Tag: Health Care

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Dear Congress, You Needed to Pass Funding for Pandemic Relief…Last Week

Note to readers: This post is going to be unlike any other blog post I’ve ever done, in that this is going to be written like a letter, namely, an open letter to Congress. I hope this open letter will inspire others who care about the issue I am writing about to think about this further, and perhaps write letters to their own congressional representatives about the issue I write on here.

Additionally, I will add that there are reports that Congress has agreed to a deal on this. To my knowledge, the deal hasn’t passed yet so I decided to still publish tonight’s post.

Dear Congress,

Over two years into the COVID-19 pandemic, it may be tempting to throw in the towel and say that the pandemic is over, endemic, or not a big deal. But not one of those three things is a reality yet. As of the time I’m writing this, the pandemic is still taking the lives of over 600 Americans a day, meaning that we are losing thousands a week to this virus. I remember when America grieved over 1,000 troops and then 2,000 troops lost in the Iraq War. We are losing that number of Americans to the pandemic every 2-3 days.

Worse yet, there are parts of the United States, including where I live in New York City, where the BA.2 subvariant of the Omicron variant is spreading.

During a time like this, a time when we may need to prepare for another wave of this pandemic (regrettably, as I’m tired of the pandemic too), we should be doubling down on three basic public health measures we’ve been pushing for many months: testing, tracing, and vaccinating.

And yet, because of your inability to do your jobs as public servants—serving the public, first and foremost—you have put this into doubt for uninsured Americans.

Also, just on a semi-random tangent: the fact that the phrase “uninsured Americans” exists is an indictment on Congress’s ability to give even the most basic of safety nets to people who might not otherwise have a safety net. That’s before we even start talking about all the Americans who are underinsured, as well as Americans with insurance companies that lack any sort of generosity or compassion with the benefits they give out.

Because you failed to do your jobs, COVID tests for uninsured patients are no longer free, even if they have COVID symptoms. How can people test or trace when they struggle to pay out of pocket for health care? Millions of Americans don’t have the money to make such a choice, and as a result have to resort to rapid tests that aren’t quite as accurate but still require a certain amount of money to buy them. Because of your inability to do your jobs, the public health strategy of testing and tracing has been put in danger in at least some parts of the United States.

Then there is the free funding for vaccines for those who are uninsured. Funding is supposed to run out for that this week. By not ensuring funding for this, especially at a time when we are urging people to get boosted and others fifty and older to get their second boosters, Congress is essentially taking an anti-vaxxer posture, or at least an anti-vaxxer posture for the uninsured. Let us be clear—not ensuring funding for COVID vaccines for the uninsured is an anti-vax policy, period.

And then there are all the other things in danger as a result of your irresponsibility: the curtailing of a relief fund that has allowed hospitals to treat uninsured COVID patients,[1] the potential running out of monoclonal antibodies by June,[2] and more.

I read that Republicans in Congress want “a more detailed accounting of where previous COVID-19 funding has gone.”[3] One can debate over whether there is a need for this detailed accounting, but regardless, said accounting should not keep those who are uninsured from access to things like vaccines and tests. However, one detailed accounting we really need is how we are going to prevent people from dying when we are pursuing a strategy of cutting off funding for things that help people live.

We need funding for COVID treatment, and we needed it last week. Congress needs to act.

Sincerely,

Grumpy from New York City

[1] https://www.npr.org/sections/health-shots/2022/03/29/1089355997/free-covid-tests-and-treatments-no-longer-free-for-uninsured-as-funding-runs-out

[2] https://www.newsweek.com/monoclonal-antibodies-could-run-out-june-without-more-funds-psaki-warns-1688318

[3] https://www.npr.org/sections/health-shots/2022/03/29/1089355997/free-covid-tests-and-treatments-no-longer-free-for-uninsured-as-funding-runs-out

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American Health Care and Responding to the Long-Term Impacts of the COVID-19 Pandemic

With the Omicron variant having settled down, it seems like the “health care system” (putting that phrase in quotes because, in the words of a former journalist by the name of Walter Cronkite, I believe it is “neither healthy, caring, nor a system”[1]) can perhaps take a bit of a breather, at least until the next variant. If there is another catastrophic variant, that is, and I hope there won’t be one.

Yet, even if there isn’t another variant, health care systems around the world, including the one in the United States, will in a way be responding to the long-term impacts the pandemic has had on people for years, if not decades, to come. And I am concerned about the American health care system not giving people with said impacts the sort of health care that is required.

But first of all, who are the people with these long-term impacts?

Some of us will possibly be COVID long-haulers who will need physical health care. We are learning more about the long-haulers as we go along, but it may turn out that some will end up with long-term or even permanent impacts that will affect their daily lives due to neurological conditions,[2] among other things. Regardless, the long-haulers are a population that will be dealing with long-term impacts from COVID, quite possibly, long after the pandemic ends.

However, many more of us will be people who need mental health care of various kinds due to the emotional trauma that the circumstances of COVID have caused. A wide range of populations will need this mental health care in some way, shape, or form, ranging from family members who lost loved ones due to the pandemic, to hospital workers who have emotional trauma from working in hard-hit hospitals, to people whose personal economic fortunes turned completely upside down due to the pandemic and never recovered. Dealing with the effects of trauma can be lifelong, and as such, dealing with the effects of COVID-related trauma may also be lifelong.

I have no idea how many people will need COVID-related physical health care and how many will need COVID-related mental health care after the pandemic, but I’m guessing that it will be a sizeable number of people in the United States—perhaps in the hundreds of thousands, and perhaps even in the millions. What I do know is that there will likely be a lot of people who will need one or both things, and that if preparations are not made for that long-term reality now, people are going to be hurt quite badly (physically, emotionally, and otherwise) by how poorly prepared our health care system is, by how American health care has a nasty tendency to leave people either uncovered or undercovered for so many basic needs.

Nor do I know what preparing for such a reality may look like, as I am not a health care expert. Frankly, I’m not even sure if a lot of health care experts know what preparing for such a reality may look like, either. I’m not even sure if it’s possible for a health care “system” as broken as the one in the United States—a “system” where millions are uninsured, where millions more are denied coverage for so many basic needs, and where the politicians that could change this would rather keep the status quo then actually fix these problems—could ever be truly prepared for the potential enormity of caring for scars, both physical and emotional, that come from this pandemic. Possibly not. But if it is possible, those preparations need to happen, and happen now.

[1] https://www.goodreads.com/quotes/74350-america-s-health-care-system-is-neither-healthy-caring-nor-a

[2] https://www.nbcboston.com/news/local/boston-doctors-explain-long-covid-and-neurological-symptoms/2509459/

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The Classism of Doctor’s Notes in the United States

A lot of times, social media can be a dumpster fire. But sometimes, there are people on social media who make interesting points, and such was the case with one quote I came across:

“Requiring doctor’s notes to excuse absences due to illness is inherently classist in a country w/o universal healthcare and I really wish we talked about it more.”[1]

Upon thinking about this tweet, the person who tweeted it was right: requiring a doctor’s note to excuse absences due to illness is classist in the United States, a country that unfortunately lacks universal healthcare. So, let’s talk about it more.

Many schools and workplaces require someone who’s been out sick, and particularly someone who has been out sick for more than a certain period of time, to give a doctor’s note explaining the person’s absence upon their return to school or work. For many of us, in the cases of a multitude of illnesses (though not all illnesses), it’s simple enough: you go to a doctor, you get something checked out, you find that you are ill with something that keeps you out of school or work for several days or a couple of weeks (like strep throat, an ear infection, etc.), the doctor gives you a note to present to a teacher or employer showing that you were indeed sick with something, you give the note to your teacher or employer, and then you move on.[2]

In the United States, where there is not universal healthcare, not everyone has health insurance because not everyone has a job with insurance or afford to buy insurance if they lack it through their job. Due to how a lack of health insurance can make it prohibitively expensive to visit a doctor (which seems to cost in the $300-$600 range for those who don’t have insurance to cover the visit, per what I looked up online) or even an urgent care clinic (which is less expensive than seeing a doctor without insurance, but still can be in the $100-$200 range apparently), some Americans have a difficult time affording the requisite visit to get that doctor’s note upon their return to work or their kid’s return to school. What are those people to do?

This problem should be especially noteworthy for employers that do all they can in order to avoid paying for health insurance for employees, or employers (oftentimes small businesses) who struggle to afford to pay for adequate health insurance for their employees. As a result, some employees are unable to afford doctor’s visits in general—an injustice in and of itself that prevents people from getting requisite doctor’s notes and has personal and public health ramifications that go well beyond doctor’s notes.

So what is the solution to this doctor’s note classism in the United States?

The long-term solution is universal, affordable health care of some sort so that every single American can be able to go to the doctor when they are unwell. This addresses the issue of being unable to afford a doctor’s visit—which enables someone to get a doctor’s note when they need it. But it has personal and public health benefits that go well beyond the ability to get a doctor’s note. However, to be completely realistic, Congress barely got Obamacare passed and signed into law in the United States (inadequate as it may be in terms of providing truly universal care), and the political situation in the United States is somehow even more toxic now than it was then. In other words, my pessimistic realism is telling me that it may be some time before we get truly universal healthcare. I hope I am wrong.

In the interim, I think that many bosses with uninsured or underinsured employees need to be sensitive to the fact that for some employees, all they can do to get better is to simply rest. As such, sick leave policies should reflect that fact. Admittedly, such an approach requires a certain level of trust in employees that some employers lack (and there are unfortunately some people in this world who give reason for having low trust in employees, but there are also many deserving of that trust). However, the alternative is worse: forcing a poor, uninsured person to come into work sick because they cannot afford to get the doctor’s note necessary to show that they are sick.

[1] https://twitter.com/fortunafiasco/status/1048369825045573633

[2] However, it is worth noting that there are some illnesses where things like rest and fluids are needed far more than a visit to the doctor. Asking for a doctor’s note is problematic in those sorts of situations as well, albeit such situations are not the focus of my post here.

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Coronavirus Update From New York City: September 30, 2021

I hope that all of my readers are remaining safe, regardless of where you are.

On a personal level, the news about Moderna booster shots is big, as I have some family members who took the Moderna vaccine who would be eligible to get a booster shot. Though alas, I am on Team Pfizer so the time has not come (yet) for me to get a booster. As soon as I am eligible for one (assuming the science says that people who got the Pfizer two-dose should get a third dose), I hope to get one, though.

The biggest news out of my area this week has been over vaccine mandates, for both New York City’s Department of Education (DOE) employees and for health care workers in New York State.

The vaccine mandates for DOE employees has been subject to legal challenges, but as of the time of my writing, it looks like the mandates will go into effect at 5 PM this Friday. I hear that there’s a last-ditch effort for the vaccine mandate to be appealed to the United States Supreme Court, though I would be somewhat surprised if the Supreme Court blocked it–Justice Amy Coney Barrett turned away a challenge to a vaccine mandate at Indiana University (not to be confused with University of Indiana), so if that’s any indication, it seems like even the conservative Supreme Court justices have little appetite to take up anti-vaccine mandate cases. I support this mandate, because ultimately DOE needs to look out for the best interests of those most vulnerable in their system: unvaccinated kids under the age of 12 who cannot get vaccinated at this point. A public school system of teachers and other faculty who are fully vaccinated (with exemptions for extremely limited religious and medical reasons, of course) is a system that is looking out for those unvaccinated little kids. There is some concern as to what schools will do when confronted with teachers who remain unvaccinated, in spite of the mandates. While that is an understandable concern, I still remain hopeful that the majority of currently unvaccinated teachers will get vaccinated when push comes to shove, and that in the cases where there are teachers who continue to remain unvaccinated, there will be enough vaccinated substitute teachers to step in. We’ll know by this time next week, unless I am wrong in my prediction about what the Supreme Court will do, about whether I was correct to be hopeful.

The vaccine mandate for health care workers in New York State is already in effect, and there are reports of some hospitals taking a hard line on unvaccinated health care workers, even firing some of the unvaccinated.[1] In cases where there are staffing shortages at hospitals, people from the National Guard are stepping in. I support this mandate as well. Given the tragic consequences of not being diligent enough with how we care for COVID, I personally am led to be on the side of being more rather than less diligent, including with vaccinations for our health care workers. The side of being more diligent means health care workers getting vaccinated, with some rare exceptions.

Mandates aside, the virus seems to be spreading at more or less a steady rate in my area.[2] This gives me hope that we have weathered the potential storm of schools getting started, though honestly, even if it were a storm, at least the New York City area would’ve started with a decent amount of capacity in our ICUs in order to manage it. The fact that we have weathered this also gives me hope that maybe, just maybe, the spread of the virus will slow down some more.

Speaking of ICUs, I must continue to say that thankfully, the horror stories of ICUs at capacity still do not exist in the New York City area. As of last Tuesday, only 60% of ICU beds are filled.[3] This stands in stark contrast with the parts of the country that have lower vaccination rates than New York City and higher occupancy of ICU beds (still to the point of medical care being rationed in the most extreme of cases). I genuinely hope and pray for those of my readers in those parts of the country and world where there aren’t many, if any, available ICU beds for other COVID patients.

So, that is it for me for now. Feel free to leave comments below about the situation I describe in New York, the situation with COVID in the United States, and/or the situation where you are!

[1] https://www.cbsnews.com/news/covid-vaccine-mandate-new-york-hospital-workers-2021-09-28/

[2] https://covidactnow.org/us/metro/new-york-city-newark-jersey-city_ny-nj-pa/?s=23561273

[3] Ibid.

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Coronavirus Update From New York City: September 16, 2021

I hope that all of my readers are healthy and safe, regardless of where you live.

Public schools in New York City started back last Monday. With the start of public schools again came the start of mass transit that in some places is as crowded, if not more so, as it was before the pandemic. Between schools starting back and the crew shortages on some bus and train lines in New York (I’m suspecting that it’s because a lot of mass transit workers are getting hit with COVID, though I could be wrong), I’ve experienced some very crowded buses in particular (and busy trains, albeit not quite as crowded as some buses I’ve been on). I’m hoping that this doesn’t result in our having another wave of this pandemic, but we will see. Over the past several weeks, I haven’t been particularly optimistic because all school kids under 12 cannot get vaccinated and therefore are potentially extremely vulnerable. In the next couple of weeks, we may see whether I was right to be pessimistic.

Even if my pessimism is correct, at least we continue to have a decent number of ICU beds available in the New York City area–over 4 in 10 of them.[1] Some other parts of the country are not so lucky, as Idaho is now rationing health care,[2] and so is Alaska’s largest hospital.[3] I say this because while we are not in an ideal situation in New York City, at least in my humble opinion, we are in a situation nowhere near as bad as some other parts of the country. Actually, I’m sensing that some other parts of the country may be experiencing now what people in New York City went through in March 2020.

There have been significant debates over vaccine mandates in my city, and nationwide. In fact, as some American readers know, the subject of vaccine mandates (along with COVID restrictions in general) was at the center of a recall election in California where Republicans were hoping to oust Democratic Governor Gavin Newsom. As such, I will give my two cents on such mandates…

There are numerous vaccines that are mandated for the simplest things, such as attending school. Take Nebraska for example, a state where its own governor was grilled on by Chris Wallace on Fox News for not mandating COVID vaccines even while other vaccines are mandated. That state requires vaccinations for things like hepatitis B, chickenpox, and polio.[4] Such mandates have been constitutional before, and in fact there is Supreme Court precedence for said mandates,[5] so arguments that mandates are infringing upon the liberties of people just doesn’t hold constitutional muster from what I have read.

All that being said, if one believes that the COVID vaccines are effective, just as vaccines against those other aforementioned diseases are effective, I honestly then struggle to understand why some leaders are not doing everything they can to make sure that every single person who can get vaccinated does get vaccinated. Especially with lives at stake here, I am a believer that we should do everything in our power to save as many lives as possible. People’s lives depend on it. And frankly, with how the pandemic has affected the economy, both in the United States and globally, people’s livelihoods depend on it too.

Enough of my lecturing, though. I’m curious to hear how others are doing!

[1] https://covidactnow.org/us/metro/new-york-city-newark-jersey-city_ny-nj-pa/?s=22991219

[2] https://apnews.com/article/business-health-public-health-coronavirus-pandemic-idaho-db21f9a14254996144e78aafb1518259

[3] https://www.usnews.com/news/health-news/articles/2021-09-14/latest-second-chinese-city-sees-outbreak-of-delta-variant

[4] https://dhhs.ne.gov/Pages/School-Immunization.aspx

[5] https://www.politico.com/news/magazine/2021/09/08/vaccine-mandate-strong-supreme-court-precedent-510280