The Coronavirus Does Discriminate: How Social Conditions are Shaping the COVID-19 Pandemic | Harvard Medical School Primary Care Blog

Authored by Dr. Rebekah Rollston and Sandro Galea

Part of this developing crisis is very well known: On December 31, 2019, Chinese officials reported a cluster of pneumonia cases in Wuhan and identified the novel coronavirus as the causative agent on January 7, 2020. This novel coronavirus spread rapidly, and on March 11, 2020, the World Health Organization declared COVID-19 a pandemic. To date, there are more than 1 million confirmed cases in the United States and 3.5 million worldwide.

Through this all the virus has terrified the world, in no small part because of a sense that we are all at risk, that the virus is non-discriminating, and we can all get sick. That is true, but it is also not the complete truth. Once again, as with all other health conditions, those who are most at risk are those who are already vulnerable by way of the social and economic disadvantage that characterize their lives.

Our Public Health Systems Remind Us to Invest in a Healthy Society | Thrive Global

Authored by: Dr. Sandro Galea and Michael Stein

Every health care provider—from pediatricians to geriatricians— has seen how homelessness affects health. The disordered lives of homeless patients disrupt appointment-keeping and medication adherence, even as they generate need for more treatment by driving health challenges like depression, high blood pressure, and hospitalizations.

Some health systems have begun to address the link between homelessness and health. One Boston health system, for example, announced plans to subsidize housing for the patients for whom it is accountable, to give this population some measure of the shelter and stability necessary for good health.

This is an example of a growing practice among health systems, which are beginning to address the foundational forces that shape health. Their reason for doing so is partly financial. For example, Medicaid, in some states, adjusts payments to hospitals based on whether a patient is homeless—homelessness is treated like any other complicating diagnosis, an additional cost of care. So health systems can lose money if they do not collect and appropriately bill for housing status. But there are also more charitable reasons for health systems’ new focus, including the possibility that collecting information like homeless status can drive new program development and position the health systems to help fix under- lying economic and social problems, toward the ultimate goal of improving patients’ health.

Distancing Ourselves From Disease Is Nothing New | Elemental

Authored by Nadia N. Abuelezam, ScD and Sandro Galea

“We normally distance ourselves from disease.
While social and physical distancing may be relatively new phrases, the act of distancing ourselves from those who are sick, ill, or suffering is not new. Often this distance is clinical: We put people who are sick in hospitals or other facilities, keeping illness away from us. We have also improved our ability to prevent and treat disease, therefore providing a clinical buffer. Sometimes this distance is geographical: Disease may be happening in places far from us and among groups we do not belong to. Sometimes this distance is social: We do not think of the people who are sick or suffering as being like us. The sick are often labeled with terms that signify an “other” status.”

Politics May Kill Us, Not the Coronavirus | Think Global Health

Authored by Eduardo J. Gómez and Sandro Galea.

“In a period of public health crisis, scholars and policy makers are often quick to ask the following question: what has the new public health threat revealed about a government’s health care system and its ability to respond in a timely and effective manner? Do governments have the infrastructure, resources, and technology needed to curtail the spread of disease? While focusing on health systems is important, this can often lead us to overlook what viruses reveal about the role, nature, and consequences of a country’s political environment. In a time of the coronavirus in the United States, politics is exacerbating a public health issue, making the virus much more deadly than what it should be.

Politics, in other words, can literally kill us.”

COVID-19 calls for a Marshall Plan for health | The Hill

As we begin to appreciate the full weight of the COVID-19 pandemic, we are coming to realize that we are in the midst of interlocking crises.

First, we have been facing the direct effects of the virus on the physical and mental health of the public. Then, there are the economic consequences of the physical distancing measures we have taken to slow the disease’s spread. The conversation about implementing these measures has now evolved into a debate about when we might end them in order to mitigate the damage to the global economy during this pandemic. This debate is a new version of an old argument: the needs of the many (in this case, economic prosperity) versus the needs of the relative few (those vulnerable to the consequences of coronavirus). How do we thread this needle?

Photo by Gustavo Fring by Pexels.

Africa and Coronavirus – Will Lockdowns Work? | Think Global Health

Authored by Salma Abdalla and Sandro Galea

“Many countries in Africa are burdened by high rates of malnutrition, different types of pneumonia, widespread malaria, and a large number of people living with HIV/AIDS, tuberculosis, or both. The prior existence of these endemic infectious diseases, coupled with an increasing prevalence of non-communicable diseases, make for a population in many parts of Africa that is particularly vulnerable to COVID-19. In light of that fact, it is not surprising that several African governments have enacted national responses to the outbreak and responded swiftly to address the spread of the virus. A number of these responses, however, have mimicked lockdown measures currently in place in some European countries and North America. We worry that given the differences in context, even between African countries, lockdown approaches are unlikely to succeed in the region.”

The True Costs of the COVID-19 Pandemic | Scientific American

Authored by: Nason Maani and Sandro Galea

The scale and unequal distribution of this disruption to human life must give us pause. Such measures do not just cause economic disruption but are also acutely harmful to population health. Focusing only on the health harms associated with unemployment, loss of income, and the broad impact on mental health outcomes associated with traumatic events and social isolation can give us a sense of the tip of the iceberg.

Unemployment has long been associated with a significantly increased risk of death in general, particularly for low-skilled workers in the U.S.. The risk of heart disease, the leading cause of death in the U.S. at almost 650,000 deaths per year, has been shown to increase by 15–30 percent in men unemployed for more than 90 days. Among older workers, involuntary job loss can more than double the risk of stroke, which already claims 150,000 lives in the U.S. per year, as well as increase the likelihood of depressive symptoms that then persist for years. Such harms are likely exacerbated by concomitant longer term social isolation, which in of itself is associated with a 30 percent increase in mortality risk. Loneliness and social isolation have been associated with a 29 percent increase in risk of incident coronary heart disease and a 32 percent increase in risk of stroke. The scale of these elevated health risks is significant—comparable to that caused by taking up light smoking or becoming obese.

Read the full article on Scientific American.

The Mental Health Consequences of COVID-19 and Physical Distancing | JAMA Internal Medicine

Authored by: Sandro Galea, Raina M. Merchant, and Nicole Lurie

In the context of the COVID-19 pandemic, it appears likely that there will be substantial increases in anxiety and depression, substance use, loneliness, and domestic violence; and with schools closed, there is a very real possibility of an epidemic of child abuse. This concern is so significant that the UK has issued psychological first aid guidance from Mental Health UK.7 While the literature is not clear about the science of population level prevention, it leads us to conclude that 3 steps, taken now, can help us proactively prepare for the inevitable increase in mental health conditions and associated sequelae that are the consequences of this pandemic.

First, it is necessary to plan for the inevitability of loneliness and its sequelae as populations physically and socially isolate and to develop ways to intervene. The use of digital technologies can bridge social distance, even while physical distancing measures are in place.8 Normal structures where people congregate, whether places of worship, or gyms, and yoga studios, can conduct online activities on a schedule similar to what was in place prior to social distancing. Some workplaces are creating virtual workspace where people can work and connect over video connections, so they are not virtually alone. Employers should ensure that each employee receives daily outreach during the work week, through a supervisor or buddy system, just to maintain social contact.

Read the full piece on JAMA Network.

Commonwealth’s COVID-19 response leaves too many behind | CommonWealth Magazine

“We appreciate the immense challenges facing our state policymakers. What they – and we – face is unprecedented and overwhelming. There is no playbook. Assistance and leadership from the federal government has been limited, late, and inconsistent, at best.

Even as we recognize these challenges, we are disappointed that the state’s response does not embed equity at its heart. There is, as of now, far less than we should expect in the way of clear plans, guidance, or resources that are targeted to protecting communities that already experience marginalization.

Two weeks ago, we announced urgent policy recommendations from the Emergency Task Force on Coronavirus & Equity – recommendations supported now by more than 150 Massachusetts organizations – designed to ensure communities experiencing the effects of racism, poverty, and xenophobia aren’t put at even greater risk during the outbreak. There has been some progress on these recommendations, but none have been fully implemented.”

Read the full piece on CommonWealth Magazine.

Coronavirus Made It Clear: Our Health System Needs More Compassion | Elemental

“It is worth noting that, while the science is fairly clear that an abrupt end to physical distancing would interfere with slowing this disease, the debate we are seeing has little to do with the science of this pandemic. If it did, it would be a conversation less about whether to end physical distancing and more about how to do it properly. And if the argument for resumed functioning was really all about the economy, advocates for an Easter revival would be less concerned about stock prices and more focused on the low-wage, often marginalized workers that this crisis has revealed to be the backbone of our collective fiscal health.”

POV: Coronavirus is taking a toll on mental health | BU Today

All this can weigh on mental health. I have long argued that mental health is public health, and we should address mental health with the same level of care we apply to the health of our bodies. This is no less true during the challenge of COVID-19. As our community adjusts to the measures we have collectively adopted to mitigate the spread of the disease, it is important to prioritize mental health, even as we take steps to minimize the infectious threat.

Photo by Matthew Henry from Unsplash

Slowing the spread of COVID-19 the right way | CommonWealth Magazine

Authored by Carlene Pavlos, Cheryl Bartlett and Sandro Galea

THE COVID-19 PANDEMIC is rapidly evolving. Massachusetts, like the rest of the world, is working to hone its response to this novel coronavirus. State residents have accepted physical distancing, work and school closures, and other measures necessary to slow this disease.

Yet for all our efforts to stop Covid-19, the difficult truth is that, in many ways, we opened the door to its spread. We did this by accepting the conditions that create health inequities.

Closing the Health Gap to Fight Coronavirus | U.S. News & World Report

Closing the Health Gap to Fight Coronavirus | U.S. News & World Report

THE COVID-19 PANDEMIC has emerged as a significant threat to our economy. This is reflected in falling stock prices, in whole industries grinding to a halt, and in the actions of business leaders and politicians.

This week the Trump administration and Congress moved to address the economic costs of the outbreak by considering a plan to send checks directly to Americans. On Thursday, Sen. Mitch McConnell released a $1 trillion stimulus bill that, among other things, would give many Americans a $1,200 check. Most Republicans have lined up behind the proposal and the White House has announced support.

Covid-19: The painful price of ignoring health inequities | The BMJ

Authored by: Andrew Resnick, Sandro Galea and Karthik Sivashanker

Coronavirus disease (covid-19) provides a painful reminder of why inequities harm all of us. Equity is widely misunderstood as a zero-sum game—i.e. the gain of one individual or group results in the loss to another. Yet, covid-19 is able to enter and quickly spread because of the social cracks and fissures generated by inequities.

Four lessons from the coronavirus | Fortune

As of this writing, there have been 127,863 confirmed cases and 4,718 deaths from the COVID-19 pandemic worldwide.

In the U.S., there have been over 1,200 cases and 38 deaths. In three short months, a novel coronavirus has captured global consciousness and changed day-to-day life in large parts of the world, in the process becoming a public health emergency that is testing, like perhaps no event before it, our global capacity to respond to large-scale infectious threats.

As public health agencies like the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC)work around the clock to coordinate a local, national, and global response to the rapidly changing situation, we are, collectively, learning how to better grapple with this epidemic.

While there will be much to learn when (we hope) this epidemic is over, I think there are some key lessons that emerge clearly that are worth highlighting even now, when the epidemic is at the very forefront, dominating all our conversations, sharpening our thinking.

Mental Health in a Time of Pandemic | Psychology Today

The ongoing Covid-19 outbreak is in many ways unprecedented, in both the scale of this challenge, the scale of public health response, and the historical context in which all this is unfolding. Covid-19 is the first global pandemic of the social media age, the first of the “alternative facts” era, and is occurring at a moment when politics and society seem to be in a state of accelerated flux.

Yet for all that is new about Covid-19, the disease still behaves like any number of prior epidemics. It is, for example, similar to the 2003 severe acute respiratory syndrome (SARS) outbreak, an event which created a number of lessons for our present moment. SARS was, in many ways, the best-case scenario for responding to a global infectious threat. The spread of SARS was contained fairly quickly by public health efforts, chiefly through the widespread use of quarantine. But even this relative success still had consequences for health. In 2004, I worked with colleagues on a study of SARS control and the psychological effects of quarantine in Toronto, Canada. We found among quarantined persons a high prevalence of psychological distress, including symptoms of depression and posttraumatic stress disorder (PTSD). A key takeaway: Even if we can halt the physical spread of a disease through the expeditious use of quarantine and social distancing, we will still have to contend with its mental health effects in the long-term.

BU Epidemiologist Sandro Galea Talks Coronavirus | WBGH

With the total number of confirmed U.S. coronavirus cases nearing 100, some have voiced worries about the country’s preparedness, and whether the average American ought to be seriously concerned about a coronavirus outbreak. Addressing those concerns, Dr. Sandro Galea, Boston University’s Dean of the School of Public Health, called in to Boston Public Radio on Monday to make the case that, while we shouldn’t panic, Americans are better off thinking about preparedness now.

Listen here.

This is the personal website of Sandro Galea. All photos are taken by Sandro Galea.