Authored by Sandro Galea and Nason Maani.

Whoever prevails in tomorrow’s presidential election, America’s universities face a period of immense challenge likely to test the most resilient of institutions.

Not only does the shadow of Covid-19 still loom large, along with the ensuing economic crisis that has raised the threat of staff redundancies even while universities consider the complexities of hybrid or online-only teaching, but other pressing issues also remain unresolved. Indeed, the pandemic has exposed a number of broader social crises and longer-term structural challenges for US higher education that can no longer be ignored. A major one is how to handle the ongoing calls to address structural racism; universities are grappling with their own role in perpetuating disparities, with recent campaigns such as #BlackInTheIvory highlighting the barriers faced by many academics of colour. Beyond this, higher education institutions must confront how racial disparities are exacerbated by admissions processes, fee structures, student debt and the final marks and degrees awarded to ethnic minority students. In parallel, universities must also strike the right balance between ensuring students feel welcome and safe on campus, yet are exposed to a diversity of speech and opinion.

Authored by Sandro Galea and Nason Maani.

In recent weeks, there has been an increasing conversation, including in prominent medical journals, about the failure of current U.S. political leadership during the COVID-19 pandemic, the preventable deaths it has caused, and that it is time for a change. These contributions reflect the fact that, as Virchow famously said, “Politics is nothing else but medicine on a large scale.”

Building on the challenges posed by this failure for the COVID-19 moment, we suggest that a fuller assessment of the role of leadership must also include an honest and unflinching assessment of longstanding shortcomings in our country’s health, which also contributed enormously to the challenges of the moment, and in which we all have a hand.

Before the pandemic, U.S life expectancy was lagging behind peer countries, and, uniquely, was declining. It suffered from double the chronic disease burden of the OECD average. It lacked universal health coverage. While some have wondered how the US fared so poorly considering its vaunted biomedical industry, world-leading hospitals, and history of medical innovations, the overall population health of the U.S before COVID-19 was far from the envy of its peers. Why?

Authored by Sandro Galea and Catherine Ettman.

“Since the earliest days of the Covid-19 pandemic, this crisis has posed challenges for mental health. As of April, 2020, stay-at-home advisories or shelter-in-place policies affected no less than 316 million people in the US—about 96 percent of the population—making sustained social isolation, for perhaps the first time in the country’s history, a ubiquitous experience. We have for months been physically cut off from family and friends. We have had to learn new ways of interacting, new practices for safeguarding health. Many of us now have had personal experience with the virus, either by contracting it ourselves, or knowing someone who has. Some mourn the loss of loved ones, and we all mourn the thousands who have died from this disease in the US and around the world.
These challenges—the virus itself and the policies we have adopted to contain it—have created a perfect storm for poor mental health. This was reflected by a recent report from the Centers for Disease Control and Prevention, which found during June of 2020 adults in the US reported considerably elevated adverse mental health conditions linked with the pandemic. In particular, racial/ethnic minorities, essential workers, unpaid adult caregivers, and younger adults reported disproportionately poorer mental health outcomes, including elevated levels of substance use and suicidal ideation.”

Authored by: Amy Lauren Fairchild, Cheryl Healton, and Sandro Galea.

Although we don’t yet know what proportion of new infections are the result of transmission from people who are asymptomatic or pre-symptomatic, we know enough to require everyone, unless they have a medical condition like severe asthma that would make mask a health hazard, to wear a mask anytime they are in indoor public spaces or crowded outdoor spaces.
People infected with SARS-CoV-2, the virus that causes Covid-19, most actively shed the virus at the time symptoms begin. Individuals without symptoms who test positive for Covid-19 show viral loads as high as those with symptoms. Individuals who are infected with the virus can feel fine but still transmit virus for days before they develop any symptoms.
A national mask order can be nuanced. Evidence continues to suggest that indoor aerosol or droplet transmission is key to the spread of the epidemic. A mask probably doesn’t need to be worn while jogging or strolling through a park or lightly populated outdoor area if you won’t be close to other people. But they should be worn in urban areas with heavy pedestrian traffic, during protests, or at political rallies.

In recent months, states and municipalities have begun releasing data on COVID-19 infections and death that reveal profound racial disparities. In Louisiana, Black patients account for 57 percent of COVID-19 deaths, while making up only 33 percent of the total population. In Wisconsin, Hispanic patients constitute 12 percent of confirmed COVID-19 cases, but only 7 percent of the total population. In New York City, the epicenter of the pandemic in the US, age-adjusted mortality rates are more than double for Black and Hispanic patients (243.6 and 237.7 per 100,000) compared to white and Asian patients (121.5 and 109.4 per 100,000).

In the past several weeks, the nation has been further shaken by the murders of George Floyd, Breonna Taylor, and Rayshard Brooks at the hands of police. A National Academy of Sciences study estimates that Black men are 2.5 times more likely to die from police violence than white men, and Black women are 1.4 times more likely to die from police violence than white women.

We argue that these disparities are linked. Indeed, George Floyd himself recovered from COVID-19. The data call for a reckoning with a simple question: Why?

Authored by Sandro Galea and Nason Maani.

The Trump administration’s announcement earlier this week of the extension of a visa ban to cover non-immigrant visas including H-1B, H-2B and some J and L visas resulted in opposition from leaders in science and commerce, who claimed this would make the U.S. less competitive, hampering science, education, economic growth and job creation.

The presidential proclamation, entitled “Proclamation Suspending Entry of Aliens Who Present a Risk to the U.S. Labor Market Following the Coronavirus Outbreak,” claims that to allow such “aliens” to enter the country would be “detrimental to the interests of the United States.” This is in contrast to the opinion of most experts, including the editorial pages of reliably business-friendly newspapers like the Wall Street Journal, who suggest that this proclamation would in itself be harmful to the U.S. economy. We agree that this move is self-defeating for a U.S. economy already in dire straits.