Editor's Note: This is a complimentary research note published by Healthcare Policy analyst Emily Evans. CLICK HERE to get COVID-19 analysis and alerts from our research team and access our related webcasts.
There was a virus going 'round; papa caught it, and he died last spring. And now mama doesn't seem to want to do much of anything. And me, I spend a lot of time pickin' flowers up on Choctaw Ridge. And drop them into the muddy water off the Tallahatchie Bridge
- Bobbie Gentry
N=3 but my household survey of millennials suggests they would rather listen to a Lumineers box set than vote for Joe Biden in November. Joe Biden apparently knows this too and in a bid to attract a younger demographic the Biden-Sanders Unity Task Force released recommendations on a broad range of topics last week. The health care committee, chaired by Rep. Pramila Jayapal and Vivek Murthy did not recommend Medicare for All as many wanted but still managed to come up with a sweeping agenda.
The Public Option which Biden had concieved as a buy-into Medicare, would, according to the Task Force's report be a plan or plans offered on the ACA exchange with at least one having no deductible. In a shot across the bow of Medicare Advantage, the Public Option would will be "administered by the traditional Medicare program, not private companies." People living in states that did not expand Medicaid with incomes below 138% of FPL would enroll cost-free.
Predictably, the committee recommends drug price negotiation in Medicare and a minimum $15 wage for health care workers
Sounding surprisingly Trumpian, the committee also expressed interest in health care price transparency which we actually expect will not need to wait for the election. It is likely to be included in the next stimulus package, the courts having upheld it recently. The recommendations also include anti-trust language, policies also favored by the current White House occupant.
Will the recommendations be enough to get my kids to put down the Lumineers tracks? The polling says 1-yes; 1-no and 1-undecided.
On Friday, the CDC released a report on the characteristics of persons who died from COVID-19 between February 12 and May 18. Their analysis of 10,000 deaths draws some very unsurprising conclusions, given human history's relationship with infectious disease. It also points to a massive gap between public health messaging from local, state and federal leaders and the impacts on the ground.
About 80% of the cases examined were 65 and over with a median age of 78 years old. However, of the 20% of deaths in people under 65, a high percentage were Hispanic (35%) or non-white (30%) with white people accounting for just 13.1%. Some of that difference is the result of broader demographics. The median age for a non-white person in the U.S. is 31 years. For white people the median age is 44 years. However, about 20% and 23% of the US population under 65 is Hispanic and non-white, respectively. Hispanic and non-white people are making a disproportionate contribution to deaths in people under 65.
The CDC report will come as no surprise to mayors of hotspots like Houston where 1 in 4 residents is foreign born, primarily in South and Central America. Unfortunately, the public health surveillance and containment system depends on the cooperation of the public, which, after a couple of decades of bi-polar immigration policy, is hard to find.
The high concentration of Hispanics and non-whites in essential industries like construction, agriculture and transportation has kept them at work while others have stayed home.
The disproportionate representation of Hispanics and non-whites in the service industry has sent them to work where social distancing can be impossible. The low wages associated with most of these occupations generally means poverty and the affiliated low standard of living in dense, mulitgenerational housing situations.
Yet, state and local policies have thus far done little to target at-risk populations under 65 and may be making things worse. General business closures and reduced operating capacity have been the focus. Advice to stay home if sick is incomprehensible to an hourly wage earner especially after extended restaurant and bar closures.
Testing, which may result in contact tracing of undocumented friends and relatives and a 14-day self-isolation order, is to be avoided. In short, the most frequently implemented policies in the U.S. would be perfect for a nation occupied by white office-dwelling professionals but for a richly diverse country, they fall short.
Dr. Deborah Birx has suggested spread of disease in communities with few options to isolate in already hard-pressed economic times demand different strategies. Blaming federal competence is not likely to be an option after the first week in November. Mayors and governors will have to develop new strategies for dealing with infection spread in minority communities most at risk.
This need presents many urban mayors with a problem.
No elected official wants to talk about infection and disease in Hispanic and non-white communities for fear of creating stigma similar to that forced upon Chinese immigrants in San Francisco during tuberculosis outbreaks in the early 20th century.
Yet, the case counts will call into question their ability to lead. Where they are left may be to just ignore the problem and the story of COVID-19 will be the same as many other infectious diseases; a scourge on the poor and immigrants.
One of the themes we shall explore long after the COVID-19 outbreak has receded to the history books will be the intolerance for public health responses that made way for a return to normal civic, social and economic activity. A couple weeks ago, the American Academy of Pediatrics issued clinical guidance with principles on reopening schools which included this statement: With the above principles in mind, the AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school. (Emplasis all theirs.)
Then, as we say in politics, "someone got to them."
The president had cited the AAP guidance when he threatened to withold federal funding for schools that failed to reopening in the fall. The last place in the world you want to find your organization's name is on the lips of Donald Trump. Additionally, unions criticized the AAP for failing to consider other stakeholders like teachers and staff.
Following the now familiar pattern of restating previous positions with modest amendments so they can be characterized as "walking back" to satisfy the impact-oriented media, the AAP issued a joint press release with the American Federation of Teachers and the National Education Association, the two large US teacher unions. The press release, which does not carry the same weight as clinical guidance, restates most of the previously issued principles. It adds that public health officals not politicans should make decisions and be guided by local circumstances.
I doubt most pediatricians will view the press release as a reversal of the AAP's position but it does serve the purpose of denying advocates of re-opening schools credible support. Absent concerns about the critically important role schools play in child and adolescent development not to mention as a social safety net, the political battle will be joined over the health risks, despite scant evidence children pose a threat.
For many political, economic and academic leaders, who, not coincidentally, are mostly over 65, the only acceptable probablility for death and disease is zero. From the debates over the Affordable Care Act to the current response to COVID-19, America has been obsessed with risk-proofing life, regardless of the consequences, particularly to younger generations.
Keeping schools closed, in the absence of a threat, may be a bridge too far. Closed schools mean parents can't work as much or at all. The daily monitoring by teachers for physical and sexual abuse disappears. Mental and physical health services are unavailable. Fewer meals are eaten and less exercise is taken.
The sharp divide between class and race deepens. The political fallout is at the same time terrifying and welcomed.