Thursday, July 30, 2020

CDC Blunders in Excluding Communities of Color Among High Risk Groups for Covid-19


It really makes little sense.  Despite the fact that Blacks, Hispanics and Native Americans are being hospitalized and dying at considerably higher rates than whites in the U.S., the Center for Disease Control recently changed its definition of Covid-19 high risk groups to exclude these groups.[i]  Why?  Because they have concluded that the high virus rates are not due to genetics, and they want to avoid stigmatizing these groups as “Covid carriers.”  By taking this action, the CDC can now remove their priority status for the delivery of health services – a disturbing action that suggests the injection of partisan politics.

 Let’s consider the fact that older persons were initially identified among the high-risk groups and remain in that category for good reasons. Indeed, one would not argue that their high-risk status should be changed because they often reside in nursing or retirement homes that have been plagued by the coronavirus. The purpose of identifying key demographic characteristics that are associated with the prevalence of a disease or virus is to target intervention strategies towards such groups as quickly as possible to mitigate the spread of the disease or illness – regardless of the circumstances that created their vulnerability – such as social determinants like comorbidities, living arrangements and working conditions.  

The CDC’s justification for re-defining the high-risk categories – to avoid stigmatizing these groups as “Covid carriers” – is specious.  Communities of color have long been stigmatized in many industries for the wrong reasons, including their skin color, language and many other attributes.  Assigning a high-risk category for Covid-19 is a health-related assessment, not a stigma, and should not be used as a basis for denying health-related services as the CDC is apparently proposing.

What seems plainly obvious is that the Trump administration has forced the hand of the CDC experts once again.  First by re-directing the reporting of Covid-19 hospitalizations from the CDC to the Dept. of Health and Human Services to the great dismay of the national health community.  Secondly, by pressuring the CDC to moderate the perceived risk of attending schools in person despite the increasing infection rates in many communities. And now by re-defining Covid-19 high risk groups with a questionable rationale.

These actions are setting the stage in the U.S. for the unfair distribution of the Covid-19 vaccine once it becomes available, a disturbing scenario that is likely to deprive the vaccine from communities of color and other groups that have been re-defined as lower risk by the CDC. By allowing this new definition of risk by the CDC to continue unchallenged, communities of color can expect a longer period of infections and mortalities from the pandemic, and more limited access to a vaccine once it becomes available.  There is a clear need for strong advocacy from civic, business and community groups that represent communities of color to challenge and correct the direction that the CDC has taken in defining high-risk groups for Covid-19.   


References


[i] Associated Press (2020, July 25). US agency vows steps to address COVID-19 inequalities.  WFAA, accessed at https://www.wfaa.com/article/news/health/coronavirus/coronavirus-inequalities-cdc/507-a770cfc8-9967-4359-b84d-12684c6aa46f

 

Friday, July 24, 2020

President Trump Launches a Civil War Against the American Public


As the November presidential election nears, there are noticeable palpitations from the Trump campaign and his supporters, which has prompted an undeclared civil war against the American public. Fueling the anxiety level throughout the Republican party is Trump’s epic failure in acknowledging and managing the Covid-19 pandemic as well as the double-digit lead by Joe Biden in several national polls. To breathe new life to his failing campaign strategy, Trump has chosen to heighten the misery index across the country with a series of actions designed to weaken the democratic electorate and keep his job for another term.   Following is a sampling of the extreme and somewhat bizarre actions that the Trump administration has directed at the American public:

Voting and Apportionment 
·       Aggressive efforts to eliminate the use of mail-in ballots despite little evidence of voter fraud and the potential exposure of voters to Covid-19 infections.  According to recent research by the Pew Research Center,  "About two-thirds of Americans say the option to vote early or absentee should be available to any voter without requiring a documented reason, while a third say early and absentee voting should only be allowed with a reason. Democrats overwhelmingly back “no excuse” early or absentee voting: 83% support it. By comparison, 55% of Republicans say a documented reason should be necessary to vote early or absentee." [1]  
·       Attempts to include a citizenship question in the Census 2020 questionnaire designed to discourage immigrant participation in the census – later rejected by the U.S. Supreme Court.
·       Recently signing an executive order to remove counts of unauthorized immigrants from the Census computations used to define legislative districts – an action that will be legally challenged by several civil rights organizations. According to recent analysis of government data by Pew Research, the removal of these immigrants would mean that three states each could lose a U.S. House seat, while three others each could gain one.
Covid-19
·       Stating the “testing was over-rated,” Trump has delayed increasing the level of funding for Covid-19 testing and tracking despite the growing surge in infections and mortalities throughout the country.
·       A refusal to issue a federal mandate to expand the availability of personal protective equipment (PPE).
·       Trump actually recommended the use of a disinfectant like Lysol to treat Covid-19 patients.
·       Requiring hospitals to re-direct records related for Covid-19 hospitalizations from the CDC to the Department of Health and Human Services – considered by the nation’s healthcare professionals as a political attempt to obscure the true picture of Covid-19 infections and mortalities. Further evidence that the Trump administration is politicizing the data collection and analysis the pandemic data is the recent announcement by the CDC that race and ethnic minorities are no longer considered high risk or meriting higher priority for certain health services [2]. Why?  Because their Covid-19 high hospitalization, infection and mortality rates result from social determinants, not genetics, and there is a need to avoid stigmatizing and victimizing these groups.  While social determinants are indeed important factors that contribute to the higher prevalence of Covid-19 in Black and Hispanic communities, it makes little sense to use this as a basis for removing their high risk designation -- indeed, they are still at high risk regardless of the circumstances that placed them at high risk.
·       The continued failure to order a national mandate for wearing face masks despite the advice of global medical experts.
·       The failure to clear up the large amount of missing race-ethnic data related to Covid-19 mortalities which greatly underestimates the mortality rates for communities of color. According to Janet Hamilton, executive director of Council of State and Territorial Epidemiologists, race and ethnicity data is missing 80% to 85% of the time, while patient address and telephone numbers are missing as much as 50% of the time.  A standard form to record such information if often not used by physicians since it is not considered a priority. [2]
·       The failure to increase OSHA inspections of employers to check compliance with CDC recommended practices related to Covid-19 employment policies. Clusters of Covid-19 infections have grown rapidly in factories and food suppliers where employees are forced to work in close proximity without the proper protective equipment.
Education
·       Pressuring schools to allow in-person instruction despite the high Covid-19 infection rates in their communities and the increased potential of exposure to students and teachers.
·       Issuing an executive order requiring foreign students in U.S. academic institutions to attend in-person classes despite Covid-19 risk --- later rescinded due to many protests from U.S. academic institutions and private high-tech employers.
Abusive Actions
·       Using tear gas and injuring residents engaged in peaceful protests, as recently occurred at protests at the White House and Portland, Oregon.
·       Threatening to send Federal agents to quell peaceful protests regarding Black Lives Matter, especially in “Democratic” cities like Chicago and Albuquerque.
·       Supporting the presence of the Confederate flag, statues and similar symbolism in public places that are racially divisive.
Immigration
·       Misportraying immigrants as criminals despite substantial evidence that their crime rates are lower than native-born residents in the U.S.
·       Failure to process new DACA (i.e., Dreamer) applications despite a recent ruling by the U.S. Supreme Court to allows this process.
Coupled with the support of the Republican party, Trump’s civil war against the American public will likely diminish voter participation among Democrats during the upcoming November election, expand the spread of Covid-19 infections and mortalities, and generally deteriorate the quality of life for all U.S. residents. This level of aggression towards the American public is perplexing, especially given that our political leaders are sworn to protect U.S. residents, not harm them. 
This is not the first time, however, that Trump’s patriotism for his countrymen has been the subject of some controversy. For example, Trump has consistently praised world dictators that are known to oppress the human rights of their constituents and disparaged recognized war heroes like the late Sen. John McCain.  According to a news report, Trump avoided military service during the Vietnam conflict due to a bone spur, which earned him the title “Cadet Bone Spurs” – a term attributed by Senator Tammy Duckworth, a Purpose Heart recipient.  A story in the New York Times [3] reported that a foot doctor in Queens who rented his office from Mr. Trump’s father, Fred C. Trump, suggested that the diagnosis was granted as a courtesy to the elder Mr. Trump. In addition to avoiding military service, Mr. Trump continues to show his support for racially divisive Confederate flags and statues.
By accelerating their civil war, Cadet Bone Spurs and his Republican comrades are apparently prepared to win the November election at any cost to the health, safety and civil rights of the American public. For the upcoming November election, voters should seriously question whether Donald Trump and his fellow Republicans deserve to  represent a country whose values and quality of life they have chosen to abandon.  

References