez que la cobertura caduca, este sistema podría dejar a los artistas en desventaja sobre otros trabajadores que regresan a un trabajo más convencional, donde la cobertura puede comenzar inmediatamente. Además, los miembros pueden seguir debiendo cuotas sindicales, aunque no sean elegibles para los beneficios de salud.

El momento del cierre no podría ser peor para Farber, que sólo necesitaba 12 días de trabajo o $249 en ingresos, a fines de junio, para calificar para la continuidad de la cobertura en octubre.

En los planes de los sindicatos del entretenimiento, “la cobertura siempre es prospectiva”, explicó Phyllis Borzi, ex secretaria adjunta del Departamento de Trabajo que dirigió la Administración de Seguridad de Beneficios del Empleado y que ahora es consultora. “Eso funciona bien si tienes una interrupción corta, pero han estado sin trabajo tanto tiempo, que si tuvieran horas acumuladas, ya las habrían perdido”.

SAG-AFTRA representa a unos 160,000 profesionales de la televisión, la radio, el cine y otros. El sindicato exige que los miembros de este año deberían acumular al menos 84 días de trabajo calificado o ganar $18,040 en cuatro trimestres para tener derecho a la cobertura de los próximos cuatro trimestres.

Farber finalmente obtuvo un aplazamiento temporal porque se enteró que podía calificar para la cobertura, con menores ingresos, en una categoría separada para las personas que tienen al menos 40 años y 10 o más de elegibilidad para el plan de salud. Pero no sabe cómo los cambios de cobertura planeados para el próximo año afectarán su elegibilidad.

El plan de salud ha tomado algunas medidas para aliviar las preocupaciones planteadas por los miembros. En abril, redujo las primas de atención médica a la mitad para el segundo trimestre y en septiembre anunció una reducción temporal de las primas de COBRA para algunos miembros.

El fondo de beneficios SAG-AFTRA no respondió a las solicitudes de comentarios.

Al igual que las personas que trabajan para un solo empleador, los trabajadores que pierden la cobertura de su plan de beneficios del sindicato pueden continuar su cobertura hasta 18 meses bajo la ley federal COBRA, pero los trabajadores que toman esa decisión generalmente tienen que pagar el costo total del plan.

Y la cobertura de COBRA no es barata. También pueden inscribirse en un plan en el mercado de su estado establecido por ACA o, si califican, en Medicaid, el programa federal-estatal para personas de bajos ingresos.

Dee Nichols es operador de cámara en Los Angeles. “No tienen problemas con que personas como yo contribuyan y luego no puedan sacar [beneficios] de ello. Me vuelve loco”.(Dee Nichols)

Cuando la pandemia golpeó a mediados de marzo, Dee Nichols había registrado 512 de las 600 horas que necesitaba acumular, en un período de seis meses, para calificar para la cobertura de salud con el plan de salud de la Industria Cinematográfica.

Nichols, un operador de cámara de Los Angeles que es miembro del Local 600 del International Cinematographers Guild, tenía programados dos contratos a principios de marzo que le habrían permitido alcanzar el umbral para el 21 de marzo, el final de su período de calificación para la cobertura. Pero la producción se canceló.

El plan de salud de la Industria Cinematográfica también ofreció cierto alivio a los miembros, incluyendo la extensión de algunas horas de crédito, la renuncia a las primas para los dependientes y la oferta de subsidios para COBRA.

Pero la asistencia no ayudó a Nichols a calificar para la cobertura.

Él y otro miembro forman parte de una demanda colectiva que argumenta que el plan de salud tiene la responsabilidad, según la ley federal, de tratar a todos los participantes por igual.

El plan de salud no respondió a una solicitud de comentarios.

No está claro cuándo “Volveremos a trabajar”

Para ayudar a sus miembros durante la pandemia, el plan de salud de la Actors’ Equity Association renunció a las primas durante tres meses a partir de mayo y ofrece, temporalmente, un plan de menor costo hasta fin de año.

Pero como estos planes de varios empleadores se autofinancian, pagan los reclamos de los miembros directamente. Eso puede causar problemas cuando el trabajo es escaso y los empleadores no pagan al fondo.

“Todos estos fondos de salud tienen diferentes capacidades financieras, y deben mantener reservas para preservar la cobertura de sus miembros”, explicó Brandon Lorenz, director de comunicaciones de la Actors’ Equity Association, que representa a aproximadamente 52,000 actores y directores.

SAG-AFTRA, que ha proyectado un déficit de $141 millones en su plan de salud este año, anunció cambios de gran alcance en la cobertura para el próximo año, incluyendo umbrales más altos en las ganancias y días trabajados para calificar para la cobertura.

Esto podría ser un desafío adicional para Jeffrey Farber, quien está preocupado por las oportunidades de trabajo que estarán disponibles cuando la industria se recupere.

“Nadie sabe cuándo se reanudarán las producciones o si volveremos a trabajar”, señaló.

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Lights, Camera, No Action: Insurance Woes Beset Entertainment Industry Workers

Before the coronavirus pandemic shut down the entertainment industry in March, Jeffrey Farber had a steady flow of day jobs in film and television, including work on “Hunters” and “Blue Bloods.” But when theaters, movies and TV shows stopped production, not only did Farber lose his acting income, he also stopped accruing the hours and earnings he needed to qualify for health insurance through his labor union, SAG-AFTRA.

Without the acting jobs, his insurance would be ending this month.

When the pandemic halted film and television production, Jeffrey Farber lost his acting income and stopped accruing the hours and earnings he needed to qualify for health insurance through his labor union, SAG-AFTRA.(Michael Roman)

“This is an unbelievable situation,” said Farber, 65, a survivor of pancreatic cancer. “There are going to be so many people who aren’t going to be able to make it.”

From Broadway to Hollywood, many actors, directors, backstage workers, musicians and others in the performing arts face similar coverage suspensions. Those in the entertainment industry often have several employers over the course of a year as they move from show to show. In some ways, they’re quintessential gig workers.

Their employers generally make financial contributions to a benefit fund under the terms of the union contract. And the workers pay premiums on their coverage. If workers accumulate a predetermined number of hours or earnings, they can qualify for coverage for up to a year. Coverage is typically comprehensive and quite inexpensive. Farber paid just $408 every three months to cover him and his husband.

It’s a model some academics think might work for others in the gig economy. “It makes coverage possible in industries like retail, construction and entertainment where it might not otherwise be offered,” said JoAnn Volk, a research professor at Georgetown University’s Center on Health Insurance Reforms.

As the COVID pandemic period has shown, it doesn’t always work well. Someone in the entertainment industry may be able to weather a dry spell without any work because he’s already qualified for coverage based on past employment. But once coverage lapses, this system could leave entertainers at a disadvantage over other workers returning to a more conventional job, where coverage can start immediately. Plus, members may continue to owe union dues, even though they aren’t eligible for health benefits.

The timing of the shutdown couldn’t be worse for Farber, who needed just 12 days of work or $249 in earnings by the end of June to qualify for continued coverage in October. Accumulating that would have been “easy as pie,” he said.

In the entertainment unions’ benefit plans, “coverage is always prospective,” said Phyllis Borzi, a former assistant secretary in the Department of Labor who headed the Employee Benefits Security Administration and is now a consultant. “That works fine if you have a short interruption, but they’ve been out so long, to the extent they have hours banked, they must be out of them by now.”

SAG-AFTRA represents about 160,000 professionals in TV, radio, film and other media. The union requires that members this year generally must accumulate at least 84 days of qualifying work or earn $18,040 over four quarters to be eligible for coverage for the next four quarters.

Farber eventually got a temporary reprieve because he learned he could qualify for coverage with lower earnings under a separate category for people who are least 40 years old and have 10 or more years of health plan eligibility. But he doesn’t know how coverage changes planned for next year will affect his eligibility.

The health plan has taken some steps to alleviate concerns raised by members. In April, it cut health care premiums in half for the second quarter and this month announced a temporary reduction of COBRA premiums for some members.

The SAG-AFTRA benefit fund didn’t respond to requests for comment.

Even in the best of times, it can be difficult for those in the entertainment industry whose names appear in small print in the credits to string together enough work to qualify for coverage. If social restrictions were to ease and people could get work heading into fall, any accumulated hours and income may be too far in the past to count toward future coverage, leaving them no choice but to start accumulating them all over again.

In contrast, when employers hire someone eligible for on-the-job coverage, they typically can’t impose waiting periods longer than 90 days for health insurance under the Affordable Care Act.

Like people who work for a single employer, workers who lose coverage through their union benefit plan can continue their coverage for up to 18 months under federal COBRA law, but workers who make that choice generally have to pick up the entire cost of the plan. And COBRA coverage is not cheap. They may also enroll in a plan on their state marketplace set up by the Affordable Care Act or, if they qualify, in Medicaid, the federal-state program for low-income people.

“You’re trying to fill a tub of water and it keeps getting holes,” said Dee Nichols, a camera operator in Los Angeles. “They’re fine with guys like me contributing and then not being able to pull [benefits] out of it. It drives me insane.”(Dee Nichols)

When the pandemic hit in mid-March, Dee Nichols had logged 512 of the 600 hours he needed to accumulate in a six-month period to qualify for health coverage with the Motion Picture Industry health plan.

Nichols, a camera operator in Los Angeles who is a member of Local 600 of the International Cinematographers Guild, had two shows lined up in early March that would have brought him up to the threshold by March 21, the end of his qualifying period for coverage. Then production was canceled.

It wasn’t the first time that Nichols, 49, had missed the hours target for coverage through his union plan. “You’re trying to fill a tub of water and it keeps getting holes,” Nichols said. Meanwhile, he pays $400 a month for an individual marketplace plan with a $6,000 deductible. “They’re fine with guys like me contributing and then not being able to pull [benefits] out of it,” he said. “It drives me insane.”

The Motion Picture Industry health plan also offered some relief to members, including extending them some hours of credit, waiving premiums for dependents and offering COBRA subsidies.

But the assistance didn’t help Nichols qualify for coverage.

He and another member are part of a class action lawsuit arguing that the health plan has a responsibility under federal law to treat all plan participants equally.

The health plan didn’t respond to a request for comment.

Unclear When ‘We’ll Work Again’

To assist its members during the pandemic, the Actors’ Equity Association health plan waived premiums for three months starting in May and is temporarily offering a lower-cost plan through the end of the year.

But since these multi-employer plans are self-funded, they pay members’ claims directly. That can cause problems when work is scant and employers aren’t paying into the fund.

“All of these health funds have different financial positions, and they have to maintain reserves in order to maintain coverage for their members,” said Brandon Lorenz, communications director of the Actors’ Equity Association, which represents approximately 52,000 actors and stage managers.

SAG-AFTRA, which has projected a $141 million deficit in its health plan this year, announced far-reaching changes to coverage for next year, including higher thresholds on earnings and days worked to qualify for coverage.

That could prove an added challenge for Jeffrey Farber, who is concerned about what job opportunities will be available when the industry recovers.

“None of us knows when production is going to start again or if we’ll work again,” he said.

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Sweetgreen Makes Healthful Fast Food — But Can You Afford It?

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Employees work the line at Sweetgreen, a chain restaurant that uses fresh ingredients from local farms to make fast food healthier, in Berkeley, Calif.

Employees work the line at Sweetgreen, a chain restaurant that uses fresh ingredients from local farms to make fast food healthier, in Berkeley, Calif.Credit Jason Henry for The New York Times

Healthful, fast and affordable food is the holy grail of the public health and nutrition community. A popular restaurant chain shows just how much of a challenge that is.

It began when three Georgetown University students were frustrated that they could not find a healthy fast-food restaurant near their campus. With money raised from family and friends, they started their own, renting a small storefront on M Street in Georgetown. The result was Sweetgreen, a restaurant that offered organic salads, wraps and frozen yogurt. Pretty soon, the daily line of lunchtime customers stretched out the door and around the corner.

Ten years later, the line is still there, but Sweetgreen has grown into a nationwide salad chain, with more than 40 locations. Sweetgreen is part of a small but growing breed of farm-to-table fast-food chains – like Chopt Creative Salad Company on the East Coast and Tender Greens in California – that are giving fast-food restaurants a plant-based makeover. Their mission: to fix fast food, which has long been fattening and heavily processed.

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At Sweetgreen, fresh vegetables, cheeses and other ingredients are shipped directly to each restaurant from nearby farms and then chopped or cooked on site.

At Sweetgreen, fresh vegetables, cheeses and other ingredients are shipped directly to each restaurant from nearby farms and then chopped or cooked on site.Credit Jason Henry for The New York Times

Sweetgreen’s owners say their goal is to offer customers foods made with nutritious, sustainable and locally grown ingredients. The company has decentralized its food sourcing and production. Fresh vegetables, cheeses and other ingredients are shipped directly to each restaurant from nearby farms and then chopped or cooked on site. They don’t sell soda or use refined sugar.
Sweetgreen expects to open another 20 stores in major cities around the country this year, and eventually to expand to places where experts say healthy, delicious fast food is needed most — low-income neighborhoods.

But while the chain has proven there is a big appetite for more healthful fast food, the goal of taking this concept to poor areas may be a distant reality. The company and other chains like it operate almost exclusively in affluent communities, far from the low-income food deserts where obesity is rampant and farmers’ markets and healthy food stores are scarce. And with salads that typically cost between $9 and $14, some question whether a healthful fast-food chain like Sweetgreen can ever be affordable for average Americans.

Maegan George, a Columbia University student who lives near a Sweetgreen, calculated that for the price of one Sweetgreen salad, she could buy the same ingredients in bulk at a local market and make several similar salads at home.

“I’m a first-generation student and I’m on full financial aid,” she said. “Sweetgreen is delicious and I enjoy it. But there’s no way I could afford to eat there on a regular basis.”

Jackie Hajdenberg, another Columbia student, wrote about the restaurant for the campus newspaper, The Spectator, earlier this year, lamenting that on a per calorie basis, a salad at Sweetgreen was three times the price of a Big Mac at McDonald’s.

“Sweetgreen has not only made it easier for people to make healthy decisions – it has also illustrated the unequal socioeconomic landscape of the world in which we live,” she wrote.

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Salad options at Sweetgreen change often, depending on what is available at local farms.

Salad options at Sweetgreen change often, depending on what is available at local farms.Credit Jason Henry for The New York Times

Sweetgreen says it prices its food so that it can compensate its suppliers and employees fairly, and that it expects nutritious fast food to become more affordable as the healthy food movement grows. Nicolas Jammet, a co-founder of Sweetgreen, said the company wants to serve lower-income customers, and has long-term plans to expand to low-income communities.

To get there, he said, the company will have to overcome hurdles involving its supply chain, the minimum wage and greater nutrition awareness and education among the public. For the past six years the company has been running a nutrition education program in schools that teaches children about healthier eating and locally grown food.

“It’s a long-term goal for us to be part of this larger systematic change that needs to happen,” he said. “But there are so many parts of this problem that need to be addressed.”

Mr. Jammet notes that the company was among the first to show that fast-food chains don’t need profits from soda and sugary drinks to succeed. He believes chains like Sweetgreen have caused a ripple effect throughout the fast-food industry.

In January, for example, Chick-fil-A unveiled a new kale, broccolini and nut “superfood” salad, responding to customer demands for “new tastes and healthier ways to eat in our restaurants.” McDonald’s is experimenting with kale salads, and Wendy’s is testing a spinach, chicken and quinoa salad.

“Companies like McDonald’s have more power to change the way that people eat than we do,” Mr. Jammet said. “We don’t see these companies as the enemy. We just have to force change on them.”

Public health experts say that such changes cannot come soon enough. A University of Toronto study recently showed that people have a higher risk of developing diabetes if they live in “food swamps” – an area with three or more fast-food restaurants and no healthy dining options.

Another study published in JAMA in June found that the percentage of Americans eating an unhealthy diet — high in sugar, refined grains, soft drinks and processed foods and low in fruits and vegetables — was on the decline, but the improvements in diet were much smaller for lower-income Americans.

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Customers wait in line at Sweetgreen in Berkeley, Calif.

Customers wait in line at Sweetgreen in Berkeley, Calif.Credit Jason Henry for The New York Times

Overall about twice as many people from poor households have poor diets compared to those at higher income levels.
Why is traditional fast food so cheap? One reason is the underlying infrastructure of the industry. Many of the ingredients, like the soy that’s turned into oil for deep fryers, or the the corn that’s fed to animals and used to make high-fructose corn syrup, begin with crops that are heavily subsidized by the government. To make their food economical, many traditional fast-food chains mass-produce their food in large factories, often stripping it of fiber and other nutrients that decrease its shelf life, while adding salt, sugar and other flavorings and preservatives.

Then they freeze and ship the processed components, like burger patties, bread, pickles and sauce, to their restaurants. There they are reheated and assembled, often with minimal effort, ensuring that a Big Mac in Seattle looks and tastes the same as a Big Mac in Charlotte, N.C.

By comparison, every Sweetgreen location has a chalkboard that lists the farms where its organic arugula, peaches, yogurt or blueberries are produced. As a result, the menus vary by location and by season. In Boston, Sweetgreen stores use New England Hubbard squash. In Los Angeles, the menu features a different variety of squash grown locally in California.

Those differences mean fresher, more nutritious ingredients, but ultimately costlier food for customers — one of the obstacles that Sweetgreen and other chains like it will have to overcome if they hope to make their food more accessible to all income brackets.
Marion Nestle, a professor of nutrition, food studies and public health at New York University and the author of “Food Politics,’’ says restaurants like Sweetgreen offer an encouraging, but imperfect, model for making fast food more healthful.

“What’s not to like?” she asks. “The cost, maybe, but for people who can afford it the quality is worth it. Next step: Moving the concept into low-income areas.”

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