Coronavirus Files: Scaling COVID-19's third peak

coronavirus
October 19, 2020

Since April, The Center for Health Journalism has been publishing a special newsletter geared to journalists as they report on one of the biggest and most complex stories of our times. Each Monday, while the pandemic runs its course, The Coronavirus Files will provide tips and resources and highlight exemplary work to help you with your coverage. This week, The Center for Health Journalism’s Coronavirus Files Monday newsletter is curated and reported by CHJ content editor Ryan White and community editor Chinyere Amobi. Have a suggestion or a request? Write us at editor@centerforhealthjournalism.org.
 
The Health Divide: COVID-19 pandemic strains rural hospitals
 
The COVID-19 pandemic is straining rural hospitals that were already facing a wave of closures and poorer health outcomes. “Kentucky Hospital Association President and CEO Nancy Galvagni said the decline in elective procedures has been the biggest reason for decreasing revenue,” reports Corinne Boyer of the Ohio Valley ReSource. The outlet reports that “by the end of 2020, Kentucky, Ohio, and West Virginia hospital officials anticipate more than $2.7 billion in financial losses, even after the assistance from a federal coronavirus relief bill.” Galvagni has seen patients with acute illnesses delaying care, with physicians reporting an increase in emergency surgeries. While the pandemic drains hospitals of revenue, it also brings added costs for personal protective equipment, testing, and increased telemedicine capacity.
 
Historically Black colleges host COVID-19 vaccine trials to bolster enrollment
 
Drug companies involved in the development of COVID-19 vaccines say Black enrollment in vaccine trials is lagging. Now, historically Black colleges and universities are leveraging their legacies of trust within Black communities to boost Black enrollment, reports Nicholas St. Fleur in STAT. When two college presidents from historically Black universities in New Orleans registered themselves for a vaccine trial and encouraged faculty, staff, students, and alumni to follow suit, they received a hail of outrage on their schools’ social media accounts. The backlash highlights a long-standing mistrust of medical research and the government, fueled by a long history of racism in health care. Despite the reactions at these schools, four Black medical schools have since signed on to host COVID-19 vaccine trials on their campuses and spread awareness about the importance of Black participation in vaccine trials for a disease that disproportionately affects the community. “Though people are all nearly identical genetically, people of color might respond differently than white people to a vaccine, especially for a respiratory disease, due to social differences such as exposure to air pollution that disproportionately affects Black and brown communities, or higher rates of chronic disease such as diabetes and sickle cell,” St. Fleur writes.
 
Scaling COVID-19’s third peak
 
By now you’ve seen the alarming trend line: The U.S. is climbing the slope of what appears to be a third spike in COVID-19 cases since the pandemic began. The nation’s daily case count has now pushed past 60,000, a sharp increase from the 25,000 daily cases seen at early September’s low point. Wisconsin opened a field hospital last week, and hospital systems from Utah to Missouri to New Mexico are being pushed to their limits. What’s driving the latest surge? In The Wall Street Journal, public health experts point reporter Jennifer Calfas to several factors: Vulnerable rural areas spared earlier are racking up cases, people are growing weary of basic restrictions, the return of college students to campuses, and most notably, the arrival of cooler weather that huddles people indoors, where coronavirus easily spreads.
 
A tale of 50 states
 
As we saw with earlier outbreaks in the Northeast and then Sunbelt states, COVID-19 infections are not evenly distributed. The current surge in cases has been especially steep in states such as Wisconsin, Iowa, Utah, Montana, and the Dakotas. In the absence of strong federal directives during the pandemic, states have also varied widely in how they’ve responded. A team of Politico reporters asks this week: “Which ones have done the best job so far?” Vermont stands out for its extremely low death rate, despite its older population and proximity to hard-hit states like New York. Washington state gets high marks for its rapid response to early outbreaks and its extensive data-sharing efforts. As a result of these and other actions, the state’s “per capita death toll is less than one sixth of New York’s,” Politico reports. Michigan is lauded for narrowing racial disparities, Colorado scores high on responding to jobless claims, and Rhode Island is a leader in safely returning kids to school. Read the reporters’ full analysis of what has worked so far and where during COVID-19 here.
 
How do we get out of this?
 
Herd immunity was back in the news this past week, after senior administration officials in the White House voiced support for the “Great Barrington Declaration,” a petition whose authors include scientists from high-profile institutions as Stanford, Harvard and Oxford. The document argues that vulnerable groups should be protected but that the virus should be allowed to spread among younger, healthier people. “Current lockdown policies are producing devastating effects on short and long-term public health,” the declaration states, adding that we should “allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection.”
 
While that position meshed well with the Trump administration’s push for fewer restrictions, most epidemiologists and public health officials were horrified, as science reporter Stephanie M. Lee explained in BuzzFeed. Before long, a counter-declaration arose. “This is a dangerous fallacy unsupported by scientific evidence,” a group of more than 80 scientists wrote in the Lancet. The “John Snow Memorandum,” which now carries more than 2,700 signatories, quickly appeared in response. “The evidence is very clear: controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months,” the Snow declaration states. Shooting for herd immunity before a vaccine arrives could lead to a large number of preventable deaths. As UC Berkeley epidemiologist Dr. Art Reingold told the San Francisco Chronicle, “The basic unknown with (the Great Barrington) proposal is how many hospitalizations and deaths would you end up with, and is that an acceptable toll to society. It’s anybody’s guess how many people would die if we followed through with this. But the numbers could be substantial.”
 
WHO study finds no mortality benefit in COVID-19 treatment remdesivir
 
“Remdesivir, the only antiviral drug authorized for treatment of COVID-19 in the United States, fails to prevent deaths among patients, according to a study of more than 11,000 people in 30 countries sponsored by the World Health Organization,” writes Katherine J. Wu for The New York Times. The drug was most recently in the news as part of President Trump’s battery of COVID-19 treatments. While some infectious disease experts believe the WHO study puts to rest any claims that the drug lowers the risk of death, other experts and Gilead, the drug’s manufacturer, are criticizing the study’s design, which combined data from hundreds of hospitals with treatment protocols that are hard to compare. The preprint study also has yet to be published in a scientific journal. An earlier trial conducted by the National Institutes of Health showed the drug was effective in reducing the length of hospital stays for COVID-19 patients. Dr. Maricar Malinis of Yale University and Dr. Ilan Schwartz of the University of Alberta in Canada told Wu the drug still might be useful in the early phase of COVID-19, to control the virus enough to prevent an overreaction from the immune system.
 
Resources
 
Last week, the Center for Health Journalism hosted The New Supreme Court: The End of Obamacare? Panelists JoAnne Kenan of Politico and Nicholas Bagley of University of Michigan School of Law discussed what a remade Supreme Court could mean for the future of health reform and the Affordable Care Act, and how you can clarify the stakes and tell powerful stories for your audiences. Watch a recording here!
 
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