The covid-19 pandemic has exposed the longstanding structural drivers of health inequities, such as precarious and adverse working conditions, growing economic disparities, and anti-democratic political processes and institutions. These important determinants of health have interlinked with class, ethnicity, gender, education level, and other factors during covid-19 to exacerbate existing social vulnerabilities in society. Numerous warnings of the dangers of inequity have emerged over the past decades. The Alma Ata declaration convincingly argued that “health for all” could be achieved only through a New International Economic Order and people’s participation in decisions affecting their community’s health.1 These principles were affirmed in the report of the Commission on the Social Determinants of Health2 and the 2008 World Health Report.3 The commission proposed...
The COVID-19 pandemic has caused mass disruption to our daily lives. Mobility restrictions implemented to reduce the spread of COVID-19 have impacted walking behavior, but the magnitude and spatio-temporal aspects of these changes have yet to be explored. Walking is the most common form of physical activity and non-motorized transport, and so has an important role in our health and economy. Understanding how COVID-19 response measures have affected walking behavior of populations and distinct subgroups is paramount to help devise strategies to prevent the potential health and societal impacts of declining walking levels. In this study, we integrated mobility data from mobile devices and area-level data to study the walking patterns of 1.62 million anonymous users in 10 metropolitan areas in the United States (US). The data covers the period from mid-February 2020 (pre-lockdown) to...
As a common strategy of contagious disease containment, lockdown will
inevitably weaken the economy. The ongoing COVID-19 pandemic underscores the
trade-off arising from public health and economic cost. An optimal lockdown
policy to resolve this trade-off is highly desired. Here we propose a
mathematical framework of pandemic control through an optimal non-uniform
lockdown, where our goal is to reduce the economic activity as little as
possible while decreasing the number of infected individuals at a prescribed
rate. This framework allows us to efficiently compute the optimal lockdown
policy for general epidemic spread models, including both the classical
SIS/SIR/SEIR models and a new model of COVID-19 transmissions. We demonstrate
the power of this framework by analyzing publicly available data of
inter-county travel frequencies to analyze a model of COVID-19 spread in...
Over 90 percent of the U.S. population was under stay at home orders by April 2020. These social distancing measures to slow the spread of the SARS-CoV-2 or novel coronavirus have led to over 20 million new applications for unemployment benefits. Are these economic losses justified? We find the value of statistical lives lost (VSL) from an unconstrained spread of the virus which hypothetically infected 81 percent of the population would amount to $8 to $60 trillion.
Researchers are working at unprecedented speed to develop a SARS-CoV-2 vaccine. We aimed to assess the value of a hypothetical vaccine and its potential public health impact when prioritization is required due to supply constraints. A Markov cohort model was used to estimate COVID-19 related direct medical costs and deaths in the United States (US), with and without implementation of a 60% efficacious vaccine. To prioritize the vaccine under constrained supply, the population was divided into tiers based on age; risk and age; and occupation and age; and outcomes were compared across one year under various supply assumptions. The incremental cost per quality-adjusted life-year (QALY) gained versus no vaccine was calculated for the entire adult population and for each tier in the three prioritization schemes. The incremental cost per QALY gained for the US adult population was $8,200...
Medicaid, which provides health insurance to low-income Americans, is a joint federal-state partnership that manifests as 50 unique state programs. States have policy flexibility to design programs within federal parameters. However, Medicaid also requires funding flexibility to encourage states to maintain services during times of crisis when more people need Medicaid. Currently, Medicaid’s funding formula, the Federal Medical Assistance Percentage (FMAP), adjusts federal spending by state levels of economic development but fails to adjust for nationwide recessions. During economic contractions, the federal government should use its ability to run budget deficits to reimburse states at higher rates in exchange for maintaining services. In turn, during economic expansions, states should shoulder relatively more costs of Medicaid. Although the current FMAP boost provided under the...
It is now established that across the United States, minoritized populations have borne a disproportionate burden from coronavirus disease 2019 (COVID-19). However, little is known about the interaction among a county’s racial/ethnic composition, its level of income inequality, political factors, and COVID-19 outcomes in the population. To quantify the association of economic inequality, racial/ethnic composition, political factors, and state health care policy with the incidence and mortality burden associated with COVID-19. This cross-sectional study used data from the 3142 counties in the 50 US states and for Washington, DC. Data on the first 200 days of the COVID-19 pandemic, from the first confirmed US case on January 22 to August 8, 2020, were gathered from the Centers for Disease Control and Prevention and USAFacts.org, the US Census Bureau, the American Community Survey,...
COVID-19 mitigation measures such as social distancing and mask wearing appear to be cost effective on college campuses, but routine laboratory testing would not be cost effective at current costs according to findings of a US study published in Annals of Internal Medicine.The Clinical and Economic Analysis of COVID-19 interventions (CEACOV) model was used to evaluate the cost effectiveness of 24 COVID-19 mitigation strategies including social distancing, mask wearing, isolation, and laboratory screening every 3, 7 or 14 days, in a US college with 5000 students and 1000 faculty staff within a community population of 100 000. Cost effectiveness was assessed from a modified US societal perspective over a time horizon on one semester (105 days). The assumed cost per laboratory test was $10.
1The number of COVID-19 cases in students was estimated to decrease from 3746 with no mitigation...
The evidence of racial health disparities is profound. Much attention has been given to the disparity in maternal morbidity and mortality experienced by Black mothers. The disparity in Black lives lost from coronavirus disease 2019 (COVID-19) has further highlighted the disparity in health outcomes for Black people. Although COVID-19 is a new disease, the reason for the health disparity is the same as in maternal morbidity and mortality: implicit bias and structural racism. Implicit bias among health care professionals leads to disparities in how health care is delivered. Generations of structural racism perpetuated through racial residential segregation, economic suppression, and health care inequality have normalized the poorer health outcomes for Black Americans. It is easy to dismiss these issues as someone else’s problem, because health care professionals often fail to...
We examined levels of very low food security (VLFS) among low-income households with children in California before and shortly after the economic downturn from coronavirus disease 2019 (COVID-19). Households were randomly sampled in 2018, 2019, and 2020; 11,653 mothers were administered the US Department of Agriculture 6-item Food Security Survey Module. Post-COVID-19 (April 27 to July 21, 2020, a period when stay-at-home restrictions were eased in the state), 14.0% of mothers reported VLFS versus 19.3% pre-COVID-19 (November 21, 2019, to March 14, 2020) (P = .003), 22.2% in 2019 (P < .001), and 19.0% in 2018 (P = .004). Existing systems to quickly obtain food assistance benefits in California and new federal benefits available in response to COVID-19 may have reduced VLFS.