Tagged Race and Health

A pesar del aumento de casos, California frena fondos multimillonarios para pruebas de COVID

En abril, el gobernador Gavin Newsom lanzó una iniciativa estatal multimillonaria para que las pruebas de COVID-19 llegaran a las personas y a los lugares con menos acceso: pueblos rurales y vecindarios desfavorecidos del centro de la ciudad.

Pero ahora, citando costos, California está frenando esta expansión, incluso cuando el estado está teniendo devastadores récords de nuevas infecciones y aumentos de dos dígitos en las hospitalizaciones.

El estado ya no financiará nuevos sitios de prueba, a pesar de las súplicas de los condados para obtener asistencia adicional. También ha cerrado algunos espacios y los ha trasladado a otros lugares.

Y el gobierno ha amenazado con cerrar los sitios subutilizados, de acuerdo con casi dos docenas de entrevistas con funcionarios de salud pública de los condados.

Aunque es pronto para evaluar, han surgido algunos ganadores y perdedores: el condado de El Dorado, al este de Sacramento, perdió uno de sus sitios de prueba en la ciudad de Shingle Springs en junio por no agendar suficientes citas, mientras que el condado de Fresno ganó un sitio que había sido retirado de otra parte, dijo el doctor Rais Vohra, su oficial de salud.

Sin embargo, el condado de San Mateo ha pedido tres veces a los funcionarios estatales un segundo lugar de pruebas financiado por el estado para abordar las brechas en las pruebas en los vecindarios de minorías de raza negra y de trabajadores agrícolas, pero se le ha “dicho que no repetidamente”, dijo Justin Mates, subdirector del condado.

Por eso, el condado transformó su único sitio estatal en una unidad de prueba itinerante.

“La equidad es ciertamente una preocupación para nosotros”, dijo Mates. “Realmente necesitamos ayuda con el acceso a pruebas si vamos a llegar a nuestros residentes latinos y lugares como East Palo Alto”, una ciudad diversa cuya población es principalmente latina, afroamericana, asiática y de nativos de las Islas del Pacífico.

California ha comprometido hasta $132 millones en contratos con dos compañías privadas de pruebas para COVID-19, Verily Life Sciences y OptumServe, para ofrecer pruebas gratuitas en más de 100 sitios que la administración de Newsom ha identificado como “desérticos para pruebas”.

La expansión ha elevado drásticamente los números de pruebas generales del estado, que aumentaron de 16,000 por día en abril a 105,000 el lunes 29 de junio.

Las pruebas también están disponibles en ubicaciones financiadas por condados, farmacias privadas, hospitales y clínicas comunitarias.

Mark Ghaly, secretario estatal de Salud y Servicios Humanos, confirmó que el estado está retirando los sitios de los condados que no están generando números lo suficientemente altos y cortando fondos para nuevos espacios.

“Lo que quieres es que el dinero vaya a donde más se necesita”, dijo Ghaly. “No sería prudente o sabio mantener el gasto en un lugar donde no se están utilizando los recursos”.

El propio Newsom ha expresado su preocupación por los precios, dados los déficits presupuestarios “sin precedentes”. “Hay un gran costo asociado con las pruebas”, dijo a fines de junio.

Un funcionario de la administración de Newsom confirmó que el estado quiere ver que los condados llenen al menos el 80% de las citas para pruebas en cada ubicación. Y si las pruebas caen por debajo del 50% durante unos días o más, se les advierte que los sitios podrían transferirse a otro lugar.

Los condados argumentan que existe un beneficio para la salud pública al mantener abiertas las ubicaciones de bajo rendimiento, simplemente para garantizar que las pruebas estén disponibles para las comunidades rurales y postergadas.

En todo el estado, están luchando para salvar sitios financiados por el estado, incluso cuando están siendo abrumados por los crecientes casos de coronavirus vinculados en gran medida a reuniones sociales.

“Es cómo podemos identificar rápidamente dónde está el virus y si hay puntos calientes”, dijo la doctora Olivia Kasirye, oficial de salud del condado de Sacramento, donde celebraciones familiares y reuniones con alto consumo de alcohol están elevando las tasas de infección.

El condado de Contra Costa vio caer sus números de pruebas en junio y corría el riesgo de perder un sitio financiado por el estado hasta que demostrara que podía cumplir con las citas a cerca del 80% de su capacidad, dijo el doctor Chris Farnitano, su oficial de salud.

Al condado de Riverside se le advirtió el 16 de junio de que un sitio financiado por el estado al norte de Temecula sería “trasladado a otro condado” si no cubría el 50% de sus citas, según un correo electrónico del grupo de trabajo de pruebas del estado.

Lo mismo se le dijo al condado de Mendocino, que podría perder su sitio financiado por el estado, la única prueba gratuita disponible a dos horas de manejo para algunos residentes de áreas rurales.

El condado de Alameda se sintió tan frustrado con los requisitos estatales que emprendió una expansión de pruebas por cuenta propia.

“Nos dimos cuenta que no podíamos depender del estado, especialmente para llegar a nuestras comunidades vulnerables”, dijo la doctora Jocelyn Freeman Garrick, doctora de la sala de emergencias del Hospital Highland en Oakland, quien lidera la fuerza de pruebas del condado.

El condado de El Dorado, que perdió su sitio, hasta ahora ha mantenido un recuento relativamente bajo de casos de COVID-19.

Ghaly dijo que el estado está trabajando con los condados en peligro de perder sitios para darles la oportunidad de llenar los espacios de prueba. Los funcionarios estatales se negaron a decir cuántos condados han perdido sitios, pero a medida que las nuevas infecciones se han disparado, los números de las pruebas están comenzando a recuperarse.

La lista de condados en riesgo de perder un sitio ha disminuido de alrededor de una docena a principios de junio a unos pocos la última semana de junio.

Expertos en salud pública dicen que enfocándose tan intensamente en los números de las pruebas y no en las pruebas adecuadas en los vecindarios de minorías, se corre el riesgo de abandonar las comunidades que ya enfrentan enormes barreras para la atención médica como el racismo y la pobreza.

“Si ignoras estas comunidades, seguiremos viendo las mismas urgencias que estamos viendo ahora”, dijo el doctor Tony Iton, ex alto funcionario de salud del condado de Alameda y ahora vicepresidente senior de California Endowment, que está trabajando con los condados para expandir las pruebas en vecindarios desatendidos.

Las barreras socioeconómicas arraigadas también hacen que sea difícil obtener y mantener los números de prueba. Por ejemplo, las personas que desean hacerse la prueba en sitios estatales a menudo necesitan acceso a Internet y una dirección de correo electrónico. La mayoría son al paso, por lo que deben tener un vehículo.

Muchas personas de bajos ingresos no pueden cumplir con esos requisitos, y los inmigrantes indocumentados temen que proporcionar información personal para obtener una prueba pueda exponerlos a los funcionarios de inmigración, dijo el doctor Marty Fenstersheib, ex funcionario de salud del condado de Santa Clara que lidera el programa de pruebas.

“Si las personas tienen miedo de venir y hacerse la prueba, no habrá ningún beneficio”, dijo.

Los contratos estatales que financian los sitios de prueba se extendieron en junio, pero expirarán el 31 de agosto, y los funcionarios de la administración no han dicho a los condados si el estado continuará financiándolos, dijo Mimi Hall, presidenta de la Asociación de Ejecutivos de Salud del Condado de California y directora de salud pública del condado de Santa Cruz.

“Es difícil planificar cuando no sabemos cuánto tiempo podremos mantenerlos”, expresó Hall.

Esta historia de KHN fue publicada primero en California Healthline, un servicio de la California Health Care Foundation.

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California Noticias En Español Public Health Race and Health States

As Cases Spike, California Pauses Multimillion-Dollar Testing Expansion

In April, Gov. Gavin Newsom launched a multimillion-dollar state initiative to bring COVID-19 testing to the people and places with the least access: rural towns and disadvantaged inner-city neighborhoods.

California is now halting its expansion, citing costs, even as the state is getting walloped by record-setting spikes in new infections and double-digit increases in hospitalizations.

The state will no longer fund new testing sites despite pleas from counties for additional assistance — and it has closed some locations and moved them elsewhere. It also has threatened to pull testing out of underused sites, according to nearly two dozen interviews with county public health officials.

While it’s early, some winners and losers have emerged: El Dorado County, east of Sacramento, lost its testing site in the town of Shingle Springs in June because it couldn’t fill enough appointment slots, while Fresno County gained a site that had been pulled from elsewhere, said its health officer, Dr. Rais Vohra.

Yet San Mateo County has asked state officials three times for a second state-funded testing venue to address testing gaps in Black and farmworker neighborhoods, but has been “told no, repeatedly,” said Justin Mates, deputy county manager. So the county transformed its sole state site into a roving testing unit.

“Equity is certainly a concern for us,” Mates said. “We really need help with testing access if we’re going to reach our Latino residents and places like East Palo Alto,” a diverse city whose population is mainly Latino, African American and Asian/Pacific Islander.

California has committed up to $132 million in contracts with two private COVID-19 testing companies, Verily Life Sciences and OptumServe, to offer free coronavirus tests at more than 100 sites that the Newsom administration has identified as “testing deserts.” The expansion has dramatically increased the state’s overall testing numbers, which swelled from 16,000 tests per day in April to 105,000 on Monday.

Testing is also available at county-funded locations, private pharmacies, hospitals and community clinics.

State Health and Human Services Secretary Mark Ghaly confirmed that the state is pulling sites out of counties that aren’t generating high enough numbers and cutting off funding for new locations.

“With every asset and resource — especially when it’s scarce — you want it to go to places where it’s most needed,” Ghaly said. “It wouldn’t be prudent or wise to maintain spending in a place where resources aren’t being used.”

Newsom himself has voiced concern about the price tag, given “unprecedented” budget shortfalls. “There is a big cost associated with testing,” he said in late June.

A Newsom administration official confirmed the state wants to see counties fill at least 80% of testing slots at each location. And if testing drops below 50% for a few days or longer, counties are warned the sites could be transferred elsewhere.

Counties argue there’s a public health benefit to keeping underperforming locations open — simply to ensure that testing is available to rural and disenfranchised communities. Across the state, they are fighting to save state-funded sites even as they are being overwhelmed by rising coronavirus cases linked largely to social gatherings.

“It’s how we are able to quickly identify where the virus is and if there are hot spots,” said Dr. Olivia Kasirye, health officer for Sacramento County, where holiday celebrations and booze-fueled gatherings among family and friends are sending infection rates soaring.

Contra Costa County saw its testing numbers drop in June and was at risk of losing a state-funded site until it proved it could keep appointments near 80% of capacity, said its health officer, Dr. Chris Farnitano.

Riverside County was warned June 16 that a state-funded site north of Temecula would be “moved to another county” if it didn’t get its testing above 50%, according to an email from the state’s testing taskforce. The state told Mendocino County it could lose its state-funded site, the only free testing available within a two-hour drive for some rural residents, if it didn’t push numbers up.

Alameda County grew so frustrated with state requirements that it undertook a testing expansion of its own.

“We realized we couldn’t depend on the state, especially to reach our vulnerable communities,” said Dr. Jocelyn Freeman Garrick, an emergency room doctor at Highland Hospital in Oakland, who is leading the county’s testing task force.

El Dorado County, which lost its site, so far has maintained a relatively low count of COVID-19 cases. It can’t afford to replace the site but will “make do,” said county spokesperson Carla Hass.

Ghaly said the state is working with counties in danger of losing sites to give them a chance to fill testing slots. State officials declined to say how many counties have lost sites, but as new infections have soared, testing numbers are starting to pick back up. The list of counties at risk of losing a site has dwindled from around a dozen in early June to a few last week.

Public health experts say focusing so intently on testing numbers, and not on adequately testing in Black and Latino neighborhoods, risks abandoning communities that already face immense barriers to health care like racism and poverty.

“If you ignore these communities, then we’ll keep seeing the kinds of surges that we’re seeing now,” said Dr. Tony Iton, formerly the top health official for Alameda County and now a senior vice president of the California Endowment, which is working with counties to expand testing in underserved neighborhoods.

Entrenched socioeconomic barriers also make it difficult to get, and keep, testing numbers up. For instance, people who want to be tested at state sites often need Internet access and an email address. Most are drive-thru, requiring access to a vehicle.

Many low-income people can’t meet those requirements, and undocumented immigrants fear that providing personal information to obtain a test could expose them to immigration officials, said Dr. Marty Fenstersheib, a former health officer of Santa Clara County who is leading its testing program.

“We can have all the tests we want, but if people are afraid to come and get tested, it’s not going to be of any benefit,” he said.

State contracts funding the testing sites were extended this month but are set to expire Aug. 31, and administration officials have not told counties whether the state will continue funding them after that, said Mimi Hall, president of the County Health Executives Association of California and director of public health for Santa Cruz County.

Counties can’t afford to keep the sites running, said Hall, who is on the state’s testing task force.

“It’s hard to plan when we don’t know how long we’ll be able to keep them,” Hall said.

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

Related Topics

California Public Health Race and Health States

Watch: Teaching Teens How To Navigate Racism In America

KHN Midwest correspondent Cara Anthony appeared on KSDK’s “Today in St. Louis” television show with host Rene Knott to discuss her recent story about Darnell Hill, a mental health caseworker, who is teaching Black teens in St. Louis how to safely walk through the park, run to the store or handle an encounter with the police.

Hill, who was also on the show, spoke about the need for such unwritten rules as teens try to cope with the mental health burden of other people’s racist assumptions.

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Multimedia Public Health Race and Health

Officials Seek To Shift Resources Away From Policing To Address Black ‘Public Health Crisis’

From Boston to San Bernardino, California, communities across the U.S. are declaring racism a public health crisis.

Fueled by the COVID-19 pandemic’s disproportionate impact on communities of color, as well as the killing of George Floyd in the custody of Minneapolis police, cities and counties are calling for more funding for health care and other public services, sometimes at the expense of the police budget.

It’s unclear whether the public health crisis declarations, which are mostly symbolic, will result in more money for programs that address health disparities rooted in racism. But officials in a few communities that made the declaration last year say it helped them anticipate the COVID-19 pandemic. Some say the new perspective could expand the role of public health officials in local government, especially when it comes to reducing police brutality against Black and Latino residents.

The declarations provide officials a chance to decide “whether they are or are not going to be the chief health strategists in their community,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

“I’ve had a firm view [that] what hurts people or kills people is mine,” said Benjamin, a former state health officer in Maryland. “I may not have the authority to change it all by myself, but by being proactive, I can do something about that.”

While health officials have long recognized the impact of racial disparities on health, the surge of public support for the Black Lives Matter movement is spurring calls to move from talk to financial action.

In Boston, Mayor Martin J. Walsh declared racism a public health crisis on June 12 and a few days later submitted a budget that transferred 20% of the Boston Police Department’s overtime budget — $12 million — to services like public and mental health, housing and homelessness programs. The budget must be approved by the City Council.

In California, the San Bernardino County board on Tuesday unanimously adopted a resolution declaring racism a public health crisis. The board was spurred by a community coalition that is pushing mental health and substance abuse treatment as alternatives to incarceration. The coalition wants to remove police from schools and reduce the use of a gang database they say is flawed and unfairly affects the Black community.

The city of Columbus and Franklin County, Ohio, made similar declarations in June and May, respectively, while Ingham County, Michigan, passed a resolution June 9. All three mention the coronavirus pandemic’s disproportionate toll on minority residents.

Those localities follow in the footsteps of Milwaukee County, Wisconsin, which last year became the first jurisdiction in the country to declare racism a public health crisis, citing infant and maternal mortality rates among Blacks. The county’s focus on the issue primed officials to look for racial disparities in COVID-19, said Nicole Brookshire, executive director of the county’s Office on African American Affairs.

Milwaukee County was training employees in racial equity and had launched a long-term plan to reduce disparities in health when the pandemic hit. “It was right on our radar to know that having critical pieces of data would help shape what the story was,” said Brookshire.

She credits this focus for the county’s speedy publication of information showing that Black residents were becoming infected with and dying of COVID-19 at disproportionate rates.

Using data to tell the story of racial disparities “was ingrained” in staff, she said.

On March 27, the county launched an online dashboard containing race and ethnicity data for COVID-19 cases and began to reach out to minority communities with culturally relevant messaging about stay-at-home and social distancing measures. Los Angeles County and New York City did not publish their first racial disparity data until nearly two weeks later.

Declaring racism a public health crisis could motivate health officials to demand a seat at the table when municipalities make policing decisions, and eventually lead to greater spending on services for minorities, some public health experts say.

The public is pressuring officials to acknowledge that racism shortens lives, said Natalia Linos, executive director of Harvard’s Center for Health and Human Rights. Police are 2½ times as likely to kill a Black man as a white man, and research has shown that such deaths have ripple effects on mental health in the wider Black community, she said.

“Police brutality is racism and it kills immediately,” Linos said. “But racism also kills quietly and insidiously in terms of the higher rates of infant mortality, maternal mortality and higher rates of chronic diseases.”

The public health declarations, while symbolic, could help governments see policing in a new light, Linos said. If they treated police-involved killings the way they did COVID-19, health departments would get an automatic notification every time someone died in custody, she said. Currently, no official database tracks these deaths, although news outlets like The Washington Post and The Guardian do.

Reliable data would allow local governments to examine how many homeless or mentally ill people would be better served by social or public health workers than armed police, said Linos.

“Even symbolic declarations are important, especially if they’re accurately capturing public opinion,” said Linos, who is running to represent the 4th Congressional District of Massachusetts on a platform of health and equity. “They’re important for communities to feel like they’re being listened to, and they’re important as a way to begin conversations around budgeting and concrete steps.”

Derrell Slaughter, a district commissioner in Ingham County, Michigan, said he hopes his county’s declaration will lead to more funding for social and mental health as opposed to additional policing. Slaughter and his colleagues are attempting to create an advisory committee, with community participation, to make budget and policy recommendations to that end, he said.

Columbus City Council members coincidentally declared racism a public health crisis on May 25, the day Floyd died in Minneapolis. Four months earlier, the mayor had asked health commissioner Dr. Mysheika Roberts for recommendations to address health issues that stem from racism.

The recent protests against police brutality have made Roberts realize that public health officials need to take part in discussions about crowd control tactics like tear gas, pepper spray and wooden bullets, she said. However, she has reservations about giving the appearance that her office sanctions their use.

“That definitely is one of the cons,” she said, “but I think it’s better than not being there at all.”

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

Related Topics

California Public Health Race and Health

For A Black Social Media Manager In The George Floyd Age, Each Click Holds Trauma

Recently, as I scrolled the more than 1 million tweets connected to the hashtag #Black_Lives_Matter, this is what flashed before my eyes: the black-and-white dashcam video of Philando Castile’s girlfriend, Diamond Reynolds, in handcuffs crying, her 4-year-old daughter trying to comfort her; protesters in Berlin standing in solidarity with the BLM movement; a Now This video of a young Black girl calling herself ugly; police attacking protesters and protesters fighting back; an image of George Floyd unable to breathe.

Suddenly neither could I. My chest tightened, my heart beat faster and hot tears began to bubble from my eyes.

For a person of color, engaging in this moment of collective trauma — whether by watching and sharing the video of George Floyd’s death, discussing racial injustice on social media or speaking out in the 3D world — involves anxiously teetering across the fine lines between personal experience, obligations to the community, and — in my case — professional responsibilities. Since I manage a news organization’s social media platforms, it’s part of my job.

Many Americans describe watching the videos as a wake-up call to persistent racial injustice. For Black Americans, it touches a deeper nerve.

“I watched it. I tried not to cry. I was just in awe,” said Jason Cordova, 31, a comedian in Weymouth, Massachusetts. “I have a son. He’s 11. You gotta really prepare a Black kid to be treated less than human.”

Ann Ebhojiaye, a psychotherapist in Baltimore, said the reaction is normal, reflecting “vicarious trauma” or “retraumatization from the Black experience in America.” You’re “seeing images and videos of violence against people that look like you and sometimes not being aware of what you’re experiencing,” she told me. Research suggests that repeated viewing of terrorism news coverage can lead to symptoms of post-traumatic stress disorder, especially in people who have previous exposure to violence. Yet the onslaught of distressing images is hard to escape.

These videos carry echoes of historical images showing slaves being punished and Ku Klux Klan lynchings, often made to publicize and celebrate these heinous acts, said Deirdre Cooper Owens, a professor and the director of the Humanities in Medicine Program at the University of Nebraska. “There is a long memory and expectation extending from slavery that Black suffering be public,” she said.

But Cooper Owens does not call for censorship of images. Instead, she points to the gratuitous nature of their sharing as a problem. Why, she asked, should Black people be subject to “the overrepresentation of our trauma?”

Yet there’s little doubt that these kinds of videos helped to grow the Black Lives Matter movement into an urgent national protest. Their viral nature forced society and even the global community to witness the brutality so many wanted to deny.

Some people of color are careful to consume in small doses to protect their equilibrium: “Anytime I decide to watch any of these videos, I always think before I do it. Once you see it, you can’t unsee it,” said Michelle Stafford (@divayogi), 42, a yogi and healer in Baltimore. After watching the video of Floyd, she said, “I took a shower. I was feeling so anxious, my heart rate was up. If I’m feeling this way in my house, in a safe space, I can only imagine what people in other circumstances are feeling.”

She is trying to help others in her community process their feelings by leading regular yoga sessions via Zoom, followed by group discussions, that are payment-optional. Kyaira Carter, 26 (@yokyni), offers similar sessions in Houston. “I want to use my platform to remind the Black community that healing is possible for us,” she said.

But Shannon Johnson, 37, of Los Angeles said watching these videos and discussing Floyd’s death on social media — however painful — helped her process what she saw and might force others to face buried truths. “I think if we can talk about everything else, we can talk about the uncomfortable stuff.”

As a script consultant and fan of horror films, she said she is somewhat “desensitized” to violence, so going through the hashtags reminds her of the reality of being Black in America. “When people say George Floyd’s name,” she said, “I see the video.”

She and many others credit the videos for helping to grow the Black Lives Matter movement into an urgent national conversation.

As a social media manager, I wonder if those of us in this field should be doing more to help users navigate this traumatic moment.

If you type the word “suicide” into your Twitter search bar, you are immediately presented with an embedded message that reads “Help is available,” as well as a phone number and link to the National Suicide Prevention Lifeline website.

If sensitive content such as the video of Floyd’s death and countless others like it is allowed on social media platforms, why shouldn’t that content be flagged with additional support and resources?

“There is a general lack of understanding from the social media industry about the effects of repeatedly consuming disturbing content,” said C. Vaile Wright, senior director of health care innovation at the American Psychological Association.

For instance, images that depict gratuitous gore and certain sexual content are not allowed on Twitter, but sensitive content such as the video of Floyd’s death does not break Twitter’s rules. It is allowed to appear on the platform, but it should appear with an interstitial — a filter that warns of sensitive content and blurs the content until you click and agree to see it, said Lauren Alexander, a senior manager on the product communications team at the Twitter HQ in San Francisco.

Video hashing tools are used across the social media industry to prevent re-uploads of violent videos, but they can’t stop re-uploads of versions that have been altered or edited. Likewise, the interstitial warnings may disappear when sensitive videos are edited and re-uploaded, as is the case with viral content, such as the killing of George Floyd.

One option is for users to adjust their safety settings on Twitter to block sensitive content and disable the autoplay function of videos on their timelines. “What we are trying to do and how we approach sensitive media is to not be the decision-maker, Alexander said. “We are not mental health providers.” She pointed out that she has more choice in what to watch on social media than if she kept CNN on in the background, where the video of the killing played repeatedly.

What’s clear is that simply unplugging isn’t adequate advice for communities of color trying to cope with the effects of vicarious trauma. Sometimes, as Ebhojiaye said, “it’s important to really process, why are you so emotional?” When you have that awareness, you can work toward taking action in a way that you feel is empowering, she said.

For me, watching Floyd’s agonizing death caused me to confront the pain of a lifetime of digesting racist and colorist messaging that seemed to scream, “Your skin is too dark, your hair is too kinky, your voice does not matter, your life does not matter!”

Viewing that video and other images that assault people who look like me is part of my profession. It can be very hard to steel yourself against the pain you see.

Part of my healing has involved reminding myself that I am both beautiful and worthy. That’s something I do through the art of storytelling, songwriting, performance art — and writing like this.

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Mental Health Public Health Race and Health

Readers And Tweeters Ponder Racism, Public Health Threats And COVID’s Cost

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.


Rising Above Racism

I want to compliment writer Anna Almendrala on her article “Masked or Not, Asians Are Still Attacked” in the Los Angeles Times (“Hate Unmasked In America, May 29). I was deeply moved by her eloquent prose and her compassionate voice. During this difficult time, after being cruelly attacked by a neighbor, she was still able to respond to an egregious insult with an impressive amount of empathy. I hope that readers learn from her example. I have.

— Jayne Muñoz, Santa Ana, California


— Barbara Glickstein, New York City


Threats Against Public Health Workers

Thank you for publishing the story describing the dire threats that public health professionals have received (“Public Health Officials Face Wave Of Threats, Pressure Amid Coronavirus Response,” June 12). I left an academic career in public health, as the former director of prevention and control for the Cancer Center of Hawaii, because of institutional racism. But that pales in comparison to what these professionals are being subjected to.

— Dr. Brian Martin, Portland, Oregon


I would have liked the authors of this article to also have mentioned what percentage of the officials who quit or were fired were female. I have noticed since the beginning that most state and local health officials are female. (Noticed it is the same in Canada.) And did they investigate/consider whether that fact has also played a part in the hostility and threats?

— Ann-Marie Tate, Phoenix

Editor’s note: Please be on the lookout for follow-up stories, produced in partnership with The Associated Press, which will include more data. 


— Dr. Faiz Kidwai, Syracuse, New York


Lessons In Holistic Healing

The long history of mistreatment and distrust between Native Americans and the federal government is no secret (“Returning to Roots, Indian Health Service Seeks Traditional Healers,” May 14), but I find that myself and many of my peers in medical school have limited knowledge when it comes to the health care of Native Americans. This article provides an enriching example of the importance of cultural diversity and holistic medicine.

In the era of medicine where chronic diseases such as cardiovascular disease are the most common cause of death, there are no treatments that “cure” conditions as there are with many infectious diseases. As such, treatment relies on addressing risk factors, lifestyle changes, and the social environment. While the advancement of modern medicine is nothing short of remarkable, there is something to be learned from the traditional healers of the Native American reservations. They seek not only to treat physical conditions, but also to address the “mental, emotional, and spiritual needs” of the community, as so elegantly stated in the article. This comprehensive approach to medicine is perhaps more suitable to the chronic diseases we see today, where cardiovascular disease is intertwined with risk factors such as poor diet, low income, distrust of medicine, etc.

The recruitment of traditional healers by the Indian Health Service, a federally funded organization, gives me hope that not only is the government starting to accept the importance of cultural diversity, but that it is beginning to acknowledge a more holistic approach to medicine.

— Brandon Jocher, St. Louis


— Brett Chapman, Tulsa, Oklahoma


Their Lives Did Count

I watched Dr. Elisabeth Rosenthal on CNN and related to her story “First-Person Perspective: My Mother Died Of The Coronavirus. It’s Time She Was Counted,” May 27). I lost two parents. Ten hours apart. In two different New York City hospitals. One came from a skilled nursing facility. One came from an independent living facility. 92 and 93 years old. Neither of them “counted.” It’s a terrible feeling. Their lives surely counted, but not their deaths.

— Robin Tolkoff Levy, Owings Mills, Maryland


On Dentists Cleaning Up

I saw your article on increased dental fees (“Open (Your Wallet) Wide: Dentists Charge Extra For Infection Control,” June 3). It is very true. I am a private practice dentist and am facing increased “disposable goods” costs, as well as additional trash collection fees, and have hired an additional staff member whose sole task is cross-contamination prevention. I am forced to pass these charges along to the patients.

To the patients interviewed in your article who were “shocked” by the added fees, you can look for a dentist who will not have to increase his or her fees — but you likely won’t find one. I have had a few patients refuse to pay the charge and they are dismissed from my practice. When they realize that our charges are reasonable and call to try and get an appointment (and 80% do), we won’t make them an appointment. “But there isn’t another dentist in 200 miles who takes my insurance,” they complain. Shouldn’t have complained.

Several local dentists have retired completely because they couldn’t (or chose not to)  keep up with the changes. We are booked into November. On the plus side, my existing patients are thrilled to be able to be seen and arrive early, don’t balk at having to wait in the parking lot and are extremely pleased with our efforts to avoid cross-contamination. My rate of “missed appointments” is way down.

Dentistry now outpaces logging and fishing as the most hazardous job on the planet. We went from being the brunt of jokes to valued members of the health care community.

In 1962, there were 100,000 dentists, 100,000 physicians and 70,000 attorneys. Today there are about 190,000 dentists, 950,000 physicians and 1.1 million lawyers. Earning a dental degree requires more than a quarter of a million dollars. There is a reason modern dental care is so expensive — because it is worth it.

— Dr. William Hartel, Bristol, Tennessee


— Jennifer Hyk, Sioux Falls, South Dakota


Not only am I disturbed by the inflammatory title, but also by the tone of this article. I am waiting for one journalist to actually do some research and find out exactly the level of expense related to all the new (and ever-changing) rules and regulations related to patient safety because of COVID-19. These additional measures are costly and ongoing. Add to that the fact that many suppliers are acting like black-market profiteers by escalating their costs. It’s almost like Martin Shkreli bought out all the supply chains that provide PPE.

The dental offices you covered in your article all handled this exactly how the CDC, OSHA, ADA and almost every state dental organization has recommended. This is not a routine “cost of doing business.” For offices contracted with the dental “insurance” companies, the offices are contractually forbidden to charge above the usual, customary and reasonable (UCR) cost dictated by the companies. In short, if the dentist tries to bundle the fee into the cost of a procedure, he/she will not be reimbursed by the insurance companies. Bottom line: The dentist is expected to eat the cost.

In contrast to what the general public may think, the great majority of dentists are not millionaires. They are hardworking men and women who sacrificed eight additional years of their early adulthood to learn their specialty. Many graduate from dental school with loans in excess of $250,000, which is close to what the average American spends to buy a home. Once in practice, they are pushed around by the dental “insurance” Goliaths that have not increased their average annual “benefit” maximum since the 1960s. Oh, and let’s not discount this increasingly litigious society that directly affects annual malpractice premiums.

These dentists endure all of this. They carry the responsibility of usually being a solo business owner, leader of a team and responsible for them and their families, having to deal with constantly changing local, state and national regulations, ever-increasing license and business costs, and possibly being exposed to a deadly disease on a daily basis. (By the way, I’m not lumping COVID in with “deadly disease” — I’m talking about deadly diseases like hepatitis, tuberculosis, HIV, etc.).

I don’t know of any dentist who has gotten one red cent in “unemployment benefits” during the past three months. Yes, they may have received PPP money, but guess what? That goes straight to expenses or must be paid back. This is quite different from the unemployment benefits that millions of American employees have received since the middle of March.

Lastly, for those patients who are complaining about the $10 PPE fee, I wonder how many of them drop at least that much within two days of going to their local Starbucks? I’m willing to bet it’s a pretty high percentage of them. It’s almost as if those people value their full-fat, whipped-cream, half-caf, double shot, venti mochaccino more than they do their oral and general health.

— Dr. Gerilyn Alfe, Chicago


‘Lost on the Frontline’: Beyond The Statistics

Not sure why this is a story (“Lost on the Frontline: Exclusive: Nearly 600 — And Counting — US Health Workers Have Died Of COVID-19,” June 6). The ratio of COVID deaths in health care workers to the number of health care workers (about 600 of 16 million) is the same as the national rate (about 11,000 of 328 million) and is virtually the same as the world rate (about 400,000 of 7.8 billion). Presenting the death toll in that light would show that health care workers are contracting COVID at the same rate as everyone else. We’re not special (in the eyes of disease). Who’d a thunk?

— John Coburn, Atascadero, California


— Julie Fairman, Philadelphia


This is a wonderful service. Thank you for doing it. They are the heroes in this world and should be memorialized. I’m a retired surgeon and have nothing but awe for every single one of these people and their efforts on our behalf.

One request: Dr. Atul Gawande and others have indicated that “properly protected” health care workers have a very low risk of infection with SARS CoV-2. It would be beneficial to all of us if you could perhaps publish weekly a tally of those who have passed and how many of those were wearing adequate PPE. I’m particularly interested in how well surgical masks protect people (as opposed to N95, which we know work but don’t have enough of), so having that tidbit of information would be great. Thanks again so much for your work and dedication.

— Dr. Robert Ley, Aptos, California


I read the article and sent it to family and friends. Everyone was very pleased and also saddened. Once people see all the faces and the different occupations, it seems to be a collective gasp. Thank you again for reaching out to me so that I could be a part of this expression of love, knowledge, informative journalism and dedication.

Barbara Abernathy, Chicago, mother of Michelle Abernathy, a residential services supervisor who died of COVID-19 on April 13


— Laura Elena Belmonte, Albuquerque, New Mexico


I just wanted to drop you a note of thanks for your ongoing documentation of medical workers killed by COVID-19 in the line of duty. Our charity is dedicated to providing recognition and support for both medical services personnel who become casualties, and their families who suffer loss, as a result of the providers’ care for patients in the fight against COVID-19 and infectious disease. So we’re very appreciative of your efforts and hope that we can do more to support these incredible people.

— Kevin Higgins, president of The Fallen Providers Project Inc., Lebanon, Ohio


— Nancy Quinn, Concho, Arizona


In your “Lost on the Frontline” series, respiratory therapists are not mentioned as health care providers. They intubate and place patients who have difficulty breathing on life support. They make up an important front-line team that manages the ventilators and helps with transport while patients are on life support. Respiratory therapists work with COVID-19 patients and many have been exposed — in the ICU. The doctors, nurses — and respiratory therapists — are the main people in the COVID-19 rooms!

— Barb Homberger, Virginia Beach, Virginia


Steer Clear Of ‘Painkillers’

While I appreciate the info and public education on the need to be prepared (“Asking Never Hurts: Society Is Reopening. Prepare To Hunker Down At Home Again,” June 9), I think using the term “painkillers” in this article was not the best choice of words. If your point is to educate people to have medications that help relieve body aches from the virus, using a different term such as OTC pain relievers (Tylenol, etc.) is more appropriate.

Many people think the term painkiller means opioids/narcotics. We are in the middle of an opioid crisis, so using that term should be avoided if we are encouraging people to make sure they are prepared for the coronavirus.

— Amy Krajec, Oceanside, California


A Missed Opportunity To Educate

You are missing an important opportunity with this story (“A Teen’s Death From COVID,” June 15). You glossed over the importance of diabetic ketoacidosis (DKA) and focused mainly on the positive COVID test. This boy died from something that, if caught early enough, Type 1 diabetes, is entirely manageable. There are many groups and families trying to work and raise awareness about DKA and the warning signs of Type 1 diabetes. This story could have helped these efforts. If more had been known, that child may not have died. His symptoms were normal for advanced DKA and coma associated with that. Organizations like Beyond Type 1, Project Blue November and Kisses for Kycie have been trying to raise awareness of the symptoms of DKA and need help from the media. Too many children die needlessly in this country and around the world each year from undiagnosed Type 1 diabetes. Not to undermine the reporting and seriousness of COVID-19, but we are fighting an uphill battle to raise awareness and save lives.

— Carrie Berry, Austin, Texas


— Rob Szczerba, Pittsburgh


I was overwhelmed by the story about Andre Guest’s battle with COVID-19 and his passing. I can’t get it out of my head. Cry every time I think about that sweet, beautiful child devastated by this thing. Is there a way to let the parents know my thoughts are with them?

— Kevin Orton, Newcastle, Washington


While this is a tragic story, the reporting is not thorough and the stated facts are concerning, indicating possible negligence of care.

Despite this teen’s age, obesity is a known and well-reported underlying condition associated with higher mortality in those who are infected with the coronavirus. And, for still unknown reasons, so is being Black. Although the article does not mention in the text either contributing factor, the accompanying photos show them clearly.

The article states: “Although Andre had no underlying medical conditions, the first thing doctors discovered was that he had developed Type 1 diabetes. …” It is also well known that obesity and diabetes are comorbidities. While a recent COVID-19 finding is a possible potential for the development of acute diabetes, this teen’s obesity should have alerted health care professionals to the potential for diabetes and prior monitoring, especially considering it “was the first thing doctors discovered” in this case.

It is also known that autoimmune disease is associated with autism, although the precise etiology remains unknown. Diabetes is an autoimmune disease associated with increased mortality in COVID-19 patients.

The actual facts of this boy’s health and that the mother is a nurse and that this article originates from a major hospital system seems to imply ignorance and potential negligence of care. The bizarre inclusion of quotes about bedtime peanut butter and jelly sandwiches and video games implies further evidence of questionable lifestyle choices contributing to childhood obesity.

While this case does highlight the fact that young people can die from COVID-19, that this particular boy’s death would be publicized as an example that “perfectly healthy” young people are dying of COVID-19 is inaccurate. The real takeaway of this tragic story should be a focus on the fact that young people can and do have multiple underlying health concerns and that parents need to be informed and proactive in the health care of their children.

— Barbara Tefft, Newfield, New York


It Happened To Me

When I read your article about unusual symptoms in the elderly, it sounded like my experience (“Seniors With COVID-19 Show Unusual Symptoms, Doctors Say,” April 24). I am 77 and on the evening of March 2 something clicked off in my brain. When speaking, all that came out of my mouth was gibberish. I went to bed but don’t remember doing that. My alarm went off at 6 a.m. — I had an appointment at 9 a.m. for chemotherapy and my daughter was coming to pick me up for that appointment. When I got up at 6, I could not figure out what I was supposed to do. I could not figure out how to get dressed, so I went back to bed. The doorbell rang at 8 a.m. I got up but was in some kind of fog.

We live in a two-story house. I went to the top of the stairs and kept walking. I fell facedown and bounced down the stairs. My daughter called 911. I do not remember the paramedics coming or the 18 hours I spent in the ER. My daughter said I never spoke a word during that time. When spoken to, she said, I would get a confused look on my face but never spoke. I did not have a stroke. An MRI showed no clots or bleeds. I woke up the next morning and was able to speak and answer questions.

I was in the hospital for 10 days due to my injuries related to the fall. I am doing fine now. The doctors were never able to come up with a reason for what happened. He said we’ll just call it a TIA (transient ischemic attack) because we don’t know what else to call it. But my symptoms were not those caused by a TIA. I am wondering if what happened could have been caused by COVID 19. The symptoms were so bizarre. It frustrates me not to know the cause. I only hope that reliable antibody tests might eventually provide an answer.

— Kathy Oldershaw, Visalia, California


— Amy Abrams, San Diego


Cutting Through The Confusion

The article “Antibody Tests Were Hailed As Way To End Lockdowns. Instead, They Cause Confusion” (May 28) is misleading and reflects incomplete reporting.

  1. Both the FDA and the CDC have suggested doing two independent antibody tests to confirm a positive finding in low prevalence areas. The FDA has had those data pertaining to test accuracy posted for a long time.
  2. This story ignores the many other places in the USA and abroad that have done seroprevalence studies.
  3. There is an indication for using antibody testing: the large number of people who had classic COVID-19 symptoms and clinical course but who were told to stay home and were never tested. It’s too late to do antigen studies on them. They need antibody testing to confirm the diagnosis.
  4. People with symptoms shed antigen for perhaps 10-14 days or even longer. But testing for antigen later in the disease can yield negative findings and antibody testing can be useful.
  5. The “gold standard” antigen test can be falsely negative 30-40% of the time.
  6. Then there is the problem of the large numbers of asymptomatic persons with the disease. Antigen testing can be misleading, too. Antibody testing plays a role.
  7. Given the complex nature of the disease, the timing of testing both for antigen and antibodies is critical. That’s why the instructions for use (IFUs) for antibody tests break down test results in terms of days since symptom onset.
  8. Just because the disease is complex does not mean that testing should not be done. What is needed is a better understanding and less media bashing of manufacturers and labs.
  9. Why don’t you interview some of the professors who have done seroprevalence testing and who have the required academic credentials you approve of?
  10. This report sounds like the ones that were written weeks ago. Nothing new here.
  11. Those of us who participate in the weekly live FDA town hall webinars have heard these issues discussed for weeks and seen them reported also.

— Dr. Brant Mittler, San Antonio, Texas


— Carmel Shachar, Cambridge, Massachusetts


Emergency Care’s Most Urgent Problem

The extortionate costs of ambulance services in California is worse than that ER bill (“Bill Of The Month: COVID-Like Cough Sent Him To ER — Where He Got A $3,278 Bill,” May 25). My daughter experienced a medical emergency while traveling in California. The first hospital where she received care arranged to transfer her to another hospital. The ambulance service selected by hospital A was outside her network. She has been hit with an $8,000 bill, which includes a $4,600 base rate and $2,645.50 for mileage (37 miles from hospital A to hospital B).

The selection of ambulance service was completely outside her control. Of course, a reasonable rate is appropriate, but this amount is extortionate and bears no relationship to the cost or value of the transport.

This should not be allowed to occur to anyone, but especially not to someone who is not in a position to select their own provider. Apparently, the hospital staff arranging the transfer confirmed that hospital B was within the insurance network, but did not confirm the status of the ambulance service.

I am outraged by the impact of this incident on my family and suspect others have also been treated this way. This is price gouging at its worst! This practice should also be exposed by KHN.

— Bobbie Gregg, Dallas


— Daniel Sosnoski, Jacksonville, Florida


I was a nurse contractor in San Jose, California, when I started getting short of breath and experiencing chest pain. I went to the Valley Health emergency room, the one closest to me, and I received an $8,000 ER bill. I can’t afford to pay this bill and our insurance didn’t pay. I’m trying to negotiate the bill, but I was never tested for COVID-19 while there, which I found out I had after I returned home to Houston. Ridiculous charge for a non-traumatic ER visit.

— Kelly Lenz, Houston


— Devon Seeley, Salt Lake City


Perhaps the most important takeaway is not that his bill was coded incorrectly, but that we need low-cost urgent care facilities that are open 24/7, so that we are not billed thousands of dollars for simple tests or a couple of stitches. How many people go into debt or go untreated because basic services are simply not available?

— Isabel Cabanne, Glencoe, Illinois


Getting The COVID Code Right

I am a certified professional medical coder, and love your podcast, as I am also a grad student majoring in epidemiology. I listened to the episode in which Phil Galewitz suggested patients should tell their health care providers to code “possible COVID-19” in order to avoid the bill for services (“KHN’s ‘What The Health?’: Still Seeking A Federal Coronavirus Strategy,” May 28).

This is incorrect; national coding guidelines prohibit coders to code “suspected, possible or rule-out diagnoses.” Health care providers as well are not able to document such conditions until confirmed by a test, study or another diagnostic means, described as “gold standard” for that specific condition. This rule is described in “ICD-10-CM Professional for Physicians” manual, 2020.

What UnitedHealthcare stated was correct: It is unable to recognize a claim for COVID-19 when an ICD-10 diagnosis for it (U07.1) was not reported. The proper procedure would have been to get the patient tested, defer the claim processing until the results came back, and then report the U07.1 as the reason for the encounter. When a patient is not tested, the proper coding initiative would be to report symptoms only, which of course would not suffice for the copay reduction initiative. However, a patient would have the option to request that Denver Health appeal the claim with proof of documentation, which would require them to submit a provider’s note from the visit and prompt UHC to manually review the claim and have it reprocessed.

Overall, this is a common reason certain claims are not covered by payers, but there are multiple stipulations in terms of coding guidelines that limit what can be coded for any particular encounter.

— Ksenia Brewster, Poquoson, Virginia

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Listen: Navigating The Pandemic And Protests As The U.S. Reopens

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KHN Midwest correspondent Cara Anthony appeared on Illinois Public Media’s “The 21st” with host Brian Mackey in a reporter’s roundtable about the latest on the coronavirus pandemic and the civil rights protests. After the protests highlighted police brutality and systemic racism, she reported on the unwritten rules that Black teens learn to try to cope with the mental health burden of other people’s racist assumptions.

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