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Commentary, activities, or information related to the impacts of the COVID-19 pandemic on the academic population health community, including administrative and curricular challenges such as distance learning.

 

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Top tags: Academic Public Health Volunteers Corps  Migrant Health 

Migrant Health, COVID-19, and the Demands of Justice

Posted By Rachel Fabi, SUNY Upstate Medical University, Wednesday, July 1, 2020
Updated: Wednesday, July 1, 2020

As the COVID-19 pandemic continues to rage across the country and around the world, its disparate impact on marginalized populations has become increasingly apparent. Two particularly vulnerable groups that are suffering the harms of inadequate protection from the dangers of COVID-19 are migrants currently held in immigration detention facilities and immigrants living in the United States. At a time when many public health scholars have the ear of the nation, it is incumbent upon all of us to advocate for marginalized and excluded non-citizens held in detention at our borders, living in our communities, and working in essential jobs across the nation. The harms being perpetrated by the Trump administration in the name of public health will echo through generations if we do not, as a profession, reject these measures and stand for justice.

While the CDC has instructed residents of the United States to wash their hands, wear masks, and practice social distancing, migrants in detention facilities run by Immigration and Customs Enforcement (ICE) and Customs and Border Protection (CBP) have no control over their ability to engage in any of these practices. As a result, cases of COVID-19 have skyrocketed in immigration detention, with ICE’s own numbers indicating that over 1700 migrants have tested positive for COVID-19, and at least two migrants and four guards have died from the disease. The public health community has for years decried the unsanitary and unsafe conditions in detention facilities in the United States and the inhumane treatment of migrants, particularly women and children, seeking to enter the U.S., but in the midst of a nationwide communicable disease outbreak, the plight of migrants is at risk of being overlooked.

Consider the parallel between immigration detention and the U.S. prison system. At the urging of public health experts and advocates, some prisons and correctional facilities across the country have begun releasing inmates accused of nonviolent crimes in order to reduce the chances of widespread outbreaks. Despite this small step towards progress in the wider carceral system, immigration detention facilities are still holding thousands of migrants and asylum seekers, the overwhelming majority of whom did not commit violent crimes. According to the non-partisan Center for Migration Studies, ICE still held over 4,000 asylum seekers determined to have a “credible fear” of persecution or violence in their home countries, even several months into the pandemic. Meanwhile, COVID-19 cases continue to rise as ICE shuffles detained migrants between facilities.

In addition to continuing to detain some migrants and asylum seekers in unsafe conditions, the Trump administration is also using COVID-19 as an excuse to ramp up immigration enforcement and deterrence strategies. Border Patrol agents have been instructed to expel people apprehended at the border without following legal requirements to determine if a migrant has a valid asylum claim. In the name of public health, hundreds of minors have been sent to Mexico, where they face the dangerous conditions experienced by people subject to the Migrant Protection Protocols (MPP, also known as “Remain in Mexico”), including rampant kidnapping, sexual assault, and murder.

The COVID-19 crisis does not only affect asylum-seekers and migrants in detention. Immigrants who live in the United States, with or without legal status, are also disproportionately harmed by the fatal intersection of anti-immigrant policy and inadequate public health measures. When the Trump administration changed the public charge rule in 2019 to discourage legally residing immigrants from using social services like Medicaid and SNAP, tens of thousands of commenters wrote to oppose the changes. Some who wrote in opposition argued that the policy would be bad for the health of immigrants and American citizens alike, citing the communicability of disease outbreaks and the dangers of discouraging vulnerable people from seeking health care. They could not have known how prescient those concerns were, as we can now see the effect the public charge rule has had on immigrants’ willingness to seek care for COVID-19. 

In addition to the damaging public charge rule, the U.S. government has doubled down on the harm to undocumented immigrants by excluding them from the 2 trillion dollar Coronavirus Aid, Relief, and Economic Security (CARES) Act. Although many undocumented immigrants are essential workers, they are not entitled to relief under the CARES Act, and even the U.S. citizen children of undocumented immigrants are unable to access the benefits of the program. Most undocumented immigrant adults are ineligible for publicly funded insurance, and their children are only eligible if they are citizens or reside in one of the few states that provide coverage to undocumented children. These exclusions from social safety-net programs, while clearly unjust even during non-pandemic times, seem downright cruel and counter-productive to the goals of public health in the midst of a dangerous pandemic disease outbreak.

The injustice of this moment, directed against some of the most marginalized members of society, presents a unique challenge to public health scholars and practitioners. As COVID-19 continues to ravage communities of color and tear through immigration detention facilities, it is incumbent upon all of us, as members of the public health community, to use our collective voice, power, and privilege to call for immediate and long-term change. This crisis has demonstrated the moral and practical dangers of excluding some populations from the benefits of publicly funded health care and denying the humanity of non-citizens seeking to make a better life for themselves and their families. We must meet this moment with persistent advocacy for justice in all of the systems that perpetuate health disparities, including a reimagining of both our health care and immigration systems. If we truly believe that the “public” in public health includes all of us, there is no other alternative. 

 

Rachel Fabi, PhD

Tags:  Migrant Health 

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Now At Over 100,000 COVID Deaths, What Have We Learned?

Posted By Willie Oglesby, Thomas Jefferson University, Wednesday, June 17, 2020
Updated: Wednesday, June 17, 2020

It’s easy to forget that it was only a few months ago when the world first heard about an unusual pneumonia affecting a few dozen people in Wuhan, China.  Since that announcement by the World Health Organization in January, what eventually became known as the 2019 novel coronavirus disease (COVID-19) spread throughout the region, Europe, and the rest of the world at nearly unprecedented levels. 

Today, there are more than more than 5.5 million confirmed cases and 350,000 deaths attributed to COVID-19 worldwide.  Due to reporting discrepancies across countries (including in the US), uneven and inadequate testing, and other factors, many experts believe the actual numbers of COVID-19 cases and deaths are likely much, much higher. 

Recently, the US recorded it’s 100,000th death due to COVID-19.  Although the number of new cases in the US is currently declining each day, the total number of cases and deaths will continue to rise, and the daily number of new cases could accelerate again if testing and mitigation strategies fail.  At this difficult milestone in the epidemic, I took some time to look back over the last few months and share my observations on what we’ve learned—in hopes that we’ll apply these lessons to the next phase of the pandemic.

Our public health system is more fragile than we thought.  Early in the epidemic, the Centers for Disease Control and Prevention were unable to provide reliable estimates on how COVID was spreading due to poor reporting infrastructure and problems receiving data from state and local jurisdictions.  Even now, the agency is still trying to detangle the data they have to more clearly document those who have tested positive using the viral tests (the primary means of tracking the spread of the virus) and those who are testing positive using the antibody tests (the primary measure of tracking who ever had the disease—regardless if they are currently infectious or not).  Combined with the failures of its labs early on to create test kits necessary to track the spread of the virus, CDC has led many (including me) to seriously doubt its ability to effectively manage pandemics without sufficient infrastructural investments and perhaps a change in leadership at multiple levels within the agency.

The healthcare “safety net” doesn’t really exist.  In the US, we use market-based approaches to provide access to healthcare services rather than socialized or nationalized models that guarantee access for everyone.  Consequently, gaps exist for populations that are either too sick for insurance companies to want to insure or they simply cannot afford to pay the high costs for coverage.  To address these gaps, federal and state governments spend billions annually implementing a myriad of programs including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) and supporting access points for services such as Federally Qualified Health Centers, Critical Access Hospitals, and others.  What has all of that spending on healthcare given us during a time when we need it the most?  Some of the largest disparities in COVID-related morbidity and mortality ever seen in modern times.  How can we legitimately claim to have a healthcare safety net when the cracks are so large that entire populations fall through them to their demise?

We are more caring, hopeful, and resilient than it usually appears.  The political discourse over the last decade has grown increasingly vitriolic.  Supporters from all sides of an issue seem to revel in the idea of demonizing each other on television and social media—and the anger isn’t limited to words.  Political violence has increased substantially over the last five years and is beginning to rival the number of domestic terrorism events pervasive during the periods of significant political unrest in the 1960s and 1970s. 

In spite of the hate-filled cloud that seems to hang over every subject with more than one point of view, we did manage to come together in many interesting ways to support each other.  School teachers made house visits to check on their students; people around the world clapped and banged pots and pans to honor the sacrifices of healthcare workers; untold numbers of food bank volunteers literally fed hundreds of thousands of people in need; school administrators found creative ways to celebrate graduation; people from all walks of life learned how to sew countless masks for essential workers and their high-risk neighbors; mutual aid networks popped up to support the various needs of community residents; and the list goes on and on…

The biggest lesson that I hope we all have learned is that together, we are more powerful than we realize.  We stepped up when our leaders didn’t, we took care of each other when they couldn’t or wouldn’t, and we all contributed in our own way toward the same simple goal: helping each other when it mattered most. 

Now my question for you:  Can we learn to do this again?

 

Billy Oglesby, PhD, MSPH, MBA, FACHE

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How Our Academic Health Department Consortium Mobilized to Meet COVID-19

Posted By Carly Levy, MCPHS University, Wednesday, May 20, 2020
Updated: Tuesday, May 19, 2020

In the spring of 2019, the Massachusetts College of Pharmacy and Health Sciences and seven other schools and programs in public health formed an Academic Health Department Consortium (AHD) with the Massachusetts Department of Public Health to help bridge the gap between public health practice and academia. In March 2020, at the request of the Governor of Massachusetts and the COVID-19 command center, the AHD was mobilized to provide support to local boards of health who were responding to the pandemic. On behalf of the AHD, the Massachusetts Health Officers Association (MHOA) surveyed all 351 local boards of health in Massachusetts to identify some of the most pressing needs. In response, the AHD shared resources to develop the Academic Public Health Volunteers Corps (APHVC), a collaboration of 12 academic institutions, MHOA, and the Massachusetts Public Health Association (MPHA).

The mission of the APHVC is to “leverage public health students, alumni, and expert volunteers to augment, amplify, and promote local public health efforts in Massachusetts.” An initial wave of over 600 volunteers were deployed in April to meet emergent needs of over 90 communities across Massachusetts. This summer the APHVC will continue to deploy hundreds of public health volunteers to local boards of health to support many different services such as developing health communication materials, conducting data analysis and GIS mapping, conducting wellness checks and doing community outreach, developing policies and protocols, and more. 

While there have been many successes of the APHVC and AHD mobilization, the focus of this post is to highlight lessons learned from this collaboration for academic institutions, particularly for programs in public health or the health professions. These lessons are from my perspective as a board member of APTR and are not representative of the AHD as a whole:

(1)  Stay true to the mission of the collaboration. For the AHD and the APHVC, this has meant ensuring local boards of health continue to inform the work. Moreover, the response to COVID-19 has been rapidly evolving over the past eight weeks. Whenever discussions arose of where best to focus our efforts, the team worked hard to bring it back to whether or not the proposed action supported local health. This group reminds each other of the hard work being done at the local level and that the AHD and APHVC are there to support, augment, and amplify local health, not work in silos or out of sync with what is needed on the ground.

(2)  Keep health equity and racial justice at the center of the conversation. Article, after article, after article, in both peer-reviewed literature and mainstream media highlights disparities by race/ethnicity, disability status, income, geography, and other social factors. As Meenakshi Verma-Agrawal, Associate Professor of Practice and Assistant MPH Program Director at Simmons University reminded the group, “I think it is important that folks are applying some type of Racial Equity Impact Assessment or similar tool when decision making:

a. What would this [policy/communication] discourage/encourage us from doing?

b. What are the possible unintended outcomes of this [policy/communication]?

c. Does this [policy/communication] address historic/ structural racism?”

(3)  Provide high impact educational practices for students during the response. Although alumni, staff, and faculty from the academic institutions participate in this effort, the majority of the volunteers are students. Collaborating with community partners can provide excellent real-world problems for students to address and serve as a high impact educational practice (HIP). HIPs have been discussed in the education literature for almost two decades. HIPs are teaching and learning practices that have shown to increase success for students, particularly those with diverse backgrounds (Kuh, 2008). Service Learning or community-based learning, as a HIP, is an approach that gives students direct experience with issues they are learning about in a theoretical way (Kuh, 2008).

So there you have it, three considerations while engaging with state and local public health during a pandemic –stay focused on the mission of supporting local health, center health equity and racial justice, and utilize the collaboration as a HIP for students. Are you looking to engage community partners in the COVID-19 response? I would be happy to brainstorm ways to help you mobilize.

Kuh, George D. (2008). High-impact educational practices: What they are, who has access to them, and why they matter. AAC&U, Washington, D.C.

 

Carly Levy, MPH, CPH

Tags:  Academic Public Health Volunteers Corps 

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The?

Posted By Scott Frank, Case Western Reserve University School of Medicine, Monday, May 4, 2020

A wicked problem is a social or cultural problem that is difficult or impossible to solve for many reasons, including incomplete or contradictory knowledge; dynamically changing requirements; a large number of people and opinions involved; a large economic burden; and the interconnected nature of wicked problems with other wicked problems. Wicked problems can’t be solved. They can only be iteratively improved. The use of the term "wicked" here represents resistance to resolution, rather than evil. But there may be a little bit of evil embedded in the irrational, dysfunctional response to the problem. Sounds a lot like Covid.

 

The secret of dealing with wicked problems—and the reason for labeling them as such—is to recognize that these problems can’t be solved, but rather must be managed. Wicked problems can’t be ignored, manipulated, denied, or wished away. More than solutions, wicked problems require healing, a characteristic not at the top of the US population skills list. To heal is to make whole, a space we are currently far from. Full of holes, yes. Full and whole, nope. Don’t you love the wisdom of language?

 

Ironically, Covid does not “qualify” as a wicked problem, because this designation is reserved for problems humans invented rather than natural phenomena. While Covid is therefore not itself a wicked problem, the pandemic response to Covid is very much so. The excess burden of illness we are experiencing in the US represents problems that humans invented through denial of science and personal self-interest. All amplified by the interconnected nature of Covid with other wicked problems. And every wicked problem is a symptom of another problem.

 

One of the key principles for effectively managing wicked problems is that decision-makers must be fully responsible for their actions. This is happening in many state and local jurisdictions, but others seek to obfuscate and mislead. While the template for emergency response is imperfect, had the emergency preparedness science been respected and implemented the US might be in a different place right now.

 

Finally, Covid is distinguished from “true” wicked problems because for other such problems it is hard, maybe impossible, to measure success. Not so here. Success and failure can and will be measured by the rate of illness, hospitalization, and death from Covid-19. Particularly for the most vulnerable victims best by a myriad of wicked problems; and those we have made vulnerable by inadequate preparation (healthcare workers, police officers, bus and truck drivers, grocery and food service workers, custodians, and anyone working in at risk positions without adequate protection).

 

For wicked problems—for the Covid response and the problems Covid reveals in our society—we need righteous solutions, honorable, upright, and yes, unimpeachable. Such a response is being role modeled in many locations, to our enduring benefit. Thank you to political decision makers who are respecting science and acting to limit morbidity and mortality. Public Health means loving the world like your family. Good to be a Publichealther.

 

Scott Frank, MD, MS

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