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How COVID-19 is compounding the need for reform:Expansion of Social Programs & Universal Healthcare

How COVID-19 is compounding the need for reform: Expansion of Social Programs and Universal Healthcare

As a citizen of the world, I am dutifully practicing social distancing. As a crohnie, I am hoping that everyone understands the importance of social distancing and the risk to themselves as well as others. As the sibling of a crohnie on immunosuppressants, I will drop kick anyone who sneezes in the general area without covering their mouth.

Click here to learn more about social distancing and other recommendations for preventing the spread of infection.

While this pandemic is not to be taken lightly and decreasing the spread of infection is the first priority, today, I’m interested in discussing the state of America’s healthcare system and social programs, or lack thereof, that directly impact each citizens’ ability to effectively practice social distancing and America's response to this pandemic.

I actually cackled to the point of tears when I read the news of Norway calling on University students to return home from the U.S. citing “poorly developed health services and infrastructure and/or collective infrastructure.” You can be big mad if you want to, but there is truth in that statement.

The Beginning. I am not a politician. I do not have inside information concerning the exact nature of the original outbreak in China nor the accuracy of the information relayed to countries around the world regarding infection, hospitalization or mortality rates of COVID-19. What I do know is that three weeks prior to the initial news coverage made available to the general public, several politicians were briefed about COVID-19. In that time, those same politicians sold millions of dollars worth of stock and purchased stocks that were likely to gain valuable in the event of a health crisis (eg. technology companies that could equip hospitals and clinics for telemedicine). That suggests to me that there was significant concern about the potential for widespread infection and mortality. With that in mind, why did the government continue to insist that we were low risk as the outbreak in China gained in severity.

Despite brewing concerns about an impending pandemic among government officials, there was no effort on the part of the government to proactively implement protocols to reduce the initial outbreak and subsequent spread of infection in the United States.

Who knows?

What might have happened if we had implemented social distancing at the time of the COVID-19 briefing? What would the curve look like today?

On January 31, a full week after Wuhan announced a quarantine on 11 million people, Trump banned foreign nationals from entering the country ONLY IF they had been to China within the last two weeks. With the first case reported in China in December, it is reasonable to assume that millions of people had already entered the U.S. with active infection or carrier status and that the virus had already begun to disseminate. Not to mention, what if someone had been to China three weeks prior, but had symptoms for the last week. What if they themselves were immune, but were carrying contaminated items. This would have been the time, given the knowledge they had already had and witnessing what had taken place in China, to put the American people on high alert. Re-enforce hygiene practices and begin social distancing to mitigate the spread of infection. Develop testing, stock PPE and ventilators, brief healthcare workers and implement protocols for testing, plans of care and patient education. Instead the government implemented a wait-and-see policy and so began the relentless game of catch up.

Patient Zero - Government Response. Many healthcare providers have reported treating an influx of patient with COVID-19 symptoms weeks before the initial case in Washington was confirmed and reported. For the sake of this blog and our collective sanity, we will consider the Washington patient, patient-zero and the first red flag on the government’s radar. In the wake of the first confirmed case in the U.S., the initial response by the state AND the federal government, who had already been briefed, (I must keep hammering this home; it is so important to understand the context that many of these officials had while making decisions) was to reject any idea of an epidemic occurring as had happened in China. There were no protocols put in place to guide healthcare professionals about how to manage suspected COVID-19 patients and there were no preparations to create and distribute tests. Instead the government insisted that the COVID cases would “soon be zero.”

NYC and State Response. Today, NYC is regarded as the epicenter of the outbreak in the U.S. with more that 37,000 confirmed COVID-19 cases. This is likely due to the high level of international travel and high population density which increases exposure in NYC and exacerbated the spread of infection.

On March 1, the first confirmed case of COVID-19 was reported in NYC and while NYC demographics made it clear the we were a prime candidate for widespread infection, the federal government rejected the WHO's coronavirus tests and continued with business as usual. On January 23rd, thirty-eight days (more than a month), before the first confirmed test in NYC, Wuhan's government officials implemented a complete lockdown, effectively sheltering in place. This lockdown continues today and is projected to end on April 8th.

Many have argued that a complete lockdown would not be attainable given the human rights that are afforded to Americans. This may or may not be true, but Americans also weren't given the benefit of full disclosure. They were not briefed as the government officials had been, they were not given the option to socially distance at a time when it may have impacted the initial outbreak. Instead Americans were reprimanded for their indifference, which was only a reflection of what they had originally been told (eg. "it's a political hoax," "it's just like the flu," it's not a big deal for young people"), as government officials desperately tried to rewrite the COVID-19 narrative.

Surge In Cases. In response to the rapid spread of infection (indicated by the increase in doctor's visits and symptom reporting) and increasing hospitalizations, New York increased production and access to COVID-19 testing. Additionally, a soft launch of social distancing was implemented in a half-hearted attempt to curb the curve that is quickly surpassing those of Italy and Spain. Quite frankly we sound like a team of out of shape basketball players showing up to a game at half-time, after the opposing team has already scored 50 points, only to suggest that we play defense if we are up to it.

In any case, social distancing was the order...well suggestion of the day. If you aren't feeling well, consider staying home. "If you can stay home from work" became university/college closures which heavily influenced the decision to close New York City public schools until further notice. At each stage, New Yorkers scratched their heads in collective confusion and concern. Without paid sick leave or the protection of an official mandate, how could anyone demand to stay home or work remotely without clearance from their employer? Who would ensure that they would not lose their jobs if they were to heed warnings to stay home? The short answer to both questions is: no one. For those who are living paycheck-to-paycheck, losing their job would effectively slick the runway for the boulder they are already struggling to push uphill. That paycheck pays for mortgage/rent, utilities, health insurance, childcare, food, etc. Without any guarantees, New Yorkers were unwilling and unable to risk the employment that provided, directly or indirectly, the very same health insurance that would serve them if they, their spouse/partner, or their children became ill.

Paid Sick Leave Around the World. 94% of countries around the world (of high, middle and low-income classification) guarantee paid sick leave through social insurance and/or employer mandate. Globally, 73% of countries guarantee paid leave from the first day of illness. This allows employees to stay home when they are ill and reduce workplace exposure to illness and the spread of infection. In many cases, these policies are not full proof, but compare this to the United States which does not guarantee paid sick leave at all.

In the United States, 12 states and the District of Columbia have legislation that guarantees paid sick leave. While some employers may offer paid leave as an additional benefit, financial hardship may influence employers to retract it to preserve their businesses. Furthermore, there are significant discrepancies in paid sick leave based on occupation and income level. 90% of private-sector workers in management, professional and related occupations, such as corporate executives, software engineers, bankers and lawyers (individuals who may have the option to work remotely anyway) have access to paid sick leave. Compare this to 56% of construction workers and 58% of service workers.

Let's take a closer look at the paid sick leave being offered:

*Barring appropriate documentation*

Due to rounding totals may not sum 100%

The comprehensive paid sick leave guaranteed in Norway provides more security for workers and normalizes social distancing in the case of everyday viral illness which provides a smoother transition to quarantine in the face of a global pandemic.

Universal Healthcare. So what does universal healthcare have to do with COVID-19? When we discuss universal healthcare it is typically in the context of preventative and primary care. Expanding coverage increases primary care access and utilization which leads to better case management and long-term patient health outcomes. For those who are concerned that universal healthcare and a single-payer system would increase wait times for specialists appointments, I'd argue that compared to other high-income countries, our shorter wait times have not improved our mortality or morbidity rates. But how would that make a difference during a pandemic?

Universal healthcare cannot prevent the outbreak of a deadly virus, but it can impact access to care. Due to poor or no insurance coverage, those who are acutely and severely ill may be reluctant to seek medical support in anticipation of astronomical medical bills. That means these patients are circulating in general population longer and increasing exposure. In terms of mortality, acutely-severely ill patients are more likely to decompensate. Without the appropriate medical support, (eg. medication, ventilation, etc.) these patients will likely die of COVID-19 complications such as pneumonia and heart failure. Patients that do not require hospitalization, can seek medical counsel and receive patient education about effective hygiene practices, social distancing/quarantining and implement those practices under the guarantee of paid sick leave.

Though the stimulus package signed into law this week does cover COVID-19 testing and preventive measures (eg. vaccines) that may decrease susceptibility to COVID-19, it DOES NOT cover COVID-19-related treatment. While we hope that more legislation will be passed to address this glaring problem, this does not alter the current circumstances. Upon discharge from the hospital, underinsured and uninsured persons recovering from COVID-19 will face substantial, if not monumental, financial hardship in the form of medical bills.

Medicare For All as A Single-Payer System. In this context, the greatest advantage of a single-payer system is unified financing and governance of the healthcare system. Per person, the United States spends twice as much on healthcare as comparable high-income countries. Despite this fact, the U.S. has fewer hospital beds per capita and rural hospitals deemed unprofitable are closing at an alarming rate. Moreover, there are large regional disparities in the distribution of ICU beds. The United States' current multi-payer system always hospitals with disproportionate funding and profit to outbid others for resources, regardless of need. In 2010, researchers noted:

"There is substantial variability in critical care resources across the United States, and a pandemic or disaster affecting a small proportion of the population could quickly exceed critical care capacity in some areas while leaving resources idle in others. This reflects the limitations of a private health system in which planning occurs primarily from the hospital perspective" (Carr, Addyson & Kahn, 2010).

You may have also heard that hospitals, and city and state governments are locked in bidding wars for ventilators. This is the direct result of a multi-payer system which leaves each entity to fend for themselves to acquire adequate resources. A single-payer system facilitated by the federal government would ensure the appropriate distribution of these resources as indicated by number of cases, and rates of hospitalizations and mortality. By reforming our healthcare system, we can: (1) eliminate profit-driven sick care (2), reduce healthcare spending (3), decrease health costs for patients (4), improve patient outcomes (5), and support areas with greater need.

Hear Me Out. The purpose of this article is to challenge the misconceptions associated with social programming and universal healthcare. These ideologies are often denounced as socialist views that seek to shatter the traditional American capitalist-dream. Consider the benefits we've discussed today and weigh them against any disadvantages of such systems. I will not pretend that these proposals are perfect, but in my eyes there's no contest.

To each and every healthcare worker on the frontlines... to every healthcare student volunteering for hotlines or telemedicine... to those producing and donating supplies... to politicians who are actually working for the people to pass comprehensive legislation and save lives... to those abiding by the quarantine and practicing social distancing... to essential workers across industries and to millions more who have offered their time, energy and resources to serve the most vulnerable in our nation, we applaud you. We applaud you. WE APPLAUD YOU.

Nuff Love,

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