Public health

Study finds link between neighborhood disadvantage and COVID-19 disparities

New research has found a strong link between COVID-19 and neighborhood disadvantage, a finding that supports earlier contentions of the connection between social factors and coronavirus disparities (Source: “How Neighborhood Disadvantage Drove COVID Health Disparities,” Patient Engagement HIT, July 21).

The study examined the connection between COVID-19 inequity and subway ridership in New York City. Neighborhoods that ranked higher on a COVID-19 inequity index — meaning that the neighborhood saw more factors that could put inhabitants at risk — also had higher subway ridership even after COVID-19 forced city-wide shutdowns.

Daniel Carrión, a researcher from Mount Sinai, said needing to ride the subway — or work an essential job — had a strong link to the unequal infection rates seen during the height of the coronavirus pandemic, largely because it limits the ability to socially distance.

“For us, subway utilization was a proxy measure for the capacity to socially distance,” Carrión, a postdoctoral researcher in the Department of Environmental Medicine and Public Health at the Icahn School of Medicine, told PatientEngagementHIT in an interview.

Although public health experts have made the link between the social determinants of health leading to actual infection, not just poor outcomes, Carrión and his colleagues put some data behind that. Social disadvantage was linked with higher subway utilization, and ultimately to higher infection rates and starker disparities.

“Folks like me were able to stay home for the majority of the pandemic and work from home. I didn't need to use public transit whereas others did. What we found was that areas that had higher COVID inequity indices were also riding the subways more after the stay-at-home orders compared to folks that were low in the COVID inequity index.”


CDC extends national moratorium on evictions

The Centers for Disease Control and Prevention (CDC) has extended a moratorium on evictions until the end of July (Source: “CDC Extends Eviction Moratorium Through July,” National Public Radio, June 24).

The ban had been set to expire next week, raising concerns that there could be a flood of evictions with some 7 million tenants currently behind on their rent.

The Biden administration says the extension is for "one final month" and will allow time for it to take other steps to stabilize housing for those facing eviction and foreclosure. The White House says it is encouraging state and local courts to adopt anti-eviction diversion programs to help delinquent tenants stay housed and avoid legal action.

The federal government will also try to speed up distribution of tens of billions of dollars in emergency rental assistance that's available but has yet to be spent. In addition, a moratorium on foreclosures involving federally backed mortgages has been extended for "a final month," until July 31.


Study: Death rates from chronic conditions rising in rural America

In rural America, more people die from chronic health conditions and substance abuse than in suburbs and cities, and the gap is widening.

A new study has found that the difference in rural and urban death rates tripled over the past 20 years mostly due to deaths among middle-aged white men and women (Source: “Study: Death rates from chronic conditions, 'deaths of despair' rising in rural U.S.,” United Press International, June 9).

This gap is partly due to access to care, but other factors also contribute, said lead researcher Dr. Haider Warraich, a cardiologist at Brigham and Women's Hospital in Boston and the VA Boston Healthcare System. In terms of access, rural areas have seen a wave of hospital closures driven largely by economics, especially during the COVID-19 pandemic, he said.

"But it's hard to disconnect health from other factors in our societies," Warraich said. "I think it's linked to the overall economic outlook of rural America as well, and also, health behaviors that contribute to poor health, such as poor nutrition, lack of exercise, smoking, substance use, etc."

For the study, which was published in the Journal of the American Medical Association, Warraich and his colleagues used federal government health data for 1999 through 2019. They found that age-adjusted death rates dropped in both rural and urban areas over that period. But the gap widened dramatically as death rates rose among white rural residents between 25 and 64.

Over the study period, rural death rates increased 12% for that group. Although death rates dropped among rural Black residents, they still had a higher death rate than all other groups in both rural and urban areas, researchers noted.


Biden administration announces $7.4 billion in public health spending

The White House announced Thursday that it is investing $7.4 billion to hire more public health workers to deal with the coronavirus pandemic and future health crises (Source: “Biden announces $7.4 billion to hire more public health workers amid pandemic,” Washington Post, May 13).

The money will come from the $1.9 trillion coronavirus relief package, which Congress passed in March.

The Biden administration said $4.4 billion will go toward boosting states’ overstretched public health departments, allowing them to hire disease specialists to do contact tracing, case management, and support outbreak investigations and school nurses to help schools reopen. Some of the money will also go to expanding the Epidemic Intelligence Service at the Centers for Disease Control and Prevention — which plays a critical role in containing outbreaks.

The remaining $3 billion will be used to create a new grant program to train and modernize the country’s public health workforce. Applicants for those grants will be asked to prioritize recruiting staff from the communities they will serve, especially those from underrepresented backgrounds.

HPIO’s 2021 Health Value Dashboard, which was released last month, found that one reason Ohio ranks poorly on health value (47th out of the 50 states and D.C.) is that the state’s sparse public health workforce leads to missed opportunities for prevention. Data in the Dashboard shows that only three states spend less on public health than Ohio.


Public health officials concerned about sustaining resources after pandemic passes

After the pandemic is over, public health officials across the U.S. fear that they will be back to scraping together money from a patchwork of sources to provide basic services to their communities — much like after 9/11, SARS and Ebola (Source: “Public Health Experts Worry About Boom-Bust Cycle of Support,” Kaiser Health News/Associated Press, April 19).

Funding for the federal Public Health Emergency Preparedness program, which pays for emergency capabilities for state and local health departments, dropped by about half between the 2003 and 2021 fiscal years, accounting for inflation, according to Trust for America’s Health, a public health research and advocacy organization.

Spending for state public health departments dropped by 16% per capita from 2010 to 2019, and spending for local health departments fell by 18%, Kaiser Health News and the Associated Press found in a July investigation. At least 38,000 public health jobs were lost at the state and local level between the 2008 recession and 2019. Today, many public health workers are hired on a temporary or part-time basis. Some are paid so poorly they qualify for public aid. Those factors reduce departments’ ability to retain people with expertise.

The recently released HPIO Health Value Dashboard found that one reason Ohio ranks poorly for health value compared to most other states and D.C. is that Ohio’s “sparse public health workforce leads to missed opportunities for prevention.”

The report also found that “Ohioans spend a lot on downstream medical care, but investment in public health infrastructure is limited and prevention policies could be stronger.”


Pandemic could cause more childhood lead poisoning, CDC says

Lead screenings for children plummeted last spring, and stay-at-home orders may have increased household exposure to the toxic metal (Source: “More Childhood Lead Poisoning Is a Side Effect of Covid Lockdowns,” New York Times, March 11).

Over the past half-century, public health officials have made enormous progress in protecting American children from lead poisoning and the irreversible neurological damage it can cause. Since the 1970s, the percentage of children with high levels of lead in their blood has plummeted.

But in 2020, when Covid-19 cases spiked, lockdowns and day care closures confined young children to their homes, where lead exposure can be particularly high. The growing national emergency also delayed lead-removal efforts and disrupted routine childhood lead screenings, leaving health officials unable to identify and treat many children living in lead-laden homes.

Last month, the Centers for Disease Control and Prevention estimated that in the early months of the pandemic, roughly 10,000 children with elevated levels of lead in their blood may have gone undetected.

There is no safe level of exposure to lead, which can disrupt neurological and cognitive development, causing learning disabilities, behavioral problems and developmental delays.


Child vaccine declines amid COVID-19 shutdowns could lead to outbreaks of illnesses

Economic shutdowns implemented to slow the spread of the coronavirus may indirectly lead to outbreaks of other deadly diseases in the coming months, health experts are warning (Source: “COVID shutdowns may lead to outbreaks of measles, mumps as childhood vaccinations decline,” Columbus Dispatch, Oct. 10).

With more people staying home, fewer children got their vaccines for dangerous diseases such as measles, mumps, rubella and pertussis this year.

More than 90% of people need to be vaccinated for a disease to establish herd immunity and prevent an outbreak. In April, pediatric vaccines dropped by more than 45% across Ohio compared to April 2019, according to the state’s Immunization Registry.

And if outbreaks of measles or other diseases occur, Ohio and its health departments could be at a disadvantage financially and manpower-wise. Health departments in Ohio receive less state and federal funding for emergency preparedness than nearly every other state and the District of Columbia, according to HPIO analysis. The state ranks 48th for emergency preparedness dollars per capita in HPIO’s 2019 Health Value Dashboard.


Study: Flu vaccine cut child ED visits by up to 60%

The 2018-19 influenza vaccine reduced flu-related hospitalizations and emergency department visits among children by 40% to 60%, a new study shows (Source: “Flu vaccine cut childrens' hospital stays, ED visits by as much as 60%, study finds,” Beckers Hospital Review, Oct. 6)

Published in the journal Pediatrics, the study estimated vaccine effectiveness against flu-related hospitalizations and ED visits among U.S. children. Researchers found that the vaccine's effectiveness against any flu-related hospitalizations was 41% and 51% against flu-related ED visits. Vaccine effectiveness increased to 61% against ED visits related to the A(H1N1)pdm09 strain of the flu, which was initially predominant during the 2018-19 season.

Researchers tested children 6 months to 17 years with the flu at seven pediatric hospitals.


Understanding COVID-19 immunity proves elusive for researchers

Because scientists have yet to prove that just because someone has recovered from COVID-19 and produced antibodies to the virus does not mean they are protected from contracting it a second time, researchers still do not have a clear picture of what immunity looks like (Source: “Immunity to the coronavirus remains a mystery. Scientists are trying to crack the case,” STAT, June 11).

Experts anticipate an initial coronavirus infection will lend people some level of immunity for some amount of time. But they still do not know what combination of antibodies, cells and other markers in a person’s blood will signify that protection. And determining those “correlates of protection”  is crucial both so individuals can know if they are again at risk, and so researchers can understand how well potential vaccines work, how long they last and how to accelerate their development.

“What you would like is to have some blood measure that serves as a correlate of that protective efficacy or immunity,” said Sarah Fortune, the chair of immunology and infectious diseases at Harvard’s T.H. Chan School of Public Health. “Which sounds like it’s simple, but it’s much more complicated than you’d think.”


Coronavirus testing capacity expanding, but not fast enough, experts say

As the Trump administration scrambles to make more coronavirus tests available, demand for testing still outstrips availability  (Source: “U.S. Coronavirus Testing Starts To Ramp Up But Still Lags,” National Public Radio, March 18, 2020).

Most experts are pushing for making more testing available even faster, but some also question some of the steps the government is taking to try to make that happen.

More than 71,000 tests have been done so far in the U.S., according to the Covid Tracking Project, and thousands more are being conducted each week by federal and state labs, hospitals and private companies, officials say.

Every state public health lab is now testing; new high-volume, high-speed tests have been approved and are being shipped around the country; and some drive-through testing sites are slowly starting to open. The federal government hopes to open 47 drive-through sites in 12 states soon.

"The testing capacity remains extraordinarily limited compared to where we should be. And in many ways we are absolutely flying blind at the moment," says Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health.