July Covid Notes: Four Covid Patients in July, DeSantis and the Definition of Freedom, ACA Strengthening

I had 4 Covid positive patients in the past month including one today. I gave Paxlovid to 3 of them. On a positive note, as the NYT reported in July, “In a sign that the pandemic really is over, the total number of Americans dying each day is no longer historically abnormal.” There is more research on Republican vs Democrat willingness to have the Covid vaccine and its consequences; 49% of Republicans vs 88% of Democrats have confidence in the vaccines. It is likely (as also documented in this article about DeSantis’ Covid missteps) that this has resulted in excess death rates among Republicans in Florida and Ohio. Lastly, regarding Covid the Post came out on July 26 with an investigatory piece, documenting yet again how the medical profession has done little to fight against Covid misinformation.

We are nowhere close to being prepared for another pandemic; e.g. the CDC is cutting funding for established childhood vaccines. According to Dylan Scott, there is a summer Covid uptick detected in wastewater, increased ER visits but not hospitalizations. What to do? As an at-risk person, I continue to wear masks indoors/ at my practice. Overseas, third world countries are trying to prevent d rich countries from taking all the vaccines for themselves for the next pandemic.

According to Dylan Scott at Vox: “The Biden administration has been … undoing the damage done to the Affordable Care Act by his predecessor and … strengthening it beyond what Democrats passed in 2010. The uninsured rate is at an all-time low, about 8 percent, though the end to emergency Medicaid coverage instituted for the pandemic is eroding some of those gains. More than 16 million Americans signed up for ACA coverage on the law’s marketplaces for 2023, an increase of nearly 2 million from the year before…More states have expanded Medicaid during Biden’s first term, and the number of Americans covered by the ACA’s expansion has almost reached 23 million. The Biden administration announced this month its most significant step to reverse the Trump health department’s regulatory sabotage. The new regulations would target short-term limited-duration insurance plans, which threaten the viability of the ACA markets and which Trump had sought to expand. It was, as I wrote in an investigation in collaboration with the Center for Public Integrity, an attempt to set up a shadow market for health insurance that would erode the stability of the marketplaces.”

Substantive health reform is not going to occur at a national level until there are more members of Congress who believe in universal coverage and pharma payment reform. Pharmaceutical prices will continue to stay in the news with insulin prices continuing to be unaffordable for many without health insurance; this despite drug makers commitments to the contrary. Universal coverage can occur at a state level. But even if we arrive at this at a state level, we will confront the fact that the poverty rate in this country is higher than other peer countries; and poverty itself is a significant risk factor for poor health outcomes. Diabetes is tied to poverty; the Lancet estimates that there will be 1.3 billion diabetics by 2050.

Ohio will be ground zero as the only state this November that will vote on enshrining the right to an abortion in the state constitution. First over the counter birth control pill might make a significant difference. Here are ten things we’ve learned about abortion politics since Roe fell.; yet funding for choice has decreased.

Misinformation obscures standards guiding Gender-Affirming Care for Trans Youth.

The black maternal health crisis is not just in the U.S. but the entire world.

The health effects of climate change range from 10 people hospitalized in Phoenix for heat stroke last week to a number of deaths from fires and collapsed trees from a hurricane falling on people in my birthplace Italy. Climate change and its impact on health is in the news every day. Another global point according to the Post: nearly 30 percent of humanity, or roughly 2.4 billion people, lacked access to adequate food in 2022, while an even greater number — 3.1 billion people — were unable to afford a healthy diet. It projected that by the end of the decade, despite significant poverty alleviation initiatives, some 600 million people will still be chronically undernourished, a blow to U.N.-outlined goals of eliminating hunger by 2030.

AND continues to focus on 3 parallel set of activities: helping pass legislation; political engagement and expanding the health professional network. AND was instrumental in the passage on July 11 of Paid Family Medical Leave legislation in Maine. We organized 175 health professionals who in turn wrote op-eds and letters to the editor, provided legislative testimony, and held press conferences. Regarding political engagement please see the attached flyer that we created in response to DeSantis’ definition of freedom. References are in the second attachment. The attachments will be on the AND website shortly. The Florida flyer is intended to expand our health professional network in Florida/ elsewhere and to organize meetings in swing states to make citizens aware of the challenges in a DeSantis candidacy. Looking forward to your feedback.

Norbert Goldfield, M.D.

Author of forthcoming (Sept 2023) Public Health, Public Trust and American Fragility in a Pandemic Era: The Critical Role of Health Care Professionals (Routledge, Taylor Francis).

Attachments:
– Freedoms for Floridians…NOT
– Florida’s Health Care System and the Health of Floridians – The DeSantis Record