Despite pronouncements to the contrary from the White House, the actual numbers show that COVID-19 is still running rampant in the United States. Our country’s daily average of new cases has plateaued at around 20,000 per day. It appears that a larger number of people under 40 years old are now being diagnosed as infected. Fortunately, they generally experience less lethal outcomes. This changing demographic of positive tests is probably partly attributable to testing now being expanded to include more young people. Older Americans have probably gotten the message and are more likely to remain safe at home, properly socially distance when they go out, or wear masks. Experts note that this trend toward a younger demographic, at the current time, is not likely to last because these young individuals are likely to infect the older people in their lives. Twenty-three states are reporting higher case numbers than last week. These increases are out of proportion to the increased numbers of tests. Florida, which was one of the last states to shut down and among the earliest to reopen just this week experienced a day with its largest single day count since the pandemic began. Concerns are that it may well be the next epicenter for this very contagious virus. Eight other states experienced record high 7-day averages of new cases. Hospitalizations and ICU bed usage in several states, mostly in the Southern and Southwestern states, is still rising. We have lost 118,000 Americans and 2.1 million citizens have been diagnosed as COVID-19 positive. To successfully fight this continuation of the first wave of this pandemic, several states, and large cities (California, Oregon, Montgomery, AL., Dallas, and Phoenix) are initiating processes to implement mandatory mask wearing while in public. On the treatment front, a commonly used steroid, dexamethasone, has reportedly shown to decrease deaths by one third when used in extremely ill patients who are on ventilators. The USA is saddled with 63 million doses of hydroxychloroquine after the FDA revoked the emergency use authorization and the WHO stopped the clinical trials because of a lack of efficacy and increased incidence of severe cardiac side effects.
As we celebrate Juneteenth, we note that the atrocity of delayed and ineffective communication is still present today. The Emancipation Proclamation became effective on January 1, 1863 and it was not until June 19, 1865 that the last enslaved Africans in the Confederacy were informed about their freedom. Contradictory and delayed messaging continue in this COVID-19 pandemic. There seems to be no rush to do anything about the disproportionate number of African Americans affected by this virus. A Brookings Institute study this week reveals that the death rates from COVID-19 is higher amongst African Americans compared to whites and Hispanic/Latino. It is starker in certain age groups. Specifically, the death rate (per thousand) in the 45-54 age group is six times higher for Black and Hispanic/Latino compared to Caucasians, and TEN times higher in the 35-44-year age group. Partial explanations for these disparities include unequal access to healthcare, the increased incidence and severity of pre-existing chronic conditions such as hypertension, diabetes, obesity, and lung disease; and occupations allowing for less social distancing. Nothing but cursory lip service has been given to this plight. Secondly, the messaging regarding the benefit of wearing of a face mask is absent. The President, VP, and people in their control do not wear masks while the medical experts and the CDC advocate just the opposite for people out in public. Thirdly, the continuing need to socially distance remains a mainstay of treatment for COVID-19. Yet more mixed messaging arises from the Administration. In multiple appearances by the President and VP, there is no social distancing. This behavior is averse to the recommendations of the CDC. There is even a Tulsa campaign rally scheduled by the President soon. The medical experts in Tulsa and Dr. Anthony Fauci, from the NIH, both feel that it is a bad idea to conduct or attend large gatherings of people, particularly indoors. Further mixed messaging arises from the President saying that he is not worried about attendees becoming infected yet those who attend must sign a “hold harmless” waiver.
As healthcare providers we are committed to empowering our patients by providing truth and updated information. Our job is made immensely more difficult by the mixed messaging and by our federal government’s lack of commitment for addressing racial health disparities. Though freed from slavery, we are not free from systemic racism and the economic and health disparities of this COVID-19 scourge.
Clyde E. Henderson, MD
Cincinnati Medical Association