African Americans make up 44% of Philadelphians but 55% of those hospitalized for COVID-19.

This article was published on Tuesday, October 13, 2020 in Kaiser Health News.

By Nina Feldman, WHYY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"When the time comes, we'll be ready," she said. "But it's not today."

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

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

This article was published on Monday, October 12, 2020 in Kaiser Health News.

By Lauren Weber

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

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

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

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

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

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

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

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

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

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

"COVID is just a different scale," she said.

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

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

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

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

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

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

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

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

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

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

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

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

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

Lauren Weber: LaurenW@kff.org, @LaurenWeberHP

The shift away from Trump may reflect industry expectations that Democratic presidential candidate Joe Biden will win.

This article was published on Friday, October 9, 2020 in Kaiser Health News.

By Jay Hancock

Pharmaceutical giants Regeneron and Gilead Sciences got the kind of publicity money can't buy this week after President Donald Trump took their experimental drugs for his coronavirus infection, left the hospital and pronounced himself fully recovered.

"It was, like, unbelievable. I felt good immediately," Trump said Wednesday in a tweeted video. "I call that a cure."

He praised Regeneron's monoclonal antibody cocktail, which mimics elements of the immune system, and mentioned a similar drug under investigation by Eli Lilly and Co. The president also took Gilead's remdesivir, an antiviral that has shortened recovery times for COVID-19 patients in early research.

There is no scientific evidence that any of these drugs contributed to the president's recovery, since many patients do fine without them. It is also not known whether the president has been "cured," since the White House has released few specifics about the course of his illness.

Yet as his campaign for reelection enters its final stretch, Trump is not feeling the love in campaign contributions. Regeneron, Gilead, Lilly and the industry as a whole are sending more money elsewhere.

Reversing a trend in which contributions from drugmakers' political committees and their employees have gone largely to Republican candidates for president and Congress, so far for 2020 the industry has tilted toward Democrats.

The shift may reflect industry expectations that Democratic presidential candidate Joe Biden will win, said Steven Billet, who teaches courses in corporate lobbying and political donations at George Washington University. Pharma companies may see campaign largesse as leverage if Biden follows through on promises to address high drug prices, he said.

In a year when complaints about high prescription drug prices have been overshadowed by the pandemic, donors with ties to pharma manufacturers have given around $976,000 to Biden, according to data from the Center for Responsive Politics. That's nearly three times the pharma contributions to Trump, who recently switched his tune from complaining about "rip-off" prescription prices to describing drug firms as "great companies."

"Traditionally the industry tends to favor Republicans," said Sarah Bryner, CRP's research director. "But this cycle, we're seeing that flipped," partly reflecting Democrats' overall greater success in fundraising, she said.

Pharmaceutical companies and their trade groups have a history of supporting Trump and other Republicans indirectly through hard-to-trace "dark money" nonprofits. But those contributions may not be disclosed until long after the election, if ever.

Of $177,000 given so far to 2020 federal candidates by Regeneron's employees and political action committee, four-fifths have gone to Democrats, including $35,203 to Biden, according to CRP.

Regeneron CEO Leonard Schleifer, a billionaire who has known Trump for years and belongs to the Trump National Golf Club Westchester in New York's Westchester County, has a long history of giving to Democrats. He gave $5,400 to Hillary Clinton's 2016 presidential run and $120,000 in 2018 to a political action committee attempting to flip the Senate to Democratic control.

Schleifer has made no registered political donations since last year, when his contributions went mainly to his son, Adam Schleifer, a Democrat running for Congress who lost in a primary this summer.

North Carolina Sen. Thom Tillis, representing a state with a large biotech industry and running for reelection in a tight race, has been the biggest Republican recipient of Regeneron dollars for 2020 races, tallying $5,526 so far.

"This is a company that looks as though they've always been committed to Democrats," said Billet, a former AT&T lobbyist who teaches PAC management. "And my guess is they just have a Democratic culture in this company."

A spokesperson for Regeneron, which has applied for emergency use authorization to bypass the Food and Drug Administration approval process for its drug, declined to comment on campaign donations and said the company will continue clinical trials.

The drug is expected to cost thousands of dollars per dose. "You're going to get them for free," Trump said of the COVID-19 drugs he took. The government has agreed to make initial doses of Regeneron's antibody treatment "available to the American people at no cost," the company says.

But details of the contract, including the price, remained secret. In any event, if patients get the drug at no direct cost, "it doesn't mean they're not paying for it," said James Love, director of Knowledge Ecology International, a nonprofit that works to expand access to medical technology. "They're just paying for it through taxes."

The government is giving Regeneron $450 million to make and supply the antibody cocktail.

Donors with Gilead ties also lean left, giving two-thirds of their roughly $284,000 in contributions so far this cycle to Democratic candidates for Congress and president, the CRP data shows, including about $36,000 to Biden.

At Lilly, where Health and Human Services Secretary Alex Azar once ran the U.S. division, 54% of the money has gone to Democrats and 46% to Republicans. Lilly employees have given $45,000 to Biden and $13,000 to Trump, according to CRP.

Biden does not accept donations from corporate PACs; all his Regeneron, Lilly and Gilead dollars came from their employees.

Much of this year's overall pharma shift to Democrats comes in the presidential race. KHN's Pharma Cash to Congress data tracking sitting members still shows a preference this cycle of pharma PACs targeting congressional Republicans, $6 million so far compared with $4.7 million given to Democrats.

"Joe Biden has Big Pharma — as well as Big Tech and big banks — in his pocket because he's worked for them for nearly 50 years, rather than the American people," said Samantha Zager, a spokesperson for the Trump campaign.

On the campaign trail, Biden has focused largely on improving health insurance. But he also proposes letting Medicare negotiate drug prices, tying drug-price increases to inflation and allowing patients to buy imported pharmaceuticals.

Biden "will further reduce healthcare costs while expanding coverage, end practices like surprise billing, lower premiums and stand up to abuses of power by prescription drug companies," said campaign spokesperson Rosemary Boeglin.

Before Trump took office, he said pharma companies were "getting away with murder" over the prices they charge. Despite the president's claims and promises, he has done little to lower prescription drug prices, according to experts and fact-checkers.

A Trump executive order this month would require Medicare to pay no more for drugs than other developed nations, but it starts with a test program and could take months or years to implement.

Pharma companies were among the biggest beneficiaries of Trump's 2017 tax cut, saving billions by being able to bring home untaxed foreign cash and billions more in lower rates.

KHN data editor Elizabeth Lucas contributed to this report.

Jay Hancock: jhancock@kff.org, @JayHancock1

Financial fears reignited this year when Matthew Fentress' cardiologist suggested he undergo an ablation procedure to restore a normal heart rhythm.

This article was published on Thursday, October 8, 2020 in Kaiser Health News.

By Laura Ungar

Even with insurance, Matthew Fentress faced a medical bill of more than $10,000 after a heart operation. A cook at a senior living community in Kentucky, he figured he could never pay what he owed — until a stranger who lives 2,000 miles away stepped in to help.

“The system still failed me,” said Fentress, 31. “It was humanity that stepped up.”

Karen Fritz, a retired college professor in Las Vegas, saw part of his story on “CBS This Morning,” which partners with KHN and NPR on the crowdsourced Bill of the Month investigation. Fritz found the story online, and then she called the hospital to donate $5,000 toward Fentress’ bill.

“I’ve been a young person in college with medical bills. I just really felt convicted to help him out, to help him get beyond his financial struggles. I had no hesitation; I felt led by the Holy Spirit to do that,” said Fritz, 64, who taught business and marketing at various schools. “When you help other people, it gives you joy.”

Fentress was just 25 when doctors diagnosed him with viral cardiomyopathy, a heart disease that developed after a bout of the flu. In his six years of grappling with that chronic condition, which could lead to heart failure, he had already been sued by his hospital after missing a payment and declared bankruptcy.

Financial fears reignited this year when his cardiologist suggested he undergo an ablation procedure to restore a normal heart rhythm. He said hospital officials at Baptist Health Louisville assured him he wouldn’t be on the hook for more than $7,000, a huge stretch on his $30,000 annual salary.

Though the procedure went well, the bill filled him with dread. His portion totaled more than $10,000 for the ablation and related visits in 2019 and 2020. After an adjustment, a spokesperson for his insurer, United Healthcare, said he owed nearly $7,900. That was the same as the annual out-of-pocket maximum for in-network care under his plan, which also included a $1,500 annual deductible. Like millions of other Americans, Fentress is considered underinsured.

Fentress said he learned about Fritz’s donation when he got a call from a hospital representative. He submitted a recent pay stub to the hospital, and its financial aid program covered the rest.

Hospital officials said Fentress at one point had been under the incorrect impression that he’d have to pay big monthly payments and couldn’t apply for financial assistance because he’d gotten it before.

“Baptist Health consistently has encouraged Mr. Fentress to apply for financial assistance to provide the information we need to determine a qualifying amount,” Charles Colvin, Baptist Health’s vice president for revenue strategy, said in a statement. “We are pleased to have received the additional information needed to provide that financial assistance.”

Fentress said he’s incredibly grateful to Fritz. He plans to stay in touch with her, and he’s sending her a T-shirt he designed with a picture of a heart and the words “Be nice.”

“This is the first time ever since I was 25 that I haven’t had medical debt. It’s a wonderful feeling. It gives me a lot of peace of mind,” Fentress said. “But I feel guilty that a lot of other people are still suffering.”

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