COVID Toll Requires We Look Back - For The Living And The Dead
“Groups with lower health insurance coverage had significantly higher mortality as well as greater case counts and hospitalization.” — Lancet report.
By Bob Hennelly
Tuesday of next week will be the last public hearing being held by New Jersey’s Coronavirus Disease Pandemic Task Force on Racial and Health Disparities where people can offer their first-hand account of their COVID tribulation that at last count killed over 35,110 New Jersey residents and 1.1 million Americans nationally.
There’s a lot to unpack here considering that at one point in 2020 the United States, only 4 percent of the world’s population was 25 percent of the earth’s COVID cases and had the highest body count by far. And for much of the peak of the outbreak, New Jersey was the epicenter for the mass death event. Even now, almost three years in the U.S accounts for 14 percent of the planet’s COVID deaths, more than three times our share of the earth’s population.
Going into the pandemic, the U.S. was spending the most on health care by far when compared to the 37 other nations that make up the Organization for Economic Co-operation and Development with the least to show for it in terms of health outcomes. According to a research report from the Commonwealth Fund, a foundation committed to improving healthcare access, when the U.S. is compared to the world’s other wealthy nations it “ranks last overall, despite spending far more of its gross domestic product on health care… last on access to care, administrative efficiency, equity, and health care outcomes, but second on measures of care process.”
Translation: we are good at collecting the data that tracks what works but haven’t displayed the capability to universally apply it.
THE MISSION
New Jersey’s Disease Pandemic Task Force’s remit from the legislature was to “develop effective strategies to: address the racial, ethnic, and health disparities, and historical and systematic inequalities pertaining to race and ethnicity that have amplified the death rate in the State’s minority and vulnerable communities during the COVID-19 pandemic; and reduce and eliminate disparities among the various racial and ethnic populations within the State’s minority and vulnerable communities with respect to health status, access to high-quality health care, and utilization of health care services.”
It remains to be seen how the state’s pandemic self-examination will look at the intersectionality of New Jersey pronounced wealth disparity and healthcare access as well as outcomes. According to the Economic Policy Institute, New Jersey’s top one percent average income is in excess of $1.5 million a year while the average income for the remaining 99 percent is just over $65,000. That top one percent’s average annual income is 24 times that of the lower cohort.
A 2015 study by the Urban Institute documented the linkage between wealth and the access to health care.
“The greater one’s income, the lower one’s likelihood of disease and premature death,” according to the Urban Institute analysis that predated the pandemic. “Studies show that Americans at all income levels are less healthy than those with incomes higher than their own. Not only is income (the earnings and other money acquired each year) associated with better health, but wealth (net worth and assets) affects health as well… Even wealthy Americans are less healthy than those Americans with higher incomes. Income is a driving force behind the striking health disparities that many minorities experience.”
New Jersey’s Disease Pandemic Task Force certainly does not have to start with a blank slate. A study published in the Lancet which looked at the potential linkage between a lack of health insurance coverage and increase COVID mortality in the months before vaccinations were widely available.
“Groups with lower health insurance coverage had significantly higher mortality as well as greater case counts and hospitalization,” Lancet researchers found. “Early in the pandemic, they were also less likely to be tested for COVID-19. Applying our regression estimates, we estimate that had there been full health insurance coverage of the population, there would have been 60,000 fewer deaths, 26 percent of the total death toll in the period of this analysis.”
FLYING WITHOUT ANY NET
According to New Jersey’s State Health Assessment Data as of 2020, 8.7 percent of the state’s persons under 65 were uninsured with the disparity between individual counties varies from 5.1 percent in Hunterdon County to as high as 12 percent in Hudson, 12.4 percent in Essex, 12.8 percent in Cumberland, 13.2 percent in Union and 14.4 percent in Passaic County.
Some international studies have flagged a relationship between childhood poverty and an increased incidence of pediatric COVID hospitalizations.
“Low area-level income, smaller mean living space, and higher degree of urbanization all increased the risk of COVID-19 hospitalization,” according to the journal Contemporary Pediatrics. “These incidence rates increased in cases of comorbidity. Children living in the area with the lowest median income were three times more likely to be hospitalized from COVID-19 than those in the area with the highest median income. Outcomes were similarly drastic based on living space. Children who used immunosuppressants or had diabetes saw an even higher risk of COVID-19 hospitalization.”
New Jersey’s poverty rate for children under five years old varies dramatically depending on the county ranging from as low as 3.8 percent in Hunterdon to more than one in four of kids in this age cohort living in poverty in Salem and Passaic counties. In Atlantic and Essex, it’s well over 20 percent. Cumberland’s not far behind at 19.2 percent and Camden with 18.4 percent of its youngest residents living in poverty.
Usually, such blue ribbon panels are little more than window dressing that officials revert to when actually taking action would be too heavy a lift. But in this case Trenton’s actions back in June of 2021 must be seen as courageous. Elected officials that presided over that traumatic period, where so much was improvised and we were so unprepared, have been reluctant to revisit the tick tock of the crisis which is still causing close to 300 deaths a day.
Just this week, New York Gov. Kathy Hockul disappointed advocates when she vetoed legislation that called for a study of the impact of COVID-19 on her state’s adult group homes citing budgetary concerns.
Last month, NJ Advance Media reported that Gov. Phil Murphy “reiterated his long-standing promise that New Jersey will conduct a review of the state’s response to COVID-19, including how it handled the crisis in long-term care facilities — yet he still does not have a timeframe for when that will happen.”
The state has however had time to complete a new Department of Health building in Trenton. Last year Murphy presided over a ribbon cutting at which the headquarters was named for Health Commissioner Judy Persichilli. (Perhaps it would have been more appropriate to name it for a New Jersey healthcare worker who died before the vaccine was available and PPE was being rationed.)
An effort led by Bob Menendez (D-NJ) U.S. Senators Susan Collins (R-ME) to “create an independent, non-partisan commission, closely modeled after the 9/11 Commission that investigated the September 11, 2001, terror attacks, to assess the nation’s pandemic preparedness and response” and “provide recommendations to improve our country’s readiness for future public health crises” didn’t get far.
‘DOOMED TO REPEAT’
Back when Menendez first made the case for the measure, the death toll was at a half-million Americans.
“Millions of American lives have been devastated, our health systems have been pushed to the brink, and our economy has been decimated,” Menendez said in a statement at the time. “We can never put our country, our communities and our families through this again. This isn’t about pointing fingers but learning from our experiences and promising to do better. In the aftermath of the worst public health catastrophe in our lifetimes, we will need to come together in a bipartisan way, as we did after 9/11, to do the serious, necessary work to protect American lives, because if we fail to learn anything from COVID-19, we are doomed to repeat this.”
Such a national examination could still happen if Congress passes the Prepare for and Respond to Existing Viruses, Emerging New Threats and Pandemics Act — or PREVENT Pandemics Act that was introduced earlier this year by the top Democrat and Republican on the Senate Health Committee — Senator Patty Murray (D-WA) and Senator Richard M. Burr (R-NC). According to the New York Times, the measure calls for a 12-member panel that would have subpoena power to “get a full accounting of what went wrong during this pandemic,” Murray told the newspaper.
For now, some people are seeking accountability in the courts.
In August, the State of New Jersey signed off on a $15.9 million payout to 71 families of residents who died in New Jersey’s three state-run veterans homes in the early on in the pandemic. Last year, the state agreed to pay $53 million to settle the claims by 119 residents who also died in the first 12 weeks of the public health emergency. “The state admitted no wrongdoing as part of either settlement,” NJ Advance Media reported.
According to NJ Advance Media reporter Ted Sherman’s reporting there are pending lawsuits brought by employees at the New Jersey Veterans Memorial at Menlo Park that allege “the state, the state Department of Military and Veterans Affairs, the governor’s office, and administrators of the nursing home put them in harm’s way as the virus struck. The complaints accuse the state of being ‘grossly negligent, knowingly careless, and reckless.’”
Fisher Phillips, a national labor law firm that tracks workplace related COVID lawsuits, reports that nationally there have been 6,798 such cases filed against employers with over 22 percent of the cases being brought against healthcare employers and 11 percent naming government agencies as a defendant.
With 653 cases in New Jersey, our state accounts for almost 10 percent of the cases being filed, the highest per capita rate of all 50 states. These cases need to be tracked and examined for common fact patterns.
Hopefully, next Tuesday the New Jersey’s Coronavirus Disease Pandemic Task Force on Racial and Health Disparities will hear from frontline healthcare workers of color whose colleagues paid the ultimate price for caring for others or are now facing long term disability from the ravages of long COVID.
According to a research study published by Rutgers University entitled Effects of Race, Workplace Racism, and COVID Worry on the Emotional Well-Being of Hospital Based Nurses: A Dual Pandemic “COVID-19 and race in both the US general population and the healthcare workforce are inextricably linked. Black, Hispanic, and Asian persons in the US have experienced the highest rates of COVID-19 cases, deaths, and hospitalizations compared to Whites. Similarly, the COVID-19 pandemic has disproportionately harmed healthcare workers of color in the US. Nearly one-half of all confirmed healthcare worker cases of COVID-19 and COVID-related hospitalizations and deaths have occurred among workers of color.”
The study continued. “Even though nurses of color comprise only 28 percent of the US nursing workforce, in a pandemic where minority populations and healthcare workers are among the hardest hit, nonwhite nurses are undoubtedly taxed and are highly vulnerable to negative effects on their mental health from trying to balance workplace COVID-19 exposure with ensuring safety for themselves and their families.”
We need to have the courage to look back and investigate how our for-profit healthcare system resulted in the scarcity of essential PPE and short staffing that turned our hospitals into vectors for the virus that took the lives of so many.
We owe it to the dead and the living.