People of color are disproportionately affected by the coronavirus. It is not merely because they're more likely to have front-line jobs that expose them to it and the underlying conditions that make COVID-19 worse.
This article was published on Wednesday, October 21, 2020 in Kaiser Health News.
In mid-March, Karla Monterroso flew home to Alameda, California, after a hiking trip in Utah's Zion National Park. Four days later, she began to develop a bad, dry cough. Her lungs felt sticky.
The fevers that persisted for the next nine weeks grew so high — 100.4, 101.2, 101.7, 102.3 — that, on the worst night, she was in the shower on all fours, ice-cold water running down her back, willing her temperature to go down.
"That night I had written down in a journal, letters to everyone I'm close to, the things I wanted them to know in case I died," she remembered.
Then, in the second month, came a new batch of symptoms: headaches and shooting pains in her legs and abdomen that made her worry she could be at risk for the blood clots and strokes that other COVID-19 patients in their 30s had reported.
Still, she wasn't sure if she should go to the hospital.
"As women of color, you get questioned a lot about your emotions and the truth of your physical state. You get called an exaggerator a lot throughout the course of your life," said Monterroso, who is Latina. "So there was this weird, 'I don't want to go and use resources for nothing' feeling."
It took four friends to convince her she needed to call 911.
But what happened in the emergency room at Alameda Hospital only confirmed her worst fears.
At nearly every turn during her emergency room visit, Monterroso said, providers dismissed her symptoms and concerns. Her low blood pressure? That's a false reading. Her cycling oxygen levels? The machine's wrong. The shooting pains in her leg? Probably just a cyst.
"The doctor came in and said, 'I don't think that much is happening here. I think we can send you home,'" Monterroso recalled.
Her experiences, she reasons, are part of why people of color are disproportionately affected by the coronavirus. It is not merely because they're more likely to have front-line jobs that expose them to it and the underlying conditions that make COVID-19 worse.
"That is certainly part of it, but the other part is the lack of value people see in our lives," Monterroso wrote in a Twitter thread detailing her experience.
In the hospital that day in May, Monterroso was feeling woozy and having trouble communicating, so she had a friend and her friend's cousin, a cardiac nurse, on the phone to help. They started asking questions: What about Karla's accelerated heart rate? Her low oxygen levels? Why are her lips blue?
The doctor walked out of the room. He refused to care for Monterroso while her friends were on the phone, she said, and when he came back, the only thing he wanted to talk about was Monterroso's tone and her friends' tone.
"The implication was that we were insubordinate," Monterroso said.
She told the doctor she didn't want to talk about her tone. She wanted to talk about her health care. She was worried about possible blood clots in her leg and she asked for a CT scan.
"Well, you know, the CT scan is radiation right next to your breast tissue. Do you want to get breast cancer?" Monterroso recalled the doctor saying to her. "I only feel comfortable giving you that test if you say that you're fine getting breast cancer."
Monterroso thought to herself, "Swallow it up, Karla. You need to be well." And so she said to the doctor: "I'm fine getting breast cancer."
He never ordered the test.
Monterroso asked for a different doctor, for a hospital advocate. No and no, she was told. She began to worry about her safety. She wanted to get out of there. Her friends, all calling every medical professional they knew to confirm that this treatment was not right, came to pick her up and drove her to the University of California-San Francisco. The team there gave her an EKG, a chest X-ray and a CT scan.
"One of the nurses came in and she was like, 'I heard about your ordeal. I just want you to know that I believe you. And we are not going to let you go until we know that you are safe to go,'" Monterroso said. "And I started bawling. Because that's all you want is to be believed. You spend so much of the process not believing yourself, and then to not be believed when you go in? It's really hard to be questioned in that way."
Alameda Health System, which operates Alameda Hospital, declined to comment on the specifics of Monterroso's case, but said in a statement that it is "deeply committed to equity in access to health care" and "providing culturally-sensitive care for all we serve." After Monterroso filed a grievance with the hospital, management invited her to come talk to their staff and residents, but she declined.
She believes her experience is an example of why people of color are faring so badly in the pandemic.
"Because when we go and seek care, if we are advocating for ourselves, we can be treated as insubordinate," she said. "And if we are not advocating for ourselves, we can be treated as invisible."
Unconscious Bias in Health Care
Experts say this happens routinely, and regardless of a doctor's intentions or race. Monterroso's doctor was not white, for example.
Research shows that every doctor, every human being, has biases they're not aware of, said Dr. René Salazar, assistant dean for diversity at the University of Texas-Austin medical school.
"Do I question a white man in a suit who's coming in looking like he's a professional when he asks for pain meds versus a Black man?" Salazar said, noting one of his own possible biases.
Unconscious bias most often surfaces in high-stress environments, like emergency rooms — where doctors are under tremendous pressure and have to make quick, high-stakes decisions. Add in a deadly pandemic, in which the science is changing by the day, and things can spiral.
"There's just so much uncertainty," he said. "When there is this uncertainty, there always is a level of opportunity for bias to make its way in and have an impact."
Salazar used to teach at UCSF, where he helped develop unconscious-bias training for medical and pharmacy students. Although dozens of medical schools are picking up the training, he said, it's not as commonly performed in hospitals. Even when a negative patient encounter like Monterroso's is addressed, the intervention is usually weak.
"How do I tell my clinician, 'Well, the patient thinks you're racist?'" Salazar said. "It's a hard conversation: 'I gotta be careful, I don't want to say the race word because I'm going to push some buttons here.' So it just starts to become really complicated."
A Data-Based Approach
Dr. Ronald Copeland said he remembers doctors also resisting these conversations in the early days of his training. Suggestions for workshops in cultural sensitivity or unconscious bias were met with a backlash.
"It was viewed almost from a punishment standpoint. 'Doc, your patients of this persuasion don't like you and you've got to do something about it.' It's like, 'You're a bad doctor, and so your punishment is you have to go get training," said Copeland, who is chief of equity, inclusion and diversity at the Kaiser Permanente health system. (KHN is an editorially independent program of KFF, which is not affiliated with Kaiser Permanente.)
Now, KP's approach is rooted in data from patient surveys that ask if a person felt respected, if the communication was good and if they were satisfied with the experience.
KP then breaks this data down by demographics, to see if a doctor may get good scores on respect and empathy from white patients, but not Black patients.
"If you see a pattern evolving around a certain group and it's a persistent pattern, then that tells you there's something that from a cultural, from an ethnicity, from a gender, something that group has in common, that you're not addressing," Copeland said. "Then the real work starts."
When doctors are presented with the data from their patients and the science on unconscious bias, they're less likely to resist it or deny it, Copeland said. At his health system, they've reframed the goal of training around delivering better quality care and getting better patient outcomes, so doctors want to do it.
"Folks don't flinch about it," he said. "They're eager to learn more about it, particularly about how you mitigate it."
Still Unwell
It's been nearly six months since Monterroso first got sick, and she's still not feeling well.
Her heart rate continues to spike and doctors told her she may need gallbladder surgery to address the gallstones she developed as a result of COVID-related dehydration. She decided recently to leave the Bay Area and move to Los Angeles so she could be closer to her family for the long recovery.
She declined Alameda Hospital's invitation to speak to their staff about her experience, concluding it wasn't her responsibility to fix the system. But she wants the broader health care system to take responsibility for the bias perpetuated in hospitals and clinics.
She acknowledges that Alameda Hospital is public, and it doesn't have the kind of resources that KP and UCSF do. A recent audit warned that the Alameda Health System was on the brink of insolvency. But Monterroso is the CEO of Code2040, a racial equity nonprofit in the tech sector and even for her, she said, it took an army of support for her to be heard.
"Ninety percent of the people that are going to come through that hospital are not going to have what I have to fight that," she said. "And if I don't say what's happening, then people with much less resources are going to come into this experience, and they're going to die."
This story is part of a partnership that includes KQED, NPR and KHN.
This election cycle — coinciding with a looming threat to the Affordable Care Act and millions of people losing jobs and employer-sponsored health insurance during the pandemic — the high price of prescription drugs has gained new significance.
This article was published on Tuesday, October 20, 2020 in Kaiser Health News.
During the first presidential debate of 2020, President Donald Trump touted his efforts to curb skyrocketing drug prices and declared that insulin is now “so cheap, it’s like water.” The response on social media was swift, and divided, with some people sharing pharmacy bills showing thousands of dollars they’d spent on insulin, while others boasted of newfound savings.
The next day, a self-described progressive political action committee called Change Now jumped into the fray by releasing an ad that circulated on Facebook attacking Trump and Sen. Thom Tillis (R-N.C.) on this issue.
In the 30-second ad, a North Carolina woman in her 30s explains she was diagnosed with Type 1 diabetes at age 4.
“Donald Trump and Thom Tillis opposed legislation that would lower the price of insulin and other prescription drugs,” she says. “People with diabetes can’t afford to wait for Trump and Tillis to fight for us. … We need affordable insulin now.”
(Posts sharing the quote were flagged as part of Facebook’s efforts to combat false news and misinformation on its news feed. Read more about PolitiFact’s partnership with Facebook.)
In recent years, politicians on both sides of the aisle have committed to addressing the cost of insulin. This election cycle — coinciding with a looming threat to the Affordable Care Act and millions of people losing jobs and employer-sponsored health insurance during the pandemic — the high price of prescription drugs has gained new significance.
Tillis is in one of the most heated Senate races in the country and has been repeatedly criticized by his opponent for receiving more than $400,000 in campaign contributions from the pharmaceutical and health product industries. Across the country, many voters say lowering prescription drug costs should be the top health priority for elected officials.
So, did Trump and Tillis really oppose policies that would accomplish that goal? We decided to take a closer look.
It turns out they’ve both opposed certain pieces of legislation that could have lowered the price of insulin and other prescription drugs, but they’ve also offered alternatives. The question is how aggressive those alternatives are and how many Americans would benefit from them.
Opposing the Strongest Reforms
Change Now pointed to two congressional bills to support the ad’s claim: one opposed by Trump, and the other by Tillis.
The first bill, known as H.R. 3, passed the House in December 2019, largely due to Democratic votes. It contains three main elements: decreasing out-of-pocket costs for people on Medicare, penalizing pharmaceutical companies that raise the price of drugs faster than the rate of inflation and — the most aggressive and controversial feature — allowing the federal government, which administers Medicare, to negotiate the price of certain drugs, including insulin. It also requires manufacturers to offer those agreed-on prices to private insurers, extending the benefits to a wider swath of Americans.
Stacie Dusetzina, an associate professor of health policy at Vanderbilt University School of Medicine, called it “the broadest-reaching policy that has been put forward” on drug pricing.
“While a lot of reform has focused on Medicare beneficiaries, that misses many insulin users,” Dusetzina said. “H.R. 3 does the most to affect prices for young consumers, like the woman in the ad.”
At the time, Trump vowed to veto that bill, saying the price controls it imposed “would likely undermine access to lifesaving medications” by decreasing the incentive for companies to innovate. When we checked in with the Trump campaign about the ad, a spokesperson reiterated this position, adding that the president continues to seek better legislative options.
The House bill in question, though, never made it to the president’s desk because the Senate didn’t take it up. Instead, the Senate Finance Committee proposed its own bill, which brings us to the second piece of legislation cited by Change Now.
Known as the Prescription Drug Pricing Reduction Act of 2019, the Senate bill echoes two aims of the House proposal: decreasing out-of-pocket costs for people on Medicare and putting an inflation-based cap on some drug prices.
So, it’s true that Trump and Tillis have both opposed legislation that could lower the cost of insulin and other prescription drugs. But that’s not the full picture of what either politician has done on this issue.
Alternative Solutions for a Smaller Group of Americans
The Trump campaign provided a long list of actions taken by his administration to curb the high costs of medication, including a flurry of executive orders related to insulin and prescription drugs. Tillis’ campaign highlighted an alternative bill the senator co-sponsored to target drug costs. Let’s break them down one at a time.
One of Trump’s orders aims to have Federally Qualified Health Centers provide insulin and EpiPens at a discounted rate to the low-income individuals they serve. These centers, however, are already required to offer sliding-scale payments, and a full discount to patients who earn below the federal poverty line, said Rachel Sachs, an associate professor of law at Washington University in St. Louis, who tracks drug-pricing laws.
Another order deals with the importation of drugs from Canada, where they are often cheaper. Although the order specifically excludes biologic drugs, including insulin, the administration has requested proposals from private companies on how insulin could be safely brought in from other countries.
The president also issued a particularly ambitious order that seeks to tie the price Medicare pays for drugs to a lower international reference price. The Trump administration, however, hasn’t released final regulations to implement that policy, which could take years. If implemented, the policy is expected to be challenged in court by the drug industry.
Perhaps the most notable measure on insulin at the moment, experts said, is a federal demonstration project that Medicare plans can voluntarily opt into, to cap the monthly copay for insulin at $35 for some seniors. The project is slated to begin in January 2021, but its long-term future is uncertain, Sachs said, because it relies on parts of the Affordable Care Act, which could be struck down by a Supreme Court ruling later this year.
Tillis believes this is “the better option,” campaign spokesperson Andrew Romeo said, because “in addition to helping control drug prices, the legislation also seeks to preserve America’s capacity to research and develop lifesaving medications.” It includes a monthly cap on insulin copays for Medicare beneficiaries and requires manufacturers to disclose prices in consumer ads.
But experts said Tillis’ proposal is weaker than other options before the House and Senate. It doesn’t include an inflation cap, Sachs said, and the bill’s benefit would likely be limited to some seniors on Medicare, leaving out the more than 150 million Americans covered by private insurance.
Jason Roberts, an associate professor of political science at the University of North Carolina-Chapel Hill, said the bill is largely symbolic.
“Tillis is getting hit for not supporting a bill that could move,” Roberts said. “Instead, he introduces something that has no chance of going anywhere, and he knows that. But it’s a way of trying to deflect that criticism without getting a lot accomplished.”
Our Ruling
An ad sponsored by a progressive political action committee claims that Trump and Tillis have opposed legislation that would decrease the cost of insulin and other prescription drugs.
Based on the two pieces of drug-pricing legislation Change Now points to, that’s accurate. Trump and Tillis have voiced opposition to prominent bills that experts say could decrease the cost of insulin for a broad group of Americans.
However, both politicians have also proposed alternative policies to lower the price of insulin and other prescription drugs. Most of their proposals have not taken effect yet and are largely targeted at seniors.
For months, as Marilyn Walters has struggled to recover from COVID-19, she has repeated this prayer day and night.
Like other older adults who've become critically ill from the coronavirus, Walters, 65, describes what she calls "brain fog" — difficulty putting thoughts together, problems with concentration, the inability to remember what happened a short time before.
This sudden cognitive dysfunction is a common concern for seniors who've survived a serious bout of COVID-19.
"Many older patients are having trouble organizing themselves and planning what they need to do to get through the day," said Dr. Zijian Chen, medical director of the Center for Post-COVID Care at Mount Sinai Health System in New York City. "They're reporting that they've become more and more forgetful."
Other challenges abound: overcoming muscle and nerve damage, improving breathing, adapting to new impairments, regaining strength and stamina, and coping with the emotional toll of unexpected illness.
Most seniors survive COVID-19 and will encounter these concerns to varying degrees. Even among the age group at greatest risk — people 85 and older — just 28% of those with confirmed cases end up dying, according to data from the Centers for Disease Control and Prevention. (Because of gaps in testing, the actual death rate may be lower.)
Walters, who lives in Indianapolis, spent almost three weeks in March and April heavily sedated, on a ventilator, fighting for her life in intensive care. Today, she said, "I still get tired real easy and I can't breathe sometimes. If I'm walking sometimes my legs get wobbly and my arms get like jelly."
"Emotionally, it's been hard because I've always been able to do for myself, and I can't do that as I like. I've been really nervous and jittery," Walters said.
Younger adults who've survived a serious course of COVID-19 experience similar issues but older adults tend to have "more severe symptoms, and more limitations in terms of what they can do," Chen said.
"Recovery will be on the order of months and years, not days or weeks," said Dr. E. Wesley Ely, co-director of the Critical Illness, Brain Dysfunction and Survivorship Center at Vanderbilt University Medical Center. Most likely, he speculated, a year after fighting the disease at least half of the critically ill older patients will not have fully recovered.
The aftereffects of delirium — an acute, sudden change of consciousness and mental acuity — can complicate recovery from COVID-19. Seniors hospitalized for serious illness are susceptible to the often-unrecognized condition when they're immobilized for a long time, isolated from family and friends, and given sedatives to ease agitation or narcotics for pain, among other contributing factors.
In older adults, delirium is associated with a heightened risk of losing independence, developing dementia and dying. It can manifest as acute confusion and agitation or as uncharacteristic unresponsiveness and lethargy.
"What we're seeing with COVID-19 and older adults are rates of delirium in the 70% to 80% range," said Dr. Babar Khan, associate director of Indiana University's Center for Aging Research at the Regenstrief Institute, and one of Walters' physicians.
Gordon Quinn, 77, a Chicago documentary filmmaker, believes he contracted COVID-19 at a conference in Australia in early March. At Northwestern Memorial Hospital, he was put on a ventilator twice in the ICU, for a total of nearly two weeks, and remembers having "a lot of hallucinations" — a symptom of delirium.
"I remember vividly believing I was in purgatory. I was paralyzed — I couldn't move. I could hear snatches of TV — reruns of 'Law & Order: Special Victims Unit' — and I asked myself, 'Is this my life for eternity?'" Quinn said.
Given the extent of delirium and mounting evidence of neurological damage from COVID-19, Khan said he expects to see "an increased prevalence of ICU-acquired cognitive impairment in older COVID patients."
Ely agrees. "These patients will urgently need to work on recovery," he said. Family members should insist on securing rehabilitation services — physical therapy, occupational therapy, speech therapy, cognitive rehabilitation — after the patient leaves the hospital and returns home, he advised.
"Even at my age, people can get incredible benefit from rehab," said Quinn, who spent nearly two weeks at Chicago's Shirley Ryan AbilityLab, a rehabilitation hospital, before returning home and getting several weeks of home-based therapy. Today, he's able to walk nearly 2 miles and has returned to work, feeling almost back to normal.
James Talaganis, 72, of Indian Head Park, Illinois, also benefited from rehab at Shirley Ryan AbilityLab after spending nearly four months in various hospitals beginning in early May.
Talaganis had a complicated case of COVID-19: His kidneys failed and he was put on dialysis. He experienced cardiac arrest and was in a coma for almost 58 days while on a ventilator. He had intestinal bleeding, requiring multiple blood transfusions, and was found to have crystallization and fibrosis in his lungs.
When Talaganis began his rehab on Aug. 22, he said, "my whole body, my muscles were atrophied. I couldn't get out of bed or go to the toilet. I was getting fed through a tube. I couldn't eat solid foods."
In early October, after getting hours of therapy each day, Talaganis was able to walk 660 feet in six minutes and eat whatever he wanted. "My recovery — it's a miracle. Every day I feel better," he said.
Unfortunately, rehabilitation needs for most older adults are often overlooked. Notably, a recent study found that one-third of critically ill older adults who survive a stay in the ICU did not receive rehab services at home after hospital discharge.
"Seniors who live in more rural areas or outside bigger cities where major hospital systems are providing cutting-edge services are at significant risk of losing out on this potentially restorative care," said Dr. Sean Smith, an associate professor of physical medicine and rehabilitation at the University of Michigan.
Sometimes what's most needed for recovery from critical illness is human connection. That was true for Tom and Virginia Stevens of Nashville, Tennessee, in their late 80s, who were both hospitalized with COVID-19 in early August.
Ely, one of their physicians, found them in separate hospital rooms, frightened and miserable. "I'm worried about my husband," he said Virginia told him. "Where am I? What is happening? Where is my wife?" the doctor said Tom asked, before crying out, "I have to get out of here."
Ely and another physician taking care of the couple agreed. Being isolated from each other was dangerous for this couple, married for 66 years. They needed to be put in a room together.
When the doctor walked into their new room the next day, he said, "it was a night-and-day difference." The couple was sipping coffee, eating and laughing on beds that had been pushed together.
"They both got better from that point on. I know that was because of the loving touch, being together," Ely said.
That doesn't mean recovery has been easy. Virginia and Tom still struggle with confusion, fatigue, weakness and anxiety after their two-week stay in the hospital, followed by two weeks in inpatient rehabilitation. Now, they're in a new assisted living residence, which is allowing outdoor visits with their family.
"Doctors have told us it will take a long time and they may never get back to where they were before COVID," said their daughter, Karen Kreager, also of Nashville. "But that's OK. I'm just so grateful that they came through this and we get to spend more time with them."
When Terry Mutter woke up with a headache and sore muscles on a recent Wednesday, the competitive weightlifter chalked it up to a hard workout.
By that evening, though, he had a fever of 101 degrees and was clearly ill. "I felt like I had been hit by a truck," recalled Mutter, who lives near Seattle.
The next day he was diagnosed with COVID-19. By Saturday, the 58-year-old was enrolled in a clinical trial for the same antibody cocktail that President Donald Trump claimed was responsible for his coronavirus "cure."
"I had heard a little bit about it because of the news," said Mutter, who joined thestudy by drugmaker Regeneron to test whether its combination of two man-made antibodies can neutralize the deadly virus. "I think they probably treated him with everything they had."
Mutter learned about the study from his sister-in-law, who works at Seattle's Fred Hutchinson Cancer Research Center, one of dozens of trial sites nationwide. He is among hundreds of thousands of Americans — including the president — who've taken a chance on experimental therapies to treat or prevent COVID-19.
But with nearly 8 million people in the U.S. infected with the coronavirus and more than 217,000 deaths attributed to COVID, many patients are unaware of such options or unable to access them. Others remain wary of unproven treatments that can range from drugs to vaccines.
"Honestly, I don't know whether I would have gotten a call if I hadn't known somebody who said, 'Hey, here's this study,'" said Mutter, a retired executive with Boeing Co.
The website clinicaltrials.gov, which tracks such research, reports more than 3,600 studies involving COVID-19 or SARS-CoV-2, the virus that causes the disease. More than 430,000 people have volunteered for such studies through the COVID-19 Prevention Network. Thousands of others have received therapies, like the antiviral drug remdesivir, under federal emergency authorizations.
Faced with a dire COVID diagnosis, how do patients or their families know whether they can — or should — aggressively seek out such treatments? Conversely, how can they decide whether to refuse them if they're offered?
Such medical decisions are never easy — and they're even harder during a pandemic, said Annette Totten, an associate professor of medical informatics and clinical epidemiology at Oregon Health & Science University.
"The challenge is the evidence is not good because everything with COVID is new," said Totten, who specializes in medical decision-making. "I think it's hard to cut through all the noise."
Consumers have been understandably whipsawed by conflicting information about potential COVID treatments from political leaders, including Trump, and the scientific community. The antimalarial drug hydroxychloroquine, touted by the president, received emergency authorization from the federal Food and Drug Administration, only to have the decision revoked several weeks later out of concern it could cause harm.
Convalescent plasma, which uses blood products from people recovered from COVID-19 to treat those who are still ill, was given to more than 100,000 patients in an expanded-access program and made widely available through another emergency authorization — even though scientists remain uncertain of its benefits.
Regeneron and the pharmaceutical firm Eli Lilly and Co. have both requested emergency use authorization for their monoclonal antibody therapies, even as scientists say such approval could jeopardize enrollment in the randomized controlled trials that will prove whether or how well they work. So far, about 2,500 people have enrolled in the Regeneron trials, with about 2,000 of them receiving the therapy, a company spokesperson said. Others have received the treatment through so-called compassionate use programs, though the company wouldn't say how many.
"With all of the information swirling around in the media, it's hard for patients to make good decisions — and for doctors to make those decisions," said Dr. Benjamin Rome, a general internist and health policy researcher at Harvard Medical School's Portal program. "You shouldn't expect that what you've heard about on the news is the right treatment for you."
Even so, people facing COVID shouldn't be afraid to question whether treatment options are available to them, Rome said. "As a doctor, I never mind when patients ask," he said.
Patients and families should understand what the implications of those treatments might be, Totten advised. Early phase 1 clinical trials focus largely on safety, while larger phase 2 and phase 3 trials determine efficacy. Any experimental treatment raises the possibility of serious side effects.
Ideally, healthcare providers would provide such information about treatments and risks unprompted. But during a pandemic, especially in a high-stress environment, they might not, Totten noted.
"It's important to be sort of insistent," she said. "If you ask a question, you have to ask it again. Sometimes you have to be willing to be a little pushy," she said.
Patients and families should take notes or record conversations for later review. They should ask about financial compensation for participation. Many patients in COVID-19 trials are paid modest amounts for their time and travel.
And they should think about how any treatment fits into their larger system of values and goals, said Angie Fagerlin, a professor and the chair of the population health sciences department at the University of Utah.
"What are the pros and what are the cons?" Fagerlin said. "Where would your decision regret be: Not doing something and getting sicker? Or doing something and having a really negative reaction?"
One consideration may be the benefit to the wider society, not just yourself, she said. For Mutter, helping advance science was a big reason he agreed to enroll in the Regeneron trial.
"The main thing that made me interested in it was in order for therapeutics to move forward, they need people," he said. "At a time when there's so much we can't control, this would be a way to come up with some kind of a solution."
That decision led him to Fred Hutch, which is collaborating on two Regeneron trials, one for prevention of COVID-19 and one for treatment of the disease.
"It was a six-hour visit," he said. "It's two hours to get the infusion. It's a very slow IV drip."
Mutter was the second person enrolled in the treatment trial at Fred Hutch, said Dr. Shelly Karuna, a co-principal investigator. The study is testing high and low doses of the monoclonal antibody cocktail against a placebo.
"I am struck by the profound altruism of the people we are screening," she said.
Mutter isn't sure how he contracted COVID-19. He and his family have been careful about masks and social distancing — and critical of others who weren't.
"The irony now is that we're the ones who got sick," said Mutter, whose wife, Gina Mutter, 54, is also ill.
Mutter knows he has a 1-in-3 chance that he got a placebo rather than one of two active treatment dosages, but he said he was willing to take that chance. His wife didn't enroll in the trial.
"I said, there's some risks involved. We're taking one for the team here. I don't think we both need to do that," he said.
So far, Mutter has struggled with a persistent cough and lingering fatigue. He can't tell if his infusion has been helpful, never mind whether it's a cure.
"Just no way of telling if I got the antibodies or not," he said. "Did I get them and that kept me out of disaster, or did I get the placebo and my own immune system did its job?"
Stakeholders in California see Proposition 15 as a potential savior for chronically underfunded local health departments struggling to respond to the worst public health crisis in more than a century.
This article was published on Monday, October 19, 2020 in Kaiser Health News.
SACRAMENTO — A November ballot initiative to raise property taxes on big-business owners in California is drawing unconventional political support from healthcare power players and public health leaders.
They see Proposition 15 as a potential savior for chronically underfunded local health departments struggling to respond to the worst public health crisis in more than a century. The initiative would change California's property tax system to tax some commercial properties higher than residential properties, which backers say could generate billions to help local governments pay for critical public health infrastructure and staffing.
Without such additional state or federal funding, local governments could be forced to make deeper budget cuts in health and other departments next year as the COVID-19 pandemic continues to strain city and county finances.
"When you're talking about healthcare, you're talking about money," said Anthony Wright, executive director of Health Access California, a Sacramento-based consumer advocacy group. "This is the major revenue measure on the ballot this year, and it's an opportunity to fund public health at the place where the main responsibility for public health lies — at the county level."
At least that's how healthcare advocates are casting the tax hike. But there's no guarantee that if the measure passes counties would use new revenue to address COVID-19 or other healthcare needs. And some rural counties fear they would lose money if the ballot measure passes, which could undercut public health efforts.
Support within the healthcare and local government worlds is not unanimous. The powerful California Hospital Association opposes the measure because it would result in higher taxes on private and investor-owned hospitals, said spokesperson Jan Emerson-Shea. Nonprofit hospitals, including those run by Sutter Health, Kaiser Permanente and Dignity Health, are exempt from paying property taxes despite their regular high revenue. They would remain exempt under the initiative. (KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.)
"This new tax will mean millions of dollars will be taken away from patient care, in perpetuity," Emerson-Shea said.
Proposition 15 would amend California's landmark 1978 property tax initiative, Proposition 13, which capped commercial and residential property tax rates at 1% of assessed value at the time of purchase, and limited annual increases thereafter to 2%. The drop in property taxes as a result of the initiative decimated a major revenue source for public schools and social welfare programs, leaving many underfunded.
Voters are now being asked to allow higher taxes for business owners with commercial holdings valued at more than $3 million. If passed, the measure could generate up to $11.5 billion a year, according to the nonpartisan state Legislative Analyst's Office. It would not apply to residential properties.
Forty percent of annual revenue would be distributed to K-12 schools and community colleges, with 60% sent to cities and counties. Nothing in the measure would require new local revenue to be spent on healthcare, but supporters say it's their best hope after losing $134 million in state public health money this year as one-time funding for specific programs expired. At the same time, slammed by a projected $54 billion deficit, Gov. Gavin Newsom and state lawmakers declinedthis year to increase funding for local health departments to combat COVID-19 and rebuild public health infrastructure.
Sponsors of Proposition 15, including the California Teachers Association and the Service Employees International Union California, argue it's an overdue change that would tax wealthier enterprises in exchange for funding vital school and healthcare programs. They point out that the initiative, supported by Newsom and Democratic presidential nominee Joe Biden, would require schools and local governments to disclose all new revenue they receive and how money is spent.
If passed, money from the measure would begin flowing to schools and counties in 2022 at the earliest.
Opponents of the measure, including the California Chamber of Commerce, the California Republican Party and the Howard Jarvis Taxpayers Association, say hiking taxes on commercial property owners would harm struggling businesses hit hard by COVID-related closures.
"This is being pushed as a panacea cure-all, but at the end of the day, there is no accountability for where these funds go," said Michael Bustamante, a spokesperson for the "No on Prop 15" campaign. "There are, without question, an infinite number of needs, but there is no specificity with what it can or can't be spent on."
Kat DeBurgh, executive director of the Health Officers Association of California, which represents the state's 61 local health officers and has not taken a position on the initiative, said ongoing, unrestricted revenue could actually benefit counties by allowing them to spearhead public health programs that address local needs.
At present, counties are limited in what they can do with their public health dollars, she said. Most additional funding in recent years has largely been earmarked for specific programs or diseases, such as hepatitis C and HIV, and counties are not allowed to spend it on their COVID-19 response or other public health activities.
"Maybe your community's highest priority is not something easily funded by one of these grants. Many rural areas in our state don't have access to clean drinking water, for example," DeBurgh said. "And our greatest demand — more public health workers — can't be funded with grants or one-time money."
Healthcare leaders also argue the initiative could help support community clinics and public hospitals that provide care for uninsured people, who have also suffered financially during the pandemic.
"What we're really trying to avoid is having to balance the budget on the backs of people who need services," said Jodi Hicks, president and CEO of Planned Parenthood Affiliates of California. "Our public health system has clear inequities that we need to address, and additional funding can help fill in the gaps at the county level."
Hicks said Planned Parenthood, which provides sex education in California public schools, is supporting the initiative not only to improve public health, but also because she worries programs like sex education will be on the chopping block as the state experiences unprecedented job and economic losses.
"Those types of programs are the first to get cut when there's not enough funding," she said.
Small, rural counties could also lose funding, county assessors said.
While the initiative would likely raise taxes on large commercial property owners who have seen their land and property appreciate in value over the years, it would eliminate property taxes for other business assets, such as machinery and equipment, for the first $500,000 in value.
Counties that haven't seen land values climb as high as those in coastal regions like the Bay Area may not collect more property taxes while also losing revenue from the tax cut on other business assets.
Chuck Leonhardt, the elected assessor for rural Plumas County, projects that his county could be one of the losers.
"This would take $90 million in assessed value from our tax roll at the beginning, and then I'd have to reassess 2,000 commercial properties," he said. "Many of us rural counties don't feel we'll benefit from doing these reappraisals and my expectation is we could lose some money."
Even among supporters in public health, some fear that any potential windfall for counties would be allocated based on the whims of local politics.
"Even though I support it, I am skeptical that this money will go to the public health programs and basic infrastructure we so desperately need because public health has no constituency," said Bruce Pomer, a public health expert and chief lobbyist for the California Association of Public Health Laboratory Directors.
He pointed to Sacramento County, where the sheriff's department received a larger share of the $181 million in federal COVID-19 relief money than the county public health department.
"I'm worried we'll see the same thing we saw with Sacramento County," Pomer said.
Doris Hutchinson wanted to use money from the sale of her late mother's house to help her grandchildren go to college.
Then she learned the University of Virginia Health System was taking $38,000 of the proceeds because a 13-year-old medical bill owed by her deceased brother had somehow turned into a lien on the property.
Over six years, the state institution filed 36,000 lawsuits against patients seeking a total of more than $106 million in unpaid bills, a KHN analysis finds.
"It was a mess," she said. "There are bills I could pay with that money. I could pay off my car, for one thing."
Property liens are the hidden icebergs of patient medical debt, legal experts say, lying unseen, often for decades, before they surface to claim hard-won family savings or inheritance proceeds.
An ongoing examination by KHN into hospital billing and collections in Virginia shows just how widespread and destructive they can be. KHNreported a year ago that UVA Health had sued patients 36,000 times over six years for more than $100 million, often for amounts far higher than what an insurer would have paid for their care. In response to the articles, the system temporarily suspended patient lawsuits and wage garnishments, increased discounts for the uninsured and broadened financial assistance, including for cases dating to 2017.
Those changes were "a first step" in reforming billing and collection practices, university officials said at the time.
However, UVA Health continues to rely on thousands of property liens to collect old bills, in contrast to VCU Health, another huge, state-owned medical system examined by KHN. VCU Healthpledged in March to stop seizing patients' wages over unpaid bills and to remove all property liens, which are created after a creditor wins a court judgment.
Working courthouse-by-courthouse, VCU Health now says it has discovered and released 45,000 property liens filed against patients just in Richmond, its home city, some dating to the 1990s. There are an estimated 35,000 more in other parts of the state. Fifteen thousand of those have been canceled and they are working on the rest, officials said. These figures have not been previously reported. The system is part of Virginia Commonwealth University.
VCU Health's total caseload is "a huge number" but perhaps not astonishing given the energy with which many hospital systems sue their patients, said Carolyn Carter, deputy director of the National Consumer Law Center.
Despite having suspended patient lawsuits, UVA Health has continued to create property liens based on older court cases, court records show. The number of new liens is "small," said UVA Health spokesperson Eric Swensen.
An advisory council of UVA Health officials and community leaders is expected to deliver new recommendations by the end of October, Swensen said. The council, whose schedule has been slowed by the coronavirus crisis, has discussed property liens, Don Gathers, an activist and council member, said in an interview this summer.
Nobody knows how many old or new UVA Health liens are scattered through scores of Virginia courthouses. The health system, which has sued patients in almost every county and city in the state, has failed to respond to repeated requests over two years to disclose the number and value of its property liens.
But in Albemarle County alone, which surrounds the university's Charlottesville home, "there are thousands" of UVA Health judgments filed in the land records, which creates a lien, said Circuit Court Clerk Jon Zug.
Not just Virginia homes are at risk. UVA Health lawyers search the nation for property or other assets owned by patients with outstanding bills and have filed liens in Maryland, West Virginia, Ohio and Florida, court records show.
The system put a lien on a Nevada vacation condo owned by Veronica Musie's family a decade ago over a $30,600 hospital bill, said Musie, who lives in northern Virginia. The family has since paid the debt.
Virginia property liens expire after 20 years. But UVA Health often renews them. Since 2017, just in Albemarle County, it has renewed more than three dozen liens. That means the medical system could seize families' home equity until 2039 for bills dating to the last century.
UVA Health and other medical systems rarely force the sale of a home to claim money. Instead, they wait for families to refinance or sell, taking their cut at the settlement table. But with 6% simple interest accumulating year after year after the court judgment, as allowed by Virginia law, the final amount owed can be much more than the original charges.
UVA Health treated Hutchinson's brother for heart disease in the early 2000s. The unpaid bill was $24,868. The system laid claim to their mother's home because he was one of her heirs. The claim is up to $38,000 now, she said, because of interest charges. Hutchinson has been disputing it for more than a year.
VCU Health and its MCV Physicians affiliate estimate that eliminating two decades of property liens in courthouses across the state, which they began to do last year after KHN published its reports, won't be finished until spring.
Richmond was especially problematic. Because releasing 40,000 Richmond liens by hand would have been impractical, VCU Health got a judge's permission to do it with computer code.
Creditors such as UVA and VCU don't need addresses to create liens. All they have to do is file a judgment in county or city land records. If debtors own any property there, title companies won't approve a sale until the debt is paid, often with home equity.
Often owners don't know debts exist until paralegals unearth them when homes are sold, property pros say. Old debts can create liens on newly acquired real estate.
"It could be your grandmother's house, and as soon as you've inherited it, and you've got judgments, those [liens] are now attached," said Richmond Court Clerk Edward Jewett.
Frequently debtors own no property, so judgments in the land records expire without hospitals or other creditors getting anything.
VCU and MCV had no idea how many liens they had placed across the state until they began investigating last year after KHN's inquiries, officials said.
"It's an incredibly manual process" to cancel the claims, partly because computer systems at many courthouses prohibit an easy tech solution, said Melinda Hancock, VCU Health's chief administrative and financial officer. But it's worth it to remove a burden on patients, she said, adding, "This is an outdated collections practice whose time has come and gone."
But many medical systems still do it, consumer debt experts say, noting that obtaining a complete picture of hospital property liens is impossible.
Land and judgment records are held by thousands of local court clerks, often using separate computer systems. Records are difficult or impossible to obtain in bulk.
"There is not a good nationwide study that I know of that looks at how widespread this is, how many consumers are affected, what's the average size of a lien," said Erin Fuse Brown, a law professor at Georgia State University who studies hospital billing.
Mike Miller and Kitt Klein are among those hoping UVA Health follows VCU Health in canceling thousands of property liens. They fear a $129,000 judgment won by UVA in 2017 against Miller will cost them the equity in their home in Quicksburg, Virginia.
They make about $25,000 a year. Miller, a house painter, was insured but received out-of-network radiation at UVA that doctors said was necessary to treat his lung cancer.
After KHN wrote about his case a year ago, benefits firm WellRithms analyzed his UVA bill and found that a commercial insurer would have paid a little more than $13,000, not $129,000, for the treatment.
"We know all [health care] providers bill a lot, but usually 'a lot' is three to six times what reasonable prices would be," said Jordan Weintraub, vice president of claims for WellRithms. Trying to collect 10 times as much, she said, "is really out there."
UVA Health does not comment on individual patient cases, Swensen said.
KHN found last year that UVA frequently sued patients for far more than what the system could have collected from insurance.
Early this year Miller and Klein emailed UVA President James Ryan, asking for help in reducing or eliminating the judgment. His office phoned in February, saying it would review the case.
"I became very emotional, filled with gratitude," Klein said. "I couldn't talk."
Months went by with no contact. Recently a lawyer from the office of Virginia Attorney General Mark Herring offered to settle the case for $120,000, Klein said, reducing the bill by only $9,000. They don't have the money. Miller's cancer has returned. Interest is mounting at 6%.
University officials do not comment on legal matters or individual cases, a Ryan spokesperson said. Herring's office did not respond to requests for comment.
During the pandemic, home health aides have buttressed the U.S. healthcare system by keeping the most vulnerable patients — seniors, the disabled, the infirm — out of hospitals.
This article was published on Friday, October 16, 2020 in Kaiser Health News.
In March, Sue Williams-Ward took a new job, with a $1-an-hour raise.
The employer, a home health care agency called Together We Can, was paying a premium — $13 an hour — after it started losing aides when COVID-19 safety concerns mounted.
Williams-Ward, a 68-year-old Indianapolis native, was a devoted caregiver who bathed, dressed and fed clients as if they were family. She was known to entertain clients with some of her own 26 grandchildren, even inviting her clients along on charitable deliveries of Thanksgiving turkeys and Christmas hams.
Without her, the city’s most vulnerable would have been “lost, alone or mistreated,” said her husband, Royal Davis.
Despite her husband’s fears for her health, Williams-Ward reported to work on March 16 at an apartment with three elderly women. One was blind, one was wheelchair-bound, and the third had a severe mental illness. None had been diagnosed with COVID-19 but, Williams-Ward confided in Davis, at least one had symptoms of fatigue and shortness of breath, now associated with the virus.
Even after a colleague on the night shift developed pneumonia, Williams-Ward tended to her patients — without protective equipment, which she told her husband she’d repeatedly requested from the agency. Together We Can did not respond to multiple phone and email requests for comment about the PPE available to its workers.
Still, Davis said, “Sue did all the little, unseen, everyday things that allowed them to maintain their liberty, dignity and freedom.”
He said that within three days Williams-Ward was coughing, too. After six weeks in a hospital and weeks on a ventilator, she died of COVID-19. Hers is one of more than 1,200 health worker COVID deaths that KHN and The Guardian are investigating, including those of dozens of home health aides.
Home health providers scavenged for their own face masks and other protective equipment, blended disinfectant and fabricated sanitizing wipes amid widespread shortages. They’ve often done it all on poverty wages, without overtime pay, hazard pay, sick leave and health insurance. And they’ve gotten sick and died — leaving little to their survivors.
Speaking out about their work conditions during the pandemic has triggered retaliation by employers, according to representatives of the Service Employees International Union in Massachusetts, California and Virginia. “It’s been shocking, egregious and unethical,” said David Broder, president of SEIU Virginia 512.
The pandemic has laid bare deeply ingrained inequities among health workers, as Broder puts it: “This is exactly what structural racism looks like today in our health care system.”
Every worker who spoke with KHN for this article said they felt intimidated by the prospect of voicing their concerns. All have seen colleagues fired for doing so. They agreed to talk candidly about their work environments on the condition their full names not be used.
***
Tina, a home health provider, said she has faced these challenges in Springfield, Massachusetts, one of the nation’s poorest cities.
Like many of her colleagues — 82%, according to a survey by the National Domestic Workers Alliance — Tina has lacked protective equipment throughout the pandemic. Her employer is a family-owned company that gave her one surgical mask and two pairs of latex gloves a week to clean body fluids, change wound dressings and administer medications to incontinent or bedridden clients.
When Tina received the company’s do-it-yourself blueprints — to make masks from hole-punched sheets of paper towel reinforced with tongue depressors and gloves from garbage bags looped with rubber bands — she balked. “It felt like I was in a Third World country,” she said.
The home health agencies that Tina and others in this article work for declined to comment on work conditions during the pandemic.
In other workplaces — hospitals, mines, factories — employers are responsible for the conditions in which their employees operate. Understanding the plight of home health providers begins with American labor law.
The Fair Labor Standards Act, which forms the basis of protections in the American workplace, was passed in an era dually marked by President Franklin Delano Roosevelt’s New Deal changes and marred by the barriers of the Jim Crow era. The act excluded domestic care workers — including maids, butlers and home health providers — from protections such as overtime pay, sick leave, hazard pay and insurance. Likewise, standards set by the Occupational Safety and Health Administration three decades later carved out “domestic household employment activities in private residences.”
“A deliberate decision was made to discriminate against colored people — mostly women — to unburden distinguished elderly white folks from the responsibility of employment,” said Ruqaiijah Yearby, a law professor at St. Louis University.
In 2015, several of these exceptions were eliminated, and protections for home health providers became “very well regulated on paper,” said Nina Kohn, a professor specializing in civil rights law at Syracuse University. “But the reality is, noncompliance is a norm and the penalties for noncompliance are toothless.”
Burkett McInturff, a civil rights lawyer working on behalf of home health workers, said, “The law itself is very clear. The problem lies in the ability to hold these companies accountable.”
The Occupational Safety and Health Administration has “abdicated its responsibility for protecting workers” in the pandemic, said Debbie Berkowitz, director of the National Employment Law Project. Berkowitz is also a former OSHA chief. In her view, political and financial decisions in recent years have hollowed out the agency: It now has the fewest inspectors and conducts the fewest inspections per year in its history.
Furthermore, some home health care agencies have classified home health providers as contractors, akin to gig workers such as Uber drivers. This loophole protects them from the responsibilities of employers, said Seema Mohapatra, an Indiana University associate professor of law. Furthermore, she said, “these workers are rarely in a position to question, or advocate or lobby for themselves.”
Should workers contract COVID-19, they are unlikely to receive remuneration or damages.
Demonstrating causality — that a person caught the coronavirus on the job — for workers’ compensation has been extremely difficult, Berkowitz said. As with other health care jobs, employers have been quick to point out that workers might have caught the virus at the gas station, grocery store or home.
Many home health providers care for multiple patients, who also bear the consequences of their work conditions. “If you think about perfect vectors for transmission, unprotected individuals going from house to house have to rank at the top of list,” Kohn said. “Even if someone didn’t care at all about these workers, we need to fix this to keep Grandma and Grandpa safe.”
Nonetheless, caregivers like Samira, in Richmond, Virginia, have little choice but to work. Samira — who makes $8.25 an hour with one client and $9.44 an hour with another, and owes tens of thousands of dollars in hospital bills from previous work injuries — has no other option but to risk getting sick.
“I can’t afford not to work. And my clients, they don’t have anybody but me,” she said. “So I just pray every day I don’t get it.”
On Monday, President Donald Trump claimed that the World Health Organization (WHO) “admitted” he was correct that using lockdowns to control the spread of COVID-19 was more damaging than the illness.
In a post on Twitter, Trump wrote: “The World Health Organization just admitted that I was right. Lockdowns are killing countries all over the world. The cure cannot be worse than the problem itself. Open up your states, Democrat governors. Open up New York. A long battle, but they finally did the right thing!”
He reiterated his statement later that night during a campaign rally, saying, “But the World Health Organization, did you see what happened? They just came out a little while ago, and they admitted that Donald Trump was right. The lockdowns are doing tremendous damage to these Democrat-run states, where they’re locked out, sealed up. Suicide rates, drug rates, alcoholism, deaths by so many different forms. You can’t do that.”
Together, the tweet and these comments got considerable attention on social media.
But did the WHO change its stance on lockdowns or concede anything to Trump, as he said it did? Briefly, no.
Since May, Trump has been vocal about asking states to reopen businesses, schools, religious services and other social activities. He also took credit for locking down the U.S. in the early stages of the pandemic, however. And his administration largely delegated lockdown decisions to governors and local governments.
Yet those lockdowns — marked by stay-at-home orders and other restrictions — have been less stringent than those implemented in other countries, said Brooke Nichols, an assistant professor of global health at Boston University.
The “definition has differed country by country and state by state. I would argue that the U.S. has never had an actual enforced lockdown like there have been in some Asian countries and in Italy last spring,” Nichols wrote in an email.
We reached out to the Trump campaign and the White House to ask for more information about Trump’s assertion but didn’t receive a response.
A Clip Doesn’t Tell the Full Story
Although the Trump team didn’t get back to us, we noticed that the Trump War Room Twitter account responded to Trump’s tweet with a link to a video, appearing to back up the president’s claim.
The video is a clip from an Oct. 8 interview with Dr. David Nabarro, a special envoy on COVID-19 for the WHO, by Scottish journalist Andrew Neil. The segment was televised by the British news outlet Spectator TV.
In response to a question about the economic consequences of lockdowns, Nabarro said: “We in the World Health Organization do not advocate lockdowns as the primary means of control of this virus. The only time we believe a lockdown is justified is to buy you time to reorganize, regroup, rebalance your resources; protect your health workers who are exhausted. But by and large, we’d rather not do it.” Nabarro then went on to describe potential economic consequences, including effects on the tourism industry and farmers or the worsening of world poverty.
We checked with Nabarro to find out if the clip accurately reflected the points he raised during a nearly 20-minute interview. He responded, by email: “My comments were taken totally out of context. The WHO position is consistent.”
That context Nabarro mentioned covered a range of topics, such as the estimate that about 90% of the world’s population is still vulnerable to COVID-19, that lockdowns are only an effective pandemic response in extreme circumstances and what Nabarro means when he talks about finding the “middle path.”
“We’re saying we really do have to learn how to coexist with this virus in a way that doesn’t require constant closing down of economies, but at the same time in a way that is not associated with high levels of suffering and death,” Nabarro said in the interview.
To achieve that via the middle-path approach, robust defenses against the virus must be put in place, said Nabarro, including having well-organized public health services, such as testing, contact tracing and isolation. It also involves communities adhering to public health guidelines such as wearing masks, physical distancing and practicing good hygiene.
So, it’s really not accurate for the president to imply that the WHO has or has not supported lockdowns, said Lawrence Gostin, a global health law professor at Georgetown University. It’s not as simple as an either-or choice.
“No one is saying that lockdowns should never be used, just that they shouldn’t be used as a primary or only method,” Gostin wrote in an email.
And Josh Michaud, associate director of global health policy at KFF, said both the WHO and public health experts have acknowledged there are economic consequences to lockdowns. (KHN is an editorially independent program of KFF.)
“Strict lockdowns are best used sparingly and in a time-limited fashion because they can cause negative health and economic consequences,” said Michaud. “That is why Nabarro said lockdowns are not recommended as the ‘primary’ control measure. Critics like to frame lockdowns as being recommended as the only measure, when in reality that is not the case.”
Has the WHO Flipped on Its Stance on Lockdowns?
And what about Trump’s assertion that the WHO had changed its position and admitted he was right?
A member of the WHO media office told us in a statement, “Our position on lockdowns and other severe movement restrictions has been consistent since the beginning. We recognize that they are costly to societies, economies and individuals, but may need to be used if COVID-19 transmission is out of control.”
“WHO has never advocated for national lockdowns as a primary means for controlling the virus. Dr. Nabarro was repeating our advice to governments to ‘do it all,’” the spokesperson said.
To test this premise, we looked at statements by WHO leaders over the course of the pandemic. In the multiple media briefings we reviewed from February onward, the WHO appeared consistent in its messaging about what lockdowns should be deployed for: to give governments time to respond to a high number of COVID-19 cases and get a reprieve for health care workers. Although WHO leaders in February supported the shutting down of the city of Wuhan, China, the presumed source of the COVID-19 outbreak, they have also acknowledged that lockdowns can have serious economic effects, and that robust testing, contact tracing and physical distancing are usually preferable to completely locking down.
There is also no evidence the WHO “admitted” Trump was right about lockdowns.
Our Ruling
Trump tweeted on Monday and then said later that night at a campaign rally that the WHO admitted he was right about lockdowns.
We found no evidence the WHO made this admission. And, based on a review of WHO communications, we found its messaging on the topic has been consistent since the pandemic’s early days.
Trump also appears to have relied on a brief video clip of a wide-ranging interview with WHO special envoy Dr. David Nabarro that didn’t give an accurate portrayal of how Nabarro characterized the use of this intervention.
A new poll shows 79% of the public does not want the court to cancel coverage protections for Americans with preexisting conditions. A majority of Republicans, 66%, said they do not want those safeguards overturned.
This article was published on Friday, October 16, 2020 in Kaiser Health News.
At least half of voters prefer former Vice President Joe Biden's approach to healthcare over President Donald Trump's, suggesting voter concern about lowering costs and managing the pandemic could sway the outcome of this election, a new poll shows.
The findings, from KFF's monthly tracking poll, signal that voters do not trust assurances from the president that he will protect people with preexisting conditions from being penalized by insurance companies if the Supreme Court overturns the Affordable Care Act. (KHN is an editorially independent program of KFF.)
Coming a month before the court will hear arguments from Republican attorneys general and the Trump administration that the health law should be overturned, the poll shows 79% of the public does not want the court to cancel coverage protections for Americans with preexisting conditions. A majority of Republicans, 66%, said they do not want those safeguards overturned.
In addition to leaving about 21 million Americans uninsured, overturning the ACA could allow insurance companies to charge more or deny coverage to individuals because they have preexisting conditions — a common practice before the law was established, and one that a government analysis said in 2017 could affect as many as 133 million Americans.
Nearly 6 in 10 people said they have a family member with a preexisting or chronic condition, such as diabetes or cancer, and about half said they worry about a relative being unable to afford coverage, or lose it outright, if the law is overturned.
The poll reveals a striking preference for Biden over Trump when it comes to protecting preexisting conditions, an issue that 94% of voters said would help decide who they vote for. Biden has a 20-point advantage, with voters preferring his approach 56% to 36% for Trump.
In fact, it shows a preference for Biden on every healthcare issue posed, including among those age 65 and older and on issues that Trump has said were his priorities while in office — signaling voters are not satisfied with the president's work to lower healthcare costs, in particular. Support for Trump's efforts to lower prescription drug costs has been slipping, with voters now preferring Biden's approach, 50% to 43%.
A majority of voters said they prefer Biden's plan for dealing with the COVID-19 outbreak, 55% to 39%, and for developing and distributing a vaccine for COVID-19, 51% to 42%. Trump has largely left it up to state and local officials to manage the outbreak, while promising that scientists would defy expectations and produce a vaccine before Election Day.
Asked which issue is most important to deciding whom to vote for, most pointed to healthcare issues, with 18% choosing the COVID-19 outbreak and 12% saying healthcare overall. Nearly an equal share, 29%, selected the economy.
The survey was conducted Oct. 7-12, after the first presidential debate and Trump's announcement that he had tested positive for COVID-19. The margin of error is plus or minus 3 percentage points for the full sample and 4 percentage points for voters.
Latino case rates were only 64% higher by mid-September, while positivity rate among Blacks was 60% higher than that of whites in late July, but the disparity had waned by mid-September.
This article was published on Thursday, October 15, 2020 in Kaiser Health News.
Los Angeles County officials attribute a dramatic decline in COVID-19 death and case rates among Blacks and Latinos over the past two months to aggressive workplace health enforcement and the opening of tip lines to report violations.
Now, officials intend to cement those gains by creating workplace councils among employees trained to look for COVID-19 prevention violations and correct or report them — without fear of being fired or punished.
Cal/OSHA, the state’s workplace safety and health authority, is overwhelmed with complaints and tips about COVID-19 violations, and the county’s health investigators — there were officially 346 of them as of last Friday — can’t possibly keep tabs on all of Los Angeles’ more than 240,000 businesses, labor advocates say.
The councils could help keep Los Angeles from backsliding on its progress in mitigating cases and racial disparities in the fall as more businesses are likely to reopen, said Tia Koonse, a researcher with the UCLA Labor Center and co-author of an assessment of the workplace council proposal. The L.A. County Board of Supervisors is expected to approve an ordinance this month requiring businesses to permit employees to form the councils, which would troubleshoot compliance issues and report to the health department when necessary.
Critics, including many business leaders, say the measure will create more red tape at the worst possible time for the economy. But labor groups and some businesses say it is crucial to fighting the pandemic. Workers around the country have been sacked or reprimanded for complaining about COVID-related safety violations, and laws protecting them are spotty.
"Workers have a right to be in a safe space and shouldn’t face any retaliation" for noting poor practices, said Barbara Ferrer, director of the L.A. County Public Health Department. Low-wage workers have been "tremendously disadvantaged" by having to work outside the home in contact with other people, often without sufficient protection, she said.
During the upsurge of COVID cases that followed Memorial Day weekend family gatherings and business openings, Latinos in Los Angeles were dying at a rate more than four times higher than that of whites, while Blacks were twice as likely as whites to die of the disease. Two months later, death rates among Blacks and Latinos had fallen by more than half and were approaching the rate for whites, according to age-adjusted data from the county health department.
While four times as many Latinos as whites were reported COVID-positive in late July, the Latino case rates were only 64% higher by mid-September. The positivity rate among Blacks was 60% higher than that of whites in late July, but the disparity had waned by mid-September.
Experts can’t be certain that any one policy is responsible for the decline in deaths among Blacks and Latinos in Los Angeles — and state and county rates have declined for the entire population in recent weeks. But Ferrer attributed the progress to her department’s focus on workplace enforcement of health orders, which include rules about physical distancing, providing face coverings for workers and requiring face coverings for customers.
"If you’re in violation, at this point we can either issue citations, or there are cases where we just close the place down because the violations are egregious," she said.
The sharp racial disparities that characterized the pandemic from the beginning are under even more scrutiny now that California has become the first state to make "health equity" a factor in its decisions to allow expanded reopening.
Large counties may not advance toward full reopening until their most disadvantaged neighborhoods, and not just the county as a whole, meet or are lower than the targeted levels of disease. The criteria prod local governments to invest more in testing, contact tracing and education in poor neighborhoods with high levels of the disease.
Ferrer’s focus on workplaces crystallized during a crackdown on Los Angeles Apparel, a clothing factory that had pivoted to face mask manufacturing during the pandemic. Despite the ready inventory of masks, an outbreak at the factory resulted in at least 300 cases — and four deaths.
The health department, acting on a tip from community health centers flooded with sick Los Angeles Apparel workers, shut down the factory on June 27. That action highlighted the need to bring the government and labor unions together to fight the pandemic, said Jim Mangia, CEO of St. John’s Well Child & Family Center, a chain of community health centers in South L.A.
"At St. John’s, almost all of our patients are the working poor," Mangia said. "They were getting infected at work and bringing it home to their families, and I think intervening at the workplace is what really made all the difference."
Early in the pandemic, Ferrer had also set up an anonymous complaint line for employees who want to report workplace violations. It gets about 2,000 calls a week, she said. As of Oct. 10, the department’s website lists 132 workplaces that have had three or more confirmed COVID-19 cases, with a total of 2,191 positives. Another table dated Oct. 7 lists 124 citations — mostly to gyms and places of worship — for failing to comply with a health officer order.
"Fortunately, we’re not like Cal/OSHA, in the sense that it doesn’t take us months to complete an investigation," Ferrer said. "We’re able to move more swiftly under the health officer orders to actually make sure that we’re protecting workers."
Public health councils are the next phase in Ferrer’s plan to keep workers safe. The plan stemmed from the response of Overhill Farms, a frozen-food factory in Vernon, California, after an outbreak of more than 20 cases and one death. The factory and its temporary job agency were hit with more than $200,000 in proposed penalties from Cal/OSHA in September, but before the fines landed, the factory leadership was already responding by beginning to hold meetings with workers to improve safety there.
"They found that the workers helped them bring down infection rates and helped solve problems," said Roxana Tynan, executive director of the Los Angeles Alliance for a New Economy, a worker advocacy organization.
While it’s not exactly a feel-good story about corporate beneficence, the turnaround at Overhill Farms added credence to the benefits of workplace councils, said Koonse of UCLA.
No company would have to spend more than 0.44% of its payroll cost on the health councils, she estimated.
Still, the idea has gotten a mixed reception from businesses. In an Aug. 24 statement, CEO Tracy Hernandez of the L.A. County Business Federation wrote that the proposal would add “burdensome and convoluted programs that will further hinder an employer’s ability to meet demands, get back on their feet, and adequately serve their employees and customers.”
But Jim Amen, president of the eight-store Super A Foods grocery chain, said businesses should welcome the councils as a way to keep lines of communication open. Such practices have kept infection rates low at his stores, even without a mandate, Amen said.
"All I know is, for Super A, our employees are heavily involved in everything we do," Amen said.
Labor groups see the councils as a crucial way for workers to raise concerns without fear of retaliation.
"In low-wage industries like the garment industry, workers coming together gets them fired," said Marissa Nuncio, director of the Garment Worker Center, a nonprofit that mainly serves immigrants from Mexico and Central America.
While disparities are narrowing in L.A. County, some shops are still unsafe and potential whistleblowers aren’t confident their reports to the county’s tip line are being acted on, she said.
"We continue to get calls from our members who are sick, have COVID and are hospitalized," Nuncio said. "And the most obvious location for them to have been infected is in their workplace, because so many precautions are not being taken."